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.

Participatory design for drug-drug interaction alerts.

PubMed

Luna, Daniel; Otero, Carlos; Almerares, Alfredo; Stanziola, Enrique; Risk, Marcelo; González Bernaldo de Quirós, Fernán

2015-01-01

The utilization of decision support systems, in the point of care, to alert drug-drug interactions has been shown to improve quality of care. Still, the use of these systems has not been as expected, it is believed, because of the difficulties in their knowledge databases; errors in the generation of the alerts and the lack of a suitable design. This study expands on the development of alerts using participatory design techniques based on user centered design process. This work was undertaken in three stages (inquiry, participatory design and usability testing) it showed that the use of these techniques improves satisfaction, effectiveness and efficiency in an alert system for drug-drug interactions, a fact that was evident in specific situations such as the decrease of errors to meet the specified task, the time, the workload optimization and users overall satisfaction in the system.

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

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.

Work Practice Simulation of Complex Human-Automation Systems in Safety Critical Situations: The Brahms Generalized berlingen Model

NASA Technical Reports Server (NTRS)

Clancey, William J.; Linde, Charlotte; Seah, Chin; Shafto, Michael

2013-01-01

The transition from the current air traffic system to the next generation air traffic system will require the introduction of new automated systems, including transferring some functions from air traffic controllers to on­-board automation. This report describes a new design verification and validation (V&V) methodology for assessing aviation safety. The approach involves a detailed computer simulation of work practices that includes people interacting with flight-critical systems. The research is part of an effort to develop new modeling and verification methodologies that can assess the safety of flight-critical systems, system configurations, and operational concepts. The 2002 Ueberlingen mid-air collision was chosen for analysis and modeling because one of the main causes of the accident was one crew's response to a conflict between the instructions of the air traffic controller and the instructions of TCAS, an automated Traffic Alert and Collision Avoidance System on-board warning system. It thus furnishes an example of the problem of authority versus autonomy. It provides a starting point for exploring authority/autonomy conflict in the larger system of organization, tools, and practices in which the participants' moment-by-moment actions take place. We have developed a general air traffic system model (not a specific simulation of Überlingen events), called the Brahms Generalized Ueberlingen Model (Brahms-GUeM). Brahms is a multi-agent simulation system that models people, tools, facilities/vehicles, and geography to simulate the current air transportation system as a collection of distributed, interactive subsystems (e.g., airports, air-traffic control towers and personnel, aircraft, automated flight systems and air-traffic tools, instruments, crew). Brahms-GUeM can be configured in different ways, called scenarios, such that anomalous events that contributed to the Überlingen accident can be modeled as functioning according to requirements or in an anomalous condition, as occurred during the accident. Brahms-GUeM thus implicitly defines a class of scenarios, which include as an instance what occurred at Überlingen. Brahms-GUeM is a modeling framework enabling "what if" analysis of alternative work system configurations and thus facilitating design of alternative operations concepts. It enables subsequent adaption (reusing simulation components) for modeling and simulating NextGen scenarios. This project demonstrates that BRAHMS provides the capacity to model the complexity of air transportation systems, going beyond idealized and simple flights to include for example the interaction of pilots and ATCOs. The research shows clearly that verification and validation must include the entire work system, on the one hand to check that mechanisms exist to handle failures of communication and alerting subsystems and/or failures of people to notice, comprehend, or communicate problematic (unsafe) situations; but also to understand how people must use their own judgment in relating fallible systems like TCAS to other sources of information and thus to evaluate how the unreliability of automation affects system safety. The simulation shows in particular that distributed agents (people and automated systems) acting without knowledge of each others' actions can create a complex, dynamic system whose interactive behavior is unexpected and is changing too quickly to comprehend and control.

Core drug-drug interaction alerts for inclusion in pediatric electronic health records with computerized prescriber order entry.

PubMed

Harper, Marvin B; Longhurst, Christopher A; McGuire, Troy L; Tarrago, Rod; Desai, Bimal R; Patterson, Al

2014-03-01

The study aims to develop a core set of pediatric drug-drug interaction (DDI) pairs for which electronic alerts should be presented to prescribers during the ordering process. A clinical decision support working group composed of Children's Hospital Association (CHA) members was developed. CHA Pharmacists and Chief Medical Information Officers participated. Consensus was reached on a core set of 19 DDI pairs that should be presented to pediatric prescribers during the order process. We have provided a core list of 19 high value drug pairs for electronic drug-drug interaction alerts to be recommended for inclusion as high value alerts in prescriber order entry software used with a pediatric patient population. We believe this list represents the most important pediatric drug interactions for practical implementation within computerized prescriber order entry systems.

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

Clinical Implementation of a Model-Based In Vivo Dose Verification System for Stereotactic Body Radiation Therapy-Volumetric Modulated Arc Therapy Treatments Using the Electronic Portal Imaging Device.

PubMed

McCowan, Peter M; Asuni, Ganiyu; Van Uytven, Eric; VanBeek, Timothy; McCurdy, Boyd M C; Loewen, Shaun K; Ahmed, Naseer; Bashir, Bashir; Butler, James B; Chowdhury, Amitava; Dubey, Arbind; Leylek, Ahmet; Nashed, Maged

2017-04-01

To report findings from an in vivo dosimetry program implemented for all stereotactic body radiation therapy patients over a 31-month period and discuss the value and challenges of utilizing in vivo electronic portal imaging device (EPID) dosimetry clinically. From December 2013 to July 2016, 117 stereotactic body radiation therapy-volumetric modulated arc therapy patients (100 lung, 15 spine, and 2 liver) underwent 602 EPID-based in vivo dose verification events. A developed model-based dose reconstruction algorithm calculates the 3-dimensional dose distribution to the patient by back-projecting the primary fluence measured by the EPID during treatment. The EPID frame-averaging was optimized in June 2015. For each treatment, a 3%/3-mm γ comparison between our EPID-derived dose and the Eclipse AcurosXB-predicted dose to the planning target volume (PTV) and the ≥20% isodose volume were performed. Alert levels were defined as γ pass rates <85% (lung and liver) and <80% (spine). Investigations were carried out for all fractions exceeding the alert level and were classified as follows: EPID-related, algorithmic, patient setup, anatomic change, or unknown/unidentified errors. The percentages of fractions exceeding the alert levels were 22.6% for lung before frame-average optimization and 8.0% for lung, 20.0% for spine, and 10.0% for liver after frame-average optimization. Overall, mean (± standard deviation) planning target volume γ pass rates were 90.7% ± 9.2%, 87.0% ± 9.3%, and 91.2% ± 3.4% for the lung, spine, and liver patients, respectively. Results from the clinical implementation of our model-based in vivo dose verification method using on-treatment EPID images is reported. The method is demonstrated to be valuable for routine clinical use for verifying delivered dose as well as for detecting errors. Copyright © 2017 Elsevier Inc. All rights reserved.

Clinical Implementation of a Model-Based In Vivo Dose Verification System for Stereotactic Body Radiation Therapy–Volumetric Modulated Arc Therapy Treatments Using the Electronic Portal Imaging Device

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

McCowan, Peter M., E-mail: pmccowan@cancercare.mb.ca; Asuni, Ganiyu; Van Uytven, Eric

Purpose: To report findings from an in vivo dosimetry program implemented for all stereotactic body radiation therapy patients over a 31-month period and discuss the value and challenges of utilizing in vivo electronic portal imaging device (EPID) dosimetry clinically. Methods and Materials: From December 2013 to July 2016, 117 stereotactic body radiation therapy–volumetric modulated arc therapy patients (100 lung, 15 spine, and 2 liver) underwent 602 EPID-based in vivo dose verification events. A developed model-based dose reconstruction algorithm calculates the 3-dimensional dose distribution to the patient by back-projecting the primary fluence measured by the EPID during treatment. The EPID frame-averaging was optimized in Junemore » 2015. For each treatment, a 3%/3-mm γ comparison between our EPID-derived dose and the Eclipse AcurosXB–predicted dose to the planning target volume (PTV) and the ≥20% isodose volume were performed. Alert levels were defined as γ pass rates <85% (lung and liver) and <80% (spine). Investigations were carried out for all fractions exceeding the alert level and were classified as follows: EPID-related, algorithmic, patient setup, anatomic change, or unknown/unidentified errors. Results: The percentages of fractions exceeding the alert levels were 22.6% for lung before frame-average optimization and 8.0% for lung, 20.0% for spine, and 10.0% for liver after frame-average optimization. Overall, mean (± standard deviation) planning target volume γ pass rates were 90.7% ± 9.2%, 87.0% ± 9.3%, and 91.2% ± 3.4% for the lung, spine, and liver patients, respectively. Conclusions: Results from the clinical implementation of our model-based in vivo dose verification method using on-treatment EPID images is reported. The method is demonstrated to be valuable for routine clinical use for verifying delivered dose as well as for detecting errors.« less

Development of attention networks and their interactions in childhood.

PubMed

Pozuelos, Joan P; Paz-Alonso, Pedro M; Castillo, Alejandro; Fuentes, Luis J; Rueda, M Rosario

2014-10-01

In the present study, we investigated developmental trajectories of alerting, orienting, and executive attention networks and their interactions over childhood. Two cross-sectional experiments were conducted with different samples of 6- to 12-year-old children using modified versions of the attention network task (ANT). In Experiment 1 (N = 106), alerting and orienting cues were independently manipulated, thus allowing examination of interactions between these 2 networks, as well as between them and the executive attention network. In Experiment 2 (N = 159), additional changes were made to the task in order to foster exogenous orienting cues. Results from both studies consistently revealed separate developmental trajectories for each attention network. Children younger than 7 years exhibited stronger benefits from having an alerting auditory signal prior to the target presentation. Developmental changes in orienting were mostly observed on response accuracy between middle and late childhood, whereas executive attention showed increases in efficiency between 7 years and older ages, and further improvements in late childhood. Of importance, across both experiments, significant interactions between alerting and orienting, as well as between each of these and the executive attention network, were observed. Alerting cues led to speeding shifts of attention and enhancing orienting processes. Also, both alerting and orienting cues modulated the magnitude of the flanker interference effect. These findings inform current theoretical models of human attention and its development, characterizing for the first time, the age-related course of attention networks interactions that, present in adults, stem from further refinements over childhood.

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

Attentional networks in developmental dyscalculia.

PubMed

Askenazi, Sarit; Henik, Avishai

2010-01-07

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. 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. 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. 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.

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.

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.

On the Formal Verification of Conflict Detection Algorithms

NASA Technical Reports Server (NTRS)

Munoz, Cesar; Butler, Ricky W.; Carreno, Victor A.; Dowek, Gilles

2001-01-01

Safety assessment of new air traffic management systems is a main issue for civil aviation authorities. Standard techniques such as testing and simulation have serious limitations in new systems that are significantly more autonomous than the older ones. In this paper, we present an innovative approach, based on formal verification, for establishing the correctness of conflict detection systems. Fundamental to our approach is the concept of trajectory, which is a continuous path in the x-y plane constrained by physical laws and operational requirements. From the Model of trajectories, we extract, and formally prove, high level properties that can serve as a framework to analyze conflict scenarios. We use the Airborne Information for Lateral Spacing (AILS) alerting algorithm as a case study of our approach.

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.

Current status of 3D EPID-based in vivo dosimetry in The Netherlands Cancer Institute

NASA Astrophysics Data System (ADS)

Mijnheer, B.; Olaciregui-Ruiz, I.; Rozendaal, R.; Spreeuw, H.; van Herk, M.; Mans, A.

2015-01-01

3D in vivo dose verification using a-Si EPIDs is performed routinely in our institution for almost all RT treatments. The EPID-based 3D dose distribution is reconstructed using a back-projection algorithm and compared with the planned dose distribution using 3D gamma evaluation. Dose-reconstruction and gamma-evaluation software runs automatically, and deviations outside the alert criteria are immediately available and investigated, in combination with inspection of cone-beam CT scans. The implementation of our 3D EPID- based in vivo dosimetry approach was able to replace pre-treatment verification for more than 90% of the patient treatments. Clinically relevant deviations could be detected for approximately 1 out of 300 patient treatments (IMRT and VMAT). Most of these errors were patient related anatomical changes or deviations from the routine clinical procedure, and would not have been detected by pre-treatment verification. Moreover, 3D EPID-based in vivo dose verification is a fast and accurate tool to assure the safe delivery of RT treatments. It provides clinically more useful information and is less time consuming than pre-treatment verification measurements. Automated 3D in vivo dosimetry is therefore a prerequisite for large-scale implementation of patient-specific quality assurance of RT treatments.

Clinical reasoning in the context of active decision support during medication prescribing.

PubMed

Horsky, Jan; Aarts, Jos; Verheul, Leonie; Seger, Diane L; van der Sijs, Heleen; Bates, David W

2017-01-01

Describe and analyze reasoning patterns of clinicians responding to drug-drug interaction alerts in order to understand the role of patient-specific information in the decision-making process about the risks and benefits of medication therapy. Insights could be used to inform the design of decision-support interventions. Thirty-two clinicians working with five EHRs in two countries completed sets of six medication orders each and responded to high- and low-severity drug-drug interaction alerts while verbalizing their thoughts in a standard think-aloud protocol. Tasks were recorded and analyzed to describe reasoning patterns about patient-risk assessment and strategies to avoid or mitigate it. We observed a total of 171 prescribing decisions. Clinicians actively sought to reduce risk when responding to high-severity alerts, mostly by monitoring patients and making dose adjustments (52 alerts, 40%). In contrast, they routinely left prescriptions unchanged after low-severity alerts when they felt confident that patients would tolerate the drug combination and that treatment benefits outweighed the risks (30 alerts, 71%). Clinicians used similar reasoning patterns regardless of the EHR used and differences in alert design. Clinicians conceptualized risk as a complex set of interdependent tradeoffs specific to individual patients and had a tendency not to follow advice they considered of low clinical value. Omission of patient-specific data, which was not shown in alerts or included in trigger logic, may have contributed to the constancy of reasoning and to similarities in risk-control strategies we observed despite significant differences in interface design and system function. Declining an alert suggestion was preceded by sometimes brief but often complex reasoning, prioritizing different aspects of care quality and safety, especially when the perceived risk was higher. Clinicians believed that the risk indicated in drug-drug interaction alerts needs to be interpreted as one factor in the broader context of care, specific to a patient. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

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.

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

Testing the Behavioral Interaction and Integration of Attentional Networks

ERIC Educational Resources Information Center

Fan, Jin; Gu, Xiaosi; Guise, Kevin G.; Liu, Xun; Fossella, John; Wang, Hongbin; Posner, Michael I.

2009-01-01

One current conceptualization of attention subdivides it into functions of alerting, orienting, and executive control. Alerting describes the function of tonically maintaining the alert state and phasically responding to a warning signal. Automatic and voluntary orienting are involved in the selection of information among multiple sensory inputs.…

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.

Flare forecasting at the Met Office Space Weather Operations Centre

NASA Astrophysics Data System (ADS)

Murray, S. A.; Bingham, S.; Sharpe, M.; Jackson, D. R.

2017-04-01

The Met Office Space Weather Operations Centre produces 24/7/365 space weather guidance, alerts, and forecasts to a wide range of government and commercial end-users across the United Kingdom. Solar flare forecasts are one of its products, which are issued multiple times a day in two forms: forecasts for each active region on the solar disk over the next 24 h and full-disk forecasts for the next 4 days. Here the forecasting process is described in detail, as well as first verification of archived forecasts using methods commonly used in operational weather prediction. Real-time verification available for operational flare forecasting use is also described. The influence of human forecasters is highlighted, with human-edited forecasts outperforming original model results and forecasting skill decreasing over longer forecast lead times.

Incidence of potential drug interactions in a transplant centre setting and relevance of electronic alerts for clinical practice support.

PubMed

Polidori, Piera; Di Giorgio, Concetta; Provenzani, Alessio

2012-01-01

Adverse drug events may occur as a result of drug-drug interactions (DDIs). Information technology (IT) systems can be an important decision-making tool for healthcare workers to identify DDIs. The aim of the study is to analyse drug prescriptions in our main hospital units, in order to measure the incidence and severity of potential DDIs. The utility of clinical decision-support systems (CDSSs) and computerised physician order entry (CPOE) in term of alerts adherence was also assessed. DDIs were assessed using a Micromedex® healthcare series database. The system, adopted by the hospital, generates alerts for prescriptions with negative interactions and thanks to an 'acknowledgement function' it is possible to verify physician adherence to alerts. This function, although used previously, became mandatory from September 2010. Physician adherence to alerts and mean monthly incidence of potential DDIs in analysed units, before and after the mandatory 'acknowledgement function', were calculated. The intensive care unit (ICU) registered the greatest incidence of potential DDIs (49.0%), followed by the abdominal surgery unit and dialysis (43.4 and 42.0%, respectively). The cardiothoracic surgery unit (41.6%), step-down unit (38.3%) and post-anaesthesia care unit (30.0%) were comparable. The operating theatre and endoscopy registered the fewest potential DDIs (28.2 and 22.7%, respectively). Adherence to alerts after the 'acknowledgement function' increased by 25.0% in the ICU, 54.0% in the cardiothoracic surgery unit, 52.5% in the abdominal surgery unit, 58.0% in the stepdown unit, 67.0% in dialysis, 51.0% in endoscopy and 48.0% in the post-anaesthesia care unit. In the operating theatre, adherence to alerts decreased from 34.0 to 30.0%. The incidence of potential DDIs after mandatory use of the 'acknowledgement function' decreased slightly in endoscopy (-2.9%), the abdominal surgery unit (-2.7%), dialysis (-1.9%) and the step-down unit (-1.4%). Improving DDI alerts will improved patient safety by more appropriately alerting clinicians.

FIM Avionics Operations Manual

NASA Technical Reports Server (NTRS)

Alves, Erin E.

2017-01-01

This document describes the operation and use of the Flight Interval Management (FIM) Application installed on an electronic flight bag (EFB). Specifically, this document includes: 1) screen layouts for each page of the interface; 2) step-by-step instructions for data entry, data verification, and input error correction; 3) algorithm state messages and error condition alerting messages; 4) aircraft speed guidance and deviation indications; and 5) graphical display of the spatial relationships between the Ownship aircraft and the Target aircraft.

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

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".

Comparative evaluation of the drug interaction screening programs MediQ and ID PHARMA CHECK in neurological inpatients.

PubMed

Zorina, Olesya I; Haueis, Patrick; Semmler, Alexander; Marti, Isabelle; Gonzenbach, Roman R; Guzek, Markus; Kullak-Ublick, Gerd A; Weller, Michael; Russmann, Stefan

2012-08-01

The comparative evaluation of clinical decision support software (CDSS) programs regarding their sensitivity and positive predictive value for the identification of clinically relevant drug interactions. In this research, we used a cross-sectional study that identified potential drug interactions using the CDSS MediQ and the ID PHARMA CHECK in 484 neurological inpatients. Interactions were reclassified according to the Zurich Interaction System, a multidimensional classification that incorporates the Operational Classification of Drug Interactions. In 484 patients with 2812 prescriptions, MediQ and ID PHARMA CHECK generated a total of 1759 and 1082 alerts, respectively. MediQ identified 658 unique potentially interacting combinations, 8 classified as "high danger," 164 as "average danger," and 486 as "low danger." ID PHARMA CHECK detected 336 combinations assigned to one or several of 12 risk and management categories. Altogether, both CDSS issued alerts relating to 808 unique potentially interacting combinations. According to the Zurich Interaction System, 6 of these were contraindicated, 25 were provisionally contraindicated, 190 carried a conditional risk, and 587 had a minimal risk of adverse events. The positive predictive value for alerts having at least a conditional risk was 0.24 for MediQ and 0.48 for ID PHARMA CHECK. CDSS showed major differences in the identification and grading of interactions, and many interactions were only identified by one of the two CDSS. For both programs, only a small proportion of all identified interactions appeared clinically relevant, and the selected display of alerts that imply management changes is a key issue in the further development and local setup of such programs. Copyright © 2012 John Wiley & Sons, Ltd.

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

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

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.

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.

Development of a SNOMED CT based national medication decision support system.

PubMed

Greibe, Kell

2013-01-01

Physicians often lack the time to familiarize themselves with the details of particular allergies or other drug restrictions. Clinical Decision Support (CDS), based on a structured terminology as SNOMED CT (SCT), can help physicians get an overview, by automatically alerting allergy, interactions and other important information. The centralized CDS platform based on SCT, controls Allergy, Interactions, Risk Situation Drugs and Max Dose restrictions by the help of databases developed for these specific purposes. The CDS will respond to automatic web service requests from the hospital or GP electronic medication system (EMS) during prescription, and return alerts and information. The CDS also contains a Physicians Preference Database where the physicians individually can set which kind of alerts they want to see. The result is clinically useful information physicians can use as a base for a more effective and safer treatment, without developing alert fatigue.

Verbal collision avoidance messages during simulated driving: perceived urgency, alerting effectiveness and annoyance.

PubMed

Baldwin, Carryl L

2011-04-01

Matching the perceived urgency of an alert with the relative hazard level of the situation is critical for effective alarm response. Two experiments describe the impact of acoustic and semantic parameters on ratings of perceived urgency, annoyance and alerting effectiveness and on alarm response speed. Within a simulated driving context, participants rated and responded to collision avoidance system (CAS) messages spoken by a female or male voice (experiments 1 and 2, respectively). Results indicated greater perceived urgency and faster alarm response times as intensity increased from -2 dB signal to noise (S/N) ratio to +10 dB S/N, although annoyance ratings increased as well. CAS semantic content interacted with alarm intensity, indicating that at lower intensity levels participants paid more attention to the semantic content. Results indicate that both acoustic and semantic parameters independently and interactively impact CAS alert perceptions in divided attention conditions and this work can inform auditory alarm design for effective hazard matching. Matching the perceived urgency of an alert with the relative hazard level of the situation is critical for effective alarm response. Here, both acoustic and semantic parameters independently and interactively impacted CAS alert perceptions in divided attention conditions. This work can inform auditory alarm design for effective hazard matching. STATEMENT OF RELEVANCE: Results indicate that both acoustic parameters and semantic content can be used to design collision warnings with a range of urgency levels. Further, these results indicate that verbal warnings tailored to a specific hazard situation may improve hazard-matching capabilities without substantial trade-offs in perceived annoyance.

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).

Verification of Space Weather Forecasts using Terrestrial Weather Approaches

NASA Astrophysics Data System (ADS)

Henley, E.; Murray, S.; Pope, E.; Stephenson, D.; Sharpe, M.; Bingham, S.; Jackson, D.

2015-12-01

The Met Office Space Weather Operations Centre (MOSWOC) provides a range of 24/7 operational space weather forecasts, alerts, and warnings, which provide valuable information on space weather that can degrade electricity grids, radio communications, and satellite electronics. Forecasts issued include arrival times of coronal mass ejections (CMEs), and probabilistic forecasts for flares, geomagnetic storm indices, and energetic particle fluxes and fluences. These forecasts are produced twice daily using a combination of output from models such as Enlil, near-real-time observations, and forecaster experience. Verification of forecasts is crucial for users, researchers, and forecasters to understand the strengths and limitations of forecasters, and to assess forecaster added value. To this end, the Met Office (in collaboration with Exeter University) has been adapting verification techniques from terrestrial weather, and has been working closely with the International Space Environment Service (ISES) to standardise verification procedures. We will present the results of part of this work, analysing forecast and observed CME arrival times, assessing skill using 2x2 contingency tables. These MOSWOC forecasts can be objectively compared to those produced by the NASA Community Coordinated Modelling Center - a useful benchmark. This approach cannot be taken for the other forecasts, as they are probabilistic and categorical (e.g., geomagnetic storm forecasts give probabilities of exceeding levels from minor to extreme). We will present appropriate verification techniques being developed to address these forecasts, such as rank probability skill score, and comparing forecasts against climatology and persistence benchmarks. As part of this, we will outline the use of discrete time Markov chains to assess and improve the performance of our geomagnetic storm forecasts. We will also discuss work to adapt a terrestrial verification visualisation system to space weather, to help MOSWOC forecasters view verification results in near real-time; plans to objectively assess flare forecasts under the EU Horizon 2020 FLARECAST project; and summarise ISES efforts to achieve consensus on verification.

Factors influencing alert acceptance: a novel approach for predicting the success of clinical decision support

PubMed Central

Seidling, Hanna M; Phansalkar, Shobha; Seger, Diane L; Paterno, Marilyn D; Shaykevich, Shimon; Haefeli, Walter E

2011-01-01

Background Clinical decision support systems can prevent knowledge-based prescription errors and improve patient outcomes. The clinical effectiveness of these systems, however, is substantially limited by poor user acceptance of presented warnings. To enhance alert acceptance it may be useful to quantify the impact of potential modulators of acceptance. Methods We built a logistic regression model to predict alert acceptance of drug–drug interaction (DDI) alerts in three different settings. Ten variables from the clinical and human factors literature were evaluated as potential modulators of provider alert acceptance. ORs were calculated for the impact of knowledge quality, alert display, textual information, prioritization, setting, patient age, dose-dependent toxicity, alert frequency, alert level, and required acknowledgment on acceptance of the DDI alert. Results 50 788 DDI alerts were analyzed. Providers accepted only 1.4% of non-interruptive alerts. For interruptive alerts, user acceptance positively correlated with frequency of the alert (OR 1.30, 95% CI 1.23 to 1.38), quality of display (4.75, 3.87 to 5.84), and alert level (1.74, 1.63 to 1.86). Alert acceptance was higher in inpatients (2.63, 2.32 to 2.97) and for drugs with dose-dependent toxicity (1.13, 1.07 to 1.21). The textual information influenced the mode of reaction and providers were more likely to modify the prescription if the message contained detailed advice on how to manage the DDI. Conclusion We evaluated potential modulators of alert acceptance by assessing content and human factors issues, and quantified the impact of a number of specific factors which influence alert acceptance. This information may help improve clinical decision support systems design. PMID:21571746

Insider Alert 1.0 Beta Version

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

Abbott, Robert

2004-02-01

Insider Alert 1.0 Beta Version supports interactive selection and graphical display of data generated by the Sandia Cognitive Framework, which simulates the examination of security data by experts of various specialties. Insider Alert also encompasses the configuration and data files input to the Cognitive Framework for this application. Insider Alert 1.0 Beta Version is a computer program for analyzing data indicative of possible espionage or improper handling of data by employees at Sandia National Laboratories (or other facilities with comparable policies and procedures for managing sensitive information) It prioritizes and displays information for review by security analysts.

Implementation of an Alert and Response System in Haiti during the Early Stage of the Response to the Cholera Epidemic

PubMed Central

Santa-Olalla, Patricia; Gayer, Michelle; Magloire, Roc; Barrais, Robert; Valenciano, Marta; Aramburu, Carmen; Poncelet, Jean Luc; Gustavo Alonso, Juan Carlos; Van Alphen, Dana; Heuschen, Florence; Andraghetti, Roberta; Lee, Robert; Drury, Patrick; Aldighieri, Sylvain

2013-01-01

The start of the cholera epidemic in Haiti quickly highlighted the necessity of the implementation of an Alert and Response (A&R) System to complement the existing national surveillance system. The national system had been able to detect and confirm the outbreak etiology but required external support to monitor the spread of cholera and coordinate response, because much of the information produced was insufficiently timely for real-time monitoring and directing of a rapid, targeted response. The A&R System was designed by the Pan American Health Organization/World Health Organization in collaboration with the Haiti Ministry of Health, and it was based on a network of partners, including any institution, structure, or individual that could identify, verify, and respond to alerts. The defined objectives were to (1) save lives through early detection and treatment of cases and (2) control the spread through early intervention at the community level. The operational structure could be broken down into three principle categories: (1) alert (early warning), (2) verification and assessment of the information, and (3) efficient and timely response in coordination with partners to avoid duplication. Information generated by the A&R System was analyzed and interpreted, and the qualitative information was critical in qualifying the epidemic and defining vulnerable areas, particularly because the national surveillance system reported incomplete data for more than one department. The A&R System detected a number of alerts unrelated to cholera and facilitated rapid access to that information. The sensitivity of the system and its ability to react quickly was shown in May of 2011, when an abnormal increase in alerts coming from several communes in the Sud-Est Department in epidemiological weeks (EWs) 17 and 18 were noted and disseminated network-wide and response activities were implemented. The national cholera surveillance system did not register the increase until EWs 21 and 22, and the information did not become available until EWs 23 and 24, when the peak of cases had already been reached. Although many of the partners reporting alerts during the peak of the cholera epidemic have since left Haiti, the A&R System has continued to function as an Early Warning (EWARN) System, and it continues to be developed with recent activities, such as the distribution of cell phones to enhance alert communication. PMID:24106196

Implementation of an alert and response system in Haiti during the early stage of the response to the cholera epidemic.

PubMed

Santa-Olalla, Patricia; Gayer, Michelle; Magloire, Roc; Barrais, Robert; Valenciano, Marta; Aramburu, Carmen; Poncelet, Jean Luc; Gustavo Alonso, Juan Carlos; Van Alphen, Dana; Heuschen, Florence; Andraghetti, Roberta; Lee, Robert; Drury, Patrick; Aldighieri, Sylvain

2013-10-01

The start of the cholera epidemic in Haiti quickly highlighted the necessity of the implementation of an Alert and Response (A&R) System to complement the existing national surveillance system. The national system had been able to detect and confirm the outbreak etiology but required external support to monitor the spread of cholera and coordinate response, because much of the information produced was insufficiently timely for real-time monitoring and directing of a rapid, targeted response. The A&R System was designed by the Pan American Health Organization/World Health Organization in collaboration with the Haiti Ministry of Health, and it was based on a network of partners, including any institution, structure, or individual that could identify, verify, and respond to alerts. The defined objectives were to (1) save lives through early detection and treatment of cases and (2) control the spread through early intervention at the community level. The operational structure could be broken down into three principle categories: (1) alert (early warning), (2) verification and assessment of the information, and (3) efficient and timely response in coordination with partners to avoid duplication. Information generated by the A&R System was analyzed and interpreted, and the qualitative information was critical in qualifying the epidemic and defining vulnerable areas, particularly because the national surveillance system reported incomplete data for more than one department. The A&R System detected a number of alerts unrelated to cholera and facilitated rapid access to that information. The sensitivity of the system and its ability to react quickly was shown in May of 2011, when an abnormal increase in alerts coming from several communes in the Sud-Est Department in epidemiological weeks (EWs) 17 and 18 were noted and disseminated network-wide and response activities were implemented. The national cholera surveillance system did not register the increase until EWs 21 and 22, and the information did not become available until EWs 23 and 24, when the peak of cases had already been reached. Although many of the partners reporting alerts during the peak of the cholera epidemic have since left Haiti, the A&R System has continued to function as an Early Warning (EWARN) System, and it continues to be developed with recent activities, such as the distribution of cell phones to enhance alert communication.

CISN ShakeAlert Earthquake Early Warning System Monitoring Tools

NASA Astrophysics Data System (ADS)

Henson, I. H.; Allen, R. M.; Neuhauser, D. S.

2015-12-01

CISN ShakeAlert is a prototype earthquake early warning system being developed and tested by the California Integrated Seismic Network. The system has recently been expanded to support redundant data processing and communications. It now runs on six machines at three locations with ten Apache ActiveMQ message brokers linking together 18 waveform processors, 12 event association processes and 4 Decision Module alert processes. The system ingests waveform data from about 500 stations and generates many thousands of triggers per day, from which a small portion produce earthquake alerts. We have developed interactive web browser system-monitoring tools that display near real time state-of-health and performance information. This includes station availability, trigger statistics, communication and alert latencies. Connections to regional earthquake catalogs provide a rapid assessment of the Decision Module hypocenter accuracy. Historical performance can be evaluated, including statistics for hypocenter and origin time accuracy and alert time latencies for different time periods, magnitude ranges and geographic regions. For the ElarmS event associator, individual earthquake processing histories can be examined, including details of the transmission and processing latencies associated with individual P-wave triggers. Individual station trigger and latency statistics are available. Detailed information about the ElarmS trigger association process for both alerted events and rejected events is also available. The Google Web Toolkit and Map API have been used to develop interactive web pages that link tabular and geographic information. Statistical analysis is provided by the R-Statistics System linked to a PostgreSQL database.

Physician access to drug profiles to reduce adverse reactions

NASA Astrophysics Data System (ADS)

Yasnoff, William A.; Tomkins, Edward L.; Dunn, Louise M.

1995-10-01

Adverse drug reactions (ADRs) are a major source of preventable morbidity and mortality, especially among the elderly, who use more drugs and are more sensitive to them. The insurance industry has recently addressed this problem through the implementation of drug interaction alerts to pharmacists in conjunction with immediate online claims adjudication for almost 60% of prescriptions (expected to reach 90% within 5 years). These alerts are based on stored patient drug profiles maintained by pharmacy benefit managers (PBMs) which are updated whenever prescriptions are filled. While these alerts are very helpful, the pharmacist does not prescribe, resulting in time-consuming and costly delays to contact the physician and remedy potential interactions. We have developed and demonstrated the feasibility of the PINPOINT (Pharmaceutical Information Network for prevention of interactions) system for making the drug profile and interaction information easily available to the physician before the prescription is written. We plan to test the cost-effectiveness of the system in a prospective controlled clinical trial.

