EEG quantification of alertness: methods for early identification of individuals most susceptible to sleep deprivation

NASA Astrophysics Data System (ADS)

Berka, Chris; Levendowski, Daniel J.; Westbrook, Philip; Davis, Gene; Lumicao, Michelle N.; Olmstead, Richard E.; Popovic, Miodrag; Zivkovic, Vladimir T.; Ramsey, Caitlin K.

2005-05-01

Electroencephalographic (EEG) and neurocognitive measures were simultaneously acquired to quantify alertness from 24 participants during 44-hours of sleep deprivation. Performance on a three-choice vigilance task (3C-VT), paired-associate learning/memory task (PAL) and modified Maintenance of Wakefulness Test (MWT), and sleep technician-observed drowsiness (eye-closures, head-nods, EEG slowing) were quantified. The B-Alert system automatically classifies each second of EEG on an alertness/drowsiness continuum. B-Alert classifications were significantly correlated with technician-observations, visually scored EEG and performance measures. B-Alert classifications during 3C-VT, and technician observations and performance during the 3C-VT and PAL evidenced progressively increasing drowsiness as a result of sleep deprivation with a stabilizing effect observed at the batteries occurring between 0600 and 1100 suggesting a possible circadian effect similar to those reported in previous sleep deprivation studies. Participants were given an opportunity to take a 40-minute nap approximately 24-hours into the sleep deprivation portion of the study (i.e., 7 PM on Saturday). The nap was followed by a transient period of increased alertness. Approximately 8 hours after the nap, behavioral and physiological measures of drowsiness returned to levels prior to the nap. Cluster analysis was used to stratify individuals into three groups based on their level of impairment as a result of sleep deprivation. The combination of B-Alert and neuro-behavioral measures may identify individuals whose performance is most susceptible to sleep deprivation. These objective measures could be applied in an operational setting to provide a "biobehavioral assay" to determine vulnerability to sleep deprivation.

Validation of a personal fluid loss monitor.

PubMed

Wickwire, J; Bishop, P A; Green, J M; Richardson, M T; Lomax, R G; Casaru, C; Jones, E; Curtner-Smith, M

2008-02-01

Dehydration raises heat injury risk and reduces performance [ , , ]. The purpose was to validate the Hydra-Alert Jr (Acumen). The Hydra-Alert was tested in two exercise/clothing conditions. Participants wore it while wearing exercise clothing and exercising at a self-selected intensity (n = 8). Others wore the Hydra-Alert while wearing a ballistic-vest and performing an industrial-protocol (n = 8). For each condition, the Hydra-Alert was tested on two occasions (T1 and T2). The Hydra-Alert was tested against nude weight loss for both conditions. The Hydra-Alert had low test-retest reliability for both conditions (average absolute value of the error between Hydra-Alert outputs of T1 and T2 = 0.08 +/- 0.08 percentage points). With exercise-clothing, the Hydra-Alert evidenced low-moderate correlations between percent nude weight loss and Hydra-Alert output at 20 min (r = 0.59-T1, p = 0.13; r = 0.12-T2, p = 0.78), at 40 min (r = 0.93-T1, p = 0.001; r = 0.63-T2, p = 0.10), and at approximately 2 % weight loss (r = 0.21-T1 and T2, p = 0.61 and 0.62, respectively). The correlation at 40 min during T1 fell during T2 suggesting the Hydra-Alert was inconsistent. When wearing a ballistic-vest, the Hydra-Alert had poor validity (T1: r = - 0.29 [p = 0.48] for weight loss vs. monitor; T2: r = 0.11 [p = 0.80]). At the higher levels of dehydration ( approximately 2 %), the Hydra-Alert error was so high as to render its readings of little value. In some cases, the Hydra-Alert could lead to a false level of security if dehydrated. Therefore, the Hydra-Alert is of little use for those who want to measure their fluid loss while exercising in the heat.

Pilot evaluation of a method to assess prescribers' information processing of medication alerts.

PubMed

Russ, Alissa L; Melton, Brittany L; Daggy, Joanne K; Saleem, Jason J

2017-02-01

Prescribers commonly receive alerts during medication ordering. Prescribers work in a complex, time-pressured environment; to enhance the effectiveness of safety alerts, the effort needed to cognitively process these alerts should be minimized. Methods to evaluate the extent to which computerized alerts support prescribers' information processing are lacking. To develop a methodological protocol to assess the extent to which alerts support prescribers' information processing at-a-glance; specifically, the incorporation of information into their working memory. We hypothesized that the method would be feasible and that we would be able to detect a significant difference in prescribers' information processing with a revised alert display that incorporates warning design guidelines compared to the original alert display. A counterbalanced, within-subject study was conducted with 20 prescribers in a human-computer interaction laboratory. We tested a single alert that was displayed in two different ways. Prescribers were informed that an alert would appear for 10s. After the alert was shown, a white screen was displayed, and prescribers were asked to verbally describe what they saw; indicate how many total warnings; and describe anything else they remembered about the alert. We measured information processing via the accuracy of prescribers' free recall and their ability to identify that three warning messages were present. Two analysts independently evaluated participants' responses against a comprehensive catalog of alert elements and then discussed discrepancies until reaching consensus. This feasibility study demonstrated that the method seemed to be effective for evaluating prescribers' information processing of medication alert displays. With this method, we were able to detect significant differences in prescribers' recall of alert information. The proportion of total data elements that prescribers were able to accurately recall was significantly greater for the revised versus original alert display (p=0.006). With the revised display, more prescribers accurately reported that three warnings were shown (p=0.002). The methodological protocol was feasible for evaluating the alert display and yielded important findings on prescribers' information processing. Study methods supplement traditional usability evaluation methods and may be useful for evaluating information processing of other healthcare technologies. Published by Elsevier Inc.

Neuronal correlates of visual and auditory alertness in the DMT and ketamine model of psychosis.

PubMed

Daumann, J; Wagner, D; Heekeren, K; Neukirch, A; Thiel, C M; Gouzoulis-Mayfrank, E

2010-10-01

Deficits in attentional functions belong to the core cognitive symptoms in schizophrenic patients. Alertness is a nonselective attention component that refers to a state of general readiness that improves stimulus processing and response initiation. The main goal of the present study was to investigate cerebral correlates of alertness in the human 5HT(2A) agonist and N-methyl-D-aspartic acid (NMDA) antagonist model of psychosis. Fourteen healthy volunteers participated in a randomized double-blind, cross-over event-related functional magnetic resonance imaging (fMRI) study with dimethyltryptamine (DMT) and S-ketamine. A target detection task with cued and uncued trials in both the visual and the auditory modality was used. Administration of DMT led to decreased blood oxygenation level-dependent response during performance of an alertness task, particularly in extrastriate regions during visual alerting and in temporal regions during auditory alerting. In general, the effects for the visual modality were more pronounced. In contrast, administration of S-ketamine led to increased cortical activation in the left insula and precentral gyrus in the auditory modality. The results of the present study might deliver more insight into potential differences and overlapping pathomechanisms in schizophrenia. These conclusions must remain preliminary and should be explored by further fMRI studies with schizophrenic patients performing modality-specific alertness tasks.

Circadian rhythms in human performance and mood under constant conditions

NASA Technical Reports Server (NTRS)

Monk, T. H.; Buysse, D. J.; Reynolds, C. F. 3rd; Berga, S. L.; Jarrett, D. B.; Begley, A. E.; Kupfer, D. J.

1997-01-01

This study explored the relationship between circadian performance rhythms and rhythms in rectal temperature, plasma cortisol, plasma melatonin, subjective alertness and well-being. Seventeen healthy young adults were studied under 36 h of 'unmasking' conditions (constant wakeful bedrest, temporal isolation, homogenized 'meals') during which rectal temperatures were measured every minute, and plasma cortisol and plasma melatonin measured every 20 min. Hourly subjective ratings of global vigour (alertness) and affect (well-being) were obtained followed by one of two performance batteries. On odd-numbered hours performance (speed and accuracy) of serial search, verbal reasoning and manual dexterity tasks was assessed. On even-numbered hours, performance (% hits, response speed) was measured at a 25-30 min visual vigilance task. Performance of all tasks (except search accuracy) showed a significant time of day variation usually with a nocturnal trough close to the trough in rectal temperature. Performance rhythms appeared not to reliably differ with working memory load. Within subjects, predominantly positive correlations emerged between good performance and higher temperatures and better subjective alertness; predominantly negative correlations between good performance and higher plasma levels of cortisol and melatonin. Temperature and cortisol rhythms correlated with slightly more performance measures (5/7) than did melatonin rhythms (4/7). Global vigour correlated about as well with performance (5/7) as did temperature, and considerably better than global affect (1/7). In conclusion: (1) between-task heterogeneity in circadian performance rhythms appeared to be absent when the sleep/wake cycle was suspended; (2) temperature (positively), cortisol and melatonin (negatively) appeared equally good as circadian correlates of performance, and (3) subjective alertness correlated with performance rhythms as well as (but not better than) body temperature, suggesting that performance rhythms were not directly mediated by rhythms in subjective alertness.

Dose-response relationship for light intensity and ocular and electroencephalographic correlates of human alertness

NASA Technical Reports Server (NTRS)

Cajochen, C.; Zeitzer, J. M.; Czeisler, C. A.; Dijk, D. J.

2000-01-01

Light can elicit both circadian and acute physiological responses in humans. In a dose response protocol men and women were exposed to illuminances ranging from 3 to 9100 lux for 6.5 h during the early biological night after they had been exposed to <3 lux for several hours. Light exerted an acute alerting response as assessed by a reduction in the incidence of slow-eye movements, a reduction of EEG activity in the theta-alpha frequencies (power density in the 5-9 Hz range) as well as a reduction in self-reported sleepiness. This alerting response was positively correlated with the degree of melatonin suppression by light. In accordance with the dose response function for circadian resetting and melatonin suppression, the responses of all three indices of alertness to variations in illuminance were consistent with a logistic dose response curve. Half of the maximum alerting response to bright light of 9100 lux was obtained with room light of approximately 100 lux. This sensitivity to light indicates that variations in illuminance within the range of typical, ambient, room light (90-180 lux) can have a significant impact on subjective alertness and its electrophysiologic concomitants in humans during the early biological night.

Case-Based Multi-Sensor Intrusion Detection

NASA Astrophysics Data System (ADS)

Schwartz, Daniel G.; Long, Jidong

2009-08-01

Multi-sensor intrusion detection systems (IDSs) combine the alerts raised by individual IDSs and possibly other kinds of devices such as firewalls and antivirus software. A critical issue in building a multi-sensor IDS is alert-correlation, i.e., determining which alerts are caused by the same attack. This paper explores a novel approach to alert correlation using case-based reasoning (CBR). Each case in the CBR system's library contains a pattern of alerts raised by some known attack type, together with the identity of the attack. Then during run time, the alert streams gleaned from the sensors are compared with the patterns in the cases, and a match indicates that the attack described by that case has occurred. For this purpose the design of a fast and accurate matching algorithm is imperative. Two such algorithms were explored: (i) the well-known Hungarian algorithm, and (ii) an order-preserving matching of our own device. Tests were conducted using the DARPA Grand Challenge Problem attack simulator. These showed that the both matching algorithms are effective in detecting attacks; but the Hungarian algorithm is inefficient; whereas the order-preserving one is very efficient, in fact runs in linear time.

Conditional Outlier Detection for Clinical Alerting

PubMed Central

Hauskrecht, Milos; Valko, Michal; Batal, Iyad; Clermont, Gilles; Visweswaran, Shyam; Cooper, Gregory F.

2010-01-01

We develop and evaluate a data-driven approach for detecting unusual (anomalous) patient-management actions using past patient cases stored in an electronic health record (EHR) system. Our hypothesis is that patient-management actions that are unusual with respect to past patients may be due to a potential error and that it is worthwhile to raise an alert if such a condition is encountered. We evaluate this hypothesis using data obtained from the electronic health records of 4,486 post-cardiac surgical patients. We base the evaluation on the opinions of a panel of experts. The results support that anomaly-based alerting can have reasonably low false alert rates and that stronger anomalies are correlated with higher alert rates. PMID:21346986

Conditional outlier detection for clinical alerting.

PubMed

Hauskrecht, Milos; Valko, Michal; Batal, Iyad; Clermont, Gilles; Visweswaran, Shyam; Cooper, Gregory F

2010-11-13

We develop and evaluate a data-driven approach for detecting unusual (anomalous) patient-management actions using past patient cases stored in an electronic health record (EHR) system. Our hypothesis is that patient-management actions that are unusual with respect to past patients may be due to a potential error and that it is worthwhile to raise an alert if such a condition is encountered. We evaluate this hypothesis using data obtained from the electronic health records of 4,486 post-cardiac surgical patients. We base the evaluation on the opinions of a panel of experts. The results support that anomaly-based alerting can have reasonably low false alert rates and that stronger anomalies are correlated with higher alert rates.

Method and apparatus for extraction of low-frequency artifacts from brain waves for alertness detection

DOEpatents

Clapp, Ned E.; Hively, Lee M.

1997-01-01

Methods and apparatus automatically detect alertness in humans by monitoring and analyzing brain wave signals. Steps include: acquiring the brain wave (EEG or MEG) data from the subject, digitizing the data, separating artifact data from raw data, and comparing trends in f-data to alertness indicators, providing notification of inadequate alertness.

An Evaluation of Microbial Profile in Halitosis with Tongue Coating Using PCR (Polymerase Chain Reaction)- A Clinical and Microbiological Study

PubMed Central

Kamaraj R., Dinesh; Bhushan, Kala S.; K.L., Vandana

2014-01-01

Background: Medline search using key words halitosis, tongue coating, polymerase chain reaction, microbial profile did not reveal any study. Hence, the purpose of the present investigation was to assess the malodor using the organoleptic method and tanita device; to quantify odoriferous microorganisms using Polymerase Chain Reaction technique in chronic periodontitis patients. Materials and Methods: The study included 30 chronic periodontitis patients. Halitosis was detected using organoleptic assessment & tanita breath alert. Microbial analysis of Pg, Tf & Fn was done using PCR. Plaque index (PI), gingival index (GI), gingival bleeding index (GBI) were recorded. Result: The maximum score of 3 for tongue coating was found in 60% of selected subjects. The tanita breath alert measured VSC level of score 2 in 60% of selected subjects while organoleptic score of 4 was found in 50% of subjects. The maximum mean value of 31.1±36.5 was found to be of F. nucleatum (Fn) followed by P. gingivalis (Pg) (13±13.3) & T. forsythia (Tf) (7.16±8.68) in tongue samples of selected patients. A weak positive correlation was found between VSC levels (tanita score & organoleptic score) and clinical parameters. Conclusion: The halitosis assessment by measuring VSC levels using organoleptic method and tanita breath alert are clinically feasible. Maximum tongue coating was found in 60% of patients. Fn was found comparatively more than the Pg & Tf. A weak positive correlation was found between VSC levels and clinical parameters such as PI, GI & GBI. Thus,the dentist/ periodontist should emphasise on tongue cleaning measures that would reduce the odoriferous microbial load. PMID:24596791

Optical and X-ray early follow-up of ANTARES neutrino alerts

NASA Astrophysics Data System (ADS)

Adrián-Martínez, S.; Ageron, M.; Albert, A.; Samarai, I. Al; André, M.; Anton, G.; Ardid, M.; Aubert, J.-J.; Baret, B.; Barrios-Martí, J.; Basa, S.; Bertin, V.; Biagi, S.; Bogazzi, C.; Bormuth, R.; Bou-Cabo, M.; Bouwhuis, M. C.; Bruijn, R.; Brunner, J.; Busto, J.; Capone, A.; Caramete, L.; Carr, J.; Chiarusi, T.; Circella, M.; Coniglione, R.; Costantini, H.; Coyle, P.; Creusot, A.; Dekeyser, I.; Deschamps, A.; De Bonis, G.; Distefano, C.; Donzaud, C.; Dornic, D.; Drouhin, D.; Dumas, A.; Eberl, T.; Elsässer, D.; Enzenhöfer, A.; Fehn, K.; Felis, I.; Fermani, P.; Folger, F.; Fusco, L. A.; Galatà, S.; Gay, P.; Geißelsöder, S.; Geyer, K.; Giordano, V.; Gleixner, A.; Gracia-Ruiz, R.; Graf, K.; van Haren, H.; Heijboer, A. J.; Hello, Y.; Hernández-Rey, J. J.; Herrero, A.; Hößl, J.; Hofestädt, J.; Hugon, C.; James, C. W.; de Jong, M.; Kadler, M.; Kalekin, O.; Katz, U.; Kießling, D.; Kooijman, P.; Kouchner, A.; Kreykenbohm, I.; Kulikovskiy, V.; Lahmann, R.; Lambard, G.; Lattuada, D.; Lefèvre, D.; Leonora, E.; Loucatos, S.; Mangano, S.; Marcelin, M.; Margiotta, A.; Martínez-Mora, J. A.; Martini, S.; Mathieu, A.; Michael, T.; Migliozzi, P.; Moussa, A.; Mueller, C.; Neff, M.; Nezri, E.; Păvălaš, G. E.; Pellegrino, C.; Perrina, C.; Piattelli, P.; Popa, V.; Pradier, T.; Racca, C.; Riccobene, G.; Richter, R.; Roensch, K.; Rostovtsev, A.; Saldaña, M.; Samtleben, D. F. E.; Sanguineti, M.; Sapienza, P.; Schmid, J.; Schnabel, J.; Schulte, S.; Schüssler, F.; Seitz, T.; Sieger, C.; Spurio, M.; Steijger, J. J. M.; Stolarczyk, Th.; Sánchez-Losa, A.; Taiuti, M.; Tamburini, C.; Trovato, A.; Tselengidou, M.; Tönnis, C.; Turpin, D.; Vallage, B.; Vallée, C.; Van Elewyck, V.; Vecchi, M.; Visser, E.; Vivolo, D.; Wagner, S.; Wilms, J.; Zornoza, J. D.; Zúñiga, J.; Klotz, A.; Boer, M.; Le Van Suu, A.; Akerlof, C.; Zheng, W.; Evans, P.; Gehrels, N.; Kennea, J.; Osborne, J. P.; Coward, D. M.

2016-02-01

High-energy neutrinos could be produced in the interaction of charged cosmic rays with matter or radiation surrounding astrophysical sources. Even with the recent detection of extraterrestrial high-energy neutrinos by the IceCube experiment, no astrophysical neutrino source has yet been discovered. Transient sources, such as gamma-ray bursts, core-collapse supernovae, or active galactic nuclei are promising candidates. Multi-messenger programs offer a unique opportunity to detect these transient sources. By combining the information provided by the ANTARES neutrino telescope with information coming from other observatories, the probability of detecting a source is enhanced, allowing the possibility of identifying a neutrino progenitor from a single detected event. A method based on optical and X-ray follow-ups of high-energy neutrino alerts has been developed within the ANTARES collaboration. This method does not require any assumptions on the relation between neutrino and photon spectra other than time-correlation. This program, denoted as TAToO, triggers a network of robotic optical telescopes (TAROT and ROTSE) and the Swift-XRT with a delay of only a few seconds after a neutrino detection, and is therefore well-suited to search for fast transient sources. To identify an optical or X-ray counterpart to a neutrino signal, the images provided by the follow-up observations are analysed with dedicated pipelines. A total of 42 alerts with optical and 7 alerts with X-ray images taken with a maximum delay of 24 hours after the neutrino trigger have been analysed. No optical or X-ray counterparts associated to the neutrino triggers have been found, and upper limits on transient source magnitudes have been derived. The probability to reject the gamma-ray burst origin hypothesis has been computed for each alert.

Optical and X-ray early follow-up of ANTARES neutrino alerts

DOE Office of Scientific and Technical Information (OSTI.GOV)

Adrián-Martínez, S.; Ardid, M.; Ageron, M.

High-energy neutrinos could be produced in the interaction of charged cosmic rays with matter or radiation surrounding astrophysical sources. Even with the recent detection of extraterrestrial high-energy neutrinos by the IceCube experiment, no astrophysical neutrino source has yet been discovered. Transient sources, such as gamma-ray bursts, core-collapse supernovae, or active galactic nuclei are promising candidates. Multi-messenger programs offer a unique opportunity to detect these transient sources. By combining the information provided by the ANTARES neutrino telescope with information coming from other observatories, the probability of detecting a source is enhanced, allowing the possibility of identifying a neutrino progenitor from amore » single detected event. A method based on optical and X-ray follow-ups of high-energy neutrino alerts has been developed within the ANTARES collaboration. This method does not require any assumptions on the relation between neutrino and photon spectra other than time-correlation. This program, denoted as TAToO, triggers a network of robotic optical telescopes (TAROT and ROTSE) and the Swift-XRT with a delay of only a few seconds after a neutrino detection, and is therefore well-suited to search for fast transient sources. To identify an optical or X-ray counterpart to a neutrino signal, the images provided by the follow-up observations are analysed with dedicated pipelines. A total of 42 alerts with optical and 7 alerts with X-ray images taken with a maximum delay of 24 hours after the neutrino trigger have been analysed. No optical or X-ray counterparts associated to the neutrino triggers have been found, and upper limits on transient source magnitudes have been derived. The probability to reject the gamma-ray burst origin hypothesis has been computed for each alert.« less

Method and apparatus for extraction of low-frequency artifacts from brain waves for alertness detection

DOEpatents

Clapp, N.E.; Hively, L.M.

1997-05-06

Methods and apparatus automatically detect alertness in humans by monitoring and analyzing brain wave signals. Steps include: acquiring the brain wave (EEG or MEG) data from the subject, digitizing the data, separating artifact data from raw data, and comparing trends in f-data to alertness indicators, providing notification of inadequate alertness. 4 figs.

Clinical Decision Support Alert Appropriateness: A Review and Proposal for Improvement

PubMed Central

McCoy, Allison B.; Thomas, Eric J.; Krousel-Wood, Marie; Sittig, Dean F.

2014-01-01

Background Many healthcare providers are adopting clinical decision support (CDS) systems to improve patient safety and meet meaningful use requirements. Computerized alerts that prompt clinicians about drug-allergy, drug-drug, and drug-disease warnings or provide dosing guidance are most commonly implemented. Alert overrides, which occur when clinicians do not follow the guidance presented by the alert, can hinder improved patient outcomes. Methods We present a review of CDS alerts and describe a proposal to develop novel methods for evaluating and improving CDS alerts that builds upon traditional informatics approaches. Our proposal incorporates previously described models for predicting alert overrides that utilize retrospective chart review to determine which alerts are clinically relevant and which overrides are justifiable. Results Despite increasing implementations of CDS alerts, detailed evaluations rarely occur because of the extensive labor involved in manual chart reviews to determine alert and response appropriateness. Further, most studies have solely evaluated alert overrides that are appropriate or justifiable. Our proposal expands the use of web-based monitoring tools with an interactive dashboard for evaluating CDS alert and response appropriateness that incorporates the predictive models. The dashboard provides 2 views, an alert detail view and a patient detail view, to provide a full history of alerts and help put the patient's events in context. Conclusion The proposed research introduces several innovations to address the challenges and gaps in alert evaluations. This research can transform alert evaluation processes across healthcare settings, leading to improved CDS, reduced alert fatigue, and increased patient safety. PMID:24940129

A framework for evaluating the appropriateness of clinical decision support alerts and responses

PubMed Central

Waitman, Lemuel R; Lewis, Julia B; Wright, Julie A; Choma, David P; Miller, Randolph A; Peterson, Josh F

2011-01-01

Objective Alerting systems, a type of clinical decision support, are increasingly prevalent in healthcare, yet few studies have concurrently measured the appropriateness of alerts with provider responses to alerts. Recent reports of suboptimal alert system design and implementation highlight the need for better evaluation to inform future designs. The authors present a comprehensive framework for evaluating the clinical appropriateness of synchronous, interruptive medication safety alerts. Methods Through literature review and iterative testing, metrics were developed that describe successes, justifiable overrides, provider non-adherence, and unintended adverse consequences of clinical decision support alerts. The framework was validated by applying it to a medication alerting system for patients with acute kidney injury (AKI). Results Through expert review, the framework assesses each alert episode for appropriateness of the alert display and the necessity and urgency of a clinical response. Primary outcomes of the framework include the false positive alert rate, alert override rate, provider non-adherence rate, and rate of provider response appropriateness. Application of the framework to evaluate an existing AKI medication alerting system provided a more complete understanding of the process outcomes measured in the AKI medication alerting system. The authors confirmed that previous alerts and provider responses were most often appropriate. Conclusion The new evaluation model offers a potentially effective method for assessing the clinical appropriateness of synchronous interruptive medication alerts prior to evaluating patient outcomes in a comparative trial. More work can determine the generalizability of the framework for use in other settings and other alert types. PMID:21849334

VTAC: virtual terrain assisted impact assessment for cyber attacks

NASA Astrophysics Data System (ADS)

Argauer, Brian J.; Yang, Shanchieh J.

2008-03-01

Overwhelming intrusion alerts have made timely response to network security breaches a difficult task. Correlating alerts to produce a higher level view of intrusion state of a network, thus, becomes an essential element in network defense. This work proposes to analyze correlated or grouped alerts and determine their 'impact' to services and users of the network. A network is modeled as 'virtual terrain' where cyber attacks maneuver. Overlaying correlated attack tracks on virtual terrain exhibits the vulnerabilities exploited by each track and the relationships between them and different network entities. The proposed impact assessment algorithm utilizes the graph-based virtual terrain model and combines assessments of damages caused by the attacks. The combined impact scores allow to identify severely damaged network services and affected users. Several scenarios are examined to demonstrate the uses of the proposed Virtual Terrain Assisted Impact Assessment for Cyber Attacks (VTAC).

An evaluation of microbial profile in halitosis with tongue coating using PCR (polymerase chain reaction)- a clinical and microbiological study.

PubMed

Kamaraj R, Dinesh; Bhushan, Kala S; K L, Vandana

2014-01-01

Medline search using key words halitosis, tongue coating, polymerase chain reaction, microbial profile did not reveal any study. Hence, the purpose of the present investigation was to assess the malodor using the organoleptic method and tanita device; to quantify odoriferous microorganisms using Polymerase Chain Reaction technique in chronic periodontitis patients. The study included 30 chronic periodontitis patients. Halitosis was detected using organoleptic assessment & tanita breath alert. Microbial analysis of Pg, Tf & Fn was done using PCR. Plaque index (PI), gingival index (GI), gingival bleeding index (GBI) were recorded. The maximum score of 3 for tongue coating was found in 60% of selected subjects. The tanita breath alert measured VSC level of score 2 in 60% of selected subjects while organoleptic score of 4 was found in 50% of subjects. The maximum mean value of 31.1±36.5 was found to be of F. nucleatum (Fn) followed by P. gingivalis (Pg) (13±13.3) & T. forsythia (Tf) (7.16±8.68) in tongue samples of selected patients. A weak positive correlation was found between VSC levels (tanita score & organoleptic score) and clinical parameters. The halitosis assessment by measuring VSC levels using organoleptic method and tanita breath alert are clinically feasible. Maximum tongue coating was found in 60% of patients. Fn was found comparatively more than the Pg & Tf. A weak positive correlation was found between VSC levels and clinical parameters such as PI, GI & GBI. Thus,the dentist/ periodontist should emphasise on tongue cleaning measures that would reduce the odoriferous microbial load.

The comparison of rapid bioassays for the assessment of urban groundwater quality.

PubMed

Dewhurst, R E; Wheeler, J R; Chummun, K S; Mather, J D; Callaghan, A; Crane, M

2002-05-01

Groundwater is a complex mixture of chemicals that is naturally variable. Current legislation in the UK requires that groundwater quality and the degree of contamination are assessed using chemical methods. Such methods do not consider the synergistic or antagonistic interactions that may affect the bioavailability and toxicity of pollutants in the environment. Bioassays are a method for assessing the toxic impact of whole groundwater samples on the environment. Three rapid bioassays, Eclox, Microtox and ToxAlert, and a Daphnia magna 48-h immobilisation test were used to assess groundwater quality from sites with a wide range of historical uses. Eclox responses indicated that the test was very sensitive to changes in groundwater chemistry; 77% of the results had a percentage inhibition greater than 90%. ToxAlert, although suitable for monitoring changes in water quality under laboratory conditions, produced highly variable results due to fluctuations in temperature and the chemical composition of the samples. Microtox produced replicable results that correlated with those from D. magna tests.

Alert dwell time: introduction of a measure to evaluate interruptive clinical decision support alerts

PubMed Central

McDaniel, Robert B; Burlison, Jonathan D; Baker, Donald K; Hasan, Murad; Robertson, Jennifer; Hartford, Christine; Howard, Scott C; Sablauer, Andras

2016-01-01

Metrics for evaluating interruptive prescribing alerts have many limitations. Additional methods are needed to identify opportunities to improve alerting systems and prevent alert fatigue. In this study, the authors determined whether alert dwell time—the time elapsed from when an interruptive alert is generated to when it is dismissed—could be calculated by using historical alert data from log files. Drug–drug interaction (DDI) alerts from 3 years of electronic health record data were queried. Alert dwell time was calculated for 25,965 alerts, including 777 unique DDIs. The median alert dwell time was 8 s (range, 1–4913 s). Resident physicians had longer median alert dwell times than other prescribers (P < .001). The 10 most frequent DDI alerts (n = 8759 alerts) had shorter median dwell times than alerts that only occurred once (P < .001). This metric can be used in future research to evaluate the effectiveness and efficiency of interruptive prescribing alerts. PMID:26499101

Assessing the temporal aspects of attention and its correlates in aging and chronic stroke patients.

PubMed

Shalev, Nir; Humphreys, Glyn; Demeyere, Nele

2016-11-01

Temporal dynamics of attention have been in the spotlight of research since the earliest days of cognitive psychology. Typically, researchers describe two different aspects of the temporal fluctuations of attention: one is in intervals of milliseconds (phasic alertness), and the other over minutes or even hours (tonic alertness or sustained attention). In order to evaluate individual capacities for sustained attention and phasic alertness, most studies rely on variations of the Continuous Performance Task (CPT). Indices of sustained attention and phasic alertness are typically based on reaction times to targets; phasic alertness is related to the change in reaction times following a cue, and sustained attention is related to variability of reaction times during the task. In the following study, we attempted to establish a new approach for studying sustained attention and phasic alertness, not reliant solely on reaction time measures. We developed a new variation of the CPT with conjunctive feature targets and forward and backward masking to induce a higher variability in accuracy. This allowed us to assess an individual's ability to maintain the same level of sensitivity to targets (d-prime) across a ten minute period on the task as an index for sustained attention. We also assessed reaction times as a function of previous trial type, and suggest previous trial RT benefit might be a marker for an individual's phasic alertness. We demonstrated the use of this task with healthy aging controls and stroke survivors. As a demonstration of external validity of the novel paradigm, we present a correlation between how individual performance drops over time and individual reports of distractibility in everyday life on the Cognitive Failures Questionnaire. In addition, we found significant differences between the patient and control groups in our proposed marker of phasic alertness. We discuss the implications of our study for current assessment tools, as well as general differences in phasic alertness between clinical and neurologically unimpaired groups. Copyright © 2016 Elsevier Ltd. All rights reserved.

Monitoring alert and drowsy states by modeling EEG source nonstationarity

NASA Astrophysics Data System (ADS)

Hsu, Sheng-Hsiou; Jung, Tzyy-Ping

2017-10-01

Objective. As a human brain performs various cognitive functions within ever-changing environments, states of the brain characterized by recorded brain activities such as electroencephalogram (EEG) are inevitably nonstationary. The challenges of analyzing the nonstationary EEG signals include finding neurocognitive sources that underlie different brain states and using EEG data to quantitatively assess the state changes. Approach. This study hypothesizes that brain activities under different states, e.g. levels of alertness, can be modeled as distinct compositions of statistically independent sources using independent component analysis (ICA). This study presents a framework to quantitatively assess the EEG source nonstationarity and estimate levels of alertness. The framework was tested against EEG data collected from 10 subjects performing a sustained-attention task in a driving simulator. Main results. Empirical results illustrate that EEG signals under alert versus drowsy states, indexed by reaction speeds to driving challenges, can be characterized by distinct ICA models. By quantifying the goodness-of-fit of each ICA model to the EEG data using the model deviation index (MDI), we found that MDIs were significantly correlated with the reaction speeds (r  =  -0.390 with alertness models and r  =  0.449 with drowsiness models) and the opposite correlations indicated that the two models accounted for sources in the alert and drowsy states, respectively. Based on the observed source nonstationarity, this study also proposes an online framework using a subject-specific ICA model trained with an initial (alert) state to track the level of alertness. For classification of alert against drowsy states, the proposed online framework achieved an averaged area-under-curve of 0.745 and compared favorably with a classic power-based approach. Significance. This ICA-based framework provides a new way to study changes of brain states and can be applied to monitoring cognitive or mental states of human operators in attention-critical settings or in passive brain-computer interfaces.

Terrorism-Related Fear and Avoidance Behavior in a Multiethnic Urban Population

PubMed Central

Glik, Deborah; Ong, Michael; Zhou, Qiong; Tseng, Chi-Hong; Long, Anna; Fielding, Jonathan; Asch, Steven

2009-01-01

Objectives. We sought to determine whether groups traditionally most vulnerable to disasters would be more likely than would be others to perceive population-level risk as high (as measured by the estimated color-coded alert level) would worry more about terrorism, and would avoid activities because of terrorism concerns. Methods. We conducted a random digit dial survey of the Los Angeles County population October 2004 through January 2005 in 6 languages. We asked respondents what color alert level the country was under, how often they worry about terrorist attacks, and how often they avoid activities because of terrorism. Multivariate regression modeled correlates of worry and avoidance, including mental illness, disability, demographic factors, and estimated color-coded alert level. Results. Persons who are mentally ill, those who are disabled, African Americans, Latinos, Chinese Americans, Korean Americans, and non-US citizens were more likely to perceive population-level risk as high, as measured by the estimated color-coded alert level. These groups also reported more worry and avoidance behaviors because of concerns about terrorism. Conclusions. Vulnerable populations experience a disproportionate burden of the psychosocial impact of terrorism threats and our national response. Further studies should investigate the specific behaviors affected and further elucidate disparities in the disaster burden associated with terrorism and terrorism policies. PMID:19008521

Correlation of the Hippocampal theta rhythm to changes in hypothalamic temperature

NASA Technical Reports Server (NTRS)

Saleh, M. A.; Horowitz, J. M.; Hsieh, A. C. L.

1974-01-01

Warming and cooling the preoptic anterior hypothalamic area in awake, loosely restrained rabbits was found to evoke theta rhythm. This is consistent with previous studies indicating that theta rhythm is a nonspecific response evoked by stimulation of several sensory modalities. Several studies have correlated theta rhythm with alertness. A neural pathway involving the hypothalamus, the hippocampus, the septal area, and the reticular formation is proposed. Thus, a role of this pathway may be to alert the animal to changes in its body temperature.

Is there a link between the hospital-acquired injurious fall rates in US acute care hospitals and these institutions' implementation levels of computerized systems?

PubMed

Tzeng, Huey-Ming; Hu, Hsou Mei; Yin, Chang-Yi

2011-12-01

Medicare no longer reimburses acute care hospitals for the costs of additional care required due to hospital-acquired injuries. Consequently, this study explored the effective computerized systems to inform practice for better interventions to reduce fall risk. It provided a correlation between type of computerized system and hospital-acquired injurious fall rates at acute care hospitals in California, Florida, and New York. It used multiple publicly available data sets, with the hospital as the unit of analysis. Descriptive and Pearson correlation analyses were used. The analysis included 462 hospitals. Significant correlations could be categorized into two groups: (1) meaningful computerized systems that were associated with lower injurious fall rates: the decision support systems for drug allergy alerts, drug-drug interaction alerts, and drug-laboratory interaction alerts; and (2) computerized systems that were associated with higher injurious fall rates: the decision support system for drug-drug interaction alerts and the computerized provider order entry system for radiology tests. Future research may include additional states, multiple years of data, and patient-level data to validate this study's findings. This effort may further inform policy makers and the public about effective clinical computerized systems provided to clinicians to improve their practice decisions and care outcomes.

Behavior of Cackling Canada Geese during brood rearing

USGS Publications Warehouse

Fowler, Ada C.; Ely, Craig R.

1997-01-01

We studied behavior of Cackling Canada Goose (Branta canadensis minima, cacklers) broods between 1992 and 1996 on the Yukon Delta National Wildlife Refuge in western Alaska. An increase in time spent foraging by goslings during our study was weakly correlated with an increase in the size of the local breeding population. Amount of time spent feeding by adults and goslings increased throughout the brood rearing period. Overall, goslings spent more time feeding than either adult females or males, and adult males spent the most time alert. Time alert varied among brood rearing areas and increased with brood size, but there was no variation in time spent alert among years. Increases in feeding or alert behaviors were at a cost to time spent in all other behaviors. We suggest that there is not a simple trade-off between feeding and alert behavior in cacklers, but instead that time spent feeding and alert are optimized against all other behaviors. We suggest that forage quality and availability determines the amount of time spent feeding, whereas the threat of predation or disturbance determines the amount of time spent alert.

Development and Evaluation of an Ontology for Guiding Appropriate Antibiotic Prescribing

PubMed Central

Furuya, E. Yoko; Kuperman, Gilad J.; Cimino, James J.; Bakken, Suzanne

2011-01-01

Objectives To develop and apply formal ontology creation methods to the domain of antimicrobial prescribing and to formally evaluate the resulting ontology through intrinsic and extrinsic evaluation studies. Methods We extended existing ontology development methods to create the ontology and implemented the ontology using Protégé-OWL. Correctness of the ontology was assessed using a set of ontology design principles and domain expert review via the laddering technique. We created three artifacts to support the extrinsic evaluation (set of prescribing rules, alerts and an ontology-driven alert module, and a patient database) and evaluated the usefulness of the ontology for performing knowledge management tasks to maintain the ontology and for generating alerts to guide antibiotic prescribing. Results The ontology includes 199 classes, 10 properties, and 1,636 description logic restrictions. Twenty-three Semantic Web Rule Language rules were written to generate three prescribing alerts: 1) antibiotic-microorganism mismatch alert; 2) medication-allergy alert; and 3) non-recommended empiric antibiotic therapy alert. The evaluation studies confirmed the correctness of the ontology, usefulness of the ontology for representing and maintaining antimicrobial treatment knowledge rules, and usefulness of the ontology for generating alerts to provide feedback to clinicians during antibiotic prescribing. Conclusions This study contributes to the understanding of ontology development and evaluation methods and addresses one knowledge gap related to using ontologies as a clinical decision support system component—a need for formal ontology evaluation methods to measure their quality from the perspective of their intrinsic characteristics and their usefulness for specific tasks. PMID:22019377

Alert dwell time: introduction of a measure to evaluate interruptive clinical decision support alerts.

PubMed

McDaniel, Robert B; Burlison, Jonathan D; Baker, Donald K; Hasan, Murad; Robertson, Jennifer; Hartford, Christine; Howard, Scott C; Sablauer, Andras; Hoffman, James M

2016-04-01

Metrics for evaluating interruptive prescribing alerts have many limitations. Additional methods are needed to identify opportunities to improve alerting systems and prevent alert fatigue. In this study, the authors determined whether alert dwell time-the time elapsed from when an interruptive alert is generated to when it is dismissed-could be calculated by using historical alert data from log files. Drug-drug interaction (DDI) alerts from 3 years of electronic health record data were queried. Alert dwell time was calculated for 25,965 alerts, including 777 unique DDIs. The median alert dwell time was 8 s (range, 1-4913 s). Resident physicians had longer median alert dwell times than other prescribers (P < 001). The 10 most frequent DDI alerts (n = 8759 alerts) had shorter median dwell times than alerts that only occurred once (P < 001). This metric can be used in future research to evaluate the effectiveness and efficiency of interruptive prescribing alerts. © The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Tracking wakefulness as it fades: Micro-measures of alertness.

PubMed

Jagannathan, Sridhar R; Ezquerro-Nassar, Alejandro; Jachs, Barbara; Pustovaya, Olga V; Bareham, Corinne A; Bekinschtein, Tristan A

2018-08-01

A major problem in psychology and physiology experiments is drowsiness: around a third of participants show decreased wakefulness despite being instructed to stay alert. In some non-visual experiments participants keep their eyes closed throughout the task, thus promoting the occurrence of such periods of varying alertness. These wakefulness changes contribute to systematic noise in data and measures of interest. To account for this omnipresent problem in data acquisition we defined criteria and code to allow researchers to detect and control for varying alertness in electroencephalography (EEG) experiments under eyes-closed settings. We first revise a visual-scoring method developed for detection and characterization of the sleep-onset process, and adapt the same for detection of alertness levels. Furthermore, we show the major issues preventing the practical use of this method, and overcome these issues by developing an automated method (micro-measures algorithm) based on frequency and sleep graphoelements, which are capable of detecting micro variations in alertness. The validity of the micro-measures algorithm was verified by training and testing using a dataset where participants are known to fall asleep. In addition, we tested generalisability by independent validation on another dataset. The methods developed constitute a unique tool to assess micro variations in levels of alertness and control trial-by-trial retrospectively or prospectively in every experiment performed with EEG in cognitive neuroscience under eyes-closed settings. Copyright © 2018. Published by Elsevier Inc.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Gustafsson, Helena; Runesson, Johan; Lundqvist, Jessica

The objective of the EU-funded integrated project ACuteTox is to develop a strategy in which general cytotoxicity, together with organ-specific toxicity and biokinetic features, are used for the estimation of human acute systemic toxicity. Our role in the project is to characterise the effect of reference chemicals with regard to neurotoxicity. We studied cell membrane potential (CMP), noradrenalin (NA) uptake, acetylcholine esterase (AChE) activity, acetylcholine receptor (AChR) signalling and voltage-operated calcium channel (VOCC) function in human neuroblastoma SH-SY5Y cells after exposure to 23 pharmaceuticals, pesticides or industrial chemicals. Neurotoxic alert chemicals were identified by comparing the obtained data with cytotoxicitymore » data from the neutral red uptake assay in 3T3 mouse fibroblasts. Furthermore, neurotoxic concentrations were correlated with estimated human lethal blood concentrations (LC50). The CMP assay was the most sensitive assay, identifying eight chemicals as neurotoxic alerts and improving the LC50 correlation for nicotine, lindane, atropine and methadone. The NA uptake assay identified five neurotoxic alert chemicals and improved the LC50 correlation for atropine, diazepam, verapamil and methadone. The AChE, AChR and VOCC assays showed limited potential for detection of acute toxicity. The CMP assay was further evaluated by testing 36 additional reference chemicals. Five neurotoxic alert chemicals were generated and orphendrine and amitriptyline showed improved LC50 correlation. Due to the high sensitivity and the simplicity of the test protocol, the CMP assay constitutes a good candidate assay to be included in an in vitro test strategy for prediction of acute systemic toxicity.« less

Development and evaluation of an ontology for guiding appropriate antibiotic prescribing.

PubMed

Bright, Tiffani J; Yoko Furuya, E; Kuperman, Gilad J; Cimino, James J; Bakken, Suzanne

2012-02-01

To develop and apply formal ontology creation methods to the domain of antimicrobial prescribing and to formally evaluate the resulting ontology through intrinsic and extrinsic evaluation studies. We extended existing ontology development methods to create the ontology and implemented the ontology using Protégé-OWL. Correctness of the ontology was assessed using a set of ontology design principles and domain expert review via the laddering technique. We created three artifacts to support the extrinsic evaluation (set of prescribing rules, alerts and an ontology-driven alert module, and a patient database) and evaluated the usefulness of the ontology for performing knowledge management tasks to maintain the ontology and for generating alerts to guide antibiotic prescribing. The ontology includes 199 classes, 10 properties, and 1636 description logic restrictions. Twenty-three Semantic Web Rule Language rules were written to generate three prescribing alerts: (1) antibiotic-microorganism mismatch alert; (2) medication-allergy alert; and (3) non-recommended empiric antibiotic therapy alert. The evaluation studies confirmed the correctness of the ontology, usefulness of the ontology for representing and maintaining antimicrobial treatment knowledge rules, and usefulness of the ontology for generating alerts to provide feedback to clinicians during antibiotic prescribing. This study contributes to the understanding of ontology development and evaluation methods and addresses one knowledge gap related to using ontologies as a clinical decision support system component-a need for formal ontology evaluation methods to measure their quality from the perspective of their intrinsic characteristics and their usefulness for specific tasks. Copyright © 2011 Elsevier Inc. All rights reserved.

Collaborative knowledge acquisition for the design of context-aware alert systems.

PubMed

Joffe, Erel; Havakuk, Ofer; Herskovic, Jorge R; Patel, Vimla L; Bernstam, Elmer Victor

2012-01-01

To present a framework for combining implicit knowledge acquisition from multiple experts with machine learning and to evaluate this framework in the context of anemia alerts. Five internal medicine residents reviewed 18 anemia alerts, while 'talking aloud'. They identified features that were reviewed by two or more physicians to determine appropriate alert level, etiology and treatment recommendation. Based on these features, data were extracted from 100 randomly-selected anemia cases for a training set and an additional 82 cases for a test set. Two staff internists assigned an alert level, etiology and treatment recommendation before and after reviewing the entire electronic medical record. The training set of 118 cases (100 plus 18) and the test set of 82 cases were explored using RIDOR and JRip algorithms. The feature set was sufficient to assess 93% of anemia cases (intraclass correlation for alert level before and after review of the records by internists 1 and 2 were 0.92 and 0.95, respectively). High-precision classifiers were constructed to identify low-level alerts (precision p=0.87, recall R=0.4), iron deficiency (p=1.0, R=0.73), and anemia associated with kidney disease (p=0.87, R=0.77). It was possible to identify low-level alerts and several conditions commonly associated with chronic anemia. This approach may reduce the number of clinically unimportant alerts. The study was limited to anemia alerts. Furthermore, clinicians were aware of the study hypotheses potentially biasing their evaluation. Implicit knowledge acquisition, collaborative filtering and machine learning were combined automatically to induce clinically meaningful and precise decision rules.

Building a Communication, Education, an Outreach Program for the ShakeAlert National Earthquake Early Warning Program - Recommendations for Public Alerts Via Cell Phones

NASA Astrophysics Data System (ADS)

DeGroot, R. M.; Long, K.; Strauss, J. A.

2017-12-01

The United States Geological Survey (USGS) and its partners are developing the ShakeAlert Earthquake Early Warning System for the West Coast of the United States. To be an integral part of successful implementation, ShakeAlert engagement programs and materials must integrate with and leverage broader earthquake risk programs. New methods and products for dissemination must be multidisciplinary, cost effective, and consistent with existing hazards education and communication efforts. The ShakeAlert Joint Committee for Communication, Education, and Outreach (JCCEO), is identifying, developing, and cultivating partnerships with ShakeAlert stakeholders including Federal, State, academic partners, private companies, policy makers, and local organizations. Efforts include developing materials, methods for delivery, and reaching stakeholders with information on ShakeAlert, earthquake preparedness, and emergency protective actions. It is essential to develop standards to ensure information communicated via the alerts is consistent across the public and private sector and achieving a common understanding of what actions users take when they receive a ShakeAlert warning. In February 2017, the JCCEO convened the Warning Message Focus Group (WMFG) to provide findings and recommendations to the Alliance for Telecommunications Industry Solutions on the use of earthquake early warning message content standards for public alerts via cell phones. The WMFG represents communications, education, and outreach stakeholders from various sectors including ShakeAlert regional coordinators, industry, emergency managers, and subject matter experts from the social sciences. The group knowledge was combined with an in-depth literature review to ensure that all groups who could receive the message would be taken into account. The USGS and the participating states and agencies acknowledge that the implementation of ShakeAlert is a collective effort requiring the participation of hundreds of stakeholders committed to ensuring public accessibility.

A new method for determining a sector alert

DOT National Transportation Integrated Search

2008-09-29

The Traffic Flow Management System (TFMS) currently declares an alert for any 15-minute interval in which the predicted demand exceeds the Monitor/Alert Parameter (MAP) for any airport, sector, or fix. For a sector, TFMS predicts the demand for each ...

Comparison of methods of alert acknowledgement by critical care clinicians in the ICU setting

PubMed Central

Harrison, Andrew M.; Thongprayoon, Charat; Aakre, Christopher A.; Jeng, Jack Y.; Dziadzko, Mikhail A.; Gajic, Ognjen; Pickering, Brian W.

2017-01-01

Background Electronic Health Record (EHR)-based sepsis alert systems have failed to demonstrate improvements in clinically meaningful endpoints. However, the effect of implementation barriers on the success of new sepsis alert systems is rarely explored. Objective To test the hypothesis time to severe sepsis alert acknowledgement by critical care clinicians in the ICU setting would be reduced using an EHR-based alert acknowledgement system compared to a text paging-based system. Study Design In one arm of this simulation study, real alerts for patients in the medical ICU were delivered to critical care clinicians through the EHR. In the other arm, simulated alerts were delivered through text paging. The primary outcome was time to alert acknowledgement. The secondary outcomes were a structured, mixed quantitative/qualitative survey and informal group interview. Results The alert acknowledgement rate from the severe sepsis alert system was 3% (N = 148) and 51% (N = 156) from simulated severe sepsis alerts through traditional text paging. Time to alert acknowledgement from the severe sepsis alert system was median 274 min (N = 5) and median 2 min (N = 80) from text paging. The response rate from the EHR-based alert system was insufficient to compare primary measures. However, secondary measures revealed important barriers. Conclusion Alert fatigue, interruption, human error, and information overload are barriers to alert and simulation studies in the ICU setting. PMID:28316887

Comparison of methods of alert acknowledgement by critical care clinicians in the ICU setting.

PubMed

Harrison, Andrew M; Thongprayoon, Charat; Aakre, Christopher A; Jeng, Jack Y; Dziadzko, Mikhail A; Gajic, Ognjen; Pickering, Brian W; Herasevich, Vitaly

2017-01-01

Electronic Health Record (EHR)-based sepsis alert systems have failed to demonstrate improvements in clinically meaningful endpoints. However, the effect of implementation barriers on the success of new sepsis alert systems is rarely explored. To test the hypothesis time to severe sepsis alert acknowledgement by critical care clinicians in the ICU setting would be reduced using an EHR-based alert acknowledgement system compared to a text paging-based system. In one arm of this simulation study, real alerts for patients in the medical ICU were delivered to critical care clinicians through the EHR. In the other arm, simulated alerts were delivered through text paging. The primary outcome was time to alert acknowledgement. The secondary outcomes were a structured, mixed quantitative/qualitative survey and informal group interview. The alert acknowledgement rate from the severe sepsis alert system was 3% ( N  = 148) and 51% ( N  = 156) from simulated severe sepsis alerts through traditional text paging. Time to alert acknowledgement from the severe sepsis alert system was median 274 min ( N  = 5) and median 2 min ( N  = 80) from text paging. The response rate from the EHR-based alert system was insufficient to compare primary measures. However, secondary measures revealed important barriers. Alert fatigue, interruption, human error, and information overload are barriers to alert and simulation studies in the ICU setting.

Effect of station-specific alerting and ramp-up tones on firefighters' alarm time heart rates.

PubMed

MacNeal, James J; Cone, David C; Wistrom, Christopher L

2016-11-01

A number of long-term health effects are suffered by emergency responders, some influenced by psychological stress and fatigue. This study explored if stress and fatigue can be reduced by changing the method by which firefighters are alerted to emergency responses. Over several months, the method by which responders at a fire department were alerted was altered. Firefighter heart rates were measured first with standard alerting as a control (phase 1: all stations alerted simultaneously, with high-volume tones). The department then implemented station-specific (phase 2) and gradual volume ramp-up (phase 3) tone alerting, and heart rate increases were compared. The Fatigue Severity Score was used to examine firefighter fatigue, and the department administered a follow-up survey on personnel preferences. Individual heart rate increases (Δbpm) ranged from 2-48 bpm. Median increases were 7 bpm (IQR 4-11 bpm) during phase 1 (72.2% of alarms Δbpm<10), 7 bpm (IQR 5-12 bpm) during phase 2 (60.7% of alarms Δbpm<10), and 5 bpm (IQR 3-8 bpm) during phase 3 (82.7% of alarms Δbpm<10). The difference in medians was lower for phases 1 and 2 than for phase 3 (p = 0.0069), and more alarms in phase 3 resulted in increases of <10 bpm than in phase 2 (p = 0.0089). The Fatigue Severity Scale showed little variability: median scores 7 in phase 1, 8 in phase 2, and 7 in phase 3. Firefighters reported a strong preference for the "ramp-up" tones, and were roughly evenly divided between preferring alerting all stations simultaneously 24/7 (40% rating this 4 or 5 on a five-point Likert scale), station-specific alerting 24/7 (47.5%), or all stations during the day but station-specific at night (40%). Ramp-up tones were perceived as the best method to reduce stress during the day and overnight. Small but significant decreases in the amount of tachycardic response to station alerting are associated with simple alterations in alerting methods. Station-specific and ramp-up tones improve perceived working conditions for emergency responders.

Optimized molecular resolution of cross-contamination alerts in clinical mycobacteriology laboratories.

PubMed

Martín, Ana; Herranz, Marta; Lirola, Miguel Martínez; Fernández, Rosa Fernández; Bouza, Emilio; García de Viedma, Darío

2008-02-14

The phenomenon of misdiagnosing tuberculosis (TB) by laboratory cross-contamination when culturing Mycobacterium tuberculosis (MTB) has been widely reported and it has an obvious clinical, therapeutic and social impact. The final confirmation of a cross-contamination event requires the molecular identification of the same MTB strain cultured from both the potential source of the contamination and from the false-positive candidate. The molecular tool usually applied in this context is IS6110-RFLP which takes a long time to provide an answer, usually longer than is acceptable for microbiologists and clinicians to make decisions. Our purpose in this study is to evaluate a novel PCR-based method, MIRU-VNTR as an alternative to assure a rapid and optimized analysis of cross-contamination alerts. MIRU-VNTR was prospectively compared with IS6110-RFLP for clarifying 19 alerts of false positivity from other laboratories. MIRU-VNTR highly correlated with IS6110-RFLP, reduced the response time by 27 days and clarified six alerts unresolved by RFLP. Additionally, MIRU-VNTR revealed complex situations such as contamination events involving polyclonal isolates and a false-positive case due to the simultaneous cross-contamination from two independent sources. Unlike standard RFLP-based genotyping, MIRU-VNTR i) could help reduce the impact of a false positive diagnosis of TB, ii) increased the number of events that could be solved and iii) revealed the complexity of some cross-contamination events that could not be dissected by IS6110-RFLP.

Attention Network Dysfunction in Bulimia Nervosa - An fMRI Study

PubMed Central

Dahmen, Brigitte; Schulte-Rüther, Martin; Legenbauer, Tanja; Herpertz-Dahlmann, Beate; Konrad, Kerstin

2016-01-01

Objective Recent evidence has suggested an increased rate of comorbid ADHD and subclinical attentional impairments in bulimia nervosa (BN) patients. However, little is known regarding the underlying neural mechanisms of attentional functions in BN. Method Twenty BN patients and twenty age- and weight-matched healthy controls (HC) were investigated using a modified version of the Attention Network Task (ANT) in an fMRI study. This design enabled an investigation of the neural mechanisms associated with the three attention networks involved in alerting, reorienting and executive attention. Results The BN patients showed hyperactivation in parieto-occipital regions and reduced deactivation of default-mode-network (DMN) areas during alerting compared with HCs. Posterior cingulate activation during alerting correlated with the severity of eating-disorder symptoms within the patient group. Conversely, BN patients showed hypoactivation during reorienting and executive attention in anterior cingulate regions, the temporo-parietal junction (TPJ) and parahippocampus compared with HCs, which was negatively associated with global ADHD symptoms and impulsivity, respectively. Discussion Our findings demonstrate altered brain mechanisms in BN associated with all three attentional networks. Failure to deactivate the DMN and increased parieto-occipital activation required for alerting might be associated with a constant preoccupation with food or body image-related thoughts. Hypoactivation of executive control networks and TPJ might increase the likelihood of inattentive and impulsive behaviors and poor emotion regulation. Thus, dysfunction in the attentional network in BN goes beyond an altered executive attentional domain and needs to be considered in the diagnosis and treatment of BN. PMID:27607439

Humanizing Aggregated Data: Developing Personas to Prioritize User Needs for Earthquake Early Warning

NASA Astrophysics Data System (ADS)

Burkett, E. R.; Jayanty, N. K.; Sellnow, D. D.; Given, D. D.; DeGroot, R. M.

2016-12-01

Methods that use storytelling to gather and synthesize data from people can be advantageous in understanding user needs and designing successful communication products. Using a multidisciplinary approach, we research and prioritize user needs for the ShakeAlert Earthquake Early Warning system (http://pubs.usgs.gov/fs/2014/3083/), drawing on best practices from social and behavioral science, risk communication, and human-centered design. We apply quantitative and qualitative human data collection methods including user surveys, interviews, journey maps, personas, and scenarios. Human-centered design methods leverage storytelling (a) in the acquisition of qualitative behavioral data (e.g. with journey mapping), (b) through goal-driven behaviors and needs that are synthesized into a persona as a composite model of the data, and (c) within context scenarios (the story plot or projected circumstances) in which the persona is placed in context to inform the design of relevant and usable products or services. ShakeAlert, operated by the USGS and partners, has transitioned into a production prototype phase in which users are permitted to begin testing pilot implementations to take protective actions in response to an earthquake alert. While a subset of responses will be automated (e.g., opening fire house doors), other applications of the technology will alert individuals by broadcast, public address, or mobile device notifications and require self-protective behavioral decisions (e.g., "Drop, Cover, and Hold On"). To better understand ShakeAlert user decisions and needs, we use human-centered design methods to synthesize aggregated behavioral data into "personas," which model the common behavioral patterns that can be used to guide plans for the ShakeAlert interface, messaging, and training. We present user data, methods, and resulting personas that will inform decisions moving forward to shape ShakeAlert messaging and training that will be most usable by alert recipients.

Personalized and automated remote monitoring of atrial fibrillation.

PubMed

Rosier, Arnaud; Mabo, Philippe; Temal, Lynda; Van Hille, Pascal; Dameron, Olivier; Deléger, Louise; Grouin, Cyril; Zweigenbaum, Pierre; Jacques, Julie; Chazard, Emmanuel; Laporte, Laure; Henry, Christine; Burgun, Anita

2016-03-01

Remote monitoring of cardiac implantable electronic devices is a growing standard; yet, remote follow-up and management of alerts represents a time-consuming task for physicians or trained staff. This study evaluates an automatic mechanism based on artificial intelligence tools to filter atrial fibrillation (AF) alerts based on their medical significance. We evaluated this method on alerts for AF episodes that occurred in 60 pacemaker recipients. AKENATON prototype workflow includes two steps: natural language-processing algorithms abstract the patient health record to a digital version, then a knowledge-based algorithm based on an applied formal ontology allows to calculate the CHA2DS2-VASc score and evaluate the anticoagulation status of the patient. Each alert is then automatically classified by importance from low to critical, by mimicking medical reasoning. Final classification was compared with human expert analysis by two physicians. A total of 1783 alerts about AF episode >5 min in 60 patients were processed. A 1749 of 1783 alerts (98%) were adequately classified and there were no underestimation of alert importance in the remaining 34 misclassified alerts. This work demonstrates the ability of a pilot system to classify alerts and improves personalized remote monitoring of patients. In particular, our method allows integration of patient medical history with device alert notifications, which is useful both from medical and resource-management perspectives. The system was able to automatically classify the importance of 1783 AF alerts in 60 patients, which resulted in an 84% reduction in notification workload, while preserving patient safety. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.

Auditory alert systems with enhanced detectability

NASA Technical Reports Server (NTRS)

Begault, Durand R. (Inventor)

2008-01-01

Methods and systems for distinguishing an auditory alert signal from a background of one or more non-alert signals. In a first embodiment, a prefix signal, associated with an existing alert signal, is provided that has a signal component in each of three or more selected frequency ranges, with each signal component in each of three or more selected level at least 3-10 dB above an estimated background (non-alert) level in that frequency range. The alert signal may be chirped within one or more frequency bands. In another embodiment, an alert signal moves, continuously or discontinuously, from one location to another over a short time interval, introducing a perceived spatial modulation or jitter. In another embodiment, a weighted sum of background signals adjacent to each ear is formed, and the weighted sum is delivered to each ear as a uniform background; a distinguishable alert signal is presented on top of this weighted sum signal at one ear, or distinguishable first and second alert signals are presented at two ears of a subject.

System and Method for Providing Model-Based Alerting of Spatial Disorientation to a Pilot

NASA Technical Reports Server (NTRS)

Johnson, Steve (Inventor); Conner, Kevin J (Inventor); Mathan, Santosh (Inventor)

2015-01-01

A system and method monitor aircraft state parameters, for example, aircraft movement and flight parameters, applies those inputs to a spatial disorientation model, and makes a prediction of when pilot may become spatially disoriented. Once the system predicts a potentially disoriented pilot, the sensitivity for alerting the pilot to conditions exceeding a threshold can be increased and allow for an earlier alert to mitigate the possibility of an incorrect control input.

Physician Perspectives of CYP2C19 and Clopidogrel Drug-Gene Interaction Active Clinical Decision Support Alerts

PubMed Central

Nishimura, Adam A.; Shirts, Brian H.; Salama, Joseph; Smith, Joe W.; Devine, Beth; Tarczy-Hornoch, Peter

2015-01-01

Objective To determine if physicians find clinical decision support alerts for pharmacogenomic drug-gene interactions useful and assess their perceptions of usability aspects that impact usefulness. Materials and Methods 52 physicians participated in an online simulation and questionnaire involving a prototype alert for the clopidogrel and CYP2C19 drug-gene interaction. Results Only 4% of participants stated they would override the alert. 92% agreed that the alerts were useful. 87% found the visual interface appropriate, 91% felt the timing of the alert was appropriate and 75% were unfamiliar with the specific drug-gene interaction. 80% of providers preferred the ability to order the recommended medication within the alert. Qualitative responses suggested that supplementary information is important, but should be provided as external links, and that the utility of pharmacogenomic alerts depends on the broader ecosystem of alerts. Principal Conclusions Pharmacogenomic alerts would be welcomed by many physicians, can be built with minimalist design principles, and are appropriately placed at the end of the prescribing process. Since many physicians lack familiarity with pharmacogenomics but have limited time, information and educational resources within the alert should be carefully selected and presented in concise ways. PMID:26642939

Evaluation of health alerts from an early illness warning system in independent living.

PubMed

Rantz, Marilyn J; Scott, Susan D; Miller, Steven J; Skubic, Marjorie; Phillips, Lorraine; Alexander, Greg; Koopman, Richelle J; Musterman, Katy; Back, Jessica

2013-06-01

Passive sensor networks were deployed in independent living apartments to monitor older adults in their home environments to detect signs of impending illness and alert clinicians so they can intervene and prevent or delay significant changes in health or functional status. A retrospective qualitative deductive content analysis was undertaken to refine health alerts to improve clinical relevance to clinicians as they use alerts in their normal workflow of routine care delivery to older adults. Clinicians completed written free-text boxes to describe actions taken (or not) as a result of each alert; they also rated the clinical significance (relevance) of each health alert on a scale of 1 to 5. Two samples of the clinician's written responses to the health alerts were analyzed after alert algorithms had been adjusted based on results of a pilot study using health alerts to enhance clinical decision-making. In the first sample, a total of 663 comments were generated by seven clinicians in response to 385 unique alerts; there are more comments than alerts because more than one clinician rated the same alert. The second sample had a total of 142 comments produced by three clinicians in response to 88 distinct alerts. The overall clinical relevance of the alerts, as judged by the content of the qualitative comments by clinicians for each alert, improved from 33.3% of the alerts in the first sample classified as clinically relevant to 43.2% in the second. The goal is to produce clinically relevant alerts that clinicians find useful in daily practice. The evaluation methods used are described to assist others as they consider building and iteratively refining health alerts to enhance clinical decision making.

Evaluation of Antimicrobial Stewardship-Related Alerts Using a Clinical Decision Support System.

PubMed

Ghamrawi, Riane J; Kantorovich, Alexander; Bauer, Seth R; Pallotta, Andrea M; Sekeres, Jennifer K; Gordon, Steven M; Neuner, Elizabeth A

2017-11-01

Background: Information technology, including clinical decision support systems (CDSS), have an increasingly important and growing role in identifying opportunities for antimicrobial stewardship-related interventions. Objective: The aim of this study was to describe and compare types and outcomes of CDSS-built antimicrobial stewardship alerts. Methods: Fifteen alerts were evaluated in the initial antimicrobial stewardship program (ASP) review. Preimplementation, alerts were reviewed retrospectively. Postimplementation, alerts were reviewed in real-time. Data collection included total number of actionable alerts, recommendation acceptance rates, and time spent on each alert. Time to de-escalation to narrower spectrum agents was collected. Results: In total, 749 alerts were evaluated. Overall, 306 (41%) alerts were actionable (173 preimplementation, 133 postimplementation). Rates of actionable alerts were similar for custom-built and prebuilt alert types (39% [53 of 135] vs 41% [253 of 614], P = .68]. In the postimplementation group, an intervention was attempted in 97% of actionable alerts and 70% of interventions were accepted. The median time spent per alert was 7 minutes (interquartile range [IQR], 5-13 minutes; 15 [12-17] minutes for actionable alerts vs 6 [5-7] minutes for nonactionable alerts, P < .001). In cases where the antimicrobial was eventually de-escalated, the median time to de-escalation was 28.8 hours (95% confidence interval [CI], 10.0-69.1 hours) preimplementation vs 4.7 hours (95% CI, 2.4-22.1 hours) postimplementation, P < .001. Conclusions: CDSS have played an important role in ASPs to help identify opportunities to optimize antimicrobial use through prebuilt and custom-built alerts. As ASP roles continue to expand, focusing time on customizing institution specific alerts will be of vital importance to help redistribute time needed to manage other ASP tasks and opportunities.

75 FR 72773 - Empowering Consumers to Avoid Bill Shock; Consumer Information and Disclosure

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-26

... require mobile service providers to provide usage alerts and information that will assist consumers in... proposes rules that would require mobile service providers to provide usage alerts, such as voice or text... consumers, including methods such as providing voice or text alerts. In addition, the Commission seeks...

Applying human factors principles to alert design increases efficiency and reduces prescribing errors in a scenario-based simulation

PubMed Central

Russ, Alissa L; Zillich, Alan J; Melton, Brittany L; Russell, Scott A; Chen, Siying; Spina, Jeffrey R; Weiner, Michael; Johnson, Elizabette G; Daggy, Joanne K; McManus, M Sue; Hawsey, Jason M; Puleo, Anthony G; Doebbeling, Bradley N; Saleem, Jason J

2014-01-01

Objective To apply human factors engineering principles to improve alert interface design. We hypothesized that incorporating human factors principles into alerts would improve usability, reduce workload for prescribers, and reduce prescribing errors. Materials and methods We performed a scenario-based simulation study using a counterbalanced, crossover design with 20 Veterans Affairs prescribers to compare original versus redesigned alerts. We redesigned drug–allergy, drug–drug interaction, and drug–disease alerts based upon human factors principles. We assessed usability (learnability of redesign, efficiency, satisfaction, and usability errors), perceived workload, and prescribing errors. Results Although prescribers received no training on the design changes, prescribers were able to resolve redesigned alerts more efficiently (median (IQR): 56 (47) s) compared to the original alerts (85 (71) s; p=0.015). In addition, prescribers rated redesigned alerts significantly higher than original alerts across several dimensions of satisfaction. Redesigned alerts led to a modest but significant reduction in workload (p=0.042) and significantly reduced the number of prescribing errors per prescriber (median (range): 2 (1–5) compared to original alerts: 4 (1–7); p=0.024). Discussion Aspects of the redesigned alerts that likely contributed to better prescribing include design modifications that reduced usability-related errors, providing clinical data closer to the point of decision, and displaying alert text in a tabular format. Displaying alert text in a tabular format may help prescribers extract information quickly and thereby increase responsiveness to alerts. Conclusions This simulation study provides evidence that applying human factors design principles to medication alerts can improve usability and prescribing outcomes. PMID:24668841

Notification of real-time clinical alerts generated by pharmacy expert systems.

PubMed Central

Miller, J. E.; Reichley, R. M.; McNamee, L. A.; Steib, S. A.; Bailey, T. C.

