Accuracy of vaginal symptom self-diagnosis algorithms for deployed military women.

PubMed

Ryan-Wenger, Nancy A; Neal, Jeremy L; Jones, Ashley S; Lowe, Nancy K

2010-01-01

Deployed military women have an increased risk for development of vaginitis due to extreme temperatures, primitive sanitation, hygiene and laundry facilities, and unavailable or unacceptable healthcare resources. The Women in the Military Self-Diagnosis (WMSD) and treatment kit was developed as a field-expedient solution to this problem. The primary study aims were to evaluate the accuracy of women's self-diagnosis of vaginal symptoms and eight diagnostic algorithms and to predict potential self-medication omission and commission error rates. Participants included 546 active duty, deployable Army (43.3%) and Navy (53.6%) women with vaginal symptoms who sought healthcare at troop medical clinics on base.In the clinic lavatory, women conducted a self-diagnosis using a sterile cotton swab to obtain vaginal fluid, a FemExam card to measure positive or negative pH and amines, and the investigator-developed WMSD Decision-Making Guide. Potential self-diagnoses were "bacterial infection" (bacterial vaginosis [BV] and/or trichomonas vaginitis [TV]), "yeast infection" (candida vaginitis [CV]), "no infection/normal," or "unclear." The Affirm VPIII laboratory reference standard was used to detect clinically significant amounts of vaginal fluid DNA for organisms associated with BV, TV, and CV. Women's self-diagnostic accuracy was 56% for BV/TV and 69.2% for CV. False-positives would have led to a self-medication commission error rate of 20.3% for BV/TV and 8% for CV. Potential self-medication omission error rates due to false-negatives were 23.7% for BV/TV and 24.8% for CV. The positive predictive value of diagnostic algorithms ranged from 0% to 78.1% for BV/TV and 41.7% for CV. The algorithms were based on clinical diagnostic standards. The nonspecific nature of vaginal symptoms, mixed infections, and a faulty device intended to measure vaginal pH and amines explain why none of the algorithms reached the goal of 95% accuracy. The next prototype of the WMSD kit will not include nonspecific vaginal signs and symptoms in favor of recently available point-of-care devices that identify antigens or enzymes of the causative BV, TV, and CV organisms.

Analysis of error type and frequency in apraxia of speech among Portuguese speakers.

PubMed

Cera, Maysa Luchesi; Minett, Thaís Soares Cianciarullo; Ortiz, Karin Zazo

2010-01-01

Most studies characterizing errors in the speech of patients with apraxia involve English language. To analyze the types and frequency of errors produced by patients with apraxia of speech whose mother tongue was Brazilian Portuguese. 20 adults with apraxia of speech caused by stroke were assessed. The types of error committed by patients were analyzed both quantitatively and qualitatively, and frequencies compared. We observed the presence of substitution, omission, trial-and-error, repetition, self-correction, anticipation, addition, reiteration and metathesis, in descending order of frequency, respectively. Omission type errors were one of the most commonly occurring whereas addition errors were infrequent. These findings differed to those reported in English speaking patients, probably owing to differences in the methodologies used for classifying error types; the inclusion of speakers with apraxia secondary to aphasia; and the difference in the structure of Portuguese language to English in terms of syllable onset complexity and effect on motor control. The frequency of omission and addition errors observed differed to the frequency reported for speakers of English.

Clinical review: The hospital of the future - building intelligent environments to facilitate safe and effective acute care delivery

PubMed Central

2012-01-01

The translation of knowledge into rational care is as essential and pressing a task as the development of new diagnostic or therapeutic devices, and is arguably more important. The emerging science of health care delivery has identified the central role of human factor ergonomics in the prevention of medical error, omission, and waste. Novel informatics and systems engineering strategies provide an excellent opportunity to improve the design of acute care delivery. In this article, future hospitals are envisioned as organizations built around smart environments that facilitate consistent delivery of effective, equitable, and error-free care focused on patient-centered rather than provider-centered outcomes. PMID:22546172

Dissociation in Optokinetic Stimulation Sensitivity between Omission and Substitution Reading Errors in Neglect Dyslexia.

PubMed

Daini, Roberta; Albonico, Andrea; Malaspina, Manuela; Martelli, Marialuisa; Primativo, Silvia; Arduino, Lisa S

2013-01-01

Although omission and substitution errors in neglect dyslexia (ND) patients have always been considered as different manifestations of the same acquired reading disorder, recently, we proposed a new dual mechanism model. While omissions are related to the exploratory disorder which characterizes unilateral spatial neglect (USN), substitutions are due to a perceptual integration mechanism. A consequence of this hypothesis is that specific training for omission-type ND patients would aim at restoring the oculo-motor scanning and should not improve reading in substitution-type ND. With this aim we administered an optokinetic stimulation (OKS) to two brain-damaged patients with both USN and ND, MA and EP, who showed ND mainly characterized by omissions and substitutions, respectively. MA also showed an impairment in oculo-motor behavior with a non-reading task, while EP did not. The two patients presented a dissociation with respect to their sensitivity to OKS, so that, as expected, MA was positively affected, while EP was not. Our results confirm a dissociation between the two mechanisms underlying omission and substitution reading errors in ND patients. Moreover, they suggest that such a dissociation could possibly be extended to the effectiveness of rehabilitative procedures, and that patients who mainly omit contralesional-sided letters would benefit from OKS.