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

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.

Verification and classification bias interactions in diagnostic test accuracy studies for fine-needle aspiration biopsy.

PubMed

Schmidt, Robert L; Walker, Brandon S; Cohen, Michael B

2015-03-01

Reliable estimates of accuracy are important for any diagnostic test. Diagnostic accuracy studies are subject to unique sources of bias. Verification bias and classification bias are 2 sources of bias that commonly occur in diagnostic accuracy studies. Statistical methods are available to estimate the impact of these sources of bias when they occur alone. The impact of interactions when these types of bias occur together has not been investigated. We developed mathematical relationships to show the combined effect of verification bias and classification bias. A wide range of case scenarios were generated to assess the impact of bias components and interactions on total bias. Interactions between verification bias and classification bias caused overestimation of sensitivity and underestimation of specificity. Interactions had more effect on sensitivity than specificity. Sensitivity was overestimated by at least 7% in approximately 6% of the tested scenarios. Specificity was underestimated by at least 7% in less than 0.1% of the scenarios. Interactions between verification bias and classification bias create distortions in accuracy estimates that are greater than would be predicted from each source of bias acting independently. © 2014 American Cancer Society.

Warfarin monitoring in nursing homes assessed by case histories. Do recommendations and electronic alerts affect judgements?

PubMed

Teruel, Reyes Serrano; Thue, Geir; Fylkesnes, Svein Ivar; Sandberg, Sverre; Kristoffersen, Ann Helen

2017-09-01

Older adults treated with warfarin are prone to complications, and high-quality monitoring is essential. The aim of this case history based study was to assess the quality of warfarin monitoring in a routine situation, and in a situation with an antibiotic-warfarin interaction, before and after receiving an electronic alert. In April 2014, a national web-based survey with two case histories was distributed among Norwegian nursing home physicians and general practitioners working part-time in nursing homes. Case A represented a patient on stable warfarin treatment, but with a substantial INR increase within the therapeutic interval. Case B represented a more challenging patient with trimethoprim sulfamethoxazole (TMS) treatment due to pyelonephritis. In both cases, the physicians were asked to state the next warfarin dose and the INR recall interval. In case B, the physicians could change their suggestions after receiving an electronic alert on the TMS-warfarin interaction. Three hundred and ninety eight physicians in 292 nursing homes responded. Suggested INR recall intervals and warfarin doses varied substantially in both cases. In case A, 61% gave acceptable answers according to published recommendations, while only 9% did so for case B. Regarding the TMS-warfarin interaction in case history B, the electronic alert increased the percentage of respondents correctly suggesting a dose reduction from 29% to 53%. Having an INR instrument in the nursing home was associated with shortened INR recall times. Practical advice on handling of warfarin treatment and drug interactions is needed. Electronic alerts as presented in electronic medical records seem insufficient to change practice. Availability of INR instruments may be important regarding recall time.

Use of MODIS Satellite Data to Evaluate Juniperus spp. Pollen Phenology to Support a Pollen Dispersal Model, PREAM, to Support Public Health Allergy Alerts

NASA Technical Reports Server (NTRS)

Luvall, J. C.; Sprigg, W. A.; Levetin, E.; Huete, A.; Nickovic, S.; Prasad, A.; Pejanovic, G. A.; Vukovic, A.; VandeWater, P. K.; Budge, A. M.;

Use of MODIS Satellite Data to Evaluate Juniperus spp. Pollen Phenology to Support a Pollen Dispersal Model, PREAM, to Support Public Health Allergy Alerts

NASA Technical Reports Server (NTRS)

Luvall, J. C.; Sprigg, W. A.; Levetin, E.; Huete, A.; Nickovic, S.; Prasad, A.; Pejanovic, G. A.; Vukovic, A.; VandeWater, P. K.; Budge, A. M.;

Use of MODIS Satellite Data to Evaluate Juniperus spp. Pollen Phenology to Support a Pollen Dispersal Model, PREAM, to Support Public Health Allergy Alerts

NASA Astrophysics Data System (ADS)

Luvall, J. C.; Sprigg, W. A.; Levetin, E.; Huete, A. R.; Nickovic, S.; Prasad, A. K.; Pejanovic, G.; Vukovic, A.; Van De Water, P. K.; Budge, A.; Hudspeth, W. B.; Krapfl, H.; Toth, B.; Zelicoff, A.; Myers, O.; Bunderson, L.; Ponce-Campos, G.; Menache, M.; Crimmins, T. M.; Vujadinovic, M.

2012-12-01

Pollen can be transported great distances. Van de Water et. al., 2003 reported Juniperus spp. pollen was transported 200-600 km. Hence local observations of plant phenology may not be consistent with the timing and source of pollen collected by pollen sampling instruments. The DREAM (Dust REgional Atmospheric Model, Nickovic et al. 2001) is a verified model for atmospheric dust transport modeling using MODIS data products to identify source regions and concentrations of dust. We are modifying the DREAM model to incorporate pollen transport. Pollen emission is based on MODIS-derived phenology of Juniperus spp. communities. Ground-based observational records of pollen release timing and quantities will be used as model verification. This information will be used to support the Centers for Disease Control and Prevention's National Environmental Public Health Tracking Program and the State of New Mexico environmental public health decision support for asthma and allergies alerts.

Unmanned Aircraft Systems Minimum Operations Performance Standards End-to-End Verification and Validation (E2-V2) Simulation

NASA Technical Reports Server (NTRS)

Ghatas, Rania W.; Jack, Devin P.; Tsakpinis, Dimitrios; Vincent, Michael J.; Sturdy, James L.; Munoz, Cesar A.; Hoffler, Keith D.; Dutle, Aaron M.; Myer, Robert R.; Dehaven, Anna M.;

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.

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.

Great expectations: top-down attention modulates the costs of clutter and eccentricity.

PubMed

Steelman, Kelly S; McCarley, Jason S; Wickens, Christopher D

2013-12-01

An experiment and modeling effort examined interactions between bottom-up and top-down attentional control in visual alert detection. Participants performed a manual tracking task while monitoring peripheral display channels for alerts of varying salience, eccentricity, and spatial expectancy. Spatial expectancy modulated the influence of salience and eccentricity; alerts in low-probability locations engendered higher miss rates, longer detection times, and larger costs of visual clutter and eccentricity, indicating that top-down attentional control offset the costs of poor bottom-up stimulus quality. Data were compared to the predictions of a computational model of scanning and noticing that incorporates bottom-up and top-down sources of attentional control. The model accounted well for the overall pattern of miss rates and response times, predicting each of the observed main effects and interactions. Empirical results suggest that designers should expect the costs of poor bottom-up visibility to be greater for low expectancy signals, and that the placement of alerts within a display should be determined based on the combination of alert expectancy and response priority. Model fits suggest that the current model can serve as a useful tool for exploring a design space as a precursor to empirical data collection and for generating hypotheses for future experiments. PsycINFO Database Record (c) 2013 APA, all rights reserved.

Probabilistic rainfall warning system with an interactive user interface

NASA Astrophysics Data System (ADS)

Koistinen, Jarmo; Hohti, Harri; Kauhanen, Janne; Kilpinen, Juha; Kurki, Vesa; Lauri, Tuomo; Nurmi, Pertti; Rossi, Pekka; Jokelainen, Miikka; Heinonen, Mari; Fred, Tommi; Moisseev, Dmitri; Mäkelä, Antti

2013-04-01

A real time 24/7 automatic alert system is in operational use at the Finnish Meteorological Institute (FMI). It consists of gridded forecasts of the exceedance probabilities of rainfall class thresholds in the continuous lead time range of 1 hour to 5 days. Nowcasting up to six hours applies ensemble member extrapolations of weather radar measurements. With 2.8 GHz processors using 8 threads it takes about 20 seconds to generate 51 radar based ensemble members in a grid of 760 x 1226 points. Nowcasting exploits also lightning density and satellite based pseudo rainfall estimates. The latter ones utilize convective rain rate (CRR) estimate from Meteosat Second Generation. The extrapolation technique applies atmospheric motion vectors (AMV) originally developed for upper wind estimation with satellite images. Exceedance probabilities of four rainfall accumulation categories are computed for the future 1 h and 6 h periods and they are updated every 15 minutes. For longer forecasts exceedance probabilities are calculated for future 6 and 24 h periods during the next 4 days. From approximately 1 hour to 2 days Poor man's Ensemble Prediction System (PEPS) is used applying e.g. the high resolution short range Numerical Weather Prediction models HIRLAM and AROME. The longest forecasts apply EPS data from the European Centre for Medium Range Weather Forecasts (ECMWF). The blending of the ensemble sets from the various forecast sources is performed applying mixing of accumulations with equal exceedance probabilities. The blending system contains a real time adaptive estimator of the predictability of radar based extrapolations. The uncompressed output data are written to file for each member, having total size of 10 GB. Ensemble data from other sources (satellite, lightning, NWP) are converted to the same geometry as the radar data and blended as was explained above. A verification system utilizing telemetering rain gauges has been established. Alert dissemination e.g. for citizens and professional end users applies SMS messages and, in near future, smartphone maps. The present interactive user interface facilitates free selection of alert sites and two warning thresholds (any rain, heavy rain) at any location in Finland. The pilot service was tested by 1000-3000 users during summers 2010 and 2012. As an example of dedicated end-user services gridded exceedance scenarios (of probabilities 5 %, 50 % and 90 %) of hourly rainfall accumulations for the next 3 hours have been utilized as an online input data for the influent model at the Greater Helsinki Wastewater Treatment Plant.

High-priority and low-priority drug-drug interactions in different international electronic health record systems: A comparative study.

PubMed

Cornu, Pieter; Phansalkar, Shobha; Seger, Diane L; Cho, Insook; Pontefract, Sarah; Robertson, Alexandra; Bates, David W; Slight, Sarah P

2018-03-01

To investigate whether alert warnings for high-priority and low-priority drug-drug interactions (DDIs) were present in five international electronic health record (EHR) systems, to compare and contrast the severity level assigned to them, and to establish the proportion of alerts that were overridden. We conducted a comparative, retrospective, multinational study using a convenience sample of 5 EHRs from the U.S., U.K., Republic of Korea and Belgium. Of the 15 previously defined, high-priority, class-based DDIs, alert warnings were found to exist for 11 in both the Korean and UK systems, 9 in the Belgian system, and all 15 in the two US systems. The specific combinations that were included in these class-based DDIs varied considerably in number, type and level of severity amongst systems. Alerts were only active for 8.4% (52/619) and 52.4% (111/212) of the specific drug-drug combinations contained in the Belgian and UK systems, respectively. Hard stops (not possible to override) existed in the US and UK systems only. The override rates for high-priority alerts requiring provider action ranged from 56.7% to 83.3%. Of the 33 previously defined low-priority DDIs, active alerts existed only in the US systems, for three class-based DDIs. The majority were non-interruptive. Alert warnings existed for most of the high-priority DDIs in the different EHRs but overriding them was easy in most of the systems. In addition to validating the high- and low-priority DDIs, this study reported a lack of standardization in DDI levels across different international knowledge bases. Copyright © 2017. Published by Elsevier B.V.

Successful Outcomes of a Clinical Decision Support System in an HIV Practice: A Randomized Controlled Trial

PubMed Central

Robbins, Gregory K.; Lester, William; Johnson, Kristin L.; Chang, Yuchiao; Estey, Gregory; Surrao, Dominic; Zachary, Kimon; Lammert, Sara M.; Chueh, Henry; Meigs, James B.; Freedberg, Kenneth A.

2013-01-01

Background Data to support improved patient outcomes from clinical decision support systems (CDSS) are lacking in HIV care. Objective To conduct a randomized controlled trial testing the efficacy of a CDSS to improve HIV outcomes in an outpatient clinic. Design We conducted a randomized controlled trial where half of each provider’s patients were randomized to interactive or static computer alerts (ClinicalTrials.gov #NCT00678600). Setting The study was conducted at the Massachusetts General Hospital HIV Clinic. Subjects Participants were HIV providers and their HIV-infected patients. Intervention Computer alerts were generated for virologic failure (HIV RNA >400 c/mL after HIV RNA ≤400 c/mL), evidence of suboptimal follow-up, and 11 abnormal laboratory tests. Providers received interactive computer alerts, facilitating appointment rescheduling and repeat laboratory testing, for half of their patients and static alerts for the other half. Measurements The primary endpoint was change in CD4 count. Other endpoints included time-to-clinical event, 6-month suboptimal follow-up, and severe laboratory toxicity. Results Thirty-three HIV providers followed 1,011 HIV-infected patients. For the intervention arm, the mean CD4 count increase was greater (5.3 versus 3.2 cells/mm3/month; difference = 2.0 cells/mm3/month 95% CI [0.1, 4.0], p=0.040) and the rate of 6-month suboptimal follow-up was lower (20.6 versus 30.1 events per 100 patient-years, p=0.022). Median time-to-next scheduled appointment was shorter in the intervention arm after a suboptimal follow-up alert (1.71 versus 3.48 months; p<0.001) and after a toxicity alert (2.79 versus >6 months for control); p=0.072). Ninety-six percent of providers supported adopting the CDSS as part of standard care. Limitations This was a one-year informatics study conducted at a single hospital sub-specialty clinic. Conclusion A CDSS using interactive provider alerts improved CD4 counts and clinic follow-up for HIV-infected patients. Wider implementation of such systems can provide important clinical benefits. PMID:23208165

Real-Time Mapping alert system; user's manual

USGS Publications Warehouse

Torres, L.A.

1996-01-01

The U.S. Geological Survey has an extensive hydrologic network that records and transmits precipitation, stage, discharge, and other water- related data on a real-time basis to an automated data processing system. Data values are recorded on electronic data collection platforms at field monitoring sites. These values are transmitted by means of orbiting satellites to receiving ground stations, and by way of telecommunication lines to a U.S. Geological Survey office where they are processed on a computer system. Data that exceed predefined thresholds are identified as alert values. These alert values can help keep water- resource specialists informed of current hydrologic conditions. The current alert status at monitoring sites is of critical importance during floods, hurricanes, and other extreme hydrologic events where quick analysis of the situation is needed. This manual provides instructions for using the Real-Time Mapping software, a series of computer programs developed by the U.S. Geological Survey for quick analysis of hydrologic conditions, and guides users through a basic interactive session. The software provides interactive graphics display and query of real-time information in a map-based, menu-driven environment.

Formal verification of an oral messages algorithm for interactive consistency

NASA Technical Reports Server (NTRS)

Rushby, John

1992-01-01

The formal specification and verification of an algorithm for Interactive Consistency based on the Oral Messages algorithm for Byzantine Agreement is described. We compare our treatment with that of Bevier and Young, who presented a formal specification and verification for a very similar algorithm. Unlike Bevier and Young, who observed that 'the invariant maintained in the recursive subcases of the algorithm is significantly more complicated than is suggested by the published proof' and who found its formal verification 'a fairly difficult exercise in mechanical theorem proving,' our treatment is very close to the previously published analysis of the algorithm, and our formal specification and verification are straightforward. This example illustrates how delicate choices in the formulation of the problem can have significant impact on the readability of its formal specification and on the tractability of its formal verification.

Hot spots in a wired world: WHO surveillance of emerging and re-emerging infectious diseases.

PubMed

Heymann, D L; Rodier, G R

2001-12-01

The resurgence of the microbial threat, rooted in several recent trends, has increased the vulnerability of all nations to the risk of infectious diseases, whether newly emerging, well-established, or deliberately caused. Infectious disease intelligence, gleaned through sensitive surveillance, is the best defence. The epidemiological and laboratory techniques needed to detect, investigate, and contain a deliberate outbreak are the same as those used for natural outbreaks. In April 2000, WHO formalised an infrastructure (the Global Outbreak Alert and Response Network) for responding to the heightened need for early awareness of outbreaks and preparedness to respond. The Network, which unites 110 existing networks, is supported by several new mechanisms and a computer-driven tool for real time gathering of disease intelligence. The procedure for outbreak alert and response has four phases: systematic detection, outbreak verification, real time alerts, and rapid response. For response, the framework uses different strategies for combating known risks and unexpected events, and for improving both global and national preparedness. New forces at work in an electronically interconnected world are beginning to break down the traditional reluctance of countries to report outbreaks due to fear of the negative impact on trade and tourism. About 65% of the world's first news about infectious disease events now comes from informal sources, including press reports and the internet.

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.

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.

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.

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.

Development and validation of a survey instrument for assessing prescribers' perception of computerized drug-drug interaction alerts.

PubMed

Zheng, Kai; Fear, Kathleen; Chaffee, Bruce W; Zimmerman, Christopher R; Karls, Edward M; Gatwood, Justin D; Stevenson, James G; Pearlman, Mark D

2011-12-01

To develop a theoretically informed and empirically validated survey instrument for assessing prescribers' perception of computerized drug-drug interaction (DDI) alerts. The survey is grounded in the unified theory of acceptance and use of technology and an adapted accident causation model. Development of the instrument was also informed by a review of the extant literature on prescribers' attitude toward computerized medication safety alerts and common prescriber-provided reasons for overriding. To refine and validate the survey, we conducted a two-stage empirical validation study consisting of a pretest with a panel of domain experts followed by a field test among all eligible prescribers at our institution. The resulting survey instrument contains 28 questionnaire items assessing six theoretical dimensions: performance expectancy, effort expectancy, social influence, facilitating conditions, perceived fatigue, and perceived use behavior. Satisfactory results were obtained from the field validation; however, a few potential issues were also identified. We analyzed these issues accordingly and the results led to the final survey instrument as well as usage recommendations. High override rates of computerized medication safety alerts have been a prevalent problem. They are usually caused by, or manifested in, issues of poor end user acceptance. However, standardized research tools for assessing and understanding end users' perception are currently lacking, which inhibits knowledge accumulation and consequently forgoes improvement opportunities. The survey instrument presented in this paper may help fill this methodological gap. We developed and empirically validated a survey instrument that may be useful for future research on DDI alerts and other types of computerized medication safety alerts more generally.

Phasic and tonic alerting in mild cognitive impairment: A preliminary study.

PubMed

Martella, Diana; Manzanares, Salvadora; Campoy, Guillermo; Roca, Javier; Antúnez, Carmen; Fuentes, Luis J

2014-01-01

In this preliminary study we assessed the functioning of the different attentional networks in mild cognitive impairment (MCI) patients, taking as theoretical framework the Posner's cognitive neuroscience approach. Two groups of participants were tested in a single short experiment: 20 MCI patients (6 amnestic, 6 non-amnestic and 8 multiple-domain) and 18 healthy matched controls (HC). For attentional assessment we used a version of the Attention Network Test (the ANTI-V) that provided not only a score of the orienting, the executive, and the alerting networks and their interactions, but also an independent measure of vigilance (tonic alerting). The results showed that all subtypes of MCI patients exhibited a selective impairment in the tonic component of alerting, as indexed by a decrease in the d' sensitivity index, and their performance in executive network increased up to the HC group level when phasic alerting was provided by a warning tone. Our findings suggest that a core attentional deficit, especially the endogenous component of alerting, may significantly contribute to the behavioral and cognitive deficits associated with MCI. Copyright © 2013 Elsevier Inc. All rights reserved.

Integrating UF6 Cylinder RF Tracking With Continuous Load Cell Monitoring for Verifying Declared UF6 Feed and Withdrawal Operations Verifying Declared UF6 Feed and Withdrawal Operations

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

Krichinsky, Alan M; Miller, Paul; Pickett, Chris A

2009-01-01

Oak Ridge National Laboratory is demonstrating the integration of UF6 cylinder tracking, using RF technology, with continuous load cell monitoring (CLCM) at mock UF6 feed and withdrawal (F&W) stations. CLCM and cylinder tracking are two of several continuous-monitoring technologies that show promise in providing integrated safeguards of F&W operations at enrichment plants. Integrating different monitoring technologies allows advanced, automated event processing to screen innocuous events thereby minimizing false alerts to independent inspectors. Traditionally, international inspectors rely on batch verification of material inputs and outputs derived from operator declarations and periodic on-site inspections at uranium enrichment plants or other nuclear processingmore » facilities. Continuously monitoring F&W activities between inspections while providing filtered alerts of significant operational events will substantially increase the amount of valuable information available to inspectors thereby promising to enhance the effectiveness of safeguards and to improve efficiency in conducting on-site inspections especially at large plants for ensuring that all operations are declared.« less

The effects of L-theanine, caffeine and their combination on cognition and mood.

PubMed

Haskell, Crystal F; Kennedy, David O; Milne, Anthea L; Wesnes, Keith A; Scholey, Andrew B

2008-02-01

L-Theanine is an amino acid found naturally in tea. Despite the common consumption of L-theanine, predominantly in combination with caffeine in the form of tea, only one study to date has examined the cognitive effects of this substance alone, and none have examined its effects when combined with caffeine. The present randomised, placebo-controlled, double-blind, balanced crossover study investigated the acute cognitive and mood effects of L-theanine (250 mg), and caffeine (150 mg), in isolation and in combination. Salivary caffeine levels were co-monitored. L-Theanine increased 'headache' ratings and decreased correct serial seven subtractions. Caffeine led to faster digit vigilance reaction time, improved Rapid Visual Information Processing (RVIP) accuracy and attenuated increases in self-reported 'mental fatigue'. In addition to improving RVIP accuracy and 'mental fatigue' ratings, the combination also led to faster simple reaction time, faster numeric working memory reaction time and improved sentence verification accuracy. 'Headache' and 'tired' ratings were reduced and 'alert' ratings increased. There was also a significant positive caffeine x L-theanine interaction on delayed word recognition reaction time. These results suggest that beverages containing L-theanine and caffeine may have a different pharmacological profile to those containing caffeine alone.

Verification of the FtCayuga fault-tolerant microprocessor system. Volume 1: A case study in theorem prover-based verification

NASA Technical Reports Server (NTRS)

Srivas, Mandayam; Bickford, Mark

1991-01-01

The design and formal verification of a hardware system for a task that is an important component of a fault tolerant computer architecture for flight control systems is presented. The hardware system implements an algorithm for obtaining interactive consistancy (byzantine agreement) among four microprocessors as a special instruction on the processors. The property verified insures that an execution of the special instruction by the processors correctly accomplishes interactive consistency, provided certain preconditions hold. An assumption is made that the processors execute synchronously. For verification, the authors used a computer aided design hardware design verification tool, Spectool, and the theorem prover, Clio. A major contribution of the work is the demonstration of a significant fault tolerant hardware design that is mechanically verified by a theorem prover.

U.S. Geological Survey Global Seismographic Network - Five-Year Plan 2006-2010

USGS Publications Warehouse

Leith, William S.; Gee, Lind S.; Hutt, Charles R.

2009-01-01

The Global Seismographic Network provides data for earthquake alerting, tsunami warning, nuclear treaty verification, and Earth science research. The system consists of nearly 150 permanent digital stations, distributed across the globe, connected by a modern telecommunications network. It serves as a multi-use scientific facility and societal resource for monitoring, research, and education, by providing nearly uniform, worldwide monitoring of the Earth. The network was developed and is operated through a partnership among the National Science Foundation (http://www.nsf.gov), the Incorporated Research Institutions for Seismology (http://www.iris.edu/hq/programs/gsn), and the U.S. Geological Survey (http://earthquake.usgs.gov/gsn).

Formal verification of human-automation interaction

NASA Technical Reports Server (NTRS)

Degani, Asaf; Heymann, Michael

2002-01-01

This paper discusses a formal and rigorous approach to the analysis of operator interaction with machines. It addresses the acute problem of detecting design errors in human-machine interaction and focuses on verifying the correctness of the interaction in complex and automated control systems. The paper describes a systematic methodology for evaluating whether the interface provides the necessary information about the machine to enable the operator to perform a specified task successfully and unambiguously. It also addresses the adequacy of information provided to the user via training material (e.g., user manual) about the machine's behavior. The essentials of the methodology, which can be automated and applied to the verification of large systems, are illustrated by several examples and through a case study of pilot interaction with an autopilot aboard a modern commercial aircraft. The expected application of this methodology is an augmentation and enhancement, by formal verification, of human-automation interfaces.

Identity Verification, Control, and Aggression in Marriage

ERIC Educational Resources Information Center

Stets, Jan E.; Burke, Peter J.

2005-01-01

In this research we study the identity verification process and its effects in marriage. Drawing on identity control theory, we hypothesize that a lack of verification in the spouse identity (1) threatens stable self-meanings and interaction patterns between spouses, and (2) challenges a (nonverified) spouse's perception of control over the…

Comparison of Overridden Medication-related Clinical Decision Support in the Intensive Care Unit between a Commercial System and a Legacy System.

PubMed

Wong, Adrian; Wright, Adam; Seger, Diane L; Amato, Mary G; Fiskio, Julie M; Bates, David

2017-08-23

Electronic health records (EHRs) with clinical decision support (CDS) have shown to be effective at improving patient safety. Despite this, alerts delivered as part of CDS are overridden frequently, which is of concern in the critical care population as this group may have an increased risk of harm. Our organization recently transitioned from an internally-developed EHR to a commercial system. Data comparing various EHR systems, especially after transitions between EHRs, are needed to identify areas for improvement. To compare the two systems and identify areas for potential improvement with the new commercial system at a single institution. Overridden medication-related CDS alerts were included from October to December of the systems' respective years (legacy, 2011; commercial, 2015), restricted to three intensive care units. The two systems were compared with regards to CDS presentation and override rates for four types of CDS: drug-allergy, drug-drug interaction (DDI), geriatric and renal alerts. A post hoc analysis to evaluate for adverse drug events (ADEs) potentially resulting from overridden alerts was performed for 'contraindicated' DDIs via chart review. There was a significant increase in provider exposure to alerts and alert overrides in the commercial system (commercial: n=5,535; legacy: n=1,030). Rates of overrides were higher for the allergy and DDI alerts (p<0.001) in the commercial system. Geriatric and renal alerts were significantly different in incidence and presentation between the two systems. No ADEs were identified in an analysis of 43 overridden contraindicated DDI alerts. The vendor system had much higher rates of both alerts and overrides, although we did not find evidence of harm in a review of DDIs which were overridden. We propose recommendations for improving our current system which may be helpful to other similar institutions; improving both alert presentation and the underlying knowledge base appear important.

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.

Analysis and verification of a prediction model of solar energetic proton events

NASA Astrophysics Data System (ADS)

Wang, J.; Zhong, Q.

2017-12-01

The solar energetic particle event can cause severe radiation damages near Earth. The alerts and summary products of the solar energetic proton events were provided by the Space Environment Prediction Center (SEPC) according to the flux of the greater than 10 MeV protons taken by GOES satellite in geosynchronous orbit. The start of a solar energetic proton event is defined as the time when the flux of the greater than 10 MeV protons equals or exceeds 10 proton flux units (pfu). In this study, a model was developed to predict the solar energetic proton events, provide the warning for the solar energetic proton events at least minutes in advance, based on both the soft X-ray flux and integral proton flux taken by GOES. The quality of the forecast model was measured against verifications of accuracy, reliability, discrimination capability, and forecast skills. The peak flux and rise time of the solar energetic proton events in the six channels, >1MeV, >5 MeV, >10 MeV, >30 MeV, >50 MeV, >100 MeV, were also simulated and analyzed.

Human-computer interaction for alert warning and attention allocation systems of the multimodal watchstation

NASA Astrophysics Data System (ADS)

Obermayer, Richard W.; Nugent, William A.

2000-11-01

The SPAWAR Systems Center San Diego is currently developing an advanced Multi-Modal Watchstation (MMWS); design concepts and software from this effort are intended for transition to future United States Navy surface combatants. The MMWS features multiple flat panel displays and several modes of user interaction, including voice input and output, natural language recognition, 3D audio, stylus and gestural inputs. In 1999, an extensive literature review was conducted on basic and applied research concerned with alerting and warning systems. After summarizing that literature, a human computer interaction (HCI) designer's guide was prepared to support the design of an attention allocation subsystem (AAS) for the MMWS. The resultant HCI guidelines are being applied in the design of a fully interactive AAS prototype. An overview of key findings from the literature review, a proposed design methodology with illustrative examples, and an assessment of progress made in implementing the HCI designers guide are presented.

Development and preliminary evidence for the validity of an instrument assessing implementation of human-factors principles in medication-related decision-support systems—I-MeDeSA

PubMed Central

Zachariah, Marianne; Seidling, Hanna M; Neri, Pamela M; Cresswell, Kathrin M; Duke, Jon; Bloomrosen, Meryl; Volk, Lynn A; Bates, David W

2011-01-01

Background Medication-related decision support can reduce the frequency of preventable adverse drug events. However, the design of current medication alerts often results in alert fatigue and high over-ride rates, thus reducing any potential benefits. Methods The authors previously reviewed human-factors principles for relevance to medication-related decision support alerts. In this study, instrument items were developed for assessing the appropriate implementation of these human-factors principles in drug–drug interaction (DDI) alerts. User feedback regarding nine electronic medical records was considered during the development process. Content validity, construct validity through correlation analysis, and inter-rater reliability were assessed. Results The final version of the instrument included 26 items associated with nine human-factors principles. Content validation on three systems resulted in the addition of one principle (Corrective Actions) to the instrument and the elimination of eight items. Additionally, the wording of eight items was altered. Correlation analysis suggests a direct relationship between system age and performance of DDI alerts (p=0.0016). Inter-rater reliability indicated substantial agreement between raters (κ=0.764). Conclusion The authors developed and gathered preliminary evidence for the validity of an instrument that measures the appropriate use of human-factors principles in the design and display of DDI alerts. Designers of DDI alerts may use the instrument to improve usability and increase user acceptance of medication alerts, and organizations selecting an electronic medical record may find the instrument helpful in meeting their clinicians' usability needs. PMID:21946241

IoT for Real-Time Measurement of High-Throughput Liquid Dispensing in Laboratory Environments.

PubMed

Shumate, Justin; Baillargeon, Pierre; Spicer, Timothy P; Scampavia, Louis

2018-04-01

Critical to maintaining quality control in high-throughput screening is the need for constant monitoring of liquid-dispensing fidelity. Traditional methods involve operator intervention with gravimetric analysis to monitor the gross accuracy of full plate dispenses, visual verification of contents, or dedicated weigh stations on screening platforms that introduce potential bottlenecks and increase the plate-processing cycle time. We present a unique solution using open-source hardware, software, and 3D printing to automate dispenser accuracy determination by providing real-time dispense weight measurements via a network-connected precision balance. This system uses an Arduino microcontroller to connect a precision balance to a local network. By integrating the precision balance as an Internet of Things (IoT) device, it gains the ability to provide real-time gravimetric summaries of dispensing, generate timely alerts when problems are detected, and capture historical dispensing data for future analysis. All collected data can then be accessed via a web interface for reviewing alerts and dispensing information in real time or remotely for timely intervention of dispense errors. The development of this system also leveraged 3D printing to rapidly prototype sensor brackets, mounting solutions, and component enclosures.

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.

Prediction of Vigilant Attention and Cognitive Performance Using Self-Reported Alertness, Circadian Phase, Hours since Awakening, and Accumulated Sleep Loss

PubMed Central

Bermudez, Eduardo B.; Klerman, Elizabeth B.; Czeisler, Charles A.; Cohen, Daniel A.; Wyatt, James K.; Phillips, Andrew J. K.

2016-01-01

Sleep restriction causes impaired cognitive performance that can result in adverse consequences in many occupational settings. Individuals may rely on self-perceived alertness to decide if they are able to adequately perform a task. It is therefore important to determine the relationship between an individual’s self-assessed alertness and their objective performance, and how this relationship depends on circadian phase, hours since awakening, and cumulative lost hours of sleep. Healthy young adults (aged 18–34) completed an inpatient schedule that included forced desynchrony of sleep/wake and circadian rhythms with twelve 42.85-hour “days” and either a 1:2 (n = 8) or 1:3.3 (n = 9) ratio of sleep-opportunity:enforced-wakefulness. We investigated whether subjective alertness (visual analog scale), circadian phase (melatonin), hours since awakening, and cumulative sleep loss could predict objective performance on the Psychomotor Vigilance Task (PVT), an Addition/Calculation Test (ADD) and the Digit Symbol Substitution Test (DSST). Mathematical models that allowed nonlinear interactions between explanatory variables were evaluated using the Akaike Information Criterion (AIC). Subjective alertness was the single best predictor of PVT, ADD, and DSST performance. Subjective alertness alone, however, was not an accurate predictor of PVT performance. The best AIC scores for PVT and DSST were achieved when all explanatory variables were included in the model. The best AIC score for ADD was achieved with circadian phase and subjective alertness variables. We conclude that subjective alertness alone is a weak predictor of objective vigilant or cognitive performance. Predictions can, however, be improved by knowing an individual’s circadian phase, current wake duration, and cumulative sleep loss. PMID:27019198

Design of decision support interventions for medication prescribing.