1999-01-01

We developed and implemented a strategy for notifying clinical pharmacists of alerts generated in real-time by two pharmacy expert systems: one for drug dosing and the other for adverse drug event prevention. Display pagers were selected as the preferred notification method and a concise, yet readable, format for displaying alert data was developed. This combination of real-time alert generation and notification via display pagers was shown to be efficient and effective in a 30-day trial. PMID:10566374

Triggering Interventions for Influenza: The ALERT Algorithm

PubMed Central

Reich, Nicholas G.; Cummings, Derek A. T.; Lauer, Stephen A.; Zorn, Martha; Robinson, Christine; Nyquist, Ann-Christine; Price, Connie S.; Simberkoff, Michael; Radonovich, Lewis J.; Perl, Trish M.

2015-01-01

Background. Early, accurate predictions of the onset of influenza season enable targeted implementation of control efforts. Our objective was to develop a tool to assist public health practitioners, researchers, and clinicians in defining the community-level onset of seasonal influenza epidemics. Methods. Using recent surveillance data on virologically confirmed infections of influenza, we developed the Above Local Elevated Respiratory Illness Threshold (ALERT) algorithm, a method to identify the period of highest seasonal influenza activity. We used data from 2 large hospitals that serve Baltimore, Maryland and Denver, Colorado, and the surrounding geographic areas. The data used by ALERT are routinely collected surveillance data: weekly case counts of laboratory-confirmed influenza A virus. The main outcome is the percentage of prospective seasonal influenza cases identified by the ALERT algorithm. Results. When ALERT thresholds designed to capture 90% of all cases were applied prospectively to the 2011–2012 and 2012–2013 influenza seasons in both hospitals, 71%–91% of all reported cases fell within the ALERT period. Conclusions. The ALERT algorithm provides a simple, robust, and accurate metric for determining the onset of elevated influenza activity at the community level. This new algorithm provides valuable information that can impact infection prevention recommendations, public health practice, and healthcare delivery. PMID:25414260

Preventing dispensing errors by alerting for drug confusions in the pharmacy information system—A survey of users

PubMed Central

Campmans, Zizi; van Rhijn, Arianne; Dull, René M.; Santen-Reestman, Jacqueline; Taxis, Katja

2018-01-01

Introduction Drug confusion is thought to be the most common type of dispensing error. Several strategies can be implemented to reduce the risk of medication errors. One of these are alerts in the pharmacy information system. Objective To evaluate the experiences of pharmacists and pharmacy technicians with alerts for drug name and strength confusion. Methods In May 2017, a cross-sectional survey of pharmacists and pharmacy technicians was performed in community pharmacies in the Netherlands using an online questionnaire. Results Of the 269 respondents, 86% (n = 230) had noticed the alert for drug name confusion, and 26% (n = 67) for drug strength confusion. Of those 230, 9% (n = 20) had experienced that the alert had prevented dispensing the wrong drug. For drug strength confusion, this proportion was 12% (n = 8). Respondents preferred to have an alert for drug name and strength confusion in the pharmacy information system. ‘Alert fatigue’ was an important issue, so alerts should only be introduced for frequent confusions or confusions with serious consequences. Conclusion Pharmacists and pharmacy technicians were positive about having alerts for drug confusions in their pharmacy information system and experienced that alerts contributed to the prevention of dispensing errors. To prevent alert fatigue, it was considered important not to include all possible confusions as a new alert: the potential contribution to the prevention of drug confusion should be weighed against the risk of alert fatigue. PMID:29813099

Latencies in BOLD response during visual attention processes.

PubMed

Kellermann, Thilo; Reske, Martina; Jansen, Andreas; Satrapi, Peyman; Shah, N Jon; Schneider, Frank; Habel, Ute

2011-04-22

One well-investigated division of attentional processes focuses on alerting, orienting and executive control, which can be assessed applying the attentional network test (ANT). The goal of the present study was to add further knowledge about the temporal dynamics of relevant neural correlates. As a right hemispheric dominance for alerting and orienting has previously been reported for intrinsic but not for phasic alertness, we additionally addressed a potential impact of this lateralization of attention by employing a lateralized version of the ANT, capturing phasic alertness processes. Sixteen healthy subjects underwent event-related functional magnetic resonance imaging (fMRI) while performing the ANT. Analyses of BOLD magnitude replicated the engagement of a fronto-parietal network in the attentional subsystems. The amplitudes of the attentional contrasts interacted with visual field presentation in the sense that the thalamus revealed a greater involvement for spatially cued items presented in the left visual field. Comparisons of BOLD latencies in visual cortices, first, verified faster BOLD responses following contra-lateral stimulus presentation. Second and more importantly, we identified attention-modulated activation in secondary visual and anterior cingulate cortices. Results are discussed in terms of bottom-up and lateralization processes. Although intrinsic and phasic alertness are distinct cognitive processes, we propose that neural substrates of intrinsic alertness may be accessed by phasic alertness provided that the attention-dominant (i.e., the right) hemisphere is activated directly by a warning stimulus. Copyright © 2011 Elsevier B.V. All rights reserved.

Neural Correlates of Alerting and Orienting Impairment in Multiple Sclerosis Patients

PubMed Central

Vázquez-Marrufo, Manuel; Galvao-Carmona, Alejandro; González-Rosa, Javier J.; Hidalgo-Muñoz, Antonio R.; Borges, Mónica; Ruiz-Peña, Juan Luis; Izquierdo, Guillermo

2014-01-01

Background A considerable percentage of multiple sclerosis patients have attentional impairment, but understanding its neurophysiological basis remains a challenge. The Attention Network Test allows 3 attentional networks to be studied. Previous behavioural studies using this test have shown that the alerting network is impaired in multiple sclerosis. The aim of this study was to identify neurophysiological indexes of the attention impairment in relapsing-remitting multiple sclerosis patients using this test. Results After general slowing had been removed in patients group to isolate the effects of each condition, some behavioral differences between them were obtained. About Contingent Negative Variation, a statistically significant decrement were found in the amplitude for Central and Spatial Cue Conditions for patient group (p<0.05). ANOVAs showed for the patient group a significant latency delay for P1 and N1 components (p<0.05) and a decrease of P3 amplitude for congruent and incongruent stimuli (p<0.01). With regard to correlation analysis, PASAT-3s and SDMT showed significant correlations with behavioral measures of the Attention Network Test (p<0.01) and an ERP parameter (CNV amplitude). Conclusions Behavioral data are highly correlated with the neuropsychological scores and show that the alerting and orienting mechanisms in the patient group were impaired. Reduced amplitude for the Contingent Negative Variation in the patient group suggests that this component could be a physiological marker related to the alerting and orienting impairment in relapsing-remitting multiple sclerosis. P1 and N1 delayed latencies are evidence of the demyelination process that causes impairment in the first steps of the visual sensory processing. Lastly, P3 amplitude shows a general decrease for the pathological group probably indexing a more central impairment. These results suggest that the Attention Network Test give evidence of multiple levels of attention impairment, which could help in the assessment and treatment of relapsing-remitting multiple sclerosis patients. PMID:24820333

Neural correlates of alerting and orienting impairment in multiple sclerosis patients.

PubMed

Vázquez-Marrufo, Manuel; Galvao-Carmona, Alejandro; González-Rosa, Javier J; Hidalgo-Muñoz, Antonio R; Borges, Mónica; Ruiz-Peña, Juan Luis; Izquierdo, Guillermo

2014-01-01

A considerable percentage of multiple sclerosis patients have attentional impairment, but understanding its neurophysiological basis remains a challenge. The Attention Network Test allows 3 attentional networks to be studied. Previous behavioural studies using this test have shown that the alerting network is impaired in multiple sclerosis. The aim of this study was to identify neurophysiological indexes of the attention impairment in relapsing-remitting multiple sclerosis patients using this test. After general slowing had been removed in patients group to isolate the effects of each condition, some behavioral differences between them were obtained. About Contingent Negative Variation, a statistically significant decrement were found in the amplitude for Central and Spatial Cue Conditions for patient group (p<0.05). ANOVAs showed for the patient group a significant latency delay for P1 and N1 components (p<0.05) and a decrease of P3 amplitude for congruent and incongruent stimuli (p<0.01). With regard to correlation analysis, PASAT-3s and SDMT showed significant correlations with behavioral measures of the Attention Network Test (p<0.01) and an ERP parameter (CNV amplitude). Behavioral data are highly correlated with the neuropsychological scores and show that the alerting and orienting mechanisms in the patient group were impaired. Reduced amplitude for the Contingent Negative Variation in the patient group suggests that this component could be a physiological marker related to the alerting and orienting impairment in relapsing-remitting multiple sclerosis. P1 and N1 delayed latencies are evidence of the demyelination process that causes impairment in the first steps of the visual sensory processing. Lastly, P3 amplitude shows a general decrease for the pathological group probably indexing a more central impairment. These results suggest that the Attention Network Test give evidence of multiple levels of attention impairment, which could help in the assessment and treatment of relapsing-remitting multiple sclerosis patients.

Nursing, Pharmacy, and Prescriber Knowledge and Perceptions of High-Alert Medications in a Large, Academic Medical Hospital

PubMed Central

Engels, Melanie J.

2015-01-01

Background: High-alert medications pose a greater risk of causing significant harm to patients if used in error. The Joint Commission requires that hospitals define institution-specific high-alert medications and implement processes to ensure safe medication use. Method: Nursing, pharmacy, and prescribers were asked to voluntarily complete a 34-question survey to assess their knowledge, experience, and perceptions regarding high-alert medications in an academic hospital. Results: The majority of respondents identified the organization’s high-alert medications, the consequences of an error involving a high-alert medication, and the reversal agent. Most of the risk-reduction strategies within the institution were viewed as being effective by respondents. Forty-five percent of the respondents utilized a high-alert medication in the previous 24 hours. Only 14.2% had experienced an error with a high-alert medication in the previous 12 months, with 46% being near misses. The survey found the 5 rights for medication administration were not being utilized consistently. Respondents indicated that work experience or hospital orientation is the preferred learning experience for high-alert medications. Conclusions: This study assessed all disciplines involved in the medication use process. Perceptions about high-alert medications differ between disciplines. Ongoing discipline-specific education is required to ensure that individuals accept accountability in the medication use process and to close knowledge gaps on high-alert medications and risk-reduction strategies. PMID:26446747

Physicians’ use of computerized clinical decision supports to improve medication management in the elderly – the Seniors Medication Alert and Review Technology intervention

PubMed Central

Alagiakrishnan, Kannayiram; Wilson, Patricia; Sadowski, Cheryl A; Rolfson, Darryl; Ballermann, Mark; Ausford, Allen; Vermeer, Karla; Mohindra, Kunal; Romney, Jacques; Hayward, Robert S

2016-01-01

Background Elderly people (aged 65 years or more) are at increased risk of polypharmacy (five or more medications), inappropriate medication use, and associated increased health care costs. The use of clinical decision support (CDS) within an electronic medical record (EMR) could improve medication safety. Methods Participatory action research methods were applied to preproduction design and development and postproduction optimization of an EMR-embedded CDS implementation of the Beers’ Criteria for medication management and the Cockcroft–Gault formula for estimating glomerular filtration rates (GFR). The “Seniors Medication Alert and Review Technologies” (SMART) intervention was used in primary care and geriatrics specialty clinics. Passive (chart messages) and active (order-entry alerts) prompts exposed potentially inappropriate medications, decreased GFR, and the possible need for medication adjustments. Physician reactions were assessed using surveys, EMR simulations, focus groups, and semi-structured interviews. EMR audit data were used to identify eligible patient encounters, the frequency of CDS events, how alerts were managed, and when evidence links were followed. Results Analysis of subjective data revealed that most clinicians agreed that CDS appeared at appropriate times during patient care. Although managing alerts incurred a modest time burden, most also agreed that workflow was not disrupted. Prevalent concerns related to clinician accountability and potential liability. Approximately 36% of eligible encounters triggered at least one SMART alert, with GFR alert, and most frequent medication warnings were with hypnotics and anticholinergics. Approximately 25% of alerts were overridden and ~15% elicited an evidence check. Conclusion While most SMART alerts validated clinician choices, they were received as valuable reminders for evidence-informed care and education. Data from this study may aid other attempts to implement Beers’ Criteria in ambulatory care EMRs. PMID:26869776

Development of an "Alert Framework" Based on the Practices in the Medical Front.

PubMed

Sakata, Takuya; Araki, Kenji; Yamazaki, Tomoyoshi; Kawano, Koichi; Maeda, Minoru; Kushima, Muneo; Araki, Sanae

2018-05-09

At the University of Miyazaki Hospital (UMH), we have accumulated and semantically structured a vast amount of medical information since the activation of the electronic health record system approximately 10 years ago. With this medical information, we have decided to develop an alert system for aiding in medical treatment. The purpose of this investigation is to not only to integrate an alert framework into the electronic heath record system, but also to formulate a modeling method of this knowledge. A trial alert framework was developed for the staff in various occupational categories at the UMH. Based on findings of subsequent interviews, a more detailed and upgraded alert framework was constructed, resulting in the final model. Based on our current findings, an alert framework was developed with four major items. Based on the analysis of the medical practices from the trial model, it has been concluded that there are four major risk patterns that trigger the alert. Furthermore, the current alert framework contains detailed definitions which are easily substituted into the database, leading to easy implementation of the electronic health records.

Comparison of Two Sepsis Recognition Methods in a Pediatric Emergency Department

PubMed Central

Balamuth, Fran; Alpern, Elizabeth R.; Grundmeier, Robert W.; Chilutti, Marianne; Weiss, Scott L.; Fitzgerald, Julie C.; Hayes, Katie; Bilker, Warren; Lautenbach, Ebbing

2015-01-01

Objectives To compare the effectiveness of physician judgment and an electronic algorithmic alert to identify pediatric patients with severe sepsis/septic shock in a pediatric emergency department (ED). Methods This was an observational cohort study of patients older than 56 days with fever or hypothermia. All patients were evaluated for potential sepsis in real time by the ED clinical team. An electronic algorithmic alert was retrospectively applied to identify patients with potential sepsis independent of physician judgment. The primary outcome was the proportion of patients correctly identified with severe sepsis/septic shock defined by consensus criteria. Test characteristics were determined and receiver operating characteristic (ROC) curves were compared. Results Of 19,524 eligible patient visits, 88 patients developed consensus-confirmed severe sepsis or septic shock. Physician judgment identified 159, and the algorithmic alert identified 3,301 patients with potential sepsis. Physician judgment had sensitivity of 72.7% (95% CI = 72.1% to 73.4%) and specificity 99.5% (95% CI = 99.4% to 99.6%); the algorithmic alert had sensitivity 92.1% (95% CI = 91.7% to 92.4%), and specificity 83.4% (95% CI = 82.9% to 83.9%) for severe sepsis/septic shock. There was no significant difference in the area under the ROC curve for physician judgment (0.86, 95% CI = 0.81 to 0.91) or the algorithm (0.88, 95% CI = 0.85 to 0.91; p = 0.54). A combination method using either positive physician judgment or an algorithmic alert improved sensitivity to 96.6% and specificity to 83.3%. A sequential approach, in which positive identification by the algorithmic alert was then confirmed by physician judgment, achieved 68.2% sensitivity and 99.6% specificity. Positive and negative predictive values for physician judgment vs. algorithmic alert were 40.3% vs. 2.5% and 99.88 % vs. 99.96%, respectively. Conclusions The electronic algorithmic alert was more sensitive but less specific than physician judgment for recognition of pediatric severe sepsis and septic shock. These findings can help to guide institutions in selecting pediatric sepsis recognition methods based on institutional needs and priorities. PMID:26474032

Functional Characterization of the Cingulo-Opercular Network in the Maintenance of Tonic Alertness

PubMed Central

Sadaghiani, Sepideh; D'Esposito, Mark

2015-01-01

The complex processing architecture underlying attentional control requires delineation of the functional role of different control-related brain networks. A key component is the cingulo-opercular (CO) network composed of anterior insula/operculum, dorsal anterior cingulate cortex, and thalamus. Its function has been particularly difficult to characterize due to the network's pervasive activity and frequent co-activation with other control-related networks. We previously suggested this network to underlie intrinsically maintained tonic alertness. Here, we tested this hypothesis by separately manipulating the demand for selective attention and for tonic alertness in a two-factorial, continuous pitch discrimination paradigm. The 2 factors had independent behavioral effects. Functional imaging revealed that activity as well as functional connectivity in the CO network increased when the task required more tonic alertness. Conversely, heightened selective attention to pitch increased activity in the dorsal attention (DAT) network but not in the CO network. Across participants, performance accuracy showed dissociable correlation patterns with activity in the CO, DAT, and fronto-parietal (FP) control networks. These results support tonic alertness as a fundamental function of the CO network. They further the characterization of this function as the effortful process of maintaining cognitive faculties available for current processing requirements. PMID:24770711

Automated health alerts from Kinect-based in-home gait measurements.

PubMed

Stone, Erik E; Skubic, Marjorie; Back, Jessica

2014-01-01

A method for automatically generating alerts to clinicians in response to changes in in-home gait parameters is investigated. Kinect-based gait measurement systems were installed in apartments in a senior living facility. The systems continuously monitored the walking speed, stride time, and stride length of apartment residents. A framework for modeling uncertainty in the residents' gait parameter estimates, which is critical for robust change detection, is developed; along with an algorithm for detecting changes that may be clinically relevant. Three retrospective case studies, of individuals who had their gait monitored for periods ranging from 12 to 29 months, are presented to illustrate use of the alert method. Evidence suggests that clinicians could be alerted to health changes at an early stage, while they are still small and interventions may be most successful. Additional potential uses are also discussed.

Reliability of Trained Dogs to Alert to Hypoglycemia in Patients With Type 1 Diabetes

PubMed Central

Los, Evan A.; Ramsey, Katrina L.; Guttmann-Bauman, Ines; Ahmann, Andrew J.

2016-01-01

Background: We examined the reliability of trained dogs to alert to hypoglycemia in individuals with type 1 diabetes. Methods: Patients with type 1 diabetes who currently used diabetes alert dogs participated in this exploratory study. Subjects reported satisfaction, perceived dog glucose sensing ability and reasons for obtaining a trained dog. Reliability of dog alerts was assessed using capillary blood glucose (CBG) and blinded continuous glucose monitoring (CGM) as comparators in 8 subjects (age 4-48). Hypoglycemia was defined as CBG or CGM <70 mg/dL. Results: Dog users were very satisfied (8.9/10 on a Likert-type scale) and largely confident (7.9/10) in their dog’s ability to detect hypoglycemia. Detection of hypoglycemia was the primary reason for obtaining a trained dog. During hypoglycemia, spontaneous dog alerts occurred at a rate 3.2 (2.0-5.2, 95% CI) times higher than during euglycemia (70-179 mg/dL). Dogs provided timely alerts in 36% (sensitivity) of all hypoglycemia events (n = 45). Due to inappropriate alerts, the PPV of a dog alert for hypoglycemia was 12%. When there was concurrence of a hypoglycemic event between the dog alert and CGM (n = 30), CGM would have alerted prior to the dog in 73% of events (median 22-minute difference). Conclusions: This is the first study evaluating reliability of trained dogs to alert to hypoglycemia under real-life conditions. Trained dogs often alert a human companion to otherwise unknown hypoglycemia; however due to high false-positive rate, a dog alert alone is unlikely to be helpful in differentiating hypo-/hyper-/euglycemia. CGM often detects hypoglycemia before a trained dog by a clinically significant margin. PMID:27573791

Alarms based on real-time sensor glucose values alert patients to hypo- and hyperglycemia: the guardian continuous monitoring system.

PubMed

Bode, Bruce; Gross, Kenneth; Rikalo, Nancy; Schwartz, Sherwyn; Wahl, Timothy; Page, Casey; Gross, Todd; Mastrototaro, John

2004-04-01

The purposes of this study were to demonstrate the accuracy and effectiveness of the Guardian Continuous Monitoring System (Medtronic MiniMed, Northridge, California) and to demonstrate that the application of real-time alarms to continuous monitoring alerts users to hypo and hyperglycemia and reduces excursions in people with diabetes. A total of 71 subjects with type 1 diabetes, mean hemoglobin A1c of 7.6 +/- 1.1%, age 44.0 +/- 11.4 years, and duration of diabetes 23.6 +/- 10.6 years were enrolled in this two-period, randomized, multicenter study. Subjects were randomized into either an Alert group or a Control group. The accuracy of the Guardian was evaluated by treating the study data as a single-sample correlational design. Effectiveness of the Guardian alerts was evaluated by comparing the Alert group with the Control group. The mean (median) absolute relative error between home blood glucose meter readings and sensor values was 21.3% (17.3%), and the Guardian, on average, read 12.8 mg/dL below the concurrent home blood glucose meter readings. The hypoglycemia alert was able to distinguished glucose values < or =70 mg/dL with 67% sensitivity, 90% specificity, and 47% false alerts. The hyperglycemia alert showed a similar ability to detect sensor values > or =250 mg/dL with 63% sensitivity, 97% specificity, and 19% false alerts. The Alert group demonstrated a median decrease in the duration of hypoglycemic excursions (-27.8 min) that was significantly greater than the median decrease in the duration of hypoglycemic excursions in the Control group (-4.5 min) (P = 0.03). A marginally significant increase in the frequency of hyperglycemic excursions (P = 0.07) between Period 1 and Period 2 was accompanied by a decrease of 9.6 min in the duration of hyperglycemic excursions in the Alert group. Glucose measurements differ between blood samples taken from the finger and interstitial fluid, especially when levels are changing rapidly; however, these results demonstrate that the Guardian is reasonably accurate while performing continuous glucose monitoring. The subjects' responses to hypoglycemia alerts resulted in a significant reduction in the duration of hypoglycemic excursions; however, overtreating hypoglycemia may have resulted in a marginally significant increase in the frequency of hyperglycemic excursions.

An Investigation of Drug-Drug Interaction Alert Overrides at a Pediatric Hospital.

PubMed

Humphrey, Kate; Jorina, Maria; Harper, Marvin; Dodson, Brenda; Kim, Seung-Yeon; Ozonoff, Al

2018-05-01

Drug-drug interactions (DDIs) can result in patient harm. DDI alerts are intended to help prevent harm; when the majority of alerts presented to providers are being overridden, their value is diminished. Our objective was to evaluate the overall rates of DDI alert overrides and how rates varied by specialty, clinician type, and patient complexity. A retrospective study of DDI alert overrides that occurred during 2012 and 2013 within the inpatient setting described at the medication-, hospital-, provider-, and patient encounter-specific levels was performed at an urban, quaternary-care, pediatric hospital. There were >41 000 DDI alerts presented to clinicians; ∼90% were overridden. The 5 DDI pairs that were most frequently presented and overridden included the following: potassium chloride-spironolactone, methadone-ondansetron, ketorolac-ibuprofen, cyclosporine-fluconazole, and potassium chloride-enalapril, each with an alert override rate of ≥0.89. Override rates across provider groups ranged between 0.84 and 0.97. In general, patients with high complexity had a higher frequency of alert overrides, but the rates of alert overrides for each DDI pairing did not differ significantly. High rates of DDI alert overrides occur across medications, provider groups, and patient encounters. Methods to decrease DDI alerts which are likely to be overridden exist, but it is also clear that more robust and intelligent tools are needed. Characteristics exist at the medication, hospital, provider, and patient levels that can be used to help specialize and enhance information transmission. Copyright © 2018 by the American Academy of Pediatrics.

Automated Health Alerts Using In-Home Sensor Data for Embedded Health Assessment

PubMed Central

Guevara, Rainer Dane; Rantz, Marilyn

2015-01-01

We present an example of unobtrusive, continuous monitoring in the home for the purpose of assessing early health changes. Sensors embedded in the environment capture behavior and activity patterns. Changes in patterns are detected as potential signs of changing health. We first present results of a preliminary study investigating 22 features extracted from in-home sensor data. A 1-D alert algorithm was then implemented to generate health alerts to clinicians in a senior housing facility. Clinicians analyze each alert and provide a rating on the clinical relevance. These ratings are then used as ground truth for training and testing classifiers. Here, we present the methodology for four classification approaches that fuse multisensor data. Results are shown using embedded sensor data and health alert ratings collected on 21 seniors over nine months. The best results show similar performance for two techniques, where one approach uses only domain knowledge and the second uses supervised learning for training. Finally, we propose a health change detection model based on these results and clinical expertise. The system of in-home sensors and algorithms for automated health alerts provides a method for detecting health problems very early so that early treatment is possible. This method of passive in-home sensing alleviates compliance issues. PMID:27170900

Optimizing the response to surveillance alerts in automated surveillance systems.

PubMed

Izadi, Masoumeh; Buckeridge, David L

2011-02-28

Although much research effort has been directed toward refining algorithms for disease outbreak alerting, considerably less attention has been given to the response to alerts generated from statistical detection algorithms. Given the inherent inaccuracy in alerting, it is imperative to develop methods that help public health personnel identify optimal policies in response to alerts. This study evaluates the application of dynamic decision making models to the problem of responding to outbreak detection methods, using anthrax surveillance as an example. Adaptive optimization through approximate dynamic programming is used to generate a policy for decision making following outbreak detection. We investigate the degree to which the model can tolerate noise theoretically, in order to keep near optimal behavior. We also evaluate the policy from our model empirically and compare it with current approaches in routine public health practice for investigating alerts. Timeliness of outbreak confirmation and total costs associated with the decisions made are used as performance measures. Using our approach, on average, 80 per cent of outbreaks were confirmed prior to the fifth day of post-attack with considerably less cost compared to response strategies currently in use. Experimental results are also provided to illustrate the robustness of the adaptive optimization approach and to show the realization of the derived error bounds in practice. Copyright © 2011 John Wiley & Sons, Ltd.

Separating Spike Count Correlation from Firing Rate Correlation

PubMed Central

Vinci, Giuseppe; Ventura, Valérie; Smith, Matthew A.; Kass, Robert E.

2016-01-01

Populations of cortical neurons exhibit shared fluctuations in spiking activity over time. When measured for a pair of neurons over multiple repetitions of an identical stimulus, this phenomenon emerges as correlated trial-to-trial response variability via spike count correlation (SCC). However, spike counts can be viewed as noisy versions of firing rates, which can vary from trial to trial. From this perspective, the SCC for a pair of neurons becomes a noisy version of the corresponding firing-rate correlation (FRC). Furthermore, the magnitude of the SCC is generally smaller than that of the FRC, and is likely to be less sensitive to experimental manipulation. We provide statistical methods for disambiguating time-averaged drive from within-trial noise, thereby separating FRC from SCC. We study these methods to document their reliability, and we apply them to neurons recorded in vivo from area V4, in an alert animal. We show how the various effects we describe are reflected in the data: within-trial effects are largely negligible, while attenuation due to trial-to-trial variation dominates, and frequently produces comparisons in SCC that, because of noise, do not accurately reflect those based on the underlying FRC. PMID:26942746

Pilot Non-Conformance to Alerting System Commands During Closely Spaced Parallel Approaches

NASA Technical Reports Server (NTRS)

Pritchett, Amy Ruth; Hansman, R. John; Corker, Kevin (Technical Monitor)

1997-01-01

Cockpit alerting systems monitor potentially hazardous situations, both inside and outside the aircraft. When a hazard is projected to occur, the alerting system displays alerts and/or command decisions to the pilot. However, pilots have been observed to not conform to alerting system commands by delaying their response or by not following the automatic commands exactly. This non-conformance to the automatic alerting system can reduce its benefit. Therefore, a need exists to understand the causes and effects of pilot non-conformance in order to develop automatic alerting systems whose commands the pilots are more likely to follow. These considerations were examined through flight simulator evaluations of the collision avoidance task during closely spaced parallel approaches. This task provided a useful case-study because the effects of non-conformance can be significant, given the time-critical nature of the task. A preliminary evaluation of alerting systems identified non-conformance in over 40% of the cases and a corresponding drop in collision avoidance performance. A follow-on experiment found subjects' alerting and maneuver selection criteria were consistent with different strategies than those used by automatic systems, indicating the pilot may potentially disagree with the alerting system if the pilot attempts to verify automatic alerts and commanded avoidance maneuvers. A final experiment found supporting automatic alerts with the explicit display of its underlying criteria resulted in more consistent subject reactions. In light of these experimental results, a general discussion of pilot non-conformance is provided. Contributing factors in pilot non-conformance include a lack of confidence in the automatic system and mismatches between the alerting system's commands and the pilots' own decisions based on the information available to them. The effects of non-conformance on system performance are discussed. Possible methods of reconciling mismatches are given, and design considerations for alerting systems which alleviate the problem of non-conformance are provided.

Does integrating nonurgent, clinically significant radiology alerts within the electronic health record impact closed-loop communication and follow-up?

PubMed Central

Dalal, Anuj K; Sahni, V Anik; Lacson, Ronilda; Khorasani, Ramin

2016-01-01

Objective To assess whether integrating critical result management software—Alert Notification of Critical Results (ANCR)—with an electronic health record (EHR)-based results management application impacts closed-loop communication and follow-up of nonurgent, clinically significant radiology results by primary care providers (PCPs). Materials and Methods This institutional review board-approved study was conducted at a large academic medical center. Postintervention, PCPs could acknowledge nonurgent, clinically significant ANCR-generated alerts (“alerts”) within ANCR or the EHR. Primary outcome was the proportion of alerts acknowledged via EHR over a 24-month postintervention. Chart abstractions for a random sample of alerts 12 months preintervention and 24 months postintervention were reviewed, and the follow-up rate of actionable alerts (eg, performing follow-up imaging, administering antibiotics) was estimated. Pre- and postintervention rates were compared using the Fisher exact test. Postintervention follow-up rate was compared for EHR-acknowledged alerts vs ANCR. Results Five thousand nine hundred and thirty-one alerts were acknowledged by 171 PCPs, with 100% acknowledgement (consistent with expected ANCR functionality). PCPs acknowledged 16% (688 of 4428) of postintervention alerts in the EHR, with the remaining in ANCR. Follow-up was documented for 85 of 90 (94%; 95% CI, 88%-98%) preintervention and 79 of 84 (94%; 95% CI, 87%-97%) postintervention alerts (P > .99). Postintervention, 11 of 14 (79%; 95% CI, 52%-92%) alerts were acknowledged via EHR and 68 of 70 (97%; 95% CI, 90%-99%) in ANCR had follow-up (P = .03). Conclusions Integrating ANCR and EHR provides an additional workflow for acknowledging nonurgent, clinically significant results without significant change in rates of closed-loop communication or follow-up of alerts. PMID:26335982

Potential for driver attention monitoring system development

DOT National Transportation Integrated Search

1985-06-01

The objective of this effort was to determine the potential of developing techniques and : methods for reducing the occurrence of highway accidents attributable to degraded : driver alertness. : Lapses in driver alertness are thought to be a maior fa...

Evaluation of medication alerts in electronic health records for compliance with human factors principles

PubMed Central

Phansalkar, Shobha; Zachariah, Marianne; Seidling, Hanna M; Mendes, Chantal; Volk, Lynn; Bates, David W

2014-01-01

Introduction Increasing the adoption of electronic health records (EHRs) with integrated clinical decision support (CDS) is a key initiative of the current US healthcare administration. High over-ride rates of CDS alerts strongly limit these potential benefits. As a result, EHR designers aspire to improve alert design to achieve better acceptance rates. In this study, we evaluated drug–drug interaction (DDI) alerts generated in EHRs and compared them for compliance with human factors principles. Methods We utilized a previously validated questionnaire, the I-MeDeSA, to assess compliance with nine human factors principles of DDI alerts generated in 14 EHRs. Two reviewers independently assigned scores evaluating the human factors characteristics of each EHR. Rankings were assigned based on these scores and recommendations for appropriate alert design were derived. Results The 14 EHRs evaluated in this study received scores ranging from 8 to 18.33, with a maximum possible score of 26. Cohen's κ (κ=0.86) reflected excellent agreement among reviewers. The six vendor products tied for second and third place rankings, while the top system and bottom five systems were home-grown products. The most common weaknesses included the absence of characteristics such as alert prioritization, clear and concise alert messages indicating interacting drugs, actions for clinical management, and a statement indicating the consequences of over-riding the alert. Conclusions We provided detailed analyses of the human factors principles which were assessed and described our recommendations for effective alert design. Future studies should assess whether adherence to these recommendations can improve alert acceptance. PMID:24780721

In Silico Prediction of Chemical Toxicity for Drug Design Using Machine Learning Methods and Structural Alerts

NASA Astrophysics Data System (ADS)

Yang, Hongbin; Sun, Lixia; Li, Weihua; Liu, Guixia; Tang, Yun

2018-02-01

For a drug, safety is always the most important issue, including a variety of toxicities and adverse drug effects, which should be evaluated in preclinical and clinical trial phases. This review article at first simply introduced the computational methods used in prediction of chemical toxicity for drug design, including machine learning methods and structural alerts. Machine learning methods have been widely applied in qualitative classification and quantitative regression studies, while structural alerts can be regarded as a complementary tool for lead optimization. The emphasis of this article was put on the recent progress of predictive models built for various toxicities. Available databases and web servers were also provided. Though the methods and models are very helpful for drug design, there are still some challenges and limitations to be improved for drug safety assessment in the future.

In Silico Prediction of Chemical Toxicity for Drug Design Using Machine Learning Methods and Structural Alerts

PubMed Central

Yang, Hongbin; Sun, Lixia; Li, Weihua; Liu, Guixia; Tang, Yun

2018-01-01

During drug development, safety is always the most important issue, including a variety of toxicities and adverse drug effects, which should be evaluated in preclinical and clinical trial phases. This review article at first simply introduced the computational methods used in prediction of chemical toxicity for drug design, including machine learning methods and structural alerts. Machine learning methods have been widely applied in qualitative classification and quantitative regression studies, while structural alerts can be regarded as a complementary tool for lead optimization. The emphasis of this article was put on the recent progress of predictive models built for various toxicities. Available databases and web servers were also provided. Though the methods and models are very helpful for drug design, there are still some challenges and limitations to be improved for drug safety assessment in the future. PMID:29515993

Towards cross-lingual alerting for bursty epidemic events.

PubMed

Collier, Nigel

2011-10-06

Online news reports are increasingly becoming a source for event-based early warning systems that detect natural disasters. Harnessing the massive volume of information available from multilingual newswire presents as many challanges as opportunities due to the patterns of reporting complex spatio-temporal events. In this article we study the problem of utilising correlated event reports across languages. We track the evolution of 16 disease outbreaks using 5 temporal aberration detection algorithms on text-mined events classified according to disease and outbreak country. Using ProMED reports as a silver standard, comparative analysis of news data for 13 languages over a 129 day trial period showed improved sensitivity, F1 and timeliness across most models using cross-lingual events. We report a detailed case study analysis for Cholera in Angola 2010 which highlights the challenges faced in correlating news events with the silver standard. The results show that automated health surveillance using multilingual text mining has the potential to turn low value news into high value alerts if informed choices are used to govern the selection of models and data sources. An implementation of the C2 alerting algorithm using multilingual news is available at the BioCaster portal http://born.nii.ac.jp/?page=globalroundup.

Modeling, Analyzing, and Mitigating Dissonance Between Alerting Systems

NASA Technical Reports Server (NTRS)

Song, Lixia; Kuchar, James K.

2003-01-01

Alerting systems are becoming pervasive in process operations, which may result in the potential for dissonance or conflict in information from different alerting systems that suggests different threat levels and/or actions to resolve hazards. Little is currently available to help in predicting or solving the dissonance problem. This thesis presents a methodology to model and analyze dissonance between alerting systems, providing both a theoretical foundation for understanding dissonance and a practical basis from which specific problems can be addressed. A state-space representation of multiple alerting system operation is generalized that can be tailored across a variety of applications. Based on the representation, two major causes of dissonance are identified: logic differences and sensor error. Additionally, several possible types of dissonance are identified. A mathematical analysis method is developed to identify the conditions for dissonance originating from logic differences. A probabilistic analysis methodology is developed to estimate the probability of dissonance originating from sensor error, and to compare the relative contribution to dissonance of sensor error against the contribution from logic differences. A hybrid model, which describes the dynamic behavior of the process with multiple alerting systems, is developed to identify dangerous dissonance space, from which the process can lead to disaster. Methodologies to avoid or mitigate dissonance are outlined. Two examples are used to demonstrate the application of the methodology. First, a conceptual In-Trail Spacing example is presented. The methodology is applied to identify the conditions for possible dissonance, to identify relative contribution of logic difference and sensor error, and to identify dangerous dissonance space. Several proposed mitigation methods are demonstrated in this example. In the second example, the methodology is applied to address the dissonance problem between two air traffic alert and avoidance systems: the existing Traffic Alert and Collision Avoidance System (TCAS) vs. the proposed Airborne Conflict Management system (ACM). Conditions on ACM resolution maneuvers are identified to avoid dynamic dissonance between TCAS and ACM. Also included in this report is an Appendix written by Lee Winder about recent and continuing work on alerting systems design. The application of Markov Decision Process (MDP) theory to complex alerting problems is discussed and illustrated with an abstract example system.

Alerting, orienting or executive attention networks: differential patters of pupil dilations

PubMed Central

Geva, Ronny; Zivan, Michal; Warsha, Aviv; Olchik, Dov

2013-01-01

Attention capacities, alerting responses, orienting to sensory stimulation, and executive monitoring of performance are considered independent yet interrelated systems. These operations play integral roles in regulating the behavior of diverse species along the evolutionary ladder. Each of the primary attention constructs—alerting, orienting, and executive monitoring—involves salient autonomic correlates as evidenced by changes in reactive pupil dilation (PD), heart rate, and skin conductance. Recent technological advances that use remote high-resolution recording may allow the discernment of temporo-spatial attributes of autonomic responses that characterize the alerting, orienting, and executive monitoring networks during free viewing, irrespective of voluntary performance. This may deepen the understanding of the roles of autonomic regulation in these mental operations and may deepen our understanding of behavioral changes in verbal as well as in non-verbal species. The aim of this study was to explore differences between psychosensory PD responses in alerting, orienting, and executive conflict monitoring tasks to generate estimates of concurrent locus coeruleus (LC) noradrenergic input trajectories in healthy human adults using the attention networks test (ANT). The analysis revealed a construct-specific pattern of pupil responses: alerting is characterized by an early component (Pa), its acceleration enables covert orienting, and executive control is evidenced by a prominent late component (Pe). PD characteristics seem to be task-sensitive, allowing exploration of mental operations irrespective of conscious voluntary responses. These data may facilitate development of studies designed to assess mental operations in diverse species using autonomic responses. PMID:24133422

Development of Flood Inundation Libraries using Historical Satellite Data and DEM for Part of Godavari Basin: An Approach Towards Better Flood Management

NASA Astrophysics Data System (ADS)

Bhatt, C. M.; Rao, G. S.; Patro, B.

2014-12-01

Conventional method of identifying areas to be inundated for issuing flood alert require inputs like discharge data, fine resolution digital elevation model (DEM), software for modelling and technically trained manpower to interpret the results meaningfully. Due to poor availability of these inputs, including good network of historical hydrological observations and limitation of time, quick flood early warning becomes a difficult task. Presently, based on the daily river water level and forecasted water level for major river systems in India, flood alerts are provided which are non-spatial in nature and does not help in understanding the inundation (spatial dimension) which may be caused at various water levels. In the present paper a concept for developing a series of flood-inundation map libraries two approaches are adopted one by correlating inundation extent derived from historical satellite data analysis with the corresponding water level recorded by the gauge station and the other simulation of inundation using digital elevation model (DEM's) is demonstrated for a part of Godavari Basin. The approach explained can be one of quick and cost-effective method for building a library of flood inundation extents, which can be utilized during flood disaster for alerting population and taking the relief and rescue operations. This layer can be visualized from a spatial dimension together with other spatial information like administrative boundaries, transport network, land use and land cover, digital elevation data and satellite images for better understanding and visualization of areas to be inundated spatially on free web based earth visualization portals like ISRO's Bhuvan portal (http://bhuvan.nrsc.gov.in). This can help decision makers in taking quick appropriate measures for warning, planning relief and rescue operations for the population to get affected under that river stage.

Diurnal Spectral Sensitivity of the Acute Alerting Effects of Light

PubMed Central

Rahman, Shadab A.; Flynn-Evans, Erin E.; Aeschbach, Daniel; Brainard, George C.; Czeisler, Charles A.; Lockley, Steven W.

2014-01-01

Study Objectives: Previous studies have demonstrated short-wavelength sensitivity for the acute alerting response to nocturnal light exposure. We assessed daytime spectral sensitivity in alertness, performance, and waking electroencephalogram (EEG). Design: Between-subjects (n = 8 per group). Setting: Inpatient intensive physiologic monitoring unit. Participants: Sixteen healthy young adults (mean age ± standard deviation = 23.8 ± 2.7 y). Interventions: Equal photon density exposure (2.8 × 1013 photons/cm2/s) to monochromatic 460 nm (blue) or 555 nm (green) light for 6.5 h centered in the middle of the 16-h episode of wakefulness during the biological day. Results were compared retrospectively to 16 individuals who were administered the same light exposure during the night. Measurements and Results: Daytime and nighttime 460-nm light exposure significantly improved auditory reaction time (P < 0.01 and P < 0.05, respectively) and reduced attentional lapses (P < 0.05), and improved EEG correlates of alertness compared to 555-nm exposure. Whereas subjective sleepiness ratings did not differ between the two spectral conditions during the daytime (P > 0.05), 460-nm light exposure at night significantly reduced subjective sleepiness compared to 555-nm light exposure at night (P < 0.05). Moreover, nighttime 460-nm exposure improved alertness to near-daytime levels. Conclusions: The alerting effects of short-wavelength 460-nm light are mediated by counteracting both the circadian drive for sleepiness and homeostatic sleep pressure at night, but only via reducing the effects of homeostatic sleep pressure during the day. Citation: Rahman SA; Flynn-Evans EE; Aeschbach D; Brainard GC; Czeisler CA; Lockley SW. Diurnal spectral sensitivity of the acute alerting effects of light. SLEEP 2014;37(2):271-281. PMID:24501435

Comparison of Two Sepsis Recognition Methods in a Pediatric Emergency Department.

PubMed

Balamuth, Fran; Alpern, Elizabeth R; Grundmeier, Robert W; Chilutti, Marianne; Weiss, Scott L; Fitzgerald, Julie C; Hayes, Katie; Bilker, Warren; Lautenbach, Ebbing

2015-11-01

The objective was to compare the effectiveness of physician judgment and an electronic algorithmic alert to identify pediatric patients with severe sepsis/septic shock in a pediatric emergency department (ED). This was an observational cohort study of patients older than 56 days with fever or hypothermia. All patients were evaluated for potential sepsis in real time by the ED clinical team. An electronic algorithmic alert was retrospectively applied to identify patients with potential sepsis independent of physician judgment. The primary outcome was the proportion of patients correctly identified with severe sepsis/septic shock defined by consensus criteria. Test characteristics were determined and receiver operating characteristic (ROC) curves were compared. Of 19,524 eligible patient visits, 88 patients developed consensus-confirmed severe sepsis or septic shock. Physician judgment identified 159 and the algorithmic alert identified 3,301 patients with potential sepsis. Physician judgment had sensitivity of 72.7% (95% confidence interval [CI] = 72.1% to 73.4%) and specificity of 99.5% (95% CI = 99.4% to 99.6%); the algorithmic alert had sensitivity of 92.1% (95% CI = 91.7% to 92.4%) and specificity of 83.4% (95% CI = 82.9% to 83.9%) for severe sepsis/septic shock. There was no significant difference in the area under the ROC curve for physician judgment (0.86, 95% CI = 0.81 to 0.91) or the algorithm (0.88, 95% CI = 0.85 to 0.91; p = 0.54). A combination method using either positive physician judgment or an algorithmic alert improved sensitivity to 96.6% and specificity to 83.3%. A sequential approach, in which positive identification by the algorithmic alert was then confirmed by physician judgment, achieved 68.2% sensitivity and 99.6% specificity. Positive and negative predictive values for physician judgment versus algorithmic alert were 40.3% versus 2.5% and 99.88% versus 99.96%, respectively. The electronic algorithmic alert was more sensitive but less specific than physician judgment for recognition of pediatric severe sepsis and septic shock. These findings can help to guide institutions in selecting pediatric sepsis recognition methods based on institutional needs and priorities. © 2015 by the Society for Academic Emergency Medicine.

Wireless Sensor Node for Autonomous Monitoring and Alerts in Remote Environments

NASA Technical Reports Server (NTRS)

Panangadan, Anand V. (Inventor); Monacos, Steve P. (Inventor)

2015-01-01

A method, apparatus, system, and computer program products provides personal alert and tracking capabilities using one or more nodes. Each node includes radio transceiver chips operating at different frequency ranges, a power amplifier, sensors, a display, and embedded software. The chips enable the node to operate as either a mobile sensor node or a relay base station node while providing a long distance relay link between nodes. The power amplifier enables a line-of-sight communication between the one or more nodes. The sensors provide a GPS signal, temperature, and accelerometer information (used to trigger an alert condition). The embedded software captures and processes the sensor information, provides a multi-hop packet routing protocol to relay the sensor information to and receive alert information from a command center, and to display the alert information on the display.

Attentional networks and visuospatial working memory capacity in social anxiety.

PubMed

Moriya, Jun

2018-02-01

Social anxiety is associated with attentional bias and working memory for emotional stimuli; however, the ways in which social anxiety affects cognitive functions involving non-emotional stimuli remains unclear. The present study focused on the role of attentional networks (i.e. alerting, orienting, and executive control networks) and visuospatial working memory capacity (WMC) for non-emotional stimuli in the context of social anxiety. One hundred and seventeen undergraduates completed questionnaires on social anxiety. They then performed an attentional network test and a change detection task to measure visuospatial WMC. Orienting network and visuospatial WMC were positively correlated with social anxiety. A multiple regression analysis showed significant positive associations of alerting, orienting, and visuospatial WMC with social anxiety. Alerting, orienting networks, and high visuospatial WMC for non-emotional stimuli may predict degree of social anxiety.

Vaginal temperature measurement by a wireless sensor for predicting the onset of calving in Japanese Black cows.

PubMed

Sakatani, Miki; Sugano, Takaaki; Higo, Aiki; Naotsuka, Koji; Hojo, Takuo; Gessei, Satoru; Uehara, Hiroshi; Takenouchi, Naoki

2018-04-15

We evaluated the utility of the continuous measurement of vaginal temperature by a wireless sensor and wireless connection for predicting the onset of calving and for clarifying the relationships among dystocia, calf conditions, and temperature changes at a commercial beef cattle farm in Japan. A total of 625 effective delivery data was collected. The temperature sensor inserted to the vagina on 7 days before the expected due date and collected the vaginal temperature every 5 min. The sensor detected two alerts according to the temperature change, one was the vaginal temperature of 4 h moving average compared to the same time temperature of last two days decreased more than 0.4 °C (Alert 1) and the other was the rupture of the allantoic sac and the dropped sensor temperature reached to the ambient temperature (Alert 2). The detection rates of Alert 1 and Alert 2 were 88.3% and 99.4%, respectively. The average time between Alert 1 and Alert 2 (Time 1) was 22 h, and that between Alert 2 and delivery (Time 2) was 2 h. These results indicated that the continuous measurement of vaginal temperature is effective for predicting the calving time. The necessity of assistance was correlated with dystocia, calf birth weight (BW), sex, and gestation periods. Interestingly, the durations of Times 1 and 2 were also associated with dystocia. The calf BW, sex, and gestation periods affected the length of Time 2. Our findings indicate that the BW of the calf is the most important factor for dystocia risk, and that the continuous measurement of vaginal temperature could become a good indicator for predicting not only the onset of calving, but also the necessity of assistance. Copyright © 2018 Elsevier Inc. All rights reserved.

Using Heuristic Evaluation to Improve Sepsis Alert Usability.

PubMed

Pertiwi, Ariani Arista Putri; Fraczkowski, Dan; Stogis, Sheryl L; Lopez, Karen Dunn

2018-06-01

Sepsis, life-threatening organ dysfunction in response to infection, is an alarmingly common and aggressive illness in US hospitals, especially for intensive care patients. Preventing sepsis deaths rests on the clinicians' ability to promptly recognize and treat sepsis. To aid early recognition, many organizations have employed clinician-facing electronic sepsis alert systems. However, the effectiveness of the alert relies on heavily on the visual interface, textual information, and overall usability. This article reports a usability inspection of a sepsis alert system. The authors found violations in 12 of the 14 usability principles and promote use of this method in practice to systematically identify usability problems. Copyright © 2018 Elsevier Inc. All rights reserved.

Validation of Test Performance and Clinical Time Zero for an Electronic Health Record Embedded Severe Sepsis Alert

PubMed Central

Downing, N. Lance; Shepard, John; Chu, Weihan; Tam, Julia; Wessels, Alexander; Li, Ron; Dietrich, Brian; Rudy, Michael; Castaneda, Leon; Shieh, Lisa

2016-01-01

Summary Bachground Increasing use of EHRs has generated interest in the potential of computerized clinical decision support to improve treatment of sepsis. Electronic sepsis alerts have had mixed results due to poor test characteristics, the inability to detect sepsis in a timely fashion and the use of outside software limiting widespread adoption. We describe the development, evaluation and validation of an accurate and timely severe sepsis alert with the potential to impact sepsis management. Objective To develop, evaluate, and validate an accurate and timely severe sepsis alert embedded in a commercial EHR. Methods The sepsis alert was developed by identifying the most common severe sepsis criteria among a cohort of patients with ICD 9 codes indicating a diagnosis of sepsis. This alert requires criteria in three categories: indicators of a systemic inflammatory response, evidence of suspected infection from physician orders, and markers of organ dysfunction. Chart review was used to evaluate test performance and the ability to detect clinical time zero, the point in time when a patient develops severe sepsis. Results Two physicians reviewed 100 positive cases and 75 negative cases. Based on this review, sensitivity was 74.5%, specificity was 86.0%, the positive predictive value was 50.3%, and the negative predictive value was 94.7%. The most common source of end-organ dysfunction was MAP less than 70 mm/Hg (59%). The alert was triggered at clinical time zero in 41% of cases and within three hours in 53.6% of cases. 96% of alerts triggered before a manual nurse screen. Conclusion We are the first to report the time between a sepsis alert and physician chart-review clinical time zero. Incorporating physician orders in the alert criteria improves specificity while maintaining sensitivity, which is important to reduce alert fatigue. By leveraging standard EHR functionality, this alert could be implemented by other healthcare systems. PMID:27437061

Implementing a Commercial Rule Base as a Medication Order Safety Net

PubMed Central

Reichley, Richard M.; Seaton, Terry L.; Resetar, Ervina; Micek, Scott T.; Scott, Karen L.; Fraser, Victoria J.; Dunagan, W. Claiborne; Bailey, Thomas C.

2005-01-01

A commercial rule base (Cerner Multum) was used to identify medication orders exceeding recommended dosage limits at five hospitals within BJC HealthCare, an integrated health care system. During initial testing, clinical pharmacists determined that there was an excessive number of nuisance and clinically insignificant alerts, with an overall alert rate of 9.2%. A method for customizing the commercial rule base was implemented to increase rule specificity for problematic rules. The system was subsequently deployed at two facilities and achieved alert rates of less than 1%. Pharmacists screened these alerts and contacted ordering physicians in 21% of cases. Physicians made therapeutic changes in response to 38% of alerts presented to them. By applying simple techniques to customize rules, commercial rule bases can be used to rapidly deploy a safety net to screen drug orders for excessive dosages, while preserving the rule architecture for later implementations of more finely tuned clinical decision support. PMID:15802481

Increased appropriateness of customized alert acknowledgement reasons for overridden medication alerts in a computerized provider order entry system.

PubMed

Dekarske, Brian M; Zimmerman, Christopher R; Chang, Robert; Grant, Paul J; Chaffee, Bruce W

2015-12-01

Computerized provider order entry systems commonly contain alerting mechanisms for patient allergies, incorrect doses, or drug-drug interactions when ordering medications. Providers have the option to override (bypass) these alerts and continue with the order unchanged. This study examines the effect of customizing medication alert override options on the appropriateness of override selection related to patient allergies, drug dosing, and drug-drug interactions when ordering medications in an electronic medical record. In this prospective, randomized crossover study, providers were randomized into cohorts that required a reason for overriding a medication alert from a customized or non-customized list of override reasons and/or by free-text entry. The primary outcome was to compare override responses that appropriately correlate with the alert type between the customized and non-customized configurations. The appropriateness of a subset of free-text responses that represented an affirmative and active acknowledgement of the alert without further explanation was classified as "indeterminate." Results were analyzed in three different ways by classifying indeterminate answers as either appropriate, inappropriate, or excluded entirely. Secondary outcomes included the appropriateness of override reasons when comparing cohorts and individual providers, reason selection based on order within the override list, and the determination of the frequency of free-text use, nonsensical responses, and multiple selection responses. Twenty-two clinicians were randomized into 2 cohorts and a total of 1829 alerts with a required response were generated during the study period. The customized configuration had a higher rate of appropriateness when compared to the non-customized configuration regardless of how indeterminate responses were classified (p<0.001). When comparing cohorts, appropriateness was significantly higher in the customized configuration regardless of the classification of indeterminate responses (p<0.001) with one exception: when indeterminate responses were considered inappropriate for the cohort of providers that were first exposed to the non-customized list (p=0.103). Free-text use was higher in the customized configuration overall (p<0.001), and there was no difference in nonsensical response between configurations (p=0.39). There is a benefit realized by using a customized list for medication override reasons. Poor application design or configuration can negatively affect provider behavior when responding to important medication alerts. Copyright © 2015. Published by Elsevier Ireland Ltd.

Detecting a trend change in cross-border epidemic transmission

NASA Astrophysics Data System (ADS)

Maeno, Yoshiharu

2016-09-01

A method for a system of Langevin equations is developed for detecting a trend change in cross-border epidemic transmission. The equations represent a standard epidemiological SIR compartment model and a meta-population network model. The method analyzes a time series of the number of new cases reported in multiple geographical regions. The method is applicable to investigating the efficacy of the implemented public health intervention in managing infectious travelers across borders. It is found that the change point of the probability of travel movements was one week after the WHO worldwide alert on the SARS outbreak in 2003. The alert was effective in managing infectious travelers. On the other hand, it is found that the probability of travel movements did not change at all for the flu pandemic in 2009. The pandemic did not affect potential travelers despite the WHO alert.

Improving the Health Forecasting Alert System for Cold Weather and Heat-Waves In England: A Proof-of-Concept Using Temperature-Mortality Relationships

PubMed Central

Masato, Giacomo; Bone, Angie; Charlton-Perez, Andrew; Cavany, Sean; Neal, Robert; Dankers, Rutger; Dacre, Helen; Carmichael, Katie; Murray, Virginia

2015-01-01

Objectives In this study a prototype of a new health forecasting alert system is developed, which is aligned to the approach used in the Met Office’s (MO) National Severe Weather Warning Service (NSWWS). This is in order to improve information available to responders in the health and social care system by linking temperatures more directly to risks of mortality, and developing a system more coherent with other weather alerts. The prototype is compared to the current system in the Cold Weather and Heatwave plans via a case-study approach to verify its potential advantages and shortcomings. Method The prototype health forecasting alert system introduces an “impact vs likelihood matrix” for the health impacts of hot and cold temperatures which is similar to those used operationally for other weather hazards as part of the NSWWS. The impact axis of this matrix is based on existing epidemiological evidence, which shows an increasing relative risk of death at extremes of outdoor temperature beyond a threshold which can be identified epidemiologically. The likelihood axis is based on a probability measure associated with the temperature forecast. The new method is tested for two case studies (one during summer 2013, one during winter 2013), and compared to the performance of the current alert system. Conclusions The prototype shows some clear improvements over the current alert system. It allows for a much greater degree of flexibility, provides more detailed regional information about the health risks associated with periods of extreme temperatures, and is more coherent with other weather alerts which may make it easier for front line responders to use. It will require validation and engagement with stakeholders before it can be considered for use. PMID:26431427

Variability of Diabetes Alert Dog Accuracy in a Real-World Setting

PubMed Central

Gonder-Frederick, Linda A.; Grabman, Jesse H.; Shepard, Jaclyn A.; Tripathi, Anand V.; Ducar, Dallas M.; McElgunn, Zachary R.

2017-01-01

Background: Diabetes alert dogs (DADs) are growing in popularity as an alternative method of glucose monitoring for individuals with type 1 diabetes (T1D). Only a few empirical studies have assessed DAD accuracy, with inconsistent results. The present study examined DAD accuracy and variability in performance in real-world conditions using a convenience sample of owner-report diaries. Method: Eighteen DAD owners (44.4% female; 77.8% youth) with T1D completed diaries of DAD alerts during the first year after placement. Diary entries included daily BG readings and DAD alerts. For each DAD, percentage hits (alert with BG ≤ 5.0 or ≥ 11.1 mmol/L; ≤90 or ≥200 mg/dl), percentage misses (no alert with BG out of range), and percentage false alarms (alert with BG in range) were computed. Sensitivity, specificity, positive likelihood ratio (PLR), and true positive rates were also calculated. Results: Overall comparison of DAD Hits to Misses yielded significantly more Hits for both low and high BG. Total sensitivity was 57.0%, with increased sensitivity to low BG (59.2%) compared to high BG (56.1%). Total specificity was 49.3% and PLR = 1.12. However, high variability in accuracy was observed across DADs, with low BG sensitivity ranging from 33% to 100%. Number of DADs achieving ≥ 60%, 65% and 70% true positive rates was 71%, 50% and 44%, respectively. Conclusions: DADs may be able to detect out-of-range BG, but variability across DADs is evident. Larger trials are needed to further assess DAD accuracy and to identify factors influencing the complexity of DAD accuracy in BG detection. PMID:28627305

Improved Conflict Detection for Reducing Operational Errors in Air Traffic Control

NASA Technical Reports Server (NTRS)

Paielli, Russell A.; Erzberger, Hainz

2003-01-01

An operational error is an incident in which an air traffic controller allows the separation between two aircraft to fall below the minimum separation standard. The rates of such errors in the US have increased significantly over the past few years. This paper proposes new detection methods that can help correct this trend by improving on the performance of Conflict Alert, the existing software in the Host Computer System that is intended to detect and warn controllers of imminent conflicts. In addition to the usual trajectory based on the flight plan, a "dead-reckoning" trajectory (current velocity projection) is also generated for each aircraft and checked for conflicts. Filters for reducing common types of false alerts were implemented. The new detection methods were tested in three different ways. First, a simple flightpath command language was developed t o generate precisely controlled encounters for the purpose of testing the detection software. Second, written reports and tracking data were obtained for actual operational errors that occurred in the field, and these were "replayed" to test the new detection algorithms. Finally, the detection methods were used to shadow live traffic, and performance was analysed, particularly with regard to the false-alert rate. The results indicate that the new detection methods can provide timely warnings of imminent conflicts more consistently than Conflict Alert.

An evaluation of three processing methods and the effect of reduced culture times for faster direct identification of pathogens from BacT/ALERT blood cultures by MALDI-TOF MS.

PubMed

Loonen, A J M; Jansz, A R; Stalpers, J; Wolffs, P F G; van den Brule, A J C

2012-07-01

Matrix-assisted laser desorption/ionisation time-of-flight mass spectrometry (MALDI-TOF MS) is a fast and reliable method for the identification of bacteria from agar media. Direct identification from positive blood cultures should decrease the time to obtaining the result. In this study, three different processing methods for the rapid direct identification of bacteria from positive blood culture bottles were compared. In total, 101 positive aerobe BacT/ALERT bottles were included in this study. Aliquots from all bottles were used for three bacterial processing methods, i.e. the commercially available Bruker's MALDI Sepsityper kit, the commercially available Molzym's MolYsis Basic5 kit and a centrifugation/washing method. In addition, the best method was used to evaluate the possibility of MALDI application after a reduced incubation time of 7 h of Staphylococcus aureus- and Escherichia coli-spiked (1,000, 100 and 10 colony-forming units [CFU]) aerobe BacT/ALERT blood cultures. Sixty-six (65%), 51 (50.5%) and 79 (78%) bottles were identified correctly at the species level when the centrifugation/washing method, MolYsis Basic 5 and Sepsityper were used, respectively. Incorrect identification was obtained in 35 (35%), 50 (49.5%) and 22 (22%) bottles, respectively. Gram-positive cocci were correctly identified in 33/52 (64%) of the cases. However, Gram-negative rods showed a correct identification in 45/47 (96%) of all bottles when the Sepsityper kit was used. Seven hours of pre-incubation of S. aureus- and E. coli-spiked aerobe BacT/ALERT blood cultures never resulted in reliable identification with MALDI-TOF MS. Sepsityper is superior for the direct identification of microorganisms from aerobe BacT/ALERT bottles. Gram-negative pathogens show better results compared to Gram-positive bacteria. Reduced incubation followed by MALDI-TOF MS did not result in faster reliable identification.

External modulation of the sustained attention network in traumatic brain injury.

PubMed

Richard, Nadine M; O'Connor, Charlene; Dey, Ayan; Robertson, Ian H; Levine, Brian

2018-05-07

Traumatic brain injury (TBI) is associated with impairments in processing speed as well as higher-level cognitive functions that depend on distributed neural networks, such as regulating and sustaining attention. Although exogenous alerting cues have been shown to support patients in sustaining attentive, goal-directed behavior, the neural correlates of this rehabilitative effect are unclear. The purpose of this study was to explore the effects of moderate to severe TBI on activity and functional connectivity in the well-documented right-lateralized frontal-subcortical-parietal sustained attention network, and to assess the effects of alerting cues. Using multivariate analysis of fMRI data, TBI patients and matched neurologically healthy (NH) comparison participants were scanned as they performed the Sustained Attention to Response Task (SART) in 60-s blocks, with or without exogenous cueing through brief auditory alerting tones. Results documented inefficient voluntary control of attention in the TBI patients, with reduced functional connectivity in the sustained attention network relative to NH participants. When alerting cues were present during the SART, however, functional connectivity increased and became comparable to activity patterns seen in the NH group. These findings provide novel evidence of a neural mechanism for the facilitatory effects of alerting cues on goal-directed behavior in patients with damaged attentional brain systems, and support their use in cognitive rehabilitation. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Alarms about structural alerts.

PubMed

Alves, Vinicius; Muratov, Eugene; Capuzzi, Stephen; Politi, Regina; Low, Yen; Braga, Rodolpho; Zakharov, Alexey V; Sedykh, Alexander; Mokshyna, Elena; Farag, Sherif; Andrade, Carolina; Kuz'min, Victor; Fourches, Denis; Tropsha, Alexander

2016-08-21

Structural alerts are widely accepted in chemical toxicology and regulatory decision support as a simple and transparent means to flag potential chemical hazards or group compounds into categories for read-across. However, there has been a growing concern that alerts disproportionally flag too many chemicals as toxic, which questions their reliability as toxicity markers. Conversely, the rigorously developed and properly validated statistical QSAR models can accurately and reliably predict the toxicity of a chemical; however, their use in regulatory toxicology has been hampered by the lack of transparency and interpretability. We demonstrate that contrary to the common perception of QSAR models as "black boxes" they can be used to identify statistically significant chemical substructures (QSAR-based alerts) that influence toxicity. We show through several case studies, however, that the mere presence of structural alerts in a chemical, irrespective of the derivation method (expert-based or QSAR-based), should be perceived only as hypotheses of possible toxicological effect. We propose a new approach that synergistically integrates structural alerts and rigorously validated QSAR models for a more transparent and accurate safety assessment of new chemicals.

Behavioral Modification of Intraoperative Hyperglycemia Management with a Novel Real-time Audiovisual Monitor.

PubMed

Sathishkumar, Subramanian; Lai, Manda; Picton, Paul; Kheterpal, Sachin; Morris, Michelle; Shanks, Amy; Ramachandran, Satya Krishna

2015-07-01

Hyperglycemia, defined as blood glucose (BG) levels above 200 mg/dl (11.1 mM), is associated with increased postoperative morbidity. Yet, the treatment standard for intraoperative glycemic control is poorly defined for noncardiac surgery. Little is known of the interindividual treatment variability or methods to modify intraoperative glycemic management behaviors. AlertWatch (AlertWatch, USA) is a novel audiovisual alert system that serves as a secondary patient monitor for use in operating rooms. The authors evaluated the influence of use of AlertWatch on intraoperative glycemic management behavior. AlertWatch displays historical patient data (risk factors and laboratory results) from multiple networked information systems, combined with the patient's live physiologic data. The authors extracted intraoperative data for 19 months to evaluate the relationship between AlertWatch usage and initiation of insulin treatment for hyperglycemia. Outcome associations were adjusted for physical status, case duration, procedural complexity, emergent procedure, fasting BG value, home insulin therapy, patient age, and primary anesthetist. Overall, 2,341 patients had documented intraoperative hyperglycemia. Use of AlertWatch (791 of 2,341; 33.5%) was associated with 55% increase in insulin treatment (496 of 791 [62.7%] with and 817 of 1,550 [52.7%] without AlertWatch; adjusted odds ratio [95% CI], 1.55 [1.23 to 1.95]; P < 0.001) and 44% increase in BG recheck after insulin administration (407 of 791 [51.5%] with AlertWatch and 655 of 1,550 [42.3%] in controls; adjusted odds ratio [95% CI], 1.44 [1.14 to 1.81]; P = 0.002). AlertWatch is associated with a significant increase in desirable intraoperative glycemic management behavior and may help achieve tighter intraoperative glycemic control.

Rapid deployable global sensing hazard alert system

DOEpatents

Cordaro, Joseph V; Tibrea, Steven L; Shull, Davis J; Coleman, Jerry T; Shuler, James M

2015-04-28

A rapid deployable global sensing hazard alert system and associated methods of operation are provided. An exemplary system includes a central command, a wireless backhaul network, and a remote monitoring unit. The remote monitoring unit can include a positioning system configured to determine a position of the remote monitoring unit based on one or more signals received from one or more satellites located in Low Earth Orbit. The wireless backhaul network can provide bidirectional communication capability independent of cellular telecommunication networks and the Internet. An exemplary method includes instructing at least one of a plurality of remote monitoring units to provide an alert based at least in part on a location of a hazard and a plurality of positions respectively associated with the plurality of remote monitoring units.

Risk management, or just a different risk?

PubMed Central

Freer, Y; Lyon, A

2006-01-01

Background National reporting of adverse incidents has resulted in a number of clinical alerts being issued. Despite a lack of evidence, these alerts are often accompanied by a mandatory requirement to alter practice. There is likely to be clinician resistance to such a method of change management, particularly where evidence of safety is missing. Aim To determine the level of implementation within neonatal units of an alert requiring the change from litmus to pH paper to test nasogastric tube position. Method A questionnaire sent to all neonatal units in the United Kingdom with more than 12 cots. Results From the 207 questionnaires sent, there were 165 (80%) responses. Fifty five percent of units were still using litmus. All continued to use supplementary tests not recommended in best practice statements issued at the time of the alert. There was considerable variation in the pH value at which it was considered safe to feed. Conclusions Nine months after the alert, more than half the units had not changed to pH paper, and supplementary methods of testing were still being used. The wide range of pH values highlights the uncertainty about the “normal” gastric pH in the newborn. The evidence that, in neonatal units, changing to pH paper is safer than the long established use of litmus is lacking. Recommendations for change in practice must be based on good information and not seen just as a “knee jerk” response to adverse incidents. PMID:16464936

Method for stationarity-segmentation of spike train data with application to the Pearson cross-correlation.

PubMed

Quiroga-Lombard, Claudio S; Hass, Joachim; Durstewitz, Daniel

2013-07-01

Correlations among neurons are supposed to play an important role in computation and information coding in the nervous system. Empirically, functional interactions between neurons are most commonly assessed by cross-correlation functions. Recent studies have suggested that pairwise correlations may indeed be sufficient to capture most of the information present in neural interactions. Many applications of correlation functions, however, implicitly tend to assume that the underlying processes are stationary. This assumption will usually fail for real neurons recorded in vivo since their activity during behavioral tasks is heavily influenced by stimulus-, movement-, or cognition-related processes as well as by more general processes like slow oscillations or changes in state of alertness. To address the problem of nonstationarity, we introduce a method for assessing stationarity empirically and then "slicing" spike trains into stationary segments according to the statistical definition of weak-sense stationarity. We examine pairwise Pearson cross-correlations (PCCs) under both stationary and nonstationary conditions and identify another source of covariance that can be differentiated from the covariance of the spike times and emerges as a consequence of residual nonstationarities after the slicing process: the covariance of the firing rates defined on each segment. Based on this, a correction of the PCC is introduced that accounts for the effect of segmentation. We probe these methods both on simulated data sets and on in vivo recordings from the prefrontal cortex of behaving rats. Rather than for removing nonstationarities, the present method may also be used for detecting significant events in spike trains.