Dissociation in Optokinetic Stimulation Sensitivity between Omission and Substitution Reading Errors in Neglect Dyslexia

PubMed Central

Daini, Roberta; Albonico, Andrea; Malaspina, Manuela; Martelli, Marialuisa; Primativo, Silvia; Arduino, Lisa S.

2013-01-01

Although omission and substitution errors in neglect dyslexia (ND) patients have always been considered as different manifestations of the same acquired reading disorder, recently, we proposed a new dual mechanism model. While omissions are related to the exploratory disorder which characterizes unilateral spatial neglect (USN), substitutions are due to a perceptual integration mechanism. A consequence of this hypothesis is that specific training for omission-type ND patients would aim at restoring the oculo-motor scanning and should not improve reading in substitution-type ND. With this aim we administered an optokinetic stimulation (OKS) to two brain-damaged patients with both USN and ND, MA and EP, who showed ND mainly characterized by omissions and substitutions, respectively. MA also showed an impairment in oculo-motor behavior with a non-reading task, while EP did not. The two patients presented a dissociation with respect to their sensitivity to OKS, so that, as expected, MA was positively affected, while EP was not. Our results confirm a dissociation between the two mechanisms underlying omission and substitution reading errors in ND patients. Moreover, they suggest that such a dissociation could possibly be extended to the effectiveness of rehabilitative procedures, and that patients who mainly omit contralesional-sided letters would benefit from OKS. PMID:24062678

Inaccuracy in health research news: a typology and predictions of scientists' perceptions of the accuracy of research news.

PubMed

Chang, Chingching

2015-01-01

This article introduces an integrated inaccuracy typology to explore the prevalence of inaccurate news coverage of health research. This typology suggests that errors, omissions, and misinterpretations are three common types of inaccuracy; errors and omissions are objective, whereas misinterpretations are subjective. Objective inaccuracy involves errors and omissions in describing the background or substantive information about the research, such as how, when, where, and on whom research was conducted. Subjective inaccuracy entails misinterpretations as a result of a lack of expertise among journalists (e.g., misstating facts, errors in inferences, offering speculations as facts) or media's interest in profits (e.g., overemphasis on unique findings, overgeneralizations of findings, shifting emphases). For this study, coders analyzed objective inaccuracy, while scientists rated subjective inaccuracy. In turn, it identifies what can account for the variance in scientists' perceptions of inaccuracy in news articles citing their research. Objective and subjective inaccuracy offer significant predictors. Of the different types of objective inaccuracy, omissions of research methods represent a significant factor, whereas of the types of subjective inaccuracy, errors in inferences, overemphasis on uniqueness, and overgeneralizations of findings are all significant predictors.

17 CFR 232.103 - Liability for transmission errors or omissions in documents filed via EDGAR.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 17 Commodity and Securities Exchanges 2 2010-04-01 2010-04-01 false Liability for transmission errors or omissions in documents filed via EDGAR. 232.103 Section 232.103 Commodity and Securities Exchanges SECURITIES AND EXCHANGE COMMISSION REGULATION S-T-GENERAL RULES AND REGULATIONS FOR ELECTRONIC...

45 CFR 61.6 - Reporting errors, omissions, revisions or whether an action is on appeal.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 45 Public Welfare 1 2011-10-01 2011-10-01 false Reporting errors, omissions, revisions or whether an action is on appeal. 61.6 Section 61.6 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION HEALTHCARE INTEGRITY AND PROTECTION DATA BANK FOR FINAL ADVERSE INFORMATION ON...

45 CFR 61.6 - Reporting errors, omissions, revisions or whether an action is on appeal.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 45 Public Welfare 1 2012-10-01 2012-10-01 false Reporting errors, omissions, revisions or whether an action is on appeal. 61.6 Section 61.6 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION HEALTHCARE INTEGRITY AND PROTECTION DATA BANK FOR FINAL ADVERSE INFORMATION ON...

45 CFR 61.6 - Reporting errors, omissions, revisions or whether an action is on appeal.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 1 2010-10-01 2010-10-01 false Reporting errors, omissions, revisions or whether an action is on appeal. 61.6 Section 61.6 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION HEALTHCARE INTEGRITY AND PROTECTION DATA BANK FOR FINAL ADVERSE INFORMATION ON...

Prospective and retrospective memory are differentially related to self-rated omission and commission errors in medication adherence in multimorbidity.