PubMed

Horsky, Jan; Phansalkar, Shobha; Desai, Amrita; Bell, Douglas; Middleton, Blackford

2013-06-01

Describe optimal design attributes of clinical decision support (CDS) interventions for medication prescribing, emphasizing perceptual, cognitive and functional characteristics that improve human-computer interaction (HCI) and patient safety. Findings from published reports on success, failures and lessons learned during implementation of CDS systems were reviewed and interpreted with regard to HCI and software usability principles. We then formulated design recommendations for CDS alerts that would reduce unnecessary workflow interruptions and allow clinicians to make informed decisions quickly, accurately and without extraneous cognitive and interactive effort. Excessive alerting that tends to distract clinicians rather than provide effective CDS can be reduced by designing only high severity alerts as interruptive dialog boxes and less severe warnings without explicit response requirement, by curating system knowledge bases to suppress warnings with low clinical utility and by integrating contextual patient data into the decision logic. Recommended design principles include parsimonious and consistent use of color and language, minimalist approach to the layout of information and controls, the use of font attributes to convey hierarchy and visual prominence of important data over supporting information, the inclusion of relevant patient data in the context of the alert and allowing clinicians to respond with one or two clicks. Although HCI and usability principles are well established and robust, CDS and EHR system interfaces rarely conform to the best known design conventions and are seldom conceived and designed well enough to be truly versatile and dependable tools. These relatively novel interventions still require careful monitoring, research and analysis of its track record to mature. Clarity and specificity of alert content and optimal perceptual and cognitive attributes, for example, are essential for providing effective decision support to clinicians. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

New developments in EPID-based 3D dosimetry in The Netherlands Cancer Institute

NASA Astrophysics Data System (ADS)

Mijnheer, B.; Rozendaal, R.; Olaciregui-Ruiz, I.; González, P.; van Oers, R.; Mans, A.

2017-05-01

EPID-based offline 3D in vivo dosimetry is performed routinely in The Netherlands Cancer Institute for almost all RT treatments. The 3D dose distribution is reconstructed using the EPID primary dose in combination with a back-projection algorithm and compared with the planned dose distribution. Recently the method was adapted for real-time dose verification, performing 3D dose verification in less than 300 ms, which is faster than the current portal frame acquisition rate. In this way a possibility is created for halting the linac in case of large delivery errors. Furthermore, a new method for pre-treatment QA was developed in which the EPID primary dose behind a phantom or patient is predicted using the CT data of that phantom or patient in combination with in-air EPID measurements. This virtual EPID primary transit dose is then used to reconstruct the 3D dose distribution within the phantom or patient geometry using the same dose engine as applied offline. In order to assess the relevance of our clinically applied alert criteria, we investigated the sensitivity of our EPID-based 3D dose verification system to detect delivery errors in VMAT treatments. This was done through simulation by modifying patient treatment plans, as well as experimentally by performing EPID measurements during the irradiation of an Alderson phantom, both after deliberately introducing errors during VMAT delivery. In this presentation these new developments will be elucidated.

Effects of cognitive appraisal and mental workload factors on performance in an arithmetic task.

PubMed

Galy, Edith; Mélan, Claudine

2015-12-01

We showed in a previous study an additive interaction between intrinsic and extraneous cognitive loads and of participants' alertness in an 1-back working memory task. The interaction between intrinsic and extraneous cognitive loads was only observed when participants' alertness was low (i.e. in the morning). As alertness is known to reflect an individual's general functional state, we suggested that the working memory capacity available for germane cognitive load depends on a participant's functional state, in addition to intrinsic and extraneous loads induced by the task and task conditions. The relationships between the different load types and their assessment by specific load measures gave rise to a modified cognitive load model. The aim of the present study was to complete the model by determining to what extent and at what processing level an individual's characteristics intervene in order to implement efficient strategies in a working memory task. Therefore, the study explored participants' cognitive appraisal of the situation in addition to the load factors considered previously-task difficulty, time pressure and alertness. Each participant performed a mental arithmetic task in four different cognitive load conditions (crossover of two task difficulty conditions and of two time pressure conditions), both while their alertness was low (9 a.m.) and high (4 p.m.). Results confirmed an additive effect of task difficulty and time pressure, previously reported in the 1-back memory task, thereby lending further support to the modified cognitive load model. Further, in the high intrinsic and extraneous load condition, performance was reduced on the morning session (i.e. when alertness was low) on one hand, and in those participants' having a threat appraisal of the situation on the other hand. When these factors were included into the analysis, a performance drop occurred in the morning irrespective of cognitive appraisal, and with threat appraisal in the afternoon (i.e. high alertness). Taken together, these findings indicate that mental overload can be the result of a combination of subject-related characteristics, including alertness and cognitive appraisal, in addition to well-documented task-related components (intrinsic and extraneous load). As the factors investigated in the study are known to be critically involved in a number of real job-activities, the findings suggest that solutions designed to reduce incidents and accidents at work should consider the situation from a global perspective, including individual characteristics, task parameters, and work organization, rather than dealing with each factor separately.

DAIDALUS: Detect and Avoid Alerting Logic for Unmanned Systems

NASA Technical Reports Server (NTRS)

Munoz, Cesar; Narkawicz, Anthony; Hagen, George; Upchurch, Jason; Dutle, Aaron; Consiglio, Maria; Chamberlain, James

2015-01-01

This paper presents DAIDALUS (Detect and Avoid Alerting Logic for Unmanned Systems), a reference implementation of a detect and avoid concept intended to support the integration of Unmanned Aircraft Systems into civil airspace. DAIDALUS consists of self-separation and alerting algorithms that provide situational awareness to UAS remote pilots. These algorithms have been formally specified in a mathematical notation and verified for correctness in an interactive theorem prover. The software implementation has been verified against the formal models and validated against multiple stressing cases jointly developed by the US Air Force Research Laboratory, MIT Lincoln Laboratory, and NASA. The DAIDALUS reference implementation is currently under consideration for inclusion in the appendices to the Minimum Operational Performance Standards for Unmanned Aircraft Systems presently being developed by RTCA Special Committee 228.

Cognitive and mood improvements of caffeine in habitual consumers and habitual non-consumers of caffeine.

PubMed

Haskell, Crystal F; Kennedy, David O; Wesnes, Keith A; Scholey, Andrew B

2005-06-01

The cognitive and mood effects of caffeine are well documented. However, the majority of studies in this area involve caffeine-deprived, habitual caffeine users. It is therefore unclear whether any beneficial findings are due to the positive effects of caffeine or to the alleviation of caffeine withdrawal. The present placebo-controlled, double-blind, balanced crossover study investigated the acute cognitive and mood effects of caffeine in habitual users and habitual non-users of caffeine. Following overnight caffeine withdrawal, 24 habitual caffeine consumers (mean=217 mg/day) and 24 habitual non-consumers (20 mg/day) received a 150 ml drink containing either 75 or 150 mg of caffeine or a matching placebo, at intervals of > or =48 h. Cognitive and mood assessments were undertaken at baseline and 30 min post-drink. These included the Cognitive Drug Research computerised test battery, two serial subtraction tasks, a sentence verification task and subjective visual analogue mood scales. There were no baseline differences between the groups' mood or performance. Following caffeine, there were significant improvements in simple reaction time, digit vigilance reaction time, numeric working memory reaction time and sentence verification accuracy, irrespective of group. Self-rated mental fatigue was reduced and ratings of alertness were significantly improved by caffeine independent of group. There were also group effects for rapid visual information processing false alarms and spatial memory accuracy with habitual consumers outperforming non-consumers. There was a single significant interaction of group and treatment effects on jittery ratings. Separate analyses of each groups' responses to caffeine revealed overlapping but differential responses to caffeine. Caffeine tended to benefit consumers' mood more while improving performance more in the non-consumers. These results do not support a withdrawal alleviation model. Differences in the patterns of responses to caffeine by habitual consumers and habitual non-consumers may go some way to explaining why some individuals become caffeine consumers.

Automation bias in electronic prescribing.

PubMed

Lyell, David; Magrabi, Farah; Raban, Magdalena Z; Pont, L G; Baysari, Melissa T; Day, Richard O; Coiera, Enrico

2017-03-16

Clinical decision support (CDS) in e-prescribing can improve safety by alerting potential errors, but introduces new sources of risk. Automation bias (AB) occurs when users over-rely on CDS, reducing vigilance in information seeking and processing. Evidence of AB has been found in other clinical tasks, but has not yet been tested with e-prescribing. This study tests for the presence of AB in e-prescribing and the impact of task complexity and interruptions on AB. One hundred and twenty students in the final two years of a medical degree prescribed medicines for nine clinical scenarios using a simulated e-prescribing system. Quality of CDS (correct, incorrect and no CDS) and task complexity (low, low + interruption and high) were varied between conditions. Omission errors (failure to detect prescribing errors) and commission errors (acceptance of false positive alerts) were measured. Compared to scenarios with no CDS, correct CDS reduced omission errors by 38.3% (p < .0001, n = 120), 46.6% (p < .0001, n = 70), and 39.2% (p < .0001, n = 120) for low, low + interrupt and high complexity scenarios respectively. Incorrect CDS increased omission errors by 33.3% (p < .0001, n = 120), 24.5% (p < .009, n = 82), and 26.7% (p < .0001, n = 120). Participants made commission errors, 65.8% (p < .0001, n = 120), 53.5% (p < .0001, n = 82), and 51.7% (p < .0001, n = 120). Task complexity and interruptions had no impact on AB. This study found evidence of AB omission and commission errors in e-prescribing. Verification of CDS alerts is key to avoiding AB errors. However, interventions focused on this have had limited success to date. Clinicians should remain vigilant to the risks of CDS failures and verify CDS.

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

Signal verification can promote reliable signalling.

PubMed

Broom, Mark; Ruxton, Graeme D; Schaefer, H Martin

2013-11-22

The central question in communication theory is whether communication is reliable, and if so, which mechanisms select for reliability. The primary approach in the past has been to attribute reliability to strategic costs associated with signalling as predicted by the handicap principle. Yet, reliability can arise through other mechanisms, such as signal verification; but the theoretical understanding of such mechanisms has received relatively little attention. Here, we model whether verification can lead to reliability in repeated interactions that typically characterize mutualisms. Specifically, we model whether fruit consumers that discriminate among poor- and good-quality fruits within a population can select for reliable fruit signals. In our model, plants either signal or they do not; costs associated with signalling are fixed and independent of plant quality. We find parameter combinations where discriminating fruit consumers can select for signal reliability by abandoning unprofitable plants more quickly. This self-serving behaviour imposes costs upon plants as a by-product, rendering it unprofitable for unrewarding plants to signal. Thus, strategic costs to signalling are not a prerequisite for reliable communication. We expect verification to more generally explain signal reliability in repeated consumer-resource interactions that typify mutualisms but also in antagonistic interactions such as mimicry and aposematism.

Correlated colour temperature of morning light influences alertness and body temperature.

PubMed

Te Kulve, Marije; Schlangen, Luc; Schellen, Lisje; Souman, Jan L; van Marken Lichtenbelt, Wouter

2018-03-01

Though several studies have reported human alertness to be affected by the intensity and spectral composition of ambient light, the mechanism behind this effect is still largely unclear, especially for daytime exposure. Alerting effects of nocturnal light exposure are correlated with melatonin suppression, but melatonin levels are generally low during the day. The aim of this study was to explore the alerting effect of light in the morning for different correlated colour temperature (CCT) values, as well as its interaction with ambient temperature. Body temperature and perceived comfort were included in the study as possible mediating factors. In a randomized crossover design, 16 healthy females participated in two sessions, once under 2700K and once under 6500K light (both 55lx). Each session consisted of a baseline, a cool, a neutral and a warm thermal environment. Alertness as measured in a reaction time task was lower for the 6500K exposure, while subjective sleepiness was not affected by CCT. Also, core body temperature was higher under 6500K. Skin temperature parameters and perceived comfort were positively correlated with subjective sleepiness. Reaction time correlated with heat loss, but this association did not explain why the reaction time was improved for 2700K. Copyright © 2017 Elsevier Inc. All rights reserved.

Interactions between traditional Chinese medicine and western drugs in Taiwan: A population-based study.

PubMed

Chen, Kuan Chen; Lu, Richard; Iqbal, Usman; Hsu, Ko-Ching; Chen, Bi-Li; Nguyen, Phung-Anh; Yang, Hsuan-Chia; Huang, Chih-Wei; Li, Yu-Chuan Jack; Jian, Wen-Shan; Tsai, Shin-Han

2015-12-01

Drug-drug interactions have long been an active research area in clinical medicine. In Taiwan, however, the widespread use of traditional Chinese medicines (TCM) presents additional complexity to the topic. Therefore, it is important to see the interaction between traditional Chinese and western medicine. (1) To create a comprehensive database of multi-herb/western drug interactions indexed according to the ways in which physicians actually practice and (2) to measure this database's impact on the detection of adverse effects between traditional Chinese medicine compounds and western medicines. First, a multi-herb/western medicine drug interactions database was created by separating each TCM compound into its constituent herbs. Each individual herb was then checked against an existing single-herb/western drug interactions database. The data source comes from the National Health Insurance research database, which spans the years 1998-2011. This study estimated the interaction prevalence rate and further separated the rates according to patient characteristics, distribution by county, and hospital accreditation levels. Finally, this new database was integrated into a computer order entry module of the electronic medical records system of a regional teaching hospital. The effects it had were measured for two months. The most commonly interacting Chinese herbs were Ephedrae Herba and Angelicae Sinensis Radix/Angelicae Dahuricae Radix. Ephedrae Herba contains active ingredients similar to in ephedrine. 15 kinds of traditional Chinese medicine compounds contain Ephedrae Herba. Angelicae Sinensis Radix and Angelicae Dahuricae Radix contain ingredients similar to coumarin, a blood thinner. 9 kinds of traditional Chinese medicine compounds contained Angelicae Sinensis Radix/Angelicae Dahuricae Radix. In the period from 1998 to 2011, the prevalence of herb-drug interactions related to Ephedrae Herba was 0.18%. The most commonly prescribed traditional Chinese compounds were MA SHING GAN SHYR TANG (23.1%), followed by SHEAU CHING LONG TANG (15.5%) and DINQ CHUAN TANG (13.2%). The prevalence of herb-drug interactions related to Angelicae Sinensis Radix, Angelicae Dahuricae Radix was 4.59%. The most common traditional Chinese compound formula were TSANG EEL SAAN (32%), followed by HUOH SHIANG JENQ CHIH SAAN (31.4%) and SHY WUH TANG (10.7%). Once the multi-herb drug interaction database was deployed in a hospital system, there were 480 prescriptions that indicated a TCM-western drug interaction. Physicians were alerted 24 times during two months. These alerts resulted in a prescription change four times (16.7%). Due to the unique cultural factors that have resulted in widespread acceptance of both western and traditional Chinese medicine, Taiwan stands well positioned to report on the prevalence of interactions between western drugs and traditional Chinese medicine and devise ways to reduce their incidence. This study built a multi-herb/western drug interactions database, embedded inside a hospital clinical information system, and then examined the effects that drug interaction alerts had on clinician prescribing behaviour. The results demonstrated that western drug/traditional Chinese medicine interactions are prevalent and that western-trained physicians tend to change their prescribing behaviour more than traditional Chinese medicine physicians in their response to medication interaction alerts. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

What is the relationship between mental workload factors and cognitive load types?

PubMed

Galy, Edith; Cariou, Magali; Mélan, Claudine

2012-03-01

The present study tested the hypothesis of an additive interaction between intrinsic, extraneous and germane cognitive load, by manipulating factors of mental workload assumed to have a specific effect on either type of cognitive load. The study of cognitive load factors and their interaction is essential if we are to improve workers' wellbeing and safety at work. High cognitive load requires the individual to allocate extra resources to entering information. It is thought that this demand for extra resources may reduce processing efficiency and performance. The present study tested the effects of three factors thought to act on either cognitive load type, i.e. task difficulty, time pressure and alertness in a working memory task. Results revealed additive effects of task difficulty and time pressure, and a modulation by alertness on behavioral, subjective and psychophysiological workload measures. Mental overload can be the result of a combination of task-related components, but its occurrence may also depend on subject-related characteristics, including alertness. Solutions designed to reduce incidents and accidents at work should consider work organization in addition to task constraints in so far that both these factors may interfere with mental workload. Copyright © 2011 Elsevier B.V. All rights reserved.

Ocular exposure to blue-enriched light has an asymmetric influence on neural activity and spatial attention.

PubMed

Newman, Daniel P; Lockley, Steven W; Loughnane, Gerard M; Martins, Ana Carina P; Abe, Rafael; Zoratti, Marco T R; Kelly, Simon P; O'Neill, Megan H; Rajaratnam, Shantha M W; O'Connell, Redmond G; Bellgrove, Mark A

2016-06-13

Brain networks subserving alertness in humans interact with those for spatial attention orienting. We employed blue-enriched light to directly manipulate alertness in healthy volunteers. We show for the first time that prior exposure to higher, relative to lower, intensities of blue-enriched light speeds response times to left, but not right, hemifield visual stimuli, via an asymmetric effect on right-hemisphere parieto-occipital α-power. Our data give rise to the tantalising possibility of light-based interventions for right hemisphere disorders of spatial attention.

Ocular exposure to blue-enriched light has an asymmetric influence on neural activity and spatial attention

PubMed Central

Newman, Daniel P.; Lockley, Steven W.; Loughnane, Gerard M.; Martins, Ana Carina P.; Abe, Rafael; Zoratti, Marco T. R.; Kelly, Simon P.; O’Neill, Megan H.; Rajaratnam, Shantha M. W.; O’Connell, Redmond G.; Bellgrove, Mark A.

2016-01-01

Brain networks subserving alertness in humans interact with those for spatial attention orienting. We employed blue-enriched light to directly manipulate alertness in healthy volunteers. We show for the first time that prior exposure to higher, relative to lower, intensities of blue-enriched light speeds response times to left, but not right, hemifield visual stimuli, via an asymmetric effect on right-hemisphere parieto-occipital α-power. Our data give rise to the tantalising possibility of light-based interventions for right hemisphere disorders of spatial attention. PMID:27291291

STCA, TCAS, Airproxes and Collision Risk

NASA Astrophysics Data System (ADS)

Brooker, Peter

2005-09-01

The focus here is on the performance of and interaction between the Traffic Alert and Collision Avoidance System (TCAS) and the controller's short-term conflict alert (STCA) system. The data source used is UK Airprox Board Reports of close encounters between aircraft, and the focus is on commercial air transport aircraft using UK controlled airspace with a radar service. Do the systems work well together? Are controllers surprised when they find out that a pilot has received a TCAS resolution advisory? What do TCAS and STCA events say about collision risk? Generally, the systems seem to work together well. On most occasions, controllers are not surprised by TCAS advisories: either they have detected the problem themselves or STCA has alerted them to it. The statistically expected rate of future mid-air collisions is estimated by extrapolation of Airprox closest encounter distances.

JPL control/structure interaction test bed real-time control computer architecture

NASA Technical Reports Server (NTRS)

Briggs, Hugh C.

1989-01-01

The Control/Structure Interaction Program is a technology development program for spacecraft that exhibit interactions between the control system and structural dynamics. The program objectives include development and verification of new design concepts - such as active structure - and new tools - such as combined structure and control optimization algorithm - and their verification in ground and possibly flight test. A focus mission spacecraft was designed based upon a space interferometer and is the basis for design of the ground test article. The ground test bed objectives include verification of the spacecraft design concepts, the active structure elements and certain design tools such as the new combined structures and controls optimization tool. In anticipation of CSI technology flight experiments, the test bed control electronics must emulate the computation capacity and control architectures of space qualifiable systems as well as the command and control networks that will be used to connect investigators with the flight experiment hardware. The Test Bed facility electronics were functionally partitioned into three units: a laboratory data acquisition system for structural parameter identification and performance verification; an experiment supervisory computer to oversee the experiment, monitor the environmental parameters and perform data logging; and a multilevel real-time control computing system. The design of the Test Bed electronics is presented along with hardware and software component descriptions. The system should break new ground in experimental control electronics and is of interest to anyone working in the verification of control concepts for large structures.

Rett syndrome

MedlinePlus

... and height. Weight gain may improve alertness and social interaction. Medicines may be used to treat seizures. Supplements ... Bethesda, MD 20894 U.S. Department of Health and Human Services National Institutes of Health Page last updated: ...

Development of Attention Networks and Their Interactions in Childhood

ERIC Educational Resources Information Center

Pozuelos, Joan P.; Paz-Alonso, Pedro M.; Castillo, Alejandro; Fuentes, Luis J.; Rueda, M. Rosario

2014-01-01

In the present study, we investigated developmental trajectories of alerting, orienting, and executive attention networks and their interactions over childhood. Two cross-sectional experiments were conducted with different samples of 6-to 12-year-old children using modified versions of the attention network task (ANT). In Experiment 1 (N = 106),…

Structure alerts for carcinogenicity, and the Salmonella assay system: a novel insight through the chemical relational databases technology.

PubMed

Benigni, Romualdo; Bossa, Cecilia

2008-01-01

In the past decades, chemical carcinogenicity has been the object of mechanistic studies that have been translated into valuable experimental (e.g., the Salmonella assays system) and theoretical (e.g., compilations of structure alerts for chemical carcinogenicity) models. These findings remain the basis of the science and regulation of mutagens and carcinogens. Recent advances in the organization and treatment of large databases consisting of both biological and chemical information nowadays allows for a much easier and more refined view of data. This paper reviews recent analyses on the predictive performance of various lists of structure alerts, including a new compilation of alerts that combines previous work in an optimized form for computer implementation. The revised compilation is part of the Toxtree 1.50 software (freely available from the European Chemicals Bureau website). The use of structural alerts for the chemical biological profiling of a large database of Salmonella mutagenicity results is also reported. Together with being a repository of the science on the chemical biological interactions at the basis of chemical carcinogenicity, the SAs have a crucial role in practical applications for risk assessment, for: (a) description of sets of chemicals; (b) preliminary hazard characterization; (c) formation of categories for e.g., regulatory purposes; (d) generation of subsets of congeneric chemicals to be analyzed subsequently with QSAR methods; (e) priority setting. An important aspect of SAs as predictive toxicity tools is that they derive directly from mechanistic knowledge. The crucial role of mechanistic knowledge in the process of applying (Q)SAR considerations to risk assessment should be strongly emphasized. Mechanistic knowledge provides a ground for interaction and dialogue between model developers, toxicologists and regulators, and permits the integration of the (Q)SAR results into a wider regulatory framework, where different types of evidence and data concur or complement each other as a basis for making decisions and taking actions.

Geoethical issues involved in Tsunami Warning System concepts and operations

NASA Astrophysics Data System (ADS)

Charalampakis, Marinos; Papadopoulos, Gerassimos A.; Tinti, Stefano

2016-04-01

The main goal of a Tsunami Warning System (TWS) is to mitigate the effect of an incoming tsunami by alerting coastal population early enough to allow people to evacuate safely from inundation zones. Though this representation might seem oversimplified, nonetheless, achieving successfully this goal requires a positive synergy of geoscience, communication, emergency management, technology, education, social sciences, politics. Geoethical issues arise always when there is an interaction between geoscience and society, and TWS is a paradigmatic case where interaction is very strong and is made critical because a) the formulation of the tsunami alert has to be made in a time as short as possible and therefore on uncertain data, and b) any evaluation error (underestimation or overestimation) can lead to serious (and sometimes catastrophic) consequences involving wide areas and a large amount of population. From the geoethical point of view three issues are critical: how to (i) combine forecasts and uncertainties reasonably and usefully, (ii) cope and possibly solve the dilemma whether it is better over-alerting or under-alerting population and (iii) deal with responsibility and liability of geoscientists, TWS operators, emergency operators and coastal population. The discussion will be based on the experience of the Hellenic National Tsunami Warning Center (HL-NTWC, Greece), which operates on 24/7 basis as a special unit of the Institute of Geodynamics, National Observatory of Athens, and acts also as Candidate Tsunami Service Provider (CTSP) in the framework of the North-Eastern Atlantic, the Mediterranean and connected seas Tsunami Warning System (NEAMTWS) of the IOC/UNESCO. Since August 2012, when HL-NTWC was officially declared as operational, 14 tsunami warning messages have been disseminated to a large number of subscribers after strong submarine earthquakes occurring in Greece and elsewhere in the eastern Mediterranean. It is recognized that the alerting process and procedure are quite complex and deserve an open and wide debate, that at the moment seems to be absent from media, scientific community and society, very likely until the next tsunami disaster.

TU-C-BRE-11: 3D EPID-Based in Vivo Dosimetry: A Major Step Forward Towards Optimal Quality and Safety in Radiation Oncology Practice

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

Mijnheer, B; Mans, A; Olaciregui-Ruiz, I

Purpose: To develop a 3D in vivo dosimetry method that is able to substitute pre-treatment verification in an efficient way, and to terminate treatment delivery if the online measured 3D dose distribution deviates too much from the predicted dose distribution. Methods: A back-projection algorithm has been further developed and implemented to enable automatic 3D in vivo dose verification of IMRT/VMAT treatments using a-Si EPIDs. New software tools were clinically introduced to allow automated image acquisition, to periodically inspect the record-and-verify database, and to automatically run the EPID dosimetry software. The comparison of the EPID-reconstructed and planned dose distribution is donemore » offline to raise automatically alerts and to schedule actions when deviations are detected. Furthermore, a software package for online dose reconstruction was also developed. The RMS of the difference between the cumulative planned and reconstructed 3D dose distributions was used for triggering a halt of a linac. Results: The implementation of fully automated 3D EPID-based in vivo dosimetry was able to replace pre-treatment verification for more than 90% of the patient treatments. The process has been fully automated and integrated in our clinical workflow where over 3,500 IMRT/VMAT treatments are verified each year. By optimizing the dose reconstruction algorithm and the I/O performance, the delivered 3D dose distribution is verified in less than 200 ms per portal image, which includes the comparison between the reconstructed and planned dose distribution. In this way it was possible to generate a trigger that can stop the irradiation at less than 20 cGy after introducing large delivery errors. Conclusion: The automatic offline solution facilitated the large scale clinical implementation of 3D EPID-based in vivo dose verification of IMRT/VMAT treatments; the online approach has been successfully tested for various severe delivery errors.« less

WE-D-BRA-04: Online 3D EPID-Based Dose Verification for Optimum Patient Safety

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

Spreeuw, H; Rozendaal, R; Olaciregui-Ruiz, I

2015-06-15

Purpose: To develop an online 3D dose verification tool based on EPID transit dosimetry to ensure optimum patient safety in radiotherapy treatments. Methods: A new software package was developed which processes EPID portal images online using a back-projection algorithm for the 3D dose reconstruction. The package processes portal images faster than the acquisition rate of the portal imager (∼ 2.5 fps). After a portal image is acquired, the software seeks for “hot spots” in the reconstructed 3D dose distribution. A hot spot is in this study defined as a 4 cm{sup 3} cube where the average cumulative reconstructed dose exceedsmore » the average total planned dose by at least 20% and 50 cGy. If a hot spot is detected, an alert is generated resulting in a linac halt. The software has been tested by irradiating an Alderson phantom after introducing various types of serious delivery errors. Results: In our first experiment the Alderson phantom was irradiated with two arcs from a 6 MV VMAT H&N treatment having a large leaf position error or a large monitor unit error. For both arcs and both errors the linac was halted before dose delivery was completed. When no error was introduced, the linac was not halted. The complete processing of a single portal frame, including hot spot detection, takes about 220 ms on a dual hexacore Intel Xeon 25 X5650 CPU at 2.66 GHz. Conclusion: A prototype online 3D dose verification tool using portal imaging has been developed and successfully tested for various kinds of gross delivery errors. The detection of hot spots was proven to be effective for the timely detection of these errors. Current work is focused on hot spot detection criteria for various treatment sites and the introduction of a clinical pilot program with online verification of hypo-fractionated (lung) treatments.« less

National Rules for Drug–Drug Interactions: Are They Appropriate for Tertiary Hospitals?

PubMed Central

2016-01-01

The application of appropriate rules for drug–drug interactions (DDIs) could substantially reduce the number of adverse drug events. However, current implementations of such rules in tertiary hospitals are problematic as physicians are receiving too many alerts, causing high override rates and alert fatigue. We investigated the potential impact of Korean national DDI rules in a drug utilization review program in terms of their severity coverage and the clinical efficiency of how physicians respond to them. Using lists of high-priority DDIs developed with the support of the U.S. government, we evaluated 706 contraindicated DDI pairs released in May 2015. We evaluated clinical log data from one tertiary hospital and prescription data from two other tertiary hospitals. The measured parameters were national DDI rule coverage for high-priority DDIs, alert override rate, and number of prescription pairs. The coverage rates of national DDI rules were 80% and 3.0% at the class and drug levels, respectively. The analysis of the system log data showed an overall override rate of 79.6%. Only 0.3% of all of the alerts (n = 66) were high-priority DDI rules. These showed a lower override rate of 51.5%, which was much lower than for the overall DDI rules. We also found 342 and 80 unmatched high-priority DDI pairs which were absent in national rules in inpatient orders from the other two hospitals. The national DDI rules are not complete in terms of their coverage of severe DDIs. They also lack clinical efficiency in tertiary settings, suggesting improved systematic approaches are needed. PMID:27822925

Investigating the interaction between the homeostatic and circadian processes of sleep-wake regulation for the prediction of waking neurobehavioural performance

NASA Technical Reports Server (NTRS)

Van Dongen, Hans P A.; Dinges, David F.

2003-01-01

The two-process model of sleep regulation has been applied successfully to describe, predict, and understand sleep-wake regulation in a variety of experimental protocols such as sleep deprivation and forced desynchrony. A non-linear interaction between the homeostatic and circadian processes was reported when the model was applied to describe alertness and performance data obtained during forced desynchrony. This non-linear interaction could also be due to intrinsic non-linearity in the metrics used to measure alertness and performance, however. Distinguishing these possibilities would be of theoretical interest, but could also have important implications for the design and interpretation of experiments placing sleep at different circadian phases or varying the duration of sleep and/or wakefulness. Although to date no resolution to this controversy has been found, here we show that the issue can be addressed with existing data sets. The interaction between the homeostatic and circadian processes of sleep-wake regulation was investigated using neurobehavioural performance data from a laboratory experiment involving total sleep deprivation. The results provided evidence of an actual non-linear interaction between the homeostatic and circadian processes of sleep-wake regulation for the prediction of waking neurobehavioural performance.

Co-Prescription Trends in a Large Cohort of Subjects Predict Substantial Drug-Drug Interactions

PubMed Central

Sutherland, Jeffrey J.; Daly, Thomas M.; Liu, Xiong; Goldstein, Keith; Johnston, Joseph A.; Ryan, Timothy P.

2015-01-01

Pharmaceutical prescribing and drug-drug interaction data underlie recommendations on drug combinations that should be avoided or closely monitored by prescribers. Because the number of patients taking multiple medications is increasing, a comprehensive view of prescribing patterns in patients is important to better assess real world pharmaceutical response and evaluate the potential for multi-drug interactions. We obtained self-reported prescription data from NHANES surveys between 1999 and 2010, and confirm the previously reported finding of increasing drug use in the elderly. We studied co-prescription drug trends by focusing on the 2009-2010 survey, which contains prescription data on 690 drugs used by 10,537 subjects. We found that medication profiles were unique for individuals aged 65 years or more, with ≥98 unique drug regimens encountered per 100 subjects taking 3 or more medications. When drugs were viewed by therapeutic class, it was found that the most commonly prescribed drugs were not the most commonly co-prescribed drugs for any of the 16 drug classes investigated. We cross-referenced these medication lists with drug interaction data from Drugs.com to evaluate the potential for drug interactions. The number of drug alerts rose proportionally with the number of co-prescribed medications, rising from 3.3 alerts for individuals prescribed 5 medications to 11.7 alerts for individuals prescribed 10 medications. We found 22% of elderly subjects taking both a substrate and inhibitor of a given cytochrome P450 enzyme, and 4% taking multiple inhibitors of the same enzyme simultaneously. By examining drug pairs prescribed in 0.1% of the population or more, we found low agreement between co-prescription rate and co-discussion in the literature. These data show that prescribing trends in treatment could drive a large extent of individual variability in drug response, and that current pairwise approaches to assessing drug-drug interactions may be inadequate for predicting real world outcomes. PMID:25739022

Projected Impact of Compositional Verification on Current and Future Aviation Safety Risk

NASA Technical Reports Server (NTRS)

Reveley, Mary S.; Withrow, Colleen A.; Leone, Karen M.; Jones, Sharon M.

2014-01-01

The projected impact of compositional verification research conducted by the National Aeronautic and Space Administration System-Wide Safety and Assurance Technologies on aviation safety risk was assessed. Software and compositional verification was described. Traditional verification techniques have two major problems: testing at the prototype stage where error discovery can be quite costly and the inability to test for all potential interactions leaving some errors undetected until used by the end user. Increasingly complex and nondeterministic aviation systems are becoming too large for these tools to check and verify. Compositional verification is a "divide and conquer" solution to addressing increasingly larger and more complex systems. A review of compositional verification research being conducted by academia, industry, and Government agencies is provided. Forty-four aviation safety risks in the Biennial NextGen Safety Issues Survey were identified that could be impacted by compositional verification and grouped into five categories: automation design; system complexity; software, flight control, or equipment failure or malfunction; new technology or operations; and verification and validation. One capability, 1 research action, 5 operational improvements, and 13 enablers within the Federal Aviation Administration Joint Planning and Development Office Integrated Work Plan that could be addressed by compositional verification were identified.