Vestibular afferent responses to linear accelerations in the alert squirrel monkey

NASA Technical Reports Server (NTRS)

Somps, Christopher J.; Schor, Robert H.; Tomko, David L.

1994-01-01

The spontaneous activity of 40 otolith afferents and 44 canal afferents was recorded in 4 alert, intact squirrel monkeys. Polarization vectors and response properties of otolith afferents were determined during static re-orientations relative to gravity and during Earth-horizontal, sinusoidal, linear oscillations. Canal afferents were tested for sensitivity to linear accelerations. For regular otolith afferents, a significant correlation between upright discharge rate and sensitivity to dynamic acceleration in the horizontal plane was observed. This correlation was not present in irregular units. The sensitivity of otolith afferents to both static tilts and dynamic linear acceleration was much greater in irregularly discharging units than in regularly discharging units. The spontaneous activity and static and dynamic response properties of regularly discharging otolith afferents were similar to those reported in barbiturate-anesthetized squirrel monkeys. Irregular afferents also had similar dynamic response properties when compared to anesthetized monkeys. However, this sample of irregular afferents in alert animals had higher resting discharge rates and greater sensitivity to static tilts. The majority of otolith polarization vectors were oriented near the horizontal in the plane of the utricular maculae; however, directions of maximum sensitivity were different during dynamic and static testing. Canal afferents were not sensitive to static tilts or linear oscillations of the head.

An evidence- and risk-based approach to a harmonized laboratory alert list in Australia and New Zealand.

PubMed

Campbell, Craig A; Lam, Que; Horvath, Andrea R

2018-04-19

Individual laboratories are required to compose an alert list for identifying critical and significant risk results. The high-risk result working party of the Royal College of Pathologists of Australasia (RCPA) and the Australasian Association of Clinical Biochemists (AACB) has developed a risk-based approach for a harmonized alert list for laboratories throughout Australia and New Zealand. The six-step process for alert threshold identification and assessment involves reviewing the literature, rating the available evidence, performing a risk analysis, assessing method transferability, considering workload implications and seeking endorsement from stakeholders. To demonstrate this approach, a worked example for deciding the upper alert threshold for potassium is described. The findings of the worked example are for infants aged 0-6 months, a recommended upper potassium alert threshold of >7.0 mmol/L in serum and >6.5 mmol/L in plasma, and for individuals older than 6 months, a threshold of >6.2 mmol/L in both serum and plasma. Limitations in defining alert thresholds include the lack of well-designed studies that measure the relationship between high-risk results and patient outcomes or the benefits of treatment to prevent harm, and the existence of a wide range of clinical practice guidelines with conflicting decision points at which treatment is required. The risk-based approach described presents a transparent, evidence- and consensus-based methodology that can be used by any laboratory when designing an alert list for local use. The RCPA-AACB harmonized alert list serves as a starter set for further local adaptation or adoption after consultation with clinical users.

Usability flaws of medication-related alerting functions: A systematic qualitative review.

PubMed

Marcilly, Romaric; Ammenwerth, Elske; Vasseur, Francis; Roehrer, Erin; Beuscart-Zéphir, Marie-Catherine

2015-06-01

Medication-related alerting functions may include usability flaws that limit their optimal use. A first step on the way to preventing usability flaws is to understand the characteristics of these usability flaws. This systematic qualitative review aims to analyze the type of usability flaws found in medication-related alerting functions. Papers were searched via PubMed, Scopus and Ergonomics Abstracts databases, along with references lists. Paper selection, data extraction and data analysis was performed by two to three Human Factors experts. Meaningful semantic units representing instances of usability flaws were the main data extracted. They were analyzed through qualitative methods: categorization following general usability heuristics and through an inductive process for the flaws specific to medication-related alerting functions. From the 6380 papers initially identified, 26 met all eligibility criteria. The analysis of the papers identified a total of 168 instances of usability flaws that could be classified into 13 categories of usability flaws representing either violations of general usability principles (i.e. they could be found in any system, e.g. guidance and workload issues) or infractions specific to medication-related alerting functions. The latter refer to issues of low signal-to-noise ratio, incomplete content of alerts, transparency, presentation mode and timing, missing alert features, tasks and control distribution. The list of 168 instances of usability flaws of medication-related alerting functions provides a source of knowledge for checking the usability of medication-related alerting functions during their design and evaluation process and ultimately constructs evidence-based usability design principles for these functions. Copyright © 2015 Elsevier Inc. All rights reserved.

Eisenhower's Farewell Call: Arguing for an Alert and Knowledgeable Citizenry.

ERIC Educational Resources Information Center

Haapanen, Larry

In his January 17, 1961 farewell address, President Dwight D. Eisenhower warned Americans to be wary of the "military-industrial complex." He called for "an alert and knowledgeable citizenry" which would assure the proper meshing of the military and industrial defense machinery with peaceful methods and goals. Eisenhower's…

The Effect of Happiness and Sadness on Alerting, Orienting, and Executive Attention

ERIC Educational Resources Information Center

Finucane, Anne M.; Whiteman, Martha C.; Power, Mick J.

2010-01-01

Objective: According to the attention network approach, attention is best understood in terms of three functionally and neuroanatomically distinct networks--alerting, orienting, and executive attention. An important question is whether the experience of emotion differentially influences the efficiency of these networks. Method: This study examines…

Attention Performance Measured by Attention Network Test Is Correlated with Global and Regional Efficiency of Structural Brain Networks

PubMed Central

Xiao, Min; Ge, Haitao; Khundrakpam, Budhachandra S.; Xu, Junhai; Bezgin, Gleb; Leng, Yuan; Zhao, Lu; Tang, Yuchun; Ge, Xinting; Jeon, Seun; Xu, Wenjian; Evans, Alan C.; Liu, Shuwei

2016-01-01

Functional neuroimaging studies have indicated the involvement of separate brain areas in three distinct attention systems: alerting, orienting, and executive control (EC). However, the structural correlates underlying attention remains unexplored. Here, we utilized graph theory to examine the neuroanatomical substrates of the three attention systems measured by attention network test (ANT) in 65 healthy subjects. White matter connectivity, assessed with diffusion tensor imaging deterministic tractography was modeled as a structural network comprising 90 nodes defined by the automated anatomical labeling (AAL) template. Linear regression analyses were conducted to explore the relationship between topological parameters and the three attentional effects. We found a significant positive correlation between EC function and global efficiency of the whole brain network. At the regional level, node-specific correlations were discovered between regional efficiency and all three ANT components, including dorsolateral superior frontal gyrus, thalamus and parahippocampal gyrus for EC, thalamus and inferior parietal gyrus for alerting, and paracentral lobule and inferior occipital gyrus for orienting. Our findings highlight the fundamental architecture of interregional structural connectivity involved in attention and could provide new insights into the anatomical basis underlying human behavior. PMID:27777556

Role of data aggregation in biosurveillance detection strategies with applications from ESSENCE.

PubMed

Burkom, Howard S; Elbert, Y; Feldman, A; Lin, J

2004-09-24

Syndromic surveillance systems are used to monitor daily electronic data streams for anomalous counts of features of varying specificity. The monitored quantities might be counts of clinical diagnoses, sales of over-the-counter influenza remedies, school absenteeism among a given age group, and so forth. Basic data-aggregation decisions for these systems include determining which records to count and how to group them in space and time. This paper discusses the application of spatial and temporal data-aggregation strategies for multiple data streams to alerting algorithms appropriate to the surveillance region and public health threat of interest. Such a strategy was applied and evaluated for a complex, authentic, multisource, multiregion environment, including >2 years of data records from a system-evaluation exercise for the Defense Advanced Research Project Agency (DARPA). Multivariate and multiple univariate statistical process control methods were adapted and applied to the DARPA data collection. Comparative parametric analyses based on temporal aggregation were used to optimize the performance of these algorithms for timely detection of a set of outbreaks identified in the data by a team of epidemiologists. The sensitivity and timeliness of the most promising detection methods were tested at empirically calculated thresholds corresponding to multiple practical false-alert rates. Even at the strictest false-alert rate, all but one of the outbreaks were detected by the best method, and the best methods achieved a 1-day median time before alert over the set of test outbreaks. These results indicate that a biosurveillance system can provide a substantial alerting-timeliness advantage over traditional public health monitoring for certain outbreaks. Comparative analyses of individual algorithm results indicate further achievable improvement in sensitivity and specificity.

An Automated Sample Preparation Instrument to Accelerate Positive Blood Cultures Microbial Identification by MALDI-TOF Mass Spectrometry (Vitek®MS).

PubMed

Broyer, Patrick; Perrot, Nadine; Rostaing, Hervé; Blaze, Jérome; Pinston, Frederic; Gervasi, Gaspard; Charles, Marie-Hélène; Dachaud, Fabien; Dachaud, Jacques; Moulin, Frederic; Cordier, Sylvain; Dauwalder, Olivier; Meugnier, Hélène; Vandenesch, Francois

2018-01-01

Sepsis is the leading cause of death among patients in intensive care units (ICUs) requiring an early diagnosis to introduce efficient therapeutic intervention. Rapid identification (ID) of a causative pathogen is key to guide directed antimicrobial selection and was recently shown to reduce hospitalization length in ICUs. Direct processing of positive blood cultures by MALDI-TOF MS technology is one of the several currently available tools used to generate rapid microbial ID. However, all recently published protocols are still manual and time consuming, requiring dedicated technician availability and specific strategies for batch processing. We present here a new prototype instrument for automated preparation of Vitek ® MS slides directly from positive blood culture broth based on an "all-in-one" extraction strip. This bench top instrument was evaluated on 111 and 22 organisms processed using artificially inoculated blood culture bottles in the BacT/ALERT ® 3D (SA/SN blood culture bottles) or the BacT/ALERT Virtuo TM system (FA/FN Plus bottles), respectively. Overall, this new preparation station provided reliable and accurate Vitek MS species-level identification of 87% (Gram-negative bacteria = 85%, Gram-positive bacteria = 88%, and yeast = 100%) when used with BacT/ALERT ® 3D and of 84% (Gram-negative bacteria = 86%, Gram-positive bacteria = 86%, and yeast = 75%) with Virtuo ® instruments, respectively. The prototype was then evaluated in a clinical microbiology laboratory on 102 clinical blood culture bottles and compared to routine laboratory ID procedures. Overall, the correlation of ID on monomicrobial bottles was 83% (Gram-negative bacteria = 89%, Gram-positive bacteria = 79%, and yeast = 78%), demonstrating roughly equivalent performance between manual and automatized extraction methods. This prototype instrument exhibited a high level of performance regardless of bottle type or BacT/ALERT system. Furthermore, blood culture workflow could potentially be improved by converting direct ID of positive blood cultures from a batch-based to real-time and "on-demand" process.

Attentional Lapses of Adults with Attention Deficit Hyperactivity Disorder in Tasks of Sustained Attention.

PubMed

Gmehlin, Dennis; Fuermaier, Anselm B M; Walther, Stephan; Tucha, Lara; Koerts, Janneke; Lange, Klaus W; Tucha, Oliver; Weisbrod, Matthias; Aschenbrenner, Steffen

2016-06-01

Adults with attention deficit hyperactivity disorder (ADHD) show attentional dysfunction such as distractibility and mind-wandering, especially in lengthy tasks. However, fundamentals of dysfunction are ambiguous and relationships of neuropsychological test parameters with self-report measures of ADHD symptoms are marginal. We hypothesize that basic deficits in sustaining attention explain more complex attentional dysfunction in persons with ADHD and relate to ADHD symptoms. Attentional function was analyzed by computing ex-Gaussian parameters for 3 time Blocks in a 20 min test of sustained alertness. Changes in performance across these blocks were analyzed by comparing adult persons with ADHD (n = 24) with healthy matched controls (n = 24) and correlated with neuropsychological measures of selective and divided attention as well as self-report measures of ADHD symptoms. We found a significantly steeper increase in the number of slow responses (ex-Gaussian parameter τ) in persons with ADHD with time on task in basic sustained alertness. They also performed significantly worse in tasks of sustained selective and divided attention. However, after controlling for an increase in τ during the alertness task, significant differences between groups disappeared for divided and partly selective attention. Increases in τ in the sustained alertness task correlated significantly with self-report measures of ADHD symptoms. Our results provide evidence that very basic deficits in sustaining attention in adults with ADHD are related to infrequent slow responses (=attentional lapses), with changes over time being relevant for more complex attentional function and experienced ADHD symptoms in everyday life. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Advantages and Disadvantages of Educational Email Alerts for Family Physicians: Viewpoint

PubMed Central

Badran, Hani; Grad, Roland

2015-01-01

Background Electronic knowledge resources constitute an important channel for accredited Continuing Medical Education (CME) activities. However, email usage for educational purposes is controversial. On the one hand, family physicians become aware of new information, confirm what they already know, and obtain reassurance by reading educational email alerts. Email alerts can also encourage physicians to search Web-based resources. On the other hand, technical difficulties and privacy issues are common obstacles. Objective The purpose of this discussion paper, informed by a literature review and a small qualitative study, was to understand family physicians’ knowledge, attitudes, and behavior in regard to email in general and educational emails in particular, and to explore the advantages and disadvantages of educational email alerts. In addition, we documented participants’ suggestions to improve email alert services for CME. Methods We conducted a qualitative descriptive study using the “Knowledge, Attitude, Behavior” model. We conducted semi-structured face-to-face interviews with 15 family physicians. We analyzed the collected data using inductive-deductive thematic qualitative data analysis. Results All 15 participants scanned and prioritized their email, and 13 of them checked their email daily. Participants mentioned (1) advantages of educational email alerts such as saving time, convenience and valid information, and (2) disadvantages such as an overwhelming number of emails and irrelevance. They offered suggestions to improve educational email. Conclusions The advantages of email alerts seem to compensate for their disadvantages. Suggestions proposed by family physicians can help to improve educational email alerts. PMID:25803184

Association of a Best-Practice Alert and Prenatal Administration With Tetanus Toxoid, Reduced Diphtheria Toxoid, and Acellular Pertussis Vaccination Rates.

PubMed

Morgan, Jamie L; Baggari, Sangameshwar R; Chung, Wendy; Ritch, Julia; McIntire, Donald D; Sheffield, Jeanne S

2015-08-01

To evaluate how implementation of a best-practice alert, a reminder of clinical guidelines within the electronic medical record, in combination with the recommended change in immunization timing from postpartum to antepartum, affected tetanus toxoid, reduced diphtheria toxoid and acellular pertussis (Tdap) rates, and to examine the association of vaccination with local pertussis attack rates. A Tdap best-practice alert was introduced into the electronic prenatal charting system in June 2013. The best-practice alert was designed to appear starting at 32 weeks of gestation and to reappear at every subsequent encounter until vaccine acceptance was recorded or delivery occurred. The overall acceptance rate was then compared with postpartum vaccination rates at our institution from the previous year. Records of pertussis cases in children younger than 2 years of age diagnosed since 2012 in Dallas County were also reviewed to correlate local trends with vaccination efforts. Of the 10,201 women offered Tdap during prenatal care, 9,879 (96.8%) ultimately accepted. This is compared with a 48% (5,064 of 10,600) Tdap postpartum immunization rate in the year prior, before introduction of the best-practice alert. The incidence of pertussis among neonates born to mothers who received prenatal care at Parkland Hospital showed a nonsignificant decline from 13 cases per 10,000 deliveries (19 of 14,834, 95% confidence interval [CI] 7-19) between January 2012 and May 2013 to seven per 10,000 deliveries during the study period (eight of 11,788, 95% CI 2-11, P=.174). The use of a best-practice alert, in concert with the recommended change in timing of maternal vaccination from postpartum to antepartum, was associated with an increase in the Tdap immunization rate to 97%. II.

Evaluation of growth based rapid microbiological methods for sterility testing of vaccines and other biological products.

PubMed

Parveen, Seema; Kaur, Simleen; David, Selwyn A Wilson; Kenney, James L; McCormick, William M; Gupta, Rajesh K

2011-10-19

Most biological products, including vaccines, administered by the parenteral route are required to be tested for sterility at the final container and also at various stages during manufacture. The sterility testing method described in the Code of Federal Regulations (21 CFR 610.12) and the United States Pharmacopoeia (USP, Chapter <71>) is based on the observation of turbidity in liquid culture media due to growth of potential contaminants. We evaluated rapid microbiological methods (RMM) based on detection of growth 1) by adenosine triphosphate (ATP) bioluminescence technology (Rapid Milliflex(®) Detection System [RMDS]), and 2) by CO(2) monitoring technologies (BacT/Alert and the BACTEC systems), as alternate sterility methods. Microorganisms representing Gram negative, Gram positive, aerobic, anaerobic, spore forming, slow growing bacteria, yeast, and fungi were prepared in aliquots of Fluid A or a biological matrix (including inactivated influenza vaccines) to contain approximately 0.1, 1, 10 and 100 colony forming units (CFU) in an inoculum of 10 ml. These preparations were inoculated to the specific media required for the various methods: 1) fluid thioglycollate medium (FTM) and tryptic soy broth (TSB) of the compendial sterility method (both membrane filtration and direct inoculation); 2) tryptic soy agar (TSA), Sabouraud dextrose agar (SDA) and Schaedler blood agar (SBA) of the RMDS; 3) iAST and iNST media of the BacT/Alert system and 4) Standard 10 Aerobic/F and Standard Anaerobic/F media of the BACTEC system. RMDS was significantly more sensitive in detecting various microorganisms at 0.1CFU than the compendial methods (p<0.05), whereas the compendial membrane filtration method was significantly more sensitive than the BACTEC and BacT/Alert methods (p<0.05). RMDS detected all microorganisms significantly faster than the compendial method (p<0.05). BacT/Alert and BACTEC methods detected most microorganisms significantly faster than the compendial method (p<0.05), but took almost the same time to detect the slow growing microorganism P. acnes, compared to the compendial method. RMDS using SBA detected all test microorganisms in the presence of a matrix containing preservative 0.01% thimerosal, whereas the BacT/Alert and BACTEC systems did not consistently detect all the test microorganisms in the presence of 0.01% thimerosal. RMDS was compatible with inactivated influenza vaccines and aluminum phosphate or aluminum hydroxide adjuvants at up to 8 mg/ml without any interference in bioluminescence. RMDS was shown to be acceptable as an alternate sterility method taking 5 days as compared to the 14 days required of the compendial method. Isolation of microorganisms from the RMDS was accomplished by re-incubation of membranes with fresh SBA medium and microbial identification was confirmed using the MicroSEQ Identification System. BacT/Alert and BACTEC systems may be applicable as alternate methods to the compendial direct inoculation sterility method for products that do not contain preservatives or anti-microbial agents. Published by Elsevier Ltd.

Utility and potential of rapid epidemic intelligence from internet-based sources.

PubMed

Yan, S J; Chughtai, A A; Macintyre, C R

2017-10-01

Rapid epidemic detection is an important objective of surveillance to enable timely intervention, but traditional validated surveillance data may not be available in the required timeframe for acute epidemic control. Increasing volumes of data on the Internet have prompted interest in methods that could use unstructured sources to enhance traditional disease surveillance and gain rapid epidemic intelligence. We aimed to summarise Internet-based methods that use freely-accessible, unstructured data for epidemic surveillance and explore their timeliness and accuracy outcomes. Steps outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist were used to guide a systematic review of research related to the use of informal or unstructured data by Internet-based intelligence methods for surveillance. We identified 84 articles published between 2006-2016 relating to Internet-based public health surveillance methods. Studies used search queries, social media posts and approaches derived from existing Internet-based systems for early epidemic alerts and real-time monitoring. Most studies noted improved timeliness compared to official reporting, such as in the 2014 Ebola epidemic where epidemic alerts were generated first from ProMED-mail. Internet-based methods showed variable correlation strength with official datasets, with some methods showing reasonable accuracy. The proliferation of publicly available information on the Internet provided a new avenue for epidemic intelligence. Methodologies have been developed to collect Internet data and some systems are already used to enhance the timeliness of traditional surveillance systems. To improve the utility of Internet-based systems, the key attributes of timeliness and data accuracy should be included in future evaluations of surveillance systems. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Sensitivity and specificity of dosing alerts for dosing errors among hospitalized pediatric patients

PubMed Central

Stultz, Jeremy S; Porter, Kyle; Nahata, Milap C

2014-01-01

Objectives To determine the sensitivity and specificity of a dosing alert system for dosing errors and to compare the sensitivity of a proprietary system with and without institutional customization at a pediatric hospital. Methods A retrospective analysis of medication orders, orders causing dosing alerts, reported adverse drug events, and dosing errors during July, 2011 was conducted. Dosing errors with and without alerts were identified and the sensitivity of the system with and without customization was compared. Results There were 47 181 inpatient pediatric orders during the studied period; 257 dosing errors were identified (0.54%). The sensitivity of the system for identifying dosing errors was 54.1% (95% CI 47.8% to 60.3%) if customization had not occurred and increased to 60.3% (CI 54.0% to 66.3%) with customization (p=0.02). The sensitivity of the system for underdoses was 49.6% without customization and 60.3% with customization (p=0.01). Specificity of the customized system for dosing errors was 96.2% (CI 96.0% to 96.3%) with a positive predictive value of 8.0% (CI 6.8% to 9.3). All dosing errors had an alert over-ridden by the prescriber and 40.6% of dosing errors with alerts were administered to the patient. The lack of indication-specific dose ranges was the most common reason why an alert did not occur for a dosing error. Discussion Advances in dosing alert systems should aim to improve the sensitivity and positive predictive value of the system for dosing errors. Conclusions The dosing alert system had a low sensitivity and positive predictive value for dosing errors, but might have prevented dosing errors from reaching patients. Customization increased the sensitivity of the system for dosing errors. PMID:24496386

Improving regional influenza surveillance through a combination of automated outbreak detection methods: the 2015/16 season in France.

PubMed

Pelat, Camille; Bonmarin, Isabelle; Ruello, Marc; Fouillet, Anne; Caserio-Schönemann, Céline; Levy-Bruhl, Daniel; Le Strat, Yann

2017-08-10

The 2014/15 influenza epidemic caused a work overload for healthcare facilities in France. The French national public health agency announced the start of the epidemic - based on indicators aggregated at the national level - too late for many hospitals to prepare. It was therefore decided to improve the influenza alert procedure through (i) the introduction of a pre-epidemic alert level to better anticipate future outbreaks, (ii) the regionalisation of surveillance so that healthcare structures can be informed of the arrival of epidemics in their region, (iii) the standardised use of data sources and statistical methods across regions. A web application was developed to deliver statistical results of three outbreak detection methods applied to three surveillance data sources: emergency departments, emergency general practitioners and sentinel general practitioners. This application was used throughout the 2015/16 influenza season by the epidemiologists of the headquarters and regional units of the French national public health agency. It allowed them to signal the first influenza epidemic alert in week 2016-W03, in Brittany, with 11 other regions in pre-epidemic alert. This application received positive feedback from users and was pivotal for coordinating surveillance across the agency's regional units. This article is copyright of The Authors, 2017.

Do Family Physicians Retrieve Synopses of Clinical Research Previously Read as Email Alerts?

PubMed Central

Pluye, Pierre; Johnson-Lafleur, Janique; Granikov, Vera; Shulha, Michael; Bartlett, Gillian; Marlow, Bernard

2011-01-01

Background A synopsis of new clinical research highlights important aspects of one study in a brief structured format. When delivered as email alerts, synopses enable clinicians to become aware of new developments relevant for practice. Once read, a synopsis can become a known item of clinical information. In time-pressured situations, remembering a known item may facilitate information retrieval by the clinician. However, exactly how synopses first delivered as email alerts influence retrieval at some later time is not known. Objectives We examined searches for clinical information in which a synopsis previously read as an email alert was retrieved (defined as a dyad). Our study objectives were to (1) examine whether family physicians retrieved synopses they previously read as email alerts and then to (2) explore whether family physicians purposefully retrieved these synopses. Methods We conducted a mixed-methods study in which a qualitative multiple case study explored the retrieval of email alerts within a prospective longitudinal cohort of practicing family physicians. Reading of research-based synopses was tracked in two contexts: (1) push, meaning to read on email and (2) pull, meaning to read after retrieval from one electronic knowledge resource. Dyads, defined as synopses first read as email alerts and subsequently retrieved in a search of a knowledge resource, were prospectively identified. Participants were interviewed about all of their dyads. Outcomes were the total number of dyads and their type. Results Over a period of 341 days, 194 unique synopses delivered to 41 participants resulted in 4937 synopsis readings. In all, 1205 synopses were retrieved over an average of 320 days. Of the 1205 retrieved synopses, 21 (1.7%) were dyads made by 17 family physicians. Of the 1205 retrieved synopses, 6 (0.5%) were known item type dyads. However, dyads also occurred serendipitously. Conclusion In the single knowledge resource we studied, email alerts containing research-based synopses were rarely retrieved. Our findings help us to better understand the effect of push on pull and to improve the integration of research-based information within electronic resources for clinicians. PMID:22130465

Analyzing Information Seeking and Drug-Safety Alert Response by Health Care Professionals as New Methods for Surveillance

PubMed Central

Pernek, Igor; Stiglic, Gregor; Leskovec, Jure; Strasberg, Howard R; Shah, Nigam Haresh

2015-01-01

Background Patterns in general consumer online search logs have been used to monitor health conditions and to predict health-related activities, but the multiple contexts within which consumers perform online searches make significant associations difficult to interpret. Physician information-seeking behavior has typically been analyzed through survey-based approaches and literature reviews. Activity logs from health care professionals using online medical information resources are thus a valuable yet relatively untapped resource for large-scale medical surveillance. Objective To analyze health care professionals’ information-seeking behavior and assess the feasibility of measuring drug-safety alert response from the usage logs of an online medical information resource. Methods Using two years (2011-2012) of usage logs from UpToDate, we measured the volume of searches related to medical conditions with significant burden in the United States, as well as the seasonal distribution of those searches. We quantified the relationship between searches and resulting page views. Using a large collection of online mainstream media articles and Web log posts we also characterized the uptake of a Food and Drug Administration (FDA) alert via changes in UpToDate search activity compared with general online media activity related to the subject of the alert. Results Diseases and symptoms dominate UpToDate searches. Some searches result in page views of only short duration, while others consistently result in longer-than-average page views. The response to an FDA alert for Celexa, characterized by a change in UpToDate search activity, differed considerably from general online media activity. Changes in search activity appeared later and persisted longer in UpToDate logs. The volume of searches and page view durations related to Celexa before the alert also differed from those after the alert. Conclusions Understanding the information-seeking behavior associated with online evidence sources can offer insight into the information needs of health professionals and enable large-scale medical surveillance. Our Web log mining approach has the potential to monitor responses to FDA alerts at a national level. Our findings can also inform the design and content of evidence-based medical information resources such as UpToDate. PMID:26293444

Effectiveness of Provider Education Followed by Computerized Provider Order Entry Alerts in Reducing Inappropriate Red Blood Cell Transfusion.

PubMed

Patel, Vijay M; Rains, Anna W; Clark, Christopher T

2016-01-01

To reduce the rate of inappropriate red blood cell transfusion, a provider education program, followed by alerts in the computerized provider order entry system (CPOE), was established to encourage AABB transfusion guidelines. Metrics were established for nonemergent inpatient transfusions. Service lines with high order volume were targeted with formal education regarding AABB 2012 transfusion guidelines. Transfusion orders were reviewed in real time with email communications sent to ordering providers falling outside of AABB recommendations. After 12 months of provider education, alerts were activated in CPOE. With provider education alone, the incidence of pretransfusion hemoglobin levels greater than 8 g/dL decreased from 16.64% to 6.36%, posttransfusion hemoglobin levels greater than 10 g/dL from 14.03% to 3.78%, and number of nonemergent two-unit red blood cell orders from 45.26% to 22.66%. Red blood cell utilization decreased by 13%. No additional significant reduction in nonemergent two-unit orders was observed with CPOE alerts. Provider education, an effective and low-cost method, should be considered as a first-line method for reducing inappropriate red blood cell transfusion rates in stable adult inpatients. Alerts in the computerized order entry system did not significantly lower the percentage of two-unit red blood cells orders but may help to maintain educational efforts.

Risk management, or just a different risk?

PubMed

Freer, Y; Lyon, A

2006-09-01

National reporting of adverse incidents has resulted in a number of clinical alerts being issued. Despite a lack of evidence, these alerts are often accompanied by a mandatory requirement to alter practice. There is likely to be clinician resistance to such a method of change management, particularly where evidence of safety is missing. To determine the level of implementation within neonatal units of an alert requiring the change from litmus to pH paper to test nasogastric tube position. A questionnaire sent to all neonatal units in the United Kingdom with more than 12 cots. From the 207 questionnaires sent, there were 165 (80%) responses. Fifty five percent of units were still using litmus. All continued to use supplementary tests not recommended in best practice statements issued at the time of the alert. There was considerable variation in the pH value at which it was considered safe to feed. Nine months after the alert, more than half the units had not changed to pH paper, and supplementary methods of testing were still being used. The wide range of pH values highlights the uncertainty about the "normal" gastric pH in the newborn. The evidence that, in neonatal units, changing to pH paper is safer than the long established use of litmus is lacking. Recommendations for change in practice must be based on good information and not seen just as a "knee jerk" response to adverse incidents.

Using Supervised Machine Learning to Classify Real Alerts and Artifact in Online Multi-signal Vital Sign Monitoring Data

PubMed Central

Chen, Lujie; Dubrawski, Artur; Wang, Donghan; Fiterau, Madalina; Guillame-Bert, Mathieu; Bose, Eliezer; Kaynar, Ata M.; Wallace, David J.; Guttendorf, Jane; Clermont, Gilles; Pinsky, Michael R.; Hravnak, Marilyn

2015-01-01

OBJECTIVE Use machine-learning (ML) algorithms to classify alerts as real or artifacts in online noninvasive vital sign (VS) data streams to reduce alarm fatigue and missed true instability. METHODS Using a 24-bed trauma step-down unit’s non-invasive VS monitoring data (heart rate [HR], respiratory rate [RR], peripheral oximetry [SpO2]) recorded at 1/20Hz, and noninvasive oscillometric blood pressure [BP] less frequently, we partitioned data into training/validation (294 admissions; 22,980 monitoring hours) and test sets (2,057 admissions; 156,177 monitoring hours). Alerts were VS deviations beyond stability thresholds. A four-member expert committee annotated a subset of alerts (576 in training/validation set, 397 in test set) as real or artifact selected by active learning, upon which we trained ML algorithms. The best model was evaluated on alerts in the test set to enact online alert classification as signals evolve over time. MAIN RESULTS The Random Forest model discriminated between real and artifact as the alerts evolved online in the test set with area under the curve (AUC) performance of 0.79 (95% CI 0.67-0.93) for SpO2 at the instant the VS first crossed threshold and increased to 0.87 (95% CI 0.71-0.95) at 3 minutes into the alerting period. BP AUC started at 0.77 (95%CI 0.64-0.95) and increased to 0.87 (95% CI 0.71-0.98), while RR AUC started at 0.85 (95%CI 0.77-0.95) and increased to 0.97 (95% CI 0.94–1.00). HR alerts were too few for model development. CONCLUSIONS ML models can discern clinically relevant SpO2, BP and RR alerts from artifacts in an online monitoring dataset (AUC>0.87). PMID:26992068

Impact of e-alert for detection of acute kidney injury on processes of care and outcomes: protocol for a systematic review and meta-analysis.

PubMed

Lachance, Philippe; Villeneuve, Pierre-Marc; Wilson, Francis P; Selby, Nicholas M; Featherstone, Robin; Rewa, Oleksa; Bagshaw, Sean M

2016-05-05

Acute kidney injury (AKI) is a common complication in hospitalised patients. It imposes significant risk for major morbidity and mortality. Moreover, patients suffering an episode of AKI consume considerable health resources. Recently, a number of studies have evaluated the implementation of automated electronic alerts (e-alerts) configured from electronic medical records (EMR) and clinical information systems (CIS) to warn healthcare providers of early or impending AKI in hospitalised patients. The impact of e-alerts on care processes, patient outcomes and health resource use, however, remains uncertain. We will perform a systematic review to describe and appraise e-alerts for AKI, and evaluate their impact on processes of care, clinical outcomes and health services use. In consultation with a research librarian, a search strategy will be developed and electronic databases (ie, MEDLINE, EMBASE, CINAHL, Cochrane Library and Inspec via Engineering Village) searched. Selected grey literature sources will also be searched. Search themes will focus on e-alerts and AKI. Citation screening, selection, quality assessment and data abstraction will be performed in duplicate. The primary analysis will be narrative; however, where feasible, pooled analysis will be performed. Each e-alert will be described according to trigger, type of alert, target recipient and degree of intrusiveness. Pooled effect estimates will be described, where applicable. Our systematic review will synthesise the literature on the value of e-alerts to detect AKI, and their impact on processes, patient-centred outcomes and resource use, and also identify key knowledge gaps and barriers to implementation. This is a fundamental step in a broader research programme aimed to understand the ideal structure of e-alerts, target population and methods for implementation, to derive benefit. Research ethics approval is not required for this review. CRD42016033033. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Notification of abnormal lab test results in an electronic medical record: do any safety concerns remain?

PubMed Central

Singh, Hardeep; Thomas, Eric J.; Sittig, Dean F.; Wilson, Lindsey; Espadas, Donna; Khan, Myrna M.; Petersen, Laura A.

2010-01-01

Background: Follow-up of abnormal outpatient laboratory test results is a major patient safety concern. Electronic medical records can potentially address this concern through automated notification. We examined whether automated notifications of abnormal laboratory results (alerts) in an integrated electronic medical record resulted in timely follow-up actions. Methods: We studied four alerts: hemoglobin A1c (HbA1c) ≥15%, positive hepatitis C antibody (HCV), prostate specific antigen (PSA) ≥15 ng/mL, and thyroid stimulating hormone (TSH) ≥ 15 mIU/L. An alert tracking system determined whether the alert was acknowledged (i.e. provider clicked on and opened the message) within two weeks of transmission; acknowledged alerts were considered read. Within 30 days of result transmission, record review and provider contact determined follow-up actions (e.g. patient contact, treatment etc.). Multivariable logistic regression models analyzed predictors for lack of timely follow-up. Results: Between May 2008 and December 2008, 78,158 tests (HbA1c, HCV, TSH and PSA) were performed, of which 1163 (1.48%) were transmitted as alerts; 10.2% of these (119/1163) were unacknowledged. Timely follow-up was lacking in 79 (6.8%) and was statistically not different for acknowledged and unacknowledged alerts (6.4% vs. 10.1%; p =.13). Two-hundred two alerts (17.4% of 1163) arose from unnecessarily ordered (redundant) tests. Alerts for a new versus known diagnosis were more likely to lack timely follow-up (OR: 7.35; 95% CI: 4.16-12.97) whereas alerts related to redundant tests were less likely to lack timely follow-up (OR: 0.24; 95% CI: 0.07-0.84). Conclusions: Safety concerns related to timely patient follow-up remain despite automated notification of non-life threatening abnormal laboratory results in the outpatient setting. PMID:20193832

Faster clinical response to the onset of adverse events: A wearable metacognitive attention aid for nurse triage of clinical alarms

PubMed Central

Doig, Alexa K.; Agutter, James A.; Brewer, Lara M.; Syroid, Noah D.; Mittu, Ranjeev

2018-01-01

Objective This study evaluates the potential for improving patient safety by introducing a metacognitive attention aid that enables clinicians to more easily access and use existing alarm/alert information. It is hypothesized that this introduction will enable clinicians to easily triage alarm/alert events and quickly recognize emergent opportunities to adapt care delivery. The resulting faster response to clinically important alarms/alerts has the potential to prevent adverse events and reduce healthcare costs. Materials and methods A randomized within-subjects single-factor clinical experiment was conducted in a high-fidelity 20-bed simulated acute care hospital unit. Sixteen registered nurses, four at a time, cared for five simulated patients each. A two-part highly realistic clinical scenario was used that included representative: tasking; information; and alarms/alerts. The treatment condition introduced an integrated wearable attention aid that leveraged metacognition methods from proven military systems. The primary metric was time for nurses to respond to important alarms/alerts. Results Use of the wearable attention aid resulted in a median relative within-subject improvement for individual nurses of 118% (W = 183, p = 0.006). The top quarter of relative improvement was 3,303% faster (mean; 17.76 minutes reduced to 1.33). For all unit sessions, there was an overall 148% median faster response time to important alarms (8.12 minutes reduced to 3.27; U = 2.401, p = 0.016), with 153% median improvement in consistency across nurses (F = 11.670, p = 0.001). Discussion and conclusion Existing device-centric alarm/alert notification solutions can require too much time and effort for nurses to access and understand. As a result, nurses may ignore alarms/alerts as they focus on other important work. There has been extensive research on reducing alarm frequency in healthcare. However, alarm safety remains a top problem. Empirical observations reported here highlight the potential of improving patient safety by supporting the meta-work of checking alarms. PMID:29768477

Stand-alone tsunami alarm equipment

NASA Astrophysics Data System (ADS)

Katsumata, Akio; Hayashi, Yutaka; Miyaoka, Kazuki; Tsushima, Hiroaki; Baba, Toshitaka; Catalán, Patricio A.; Zelaya, Cecilia; Riquelme Vasquez, Felipe; Sanchez-Olavarria, Rodrigo; Barrientos, Sergio

2017-05-01

One of the quickest means of tsunami evacuation is transfer to higher ground soon after strong and long ground shaking. Ground shaking itself is a good initiator of the evacuation from disastrous tsunami. Longer period seismic waves are considered to be more correlated with the earthquake magnitude. We investigated the possible application of this to tsunami hazard alarm using single-site ground motion observation. Information from the mass media is sometimes unavailable due to power failure soon after a large earthquake. Even when an official alarm is available, multiple information sources of tsunami alert would help people become aware of the coming risk of a tsunami. Thus, a device that indicates risk of a tsunami without requiring other data would be helpful to those who should evacuate. Since the sensitivity of a low-cost MEMS (microelectromechanical systems) accelerometer is sufficient for this purpose, tsunami alarm equipment for home use may be easily realized. Amplitude of long-period (20 s cutoff) displacement was proposed as the threshold for the alarm based on empirical relationships among magnitude, tsunami height, hypocentral distance, and peak ground displacement of seismic waves. Application of this method to recent major earthquakes indicated that such equipment could effectively alert people to the possibility of tsunami.

Alerting, Orienting, and Executive Attention in Children with ADHD

ERIC Educational Resources Information Center

Mullane, Jennifer C.; Corkum, Penny V.; Klein, Raymond M.; McLaughlin, Elizabeth N.; Lawrence, Michael A.

2011-01-01

Objective: This study evaluated the alerting, orienting, and executive attention abilities of children with ADHD and their typically developing (TD) peers using a modified version of the adult attention network test (ANT-I). Method: A total of 25 children with ADHD, Combined Type (ADHD-C, mean age = 9.20 years), 20 children with ADHD,…

Relationship between alertness, performance, and body temperature in humans.

PubMed

Wright, Kenneth P; Hull, Joseph T; Czeisler, Charles A

2002-12-01

Body temperature has been reported to influence human performance. Performance is reported to be better when body temperature is high/near its circadian peak and worse when body temperature is low/near its circadian minimum. We assessed whether this relationship between performance and body temperature reflects the regulation of both the internal biological timekeeping system and/or the influence of body temperature on performance independent of circadian phase. Fourteen subjects participated in a forced desynchrony protocol allowing assessment of the relationship between body temperature and performance while controlling for circadian phase and hours awake. Most neurobehavioral measures varied as a function of internal biological time and duration of wakefulness. A number of performance measures were better when body temperature was elevated, including working memory, subjective alertness, visual attention, and the slowest 10% of reaction times. These findings demonstrate that an increased body temperature, associated with and independent of internal biological time, is correlated with improved performance and alertness. These results support the hypothesis that body temperature modulates neurobehavioral function in humans.

Attention failures versus misplaced diligence: separating attention lapses from speed-accuracy trade-offs.

PubMed

Seli, Paul; Cheyne, James Allan; Smilek, Daniel

2012-03-01

In two studies of a GO-NOGO task assessing sustained attention, we examined the effects of (1) altering speed-accuracy trade-offs through instructions (emphasizing both speed and accuracy or accuracy only) and (2) auditory alerts distributed throughout the task. Instructions emphasizing accuracy reduced errors and changed the distribution of GO trial RTs. Additionally, correlations between errors and increasing RTs produced a U-function; excessively fast and slow RTs accounted for much of the variance of errors. Contrary to previous reports, alerts increased errors and RT variability. The results suggest that (1) standard instructions for sustained attention tasks, emphasizing speed and accuracy equally, produce errors arising from attempts to conform to the misleading requirement for speed, which become conflated with attention-lapse produced errors and (2) auditory alerts have complex, and sometimes deleterious, effects on attention. We argue that instructions emphasizing accuracy provide a more precise assessment of attention lapses in sustained attention tasks. Copyright © 2011 Elsevier Inc. All rights reserved.

Relationship between alertness, performance, and body temperature in humans

NASA Technical Reports Server (NTRS)

Wright, Kenneth P Jr; Hull, Joseph T.; Czeisler, Charles A.

2002-01-01

Body temperature has been reported to influence human performance. Performance is reported to be better when body temperature is high/near its circadian peak and worse when body temperature is low/near its circadian minimum. We assessed whether this relationship between performance and body temperature reflects the regulation of both the internal biological timekeeping system and/or the influence of body temperature on performance independent of circadian phase. Fourteen subjects participated in a forced desynchrony protocol allowing assessment of the relationship between body temperature and performance while controlling for circadian phase and hours awake. Most neurobehavioral measures varied as a function of internal biological time and duration of wakefulness. A number of performance measures were better when body temperature was elevated, including working memory, subjective alertness, visual attention, and the slowest 10% of reaction times. These findings demonstrate that an increased body temperature, associated with and independent of internal biological time, is correlated with improved performance and alertness. These results support the hypothesis that body temperature modulates neurobehavioral function in humans.

Modifying pro-drug risk factors in adolescents: results from project ALERT.

PubMed

Ghosh-Dastidar, Bonnie; Longshore, Douglas L; Ellickson, Phyllis L; McCaffrey, Daniel F

2004-06-01

The objective of this study was to evaluate the impact of a revised state-of-the-art drug prevention program, Project ALERT, on risk factors for drug use in mostly rural midwestern schools and communities. Fifty-five middle schools from South Dakota were randomly assigned to treatment or control conditions. Treatment-group students received 11 lessons in Grade 7 and 3 more in Grade 8. Effects for 4276 eighth graders were assessed 18 months after baseline. Results indicate that Project ALERT had statistically significant effects on all the targeted risk factors associated with cigarette and marijuana use and more modest gains with the pro-alcohol risk factors. The program helped adolescents at low, moderate, and high risk for future use, with the effect sizes typically stronger for the low- and moderate-risk groups. Thus, school-based drug prevention programs can lower risk factors that correlate with drug use, help low- to high-risk adolescents, and be effective in diverse school environments.

Passive pavement-mounted acoustical linguistic drive alert system and method

DOEpatents

Kisner, Roger A.; Anderson, Richard L.; Carnal, Charles L.; Hylton, James O.; Stevens, Samuel S.

2001-01-01

Systems and methods are described for passive pavement-mounted acoustical alert of the occupants of a vehicle. A method of notifying a vehicle occupant includes providing a driving medium upon which a vehicle is to be driven; and texturing a portion of the driving medium such that the textured portion interacts with the vehicle to produce audible signals, the textured portion pattern such that a linguistic message is encoded into the audible signals. The systems and methods provide advantages because information can be conveyed to the occupants of the vehicle based on the location of the vehicle relative to the textured surface.

Terrorism-related fear and avoidance behavior in a multiethnic urban population.

PubMed

Eisenman, David P; Glik, Deborah; Ong, Michael; Zhou, Qiong; Tseng, Chi-Hong; Long, Anna; Fielding, Jonathan; Asch, Steven

2009-01-01

We sought to determine whether groups traditionally most vulnerable to disasters would be more likely than would be others to perceive population-level risk as high (as measured by the estimated color-coded alert level) would worry more about terrorism, and would avoid activities because of terrorism concerns. We conducted a random digit dial survey of the Los Angeles County population October 2004 through January 2005 in 6 languages. We asked respondents what color alert level the country was under, how often they worry about terrorist attacks, and how often they avoid activities because of terrorism. Multivariate regression modeled correlates of worry and avoidance, including mental illness, disability, demographic factors, and estimated color-coded alert level. Persons who are mentally ill, those who are disabled, African Americans, Latinos, Chinese Americans, Korean Americans, and non-US citizens were more likely to perceive population-level risk as high, as measured by the estimated color-coded alert level. These groups also reported more worry and avoidance behaviors because of concerns about terrorism. Vulnerable populations experience a disproportionate burden of the psychosocial impact of terrorism threats and our national response. Further studies should investigate the specific behaviors affected and further elucidate disparities in the disaster burden associated with terrorism and terrorism policies.

Influence of infectious disease seasonality on the performance of the outbreak detection algorithm in the China Infectious Disease Automated-alert and Response System

PubMed Central

Wang, Ruiping; Jiang, Yonggen; Guo, Xiaoqin; Wu, Yiling; Zhao, Genming

2017-01-01

Objective The Chinese Center for Disease Control and Prevention developed the China Infectious Disease Automated-alert and Response System (CIDARS) in 2008. The CIDARS can detect outbreak signals in a timely manner but generates many false-positive signals, especially for diseases with seasonality. We assessed the influence of seasonality on infectious disease outbreak detection performance. Methods Chickenpox surveillance data in Songjiang District, Shanghai were used. The optimized early alert thresholds for chickenpox were selected according to three algorithm evaluation indexes: sensitivity (Se), false alarm rate (FAR), and time to detection (TTD). Performance of selected proper thresholds was assessed by data external to the study period. Results The optimized early alert threshold for chickenpox during the epidemic season was the percentile P65, which demonstrated an Se of 93.33%, FAR of 0%, and TTD of 0 days. The optimized early alert threshold in the nonepidemic season was P50, demonstrating an Se of 100%, FAR of 18.94%, and TTD was 2.5 days. The performance evaluation demonstrated that the use of an optimized threshold adjusted for seasonality could reduce the FAR and shorten the TTD. Conclusions Selection of optimized early alert thresholds based on local infectious disease seasonality could improve the performance of the CIDARS. PMID:28728470

Influence of infectious disease seasonality on the performance of the outbreak detection algorithm in the China Infectious Disease Automated-alert and Response System.

PubMed

Wang, Ruiping; Jiang, Yonggen; Guo, Xiaoqin; Wu, Yiling; Zhao, Genming

2018-01-01

Objective The Chinese Center for Disease Control and Prevention developed the China Infectious Disease Automated-alert and Response System (CIDARS) in 2008. The CIDARS can detect outbreak signals in a timely manner but generates many false-positive signals, especially for diseases with seasonality. We assessed the influence of seasonality on infectious disease outbreak detection performance. Methods Chickenpox surveillance data in Songjiang District, Shanghai were used. The optimized early alert thresholds for chickenpox were selected according to three algorithm evaluation indexes: sensitivity (Se), false alarm rate (FAR), and time to detection (TTD). Performance of selected proper thresholds was assessed by data external to the study period. Results The optimized early alert threshold for chickenpox during the epidemic season was the percentile P65, which demonstrated an Se of 93.33%, FAR of 0%, and TTD of 0 days. The optimized early alert threshold in the nonepidemic season was P50, demonstrating an Se of 100%, FAR of 18.94%, and TTD was 2.5 days. The performance evaluation demonstrated that the use of an optimized threshold adjusted for seasonality could reduce the FAR and shorten the TTD. Conclusions Selection of optimized early alert thresholds based on local infectious disease seasonality could improve the performance of the CIDARS.

Validation of sleep-2-Peak: A smartphone application that can detect fatigue-related changes in reaction times during sleep deprivation.

PubMed

Brunet, Jean-François; Dagenais, Dominique; Therrien, Marc; Gartenberg, Daniel; Forest, Geneviève

2017-08-01

Despite its high sensitivity and validity in the context of sleep loss, the Psychomotor Vigilance Test (PVT) could be improved. The aim of the present study was to validate a new smartphone PVT-type application called sleep-2-Peak (s2P) by determining its ability to assess fatigue-related changes in alertness in a context of extended wakefulness. Short 3-min versions of s2P and of the classic PVT were administered at every even hour during a 35-h total sleep deprivation protocol. In addition, subjective measures of sleepiness were collected. The outcomes on these tests were then compared using Pearson product-moment correlations, t tests, and repeated measures within-groups analyses of variance. The results showed that both tests significantly correlated on all outcome variables, that both significantly distinguished between the alert and sleepy states in the same individual, and that both varied similarly through the sleep deprivation protocol as sleep loss accumulated. All outcome variables on both tests also correlated significantly with the subjective measures of sleepiness. These results suggest that a 3-min version of s2P is a valid tool for differentiating alert from sleepy states and is as sensitive as the PVT for tracking fatigue-related changes during extended wakefulness and sleep loss. Unlike the PVT, s2P does not provide feedback to subjects on each trial. We discuss how this feature of s2P raises the possibility that the performance results measured by s2P could be less impacted by motivational confounds, giving this tool added value in particular clinical and/or research settings.

Look Closer: The Alertness of People with Profound Intellectual and Multiple Disabilities during Multi-Sensory Storytelling, a Time Sequential Analysis

ERIC Educational Resources Information Center

Ten Brug, Annet; Munde, Vera S.; van der Putten, Annette A.J.; Vlaskamp, Carla

2015-01-01

Introduction: Multi-sensory storytelling (MSST) is a storytelling method designed for individuals with profound intellectual and multiple disabilities (PIMD). It is essential that listeners be alert during MSST, so that they become familiar with their personalised stories. Repetition and the presentation of stimuli are likely to affect the…

Nowcasting and assessing thunderstorm risk on the Lombardy region (Italy)

NASA Astrophysics Data System (ADS)

Bonelli, P.; Marcacci, P.; Bertolotti, E.; Collino, E.; Stella, G.

2011-06-01

The problem of severe thunderstorm risk in the Lombardy region (Italy) is serious. In fact during the warm season many thunderstorms (TS) occur in high density populated area located between the river Po and the Alps. In the year 2003, about 90 TS caused damage to people, houses, cars, agriculture and electrical lines. About 30 municipalities undergo damage by tornadoes. The 2003 summer was not particularly anomalous with respect to others for TS activity. In this region storms are well detected by some C-band radars and the Meteosat satellites, but the study of the correlation between these variables and the TS severity needs the collection of many met-data at the ground. Unfortunately the lack of a fine mesh met-station network forces the use of local press news or subjective reports to identify the impact of TS. Since 2006 ERSE has been collaborating with the Lombardy Region - Civil Protection Service/Office - in developing and testing a system to detect and nowcast severe thunderstorms, STAF (Storm Track Alert and Forecast). STAF is a nowcasting tool based on Radar and MSG (Meteosat Second Generation) data that selects only severe TS, tracks them and produces alert messages to users. In order to evaluate the severity of a TS, a crucial issue for STAF is the correlation between variables detected by the remote-sensing instruments and the effects at the ground. The paper describes a method to classify the severity of a TS by computing an index named "probability of damage" (PD). The index has been carried out by means of a storm archive, where radar and satellite data are stored together with damages reports from newspapers, all collected in 2003 summer. The index has been verified during the 2009 summer, when STAF was applied in a field test involving a group of Civil Protection observers and users. The results of this test are reported in the paper. The test has been also an occasion for verifying the effectiveness of information provided by STAF to selected people locally responsible for public alert and rescue in the case of a severe weather event.

Real-time Automated Sampling of Electronic Medical Records Predicts Hospital Mortality

PubMed Central

Khurana, Hargobind S.; Groves, Robert H.; Simons, Michael P.; Martin, Mary; Stoffer, Brenda; Kou, Sherri; Gerkin, Richard; Reiman, Eric; Parthasarathy, Sairam

2016-01-01

Background Real-time automated continuous sampling of electronic medical record data may expeditiously identify patients at risk for death and enable prompt life-saving interventions. We hypothesized that a real-time electronic medical record-based alert could identify hospitalized patients at risk for mortality. Methods An automated alert was developed and implemented to continuously sample electronic medical record data and trigger when at least two of four systemic inflammatory response syndrome criteria plus at least one of 14 acute organ dysfunction parameters was detected. The SIRS/OD alert was applied real-time to 312,214 patients in 24 hospitals and analyzed in two phases: training and validation datasets. Results In the training phase, 29,317 (18.8%) triggered the alert and 5.2% of such patients died whereas only 0.2% without the alert died (unadjusted odds ratio 30.1; 95% confidence interval [95%CI] 26.1, 34.5; P<0.0001). In the validation phase, the sensitivity, specificity, area under curve (AUC), positive and negative likelihood ratios for predicting mortality were 0.86, 0.82, 0.84, 4.9, and 0.16, respectively. Multivariate Cox-proportional hazard regression model revealed greater hospital mortality when the alert was triggered (adjusted Hazards Ratio 4.0; 95%CI 3.3, 4.9; P<0.0001). Triggering the alert was associated with additional hospitalization days (+3.0 days) and ventilator days (+1.6 days; P<0.0001). Conclusion An automated alert system that continuously samples electronic medical record-data can be implemented, has excellent test characteristics, and can assist in the real-time identification of hospitalized patients at risk for death. PMID:27019043

A Retrospective Study on Patient Characteristics and Telehealth Alerts Indicative of Key Medical Events for Heart Failure Patients at a Home Health Agency

PubMed Central

Bowles, Kathryn; Hanlon, Alexandra; Topaz, Maxim; Chittams, Jesse

2013-01-01

Abstract Objective: To explore association of patient characteristics and telehealth alert data with all-cause key medical events (KMEs) of emergency department (ED) visits and hospitalizations as well as cardiac-related KMEs of ED visits, hospitalizations, and medication changes. Materials and Methods: A 6-month retrospective study was conducted of electronic patient records of heart failure (HF) patients using telehealth services at a Massachusetts home health agency. Data collected included patient demographic, psychosocial, disease severity factors and telehealth vital signs alerts. Association between patient characteristics and KMEs was analyzed by Generalized Estimating Equations. Results: The sample comprised 168 patients with a mean age of 83 years, 56% females, and 96% white. Ninety-nine cardiac-related KMEs and 87 all-cause KMEs were recorded for the subjects. Odds of a cardiac-related KME increased by 161% with the presence of valvular co-morbidity (p=0.001) and 106% with increased number of telehealth alerts (adjusted p<0.0001). Odds of an all-cause KME increased by 124% (p=0.02), 127% (p=0.01), and 70% (adjusted p<0.0001) with the presence of cancer co-morbidity, anxiety, and increased number of telehealth alerts, respectively. Overall, only 3% of all telehealth alerts were associated with KMEs. Conclusions: The very low proportion of telehealth vital sign alerts associated with KMEs indicates that telehealth alerts alone cannot inform the need for intervention within the larger context of HF care delivery in the homecare setting. Patient-relevant data such as psychosocial and symptom status, involvement with HF self-management, and presence of co-morbidities could further inform the need for interventions for HF patients in the homecare setting. PMID:23808888

Automated Critical Test Result Notification System: Architecture, Design, and Assessment of Provider Satisfaction

PubMed Central

Lacson, Ronilda; O'Connor, Stacy D.; Andriole, Katherine P.; Prevedello, Luciano M.; Khorasani, Ramin

2015-01-01

OBJECTIVE Communicating critical results of diagnostic imaging procedures is a national patient safety goal. The purposes of this study were to describe the system architecture and design of Alert Notification of Critical Results (ANCR), an automated system designed to facilitate communication of critical imaging results between care providers; to report providers’ satisfaction with ANCR; and to compare radiologists’ and ordering providers’ attitudes toward ANCR. MATERIALS AND METHODS The design decisions made for each step in the alert communication process, which includes user authentication, alert creation, alert communication, alert acknowledgment and management, alert reminder and escalation, and alert documentation, are described. To assess attitudes toward ANCR, internally developed and validated surveys were administered to all radiologists (n = 320) and ordering providers (n = 4323) who sent or received alerts 3 years after ANCR implementation. RESULTS The survey response rates were 50.4% for radiologists and 36.1% for ordering providers. Ordering providers were generally dissatisfied with the training received for use of ANCR and with access to technical support. Radiologists were more satisfied with documenting critical result communication (61.1% vs 43.2%; p = 0.0001) and tracking critical results (51.6% vs 35.1%; p = 0.0003) than were ordering providers. Both groups agreed use of ANCR reduces medical errors and improves the quality of patient care. CONCLUSION Use of ANCR enables automated communication of critical test results. The survey results confirm overall provider satisfaction with ANCR but highlight the need for improved training strategies for large numbers of geographically dispersed ordering providers. Future enhancements beyond acknowledging receipt of critical results are needed to help ensure timely and appropriate follow-up of critical results to improve quality and patient safety. PMID:25341163

Use of a Clinical Decision Support System Alert to Prevent Supratherapeutic Vancomycin Concentrations

PubMed Central

Ralph, Rachel; Patel, Jean A.; Postelnick, Michael; Ziauddin, Salma; Flis, Weronika; Galal, Audrey N.

2014-01-01

Background: Alerts issued by clinical decision support systems (CDSS) may be useful to identify and prevent the occurrence of acute kidney injury among patients on nephrotoxic drugs, particularly vancomycin. Objective: The purpose of this instructive study was to determine the effectiveness of using a pharmacist-run CDSS alert of early serum creatinine increases in patients receiving intravenous vancomycin to decrease the proportion of severely elevated vancomycin concentrations. Methods: This was a retrospective study of a prospectively reviewed CDSS alert that triggered in patients with an increase in serum creatinine by 25% from baseline within 24 hours. Severely elevated vancomycin concentrations were divided into a control group (before alert implementation) and a study group (after alert implementation) and considered for study inclusion. The proportion of severely elevated vancomycin concentrations (ie, >30 mg/L) were collected in the control and study groups. Results: There were 1290 and 1501 vancomycin concentrations in the control group and the study group, respectively. A total of 696 CDSS alerts triggered during the study period. The proportion of severely elevated vancomycin troughs decreased from 5.3% (n = 68, median = 36.6 mg/L, interquartile range = 33.75-43.2 mg/L) in the control group to 3.7% (n = 55, median = 34.7 mg/L, interquartile range = 31.3-39.3 mg/L) in the study group. This reflects a statistically significant decrease in the proportion of severely elevated vancomycin concentrations (P = .04). Conclusion: Overall, this instructive analysis on a novel use of CDSS software suggests that the implementation of an alert based on early detection of serum creatinine changes led to a significant decrease in the proportion of severely elevated serum vancomycin concentrations.

Weak central coherence in weight-restored adolescent anorexia nervosa: Characteristics and remediation.

PubMed

Weinbach, Noam; Perry, Amit; Sher, Helene; Lock, James D; Henik, Avishai

2017-08-01

Weak central coherence (WCC) refers to a bias towards processing details (local processing) at the expense of paying attention to the bigger picture (global processing). Multiple studies reported WCC in adults with anorexia nervosa (AN). Evidence for WCC in adolescents with AN has been inconsistent. The current study characterizes WCC in weight-restored adolescents with AN (WR-AN) using a direct measure of WCC, and examines whether WCC can be remediated by increasing alertness level-a manipulation that was found useful in enhancing global processing in healthy individuals and clinical populations. 40 adolescents (18 WR-AN and 22 healthy adolescents) performed a global/local processing task (Navon task). Auditory alerting cues that elevate alertness level were integrated into the task. Both groups processed global information faster than local information. However, compared with controls, adolescents with WR-AN were better at ignoring an irrelevant bigger picture while attending to details (smaller global interference) and had greater difficulty ignoring irrelevant details while attending to the bigger picture (larger local interference). These differences were attenuated when adolescents with WR-AN were under a state of high alertness. Additionally, the local interference effect was positively correlated with three independent self-report questionnaires assessing eating disorders symptomatology. This study suggests that abnormal interference by irrelevant global and local information is a central characteristic of WCC in adolescents with WR-AN that cannot be accounted for by enduring illness or malnourishment. Additionally, this study demonstrates that WCC can be temporarily remediated by encouraging a state of high alertness. © 2017 Wiley Periodicals, Inc.

Sleep and alertness in North Sea helicopter operations.

PubMed

Simons, Ries; Wilschut, Ellen S; Valk, Pierre J L

2011-07-01

Dutch North Sea helicopter operations are characterized by multiple sector flights to offshore platforms under difficult environmental conditions. In the context of a Ministry of Transport program to improve safety levels of helicopter operations, we assessed effects of pre-duty sleep, pre-duty travel time, and workload factors on the alertness and vigilance of pilots. Data of 24 pilots comprising 224 duty days were analyzed. Pilots performed 10-min test sessions after wake up, pre-duty, halfway-duty, end-duty, and at bedtime during normal duty rosters. Test sessions included completion of a vigilance task, vigor and sleepiness ratings, and questions on sleep and operational characteristics. Pilots wore an actometer to objectify sleep data. Vigor scores were high and sleepiness levels were low during the entire flight duty periods (FDPs), while vigilance was impaired only 6.8% in the course of the FDPs. Pre-duty sleep before morning duties was 1.5 h shorter than sleep before duties starting after midday. Longer pre-duty travel time was correlated with shorter pre-duty sleep and lower vigilance levels during duty. During the FDPs, pilots maintained alertness and vigilance levels that may be considered safe in terms of alertness-related flight safety. This favorable outcome may be attributed to reasonable length of FDPs, favorable circadian start and end times of duties, sufficient opportunities for restorative pre-duty sleep, and relatively good weather conditions. Appropriate FDP scheduling is an important measure to optimize alertness of helicopter pilots who have to cope with adverse environmental conditions and limited landing and air traffic control facilities.

Aircraft Conflict Analysis and Real-Time Conflict Probing Using Probabilistic Trajectory Modeling

NASA Technical Reports Server (NTRS)

Yang, Lee C.; Kuchar, James K.

2000-01-01

Methods for maintaining separation between aircraft in the current airspace system have been built from a foundation of structured routes and evolved procedures. However, as the airspace becomes more congested and the chance of failures or operational error become more problematic, automated conflict alerting systems have been proposed to help provide decision support and to serve as traffic monitoring aids. The problem of conflict detection and resolution has been tackled from a number of different ways, but in this thesis, it is recast as a problem of prediction in the presence of uncertainties. Much of the focus is concentrated on the errors and uncertainties from the working trajectory model used to estimate future aircraft positions. The more accurate the prediction, the more likely an ideal (no false alarms, no missed detections) alerting system can be designed. Additional insights into the problem were brought forth by a review of current operational and developmental approaches found in the literature. An iterative, trial and error approach to threshold design was identified. When examined from a probabilistic perspective, the threshold parameters were found to be a surrogate to probabilistic performance measures. To overcome the limitations in the current iterative design method, a new direct approach is presented where the performance measures are directly computed and used to perform the alerting decisions. The methodology is shown to handle complex encounter situations (3-D, multi-aircraft, multi-intent, with uncertainties) with relative ease. Utilizing a Monte Carlo approach, a method was devised to perform the probabilistic computations in near realtime. Not only does this greatly increase the method's potential as an analytical tool, but it also opens up the possibility for use as a real-time conflict alerting probe. A prototype alerting logic was developed and has been utilized in several NASA Ames Research Center experimental studies.

Is intra-bladder pressure measurement a reliable indicator for raised intra-abdominal pressure? A prospective comparative study.

PubMed

Al-Abassi, Abdulla Ahmed; Al Saadi, Azan Saleh; Ahmed, Faisal

2018-06-19

Intra-abdominal pressure (IAP) can be measured by several indirect methods; however, the urinary bladder is largely preferred. The aim of this study was to compare intra-bladder pressure (IBP) at different levels of IAPs and assess its reliability as an indirect method for IAP measurement. We compared IBP with IAP in twenty-one patients undergoing laparoscopic cholecystectomy under general anesthesia. Measurements were recorded at increasing levels of insufflation pressures to approximately 22 mmHg. Pearson's correlation coefficient was calculated to establish the relationship between the two pressure measurements and Bland-Altman analysis was used to assess the limits of agreement between the two methods of measurements. The urinary bladder pressures reflected well the pressures in the abdominal cavity. Pearson correlation coefficient showed a good correlation between the two measurement techniques (r = 0.966, p < 0.0001) and Bland-Altman analysis indicated that the 95% limits of agreement between the two methods ranged from - 2.83 to 2.64. This range is accepted both clinically and according to the recommendations of the World Society of Abdominal Compartment Syndrome (WSACS). Our study showed that IBP measurement is a simple, minimally invasive method that may reliably estimates IAP in patients placed in supine position. Measurements for pressures higher than 12 mmHg may be less reliable. When applied clinically, this should alert the clinician to take safety measures to avoid abdominal compartment syndrome (ACS).

Reduced Effectiveness of Interruptive Drug-Drug Interaction Alerts after Conversion to a Commercial Electronic Health Record.

PubMed

Wright, Adam; Aaron, Skye; Seger, Diane L; Samal, Lipika; Schiff, Gordon D; Bates, David W

2018-05-15

Drug-drug interaction (DDI) alerts in electronic health records (EHRs) can help prevent adverse drug events, but such alerts are frequently overridden, raising concerns about their clinical usefulness and contribution to alert fatigue. To study the effect of conversion to a commercial EHR on DDI alert and acceptance rates. Two before-and-after studies. 3277 clinicians who received a DDI alert in the outpatient setting. Introduction of a new, commercial EHR and subsequent adjustment of DDI alerting criteria. Alert burden and proportion of alerts accepted. Overall interruptive DDI alert burden increased by a factor of 6 from the legacy EHR to the commercial EHR. The acceptance rate for the most severe alerts fell from 100 to 8.4%, and from 29.3 to 7.5% for medium severity alerts (P < 0.001). After disabling the least severe alerts, total DDI alert burden fell by 50.5%, and acceptance of Tier 1 alerts rose from 9.1 to 12.7% (P < 0.01). Changing from a highly tailored DDI alerting system to a more general one as part of an EHR conversion decreased acceptance of DDI alerts and increased alert burden on users. The decrease in acceptance rates cannot be fully explained by differences in the clinical knowledge base, nor can it be fully explained by alert fatigue associated with increased alert burden. Instead, workflow factors probably predominate, including timing of alerts in the prescribing process, lack of differentiation of more and less severe alerts, and features of how users interact with alerts.

The Diagnostic Utility of Bact/ALERT and Nested PCR in the Diagnosis of Tuberculous Meningitis.

PubMed

Sastry, Apurba Sankar; Bhat K, Sandhya; Kumudavathi

2013-01-01

The early laboratory diagnosis of Tuberculous Meningitis (TBM) is crucial, to start the antitubercular chemotherapy and to prevent its complications. However, the conventional methods are either less sensitive or time consuming. Hence, the diagnostic potentials of BacT/ALERT and Polymerase Chain Reaction (PCR) was evaluated in this study. The study group comprised of 62 cases and 33 controls. The cases were divided according to Ahuja's criteria into the confirmed (two cases), highly probable (19 cases), probable (26 cases) and the possible (15 cases) subgroups. Ziehl Neelsen's (ZN) and Auramine Phenol (AP) staining, Lowenstein Jensen (LJ) medium culture, BacT/ALERT and nested Polymerase Chain Reaction (PCR) which targeted IS6110 were carried out on all the patients. The sensitivity of the LJ culture was 3.22%. BacT/ALERT showed a sensitivity and a specificity of 25.80% and 100% and those of nested PCR were found to be 40.32% and 96.97% respectively. The mean detection time of growth of the LJ culture was 31.28 days, whereas that of BacT/ALERT was 20.68 days. The contamination rate in the LJ culture and BacT/ALERT were 7.2% and 5.8% respectively. Nested PCR was found to be more sensitive, followed by BacT/ALERT as compared to the LJ culture and smear microscopy. As both false negative and false positive results have been reported for nested PCR, so it should not be used alone as a criterion for initiating or terminating the therapy, but it should be supported by clinical, radiological, cytological and other microbiological findings.