PubMed

Ihle, Andreas; Inauen, Jennifer; Scholz, Urte; König, Claudia; Holzer, Barbara; Zimmerli, Lukas; Battegay, Edouard; Tobias, Robert; Kliegel, Matthias

2017-01-01

We investigated the relations of self-rated omission errors (i.e., forgetting to take one's medication) and commission errors (i.e., unnecessary repetitions of medication intake because of forgetting that it has already been taken) in medication adherence in multimorbidity to prospective and retrospective memory performance. Moreover, we examined whether these relations were moderated by the number of medications that had to be taken. Eighty-four patients with multimorbidity (aged 28-84 years, M = 62.4) reported medication adherence regarding the last seven days and the number of medications they had to take. In addition, we administered psychometric tests on prospective memory (PM) and retrospective memory performance. We found that reported omission errors in medication adherence were related significantly to lower PM performance. This relationship was increased in individuals with a lower number of medications. In comparison, reported commission errors in medication adherence were related significantly to lower retrospective memory performance. This relationship was increased in individuals with a larger number of medications. Present data suggest that omission errors in medication adherence in multimorbidity may reflect primarily PM errors, particularly if few medications have to be taken, while commission errors may reflect mainly retrospective memory failures, especially with a large number of medications that need to be taken as prescribed. From an applied neuropsychological perspective, these results underline the importance of trying to enhance PM and retrospective memory performance in patients with multimorbidity.

Prevalence of medication errors in primary health care at Bahrain Defence Force Hospital – prescription-based study

PubMed Central

Aljasmi, Fatema; Almalood, Fatema

2018-01-01

Background One of the important activities that physicians – particularly general practitioners – perform is prescribing. It occurs in most health care facilities and especially in primary health care (PHC) settings. Objectives This study aims to determine what types of prescribing errors are made in PHC at Bahrain Defence Force (BDF) Hospital, and how common they are. Methods This was a retrospective study of data from PHC at BDF Hospital. The data consisted of 379 prescriptions randomly selected from the pharmacy between March and May 2013, and errors in the prescriptions were classified into five types: major omission, minor omission, commission, integration, and skill-related errors. Results Of the total prescriptions, 54.4% (N=206) were given to male patients and 45.6% (N=173) to female patients; 24.8% were given to patients under the age of 10 years. On average, there were 2.6 drugs per prescription. In the prescriptions, 8.7% of drugs were prescribed by their generic names, and 28% (N=106) of prescriptions included an antibiotic. Out of the 379 prescriptions, 228 had an error, and 44.3% (N=439) of the 992 prescribed drugs contained errors. The proportions of errors were as follows: 9.9% (N=38) were minor omission errors; 73.6% (N=323) were major omission errors; 9.3% (N=41) were commission errors; and 17.1% (N=75) were skill-related errors. Conclusion This study provides awareness of the presence of prescription errors and frequency of the different types of errors that exist in this hospital. Understanding the different types of errors could help future studies explore the causes of specific errors and develop interventions to reduce them. Further research should be conducted to understand the causes of these errors and demonstrate whether the introduction of electronic prescriptions has an effect on patient outcomes. PMID:29445304

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.

Lexical diversity and omission errors as predictors of language ability in the narratives of sequential Spanish-English bilinguals: a cross-language comparison.

PubMed

Jacobson, Peggy F; Walden, Patrick R

2013-08-01

This study explored the utility of language sample analysis for evaluating language ability in school-age Spanish-English sequential bilingual children. Specifically, the relative potential of lexical diversity and word/morpheme omission as predictors of typical or atypical language status was evaluated. Narrative samples were obtained from 48 bilingual children in both of their languages using the suggested narrative retell protocol and coding conventions as per Systematic Analysis of Language Transcripts (SALT; Miller & Iglesias, 2008) software. An additional lexical diversity measure, VocD, was also calculated. A series of logistical hierarchical regressions explored the utility of the number of different words, VocD statistic, and word and morpheme omissions in each language for predicting language status. Omission errors turned out to be the best predictors of bilingual language impairment at all ages, and this held true across languages. Although lexical diversity measures did not predict typical or atypical language status, the measures were significantly related to oral language proficiency in English and Spanish. The results underscore the significance of omission errors in bilingual language impairment while simultaneously revealing the limitations of lexical diversity measures as indicators of impairment. The relationship between lexical diversity and oral language proficiency highlights the importance of considering relative language proficiency in bilingual assessment.

Optokinetic Stimulation Affects Word Omissions but Not Stimulus-Centered Reading Errors in Paragraph Reading in Neglect Dyslexia

ERIC Educational Resources Information Center

Reinhart, Stefan; Schindler, Igor; Kerkhoff, Georg

2011-01-01

Patients with right hemisphere lesions often omit or misread words on the left side of a text or the initial letters of single words, a phenomenon termed neglect dyslexia (ND). Omissions of words on the contralesional side of the page are considered as egocentric or space-based errors, whereas misread words can be viewed as a type of…

Assessment of Functional Change and Cognitive Correlates in the Progression from Healthy Cognitive Aging to Dementia

PubMed Central

Schmitter-Edgecombe, Maureen; Parsey, Carolyn M.