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

National Centers for Environmental Prediction

Science.gov Websites

Reference List Table of Contents NCEP OPERATIONAL MODEL FORECAST GRAPHICS PARALLEL/EXPERIMENTAL MODEL Developmental Air Quality Forecasts and Verification Back to Table of Contents 2. PARALLEL/EXPERIMENTAL GRAPHICS VERIFICATION (GRID VS.OBS) WEB PAGE (NCEP EXPERIMENTAL PAGE, INTERNAL USE ONLY) Interactive web page tool for

Mechanical verification of a schematic Byzantine clock synchronization algorithm

NASA Technical Reports Server (NTRS)

Shankar, Natarajan

1991-01-01

Schneider generalizes a number of protocols for Byzantine fault tolerant clock synchronization and presents a uniform proof for their correctness. The authors present a machine checked proof of this schematic protocol that revises some of the details in Schneider's original analysis. The verification was carried out with the EHDM system developed at the SRI Computer Science Laboratory. The mechanically checked proofs include the verification that the egocentric mean function used in Lamport and Melliar-Smith's Interactive Convergence Algorithm satisfies the requirements of Schneider's protocol.

Real-Time Mapping alert system; characteristics and capabilities

USGS Publications Warehouse

Torres, L.A.; Lambert, S.C.; Liebermann, T.D.

1995-01-01

The U.S. Geological Survey has an extensive hydrologic network that records and transmits precipitation, stage, discharge, and other water-related data on a real-time basis to an automated data processing system. Data values are recorded on electronic data collection platforms at field sampling sites. These values are transmitted by means of orbiting satellites to receiving ground stations, and by way of telecommunication lines to a U.S. Geological Survey office where they are processed on a computer system. Data that exceed predefined thresholds are identified as alert values. The current alert status at monitoring sites within a state or region is of critical importance during floods, hurricanes, and other extreme hydrologic events. This report describes the characteristics and capabilities of a series of computer programs for real-time mapping of hydrologic data. The software provides interactive graphics display and query of hydrologic information from the network in a real-time, map-based, menu-driven environment.

Next Generation Monitoring: Tier 2 Experience

NASA Astrophysics Data System (ADS)

Fay, R.; Bland, J.; Jones, S.

2017-10-01

Monitoring IT infrastructure is essential for maximizing availability and minimizing disruption by detecting failures and developing issues. The HEP group at Liverpool have recently updated our monitoring infrastructure with the goal of increasing coverage, improving visualization capabilities, and streamlining configuration and maintenance. Here we present a summary of Liverpool’s experience, the monitoring infrastructure, and the tools used to build it. In brief, system checks are configured in Puppet using Hiera, and managed by Sensu, replacing Nagios. Centralised logging is managed with Elasticsearch, together with Logstash and Filebeat. Kibana provides an interface for interactive analysis, including visualization and dashboards. Metric collection is also configured in Puppet, managed by collectd and stored in Graphite, with Grafana providing a visualization and dashboard tool. The Uchiwa dashboard for Sensu provides a web interface for viewing infrastructure status. Alert capabilities are provided via external handlers. A custom alert handler is in development to provide an easily configurable, extensible and maintainable alert facility.

Potential Drug-Drug Interactions in a Cohort of Elderly, Polymedicated Primary Care Patients on Antithrombotic Treatment.

PubMed

Schneider, Katharina Luise; Kastenmüller, Kathrin; Weckbecker, Klaus; Bleckwenn, Markus; Böhme, Miriam; Stingl, Julia Carolin

2018-06-01

Drug-drug interactions (DDIs) are an important risk factor for adverse drug reactions. Older, polymedicated patients are particularly affected. Although antithrombotics have been detected as high-risk drugs for DDIs, data on older patients exposed to them are scarce. Baseline data of 365 IDrug study outpatients (≥ 60 years, use of an antithrombotic and one or more additional long-term drug) were analyzed regarding potential drug-drug interactions (pDDIs) with a clinical decision support system. Data included prescription and self-medication drugs. The prevalence of having one or more pDDI was 85.2%. The median number of alerts per patient was three (range 0-17). For 58.4% of the patients, potential severe/contraindicated interactions were detected. Antiplatelets and non-steroidal anti-inflammatory drugs (NSAIDs) showed the highest number of average pDDI alert involvements per use (2.9 and 2.2, respectively). For NSAIDs, also the highest average number of severe/contraindicated alert involvements per use (1.2) was observed. 91.8% of all pDDI involvements concerned the 25 most frequently used drug classes. 97.5% of the severe/contraindicated pDDIs were attributed to only nine different potential clinical manifestations. The most common management recommendation for severe/contraindicated pDDIs was to intensify monitoring. Number of drugs was the only detected factor significantly associated with increased number of pDDIs (p < 0.001). The findings indicate a high risk for pDDIs in older, polymedicated patients on antithrombotics. As a consequence of patients' frequently similar drug regimens, the variety of potential clinical manifestations was small. Awareness of these pDDI symptoms and the triggering drugs as well as patients' self-medication use may contribute to increased patient safety.

American Association of Poison Control Centers

MedlinePlus

... all alerts right left NEW! Check out PoisonHelp.org Now there are two ways to get help ... AAPCC's new interactive online poison information tool, PoisonHelp.org. PoisonHelp.org Make your smartphone even smarter. Text " ...

Computer-assisted upper extremity training using interactive biking exercise (iBikE) platform.

PubMed

Jeong, In Cheol; Finkelstein, Joseph

2012-01-01

Upper extremity exercise training has been shown to improve clinical outcomes in different chronic health conditions. Arm-operated bicycles are frequently used to facilitate upper extremity training however effective use of these devices at patient homes is hampered by lack of remote connectivity with clinical rehabilitation team, inability to monitor exercise progress in real time using simple graphical representation, and absence of an alert system which would prevent exertion levels exceeding those approved by the clinical rehabilitation team. We developed an interactive biking exercise (iBikE) platform aimed at addressing these limitations. The platform uses a miniature wireless 3-axis accelerometer mounted on a patient wrist that transmits the cycling acceleration data to a laptop. The laptop screen presents an exercise dashboard to the patient in real time allowing easy graphical visualization of exercise progress and presentation of exercise parameters in relation to prescribed targets. The iBikE platform is programmed to alert the patient when exercise intensity exceeds the levels recommended by the patient care provider. The iBikE platform has been tested in 7 healthy volunteers (age range: 26-50 years) and shown to reliably reflect exercise progress and to generate alerts at pre-setup levels. Implementation of remote connectivity with patient rehabilitation team is warranted for future extension and evaluation efforts.

The Interaction between Surface Color and Color Knowledge: Behavioral and Electrophysiological Evidence

ERIC Educational Resources Information Center

Bramao, Ines; Faisca, Luis; Forkstam, Christian; Inacio, Filomena; Araujo, Susana; Petersson, Karl Magnus; Reis, Alexandra

2012-01-01

In this study, we used event-related potentials (ERPs) to evaluate the contribution of surface color and color knowledge information in object identification. We constructed two color-object verification tasks--a surface and a knowledge verification task--using high color diagnostic objects; both typical and atypical color versions of the same…

Verification of the FtCayuga fault-tolerant microprocessor system. Volume 2: Formal specification and correctness theorems

NASA Technical Reports Server (NTRS)

Bickford, Mark; Srivas, Mandayam

1991-01-01

Presented here is a formal specification and verification of a property of a quadruplicately redundant fault tolerant microprocessor system design. A complete listing of the formal specification of the system and the correctness theorems that are proved are given. The system performs the task of obtaining interactive consistency among the processors using a special instruction on the processors. The design is based on an algorithm proposed by Pease, Shostak, and Lamport. The property verified insures that an execution of the special instruction by the processors correctly accomplishes interactive consistency, providing certain preconditions hold, using a computer aided design verification tool, Spectool, and the theorem prover, Clio. A major contribution of the work is the demonstration of a significant fault tolerant hardware design that is mechanically verified by a theorem prover.

Education and Training Module in Alertness Management

NASA Technical Reports Server (NTRS)

Mallis, M. M.; Brandt, S. L.; Oyung, R. L.; Reduta, D. D.; Rosekind, M. R.

2006-01-01

The education and training module (ETM) in alertness management has now been integrated as part of the training regimen of the Pilot Proficiency Awards Program ("WINGS") of the Federal Aviation Administration. Originated and now maintained current by the Fatigue Countermeasures Group at NASA Ames Research Center, the ETM in Alertness Management is designed to give pilots the benefit of the best and most recent research on the basics of sleep physiology, the causes of fatigue, and strategies for managing alertness during flight operations. The WINGS program is an incentive program that encourages pilots at all licensing levels to participate in recurrent training, upon completion of which distinctive lapel or tie pins (wings) and certificates of completion are awarded. In addition to flight training, all WINGS applicants must attend at least one FAA-sponsored safety seminar, FAA-sanctioned safety seminar, or industry recurrent training program. The Fatigue Countermeasures Group provides an FAA-approved industry recurrent training program through an on-line General Aviation (GA) WINGS ETM in alertness management to satisfy this requirement. Since 1993, the Fatigue Countermeasures Group has translated fatigue and alertness information to operational environments by conducting two-day ETM workshops oriented primarily toward air-carrier operations subject to Part 121 of the Federal Aviation Regulations pertaining to such operations. On the basis of the information presented in the two-day ETM workshops, an ETM was created for GA pilots and was transferred to a Web-based version. To comply with the requirements of the WINGS Program, the original Web-based version has been modified to include hypertext markup language (HTML) content that makes information easily accessible, in-depth testing of alertness-management knowledge, new interactive features, and increased informational resources for GA pilots. Upon successful completion of this training module, a participant receives a computer- screen display of a certificate of completion. The certificate, which includes the pilot s name and an identifying number, can be printed out and submitted, for ground training credit, with the pilot s WINGS application.

A fresh look at runway incursions: onboard surface movement awareness and alerting system based on SVS

NASA Astrophysics Data System (ADS)

Vernaleken, Christoph; Mihalic, Lamir; Güttler, Mathias; Klingauf, Uwe

2006-05-01

Increasing traffic density on the aerodrome surface due to the continuous worldwide growth in the number of flight operations does not only cause capacity and efficiency problems, but also increases the risk of serious incidents and accidents on the airport movement area. Of these, Runway Incursions are the by far most safety-critical. In fact, the worst-ever accident in civil aviation, the collision of two Boeing B747s on Tenerife in 1977 with 583 fatalities, was caused by a Runway Incursion. Therefore, various Runway Safety programs have recently been initiated around the globe, often focusing on ground-based measures such as improved surveillance. However, as a lack of flight crew situational awareness is a key causal factor in many Runway Incursion incidents and accidents, there is a strong need for an onboard solution, which should be capable of interacting cooperatively with ground-based ATM systems, such as A-SMGCS where available. This paper defines the concept of preventive and reactive Runway Incursion avoidance and describes a Surface Movement Awareness & Alerting System (SMAAS) designed to alert the flight crew if they are at risk of infringing a runway. Both the SVS flight deck displays and the corresponding alerting algorithms utilize an ED 99A/RTCA DO-272A compliant aerodrome database, as well as airport operational, traffic and clearance data received via ADS-B or other data links, respectively. The displays provide the crew with enhanced positional, operational, clearance and traffic awareness, and they are used to visualize alerts. A future enhancement of the system will provide intelligent alerting for conflicts caused by surrounding traffic.

31 CFR 901.4 - Reporting debts.

Code of Federal Regulations, 2011 CFR

2011-07-01

... and Urban Development's Credit Alert Interactive Voice Response System (CAIVRS). For information about the CAIVRS program, agencies should contact the Director of Information Resources Management Policy and Management Division, Office of Information Technology, Department of Housing and Urban Development...

31 CFR 901.4 - Reporting debts.

Code of Federal Regulations, 2010 CFR

2010-07-01

... and Urban Development's Credit Alert Interactive Voice Response System (CAIVRS). For information about the CAIVRS program, agencies should contact the Director of Information Resources Management Policy and Management Division, Office of Information Technology, Department of Housing and Urban Development...

Effects of operating practices on commercial driver alertness

DOT National Transportation Integrated Search

1999-09-01

This report summarizes the results of a one-year effort to establish the interaction between operating practices in the trucking industry and driver performance, particularly with respect to safety and fatigue. Principal topics were: Loading and unlo...

Recommendations for selecting drug-drug interactions for clinical decision support.

PubMed

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

2016-04-15

Recommendations for including drug-drug interactions (DDIs) in clinical decision support (CDS) are presented. A conference series was conducted to improve CDS for DDIs. A work group consisting of 20 experts in pharmacology, drug information, and CDS from academia, government agencies, health information vendors, and healthcare organizations was convened to address (1) the process to use for developing and maintaining a standard set of DDIs, (2) the information that should be included in a knowledge base of standard DDIs, (3) whether a list of contraindicated drug pairs can or should be established, and (4) how to more intelligently filter DDI alerts. 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 and more research to identify methods to safely reduce repetitive and less-relevant alerts. An expert panel with a centralized organizer or convener should be established to develop and maintain a standard set of DDIs for CDS in the United States. The process should be evidence driven, transparent, and systematic, with feedback from multiple stakeholders for continuous improvement. The scope of the expert panel's work should be carefully managed to ensure that the process is sustainable. Support for research to improve DDI alerting in the future is also needed. Adoption of these steps may lead to consistent and clinically relevant content for interruptive DDIs, thus reducing alert fatigue and improving patient safety. Copyright © 2016 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Simultaneous recordings from the primary visual cortex and lateral geniculate nucleus reveal rhythmic interactions and a cortical source for γ-band oscillations.

PubMed

Bastos, Andre M; Briggs, Farran; Alitto, Henry J; Mangun, George R; Usrey, W Martin

2014-05-28

Oscillatory synchronization of neuronal activity has been proposed as a mechanism to modulate effective connectivity between interacting neuronal populations. In the visual system, oscillations in the gamma-frequency range (30-100 Hz) are thought to subserve corticocortical communication. To test whether a similar mechanism might influence subcortical-cortical communication, we recorded local field potential activity from retinotopically aligned regions in the lateral geniculate nucleus (LGN) and primary visual cortex (V1) of alert macaque monkeys viewing stimuli known to produce strong cortical gamma-band oscillations. As predicted, we found robust gamma-band power in V1. In contrast, visual stimulation did not evoke gamma-band activity in the LGN. Interestingly, an analysis of oscillatory phase synchronization of LGN and V1 activity identified synchronization in the alpha (8-14 Hz) and beta (15-30 Hz) frequency bands. Further analysis of directed connectivity revealed that alpha-band interactions mediated corticogeniculate feedback processing, whereas beta-band interactions mediated geniculocortical feedforward processing. These results demonstrate that although the LGN and V1 display functional interactions in the lower frequency bands, gamma-band activity in the alert monkey is largely an emergent property of cortex. Copyright © 2014 the authors 0270-6474/14/347639-06$15.00/0.

Postural control system influences intrinsic alerting state.

PubMed

Barra, Julien; Auclair, Laurent; Charvillat, Agnès; Vidal, Manuel; Pérennou, Dominic

2015-03-01

Numerous studies using dual-task paradigms (postural and cognitive) have shown that postural control requires cognitive resources. However, the influence of postural control on attention components has never been directly addressed. Using the attention network test (ANT), which assesses specifically each of the 3 components of attention-alertness, orientation, and executive control-within a single paradigm, we investigated the effect of postural balance demand on these 3 components. Forty-two participants completed the ANT in 3 postural conditions: (a) supine, a very stable position; (b) sitting on a chair, an intermediate position; and (c) standing with feet lined up heel to toe, a very instable position known as the Romberg position. Our results revealed that the difficulty of postural control does modulate alerting in such a way that it improves with the level of instability of the position. Regarding the orienting and executive control components of attention, performance was not different when participants were standing upright or seated, whereas in the supine position, performance dropped. The strong and specific interaction between postural control and the alerting system suggests that these mechanisms may share parts of the underlying neural circuits. We discuss the possible implication of the locus coeruleus, known to be involved in both postural balance and alerting. Also, our findings concerning orienting and executive control systems suggest that supine posture could have a specific effect on cognitive activities. These effects are discussed in terms of particularities resulting from the supine position. PsycINFO Database Record (c) 2015 APA, all rights reserved.

Environmental Technology Verification Program Advanced Monitoring Systems Center Quality Assurance Project Plan for Verification of Black Carbon Monitors

EPA Science Inventory

Black carbon is a term that is commonly used to describe strongly light absorbing carbon (LAC), which is thought to play a significant role in global climate change through direct absorption of light, interaction with clouds, and by reducing the reflectivity of snow and ice. BC ...

Control/structure interaction design methodology

NASA Technical Reports Server (NTRS)

Briggs, Hugh C.; Layman, William E.

1989-01-01

The Control Structure Interaction Program is a technology development program for spacecraft that exhibit interactions between the control system and structural dynamics. The program objectives include development and verification of new design concepts (such as active structure) and new tools (such as a combined structure and control optimization algorithm) and their verification in ground and possibly flight test. The new CSI design methodology is centered around interdisciplinary engineers using new tools that closely integrate structures and controls. Verification is an important CSI theme and analysts will be closely integrated to the CSI Test Bed laboratory. Components, concepts, tools and algorithms will be developed and tested in the lab and in future Shuttle-based flight experiments. The design methodology is summarized in block diagrams depicting the evolution of a spacecraft design and descriptions of analytical capabilities used in the process. The multiyear JPL CSI implementation plan is described along with the essentials of several new tools. A distributed network of computation servers and workstations was designed that will provide a state-of-the-art development base for the CSI technologies.

A formally verified algorithm for interactive consistency under a hybrid fault model

NASA Technical Reports Server (NTRS)

Lincoln, Patrick; Rushby, John

1993-01-01

Consistent distribution of single-source data to replicated computing channels is a fundamental problem in fault-tolerant system design. The 'Oral Messages' (OM) algorithm solves this problem of Interactive Consistency (Byzantine Agreement) assuming that all faults are worst-cass. Thambidurai and Park introduced a 'hybrid' fault model that distinguished three fault modes: asymmetric (Byzantine), symmetric, and benign; they also exhibited, along with an informal 'proof of correctness', a modified version of OM. Unfortunately, their algorithm is flawed. The discipline of mechanically checked formal verification eventually enabled us to develop a correct algorithm for Interactive Consistency under the hybrid fault model. This algorithm withstands $a$ asymmetric, $s$ symmetric, and $b$ benign faults simultaneously, using $m+1$ rounds, provided $n is greater than 2a + 2s + b + m$, and $m\\geg a$. We present this algorithm, discuss its subtle points, and describe its formal specification and verification in PVS. We argue that formal verification systems such as PVS are now sufficiently effective that their application to fault-tolerance algorithms should be considered routine.

Study of the penetration of a plate made of titanium alloy VT6 with a steel ball

NASA Astrophysics Data System (ADS)

Buzyurkin, A. E.

2018-03-01

The purpose of this work is the development and verification of mathematical relationships, adapted to the package of finite element analysis LS-DYNA and describing the deformation and destruction of a titanium plate in a high-speed collision. Using data from experiments on the interaction of a steel ball with a titanium plate made of VT6 alloy, verification of the available constants necessary for describing the behavior of the material using the Johnson-Cook relationships was performed, as well as verification of the parameters of the fracture model used in the numerical modeling of the collision process. An analysis of experimental data on the interaction of a spherical impactor with a plate showed that the data accepted for VT6 alloy in the first approximation for deformation hardening in the Johnson-Cook model give too high results on the residual velocities of the impactor when piercing the plate.

Formal verification of a fault tolerant clock synchronization algorithm

NASA Technical Reports Server (NTRS)

Rushby, John; Vonhenke, Frieder

1989-01-01

A formal specification and mechanically assisted verification of the interactive convergence clock synchronization algorithm of Lamport and Melliar-Smith is described. Several technical flaws in the analysis given by Lamport and Melliar-Smith were discovered, even though their presentation is unusally precise and detailed. It seems that these flaws were not detected by informal peer scrutiny. The flaws are discussed and a revised presentation of the analysis is given that not only corrects the flaws but is also more precise and easier to follow. Some of the corrections to the flaws require slight modifications to the original assumptions underlying the algorithm and to the constraints on its parameters, and thus change the external specifications of the algorithm. The formal analysis of the interactive convergence clock synchronization algorithm was performed using the Enhanced Hierarchical Development Methodology (EHDM) formal specification and verification environment. This application of EHDM provides a demonstration of some of the capabilities of the system.

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.

Douglas flight deck design philosophy

NASA Technical Reports Server (NTRS)

Oldale, Paul

1990-01-01

The systems experience gained from 17 years of DC-10 operation was used during the design of the MD-11 to automate system operation and reduce crew workload. All functions, from preflight to shutdown at the termination of flight, require little input from the crew. The MD-11 aircraft systems are monitored for proper operation by the Aircraft Systems Controllers (ASC). In most cases, system reconfiguration as a result of a malfunction is automated. Manual input is required for irreversible actions such as engine shutdown, fuel dump, fire agent discharge, or Integrated Drive Generator (IDG) disconnect. During normal operations, when the cockpit is configured for flight, all annunciators on the overhead panel will be extinguished. This Dark Cockpit immediately confirms to the crew that the panels are correctly configured and that no abnormalities are present. Primary systems annunciations are shown in text on the Alert Area of the Engine and Alert Display (EAD). This eliminates the need to scan the overhead. The MD-11 aircraft systems can be manually controlled from the overhead area of the cockpit. The center portion of the overhead panel is composed of the primary aircraft systems panels, which include FUEL, AIR, Electrical (ELEC) and Hydraulic (HYD) systems, which are easily accessible from both flight crew positions. Each Aircraft Systems Controller (ASC) has two automatic channels and a manual mode. All rectangular lights are annunciators. All square lights are combined switches and annunciators called switch/lights. Red switch/lights on the overhead (Level 3 alerts) are for conditions requiring immediate crew action. Amber (Level 2 or Level 1 alerts) indicates a fault or switch out of position requiring awareness or crew interaction. Overhead switches used in normal operating conditions will illuminate blue when in use (Level 0 alerts) such as WING ANTI-ICE - ON. An overhead switch/light with BLACK LETTERING on an amber or red background indicates a system failure and that crew interaction is required. A switch/light with blue or amber lettering and a BLACK BACKGROUND indicates a switch out of normal position and that crew action is necessary only if the system is in manual operation.

Can self-verification strivings fully transcend the self-other barrier? Seeking verification of ingroup identities.

PubMed

Gómez, Angel; Seyle, D Conor; Huici, Carmen; Swann, William B

2009-12-01

Recent research has demonstrated self-verification strivings in groups, such that people strive to verify collective identities, which are personal self-views (e.g., "sensitive") associated with group membership (e.g., "women"). Such demonstrations stop short of showing that the desire for self-verification can fully transcend the self-other barrier, as in people working to verify ingroup identities (e.g., "Americans are loud") even when such identities are not self-descriptive ("I am quiet and unassuming"). Five studies focus on such ingroup verification strivings. Results indicate that people prefer to interact with individuals who verify their ingroup identities over those who enhance these identities (Experiments 1-5). Strivings for ingroup identity verification were independent of the extent to which the identities were self-descriptive but were stronger among participants who were highly invested in their ingroup identities, as reflected in high certainty of these identities (Experiments 1-4) and high identification with the group (Experiments 1-5). In addition, whereas past demonstrations of self-verification strivings have been limited to efforts to verify the content of identities (Experiments 1 to 3), the findings also show that they strive to verify the valence of their identities (i.e., the extent to which the identities are valued; Experiments 4 and 5). Self-verification strivings, rather than self-enhancement strivings, appeared to motivate participants' strivings for ingroup identity verification. Links to collective self-verification strivings and social identity theory are discussed.

Improving visual spatial working memory in younger and older adults: effects of cross-modal cues.

PubMed

Curtis, Ashley F; Turner, Gary R; Park, Norman W; Murtha, Susan J E

2017-11-06

Spatially informative auditory and vibrotactile (cross-modal) cues can facilitate attention but little is known about how similar cues influence visual spatial working memory (WM) across the adult lifespan. We investigated the effects of cues (spatially informative or alerting pre-cues vs. no cues), cue modality (auditory vs. vibrotactile vs. visual), memory array size (four vs. six items), and maintenance delay (900 vs. 1800 ms) on visual spatial location WM recognition accuracy in younger adults (YA) and older adults (OA). We observed a significant interaction between spatially informative pre-cue type, array size, and delay. OA and YA benefitted equally from spatially informative pre-cues, suggesting that attentional orienting prior to WM encoding, regardless of cue modality, is preserved with age.  Contrary to predictions, alerting pre-cues generally impaired performance in both age groups, suggesting that maintaining a vigilant state of arousal by facilitating the alerting attention system does not help visual spatial location WM.

Development of a Human Motor Model for the Evaluation of an Integrated Alerting and Notification Flight Deck System

NASA Technical Reports Server (NTRS)

Daiker, Ron; Schnell, Thomas

2010-01-01

A human motor model was developed on the basis of performance data that was collected in a flight simulator. The motor model is under consideration as one component of a virtual pilot model for the evaluation of NextGen crew alerting and notification systems in flight decks. This model may be used in a digital Monte Carlo simulation to compare flight deck layout design alternatives. The virtual pilot model is being developed as part of a NASA project to evaluate multiple crews alerting and notification flight deck configurations. Model parameters were derived from empirical distributions of pilot data collected in a flight simulator experiment. The goal of this model is to simulate pilot motor performance in the approach-to-landing task. The unique challenges associated with modeling the complex dynamics of humans interacting with the cockpit environment are discussed, along with the current state and future direction of the model.

Formal verification of an MMU and MMU cache

NASA Technical Reports Server (NTRS)

Schubert, E. T.

1991-01-01

We describe the formal verification of a hardware subsystem consisting of a memory management unit and a cache. These devices are verified independently and then shown to interact correctly when composed. The MMU authorizes memory requests and translates virtual addresses to real addresses. The cache improves performance by maintaining a LRU (least recently used) list from the memory resident segment table.

Verification of fluid-structure-interaction algorithms through the method of manufactured solutions for actuator-line applications

NASA Astrophysics Data System (ADS)

Vijayakumar, Ganesh; Sprague, Michael

2017-11-01

Demonstrating expected convergence rates with spatial- and temporal-grid refinement is the ``gold standard'' of code and algorithm verification. However, the lack of analytical solutions and generating manufactured solutions presents challenges for verifying codes for complex systems. The application of the method of manufactured solutions (MMS) for verification for coupled multi-physics phenomena like fluid-structure interaction (FSI) has only seen recent investigation. While many FSI algorithms for aeroelastic phenomena have focused on boundary-resolved CFD simulations, the actuator-line representation of the structure is widely used for FSI simulations in wind-energy research. In this work, we demonstrate the verification of an FSI algorithm using MMS for actuator-line CFD simulations with a simplified structural model. We use a manufactured solution for the fluid velocity field and the displacement of the SMD system. We demonstrate the convergence of both the fluid and structural solver to second-order accuracy with grid and time-step refinement. This work was funded by the U.S. Department of Energy, Office of Energy Efficiency and Renewable Energy, Wind Energy Technologies Office, under Contract No. DE-AC36-08-GO28308 with the National Renewable Energy Laboratory.

Deliberate real-time mood regulation in adulthood: the importance of age, fixation and attentional functioning.

PubMed

Noh, Soo Rim; Lohani, Monika; Isaacowitz, Derek M

2011-09-01

While previous research has linked executive attention to emotion regulation, the current study investigated the role of attentional alerting (i.e., efficient use of external warning cues) on younger (N=39) and older (N=44) adults' use of gaze to regulate their mood in real time. Participants viewed highly arousing unpleasant images while reporting their mood and were instructed to deliberately manage how they felt and to minimise the effect of those stimuli on their mood. Fixations toward the most negative areas of the images were recorded with eye tracking. We examined whether looking less at the most negative regions, compared to each individual's own tendency, was a beneficial mood regulatory strategy and how it interacted with age and alerting ability. High alerting older adults, who rely more on external cues to guide their attention, experienced a smaller decline in mood over time by activating a less-negative-looking approach (compared to their own average tendency), effectively looking away from the most negative areas of the images. More negative gaze patterns predicted better mood for younger adults, though this effect decreased over time. Alerting did not moderate gaze-mood links in younger adults. Successful mood regulation may thus depend on particular combinations of age, fixation, and attention.

Deliberate Real-time Mood Regulation in Adulthood: The Importance of Age, Fixation and Attentional Functioning

PubMed Central

Noh, Soo Rim; Lohani, Monika; Isaacowitz, Derek M.

2011-01-01

While previous research has linked executive attention to emotion regulation, the current study investigated the role of attentional alerting (i.e., efficient use of external warning cues) on younger (N = 39) and older (N = 44) adults’ use of gaze to regulate their mood in real time. Participants viewed highly arousing unpleasant images while reporting their mood and were instructed to deliberately manage how they felt and to minimize the effect of those stimuli on their mood. Fixations toward the most negative areas of the images were recorded with eye tracking. We examined whether looking less at the most negative regions, compared to each individual’s own tendency, was a beneficial mood regulatory strategy and how it interacted with age and alerting ability. High alerting older adults, who rely more on external cues to guide their attention, experienced a smaller decline in mood over time by activating a less-negative-looking approach (compared to their own average tendency), effectively looking away from the most negative areas of the images. More negative gaze patterns predicted better mood for younger adults, though this effect decreased over time. Alerting did not moderate gaze-mood links in younger adults. Successful mood regulation may thus depend on particular combinations of age, fixation, and attention. PMID:21432641

Partner verification: restoring shattered images of our intimates.

PubMed

De La Ronde, C; Swann, W B

1998-08-01

When spouses received feedback that disconfirmed their impressions of their partners, they attempted to undermine that feedback during subsequent interactions with these partners. Such partner verification activities occurred whether partners construed the feedback as overly favorable or overly unfavorable. Furthermore, because spouses tended to see their partners as their partners saw themselves, their efforts to restore their impressions of partners often worked hand-in-hand with partners' efforts to verify their own views. Finally, support for self-verification theory emerged in that participants were more intimate with spouses who verified their self-views, whether their self-views happened to be positive or negative.

Identifying high risk medications causing potential drug-drug interactions in outpatients: A prescription database study based on an online surveillance system.

PubMed

Toivo, T M; Mikkola, J A V; Laine, K; Airaksinen, M

2016-01-01

Drug-drug interactions (DDIs) are a significant cause for adverse drug events (ADEs). DDIs are often predictable and preventable, but their prevention and management require systematic service development. Most DDI studies focus on interaction rates in hospitalized patients. Less is known of DDIs in outpatients, particularly how community pharmacists could contribute to DDI management by applying their surveillance systems for identifying high-risk medications. The study was related to the implementation of the first online DDI surveillance system in Finnish community pharmacies. The goal was to demonstrate how community pharmacies can utilize their prospective surveillance system 1) for identifying high risk medications causing potential DDIs in outpatients, 2) for collaborative service development with local physicians, and 3) for academic risk management research purposes. All DDI alerts given by the online surveillance system were collected during a one-month period in 16 out of 17 University Pharmacy outlets in Finland, covering approximately 10% of the national outpatient prescription volume. The surveillance system was based on the FASS database, which categorizes DDIs into four classes (A-D) according to their clinical significance. Potential drug-drug DDIs were analyzed for 276,891 dispensed community pharmacy prescriptions. Potential DDIs were associated with 10.8%, or 31,110 of these prescriptions. Clinically significant interaction alerts categorized as FASS classes D (most severe, should be avoided) and C (clinically significant but controllable) were associated with 0.5% and 7.0% of the prescriptions, respectively. Methotrexate and warfarin had the highest risk of causing potentially serious (class D) interactions. These interaction alerts were most frequently between methotrexate and NSAIDs and warfarin and NSAIDs. In general, NSAIDs were the most commonly interacting drugs in this study. This study demonstrates that community pharmacies can actively contribute to DDI risk management and systematically use their surveillance systems for identifying patients having clinically significant DDIs. The findings also indicate that the majority of potentially serious interactions in outpatients involve a limited number of drugs, particularly NSAIDs, warfarin and methotrexate. Further research should focus on community pharmacists' involvement in DDI risk management in collaboration with local health care providers. Copyright © 2015 Elsevier Inc. All rights reserved.

The Verification-based Analysis of Reliable Multicast Protocol

NASA Technical Reports Server (NTRS)

Wu, Yunqing

1996-01-01

Reliable Multicast Protocol (RMP) is a communication protocol that provides an atomic, totally ordered, reliable multicast service on top of unreliable IP Multicasting. In this paper, we develop formal models for R.W using existing automatic verification systems, and perform verification-based analysis on the formal RMP specifications. We also use the formal models of RW specifications to generate a test suite for conformance testing of the RMP implementation. Throughout the process of RMP development, we follow an iterative, interactive approach that emphasizes concurrent and parallel progress between the implementation and verification processes. Through this approach, we incorporate formal techniques into our development process, promote a common understanding for the protocol, increase the reliability of our software, and maintain high fidelity between the specifications of RMP and its implementation.