Physician response to a medication alert system in inpatients with levodopa-treated diseases

PubMed Central

Morris, Marie; Willis, Allison W.; Searles Nielsen, Susan; McCann, Franklin; Birke, Angela

2015-01-01

Objective: To evaluate the appropriateness of dopamine receptor antagonist prescriptions in hospitalized patients with dopamine-requiring diseases after implementation of an automated prescription alert system. Methods: We examined dopamine receptor antagonist prescriptions in hospitalized patients with dopamine-requiring diseases and physician response to an automated drug contraindication alert system at Barnes-Jewish Hospital from 2009 to 2013. A detailed review of patient medical records was performed for all alert events generated when a physician prescribed a dopamine receptor antagonist concurrently with a dopamine receptor agonist in hospitalized patients. Two movement disorders neurologists determined the appropriateness of each prescription, based on patient medical history, through consensus. Physician response to alert was compared by indication for the prescription and physician specialty. Results: Of 237 orders, 197 (83.1%) prescriptions for dopamine receptor antagonists were considered inappropriate. The prevalence of inappropriate dopamine receptor antagonist prescriptions per levodopa prescriptions was 16.10% (95% confidence interval 9.47, 22.73) in psychiatry, 7.51% (6.16, 8.86) in general medicine, 6.14% (4.49, 7.79) in the surgical specialties, and 0.85% (0.46, 1.25) in the neurologic/neurosurgical specialties. Of the inappropriate prescriptions, 146 (74.1%) were continued despite the alert. The strongest predictor of discontinuation of dopamine receptor antagonist medications was use of the medication to treat nausea or emesis (p < 0.001). Conclusions: Despite successfully identifying instances when dopamine antagonists were prescribed to patients with dopamine-requiring diseases, the alert system modestly affected physician prescribing behavior, highlighting the need for improved education of health care providers. PMID:26092916

INITIATE: An Intelligent Adaptive Alert Environment.

PubMed

Jafarpour, Borna; Abidi, Samina Raza; Ahmad, Ahmad Marwan; Abidi, Syed Sibte Raza

2015-01-01

Exposure to a large volume of alerts generated by medical Alert Generating Systems (AGS) such as drug-drug interaction softwares or clinical decision support systems over-whelms users and causes alert fatigue in them. Some of alert fatigue effects are ignoring crucial alerts and longer response times. A common approach to avoid alert fatigue is to devise mechanisms in AGS to stop them from generating alerts that are deemed irrelevant. In this paper, we present a novel framework called INITIATE: an INtellIgent adapTIve AlerT Environment to avoid alert fatigue by managing alerts generated by one or more AGS. We have identified and categories the lifecycle of different alerts and have developed alert management logic as per the alerts' lifecycle. Our framework incorporates an ontology that represents the alert management strategy and an alert management engine that executes this strategy. Our alert management framework offers the following features: (1) Adaptability based on users' feedback; (2) Personalization and aggregation of messages; and (3) Connection to Electronic Medical Records by implementing a HL7 Clinical Document Architecture parser.

Attentional networks in developmental dyscalculia

PubMed Central

2010-01-01

Background Very little is known about attention deficits in developmental dyscalculia, hence, this study was designed to provide the missing information. We examined attention abilities of participants suffering from developmental dyscalculia using the attention networks test - interactions. This test was designed to examine three different attention networks--executive function, orienting and alerting--and the interactions between them. Methods Fourteen university students that were diagnosed as suffering from developmental dyscalculia--intelligence and reading abilities in the normal range and no indication of attention-deficit hyperactivity disorder--and 14 matched controls were tested using the attention networks test - interactions. All participants were given preliminary tests to measure mathematical abilities, reading, attention and intelligence. Results The results revealed deficits in the alerting network--a larger alerting effect--and in the executive function networks--a larger congruity effect in developmental dyscalculia participants. The interaction between the alerting and executive function networks was also modulated by group. In addition, developmental dyscalculia participants were slower to respond in the non-cued conditions. Conclusions These results imply specific attentional deficits in pure developmental dyscalculia. Namely, those with developmental dyscalculia seem to be deficient in the executive function and alertness networks. They suffer from difficulty in recruiting attention, in addition to the deficits in numerical processing. PMID:20157427

Decreased human circadian pacemaker influence after 100 days in space: a case study

NASA Technical Reports Server (NTRS)

Monk, T. H.; Kennedy, K. S.; Rose, L. R.; Linenger, J. M.

2001-01-01

OBJECTIVE: The objectives of this study were (1) to assess the circadian rhythms and sleep of a healthy, 42-year-old male astronaut experiencing microgravity (weightlessness) for nearly 5 months while living aboard Space Station Mir as it orbited Earth and (2) to determine the effects of prolonged space flight on the endogenous circadian pacemaker, as indicated by oral temperature and subjective alertness rhythms, and their ramifications for sleep, alertness, and performance. METHODS: For three 12- to 14-day blocks of time (spread throughout the mission), oral temperatures were taken and subjective alertness was self-rated five times per day. Sleep diaries and performance tests were also completed daily during each block. RESULTS: Examination of the subject's circadian alertness and oral temperature rhythms suggested that the endogenous circadian pacemaker seemed to function quite well up to 90 days in space. Thereafter (on days 110-122), the influence of the endogenous circadian pacemaker on oral temperature and subjective alertness circadian rhythms was considerably weakened, with consequent disruptions in sleep. CONCLUSIONS: Space missions lasting more than 3 months might result in diminished circadian pacemaker influence in astronauts, leading to eventual sleep problems.

The Study of Biobehavioral Rhythms in a Psychology Laboratory Course.

ERIC Educational Resources Information Center

Rowland, David L.; Wesselhoft, Theresa

1998-01-01

Reports on a laboratory experiment where students measured their heart rate, blood pressure, mood, alertness, and cognitive performance. Measures showed significant circadian heart rhythm variations. They were strongly correlated and peaked at different times. Discusses the implications of this and students' reactions to the experiment. (MJP)

Improving Service Management in Campus IT Operations

ERIC Educational Resources Information Center

Wan, Stewart H. C.; Chan, Yuk-Hee

2008-01-01

Purpose: This paper aims at presenting the benefits from implementing IT service management (ITSM) in an organization for managing campus-wide IT operations. In order to improve the fault correlation from business perspectives, we proposed a framework to automate network and system alerts with respect to its business service impact for proactive…

Dengue disease surveillance: an updated systematic literature review

PubMed Central

Runge-Ranzinger, S; McCall, P J; Kroeger, A; Horstick, O

2014-01-01

Objectives To review the evidence for the application of tools for dengue outbreak prediction/detection and trend monitoring in passive and active disease surveillance systems in order to develop recommendations for endemic countries and identify important research needs. Methods This systematic literature review followed the protocol of a review from 2008, extending the systematic search from January 2007 to February 2013 on PubMed, EMBASE, CDSR, WHOLIS and Lilacs. Data reporting followed the PRISMA statement. The eligibility criteria comprised (i) population at risk of dengue, (ii) dengue disease surveillance, (iii) outcome of surveillance described and (iv) empirical data evaluated. The analysis classified studies based on the purpose of the surveillance programme. The main limitation of the review was expected publication bias. Results A total of 1116 papers were identified of which 36 articles were included in the review. Four cohort-based prospective studies calculated expansion factors demonstrating remarkable levels of underreporting in the surveillance systems. Several studies demonstrated that enhancement methods such as laboratory support, sentinel-based reporting and staff motivation contributed to improvements in dengue reporting. Additional improvements for passive surveillance systems are possible by incorporating simple data forms/entry/electronic-based reporting; defining clear system objectives; performing data analysis at the lowest possible level (e.g. district); seeking regular data feedback. Six studies showed that serotype changes were positively correlated with the number of reported cases or with dengue incidence, with lag times of up to 6 months. Three studies found that data on internet searches and event-based surveillance correlated well with the epidemic curve derived from surveillance data. Conclusions Passive surveillance providing the baseline for outbreak alert should be strengthened and appropriate threshold levels for outbreak alerts investigated. Additional enhancement tools such as syndromic surveillance, laboratory support and motivation strategies can be added. Appropriate alert signals need to be identified and integrated into a risk assessment tool. Shifts in dengue serotypes/genotype or electronic event-based surveillance have also considerable potential as indicator in dengue surveillance. Further research on evidence-based response strategies and cost-effectiveness is needed. Objectifs Analyser les résultats de l'application d'outils pour la prédiction/détection des épidémies de dengue et la surveillance des tendances dans les systèmes de surveillance active et passive des maladies, afin d’élaborer des recommandations pour les pays endémiques et identifier les besoins importants de recherche. PMID:24889501

Performance of the BacT Alert 3D System Versus Solid Media for Recovery and Drug Susceptibility Testing of Mycobacterium tuberculosis in a Tertiary Hospital in Korea.

PubMed

Kim, Seoung-Cheol; Jeon, Bo-Young; Kim, Jin-Sook; Choi, In Hwan; Kim, Jiro; Woo, Jeongim; Kim, Soojin; Lee, Hyeong Woo; Sezim, Monoldorova; Cho, Sang-Nae

2016-10-01

Tuberculosis (TB) is a major health problem, and accurate and rapid diagnosis of multidrug-resistant (MDR) and extended drug-resistant (XDR) TB is important for appropriate treatment. In this study, performances of solid and liquid culture methods were compared with respect to MDR- and XDR-TB isolate recovery and drug susceptibility testing. Sputum specimens from 304 patients were stained with Ziehl-Neelsen method. Mycobacterium tuberculosis (Mtb) isolates were tested for recovery on Löwenstein-Jensen (LJ) medium and the BacT Alert 3D system. For drug susceptibility testing of Mtb, isolates were evaluated on M-KIT plates and the BacT Alert 3D system. The recovery rates were 94.9% (206/217) and 98.2% (213/217) for LJ medium and the BacT Alert 3D system, respectively (kappa coefficient, 0.884). The rate of drug resistance was 13.4% for at least one or more drugs, 6.0% for MDR-TB and 2.3% for XDR-TB. M-KIT plate and BacT 3D Alert 3D system were comparable in drug susceptibility testing for isoniazid (97.7%; kappa coefficient, 0.905) and rifampin (98.6%; kappa coefficient, 0.907). Antibiotic resistance was observed using M-KIT plates for 24 of the total 29 Mtb isolates (82.8%). The liquid culture system showed greater reduction in the culture period, as compared with LJ medium; however, drug susceptibility testing using M-KIT plates was advantageous for simultaneous testing against multiple drug targets.

Analysis of clinical decision support system malfunctions: a case series and survey

PubMed Central

Wright, Adam; Hickman, Thu-Trang T; McEvoy, Dustin; Aaron, Skye; Ai, Angela; Andersen, Jan Marie; Hussain, Salman; Ramoni, Rachel; Fiskio, Julie; Sittig, Dean F; Bates, David W

2016-01-01

Objective To illustrate ways in which clinical decision support systems (CDSSs) malfunction and identify patterns of such malfunctions. Materials and Methods We identified and investigated several CDSS malfunctions at Brigham and Women’s Hospital and present them as a case series. We also conducted a preliminary survey of Chief Medical Information Officers to assess the frequency of such malfunctions. Results We identified four CDSS malfunctions at Brigham and Women’s Hospital: (1) an alert for monitoring thyroid function in patients receiving amiodarone stopped working when an internal identifier for amiodarone was changed in another system; (2) an alert for lead screening for children stopped working when the rule was inadvertently edited; (3) a software upgrade of the electronic health record software caused numerous spurious alerts to fire; and (4) a malfunction in an external drug classification system caused an alert to inappropriately suggest antiplatelet drugs, such as aspirin, for patients already taking one. We found that 93% of the Chief Medical Information Officers who responded to our survey had experienced at least one CDSS malfunction, and two-thirds experienced malfunctions at least annually. Discussion CDSS malfunctions are widespread and often persist for long periods. The failure of alerts to fire is particularly difficult to detect. A range of causes, including changes in codes and fields, software upgrades, inadvertent disabling or editing of rules, and malfunctions of external systems commonly contribute to CDSS malfunctions, and current approaches for preventing and detecting such malfunctions are inadequate. Conclusion CDSS malfunctions occur commonly and often go undetected. Better methods are needed to prevent and detect these malfunctions. PMID:27026616

The effects of spectral tuning of evening ambient light on melatonin suppression, alertness and sleep.

PubMed

Rahman, Shadab A; St Hilaire, Melissa A; Lockley, Steven W

2017-08-01

We compared the effects of bedroom-intensity light from a standard fluorescent and a blue- (i.e., short-wavelength) depleted LED source on melatonin suppression, alertness, and sleep. Sixteen healthy participants (8 females) completed a 4-day inpatient study. Participants were exposed to blue-depleted circadian-sensitive (C-LED) light and a standard fluorescent light (FL, 4100K) of equal illuminance (50lx) for 8h prior to a fixed bedtime on two separate days in a within-subject, randomized, cross-over design. Each light exposure day was preceded by a dim light (<3lx) control at the same time 24h earlier. Compared to the FL condition, control-adjusted melatonin suppression was significantly reduced. Although subjective sleepiness was not different between the two light conditions, auditory reaction times were significantly slower under C-LED conditions compared to FL 30min prior to bedtime. EEG-based correlates of alertness corroborated the reduced alertness under C-LED conditions as shown by significantly increased EEG spectral power in the delta-theta (0.5-8.0Hz) bands under C-LED as compared to FL exposure. There was no significant difference in total sleep time (TST), sleep efficiency (SE%), and slow-wave activity (SWA) between the two conditions. Unlike melatonin suppression and alertness, a significant order effect was observed on all three sleep variables, however. Individuals who received C-LED first and then FL had increased TST, SE% and SWA averaged across both nights compared to individuals who received FL first and then C-LED. These data show that the spectral characteristics of light can be fine-tuned to attenuate non-visual responses to light in humans. Copyright © 2017 Elsevier Inc. All rights reserved.

Lack of utility of a decision support system to mitigate delays in admission from the operating room to the postanesthesia care unit.

PubMed

Ehrenfeld, Jesse M; Dexter, Franklin; Rothman, Brian S; Minton, Betty Sue; Johnson, Diane; Sandberg, Warren S; Epstein, Richard H

2013-12-01

When the phase I postanesthesia care unit (PACU) is at capacity, completed cases need to be held in the operating room (OR), causing a "PACU delay." Statistical methods based on historical data can optimize PACU staffing to achieve the least possible labor cost at a given service level. A decision support process to alert PACU charge nurses that the PACU is at or near maximum census might be effective in lessening the incidence of delays and reducing over-utilized OR time, but only if alerts are timely (i.e., neither too late nor too early to act upon) and the PACU slot can be cleared quickly. We evaluated the maximum potential benefit of such a system, using assumptions deliberately biased toward showing utility. We extracted 3 years of electronic PACU data from a tertiary care medical center. At this hospital, PACU admissions were limited by neither inadequate PACU staffing nor insufficient PACU beds. We developed a model decision support system that simulated alerts to the PACU charge nurse. PACU census levels were reconstructed from the data at a 1-minute level of resolution and used to evaluate if subsequent delays would have been prevented by such alerts. The model assumed there was always a patient ready for discharge and an available hospital bed. The time from each alert until the maximum census was exceeded ("alert lead time") was determined. Alerts were judged to have utility if the alert lead time fell between various intervals from 15 or 30 minutes to 60, 75, or 90 minutes after triggering. In addition, utility for reducing over-utilized OR time was assessed using the model by determining if 2 patients arrived from 5 to 15 minutes of each other when the PACU census was at 1 patient less than the maximum census. At most, 23% of alerts arrived 30 to 60 minutes prior to the admission that resulted in the PACU exceeding the specified maximum capacity. When the notification window was extended to 15 to 90 minutes, the maximum utility was <50%. At most, 45% of alerts potentially would have resulted in reassigning the last available PACU slot to 1 OR versus another within 15 minutes of the original assignment. Despite multiple biases that favored effectiveness, the maximum potential benefit of a decision support system to mitigate PACU delays on the day on the surgery was below the 70% minimum threshold for utility of automated decision support messages, previously established via meta-analysis. Neither reduction in PACU delays nor reassigning promised PACU slots based on reducing over-utilized OR time were realized sufficiently to warrant further development of the system. Based on these results, the only evidence-based method of reducing PACU delays is to adjust PACU staffing and staff scheduling using computational algorithms to match the historical workload (e.g., as developed in 2001).

Sleep and Alertness in Medical Interns and Residents: An Observational Study on the Role of Extended Shifts

PubMed Central

Dinges, David F.; Shea, Judy A.; Small, Dylan S.; Zhu, Jingsan; Norton, Laurie; Ecker, Adrian J.; Novak, Cristina; Bellini, Lisa M.; Volpp, Kevin G.

2017-01-01

Abstract Study Objectives: Fatigue from sleep loss is a risk to physician and patient safety, but objective data on physician sleep and alertness on different duty hour schedules is scarce. This study objectively quantified differences in sleep duration and alertness between medical interns working extended overnight shifts and residents not or rarely working extended overnight shifts. Methods: Sleep–wake activity of 137 interns and 87 PGY-2/3 residents on 2-week Internal Medicine and Oncology rotations was assessed with wrist-actigraphy. Alertness was assessed daily with a brief Psychomotor Vigilance Test (PVT) and the Karolinska Sleepiness Scale. Results: Interns averaged 6.93 hours (95% confidence interval [CI] 6.84–7.03 hours) sleep per 24 hours across shifts, significantly less than residents not working overnight shifts (7.18 hours, 95% CI 7.06–7.30 hours, p = .007). Interns obtained on average 2.19 hours (95% CI 2.02–2.36 hours) sleep during on-call nights (17.5% obtained no sleep). Alertness was significantly lower on mornings after on-call nights compared to regular shifts (p < .001). Naps between 9 am and 6 pm on the first day post‐call were frequent (90.8%) and averaged 2.84 hours (95% CI 2.69–3.00 hours), but interns still slept 1.66 hours less per 24 hours (95% CI 1.56–1.76 hours) compared to regular shift days (p < .001). Sleep inertia significantly affected alertness in the 60 minutes after waking on-call. Conclusions: Extended overnight shifts increase the likelihood of chronic sleep restriction in interns. Reduced levels of alertness after on-call nights need to be mitigated. A systematic comparison of sleep, alertness, and safety outcomes under current and past duty hour rules is encouraged. PMID:28329124

Potential drug related problems detected by electronic expert support system in patients with multi-dose drug dispensing.

PubMed

Tora, Hammar; Bo, Hovstadius; Bodil, Lidström; Göran, Petersson; Birgit, Eiermann

2014-10-01

Background Drug related problems (DRPs) are frequent and cause suffering for patients and substantial costs for society. Multi-dose drug dispensing (MDDD) is a service by which patients receive their medication packed in bags with one unit for each dose occasion. The clinical decision support system (CDSS) electronic expert support (EES) analyses patients' prescriptions in the Swedish national e-prescription repository and provides alerts if potential DRPs are detected, i.e. drug-drug interactions, duplicate therapy, drug-disease contraindications, high dose, gender warnings, geriatric, and paediatric alerts. Objective To analyse potential DRPs in patients with MDDD, detected by means of EES. Setting A register study of all electronically stored prescriptions for patients with MDDD in Sweden (n = 180,059) March 5-June 5, 2013. Method Drug use and potential DRPs detected in the study population during the 3 month study period by EES were analysed. The potential DRPs were analysed in relation to patients' age, gender, number of drugs, and type of medication. Main outcome measure Prevalence of potential DRPs measured as EES alerts. Results The study population was on average 75.8 years of age (± 17.5, range 1-110) and had 10.0 different medications (± 4.7, range 1-53). EES alerted for potential DRPs in 76 % of the population with a mean of 2.2 alerts per patient (± 2.4, range 0-27). The older patients received a lower number of alerts compared to younger patients despite having a higher number of drugs. The most frequent alert categories were drug-drug interactions (37 % of all alerts), duplicate therapy (30 %), and geriatric warnings for high dose or inappropriate drugs (23 %). Psycholeptics, psychoanaleptics, antithrombotic agents, anti-epileptics, renin-angiotensin system agents, and analgesics represented 71 % of all drugs involved in alerts. Conclusions EES detected potential DRPs in the majority of patients with MDDD. The number of potential DRPs was associated with the number of drugs, age, gender, and type of medication. A CDSS such as EES might be a useful tool for physicians and pharmacists to assist in the important task of monitoring patients with MDDD for potential DRPs.

Improving the Health Forecasting Alert System for Cold Weather and Heat-Waves In England: A Proof-of-Concept Using Temperature-Mortality Relationships.

PubMed

Masato, Giacomo; Bone, Angie; Charlton-Perez, Andrew; Cavany, Sean; Neal, Robert; Dankers, Rutger; Dacre, Helen; Carmichael, Katie; Murray, Virginia

2015-01-01

In this study a prototype of a new health forecasting alert system is developed, which is aligned to the approach used in the Met Office's (MO) National Severe Weather Warning Service (NSWWS). This is in order to improve information available to responders in the health and social care system by linking temperatures more directly to risks of mortality, and developing a system more coherent with other weather alerts. The prototype is compared to the current system in the Cold Weather and Heatwave plans via a case-study approach to verify its potential advantages and shortcomings. The prototype health forecasting alert system introduces an "impact vs likelihood matrix" for the health impacts of hot and cold temperatures which is similar to those used operationally for other weather hazards as part of the NSWWS. The impact axis of this matrix is based on existing epidemiological evidence, which shows an increasing relative risk of death at extremes of outdoor temperature beyond a threshold which can be identified epidemiologically. The likelihood axis is based on a probability measure associated with the temperature forecast. The new method is tested for two case studies (one during summer 2013, one during winter 2013), and compared to the performance of the current alert system. The prototype shows some clear improvements over the current alert system. It allows for a much greater degree of flexibility, provides more detailed regional information about the health risks associated with periods of extreme temperatures, and is more coherent with other weather alerts which may make it easier for front line responders to use. It will require validation and engagement with stakeholders before it can be considered for use.

Effects of dietary tryptophan and phenylalanine-tyrosine depletion on phasic alertness in healthy adults - A pilot study.

PubMed

Hildebrand, Patricia; Königschulte, Werner; Gaber, Tilman Jakob; Bubenzer-Busch, Sarah; Helmbold, Katrin; Biskup, Caroline Sarah; Langen, Karl-Josef; Fink, Gereon Rudolf; Zepf, Florian Daniel

2015-01-01

The synthesis of the neurotransmitters serotonin (5-HT) and dopamine (DA) in the brain can be directly altered by dietary manipulation of their relevant precursor amino acids (AA). There is evidence that altered serotonergic and dopaminergic neurotransmission are both associated with impaired attentional control. Specifically, phasic alertness is one specific aspect of attention that has been linked to changes in 5-HT and DA availability in different neurocircuitries related to attentional processes. The present study investigated the impact of short-term reductions in central nervous system 5-HT and DA synthesis, which was achieved by dietary depletion of the relevant precursor AA, on phasic alertness in healthy adult volunteers; body weight-adapted dietary tryptophan and phenylalanine-tyrosine depletion (PTD) techniques were used. The study employed a double-blind between-subject design. Fifty healthy male and female subjects were allocated to three groups in a randomized and counterbalanced manner and received three different dietary challenge conditions: acute tryptophan depletion (ATD, for the depletion of 5-HT; N=16), PTD (for the depletion of DA; N=17), and a balanced AA load (BAL; N=17), which served as a control condition. Three hours after challenge intake (ATD/PTD/BAL), phasic alertness was assessed using a standardized test battery for attentional performance (TAP). Blood samples for AA level analyses were obtained at baseline and 360 min after the challenge intake. Overall, there were no significant differences in phasic alertness for the different challenge conditions. Regarding PTD administration, a positive correlation between the reaction times and the DA-related depletion magnitude was detected via the lower plasma tyrosine levels and the slow reaction times of the first run of the task. In contrast, higher tryptophan concentrations were associated with slower reaction times in the fourth run of the task in the same challenge group. The present study is the first to demonstrate preliminary data that support an association between decreased central nervous system DA synthesis, which was achieved by dietary depletion strategies, and slower reaction times in specific runs of a task designed to assess phasic alertness in healthy adult volunteers; these findings are consistent with previous evidence that links phasic alertness with dopaminergic neurotransmission. A lack of significant differences between the three groups could be due to compensatory mechanisms and the limited sample size, as well as the dietary challenge procedures administered to healthy participants and the strict exclusion criteria used. The potential underlying neurochemical processes related to phasic alertness should be the subject of further investigations.

Improving the health forecasting alert system for cold weather and heat-waves in England: a case-study approach using temperature-mortality relationships

NASA Astrophysics Data System (ADS)

Masato, Giacomo; Cavany, Sean; Charlton-Perez, Andrew; Dacre, Helen; Bone, Angie; Carmicheal, Katie; Murray, Virginia; Danker, Rutger; Neal, Rob; Sarran, Christophe

2015-04-01

The health forecasting alert system for cold weather and heatwaves currently in use in the Cold Weather and Heatwave plans for England is based on 5 alert levels, with levels 2 and 3 dependent on a forecast or actual single temperature action trigger. Epidemiological evidence indicates that for both heat and cold, the impact on human health is gradual, with worsening impact for more extreme temperatures. The 60% risk of heat and cold forecasts used by the alerts is a rather crude probabilistic measure, which could be substantially improved thanks to the state-of-the-art forecast techniques. In this study a prototype of a new health forecasting alert system is developed, which is aligned to the approach used in the Met Office's (MO) National Severe Weather Warning Service (NSWWS). This is in order to improve information available to responders in the health and social care system by linking temperatures more directly to risks of mortality, and developing a system more coherent with other weather alerts. The prototype is compared to the current system in the Cold Weather and Heatwave plans via a case-study approach to verify its potential advantages and shortcomings. The prototype health forecasting alert system introduces an "impact vs likelihood matrix" for the health impacts of hot and cold temperatures which is similar to those used operationally for other weather hazards as part of the NSWWS. The impact axis of this matrix is based on existing epidemiological evidence, which shows an increasing relative risk of death at extremes of outdoor temperature beyond a threshold which can be identified epidemiologically. The likelihood axis is based on a probability measure associated with the temperature forecast. The new method is tested for two case studies (one during summer 2013, one during winter 2013), and compared to the performance of the current alert system. The prototype shows some clear improvements over the current alert system. It allows for a much greater degree of flexibility, provides more detailed regional information about the health risks associated with periods of extreme temperatures, and is more coherent with other weather alerts which may make it easier for front line responders to use. It will require validation and engagement with stakeholders before it can be considered for use.

Advanced alerting features: displaying new relevant data and retracting alerts.

PubMed Central

Kuperman, G. J.; Hiltz, F. L.; Teich, J. M.

1997-01-01

We added two advanced features to our automated alerting system. The first feature identifies and displays, at the time an alert is reviewed, relevant data filed between the login time of a specimen leading to an alerting result and the time the alert is reviewed. Relevant data is defined as data of the same kind as generated the alert. The other feature retracts alerts when the alerting value is edited and no longer satisfies the alerting criteria. We evaluated the two features for a 14-week period (new relevant data) and a 6-week period (retraction). Of a total of 1104 alerts in the 14-week evaluation, 286 (25.9%) had new relevant data displayed at alert review time. Of the 286, 75.2% were due to additions of comments to the original piece of alerting data; 24.1% were due to new or pending laboratory results of the same type that generated the alert. Two alerts (out of 490) were retracted in a 6 week period. We conclude that in our system, new clinically relevant data is often added between the time of specimen login and the time that an alerting result from that specimen is reviewed. Retractions occur rarely but are important to detect and communicate. PMID:9357625

The use of point-of-sale machines in school cafeterias as a method of parental influence over child lunch food choices.

PubMed

Andrepont, Emmy; Cullen, Karen W; Taylor, Wendell C

2011-05-01

Computerized point-of-sale (POS) machine software that allows parents to place restrictions on their child's school meal accounts is available. Parents could restrict specific foods (eg, chips), identify specific days the child can purchase extra foods, or set monetary limits. This descriptive study examines the use of parental restrictions on student cafeteria POS accounts in a convenience sample of 2 school districts. POS alerts, with student gender, grade, ethnicity, and students' free or reduced-price meal eligibility, were obtained from 2 school food service departments for the 2007-2008 school year. The alerts were coded into 5 categories: financial, medical, restrictions, snacks OK, and extras OK. The distribution of alerts by district, students, and demographics was then tabulated. District A (4839 students) had more students with alerts (n = 789, 16%) than District B (8510 students; n = 217, 2.6%), and 94 District A students had a second alert. District A parents had to provide written permission for their child to purchase snacks (n = 654, 13.5%) and extra meal items (n = 113, 2.3%). Most alerts were for full-pay students in both districts (74% and 66%) and varied by demographics of the students. Few parents actually used this system to limit student purchases of foods outside the school meal. Future studies should investigate the influence of these restrictions on student food choices. © 2011, American School Health Association.

Technologic Distractions (Part 1): Summary of Approaches to Manage Alert Quantity With Intent to Reduce Alert Fatigue and Suggestions for Alert Fatigue Metrics.

PubMed

Kane-Gill, Sandra L; O'Connor, Michael F; Rothschild, Jeffrey M; Selby, Nicholas M; McLean, Barbara; Bonafide, Christopher P; Cvach, Maria M; Hu, Xiao; Konkani, Avinash; Pelter, Michele M; Winters, Bradford D

2017-09-01

To provide ICU clinicians with evidence-based guidance on tested interventions that reduce or prevent alert fatigue within clinical decision support systems. Systematic review of PubMed, Embase, SCOPUS, and CINAHL for relevant literature from 1966 to February 2017. Focus on critically ill patients and included evaluations in other patient care settings, as well. Identified interventions designed to reduce or prevent alert fatigue within clinical decision support systems. Study selection was based on one primary key question to identify effective interventions that attempted to reduce alert fatigue and three secondary key questions that covered the negative effects of alert fatigue, potential unintended consequences of efforts to reduce alert fatigue, and ideal alert quantity. Data were abstracted by two reviewers independently using a standardized abstraction tool. Surveys, meeting abstracts, "gray" literature, studies not available in English, and studies with non-original data were excluded. For the primary key question, articles were excluded if they did not provide a comparator as key question 1 was designed as a problem, intervention, comparison, and outcome question. We anticipated that reduction in alert fatigue, including the concept of desensitization may not be directly measured and thus considered interventions that reduced alert quantity as a surrogate marker for alert fatigue. Twenty-six articles met the inclusion criteria. Approaches for managing alert fatigue in the ICU are provided as a result of reviewing tested interventions that reduced alert quantity with the anticipated effect of reducing fatigue. Suggested alert management strategies include prioritizing alerts, developing sophisticated alerts, customizing commercially available alerts, and including end user opinion in alert selection. Alert fatigue itself is studied less frequently, as an outcome, and there is a need for more precise evaluation. Standardized metrics for alert fatigue is needed to advance the field. Suggestions for standardized metrics are provided in this document.

Medication-related clinical decision support alert overrides in inpatients.

PubMed

Nanji, Karen C; Seger, Diane L; Slight, Sarah P; Amato, Mary G; Beeler, Patrick E; Her, Qoua L; Dalleur, Olivia; Eguale, Tewodros; Wong, Adrian; Silvers, Elizabeth R; Swerdloff, Michael; Hussain, Salman T; Maniam, Nivethietha; Fiskio, Julie M; Dykes, Patricia C; Bates, David W

2018-05-01

To define the types and numbers of inpatient clinical decision support alerts, measure the frequency with which they are overridden, and describe providers' reasons for overriding them and the appropriateness of those reasons. We conducted a cross-sectional study of medication-related clinical decision support alerts over a 3-year period at a 793-bed tertiary-care teaching institution. We measured the rate of alert overrides, the rate of overrides by alert type, the reasons cited for overrides, and the appropriateness of those reasons. Overall, 73.3% of patient allergy, drug-drug interaction, and duplicate drug alerts were overridden, though the rate of overrides varied by alert type (P < .0001). About 60% of overrides were appropriate, and that proportion also varied by alert type (P < .0001). Few overrides of renal- (2.2%) or age-based (26.4%) medication substitutions were appropriate, while most duplicate drug (98%), patient allergy (96.5%), and formulary substitution (82.5%) alerts were appropriate. Despite warnings of potential significant harm, certain categories of alert overrides were inappropriate >75% of the time. The vast majority of duplicate drug, patient allergy, and formulary substitution alerts were appropriate, suggesting that these categories of alerts might be good targets for refinement to reduce alert fatigue. Almost three-quarters of alerts were overridden, and 40% of the overrides were not appropriate. Future research should optimize alert types and frequencies to increase their clinical relevance, reducing alert fatigue so that important alerts are not inappropriately overridden.

Landfast ice thickness in the Canadian Arctic Archipelago from observations and models

NASA Astrophysics Data System (ADS)

Howell, Stephen E. L.; Laliberté, Frédéric; Kwok, Ron; Derksen, Chris; King, Joshua

2016-07-01

Observed and modelled landfast ice thickness variability and trends spanning more than 5 decades within the Canadian Arctic Archipelago (CAA) are summarized. The observed sites (Cambridge Bay, Resolute, Eureka and Alert) represent some of the Arctic's longest records of landfast ice thickness. Observed end-of-winter (maximum) trends of landfast ice thickness (1957-2014) were statistically significant at Cambridge Bay (-4.31 ± 1.4 cm decade-1), Eureka (-4.65 ± 1.7 cm decade-1) and Alert (-4.44 ± 1.6 cm -1) but not at Resolute. Over the 50+-year record, the ice thinned by ˜ 0.24-0.26 m at Cambridge Bay, Eureka and Alert with essentially negligible change at Resolute. Although statistically significant warming in spring and fall was present at all sites, only low correlations between temperature and maximum ice thickness were present; snow depth was found to be more strongly associated with the negative ice thickness trends. Comparison with multi-model simulations from Coupled Model Intercomparison project phase 5 (CMIP5), Ocean Reanalysis Intercomparison (ORA-IP) and Pan-Arctic Ice-Ocean Modeling and Assimilation System (PIOMAS) show that although a subset of current generation models have a "reasonable" climatological representation of landfast ice thickness and distribution within the CAA, trends are unrealistic and far exceed observations by up to 2 orders of magnitude. ORA-IP models were found to have positive correlations between temperature and ice thickness over the CAA, a feature that is inconsistent with both observations and coupled models from CMIP5.

Implementation of Advanced Inventory Management Functionality in Automated Dispensing Cabinets

PubMed Central

Webb, Aaron; Lund, Jim

2015-01-01

Background: Automated dispensing cabinets (ADCs) are an integral component of distribution models in pharmacy departments across the country. There are significant challenges to optimizing ADC inventory management while minimizing use of labor and capital resources. The role of enhanced inventory control functionality is not fully defined. Objective: The aim of this project is to improve ADC inventory management by leveraging dynamic inventory standards and a low inventory alert platform. Methods: Two interventional groups and 1 historical control were included in the study. Each intervention group consisted of 6 ADCs that tested enhanced inventory management functionality. Interventions included dynamic inventory standards and a low inventory alert messaging system. Following separate implementation of each platform, dynamic inventory and low inventory alert systems were applied concurrently to all 12 ADCs. Outcome measures included number and duration of daily stockouts, ADC inventory turns, and number of phone calls related to stockouts received by pharmacy staff. Results: Low inventory alerts reduced both the number and duration of stockouts. Dynamic inventory standards reduced the number of daily stockouts without changing the inventory turns and duration of stockouts. No change was observed in number of calls related to stockouts made to pharmacy staff. Conclusions: Low inventory alerts and dynamic inventory standards are feasible mechanisms to help optimize ADC inventory management while minimizing labor and capital resources. PMID:26448672

Using the Electronic Medical Record to Refer Women Taking Category D or X Medications for Teratogen and Contraceptive Counseling

PubMed Central

Mody, Sheila K.; Wu, Jennifer; Ornelas, Marla; Kernahan, Colleen; Salas, Elizabeth; Kao, Kelly; Felix, Robert; Chambers, Christina

2015-01-01

Background Women taking teratogens may not receive teratogen and contraceptive counseling. The objective of this study is to explore the feasibility of an electronic medical record (EMR) alert and referral system to improve teratogen and contraceptive counseling. Methods We conducted a descriptive study in an academic outpatient setting to evaluate the feasibility of an EMR alert and referral system. Reproductive age women taking category D or X medications seen in family medicine clinics were referred by means of an EMR alert for teratogen and contraceptive counseling. A subset of these women consented to follow-up surveys assessing contraceptive usage before counseling, intended contraceptive method after counseling and satisfaction with the counseling. Participants were contacted at 1 and 3 months to assess contraceptive usage. Results A total of 354 women were prescribed category D or X medications by clinicians who received the EMR alert, 170 women were referred, 59 women received counseling, and 33 participants enrolled in the study. One participant did not use any contraception. Among the 32 participants using contraception, 12 (37.5%) used oral contraceptives, 11 (34.4%) used condoms, 3 (9.4%) used withdrawal, 3 (9.4%) used intrauterine devices, 2 (6.3%) used contraceptive rings, and 1 (3.1%) used the diaphragm. After counseling, one-third of participants were considering more effective contraception. Almost all participants strongly agreed or agreed that the counseling was helpful. Conclusion Creating an EMR alert and referral system for women prescribed category X or D medications is feasible. Counseling on teratogen exposure and contraception may improve the acceptability of more effective contraception. PMID:26100297

Physicians’ response to computerised alerts for psychotropic drugs in older persons: a multilevel analysis of the associated alert, patient and physician characteristics

PubMed Central

Tamblyn, Robyn; Reidel, Kristen; Patel, Vaishali

2012-01-01

Objective Computerised drug alerts are expected to reduce patients’ risk of adverse drug events. However, physicians over-ride most drug alerts, because they believe that the benefit exceeds the risk. The purpose of this study was to determine the drug alert, patient and physician characteristics associated with the: (1) occurrence of psychotropic drug alerts for elderly patients and the (2) response to these alerts by their primary care physicians. Setting Primary care, Quebec, Canada. Design Prospective cohort study. Participants Sixty-one physicians using an electronic prescribing and drug alert decision-support system in their practice, and 3413 elderly patients using psychotropic drugs. Primary and secondary measures Psychotropic drug class, alert severity, patient risk for fall injuries and physician experience, practice volume and computer use were evaluated in relationship to the likelihood of having: (1) a psychotropic drug alert, (2) the prescription revised in response to an alert. Cluster-adjusted alternating logistic regression was used to assess multilevel predictors of alert occurrence and response. Results In total 13 080 psychotropic drug alerts were generated in 8931 visits. Alerts were more likely to be generated for male patients at higher risk of fall-related injury and for physicians who established the highest alert threshold. In 9.9% of alerts seen, the prescription was revised. The highest revision rate was for antipsychotic alerts (22.6%). Physicians were more likely to revise prescriptions for severe alerts (OR 2.03; 95%CI 1.39 to 2.98), if patients had cognitive impairment (OR 1.95; 95%CI 1.13 to 3.36), and if they made more visits to their physician (OR 1.05 per 5 visits; 95%CI 1 to 1.09). Conclusions Physicians view and respond to a small proportion of alerts, mainly for higher-risk patients. To reduce the risk of psychotropic drug-related fall injuries, a new generation of evidence-based drug alerts should be developed. PMID:23024254

Differential effects of phasic and tonic alerting on the efficiency of executive attention.

PubMed

Asanowicz, Dariusz; Marzecová, Anna

2017-05-01

The study examined how alerting and executive attention interact in a task involving conflict resolution. We proposed a tentative scenario in which an initial exogenous phasic alerting phase is followed by an endogenous tonic alerting phase, and hypothesized that these two processes may have distinct effects on conflict resolution. Phasic alerting was expected to increase the conflict, whereas tonic alerting was expected to decrease the conflict. Three experiments were conducted using different variants of the flanker task with visual alerting cues and varied cue-target intervals (SOA), to differentiate between effects of phasic alerting (short SOA) and tonic alerting (long SOA). The results showed that phasic alerting consistently decreased the efficiency of conflict resolution indexed by response time and accuracy, whereas tonic alerting increased the accuracy of conflict resolution, but at a cost in the speed of processing the conflict. The third experiment additionally showed that the effects of phasic alerting may be modulated by the psychophysical strength of alerting cues. Discussed are possible mechanisms that could account for the observed interactions between alerting and conflict resolution, as well as some discrepancies between the current and previous studies. Copyright © 2017 Elsevier B.V. All rights reserved.

Development and evaluation of a data-adaptive alerting algorithm for univariate temporal biosurveillance data.

PubMed

Elbert, Yevgeniy; Burkom, Howard S

2009-11-20

This paper discusses further advances in making robust predictions with the Holt-Winters forecasts for a variety of syndromic time series behaviors and introduces a control-chart detection approach based on these forecasts. Using three collections of time series data, we compare biosurveillance alerting methods with quantified measures of forecast agreement, signal sensitivity, and time-to-detect. The study presents practical rules for initialization and parameterization of biosurveillance time series. Several outbreak scenarios are used for detection comparison. We derive an alerting algorithm from forecasts using Holt-Winters-generalized smoothing for prospective application to daily syndromic time series. The derived algorithm is compared with simple control-chart adaptations and to more computationally intensive regression modeling methods. The comparisons are conducted on background data from both authentic and simulated data streams. Both types of background data include time series that vary widely by both mean value and cyclic or seasonal behavior. Plausible, simulated signals are added to the background data for detection performance testing at signal strengths calculated to be neither too easy nor too hard to separate the compared methods. Results show that both the sensitivity and the timeliness of the Holt-Winters-based algorithm proved to be comparable or superior to that of the more traditional prediction methods used for syndromic surveillance.

Optimizing the real-time ground level enhancement alert system based on neutron monitor measurements: Introducing GLE Alert Plus

NASA Astrophysics Data System (ADS)

Souvatzoglou, G.; Papaioannou, A.; Mavromichalaki, H.; Dimitroulakos, J.; Sarlanis, C.

2014-11-01

Whenever a significant intensity increase is being recorded by at least three neutron monitor stations in real-time mode, a ground level enhancement (GLE) event is marked and an automated alert is issued. Although, the physical concept of the algorithm is solid and has efficiently worked in a number of cases, the availability of real-time data is still an open issue and makes timely GLE alerts quite challenging. In this work we present the optimization of the GLE alert that has been set into operation since 2006 at the Athens Neutron Monitor Station. This upgrade has led to GLE Alert Plus, which is currently based upon the Neutron Monitor Database (NMDB). We have determined the critical values per station allowing us to issue reliable GLE alerts close to the initiation of the event while at the same time we keep the false alert rate at low levels. Furthermore, we have managed to treat the problem of data availability, introducing the Go-Back-N algorithm. A total of 13 GLE events have been marked from January 2000 to December 2012. GLE Alert Plus issued an alert for 12 events. These alert times are compared to the alert times of GOES Space Weather Prediction Center and Solar Energetic Particle forecaster of the University of Málaga (UMASEP). In all cases GLE Alert Plus precedes the GOES alert by ≈8-52 min. The comparison with UMASEP demonstrated a remarkably good agreement. Real-time GLE alerts by GLE Alert Plus may be retrieved by http://cosray.phys.uoa.gr/gle_alert_plus.html, http://www.nmdb.eu, and http://swe.ssa.esa.int/web/guest/space-radiation. An automated GLE alert email notification system is also available to interested users.

Alerting device and method for reminding a person of a risk

DOEpatents

Runyon, Larry [Richland, WA; Gunter, Wayne M [West Richland, WA; Pratt, Richard M [Richland, WA

2001-11-27

An alerting device and method to remind personnel of a risk is disclosed. The device has at least two sensors, a logic controller, a power source, and an annunciator that delivers a visual message, with or without an audible alarm, about a risk to a person when the sensors detect the person exiting a predetermined space. In particular, the present invention reminds a person of a security, safety, or health risk upon exiting a predetermined space. More particularly, the present invention reminds a person of an information security risk relating to sensitive, proprietary, confidential, trade secret, classified, or intellectual property information.

Prediction of fatigue-related driver performance from EEG data by deep Riemannian model.

PubMed

Hajinoroozi, Mehdi; Jianqiu Zhang; Yufei Huang

2017-07-01

Prediction of the drivers' drowsy and alert states is important for safety purposes. The prediction of drivers' drowsy and alert states from electroencephalography (EEG) using shallow and deep Riemannian methods is presented. For shallow Riemannian methods, the minimum distance to Riemannian mean (mdm) and Log-Euclidian metric are investigated, where it is shown that Log-Euclidian metric outperforms the mdm algorithm. In addition the SPDNet, a deep Riemannian model, that takes the EEG covariance matrix as the input is investigated. It is shown that SPDNet outperforms all tested shallow and deep classification methods. Performance of SPDNet is 6.02% and 2.86% higher than the best performance by the conventional Euclidian classifiers and shallow Riemannian models, respectively.

Self-regulation method: psychological, physiological and clinical considerations. An overview.

PubMed

Ikemi, A; Tomita, S; Kuroda, M; Hayashida, Y; Ikemi, Y

1986-01-01

Body-oriented therapies as relaxation training and certain forms of meditation are gaining popularity in the treatment and prevention of psychosomatic disorders. In this paper, a new method of self-control called self-regulation method (SRM), derived from autogenic training and Zen meditation, is presented. The technique of SRM is introduced. Secondly, physiological studies on SRM using skin temperature, galvanic skin response, and cortical evoked potentials are presented. Thirdly, the results of psychological tests conducted on SRM are presented. These psycho-physiological studies suggest that SRM may elicit a state of 'relaxed alertness'. Fourthly, clinical applications of SRM are discussed, and 3 cases are presented. Finally, SRM is discussed in relation to the psychology and physiology of 'relaxed alertness'.

2005 Science and Technology for Chem-Bio Information Systems (S and T CBIS). Volume 2 - Wednesday

DTIC Science & Technology

2005-10-28

historical example of using both an audible and visual alerting method. In April 1775, Revere hung two lanterns in the bell-tower of Christ Church in...individual building systems, outdoor systems, telephone notification systems and a network of alert sensors . Fire protection systems are often... sensor , be it a pushbutton at a gate, a wireless “panic” button or a CBRNE detector, may be programmed to trigger notifications without further

An IDS Alerts Aggregation Algorithm Based on Rough Set Theory

NASA Astrophysics Data System (ADS)

Zhang, Ru; Guo, Tao; Liu, Jianyi

2018-03-01

Within a system in which has been deployed several IDS, a great number of alerts can be triggered by a single security event, making real alerts harder to be found. To deal with redundant alerts, we propose a scheme based on rough set theory. In combination with basic concepts in rough set theory, the importance of attributes in alerts was calculated firstly. With the result of attributes importance, we could compute the similarity of two alerts, which will be compared with a pre-defined threshold to determine whether these two alerts can be aggregated or not. Also, time interval should be taken into consideration. Allowed time interval for different types of alerts is computed individually, since different types of alerts may have different time gap between two alerts. In the end of this paper, we apply proposed scheme on DAPRA98 dataset and the results of experiment show that our scheme can efficiently reduce the redundancy of alerts so that administrators of security system could avoid wasting time on useless alerts.

Alertness and cognitive control: Toward a spatial grouping hypothesis.

PubMed

Schneider, Darryl W

2018-05-01

A puzzling interaction involving alertness and cognitive control is indicated by the finding of faster performance but larger congruency effects on alert trials (on which alerting cues are presented before the task stimuli) than on no-alert trials in selective attention tasks. In the present study, the author conducted four experiments to test hypotheses about the interaction. Manipulation of stimulus spacing revealed a difference in congruency effects between alert and no-alert trials for narrowly spaced stimuli but not for widely spaced stimuli, inconsistent with the hypothesis that increased alertness is associated with more diffuse attention. Manipulation of color grouping revealed similar differences in congruency effects between alert and no-alert trials for same-color and different-color groupings of targets and distractors, inconsistent with the general hypothesis that increased alertness is associated with more perceptual grouping. To explain the results, the author proposes that increased alertness is associated specifically with more spatial grouping of stimuli, possibly by modulating the threshold for parsing stimulus displays into distinct objects.

Managing the Alert Process at NewYork-Presbyterian Hospital

PubMed Central

Kuperman, Gilad J; Diamente, Rosanna; Khatu, Vrinda; Chan-Kraushar, Terri; Stetson, Pete; Boyer, Aurelia; Cooper, Mary

2005-01-01

Clinical decision support can improve the quality of care, but requires substantial knowledge management activities. At NewYork-Presbyterian Hospital in New York City, we have implemented a formal alert management process whereby only hospital committees and departments can request alerts. An explicit requestor, who will help resolve the details of the alert logic and the alert message must be identified. Alerts must be requested in writing using a structured alert request form. Alert requests are reviewed by the Alert Committee and then forwarded to the Information Systems department for a software development estimate. The model required that clinical committees and departments become more actively involved in the development of alerts than had previously been necessary. In the 12 months following implementation, 10 alert requests were received. The model has been well received. A lot of the knowledge engineering work has been distributed and burden has been removed from scarce medical informatics resources. PMID:16779073

Optimizing drug-dose alerts using commercial software throughout an integrated health care system.

PubMed

Saiyed, Salim M; Greco, Peter J; Fernandes, Glenn; Kaelber, David C

2017-11-01

All default electronic health record and drug reference database vendor drug-dose alerting recommendations (single dose, daily dose, dose frequency, and dose duration) were silently turned on in inpatient, outpatient, and emergency department areas for pediatric-only and nonpediatric-only populations. Drug-dose alerts were evaluated during a 3-month period. Drug-dose alerts fired on 12% of orders (104 098/834 911). System-level and drug-specific strategies to decrease drug-dose alerts were analyzed. System-level strategies included: (1) turning off all minimum drug-dosing alerts, (2) turning off all incomplete information drug-dosing alerts, (3) increasing the maximum single-dose drug-dose alert threshold to 125%, (4) increasing the daily dose maximum drug-dose alert threshold to 125%, and (5) increasing the dose frequency drug-dose alert threshold to more than 2 doses per day above initial threshold. Drug-specific strategies included changing drug-specific maximum single and maximum daily drug-dose alerting parameters for the top 22 drug categories by alert frequency. System-level approaches decreased alerting to 5% (46 988/834 911) and drug-specific approaches decreased alerts to 3% (25 455/834 911). Drug-dose alerts varied between care settings and patient populations. © The Author 2017. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

The Three-item ALERT-B Questionnaire Provides a Validated Screening Tool to Detect Chronic Gastrointestinal Symptoms after Pelvic Radiotherapy in Cancer Survivors.

PubMed

Taylor, S; Byrne, A; Adams, R; Turner, J; Hanna, L; Staffurth, J; Farnell, D; Sivell, S; Nelson, A; Green, J

2016-10-01

Although pelvic radiotherapy is an effective treatment for various malignancies, around half of patients develop significant gastrointestinal problems. These symptoms often remain undetected, despite the existence of effective treatments. This study developed and refined a simple screening tool to detect common gastrointestinal symptoms in outpatient clinics. These symptoms have a significant effect on quality of life. This tool will increase detection rates and so enable access to specialist gastroenterologists, which will in turn lead to improved symptom control and quality of life after treatment. A literature review and expert consensus meeting identified four items for the ALERT-B (Assessment of Late Effects of RadioTherapy - Bowel) screening tool. ALERT-B was face tested for its usability and acceptability using cognitive interviews with 12 patients experiencing late gastrointestinal symptoms after pelvic radiotherapy. Thematic analysis and probe category were used to analyse interview transcripts. Interview data were presented to a group of experts to agree on the final content and format of the tool. ALERT-B was assessed for reliability and tested for validity against the Gastrointestinal Symptom Rating Scale in a clinical study (EAGLE). Overall, the tool was found to be acceptable in terms of wording, response format and completion time. Participant-reported experiences, including lifestyle modifications and the psychological effect of the symptoms, led to further modifications of the tool. The refined tool includes three questions covering rectal bleeding, incontinence, nocturnal bowel movements and impact on quality of life, including mood, relationships and socialising. ALERT-B was successfully validated against the Gastrointestinal Symptom Rating Scale in the EAGLE study with the tool shown broadly to be internally consistent (Cronbach's α = 0.61 and all item-subscale correlation [Spearman] coefficients are > 0.6). The ALERT-B screening tool can be used in clinical practice to improve post-treatment supportive care by triggering the clinical assessment of patients suitable for referral to a gastroenterologist. Copyright © 2016 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

A compilation of safety impact information for extractables associated with materials used in pharmaceutical packaging, delivery, administration, and manufacturing systems.

PubMed

Jenke, Dennis; Carlson, Tage

2014-01-01

Demonstrating suitability for intended use is necessary to register packaging, delivery/administration, or manufacturing systems for pharmaceutical products. During their use, such systems may interact with the pharmaceutical product, potentially adding extraneous entities to those products. These extraneous entities, termed leachables, have the potential to affect the product's performance and/or safety. To establish the potential safety impact, drug products and their packaging, delivery, or manufacturing systems are tested for leachables or extractables, respectively. This generally involves testing a sample (either the extract or the drug product) by a means that produces a test method response and then correlating the test method response with the identity and concentration of the entity causing the response. Oftentimes, analytical tests produce responses that cannot readily establish the associated entity's identity. Entities associated with un-interpretable responses are termed unknowns. Scientifically justifiable thresholds are used to establish those individual unknowns that represent an acceptable patient safety risk and thus which do not require further identification and, conversely, those unknowns whose potential safety impact require that they be identified. Such thresholds are typically based on the statistical analysis of datasets containing toxicological information for more or less relevant compounds. This article documents toxicological information for over 540 extractables identified in laboratory testing of polymeric materials used in pharmaceutical applications. Relevant toxicological endpoints, such as NOELs (no observed effects), NOAELs (no adverse effects), TDLOs (lowest published toxic dose), and others were collated for these extractables or their structurally similar surrogates and were systematically assessed to produce a risk index, which represents a daily intake value for life-long intravenous administration. This systematic approach uses four uncertainty factors, each assigned a factor of 10, which consider the quality and relevance of the data, differences in route of administration, non-human species to human extrapolations, and inter-individual variation among humans. In addition to the risk index values, all extractables and most of their surrogates were classified for structural safety alerts using Cramer rules and for mutagenicity alerts using an in silico approach (Benigni/Bossa rule base for mutagenicity via Toxtree). Lastly, in vitro mutagenicity data (Ames Salmonella typimurium and Mouse Lymphoma tests) were collected from available databases (Chemical Carcinogenesis Research Information and Carcinogenic Potency Database). The frequency distributions of the resulting data were established; in general risk index values were normally distributed around a band ranging from 5 to 20 mg/day. The risk index associated with 95% level of the cumulative distribution plot was approximately 0.1 mg/day. Thirteen extractables in the dataset had individual risk index values less than 0.1 mg/day, although four of these had additional risk indices, based on multiple different toxicological endpoints, above 0.1 mg/day. Additionally, approximately 50% of the extractables were classified in Cramer Class 1 (low risk of toxicity) and approximately 35% were in Cramer Class 3 (no basis to assume safety). Lastly, roughly 20% of the extractables triggered either an in vitro or in silico alert for mutagenicity. When Cramer classifications and the mutagenicity alerts were compared to the risk indices, extractables with safety alerts generally had lower risk index values, although the differences in the risk index data distributions, extractables with or without alerts, were small and subtle. Leachables from packaging systems, manufacturing systems, or delivery devices can accumulate in drug products and potentially affect the drug product. Although drug products can be analyzed for leachables (and material extracts can be analyzed for extractables), not all leachables or extractables can be fully identified. Safety thresholds can be used to establish whether the unidentified substances can be deemed to be safe or whether additional analytical efforts need to be made to secure the identities. These thresholds are typically based on the statistical analysis of datasets containing toxicological information for more or less relevant compounds. This article contains safety data for over 500 extractables that were identified in laboratory characterizations of polymers used in pharmaceutical applications. The safety data consists of structural toxicity classifications of the extractables as well as calculated risk indices, where the risk indices were obtained by subjecting toxicological safety data, such as NOELs (no observed effects), NOAELs (no adverse effects), TDLOs (lowest published toxic dose), and others to a systematic evaluation process using appropriate uncertainty factors. Thus the risk index values represent daily exposures for the lifetime intravenous administration of drugs. The frequency distributions of the risk indices and Cramer classifications were examined. The risk index values were normally distributed around a range of 5 to 20 mg/day, and the risk index associated with the 95% level of the cumulative frequency plot was 0.1 mg/day. Approximately 50% of the extractables were in Cramer Class 1 (low risk of toxicity) and approximately 35% were in Cramer Class 3 (high risk of toxicity). Approximately 20% of the extractables produced an in vitro or in silico mutagenicity alert. In general, the distribution of risk index values was not strongly correlated with the either extractables' Cramer classification or by mutagenicity alerts. However, extractables with either in vitro or in silico alerts were somewhat more likely to have low risk index values. © PDA, Inc. 2014.

A systematic review of the effectiveness of interruptive medication prescribing alerts in hospital CPOE systems to change prescriber behavior and improve patient safety.

PubMed

Page, N; Baysari, M T; Westbrook, J I

2017-09-01

To assess the evidence of the effectiveness of different categories of interruptive medication prescribing alerts to change prescriber behavior and/or improve patient outcomes in hospital computerized provider order entry (CPOE) systems. PubMed, Embase, CINAHL and the Cochrane Library were searched for relevant articles published between January 2000 and February 2016. Studies were included if they compared the outcomes of automatic, interruptive medication prescribing alert/s to a control/comparison group to determine alert effectiveness. Twenty-three studies describing 32 alerts classified into 11 alert categories were identified. The most common alert categories studied were drug-condition interaction (n=6), drug-drug interaction alerts (n=6) and corollary order alerts (n=6). All 23 papers investigated the effect of the intervention alert on at least one outcome measure of prescriber behavior. Just over half of the studies (53%, n=17) reported a statistically significant beneficial effect from the intervention alert; 34% (n=11) reported no statistically significant effect, and 6% (n=2) reported a significant detrimental effect. Two studies also evaluated the effect of alerts on patient outcome measures; neither finding that patient outcomes significantly improved following alert implementation (6%, n=2). The greatest volume of evidence relates to three alert categories: drug-condition, drug-drug and corollary order alerts. Of these, drug-condition alerts had the greatest number of studies reporting positive effects (five out of six studies). Only two of six studies of drug-drug interaction and one of six of corollary alerts reported positive benefits. The current evidence-base does not show a clear indication that particular categories of alerts are more effective than others. While the majority of alert categories were shown to improve outcomes in some studies, there were also many cases where outcomes did not improve. This lack of evidence hinders decisions about the amount and type of decision support that should be integrated into CPOE systems to increase safety while reducing the risk of alert fatigue. Virtually no studies have sought to investigate the impact on changes to prescriber behavior and outcomes overall when alerts from multiple categories are incorporated within the same system. Copyright © 2017 Elsevier B.V. All rights reserved.

Prescription order risk factors for pediatric dosing alerts.

PubMed

Stultz, J S; Porter, K; Nahata, M C

2015-02-01

To determine dosing alert rates based on prescription order characteristics and identify prescription order risk factors for the occurrence of dosing alerts. A retrospective analysis of inpatient medication orders and dosing alerts occurring during October 2011 and January, April, and July 2012 at a pediatric institution. Prescription orders and alerts were categorized by: medication class, patient age, route of administration, and month of the year. There were 228,259 orders during the studied period, with 11,072 alerted orders (4.9%). The most frequently alerted medication class was the non-analgesic central nervous system agent class (14% of alerts). Age, route, medication class, and month all independently affected dosing alert rates. The alert rate was highest for immunosuppressive agents (54%), neonates (6.7%), and orders for rectal administration (9.5%). The alert rate was higher in adult patients receiving their care at a pediatric institution (5.7%) compared to children (4.7%), but after multivariate analysis, pediatric orders had higher odds for an alert (OR 1.1, 95% CI 1.05-1.16). Mercaptopurine had the highest alert rate when categorized by active ingredient (73.9%). Albuterol 2.5mg/mL continuous aerosol and heparin 1000 units in 0.9% sodium chloride injection solution were the unique medications with the highest alert rates (100.0% and 97.7%, respectively). Certain types of prescription orders have a higher risk for causing dosing alerts than others. Patient age, medication class, route of administration, and the month of year can affect dosing alert rates. Design and customization efforts should focus on these medications and prescription order characteristics that increase the risk for dosing alerts. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Optimization of drug-drug interaction alert rules in a pediatric hospital's electronic health record system using a visual analytics dashboard.

PubMed

Simpao, Allan F; Ahumada, Luis M; Desai, Bimal R; Bonafide, Christopher P; Gálvez, Jorge A; Rehman, Mohamed A; Jawad, Abbas F; Palma, Krisha L; Shelov, Eric D

2015-03-01

To develop and evaluate an electronic dashboard of hospital-wide electronic health record medication alerts for an alert fatigue reduction quality improvement project. We used visual analytics software to develop the dashboard. We collaborated with the hospital-wide Clinical Decision Support committee to perform three interventions successively deactivating clinically irrelevant drug-drug interaction (DDI) alert rules. We analyzed the impact of the interventions on care providers' and pharmacists' alert and override rates using an interrupted time series framework with piecewise regression. We evaluated 2 391 880 medication alerts between January 31, 2011 and January 26, 2014. For pharmacists, the median alert rate prior to the first DDI deactivation was 58.74 alerts/100 orders (IQR 54.98-60.48) and 25.11 alerts/100 orders (IQR 23.45-26.57) following the three interventions (p<0.001). For providers, baseline median alert rate prior to the first round of DDI deactivation was 19.73 alerts/100 orders (IQR 18.66-20.24) and 15.11 alerts/100 orders (IQR 14.44-15.49) following the three interventions (p<0.001). In a subgroup analysis, we observed a decrease in pharmacists' override rates for DDI alerts that were not modified in the system from a median of 93.06 overrides/100 alerts (IQR 91.96-94.33) to 85.68 overrides/100 alerts (IQR 84.29-87.15, p<0.001). The medication serious safety event rate decreased during the study period, and there were no serious safety events reported in association with the deactivated alert rules. An alert dashboard facilitated safe rapid-cycle reductions in alert burden that were temporally associated with lower pharmacist override rates in a subgroup of DDIs not directly affected by the interventions; meanwhile, the pharmacists' frequency of selecting the 'cancel' option increased. We hypothesize that reducing the alert burden enabled pharmacists to devote more attention to clinically relevant alerts. © The Author 2014. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

The influence of essential oils on human attention. I: alertness.

PubMed

Ilmberger, J; Heuberger, E; Mahrhofer, C; Dessovic, H; Kowarik, D; Buchbauer, G

2001-03-01

Scientific research on the effects of essential oils on human behavior lags behind the promises made by popular aromatherapy. Nearly all aspects of human behavior are closely linked to processes of attention, the basic level being that of alertness, which ranges from sleep to wakefulness. In our study we measured the influence of essential oils and components of essential oils [peppermint, jasmine, ylang-ylang, 1,8-cineole (in two different dosages) and menthol] on this core attentional function, which can be experimentally defined as speed of information processing. Substances were administered by inhalation; levels of alertness were assessed by measuring motor and reaction times in a reaction time paradigm. The performances of the six experimental groups receiving substances (n = 20 in four groups, n = 30 in two groups) were compared with those of corresponding control groups receiving water. Between-group analysis, i.e. comparisons between experimental groups and their respective control groups, mainly did not reach statistical significance. However, within-group analysis showed complex correlations between subjective evaluations of substances and objective performance, indicating that effects of essentials oils or their components on basic forms of attentional behavior are mainly psychological.

Influence of acute sleep loss on the neural correlates of alerting, orientating and executive attention components.

PubMed

Muto, Vincenzo; Shaffii-le Bourdiec, Anahita; Matarazzo, Luca; Foret, Ariane; Mascetti, Laura; Jaspar, Mathieu; Vandewalle, Gilles; Phillips, Christophe; Degueldre, Christian; Balteau, Evelyne; Luxen, André; Collette, Fabienne; Maquet, Pierre

2012-12-01

The Attention Network Test (ANT) is deemed to assess the alerting, orientating and executive components of human attention. Capitalizing on the opportunity to investigate three facets of attention in a single task, we used functional magnetic resonance imaging (fMRI) to assess the effect of sleep deprivation (SD) on brain responses associated with the three attentional components elicited by the ANT. Twelve healthy volunteers were scanned in two conditions 1 week apart, after a normal night of sleep (rested wakefulness, RW) or after one night of total sleep deprivation. Sleep deprivation was associated with a global increase in reaction times, which did not affect specifically any of the three attention effects. Brain responses associated with the alerting effect did not differ between RW and SD. Higher-order attention components (orientating and conflict effects) were associated with significantly larger thalamic responses during SD than during RW. These results suggest that SD influences different components of human attention non-selectively, through mechanisms that might either affect centrencephalic structures maintaining vigilance or ubiquitously perturb neuronal function. Compensatory responses can counter these effects transiently by recruiting thalamic responses, thereby supporting thalamocortical function. © 2012 European Sleep Research Society.

Real Time Alert System: A Disease Management System Leveraging Health Information Exchange

PubMed Central

Anand, Vibha; Sheley, Meena E.; Xu, Shawn; Downs, Stephen M.

2012-01-01

Background Rates of preventive and disease management services can be improved by providing automated alerts and reminders to primary care providers (PCPs) using of health information technology (HIT) tools. Methods: Using Adaptive Turnaround Documents (ATAD), an existing Health Information Exchange (HIE) infrastructure and office fax machines, we developed a Real Time Alert (RTA) system. RTA is a computerized decision support system (CDSS) that is able to deliver alerts to PCPs statewide for recommended services around the time of the patient visit. RTA is also able to capture structured clinical data from providers using existing fax technology. In this study, we evaluate RTA’s performance for alerting PCPs when their patients with asthma have an emergency room visit anywhere in the state. Results: Our results show that RTA was successfully able to deliver “just in time” patient-relevant alerts to PCPs across the state. Furthermore, of those ATADs faxed back and automatically interpreted by the RTA system, 35% reported finding the provided information helpful. The PCPs who reported finding information helpful also reported making a phone call, sending a letter or seeing the patient for follow up care. Conclusions: We have successfully demonstrated the feasibility of electronically exchanging important patient related information with the PCPs statewide. This is despite a lack of a link with their electronic health records. We have shown that using our ATAD technology, a PCP can be notified quickly of an important event such as a patient’s asthma related emergency room admission so further follow up can happen in near real time. PMID:23569648

Weather-based prediction of Plasmodium falciparum malaria in epidemic-prone regions of Ethiopia II. Weather-based prediction systems perform comparably to early detection systems in identifying times for interventions.

PubMed

Teklehaimanot, Hailay D; Schwartz, Joel; Teklehaimanot, Awash; Lipsitch, Marc

2004-11-19

Timely and accurate information about the onset of malaria epidemics is essential for effective control activities in epidemic-prone regions. Early warning methods that provide earlier alerts (usually by the use of weather variables) may permit control measures to interrupt transmission earlier in the epidemic, perhaps at the expense of some level of accuracy. Expected case numbers were modeled using a Poisson regression with lagged weather factors in a 4th-degree polynomial distributed lag model. For each week, the numbers of malaria cases were predicted using coefficients obtained using all years except that for which the prediction was being made. The effectiveness of alerts generated by the prediction system was compared against that of alerts based on observed cases. The usefulness of the prediction system was evaluated in cold and hot districts. The system predicts the overall pattern of cases well, yet underestimates the height of the largest peaks. Relative to alerts triggered by observed cases, the alerts triggered by the predicted number of cases performed slightly worse, within 5% of the detection system. The prediction-based alerts were able to prevent 10-25% more cases at a given sensitivity in cold districts than in hot ones. The prediction of malaria cases using lagged weather performed well in identifying periods of increased malaria cases. Weather-derived predictions identified epidemics with reasonable accuracy and better timeliness than early detection systems; therefore, the prediction of malarial epidemics using weather is a plausible alternative to early detection systems.

Hazards in Motion: Development of Mobile Geofences for Use in Logging Safety

PubMed Central

Zimbelman, Eloise G.; Keefe, Robert F.; Strand, Eva K.; Kolden, Crystal A.; Wempe, Ann M.