2014-01-01

Objective There is currently limited understanding of the course of change in everyday functioning that occurs with normal aging and dementia. To better characterize the nature of this change, we evaluated the types of errors made by participants as they performed everyday tasks in a naturalistic environment. Method Participants included cognitively healthy younger adults (YA; N = 55) and older adults (OA; N =88), and individuals with mild cognitive impairment (MCI: N =55) and dementia (N = 18). Participants performed eight scripted everyday activities (e.g., filling a medication dispenser) while under direct observation in a campus apartment. Task performances were coded for the following errors: inefficient actions, omissions, substitutions, and irrelevant actions. Results Performance accuracy decreased with age and level of cognitive impairment. Relative to the YAs, the OA group exhibited more inefficient actions which were linked to performance on neuropsychological measures of executive functioning. Relative to the OAs, the MCI group committed significantly more omission errors which were strongly linked to performance on memory measures. All error types were significantly more prominent in individuals with dementia. Omission errors uniquely predicted everyday functional status as measured by both informant-report and a performance-based measure. Conclusions These findings suggest that in the progression from healthy aging to MCI, everyday task difficulties may evolve from task inefficiencies to task omission errors, leading to inaccuracies in task completion that are recognized by knowledgeable informants. Continued decline in cognitive functioning then leads to more substantial everyday errors, which compromise ability to live independently. PMID:24933485

Testing the Agreement/Tense Omission Model: Why the Data on Children's Use of Non-Nominative 3psg Subjects Count against the ATOM

ERIC Educational Resources Information Center

Pine, Julian M.; Rowland, Caroline F.; Lieven, Elena V. M.; Theakston, Anna L.

2005-01-01

One of the most influential recent accounts of pronoun case-marking errors in young children's speech is Schutze & Wexler's (1996) Agreement/Tense Omission Model (ATOM). The ATOM predicts that the rate of agreeing verbs with non-nominative subjects will be so low that such errors can be reasonably disregarded as noise in the data. The present…

The Influence of Methylphenidate on Hyperactivity and Attention Deficits in Children With ADHD: A Virtual Classroom Test.

PubMed

Mühlberger, A; Jekel, K; Probst, T; Schecklmann, M; Conzelmann, A; Andreatta, M; Rizzo, A A; Pauli, P; Romanos, M

2016-05-13

This study compares the performance in a continuous performance test within a virtual reality classroom (CPT-VRC) between medicated children with ADHD, unmedicated children with ADHD, and healthy children. N = 94 children with ADHD (n = 26 of them received methylphenidate and n = 68 were unmedicated) and n = 34 healthy children performed the CPT-VRC. Omission errors, reaction time/variability, commission errors, and body movements were assessed. Furthermore, ADHD questionnaires were administered and compared with the CPT-VRC measures. The unmedicated ADHD group exhibited more omission errors and showed slower reaction times than the healthy group. Reaction time variability was higher in the unmedicated ADHD group compared with both the healthy and the medicated ADHD group. Omission errors and reaction time variability were associated with inattentiveness ratings of experimenters. Head movements were correlated with hyperactivity ratings of parents and experimenters. Virtual reality is a promising technology to assess ADHD symptoms in an ecologically valid environment. © The Author(s) 2016.

Comparison of visual and emotional continuous performance test related to sequence of presentation, gender and age.

PubMed

Markovska-Simoska, S; Pop-Jordanova, N

2009-07-01

(Full text is available at http://www.manu.edu.mk/prilozi). Continous Performance Tests (CPTs) form a group of paradigms for the evaluation of attention and, to a lesser degree, the response inhibition (or disinhibition) component of executive control. The object of this study was to compare performance on a CPT using both visual and emotional tasks in 46 normal adult subjects. In particular, it was to examine the effects of the type of task (VCPT or ECPT), sequence of presentation, and gender/age influence on performance as measured errors of omission, errors of commission, reaction time and variation of reaction time. From the results we can assume that there are significantly worse performance parameters for ECPT than VCPT tasks, with a probable explanation of the influence of emotional stimuli on attention and information-processing and no significant effect of order of presentation and gender on performance. Significant differences with more omission errors for older groups were obtained, showing better attention in younger subjects. Key words: VCPT, ECPT, omission errors, commission errors, reaction time, variation of reaction time, normal adults.

Syntactic and semantic errors in radiology reports associated with speech recognition software.

PubMed

Ringler, Michael D; Goss, Brian C; Bartholmai, Brian J

2017-03-01

Speech recognition software can increase the frequency of errors in radiology reports, which may affect patient care. We retrieved 213,977 speech recognition software-generated reports from 147 different radiologists and proofread them for errors. Errors were classified as "material" if they were believed to alter interpretation of the report. "Immaterial" errors were subclassified as intrusion/omission or spelling errors. The proportion of errors and error type were compared among individual radiologists, imaging subspecialty, and time periods. In all, 20,759 reports (9.7%) contained errors, of which 3992 (1.9%) were material errors. Among immaterial errors, spelling errors were more common than intrusion/omission errors ( p < .001). Proportion of errors and fraction of material errors varied significantly among radiologists and between imaging subspecialties ( p < .001). Errors were more common in cross-sectional reports, reports reinterpreting results of outside examinations, and procedural studies (all p < .001). Error rate decreased over time ( p < .001), which suggests that a quality control program with regular feedback may reduce errors.

Electropalatographic analysis of apraxia of speech in a left hander and in a right hander.