Land Ice Verification and Validation Kit

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

2015-07-15

To address a pressing need to better understand the behavior and complex interaction of ice sheets within the global Earth system, significant development of continental-scale, dynamical ice-sheet models is underway. The associated verification and validation process of these models is being coordinated through a new, robust, python-based extensible software package, the Land Ice Verification and Validation toolkit (LIVV). This release provides robust and automated verification and a performance evaluation on LCF platforms. The performance V&V involves a comprehensive comparison of model performance relative to expected behavior on a given computing platform. LIVV operates on a set of benchmark and testmore » data, and provides comparisons for a suite of community prioritized tests, including configuration and parameter variations, bit-4-bit evaluation, and plots of tests where differences occur.« less

GPS: Shaping Student Success One Conversation at a Time

ERIC Educational Resources Information Center

Star, Mikhael; Collette, Lanita

2010-01-01

Increasing instructor-student interactions and improving support personnel interventions with students positively affects their academic performance, retention, and graduation rates. This article discusses the Grade Performance Status (GPS) which is Northern Arizona University's new online, academic early alert tool for increasing instructor…

The French Infectious Diseases Society's readiness and response to epidemic or biological risk-the current situation following the Middle East respiratory syndrome coronavirus and Ebola virus disease alerts.

PubMed

Coignard-Biehler, H; Rapp, C; Chapplain, J M; Hoen, B; Che, D; Berthelot, P; Cazenave-Roblot, F; Rabaud, C; Brouqui, P; Leport, C

2018-03-01

In 2012, the French Infectious Diseases Society (French acronym SPILF) initiated the "Coordination of epidemic and biological risk" (SPILF-COREB - Emergences [SCE]) group to support the readiness and response of healthcare workers (HCWs) to new alerts. To present the SCE group, its functioning, and the main support it provided for frontline HCWs. A multidisciplinary group of heads of infectious disease departments from reference hospitals was created to build a network of clinical expertise for care, training, and research in the field of epidemic and biological risk (EBR). The network developed a set of standardized operational procedures (SOPs) to guide interventions to manage EBR-suspect patients. A working group created the SOP aimed at frontline HCWs taking care of patients. Priority was given to the development of a generic procedure, which was then adapted according to the current alert. Five key steps were identified and hierarchized: detecting, protecting, caring for, alerting, and referring the EBR patient. The interaction between clinicians and those responsible for the protection of the community was crucial. The SOPs validated by the SPILF and its affiliates were disseminated to a wide range of key stakeholders through various media including workshops and the SPILF's website. SPILF can easily adapt and timely mobilize the EBR expertise in case of an alert. The present work suggests that sharing and discussing this experience, initiated at the European level, can generate a new collective expertise and needs to be further developed and strengthened. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

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.

Disentangling the attention network test: behavioral, event related potentials, and neural source analyses

PubMed Central

Galvao-Carmona, Alejandro; González-Rosa, Javier J.; Hidalgo-Muñoz, Antonio R.; Páramo, Dolores; Benítez, María L.; Izquierdo, Guillermo; Vázquez-Marrufo, Manuel

2014-01-01

Background: The study of the attentional system remains a challenge for current neuroscience. The “Attention Network Test” (ANT) was designed to study simultaneously three different attentional networks (alerting, orienting, and executive) based in subtraction of different experimental conditions. However, some studies recommend caution with these calculations due to the interactions between the attentional networks. In particular, it is highly relevant that several interpretations about attentional impairment have arisen from these calculations in diverse pathologies. Event related potentials (ERPs) and neural source analysis can be applied to disentangle the relationships between these attentional networks not specifically shown by behavioral measures. Results: This study shows that there is a basic level of alerting (tonic alerting) in the no cue (NC) condition, represented by a slow negative trend in the ERP trace prior to the onset of the target stimuli. A progressive increase in the CNV amplitude related to the amount of information provided by the cue conditions is also shown. Neural source analysis reveals specific modulations of the CNV related to a task-related expectancy presented in the NC condition; a late modulation triggered by the central cue (CC) condition and probably representing a generic motor preparation; and an early and late modulation for spatial cue (SC) condition suggesting specific motor and sensory preactivation. Finally, the first component in the information processing of the target stimuli modulated by the interaction between orienting network and the executive system can be represented by N1. Conclusions: The ANT is useful as a paradigm to study specific attentional mechanisms and their interactions. However, calculation of network effects is based in subtractions with non-comparable experimental conditions, as evidenced by the present data, which can induce misinterpretations in the study of the attentional capacity in human subjects. PMID:25352800

Loads and Structural Dynamics Requirements for Spaceflight Hardware

NASA Technical Reports Server (NTRS)

Schultz, Kenneth P.

2011-01-01

The purpose of this document is to establish requirements relating to the loads and structural dynamics technical discipline for NASA and commercial spaceflight launch vehicle and spacecraft hardware. Requirements are defined for the development of structural design loads and recommendations regarding methodologies and practices for the conduct of load analyses are provided. As such, this document represents an implementation of NASA STD-5002. Requirements are also defined for structural mathematical model development and verification to ensure sufficient accuracy of predicted responses. Finally, requirements for model/data delivery and exchange are specified to facilitate interactions between Launch Vehicle Providers (LVPs), Spacecraft Providers (SCPs), and the NASA Technical Authority (TA) providing insight/oversight and serving in the Independent Verification and Validation role. In addition to the analysis-related requirements described above, a set of requirements are established concerning coupling phenomena or other interaction between structural dynamics and aerodynamic environments or control or propulsion system elements. Such requirements may reasonably be considered structure or control system design criteria, since good engineering practice dictates consideration of and/or elimination of the identified conditions in the development of those subsystems. The requirements are included here, however, to ensure that such considerations are captured in the design space for launch vehicles (LV), spacecraft (SC) and the Launch Abort Vehicle (LAV). The requirements in this document are focused on analyses to be performed to develop data needed to support structural verification. As described in JSC 65828, Structural Design Requirements and Factors of Safety for Spaceflight Hardware, implementation of the structural verification requirements is expected to be described in a Structural Verification Plan (SVP), which should describe the verification of each structural item for the applicable requirements. The requirement for and expected contents of the SVP are defined in JSC 65828. The SVP may also document unique verifications that meet or exceed these requirements with Technical Authority approval.

Observations on coyote-mule deer interactions at Rocky Flats, Colorado

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

Alldredge, A.W.; Arthur, W.J. III

1980-01-01

Observations of interactions between coyotes (Canis latrans) and mule deer (Odocoileus hemionus) in N-central Colorado indicated that, upon discovering a coyote close to a herd, mule deer would become alert, bunch together and either flee or pursue the coyote. Two observations of coyotes attacking deer indicated that the rump was the probable point of attack and in one case the deer began a defense using its front hooves.

Oyster Fisheries App

NASA Technical Reports Server (NTRS)

Perez Guerrero, Geraldo A.; Armstrong, Duane; Underwood, Lauren

2015-01-01

This project is creating a cloud-enabled, HTML 5 web application to help oyster fishermen and state agencies apply Earth science to improve the management of this important natural and economic resource. The Oyster Fisheries app gathers and analyzes environmental and water quality information, and alerts fishermen and resources managers about problems in oyster fishing waters. An intuitive interface based on Google Maps displays the geospatial information and provides familiar interactive controls to the users. Alerts can be tailored to notify users when conditions in specific leases or public fishing areas require attention. The app is hosted on the Amazon Web Services cloud. It is being developed and tested using some of the latest web development tools such as web components and Polymer.

Use of MODIS Satellite Images and an Atmospheric Dust Transport Model to Evaluate Juniperus spp. Pollen Phenology and Dispersal

NASA Technical Reports Server (NTRS)

Luvall, J. C.; Sprigg, W. A.; Levetin, E.; Huete, A.; Nickovic, S.; Pejanovic, G. A.; Vukovic, A.; VandeWater, P. K.; Myers, O. B.; Budge, A. M.;

You Can Run, But You Can't Hide Juniper Pollen Phenology and Dispersal

NASA Technical Reports Server (NTRS)

Luvall, Jeffrey C.

2013-01-01

Pollen can be transported great distances. Van de Water et. al., 2003 reported Juniperus spp. pollen was transported 200-600 km. Hence local observations of plant phenology may not be consistent with the timing and source of pollen collected by pollen sampling instruments. The DREAM (Dust REgional Atmospheric Model, Nickovic et al. 2001) is a verified model for atmospheric dust transport modeling using MODIS data products to identify source regions and quantities of dust. We are modified the DREAM model to incorporate pollen transport. Pollen release is estimated based on MODIS derived phenology of Juniperus spp. communities. Ground based observational records of pollen release timing and quantities are used as verification. This information will be used to support the Centers for Disease Control and Prevention's National Environmental Public Health Tracking Program and the State of New Mexico environmental public health decision support for asthma and allergies alerts.

JPL space robotics: Present accomplishments and future thrusts

NASA Astrophysics Data System (ADS)

Weisbin, C. R.; Hayati, S. A.; Rodriguez, G.

1994-10-01

Complex missions require routine and unscheduled inspection for safe operation. The purpose of research in this task is to facilitate structural inspection of the planned Space Station while mitigating the need for extravehicular activity (EVA), and giving the operator supervisory control over detailed and somewhat mundane, but important tasks. The telerobotic system enables inspection relative to a given reference (e.g., the status of the facility at the time of the last inspection) and alerts the operator to potential anomalies for verification and action. There are two primary objectives of this project: (1) To develop technologies that enable well-integrated NASA ground-to-orbit telerobotics operations, and (2) to develop a prototype common architecture workstation which implements these capabilities for other NASA technology projects and planned NASA flight applications. This task develops and supports three telerobot control modes which are applicable to time delay operation: Preview teleoperation, teleprogramming, and supervised autonomy.

Use of Unstructured Event-Based Reports for Global Infectious Disease Surveillance

PubMed Central

Blench, Michael; Tolentino, Herman; Freifeld, Clark C.; Mandl, Kenneth D.; Mawudeku, Abla; Eysenbach, Gunther; Brownstein, John S.

2009-01-01

Free or low-cost sources of unstructured information, such as Internet news and online discussion sites, provide detailed local and near real-time data on disease outbreaks, even in countries that lack traditional public health surveillance. To improve public health surveillance and, ultimately, interventions, we examined 3 primary systems that process event-based outbreak information: Global Public Health Intelligence Network, HealthMap, and EpiSPIDER. Despite similarities among them, these systems are highly complementary because they monitor different data types, rely on varying levels of automation and human analysis, and distribute distinct information. Future development should focus on linking these systems more closely to public health practitioners in the field and establishing collaborative networks for alert verification and dissemination. Such development would further establish event-based monitoring as an invaluable public health resource that provides critical context and an alternative to traditional indicator-based outbreak reporting. PMID:19402953

JPL space robotics: Present accomplishments and future thrusts

NASA Technical Reports Server (NTRS)

Weisbin, C. R.; Hayati, S. A.; Rodriguez, G.

1994-01-01

Complex missions require routine and unscheduled inspection for safe operation. The purpose of research in this task is to facilitate structural inspection of the planned Space Station while mitigating the need for extravehicular activity (EVA), and giving the operator supervisory control over detailed and somewhat mundane, but important tasks. The telerobotic system enables inspection relative to a given reference (e.g., the status of the facility at the time of the last inspection) and alerts the operator to potential anomalies for verification and action. There are two primary objectives of this project: (1) To develop technologies that enable well-integrated NASA ground-to-orbit telerobotics operations, and (2) to develop a prototype common architecture workstation which implements these capabilities for other NASA technology projects and planned NASA flight applications. This task develops and supports three telerobot control modes which are applicable to time delay operation: Preview teleoperation, teleprogramming, and supervised autonomy.

Standardized Competencies for Parenteral Nutrition Order Review and Parenteral Nutrition Preparation, Including Compounding: The ASPEN Model.

PubMed

Boullata, Joseph I; Holcombe, Beverly; Sacks, Gordon; Gervasio, Jane; Adams, Stephen C; Christensen, Michael; Durfee, Sharon; Ayers, Phil; Marshall, Neil; Guenter, Peggi

2016-08-01

Parenteral nutrition (PN) is a high-alert medication with a complex drug use process. Key steps in the process include the review of each PN prescription followed by the preparation of the formulation. The preparation step includes compounding the PN or activating a standardized commercially available PN product. The verification and review, as well as preparation of this complex therapy, require competency that may be determined by using a standardized process for pharmacists and for pharmacy technicians involved with PN. An American Society for Parenteral and Enteral Nutrition (ASPEN) standardized model for PN order review and PN preparation competencies is proposed based on a competency framework, the ASPEN-published interdisciplinary core competencies, safe practice recommendations, and clinical guidelines, and is intended for institutions and agencies to use with their staff. © 2016 American Society for Parenteral and Enteral Nutrition.

E-Learning. Trends and Issues Alert.

ERIC Educational Resources Information Center

Imel, Susan

Electronic learning, also known as e-learning, is generally defined as instruction and learning experiences that are delivered via electronic technology such as the Internet, audiotape and videotape, satellite broadcast, interactive television, and CD-ROM. Web-based learning, computer-based learning, and virtual classrooms are some of the…

Development and Feasibility of an Interactive Smartphone App for Early Assessment and Management of Symptoms Following Pancreaticoduodenectomy.

PubMed

Gustavell, Tina; Langius-Eklöf, Ann; Wengström, Yvonne; Segersvärd, Ralf; Sundberg, Kay

2018-03-27

Patients who have undergone pancreaticoduodenectomy because of pancreatic cancer experience distressing symptoms and unmet supportive care needs after discharge. To meet these needs, we have developed a mobile health app (Interaktor) for daily assessment of symptoms and access to self-care advice that includes a risk assessment model for alerts with real-time interactions with professionals. The study aim was to develop and test a version of the Interaktor app adapted for patients who have undergone pancreaticoduodenectomy. The app was developed and tested for feasibility in 6 patients during 4 weeks. One nurse monitored and responded to alerts. Logged data from the app were collected, and all participants were interviewed about their experiences. Adherence to reporting daily was 84%. Alerts were generated in 41% of the reports. The patients felt reassured and cared for and received support for symptom management. The app was easy to use, had relevant content, and had few technical problems, although suggestions for improvement were given. The daily reporting of symptoms and having access to a nurse in real time in the case of an alarming symptom seem to enhance symptom management and render a feeling of security in patients. Some modifications of the app are needed before use in a larger sample. Daily reporting of symptoms after pancreaticoduodenectomy enhances symptom management, self-care, and participation without being a burden to patients, indicating that mobile health can be used in clinical practice by patients with poor prognosis who experience severe symptoms.

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

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

Proactive authenticated notifications for health practitioners: two way human computer interaction through phone.

PubMed

Majeed, Raphael W; Stöhr, Mark R; Röhrig, Rainer

2012-01-01

Notifications and alerts play an important role in clinical daily routine. Rising prevalence of clinical decision support systems and electronic health records also result in increasing demands on notification systems. Failure adequately to communicate a critical value is a potential cause of adverse events. Critical laboratory values and changing vital data depend on timely notifications of medical staff. Vital monitors and medical devices rely on acoustic signals for alerting which are prone to "alert fatigue" and require medical staff to be present within audible range. Personal computers are unsuitable to display time critical notification messages, since the targeted medical staff are not always operating or watching the computer. On the other hand, mobile phones and smart devices enjoy increasing popularity. Previous notification systems sending text messages to mobile phones depend on asynchronous confirmations. By utilizing an automated telephony server, we provide a method to deliver notifications quickly and independently of the recipients' whereabouts while allowing immediate feedback and confirmations. Evaluation results suggest the feasibility of the proposed notification system for real-time notifications.

User's guide to SSARRMENU

USGS Publications Warehouse

Mastin, M.C.; Le, Thanh

2001-01-01

The U.S. Geological Survey, in cooperation with Pierce County Department of Public Works, Washington, has developed an operational tool called the Puyallup Flood-Alert System to alert users of impending floods in the Puyallup River Basin. The system acquires and incorporates meteorological and hydrological data into the Streamflow Synthesis and Reservoir Regulation (SSARR) hydrologic flow-routing model to simulate floods in the Puyallup River Basin. SSARRMENU is the user-interactive graphical interface between the user, the input and output data, and the SSARR model. In a companion cooperative project with Pierce County, the SSARR model for the Puyallup River Basin was calibrated and validated. The calibrated model is accessed through SSARRMENU, which has been specifically programed for the Puyallup River and the needs of Pierce County. SSARRMENU automates the retrieval of data from ADAPS (Automated DAta Processing System, the U.S. Geological Survey?s real-time hydrologic database), formats the data for use with SSARR, initiates SSARR model runs, displays alerts for impending floods, and provides utilities to display the simulated and observed data. An on-screen map of the basin and a series of menu items provide the user wi

Model Checking for Verification of Interactive Health IT Systems

PubMed Central

Butler, Keith A.; Mercer, Eric; Bahrami, Ali; Tao, Cui

2015-01-01

Rigorous methods for design and verification of health IT systems have lagged far behind their proliferation. The inherent technical complexity of healthcare, combined with the added complexity of health information technology makes their resulting behavior unpredictable and introduces serious risk. We propose to mitigate this risk by formalizing the relationship between HIT and the conceptual work that increasingly typifies modern care. We introduce new techniques for modeling clinical workflows and the conceptual products within them that allow established, powerful modeling checking technology to be applied to interactive health IT systems. The new capability can evaluate the workflows of a new HIT system performed by clinicians and computers to improve safety and reliability. We demonstrate the method on a patient contact system to demonstrate model checking is effective for interactive systems and that much of it can be automated. PMID:26958166

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.

Contrast Sensitivity in Army Aviator Candidates: Cycloplegia Effects and Population Norms

DTIC Science & Technology

1988-09-01

administration; this effect is highly significant statistically (F=169.41, df=l,104, p<.0001). The interaction of cycloplegia and spatial frequency is not...and universal acceptance. Deficits observed in visual acuity immediately alert the practitioner to the presence of an ametropia or other

Artwork Interactive Design System (AIDS) program description

NASA Technical Reports Server (NTRS)

Johnson, B. T.; Taylor, J. F.

1976-01-01

An artwork interactive design system is described which provides the microelectronic circuit designer/engineer a tool to perform circuit design, automatic layout modification, standard cell design, and artwork verification at a graphics computer terminal using a graphics tablet at the designer/computer interface.

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

Toward Automatic Verification of Goal-Oriented Flow Simulations

NASA Technical Reports Server (NTRS)

Nemec, Marian; Aftosmis, Michael J.

2014-01-01

We demonstrate the power of adaptive mesh refinement with adjoint-based error estimates in verification of simulations governed by the steady Euler equations. The flow equations are discretized using a finite volume scheme on a Cartesian mesh with cut cells at the wall boundaries. The discretization error in selected simulation outputs is estimated using the method of adjoint-weighted residuals. Practical aspects of the implementation are emphasized, particularly in the formulation of the refinement criterion and the mesh adaptation strategy. Following a thorough code verification example, we demonstrate simulation verification of two- and three-dimensional problems. These involve an airfoil performance database, a pressure signature of a body in supersonic flow and a launch abort with strong jet interactions. The results show reliable estimates and automatic control of discretization error in all simulations at an affordable computational cost. Moreover, the approach remains effective even when theoretical assumptions, e.g., steady-state and solution smoothness, are relaxed.

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.

Simulation validation and management

NASA Astrophysics Data System (ADS)

Illgen, John D.

1995-06-01

Illgen Simulation Technologies, Inc., has been working interactive verification and validation programs for the past six years. As a result, they have evolved a methodology that has been adopted and successfully implemented by a number of different verification and validation programs. This methodology employs a unique case of computer-assisted software engineering (CASE) tools to reverse engineer source code and produce analytical outputs (flow charts and tables) that aid the engineer/analyst in the verification and validation process. We have found that the use of CASE tools saves time,which equate to improvements in both schedule and cost. This paper will describe the ISTI-developed methodology and how CASe tools are used in its support. Case studies will be discussed.

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

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.

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.

[Quantitative Prediction of Drug-Drug Interaction Caused by CYP Inhibition and Induction from In Vivo Data and Its Application in Daily Clinical Practices-Proposal for the Pharmacokinetic Interaction Significance Classification System (PISCS)].

PubMed

Ohno, Yoshiyuki

2018-01-01

　Drug-drug interactions (DDIs) can affect the clearance of various drugs from the body; however, these effects are difficult to sufficiently evaluate in clinical studies. This article outlines our approach to improving methods for evaluating and providing drug information relative to the effects of DDIs. In a previous study, total exposure changes to many substrate drugs of CYP caused by the co-administration of inhibitor or inducer drugs were successfully predicted using in vivo data. There are two parameters for the prediction: the contribution ratio of the enzyme to oral clearance for substrates (CR), and either the inhibition ratio for inhibitors (IR) or the increase in clearance of substrates produced by induction (IC). To apply these predictions in daily pharmacotherapy, the clinical significance of any pharmacokinetic changes must be carefully evaluated. We constructed a pharmacokinetic interaction significance classification system (PISCS) in which the clinical significance of DDIs was considered in a systematic manner, according to pharmacokinetic changes. The PISCS suggests that many current 'alert' classifications are potentially inappropriate, especially for drug combinations in which pharmacokinetics have not yet been evaluated. It is expected that PISCS would contribute to constructing a reliable system to alert pharmacists, physicians and consumers of a broad range of pharmacokinetic DDIs in order to more safely manage daily clinical practices.

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.

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.

Assessing the problem of counterfeit medications in the United Kingdom.

PubMed

Jackson, G; Patel, S; Khan, S

2012-03-01

Counterfeit medicines pose an ever-increasing threat to public health, although precise tracking of illegal counterfeit prescription drug activity is difficult. Available data indicate that all types of medications have been targeted. Adverse health effects, including death, have resulted from using counterfeit medications; consumers who self-medicate without appropriate interactions with the healthcare system rarely receive adequate healthcare. The Internet provides a large, convenient route for counterfeiters to reach potential buyers with unregulated, often dangerous, products. The majority of medicines purchased via unverified Internet sites are counterfeit; often, these products lack the purported drug compound or have variable concentrations of active ingredients and sometimes contain dangerous toxins. Although many consumers acknowledge some degree of risk with purchasing medications via the Internet, speed, convenience and cost often prompt these purchases. Counterfeit medications also have been detected in the legitimate supply chain, but represent a significantly smaller proportion of sales than those purchased via the Internet. Pilot programmes in Europe have demonstrated that product verification systems prevent penetration of counterfeit products into the legitimate supply chain. Significant EU legislation, including stronger penalties for counterfeiting, is in development. In the United Kingdom, the Medicines and Healthcare Products Regulatory Agency (MHRA) launched an initiative against counterfeit medication. Healthcare professionals should report suspected cases of counterfeit medication to the MHRA, be alert to threats to the medicine supply, and provide practical advice to patients about ordering medications online, including avoiding unregulated Internet pharmacies, and being suspicious of sites offering substantial discounts and prescription-only medication without a prescription. © 2011 Blackwell Publishing Ltd.

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.

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.

A Single-Boundary Accumulator Model of Response Times in an Addition Verification Task

PubMed Central

Faulkenberry, Thomas J.

2017-01-01

Current theories of mathematical cognition offer competing accounts of the interplay between encoding and calculation in mental arithmetic. Additive models propose that manipulations of problem format do not interact with the cognitive processes used in calculation. Alternatively, interactive models suppose that format manipulations have a direct effect on calculation processes. In the present study, we tested these competing models by fitting participants' RT distributions in an arithmetic verification task with a single-boundary accumulator model (the shifted Wald distribution). We found that in addition to providing a more complete description of RT distributions, the accumulator model afforded a potentially more sensitive test of format effects. Specifically, we found that format affected drift rate, which implies that problem format has a direct impact on calculation processes. These data give further support for an interactive model of mental arithmetic. PMID:28769853

Toward a formal verification of a floating-point coprocessor and its composition with a central processing unit

NASA Technical Reports Server (NTRS)

Pan, Jing; Levitt, Karl N.; Cohen, Gerald C.

1991-01-01

Discussed here is work to formally specify and verify a floating point coprocessor based on the MC68881. The HOL verification system developed at Cambridge University was used. The coprocessor consists of two independent units: the bus interface unit used to communicate with the cpu and the arithmetic processing unit used to perform the actual calculation. Reasoning about the interaction and synchronization among processes using higher order logic is demonstrated.

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.

Rule groupings: An approach towards verification of expert systems

NASA Technical Reports Server (NTRS)

Mehrotra, Mala

1991-01-01

Knowledge-based expert systems are playing an increasingly important role in NASA space and aircraft systems. However, many of NASA's software applications are life- or mission-critical and knowledge-based systems do not lend themselves to the traditional verification and validation techniques for highly reliable software. Rule-based systems lack the control abstractions found in procedural languages. Hence, it is difficult to verify or maintain such systems. Our goal is to automatically structure a rule-based system into a set of rule-groups having a well-defined interface to other rule-groups. Once a rule base is decomposed into such 'firewalled' units, studying the interactions between rules would become more tractable. Verification-aid tools can then be developed to test the behavior of each such rule-group. Furthermore, the interactions between rule-groups can be studied in a manner similar to integration testing. Such efforts will go a long way towards increasing our confidence in the expert-system software. Our research efforts address the feasibility of automating the identification of rule groups, in order to decompose the rule base into a number of meaningful units.

Somatic/Embodied Learning and Adult Education. Trends and Issues Alert.

ERIC Educational Resources Information Center

Kerka, Sandra

A somatic approach to education implies education that trusts individuals to learn from and listen to the information they are receiving from the interaction of self with the environment. Somatic or embodied knowing is experiential knowledge that involves senses, perceptions, and mind-body action and reaction. Western culture has been dominated by…

Nurses' response to parents' 'speaking-up' efforts to ensure their hospitalized child's safety: an attribution theory perspective.

PubMed

Bsharat, Sondos; Drach-Zahavy, Anat

2017-09-01

To understand how attribution processes (control and stability), which the nurse attributes to parental involvement in maintaining child safety, determine the nurse's response to a safety alert. Participation of parents in maintaining their child's safety is shown to reduce the incidence of and risk of clinical errors. Unless nurses respond appropriately to parents' safety alerts, this potential source of support could diminish. A 2 (controllability: high vs. low) × 2 (consistency: high vs. low) factorial design. Data were collected during the period 2013-2014 in paediatric wards. Four variants of scenarios were created corresponding to the different combinations of these variables. A total of 126 nurses read a scenario and completed self-report questionnaires measuring their response to the parent's safety alert. Additional data were collected about the manipulation check, safety norms in the ward and demographic variables. Data were analysed using analysis of variance. Results showed a main effect of stability and a significant two-way interaction effect of stability and controllability, on a nurse's tendency to help the parent and fix the safety problem. Furthermore, safety norms were significantly related to nurses' response. These findings contribute to the understanding of antecedents that affect nurses' responses to parents' speaking-up initiatives: whether nurses will reject or heed the alert. Theoretical and practical implications for promoting parents' engagement in their safety are discussed. © 2017 John Wiley & Sons Ltd.

Computerized pharmacy surveillance and alert system for drug-related problems.

PubMed

Ferrández, O; Urbina, O; Grau, S; Mateu-de-Antonio, J; Marin-Casino, M; Portabella, J; Mojal, S; Riu, M; Salas, E

2017-04-01

Because of the impact of drug-related problems (DRPs) on morbidity and mortality, there is a need for computerized strategies to increase drug safety. The detection and identification of the causes of potential DRPs can be facilitated by the incorporation of a pharmacy warning system (PWS) in the computerized prescriber order entry (CPOE) and its application in the routine validation of inpatient drug therapy. A limited number of studies have evaluated a clinical decision support system to monitor drug treatment. Most of these applications have utilized a small range of drugs with alerts and/or types of alert. The objective of this study was to describe the implementation of a PWS integrated in the electronic medical record (EMR). The PWS was developed in 2003-2004. Pharmacological information to generate drug alerts was entered on demographic data, drug dosage, laboratory tests related to the prescribed drug and drug combinations (interactions, duplications and necessary combinations). The PWS was applied in the prescription reviews conducted in patients admitted to the hospital in 2012. Information on 83% of the drugs included in the pharmacopeia was introduced into the PWS, allowing detection of 2808 potential DRPs, representing 79·1% of all potential DRPs detected during the study period. Twenty per cent of PWS DRPs were clinically relevant, requiring pharmacist intervention. The PWS detected most potential DRPs, thus increasing inpatient safety. The detection ability of the PWS was higher than that reported for other tools described in the literature. © 2017 John Wiley & Sons Ltd.

Visualization techniques for computer network defense

NASA Astrophysics Data System (ADS)

Beaver, Justin M.; Steed, Chad A.; Patton, Robert M.; Cui, Xiaohui; Schultz, Matthew

2011-06-01

Effective visual analysis of computer network defense (CND) information is challenging due to the volume and complexity of both the raw and analyzed network data. A typical CND is comprised of multiple niche intrusion detection tools, each of which performs network data analysis and produces a unique alerting output. The state-of-the-practice in the situational awareness of CND data is the prevalent use of custom-developed scripts by Information Technology (IT) professionals to retrieve, organize, and understand potential threat events. We propose a new visual analytics framework, called the Oak Ridge Cyber Analytics (ORCA) system, for CND data that allows an operator to interact with all detection tool outputs simultaneously. Aggregated alert events are presented in multiple coordinated views with timeline, cluster, and swarm model analysis displays. These displays are complemented with both supervised and semi-supervised machine learning classifiers. The intent of the visual analytics framework is to improve CND situational awareness, to enable an analyst to quickly navigate and analyze thousands of detected events, and to combine sophisticated data analysis techniques with interactive visualization such that patterns of anomalous activities may be more easily identified and investigated.

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.

Provider acceptance of an automated electronic alert for acute kidney injury

PubMed Central

Oh, Janice; Bia, Joshua R.; Ubaid-Ullah, Muhamad; Testani, Jeffrey M.; Wilson, Francis Perry

2016-01-01

Background Clinical decision support systems, including electronic alerts, ideally provide immediate and relevant patient-specific information to improve clinical decision-making. Despite the growing capabilities of such alerts in conjunction with an expanding electronic medical record, there is a paucity of information regarding their perceived usefulness. We surveyed healthcare providers' opinions concerning the practicality and efficacy of a specific text-based automated electronic alert for acute kidney injury (AKI) in a single hospital during a randomized trial of AKI alerts. Methods Providers who had received at least one electronic AKI alert in the previous 6 months, as part of a separate randomized controlled trial (clinicaltrials.gov #01862419), were asked to complete a survey concerning their opinions about this specific AKI alert system. Individual approval of the alert system was defined by a provider's desire to continue receiving the alert after termination of the trial. Results A total of 98 individuals completed the survey, including 62 physicians, 27 pharmacists and 7 non-physician providers. Sixty-nine percent of responders approved the alert, with no significant difference among the various professions (P = 0.28). Alert approval was strongly correlated with the belief that the alerts improved patient care (P < 0.0001), and negatively correlated with the belief that alerts did not provide novel information (P = 0.0001). With each additional 30 days of trial duration, odds of approval decreased by 20% (3–35%) (P = 0.02). Conclusions The alert system was generally well received, although approval waned with time. Approval was correlated with the belief that this type of alert improved patient care. These findings suggest that perceived efficacy is critical to the success of future alert trials. PMID:27478598

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

CAPTIONALS: A computer aided testing environment for the verification and validation of communication protocols

NASA Technical Reports Server (NTRS)

Feng, C.; Sun, X.; Shen, Y. N.; Lombardi, Fabrizio

1992-01-01

This paper covers the verification and protocol validation for distributed computer and communication systems using a computer aided testing approach. Validation and verification make up the so-called process of conformance testing. Protocol applications which pass conformance testing are then checked to see whether they can operate together. This is referred to as interoperability testing. A new comprehensive approach to protocol testing is presented which address: (1) modeling for inter-layer representation for compatibility between conformance and interoperability testing; (2) computational improvement to current testing methods by using the proposed model inclusive of formulation of new qualitative and quantitative measures and time-dependent behavior; (3) analysis and evaluation of protocol behavior for interactive testing without extensive simulation.

Monitoring tobacco brand websites to understand marketing strategies aimed at tobacco product users and potential users.