2017-01-01

Logging is one of the most hazardous occupations in the United States. Real-time positioning that uses global navigation satellite system (GNSS) technology paired with radio frequency transmission (GNSS-RF) has the potential to reduce fatal and non-fatal accidents on logging operations through the use of geofences that define safe work areas. Until recently, most geofences have been static boundaries. The aim of this study was to evaluate factors affecting mobile geofence accuracy in order to determine whether virtual safety zones around moving ground workers or equipment are a viable option for improving situational awareness on active timber sales. We evaluated the effects of walking pace, transmission interval, geofence radius, and intersection angle on geofence alert delay using a replicated field experiment. Simulation was then used to validate field results and calculate the proportion of GNSS error bearings resulting in early alerts. The interaction of geofence radius and intersection angle affected safety geofence alert delay in the field experiment. The most inaccurate alerts were negative, representing early warning. The magnitude of this effect was largest at the greatest intersection angles. Simulation analysis supported these field results and also showed that larger GNSS error corresponded to greater variability in alert delay. Increasing intersection angle resulted in a larger proportion of directional GNSS error that triggered incorrect, early warnings. Because the accuracy of geofence alerts varied greatly depending on GNSS error and angle of approach, geofencing for occupational safety is most appropriate for general situational awareness unless real-time correction methods to improve accuracy or higher quality GNSS-RF transponders are used. PMID:28394303

Forecasting United States heartworm Dirofilaria immitis prevalence in dogs.

PubMed

Bowman, Dwight D; Liu, Yan; McMahan, Christopher S; Nordone, Shila K; Yabsley, Michael J; Lund, Robert B

2016-10-10

This paper forecasts next year's canine heartworm prevalence in the United States from 16 climate, geographic and societal factors. The forecast's construction and an assessment of its performance are described. The forecast is based on a spatial-temporal conditional autoregressive model fitted to over 31 million antigen heartworm tests conducted in the 48 contiguous United States during 2011-2015. The forecast uses county-level data on 16 predictive factors, including temperature, precipitation, median household income, local forest and surface water coverage, and presence/absence of eight mosquito species. Non-static factors are extrapolated into the forthcoming year with various statistical methods. The fitted model and factor extrapolations are used to estimate next year's regional prevalence. The correlation between the observed and model-estimated county-by-county heartworm prevalence for the 5-year period 2011-2015 is 0.727, demonstrating reasonable model accuracy. The correlation between 2015 observed and forecasted county-by-county heartworm prevalence is 0.940, demonstrating significant skill and showing that heartworm prevalence can be forecasted reasonably accurately. The forecast presented herein can a priori alert veterinarians to areas expected to see higher than normal heartworm activity. The proposed methods may prove useful for forecasting other diseases.

Provider management strategies of abnormal test result alerts: a cognitive task analysis.

PubMed

Hysong, Sylvia J; Sawhney, Mona K; Wilson, Lindsay; Sittig, Dean F; Espadas, Donna; Davis, Traber; Singh, Hardeep

2010-01-01

Electronic medical records (EMRs) facilitate abnormal test result communication through "alert" notifications. The aim was to evaluate how primary care providers (PCPs) manage alerts related to critical diagnostic test results on their EMR screens, and compare alert-management strategies of providers with high versus low rates of timely follow-up of results. 28 PCPs from a large, tertiary care Veterans Affairs Medical Center (VAMC) were purposively sampled according to their rates of timely follow-up of alerts, determined in a previous study. Using techniques from cognitive task analysis, participants were interviewed about how and when they manage alerts, focusing on four alert-management features to filter, sort and reduce unnecessary alerts on their EMR screens. Provider knowledge of alert-management features ranged between 4% and 75%. Almost half (46%) of providers did not use any of these features, and none used more than two. Providers with higher versus lower rates of timely follow-up used the four features similarly, except one (customizing alert notifications). Providers with low rates of timely follow-up tended to manually scan the alert list and process alerts heuristically using their clinical judgment. Additionally, 46% of providers used at least one workaround strategy to manage alerts. Considerable heterogeneity exists in provider use of alert-management strategies; specific strategies may be associated with lower rates of timely follow-up. Standardization of alert-management strategies including improving provider knowledge of appropriate tools in the EMR to manage alerts could reduce the lack of timely follow-up of abnormal diagnostic test results.

The Relationship between Non-Cognitive Coaching Interventions and College Student Persistence at a Rural Community College

ERIC Educational Resources Information Center

Valora, Jenniffer

2017-01-01

The purpose of this quantitative correlation study was to contribute empirical research findings concerning the relationship of non-cognitive coaching interventions on at-risk student persistence at a rural public community college located in northwest New Mexico. The sample population included 210 undergraduate at-risk students who an alert was…

Motivational Correlates of Academic Success in an Educational Psychology Course

ERIC Educational Resources Information Center

Herman, William E.

2011-01-01

The variables of class attendance and the institution-wide Early Alert Grading System were employed to predict academic success at the end of the semester. Classroom attendance was found to be statistically and significantly related to final average and accounted for 14-16% of the variance in academic performance. Class attendance was found to…

The Effect of Automated Alerts on Provider Ordering Behavior in an Outpatient Setting

PubMed Central

Steele, Andrew W; Eisert, Sheri; Witter, Joel; Lyons, Pat; Jones, Michael A; Gabow, Patricia; Ortiz, Eduardo

2005-01-01

Background Computerized order entry systems have the potential to prevent medication errors and decrease adverse drug events with the use of clinical-decision support systems presenting alerts to providers. Despite the large volume of medications prescribed in the outpatient setting, few studies have assessed the impact of automated alerts on medication errors related to drug–laboratory interactions in an outpatient primary-care setting. Methods and Findings A primary-care clinic in an integrated safety net institution was the setting for the study. In collaboration with commercial information technology vendors, rules were developed to address a set of drug–laboratory interactions. All patients seen in the clinic during the study period were eligible for the intervention. As providers ordered medications on a computer, an alert was displayed if a relevant drug–laboratory interaction existed. Comparisons were made between baseline and postintervention time periods. Provider ordering behavior was monitored focusing on the number of medication orders not completed and the number of rule-associated laboratory test orders initiated after alert display. Adverse drug events were assessed by doing a random sample of chart reviews using the Naranjo scoring scale. The rule processed 16,291 times during the study period on all possible medication orders: 7,017 during the pre-intervention period and 9,274 during the postintervention period. During the postintervention period, an alert was displayed for 11.8% (1,093 out of 9,274) of the times the rule processed, with 5.6% for only “missing laboratory values,” 6.0% for only “abnormal laboratory values,” and 0.2% for both types of alerts. Focusing on 18 high-volume and high-risk medications revealed a significant increase in the percentage of time the provider stopped the ordering process and did not complete the medication order when an alert for an abnormal rule-associated laboratory result was displayed (5.6% vs. 10.9%, p = 0.03, Generalized Estimating Equations test). The provider also increased ordering of the rule-associated laboratory test when an alert was displayed (39% at baseline vs. 51% during post intervention, p < 0.001). There was a non-statistically significant difference towards less “definite” or “probable” adverse drug events defined by Naranjo scoring (10.3% at baseline vs. 4.3% during postintervention, p = 0.23). Conclusion Providers will adhere to alerts and will use this information to improve patient care. Specifically, in response to drug–laboratory interaction alerts, providers will significantly increase the ordering of appropriate laboratory tests. There may be a concomitant change in adverse drug events that would require a larger study to confirm. Implementation of rules technology to prevent medication errors could be an effective tool for reducing medication errors in an outpatient setting. PMID:16128621

Timely Follow-Up of Abnormal Diagnostic Imaging Test Results in an Outpatient Setting: Are Electronic Medical Records Achieving Their Potential?

PubMed Central

Singh, Hardeep; Thomas, Eric J.; Mani, Shrinidi; Sittig, Dean; Arora, Harvinder; Espadas, Donna; Khan, Myrna M.; Petersen, Laura A.

2010-01-01

Background Given the fragmentation of outpatient care, timely follow-up of abnormal diagnostic test results remains a challenge. We hypothesized that an EMR that facilitates the transmission and availability of critical imaging results through either automated notification (alerting) or direct access to the primary report would eliminate this problem. Methods We studied critical imaging alert notifications in the outpatient setting of a tertiary care VA facility from November 2007 to June 2008. Tracking software determined whether the alert was acknowledged (i.e. provider opened the message for viewing) within two weeks of transmission; acknowledged alerts were considered read. We reviewed medical records and contacted providers to determine timely follow-up actions (e.g. ordering a follow-up test or consultation) within 4 weeks of transmission. Multivariable logistic regression models accounting for clustering effect by providers analyzed predictors for two outcomes; lack of acknowledgment and lack of timely follow-up. Results Of 123,638 studies (including X-rays, CT scans, ultrasounds, MRI and mammography), 1196 (0.97%) images generated alerts; 217 (18.1%) of these were unacknowledged. Alerts had a higher risk of being unacknowledged when ordering providers were trainees (OR, 5.58;95%CI, 2.86-10.89) and when dual (more than one provider alerted) as opposed to single communication was used (OR, 2.02;95%CI, 1.22-3.36). Timely follow-up was lacking in 92 (7.7% of all alerts) and was similar for acknowledged and unacknowledged alerts (7.3% vs. 9.7%;p=0.2). Risk for lack of timely follow-up was higher with dual communication (OR,1.99;95%CI, 1.06-3.48) but lower when additional verbal communication was used by the radiologist (OR, 0.12;95%CI: 0.04-0.38). Nearly all abnormal results lacking timely follow-up at 4 weeks were eventually found to have measurable clinical impact in terms of further diagnostic testing or treatment. Conclusions Critical imaging results may not receive timely follow-up actions even when providers receive and read results in an advanced, integrated EMR system. A multidisciplinary approach is needed to improve patient safety in this area. PMID:19786677

The NAS Alert System: A look at the first eight years

USGS Publications Warehouse

Fuller, Pamela L.; Neilson, Matt; Huge, Dane H.

2013-01-01

The U.S. Geological Survey's Nonindigenous Aquatic Species (NAS) database program (http://nas.er.usgs.gov) tracks the distribution of introduced aquatic organisms across the United States. Awareness of, and timely response to, novel species introductions by those involved in nonindigenous aquatic species management and research requires a framework for rapid dissemination of occurrence data as it is incorporated into the NAS database. In May 2004, the NAS program developed an alert system to notify registered users of new introductions as part of a national early detection/rapid response system. This article summarizes information on system users and dispatched alerts from the system's inception through the end of 2011. The NAS alert system has registered over 1,700 users, with approximately 800 current subscribers. A total of 1,189 alerts had been transmitted through 2011. More alerts were sent for Florida (134 alerts) than for any other state. Fishes comprise the largest taxonomic group of alerts (440), with mollusks, plants, and crustaceans each containing over 100 alerts. Most alerts were for organisms that were intentionally released (414 alerts), with shipping, escape from captivity, and hitchhiking also representing major vectors. To explore the archive of sent alerts and to register, the search and signup page for the alert system can be found online at http://nas.er.usgs.gov/AlertSystem/default.aspx.

Applying human factors principles to alert design increases efficiency and reduces prescribing errors in a scenario-based simulation.

PubMed

Russ, Alissa L; Zillich, Alan J; Melton, Brittany L; Russell, Scott A; Chen, Siying; Spina, Jeffrey R; Weiner, Michael; Johnson, Elizabette G; Daggy, Joanne K; McManus, M Sue; Hawsey, Jason M; Puleo, Anthony G; Doebbeling, Bradley N; Saleem, Jason J

2014-10-01

To apply human factors engineering principles to improve alert interface design. We hypothesized that incorporating human factors principles into alerts would improve usability, reduce workload for prescribers, and reduce prescribing errors. We performed a scenario-based simulation study using a counterbalanced, crossover design with 20 Veterans Affairs prescribers to compare original versus redesigned alerts. We redesigned drug-allergy, drug-drug interaction, and drug-disease alerts based upon human factors principles. We assessed usability (learnability of redesign, efficiency, satisfaction, and usability errors), perceived workload, and prescribing errors. Although prescribers received no training on the design changes, prescribers were able to resolve redesigned alerts more efficiently (median (IQR): 56 (47) s) compared to the original alerts (85 (71) s; p=0.015). In addition, prescribers rated redesigned alerts significantly higher than original alerts across several dimensions of satisfaction. Redesigned alerts led to a modest but significant reduction in workload (p=0.042) and significantly reduced the number of prescribing errors per prescriber (median (range): 2 (1-5) compared to original alerts: 4 (1-7); p=0.024). Aspects of the redesigned alerts that likely contributed to better prescribing include design modifications that reduced usability-related errors, providing clinical data closer to the point of decision, and displaying alert text in a tabular format. Displaying alert text in a tabular format may help prescribers extract information quickly and thereby increase responsiveness to alerts. This simulation study provides evidence that applying human factors design principles to medication alerts can improve usability and prescribing outcomes. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Making electronic prescribing alerts more effective: scenario-based experimental study in junior doctors

PubMed Central

Shah, Priya; Wyatt, Jeremy C; Makubate, Boikanyo; Cross, Frank W

2011-01-01

Objective Expert authorities recommend clinical decision support systems to reduce prescribing error rates, yet large numbers of insignificant on-screen alerts presented in modal dialog boxes persistently interrupt clinicians, limiting the effectiveness of these systems. This study compared the impact of modal and non-modal electronic (e-) prescribing alerts on prescribing error rates, to help inform the design of clinical decision support systems. Design A randomized study of 24 junior doctors each performing 30 simulated prescribing tasks in random order with a prototype e-prescribing system. Using a within-participant design, doctors were randomized to be shown one of three types of e-prescribing alert (modal, non-modal, no alert) during each prescribing task. Measurements The main outcome measure was prescribing error rate. Structured interviews were performed to elicit participants' preferences for the prescribing alerts and their views on clinical decision support systems. Results Participants exposed to modal alerts were 11.6 times less likely to make a prescribing error than those not shown an alert (OR 11.56, 95% CI 6.00 to 22.26). Those shown a non-modal alert were 3.2 times less likely to make a prescribing error (OR 3.18, 95% CI 1.91 to 5.30) than those not shown an alert. The error rate with non-modal alerts was 3.6 times higher than with modal alerts (95% CI 1.88 to 7.04). Conclusions Both kinds of e-prescribing alerts significantly reduced prescribing error rates, but modal alerts were over three times more effective than non-modal alerts. This study provides new evidence about the relative effects of modal and non-modal alerts on prescribing outcomes. PMID:21836158

Analyzing Information Seeking and Drug-Safety Alert Response by Health Care Professionals as New Methods for Surveillance.

PubMed

Callahan, Alison; Pernek, Igor; Stiglic, Gregor; Leskovec, Jure; Strasberg, Howard R; Shah, Nigam Haresh

2015-08-20

Patterns in general consumer online search logs have been used to monitor health conditions and to predict health-related activities, but the multiple contexts within which consumers perform online searches make significant associations difficult to interpret. Physician information-seeking behavior has typically been analyzed through survey-based approaches and literature reviews. Activity logs from health care professionals using online medical information resources are thus a valuable yet relatively untapped resource for large-scale medical surveillance. To analyze health care professionals' information-seeking behavior and assess the feasibility of measuring drug-safety alert response from the usage logs of an online medical information resource. Using two years (2011-2012) of usage logs from UpToDate, we measured the volume of searches related to medical conditions with significant burden in the United States, as well as the seasonal distribution of those searches. We quantified the relationship between searches and resulting page views. Using a large collection of online mainstream media articles and Web log posts we also characterized the uptake of a Food and Drug Administration (FDA) alert via changes in UpToDate search activity compared with general online media activity related to the subject of the alert. Diseases and symptoms dominate UpToDate searches. Some searches result in page views of only short duration, while others consistently result in longer-than-average page views. The response to an FDA alert for Celexa, characterized by a change in UpToDate search activity, differed considerably from general online media activity. Changes in search activity appeared later and persisted longer in UpToDate logs. The volume of searches and page view durations related to Celexa before the alert also differed from those after the alert. Understanding the information-seeking behavior associated with online evidence sources can offer insight into the information needs of health professionals and enable large-scale medical surveillance. Our Web log mining approach has the potential to monitor responses to FDA alerts at a national level. Our findings can also inform the design and content of evidence-based medical information resources such as UpToDate.

Do family physicians retrieve synopses of clinical research previously read as email alerts?

PubMed

Grad, Roland; Pluye, Pierre; Johnson-Lafleur, Janique; Granikov, Vera; Shulha, Michael; Bartlett, Gillian; Marlow, Bernard

2011-11-30

A synopsis of new clinical research highlights important aspects of one study in a brief structured format. When delivered as email alerts, synopses enable clinicians to become aware of new developments relevant for practice. Once read, a synopsis can become a known item of clinical information. In time-pressured situations, remembering a known item may facilitate information retrieval by the clinician. However, exactly how synopses first delivered as email alerts influence retrieval at some later time is not known. We examined searches for clinical information in which a synopsis previously read as an email alert was retrieved (defined as a dyad). Our study objectives were to (1) examine whether family physicians retrieved synopses they previously read as email alerts and then to (2) explore whether family physicians purposefully retrieved these synopses. We conducted a mixed-methods study in which a qualitative multiple case study explored the retrieval of email alerts within a prospective longitudinal cohort of practicing family physicians. Reading of research-based synopses was tracked in two contexts: (1) push, meaning to read on email and (2) pull, meaning to read after retrieval from one electronic knowledge resource. Dyads, defined as synopses first read as email alerts and subsequently retrieved in a search of a knowledge resource, were prospectively identified. Participants were interviewed about all of their dyads. Outcomes were the total number of dyads and their type. Over a period of 341 days, 194 unique synopses delivered to 41 participants resulted in 4937 synopsis readings. In all, 1205 synopses were retrieved over an average of 320 days. Of the 1205 retrieved synopses, 21 (1.7%) were dyads made by 17 family physicians. Of the 1205 retrieved synopses, 6 (0.5%) were known item type dyads. However, dyads also occurred serendipitously. In the single knowledge resource we studied, email alerts containing research-based synopses were rarely retrieved. Our findings help us to better understand the effect of push on pull and to improve the integration of research-based information within electronic resources for clinicians.

Provider management strategies of abnormal test result alerts: a cognitive task analysis

PubMed Central

Sawhney, Mona K; Wilson, Lindsay; Sittig, Dean F; Espadas, Donna; Davis, Traber; Singh, Hardeep

2010-01-01

Objective Electronic medical records (EMRs) facilitate abnormal test result communication through “alert” notifications. The aim was to evaluate how primary care providers (PCPs) manage alerts related to critical diagnostic test results on their EMR screens, and compare alert-management strategies of providers with high versus low rates of timely follow-up of results. Design 28 PCPs from a large, tertiary care Veterans Affairs Medical Center (VAMC) were purposively sampled according to their rates of timely follow-up of alerts, determined in a previous study. Using techniques from cognitive task analysis, participants were interviewed about how and when they manage alerts, focusing on four alert-management features to filter, sort and reduce unnecessary alerts on their EMR screens. Results Provider knowledge of alert-management features ranged between 4% and 75%. Almost half (46%) of providers did not use any of these features, and none used more than two. Providers with higher versus lower rates of timely follow-up used the four features similarly, except one (customizing alert notifications). Providers with low rates of timely follow-up tended to manually scan the alert list and process alerts heuristically using their clinical judgment. Additionally, 46% of providers used at least one workaround strategy to manage alerts. Conclusion Considerable heterogeneity exists in provider use of alert-management strategies; specific strategies may be associated with lower rates of timely follow-up. Standardization of alert-management strategies including improving provider knowledge of appropriate tools in the EMR to manage alerts could reduce the lack of timely follow-up of abnormal diagnostic test results. PMID:20064805

Implementation of a computer-assisted monitoring system for the detection of adverse drug reactions in gastroenterology.

PubMed

Dormann, H; Criegee-Rieck, M; Neubert, A; Egger, T; Levy, M; Hahn, E G; Brune, K

2004-02-01

To investigate the effectiveness of a computer monitoring system that detects adverse drug reactions (ADRs) by laboratory signals in gastroenterology. A prospective, 6-month, pharmaco-epidemiological survey was carried out on a gastroenterological ward at the University Hospital Erlangen-Nuremberg. Two methods were used to identify ADRs. (i) All charts were reviewed daily by physicians and clinical pharmacists. (ii) A computer monitoring system generated a daily list of automatic laboratory signals and alerts of ADRs, including patient data and dates of events. One hundred and nine ADRs were detected in 474 admissions (377 patients). The computer monitoring system generated 4454 automatic laboratory signals from 39 819 laboratory parameters tested, and issued 2328 alerts, 914 (39%) of which were associated with ADRs; 574 (25%) were associated with ADR-positive admissions. Of all the alerts generated, signals of hepatotoxicity (1255), followed by coagulation disorders (407) and haematological toxicity (207), were prevalent. Correspondingly, the prevailing ADRs were concerned with the metabolic and hepato-gastrointestinal system (61). The sensitivity was 91%: 69 of 76 ADR-positive patients were indicated by an alert. The specificity of alerts was increased from 23% to 76% after implementation of an automatic laboratory signal trend monitoring algorithm. This study shows that a computer monitoring system is a useful tool for the systematic and automated detection of ADRs in gastroenterological patients.

Good pharmacovigilance practices: technology enabled.

PubMed

Nelson, Robert C; Palsulich, Bruce; Gogolak, Victor

2002-01-01

The assessment of spontaneous reports is most effective it is conducted within a defined and rigorous process. The framework for good pharmacovigilance process (GPVP) is proposed as a subset of good postmarketing surveillance process (GPMSP), a functional structure for both a public health and corporate risk management strategy. GPVP has good practices that implement each step within a defined process. These practices are designed to efficiently and effectively detect and alert the drug safety professional to new and potentially important information on drug-associated adverse reactions. These practices are enabled by applied technology designed specifically for the review and assessment of spontaneous reports. Specific practices include rules-based triage, active query prompts for severe organ insults, contextual single case evaluation, statistical proportionality and correlational checks, case-series analyses, and templates for signal work-up and interpretation. These practices and the overall GPVP are supported by state-of-the-art web-based systems with powerful analytical engines, workflow and audit trials to allow validated systems support for valid drug safety signalling efforts. It is also important to understand that a process has a defined set of steps and any one cannot stand independently. Specifically, advanced use of technical alerting methods in isolation can mislead and allow one to misunderstand priorities and relative value. In the end, pharmacovigilance is a clinical art and a component process to the science of pharmacoepidemiology and risk management.

Faster clinical response to the onset of adverse events: A wearable metacognitive attention aid for nurse triage of clinical alarms.

PubMed

McFarlane, Daniel C; Doig, Alexa K; Agutter, James A; Brewer, Lara M; Syroid, Noah D; Mittu, Ranjeev

2018-01-01

This study evaluates the potential for improving patient safety by introducing a metacognitive attention aid that enables clinicians to more easily access and use existing alarm/alert information. It is hypothesized that this introduction will enable clinicians to easily triage alarm/alert events and quickly recognize emergent opportunities to adapt care delivery. The resulting faster response to clinically important alarms/alerts has the potential to prevent adverse events and reduce healthcare costs. A randomized within-subjects single-factor clinical experiment was conducted in a high-fidelity 20-bed simulated acute care hospital unit. Sixteen registered nurses, four at a time, cared for five simulated patients each. A two-part highly realistic clinical scenario was used that included representative: tasking; information; and alarms/alerts. The treatment condition introduced an integrated wearable attention aid that leveraged metacognition methods from proven military systems. The primary metric was time for nurses to respond to important alarms/alerts. Use of the wearable attention aid resulted in a median relative within-subject improvement for individual nurses of 118% (W = 183, p = 0.006). The top quarter of relative improvement was 3,303% faster (mean; 17.76 minutes reduced to 1.33). For all unit sessions, there was an overall 148% median faster response time to important alarms (8.12 minutes reduced to 3.27; U = 2.401, p = 0.016), with 153% median improvement in consistency across nurses (F = 11.670, p = 0.001). Existing device-centric alarm/alert notification solutions can require too much time and effort for nurses to access and understand. As a result, nurses may ignore alarms/alerts as they focus on other important work. There has been extensive research on reducing alarm frequency in healthcare. However, alarm safety remains a top problem. Empirical observations reported here highlight the potential of improving patient safety by supporting the meta-work of checking alarms.

The MOnitoring Resynchronization dEvices and CARdiac patiEnts (MORE-CARE) Randomized Controlled Trial: Phase 1 Results on Dynamics of Early Intervention With Remote Monitoring

PubMed Central

Da Costa, Antoine; Ricci, Renato Pietro; Quesada, Aurelio; Favale, Stefano; Iacopino, Saverio; Romeo, Francesco; Risi, Arnaldo; Mangoni di S Stefano, Lorenza; Navarro, Xavier; Biffi, Mauro; Santini, Massimo; Burri, Haran

2013-01-01

Background Remote monitoring (RM) in patients with advanced heart failure and cardiac resynchronization therapy defibrillators (CRT-D) may reduce delays in clinical decisions by transmitting automatic alerts. However, this strategy has never been tested specifically in this patient population, with alerts for lung fluid overload, and in a European setting. Objective The main objective of Phase 1 (presented here) is to evaluate if RM strategy is able to reduce time from device-detected events to clinical decisions. Methods In this multicenter randomized controlled trial, patients with moderate to severe heart failure implanted with CRT-D devices were randomized to a Remote group (with remote follow-up and wireless automatic alerts) or to a Control group (with standard follow-up without alerts). The primary endpoint of Phase 1 was the delay between an alert event and clinical decisions related to the event in the first 154 enrolled patients followed for 1 year. Results The median delay from device-detected events to clinical decisions was considerably shorter in the Remote group compared to the Control group: 2 (25th-75th percentile, 1-4) days vs 29 (25th-75th percentile, 3-51) days respectively, P=.004. In-hospital visits were reduced in the Remote group (2.0 visits/patient/year vs 3.2 visits/patient/year in the Control group, 37.5% relative reduction, P<.001). Automatic alerts were successfully transmitted in 93% of events occurring outside the hospital in the Remote group. The annual rate of all-cause hospitalizations per patient did not differ between the two groups (P=.65). Conclusions RM in CRT-D patients with advanced heart failure allows physicians to promptly react to clinically relevant automatic alerts and significantly reduces the burden of in-hospital visits. Trial Registration Clinicaltrials.gov NCT00885677; http://clinicaltrials.gov/show/NCT00885677 (Archived by WebCite at http://www.webcitation.org/6IkcCJ7NF). PMID:23965236

The effect of phasic auditory alerting on visual perception.

PubMed

Petersen, Anders; Petersen, Annemarie Hilkjær; Bundesen, Claus; Vangkilde, Signe; Habekost, Thomas

2017-08-01

Phasic alertness refers to a short-lived change in the preparatory state of the cognitive system following an alerting signal. In the present study, we examined the effect of phasic auditory alerting on distinct perceptual processes, unconfounded by motor components. We combined an alerting/no-alerting design with a pure accuracy-based single-letter recognition task. Computational modeling based on Bundesen's Theory of Visual Attention was used to examine the effect of phasic alertness on visual processing speed and threshold of conscious perception. Results show that phasic auditory alertness affects visual perception by increasing the visual processing speed and lowering the threshold of conscious perception (Experiment 1). By manipulating the intensity of the alerting cue, we further observed a positive relationship between alerting intensity and processing speed, which was not seen for the threshold of conscious perception (Experiment 2). This was replicated in a third experiment, in which pupil size was measured as a physiological marker of alertness. Results revealed that the increase in processing speed was accompanied by an increase in pupil size, substantiating the link between alertness and processing speed (Experiment 3). The implications of these results are discussed in relation to a newly developed mathematical model of the relationship between levels of alertness and the speed with which humans process visual information. Copyright © 2017 Elsevier B.V. All rights reserved.

Preventing dispensing errors by alerting for drug confusions in the pharmacy information system-A survey of users.

PubMed

Campmans, Zizi; van Rhijn, Arianne; Dull, René M; Santen-Reestman, Jacqueline; Taxis, Katja; Borgsteede, Sander D

2018-01-01

Drug confusion is thought to be the most common type of dispensing error. Several strategies can be implemented to reduce the risk of medication errors. One of these are alerts in the pharmacy information system. To evaluate the experiences of pharmacists and pharmacy technicians with alerts for drug name and strength confusion. In May 2017, a cross-sectional survey of pharmacists and pharmacy technicians was performed in community pharmacies in the Netherlands using an online questionnaire. Of the 269 respondents, 86% (n = 230) had noticed the alert for drug name confusion, and 26% (n = 67) for drug strength confusion. Of those 230, 9% (n = 20) had experienced that the alert had prevented dispensing the wrong drug. For drug strength confusion, this proportion was 12% (n = 8). Respondents preferred to have an alert for drug name and strength confusion in the pharmacy information system. 'Alert fatigue' was an important issue, so alerts should only be introduced for frequent confusions or confusions with serious consequences. Pharmacists and pharmacy technicians were positive about having alerts for drug confusions in their pharmacy information system and experienced that alerts contributed to the prevention of dispensing errors. To prevent alert fatigue, it was considered important not to include all possible confusions as a new alert: the potential contribution to the prevention of drug confusion should be weighed against the risk of alert fatigue.

Proposing alerts for pre and pro-haptens (QSAR2016) ...

EPA Pesticide Factsheets

Predictive testing to identify and characterise substances for their skin sensitisation potential has historically been based on animal tests such as the Local Lymph Node Assay (LLNA). In recent years, regulations in the cosmetics and chemicals sectors has provided a strong impetus to develop and evaluate non-animal alternative methods. The 3 test methods that have undergone extensive development and validation are the direct peptide reactivity assay (DPRA), the KeratinoSensTM and the human Cell Line Activation Test (h-CLAT). Whilst these methods have been shown to perform relatively well in predicting LLNA results (accuracy ~ 80%), a particular concern that has been raised is their ability to predict chemicals that need to be activated to act as sensitisers (either abiotically on the skin (pre-hapten) or metabolically in the skin (pro-hapten)). This study reviewed an EURL ECVAM dataset containing 271 substances for which information was available in the LLNA and for one or more of the three non-animal test methods. The chemical structures of the substances were inspected and each assigned to a reaction mechanistic domain. Fifty-three substances were expected to require activation. Plausible reaction pathways were considered for each of the substances from which three structural alerts were hypothesised: autoxidation to hydroperoxides, aromatic ortho and para-diamino or di phenol derivatives, and aromatic meta-diamino/hydroxy derivatives. For each alert, the av

Recommendations for Selecting Drug-Drug Interactions for Clinical Decision Support

PubMed Central

Tilson, Hugh; Hines, Lisa E.; McEvoy, Gerald; Weinstein, David M.; Hansten, Philip D.; Matuszewski, Karl; le Comte, Marianne; Higby-Baker, Stefanie; Hanlon, Joseph T.; Pezzullo, Lynn; Vieson, Kathleen; Helwig, Amy L.; Huang, Shiew-Mei; Perre, Anthony; Bates, David W.; Poikonen, John; Wittie, Michael A.; Grizzle, Amy J.; Brown, Mary; Malone, Daniel C.

2016-01-01

Purpose To recommend principles for including drug-drug interactions (DDIs) in clinical decision support. Methods A conference series was conducted to improve clinical decision support (CDS) for DDIs. The Content Workgroup met monthly by webinar from January 2013 to February 2014, with two in-person meetings to reach consensus. The workgroup consisted of 20 experts in pharmacology, drug information, and CDS from academia, government agencies, health information (IT) vendors, and healthcare organizations. Workgroup members addressed four key questions: (1) What process should be used to develop and maintain a standard set of DDIs?; (2) What information should be included in a knowledgebase of standard DDIs?; (3) Can/should a list of contraindicated drug pairs be established?; and (4) How can DDI alerts be more intelligently filtered? Results To develop and maintain a standard set of DDIs for CDS in the United States, we recommend a transparent, systematic, and evidence-driven process with graded recommendations by a consensus panel of experts and oversight by a national organization. We outline key DDI information needed to help guide clinician decision-making. We recommend judicious classification of DDIs as contraindicated, as only a small set of drug combinations are truly contraindicated. Finally, we recommend more research to identify methods to safely reduce repetitive and less relevant alerts. Conclusion A systematic ongoing process is necessary to select DDIs for alerting clinicians. We anticipate that our recommendations can lead to consistent and clinically relevant content for interruptive DDIs, and thus reduce alert fatigue and improve patient safety. PMID:27045070

Adaptive sequential Bayesian classification using Page's test

NASA Astrophysics Data System (ADS)

Lynch, Robert S., Jr.; Willett, Peter K.

2002-03-01

In this paper, the previously introduced Mean-Field Bayesian Data Reduction Algorithm is extended for adaptive sequential hypothesis testing utilizing Page's test. In general, Page's test is well understood as a method of detecting a permanent change in distribution associated with a sequence of observations. However, the relationship between detecting a change in distribution utilizing Page's test with that of classification and feature fusion is not well understood. Thus, the contribution of this work is based on developing a method of classifying an unlabeled vector of fused features (i.e., detect a change to an active statistical state) as quickly as possible given an acceptable mean time between false alerts. In this case, the developed classification test can be thought of as equivalent to performing a sequential probability ratio test repeatedly until a class is decided, with the lower log-threshold of each test being set to zero and the upper log-threshold being determined by the expected distance between false alerts. It is of interest to estimate the delay (or, related stopping time) to a classification decision (the number of time samples it takes to classify the target), and the mean time between false alerts, as a function of feature selection and fusion by the Mean-Field Bayesian Data Reduction Algorithm. Results are demonstrated by plotting the delay to declaring the target class versus the mean time between false alerts, and are shown using both different numbers of simulated training data and different numbers of relevant features for each class.

Reducing duplicate testing: a comparison of two clinical decision support tools.

PubMed

Procop, Gary W; Keating, Catherine; Stagno, Paul; Kottke-Marchant, Kandice; Partin, Mary; Tuttle, Robert; Wyllie, Robert

2015-05-01

Unnecessary duplicate laboratory testing is common and costly. Systems-based means to avert unnecessary testing should be investigated and employed. We compared the effectiveness and cost savings associated with two clinical decision support tools to stop duplicate testing. The Hard Stop required telephone contact with the laboratory and justification to have the duplicate test performed, whereas the Smart Alert allowed the provider to bypass the alert at the point of order entry without justification. The Hard Stop alert was significantly more effective than the Smart Alert (92.3% vs 42.6%, respectively; P < .0001). The cost savings realized per alert activation was $16.08/alert for the Hard Stop alert vs $3.52/alert for the Smart Alert. Structural and process changes that require laboratory contact and justification for duplicate testing are more effective than interventions that allow providers to bypass alerts without justification at point of computerized physician order entry. Copyright© by the American Society for Clinical Pathology.

Commercial Mobile Alert Service (CMAS) Alerting Pipeline Taxonomy

DTIC Science & Technology

2012-03-01

for the consumer at the mo- ment but will soon become a commoditized, basic requirement. For example, as the baby boomers grow older, mobile services...Commercial Mobile Alert Service (CMAS) Alerting Pipeline Taxonomy The WEA Project Team March 2012 SPECIAL REPORT CMU/SEI-2012-TR-019 CERT...report presents a taxonomy developed for the Commercial Mobile Alert Service (CMAS). The CMAS Alerting Pipeline Taxonomy is a hierarchical classification

Wireless Emergency Alerts (WEA) Cybersecurity Risk Management Strategy for Alert Originators

DTIC Science & Technology

2014-03-01

formerly known as the Commercial Mobile Alert Service ( CMAS ) RDT&E program, is a collaborative partnership that includes the cellular industry, the...Examples illustrate a STRIDE analysis of the generic mission 1 The CMAS Alerting Pipeline Taxonomy describes in detail a hierarchical classification...SEI-2013-SR-018 | 1 1 Introduction The Wireless Emergency Alerts (WEA) service, formerly known as the Commercial Mobile Alert Service ( CMAS ), is a

Development and use of active clinical decision support for preemptive pharmacogenomics

PubMed Central

Bell, Gillian C; Crews, Kristine R; Wilkinson, Mark R; Haidar, Cyrine E; Hicks, J Kevin; Baker, Donald K; Kornegay, Nancy M; Yang, Wenjian; Cross, Shane J; Howard, Scott C; Freimuth, Robert R; Evans, William E; Broeckel, Ulrich; Relling, Mary V; Hoffman, James M

2014-01-01

Background Active clinical decision support (CDS) delivered through an electronic health record (EHR) facilitates gene-based drug prescribing and other applications of genomics to patient care. Objective We describe the development, implementation, and evaluation of active CDS for multiple pharmacogenetic test results reported preemptively. Materials and methods Clinical pharmacogenetic test results accompanied by clinical interpretations are placed into the patient's EHR, typically before a relevant drug is prescribed. Problem list entries created for high-risk phenotypes provide an unambiguous trigger for delivery of post-test alerts to clinicians when high-risk drugs are prescribed. In addition, pre-test alerts are issued if a very-high risk medication is prescribed (eg, a thiopurine), prior to the appropriate pharmacogenetic test result being entered into the EHR. Our CDS can be readily modified to incorporate new genes or high-risk drugs as they emerge. Results Through November 2012, 35 customized pharmacogenetic rules have been implemented, including rules for TPMT with azathioprine, thioguanine, and mercaptopurine, and for CYP2D6 with codeine, tramadol, amitriptyline, fluoxetine, and paroxetine. Between May 2011 and November 2012, the pre-test alerts were electronically issued 1106 times (76 for thiopurines and 1030 for drugs metabolized by CYP2D6), and the post-test alerts were issued 1552 times (1521 for TPMT and 31 for CYP2D6). Analysis of alert outcomes revealed that the interruptive CDS appropriately guided prescribing in 95% of patients for whom they were issued. Conclusions Our experience illustrates the feasibility of developing computational systems that provide clinicians with actionable alerts for gene-based drug prescribing at the point of care. PMID:23978487

A Novel Design for Drug-Drug Interaction Alerts Improves Prescribing Efficiency.

PubMed

Russ, Alissa L; Chen, Siying; Melton, Brittany L; Johnson, Elizabette G; Spina, Jeffrey R; Weiner, Michael; Zillich, Alan J

2015-09-01

Drug-drug interactions (DDIs) are common in clinical care and pose serious risks for patients. Electronic health records display DDI alerts that can influence prescribers, but the interface design of DDI alerts has largely been unstudied. In this study, the objective was to apply human factors engineering principles to alert design. It was hypothesized that redesigned DDI alerts would significantly improve prescribers' efficiency and reduce prescribing errors. In a counterbalanced, crossover study with prescribers, two DDI alert designs were evaluated. Department of Veterans Affairs (VA) prescribers were video recorded as they completed fictitious patient scenarios, which included DDI alerts of varying severity. Efficiency was measured from time-stamped recordings. Prescribing errors were evaluated against predefined criteria. Efficiency and prescribing errors were analyzed with the Wilcoxon signed-rank test. Other usability data were collected on the adequacy of alert content, prescribers' use of the DDI monograph, and alert navigation. Twenty prescribers completed patient scenarios for both designs. Prescribers resolved redesigned alerts in about half the time (redesign: 52 seconds versus original design: 97 seconds; p<.001). Prescribing errors were not significantly different between the two designs. Usability results indicate that DDI alerts might be enhanced by facilitating easier access to laboratory data and dosing information and by allowing prescribers to cancel either interacting medication directly from the alert. Results also suggest that neither design provided adequate information for decision making via the primary interface. Applying human factors principles to DDI alerts improved overall efficiency. Aspects of DDI alert design that could be further enhanced prior to implementation were also identified.

Reduction in alert fatigue in an assisted electronic prescribing system, through the Lean Six Sigma methodology.

PubMed

Cuéllar Monreal, Mª Jesús; Reig Aguado, Jorge; Font Noguera, Isabel; Poveda Andrés, José Luis

2017-01-01

To reduce the alert fatigue in our Assisted Electronic Prescribing System (AEPS), through the Lean Six Sigma (LSS) methodology. An observational (transversal) and retrospective study, in a general hospital with 850 beds and AEPS. The LSS methodology was followed in order to evaluate the alert fatigue situation in the AEPS system, to implement improvements, and to assess outcomes. The alerts generated during two trimesters studied (before and after the intervention) were analyzed. In order to measure the qualitative indicators, the most frequent alert types were analyzed, as well as the molecules responsible for over 50% of each type of alert. The action by the prescriber was analyzed in a sample of 496 prescriptions that generated such alerts. For each type of alert and molecule, there was a prioritization of the improvements to be implemented according to the alert generated and its quality. A second survey evaluated the pharmacist action for the alerts most highly valued by physicians. The problem, the objective, the work team and the project schedule were defined. A survey was designed in order to understand the opinion of the client about the alert system in the program. Based on the surveys collected (n = 136), the critical characteristics and the quanti/qualitative indicators were defined. Sixty (60) fields in the alert system were modified, corresponding to 32 molecules, and this led to a 28% reduction in the total number of alerts. Regarding quality indicators, false po sitive results were reduced by 25% (p < 0.05), 100% of those alerts ignored with justification were sustained, and there were no significant differences in user adherence to the system. The project improvements and outcomes were reviewed by the work team. LSS methodology has demonstrated being a valid tool for the quantitative and qualitative improvement of the alert system in an Assisted Electronic Prescription Program, thus reducing alert fatigue. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

The Second SWIFT Burst Alert Telescope (BAT) Gamma-Ray Burst Catalog

NASA Technical Reports Server (NTRS)

Sakamoto, T.; Barthelmy, S. D.; Baumgartner, W. H.; Cummings, J. R.; Fenimore, E. E.; Gehrels, N.; Krimm, H. A.; Markwardt, C. B.; Palmer, D. M.; Parsons, A. M.;

76 FR 80780 - Review of the Emergency Alert System

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-27

... Emergency Alert System AGENCY: Federal Communications Commission. ACTION: Final rule. SUMMARY: In this document, the Commission amends its rules governing the Emergency Alert System (EAS) rules to extend the deadline for EAS Participants to be able to receive Common Alerting Protocol (CAP)- formatted EAS alerts to...

40 CFR 280.44 - Methods of release detection for piping.

Code of Federal Regulations, 2012 CFR

2012-07-01

... accordance with the following: (a) Automatic line leak detectors. Methods which alert the operator to the... pounds per square inch line pressure within 1 hour. An annual test of the operation of the leak detector...

40 CFR 280.44 - Methods of release detection for piping.

Code of Federal Regulations, 2011 CFR

2011-07-01

... accordance with the following: (a) Automatic line leak detectors. Methods which alert the operator to the... pounds per square inch line pressure within 1 hour. An annual test of the operation of the leak detector...

40 CFR 280.44 - Methods of release detection for piping.

Code of Federal Regulations, 2013 CFR

2013-07-01

... accordance with the following: (a) Automatic line leak detectors. Methods which alert the operator to the... pounds per square inch line pressure within 1 hour. An annual test of the operation of the leak detector...

40 CFR 280.44 - Methods of release detection for piping.

Code of Federal Regulations, 2014 CFR

2014-07-01

... accordance with the following: (a) Automatic line leak detectors. Methods which alert the operator to the... pounds per square inch line pressure within 1 hour. An annual test of the operation of the leak detector...

40 CFR 280.44 - Methods of release detection for piping.

Code of Federal Regulations, 2010 CFR

2010-07-01

... accordance with the following: (a) Automatic line leak detectors. Methods which alert the operator to the... pounds per square inch line pressure within 1 hour. An annual test of the operation of the leak detector...

Providing accurate near real-time fire alerts for Protected Areas through NASA FIRMS: Opportunities and Challenges

NASA Astrophysics Data System (ADS)

Ilavajhala, S.; Davies, D.; Schmaltz, J. E.; Wong, M.; Murphy, K. J.

2013-12-01

The NASA Fire Information for Resource Management System (FIRMS) is at the forefront of providing global near real-time (NRT) MODIS thermal anomalies / hotspot location data to end-users . FIRMS serves the data via an interactive Web GIS named Web Fire Mapper, downloads of NRT active fire, archive data downloads for MODIS hotspots dating back to 1999 and a hotspot email alert system The FIRMS Email Alerts system has been successfully alerting users of fires in their area of interest in near real-time and/or via daily and weekly email summaries, with an option to receive MODIS hotspot data as a text file (CSV) attachment. Currently, there are more than 7000 email alert subscriptions from more than 100 countries. Specifically, the email alerts system is designed to generate and send an email alert for any region or area on the globe, with a special focus on providing alerts for protected areas worldwide. For many protected areas, email alerts are particularly useful for early fire detection, monitoring on going fires, as well as allocating resources to protect wildlife and natural resources of particular value. For protected areas, FIRMS uses the World Database on Protected Areas (WDPA) supplied by United Nations Environment Program - World Conservation Monitoring Centre (UNEP-WCMC). Maintaining the most up-to-date, accurate boundary geometry for the protected areas for the email alerts is a challenge as the WDPA is continuously updated due to changing boundaries, merging or delisting of certain protected areas. Because of this dynamic nature of the protected areas database, the FIRMS protected areas database is frequently out-of-date with the most current version of WDPA database. To maintain the most up-to-date boundary information for protected areas and to be in compliance with the WDPA terms and conditions, FIRMS needs to constantly update its database of protected areas. Currently, FIRMS strives to keep its database up to date by downloading the most recent WDPA database at regular intervals, processing it, and ingesting it into the FIRMS spatial database. However, due to the large size of database, the process to download, process and ingest the database is quite time consuming. The FIRMS team is currently working on developing a method to update the protected areas database via web at regular intervals or on-demand. Using such a solution, FIRMS will be able access the most up-to-date extents of any protected area and the corresponding spatial geometries in real time. As such, FIRMS can utilize such a service to access the protected areas and their associated geometries to keep users' protected area boundaries in sync with those of the most recent WDPA database, and thus serve a more accurate email alert to the users. Furthermore, any client accessing the WDPA protected areas database could potentially use the solution of real-time access to the protected areas database. This talk primarily focuses on the challenges for FIRMS in sending accurate email alerts for protected areas, along with the solution the FIRMS team is developing. This talk also introduces the FIRMS fire information system and its components, with a special emphasis on the FIRMS email alerts system.

NOAA Weather Wire Service

Science.gov Websites

& Imagery; includes NWS alerts and warnings No 6 Wireless Emergency Alerts (WEA) Mobile Phone Alerts & Warnings only No 7 Interactive NWS (iNWS) - NOTE 1 https://inws.ncep.noaa.gov/ Mobile Phone $$$$) Internet/ Mobile Phone Alerts and Warnings No 15 County or Local Emergency Management Telephone alert

75 FR 26196 - Publication of OIG Updated Special Fraud Alert on Telemarketing by Durable Medical Equipment...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-11

... Special Fraud Alert on Telemarketing by Durable Medical Equipment Suppliers AGENCY: Office of Inspector... Special Fraud Alert. Specifically, the Updated Special Fraud Alert addressed the statutory provision...) 205-0007. SUPPLEMENTARY INFORMATION: In our publication of the OIG Updated Special Fraud Alert on...

Physician perspectives of CYP2C19 and clopidogrel drug-gene interaction active clinical decision support alerts.

PubMed

Nishimura, Adam A; Shirts, Brian H; Salama, Joseph; Smith, Joe W; Devine, Beth; Tarczy-Hornoch, Peter

2016-02-01

To determine if physicians find clinical decision support alerts for pharmacogenomic drug-gene interactions useful and assess their perceptions of usability aspects that impact usefulness. 52 physicians participated in an online simulation and questionnaire involving a prototype alert for the clopidogrel and CYP2C19 drug-gene interaction. Only 4% of participants stated they would override the alert. 92% agreed that the alerts were useful. 87% found the visual interface appropriate, 91% felt the timing of the alert was appropriate and 75% were unfamiliar with the specific drug-gene interaction. 80% of providers preferred the ability to order the recommended medication within the alert. Qualitative responses suggested that supplementary information is important, but should be provided as external links, and that the utility of pharmacogenomic alerts depends on the broader ecosystem of alerts. Pharmacogenomic alerts would be welcomed by many physicians, can be built with minimalist design principles, and are appropriately placed at the end of the prescribing process. Since many physicians lack familiarity with pharmacogenomics but have limited time, information and educational resources within the alert should be carefully selected and presented in concise ways. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Primary Care Providers' Opening of Time-Sensitive Alerts Sent to Commercial Electronic Health Record InBaskets.

PubMed

Cutrona, Sarah L; Fouayzi, Hassan; Burns, Laura; Sadasivam, Rajani S; Mazor, Kathleen M; Gurwitz, Jerry H; Garber, Lawrence; Sundaresan, Devi; Houston, Thomas K; Field, Terry S

2017-11-01

Time-sensitive alerts are among the many types of clinical notifications delivered to physicians' secure InBaskets within commercial electronic health records (EHRs). A delayed alert review can impact patient safety and compromise care. To characterize factors associated with opening of non-interruptive time-sensitive alerts delivered into primary care provider (PCP) InBaskets. We analyzed data for 799 automated alerts. Alerts highlighted actionable medication concerns for older patients post-hospital discharge (2010-2011). These were study-generated alerts sent 3 days post-discharge to InBaskets for 75 PCPs across a multisite healthcare system, and represent a subset of all urgent InBasket notifications. Using EHR access and audit logs to track alert opening, we performed bivariate and multivariate analyses calculating associations between patient characteristics, provider characteristics, contextual factors at the time of alert delivery (number of InBasket notifications, weekday), and alert opening within 24 h. At the time of alert delivery, the PCPs had a median of 69 InBasket notifications and had received a median of 379.8 notifications (IQR 295.0, 492.0) over the prior 7 days. Of the 799 alerts, 47.1% were opened within 24 h. Patients with longer hospital stays (>4 days) were marginally more likely to have alerts opened (OR 1.48 [95% CI 1.00-2.19]). Alerts delivered to PCPs whose InBaskets had a higher number of notifications at the time of alert delivery were significantly less likely to be opened within 24 h (top quartile >157 notifications: OR 0.34 [95% CI 0.18-0.61]; reference bottom quartile ≤42). Alerts delivered on Saturdays were also less likely to be opened within 24 h (OR 0.18 [CI 0.08-0.39]). The number of total InBasket notifications and weekend delivery may impact the opening of time-sensitive EHR alerts. Further study is needed to support safe and effective approaches to care team management of InBasket notifications.

Computerized Dose Range Checking Using Hard and Soft Stop Alerts Reduces Prescribing Errors in a Pediatric Intensive Care Unit.

PubMed

Balasuriya, Lilanthi; Vyles, David; Bakerman, Paul; Holton, Vanessa; Vaidya, Vinay; Garcia-Filion, Pamela; Westdorp, Joan; Sanchez, Christine; Kurz, Rhonda

2017-09-01

An enhanced dose range checking (DRC) system was developed to evaluate prescription error rates in the pediatric intensive care unit and the pediatric cardiovascular intensive care unit. An enhanced DRC system incorporating "soft" and "hard" alerts was designed and implemented. Practitioner responses to alerts for patients admitted to the pediatric intensive care unit and the pediatric cardiovascular intensive care unit were retrospectively reviewed. Alert rates increased from 0.3% to 3.4% after "go-live" (P < 0.001). Before go-live, all alerts were soft alerts. In the period after go-live, 68% of alerts were soft alerts and 32% were hard alerts. Before go-live, providers reduced doses only 1 time for every 10 dose alerts. After implementation of the enhanced computerized physician order entry system, the practitioners responded to soft alerts by reducing doses to more appropriate levels in 24.7% of orders (70/283), compared with 10% (3/30) before go-live (P = 0.0701). The practitioners deleted orders in 9.5% of cases (27/283) after implementation of the enhanced DRC system, as compared with no cancelled orders before go-live (P = 0.0774). Medication orders that triggered a soft alert were submitted unmodified in 65.7% (186/283) as compared with 90% (27/30) of orders before go-live (P = 0.0067). After go-live, 28.7% of hard alerts resulted in a reduced dose, 64% resulted in a cancelled order, and 7.4% were submitted as written. Before go-live, alerts were often clinically irrelevant. After go-live, there was a statistically significant decrease in orders that were submitted unmodified and an increase in the number of orders that were reduced or cancelled.

Development of the Carers' Alert Thermometer (CAT) to identify family carers struggling with caring for someone dying at home: a mixed method consensus study.

PubMed

Knighting, Katherine; O'Brien, Mary R; Roe, Brenda; Gandy, Rob; Lloyd-Williams, Mari; Nolan, Mike; Jack, Barbara A

2015-05-03

There is an increasing international policy direction to promote home death for dying patients which will impact on the demands placed on family carers. The early identification of carer needs and appropriate intervention can help avoid crisis situations for the carer and avoidable hospital admissions which are reported to be a global concern. The aim of the study was to explore what professionals and carers of patients with cancer and advanced progressive illness, in their last year of life, find burdensome and to develop an alert system for use by non-specialist staff. A mixed-method, multi-phased, consensus study sequentially utilising qualitative and quantitative data to develop and pilot the Carers' Alert Thermometer (CAT). 245 people (117 carers and 128 professionals) participated in the study across a range of health and social care settings in the North West of England (2011-2014). A number of key domains were identified and prioritised by consensus for inclusion in the CAT. The 8 domains fit within two overarching themes of the reported carer experience; the support needed by the carer to provide care and the support needed for the carer's own health and well-being. The resultant CAT is an evidence-based alert thermometer consisting of 10 questions, guidance on the possible actions for each alert and space for an action plan to be jointly agreed by the assessor and carer. Preliminary piloting of the CAT has shown it to be valued, fit for purpose and it can be administered by a range of personnel. The CAT enables the identification of current and potential future needs so a proactive approach can be taken to supporting the carer as their role develops over time, with a view to enhancing their well-being and preventing avoidable hospital admissions; ultimately supporting patient choice to remain in their own home.

Hemochromatosis

MedlinePlus

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Bronchiectasis

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Tracheostomy

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Palpitations

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Thalassemias

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Cardioversion

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16 CFR 613.1 - Duration of active duty alerts.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 16 Commercial Practices 1 2011-01-01 2011-01-01 false Duration of active duty alerts. 613.1 Section 613.1 Commercial Practices FEDERAL TRADE COMMISSION THE FAIR CREDIT REPORTING ACT DURATION OF ACTIVE DUTY ALERTS § 613.1 Duration of active duty alerts. The duration of an active duty alert shall be...

16 CFR 613.1 - Duration of active duty alerts.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 16 Commercial Practices 1 2010-01-01 2010-01-01 false Duration of active duty alerts. 613.1 Section 613.1 Commercial Practices FEDERAL TRADE COMMISSION THE FAIR CREDIT REPORTING ACT DURATION OF ACTIVE DUTY ALERTS § 613.1 Duration of active duty alerts. The duration of an active duty alert shall be...

16 CFR 613.1 - Duration of active duty alerts.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 16 Commercial Practices 1 2012-01-01 2012-01-01 false Duration of active duty alerts. 613.1 Section 613.1 Commercial Practices FEDERAL TRADE COMMISSION THE FAIR CREDIT REPORTING ACT DURATION OF ACTIVE DUTY ALERTS § 613.1 Duration of active duty alerts. The duration of an active duty alert shall be...

47 CFR 80.277 - Ship Security Alert System (SSAS).

Code of Federal Regulations, 2010 CFR

2010-10-01

... 47 Telecommunication 5 2010-10-01 2010-10-01 false Ship Security Alert System (SSAS). 80.277... Security Alert System (SSAS). (a) Vessels equipped with a Ship Security Alert System pursuant to the Safety..., “RTCM Standard 11020.0—Ship Security Alert Systems (SSAS) using the Cospas-Sarsat System,” Version 1.0...

Pixel color feature enhancement for road signs detection

NASA Astrophysics Data System (ADS)

Zhang, Qieshi; Kamata, Sei-ichiro

2010-02-01

Road signs play an important role in our daily life which used to guide drivers to notice variety of road conditions and cautions. They provide important visual information that can help drivers operating their vehicles in a manner for enhancing traffic safety. The occurrence of some accidents can be reduced by using automatic road signs recognition system which can alert the drivers. This research attempts to develop a warning system to alert the drivers to notice the important road signs early enough to refrain road accidents from happening. For solving this, a non-linear weighted color enhancement method by pixels is presented. Due to the advantage of proposed method, different road signs can be detected from videos effectively. With suitably coefficients and operations, the experimental results have proved that the proposed method is robust, accurate and powerful in road signs detection.

Lung Transplant

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Carotid Endarterectomy

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Pulmonary Embolism

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Pernicious Anemia

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Catheter Ablation

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Immune Thrombocytopenia

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Chest MRI

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Cardiac Rehabilitation

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Cardiac MRI

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Oxygen Therapy

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Detecting alerts, notifying the physician, and offering action items: a comprehensive alerting system.

PubMed Central

Kuperman, G. J.; Teich, J. M.; Bates, D. W.; Hiltz, F. L.; Hurley, J. M.; Lee, R. Y.; Paterno, M. D.

1996-01-01

We developed and evaluated a system to automatically identify serious clinical conditions in inpatients. The system notifies the patient's covering physician via his pager that an alert is present and offers potential therapies for the patient's condition (action items) at the time he views the alert information. Over a 6 month period, physicians responded to 1214 (70.2%) of 1730 alerts for which they were paged; they responded to 1002 (82.5% of the 1214) in less than 15 minutes. They said they would take action in 71.5% of the alerts, and they placed an order directly from the alert display screen in 39.4%. Further study is needed to determine if this alerting system improves processes or outcomes of care. PMID:8947756

Revealing the functional neuroanatomy of intrinsic alertness using fMRI: methodological peculiarities.

PubMed

Clemens, Benjamin; Zvyagintsev, Mikhail; Sack, Alexander T; Sack, Alexander; Heinecke, Armin; Willmes, Klaus; Sturm, Walter

2011-01-01

Clinical observations and neuroimaging data revealed a right-hemisphere fronto-parietal-thalamic-brainstem network for intrinsic alertness, and additional left fronto-parietal activity during phasic alertness. The primary objective of this fMRI study was to map the functional neuroanatomy of intrinsic alertness as precisely as possible in healthy participants, using a novel assessment paradigm already employed in clinical settings. Both the paradigm and the experimental design were optimized to specifically assess intrinsic alertness, while at the same time controlling for sensory-motor processing. The present results suggest that the processing of intrinsic alertness is accompanied by increased activity within the brainstem, thalamus, anterior cingulate gyrus, right insula, and right parietal cortex. Additionally, we found increased activation in the left hemisphere around the middle frontal gyrus (BA 9), the insula, the supplementary motor area, and the cerebellum. Our results further suggest that rather minute aspects of the experimental design may induce aspects of phasic alertness, which in turn might lead to additional brain activation in left-frontal areas not normally involved in intrinsic alertness. Accordingly, left BA 9 activation may be related to co-activation of the phasic alertness network due to the switch between rest and task conditions functioning as an external warning cue triggering the phasic alertness network. Furthermore, activation of the intrinsic alertness network during fixation blocks due to enhanced expectancy shortly before the switch to the task block might, when subtracted from the task block, lead to diminished activation in the typical right hemisphere intrinsic alertness network. Thus, we cautiously suggest that--as a methodological artifact--left frontal activations might show up due to phasic alertness involvement and intrinsic alertness activations might be weakened due to contrasting with fixation blocks, when assessing the functional neuroanatomy of intrinsic alertness with a block design in fMRI studies.

Revealing the Functional Neuroanatomy of Intrinsic Alertness Using fMRI: Methodological Peculiarities

PubMed Central

Clemens, Benjamin; Zvyagintsev, Mikhail; Sack, Alexander; Heinecke, Armin; Willmes, Klaus; Sturm, Walter

2011-01-01

Clinical observations and neuroimaging data revealed a right-hemisphere fronto-parietal-thalamic-brainstem network for intrinsic alertness, and additional left fronto-parietal activity during phasic alertness. The primary objective of this fMRI study was to map the functional neuroanatomy of intrinsic alertness as precisely as possible in healthy participants, using a novel assessment paradigm already employed in clinical settings. Both the paradigm and the experimental design were optimized to specifically assess intrinsic alertness, while at the same time controlling for sensory-motor processing. The present results suggest that the processing of intrinsic alertness is accompanied by increased activity within the brainstem, thalamus, anterior cingulate gyrus, right insula, and right parietal cortex. Additionally, we found increased activation in the left hemisphere around the middle frontal gyrus (BA 9), the insula, the supplementary motor area, and the cerebellum. Our results further suggest that rather minute aspects of the experimental design may induce aspects of phasic alertness, which in turn might lead to additional brain activation in left-frontal areas not normally involved in intrinsic alertness. Accordingly, left BA 9 activation may be related to co-activation of the phasic alertness network due to the switch between rest and task conditions functioning as an external warning cue triggering the phasic alertness network. Furthermore, activation of the intrinsic alertness network during fixation blocks due to enhanced expectancy shortly before the switch to the task block might, when subtracted from the task block, lead to diminished activation in the typical right hemisphere intrinsic alertness network. Thus, we cautiously suggest that – as a methodological artifact – left frontal activations might show up due to phasic alertness involvement and intrinsic alertness activations might be weakened due to contrasting with fixation blocks, when assessing the functional neuroanatomy of intrinsic alertness with a block design in fMRI studies. PMID:21984928

ToxAlerts: a Web server of structural alerts for toxic chemicals and compounds with potential adverse reactions.

PubMed

Sushko, Iurii; Salmina, Elena; Potemkin, Vladimir A; Poda, Gennadiy; Tetko, Igor V

2012-08-27

The article presents a Web-based platform for collecting and storing toxicological structural alerts from literature and for virtual screening of chemical libraries to flag potentially toxic chemicals and compounds that can cause adverse side effects. An alert is uniquely identified by a SMARTS template, a toxicological endpoint, and a publication where the alert was described. Additionally, the system allows storing complementary information such as name, comments, and mechanism of action, as well as other data. Most importantly, the platform can be easily used for fast virtual screening of large chemical datasets, focused libraries, or newly designed compounds against the toxicological alerts, providing a detailed profile of the chemicals grouped by structural alerts and endpoints. Such a facility can be used for decision making regarding whether a compound should be tested experimentally, validated with available QSAR models, or eliminated from consideration altogether. The alert-based screening can also be helpful for an easier interpretation of more complex QSAR models. The system is publicly accessible and tightly integrated with the Online Chemical Modeling Environment (OCHEM, http://ochem.eu). The system is open and expandable: any registered OCHEM user can introduce new alerts, browse, edit alerts introduced by other users, and virtually screen his/her data sets against all or selected alerts. The user sets being passed through the structural alerts can be used at OCHEM for other typical tasks: exporting in a wide variety of formats, development of QSAR models, additional filtering by other criteria, etc. The database already contains almost 600 structural alerts for such endpoints as mutagenicity, carcinogenicity, skin sensitization, compounds that undergo metabolic activation, and compounds that form reactive metabolites and, thus, can cause adverse reactions. The ToxAlerts platform is accessible on the Web at http://ochem.eu/alerts, and it is constantly growing.

ToxAlerts: A Web Server of Structural Alerts for Toxic Chemicals and Compounds with Potential Adverse Reactions

PubMed Central

2012-01-01

The article presents a Web-based platform for collecting and storing toxicological structural alerts from literature and for virtual screening of chemical libraries to flag potentially toxic chemicals and compounds that can cause adverse side effects. An alert is uniquely identified by a SMARTS template, a toxicological endpoint, and a publication where the alert was described. Additionally, the system allows storing complementary information such as name, comments, and mechanism of action, as well as other data. Most importantly, the platform can be easily used for fast virtual screening of large chemical datasets, focused libraries, or newly designed compounds against the toxicological alerts, providing a detailed profile of the chemicals grouped by structural alerts and endpoints. Such a facility can be used for decision making regarding whether a compound should be tested experimentally, validated with available QSAR models, or eliminated from consideration altogether. The alert-based screening can also be helpful for an easier interpretation of more complex QSAR models. The system is publicly accessible and tightly integrated with the Online Chemical Modeling Environment (OCHEM, http://ochem.eu). The system is open and expandable: any registered OCHEM user can introduce new alerts, browse, edit alerts introduced by other users, and virtually screen his/her data sets against all or selected alerts. The user sets being passed through the structural alerts can be used at OCHEM for other typical tasks: exporting in a wide variety of formats, development of QSAR models, additional filtering by other criteria, etc. The database already contains almost 600 structural alerts for such endpoints as mutagenicity, carcinogenicity, skin sensitization, compounds that undergo metabolic activation, and compounds that form reactive metabolites and, thus, can cause adverse reactions. The ToxAlerts platform is accessible on the Web at http://ochem.eu/alerts, and it is constantly growing. PMID:22876798

Alert status of nuclear weapons

NASA Astrophysics Data System (ADS)

Kristensen, Hans M.

2017-11-01

Nuclear Alert Forces. Four nuclear-armed states deploy nuclear warheads on alert, ready to be used on relatively short notice: United States, Russia, France and Britain. Combined, the four countries deploy an estimated 1,869 nuclear alert warheads. Russia and the United States deploy 1,749 alert warheads combined, or 94% of all alert warheads. Despite some debate about possible need to increase readiness of nuclear forces (China, Pakistan), the five other nuclear-armed states (China, Pakistan, India, Israel and North Korea) are thought to store their warheads separate from launchers under normal circumstances. The overall number of alert warheads has remained relatively stable during the past five years.

Geo-targeted Weather Alerts Coming to Millions of Mobile Devices

NASA Astrophysics Data System (ADS)

Gerber, M.

2011-12-01

The Personal Localized Alert Network (PLAN), aka Commercial Mobile Alert System (CMAS), is readying for roll out and will be broadcasting emergency public alerts to millions of cell phones by the middle of 2012. Learn how the National Weather Serivce (NWS) is supplying PLAN with geo-referenced weather alert information in the industry standard Common Alerting Protocol (CAP) format and how you can access this same information for integration with mobile devices, other consumer electronics, and decision support systems. Information will also be provided on the NWS' new collaborative venue that encourages wide participation in the evolution and use of NWS CAP alerts in a variety of applications.

Centralized Alert-Processing and Asset Planning for Sensorwebs

NASA Technical Reports Server (NTRS)

Castano, Rebecca; Chien, Steve A.; Rabideau, Gregg R.; Tang, Benyang

2010-01-01

A software program provides a Sensorweb architecture for alert-processing, event detection, asset allocation and planning, and visualization. It automatically tasks and re-tasks various types of assets such as satellites and robotic vehicles in response to alerts (fire, weather) extracted from various data sources, including low-level Webcam data. JPL has adapted cons iderable Sensorweb infrastructure that had been previously applied to NASA Earth Science applications. This NASA Earth Science Sensorweb has been in operational use since 2003, and has proven reliability of the Sensorweb technologies for robust event detection and autonomous response using space and ground assets. Unique features of the software include flexibility to a range of detection and tasking methods including those that require aggregation of data over spatial and temporal ranges, generality of the response structure to represent and implement a range of response campaigns, and the ability to respond rapidly.

Automated External Defibrillator

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Thrombocythemia and Thrombocytosis

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von Willebrand Disease

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Chest X-Ray

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What Is Cardiomyopathy?

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Long QT Syndrome

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Percutaneous Coronary Intervention

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What is Hemophilia?

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Thrombotic Thrombocytopenic Purpura

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What Is Anemia?

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Cardiac CT Scan

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Coronary Calcium Scan

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Patent Ductus Arteriosus

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What is Bronchoscopy?

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Regulatory alerts for dietary supplements in Canada and the United States, 2005-13.