PubMed

Sugishita, M; Konno, K; Kabe, S; Yunoki, K; Togashi, O; Kawamura, M

1987-10-01

Two cases with 'pure' apraxia of speech are reported. The articulatory disturbances were quite similar. One of the two cases was a left-handed male with a subcortical haemorrhage and the other a right-handed male with a cerebral infarct. The MRI and CT scans showed that the first case had a lesion that mainly involved the right precentral gyrus and its deep white matter, and that the second had a lesion mainly affecting the lower parts of the left precentral and postcentral gyri and their deep white matter. These findings and a literature review suggest that a corticosubcortical lesion of the lower part of the left precentral gyrus in most right handers and a lesion of the symmetric region in the right hemisphere in some left handers cause apraxia of speech. The omission errors for sounds articulated by the tongue and the hard palate were analysed using electropalatography, which records visually the dynamics of the palatolingual contact. The results demonstrated that there were three kinds of omission errors: true omissions (no palatolingual contact); omissions with incorrect contact (palatolingual contact for a different sound or undifferentiated sound); and omissions with correct contact (correct palatolingual contact for a target sound). The latter two types of omission error were observed for initial consonants and they were probably caused by a delay in air flow. The patients also showed a tendency to substitute one of the two consonants/t, t/for other sounds, which suggested that they had difficulty in the inhibition of tongue activity.

Errors of Omission in English-Speaking Children's Production of Plurals and the Past Tense: The Effects of Frequency, Phonology, and Competition

ERIC Educational Resources Information Center

Matthews, Danielle E.; Theakston, Anna L.

2006-01-01

How do English-speaking children inflect nouns for plurality and verbs for the past tense? We assess theoretical answers to this question by considering errors of omission, which occur when children produce a stem in place of its inflected counterpart (e.g., saying "dress" to refer to 5 dresses). A total of 307 children (aged 3;11-9;9)…

Speech errors of amnesic H.M.: unlike everyday slips-of-the-tongue.

PubMed

MacKay, Donald G; James, Lori E; Hadley, Christopher B; Fogler, Kethera A

2011-03-01

Three language production studies indicate that amnesic H.M. produces speech errors unlike everyday slips-of-the-tongue. Study 1 was a naturalistic task: H.M. and six controls closely matched for age, education, background and IQ described what makes captioned cartoons funny. Nine judges rated the descriptions blind to speaker identity and gave reliably more negative ratings for coherence, vagueness, comprehensibility, grammaticality, and adequacy of humor-description for H.M. than the controls. Study 2 examined "major errors", a novel type of speech error that is uncorrected and reduces the coherence, grammaticality, accuracy and/or comprehensibility of an utterance. The results indicated that H.M. produced seven types of major errors reliably more often than controls: substitutions, omissions, additions, transpositions, reading errors, free associations, and accuracy errors. These results contradict recent claims that H.M. retains unconscious or implicit language abilities and produces spoken discourse that is "sophisticated," "intact" and "without major errors." Study 3 examined whether three classical types of errors (omissions, additions, and substitutions of words and phrases) differed for H.M. versus controls in basic nature and relative frequency by error type. The results indicated that omissions, and especially multi-word omissions, were relatively more common for H.M. than the controls; and substitutions violated the syntactic class regularity (whereby, e.g., nouns substitute with nouns but not verbs) relatively more often for H.M. than the controls. These results suggest that H.M.'s medial temporal lobe damage impaired his ability to rapidly form new connections between units in the cortex, a process necessary to form complete and coherent internal representations for novel sentence-level plans. In short, different brain mechanisms underlie H.M.'s major errors (which reflect incomplete and incoherent sentence-level plans) versus everyday slips-of-the tongue (which reflect errors in activating pre-planned units in fully intact sentence-level plans). Implications of the results of Studies 1-3 are discussed for systems theory, binding theory and relational memory theories. Copyright © 2010 Elsevier Srl. All rights reserved.

Errors in Computing the Normalized Protein Catabolic Rate due to Use of Single-pool Urea Kinetic Modeling or to Omission of the Residual Kidney Urea Clearance.

PubMed

Daugirdas, John T

2017-07-01

The protein catabolic rate normalized to body size (PCRn) often is computed in dialysis units to obtain information about protein ingestion. However, errors can manifest when inappropriate modeling methods are used. We used a variable volume 2-pool urea kinetic model to examine the percent errors in PCRn due to use of a 1-pool urea kinetic model or after omission of residual urea clearance (Kru). When a single-pool model was used, 2 sources of errors were identified. The first, dependent on the ratio of dialyzer urea clearance to urea distribution volume (K/V), resulted in a 7% inflation of the PCRn when K/V was in the range of 6 mL/min per L. A second, larger error appeared when Kt/V values were below 1.0 and was related to underestimation of urea distribution volume (due to overestimation of effective clearance) by the single-pool model. A previously reported prediction equation for PCRn was valid, but data suggest that it should be modified using 2-pool eKt/V and V coefficients instead of single-pool values. A third source of error, this one unrelated to use of a single-pool model, namely omission of Kru, was shown to result in an underestimation of PCRn, such that each ml/minute Kru per 35 L of V caused a 5.6% underestimate in PCRn. Marked overestimation of PCRn can result due to inappropriate use of a single-pool urea kinetic model, particularly when Kt/V <1.0 (as in short daily dialysis), or after omission of residual native kidney clearance. Copyright © 2017 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

Toward diagnostic and phenotype markers for genetically transmitted speech delay.