PubMed

Escobedo, Patricia; Cruz, Tess Boley; Tsai, Kai-Ya; Allem, Jon-Patrick; Soto, Daniel W; Kirkpatrick, Matthew G; Pattarroyo, Monica; Unger, Jennifer B

2017-09-11

Limited information exists about strategies and methods used on brand marketing websites to transmit pro-tobacco messages to tobacco users and potential users. This study compared age verification methods, themes, interactive activities and links to social media across tobacco brand websites. This study examined 12 tobacco brand websites representing four tobacco product categories: cigarettes, cigar/cigarillos, smokeless tobacco, and e-cigarettes. Website content was analyzed by tobacco product category and data from all website visits (n = 699) were analyzed. Adult smokers (n=32) coded websites during a one-year period, indicating whether or not they observed any of 53 marketing themes, seven interactive activities, or five external links to social media sites. Most (58%) websites required online registration before entering, however e-cigarette websites used click-through age verification. Compared to cigarette sites, cigar/cigarillo sites were more likely to feature themes related to "party" lifestyle, and e-cigarette websites were much more likely to feature themes related to harm reduction. Cigarette sites featured greater levels of interactive content compared to other tobacco products. Compared to cigarette sites, cigar/cigarillo sites were more likely to feature activities related to events and music. Compared to cigarette sites, both cigar and e-cigarette sites were more likely to direct visitors to external social media sites. Marketing methods and strategies normalize tobacco use by providing website visitors with positive themes combined with interactive content, and is an area of future research. Moreover, all tobacco products under federal regulatory authority should be required to use more stringent age verification gates. Findings indicate the Food and Drug Administration (FDA) should require brand websites of all tobacco products under its regulatory authority use more stringent age verification gates by requiring all visitors be at least 18 years of age and register online prior to entry. This is important given that marketing strategies may encourage experimentation with tobacco or deter quit attempts among website visitors. Future research should examine the use of interactive activities and social media on a wide variety of tobacco brand websites as interactive content is associated with more active information processing. © The Author 2017. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

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

Threads of Mission Success

NASA Technical Reports Server (NTRS)

Gavin, Thomas R.

2006-01-01

This viewgraph presentation reviews the many parts of the JPL mission planning process that the project manager has to work with. Some of them are: NASA & JPL's institutional requirements, the mission systems design requirements, the science interactions, the technical interactions, financial requirements, verification and validation, safety and mission assurance, and independent assessment, review and reporting.

Towards the Formal Verification of a Distributed Real-Time Automotive System

NASA Technical Reports Server (NTRS)

Endres, Erik; Mueller, Christian; Shadrin, Andrey; Tverdyshev, Sergey

2010-01-01

We present the status of a project which aims at building, formally and pervasively verifying a distributed automotive system. The target system is a gate-level model which consists of several interconnected electronic control units with independent clocks. This model is verified against the specification as seen by a system programmer. The automotive system is implemented on several FPGA boards. The pervasive verification is carried out using combination of interactive theorem proving (Isabelle/HOL) and model checking (LTL).

Verification of the Hydrodynamic and Sediment Transport Hybrid Modeling System for Cumberland Sound and Kings Bay Navigation Channel, Georgia

DTIC Science & Technology

1989-07-01

TECHNICAL REPORT HL-89-14 VERIFICATION OF THE HYDRODYNAMIC AND Si SEDIMENT TRANSPORT HYBRID MODELING SYSTEM FOR CUMBERLAND SOUND AND I’) KINGS BAY...Hydrodynamic and Sediment Transport Hybrid Modeling System for Cumberland Sound and Kings Bay Navigation Channel, Georgia 12 PERSONAL AUTHOR(S) Granat...Hydrodynamic results from RMA-2V were used in the numerical sediment transport code STUDH in modeling the interaction of the flow transport and

Impaired conflict resolution and vigilance in euthymic bipolar disorder.

PubMed

Marotta, Andrea; Chiaie, Roberto Delle; Spagna, Alfredo; Bernabei, Laura; Sciarretta, Martina; Roca, Javier; Biondi, Massimo; Casagrande, Maria

2015-09-30

Difficulty attending is a common deficit of euthymic bipolar patients. However, it is not known whether this is a global attentional deficit or relates to a specific attentional network. According to the attention network approach, attention is best understood in terms of three functionally and neuroanatomically distinct networks-alerting, orienting, and executive control. In this study, we explored whether and which of the three attentional networks are altered in euthymic Bipolar Disorder (BD). A sample of euthymic BD patients and age-matched healthy controls completed the Attention Network Test for Interactions and Vigilance (ANTI-V) that provided not only a measure of orienting, executive, and alerting networks, but also an independent measure of vigilance (tonic alerting). Compared to healthy controls, BD patients have impaired executive control (greater interference), reduced vigilance (as indexed by a decrease in the d' sensitivity) as well as slower overall reaction times and poorer accuracy. Our results show that deficits in executive attention and sustained attention often persist in BD patients even after complete remission of affective symptoms, thus suggesting that cognitive enhancing treatments programmed to improve these deficits could contribute to improve their functional recovery. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Processes Affecting the Annual Surface Energy Budget at High-Latitude Terrestrial Sites

NASA Astrophysics Data System (ADS)

Persson, P. O. G.; Stone, R. S.; Grachev, A.; Matrosova, L.

2012-04-01

Instrumentation at four Study of Environmental Arctic Change (SEARCH) sites (Barrow, Eureka, Alert, and Tiksi) have been enhanced in the past 6 years, including during the 2007-2008 IPY. Data from these sites are used to investigate the annual cycle of the surface energy budget (SEB), its coupling to atmospheric processes, and for Alert, its interannual variability. The comprehensive data sets are useful for showing interactions between the atmosphere, surface, and soil at high temporal resolution throughout the annual cycle. Processes that govern the SEB variability at each site are identified, and their impacts on the SEB are quantified. For example, mesoscale modulation of the SEB caused by forcing from the local terrain (downslope wind events) and coastlines (sea and land breezes) are significant at Alert and Eureka, with these processes affecting both radiative, turbulent, and ground heat flux terms in the SEB. Sub-seasonal and interannual variations in atmospheric processes and SEB impact soil thermal structures, such as the depth and timing of the summer active layer. These analyses provide an improved understanding of the processes producing changes in surface and soil temperature, linking them through the SEB as affected by atmospheric processes.

The Effects of Ultra-Long-Range Flights on the Alertness and Performance of Aviators

NASA Technical Reports Server (NTRS)

Caldwell, John A.; Mallis, Melissa M.; Colletti, Laura M.; Oyung, Raymond L.; Brandt, Summer L.; Arsintescu, Lucia; DeRoshia, Charlie W.; Reduta-Rojas, Dinah D.; Chapman, Patrick M.

2006-01-01

This investigation assessed the impact of ultra-long-range (ULR) simulator flights, departing either in the morning or late evening, on the alertness and performance of 17 commercial aviators. Immediately prior to and throughout each flight, alertness and performance were assessed via a computerized test of sustained attention, subjective questionnaires, and "hand-flying" tasks. There were fatigue-related effects on the majority of assessments, and the nature of these effects was consistent across the vigilance and self-report measures. However, the operational "hand-flying" manuevers proved insensitive to the impact of fatigue probably due to procedural factors. Regardless, the results of the present study suggest that fatigue associated with prolonged wakefulness in ULR flight operations will interact with flight schedules due to circadian and homeostatic influences. In this study, the pilots departing at night were at a greater initial disadvantage (during cruise) than pilots who departed earlier in the day; whereas those who departed earlier tended to be most impaired towards the end of the flight prior to landing. In real-world operations, airlines should consider the ramifications of flight schedules and what is known about human sleep and circadian rhythms to optimize safety.

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.

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.

Baseline Assessment and Prioritization Framework for IVHM Integrity Assurance Enabling Capabilities

NASA Technical Reports Server (NTRS)

Cooper, Eric G.; DiVito, Benedetto L.; Jacklin, Stephen A.; Miner, Paul S.

2009-01-01

Fundamental to vehicle health management is the deployment of systems incorporating advanced technologies for predicting and detecting anomalous conditions in highly complex and integrated environments. Integrated structural integrity health monitoring, statistical algorithms for detection, estimation, prediction, and fusion, and diagnosis supporting adaptive control are examples of advanced technologies that present considerable verification and validation challenges. These systems necessitate interactions between physical and software-based systems that are highly networked with sensing and actuation subsystems, and incorporate technologies that are, in many respects, different from those employed in civil aviation today. A formidable barrier to deploying these advanced technologies in civil aviation is the lack of enabling verification and validation tools, methods, and technologies. The development of new verification and validation capabilities will not only enable the fielding of advanced vehicle health management systems, but will also provide new assurance capabilities for verification and validation of current generation aviation software which has been implicated in anomalous in-flight behavior. This paper describes the research focused on enabling capabilities for verification and validation underway within NASA s Integrated Vehicle Health Management project, discusses the state of the art of these capabilities, and includes a framework for prioritizing activities.

Exploration of Uncertainty in Glacier Modelling

NASA Technical Reports Server (NTRS)

Thompson, David E.

1999-01-01

There are procedures and methods for verification of coding algebra and for validations of models and calculations that are in use in the aerospace computational fluid dynamics (CFD) community. These methods would be efficacious if used by the glacier dynamics modelling community. This paper is a presentation of some of those methods, and how they might be applied to uncertainty management supporting code verification and model validation for glacier dynamics. The similarities and differences between their use in CFD analysis and the proposed application of these methods to glacier modelling are discussed. After establishing sources of uncertainty and methods for code verification, the paper looks at a representative sampling of verification and validation efforts that are underway in the glacier modelling community, and establishes a context for these within overall solution quality assessment. Finally, an information architecture and interactive interface is introduced and advocated. This Integrated Cryospheric Exploration (ICE) Environment is proposed for exploring and managing sources of uncertainty in glacier modelling codes and methods, and for supporting scientific numerical exploration and verification. The details and functionality of this Environment are described based on modifications of a system already developed for CFD modelling and analysis.

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

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.

Integrating clinical decision support systems for pharmacogenomic testing into clinical routine - a scoping review of designs of user-system interactions in recent system development.

PubMed

Hinderer, Marc; Boeker, Martin; Wagner, Sebastian A; Lablans, Martin; Newe, Stephanie; Hülsemann, Jan L; Neumaier, Michael; Binder, Harald; Renz, Harald; Acker, Till; Prokosch, Hans-Ulrich; Sedlmayr, Martin

2017-06-06

Pharmacogenomic clinical decision support systems (CDSS) have the potential to help overcome some of the barriers for translating pharmacogenomic knowledge into clinical routine. Before developing a prototype it is crucial for developers to know which pharmacogenomic CDSS features and user-system interactions have yet been developed, implemented and tested in previous pharmacogenomic CDSS efforts and if they have been successfully applied. We address this issue by providing an overview of the designs of user-system interactions of recently developed pharmacogenomic CDSS. We searched PubMed for pharmacogenomic CDSS published between January 1, 2012 and November 15, 2016. Thirty-two out of 118 identified articles were summarized and included in the final analysis. We then compared the designs of user-system interactions of the 20 pharmacogenomic CDSS we had identified. Alerts are the most widespread tools for physician-system interactions, but need to be implemented carefully to prevent alert fatigue and avoid liabilities. Pharmacogenomic test results and override reasons stored in the local EHR might help communicate pharmacogenomic information to other internal care providers. Integrating patients into user-system interactions through patient letters and online portals might be crucial for transferring pharmacogenomic data to external health care providers. Inbox messages inform physicians about new pharmacogenomic test results and enable them to request pharmacogenomic consultations. Search engines enable physicians to compare medical treatment options based on a patient's genotype. Within the last 5 years, several pharmacogenomic CDSS have been developed. However, most of the included articles are solely describing prototypes of pharmacogenomic CDSS rather than evaluating them. To support the development of prototypes further evaluation efforts will be necessary. In the future, pharmacogenomic CDSS will likely include prediction models to identify patients who are suitable for preemptive genotyping.

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...

What Do Context Aware Electronic Alerts from Virtual Learning Environments Tell Us about User Time & Location?

ERIC Educational Resources Information Center

Crane, Laura; Benachour, Phillip

2013-01-01

The paper describes the analysis of user location and time stamp information automatically logged when students receive and interact with electronic updates from the University's virtual learning environment. The electronic updates are sent to students' mobile devices using RSS feeds. The mobile reception of such information can be received in…

What We Learned from a Tomato: Partnering with a Content Expert Plants New Ideas for Instruction

ERIC Educational Resources Information Center

Ermeling, Bradley A.

2014-01-01

The interactions described in this article represent an example of teachers expanding horizons of instructional plans as a direct result of outside expert contributions. After alerting teachers to oversimplified claims about the benefits of lycopene, the research fellow presented the team with a wider range of instructional options to consider…

Use of MODIS Satellite Images and an Atmospheric Dust Transport Model to Evaluate Juniperus spp. Pollen Phenology and Dispersal

NASA Technical Reports Server (NTRS)

Luvall, Jeffrey C.

2011-01-01

Pollen can be transported great distances. Van de Water et. al. reported Juniperus spp. pollen was transported 200-600 km. Hence local obse rvations of plant phenology may not be consistent with the timing and source of pollen collected by pollen sampling instruments. The DREAM (Dust REgional Atmospheric Model, Nickovic et al. 2001) is a verified model for atmospheric dust transport modeling using MODIS data produ cts to identify source regions and quantities of dust. We are modifyi ng the DREAM model to incorporate pollen transport. Pollen release wi ll be estimated based on MODIS derived phenology of Juniperus spp. communities. Ground based observations records of pollen release timing and quantities will be used as verification. This information will be used to support the Centers for Disease Control and Prevention?s Nat ional Environmental Public Health Tracking Program and the State of New Mexico environmental public health decision support for asthma and allergies alerts.

Use of MODIS Satellite Images and an Atmospheric Dust Transport Model To Evaluate Juniperus spp. Pollen Phenology and Dispersal

NASA Technical Reports Server (NTRS)

Luvall, J. C.; Sprigg, W. A.; Levetin, Estelle; Huete, Alfredo; Nickovic, S.; Pejanovic, G. A.; Vukovic, A.; VandeWater, P. K.; Myers, O. B.; Budge, A. M.;

Evaluation and Verification of the Global Rapid Identification of Threats System for Infectious Diseases in Textual Data Sources.

PubMed

Huff, Andrew G; Breit, Nathan; Allen, Toph; Whiting, Karissa; Kiley, Christopher

2016-01-01

The Global Rapid Identification of Threats System (GRITS) is a biosurveillance application that enables infectious disease analysts to monitor nontraditional information sources (e.g., social media, online news outlets, ProMED-mail reports, and blogs) for infectious disease threats. GRITS analyzes these textual data sources by identifying, extracting, and succinctly visualizing epidemiologic information and suggests potentially associated infectious diseases. This manuscript evaluates and verifies the diagnoses that GRITS performs and discusses novel aspects of the software package. Via GRITS' web interface, infectious disease analysts can examine dynamic visualizations of GRITS' analyses and explore historical infectious disease emergence events. The GRITS API can be used to continuously analyze information feeds, and the API enables GRITS technology to be easily incorporated into other biosurveillance systems. GRITS is a flexible tool that can be modified to conduct sophisticated medical report triaging, expanded to include customized alert systems, and tailored to address other biosurveillance needs.

Evaluation and Verification of the Global Rapid Identification of Threats System for Infectious Diseases in Textual Data Sources

PubMed Central

Breit, Nathan

2016-01-01

The Global Rapid Identification of Threats System (GRITS) is a biosurveillance application that enables infectious disease analysts to monitor nontraditional information sources (e.g., social media, online news outlets, ProMED-mail reports, and blogs) for infectious disease threats. GRITS analyzes these textual data sources by identifying, extracting, and succinctly visualizing epidemiologic information and suggests potentially associated infectious diseases. This manuscript evaluates and verifies the diagnoses that GRITS performs and discusses novel aspects of the software package. Via GRITS' web interface, infectious disease analysts can examine dynamic visualizations of GRITS' analyses and explore historical infectious disease emergence events. The GRITS API can be used to continuously analyze information feeds, and the API enables GRITS technology to be easily incorporated into other biosurveillance systems. GRITS is a flexible tool that can be modified to conduct sophisticated medical report triaging, expanded to include customized alert systems, and tailored to address other biosurveillance needs. PMID:27698665

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...

Contributors to Frequent Telehealth Alerts Including False Alerts for Patients with Heart Failure: A Mixed Methods Exploration

PubMed Central

Radhakrishna, K.; Bowles, K.; Zettek-Sumner, A.

2013-01-01

Summary Background Telehealth data overload through high alert generation is a significant barrier to sustained adoption of telehealth for managing HF patients. Objective To explore the factors contributing to frequent telehealth alerts including false alerts for Medicare heart failure (HF) patients admitted to a home health agency. Materials and Methods A mixed methods design that combined quantitative correlation analysis of patient characteristic data with number of telehealth alerts and qualitative analysis of telehealth and visiting nurses’ notes on follow-up actions to patients’ telehealth alerts was employed. All the quantitative and qualitative data was collected through retrospective review of electronic records of the home heath agency. Results Subjects in the study had a mean age of 83 (SD = 7.6); 56% were female. Patient co-morbidities (p<0.05) of renal disorders, anxiety, and cardiac arrhythmias emerged as predictors of telehealth alerts through quantitative analysis (n = 168) using multiple regression. Inappropriate telehealth measurement technique by patients (54%) and home healthcare system inefficiencies (37%) contributed to most telehealth false alerts in the purposive qualitative sub-sample (n = 35) of patients with high telehealth alerts. Conclusion Encouraging patient engagement with the telehealth process, fostering a collaborative approach among all the clinicians involved with the telehealth intervention, tailoring telehealth alert thresholds to patient characteristics along with establishing patient-centered telehealth outcome goals may allow meaningful generation of telehealth alerts. Reducing avoidable telehealth alerts could vastly improve the efficiency and sustainability of telehealth programs for HF management. PMID:24454576

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

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.

Control structural interaction testbed: A model for multiple flexible body verification

NASA Technical Reports Server (NTRS)

Chory, M. A.; Cohen, A. L.; Manning, R. A.; Narigon, M. L.; Spector, V. A.

1993-01-01

Conventional end-to-end ground tests for verification of control system performance become increasingly complicated with the development of large, multiple flexible body spacecraft structures. The expense of accurately reproducing the on-orbit dynamic environment and the attendant difficulties in reducing and accounting for ground test effects limits the value of these tests. TRW has developed a building block approach whereby a combination of analysis, simulation, and test has replaced end-to-end performance verification by ground test. Tests are performed at the component, subsystem, and system level on engineering testbeds. These tests are aimed at authenticating models to be used in end-to-end performance verification simulations: component and subassembly engineering tests and analyses establish models and critical parameters, unit level engineering and acceptance tests refine models, and subsystem level tests confirm the models' overall behavior. The Precision Control of Agile Spacecraft (PCAS) project has developed a control structural interaction testbed with a multibody flexible structure to investigate new methods of precision control. This testbed is a model for TRW's approach to verifying control system performance. This approach has several advantages: (1) no allocation for test measurement errors is required, increasing flight hardware design allocations; (2) the approach permits greater latitude in investigating off-nominal conditions and parametric sensitivities; and (3) the simulation approach is cost effective, because the investment is in understanding the root behavior of the flight hardware and not in the ground test equipment and environment.

Evaluating Alerting and Guidance Performance of a UAS Detect-And-Avoid System

NASA Technical Reports Server (NTRS)

Lee, Seung Man; Park, Chunki; Thipphavong, David P.; Isaacson, Douglas R.; Santiago, Confesor

2016-01-01

A key challenge to the routine, safe operation of unmanned aircraft systems (UAS) is the development of detect-and-avoid (DAA) systems to aid the UAS pilot in remaining "well clear" of nearby aircraft. The goal of this study is to investigate the effect of alerting criteria and pilot response delay on the safety and performance of UAS DAA systems in the context of routine civil UAS operations in the National Airspace System (NAS). A NAS-wide fast-time simulation study was conducted to assess UAS DAA system performance with a large number of encounters and a broad set of DAA alerting and guidance system parameters. Three attributes of the DAA system were controlled as independent variables in the study to conduct trade-off analyses: UAS trajectory prediction method (dead-reckoning vs. intent-based), alerting time threshold (related to predicted time to LoWC), and alerting distance threshold (related to predicted Horizontal Miss Distance, or HMD). A set of metrics, such as the percentage of true positive, false positive, and missed alerts, based on signal detection theory and analysis methods utilizing the Receiver Operating Characteristic (ROC) curves were proposed to evaluate the safety and performance of DAA alerting and guidance systems and aid development of DAA system performance standards. The effect of pilot response delay on the performance of DAA systems was evaluated using a DAA alerting and guidance model and a pilot model developed to support this study. A total of 18 fast-time simulations were conducted with nine different DAA alerting threshold settings and two different trajectory prediction methods, using recorded radar traffic from current Visual Flight Rules (VFR) operations, and supplemented with DAA-equipped UAS traffic based on mission profiles modeling future UAS operations. Results indicate DAA alerting distance threshold has a greater effect on DAA system performance than DAA alerting time threshold or ownship trajectory prediction method. Further analysis on the alert lead time (time in advance of predicted loss of well clear at which a DAA alert is first issued) indicated a strong positive correlation between alert lead time and DAA system performance (i.e. the ability of the UAS pilot to maneuver the unmanned aircraft to remain well clear). While bigger distance thresholds had beneficial effects on alert lead time and missed alert rate, it also generated a higher rate of false alerts. In the design and development of DAA alerting and guidance systems, therefore, the positive and negative effects of false alerts and missed alerts should be carefully considered to achieve acceptable alerting system performance by balancing false and missed alerts. The results and methodology presented in this study are expected to help stakeholders, policymakers and standards committees define the appropriate setting of DAA system parameter thresholds for UAS that ensure safety while minimizing operational impacts to the NAS and equipage requirements for its users before DAA operational performance standards can be finalized.

Software Development Technologies for Reactive, Real-Time, and Hybrid Systems: Summary of Research

NASA Technical Reports Server (NTRS)

Manna, Zohar

1998-01-01

This research is directed towards the implementation of a comprehensive deductive-algorithmic environment (toolkit) for the development and verification of high assurance reactive systems, especially concurrent, real-time, and hybrid systems. For this, we have designed and implemented the STCP (Stanford Temporal Prover) verification system. Reactive systems have an ongoing interaction with their environment, and their computations are infinite sequences of states. A large number of systems can be seen as reactive systems, including hardware, concurrent programs, network protocols, and embedded systems. Temporal logic provides a convenient language for expressing properties of reactive systems. A temporal verification methodology provides procedures for proving that a given system satisfies a given temporal property. The research covered necessary theoretical foundations as well as implementation and application issues.

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.

Hemochromatosis

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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...

Does one hour of bright or short-wavelength filtered tablet screenlight have a meaningful effect on adolescents' pre-bedtime alertness, sleep, and daytime functioning?

PubMed

Heath, Melanie; Sutherland, Cate; Bartel, Kate; Gradisar, Michael; Williamson, Paul; Lovato, Nicole; Micic, Gorica

2014-05-01

Electronic media use is prevalent among adolescent populations, as is the frequency of sleeplessness. One mechanism proposed for technology affecting adolescents' sleep is the alerting effects from bright screens. Two explanations are provided. First, screens emit significant amounts of short-wavelength light (i.e. blue), which produces acute alertness and alters sleep timing. Second, later chronotypes are hypothesised to be hypersensitive to evening light. This study analysed the pre-sleep alertness (GO/NOGO task speed, accuracy; subjective sleepiness), sleep (sleep diary, polysomnography), and morning functioning of 16 healthy adolescents (M = 17.4 ± 1.9 yrs, 56% f) who used a bright tablet screen (80 lux), dim screen (1 lux) and a filtered short-wavelength screen (f.lux; 50 lux) for 1 hr before their usual bedtime in a within-subjects protocol. Chronotype was analysed as a continuous between-subjects factor; however, no significant interactions occurred. Significant effects occurred between bright and dim screens for GO/NOGO speed and accuracy. However, the magnitude of these differences was small (e.g. GO/NOGO speed = 23 ms, accuracy = 13%), suggesting minimal clinical significance. No significant effects were found for sleep onset latency, slow-rolling eye movements, or the number of SWS and REM minutes in the first two sleep cycles. Future independent studies are needed to test short (1 hr) vs longer (>2 hrs) screen usage to provide evidence for safe-to-harmful levels of screenlight exposure before adolescents' usual bedtime.

Evaluation of the attention network test using vibrotactile stimulations.

PubMed

Salzer, Yael; Oron-Gilad, Tal; Henik, Avishai

2015-06-01

We report a vibrotactile version of the attention network test (ANT)-the tactile ANT (T-ANT). It has been questioned whether attentional components are modality specific or not. The T-ANT explores alertness, orienting, cognitive control, and their relationships, similar to its visual counterpart, in the tactile modality. The unique features of the T-ANT are in utilizing stimuli on a single plane-the torso-and replacing the original imperative flanker task with a tactile Simon task. Subjects wore a waist belt mounted with two vibrotactile stimulators situated on the back and positioned to the right and left of the spinal column. They responded by pressing keys with their right or left hand in reaction to the type of vibrotactile stimulation (pulsed/continuous signal). On a single trial, an alerting tone was followed by a short tactile (informative/noninformative) peripheral cue and an imperative tactile Simon task target. The T-ANT was compared with a variant of the ANT in which the flanker task was replaced with a visual Simon task. Experimental data showed effects of orienting over control only when the peripheral cues were informative. In contrast to the visual task, interactions between alertness and control or alertness and orienting were not found in the tactile task. A possible rationale for these results is discussed. The T-ANT allows examination of attentional processes among patients with tactile attentional deficits and patients with eyesight deficits who cannot take part in visual tasks. Technological advancement would enable implementation of the T-ANT in brain-imaging studies.

Framework to Define Structure and Boundaries of Complex Health Intervention Systems: The ALERT Project

PubMed Central

Boriani, Elena; Esposito, Roberto; Frazzoli, Chiara; Fantke, Peter; Hald, Tine; Rüegg, Simon R.

2017-01-01

Health intervention systems are complex and subject to multiple variables in different phases of implementation. This constitutes a concrete challenge for the application of translational science in real life. Complex systems as health-oriented interventions call for interdisciplinary approaches with carefully defined system boundaries. Exploring individual components of such systems from different viewpoints gives a wide overview and helps to understand the elements and the relationships that drive actions and consequences within the system. In this study, we present an application and assessment of a framework with focus on systems and system boundaries of interdisciplinary projects. As an example on how to apply our framework, we analyzed ALERT [an integrated sensors and biosensors’ system (BEST) aimed at monitoring the quality, health, and traceability of the chain of the bovine milk], a multidisciplinary and interdisciplinary project based on the application of measurable biomarkers at strategic points of the milk chain for improved food security (including safety), human, and ecosystem health (1). In fact, the European food safety framework calls for science-based support to the primary producers’ mandate for legal, scientific, and ethical responsibility in food supply. Because of its multidisciplinary and interdisciplinary approach involving human, animal, and ecosystem health, ALERT can be considered as a One Health project. Within the ALERT context, we identified the need to take into account the main actors, interactions, and relationships of stakeholders to depict a simplified skeleton of the system. The framework can provide elements to highlight how and where to improve the project development when project evaluations are required. PMID:28804707

Design and Evaluation of an Electronic Override Mechanism for Medication Alerts to Facilitate Communication Between Prescribers and Pharmacists.

PubMed

Russ, Alissa L; Chen, Siying; Melton, Brittany L; Saleem, Jason J; Weiner, Michael; Spina, Jeffrey R; Daggy, Joanne K; Zillich, Alan J

2015-07-01

Computerized medication alerts can often be bypassed by entering an override rationale, but prescribers' override reasons are frequently ambiguous to pharmacists who review orders. To develop and evaluate a new override mechanism for adverse reaction and drug-drug interaction alerts. We hypothesized that the new mechanism would improve usability for prescribers and increase the clinical appropriateness of override reasons. A counterbalanced, crossover study was conducted with 20 prescribers in a simulated prescribing environment. We modified the override mechanism timing, navigation, and text entry. Instead of free-text entry, the new mechanism presented prescribers with a predefined set of override reasons. We assessed usability (learnability, perceived efficiency, and usability errors) and used a priori criteria to evaluate the clinical appropriateness of override reasons entered. Prescribers rated the new mechanism as more efficient (Wilcoxon signed-rank test, P = 0.032). When first using the new design, 5 prescribers had difficulty finding the new mechanism, and 3 interpreted the navigation to mean that the alert could not be overridden. The number of appropriate override reasons significantly increased with the new mechanism compared with the original mechanism (median change of 3.0; interquartile range = 3.0; P < 0.0001). When prescribers were given a menu-based choice for override reasons, clinical appropriateness of these reasons significantly improved. Further enhancements are necessary, but this study is an important first step toward a more standardized menu of override choices. Findings may be used to improve communication through e-prescribing systems between prescribers and pharmacists. © The Author(s) 2015.

Framework to Define Structure and Boundaries of Complex Health Intervention Systems: The ALERT Project.

PubMed

Boriani, Elena; Esposito, Roberto; Frazzoli, Chiara; Fantke, Peter; Hald, Tine; Rüegg, Simon R

2017-01-01

Health intervention systems are complex and subject to multiple variables in different phases of implementation. This constitutes a concrete challenge for the application of translational science in real life. Complex systems as health-oriented interventions call for interdisciplinary approaches with carefully defined system boundaries. Exploring individual components of such systems from different viewpoints gives a wide overview and helps to understand the elements and the relationships that drive actions and consequences within the system. In this study, we present an application and assessment of a framework with focus on systems and system boundaries of interdisciplinary projects. As an example on how to apply our framework, we analyzed ALERT [an integrated sensors and biosensors' system (BEST) aimed at monitoring the quality, health, and traceability of the chain of the bovine milk], a multidisciplinary and interdisciplinary project based on the application of measurable biomarkers at strategic points of the milk chain for improved food security (including safety), human, and ecosystem health (1). In fact, the European food safety framework calls for science-based support to the primary producers' mandate for legal, scientific, and ethical responsibility in food supply. Because of its multidisciplinary and interdisciplinary approach involving human, animal, and ecosystem health, ALERT can be considered as a One Health project. Within the ALERT context, we identified the need to take into account the main actors, interactions, and relationships of stakeholders to depict a simplified skeleton of the system. The framework can provide elements to highlight how and where to improve the project development when project evaluations are required.

Lung Transplant

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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

Discrete Abstractions of Hybrid Systems: Verification of Safety and Application to User-Interface Design

NASA Technical Reports Server (NTRS)

Oishi, Meeko; Tomlin, Claire; Degani, Asaf

2003-01-01

Human interaction with complex hybrid systems involves the user, the automation's discrete mode logic, and the underlying continuous dynamics of the physical system. Often the user-interface of such systems displays a reduced set of information about the entire system. In safety-critical systems, how can we identify user-interface designs which do not have adequate information, or which may confuse the user? Here we describe a methodology, based on hybrid system analysis, to verify that a user-interface contains information necessary to safely complete a desired procedure or task. Verification within a hybrid framework allows us to account for the continuous dynamics underlying the simple, discrete representations displayed to the user. We provide two examples: a car traveling through a yellow light at an intersection and an aircraft autopilot in a landing/go-around maneuver. The examples demonstrate the general nature of this methodology, which is applicable to hybrid systems (not fully automated) which have operational constraints we can pose in terms of safety. This methodology differs from existing work in hybrid system verification in that we directly account for the user's interactions with the system.

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.

Automated External Defibrillator

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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.

Comparison of three commercial knowledge bases for detection of drug-drug interactions in clinical decision support.

PubMed

Fung, Kin Wah; Kapusnik-Uner, Joan; Cunningham, Jean; Higby-Baker, Stefanie; Bodenreider, Olivier

2017-07-01

To compare 3 commercial knowledge bases (KBs) used for detection and avoidance of potential drug-drug interactions (DDIs) in clinical practice. Drugs in the DDI tables from First DataBank (FDB), Micromedex, and Multum were mapped to RxNorm. The KBs were compared at the clinical drug, ingredient, and DDI rule levels. The KBs were evaluated against a reference list of highly significant DDIs from the Office of the National Coordinator for Health Information Technology (ONC). The KBs and the ONC list were applied to a prescription data set to simulate their use in clinical decision support. The KBs contained 1.6 million (FDB), 4.5 million (Micromedex), and 4.8 million (Multum) clinical drug pairs. Altogether, there were 8.6 million unique pairs, of which 79% were found only in 1 KB and 5% in all 3 KBs. However, there was generally more agreement than disagreement in the severity rankings, especially in the contraindicated category. The KBs covered 99.8-99.9% of the alerts of the ONC list and would have generated 25 (FDB), 145 (Micromedex), and 84 (Multum) alerts per 1000 prescriptions. The commercial KBs differ considerably in size and quantity of alerts generated. There is less variability in severity ranking of DDIs than suggested by previous studies. All KBs provide very good coverage of the ONC list. More work is needed to standardize the editorial policies and evidence for inclusion of DDIs to reduce variation among knowledge sources and improve relevance. Some DDIs considered contraindicated in all 3 KBs might be possible candidates to add to the ONC list. Published by Oxford University Press on behalf of the American Medical Informatics Association 2017. This work is written by US Government employees and is in the public domain in the United States.

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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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.

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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Method of Generating Transient Equivalent Sink and Test Target Temperatures for Swift BAT

NASA Technical Reports Server (NTRS)

Choi, Michael K.