PubMed

Abe, Andrew M; Hein, Darren J; Gregory, Philip J

2015-06-01

Dietary supplement regulatory alerts published by the Food and Drug Administration (FDA) and Health Canada were evaluated and characterized. FDA MedWatch and Health Canada websites were reviewed to identify regulatory alerts regarding dietary supplements from January 1, 2005, through December 31, 2013. Alerts were analyzed to identify product characteristics that may be predictive of product quality issues and potential patient harm. A total of 1560 dietary supplement-related regulatory alerts were identified. Of those, 1287 (83%) were identified through Health Canada, and 273 (18%) were identified through FDA MedWatch. The country of origin of dietary supplements associated with regulatory alerts was not provided in most regulatory alerts; however, when their origin was provided, the United States was the most common. Dietary supplements intended for sexual enhancement were the subject of 33% of all regulatory alerts identified. Products purchased online were the most likely to be associated with a regulatory alert. Dietary supplements intended for sexual enhancement, weight loss, and bodybuilding or athletic performance appeared to pose the greatest risk for patient harm due to product contamination with a pharmaceutical such as a phosphodiesterase-5 inhibitor or sibutramine. Analysis of Canadian and U.S. regulatory alerts concerning dietary supplements revealed that more than 80% of the composite alerts were issued by Health Canada. The most common intended uses of supplements for which alerts were issued were sexual enhancement, weight loss, and bodybuilding or athletic performance. The most common reason for alerts was the presence of a pharmaceutical contaminant. Copyright © 2015 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Concomitant prescribing and dispensing errors at a Brazilian hospital: a descriptive study

PubMed Central

Silva, Maria das Dores Graciano; Rosa, Mário Borges; Franklin, Bryony Dean; Reis, Adriano Max Moreira; Anchieta, Lêni Márcia; Mota, Joaquim Antônio César

2011-01-01

OBJECTIVE: To analyze the prevalence and types of prescribing and dispensing errors occurring with high-alert medications and to propose preventive measures to avoid errors with these medications. INTRODUCTION: The prevalence of adverse events in health care has increased, and medication errors are probably the most common cause of these events. Pediatric patients are known to be a high-risk group and are an important target in medication error prevention. METHODS: Observers collected data on prescribing and dispensing errors occurring with high-alert medications for pediatric inpatients in a university hospital. In addition to classifying the types of error that occurred, we identified cases of concomitant prescribing and dispensing errors. RESULTS: One or more prescribing errors, totaling 1,632 errors, were found in 632 (89.6%) of the 705 high-alert medications that were prescribed and dispensed. We also identified at least one dispensing error in each high-alert medication dispensed, totaling 1,707 errors. Among these dispensing errors, 723 (42.4%) content errors occurred concomitantly with the prescribing errors. A subset of dispensing errors may have occurred because of poor prescription quality. The observed concomitancy should be examined carefully because improvements in the prescribing process could potentially prevent these problems. CONCLUSION: The system of drug prescribing and dispensing at the hospital investigated in this study should be improved by incorporating the best practices of medication safety and preventing medication errors. High-alert medications may be used as triggers for improving the safety of the drug-utilization system. PMID:22012039

The development of a culturally appropriate school based intervention for Australian Aboriginal children living in remote communities: A formative evaluation of the Alert Program® intervention.

PubMed

Wagner, Bree; Fitzpatrick, James; Symons, Martyn; Jirikowic, Tracy; Cross, Donna; Latimer, Jane

2017-06-01

Although previous research has demonstrated the benefits of targeting self-regulation in non-Aboriginal children, it is unclear whether such programs would be effective for Aboriginal children attending school in remote communities. Some of these children have been diagnosed with a fetal alcohol spectrum disorder (FASD) impairing their ability to self-regulate. The aim of this article is to describe a three phase formative process to develop and pilot a curriculum version of the Alert Program ® , a promising intervention for improving self-regulation that could be used in remote community schools. This modified version of the program will be subsequently tested in a cluster randomised controlled trial. A mixed methods approach was used. Modifications to the Alert Program ® , its delivery and evaluation were made after community and stakeholder consultation facilitated by a senior Aboriginal community researcher. Changes to lesson plans and program resources were made to reflect the remote community context, classroom environment and the challenging behaviours of children. Standardised study outcome measures were modified by removing several questions that had little relevance to the lives of children in remote communities. Program training for school staff was reduced in length to reduce staff burden. This study identified aspects of the Alert Program ® training, delivery and measures for evaluation that need modification before their use in assessing the efficacy of the Alert Program ® in remote Aboriginal community primary schools. © 2016 Occupational Therapy Australia.

Alertness and cognitive control: Testing the early onset hypothesis.

PubMed

Schneider, Darryl W

2018-05-01

Previous research has revealed a peculiar interaction between alertness and cognitive control in selective-attention tasks: Congruency effects are larger on alert trials (on which an alerting cue is presented briefly in advance of the imperative stimulus) than on no-alert trials, despite shorter response times (RTs) on alert trials. One explanation for this finding is the early onset hypothesis, which is based on the assumptions that increased alertness shortens stimulus-encoding time and that cognitive control involves gradually focusing attention during a trial. The author tested the hypothesis in 3 experiments by manipulating alertness and stimulus quality (which were intended to shorten and lengthen stimulus-encoding time, respectively) in an arrow-based flanker task involving congruent and incongruent stimuli. Replicating past findings, the alerting manipulation led to shorter RTs but larger congruency effects on alert trials than on no-alert trials. The stimulus-quality manipulation led to longer RTs and larger congruency effects for degraded stimuli than for intact stimuli. These results provide mixed support for the early onset hypothesis, but the author discusses how data and theory might be reconciled if stimulus quality affects stimulus-encoding time and the rate of evidence accumulation in the decision process. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Holter and Event Monitors

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CHEMICAL SAFETY ALERTS-

EPA Science Inventory

Chemical Safety Alerts are short publications which explain specific hazards that have become evident through chemical accident investigation efforts. EPA has produced over a dozen Alerts to date. This year's Alert: Managing Chemical Reactivity Hazards

What Is Heart Failure?

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What Is Bronchopulmonary Dysplasia?

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What Is Cardiac Catheterization?

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What Is a Ventilator?

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What Are Sleep Studies?

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What Are the Lungs?

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What Is Sudden Cardiac Arrest?

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Blood and Bone Marrow Transplant?

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What Is Respiratory Distress Syndrome?

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What Is a Heart Transplant?

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What is Broken Heart Syndrome

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ARDS (Acute Respiratory Distress Syndrome)

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What Are Bone Marrow Tests?

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Estimating endogenous changes in task performance from EEG

PubMed Central

Touryan, Jon; Apker, Gregory; Lance, Brent J.; Kerick, Scott E.; Ries, Anthony J.; McDowell, Kaleb

2014-01-01

Brain wave activity is known to correlate with decrements in behavioral performance as individuals enter states of fatigue, boredom, or low alertness.Many BCI technologies are adversely affected by these changes in user state, limiting their application and constraining their use to relatively short temporal epochs where behavioral performance is likely to be stable. Incorporating a passive BCI that detects when the user is performing poorly at a primary task, and adapts accordingly may prove to increase overall user performance. Here, we explore the potential for extending an established method to generate continuous estimates of behavioral performance from ongoing neural activity; evaluating the extended method by applying it to the original task domain, simulated driving; and generalizing the method by applying it to a BCI-relevant perceptual discrimination task. Specifically, we used EEG log power spectra and sequential forward floating selection (SFFS) to estimate endogenous changes in behavior in both a simulated driving task and a perceptual discrimination task. For the driving task the average correlation coefficient between the actual and estimated lane deviation was 0.37 ± 0.22 (μ ± σ). For the perceptual discrimination task we generated estimates of accuracy, reaction time, and button press duration for each participant. The correlation coefficients between the actual and estimated behavior were similar for these three metrics (accuracy = 0.25 ± 0.37, reaction time = 0.33 ± 0.23, button press duration = 0.36 ± 0.30). These findings illustrate the potential for modeling time-on-task decrements in performance from concurrent measures of neural activity. PMID:24994968

Interventions for implementation of thromboprophylaxis in hospitalized patients at risk for venous thromboembolism.

PubMed

Kahn, Susan R; Morrison, David R; Diendéré, Gisèle; Piché, Alexandre; Filion, Kristian B; Klil-Drori, Adi J; Douketis, James D; Emed, Jessica; Roussin, André; Tagalakis, Vicky; Morris, Martin; Geerts, William

2018-04-24

Venous thromboembolism (VTE) is a leading cause of morbidity and mortality in hospitalized patients. While numerous randomized controlled trials (RCTs) have shown that the appropriate use of thromboprophylaxis in hospitalized patients at risk for VTE is safe, effective, and cost-effective, thromboprophylaxis remains underused or inappropriately used. Our previous review suggested that system-wide interventions, such as education, alerts, and multifaceted interventions were more effective at improving the prescribing of thromboprophylaxis than relying on individual providers' behaviors. However, 47 of the 55 included studies in our previous review were observational in design. Thus, an update to our systematic review, focused on the higher level of evidence of RCTs only, was warranted. To assess the effects of system-wide interventions designed to increase the implementation of thromboprophylaxis and decrease the incidence of VTE in hospitalized adult medical and surgical patients at risk for VTE, focusing on RCTs only. Our research librarian conducted a systematic literature search of MEDLINE Ovid, and subsequently translated it to CENTRAL, PubMed, Embase Ovid, BIOSIS Previews Ovid, CINAHL, Web of Science, the Database of Abstracts of Reviews of Effects (DARE; in the Cochrane Library), NHS Economic Evaluation Database (EED; in the Cochrane Library), LILACS, and clinicaltrials.gov from inception to 7 January 2017. We also screened reference lists of relevant review articles. We identified 12,920 potentially relevant records. We included all types of RCTs, with random or quasi-random methods of allocation of interventions, which either randomized individuals (e.g. parallel group, cross-over, or factorial design RCTs), or groups of individuals (cluster RCTs (CRTs)), which aimed to increase the use of prophylaxis or appropriate prophylaxis, or decrease the occurrence of VTE in hospitalized adult patients. We excluded observational studies, studies in which the intervention was simply distribution of published guidelines, and studies whose interventions were not clearly described. Studies could be in any language. We collected data on the following outcomes: the number of participants who received prophylaxis or appropriate prophylaxis (as defined by study authors), the occurrence of any VTE (symptomatic or asymptomatic), mortality, and safety outcomes, such as bleeding. We categorized the interventions into alerts (computer or human alerts), multifaceted interventions (combination of interventions that could include an alert component), educational interventions (e.g. grand rounds, courses), and preprinted orders (written predefined orders completed by the physician on paper or electronically). We meta-analyzed data across RCTs using a random-effects model. For CRTs, we pooled effect estimates (risk difference (RD) and risk ratio (RR), with 95% confidence interval (CI), adjusted for clustering, when possible. We pooled results if three or more trials were available for a particular intervention. We assessed the certainty of the evidence according to the GRADE approach. From the 12,920 records identified by our search, we included 13 RCTs (N = 35,997 participants) in our qualitative analysis and 11 RCTs (N = 33,207 participants) in our meta-analyses. Alerts were associated with an increase in the proportion of participants who received prophylaxis (RD 21%, 95% CI 15% to 27%; three studies; 5057 participants; I² = 75%; low-certainty evidence). The substantial statistical heterogeneity may be in part explained by patient types, type of hospital, and type of alert. Subgroup analyses were not feasible due to the small number of studies included in the meta-analysis.Multifaceted interventions were associated with a small increase in the proportion of participants who received prophylaxis (cluster-adjusted RD 4%, 95% CI 2% to 6%; five studies; 9198 participants; I² = 0%; moderate-certainty evidence). Multifaceted interventions with an alert component were found to be more effective than multifaceted interventions that did not include an alert, although there were not enough studies to conduct a pooled analysis. Alerts were associated with an increase in the proportion of participants who received appropriate prophylaxis (RD 16%, 95% CI 12% to 20%; three studies; 1820 participants; I² = 0; moderate-certainty evidence). Alerts were also associated with a reduction in the rate of symptomatic VTE at three months (RR 64%, 95% CI 47% to 86%; three studies; 5353 participants; I² = 15%; low-certainty evidence). Computer alerts were associated with a reduction in the rate of symptomatic VTE, although there were not enough studies to pool computer alerts and human alerts results separately. We reviewed RCTs that implemented a variety of system-wide strategies aimed at improving thromboprophylaxis in hospitalized patients. We found increased prescription of prophylaxis associated with alerts and multifaceted interventions, and increased prescription of appropriate prophylaxis associated with alerts. While multifaceted interventions were found to be less effective than alerts, a multifaceted intervention with an alert was more effective than one without an alert. Alerts, particularly computer alerts, were associated with a reduction in symptomatic VTE at three months, although there were not enough studies to pool computer alerts and human alerts results separately.Our analysis was underpowered to assess the effect on mortality and safety outcomes, such as bleeding.The incomplete reporting of relevant study design features did not allow complete assessment of the certainty of the evidence. However, the certainty of the evidence for improvement in outcomes was judged to be better than for our previous review (low- to moderate-certainty evidence, compared to very low-certainty evidence for most outcomes). The results of our updated review will help physicians, hospital administrators, and policy makers make practical decisions about adopting specific system-wide measures to improve prescription of thromboprophylaxis, and ultimately prevent VTE in hospitalized patients.

47 CFR 10.300 - Alert aggregator. [Reserved

Code of Federal Regulations, 2013 CFR

2013-10-01

... 47 Telecommunication 1 2013-10-01 2013-10-01 false Alert aggregator. [Reserved] 10.300 Section 10.300 Telecommunication FEDERAL COMMUNICATIONS COMMISSION GENERAL WIRELESS EMERGENCY ALERTS System Architecture § 10.300 Alert aggregator. [Reserved] ...

47 CFR 10.300 - Alert aggregator. [Reserved

Code of Federal Regulations, 2014 CFR

2014-10-01

... 47 Telecommunication 1 2014-10-01 2014-10-01 false Alert aggregator. [Reserved] 10.300 Section 10.300 Telecommunication FEDERAL COMMUNICATIONS COMMISSION GENERAL WIRELESS EMERGENCY ALERTS System Architecture § 10.300 Alert aggregator. [Reserved] ...

49 CFR 229.140 - Alerters.

Code of Federal Regulations, 2012 CFR

2012-10-01

... alerters shall provide an audio alarm upon expiration of the timing cycle interval. An alerter on a... indication to the operator at least five seconds prior to an audio alarm. The visual indication on an alerter...

What Is a Total Artificial Heart?

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What Is a Ventricular Assist Device?

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Resting cerebral blood flow, attention, and aging.

PubMed

Bertsch, Katja; Hagemann, Dirk; Hermes, Michael; Walter, Christof; Khan, Robina; Naumann, Ewald

2009-04-24

Aging is accompanied by a decline of fluid cognitive functions, e.g., a slowing of information processing, working memory, and division of attention. This is at least partly due to structural and functional changes in the aging brain. Although a decrement of resting cerebral blood flow (CBF) has been positively associated with cognitive functions in patients with brain diseases, studies with healthy participants have revealed inconsistent results. Therefore, we investigated the relation between resting cerebral blood flow and cognitive functions (tonic and phasic alertness, selective and divided attention) in two samples of healthy young and older participants. We found higher resting CBF and better cognitive performances in the young than in the older sample. In addition, resting CBF was inversely correlated with selective attention in the young and with tonic alertness in the elderly participants. This finding is discussed with regard to the neural efficiency hypothesis of human intelligence.

Wearable vital parameters monitoring system

NASA Astrophysics Data System (ADS)

Caramaliu, Radu Vadim; Vasile, Alexandru; Bacis, Irina

2015-02-01

The system we propose monitors body temperature, heart rate and beside this, it tracks if the person who wears it suffers a faint. It uses a digital temperature sensor, a pulse sensor and a gravitational acceleration sensor to monitor the eventual faint or small heights free falls. The system continuously tracks the GPS position when available and stores the last valid data. So, when measuring abnormal vital parameters the module will send an SMS, using the GSM cellular network , with the person's social security number, the last valid GPS position for that person, the heart rate, the body temperature and, where applicable, a valid fall alert or non-valid fall alert. Even though such systems exist, they contain only faint detection or heart rate detection. Usually there is a strong correlation between low/high heart rate and an eventual faint. Combining both features into one system results in a more reliable detection device.

[Ecological security early-warning in Zhoushan Islands based on variable weight model].

PubMed

Zhou, Bin; Zhong, Lin-sheng; Chen, Tian; Zhou, Rui

2015-06-01

Ecological security early warning, as an important content of ecological security research, is of indicating significance in maintaining regional ecological security. Based on driving force, pressure, state, impact and response (D-P-S-I-R) framework model, this paper took Zhoushan Islands in Zhejiang Province as an example to construct the ecological security early warning index system, test degrees of ecological security early warning of Zhoushan Islands from 2000 to 2012 by using the method of variable weight model, and forecast ecological security state of 2013-2018 by Markov prediction method. The results showed that the variable weight model could meet the study needs of ecological security early warning of Zhoushan Islands. There was a fluctuant rising ecological security early warning index from 0.286 to 0.484 in Zhoushan Islands between year 2000 and 2012, in which the security grade turned from "serious alert" into " medium alert" and the indicator light turned from "orange" to "yellow". The degree of ecological security warning was "medium alert" with the light of "yellow" for Zhoushan Islands from 2013 to 2018. These findings could provide a reference for ecological security maintenance of Zhoushan Islands.

Development and implementation of sepsis alert systems

PubMed Central

Harrison, Andrew M.; Gajic, Ognjen; Pickering, Brian W.; Herasevich, Vitaly

2016-01-01

Synopsis/Summary Development and implementation of sepsis alert systems is challenging, particularly outside the monitored intensive care unit (ICU) setting. Important barriers to wider use of sepsis alerts include evolving clinical definitions of sepsis, information overload & alert fatigue, due to suboptimal alert performance. Outside the ICU, additional barriers include differences in health care delivery models, charting behaviors, and availability of electronic data. Currently available evidence does not support routine use of sepsis alert systems in clinical practice. However, continuous improvement in both the afferent (data availability and accuracy of detection algorithms) and efferent (evidence-based decision support and smoother integration into clinical workflow) limbs of sepsis alert systems will help translate theoretical advantages into measurable patient benefit. PMID:27229639

NAS-Wide Fast-Time Simulation Study for Evaluating Performance of UAS Detect-and-Avoid Alerting and Guidance Systems

NASA Technical Reports Server (NTRS)

Lee, Seung Man; Park, Chunki; Cone, Andrew Clayton; Thipphavong, David P.; Santiago, Confesor

2016-01-01

This presentation contains the analysis results of NAS-wide fast-time simulations with UAS and VFR traffic for a single day for evaluating the performance of Detect-and-Avoid (DAA) alerting and guidance systems. This purpose of this study was to help refine and validate MOPS alerting and guidance requirements. In this study, we generated plots of all performance metrics that are specified by RTCA SC-228 Minimum Operational Performance Standards (MOPS): 1) to evaluate the sensitivity of alerting parameters on the performance metrics of each DAA alert type: Preventive, Corrective, and Warning alerts and 2) to evaluate the effect of sensor uncertainty on DAA alerting and guidance performance.

Wireless clinical alerts for physiologic, laboratory and medication data.

PubMed Central

Shabot, M. M.; LoBue, M.; Chen, J.

2000-01-01

A fully interfaced clinical information system (CIS) contains physiologic, laboratory, blood gas, medication and other data that can be used as the information base for a comprehensive alerting system. Coupled with an event driven rules engine, a CIS can generate clinical alerts which may both prevent medical errors and assist caregivers in responding to critical events in a timely way. The authors have developed a clinical alerting system which delivers alerts and reminders to clinicians in real time via a alphanumeric display pagers. This paper will describe the system, the type and number of alerts generated, and the impact on clinical practice. A major issue remains in measuring the impact of wireless alerts on patient outcomes. PMID:11079992

Chemical Safety Alert: Identifying Chemical Reactivity Hazards Preliminary Screening Method

EPA Pesticide Factsheets

Introduces small-to-medium-sized facilities to a method developed by Center for Chemical Process Safety (CCPS), based on a series of twelve yes-or-no questions to help determine hazards in warehousing, repackaging, blending, mixing, and processing.

Alerts in mobile healthcare applications: requirements and pilot study.

PubMed

Kafeza, Eleanna; Chiu, Dickson K W; Cheung, S C; Kafeza, Marina

2004-06-01

Recent advances in mobile technologies have greatly extended traditional communication technologies to mobile devices. At the same time, healthcare environments are by nature "mobile" where doctors and nurses do not have fixed workspaces. Irregular and exceptional events are generated in daily hospital routines, such as operations rescheduling, laboratory/examination results, and adverse drug events. These events may create requests that should be delivered to the appropriate person at the appropriate time. Those requests that are classified as urgent are referred to as alerts. Efficient routing and monitoring of alerts are keys to quality and cost-effective healthcare services. Presently, these are generally handled in an ad hoc manner. In this paper, we propose the use of a healthcare alert management system to handle these alert messages systematically. We develop a model for specifying alerts that are associated with medical tasks and a set of parameters for their routing. We design an alert monitor that matches medical staff and their mobile devices to receive alerts, based on the requirements of these alerts. We also propose a mechanism to handle and reroute, if necessary, an alert message when it has not been acknowledged within a specific deadline.

Wearable PPG sensor based alertness scoring system.

PubMed

Dey, Jishnu; Bhowmik, Tanmoy; Sahoo, Saswata; Tiwari, Vijay Narayan

2017-07-01

Quantifying mental alertness in today's world is important as it enables the person to adopt lifestyle changes for better work efficiency. Miniaturized sensors in wearable devices have facilitated detection/monitoring of mental alertness. Photoplethysmography (PPG) sensors through Heart Rate Variability (HRV) offer one such opportunity by providing information about one's daily alertness levels without requiring any manual interference from the user. In this paper, a smartwatch based alertness estimation system is proposed. Data collected from PPG sensor of smartwatch is processed and fed to machine learning based model to get a continuous alertness score. Utility functions are designed based on statistical analysis to give a quality score on different stages of alertness such as awake, long sleep and short duration power nap. An intelligent data collection approach is proposed in collaboration with the motion sensor in the smartwatch to reduce battery drainage. Overall, our proposed wearable based system provides a detailed analysis of alertness over a period in a systematic and optimized manner. We were able to achieve an accuracy of 80.1% for sleep/awake classification along with alertness score. This opens up the possibility for quantifying alertness levels using a single PPG sensor for better management of health related activities including sleep.

Closing the Loop in ICU Decision Support: Physiologic Event Detection, Alerts, and Documentation

PubMed Central

Norris, Patrick R.; Dawant, Benoit M.

2002-01-01

Automated physiologic event detection and alerting is a challenging task in the ICU. Ideally care providers should be alerted only when events are clinically significant and there is opportunity for corrective action. However, the concepts of clinical significance and opportunity are difficult to define in automated systems, and effectiveness of alerting algorithms is difficult to measure. This paper describes recent efforts on the Simon project to capture information from ICU care providers about patient state and therapy in response to alerts, in order to assess the value of event definitions and progressively refine alerting algorithms. Event definitions for intracranial pressure and cerebral perfusion pressure were studied by implementing a reliable system to automatically deliver alerts to clinical users’ alphanumeric pagers, and to capture associated documentation about patient state and therapy when the alerts occurred. During a 6-month test period in the trauma ICU at Vanderbilt University Medical Center, 530 alerts were detected in 2280 hours of data spanning 14 patients. Clinical users electronically documented 81% of these alerts as they occurred. Retrospectively classifying documentation based on therapeutic actions taken, or reasons why actions were not taken, provided useful information about ways to potentially improve event definitions and enhance system utility.

Reliability of Trained Dogs to Alert to Hypoglycemia in Patients With Type 1 Diabetes.

PubMed

Los, Evan A; Ramsey, Katrina L; Guttmann-Bauman, Ines; Ahmann, Andrew J

2017-05-01

We examined the reliability of trained dogs to alert to hypoglycemia in individuals with type 1 diabetes. Patients with type 1 diabetes who currently used diabetes alert dogs participated in this exploratory study. Subjects reported satisfaction, perceived dog glucose sensing ability and reasons for obtaining a trained dog. Reliability of dog alerts was assessed using capillary blood glucose (CBG) and blinded continuous glucose monitoring (CGM) as comparators in 8 subjects (age 4-48). Hypoglycemia was defined as CBG or CGM <70 mg/dL. Dog users were very satisfied (8.9/10 on a Likert-type scale) and largely confident (7.9/10) in their dog's ability to detect hypoglycemia. Detection of hypoglycemia was the primary reason for obtaining a trained dog. During hypoglycemia, spontaneous dog alerts occurred at a rate 3.2 (2.0-5.2, 95% CI) times higher than during euglycemia (70-179 mg/dL). Dogs provided timely alerts in 36% (sensitivity) of all hypoglycemia events (n = 45). Due to inappropriate alerts, the PPV of a dog alert for hypoglycemia was 12%. When there was concurrence of a hypoglycemic event between the dog alert and CGM (n = 30), CGM would have alerted prior to the dog in 73% of events (median 22-minute difference). This is the first study evaluating reliability of trained dogs to alert to hypoglycemia under real-life conditions. Trained dogs often alert a human companion to otherwise unknown hypoglycemia; however due to high false-positive rate, a dog alert alone is unlikely to be helpful in differentiating hypo-/hyper-/euglycemia. CGM often detects hypoglycemia before a trained dog by a clinically significant margin.

47 CFR 10.300 - Alert aggregator. [Reserved

Code of Federal Regulations, 2010 CFR

2010-10-01

... 47 Telecommunication 1 2010-10-01 2010-10-01 false Alert aggregator. [Reserved] 10.300 Section 10.300 Telecommunication FEDERAL COMMUNICATIONS COMMISSION GENERAL COMMERCIAL MOBILE ALERT SYSTEM System Architecture § 10.300 Alert aggregator. [Reserved] ...

47 CFR 10.300 - Alert aggregator. [Reserved

Code of Federal Regulations, 2012 CFR

2012-10-01

... 47 Telecommunication 1 2012-10-01 2012-10-01 false Alert aggregator. [Reserved] 10.300 Section 10.300 Telecommunication FEDERAL COMMUNICATIONS COMMISSION GENERAL COMMERCIAL MOBILE ALERT SYSTEM System Architecture § 10.300 Alert aggregator. [Reserved] ...

47 CFR 10.300 - Alert aggregator. [Reserved

Code of Federal Regulations, 2011 CFR

2011-10-01

... 47 Telecommunication 1 2011-10-01 2011-10-01 false Alert aggregator. [Reserved] 10.300 Section 10.300 Telecommunication FEDERAL COMMUNICATIONS COMMISSION GENERAL COMMERCIAL MOBILE ALERT SYSTEM System Architecture § 10.300 Alert aggregator. [Reserved] ...

Aspirin to Prevent a First Heart Attack or Stroke

MedlinePlus

... Learn more about getting to NIH Get Email Alerts Receive automatic alerts about NHLBI related news and ... Connect With Us Contact Us Directly Get Email Alerts Receive automatic alerts about NHLBI related news and ...

How Regrouping Alerts in Computerized Physician Order Entry Layout Influences Physicians' Prescription Behavior: Results of a Crossover Randomized Trial.

PubMed

Wipfli, Rolf; Ehrler, Frederic; Bediang, Georges; Bétrancourt, Mireille; Lovis, Christian

2016-06-02

As demonstrated in several publications, low positive predictive value alerts in computerized physician order entry (CPOE) induce fatigue and may interrupt physicians unnecessarily during prescription of medication. Although it is difficult to increase the consideration of medical alerts by physician through an improvement of their predictive value, another approach consists to act on the way they are presented. The interruption management model inspired us to propose an alternative alert display strategy of regrouping the alerts in the screen layout, as a possible solution for reducing the interruption in physicians' workflow. In this study, we compared 2 CPOE designs based on a particular alert presentation strategy: one design involved regrouping the alerts in a single place on the screen, and in the other, the alerts were located next to the triggering information. Our objective was to evaluate experimentally whether the new design led to fewer interruptions in workflow and if it affected alert handling. The 2 CPOE designs were compared in a controlled crossover randomized trial. All interactions with the system and eye movements were stored for quantitative analysis. The study involved a group of 22 users consisting of physicians and medical students who solved medical scenarios containing prescription tasks. Scenario completion time was shorter when the alerts were regrouped (mean 117.29 seconds, SD 36.68) than when disseminated on the screen (mean 145.58 seconds, SD 75.07; P=.045). Eye tracking revealed that physicians fixated longer on alerts in the classic design (mean 119.71 seconds, SD 76.77) than in the centralized alert design (mean 70.58 seconds, SD 33.53; P=.001). Visual switches between prescription and alert areas, indicating interruption, were reduced with centralized alerts (mean 41.29, SD 21.26) compared with the classic design (mean 57.81, SD 35.97; P=.04). Prescription behavior (ie, prescription changes after alerting), however, did not change significantly between the 2 strategies of display. The After-Scenario Questionnaire (ASQ) that was filled out after each scenario showed that overall satisfaction was significantly rated lower when alerts were regrouped (mean 4.37, SD 1.23) than when displayed next to the triggering information (mean 5.32, SD 0.94; P=.02). Centralization of alerts in a table might be a way to motivate physicians to manage alerts more actively, in a meaningful way, rather than just being interrupted by them. Our study could not provide clear recommendations yet, but provides objective data through a cognitive psychological approach. Future tests should work on standardized scenarios that would enable to not only measure physicians' behavior (visual fixations and handling of alerts) but also validate those actions using clinical criteria.

Building a Communication, Education, an Outreach Program for the ShakeAlert National Earthquake Early Warning Program

NASA Astrophysics Data System (ADS)

DeGroot, R. M.; Strauss, J. A.; Given, D. D.; Cochran, E. S.; Burkett, E. R.; Long, K.

2016-12-01

Earthquake Early Warning (EEW) systems can provide as much as tens of seconds of warning to people and automated systems before strong shaking arrives. The United States Geological Survey (USGS) and its partners are developing an EEW system for the West Coast of the United States. To be an integral part of successful implementation, EEW engagement programs and materials must integrate with and leverage broader earthquake risk programs. New methods and products for dissemination must be multidisciplinary, cost effective, and consistent with existing hazards education efforts. Our presentation outlines how the USGS and its partners will approach this effort in the context of the EEW system through the work of a multistate and multiagency committee that participates in the design, implementation, and evaluation of a portfolio of programs and products. This committee, referred to as the ShakeAlert Joint Committee for Communication, Education, and Outreach (ShakeAlert CEO), is working to identify, develop, and cultivate partnerships with EEW stakeholders including Federal, State, academic partners, private companies, policy makers, and local organizations. Efforts include developing materials, methods for delivery, and reaching stakeholders with information on EEW, earthquake preparedness, and emergency protective actions. It is essential to develop standards to ensure information communicated via the EEW alerts is consistent across the public and private sector and achieving a common understanding of what actions users take when they receive an EEW warning. The USGS and the participating states and agencies acknowledge that the implementation of EEW is a collective effort requiring the participation of hundreds of stakeholders committed to ensuring public accessibility.

Real-time data acquisition and alerts may reduce reaction time and improve perfusionist performance during cardiopulmonary bypass.

PubMed

Beck, J R; Fung, K; Lopez, H; Mongero, L B; Argenziano, M

2015-01-01

Delayed perfusionist identification and reaction to abnormal clinical situations has been reported to contribute to increased mortality and morbidity. The use of automated data acquisition and compliance safety alerts has been widely accepted in many industries and its use may improve operator performance. A study was conducted to evaluate the reaction time of perfusionists with and without the use of compliance alert. A compliance alert is a computer-generated pop-up banner on a pump-mounted computer screen to notify the user of clinical parameters outside of a predetermined range. A proctor monitored and recorded the time from an alert until the perfusionist recognized the parameter was outside the desired range. Group one included 10 cases utilizing compliance alerts. Group 2 included 10 cases with the primary perfusionist blinded to the compliance alerts. In Group 1, 97 compliance alerts were identified and, in group two, 86 alerts were identified. The average reaction time in the group using compliance alerts was 3.6 seconds. The average reaction time in the group not using the alerts was nearly ten times longer than the group using computer-assisted, real-time data feedback. Some believe that real-time computer data acquisition and feedback improves perfusionist performance and may allow clinicians to identify and rectify potentially dangerous situations. © The Author(s) 2014.

The Deformity Angular Ratio: Does It Correlate With High-Risk Cases for Potential Spinal Cord Monitoring Alerts in Pediatric 3-Column Thoracic Spinal Deformity Corrective Surgery?

PubMed

Lewis, Noah D H; Keshen, Sam G N; Lenke, Lawrence G; Zywiel, Michael G; Skaggs, David L; Dear, Taylor E; Strantzas, Samuel; Lewis, Stephen J

2015-08-01

A retrospective analysis. The purpose of this study was to determine whether the deformity angular ratio (DAR) can reliably assess the neurological risks of patients undergoing deformity correction. Identifying high-risk patients and procedures can help ensure that appropriate measures are taken to minimize neurological complications during spinal deformity corrections. Subjectively, surgeons look at radiographs and evaluate the riskiness of the procedure. However, 2 curves of similar magnitude and location can have significantly different risks of neurological deficit during surgery. Whether the curve spans many levels or just a few can significantly influence surgical strategies. Lenke et al have proposed the DAR, which is a measure of curve magnitude per level of deformity. The data from 35 pediatric spinal deformity correction procedures with thoracic 3-column osteotomies were reviewed. Measurements from preoperative radiographs were used to calculate the DAR. Binary logistic regression was used to model the relationship between DARs (independent variables) and presence or absence of an intraoperative alert (dependent variable). In patients undergoing 3-column osteotomies, sagittal curve magnitude and total curve magnitude were associated with increased incidence of transcranial motor evoked potential changes. Total DAR greater than 45° per level and sagittal DAR greater than 22° per level were associated with a 75% incidence of a motor evoked potential alert, with the incidence increasing to 90% with sagittal DAR of 28° per level. In patients undergoing 3-column osteotomies for severe spinal deformities, the DAR was predictive of patients developing intraoperative motor evoked potential alerts. Identifying accurate radiographical, patient, and procedural risk factors in the correction of severe deformities can help prepare the surgical team to improve safety and outcomes when carrying out complex spinal corrections. 3.

3-minute smartphone-based and tablet-based psychomotor vigilance tests for the assessment of reduced alertness due to sleep deprivation.

PubMed

Grant, Devon A; Honn, Kimberly A; Layton, Matthew E; Riedy, Samantha M; Van Dongen, Hans P A

2017-06-01

The psychomotor vigilance test (PVT) is widely used to measure reduced alertness due to sleep loss. Here, two newly developed, 3-min versions of the psychomotor vigilance test, one smartphone-based and the other tablet-based, were validated against a conventional 10-min laptop-based PVT. Sixteen healthy participants (ages 22-40; seven males, nine females) completed a laboratory study, which included a practice and a baseline day, a 38-h total sleep deprivation (TSD) period, and a recovery day, during which they performed the three different versions of the PVT every 3 h. For each version of the PVT, the number of lapses, mean response time (RT), and number of false starts showed statistically significant changes across the sleep deprivation and recovery days. The number of lapses on the laptop was significantly correlated with the numbers of lapses on the smartphone and tablet. The mean RTs were generally faster on the smartphone and tablet than on the laptop. All three versions of the PVT exhibited a time-on-task effect in RTs, modulated by time awake and time of day. False starts were relatively rare on all three PVTs. For the number of lapses, the effect sizes across 38 h of TSD were large for the laptop PVT and medium for the smartphone and tablet PVTs. These results indicate that the 3-min smartphone and tablet PVTs are valid instruments for measuring reduced alertness due to sleep deprivation and restored alertness following recovery sleep. The results also indicate that the loss of sensitivity on the 3-min PVTs may be mitigated by modifying the threshold defining lapses.

Effects on subjective and objective alertness and sleep in response to evening light exposure in older subjects

PubMed Central

Münch, M; Scheuermaier, KD; Zhang, R; Dunne, SP; Guzik, AM; Silva, EJ; Ronda, JM; Duffy, JF

2011-01-01

Evening bright light exposure is reported to ameliorate daytime sleepiness and age-related sleep complaints, and also delays the timing of circadian rhythms. We tested whether evening light exposure given to older adults with sleep-wake complaints would delay the timing of their circadian rhythms with respect to their sleep timing, thereby reducing evening sleepiness and improving subsequent sleep quality. We examined the impact of evening light exposure from two different light sources on subjective alertness, EEG activity during wakefulness, and sleep stages. Ten healthy older adults with sleep complaints (mean age=63.3 yrs; 6F) participated in a 13-day study. After three baseline days, circadian phase was assessed. On the evening of days 5–8 the subjects were exposed for 2 h to either polychromatic blue-enriched white light or standard white fluorescent light, and on the following day circadian phase was re-assessed. Subjects were allowed to leave the laboratory during all but the two days when the circadian phase assessment took place. Evening assessments of subjective alertness, and wake and sleep EEG data were analyzed. Subjective alertness and wake EEG activity in the alpha range (9.75–11.25 Hz) were significantly higher during light exposures when compared to the pre-light exposure evening (p<0.05). The light exposures produced circadian phase shifts and significantly prolonged latency to rapid eye-movement (REM) sleep for both light groups (p<0.05). The increase in wake EEG alpha activity during the light exposures was negatively correlated with REM sleep duration (p<0.05). Evening light exposure could benefit older adults with early evening sleepiness, without negatively impacting the subsequent sleep episode. PMID:21664380

47 CFR 10.310 - Federal alert gateway. [Reserved

Code of Federal Regulations, 2010 CFR

2010-10-01

... 47 Telecommunication 1 2010-10-01 2010-10-01 false Federal alert gateway. [Reserved] 10.310 Section 10.310 Telecommunication FEDERAL COMMUNICATIONS COMMISSION GENERAL COMMERCIAL MOBILE ALERT SYSTEM System Architecture § 10.310 Federal alert gateway. [Reserved] ...

47 CFR 10.310 - Federal alert gateway. [Reserved

Code of Federal Regulations, 2013 CFR

2013-10-01

... 47 Telecommunication 1 2013-10-01 2013-10-01 false Federal alert gateway. [Reserved] 10.310 Section 10.310 Telecommunication FEDERAL COMMUNICATIONS COMMISSION GENERAL WIRELESS EMERGENCY ALERTS System Architecture § 10.310 Federal alert gateway. [Reserved] ...

47 CFR 10.310 - Federal alert gateway. [Reserved

Code of Federal Regulations, 2014 CFR

2014-10-01

... 47 Telecommunication 1 2014-10-01 2014-10-01 false Federal alert gateway. [Reserved] 10.310 Section 10.310 Telecommunication FEDERAL COMMUNICATIONS COMMISSION GENERAL WIRELESS EMERGENCY ALERTS System Architecture § 10.310 Federal alert gateway. [Reserved] ...

47 CFR 10.310 - Federal alert gateway. [Reserved

Code of Federal Regulations, 2012 CFR

2012-10-01

... 47 Telecommunication 1 2012-10-01 2012-10-01 false Federal alert gateway. [Reserved] 10.310 Section 10.310 Telecommunication FEDERAL COMMUNICATIONS COMMISSION GENERAL COMMERCIAL MOBILE ALERT SYSTEM System Architecture § 10.310 Federal alert gateway. [Reserved] ...

47 CFR 10.310 - Federal alert gateway. [Reserved

Code of Federal Regulations, 2011 CFR

2011-10-01

... 47 Telecommunication 1 2011-10-01 2011-10-01 false Federal alert gateway. [Reserved] 10.310 Section 10.310 Telecommunication FEDERAL COMMUNICATIONS COMMISSION GENERAL COMMERCIAL MOBILE ALERT SYSTEM System Architecture § 10.310 Federal alert gateway. [Reserved] ...

AmberAlert / DPS / DHSEM / AAB

Science.gov Websites

cooperative public service alert to aid in the safe recovery of abducted children. The Alaska AMBER Alert children to aid in their safe return. AMBER Alert Hotline: 866-AKAMBER - (866-252-6237) State of Alaska

Analysis of Alerting System Failures in Commercial Aviation Accidents

NASA Technical Reports Server (NTRS)

Mumaw, Randall J.

2017-01-01

The role of an alerting system is to make the system operator (e.g., pilot) aware of an impending hazard or unsafe state so the hazard can be avoided or managed successfully. A review of 46 commercial aviation accidents (between 1998 and 2014) revealed that, in the vast majority of events, either the hazard was not alerted or relevant hazard alerting occurred but failed to aid the flight crew sufficiently. For this set of events, alerting system failures were placed in one of five phases: Detection, Understanding, Action Selection, Prioritization, and Execution. This study also reviewed the evolution of alerting system schemes in commercial aviation, which revealed naive assumptions about pilot reliability in monitoring flight path parameters; specifically, pilot monitoring was assumed to be more effective than it actually is. Examples are provided of the types of alerting system failures that have occurred, and recommendations are provided for alerting system improvements.

A review of human factors principles for the design and implementation of medication safety alerts in clinical information systems.

PubMed

Phansalkar, Shobha; Edworthy, Judy; Hellier, Elizabeth; Seger, Diane L; Schedlbauer, Angela; Avery, Anthony J; Bates, David W

2010-01-01

The objective of this review is to describe the implementation of human factors principles for the design of alerts in clinical information systems. First, we conduct a review of alarm systems to identify human factors principles that are employed in the design and implementation of alerts. Second, we review the medical informatics literature to provide examples of the implementation of human factors principles in current clinical information systems using alerts to provide medication decision support. Last, we suggest actionable recommendations for delivering effective clinical decision support using alerts. A review of studies from the medical informatics literature suggests that many basic human factors principles are not followed, possibly contributing to the lack of acceptance of alerts in clinical information systems. We evaluate the limitations of current alerting philosophies and provide recommendations for improving acceptance of alerts by incorporating human factors principles in their design.

Subjective assessment of usefulness and appropriate presentation mode of alerts and reminders in the outpatient setting.

PubMed Central

Krall, M. A.; Sittig, D. F.

2001-01-01

There is very little known about the limits of alerting in the setting of the outpatient Electronic Medical Record (EMR). We are interested in how users value and prefer such alerts. One hundred Kaiser Permanente primary care clinicians were sent a four-page questionnaire. It contained questions related to the usability and usefulness of different approaches to presenting reminder and alert information. The survey also contained questions about the desirability of six categories of alerts. Forty-three of 100 questionnaires were returned. Users generally preferred an active, more intrusive interaction model for "alerts" and a passive, less intrusive model for order messages and other types of reminders and notifications. Drug related alerts were more highly rated than health maintenance or disease state reminders. Users indicated that more alerts would make the system "more useful" but "less easy to use". PMID:11825206

Alerts Visualization and Clustering in Network-based Intrusion Detection

DOE Office of Scientific and Technical Information (OSTI.GOV)

Yang, Dr. Li; Gasior, Wade C; Dasireddy, Swetha

2010-04-01

Today's Intrusion detection systems when deployed on a busy network overload the network with huge number of alerts. This behavior of producing too much raw information makes it less effective. We propose a system which takes both raw data and Snort alerts to visualize and analyze possible intrusions in a network. Then we present with two models for the visualization of clustered alerts. Our first model gives the network administrator with the logical topology of the network and detailed information of each node that involves its associated alerts and connections. In the second model, flocking model, presents the network administratormore » with the visual representation of IDS data in which each alert is represented in different color and the alerts with maximum similarity move together. This gives network administrator with the idea of detecting various of intrusions through visualizing the alert patterns.« less

Subjective assessment of usefulness and appropriate presentation mode of alerts and reminders in the outpatient setting.

PubMed

Krall, M A; Sittig, D F

2001-01-01

There is very little known about the limits of alerting in the setting of the outpatient Electronic Medical Record (EMR). We are interested in how users value and prefer such alerts. One hundred Kaiser Permanente primary care clinicians were sent a four-page questionnaire. It contained questions related to the usability and usefulness of different approaches to presenting reminder and alert information. The survey also contained questions about the desirability of six categories of alerts. Forty-three of 100 questionnaires were returned. Users generally preferred an active, more intrusive interaction model for "alerts" and a passive, less intrusive model for order messages and other types of reminders and notifications. Drug related alerts were more highly rated than health maintenance or disease state reminders. Users indicated that more alerts would make the system "more useful" but "less easy to use".

Decision Support Alerts for Medication Ordering in a Computerized Provider Order Entry (CPOE) System

PubMed Central

Beccaro, M. A. Del; Villanueva, R.; Knudson, K. M.; Harvey, E. M.; Langle, J. M.; Paul, W.

2010-01-01

Objective We sought to determine the frequency and type of decision support alerts by location and ordering provider role during Computerized Provider Order Entry (CPOE) medication ordering. Using these data we adjusted the decision support tools to reduce the number of alerts. Design Retrospective analyses were performed of dose range checks (DRC), drug-drug interaction and drug-allergy alerts from our electronic medical record. During seven sampling periods (each two weeks long) between April 2006 and October 2008 all alerts in these categories were analyzed. Another audit was performed of all DRC alerts by ordering provider role from November 2008 through January 2009. Medication ordering error counts were obtained from a voluntary error reporting system. Measurement/Results Between April 2006 and October 2008 the percent of medication orders that triggered a dose range alert decreased from 23.9% to 7.4%. The relative risk (RR) for getting an alert was higher at the start of the interventions versus later (RR= 2.40, 95% CI 2.28-2.52; p< 0.0001). The percentage of medication orders that triggered alerts for drug-drug interactions also decreased from 13.5% to 4.8%. The RR for getting a drug interaction alert at the start was 1.63, 95% CI 1.60-1.66; p< 0.0001. Alerts decreased in all clinical areas without an increase in reported medication errors. Conclusion We reduced the quantity of decision support alerts in CPOE using a systematic approach without an increase in reported medication errors PMID:23616845

Determining Inappropriate Medication Alerts from "Inaccurate Warning" Overrides in the Intensive Care Unit.

PubMed

Rehr, Christine A; Wong, Adrian; Seger, Diane L; Bates, David W

2018-04-01

 This article aims to understand provider behavior around the use of the override reason "Inaccurate warning," specifically whether it is an effective way of identifying unhelpful medication alerts.  We analyzed alert overrides that occurred in the intensive care units (ICUs) of a major academic medical center between June and November 2016, focused on the following high-significance alert types: dose, drug-allergy alerts, and drug-drug interactions (DDI). Override appropriateness was analyzed by two independent reviewers using predetermined criteria.  A total of 268 of 26,501 ICU overrides (1.0%) used the reason "Inaccurate warning," with 93 of these overrides associated with our included alert types. Sixty-one of these overrides (66%) were identified to be appropriate. Twenty-one of 30 (70%) dose alert overrides were appropriate. Forty of 48 drug-allergy alert overrides (83%) were appropriate, for reasons ranging from prior tolerance ( n  = 30) to inaccurate ingredient matches ( n  = 5). None of the 15 DDI overrides were appropriate.  The "Inaccurate warning" reason was selectively used by a small proportion of providers and overrides using this reason identified important opportunities to reduce excess alerts. Potential opportunities include improved evaluation of dosing mechanisms based on patient characteristics, inclusion of institutional dosing protocols to alert logic, and evaluation of a patient's prior tolerance to a medication that they have a documented allergy for. This resource is not yet routinely used for alert tailoring at our institution but may prove to be a valuable resource to evaluate available alerts. Schattauer GmbH Stuttgart.

Speech Alarms Pilot Study

NASA Technical Reports Server (NTRS)

Sandor, A.; Moses, H. R.

2016-01-01

Currently on the International Space Station (ISS) and other space vehicles Caution & Warning (C&W) alerts are represented with various auditory tones that correspond to the type of event. This system relies on the crew's ability to remember what each tone represents in a high stress, high workload environment when responding to the alert. Furthermore, crew receive a year or more in advance of the mission that makes remembering the semantic meaning of the alerts more difficult. The current system works for missions conducted close to Earth where ground operators can assist as needed. On long duration missions, however, they will need to work off-nominal events autonomously. There is evidence that speech alarms may be easier and faster to recognize, especially during an off-nominal event. The Information Presentation Directed Research Project (FY07-FY09) funded by the Human Research Program included several studies investigating C&W alerts. The studies evaluated tone alerts currently in use with NASA flight deck displays along with candidate speech alerts. A follow-on study used four types of speech alerts to investigate how quickly various types of auditory alerts with and without a speech component - either at the beginning or at the end of the tone - can be identified. Even though crew were familiar with the tone alert from training or direct mission experience, alerts starting with a speech component were identified faster than alerts starting with a tone. The current study replicated the results from the previous study in a more rigorous experimental design to determine if the candidate speech alarms are ready for transition to operations or if more research is needed. Four types of alarms (caution, warning, fire, and depressurization) were presented to participants in both tone and speech formats in laboratory settings and later in the Human Exploration Research Analog (HERA). In the laboratory study, the alerts were presented by software and participants were asked to identify the alert as quickly and as accurately as possible. Reaction time and accuracy were measured. Participants identified speech alerts significantly faster than tone alerts. The HERA study investigated the performance of participants in a flight-like environment. Participants were instructed to complete items on a task list and respond to C&W alerts as they occurred. Reaction time and accuracy were measured to determine if the benefits of speech alarms are still present in an applied setting.

Does Telehealth Monitoring Identify Exacerbations of Chronic Obstructive Pulmonary Disease and Reduce Hospitalisations? An Analysis of System Data

PubMed Central

Bentley, Claire L; Mountain, Gail A

2017-01-01

Background The increasing prevalence and associated cost of treating chronic obstructive pulmonary disease (COPD) is unsustainable. Health care organizations are focusing on ways to support self-management and prevent hospital admissions, including telehealth-monitoring services capturing physiological and health status data. This paper reports on data captured during a pilot randomized controlled trial of telehealth-supported care within a community-based service for patients discharged from hospital following an exacerbation of their COPD. Objective The aim was to undertake the first analysis of system data to determine whether telehealth monitoring can identify an exacerbation of COPD, providing clinicians with an opportunity to intervene with timely treatment and prevent hospital readmission. Methods A total of 23 participants received a telehealth-supported intervention. This paper reports on the analysis of data from a telehealth monitoring system that captured data from two sources: (1) data uploaded both manually and using Bluetooth peripheral devices by the 23 participants and (2) clinical records entered as nursing notes by the clinicians. Rules embedded in the telehealth monitoring system triggered system alerts to be reviewed by remote clinicians who determined whether clinical intervention was required. We also analyzed data on the frequency and length (bed days) of hospital admissions, frequency of hospital Accident and Emergency visits that did not lead to hospital admission, and frequency and type of community health care service contacts—other than the COPD discharge service—for all participants for the duration of the intervention and 6 months postintervention. Results Patients generated 512 alerts, 451 of which occurred during the first 42 days that all participants used the equipment. Patients generated fewer alerts over time with typically seven alerts per day within the first 10 days and four alerts per day thereafter. They also had three times more days without alerts than with alerts. Alerts were most commonly triggered by reports of being more tired, having difficulty with self-care, and blood pressure being out of range. During the 8-week intervention, and for 6-month follow-up, eight of the 23 patients were hospitalized. Hospital readmission rates (2/23, 9%) in the first 28 days of service were lower than the 20% UK norm. Conclusions It seems that the clinical team can identify exacerbations based on both an increase in alerts and the types of system-generated alerts as evidenced by their efforts to provided treatment interventions. There was some indication that telehealth monitoring potentially delayed hospitalizations until after patients had been discharged from the service. We suggest that telehealth-supported care can fulfill an important role in enabling patients with COPD to better manage their condition and remain out of hospital, but adequate resourcing and timely response to alerts is a critical factor in supporting patients to remain at home. Trial Registration International Standard Randomized Controlled Trial Number (ISRCTN): 68856013; http://www.isrctn.com/ISRCTN68856013 (Archived by WebCite at http://www.webcitation.org/6ofApNB2e) PMID:28330829

For whom the bell tolls: Silver Alerts raise concerns regarding individual rights and governmental interests.

PubMed

Wasser, Tobias D; Fox, Patrick K

2013-01-01

The Silver Alert system was initially created to help protect missing persons who have cognitive impairments, particularly the elderly. The Silver Alert is modeled after the Amber Alert, created to help locate and safeguard missing children. Unlike the Amber Alert, however, in most states the Silver Alert applies to the elderly, adults with a mental impairment, or both, depending on the state. The goal of the Silver Alert system is the quick dissemination of information about missing persons to law enforcement personnel as well as to the general public. Previously, states notified law enforcement personnel of missing persons through teletype to other public safety jurisdictions to enlist their assistance in the retrieval of the missing person. Silver Alert programs substantially expand the notification to include the general public, who receive information through radio and television broadcasts as well as highway billboards. The programs serve a legitimate governmental interest by protecting a vulnerable population from possible harm. Yet, the implementation of these alerts can have unintended consequences, including the possible violation of an individual's right to privacy. Such consequences require careful consideration.

Evaluation of Helmet Mounted Display Alerting Symbology

NASA Technical Reports Server (NTRS)

DeMaio, Joe; Rutkowski, Michael (Technical Monitor)

2000-01-01

Proposed helicopter helmet mounted displays will be used to alert the pilot to a variety of conditions, from threats to equipment problems. The present research was performed under the NASA Safe All-weather Flight Operations Research (SAFOR) program supported by a joint Army/NASA research agreement. The purpose of the research was to examine ways to optimize the alerting effectiveness of helmet display symbology. The research used two approaches to increasing the effectiveness of alerts. One was to increase the ability of the alert to attract attention by using the entire display surface. The other was to include information about the required response in the alert itself. The investigation was conducted using the NASA Ames Research Center's six-degree-of-freedom vertical motion simulator (VMS) with a rotorcraft cockpit. Helmet display symbology was based on the AH-64's pilot night vision system (PNVS), cruise mode symbology. A standardized mission was developed, that consisted of 11 legs. The mission included four tasks, which allowed variation in the frequency of alerts. The general trend in the data points to a small benefit from both the full-screen alert and the partial information alert.

An Analysis of EMS and ED Detection of Stroke.

PubMed

Medoro, Ian; Cone, David C

2017-01-01

Studies have shown a reduction in time-to-CT and improved process measures when EMS personnel notify the ED of a "stroke alert" from the field. However, there are few data on the accuracy of these EMS stroke alerts. The goal of this study was to examine diagnostic test performance of EMS and ED stroke alerts and related process measures. The EMS and ED records of all stroke alerts in a large tertiary ED from August 2013-January 2014 were examined and data abstracted by one trained investigator, with data accuracy confirmed by a second investigator for 15% of cases. Stroke alerts called by EMS prior to ED arrival were compared to stroke alerts called by ED physicians and nurses (for walk-in patients, and patients transported by EMS without EMS stroke alerts). Means ± SD, medians, unpaired t-tests (for continuous data), and two-tailed Fisher's exact tests (for categorical data) were used. Of 260 consecutive stroke alerts, 129 were EMS stroke alerts, and 131 were ED stroke alerts (70 called by physicians, 61 by nurses). The mean NIH Stroke Scale was higher in the EMS group (8.1 ± 7.6 vs. 3.0 ± 5.0, p < 0.0001). The positive predictive value of EMS stroke alerts was 0.60 (78/129), alerts by ED nurses was 0.25 (15/61), and alerts by ED physicians was 0.31 (22/70). The PPV for EMS was better than for nurses or physicians (both p < 0.001), and more patients in the EMS group had final diagnoses of stroke (62/129 vs. 24/131, p < 0.001). The positive likelihood ratio was 1.53 for EMS personnel, 0.45 for physicians, and 0.77 for nurses. The mean time to order the CT (8.5 ± 7.1 min vs. 23.1 ± 18.2 min, p < 0.0001) and the mean ED length of stay (248 ± 116 min vs. 283 ± 128 min, p = 0.022) were shorter for the EMS stroke alert group. More EMS stroke alert patients received tPA (16/129 vs. 6/131, p = 0.027). EMS stroke alerts have better diagnostic test performance than stroke alerts by ED staff, likely due to higher NIH Stroke Scale scores (more obvious presentations) and are associated with better process measures. The fairly low PPV suggests room for improvement in prehospital stroke protocols.

47 CFR 10.240 - Notification to new subscribers of non-participation in CMAS.

Code of Federal Regulations, 2010 CFR

2010-10-01

...-participation in CMAS. 10.240 Section 10.240 Telecommunication FEDERAL COMMUNICATIONS COMMISSION GENERAL COMMERCIAL MOBILE ALERT SYSTEM Election to Participate in Commercial Mobile Alert System § 10.240... EMERGENCY ALERTS (Commercial Mobile Alert Service) [[CMS provider

47 CFR 10.320 - Provider alert gateway requirements.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 47 Telecommunication 1 2014-10-01 2014-10-01 false Provider alert gateway requirements. 10.320 Section 10.320 Telecommunication FEDERAL COMMUNICATIONS COMMISSION GENERAL WIRELESS EMERGENCY ALERTS System Architecture § 10.320 Provider alert gateway requirements. This section specifies the functions...

47 CFR 10.320 - Provider alert gateway requirements.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 47 Telecommunication 1 2013-10-01 2013-10-01 false Provider alert gateway requirements. 10.320 Section 10.320 Telecommunication FEDERAL COMMUNICATIONS COMMISSION GENERAL WIRELESS EMERGENCY ALERTS System Architecture § 10.320 Provider alert gateway requirements. This section specifies the functions...

47 CFR 10.410 - Prioritization.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 47 Telecommunication 1 2012-10-01 2012-10-01 false Prioritization. 10.410 Section 10.410 Telecommunication FEDERAL COMMUNICATIONS COMMISSION GENERAL COMMERCIAL MOBILE ALERT SYSTEM Alert Message... required to transmit Imminent Threat Alerts and AMBER Alerts on a first in-first out (FIFO) basis. ...

Commercial Motor Vehicle Driver Fatigue And Alertness Study Executive Summary

DOT National Transportation Integrated Search

1996-11-01

THE DRIVER FATIGUE AND ALERTNESS STUDY (DFAS) WAS THE LARGEST AND MOST COMPREHENSIVE OVER-THE-ROAD STUDY EVER CONDUCTED ON DRIVER FATIGUE AND ALERTNESS IN NORTH AMERICA. IT PROVIDES EXTENSIVE INFORMATION ON THE ALERTNESS, DRIVING PERFORMANCE, AND PHY...

47 CFR 11.56 - Obligation to process CAP-formatted EAS messages.

Code of Federal Regulations, 2013 CFR

2013-10-01

...), and Common Alerting Protocol, v. 1.2 USA Integrated Public Alert and Warning System Profile Version 1...) “Common Alerting Protocol, v. 1.2 USA Integrated Public Alert and Warning System Profile Version 1.0” (Oct...

47 CFR 11.56 - Obligation to process CAP-formatted EAS messages.

Code of Federal Regulations, 2012 CFR

2012-10-01

...), and Common Alerting Protocol, v. 1.2 USA Integrated Public Alert and Warning System Profile Version 1...) “Common Alerting Protocol, v. 1.2 USA Integrated Public Alert and Warning System Profile Version 1.0” (Oct...

47 CFR 11.56 - Obligation to process CAP-formatted EAS messages.

Code of Federal Regulations, 2014 CFR

2014-10-01

...), and Common Alerting Protocol, v. 1.2 USA Integrated Public Alert and Warning System Profile Version 1...) “Common Alerting Protocol, v. 1.2 USA Integrated Public Alert and Warning System Profile Version 1.0” (Oct...

Development and Implementation of Sepsis Alert Systems.

PubMed

Harrison, Andrew M; Gajic, Ognjen; Pickering, Brian W; Herasevich, Vitaly

2016-06-01

Development and implementation of sepsis alert systems is challenging, particularly outside the monitored intensive care unit (ICU) setting. Barriers to wider use of sepsis alerts include evolving clinical definitions of sepsis, information overload, and alert fatigue, due to suboptimal alert performance. Outside the ICU, barriers include differences in health care delivery models, charting behaviors, and availability of electronic data. Current evidence does not support routine use of sepsis alert systems in clinical practice. Continuous improvement in the afferent and efferent aspects will help translate theoretic advantages into measurable patient benefit. Copyright © 2016 Elsevier Inc. All rights reserved.

Analysis of UAS DAA Alerting in Fast-Time Simulations without DAA Mitigation

NASA Technical Reports Server (NTRS)

Thipphavong, David P.; Santiago, Confesor; Isaacson, Douglas R.; Lee, Seung Man; Park, Chunki; Refai, Mohamad Said; Snow, James

2015-01-01

Realization of the expected proliferation of Unmanned Aircraft System (UAS) operations in the National Airspace System (NAS) depends on the development and validation of performance standards for UAS Detect and Avoid (DAA) Systems. The RTCA Special Committee 228 is charged with leading the development of draft Minimum Operational Performance Standards (MOPS) for UAS DAA Systems. NASA, as a participating member of RTCA SC-228 is committed to supporting the development and validation of draft requirements for DAA alerting system performance. A recent study conducted using NASA's ACES (Airspace Concept Evaluation System) simulation capability begins to address questions surrounding the development of draft MOPS for DAA alerting systems. ACES simulations were conducted to study the performance of alerting systems proposed by the SC-228 DAA Alerting sub-group. Analysis included but was not limited to: 1) correct alert (and timeliness), 2) false alert (and severity and duration), 3) missed alert, and 4) probability of an alert type at the time of loss of well clear. The performance of DAA alerting systems when using intent vs. dead-reckoning for UAS ownship trajectories was also compared. The results will be used by SC-228 to inform decisions about the surveillance standards of UAS DAA systems and future requirements development and validation efforts.

Closing the loop in ICU decision support: physiologic event detection, alerts, and documentation.

PubMed Central

Norris, P. R.; Dawant, B. M.

2001-01-01

Automated physiologic event detection and alerting is a challenging task in the ICU. Ideally care providers should be alerted only when events are clinically significant and there is opportunity for corrective action. However, the concepts of clinical significance and opportunity are difficult to define in automated systems, and effectiveness of alerting algorithms is difficult to measure. This paper describes recent efforts on the Simon project to capture information from ICU care providers about patient state and therapy in response to alerts, in order to assess the value of event definitions and progressively refine alerting algorithms. Event definitions for intracranial pressure and cerebral perfusion pressure were studied by implementing a reliable system to automatically deliver alerts to clinical users alphanumeric pagers, and to capture associated documentation about patient state and therapy when the alerts occurred. During a 6-month test period in the trauma ICU at Vanderbilt University Medical Center, 530 alerts were detected in 2280 hours of data spanning 14 patients. Clinical users electronically documented 81% of these alerts as they occurred. Retrospectively classifying documentation based on therapeutic actions taken, or reasons why actions were not taken, provided useful information about ways to potentially improve event definitions and enhance system utility. PMID:11825238

Effects of a computerized feedback intervention on safety performance by junior doctors: results from a randomized mixed method study

PubMed Central

2013-01-01

Background The behaviour of doctors and their responses to warnings can inform the effective design of Clinical Decision Support Systems. We used data from a University hospital electronic prescribing and laboratory reporting system with hierarchical warnings and alerts to explore junior doctors’ behaviour. The objective of this trial was to establish whether a Junior Doctor Dashboard providing feedback on prescription warning information and laboratory alerting acceptance rates was effective in changing junior doctors’ behaviour. Methods A mixed methods approach was employed which included a parallel group randomised controlled trial, and individual and focus group interviews. Junior doctors below the specialty trainee level 3 grade were recruited and randomised to two groups. Every doctor (N = 42) in the intervention group was e-mailed a link to a personal dashboard every week for 4 months. Nineteen participated in interviews. The 44 control doctors did not receive any automated feedback. The outcome measures were the difference in responses to prescribing warnings (of two severities) and laboratory alerting (of two severities) between the months before and the months during the intervention, analysed as the difference in performance between the intervention and the control groups. Results No significant differences were observed in the rates of generating prescription warnings, or in the acceptance of laboratory alarms. However, responses to laboratory alerts differed between the pre-intervention and intervention periods. For the doctors of Foundation Year 1 grade, this improvement was significantly (p = 0.002) greater in the group with access to the dashboard (53.6% ignored pre-intervention compared to 29.2% post intervention) than in the control group (47.9% ignored pre-intervention compared to 47.0% post intervention). Qualitative interview data indicated that while junior doctors were positive about the electronic prescribing functions, they were discriminating in the way they responded to other alerts and warnings given that from their perspective these were not always immediately clinically relevant or within the scope of their responsibility. Conclusions We have only been able to provide weak evidence that a clinical dashboard providing individualized feedback data has the potential to improve safety behaviour and only in one of several domains. The construction of metrics used in clinical dashboards must take account of actual work processes. Trial registration ISRCTN: ISRCTN72253051 PMID:23734871

Exploring the Pulse Structure of the Gamma-Ray Bursts from the Swift Burst Alert Telescop

NASA Astrophysics Data System (ADS)

Martinez, Juan-Carlos; Team 1: Jon Hakkila, Amy Lien, Judith, Racusin, Team 2: Antonino Cucchiara, David Morris

2018-01-01

Gamma-ray bursts (GRBs) are one of the brightest and most intense explosions in our universe. For this project, we studied the shape of 400 single pulse GRBs using data gathered from Swift's Burst Alert Telescope (BAT). Hakkila et al. (2015) have discovered a mathematical Model that describes the GRB’s pulse shapes. Following the method in Hakkila et al. (2015), we fit GRB pulses with the Norris function and examined the residual in the fitting, to see whether the results are consistent with the one reported in Hakkila et al. (2015).

Electronic Health Record Alert-Related Workload as a Predictor of Burnout in Primary Care Providers.

PubMed

Gregory, Megan E; Russo, Elise; Singh, Hardeep

2017-07-05

Electronic health records (EHRs) have been shown to increase physician workload. One EHR feature that contributes to increased workload is asynchronous alerts (also known as inbox notifications) related to test results, referral responses, medication refill requests, and messages from physicians and other health care professionals. This alert-related workload results in negative cognitive outcomes, but its effect on affective outcomes, such as burnout, has been understudied. To examine EHR alert-related workload (both objective and subjective) as a predictor of burnout in primary care providers (PCPs), in order to ultimately inform interventions aimed at reducing burnout due to alert workload. A cross-sectional questionnaire and focus group of 16 PCPs at a large medical center in the southern United States. Subjective, but not objective, alert workload was related to two of the three dimensions of burnout, including physical fatigue (p = 0.02) and cognitive weariness (p = 0.04), when controlling for organizational tenure. To reduce alert workload and subsequent burnout, participants indicated a desire to have protected time for alert management, fewer unnecessary alerts, and improvements to the EHR system. Burnout associated with alert workload may be in part due to subjective differences at an individual level, and not solely a function of the objective work environment. This suggests the need for both individual and organizational-level interventions to improve alert workload and subsequent burnout. Additional research should confirm these findings in larger, more representative samples.

Wireless clinical alerts and patient outcomes in the surgical intensive care unit.

PubMed

Major, Kevin; Shabot, M Michael; Cunneen, Scott

2002-12-01

Errors in medicine have gained public interest since the Institute of Medicine published its 1999 report on this subject. Although errors of commission are frequently cited, errors of omission can be equally serious. A computerized surgical intensive care unit (SICU) information system when coupled to an event-driven alerting engine has the potential to reduce errors of omission for critical intensive care unit events. Automated alerts and patient outcomes were prospectively collected for all patients admitted to a tertiary-care SICU for a 2-year period. During the study period 3,973 patients were admitted to the SICU and received 13,608 days of care. A total of 15,066 alert pages were sent including alerts for physiologic condition (6,163), laboratory data (4,951), blood gas (3,774), drug allergy (130), and toxic drug levels (48). Admission Simplified Acute Physiology Score and Acute Physiology and Chronic Health Evaluation II score, SICU lengths of stay, and overall mortality rates were significantly higher in patients who triggered the alerting system. Patients triggering the alert paging system were 49.4 times more likely to die in the SICU compared with patients who did not generate an alert. Even after transfer to floor care the patients who triggered the alerting system were 5.7 times more likely to die in the hospital. An alert page identifies patients who will stay in the SICU longer and have a significantly higher chance of death compared with patients who do not trigger the alerting system.

47 CFR 10.320 - Provider alert gateway requirements.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 47 Telecommunication 1 2012-10-01 2012-10-01 false Provider alert gateway requirements. 10.320 Section 10.320 Telecommunication FEDERAL COMMUNICATIONS COMMISSION GENERAL COMMERCIAL MOBILE ALERT SYSTEM System Architecture § 10.320 Provider alert gateway requirements. This section specifies the functions...

77 FR 41331 - Commercial Mobile Alert System

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-13

... Mobile Alert System AGENCY: Federal Communications Commission. ACTION: Final rule; announcement of... with the Commission's Commercial Mobile Alert System (CMS), Second Report and Order (``CMAS Second... Alert System rules contained in the Commission's Second Report and Order, FCC 08- 164, published at 73...

47 CFR 80.1111 - Distress alerting.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) SAFETY AND SPECIAL RADIO SERVICES STATIONS IN THE... Safety Communications § 80.1111 Distress alerting. (a) The transmission of a distress alert indicates... distress message format, which is relayed through space stations. (b) The distress alert must be sent...

47 CFR 80.1111 - Distress alerting.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) SAFETY AND SPECIAL RADIO SERVICES STATIONS IN THE... Safety Communications § 80.1111 Distress alerting. (a) The transmission of a distress alert indicates... distress message format, which is relayed through space stations. (b) The distress alert must be sent...