PubMed

Shriberg, Lawrence D; Lewis, Barbara A; Tomblin, J Bruce; McSweeny, Jane L; Karlsson, Heather B; Scheer, Alison R

2005-08-01

Converging evidence supports the hypothesis that the most common subtype of childhood speech sound disorder (SSD) of currently unknown origin is genetically transmitted. We report the first findings toward a set of diagnostic markers to differentiate this proposed etiological subtype (provisionally termed speech delay-genetic) from other proposed subtypes of SSD of unknown origin. Conversational speech samples from 72 preschool children with speech delay of unknown origin from 3 research centers were selected from an audio archive. Participants differed on the number of biological, nuclear family members (0 or 2+) classified as positive for current and/or prior speech-language disorder. Although participants in the 2 groups were found to have similar speech competence, as indexed by their Percentage of Consonants Correct scores, their speech error patterns differed significantly in 3 ways. Compared with children who may have reduced genetic load for speech delay (no affected nuclear family members), children with possibly higher genetic load (2+ affected members) had (a) a significantly higher proportion of relative omission errors on the Late-8 consonants; (b) a significantly lower proportion of relative distortion errors on these consonants, particularly on the sibilant fricatives /s/, /z/, and //; and (c) a significantly lower proportion of backed /s/ distortions, as assessed by both perceptual and acoustic methods. Machine learning routines identified a 3-part classification rule that included differential weightings of these variables. The classification rule had diagnostic accuracy value of 0.83 (95% confidence limits = 0.74-0.92), with positive and negative likelihood ratios of 9.6 (95% confidence limits = 3.1-29.9) and 0.40 (95% confidence limits = 0.24-0.68), respectively. The diagnostic accuracy findings are viewed as promising. The error pattern for this proposed subtype of SSD is viewed as consistent with the cognitive-linguistic processing deficits that have been reported for genetically transmitted verbal disorders.

Lexical Diversity and Omission Errors as Predictors of Language Ability in the Narratives of Sequential Spanish-English Bilinguals: A Cross-Language Comparison

ERIC Educational Resources Information Center

Jacobson, Peggy F.; Walden, Patrick R.

2013-01-01

Purpose: This study explored the utility of language sample analysis for evaluating language ability in school-age Spanish-English sequential bilingual children. Specifically, the relative potential of lexical diversity and word/morpheme omission as predictors of typical or atypical language status was evaluated. Method: Narrative samples were…

Association of Elevated Reward Prediction Error Response With Weight Gain in Adolescent Anorexia Nervosa.

PubMed

DeGuzman, Marisa; Shott, Megan E; Yang, Tony T; Riederer, Justin; Frank, Guido K W

2017-06-01

Anorexia nervosa is a psychiatric disorder of unknown etiology. Understanding associations between behavior and neurobiology is important in treatment development. Using a novel monetary reward task during functional magnetic resonance brain imaging, the authors tested how brain reward learning in adolescent anorexia nervosa changes with weight restoration. Female adolescents with anorexia nervosa (N=21; mean age, 16.4 years [SD=1.9]) underwent functional MRI (fMRI) before and after treatment; similarly, healthy female control adolescents (N=21; mean age, 15.2 years [SD=2.4]) underwent fMRI on two occasions. Brain function was tested using the reward prediction error construct, a computational model for reward receipt and omission related to motivation and neural dopamine responsiveness. Compared with the control group, the anorexia nervosa group exhibited greater brain response 1) for prediction error regression within the caudate, ventral caudate/nucleus accumbens, and anterior and posterior insula, 2) to unexpected reward receipt in the anterior and posterior insula, and 3) to unexpected reward omission in the caudate body. Prediction error and unexpected reward omission response tended to normalize with treatment, while unexpected reward receipt response remained significantly elevated. Greater caudate prediction error response when underweight was associated with lower weight gain during treatment. Punishment sensitivity correlated positively with ventral caudate prediction error response. Reward system responsiveness is elevated in adolescent anorexia nervosa when underweight and after weight restoration. Heightened prediction error activity in brain reward regions may represent a phenotype of adolescent anorexia nervosa that does not respond well to treatment. Prediction error response could be a neurobiological marker of illness severity that can indicate individual treatment needs.

Association of Elevated Reward Prediction Error Response With Weight Gain in Adolescent Anorexia Nervosa

PubMed Central

DeGuzman, Marisa; Shott, Megan E.; Yang, Tony T.; Riederer, Justin; Frank, Guido K.W.