2004-01-01

The NASA Swift mission has a 600-km altitude and a 22 degrees maximum inclination. The sun angle varies from 45 degrees to 180 degrees in normal operation. As a result, environmental heat fluxes absorbed by the Burst Alert Telescope (BAT) radiator and loop heat pipe (LHP) compensation chambers (CCs) vary transiently. Therefore the equivalent sink temperatures for the radiator and CCs varies transiently. In thermal performance verification testing in vacuum, the radiator and CCs radiated heat to sink targets. This paper presents an analytical technique for generating orbit transient equivalent sink temperatures and a technique for generating transient sink target temperatures for the radiator and LHP CCs. Using these techniques, transient target temperatures for the radiator and LHP CCs were generated for three thermal environmental cases: worst hot case, worst cold case, and cooldown and warmup between worst hot case in sunlight and worst cold case in the eclipse, and three different heat transport values: 128 W, 255 W, and 382 W. The 128 W case assumed that the two LHPs transport 255 W equally to the radiator. The 255 W case assumed that one LHP fails so that the remaining LHP transports all the waste heat from the detector array to the radiator. The 382 W case assumed that one LHP fails so that the remaining LHP transports all the waste heat from the detector array to the radiator, and has a 50% design margin. All these transient target temperatures were successfully implemented in the engineering test unit (ETU) LHP and flight LHP thermal performance verification tests in vacuum.

Role of the pharmacist in preventing distribution of counterfeit medications.

PubMed

Chambliss, Walter G; Carroll, Wesley A; Kennedy, Daniel; Levine, Donald; Moné, Michael A; Ried, L Douglas; Shepherd, Marv; Yelvigi, Mukund

2012-01-01

To provide an overview of the counterfeit medication problem and recommendations of a joint American Pharmacists Association (APhA) Academy of Pharmaceutical Research and Science and APhA Academy of Pharmacy Practice and Management taskforce. SciFinder and PubMed were searched from 1980 to March 2011 using the following keywords: counterfeit drug product, counterfeit medications, drug product authentication, drug product verification, and track-and-trace. Publications, presentations, and websites of organizations that research the counterfeit medication problem in the United States and other countries were reviewed. A representative from the security division of a pharmaceutical manufacturer and a representative from a supplier of anticounterfeiting technologies gave presentations to the taskforce. The taskforce recommends that pharmacists (1) purchase medications from known, reliable sources; (2) warn patients of the dangers of purchasing medications over the Internet; (3) confirm with distributors that products were purchased from manufacturers or other reliable sources; (4) monitor counterfeit product alerts; (5) examine products for suspicious appearance; (6) work with the pharmaceutical industry, distributors, and the Food and Drug Administration (FDA) to close gaps in the supply chain, especially for drugs in short supply; (7) use scanning technology in the pharmacy as part of a prescription verification process; (8) educate themselves, coworkers, and patients about the risks of counterfeit medications; and (9) report suspicious medications to FDA, the distributor, and the manufacturer. The consequence of a patient receiving a counterfeit medication in the United States could be catastrophic, and pharmacists must play an active role in preventing such an event from occurring.

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

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.

Exploring Machine Learning Techniques Using Patient Interactions in Online Health Forums to Classify Drug Safety

ERIC Educational Resources Information Center

Chee, Brant Wah Kwong

2011-01-01

This dissertation explores the use of personal health messages collected from online message forums to predict drug safety using natural language processing and machine learning techniques. Drug safety is defined as any drug with an active safety alert from the US Food and Drug Administration (FDA). It is believed that this is the first…

Resolving the Problem of Aligning Communities of Interest, Data Format Differences, Orthogonal Sensor Views, Intermittency, and Security - DoD Homeland Security Command and Control Advanced Concept Technology Demonstration

DTIC Science & Technology

2005-06-01

provisioning, maintaining and guaranteeing service levels for the shared services ? Although these shared, distributed services lie well within the... shared services that interact with a common object definition for transporting alerts. The system is built on top of a rapid SOA application

Visualization Techniques for Computer Network Defense

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

Beaver, Justin M; Steed, Chad A; Patton, Robert M

2011-01-01

Effective visual analysis of computer network defense (CND) information is challenging due to the volume and complexity of both the raw and analyzed network data. A typical CND is comprised of multiple niche intrusion detection tools, each of which performs network data analysis and produces a unique alerting output. The state-of-the-practice in the situational awareness of CND data is the prevalent use of custom-developed scripts by Information Technology (IT) professionals to retrieve, organize, and understand potential threat events. We propose a new visual analytics framework, called the Oak Ridge Cyber Analytics (ORCA) system, for CND data that allows an operatormore » to interact with all detection tool outputs simultaneously. Aggregated alert events are presented in multiple coordinated views with timeline, cluster, and swarm model analysis displays. These displays are complemented with both supervised and semi-supervised machine learning classifiers. The intent of the visual analytics framework is to improve CND situational awareness, to enable an analyst to quickly navigate and analyze thousands of detected events, and to combine sophisticated data analysis techniques with interactive visualization such that patterns of anomalous activities may be more easily identified and investigated.« less

Cortical–Subcortical Interactions in Hypersomnia Disorders: Mechanisms Underlying Cognitive and Behavioral Aspects of the Sleep–Wake Cycle

PubMed Central

Larson-Prior, Linda J.; Ju, Yo-El; Galvin, James E.

2014-01-01

Subcortical circuits mediating sleep–wake functions have been well characterized in animal models, and corroborated by more recent human studies. Disruptions in these circuits have been identified in hypersomnia disorders (HDs) such as narcolepsy and Kleine–Levin Syndrome, as well as in neurodegenerative disorders expressing excessive daytime sleepiness. However, the behavioral expression of sleep–wake functions is not a simple on-or-off state determined by subcortical circuits, but encompasses a complex range of behaviors determined by the interaction between cortical networks and subcortical circuits. While conceived as disorders of sleep, HDs are equally disorders of wake, representing a fundamental instability in neural state characterized by lapses of alertness during wake. These episodic lapses in alertness and wakefulness are also frequently seen in neurodegenerative disorders where electroencephalogram demonstrates abnormal function in cortical regions associated with cognitive fluctuations (CFs). Moreover, functional connectivity MRI shows instability of cortical networks in individuals with CFs. We propose that the inability to stabilize neural state due to disruptions in the sleep–wake control networks is common to the sleep and cognitive dysfunctions seen in hypersomnia and neurodegenerative disorders. PMID:25309500

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

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

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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.

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.

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.

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

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.

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

Verification of hydrologic landscape derived basin-scale classifications in the Pacific Northwest

Treesearch

Keith Sawicz

2016-01-01

The interaction between the physical and climatic attributes of a basin (form) control how water is partitioned, stored, and conveyed through a catchment (function). Hydrologic Landscapes (HLs) were previously...

Extremely accurate sequential verification of RELAP5-3D

DOE PAGES

Mesina, George L.; Aumiller, David L.; Buschman, Francis X.

2015-11-19

Large computer programs like RELAP5-3D solve complex systems of governing, closure and special process equations to model the underlying physics of nuclear power plants. Further, these programs incorporate many other features for physics, input, output, data management, user-interaction, and post-processing. For software quality assurance, the code must be verified and validated before being released to users. For RELAP5-3D, verification and validation are restricted to nuclear power plant applications. Verification means ensuring that the program is built right by checking that it meets its design specifications, comparing coding to algorithms and equations and comparing calculations against analytical solutions and method ofmore » manufactured solutions. Sequential verification performs these comparisons initially, but thereafter only compares code calculations between consecutive code versions to demonstrate that no unintended changes have been introduced. Recently, an automated, highly accurate sequential verification method has been developed for RELAP5-3D. The method also provides to test that no unintended consequences result from code development in the following code capabilities: repeating a timestep advancement, continuing a run from a restart file, multiple cases in a single code execution, and modes of coupled/uncoupled operation. In conclusion, mathematical analyses of the adequacy of the checks used in the comparisons are provided.« less

Towards the Verification of Human-Robot Teams

NASA Technical Reports Server (NTRS)

Fisher, Michael; Pearce, Edward; Wooldridge, Mike; Sierhuis, Maarten; Visser, Willem; Bordini, Rafael H.

2005-01-01

Human-Agent collaboration is increasingly important. Not only do high-profile activities such as NASA missions to Mars intend to employ such teams, but our everyday activities involving interaction with computational devices falls into this category. In many of these scenarios, we are expected to trust that the agents will do what we expect and that the agents and humans will work together as expected. But how can we be sure? In this paper, we bring together previous work on the verification of multi-agent systems with work on the modelling of human-agent teamwork. Specifically, we target human-robot teamwork. This paper provides an outline of the way we are using formal verification techniques in order to analyse such collaborative activities. A particular application is the analysis of human-robot teams intended for use in future space exploration.

Ontology-Driven Monitoring of Patient's Vital Signs Enabling Personalized Medical Detection and Alert

PubMed Central

Hristoskova, Anna; Sakkalis, Vangelis; Zacharioudakis, Giorgos; Tsiknakis, Manolis; De Turck, Filip

2014-01-01

A major challenge related to caring for patients with chronic conditions is the early detection of exacerbations of the disease. Medical personnel should be contacted immediately in order to intervene in time before an acute state is reached, ensuring patient safety. This paper proposes an approach to an ambient intelligence (AmI) framework supporting real-time remote monitoring of patients diagnosed with congestive heart failure (CHF). Its novelty is the integration of: (i) personalized monitoring of the patients health status and risk stage; (ii) intelligent alerting of the dedicated physician through the construction of medical workflows on-the-fly; and (iii) dynamic adaptation of the vital signs’ monitoring environment on any available device or smart phone located in close proximity to the physician depending on new medical measurements, additional disease specifications or the failure of the infrastructure. The intelligence lies in the adoption of semantics providing for a personalized and automated emergency alerting that smoothly interacts with the physician, regardless of his location, ensuring timely intervention during an emergency. It is evaluated on a medical emergency scenario, where in the case of exceeded patient thresholds, medical personnel are localized and contacted, presenting ad hoc information on the patient's condition on the most suited device within the physician's reach. PMID:24445411

[Patient safety in primary care: PREFASEG project].

PubMed

Catalán, Arantxa; Borrell, Francesc; Pons, Angels; Amado, Ester; Baena, José Miguel; Morales, Vicente

2014-07-01

The Institut Català de la Salut (ICS) has designed and integrated in electronic clinical station of primary care a new software tool to support the prescription of drugs, which can detect on-line certain medication errors. The software called PREFASEG (stands for Secure drug prescriptions) aims to prevent adverse events related to medication use in the field of primary health care (PHC). This study was made on the computerized medical record called CPT, which is used by all PHC physicians in our institution -3,750- and prescribing physicians through it. PREFASEG integrated in eCAP in July 2010 and six months later we performed a cross-sectional study to evaluate their usefulness and refine their design. The software alerts on-line in 5 dimensions: drug interactions, redundant treatments, allergies, contraindications of drugs with disease, and advises against drugs in over 75 years. PREFASEG generated 1,162,765 alerts (1 per 10 high treatment), with the detection of therapeutic duplication (62%) the most alerted. The overall acceptance rate is 35%, redundancies pharmacological (43%) and allergies (26%) are the most accepted. A total of 10,808 professionals (doctors and nurses) have accepted some of the recommendations of the program. PREFASEG is a feasible and highly efficient strategy to achieve an objective of Quality Plan for the NHS. Copyright © 2014. Published by Elsevier Espana.

The impact of morning light intensity and environmental temperature on body temperatures and alertness.

PubMed

Te Kulve, Marije; Schlangen, Luc J M; Schellen, Lisje; Frijns, Arjan J H; van Marken Lichtenbelt, Wouter D

2017-06-01

Indoor temperature and light exposure are known to affect body temperature, productivity and alertness of building occupants. However, not much is known about the interaction between light and temperature exposure and the relationship between morning light induced alertness and its effect on body temperature. Light intensity and room temperature during morning office hours were investigated under strictly controlled conditions. In a randomized crossover study, two white light conditions (4000K, either bright 1200lx or dim 5lx) under three different room temperatures (26, 29 and 32°C) were investigated. A lower room temperature increased the core body temperature (CBT) and lowered skin temperature and the distal-proximal temperature gradient (DPG). Moreover, a lower room temperature reduced the subjective sleepiness and reaction time on an auditory psychomotor vigilance task (PVT), irrespective of the light condition. Interestingly, the morning bright light exposure did affect thermophysiological parameters, i.e. it decreased plasma cortisol, CBT and proximal skin temperature and increased the DPG, irrespective of the room temperature. During the bright light session, subjective sleepiness decreased irrespective of the room temperature. However, the change in sleepiness due to the light exposure was not related to these physiological changes. Copyright © 2017 Elsevier Inc. All rights reserved.

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.

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.

Is identity per se irrelevant? A contrarian view of self-verification effects.

PubMed

Gregg, Aiden P

2009-01-01

Self-verification theory (SVT) posits that people who hold negative self-views, such as depressive patients, ironically strive to verify that these self-views are correct, by actively seeking out critical feedback or interaction partners who evaluate them unfavorably. Such verification strivings are allegedly directed towards maximizing subjective perceptions of prediction and control. Nonetheless, verification strivings are also alleged to stabilize maladaptive self-perceptions, and thereby hindering therapeutic recovery. Despite the widespread acceptance of SVT, I contend that the evidence for it is weak and circumstantial. In particular, I contend that that most or all major findings cited in support of SVT can be more economically explained in terms of raison oblige theory (ROT). ROT posits that people with negative self-views solicit critical feedback, not because they want it, but because they their self-view inclines them regard it as probative, a necessary condition for considering it worth obtaining. Relevant findings are reviewed and reinterpreted with an emphasis on depression, and some new empirical data reported. (c) 2008 Wiley-Liss, Inc.

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

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.

Using Automated Scores of Student Essays to Support Teacher Guidance in Classroom Inquiry

NASA Astrophysics Data System (ADS)

Gerard, Libby F.; Linn, Marcia C.

2016-02-01

Computer scoring of student written essays about an inquiry topic can be used to diagnose student progress both to alert teachers to struggling students and to generate automated guidance. We identify promising ways for teachers to add value to automated guidance to improve student learning. Three teachers from two schools and their 386 students participated. We draw on evidence from student progress, observations of how teachers interact with students, and reactions of teachers. The findings suggest that alerts for teachers prompted rich teacher-student conversations about energy in photosynthesis. In one school, the combination of the automated guidance plus teacher guidance was more effective for student science learning than two rounds of personalized, automated guidance. In the other school, both approaches resulted in equal learning gains. These findings suggest optimal combinations of automated guidance and teacher guidance to support students to revise explanations during inquiry and build integrated understanding of science.

Negative Affect, Decision Making, and Attentional Networks.

PubMed

Ortega, Ana Raquel; Ramírez, Encarnación; Colmenero, José María; García-Viedma, Ma Del Rosario

2017-02-01

This study focuses on whether risk avoidance in decision making depends on negative affect or it is specific to anxious individuals. The Balloon Analogue Risk Task was used to obtain an objective measure in a risk situation with anxious, depressive, and control individuals. The role of attentional networks was also studied using the Attentional Network Test-Interaction (ANT-I) task with neutral stimuli. A significant difference was observed between anxious and depressive individuals in assumed risk in decision making. We found no differences between anxious and normal individuals in the alert, orientation, and congruency effects obtained in the ANT-I task. The results showed that there was no significant relationship between the risk avoidance and the indexes of alertness, orienting, and control. Future research shall determine whether emotionally relevant stimulation leads to attentional control deficit or whether differences between anxious and no anxious individuals are due to the type of strategy followed in choice tasks.

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

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.

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.

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

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.

THE DETECTION OF A SN IIn IN OPTICAL FOLLOW-UP OBSERVATIONS OF ICECUBE NEUTRINO EVENTS

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

Aartsen, M. G.; Abraham, K.; Ackermann, M.

2015-09-20

The IceCube neutrino observatory pursues a follow-up program selecting interesting neutrino events in real-time and issuing alerts for electromagnetic follow-up observations. In 2012 March, the most significant neutrino alert during the first three years of operation was issued by IceCube. In the follow-up observations performed by the Palomar Transient Factory (PTF), a Type IIn supernova (SN IIn) PTF12csy was found 0.°2 away from the neutrino alert direction, with an error radius of 0.°54. It has a redshift of z = 0.0684, corresponding to a luminosity distance of about 300 Mpc and the Pan-STARRS1 survey shows that its explosion time wasmore » at least 158 days (in host galaxy rest frame) before the neutrino alert, so that a causal connection is unlikely. The a posteriori significance of the chance detection of both the neutrinos and the SN at any epoch is 2.2σ within IceCube's 2011/12 data acquisition season. Also, a complementary neutrino analysis reveals no long-term signal over the course of one year. Therefore, we consider the SN detection coincidental and the neutrinos uncorrelated to the SN. However, the SN is unusual and interesting by itself: it is luminous and energetic, bearing strong resemblance to the SN IIn 2010jl, and shows signs of interaction of the SN ejecta with a dense circumstellar medium. High-energy neutrino emission is expected in models of diffusive shock acceleration, but at a low, non-detectable level for this specific SN. In this paper, we describe the SN PTF12csy and present both the neutrino and electromagnetic data, as well as their analysis.« less

Time budgets of Snow Geese Chen caerulescens and Ross's Geese Chen rossii in mixed flocks: Implications of body size, ambient temperature and family associations

USGS Publications Warehouse

Jonsson, J.E.; Afton, A.D.

2009-01-01

Body size affects foraging and forage intake rates directly via energetic processes and indirectly through interactions with social status and social behaviour. Ambient temperature has a relatively greater effect on the energetics of smaller species, which also generally are more vulnerable to predator attacks than are larger species. We examined variability in an index of intake rates and an index of alertness in Lesser Snow Geese Chen caerulescens caerulescens and Ross's Geese Chen rossii wintering in southwest Louisiana. Specifically we examined variation in these response variables that could be attributed to species, age, family size and ambient temperature. We hypothesized that the smaller Ross's Geese would spend relatively more time feeding, exhibit relatively higher peck rates, spend more time alert or raise their heads up from feeding more frequently, and would respond to declining temperatures by increasing their proportion of time spent feeding. As predicted, we found that Ross's Geese spent more time feeding than did Snow Geese and had slightly higher peck rates than Snow Geese in one of two winters. Ross's Geese spent more time alert than did Snow Geese in one winter, but alert rates differed by family size, independent of species, in contrast to our prediction. In one winter, time spent foraging and walking was inversely related to average daily temperature, but both varied independently of species. Effects of age and family size on time budgets were generally independent of species and in accordance with previous studies. We conclude that body size is a key variable influencing time spent feeding in Ross's Geese, which may require a high time spent feeding at the expense of other activities. ?? 2008 The Authors.

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.

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...

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.

Childrens Hospital Integrated Patient Electronic Record System Continuation (CHIPERS)

DTIC Science & Technology

2015-12-01

of our interactive BPAs and order set technology. The Cumberland Group has been the primary consulting group assisting the entire inpatient and...to allow for continued BPA development and iteration during the upgrade period, while also effecting a seamless transition of BPA and order set...clinical decision support system. Our BPA logic includes: Severe Sepsis Alert Logic Summary: Age + Temperature + White Blood Cell and (lethargy or

Clinical Decision Support to Implement CYP2D6 Drug-Gene Interaction.

PubMed

Caraballo, Pedro J; Parkulo, Mark; Blair, David; Elliott, Michelle; Schultz, Cloann; Sutton, Joseph; Rao, Padma; Bruflat, Jamie; Bleimeyer, Robert; Crooks, John; Gabrielson, Donald; Nicholson, Wayne; Rohrer Vitek, Carolyn; Wix, Kelly; Bielinski, Suzette J; Pathak, Jyotishman; Kullo, Iftikhar

2015-01-01

The level of CYP2D6 metabolic activity can be predicted by pharmacogenomic testing, and concomitant use of clinical decision support has the potential to prevent adverse effects from those drugs metabolized by this enzyme. Our initial findings after implementation of clinical decision support alerts integrated in the electronic health records suggest high feasibility, but also identify important challenges.

Combat Service Support Enabler Functional Assessment (CEFA). Volume 2: Individual (65) Mini-CEFA Assessments

DTIC Science & Technology

1997-12-01

SLOT) 356 57. Sensor Artificial Intelligence Communications Interactive Maintenance System (SACIMS) 361 58. Soldier’s Portable On- System Repair...increased mobility ; NBC overpressure, environmental control; and situational awareness.] 19. Related changes in CSS effectiveness. Increase The AMEV...to paragraph 17 above.] 19. Related changes in CSS effectiveness. Increase. Driver Minder alerts the maintainer about equipment and operator faults

Remote Sensing of Volcanic Clouds: Sulfur Gases and Plume Top Topography

NASA Technical Reports Server (NTRS)

Crisp, Joy A.

1999-01-01

New absorption line parameters for H2S were published and submitted to the Gestion et Etude des Informations Spectroscopiques Atmospheriques (GEISA) and high resolution transmission molecular absorption (HITRAN) databases. These new absorption line parameters will make it possible to use observations from the future Tropospheric Emission Spectrometer (TES) instrument [Earth Observing System (EOS) Chemistry Mission (CHEM) platform] to make more accurate H2S measurements if it observes an H2S-rich volcanic cloud. H2S is the second most abundant volcanic sulfur gas, and like SO2, it also converts to H2SO4 aerosols and can have a climate impact. A paper on the Moderate-resolution Imaging-Spectroradiometer (MODIS) SO2 alert is being revised. New aspects in the revision include verification of the SO2 alert during the EOS mission; factors affecting SO2 detection at thermal infrared, ultraviolet, and microwave wavelengths; radiative transfer tests; more description of satellite instruments; and thermal surface alert installed for MODIS. Her research involves the use of remote sensing to generate maps of plume top altitude. This parameter is important for models of volcanic eruption, aircraft hazards, and climate impact. The topographic shape of the top surface of a volcanic plume can provide information necessary to understand the physics controlling the injection and dispersal of a volcanic plume in the atmosphere. Glaze et al. describe the application of a photoclinometric technique to volcanic plumes. The software algorithm has been improved to account for more general plume and illumination geometries and for easily extracting position information directly from Advanced Very High-Resolution Radiometer (AVHRR) level 1B data. Testing of the algorithm has focused on acquiring AVHRR data for a variety of volcanic plumes in an effort to identify problems with the software as well as model sensitivities. The plumes chosen were erupted from volcanoes at a variety of latitudes, at different times of day, and in different seasons. Another important issue that is being investigated is the importance of plume opacity. A diagram illustrates the method for deriving phi, the angle a wind-blown plume makes with the horizontal, in the direction perpendicular to the remote sensing scan. A figure shows a sample output of the algorithm, a wire mesh map of plume top topography. Additional information is contained in the original.

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.

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...

From Operating-System Correctness to Pervasively Verified Applications

NASA Astrophysics Data System (ADS)

Daum, Matthias; Schirmer, Norbert W.; Schmidt, Mareike

Though program verification is known and has been used for decades, the verification of a complete computer system still remains a grand challenge. Part of this challenge is the interaction of application programs with the operating system, which is usually entrusted with retrieving input data from and transferring output data to peripheral devices. In this scenario, the correct operation of the applications inherently relies on operating-system correctness. Based on the formal correctness of our real-time operating system Olos, this paper describes an approach to pervasively verify applications running on top of the operating system.

VeriClick: an efficient tool for table format verification

NASA Astrophysics Data System (ADS)

Nagy, George; Tamhankar, Mangesh

2012-01-01

The essential layout attributes of a visual table can be defined by the location of four critical grid cells. Although these critical cells can often be located by automated analysis, some means of human interaction is necessary for correcting residual errors. VeriClick is a macro-enabled spreadsheet interface that provides ground-truthing, confirmation, correction, and verification functions for CSV tables. All user actions are logged. Experimental results of seven subjects on one hundred tables suggest that VeriClick can provide a ten- to twenty-fold speedup over performing the same functions with standard spreadsheet editing commands.

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.

Alertness Modulates Conflict Adaptation and Feature Integration in an Opposite Way

PubMed Central

Chen, Jia; Huang, Xiting; Chen, Antao

2013-01-01

Previous studies show that the congruency sequence effect can result from both the conflict adaptation effect (CAE) and feature integration effect which can be observed as the repetition priming effect (RPE) and feature overlap effect (FOE) depending on different experimental conditions. Evidence from neuroimaging studies suggests that a close correlation exists between the neural mechanisms of alertness-related modulations and the congruency sequence effect. However, little is known about whether and how alertness mediates the congruency sequence effect. In Experiment 1, the Attentional Networks Test (ANT) and a modified flanker task were used to evaluate whether the alertness of the attentional functions had a correlation with the CAE and RPE. In Experimental 2, the ANT and another modified flanker task were used to investigate whether alertness of the attentional functions correlate with the CAE and FOE. In Experiment 1, through the correlative analysis, we found a significant positive correlation between alertness and the CAE, and a negative correlation between the alertness and the RPE. Moreover, a significant negative correlation existed between CAE and RPE. In Experiment 2, we found a marginally significant negative correlation between the CAE and the RPE, but the correlation between alertness and FOE, CAE and FOE was not significant. These results suggest that alertness can modulate conflict adaptation and feature integration in an opposite way. Participants at the high alerting level group may tend to use the top-down cognitive processing strategy, whereas participants at the low alerting level group tend to use the bottom-up processing strategy. PMID:24250824

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.

Automated Analysis of Stateflow Models

NASA Technical Reports Server (NTRS)

Bourbouh, Hamza; Garoche, Pierre-Loic; Garion, Christophe; Gurfinkel, Arie; Kahsaia, Temesghen; Thirioux, Xavier

2017-01-01

Stateflow is a widely used modeling framework for embedded and cyber physical systems where control software interacts with physical processes. In this work, we present a framework a fully automated safety verification technique for Stateflow models. Our approach is two-folded: (i) we faithfully compile Stateflow models into hierarchical state machines, and (ii) we use automated logic-based verification engine to decide the validity of safety properties. The starting point of our approach is a denotational semantics of State flow. We propose a compilation process using continuation-passing style (CPS) denotational semantics. Our compilation technique preserves the structural and modal behavior of the system. The overall approach is implemented as an open source toolbox that can be integrated into the existing Mathworks Simulink Stateflow modeling framework. We present preliminary experimental evaluations that illustrate the effectiveness of our approach in code generation and safety verification of industrial scale Stateflow models.

Consistent model driven architecture

NASA Astrophysics Data System (ADS)

Niepostyn, Stanisław J.

2015-09-01

The goal of the MDA is to produce software systems from abstract models in a way where human interaction is restricted to a minimum. These abstract models are based on the UML language. However, the semantics of UML models is defined in a natural language. Subsequently the verification of consistency of these diagrams is needed in order to identify errors in requirements at the early stage of the development process. The verification of consistency is difficult due to a semi-formal nature of UML diagrams. We propose automatic verification of consistency of the series of UML diagrams originating from abstract models implemented with our consistency rules. This Consistent Model Driven Architecture approach enables us to generate automatically complete workflow applications from consistent and complete models developed from abstract models (e.g. Business Context Diagram). Therefore, our method can be used to check practicability (feasibility) of software architecture models.

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

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

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...

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.

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.

LIVVkit: An extensible, python-based, land ice verification and validation toolkit for ice sheet models

NASA Astrophysics Data System (ADS)

Kennedy, Joseph H.; Bennett, Andrew R.; Evans, Katherine J.; Price, Stephen; Hoffman, Matthew; Lipscomb, William H.; Fyke, Jeremy; Vargo, Lauren; Boghozian, Adrianna; Norman, Matthew; Worley, Patrick H.

2017-06-01

To address the pressing need to better understand the behavior and complex interaction of ice sheets within the global Earth system, significant development of continental-scale, dynamical ice sheet models is underway. Concurrent to the development of the Community Ice Sheet Model (CISM), the corresponding verification and validation (V&V) process is being coordinated through a new, robust, Python-based extensible software package, the Land Ice Verification and Validation toolkit (LIVVkit). Incorporated into the typical ice sheet model development cycle, it provides robust and automated numerical verification, software verification, performance validation, and physical validation analyses on a variety of platforms, from personal laptops to the largest supercomputers. LIVVkit operates on sets of regression test and reference data sets, and provides comparisons for a suite of community prioritized tests, including configuration and parameter variations, bit-for-bit evaluation, and plots of model variables to indicate where differences occur. LIVVkit also provides an easily extensible framework to incorporate and analyze results of new intercomparison projects, new observation data, and new computing platforms. LIVVkit is designed for quick adaptation to additional ice sheet models via abstraction of model specific code, functions, and configurations into an ice sheet model description bundle outside the main LIVVkit structure. Ultimately, through shareable and accessible analysis output, LIVVkit is intended to help developers build confidence in their models and enhance the credibility of ice sheet models overall.

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.

Formally verifying human–automation interaction as part of a system model: limitations and tradeoffs

PubMed Central

Bass, Ellen J.

2011-01-01

Both the human factors engineering (HFE) and formal methods communities are concerned with improving the design of safety-critical systems. This work discusses a modeling effort that leveraged methods from both fields to perform formal verification of human–automation interaction with a programmable device. This effort utilizes a system architecture composed of independent models of the human mission, human task behavior, human-device interface, device automation, and operational environment. The goals of this architecture were to allow HFE practitioners to perform formal verifications of realistic systems that depend on human–automation interaction in a reasonable amount of time using representative models, intuitive modeling constructs, and decoupled models of system components that could be easily changed to support multiple analyses. This framework was instantiated using a patient controlled analgesia pump in a two phased process where models in each phase were verified using a common set of specifications. The first phase focused on the mission, human-device interface, and device automation; and included a simple, unconstrained human task behavior model. The second phase replaced the unconstrained task model with one representing normative pump programming behavior. Because models produced in the first phase were too large for the model checker to verify, a number of model revisions were undertaken that affected the goals of the effort. While the use of human task behavior models in the second phase helped mitigate model complexity, verification time increased. Additional modeling tools and technological developments are necessary for model checking to become a more usable technique for HFE. PMID:21572930

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.

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.

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

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.

Very fast road database verification using textured 3D city models obtained from airborne imagery

NASA Astrophysics Data System (ADS)

Bulatov, Dimitri; Ziems, Marcel; Rottensteiner, Franz; Pohl, Melanie

2014-10-01

Road databases are known to be an important part of any geodata infrastructure, e.g. as the basis for urban planning or emergency services. Updating road databases for crisis events must be performed quickly and with the highest possible degree of automation. We present a semi-automatic algorithm for road verification using textured 3D city models, starting from aerial or even UAV-images. This algorithm contains two processes, which exchange input and output, but basically run independently from each other. These processes are textured urban terrain reconstruction and road verification. The first process contains a dense photogrammetric reconstruction of 3D geometry of the scene using depth maps. The second process is our core procedure, since it contains various methods for road verification. Each method represents a unique road model and a specific strategy, and thus is able to deal with a specific type of roads. Each method is designed to provide two probability distributions, where the first describes the state of a road object (correct, incorrect), and the second describes the state of its underlying road model (applicable, not applicable). Based on the Dempster-Shafer Theory, both distributions are mapped to a single distribution that refers to three states: correct, incorrect, and unknown. With respect to the interaction of both processes, the normalized elevation map and the digital orthophoto generated during 3D reconstruction are the necessary input - together with initial road database entries - for the road verification process. If the entries of the database are too obsolete or not available at all, sensor data evaluation enables classification of the road pixels of the elevation map followed by road map extraction by means of vectorization and filtering of the geometrically and topologically inconsistent objects. Depending on the time issue and availability of a geo-database for buildings, the urban terrain reconstruction procedure has semantic models of buildings, trees, and ground as output. Building s and ground are textured by means of available images. This facilitates the orientation in the model and the interactive verification of the road objects that where initially classified as unknown. The three main modules of the texturing algorithm are: Pose estimation (if the videos are not geo-referenced), occlusion analysis, and texture synthesis.

An In Vitro Model for Retinal Laser Damage

DTIC Science & Technology

2007-01-01

Approved for public release, distribution unlimited This paper is part of the following report: TITLE: Conference on Optical Interactions with Tissue...necessarily endorsed by the United States Air Force. Optical Interactions with Tissue and Cells XVIII, edited by Steven L. Jacques, William P. Roach, Proc...used for the 532-nm exposures. Verification of laser wavelength was performed with a spectrometer (Ocean Optics ). Figure 4 provides a schematic

DARK Technology Transition Plan

DTIC Science & Technology

1990-04-01

or suspend/resume primitives , and bounded delays. Under the above circumstances, the extra language features, and the hidden system calls they... system , this implies that the mechanisms by which units interact - to synchronise , communicate, schedule one another, or alert one another - should be...the Kernel environment are: " The host system is a DEC VAX operating under VMS 5.0 (the specific host used at the SEI is a MicroVAX II operating under

Observed Changes in the Alertness and Communicative Involvement of Students with Multiple and Severe Disability Following In-Class Mentor Modelling for Staff in Segregated and General Education Classrooms

ERIC Educational Resources Information Center

Foreman, P.; Arthur-Kelly, M.; Bennett, D.; Neilands, J.; Colyvas, K.