47 CFR 80.1111 - Distress alerting.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) SAFETY AND SPECIAL RADIO SERVICES STATIONS IN THE... Safety Communications § 80.1111 Distress alerting. (a) The transmission of a distress alert indicates... distress message format, which is relayed through space stations. (b) The distress alert must be sent...

47 CFR 80.1111 - Distress alerting.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) SAFETY AND SPECIAL RADIO SERVICES STATIONS IN THE... Safety Communications § 80.1111 Distress alerting. (a) The transmission of a distress alert indicates... distress message format, which is relayed through space stations. (b) The distress alert must be sent...

47 CFR 80.1111 - Distress alerting.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) SAFETY AND SPECIAL RADIO SERVICES STATIONS IN THE... Safety Communications § 80.1111 Distress alerting. (a) The transmission of a distress alert indicates... distress message format, which is relayed through space stations. (b) The distress alert must be sent...

Alert Triage v 0.1 beta

DOE Office of Scientific and Technical Information (OSTI.GOV)

Doak, Justin E.; Ingram, Joe; Johnson, Josh

2016-01-06

In the cyber security operations of a typical organization, data from multiple sources are monitored, and when certain conditions in the data are met, an alert is generated in an alert management system. Analysts inspect these alerts to decide if any deserve promotion to an event requiring further scrutiny. This triage process is manual, time-consuming, and detracts from the in-depth investigation of events. We have created a software system that uses supervised machine learning to automatically prioritize these alerts. In particular we utilize active learning to make efficient use of the pool of unlabeled alerts, thereby improving the performance ofmore » our ranking models over passive learning. We have demonstrated the effectiveness of our system on a large, real-world dataset of cyber security alerts.« less

Taking up national safety alerts to improve patient safety in hospitals: The perspective of healthcare quality and risk managers.

PubMed

Pfeiffer, Yvonne; Schwappach, David

2016-01-01

National safety alert systems publish relevant information to improve patient safety in hospitals. However, the information has to be transformed into local action to have an effect on patient safety. We studied three research questions: How do Swiss healthcare quality and risk managers (qm/rm(1)) see their own role in learning from safety alerts issued by the Swiss national voluntary reporting and analysis system? What are their attitudes towards and evaluations of the alerts, and which types of improvement actions were fostered by the safety alerts? A survey was developed and applied to Swiss healthcare risk and quality managers, with a response rate of 39 % (n=116). Descriptive statistics are presented. The qm/rm disseminate and communicate with a broad variety of professional groups about the alerts. While most respondents felt that they should know the alerts and their contents, only a part of them felt responsible for driving organizational change based on the recommendations. However, most respondents used safety alerts to back up their own patient safety goals. The alerts were evaluated positively on various dimensions such as usefulness and were considered as standards of good practice by the majority of the respondents. A range of organizational responses was applied, with disseminating information being the most common. An active role is related to using safety alerts for backing up own patient safety goals. To support an active role of qm/rm in their hospital's learning from safety alerts, appropriate organizational structures should be developed. Furthermore, they could be given special information or training to act as an information hub on the issues discussed in the alerts. Copyright © 2016. Published by Elsevier GmbH.

The Nature and Variability of Automated Practice Alerts Derived from Electronic Health Records in a U.S. Nationwide Critical Care Research Network.

PubMed

Benthin, Cody; Pannu, Sonal; Khan, Akram; Gong, Michelle

2016-10-01

The nature, variability, and extent of early warning clinical practice alerts derived from automated query of electronic health records (e-alerts) currently used in acute care settings for clinical care or research is unknown. To describe e-alerts in current use in acute care settings at medical centers participating in a nationwide critical care research network. We surveyed investigators at 38 institutions involved in the National Institutes of Health-funded Clinical Trials Network for the Prevention and Early Treatment of Acute Lung Injury (PETAL) for quantitative and qualitative analysis. Thirty sites completed the survey (79% response rate). All sites used electronic health record systems. Epic Systems was used at 56% of sites; the others used alternate commercially available vendors or homegrown systems. Respondents at 57% of sites represented in this survey used e-alerts. All but 1 of these 17 sites used an e-alert for early detection of sepsis-related syndromes, and 35% used an e-alert for pneumonia. E-alerts were triggered by abnormal laboratory values (37%), vital signs (37%), or radiology reports (15%) and were used about equally for clinical decision support and research. Only 59% of sites with e-alerts have evaluated them either for accuracy or for validity. A majority of the research network sites participating in this survey use e-alerts for early notification of potential threats to hospitalized patients; however, there was significant variability in the nature of e-alerts between institutions. Use of one common electronic health record vendor at more than half of the participating sites suggests that it may be possible to standardize e-alerts across multiple sites in research networks, particularly among sites using the same medical record platform.

Stimulated reporting: the impact of US food and drug administration-issued alerts on the adverse event reporting system (FAERS).

PubMed

Hoffman, Keith B; Demakas, Andrea R; Dimbil, Mo; Tatonetti, Nicholas P; Erdman, Colin B

2014-11-01

The US Food and Drug Administration (FDA) uses the Adverse Event Reporting System (FAERS) to support post-marketing safety surveillance programs. Currently, almost one million case reports are submitted to FAERS each year, making it a vast repository of drug safety information. Sometimes cited as a limitation of FAERS, however, is the assumption that "stimulated reporting" of adverse events (AEs) occurs in response to warnings, alerts, and label changes that are issued by the FDA. To determine the extent of "stimulated reporting" in the modern-day FAERS database. One hundred drugs approved by the FDA between 2001 and 2010 were included in this analysis. FDA alerts were obtained by a comprehensive search of the FDA's MedWatch and main websites. Publicly available FAERS data were used to assess the "primary suspect" AE reporting pattern for up to four quarters before, and after, the issuance of an FDA alert. A few drugs did demonstrate "stimulated reporting" trends. A majority of the drugs, however, showed little evidence for significant reporting changes associated with the issuance of alerts. When we compared the percentage changes in reporting after an FDA alert with those after a sham "control alert", the overall reporting trends appeared to be quite similar. Of 100 drugs analyzed for short-term reporting trends, 21 real alerts and 25 sham alerts demonstrated an increase (greater than or equal to 1 %) in reporting. The long-term analysis of 91 drugs showed that 24 real alerts and 28 sham alerts demonstrated a greater than or equal to 1 % increase. Our results suggest that most of modern day FAERS reporting is not significantly affected by the issuance of FDA alerts.

Improving Environmental Literacy through GO3 Citizen Science Project

NASA Astrophysics Data System (ADS)

Wilkening, B.

2011-12-01

In the Global Ozone (GO3) Project students measure ground-level ozone on a continuous basis and upload their results to a global network used by atmospheric scientists and schools. Students learn important concepts such as chemical measurement methods; instrumentation; calibration; data acquisition using computers; data quality; statistics; data analysis and graphing; posting of data to the web; the chemistry of air pollution; stratospheric ozone depletion and global climate change. Students collaborate with researchers and other students globally in the GO3 network. Wilson K-8 School is located in a suburban area in Pima County, Arizona. Throughout the year we receive high ozone alert days. Prior to joining the GO3 project, my students were unaware of air pollution alerts, risks and causes. In the past when Pima County issued alerts to the school, they were posted on signs around the school. No explanation was provided to the students and the signs were often left up for days. This discounted the potential health effects of the situation, resulting in the alerts effectively being ignored. The GO3 project is transforming both my students and our school community. Now my students are:

• Performing science research
• Utilizing technology and increasing their skills
• Collaborating in a responsible manner on the global GO3 social network
• Communicating their work to the community
• Issuing their own ozone alerts to their school
• Advocating for actions that will improve air quality

Clinical decision support alert malfunctions: analysis and empirically derived taxonomy.

PubMed

Wright, Adam; Ai, Angela; Ash, Joan; Wiesen, Jane F; Hickman, Thu-Trang T; Aaron, Skye; McEvoy, Dustin; Borkowsky, Shane; Dissanayake, Pavithra I; Embi, Peter; Galanter, William; Harper, Jeremy; Kassakian, Steve Z; Ramoni, Rachel; Schreiber, Richard; Sirajuddin, Anwar; Bates, David W; Sittig, Dean F

2018-05-01

To develop an empirically derived taxonomy of clinical decision support (CDS) alert malfunctions. We identified CDS alert malfunctions using a mix of qualitative and quantitative methods: (1) site visits with interviews of chief medical informatics officers, CDS developers, clinical leaders, and CDS end users; (2) surveys of chief medical informatics officers; (3) analysis of CDS firing rates; and (4) analysis of CDS overrides. We used a multi-round, manual, iterative card sort to develop a multi-axial, empirically derived taxonomy of CDS malfunctions. We analyzed 68 CDS alert malfunction cases from 14 sites across the United States with diverse electronic health record systems. Four primary axes emerged: the cause of the malfunction, its mode of discovery, when it began, and how it affected rule firing. Build errors, conceptualization errors, and the introduction of new concepts or terms were the most frequent causes. User reports were the predominant mode of discovery. Many malfunctions within our database caused rules to fire for patients for whom they should not have (false positives), but the reverse (false negatives) was also common. Across organizations and electronic health record systems, similar malfunction patterns recurred. Challenges included updates to code sets and values, software issues at the time of system upgrades, difficulties with migration of CDS content between computing environments, and the challenge of correctly conceptualizing and building CDS. CDS alert malfunctions are frequent. The empirically derived taxonomy formalizes the common recurring issues that cause these malfunctions, helping CDS developers anticipate and prevent CDS malfunctions before they occur or detect and resolve them expediently.

Using the diffusion of innovations theory to assess socio-technical factors in planning the implementation of an electronic health record alert across multiple primary care clinics.

PubMed

Lin, Ching-Pin; Guirguis-Blake, Janelle; Keppel, Gina A; Dobie, Sharon; Osborn, Justin; Cole, Allison M; Baldwin, Laura-Mae

2016-04-15

Adverse drug events (ADEs) are a leading cause of death in the United States. Patients with stage 3 and 4 chronic kidney disease (CKD) are at particular risk because many medications are cleared by the kidneys. Alerts in the electronic health record (EHR) about drug appropriateness and dosing at the time of prescription have been shown to reduce ADEs for patients with stage 3 and 4 CKD in inpatient settings, but more research is needed about the implementation and effectiveness of such alerts in outpatient settings.  To explore factors that might inform the implementation of an electronic drug-disease alert for patients with CKD in primary care clinics, using Rogers' diffusion of innovations theory as an analytic framework. Interviews were conducted with key informants in four diverse clinics using various EHR systems. Interviews were audio recorded and transcribed. results Although all clinics had a current method for calculating glomerular filtration rate (GFR), clinics were heterogeneous with regard to current electronic decision support practices, quality improvement resources, and organizational culture and structure. Understanding variation in organizational culture and infrastructure across primary care clinics is important in planning implementation of an intervention to reduce ADEs among patients with CKD.

Novel public health risk assessment process developed to support syndromic surveillance for the 2012 Olympic and Paralympic Games.

PubMed

Smith, Gillian E; Elliot, Alex J; Ibbotson, Sue; Morbey, Roger; Edeghere, Obaghe; Hawker, Jeremy; Catchpole, Mike; Endericks, Tina; Fisher, Paul; McCloskey, Brian

2017-09-01

Syndromic surveillance aims to provide early warning and real time estimates of the extent of incidents; and reassurance about lack of impact of mass gatherings. We describe a novel public health risk assessment process to ensure those leading the response to the 2012 Olympic Games were alerted to unusual activity that was of potential public health importance, and not inundated with multiple statistical 'alarms'. Statistical alarms were assessed to identify those which needed to result in 'alerts' as reliably as possible. There was no previously developed method for this. We identified factors that increased our concern about an alarm suggesting that an 'alert' should be made. Between 2 July and 12 September 2012, 350 674 signals were analysed resulting in 4118 statistical alarms. Using the risk assessment process, 122 'alerts' were communicated to Olympic incident directors. Use of a novel risk assessment process enabled the interpretation of large number of statistical alarms in a manageable way for the period of a sustained mass gathering. This risk assessment process guided the prioritization and could be readily adapted to other surveillance systems. The process, which is novel to our knowledge, continues as a legacy of the Games. © Crown copyright 2016.

Automated vocabulary discovery for geo-parsing online epidemic intelligence.

PubMed

Keller, Mikaela; Freifeld, Clark C; Brownstein, John S

2009-11-24

Automated surveillance of the Internet provides a timely and sensitive method for alerting on global emerging infectious disease threats. HealthMap is part of a new generation of online systems designed to monitor and visualize, on a real-time basis, disease outbreak alerts as reported by online news media and public health sources. HealthMap is of specific interest for national and international public health organizations and international travelers. A particular task that makes such a surveillance useful is the automated discovery of the geographic references contained in the retrieved outbreak alerts. This task is sometimes referred to as "geo-parsing". A typical approach to geo-parsing would demand an expensive training corpus of alerts manually tagged by a human. Given that human readers perform this kind of task by using both their lexical and contextual knowledge, we developed an approach which relies on a relatively small expert-built gazetteer, thus limiting the need of human input, but focuses on learning the context in which geographic references appear. We show in a set of experiments, that this approach exhibits a substantial capacity to discover geographic locations outside of its initial lexicon. The results of this analysis provide a framework for future automated global surveillance efforts that reduce manual input and improve timeliness of reporting.

Usability Flaws in Medication Alerting Systems: Impact on Usage and Work System

PubMed Central

Ammenwerth, E.; Roehrer, E.; Pelayo, S.; Vasseur, F.; Beuscart-Zéphir, M.-C.

2015-01-01

Summary Objectives Previous research has shown that medication alerting systems face usability issues. There has been no previous attempt to systematically explore the consequences of usability flaws in such systems on users (i.e. usage problems) and work systems (i.e. negative outcomes). This paper aims at exploring and synthesizing the consequences of usability flaws in terms of usage problems and negative outcomes on the work system. Methods A secondary analysis of 26 papers included in a prior systematic review of the usability flaws in medication alerting was performed. Usage problems and negative outcomes were extracted and sorted. Links between usability flaws, usage problems, and negative outcomes were also analyzed. Results Poor usability generates a large variety of consequences. It impacts the user from a cognitive, behavioral, emotional, and attitudinal perspective. Ultimately, usability flaws have negative consequences on the workflow, the effectiveness of the technology, the medication management process, and, more importantly, patient safety. Only few complete pathways leading from usability flaws to negative outcomes were identified. Conclusion Usability flaws in medication alerting systems impede users, and ultimately their work system, and negatively impact patient safety. Therefore, the usability dimension may act as a hidden explanatory variable that could explain, at least partly, the (absence of) intended outcomes of new technology. PMID:26123906

A New Paradigm of Technology-Enabled ‘Vital Signs’ for Early Detection of Health Change for Older Adults.

PubMed

Rantz, Marilyn J; Skubic, Marjorie; Popescu, Mihail; Galambos, Colleen; Koopman, Richelle J; Alexander, Gregory L; Phillips, Lorraine J; Musterman, Katy; Back, Jessica; Miller, Steven J

2015-01-01

Environmentally embedded (nonwearable) sensor technology is in continuous use in elder housing to monitor a new set of ‘vital signs' that continuously measure the functional status of older adults, detect potential changes in health or functional status, and alert healthcare providers for early recognition and treatment of those changes. Older adult participants' respiration, pulse, and restlessness are monitored as they sleep. Gait speed, stride length, and stride time are calculated daily, and automatically assess for increasing fall risk. Activity levels are summarized and graphically displayed for easy interpretation. Falls are detected when they occur and alerts are sent immediately to healthcare providers, so time to rescue may be reduced. Automated health alerts are sent to healthcare staff, based on continuously running algorithms applied to the sensor data, days and weeks before typical signs or symptoms are detected by the person, family members, or healthcare providers. Discovering these new functional status ‘vital signs', developing automated methods for interpreting them, and alerting others when changes occur have the potential to transform chronic illness management and facilitate aging in place through the end of life. Key findings of research in progress at the University of Missouri are discussed in this viewpoint article, as well as obstacles to widespread adoption.

Bar Code Medication Administration Technology: Characterization of High-Alert Medication Triggers and Clinician Workarounds.

PubMed

Miller, Daniel F; Fortier, Christopher R; Garrison, Kelli L

2011-02-01

Bar code medication administration (BCMA) technology is gaining acceptance for its ability to prevent medication administration errors. However, studies suggest that improper use of BCMA technology can yield unsatisfactory error prevention and introduction of new potential medication errors. To evaluate the incidence of high-alert medication BCMA triggers and alert types and discuss the type of nursing and pharmacy workarounds occurring with the use of BCMA technology and the electronic medication administration record (eMAR). Medication scanning and override reports from January 1, 2008, through November 30, 2008, for all adult medical/surgical units were retrospectively evaluated for high-alert medication system triggers, alert types, and override reason documentation. An observational study of nursing workarounds on an adult medicine step-down unit was performed and an analysis of potential pharmacy workarounds affecting BCMA and the eMAR was also conducted. Seventeen percent of scanned medications triggered an error alert of which 55% were for high-alert medications. Insulin aspart, NPH insulin, hydromorphone, potassium chloride, and morphine were the top 5 high-alert medications that generated alert messages. Clinician override reasons for alerts were documented in only 23% of administrations. Observational studies assessing for nursing workarounds revealed a median of 3 clinician workarounds per administration. Specific nursing workarounds included a failure to scan medications/patient armband and scanning the bar code once the dosage has been removed from the unit-dose packaging. Analysis of pharmacy order entry process workarounds revealed the potential for missed doses, duplicate doses, and doses being scheduled at the wrong time. BCMA has the potential to prevent high-alert medication errors by alerting clinicians through alert messages. Nursing and pharmacy workarounds can limit the recognition of optimal safety outcomes and therefore workflow processes must be continually analyzed and restructured to yield the intended full benefits of BCMA technology. © 2011 SAGE Publications.

Does integrating nonurgent, clinically significant radiology alerts within the electronic health record impact closed-loop communication and follow-up?

PubMed

O'Connor, Stacy D; Dalal, Anuj K; Sahni, V Anik; Lacson, Ronilda; Khorasani, Ramin

2016-03-01

To assess whether integrating critical result management software--Alert Notification of Critical Results (ANCR)--with an electronic health record (EHR)-based results management application impacts closed-loop communication and follow-up of nonurgent, clinically significant radiology results by primary care providers (PCPs). This institutional review board-approved study was conducted at a large academic medical center. Postintervention, PCPs could acknowledge nonurgent, clinically significant ANCR-generated alerts ("alerts") within ANCR or the EHR. Primary outcome was the proportion of alerts acknowledged via EHR over a 24-month postintervention. Chart abstractions for a random sample of alerts 12 months preintervention and 24 months postintervention were reviewed, and the follow-up rate of actionable alerts (eg, performing follow-up imaging, administering antibiotics) was estimated. Pre- and postintervention rates were compared using the Fisher exact test. Postintervention follow-up rate was compared for EHR-acknowledged alerts vs ANCR. Five thousand nine hundred and thirty-one alerts were acknowledged by 171 PCPs, with 100% acknowledgement (consistent with expected ANCR functionality). PCPs acknowledged 16% (688 of 4428) of postintervention alerts in the EHR, with the remaining in ANCR. Follow-up was documented for 85 of 90 (94%; 95% CI, 88%-98%) preintervention and 79 of 84 (94%; 95% CI, 87%-97%) postintervention alerts (P > .99). Postintervention, 11 of 14 (79%; 95% CI, 52%-92%) alerts were acknowledged via EHR and 68 of 70 (97%; 95% CI, 90%-99%) in ANCR had follow-up (P = .03). Integrating ANCR and EHR provides an additional workflow for acknowledging nonurgent, clinically significant results without significant change in rates of closed-loop communication or follow-up of alerts. © The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Identification of Patients Expected to Benefit from Electronic Alerts for Acute Kidney Injury.

PubMed

Biswas, Aditya; Parikh, Chirag R; Feldman, Harold I; Garg, Amit X; Latham, Stephen; Lin, Haiqun; Palevsky, Paul M; Ugwuowo, Ugochukwu; Wilson, F Perry

2018-06-07

Electronic alerts for heterogenous conditions such as AKI may not provide benefit for all eligible patients and can lead to alert fatigue, suggesting that personalized alert targeting may be useful. Uplift-based alert targeting may be superior to purely prognostic-targeting of interventions because uplift models assess marginal treatment effect rather than likelihood of outcome. This is a secondary analysis of a clinical trial of 2278 adult patients with AKI randomized to an automated, electronic alert system versus usual care. We used three uplift algorithms and one purely prognostic algorithm, trained in 70% of the data, and evaluated the effect of targeting alerts to patients with higher scores in the held-out 30% of the data. The performance of the targeting strategy was assessed as the interaction between the model prediction of likelihood to benefit from alerts and randomization status. The outcome of interest was maximum relative change in creatinine from the time of randomization to 3 days after randomization. The three uplift score algorithms all gave rise to a significant interaction term, suggesting that a strategy of targeting individuals with higher uplift scores would lead to a beneficial effect of AKI alerting, in contrast to the null effect seen in the overall study. The prognostic model did not successfully stratify patients with regards to benefit of the intervention. Among individuals in the high uplift group, alerting was associated with a median reduction in change in creatinine of -5.3% ( P =0.03). In the low uplift group, alerting was associated with a median increase in change in creatinine of +5.3% ( P =0.005). Older individuals, women, and those with a lower randomization creatinine were more likely to receive high uplift scores, suggesting that alerts may benefit those with more slowly developing AKI. Uplift modeling, which accounts for treatment effect, can successfully target electronic alerts for AKI to those most likely to benefit, whereas purely prognostic targeting cannot. Copyright © 2018 by the American Society of Nephrology.

12 CFR 1022.121 - Active duty alerts.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 12 Banks and Banking 8 2014-01-01 2014-01-01 false Active duty alerts. 1022.121 Section 1022.121... Consumer Reporting Agencies Regarding Identity Theft § 1022.121 Active duty alerts. (a) Duration. The duration of an active duty alert shall be twelve months. ...

12 CFR 1022.121 - Active duty alerts.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 12 Banks and Banking 8 2013-01-01 2013-01-01 false Active duty alerts. 1022.121 Section 1022.121... Consumer Reporting Agencies Regarding Identity Theft § 1022.121 Active duty alerts. (a) Duration. The duration of an active duty alert shall be twelve months. ...

78 FR 22270 - Special Fraud Alert: Physician-Owned Entities

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-15

...] Special Fraud Alert: Physician-Owned Entities AGENCY: Office of Inspector General (OIG), HHS. ACTION... Physician-Owned Entities. Specifically, the Special Fraud Alert addressed physician-owned entities that... publication of the Special Fraud Alert on Physician-Owned Entities, an inadvertent error appeared in the DATES...

76 FR 62321 - Airworthiness Directives; Aviation Communication & Surveillance Systems (ACSS) Traffic Alert and...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-10-07

... Communication & Surveillance Systems (ACSS) Traffic Alert and Collision Avoidance System (TCAS) Units AGENCY... certain Aviation Communication & Surveillance Systems (ACSS) traffic alert and collision avoidance system...) traffic alert and collision avoidance system (TCAS) units with part numbers identified in ACSS Technical...

77 FR 26701 - Review of the Emergency Alert System

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-07

... Emergency Alert System AGENCY: Federal Communications Commission. ACTION: Final rule. SUMMARY: In this document, the Federal Communications Commission (Commission) amends its rules governing the Emergency Alert... the manner in which EAS Participants must be able to receive alert messages formatted in the Common...

Using the World Wide Web for GIDEP Problem Data Processing at Marshall Space Flight Center

NASA Technical Reports Server (NTRS)

McPherson, John W.; Haraway, Sandra W.; Whirley, J. Don

1999-01-01

Since April 1997, Marshall Space Flight Center has been using electronic transfer and the web to support our processing of the Government-Industry Data Exchange Program (GIDEP) and NASA ALERT information. Specific aspects include: (1) Extraction of ASCII text information from GIDEP for loading into Word documents for e-mail to ALERT actionees; (2) Downloading of GIDEP form image formats in Adobe Acrobat (.pdf) for internal storage display on the MSFC ALERT web page; (3) Linkage of stored GRDEP problem forms with summary information for access from the MSFC ALERT Distribution Summary Chart or from an html table of released MSFC ALERTs (4) Archival of historic ALERTs for reference by GIDEP ID, MSFC ID, or MSFC release date; (5) On-line tracking of ALERT response status using a Microsoft Access database and the web (6) On-line response to ALERTs from MSFC actionees through interactive web forms. The technique, benefits, effort, coordination, and lessons learned for each aspect are covered herein.

Knowledge Integration and Use-Case Analysis for a Customized Drug-Drug Interaction CDS Service

NASA Astrophysics Data System (ADS)

Kam, Hye Jin; Park, Man Young; Kim, Woojae; Yoon, Duk Yong; Ahn, Eun Kyoung; Park, Rae Woong

Clinical decision support systems (CDSSs) are thought to reduce adverse drug events (ADEs) by monitoring drug-drug interactions(DDIs). However, clinically improper or excessive alerts can result in high alert overrides. A tailored CDS service, which is appropriate for clinicians and their ordering situations, is required to increase alert acceptance. In this study, we conducted a 12-week pilot project adopting a tailed CDSS at an emergency department. The new CDSS was conducted via a stepwise integration of additional new rules. The alert status with changes in acceptance rate was analyzed. The most frequent DDI alerts were related to prescriptions of anti-inflammatory drugs. The percentages of alert overrides for each stage were 98.0%, 96.0%, 96.9%, and 98.1%, respectively. 91.5% of overridden alerts were related to discharge medications. To reduce the potential hazards of ADEs, the development of an effective customized DDI CDSS is required, via in-depth analysis on alert patterns and overridden reasons.

Context-Sensitive Clinical Alert Packages Written in Arden Syntax.

PubMed

Zeckl, Julia; Adlassnig, Katharina; Fossler, Renate; Blacky, Alexander; de Bruin, Jeroen S; Koller, Walter; Rappelsberger, Andrea; Adlassnig, Klaus-Peter

2017-01-01

An increasing body of raw patient data is generated on each day of a patient's stay at a hospital. It is of paramount importance that critical patient information be extracted from these large data volumes and presented to the patient's clinical caregivers as early as possible. Contemporary clinical alert systems attempt to provide this service with moderate success. The efficacy of the systems is limited by the fact that they are too general to fit specific patient populations or healthcare institutions. In this study we present an extendable alerting framework implemented in Arden Syntax, which can be configured to the needs and preferences of healthcare institutions and individual patient caregivers. We illustrate the potential of this alerting framework via an alert package that analyzes hematological laboratory results with data from intensive care units at the Vienna General Hospital, Austria. The results show the effectiveness of this alert package and its ability to generate key alerts while avoiding over-alerting.

Predicting Catastrophic BGP Routing Instabilities

DTIC Science & Technology

2004-03-01

predict a BGP routing instability confine their focus to either macro- or micro -level metrics, but not to both. The inherent limitations of each of...Level and Micro -Level Metrics Correlation; Worm Attack Studies; 16. PRICE CODE 17. SECURITY CLASSIFICATION OF REPORT Unclassified 18. SECURITY... micro -level metrics, but not to both. The inherent limitations of each of these forms of metric gives rise to an excessive rate of spurious alerts

Relationship of early infant state measures to behavior over the first year of life in the tufted capuchin monkey (Cebus apella).

PubMed

Byrne, G; Suomi, S J

1998-01-01

Data on activity states were collected from 29 group-housed capuchin monkey (Cebus apella) infants for 3 h each week from birth to 11 weeks of age. The amounts of time spent in sleeping/drowsy, alert-quiet, and alert-active states were measured in these subjects. Videotaped observations of these infants were recorded 3 times/week in the home cage over the first year of life and were scored for a number of social and exploratory behaviors. The extent to which early infant activity state scores predicted later behavior in the home cage was examined. Infant state measures correlated significantly with home cage behavior during months 2-6 in that infants that had been more active in early infancy spent more time alone, with other animals, and in exploration and play and less time with mothers than did quieter infants. Early state measures were less successful in predicting home cage scores beyond 8 months of age, whereas differences in behavior attributable to housing variables became more salient in the latter part of the first year. There was also a negative correlation between mother and infant activity in months 2 and 3, in that more sedentary mothers tended to have more active infants.

Electroencephalographic correlates of states of concentrative meditation.

PubMed

DeLosAngeles, Dylan; Williams, Graham; Burston, John; Fitzgibbon, Sean P; Lewis, Trent W; Grummett, Tyler S; Clark, C Richard; Pope, Kenneth J; Willoughby, John O

2016-12-01

Meditative techniques aim for and meditators report states of mental alertness and focus, concurrent with physical and emotional calm. We aimed to determine the electroencephalographic (EEG) correlates of five states of Buddhist concentrative meditation, particularly addressing a correlation with meditative level. We studied 12 meditators and 12 pair-matched meditation-naïve participants using high-resolution scalp-recorded EEG. To maximise reduction of EMG, data were pre-processed using independent component analysis and surface Laplacian transformed data. Two non-meditative and five meditative states were used: resting baseline, mind-wandering, absorptions 1, 2, 3, 4 and 5 (corresponding to four levels of absorption and an absorption with a different object of focus, otherwise equivalent to level 4; these five meditative states produce repeatable, distinctly different experiences for experienced meditators). The experimental protocol required participants to experience the states in the order listed above, followed immediately by the reverse. We then calculated EEG power in standard frequency bands from 1 to 80Hz. We observed decreases of central scalp beta (13-25Hz), and central low gamma (25-48Hz) power in meditators during deeper absorptions. In contrast, we identified increases in frontal midline and temporo-parietal theta power in meditators, again, during deeper absorptions. Alpha activity was increased over all meditative states, not depth-related. This study demonstrates that the subjective experiences of deepening meditation partially correspond to measures of EEG. Our results are in accord with prior studies on non-graded meditative states. These results are also consistent with increased theta correlating with tightness of focus, and reduced beta/gamma with the desynchronization associated with enhanced alertness. Copyright © 2016. Published by Elsevier B.V.

Developing Software to “Track and Catch” Missed Follow-up of Abnormal Test Results in a Complex Sociotechnical Environment

PubMed Central

Smith, M.; Murphy, D.; Laxmisan, A.; Sittig, D.; Reis, B.; Esquivel, A.; Singh, H.

2013-01-01

Summary Background Abnormal test results do not always receive timely follow-up, even when providers are notified through electronic health record (EHR)-based alerts. High workload, alert fatigue, and other demands on attention disrupt a provider’s prospective memory for tasks required to initiate follow-up. Thus, EHR-based tracking and reminding functionalities are needed to improve follow-up. Objectives The purpose of this study was to develop a decision-support software prototype enabling individual and system-wide tracking of abnormal test result alerts lacking follow-up, and to conduct formative evaluations, including usability testing. Methods We developed a working prototype software system, the Alert Watch And Response Engine (AWARE), to detect abnormal test result alerts lacking documented follow-up, and to present context-specific reminders to providers. Development and testing took place within the VA’s EHR and focused on four cancer-related abnormal test results. Design concepts emphasized mitigating the effects of high workload and alert fatigue while being minimally intrusive. We conducted a multifaceted formative evaluation of the software, addressing fit within the larger socio-technical system. Evaluations included usability testing with the prototype and interview questions about organizational and workflow factors. Participants included 23 physicians, 9 clinical information technology specialists, and 8 quality/safety managers. Results Evaluation results indicated that our software prototype fit within the technical environment and clinical workflow, and physicians were able to use it successfully. Quality/safety managers reported that the tool would be useful in future quality assurance activities to detect patients who lack documented follow-up. Additionally, we successfully installed the software on the local facility’s “test” EHR system, thus demonstrating technical compatibility. Conclusion To address the factors involved in missed test results, we developed a software prototype to account for technical, usability, organizational, and workflow needs. Our evaluation has shown the feasibility of the prototype as a means of facilitating better follow-up for cancer-related abnormal test results. PMID:24155789

Alert generation and cockpit presentation for an integrated microburst alerting system

NASA Technical Reports Server (NTRS)

Wanke, Craig; Hansman, R. John, Jr.

1991-01-01

Alert generation and cockpit presentation issues for low level wind shear (microburst) alerts are investigated. Alert generation issues center on the development of a hazard criterion which allows integration of both ground based and airborne wind shear detection systems to form an accurate picture of the aviation hazard posed by a particular wind shear situation. A methodology for the testing of a hazard criteria through flight simulation has been developed, and has been used to examine the effectiveness and feasibility of several possible criteria. Also, an experiment to evaluate candidate graphical cockpit displays for microburst alerts using a piloted simulator has been designed.

Information Accessibility of the Charcoal Burning Suicide Method in Mainland China

PubMed Central

Cheng, Qijin; Chang, Shu-Sen; Guo, Yingqi; Yip, Paul S. F.

2015-01-01

Background There has been a marked rise in suicide by charcoal burning (CB) in some East Asian countries but little is known about its incidence in mainland China. We examined media-reported CB suicides and the availability of online information about the method in mainland China. Methods We extracted and analyzed data for i) the characteristics and trends of fatal and nonfatal CB suicides reported by mainland Chinese newspapers (1998–2014); ii) trends and geographic variations in online searches using keywords relating to CB suicide (2011–2014); and iii) the content of Internet search results. Results 109 CB suicide attempts (89 fatal and 20 nonfatal) were reported by newspapers in 13 out of the 31 provinces or provincial-level-municipalities in mainland China. There were increasing trends in the incidence of reported CB suicides and in online searches using CB-related keywords. The province-level search intensities were correlated with CB suicide rates (Spearman’s correlation coefficient = 0.43 [95% confidence interval: 0.08–0.68]). Two-thirds of the web links retrieved using the search engine contained detailed information about the CB suicide method, of which 15% showed pro-suicide attitudes, and the majority (86%) did not encourage people to seek help. Limitations The incidence of CB suicide was based on newspaper reports and likely to be underestimated. Conclusions Mental health and suicide prevention professionals in mainland China should be alert to the increased use of this highly lethal suicide method. Better surveillance and intervention strategies need to be developed and implemented. PMID:26474297

Posttraumatic stress disorder diagnostic criteria and suicidal ideation in a South African Police sample

PubMed Central

Steyn, R; Vawda, N; Wyatt, GE; Williams, JK; Madu, SN

2014-01-01

Objective Exposure to traumatic events may precipitate suicidal ideation. Once an individual is diagnosed with PTSD, a suicide risk assessment often follows. This study explores how PTSD symptom criteria correlate with suicidal ideation in a sample of police officers. While the psychometric measures of PTSD often mirror the DSM-IV-TR criteria, focusing on exposure, symptom, and duration criteria, suicidal ideation measures often focus on concepts quite different from that. In this report the focus was on investigating how PTSD symptom criteria correlate with the suicidal ideation. Method A group of South African police officers (N = 217) were assessed by means of the Posttraumatic Diagnostic Scale and a short version of the Adult Suicide Ideation Questionnaire. Linear and hierarchical regressions were used to determine which PTSD symptom criteria best predict suicidal ideation. Results Hyperarousal was the primary predictor of suicidal ideation (R2 [adjusted] = 0.249). Intrusive thoughts added only marginally to the model, contributing a further 2.5% to the declared variance. The contributions of the other two symptom types were negligible. Conclusion In this study hyperarousal correlated significantly with suicidal ideation. It is suggested that practitioners be alert to these symptoms as possible indicators of suicidal ideation. Implications for suicide risk assessment and prevention measures are discussed. PMID:23417631

Research on the Relationship between Reaction Ability and Mental State for Online Assessment of Driving Fatigue.

PubMed

Guo, Mengzhu; Li, Shiwu; Wang, Linhong; Chai, Meng; Chen, Facheng; Wei, Yunong

2016-11-24

Background: Driving fatigue affects the reaction ability of a driver. The aim of this research is to analyze the relationship between driving fatigue, physiological signals and driver's reaction time. Methods: Twenty subjects were tested during driving. Data pertaining to reaction time and physiological signals including electroencephalograph (EEG) were collected from twenty simulation experiments. Grey correlation analysis was used to select the input variable of the classification model. A support vector machine was used to divide the mental state into three levels. The penalty factor for the model was optimized using a genetic algorithm. Results: The results show that α/β has the greatest correlation to reaction time. The classification results show an accuracy of 86%, a sensitivity of 87.5% and a specificity of 85.53%. The average increase of reaction time is 16.72% from alert state to fatigued state. Females have a faster decrease in reaction ability than males as driving fatigue accumulates. Elderly drivers have longer reaction times than the young. Conclusions: A grey correlation analysis can be used to improve the classification accuracy of the support vector machine (SVM) model. This paper provides basic research that online detection of fatigue can be performed using only a simple device, which is more comfortable for users.

Research on the Relationship between Reaction Ability and Mental State for Online Assessment of Driving Fatigue

PubMed Central

Guo, Mengzhu; Li, Shiwu; Wang, Linhong; Chai, Meng; Chen, Facheng; Wei, Yunong

2016-01-01

Background: Driving fatigue affects the reaction ability of a driver. The aim of this research is to analyze the relationship between driving fatigue, physiological signals and driver’s reaction time. Methods: Twenty subjects were tested during driving. Data pertaining to reaction time and physiological signals including electroencephalograph (EEG) were collected from twenty simulation experiments. Grey correlation analysis was used to select the input variable of the classification model. A support vector machine was used to divide the mental state into three levels. The penalty factor for the model was optimized using a genetic algorithm. Results: The results show that α/β has the greatest correlation to reaction time. The classification results show an accuracy of 86%, a sensitivity of 87.5% and a specificity of 85.53%. The average increase of reaction time is 16.72% from alert state to fatigued state. Females have a faster decrease in reaction ability than males as driving fatigue accumulates. Elderly drivers have longer reaction times than the young. Conclusions: A grey correlation analysis can be used to improve the classification accuracy of the support vector machine (SVM) model. This paper provides basic research that online detection of fatigue can be performed using only a simple device, which is more comfortable for users. PMID:27886139

Relations among questionnaire and experience sampling measures of inner speech: a smartphone app study

PubMed Central

Alderson-Day, Ben; Fernyhough, Charles

2015-01-01

Inner speech is often reported to be a common and central part of inner experience, but its true prevalence is unclear. Many questionnaire-based measures appear to lack convergent validity and it has been claimed that they overestimate inner speech in comparison to experience sampling methods (which involve collecting data at random timepoints). The present study compared self-reporting of inner speech collected via a general questionnaire and experience sampling, using data from a custom-made smartphone app (Inner Life). Fifty-one university students completed a generalized self-report measure of inner speech (the Varieties of Inner Speech Questionnaire, VISQ) and responded to at least seven random alerts to report on incidences of inner speech over a 2-week period. Correlations and pairwise comparisons were used to compare generalized endorsements and randomly sampled scores for each VISQ subscale. Significant correlations were observed between general and randomly sampled measures for only two of the four VISQ subscales, and endorsements of inner speech with evaluative or motivational characteristics did not correlate at all across different measures. Endorsement of inner speech items was significantly lower for random sampling compared to generalized self-report, for all VISQ subscales. Exploratory analysis indicated that specific inner speech characteristics were also related to anxiety and future-oriented thinking. PMID:25964773

12 CFR 1022.121 - Active duty alerts.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 12 Banks and Banking 8 2012-01-01 2012-01-01 false Active duty alerts. 1022.121 Section 1022.121... Consumer Reporting Agencies Regarding Identity Theft § 1022.121 Active duty alerts. (a) Duration. The duration of an active duty alert shall be twelve months. (b) [Reserved] ...

76 FR 3064 - Travelers Information Stations

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-19

... phone numbers when local 911 systems fail, terror threat alert levels, public health warnings ``and all... Alerts, alternate phone numbers when local 911 systems fail, terror threat alert levels, public health..., alternate phone numbers to 911, terror threat alert levels, and public health warnings--do not appear to be...

77 FR 33661 - Review of the Emergency Alert System

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-07

... Emergency Alert System AGENCY: Federal Communications Commission. ACTION: Final rule; announcement of... Commission's Review of the Emergency Alert System, Fifth Report and Order (Order). This document is... Expiration Date: November 30, 2012. Title: Part 11--Emergency Alert System, Fifth Report and Order, FCC 12-7...

Adoption of medication alert systems in hospital outpatient departments in Taiwan.

PubMed

Kuo, Yu-Chun; Cheng, Shou-Hsia

2017-06-01

The adoption of medication alert systems in the health care sector varies among regions. In Taiwan, the health authority introduced policies in 2005 to encourage the adoption of medication alert systems in hospitals. This study aimed to understand the adoption of medication alert systems in the outpatient departments of hospitals in Taiwan using a nationwide survey. A questionnaire was developed and mailed to 380 accredited general hospitals in Taiwan in 2013. The information collected from the questionnaire concerning the outpatient department included (1) the time of adoption of a medication alert system; (2) the operation of individual alert functions: availability, management, and stability; and (3) hospital characteristics: accreditation level, teaching status, ownership, and number of beds. A total of 216 hospitals completed and returned the questionnaire, corresponding to a response rate of 56.8%. The adoption rate of medication alert systems in hospital outpatient departments increased from less than 10% in 1997-95.83% in 2012. Approximately two-thirds of the hospitals developed and maintained the alert systems independently or collaboratively with vendors. Teaching and large hospitals tended to develop more advanced alert functions such as drug-drug interaction functions. Improving the safety and quality of pharmaceutical services and meeting the policy requirements are reasons for hospitals to establish medication alert systems. The adoption rate of medication alert systems reached 95% in accredited general hospitals in Taiwan. Government policy and available health information professionals and vendors may somewhat contribute to the high adoption rate. Copyright © 2017 Elsevier B.V. All rights reserved.

Adherence to drug-drug interaction alerts in high-risk patients: a trial of context-enhanced alerting.

PubMed

Duke, Jon D; Li, Xiaochun; Dexter, Paul

2013-05-01

Drug-drug interaction (DDI) alerting is an important form of clinical decision support, yet physicians often fail to attend to critical DDI warnings due to alert fatigue. We previously described a model for highlighting patients at high risk of a DDI by enhancing alerts with relevant laboratory data. We sought to evaluate the effect of this model on alert adherence in high-risk patients. A 6-month randomized controlled trial involving 1029 outpatient physicians was performed. The target interactions were all DDIs known to cause hyperkalemia. Alerts in the intervention group were enhanced with the patient's most recent potassium and creatinine levels. The control group received unmodified alerts. High -risk patients were those with baseline potassium >5.0 mEq/l and/or creatinine ≥1.5 mg/dl (132 μmol/l). We found no significant difference in alert adherence in high-risk patients between the intervention group (15.3%) and the control group (16.8%) (p=0.71). Adherence in normal risk patients was significantly lower in the intervention group (14.6%) than in the control group (18.6%) (p<0.01). In neither group did physicians increase adherence in patients at high risk. Physicians adhere poorly to hyperkalemia-associated DDI alerts even in patients with risk factors for a clinically significant interaction, and the display of relevant laboratory data in these alerts did not improve adherence levels in the outpatient setting. Further research is necessary to determine optimal strategies for conveying patient-specific DDI risk.

The effect of automated alerts on preoperative anemia management.

PubMed

Dilla, Andrew; Wisniewski, Mary Kay; Waters, Jonathan H; Triulzi, Darrell J; Yazer, Mark H

2015-04-01

This study evaluated the role of an automated anemia notification system that alerted providers about anemic pre-operative patients. After scheduling surgery, the alert program continuously searched the patient's laboratory data for hemoglobin value(s) in the medical record. When an anemic patient according to the World Health Oganization's criteria was identified, an email was sent to the patient's surgeon, and/or assistant, and/or patient's primary care physician suggesting that the anemia be managed before surgery. Thirteen surgeons participated in this pilot study. In 11 months, there were 70 pre-surgery anemia alerts generated on 69 patients. The surgeries were 60 orthopedic, 7 thoracic, 2 general surgery, and 1 urological. The alerts were sent 15 ± 10 days before surgery. No pre-operative anemia treatment could be found in 37 of 69 (54%) patients. Some form of anemia management was found in 32 of 69 (46%) patients. Of the 23 patients who received iron, only 3 of 23 (13%) of these patients started iron shortly after the alert was generated. The alert likely resulted in the postponement of one surgery for anemia correction. Although anemia diagnosis and management can be complex, it was hoped that receipt of the alert would lead to the management of all anemic patients. Alerts are only effective if they are received and read by a healthcare provider empowered to treat the patient or to make an appropriate referral. Automated preoperative alerts alone are not likely to alter surgeons' anemia management practices. These alerts need to be part of a comprehensive anemia management strategy.

Practitioners’ Views on Computerized Drug–Drug Interaction Alerts in the VA System

PubMed Central

Ko, Yu; Abarca, Jacob; Malone, Daniel C.; Dare, Donna C.; Geraets, Doug; Houranieh, Antoun; Jones, William N.; Nichol, W. Paul; Schepers, Gregory P.; Wilhardt, Michelle

2007-01-01

Objectives To assess Veterans Affairs (VA) prescribers’ and pharmacists’ opinions about computer-generated drug–drug interaction (DDI) alerts and obtain suggestions for improving DDI alerts. Design A mail survey of 725 prescribers and 142 pharmacists from seven VA medical centers across the United States. Measurements A questionnaire asked respondents about their sources of drug and DDI information, satisfaction with the combined inpatient and outpatient computerized prescriber order entry (CPOE) system, attitude toward DDI alerts, and suggestions for improving DDI alerts. Results The overall response rate was 40% (prescribers: 36%; pharmacists: 59%). Both prescribers and pharmacists indicated that the CPOE system had a neutral to positive impact on their jobs. DDI alerts were not viewed as a waste of time and the majority (61%) of prescribers felt that DDI alerts had increased their potential to prescribe safely. However, only 30% of prescribers felt DDI alerts provided them with what they needed most of the time. Both prescribers and pharmacists agreed that DDI alerts should be accompanied by management alternatives (73% and 82%, respectively) and more detailed information (65% and 89%, respectively). When asked about suggestions for improving DDI alerts, prescribers most preferred including management options whereas pharmacists most preferred making it more difficult to override lethal interactions. Prescribers and pharmacists reported primarily relying on electronic references for general drug information (62% and 55%, respectively) and DDI information (51% and 79%, respectively). Conclusion Respondents reported neutral to positive views regarding the effect of CPOE on their jobs. Their opinions suggest DDI alerts are useful but still require additional work to increase their clinical utility. PMID:17068346

21 CFR 26.20 - Alert system.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 1 2013-04-01 2013-04-01 false Alert system. 26.20 Section 26.20 Food and Drugs... PHARMACEUTICAL GOOD MANUFACTURING PRACTICE REPORTS, MEDICAL DEVICE QUALITY SYSTEM AUDIT REPORTS, AND CERTAIN... Provisions for Pharmaceutical Good Manufacturing Practices § 26.20 Alert system. (a) The details of an alert...

21 CFR 26.20 - Alert system.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 1 2012-04-01 2012-04-01 false Alert system. 26.20 Section 26.20 Food and Drugs... PHARMACEUTICAL GOOD MANUFACTURING PRACTICE REPORTS, MEDICAL DEVICE QUALITY SYSTEM AUDIT REPORTS, AND CERTAIN... Provisions for Pharmaceutical Good Manufacturing Practices § 26.20 Alert system. (a) The details of an alert...

47 CFR 11.56 - EAS Participants receive CAP-formatted alerts.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 47 Telecommunication 1 2010-10-01 2010-10-01 false EAS Participants receive CAP-formatted alerts... SYSTEM (EAS) Emergency Operations § 11.56 EAS Participants receive CAP-formatted alerts. Notwithstanding anything herein to the contrary, all EAS Participants must be able to receive CAP-formatted EAS alerts no...

21 CFR 26.20 - Alert system.

Code of Federal Regulations, 2010 CFR

2010-04-01

... PHARMACEUTICAL GOOD MANUFACTURING PRACTICE REPORTS, MEDICAL DEVICE QUALITY SYSTEM AUDIT REPORTS, AND CERTAIN... 21 Food and Drugs 1 2010-04-01 2010-04-01 false Alert system. 26.20 Section 26.20 Food and Drugs... Provisions for Pharmaceutical Good Manufacturing Practices § 26.20 Alert system. (a) The details of an alert...

47 CFR 80.277 - Ship Security Alert System (SSAS).

Code of Federal Regulations, 2011 CFR

2011-10-01

... 47 Telecommunication 5 2011-10-01 2011-10-01 false Ship Security Alert System (SSAS). 80.277... SERVICES STATIONS IN THE MARITIME SERVICES Equipment Authorization for Compulsory Ships § 80.277 Ship Security Alert System (SSAS). (a) Vessels equipped with a Ship Security Alert System pursuant to the Safety...

47 CFR 80.277 - Ship Security Alert System (SSAS).

Code of Federal Regulations, 2014 CFR

2014-10-01

... 47 Telecommunication 5 2014-10-01 2014-10-01 false Ship Security Alert System (SSAS). 80.277... SERVICES STATIONS IN THE MARITIME SERVICES Equipment Authorization for Compulsory Ships § 80.277 Ship Security Alert System (SSAS). (a) Vessels equipped with a Ship Security Alert System pursuant to the Safety...

47 CFR 80.277 - Ship Security Alert System (SSAS).

Code of Federal Regulations, 2012 CFR

2012-10-01

... 47 Telecommunication 5 2012-10-01 2012-10-01 false Ship Security Alert System (SSAS). 80.277... SERVICES STATIONS IN THE MARITIME SERVICES Equipment Authorization for Compulsory Ships § 80.277 Ship Security Alert System (SSAS). (a) Vessels equipped with a Ship Security Alert System pursuant to the Safety...

47 CFR 80.277 - Ship Security Alert System (SSAS).

Code of Federal Regulations, 2013 CFR

2013-10-01

... 47 Telecommunication 5 2013-10-01 2013-10-01 false Ship Security Alert System (SSAS). 80.277... SERVICES STATIONS IN THE MARITIME SERVICES Equipment Authorization for Compulsory Ships § 80.277 Ship Security Alert System (SSAS). (a) Vessels equipped with a Ship Security Alert System pursuant to the Safety...

75 FR 25842 - Notice of a Grant With the Public Broadcasting Service

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-10

... development of the Commercial Mobile Alert System (CMAS), a national system to distribute emergency alert...-27 (Feb. 8, 2006) (establishing the National Alert and Tsunami Warning Program); Section 606 of the... requirements to support the distribution of geographically targeted alerts by commercial mobile service...

75 FR 26269 - Draft Programmatic Environmental Assessment for the Integrated Public Alert and Warning Program's...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-11

...] Draft Programmatic Environmental Assessment for the Integrated Public Alert and Warning Program's... from construction- related actions taken under the Integrated Public Alert and Warning Program (IPAWS... Order 13407, Public Alert and Warning System, by providing robust and survivable power generation, fuel...

78 FR 49292 - American Medical Alert Corporation, DBA Tunstall, Clovis, New Mexico; Amended Certification...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-13

... DEPARTMENT OF LABOR Employment and Training Administration [TA-W-82,859] American Medical Alert... Assistance on July 18, 2013, applicable to workers of American Medical Alert Corporation, doing business as... follows: All workers of American Medical Alert Corporation, doing business as Tunstall, Clovis, New Mexico...

76 FR 28789 - Draft Alert Entitled “Preventing Occupational Respiratory Disease From Dampness in Office...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-18

... NIOSH-238] Draft Alert Entitled ``Preventing Occupational Respiratory Disease From Dampness in Office...), announces the availability of a draft Alert entitled ``Preventing Occupational Respiratory Disease from.../niosh/docket/review/docket238/default.html . The purpose of this Alert is to provide workers and...

77 FR 28387 - Federal Advisory Committee Act; Communications Security, Reliability, and Interoperability Council

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-14

... practice recommendations on emergency alerting systems such as promoting E9-1-1 reliability and alerting platforms--Emergency Alert System and Common Alerting Protocol. DATES: June 6, 2012. ADDRESSES: Federal... Advisory Committee that will provide recommendations to the FCC regarding best practices and actions the...

Jetliner Alert Systems

NASA Technical Reports Server (NTRS)

1983-01-01

NASA research and design has significantly improved crew alert systems. The Engine Indication and Crew Alerting System (EICAS), developed by Psycho-Linguistic Research Associates, is technologically advanced and able to order alerts by priority. Ames has also developed computer controlled voice synthesizers for readouts during difficult landing approaches. This is available to airplane manufacturers.

Changes in nurses' decision making during a 12-h day shift.

PubMed

McClelland, L E; Switzer, F S; Pilcher, J J

2013-01-01

Although shift work is necessary in many health-care settings, research suggests that it can have detrimental effects on performance in health-care providers. To determine if a change in decision-making occurred across a 12-h day shift in a sample of registered nurses. The participants were nurses working a 12-h day shift (7 a.m.-7 p.m.) at a large hospital in the south-eastern USA. Participants completed a policy-capturing questionnaire, examining their likelihood of calling a physician in response to specific patient symptoms, at the beginning and end of the shift. They also completed self-report surveys on alertness, stress and sleepiness. Sixty-five nurses completed the study, an overall response rate of 41%. Participants significantly changed their decision-making policies from the beginning to the end of the work shift and also became significantly less alert and more stressed. However, there was no correlation between decision-making and reported alertness and stress. These results suggest that medical judgment in registered nurses changed from the beginning to the end of a 12-h day shift. One possible underlying mechanism responsible for the changes seen across the shift could be the ability to maintain attention, as suggested by the Controlled Attention Model. The current results expand upon previous research, indicating there are a variety of negative outcomes associated with shift work.

Response of Pacific walruses to disturbances from capture and handling activities at a haul-out in Bristol Bay, Alaska

USGS Publications Warehouse

Jay, C.V.; Olson, Tamara L.; Garner, G.W.; Ballachey, Brenda E.

1998-01-01

Observations were made on hems of the Pacific walrus (Odobenus rosmarus divergens) to study their response during the capturing and handling of adult males in summer 1995 at a haul-out at Cape Peirce in southwestern Alaska. Three behaviors (alertness, displacement, and dispersal) were quantified from 16 capture sessions. Herd sizes ranged from 622 to 5,289 walruses. Handling of an immobilized walrus consisted of attempts to attach telemetry devices to the tusks and collect various biological samples. Handling activities resulted in an average of about 10-fold or greater levels of behavior in alertness, displacement, and dispersal than during precapture and darting periods. High levels of behavior usually occurred within the first 45 min of handling. In 8 of 10 capture sessions, walruses returned to predisturbance levels of behavior within 40 min of cessation of the handling disturbance. Alertness and displacement were moderately and negatively correlated with herd size during the handling period, which may reflect an effect of a threshold distance from the point of disturbance to responding individuals. Observations of walruses tagged with VHF radio transmitters indicated that the activities from a given capture session did not preclude tagged walruses from using the haul-out over a subsequent 11-wk monitoring period. Moreover, non-tagged walruses continued to extensively use the haul-out during and after the period in which capture sessions were conducted.

Visual search and the aging brain: discerning the effects of age-related brain volume shrinkage on alertness, feature binding, and attentional control.

PubMed

Müller-Oehring, Eva M; Schulte, Tilman; Rohlfing, Torsten; Pfefferbaum, Adolf; Sullivan, Edith V

2013-01-01

Decline in visuospatial abilities with advancing age has been attributed to a demise of bottom-up and top-down functions involving sensory processing, selective attention, and executive control. These functions may be differentially affected by age-related volume shrinkage of subcortical and cortical nodes subserving the dorsal and ventral processing streams and the corpus callosum mediating interhemispheric information exchange. Fifty-five healthy adults (25-84 years) underwent structural MRI and performed a visual search task to test perceptual and attentional demands by combining feature-conjunction searches with "gestalt" grouping and attentional cueing paradigms. Poorer conjunction, but not feature, search performance was related to older age and volume shrinkage of nodes in the dorsolateral processing stream. When displays allowed perceptual grouping through distractor homogeneity, poorer conjunction-search performance correlated with smaller ventrolateral prefrontal cortical and callosal volumes. An alerting cue attenuated age effects on conjunction search, and the alertness benefit was associated with thalamic, callosal, and temporal cortex volumes. Our results indicate that older adults can capitalize on early parallel stages of visual information processing, whereas age-related limitations arise at later serial processing stages requiring self-guided selective attention and executive control. These limitations are explained in part by age-related brain volume shrinkage and can be mitigated by external cues.

Request to monitor 2035-01 AE Aqr for multiwavelength campaign AND Reminder to monitor HT Cas, Z Cha, and OY Car

NASA Astrophysics Data System (ADS)

Waagen, Elizabeth O.

2005-08-01

AAVSO Alert Notice 326 contains two topics. First: Dr. Christopher Mauche (Lawrence Livermore National Laboratory) has requested our assistance in monitoring the novalike intermediate polar AE Aqr in support of multiwavelength (gamma-ray, X-ray, UV, optical, and radio) observations scheduled for August-September 2005. AAVSO observations, particularly CCD ones, are requested to correlate with these multiwavelength observations; visual observations are also encouraged. Second: as announced in Alert Notice 317, Drs. Christopher Mauche, Peter Wheatley, and Koji Mukai have obtained time on XMM-Newton to observe HT Cas, Z Cha, or OY Car in outburst, and they have requested our assistance in monitoring these stars closely so we can inform them promptly when any of them go into outburst. Very prompt notification is essential because of the time required to trigger the satellite and the shortness of the outbursts of the target stars. Please monitor HT Cas, OY Car, and Z Cha closely from now through at least a month after the last observing window closes, and notify Headquarters immediately if any of the target stars goes into outburst. Both visual and CCD observations are encouraged. Finder charts with sequence may be created using the AAVSO Variable Star Plotter (https://www.aavso.org/vsp). Observations should be submitted to the AAVSO International Database. See full Alert Notice for more details.

Mind Wandering and Task-Focused Attention: ERP Correlates.

PubMed

Gonçalves, Óscar F; Rêgo, Gabriel; Conde, Tatiana; Leite, Jorge; Carvalho, Sandra; Lapenta, Olívia Morgan; Boggio, Paulo S

2018-05-15

Previous studies looking at how Mind Wandering (MW) impacts performance in distinct Focused Attention (FA) systems, using the Attention Network Task (ANT), showed that the presence of pure MW thoughts did not impact the overall performance of ANT (alert, orienting and conflict) performance. However, it still remains unclear if the lack of interference of MW in the ANT, reported at the behavioral level, has a neurophysiological correspondence. We hypothesize that a distinct cortical processing may be required to meet attentional demands during MW. The objective of the present study was to test if, given similar levels of ANT performance, individuals predominantly focusing on MW or FA show distinct cortical processing. Thirty-three healthy participants underwent an EEG high-density acquisition while they were performing the ANT. MW was assessed following the ANT using an adapted version of the Resting State Questionnaire (ReSQ). The following ERP's were analyzed: pN1, pP1, P1, N1, pN, and P3. At the behavioral level, participants were slower and less accurate when responding to incongruent than to congruent targets (conflict effect), benefiting from the presentation of the double (alerting effect) and spatial (orienting effect) cues. Consistent with the behavioral data, ERP's waves were discriminative of distinct attentional effects. However, these results remained true irrespective of the MW condition, suggesting that MW imposed no additional cortical demand in alert, orienting, and conflict attention tasks.

Alert Exchange Process Protocol

NASA Technical Reports Server (NTRS)

Groen, Frank

2015-01-01

The National Aeronautics and Space Administration of the United States of America (NASA), and the European Space Agency (ESA), and the Japanese Aerospace Exploration Agency (JAXA), acknowledging that NASA, ESA and JAXA have a mutual interest in exchanging Alerts and Alert Status Lists to enhance the information base for each system participant while fortifying the general level of cooperation between the policy agreement subscribers, and each Party will exchange Alert listings on regular basis and detailed Alert information on a need to know basis to the extent permitted by law.

Evaluation of a National Call Center and a Local Alerts System for Detection of New Cases of Ebola Virus Disease - Guinea, 2014-2015

DTIC Science & Technology

2016-03-11

Control and Prevention Evaluation of a National Call Center and a Local Alerts System for Detection of New Cases of Ebola Virus Disease — Guinea, 2014...principally through the use of a telephone alert system. Community members and health facilities report deaths and suspected Ebola cases to local alert ...sensitivity of the national call center with the local alerts system, the CDC country team performed probabilistic record linkage of the combined

Multimodal intraoperative neuromonitoring in corrective surgery for adolescent idiopathic scoliosis: Evaluation of 354 consecutive cases

PubMed Central

Kundnani, Vishal K; Zhu, Lisa; Tak, HH; Wong, HK

2010-01-01

Background: Multimodal intraoperative neuromonitoring is recommended during corrective spinal surgery, and has been widely used in surgery for spinal deformity with successful outcomes. Despite successful outcomes of corrective surgery due to increased safety of the patients with the usage of spinal cord monitoring in many large spine centers, this modality has not yet achieved widespread popularity. We report the analysis of prospectively collected intraoperative neurophysiological monitoring data of 354 consecutive patients undergoing corrective surgery for adolescent idiopathic scoliosis (AIS) to establish the efficacy of multimodal neuromonitoring and to evaluate comparative sensitivity and specificity. Materials and Methods: The study group consisted of 354 (female = 309; male = 45) patients undergoing spinal deformity corrective surgery between 2004 and 2008. Patients were monitored using electrophysiological methods including somatosensory-evoked potentials and motor-evoked potentials simultaneously. Results: Mean age of patients was 13.6 years (±2.3 years). The operative procedures involved were instrumented fusion of the thoracic/lumbar/both curves, Baseline somatosensory-evoked potentials (SSEP) and neurogenic motor-evoked potentials (NMEP) were recorded successfully in all cases. Thirteen cases expressed significant alert to prompt reversal of intervention. All these 13 cases with significant alert had detectable NMEP alerts, whereas significant SSEP alert was detected in 8 cases. Two patients awoke with new neurological deficit (0.56%) and had significant intraoperative SSEP + NMEP alerts. There were no false positives with SSEP (high specificity) but 5 patients with false negatives with SSEP (38%) reduced its sensitivity. There was no false negative with NMEP but 2 of 13 cases were false positive with NMEP (15%). The specificity of SSEP (100%) is higher than NMEP (96%); however, the sensitivity of NMEP (100%) is far better than SSEP (51%). Due to these results, the overall sensitivity, specificity and positive predictive value of combined multimodality neuromonitoring in this adult deformity series was 100, 98.5 and 85%, respectively. Conclusion: Neurogenic motor-evoked potential (NMEP) monitoring appears to be superior to conventional SSEP monitoring for identifying evolving spinal cord injury. Used in conjunction, the sensitivity and specificity of combined neuromonitoring may reach up to 100%. Multimodality monitoring with SSEP + NMEP should be the standard of care. PMID:20165679

Current strategies for monitoring men with localised prostate cancer lack a strong evidence base: observational longitudinal study.

PubMed

Metcalfe, C; Tilling, K; Davis, M; Lane, J A; Martin, R M; Kynaston, H; Powell, P; Neal, D E; Hamdy, F; Donovan, J L

2009-08-04

The UK National Institute for Health and Clinical Excellence (NICE) guidance recommends conservative management of men with 'low-risk' localised prostate cancer, monitoring the disease using prostate-specific antigen (PSA) kinetics and re-biopsy. However, there is little evidence of the changes in PSA level that should alert to the need for clinical re-assessment. This study compares the alerts resulting from PSA kinetics and a novel longitudinal reference range approach, which incorporates age-related changes, during the monitoring of 408 men with localised prostate cancer. Men were monitored by regular PSA tests over a mean of 2.9 years, recording when a man's PSA doubling time fell below 2 years, PSA velocity exceeded 2 ng ml(-1) per year, or when his upper 10% reference range was exceeded. Prostate-specific antigen doubling time and PSA velocity alerted a high proportion of men initially but became unresponsive to changes with successive tests. Calculating doubling time using recent PSA measurements reduced the decline in response. The reference range method maintained responsiveness to changes in PSA level throughout the monitoring. The increasing unresponsiveness of PSA kinetics is a consequence of the underlying regression model. Novel methods are needed for evaluation in cohorts currently being managed by monitoring. Meanwhile, the NICE guidance should be cautious.

Prediction of rodent carcinogenicity bioassays from molecular structure using inductive logic programming

DOE Office of Scientific and Technical Information (OSTI.GOV)

King, R.D.; Srinivasan, A.

1996-10-01

The machine learning program Progol was applied to the problem of forming the structure-activity relationship (SAR) for a set of compounds tested for carcinogenicity in rodent bioassays by the U.S. National Toxicology Program (NTP). Progol is the first inductive logic programming (ILP) algorithm to use a fully relational method for describing chemical structure in SARs, based on using atoms and their bond connectivities. Progol is well suited to forming SARs for carcinogenicity as it is designed to produce easily understandable rules (structural alerts) for sets of noncongeneric compounds. The Progol SAR method was tested by prediction of a set ofmore » compounds that have been widely predicted by other SAR methods (the compounds used in the NTP`s first round of carcinogenesis predictions). For these compounds no method (human or machine) was significantly more accurate than Progol. Progol was the most accurate method that did not use data from biological tests on rodents (however, the difference in accuracy is not significant). The Progol predictions were based solely on chemical structure and the results of tests for Salmonella mutagenicity. Using the full NTP database, the prediction accuracy of Progol was estimated to be 63% ({+-}3%) using 5-fold cross validation. A set of structural alerts for carcinogenesis was automatically generated and the chemical rationale for them investigated-these structural alerts are statistically independent of the Salmonella mutagenicity. Carcinogenicity is predicted for the compounds used in the NTP`s second round of carcinogenesis predictions. The results for prediction of carcinogenesis, taken together with the previous successful applications of predicting mutagenicity in nitroaromatic compounds, and inhibition of angiogenesis by suramin analogues, show that Progol has a role to play in understanding the SARs of cancer-related compounds. 29 refs., 2 figs., 4 tabs.« less

Extension of platelet shelf life from 4 to 5 days by implementation of a new screening strategy in Germany.

PubMed

Sireis, W; Rüster, B; Daiss, C; Hourfar, M K; Capalbo, G; Pfeiffer, H-U; Janetzko, K; Goebel, M; Kempf, V A J; Seifried, E; Schmidt, M

2011-10-01

The Paul-Ehrlich-Institute analysed all fatalities due to bacterial infections between 1997 and 2007. Thereafter, the platelet shelf life was reduced to a maximum of 4 days after blood donation because the majority of all cases of severe transfusion-transmitted bacterial infections occurred with day 5 platelets. The current study compares the analytical sensitivity and the diagnostic specificity of four rapid bacterial detection procedures. Nine transfusion-relevant bacterial strains were spiked in pooled platelets or apheresis platelets at a low concentration (10 CFU/bag). Samples were collected after day 3, day 4 and day 5 and investigated by four rapid bacterial detection methods (modified BacT/ALERT, Bactiflow, FACS method and 16s DNA PCR methods). Seven out of nine bacterial strains were adequately detected by BacT/ALERT, Bactiflow and PCR in apheresis platelets and pooled platelets after sample collection at day 3, day 4 and day 5. For three bacterial strains, analytical sensitivity was reduced for the FACS method. Two bacterial strains did not grow under the storage conditions in either pooled or apheresis platelets. A late sample collection on day 3, day 4 or day 5 after blood donation in combination with a rapid bacterial detection method offers a new opportunity to improve blood safety and reduce errors due to sampling., BacT/ALERT, Bactiflow or 16s ID-NAT are feasible for late bacterial screening in platelets may provide data which support the extension of platelet shelf life in Germany to 5 days. © 2011 The Author(s). Vox Sanguinis © 2011 International Society of Blood Transfusion.

Electronic Immunization Alerts and Spillover Effects on Other Preventive Care.

PubMed

Kim, Julia M; Rivera, Maria; Persing, Nichole; Bundy, David G; Psoter, Kevin J; Ghazarian, Sharon R; Miller, Marlene R; Solomon, Barry S

2017-08-01

The impact of electronic health record (EHR) immunization clinical alert systems on the delivery of other preventive services remains unknown. We assessed for spillover effects of an EHR immunization alert on delivery of 6 other preventive services, in children 18 to 30 months of age needing immunizations. We conducted a secondary data analysis, with additional primary data collection, of a randomized, historically controlled trial to improve immunization rates with EHR alerts, in an urban, primary care clinic. No significant differences were found in screening for anemia, lead, development, nutrition, and injury prevention counseling in children prompting EHR immunization alerts (n = 129), compared with controls (n = 135). Significant increases in oral health screening in patients prompting EHR alerts (odds ratio = 4.8, 95% CI = 1.8-13.0) were likely due to practice changes over time. An EHR clinical alert system targeting immunizations did not have a spillover effect on the delivery of other preventive services.