2017-01-01

Objective Anorexia nervosa is a psychiatric disorder of unknown etiology. Understanding associations between behavior and neurobiology is important in treatment development. Using a novel monetary reward task during functional magnetic resonance brain imaging, the authors tested how brain reward learning in adolescent anorexia nervosa changes with weight restoration. Method Female adolescents with anorexia nervosa (N=21; mean age, 15.2 years [SD=2.4]) underwent functional MRI (fMRI) before and after treatment; similarly, healthy female control adolescents (N=21; mean age, 16.4 years [SD=1.9]) underwent fMRI on two occasions. Brain function was tested using the reward prediction error construct, a computational model for reward receipt and omission related to motivation and neural dopamine responsiveness. Results Compared with the control group, the anorexia nervosa group exhibited greater brain response 1) for prediction error regression within the caudate, ventral caudate/nucleus accumbens, and anterior and posterior insula, 2) to unexpected reward receipt in the anterior and posterior insula, and 3) to unexpected reward omission in the caudate body. Prediction error and unexpected reward omission response tended to normalize with treatment, while unexpected reward receipt response remained significantly elevated. Greater caudate prediction error response when underweight was associated with lower weight gain during treatment. Punishment sensitivity correlated positively with ventral caudate prediction error response. Conclusions Reward system responsiveness is elevated in adolescent anorexia nervosa when underweight and after weight restoration. Heightened prediction error activity in brain reward regions may represent a phenotype of adolescent anorexia nervosa that does not respond well to treatment. Prediction error response could be a neurobiological marker of illness severity that can indicate individual treatment needs. PMID:28231717

Simulating Memory Impairment for Child Sexual Abuse.

PubMed

Newton, Jeremy W; Hobbs, Sue D

2015-08-01

The current study investigated effects of simulated memory impairment on recall of child sexual abuse (CSA) information. A total of 144 adults were tested for memory of a written CSA scenario in which they role-played as the victim. There were four experimental groups and two testing sessions. During Session 1, participants read a CSA story and recalled it truthfully (Genuine group), omitted CSA information (Omission group), exaggerated CSA information (Commission group), or did not recall the story at all (No Rehearsal group). One week later, at Session 2, all participants were told to recount the scenario truthfully, and their memory was then tested using free recall and cued recall questions. The Session 1 manipulation affected memory accuracy during Session 2. Specifically, compared with the Genuine group's performance, the Omission, Commission, or No Rehearsal groups' performance was characterized by increased omission and commission errors and decreased reporting of correct details. Victim blame ratings (i.e., victim responsibility and provocativeness) and participant gender predicted increased error and decreased accuracy, whereas perpetrator blame ratings predicted decreased error and increased accuracy. Findings are discussed in relation to factors that may affect memory for CSA information. Copyright © 2015 John Wiley & Sons, Ltd.

Differential relationship of recent self-reported stress and acute anxiety with divided attention performance.

PubMed

Petrac, D C; Bedwell, J S; Renk, K; Orem, D M; Sims, V

2009-07-01

There have been relatively few studies on the relationship between recent perceived environmental stress and cognitive performance, and the existing studies do not control for state anxiety during the cognitive testing. The current study addressed this need by examining recent self-reported environmental stress and divided attention performance, while controlling for state anxiety. Fifty-four university undergraduates who self-reported a wide range of perceived recent stress (10-item perceived stress scale) completed both single and dual (simultaneous auditory and visual stimuli) continuous performance tests. Partial correlation analysis showed a statistically significant positive correlation between perceived stress and the auditory omission errors from the dual condition, after controlling for state anxiety and auditory omission errors from the single condition (r = 0.41). This suggests that increased environmental stress relates to decreased divided attention performance in auditory vigilance. In contrast, an increase in state anxiety (controlling for perceived stress) was related to a decrease in auditory omission errors from the dual condition (r = - 0.37), which suggests that state anxiety may improve divided attention performance. Results suggest that further examination of the neurobiological consequences of environmental stress on divided attention and other executive functioning tasks is needed.

Data Mining on Numeric Error in Computerized Physician Order Entry System Prescriptions.

PubMed

Wu, Xue; Wu, Changxu

2017-01-01

This study revealed the numeric error patterns related to dosage when doctors prescribed in computerized physician order entry system. Error categories showed that the '6','7', and '9' key produced a higher incidence of errors in Numpad typing, while the '2','3', and '0' key produced a higher incidence of errors in main keyboard digit line typing. Errors categorized as omission and substitution were higher in prevalence than transposition and intrusion.

Interdisciplinary Coordination Reviews: A Process to Reduce Construction Costs.

ERIC Educational Resources Information Center

Fewell, Dennis A.

1998-01-01

Interdisciplinary Coordination design review is instrumental in detecting coordination errors and omissions in construction documents. Cleansing construction documents of interdisciplinary coordination errors reduces time extensions, the largest source of change orders, and limits exposure to liability claims. Improving the quality of design…

Cardiorespiratory fitness and cognitive functioning following short-term interventions in chronic stroke survivors with cognitive impairment: a pilot study.