2014-01-01

Background: The improvement of engagement and involvement in communicative and socially centred exchanges for individuals with multiple and severe disability (MSD) presents complex and urgent challenges to educators. This paper reports the findings of an intervention study designed to enhance the interactive skills of students with MSD using an…

A Hypermedia Training Module for the Navy’s P-3C Armament System

DTIC Science & Technology

1993-07-01

procedures. Both aural , and visual cues are used throughout the program as necessary to alert the learner to specific items requiring his attention... learner the opportunity for a great deal of interactivity and feedback. The project is divided into five chapters including an introduction, review of the...literature, methodology, program description, and summary and conclusions. The literature review concentrates on the foliowing topics: adult learners

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...

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.

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

The forecaster's added value in QPF

NASA Astrophysics Data System (ADS)

Turco, M.; Milelli, M.

2009-04-01

To the authors' knowledge there are relatively few studies that try to answer this topic: "Are humans able to add value to computer-generated forecasts and warnings ?". Moreover, the answers are not always positive. In particular some postprocessing method is competitive or superior to human forecast (see for instance Baars et al., 2005, Charba et al., 2002, Doswell C., 2003, Roebber et al., 1996, Sanders F., 1986). Within the alert system of ARPA Piemonte it is possible to study in an objective manner if the human forecaster is able to add value with respect to computer-generated forecasts. Every day the meteorology group of the Centro Funzionale of Regione Piemonte produces the HQPF (Human QPF) in terms of an areal average for each of the 13 regional warning areas, which have been created according to meteo-hydrological criteria. This allows the decision makers to produce an evaluation of the expected effects by comparing these HQPFs with predefined rainfall thresholds. Another important ingredient in this study is the very dense non-GTS network of rain gauges available that makes possible a high resolution verification. In this context the most useful verification approach is the measure of the QPF and HQPF skills by first converting precipitation expressed as continuous amounts into ‘‘exceedance'' categories (yes-no statements indicating whether precipitation equals or exceeds selected thresholds) and then computing the performances for each threshold. In particular in this work we compare the performances of the latest three years of QPF derived from two meteorological models COSMO-I7 (the Italian version of the COSMO Model, a mesoscale model developed in the framework of the COSMO Consortium) and IFS (the ECMWF global model) with the HQPF. In this analysis it is possible to introduce the hypothesis test developed by Hamill (1999), in which a confidence interval is calculated with the bootstrap method in order to establish the real difference between the skill scores of two competitive forecast. It is important to underline that the conclusions refer to the analysis of the Piemonte operational alert system, so they cannot be directly taken as universally true. But we think that some of the main lessons that can be derived from this study could be useful for the meteorological community. In details, the main conclusions are the following: · despite the overall improvement in global scale and the fact that the resolution of the limited area models has increased considerably over recent years, the QPF produced by the meteorological models involved in this study has not improved enough to allow its direct use: the subjective HQPF continues to offer the best performance; · in the forecast process, the step where humans have the largest added value with respect to mathematical models, is the communication. In fact the human characterisation and communication of the forecast uncertainty to end users cannot be replaced by any computer code; · the QPFs verification is one of the most important activities of a Centro Funzionale because it allows a better understanding of the model behaviour in the different meteorological configurations, highlights the systematic characteristics, and helps in evaluating the reliability, in average or extreme values, over long term or in current situations; · eventually, although there is no novelty in this study, we would like to show that the correct application of appropriated statistical tecniques permits a better definition and quantification of the errors and, mostly important, allows a correct (unbiased) communication between forecasters and decision makers.

Nature's Notebook Provides Phenology Observations for NASA Juniper Phenology and Pollen Transport Project

NASA Technical Reports Server (NTRS)

Luval, J. C.; Crimmins, T. M.; Sprigg, W. A.; Levetin, E.; Huete, A.; Nickovic, S.; Prasad, A.; Vukovic, A.; VandeWater, P. K.; Budge, A. M.;

Development of a Wearable Instrumented Vest for Posture Monitoring and System Usability Verification Based on the Technology Acceptance Model.

PubMed

Lin, Wen-Yen; Chou, Wen-Cheng; Tsai, Tsai-Hsuan; Lin, Chung-Chih; Lee, Ming-Yih

2016-12-17

Body posture and activity are important indices for assessing health and quality of life, especially for elderly people. Therefore, an easily wearable device or instrumented garment would be valuable for monitoring elderly people's postures and activities to facilitate healthy aging. In particular, such devices should be accepted by elderly people so that they are willing to wear it all the time. This paper presents the design and development of a novel, textile-based, intelligent wearable vest for real-time posture monitoring and emergency warnings. The vest provides a highly portable and low-cost solution that can be used both indoors and outdoors in order to provide long-term care at home, including health promotion, healthy aging assessments, and health abnormality alerts. The usability of the system was verified using a technology acceptance model-based study of 50 elderly people. The results indicated that although elderly people are anxious about some newly developed wearable technologies, they look forward to wearing this instrumented posture-monitoring vest in the future.

Development of a Wearable Instrumented Vest for Posture Monitoring and System Usability Verification Based on the Technology Acceptance Model

PubMed Central

Lin, Wen-Yen; Chou, Wen-Cheng; Tsai, Tsai-Hsuan; Lin, Chung-Chih; Lee, Ming-Yih

2016-01-01

Body posture and activity are important indices for assessing health and quality of life, especially for elderly people. Therefore, an easily wearable device or instrumented garment would be valuable for monitoring elderly people’s postures and activities to facilitate healthy aging. In particular, such devices should be accepted by elderly people so that they are willing to wear it all the time. This paper presents the design and development of a novel, textile-based, intelligent wearable vest for real-time posture monitoring and emergency warnings. The vest provides a highly portable and low-cost solution that can be used both indoors and outdoors in order to provide long-term care at home, including health promotion, healthy aging assessments, and health abnormality alerts. The usability of the system was verified using a technology acceptance model-based study of 50 elderly people. The results indicated that although elderly people are anxious about some newly developed wearable technologies, they look forward to wearing this instrumented posture-monitoring vest in the future. PMID:27999324

Verification of fault-tolerant clock synchronization systems. M.S. Thesis - College of William and Mary, 1992

NASA Technical Reports Server (NTRS)

Miner, Paul S.

1993-01-01

A critical function in a fault-tolerant computer architecture is the synchronization of the redundant computing elements. The synchronization algorithm must include safeguards to ensure that failed components do not corrupt the behavior of good clocks. Reasoning about fault-tolerant clock synchronization is difficult because of the possibility of subtle interactions involving failed components. Therefore, mechanical proof systems are used to ensure that the verification of the synchronization system is correct. In 1987, Schneider presented a general proof of correctness for several fault-tolerant clock synchronization algorithms. Subsequently, Shankar verified Schneider's proof by using the mechanical proof system EHDM. This proof ensures that any system satisfying its underlying assumptions will provide Byzantine fault-tolerant clock synchronization. The utility of Shankar's mechanization of Schneider's theory for the verification of clock synchronization systems is explored. Some limitations of Shankar's mechanically verified theory were encountered. With minor modifications to the theory, a mechanically checked proof is provided that removes these limitations. The revised theory also allows for proven recovery from transient faults. Use of the revised theory is illustrated with the verification of an abstract design of a clock synchronization system.

Using the eServices platform for detecting behavior patterns deviation in the elderly assisted living: a case study.

PubMed

Marcelino, Isabel; Lopes, David; Reis, Michael; Silva, Fernando; Laza, Rosalía; Pereira, António

2015-01-01

World's aging population is rising and the elderly are increasingly isolated socially and geographically. As a consequence, in many situations, they need assistance that is not granted in time. In this paper, we present a solution that follows the CRISP-DM methodology to detect the elderly's behavior pattern deviations that may indicate possible risk situations. To obtain these patterns, many variables are aggregated to ensure the alert system reliability and minimize eventual false positive alert situations. These variables comprehend information provided by body area network (BAN), by environment sensors, and also by the elderly's interaction in a service provider platform, called eServices--Elderly Support Service Platform. eServices is a scalable platform aggregating a service ecosystem developed specially for elderly people. This pattern recognition will further activate the adequate response. With the system evolution, it will learn to predict potential danger situations for a specified user, acting preventively and ensuring the elderly's safety and well-being. As the eServices platform is still in development, synthetic data, based on real data sample and empiric knowledge, is being used to populate the initial dataset. The presented work is a proof of concept of knowledge extraction using the eServices platform information. Regardless of not using real data, this work proves to be an asset, achieving a good performance in preventing alert situations.

Using the eServices Platform for Detecting Behavior Patterns Deviation in the Elderly Assisted Living: A Case Study

PubMed Central

Marcelino, Isabel; Laza, Rosalía

2015-01-01

World's aging population is rising and the elderly are increasingly isolated socially and geographically. As a consequence, in many situations, they need assistance that is not granted in time. In this paper, we present a solution that follows the CRISP-DM methodology to detect the elderly's behavior pattern deviations that may indicate possible risk situations. To obtain these patterns, many variables are aggregated to ensure the alert system reliability and minimize eventual false positive alert situations. These variables comprehend information provided by body area network (BAN), by environment sensors, and also by the elderly's interaction in a service provider platform, called eServices—Elderly Support Service Platform. eServices is a scalable platform aggregating a service ecosystem developed specially for elderly people. This pattern recognition will further activate the adequate response. With the system evolution, it will learn to predict potential danger situations for a specified user, acting preventively and ensuring the elderly's safety and well-being. As the eServices platform is still in development, synthetic data, based on real data sample and empiric knowledge, is being used to populate the initial dataset. The presented work is a proof of concept of knowledge extraction using the eServices platform information. Regardless of not using real data, this work proves to be an asset, achieving a good performance in preventing alert situations. PMID:25874219

Metabolic acidosis caused by concomitant use of paracetamol (acetaminophen) and flucloxacillin? A case report and a retrospective study.

PubMed

Berbee, J K; Lammers, L A; Krediet, C T P; Fischer, J C; Kemper, E M

2017-11-01

A patient was identified with severe metabolic acidosis, a high anion gap and 5-oxoproline accumulation, probably caused by the simultaneous use of paracetamol (acetaminophen) and flucloxacillin. We wanted to investigate the necessity to control the interaction between both drugs with an automatic alert system. To investigate the relevance of the interaction of paracetamol and flucloxacillin, a retrospective study was conducted. Data on paracetamol and flucloxacillin prescriptions and laboratory data (pH, Na + , HCO 3 - , Cl - , albumin and 5-oxoproline levels) were combined to assess the prevalence of acidosis, calculate the anion gap and analyse 5-oxoproline levels in clinically admitted patients using both drugs simultaneously. In the 2-year study period, approximately 53,000 admissions took place in our hospital. One thousand and fifty-seven patients used paracetamol and flucloxacillin simultaneously, of which 51 patients (4.8%) had a serum pH ≤ 7.35. One patient, the same patient as presented in the case report, had a high anion gap and a toxic level of 5-oxoproline. The prevalence of metabolic acidosis is very low and the only patient identified with the interaction was recognised during normal clinical care. We conclude that automatic alerts based on simultaneous use of paracetamol and flucloxacillin will generate too many signals. To recognise patients earlier and prevent severe outcomes, a warning system (clinical rule) based on paracetamol, flucloxacillin and pH measurement may be helpful. Early calculation of the anion gap can narrow the differential diagnosis of patients with metabolic acidosis and measurement of 5-oxoproline can explain acidosis due the interaction of paracetamol and flucloxacillin.

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.

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.

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...

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.

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.

Estimation of alertness levels with changes in decibel scale wavelength of EEG during dual-task simulation of auditory sonar target detection.

PubMed

Arjunan, Sridhar P; Kumar, Dinesh K; Jung, Tzyy-Ping

2010-01-01

Changes in alertness levels can have dire consequences for people operating and controlling motorized equipment. Past research studies have shown the relationship of Electroencephalogram (EEG) with alertness of the person. This research reports the fractal analysis of EEG and estimation of the alertness levels of the individual based on the changes in the maximum fractal length (MFL) of EEG. The results indicate that MFL of only 2 channels of EEG can be used to identify the loss of alertness of the individual with mean (inverse) correlation coefficient = 0.82. This study has also reported that using the changes in MFL of EEG, the changes in alertness level of a person was estimated with a mean correlation coefficient = 0.69.

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.

Experimental Verification Of The Osculating Cones Method For Two Waverider Forebodies At Mach 4 and 6

NASA Technical Reports Server (NTRS)

Miller, Rolf W.; Argrow, Brian M.; Center, Kenneth B.; Brauckmann, Gregory J.; Rhode, Matthew N.

1998-01-01

The NASA Langley Research Center Unitary Plan Wind Tunnel and the 20-Inch Mach 6 Tunnel were used to test two osculating cones waverider models. The Mach-4 and Mach-6 shapes were generated using the interactive design tool WIPAR. WIPAR performance predictions are compared to the experimental results. Vapor screen results for the Mach-4 model at the on- design Mach number provide visual verification that the shock is attached along the entire leading edge, within the limits of observation. WIPAR predictions of pressure distributions and aerodynamic coefficients show general agreement with the corresponding experimental values.

Managing Complexity in the MSL/Curiosity Entry, Descent, and Landing Flight Software and Avionics Verification and Validation Campaign

NASA Technical Reports Server (NTRS)

Stehura, Aaron; Rozek, Matthew

2013-01-01

The complexity of the Mars Science Laboratory (MSL) mission presented the Entry, Descent, and Landing systems engineering team with many challenges in its Verification and Validation (V&V) campaign. This paper describes some of the logistical hurdles related to managing a complex set of requirements, test venues, test objectives, and analysis products in the implementation of a specific portion of the overall V&V program to test the interaction of flight software with the MSL avionics suite. Application-specific solutions to these problems are presented herein, which can be generalized to other space missions and to similar formidable systems engineering problems.

NASA Formal Methods Workshop, 1990

NASA Technical Reports Server (NTRS)

Butler, Ricky W. (Compiler)

1990-01-01

The workshop brought together researchers involved in the NASA formal methods research effort for detailed technical interchange and provided a mechanism for interaction with representatives from the FAA and the aerospace industry. The workshop also included speakers from industry to debrief the formal methods researchers on the current state of practice in flight critical system design, verification, and certification. The goals were: define and characterize the verification problem for ultra-reliable life critical flight control systems and the current state of practice in industry today; determine the proper role of formal methods in addressing these problems, and assess the state of the art and recent progress toward applying formal methods to this area.

Effects of Partial and Acute Total Sleep Deprivation on Performance across Cognitive Domains, Individuals and Circadian Phase

PubMed Central

Lo, June C.; Groeger, John A.; Santhi, Nayantara; Arbon, Emma L.; Lazar, Alpar S.; Hasan, Sibah; von Schantz, Malcolm; Archer, Simon N.; Dijk, Derk-Jan

2012-01-01

Background Cognitive performance deteriorates during extended wakefulness and circadian phase misalignment, and some individuals are more affected than others. Whether performance is affected similarly across cognitive domains, or whether cognitive processes involving Executive Functions are more sensitive to sleep and circadian misalignment than Alertness and Sustained Attention, is a matter of debate. Methodology/Principal Findings We conducted a 2 × 12-day laboratory protocol to characterize the interaction of repeated partial and acute total sleep deprivation and circadian phase on performance across seven cognitive domains in 36 individuals (18 males; mean ± SD of age = 27.6±4.0 years). The sample was stratified for the rs57875989 polymorphism in PER3, which confers cognitive susceptibility to total sleep deprivation. We observed a deterioration of performance during both repeated partial and acute total sleep deprivation. Furthermore, prior partial sleep deprivation led to poorer cognitive performance in a subsequent total sleep deprivation period, but its effect was modulated by circadian phase such that it was virtually absent in the evening wake maintenance zone, and most prominent during early morning hours. A significant effect of PER3 genotype was observed for Subjective Alertness during partial sleep deprivation and on n-back tasks with a high executive load when assessed in the morning hours during total sleep deprivation after partial sleep loss. Overall, however, Subjective Alertness and Sustained Attention were more affected by both partial and total sleep deprivation than other cognitive domains and tasks including n-back tasks of Working Memory, even when implemented with a high executive load. Conclusions/Significance Sleep loss has a primary effect on Sleepiness and Sustained Attention with much smaller effects on challenging Working Memory tasks. These findings have implications for understanding how sleep debt and circadian rhythmicity interact to determine waking performance across cognitive domains and individuals. PMID:23029352

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.

77 FR 6000 - Airworthiness Directives; Aviation Communication & Surveillance Systems (ACSS) Traffic Alert and...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-07

... Airworthiness Directives; Aviation Communication & Surveillance Systems (ACSS) Traffic Alert and Collision... Communication & Surveillance Systems (ACSS) traffic alert and collision avoidance system (TCAS) units with part...

Medical alert bracelet (image)

MedlinePlus

People with diabetes should always wear a medical alert bracelet or necklace that emergency medical workers will ... People with diabetes should always wear a medical alert bracelet or necklace that emergency medical workers will ...

Divers Alert Network

MedlinePlus

... is Your Dive Safety Association Divers Alert Network DAN is Divers Alert Network, the diving industry’s largest ... Serving scuba divers for more than 30 years, DAN provides emergency assistance, medical information resources, educational opportunities ...

Comparison of warfarin therapy clinical outcomes following implementation of an automated mobile phone-based critical laboratory value text alert system.

PubMed

Lin, Shu-Wen; Kang, Wen-Yi; Lin, Dong-Tsamn; Lee, James; Wu, Fe-Lin; Chen, Chuen-Liang; Tseng, Yufeng J

2014-01-01

Computerized alert and reminder systems have been widely accepted and applied to various patient care settings, with increasing numbers of clinical laboratories communicating critical laboratory test values to professionals via either manual notification or automated alerting systems/computerized reminders. Warfarin, an oral anticoagulant, exhibits narrow therapeutic range between treatment response and adverse events. It requires close monitoring of prothrombin time (PT)/international normalized ratio (INR) to ensure patient safety. This study was aimed to evaluate clinical outcomes of patients on warfarin therapy following implementation of a Personal Handy-phone System-based (PHS) alert system capable of generating and delivering text messages to communicate critical PT/INR laboratory results to practitioners' mobile phones in a large tertiary teaching hospital. A retrospective analysis was performed comparing patient clinical outcomes and physician prescribing behavior following conversion from a manual laboratory result alert system to an automated system. Clinical outcomes and practitioner responses to both alert systems were compared. Complications to warfarin therapy, warfarin utilization, and PT/INR results were evaluated for both systems, as well as clinician time to read alert messages, time to warfarin therapy modification, and monitoring frequency. No significant differences were detected in major hemorrhage and thromboembolism, warfarin prescribing patterns, PT/INR results, warfarin therapy modification, or monitoring frequency following implementation of the PHS text alert system. In both study periods, approximately 80% of critical results led to warfarin discontinuation or dose reduction. Senior physicians' follow-up response time to critical results was significantly decreased in the PHS alert study period (46.3% responded within 1 day) compared to the manual notification study period (24.7%; P = 0.015). No difference in follow-up response time was detected for junior physicians. Implementation of an automated PHS-based text alert system did not adversely impact clinical or safety outcomes of patients on warfarin therapy. Approximately 80% immediate recognition of text alerts was achieved. The potential benefits of an automated PHS alert for senior physicians were demonstrated.

Post-OPC verification using a full-chip pattern-based simulation verification method

NASA Astrophysics Data System (ADS)

Hung, Chi-Yuan; Wang, Ching-Heng; Ma, Cliff; Zhang, Gary

2005-11-01

In this paper, we evaluated and investigated techniques for performing fast full-chip post-OPC verification using a commercial product platform. A number of databases from several technology nodes, i.e. 0.13um, 0.11um and 90nm are used in the investigation. Although it has proven that for most cases, our OPC technology is robust in general, due to the variety of tape-outs with complicated design styles and technologies, it is difficult to develop a "complete or bullet-proof" OPC algorithm that would cover every possible layout patterns. In the evaluation, among dozens of databases, some OPC databases were found errors by Model-based post-OPC checking, which could cost significantly in manufacturing - reticle, wafer process, and more importantly the production delay. From such a full-chip OPC database verification, we have learned that optimizing OPC models and recipes on a limited set of test chip designs may not provide sufficient coverage across the range of designs to be produced in the process. And, fatal errors (such as pinch or bridge) or poor CD distribution and process-sensitive patterns may still occur. As a result, more than one reticle tape-out cycle is not uncommon to prove models and recipes that approach the center of process for a range of designs. So, we will describe a full-chip pattern-based simulation verification flow serves both OPC model and recipe development as well as post OPC verification after production release of the OPC. Lastly, we will discuss the differentiation of the new pattern-based and conventional edge-based verification tools and summarize the advantages of our new tool and methodology: 1). Accuracy: Superior inspection algorithms, down to 1nm accuracy with the new "pattern based" approach 2). High speed performance: Pattern-centric algorithms to give best full-chip inspection efficiency 3). Powerful analysis capability: Flexible error distribution, grouping, interactive viewing and hierarchical pattern extraction to narrow down to unique patterns/cells.

Successful ShakeAlert Performance for the Napa Quake

NASA Astrophysics Data System (ADS)

Allen, R. M.; Given, D. D.; Heaton, T. H.; Vidale, J. E.

2014-12-01

ShakeAlert, the demonstration earthquake early warning system, developed by the USGS, UC Berkeley, Caltech, ETH, and the University of Washington, functioned as expected for the August 24, 2014, M6.0 Napa earthquake. The first ShakeAlert was generated by the ElarmS algorithm 5.1 sec after the origin time of the earthquake, and 3.3 sec after the P-wave arrived at the closest station 6.5 km from the epicenter. This initial alert, based on P-wave triggers from four stations, estimated the magnitude to be 5.7. The warning was received at the UC Berkeley Seismological Laboratory 5 seconds before the S-wave and about 10 sec prior to the onset of the strongest shaking. ShakeAlert beta-testers across the San Francisco Bay Area simultaneously received the alert, including the San Francisco 911 center with 8 sec warning, and the BART train system. BART has implemented an automated train-stopping system that was activated (although no trains were running at 3:20 am). With the available network geometry and communications, the blind zone of the first alert had a radius of 16 km. The four stations that contributed to the first alert all encapsulate data into 1-second packets, but the latency in transmitting data to the processing center ranged from 0.27 to 2.62 seconds. If all the stations were to deliver data in 0.27 seconds, then the alert would have been available 2.3 sec sooner and the blind zone would be reduced to about 8 km. This would also mean that the city of Napa would have received about 1 second of warning. The magnitude estimate and event location were accurate from the initial alert onwards. The magnitude estimate did first increase to 5.8 and then dip to 5.4 2.6 sec after the initial alert, stayed at that level for 2 sec, and then returned to 5.7. The final magnitude estimate was 6.0, consistent with the ANSS catalog.

Automated inhaled nitric oxide alerts for adult extracorporeal membrane oxygenation patient identification.

PubMed

Belenkiy, Slava M; Batchinsky, Andriy I; Park, Timothy S; Luellen, David E; Serio-Melvin, Maria L; Cancio, Leopoldo C; Pamplin, Jeremy C; Chung, Kevin K; Salinas, Josè; Cannon, Jeremy W

2014-09-01

Recently, automated alerts have been used to identify patients with respiratory failure based on set criteria, which can be gleaned from the electronic medical record (EMR). Such an approach may also be useful for identifying patients with severe adult respiratory distress syndrome (ARDS) who may benefit from extracorporeal membrane oxygenation (ECMO). Inhaled nitric oxide (iNO) is a common rescue therapy for severe ARDS which can be easily tracked in the EMR, and some patients started on iNO may have indications for initiating ECMO. This case series summarizes our experience with using automated electronic alerts for ECMO team activation focused particularly on an alert triggered by the initiation of iNO. After a brief trial evaluation, our Smart Alert system generated an automated page and e-mail alert to ECMO team members whenever a nonzero value for iNO appeared in the respiratory care section of our EMR. If iNO was initiated for severe respiratory failure, a detailed evaluation by the ECMO team determined if ECMO was indicated. For those patients managed with ECMO, we tabulated baseline characteristics, indication for ECMO, and outcomes. From September 2012 to July 2013, 45 iNO alerts were generated on 42 unique patients. Six patients (14%) met criteria for ECMO. Of these, four were identified exclusively by the iNO alert. At the time of the alert, the median PaO₂-to-FIO₂ ratio was 64 mm Hg (range, 55-107 mm Hg), the median age-adjusted oxygenation index was 73 (range, 51-96), and the median Murray score was 3.4 (range, 3-3.75), indicating severe respiratory failure. Median time from iNO alert to ECMO initiation was 81 hours (range, -2-292 hours). Survival to hospital discharge was 83% in those managed with ECMO. Automated alerts may be useful for identifying patients with severe ARDS who may be ECMO candidates. Diagnostic test, level V.

Experimental Study of Collision Detection Schema Used by Pilots During Closely Spaced Parallel Approaches

NASA Technical Reports Server (NTRS)

Pritchett, Amy R.; Hansman, R. John

1996-01-01

An experimental flight simulator study was conducted to examine the mental alerting logic and thresholds used by subjects to issue an alert and execute an avoidance maneuver. Subjects flew a series of autopilot landing approaches with traffic on a closely-spaced parallel approach; during some runs, the traffic would deviate towards the subject and the subject was to indicate the point when they recognized the potential traffic conflict, and then indicate a direction of flight for an avoidance maneuver. A variety of subjects, including graduate students, general aviation pilots and airline pilots, were tested. Five traffic displays were evaluated, with a moving map TCAS-type traffic display as a baseline. A side-task created both high and low workload situations. Subjects appeared to use the lateral deviation of the intruder aircraft from its approach path as the criteria for an alert regardless of the display available. However, with displays showing heading and/or trend information, their alerting thresholds were significantly lowered. This type of range-only schema still resulted in many near misses, as a high convergence rate was often established by the time of the subject's alert. Therefore, the properties of the intruder's trajectory had the greatest effect on the resultant near miss rate; no display system reliably caused alerts timely enough for certain collision avoidance. Subjects' performance dropped significantly on a side-task while they analyzed the need for an alert, showing alert generation can be a high workload situation at critical times. No variation was found between subjects with and with out piloting experience. These results suggest the design of automatic alerting systems should take into account the range-type alerting schema used by the human, such that the rationale for the automatic alert should be obvious to, and trusted by, the operator. Although careful display design may help generate pilot/automation trust, issues such as user non-conformance to automatically generated commands can remain a possibility.

Airport Traffic Conflict Detection and Resolution Algorithm Evaluation

NASA Technical Reports Server (NTRS)

Jones, Denise R.; Chartrand, Ryan C.; Wilson, Sara R.; Commo, Sean A.; Ballard, Kathryn M.; Otero, Sharon D.; Barker, Glover D.

2016-01-01

Two conflict detection and resolution (CD&R) algorithms for the terminal maneuvering area (TMA) were evaluated in a fast-time batch simulation study at the National Aeronautics and Space Administration (NASA) Langley Research Center. One CD&R algorithm, developed at NASA, was designed to enhance surface situation awareness and provide cockpit alerts of potential conflicts during runway, taxi, and low altitude air-to-air operations. The second algorithm, Enhanced Traffic Situation Awareness on the Airport Surface with Indications and Alerts (SURF IA), was designed to increase flight crew awareness of the runway environment and facilitate an appropriate and timely response to potential conflict situations. The purpose of the study was to evaluate the performance of the aircraft-based CD&R algorithms during various runway, taxiway, and low altitude scenarios, multiple levels of CD&R system equipage, and various levels of horizontal position accuracy. Algorithm performance was assessed through various metrics including the collision rate, nuisance and missed alert rate, and alert toggling rate. The data suggests that, in general, alert toggling, nuisance and missed alerts, and unnecessary maneuvering occurred more frequently as the position accuracy was reduced. Collision avoidance was more effective when all of the aircraft were equipped with CD&R and maneuvered to avoid a collision after an alert was issued. In order to reduce the number of unwanted (nuisance) alerts when taxiing across a runway, a buffer is needed between the hold line and the alerting zone so alerts are not generated when an aircraft is behind the hold line. All of the results support RTCA horizontal position accuracy requirements for performing a CD&R function to reduce the likelihood and severity of runway incursions and collisions.

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

PubMed Central

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

2012-01-01

Objective 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. Materials and Methods 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. Results 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). Discussion 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. Conclusion Implicit knowledge acquisition, collaborative filtering and machine learning were combined automatically to induce clinically meaningful and precise decision rules. PMID:22744961

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.

Strategies for Managing Smart Pump Alarm and Alert Fatigue: A Narrative Review.

PubMed

Shah, Parth K; Irizarry, Jamie; O'Neill, Sean

2018-06-08

Although smart infusion pumps are intended to prevent medication errors by alerting users about doses that exceed set thresholds, a large number of clinically insignificant alarms and alerts create the potential for alert and alarm fatigue. We searched the PubMed, Scopus, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases for peer-reviewed literature (January 1, 2004-August 31, 2017) on managing smart pump alerts, alarms, and related fatigue. Twenty-nine articles that met the inclusion criteria were reviewed and organized into themes. Smart pumps give users two types of signals: alarms that indicate mechanical issues such as occlusion, air in the line, or low battery; and clinical alerts that indicate that a programmed dose exceeds a predefined safety limit. Mechanical alarms occur with greater frequency than clinical alerts, but alarms and alerts vary widely by pump model, patient population, time of day, month, and type of drug. Several causes of clinically insignificant alerts and alarms may be actionable, and strategies proposed in the literature include development of a multidisciplinary team to oversee the quality improvement effort with involvement of end users, standardization of medication administration practices, widening of drug limit library thresholds when clinically appropriate, maintaining up-to-date drug limit libraries, and interoperability. Whereas many strategies have been proposed, and case studies have been reported, none have been rigorously evaluated. In addition, more research is needed related to managing occlusion and air-in-line alarms, especially for complicated infusions. Future work should focus on the evaluation of specific and replicable alert and alarm reduction strategies with a greater emphasis on quantitative metrics. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Impact of electronic-alerting of acute kidney injury: workgroup statements from the 15(th) ADQI Consensus Conference.

PubMed

Hoste, Eric A J; Kashani, Kianoush; Gibney, Noel; Wilson, F Perry; Ronco, Claudio; Goldstein, Stuart L; Kellum, John A; Bagshaw, Sean M

2016-01-01

Among hospitalized patients, acute kidney injury is common and associated with significant morbidity and risk for mortality. The use of electronic health records (EHR) for prediction and detection of this important clinical syndrome has grown in the past decade. The steering committee of the 15(th) Acute Dialysis Quality Initiative (ADQI) conference dedicated a workgroup with the task of identifying elements that may impact the course of events following Acute Kidney Injury (AKI) e-alert. Following an extensive, non-systematic literature search, we used a modified Delphi process to reach consensus regarding several aspects of the utilization of AKI e-alerts. Topics discussed in this workgroup included progress in evidence base practices, the characteristics of an optimal e-alert, the measures of efficacy and effectiveness, and finally what responses would be considered best practices following AKI e-alerts. Authors concluded that the current evidence for e-alert system efficacy, although growing, remains insufficient. Technology and human-related factors were found to be crucial elements of any future investigation or implementation of such tools. The group also concluded that implementation of such systems should not be done without a vigorous plan to evaluate the efficacy and effectiveness of e-alerts. Efficacy and effectiveness of e-alerts should be measured by context-specific process and patient outcomes. Finally, the group made several suggestions regarding the clinical decision support that should be considered following successful e-alert implementation. This paper reflects the findings of a non-systematic review and expert opinion. We recommend implementation of the findings of this workgroup report for use of AKI e-alerts.

Tactical Conflict Detection in Terminal Airspace

NASA Technical Reports Server (NTRS)

Tang, Huabin; Robinson, John E.; Denery, Dallas G.

2010-01-01

Air traffic systems have long relied on automated short-term conflict prediction algorithms to warn controllers of impending conflicts (losses of separation). The complexity of terminal airspace has proven difficult for such systems as it often leads to excessive false alerts. Thus, the legacy system, called Conflict Alert, which provides short-term alerts in both en-route and terminal airspace currently, is often inhibited or degraded in areas where frequent false alerts occur, even though the alerts are provided only when an aircraft is in dangerous proximity of other aircraft. This research investigates how a minimal level of flight intent information may be used to improve short-term conflict detection in terminal airspace such that it can be used by the controller to maintain legal aircraft separation. The flight intent information includes a site-specific nominal arrival route and inferred altitude clearances in addition to the flight plan that includes the RNAV (Area Navigation) departure route. A new tactical conflict detection algorithm is proposed, which uses a single analytic trajectory, determined by the flight intent and the current state information of the aircraft, and includes a complex set of current, dynamic separation standards for terminal airspace to define losses of separation. The new algorithm is compared with an algorithm that imitates a known en-route algorithm and another that imitates Conflict Alert by analysis of false-alert rate and alert lead time with recent real-world data of arrival and departure operations and a large set of operational error cases from Dallas/Fort Worth TRACON (Terminal Radar Approach Control). The new algorithm yielded a false-alert rate of two per hour and an average alert lead time of 38 seconds.