Using electronic health record alerts to provide public health situational awareness to clinicians.

PubMed

Lurio, Joseph; Morrison, Frances P; Pichardo, Michelle; Berg, Rachel; Buck, Michael D; Wu, Winfred; Kitson, Kwame; Mostashari, Farzad; Calman, Neil

2010-01-01

Alerting providers to public health situations requires timeliness and context-relevance, both lacking in current systems. Incorporating decision support tools into electronic health records may provide a way to deploy public health alerts to clinicians at the point of care. A timely process for responding to Health Alert Network messages sent by the New York City Department of Health and Mental Hygiene was developed by a network of community health centers. Alerts with order sets and recommended actions were created to notify primary care providers of local disease outbreaks. The process, effect, and lessons learned from alerts for Legionella, toxogenic E coli, and measles outbreaks are described. Electronic alerts have the potential to improve management of diseases during an outbreak, including appropriate laboratory testing, management guidance, and diagnostic assistance as well as to enhance bi-directional data exchange between clinical and public health organizations.

Using electronic health record alerts to provide public health situational awareness to clinicians

PubMed Central

Lurio, Joseph; Pichardo, Michelle; Berg, Rachel; Buck, Michael D; Wu, Winfred; Kitson, Kwame; Mostashari, Farzad; Calman, Neil

2010-01-01

Alerting providers to public health situations requires timeliness and context-relevance, both lacking in current systems. Incorporating decision support tools into electronic health records may provide a way to deploy public health alerts to clinicians at the point of care. A timely process for responding to Health Alert Network messages sent by the New York City Department of Health and Mental Hygiene was developed by a network of community health centers. Alerts with order sets and recommended actions were created to notify primary care providers of local disease outbreaks. The process, effect, and lessons learned from alerts for Legionella, toxogenic E coli, and measles outbreaks are described. Electronic alerts have the potential to improve management of diseases during an outbreak, including appropriate laboratory testing, management guidance, and diagnostic assistance as well as to enhance bi-directional data exchange between clinical and public health organizations. PMID:20190067

Computerized Alerts Improve Outpatient Laboratory Monitoring of Transplant Patients

PubMed Central

Staes, Catherine J.; Evans, R. Scott; Rocha, Beatriz H.S.C.; Sorensen, John B.; Huff, Stanley M.; Arata, Joan; Narus, Scott P.

2008-01-01

Authors evaluated the impact of computerized alerts on the quality of outpatient laboratory monitoring for transplant patients. For 356 outpatient liver transplant patients managed at LDS Hospital, Salt Lake City, this observational study compared traditional laboratory result reporting, using faxes and printouts, to computerized alerts implemented in 2004. Study alerts within the electronic health record notified clinicians of new results and overdue new orders for creatinine tests and immunosuppression drug levels. After implementing alerts, completeness of reporting increased from 66 to >99 %, as did positive predictive value that a report included new information (from 46 to >99 %). Timeliness of reporting and clinicians' responses improved after implementing alerts (p <0.001): median times for clinicians to receive and complete actions decreased to 9 hours from 33 hours using the prior traditional reporting system. Computerized alerts led to more efficient, complete, and timely management of laboratory information. PMID:18308982

Experimental verification, and domain definition, of structural alerts for protein binding: epoxides, lactones, nitroso, nitros, aldehydes and ketones.

PubMed

Nelms, M D; Cronin, M T D; Schultz, T W; Enoch, S J

2013-01-01

This study outlines how a combination of in chemico and Tetrahymena pyriformis data can be used to define the applicability domain of selected structural alerts within the profilers of the OECD QSAR Toolbox. Thirty-three chemicals were profiled using the OECD and OASIS profilers, enabling the applicability domain of six structural alerts to be defined, the alerts being: epoxides, lactones, nitrosos, nitros, aldehydes and ketones. Analysis of the experimental data showed the applicability domains for the epoxide, nitroso, aldehyde and ketone structural alerts to be well defined. In contrast, the data showed the applicability domains for the lactone and nitro structural alerts needed modifying. The accurate definition of the applicability domain for structural alerts within in silico profilers is important due to their use in the chemical category in predictive and regulatory toxicology. This study highlights the importance of utilizing multiple profilers in category formation.

Self-Alert Training: Volitional Modulation of Autonomic Arousal Improves Sustained Attention

ERIC Educational Resources Information Center

O'Connell, Redmond G.; Bellgrove, Mark A.; Dockree, Paul M.; Lau, Adam; Fitzgerald, Michael; Robertson, Ian H.

2008-01-01

The present study examines a new alertness training strategy (Self-Alert Training, SAT) designed to explore the relationship between the top-down control processes governing arousal and sustained attention. In order to maximally target frontal control systems SAT combines a previously validated behavioural self-alerting technique [Robertson, I.…

75 FR 2105 - Publication of OIG Updated Special Fraud Alert on Telemarketing by Durable Medical Equipment...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-14

... Inspector General Publication of OIG Updated Special Fraud Alert on Telemarketing by Durable Medical... Register notice sets forth the recently issued OIG Updated Special Fraud Alert addressing telemarketing by durable medical equipment (DME) suppliers. For the most part, OIG Special Fraud Alerts address national...

76 FR 81904 - Solicitation of New Safe Harbors and Special Fraud Alerts

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-29

... of New Safe Harbors and Special Fraud Alerts AGENCY: Office of Inspector General (OIG), HHS. ACTION... Special Fraud Alerts. DATES: To assure consideration, public comments must be delivered to the address... and Special Fraud Alerts. Please assist us by referencing the file code OIG-120-N. Inspection of...

DOE Office of Scientific and Technical Information (OSTI.GOV)

Connell, Leonard W.; Edenburn, Michael W.; Fraley, Stanley K.

This paper presents a framework for evaluating the technical merits of strategic ballistic missile de-alerting measures, and it uses the framework to evaluate a variety of possible measures for silo-based, land-mobile, and submarine-based missiles. De-alerting measures are defined for the purpose of this paper as reversible actions taken to increase the time or effort required to launch a strategic ballistic missile. The paper does not assess the desirability of pursuing a de-alerting program. Such an assessment is highly context dependent. The paper postulates that if de-alerting is desirable and is used as an arms control mechanism, de-alerting measures should satisfymore » specific cirteria relating to force security, practicality, effectiveness, significant delay, and verifiability. Silo-launched missiles lend themselves most readily to de-alerting verification, because communications necessary for monitoring do not increase the vulnerabilty of the weapons by a significant amount. Land-mobile missile de-alerting measures would be more challenging to verify, because monitoring measures that disclose the launcher's location would potentially increase their vulnerability. Submarine-launched missile de-alerting measures would be extremely challlenging if not impossible to monitor without increasing the submarine's vulnerability.« less

The effect of mental alerting on peripheral vestibular nystagmus during spontaneous, gaze (30 degrees left, 30 degrees right) and body positional (left & right lateral lying) testing using electronystagmography (ENG).

PubMed

McGovern, Tracey N; Fitzgerald, John E

2008-10-01

The performance of mental alerting during caloric testing has always been considered important, however its use/benefit during electronystagmography (ENG)/videonystagmography (VNG) testing has been questioned. The aim of this study was to investigate the effect of mental alerting tasks on peripheral type vestibular nystagmus recorded during ENG. Thirty patients with significant spontaneous/gaze or positional nystagmus (slow phase velocity >or= 6 degrees /s) were recruited from consecutive referrals for vestibular assessment. Nystagmus was recorded by ENG both in the presence and absence of mental alerting for each patient. Investigation of nystagmus by analysis of variance (ANOVA) revealed significantly larger nystagmus (higher value SPV) with mental alerting than with no alerting (p<0.001), and for some patients nystagmus traces were reduced to a flat line (no nystagmus) with no alerting. The study demonstrates the importance of mental alerting in helping overcome central suppression of nystagmus and highlights its importance to help identify peripheral type nystagmus during ENG.

The Impact of Alerting Designs on Air Traffic Controller's Eye Movement Patterns and Situation Awareness.

PubMed

Kearney, Peter; Li, Wen-Chin; Yu, Chung-San; Braithwaite, Graham

2018-06-26

This research investigated controller' situation awareness by comparing COOPANS's acoustic alerts with newly designed semantic alerts. The results demonstrate that ATCOs' visual scan patterns had significant differences between acoustic and semantic designs. ATCOs established different eye movement patterns on fixations number, fixation duration and saccade velocity. Effective decision support systems require human-centred design with effective stimuli to direct ATCO's attention to critical events. It is necessary to provide ATCOs with specific alerting information to reflect the nature of of the critical situation in order to minimize the side-effects of startle and inattentional deafness. Consequently, the design of a semantic alert can significantly reduce ATCOs' response time, therefore providing valuable extra time in a time-limited situation to formulate and execute resolution strategies in critical air safety events. The findings of this research indicate that the context-specified design of semantic alerts could improve ATCO's situational awareness and significantly reduce response time in the event of Short Term Conflict Alert activation which alerts to two aircraft having less than the required lateral or vertical separation.

Flight crew interface aspects of forward-looking airborne windshear detection systems

NASA Technical Reports Server (NTRS)

Anderson, Charles D.; Carbaugh, David C.

1993-01-01

The goal of this research effort was to conduct analyses and research which could provide guidelines for design of the crew interface of an integrated windshear system. Addressed were HF issues, crew/system requirements, candidate display formats, alerting criteria, and crew procedures. A survey identified five flight management issues as top priority: missed alert acceptability; avoidance distance needed; false alert acceptability; nuisance rate acceptability; and crew procedures. Results of a simulation study indicated that the warning time for a look-ahead alert needs to be between 11 and 36 seconds (target of 23 seconds) before the reactive system triggers in order to be effective. Pilots considered the standard go-around maneuver most appropriate for look-ahead alerts, and the escape maneuvers used did not require lateral turns. Prototype display formats were reviewed or developed for alerting the crew; providing guidance to avoid or escape windshear; and status displays to provide windshear situational awareness. The three alerting levels now in use were considered appropriate, with a fourth (time-critical) level as a possible addition, although many reviewers felt only two levels of alerting were needed. Another survey gathered expert opinion on what crew procedures and alerting criteria should be used for look-ahead, or integrated, windshear systems, with a wide diversity of opinion in these areas.

Dual-task performance consequences of imperfect alerting associated with a cockpit display of traffic information.

PubMed

Wickens, Christopher; Colcombe, Angela

2007-10-01

Performance consequences related to integrating an imperfect alert within a complex task domain were examined in two experiments. Cockpit displays of traffic information (CDTIs) are being designed for use in airplane cockpits as responsibility for safe separation becomes shared between pilots and controllers. Of interest in this work is how characteristics of the alarm system such as threshold, modality, and number of alert levels impact concurrent task (flight control) performance and response to potential conflicts. Student pilots performed a tracking task analogous to flight control while simultaneously monitoring for air traffic conflicts with the aid of a CDTI alert as the threshold, modality, and level of alert was varied. As the alerting system became more prone to false alerts, pilot compliance decreased and concurrent performance improved. There was some evidence of auditory preemption with auditory alerts as the false alarm rate increased. Finally, there was no benefit to a three-level system over a two-level system. There is justification for increased false alarm rates, as miss-prone systems appear to be costly. The 4:1 false alarm to miss ratio employed here improved accuracy and concurrent task performance. More research needs to address the potential benefits of likelihood alerting. The issues addressed in this research can be applied to any imperfect alerting system such as in aviation, driving, or air traffic control. It is crucial to understand the performance consequences of new technology and the efficacy of potential mitigating design features within the specific context desired.

Wide variation and patterns of physicians' responses to drug-drug interaction alerts.

PubMed

Cho, Insook; Lee, Yura; Lee, Jae-Ho; Bates, David W

2018-05-08

Providing physicians with alerts about potentially harmful drug-drug interactions (DDIs) is only moderately effective due to high alert override rates. To understand high override behavior on DDI alerts, we investigated how physicians respond to DDIs and their behavior patterns and variations. Retrospective system log data analysis and records review (sampling 2% of total overrides). A large tertiary academic hospital. About 560 physicians and their override responses to DDI alerts generated from 1 September to 31 December 2014. Not applicable. DDI alert frequency and override rate. We found significant variation in both the number of alerts and override rates at the levels of physicians, departments and drug-class pairs. Physician-level variations were wider for residents than for faculty staff (number of alerts: t = 254.17, P = 0.011; override rates: t = -4.77, P < 0.0001). Using the number of alerts and their override rate, we classified physicians into four groups: inexperienced incautious users, inexperienced cautious users, experienced cautious users and experienced incautious users. Medical department influenced both alert numbers and override rates. Nearly 90% of the overrides involved only five drug-class combinations, which had a wide range of appropriateness in the chart review. The variations at drug-class levels suggest issues with system design and the DDI rules. Department-level variation may be best addressed at the department level, and the rest of the variation appears related to individual physician responses, suggesting the need for interventions at an individual level.

Validation of Test Performance and Clinical Time Zero for an Electronic Health Record Embedded Severe Sepsis Alert.

PubMed

Rolnick, Joshua; Downing, N Lance; Shepard, John; Chu, Weihan; Tam, Julia; Wessels, Alexander; Li, Ron; Dietrich, Brian; Rudy, Michael; Castaneda, Leon; Shieh, Lisa

2016-01-01

Increasing use of EHRs has generated interest in the potential of computerized clinical decision support to improve treatment of sepsis. Electronic sepsis alerts have had mixed results due to poor test characteristics, the inability to detect sepsis in a timely fashion and the use of outside software limiting widespread adoption. We describe the development, evaluation and validation of an accurate and timely severe sepsis alert with the potential to impact sepsis management. To develop, evaluate, and validate an accurate and timely severe sepsis alert embedded in a commercial EHR. The sepsis alert was developed by identifying the most common severe sepsis criteria among a cohort of patients with ICD 9 codes indicating a diagnosis of sepsis. This alert requires criteria in three categories: indicators of a systemic inflammatory response, evidence of suspected infection from physician orders, and markers of organ dysfunction. Chart review was used to evaluate test performance and the ability to detect clinical time zero, the point in time when a patient develops severe sepsis. Two physicians reviewed 100 positive cases and 75 negative cases. Based on this review, sensitivity was 74.5%, specificity was 86.0%, the positive predictive value was 50.3%, and the negative predictive value was 94.7%. The most common source of end-organ dysfunction was MAP less than 70 mm/Hg (59%). The alert was triggered at clinical time zero in 41% of cases and within three hours in 53.6% of cases. 96% of alerts triggered before a manual nurse screen. We are the first to report the time between a sepsis alert and physician chart-review clinical time zero. Incorporating physician orders in the alert criteria improves specificity while maintaining sensitivity, which is important to reduce alert fatigue. By leveraging standard EHR functionality, this alert could be implemented by other healthcare systems.

Investigating the association of alerts from a national mortality surveillance system with subsequent hospital mortality in England: an interrupted time series analysis.

PubMed

Cecil, Elizabeth; Bottle, Alex; Esmail, Aneez; Wilkinson, Samantha; Vincent, Charles; Aylin, Paul P

2018-05-04

To investigate the association between alerts from a national hospital mortality surveillance system and subsequent trends in relative risk of mortality. There is increasing interest in performance monitoring in the NHS. Since 2007, Imperial College London has generated monthly mortality alerts, based on statistical process control charts and using routinely collected hospital administrative data, for all English acute NHS hospital trusts. The impact of this system has not yet been studied. We investigated alerts sent to Acute National Health Service hospital trusts in England in 2011-2013. We examined risk-adjusted mortality (relative risk) for all monitored diagnosis and procedure groups at a hospital trust level for 12 months prior to an alert and 23 months post alert. We used an interrupted time series design with a 9-month lag to estimate a trend prior to a mortality alert and the change in trend after, using generalised estimating equations. On average there was a 5% monthly increase in relative risk of mortality during the 12 months prior to an alert (95% CI 4% to 5%). Mortality risk fell, on average by 61% (95% CI 56% to 65%), during the 9-month period immediately following an alert, then levelled to a slow decline, reaching on average the level of expected mortality within 18 months of the alert. Our results suggest an association between an alert notification and a reduction in the risk of mortality, although with less lag time than expected. It is difficult to determine any causal association. A proportion of alerts may be triggered by random variation alone and subsequent falls could simply reflect regression to the mean. Findings could also indicate that some hospitals are monitoring their own mortality statistics or other performance information, taking action prior to alert notification. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Management of Patient-Reported Outcome (PRO) Alerts in Clinical Trials: A Cross Sectional Survey.

PubMed

Kyte, Derek; Ives, Jonathan; Draper, Heather; Calvert, Melanie

2016-01-01

Assessment of patient-reported outcomes (PROs) provides valuable information to inform patient-centered care, but may also reveal 'PRO alerts': psychological distress or physical symptoms that may require an immediate response. Ad-hoc management of PRO alerts in clinical trials may result in suboptimal patient care or potentially bias trial results. To gain greater understanding of current practice in PRO alert management we conducted a national survey of personnel involved in clinical trials with a PRO endpoint. We conducted a national cross-sectional survey of 767 UK-based research nurses, data managers/coordinators, trial managers and chief/principal investigators involved in clinical trials using PROs. Respondents were self-selected volunteers from a non-randomised sample of eligible individuals recruited via 55 UK Clinical Research Collaboration Registered Clinical Trials Units and 19 Comprehensive Local Research Networks. Questions centred on the proportion of trial personnel encountering alerts, how staff responded to PRO alerts and whether current guidance was deemed sufficient to support research personnel. We undertook descriptive analyses of the quantitative data and directed thematic analysis of free-text comments. 20% of research nurses did not view completed PRO questionnaires and were not in a position to discover alerts, 39-50% of the remaining respondent group participants reported encountering PRO alerts. Of these, 83% of research nurses and 54% of data managers/trial coordinators reported taking action to assist the trial participant, but less than half were able to record the intervention in the trial documentation. Research personnel reported current PRO alert guidance/training was insufficient. Research personnel are intermittently exposed to PRO alerts. Some intervene to help trial participants, but are not able to record this intervention in the trial documentation, risking co-intervention bias. Other staff do not check PRO information during the trial, meaning alerts may remain undiscovered, or do not respond to alerts if they are inadvertently encountered; both of which may impact on patient safety. Guidance is needed to support PRO alert management that protects the interests of trial participants whilst avoiding potential bias.

Improving Recognition of Pediatric Severe Sepsis in the Emergency Department: Contributions of a Vital Sign-Based Electronic Alert and Bedside Clinician Identification.

PubMed

Balamuth, Fran; Alpern, Elizabeth R; Abbadessa, Mary Kate; Hayes, Katie; Schast, Aileen; Lavelle, Jane; Fitzgerald, Julie C; Weiss, Scott L; Zorc, Joseph J

2017-12-01

Recognition of pediatric sepsis is a key clinical challenge. We evaluate the performance of a sepsis recognition process including an electronic sepsis alert and bedside assessment in a pediatric emergency department (ED). This was a cohort study with quality improvement intervention in a pediatric ED. Exposure was a positive electronic sepsis alert, defined as elevated pulse rate or hypotension, concern for infection, and at least one of the following: abnormal capillary refill, abnormal mental status, or high-risk condition. A positive electronic sepsis alert prompted team assessment or huddle to determine need for sepsis protocol. Clinicians could initiate team assessment or huddle according to clinical concern without positive electronic sepsis alert. Severe sepsis outcome defined as activation of the sepsis protocol in the ED or development of severe sepsis requiring ICU admission within 24 hours. There were 182,509 ED visits during the study period, with 86,037 before electronic sepsis alert implementation and 96,472 afterward, and 1,112 (1.2%) positive electronic sepsis alerts. Overall, 326 patients (0.3%) were treated for severe sepsis within 24 hours. Test characteristics of the electronic sepsis alert alone to detect severe sepsis were sensitivity 86.2% (95% confidence interval [CI] 82.0% to 89.5%), specificity 99.1% (95% CI 99.0% to 99.2%), positive predictive value 25.4% (95% CI 22.8% to 28.0%), and negative predictive value 100% (95% CI 99.9% to 100%). Inclusion of the clinician screen identified 43 additional electronic sepsis alert-negative children, with severe sepsis sensitivity 99.4% (95% CI 97.8% to 99.8%) and specificity 99.1% (95% CI 99.1% to 99.2%). Electronic sepsis alert implementation increased ED sepsis detection from 83% to 96%. Electronic sepsis alert for severe sepsis demonstrated good sensitivity and high specificity. Addition of clinician identification of electronic sepsis alert-negative patients further improved sensitivity. Implementation of the electronic sepsis alert was associated with improved recognition of severe sepsis. Copyright © 2017 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

Neuroimaging of Brain Injuries and Disorders at Cleveland Clinic

DTIC Science & Technology

2013-12-01

LFBFs) in the human brain during a state of alert rest. These spontaneous fluctuations are correlated in brain regions with a high degree of connectivity...behavioral performance on the finger tapping fMRI scan. One subject was excluded due to significantly different anatomy from the group (large ventricles...FSL 4.0 image processing software package (http://www.fmrib.ox.ac.uk/fsl/tbss/index.html) to create a mean white matter skeleton . Specifically, all

Electronic search and rescue aids

NASA Technical Reports Server (NTRS)

Trudell, B. J.

1980-01-01

There are two elements to the basic electronic search and rescue problem: a means for immediately alerting potential rescuers and an effective method to guide the rescue forces to the scene of the emergency. An Emergency Locator Transmitter (ELT) used by aircraft or an Emergency Position Indicating Radio Beacon (EPIRB) used by maritime vessels has the capability of providing for both an immediate alert and a homing signal to assist rescue forces in locating the site of the distress. This paper describes the development of ELT/EPIRB systems. Emphasis is placed on the SARSAT project, the COSPAS/SARSAT project, and an experimental 406 MHz ELT/EPIRB system.

Collision Avoidance for Airport Traffic Concept Evaluation

NASA Technical Reports Server (NTRS)

Jones, Denise R.; Prinzel, Lawrence J., III; Otero, Sharon D.; Barker, Glover D.

2009-01-01

An initial Collision Avoidance for Airport Traffic (CAAT) concept for the Terminal Maneuvering Area (TMA) was evaluated in a simulation study at the National Aeronautics and Space Administration (NASA) Langley Research Center. CAAT is being designed to enhance surface situation awareness and provide cockpit alerts of potential conflicts during runway, taxi, and low altitude air-to-air operations. The purpose of the study was to evaluate the initial concept for an aircraft-based method of conflict detection and resolution (CD&R) in the TMA focusing on conflict detection algorithms and alerting display concepts. This paper gives an overview of the CD&R concept, simulation study, and test results.

Experimental evaluation of candidate graphical microburst alert displays

NASA Technical Reports Server (NTRS)

Wanke, Craig; Hansman, R. John

1992-01-01

The topics addressed are: (1) experimental evaluation of candidate graphical microburst displays; (2) microburst detection and alerting; (3) previous part-task simulator experiment-comparison of presentation modes; (4) presentation mode comparison-results; (5) advantages of graphical mode of presentation; (6) graphical microburst alert experiment-objectives; and graphical microburst alert experiment-overview; and (7) candidate display design.

78 FR 78807 - Solicitation of New Safe Harbors and Special Fraud Alerts

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-27

... of New Safe Harbors and Special Fraud Alerts AGENCY: Office of Inspector General (OIG), HHS. ACTION... statute (section 1128B(b) of the Social Security Act), as well as developing new OIG Special Fraud Alerts... revised safe harbors and Special Fraud Alerts. Please assist us by referencing the file code OIG-122-N...

77 FR 76434 - Solicitation of New Safe Harbors and Special Fraud Alerts

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-28

... of New Safe Harbors and Special Fraud Alerts AGENCY: Office of Inspector General (OIG), HHS. ACTION... statute (section 1128B(b) of the Social Security Act), as well as developing new OIG Special Fraud Alerts... revised safe harbors and Special Fraud Alerts. Please assist us by referencing the file code OIG-121-N...

With Free Google Alert Services

ERIC Educational Resources Information Center

Gunn, Holly

2005-01-01

Alert services are a great way of keeping abreast of topics that interest you. Rather than searching the Web regularly to find new content about your areas of interest, an alert service keeps you informed by sending you notices when new material is added to the Web that matches your registered search criteria. Alert services are examples of push…

Developing an Early-Alert System to Promote Student Visits to Tutor Center

ERIC Educational Resources Information Center

Cai, Qijie; Lewis, Carrie L.; Higdon, Jude

2015-01-01

An early-alert system (MavCLASS) was developed and piloted in a large gateway math class with 611 freshman students to identify academically at-risk students and provide alert messages. It was found that there was significant association between the alert messages students received and their visits to the university's tutor center. Further, the…

47 CFR 80.1117 - Procedure for receipt and acknowledgement of distress alerts.

Code of Federal Regulations, 2014 CFR

2014-10-01

... radiotelephony of receipt of a distress alert from a ship station or a ship earth station must be given in the... telegraphy of receipt of a distress alert from a ship earth station must be given by the coast earth station... distress alerts. 80.1117 Section 80.1117 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED...

47 CFR 80.1117 - Procedure for receipt and acknowledgement of distress alerts.

Code of Federal Regulations, 2013 CFR

2013-10-01

... radiotelephony of receipt of a distress alert from a ship station or a ship earth station must be given in the... telegraphy of receipt of a distress alert from a ship earth station must be given by the coast earth station... distress alerts. 80.1117 Section 80.1117 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED...

47 CFR 80.1117 - Procedure for receipt and acknowledgement of distress alerts.

Code of Federal Regulations, 2012 CFR

2012-10-01

... radiotelephony of receipt of a distress alert from a ship station or a ship earth station must be given in the... telegraphy of receipt of a distress alert from a ship earth station must be given by the coast earth station... distress alerts. 80.1117 Section 80.1117 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED...

Predictive Information: Status or Alert Information?

NASA Technical Reports Server (NTRS)

Trujillo, Anna C.; Bruneau, Daniel; Press, Hayes N.

2008-01-01

Previous research investigating the efficacy of predictive information for detecting and diagnosing aircraft system failures found that subjects like to have predictive information concerning when a parameter would reach an alert range. This research focused on where the predictive information should be located, whether the information should be more closely associated with the parameter information or with the alert information. Each subject saw 3 forms of predictive information: (1) none, (2) a predictive alert message, and (3) predictive information on the status display. Generally, subjects performed better and preferred to have predictive information available although the difference between status and alert predictive information was minimal. Overall, for detection and recalling what happened, status predictive information is best; however for diagnosis, alert predictive information holds a slight edge.

PubMedAlertMe - Standalone Windows-based PubMed SDI Software Application

PubMed Central

Ma’ayan, Avi

2008-01-01

PubMedAlertMe is a Windows-based software system for automatically receiving e-mail alert messages about recent publications listed on PubMed. The e-mail messages contain links to newly available abstracts listed on PubMed describing publications that were selectively returned from a specified list of queries. Links are also provided to directly export citations to EndNote, and links are provided to directly forward articles to colleagues. The program is standalone. Thus, it does not require a remote mail server or user registration. PubMedAlertMe is free software, and can be downloaded from: http://amp.pharm.mssm.edu/PubMedAlertMe/PubMedAlertMe_setup.zip PMID:18402930

Analysis of clinical decision support system malfunctions: a case series and survey.

PubMed

Wright, Adam; Hickman, Thu-Trang T; McEvoy, Dustin; Aaron, Skye; Ai, Angela; Andersen, Jan Marie; Hussain, Salman; Ramoni, Rachel; Fiskio, Julie; Sittig, Dean F; Bates, David W

2016-11-01

To illustrate ways in which clinical decision support systems (CDSSs) malfunction and identify patterns of such malfunctions. We identified and investigated several CDSS malfunctions at Brigham and Women's Hospital and present them as a case series. We also conducted a preliminary survey of Chief Medical Information Officers to assess the frequency of such malfunctions. We identified four CDSS malfunctions at Brigham and Women's Hospital: (1) an alert for monitoring thyroid function in patients receiving amiodarone stopped working when an internal identifier for amiodarone was changed in another system; (2) an alert for lead screening for children stopped working when the rule was inadvertently edited; (3) a software upgrade of the electronic health record software caused numerous spurious alerts to fire; and (4) a malfunction in an external drug classification system caused an alert to inappropriately suggest antiplatelet drugs, such as aspirin, for patients already taking one. We found that 93% of the Chief Medical Information Officers who responded to our survey had experienced at least one CDSS malfunction, and two-thirds experienced malfunctions at least annually. CDSS malfunctions are widespread and often persist for long periods. The failure of alerts to fire is particularly difficult to detect. A range of causes, including changes in codes and fields, software upgrades, inadvertent disabling or editing of rules, and malfunctions of external systems commonly contribute to CDSS malfunctions, and current approaches for preventing and detecting such malfunctions are inadequate. CDSS malfunctions occur commonly and often go undetected. Better methods are needed to prevent and detect these malfunctions. © The Author 2016. Published by Oxford University Press on behalf of the American Medical Informatics Association.

Gaining consensus on family carer needs when caring for someone dying at home to develop the Carers' Alert Thermometer (CAT): a modified Delphi study.

PubMed

Knighting, Katherine; O'Brien, Mary R; Roe, Brenda; Gandy, Rob; Lloyd-Williams, Mari; Nolan, Mike; Jack, Barbara A

2016-01-01

To report a multi-phase modified Delphi study conducted with carers and professionals to identify the priority areas for inclusion in an alert screening tool for carers providing support to someone dying at home. Internationally, there is a growing emphasis on increasing choice for patients who wish to die at home which relies heavily on care provided by the unpaid family carers. Family carers can have high levels of unmet needs comprising their psychological and physical health and their ability to provide effective care and support. Development of an alert tool to identify carers' needs in everyday practice required identification and consensus of the priority areas of need for inclusion. Multi-phase modified Delphi study and instrument development. Qualitative and quantitative data collection took place between 2011-2013 with 111 carers and 93 professionals to identify carers' needs and gain consensus on the priority areas for inclusion in the alert tool. An expert panel stage and final evidence review post-Delphi were used. The Delphi panels had high levels of agreement and consensus. Ten areas of carer need across two themes of 'the current caring situation' and 'the carer's own health and well-being' were prioritized for inclusion in the alert tool. An optional end-of-life planning question was included following the final stages. The results provide evidence of carers' needs to be assessed, areas for consideration in the education of those who support carers and someone dying at home and targeting of services, while demonstrating the usefulness and adaptability of the Delphi method. © 2015 The Authors. Journal of Advanced Nursing Published by John Wiley & Sons Ltd.

Scheduled Evening Sleep and Enhanced Lighting Improve Adaptation to Night Shift Work in Older Adults

PubMed Central

Chinoy, Evan D.; Harris, Michael P.; Kim, Min Ju; Wang, Wei; Duffy, Jeanne F.

2017-01-01

Objectives We tested whether a sleep and circadian-based treatment shown to improve circadian adaptation to night shifts and attenuate negative effects on alertness, performance, and sleep in young adults would also be effective in older adults. Methods We assessed subjective alertness, sustained attention (psychomotor vigilance task, PVT), sleep duration (actigraphy), and circadian timing (salivary dim-light melatonin onset, DLMO) in eighteen older adults (57.2±3.8 y; mean±SD) in a simulated shift work protocol. Four day shifts were followed by three night shifts in the laboratory. Participants slept at home and were randomized to either the Treatment Group (scheduled evening sleep and enhanced lighting during the latter half of night shifts), or Control Group (ad lib sleep and typical lighting during night shifts). Results Compared to day shifts, alertness and sustained attention declined on the first night shift in both groups, and was worse in the latter half of the night shifts. Alertness and attention improved on nights 2 and 3 for the Treatment Group but remained lower for the Control Group. Sleep duration in the Treatment Group remained similar to baseline (6–7 h) following night shifts, but was shorter (3–5 h) following night shifts in the Control Group. Treatment Group circadian timing advanced by 169.3±16.1 min (mean±SEM) but did not shift (−9.7±9.9 min) in the Control Group. Conclusions The combined treatment of scheduled evening sleep and enhanced lighting increased sleep duration and partially aligned circadian phase with sleep and work timing, resulting in improved night shift alertness and performance. PMID:27566781

Phi Index: A New Metric to Test the Flush Early and Avoid the Rush Hypothesis

PubMed Central

Samia, Diogo S. M.; Blumstein, Daniel T.

2014-01-01

Optimal escape theory states that animals should counterbalance the costs and benefits of flight when escaping from a potential predator. However, in apparent contradiction with this well-established optimality model, birds and mammals generally initiate escape soon after beginning to monitor an approaching threat, a phenomena codified as the “Flush Early and Avoid the Rush” (FEAR) hypothesis. Typically, the FEAR hypothesis is tested using correlational statistics and is supported when there is a strong relationship between the distance at which an individual first responds behaviorally to an approaching predator (alert distance, AD), and its flight initiation distance (the distance at which it flees the approaching predator, FID). However, such correlational statistics are both inadequate to analyze relationships constrained by an envelope (such as that in the AD-FID relationship) and are sensitive to outliers with high leverage, which can lead one to erroneous conclusions. To overcome these statistical concerns we develop the phi index (Φ), a distribution-free metric to evaluate the goodness of fit of a 1∶1 relationship in a constraint envelope (the prediction of the FEAR hypothesis). Using both simulation and empirical data, we conclude that Φ is superior to traditional correlational analyses because it explicitly tests the FEAR prediction, is robust to outliers, and it controls for the disproportionate influence of observations from large predictor values (caused by the constrained envelope in AD-FID relationship). Importantly, by analyzing the empirical data we corroborate the strong effect that alertness has on flight as stated by the FEAR hypothesis. PMID:25405872

Phi index: a new metric to test the flush early and avoid the rush hypothesis.

PubMed

Samia, Diogo S M; Blumstein, Daniel T

2014-01-01

Optimal escape theory states that animals should counterbalance the costs and benefits of flight when escaping from a potential predator. However, in apparent contradiction with this well-established optimality model, birds and mammals generally initiate escape soon after beginning to monitor an approaching threat, a phenomena codified as the "Flush Early and Avoid the Rush" (FEAR) hypothesis. Typically, the FEAR hypothesis is tested using correlational statistics and is supported when there is a strong relationship between the distance at which an individual first responds behaviorally to an approaching predator (alert distance, AD), and its flight initiation distance (the distance at which it flees the approaching predator, FID). However, such correlational statistics are both inadequate to analyze relationships constrained by an envelope (such as that in the AD-FID relationship) and are sensitive to outliers with high leverage, which can lead one to erroneous conclusions. To overcome these statistical concerns we develop the phi index (Φ), a distribution-free metric to evaluate the goodness of fit of a 1:1 relationship in a constraint envelope (the prediction of the FEAR hypothesis). Using both simulation and empirical data, we conclude that Φ is superior to traditional correlational analyses because it explicitly tests the FEAR prediction, is robust to outliers, and it controls for the disproportionate influence of observations from large predictor values (caused by the constrained envelope in AD-FID relationship). Importantly, by analyzing the empirical data we corroborate the strong effect that alertness has on flight as stated by the FEAR hypothesis.

Large vasodilatations in skeletal muscle of resting conscious dogs and their contribution to blood pressure variability

PubMed Central

Just, Armin; Schneider, Christian; Ehmke, Heimo; Kirchheim, Hartmut R

2000-01-01

Large (up to +400 %) transient (∼20 s) increases of blood flow were observed in the external iliac arteries of resting conscious dogs (n = 10) in the absence of major alerting or muscular activity. At the same time arterial pressure (AP) fellslightly while heart rate (HR) rose. The vasodilatations were resistant to atropine, ganglionic, β-adrenergic and NO-synthase inhibition, but were suppressed by spinal or general anaesthesia. Vasodilatations of similar appearance were elicited by an alerting sound; these were abolished by atropine. The spontaneous vasodilatations occurred simultaneously and their magnitudes were well correlated between both legs, but were not correlated to the amount of concomitant activation of the surface electromyogram. The duration of this activation almost never outlasted 10 s. The reactive hyperaemia observed after a total occlusion of the artery even for 16 s was not large enough to explain the size of the spontaneous vasodilatations. Occlusion during peak flow of the vasodilatations did not affect the size of the reactive hyperaemia. Spectral analysis made separately for data segments with and without vasodilatation revealed that the vasodilatations substantially enhanced the variability of AP and HR at frequencies below ∼0.1 Hz. In conclusion, large coordinated skeletal muscle vasodilatations were identified in resting conscious dogs, which are initiated neurally, but not by sympathetic-cholinergic or nitroxidergic fibres and which do not show any clear correlation to muscular contraction. The vasodilatations substantially affect the regulation of skeletal muscle blood flow and explain a significant portion of AP and HR variability. PMID:10990545

Category-Specific Comparison of Univariate Alerting Methods for Biosurveillance Decision Support

PubMed Central

Elbert, Yevgeniy; Hung, Vivian; Burkom, Howard

2013-01-01

Objective For a multi-source decision support application, we sought to match univariate alerting algorithms to surveillance data types to optimize detection performance. Introduction Temporal alerting algorithms commonly used in syndromic surveillance systems are often adjusted for data features such as cyclic behavior but are subject to overfitting or misspecification errors when applied indiscriminately. In a project for the Armed Forces Health Surveillance Center to enable multivariate decision support, we obtained 4.5 years of out-patient, prescription and laboratory test records from all US military treatment facilities. A proof-of-concept project phase produced 16 events with multiple evidence corroboration for comparison of alerting algorithms for detection performance. We used the representative streams from each data source to compare sensitivity of 6 algorithms to injected spikes, and we used all data streams from 16 known events to compare them for detection timeliness. Methods The six methods compared were: Holt-Winters generalized exponential smoothing method (1)automated choice between daily methods, regression and an exponential weighted moving average (2)adaptive daily Shewhart-type chartadaptive one-sided daily CUSUMEWMA applied to 7-day means with a trend correction; and7-day temporal scan statistic Sensitivity testing: We conducted comparative sensitivity testing for categories of time series with similar scales and seasonal behavior. We added multiples of the standard deviation of each time series as single-day injects in separate algorithm runs. For each candidate method, we then used as a sensitivity measure the proportion of these runs for which the output of each algorithm was below alerting thresholds estimated empirically for each algorithm using simulated data streams. We identified the algorithm(s) whose sensitivity was most consistently high for each data category. For each syndromic query applied to each data source (outpatient, lab test orders, and prescriptions), 502 authentic time series were derived, one for each reporting treatment facility. Data categories were selected in order to group time series with similar expected algorithm performance: Median > 100 < Median ≤ 10Median = 0Lag 7 Autocorrelation Coefficient ≥ 0.2Lag 7 Autocorrelation Coefficient < 0.2 Timeliness testing: For the timeliness testing, we avoided artificiality of simulated signals by measuring alerting detection delays in the 16 corroborated outbreaks. The multiple time series from these events gave a total of 141 time series with outbreak intervals for timeliness testing. The following measures were computed to quantify timeliness of detection: Median Detection Delay – median number of days to detect the outbreak.Penalized Mean Detection Delay –mean number of days to detect the outbreak with outbreak misses penalized as 1 day plus the maximum detection time. Results Based on the injection results, the Holt-Winters algorithm was most sensitive among time series with positive medians. The adaptive CUSUM and the Shewhart methods were most sensitive for data streams with median zero. Table 1 provides timeliness results using the 141 outbreak-associated streams on sparse (Median=0) and non-sparse data categories. [Insert table #1 here] Data median Detection Delay, days Holt-winters Regression EWMA Adaptive Shewhart Adaptive CUSUM 7-day Trend-adj. EWMA 7-day Temporal Scan Median 0 Median 3 2 4 2 4.5 2 Penalized Mean 7.2 7 6.6 6.2 7.3 7.6 Median >0 Median 2 2 2.5 2 6 4 Penalized Mean 6.1 7 7.2 7.1 7.7 6.6 The gray shading in the table 1 indicates methods with shortest detection delays for sparse and non-sparse data streams. The Holt-Winters method was again superior for non-sparse data. For data with median=0, the adaptive CUSUM was superior for a daily false alarm probability of 0.01, but the Shewhart method was timelier for more liberal thresholds. Conclusions Both kinds of detection performance analysis showed the method based on Holt-Winters exponential smoothing superior on non-sparse time series with day-of-week effects. The adaptive CUSUM and She-whart methods proved optimal on sparse data and data without weekly patterns.

Cognitive and contextual correlates of spontaneous and deliberate mind-wandering.

PubMed

Robison, Matthew K; Unsworth, Nash

2018-01-01

Individuals with greater cognitive abilities generally show reduced rates of mind-wandering when completing relatively demanding tasks (Randall, Oswald, & Beier, 2014). However, it is yet unclear whether elevated rates of mind-wandering among low-ability individuals are manifestations of deliberate, intentional episodes of mind-wandering because of task disengagement or lack of motivation, or to spontaneous, unintentional failures to maintain task-oriented attention. The present study examined this issue by measuring working memory capacity (WMC), mind-wandering during 3 relatively demanding attention control tasks, and contextual variables (e.g., motivation, alertness, perceptions of task unpleasantness). Results indicated that the relationship between WMC and mind-wandering was primarily driven by spontaneous episodes. Lack of alertness also uniquely predicted more frequent spontaneous mind-wandering independently of WMC. Deliberate mind-wandering was primarily driven by a lack of motivation. Thus, cognitive and contextual factors can have distinct relationships with spontaneous and deliberate mind-wandering. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Influence of climate variability on near-surface ozone depletion events in the Arctic spring

NASA Astrophysics Data System (ADS)

Koo, Ja-Ho; Wang, Yuhang; Jiang, Tianyu; Deng, Yi; Oltmans, Samuel J.; Solberg, Sverre

2014-04-01

Near-surface ozone depletion events (ODEs) generally occur in the Arctic spring, and the frequency shows large interannual variations. We use surface ozone measurements at Barrow, Alert, and Zeppelinfjellet to analyze if their variations are due to climate variability. In years with frequent ODEs at Barrow and Alert, the western Pacific (WP) teleconnection pattern is usually in its negative phase, during which the Pacific jet is strengthened but the storm track originated over the western Pacific is weakened. Both factors tend to reduce the transport of ozone-rich air mass from midlatitudes to the Arctic, creating a favorable environment for the ODEs. The correlation of ODE frequencies at Zeppelinfjellet with WP indices is higher in the 2000s, reflecting stronger influence of the WP pattern in recent decade to cover ODEs in broader Arctic regions. We find that the WP pattern can be used to diagnose ODE changes and subsequent environmental impacts in the Arctic spring.

Comparative analytics of infusion pump data across multiple hospital systems.

PubMed

Catlin, Ann Christine; Malloy, William X; Arthur, Karen J; Gaston, Cindy; Young, James; Fernando, Sudheera; Fernando, Ruchith

2015-02-15

A Web-based analytics system for conducting inhouse evaluations and cross-facility comparisons of alert data generated by smart infusion pumps is described. The Infusion Pump Informatics (IPI) project, a collaborative effort led by research scientists at Purdue University, was launched in 2009 to provide advanced analytics and tools for workflow analyses to assist hospitals in determining the significance of smart-pump alerts and reducing nuisance alerts. The IPI system allows facility-specific analyses of alert patterns and trends, as well as cross-facility comparisons of alert data uploaded by more than 55 participating institutions using different types of smart pumps. Tools accessible through the IPI portal include (1) charts displaying aggregated or breakout data on the top drugs associated with alerts, numbers of alerts per device or care area, and override-to-alert ratios, (2) investigative reports that can be used to characterize and analyze pump-programming errors in a variety of ways (e.g., by drug, by infusion type, by time of day), and (3) "drill-down" workflow analytics enabling users to evaluate alert patterns—both internally and in relation to patterns at other hospitals—in a quick and efficient stepwise fashion. The formation of the IPI analytics system to support a community of hospitals has been successful in providing sophisticated tools for member facilities to review, investigate, and efficiently analyze smart-pump alert data, not only within a member facility but also across other member facilities, to further enhance smart pump drug library design. Copyright © 2015 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Impact of faxed health alerts on the preparedness of general practitioners during communicable disease outbreaks.

PubMed

Rosewell, Alexander; Patel, Mahomed; Viney, Kerri; Marich, Andrew; Lawrence, Glenda L

2010-03-01

The NSW Department of Health (NSW Health) faxed health alerts to general medical practitioners during measles outbreaks in March and May 2006. We conducted a retrospective cohort study of randomly selected general practitioners (GPs) (1 per medical practice) in New South Wales to investigate the effectiveness of faxing health alerts to GPs during a communicable disease outbreak. Fax transmission data allowed comparison of GPs sent and not sent the measles alert for self-reported awareness and practice actions aimed at the prevention and control of measles. A total of 328 GPs participated in the study. GPs who were sent the alert were more likely to be aware of the measles outbreak (RR 1.18, 95% CI 1.02, 1.38). When analysed by whether a fax had been received from either NSW Health or the Australian General Practice Network, GPs who reported receiving a faxed measles alert were more likely to be aware of the outbreak (RR 2.56, 95% CI 1.84, 3.56), to offer vaccination to susceptible staff (RR 6.46, 95% CI 2.49, 16.78), and be aware of other infection control recommendations. Respondents reported that the faxed alerts were useful with 65% reporting that the alerts had reminded them to consider measles in the differential diagnosis. This study shows that faxed health alerts were useful for preparing GPs to respond effectively to a communicable disease outbreak. The fax alert system could be improved by ensuring that all general practices in New South Wales are included in the faxstream database and that their contact details are updated regularly.

Evaluation of prescriber responses to pharmacogenomics clinical decision support for thiopurine S-methyltransferase testing.

PubMed

Ubanyionwu, Samuel; Formea, Christine M; Anderson, Benjamin; Wix, Kelly; Dierkhising, Ross; Caraballo, Pedro J

2018-02-15

Results of a study of prescribers' responses to a pharmacogenomics-based clinical decision support (CDS) alert designed to prompt thiopurine S -methyltransferase (TPMT) status testing are reported. A single-center, retrospective, chart review-based study was conducted to evaluate prescriber compliance with a pretest CDS alert that warned of potential thiopurine drug toxicity resulting from deficient TPMT activity due to TPMT gene polymorphism. The CDS alert was triggered when prescribers ordered thiopurine drugs for patients whose records did not indicate TPMT status or when historical thiopurine use was documented in the electronic health record. The alert pop-up also provided a link to online educational resources to guide thiopurine dosing calculations. During the 9-month study period, 500 CDS alerts were generated: in 101 cases (20%), TPMT phenotyping or TPMT genotyping was ordered; in 399 cases (80%), testing was not ordered. Multivariable regression analysis indicated that documentation of historical thiopurine use was the only independent predictor of test ordering. Among the 99 patients tested subsequent to CDS alerts, 70 (71%) had normal TPMT activity, 29 (29%) had intermediate activity, and none had deficient activity. The online resources provided thiopurine dosing recommendations applicable to 24 patients, but only 3 were prescribed guideline-supported doses after CDS alerts. The pretest CDS rule resulted in a large proportion of neglected alerts due to poor alerting accuracy and consequent alert fatigue. Prescriber usage of online thiopurine dosing resources was low. Copyright © 2018 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Perceptual evaluation of visual alerts in surveillance videos

NASA Astrophysics Data System (ADS)

Rogowitz, Bernice E.; Topkara, Mercan; Pfeiffer, William; Hampapur, Arun

2015-03-01

Visual alerts are commonly used in video monitoring and surveillance systems to mark events, presumably making them more salient to human observers. Surprisingly, the effectiveness of computer-generated alerts in improving human performance has not been widely studied. To address this gap, we have developed a tool for simulating different alert parameters in a realistic visual monitoring situation, and have measured human detection performance under conditions that emulated different set-points in a surveillance algorithm. In the High-Sensitivity condition, the simulated alerts identified 100% of the events with many false alarms. In the Lower-Sensitivity condition, the simulated alerts correctly identified 70% of the targets, with fewer false alarms. In the control condition, no simulated alerts were provided. To explore the effects of learning, subjects performed these tasks in three sessions, on separate days, in a counterbalanced, within subject design. We explore these results within the context of cognitive models of human attention and learning. We found that human observers were more likely to respond to events when marked by a visual alert. Learning played a major role in the two alert conditions. In the first session, observers generated almost twice as many False Alarms as in the No-Alert condition, as the observers responded pre-attentively to the computer-generated false alarms. However, this rate dropped equally dramatically in later sessions, as observers learned to discount the false cues. Highest observer Precision, Hits/(Hits + False Alarms), was achieved in the High Sensitivity condition, but only after training. The successful evaluation of surveillance systems depends on understanding human attention and performance.

Alert Workplace From Healthcare Workers' Perspective: Behavioral and Environmental Strategies to Improve Vigilance and Alertness in Healthcare Settings.

PubMed

Sagah Zadeh, Rana; Shepley, Mardelle; Sadatsafavi, Hessam; Owora, Arthur Hamie; Krieger, Ana C

2018-04-01

This study aims to identify the behavioral and environmental strategies that healthcare workers view as helpful for managing sleepiness, improving alertness, and therefore optimizing workplace safety. Reduced alertness is a common issue in healthcare work environments and is associated with impaired cognitive performance and decision-making ability as well as increased errors and injuries. We surveyed 136 healthcare professionals at a primary care clinic, an acute care hospital, and a mental health clinic. Nonstructured, semistructured, and structured questionnaires were used to elicit relevant information which was analyzed using qualitative content analysis and logistic regression models, respectively. In order by frequency of endorsement: dietary intervention; physical mobility; cognitive, sensory, or social stimulation; personal lifestyle strategies; and rest/nap opportunities were reported as behavioral strategies used to address workplace alertness. Compared to other environmental features, daylight and thermal comfort were perceived to be more important to addressing workplace alertness ( p < .05). By optimizing the physical environment and organizational policies and providing education programs, we have an opportunity to support healthcare professionals in managing sleepiness and maintaining alertness at work. In addition, such system level interventions may reduce unhealthy choices such as frequent caffeine intake to keep alert. The development of multidisciplinary evidence-based guidelines is needed to address sleepiness and alertness to improve workplace safety in healthcare facilities.

Human Factors Evaluation of Conflict Detection Tool for Terminal Area

NASA Technical Reports Server (NTRS)

Verma, Savita Arora; Tang, Huabin; Ballinger, Deborah; Chinn, Fay Cherie; Kozon, Thomas E.

2013-01-01

A conflict detection and resolution tool, Terminal-area Tactical Separation-Assured Flight Environment (T-TSAFE), is being developed to improve the timeliness and accuracy of alerts and reduce the false alert rate observed with the currently deployed technology. The legacy system in use today, Conflict Alert, relies primarily on a dead reckoning algorithm, whereas T-TSAFE uses intent information to augment dead reckoning. In previous experiments, T-TSAFE was found to reduce the rate of false alerts and increase time between the alert to the controller and a loss of separation over the legacy system. In the present study, T-TSAFE was tested under two meteorological conditions, 1) all aircraft operated under instrument flight regimen, and 2) some aircraft operated under mixed operating conditions. The tool was used to visually alert controllers to predicted Losses of separation throughout the terminal airspace, and show compression errors, on final approach. The performance of T-TSAFE on final approach was compared with Automated Terminal Proximity Alert (ATPA), a tool recently deployed by the FAA. Results show that controllers did not report differences in workload or situational awareness between the T-TSAFE and ATPA cones but did prefer T-TSAFE features over ATPA functionality. T-TSAFE will provide one tool that shows alerts in the data blocks and compression errors via cones on the final approach, implementing all tactical conflict detection and alerting via one tool in TRACON airspace.

78 FR 53774 - Guide for the Evaluation of Alert and Notification Systems for Nuclear Power Plants, FEMA-REP-10...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-30

...] Guide for the Evaluation of Alert and Notification Systems for Nuclear Power Plants, FEMA-REP-10, Rev. 1... the Guide for the Evaluation of Alert and Notification Systems for Nuclear Power Plants, FEMA-REP-10... Agency (FEMA) issued FEMA-REP-10, Guide for the Evaluation of Alert and Notification Systems for Nuclear...

A CCTV system with SMS alert (CMDSA): An implementation of pixel processing algorithm for motion detection

NASA Astrophysics Data System (ADS)

Rahman, Nurul Hidayah Ab; Abdullah, Nurul Azma; Hamid, Isredza Rahmi A.; Wen, Chuah Chai; Jelani, Mohamad Shafiqur Rahman Mohd

2017-10-01

Closed-Circuit TV (CCTV) system is one of the technologies in surveillance field to solve the problem of detection and monitoring by providing extra features such as email alert or motion detection. However, detecting and alerting the admin on CCTV system may complicate due to the complexity to integrate the main program with an external Application Programming Interface (API). In this study, pixel processing algorithm is applied due to its efficiency and SMS alert is added as an alternative solution for users who opted out email alert system or have no Internet connection. A CCTV system with SMS alert (CMDSA) was developed using evolutionary prototyping methodology. The system interface was implemented using Microsoft Visual Studio while the backend components, which are database and coding, were implemented on SQLite database and C# programming language, respectively. The main modules of CMDSA are motion detection, capturing and saving video, image processing and Short Message Service (SMS) alert functions. Subsequently, the system is able to reduce the processing time making the detection process become faster, reduce the space and memory used to run the program and alerting the system admin instantly.

Impact of Homeland Security Alert level on calls to a law enforcement peer support hotline.

PubMed

Omer, Saad B; Barnett, Daniel J; Castellano, Cherie; Wierzba, Rachel K; Hiremath, Girish S; Balicer, Ran D; Everly, George S

2007-01-01

The Homeland Security Advisory System (HSAS) was established by the Department of Homeland Security to communicate the risk of a terrorist event. In order to explore the potential psychological impacts of HSAS we analyzed the effects of terror alerts on the law enforcement community. We used data from the New Jersey Cop 2 Cop crisis intervention hotline. Incidence Rate Ratios--interpreted as average relative increases in the daily number of calls to the Cop 2 Cop hotline during an increased alert period--were computed from Poisson models. The hotline received a total of 4,145 initial calls during the study period. The mean daily number of calls was higher during alert level elevation compared to prior 7 days (7.68 vs. 8.00). In the Poisson regression analysis, the Incidence Rate Ratios of number of calls received during elevated alert levels compared to the reference period of seven days preceding each change in alert were close to 1, with confidence intervals crossing 1 (i.e. not statistically significant) for all lag periods evaluated. This investigation, in the context of New Jersey law enforcement personnel, does not support the concern that elevating the alert status places undue stress upon alert recipients.

Standard Anatomic Terminologies: Comparison for Use in a Health Information Exchange–Based Prior Computed Tomography (CT) Alerting System

PubMed Central

Lowry, Tina; Vreeman, Daniel J; Loo, George T; Delman, Bradley N; Thum, Frederick L; Slovis, Benjamin H; Shapiro, Jason S

2017-01-01

Background A health information exchange (HIE)–based prior computed tomography (CT) alerting system may reduce avoidable CT imaging by notifying ordering clinicians of prior relevant studies when a study is ordered. For maximal effectiveness, a system would alert not only for prior same CTs (exams mapped to the same code from an exam name terminology) but also for similar CTs (exams mapped to different exam name terminology codes but in the same anatomic region) and anatomically proximate CTs (exams in adjacent anatomic regions). Notification of previous same studies across an HIE requires mapping of local site CT codes to a standard terminology for exam names (such as Logical Observation Identifiers Names and Codes [LOINC]) to show that two studies with different local codes and descriptions are equivalent. Notifying of prior similar or proximate CTs requires an additional mapping of exam codes to anatomic regions, ideally coded by an anatomic terminology. Several anatomic terminologies exist, but no prior studies have evaluated how well they would support an alerting use case. Objective The aim of this study was to evaluate the fitness of five existing standard anatomic terminologies to support similar or proximate alerts of an HIE-based prior CT alerting system. Methods We compared five standard anatomic terminologies (Foundational Model of Anatomy, Systematized Nomenclature of Medicine Clinical Terms, RadLex, LOINC, and LOINC/Radiological Society of North America [RSNA] Radiology Playbook) to an anatomic framework created specifically for our use case (Simple ANatomic Ontology for Proximity or Similarity [SANOPS]), to determine whether the existing terminologies could support our use case without modification. On the basis of an assessment of optimal terminology features for our purpose, we developed an ordinal anatomic terminology utility classification. We mapped samples of 100 random and the 100 most frequent LOINC CT codes to anatomic regions in each terminology, assigned utility classes for each mapping, and statistically compared each terminology’s utility class rankings. We also constructed seven hypothetical alerting scenarios to illustrate the terminologies’ differences. Results Both RadLex and the LOINC/RSNA Radiology Playbook anatomic terminologies ranked significantly better (P<.001) than the other standard terminologies for the 100 most frequent CTs, but no terminology ranked significantly better than any other for 100 random CTs. Hypothetical scenarios illustrated instances where no standard terminology would support appropriate proximate or similar alerts, without modification. Conclusions LOINC/RSNA Radiology Playbook and RadLex’s anatomic terminologies appear well suited to support proximate or similar alerts for commonly ordered CTs, but for less commonly ordered tests, modification of the existing terminologies with concepts and relations from SANOPS would likely be required. Our findings suggest SANOPS may serve as a framework for enhancing anatomic terminologies in support of other similar use cases. PMID:29242174

Molecular Classification and Correlates in Colorectal Cancer

PubMed Central

Ogino, Shuji; Goel, Ajay

2008-01-01

Molecular classification of colorectal cancer is evolving. As our understanding of colorectal carcinogenesis improves, we are incorporating new knowledge into the classification system. In particular, global genomic status [microsatellite instability (MSI) status and chromosomal instability (CIN) status] and epigenomic status [CpG island methylator phenotype (CIMP) status] play a significant role in determining clinical, pathological and biological characteristics of colorectal cancer. In this review, we discuss molecular classification and molecular correlates based on MSI status and CIMP status in colorectal cancer. Studying molecular correlates is important in cancer research because it can 1) provide clues to pathogenesis, 2) propose or support the existence of a new molecular subtype, 3) alert investigators to be aware of potential confounding factors in association studies, and 4) suggest surrogate markers in clinical or research settings. PMID:18165277

Development of an Alert System to Detect Drug Interactions with Herbal Supplements using Medical Record Data.

PubMed

Archer, Melissa; Proulx, Joshua; Shane-McWhorter, Laura; Bray, Bruce E; Zeng-Treitler, Qing

2014-01-01

While potential medication-to-medication interaction alerting engines exist in many clinical applications, few systems exist to automatically alert on potential medication to herbal supplement interactions. We have developed a preliminary knowledge base and rules alerting engine that detects 259 potential interactions between 9 supplements, 62 cardiac medications, and 19 drug classes. The rules engine takes into consideration 12 patient risk factors and 30 interaction warning signs to help determine which of three different alert levels to categorize each potential interaction. A formative evaluation was conducted with two clinicians to set initial thresholds for each alert level. Additional work is planned add more supplement interactions, risk factors, and warning signs as well as to continue to set and adjust the inputs and thresholds for each potential interaction.

Evaluation of email alerts in practice: Part 2. Validation of the information assessment method.

PubMed

Pluye, Pierre; Grad, Roland M; Johnson-Lafleur, Janique; Bambrick, Tara; Burnand, Bernard; Mercer, Jay; Marlow, Bernard; Campbell, Craig

2010-12-01

The information assessment method (IAM) permits health professionals to systematically document the relevance, cognitive impact, use and health outcomes of information objects delivered by or retrieved from electronic knowledge resources. The companion review paper (Part 1) critically examined the literature, and proposed a 'Push-Pull-Acquisition-Cognition-Application' evaluation framework, which is operationalized by IAM. The purpose of the present paper (Part 2) is to examine the content validity of the IAM cognitive checklist when linked to email alerts. A qualitative component of a mixed methods study was conducted with 46 doctors reading and rating research-based synopses sent on email. The unit of analysis was a doctor's explanation of a rating of one item regarding one synopsis. Interviews with participants provided 253 units that were analysed to assess concordance with item definitions. The content relevance of seven items was supported. For three items, revisions were needed. Interviews suggested one new item. This study has yielded a 2008 version of IAM. © 2010 Blackwell Publishing Ltd.

Pilot Non-Conformance to Alerting System Commands

NASA Technical Reports Server (NTRS)

Pritchett, Amy R.; Hansman, R. John

1997-01-01

Instances of pilot non-conformance to alerting system commands have been identified in previous studies. Pilot non-conformance changes the final behavior of the system, and therefore may reduce actual performance from that anticipated. A simulator study has examined pilot non-conformance, using the task of collision avoidance during closely spaced parallel approaches as a case study. Consonance between the display and the alerting system was found to significantly improve subject agreement with automatic alerts. Based on these results, a more general discussion of the factors involved in pilot conformance is given, and design guidelines for alerting systems are given.

A Bayesian spatio-temporal model for forecasting Anaplasma species seroprevalence in domestic dogs within the contiguous United States.

PubMed

Liu, Yan; Watson, Stella C; Gettings, Jenna R; Lund, Robert B; Nordone, Shila K; Yabsley, Michael J; McMahan, Christopher S

2017-01-01

This paper forecasts the 2016 canine Anaplasma spp. seroprevalence in the United States from eight climate, geographic and societal factors. The forecast's construction and an assessment of its performance are described. The forecast is based on a spatial-temporal conditional autoregressive model fitted to over 11 million Anaplasma spp. seroprevalence test results for dogs conducted in the 48 contiguous United States during 2011-2015. The forecast uses county-level data on eight predictive factors, including annual temperature, precipitation, relative humidity, county elevation, forestation coverage, surface water coverage, population density and median household income. Non-static factors are extrapolated into the forthcoming year with various statistical methods. The fitted model and factor extrapolations are used to estimate next year's regional prevalence. The correlation between the observed and model-estimated county-by-county Anaplasma spp. seroprevalence for the five-year period 2011-2015 is 0.902, demonstrating reasonable model accuracy. The weighted correlation (accounting for different sample sizes) between 2015 observed and forecasted county-by-county Anaplasma spp. seroprevalence is 0.987, exhibiting that the proposed approach can be used to accurately forecast Anaplasma spp. seroprevalence. The forecast presented herein can a priori alert veterinarians to areas expected to see Anaplasma spp. seroprevalence beyond the accepted endemic range. The proposed methods may prove useful for forecasting other diseases.

A Bayesian spatio-temporal model for forecasting Anaplasma species seroprevalence in domestic dogs within the contiguous United States

PubMed Central

Liu, Yan; Watson, Stella C.; Gettings, Jenna R.; Lund, Robert B.; Nordone, Shila K.; McMahan, Christopher S.

2017-01-01

This paper forecasts the 2016 canine Anaplasma spp. seroprevalence in the United States from eight climate, geographic and societal factors. The forecast’s construction and an assessment of its performance are described. The forecast is based on a spatial-temporal conditional autoregressive model fitted to over 11 million Anaplasma spp. seroprevalence test results for dogs conducted in the 48 contiguous United States during 2011–2015. The forecast uses county-level data on eight predictive factors, including annual temperature, precipitation, relative humidity, county elevation, forestation coverage, surface water coverage, population density and median household income. Non-static factors are extrapolated into the forthcoming year with various statistical methods. The fitted model and factor extrapolations are used to estimate next year’s regional prevalence. The correlation between the observed and model-estimated county-by-county Anaplasma spp. seroprevalence for the five-year period 2011–2015 is 0.902, demonstrating reasonable model accuracy. The weighted correlation (accounting for different sample sizes) between 2015 observed and forecasted county-by-county Anaplasma spp. seroprevalence is 0.987, exhibiting that the proposed approach can be used to accurately forecast Anaplasma spp. seroprevalence. The forecast presented herein can a priori alert veterinarians to areas expected to see Anaplasma spp. seroprevalence beyond the accepted endemic range. The proposed methods may prove useful for forecasting other diseases. PMID:28738085

Fast Identification of Near-Trench Earthquakes Along the Mexican Subduction Zone Based on Characteristics of Ground Motion in Mexico City

NASA Astrophysics Data System (ADS)

Perez-Campos, X.; Singh, S. K.; Arroyo, D.; Rodríguez, Q.; Iglesias, A.

2015-12-01

The disastrous 1985 Michoacan earthquake gave rise to a seismic alert system for Mexico City which became operational in 1991. Initially limited to earthquakes along the Guerrero coast, the system now has a much wider coverage. Also, the 2004 Sumatra earthquake exposed the need for a tsunami early warning along the Mexican subduction zone. A fast identification of near-trench earthquakes along this zone may be useful in issuing a reliable early tsunami alert. The confusion caused by low PGA for the magnitude of an earthquake, leading to "missed" seismic alert, would be averted if its near-trench origin can be quickly established. It may also help reveal the spatial extent and degree of seismic coupling on the near-trench portion of the plate interface. This would lead to a better understanding of tsunami potential and seismic hazard along the Mexican subduction zone. We explore three methods for quick detection of near-trench earthquakes, testing them on recordings of 65 earthquakes at station CU in Mexico City (4.8 ≤Mw≤8.0; 270≤R≤615 km). The first method is based on the ratio of total to high-frequency energy, ER (Shapiro et al., 1998). The second method is based on parameter Sa*(6) which is the pseudo-acceleration response spectrum with 5% damping, Sa, at 6 s normalized by the PGA. The third parameter is the PGA residual, RESN, at CU, with respect to a newly-derived ground motion prediction equation at CU for coastal shallow-dipping thrust earthquakes following a bayesian approach. Since the near-trench earthquakes are relatively deficient in high-frequency radiation, we expect ER and Sa*(6) to be relatively large and RESN to be negative for such events. Tests on CU recordings show that if ER ≥ 100 and/or Sa*(6) ≥ 0.70, then the earthquake is near trench; for these events RESN ≤ 0. Such an event has greater tsunami potential. Few misidentifications and missed events are most probably a consequence of poor location, although unusual depth and source characteristics may also be responsible in some cases. We propose routine computation of these parameters (along with location and magnitude) by the National Seismological Service of Mexico and dissemination of the information to other interested agencies which are in charge of tsunami alert, seismic alert, and near real time ground motion intensity maps for Mexico City.

Impact of real-time electronic alerting of acute kidney injury on therapeutic intervention and progression of RIFLE class.

PubMed

Colpaert, Kirsten; Hoste, Eric A; Steurbaut, Kristof; Benoit, Dominique; Van Hoecke, Sofie; De Turck, Filip; Decruyenaere, Johan

2012-04-01

To evaluate whether a real-time electronic alert system or "AKI sniffer," which is based on the RIFLE classification criteria (Risk, Injury and Failure), would have an impact on therapeutic interventions and acute kidney injury progression. Prospective intervention study. Surgical and medical intensive care unit in a tertiary care hospital. A total of 951 patients having in total 1,079 admission episodes were admitted during the study period (prealert control group: 227, alert group: 616, and postalert control group: 236). Three study phases were compared: A 1.5-month prealert control phase in which physicians were blinded for the acute kidney injury sniffer and a 3-month intervention phase with real-time alerting of worsening RIFLE class through the Digital Enhanced Cordless Technology telephone system followed by a second 1.5-month postalert control phase. A total of 2593 acute kidney injury alerts were recorded with a balanced distribution over all study phases. Most acute kidney injury alerts were RIFLE class risk (59.8%) followed by RIFLE class injury (34.1%) and failure (6.1%). A higher percentage of patients in the alert group received therapeutic intervention within 60 mins after the acute kidney injury alert (28.7% in alert group vs. 7.9% and 10.4% in the pre- and postalert control groups, respectively, p μ .001). In the alert group, more patients received fluid therapy (23.0% vs. 4.9% and 9.2%, p μ .01), diuretics (4.2% vs. 2.6% and 0.8%, p μ .001), or vasopressors (3.9% vs. 1.1% and 0.8%, p μ .001). Furthermore, these patients had a shorter time to intervention (p μ .001). A higher proportion of patients in the alert group showed return to a baseline kidney function within 8 hrs after an acute kidney injury alert "from normal to risk" compared with patients in the control group (p = .048). The real-time alerting of every worsening RIFLE class by the acute kidney injury sniffer increased the number and timeliness of early therapeutic interventions. The borderline significant improvement of short-term renal outcome in the RIFLE class risk patients needs to be confirmed in a large multicenter trial.