PubMed

Blanchet, Sophie; Richards, Carol L; Leblond, Jean; Olivier, Charles; Maltais, Désirée B

2016-06-01

This study, a quasi-experimental, one-group pretest-post-test design, evaluated the effects on cognitive functioning and cardiorespiratory fitness of 8-week interventions (aerobic exercise alone and aerobic exercise and cognitive training combined) in patients with chronic stroke and cognitive impairment living in the community (participants: n=14, 61.93±9.90 years old, 51.50±38.22 months after stroke, n=7 per intervention group). Cognitive functions and cardiorespiratory fitness were evaluated before and after intervention, and at a 3-month follow-up visit (episodic memory: revised-Hopkins Verbal Learning Test; working memory: Brown-Peterson paradigm; attention omission and commission errors: Continuous Performance Test; cardiorespiratory fitness: peak oxygen uptake during a symptom-limited, graded exercise test performed on a semirecumbent ergometer). Friedman's two-way analysis of variance by ranks evaluated differences in score distributions related to time (for the two groups combined). Post-hoc testing was adjusted for multiple comparisons. Compared with before the intervention, there was a significant reduction in attention errors immediately following the intervention (omission errors: 14.6±21.5 vs. 8±13.9, P=0.01; commission errors: 16.4±6.3 vs. 10.9±7.2, P=0.04), and in part at follow-up (omission errors on follow-up: 3.4±4.3, P=0.03; commission errors on follow-up: 13.2±7.6, P=0.42). These results suggest that attention may improve in chronic stroke survivors with cognitive impairment following short-term training that includes an aerobic component, without a change in cardiorespiratory fitness. Randomized-controlled studies are required to confirm these findings.

Comparative Analysis of Daytime Fire Detection Algorithms, Using AVHRR Data for the 1995 Fire Season in Canda: Perspective for MODIS

NASA Technical Reports Server (NTRS)

Ichoku, Charles; Kaufman, Y. J.; Fraser, R. H.; Jin, J.-Z.; Park, W. M.; Lau, William K. M. (Technical Monitor)

2001-01-01

Two fixed-threshold Canada Centre for Remote Sensing and European Space Agency (CCRS and ESA) and three contextual GIGLIO, International Geosphere and Biosphere Project, and Moderate Resolution Imaging Spectroradiometer (GIGLIO, IGBP, and MODIS) algorithms were used for fire detection with Advanced Very High Resolution Radiometer (AVHRR) data acquired over Canada during the 1995 fire season. The CCRS algorithm was developed for the boreal ecosystem, while the other four are for global application. The MODIS algorithm, although developed specifically for use with the MODIS sensor data, was applied to AVHRR in this study for comparative purposes. Fire detection accuracy assessment for the algorithms was based on comparisons with available 1995 burned area ground survey maps covering five Canadian provinces. Overall accuracy estimations in terms of omission (CCRS=46%, ESA=81%, GIGLIO=75%, IGBP=51%, MODIS=81%) and commission (CCRS=0.35%, ESA=0.08%, GIGLIO=0.56%, IGBP=0.75%, MODIS=0.08%) errors over forested areas revealed large differences in performance between the algorithms, with no relevance to type (fixed-threshold or contextual). CCRS performed best in detecting real forest fires, with the least omission error, while ESA and MODIS produced the highest omission error, probably because of their relatively high threshold values designed for global application. The commission error values appear small because the area of pixels falsely identified by each algorithm was expressed as a ratio of the vast unburned forest area. More detailed study shows that most commission errors in all the algorithms were incurred in nonforest agricultural areas, especially on days with very high surface temperatures. The advantage of the high thresholds in ESA and MODIS was that they incurred the least commission errors.

26 CFR 1.42-13 - Rules necessary and appropriate; housing credit agencies' correction of administrative errors and...

Code of Federal Regulations, 2010 CFR

2010-04-01

... this paragraph (b)(2) include the following— (i) A mathematical error; (ii) An entry on a document that... errors or omissions that occurred before the publication of these regulations. Any reasonable method used... February 24, 1994, will be considered proper, provided that the method is consistent with the rules of...

Assessing Inattention and Impulsivity in Children during the Go/NoGo Task

ERIC Educational Resources Information Center

Bezdjian, Serena; Baker, Laura A.; Lozano, Dora Isabel; Raine, Adrian

2009-01-01

Behavioural performance in the Go/NoGo task was compared with caregiver and teacher reports of inattention and hyperactivity-impulsivity in 1,151 children (N = 557 boys; N = 594 girls) age 9-10 years old. Errors of commission (NoGo errors) were significantly correlated with symptom counts of hyperactivity-impulsivity, while errors of omission (Go…

A Corpus Based Study on the Preposition Error Types in Turkish EFL Learners' Essays

ERIC Educational Resources Information Center

Tunaz, Mehmet; Muyan, Emrah; Muratoglu, Nursel

2016-01-01

The purpose of this study was to investigate the categories of preposition errors made by EFL learners of elementary and intermediate proficiency levels by comparing the rate of preposition errors (addition, omission, substitution) to their total preposition uses in their essays, and by comparing the overall preposition usage of learners of both…

Cognitive Deficits Underlying Error Behavior on a Naturalistic Task after Severe Traumatic Brain Injury

PubMed Central

Hendry, Kathryn; Ownsworth, Tamara; Beadle, Elizabeth; Chevignard, Mathilde P.; Fleming, Jennifer; Griffin, Janelle; Shum, David H. K.

2016-01-01

People with severe traumatic brain injury (TBI) often make errors on everyday tasks that compromise their safety and independence. Such errors potentially arise from the breakdown or failure of multiple cognitive processes. This study aimed to investigate cognitive deficits underlying error behavior on a home-based version of the Cooking Task (HBCT) following TBI. Participants included 45 adults (9 females, 36 males) with severe TBI aged 18–64 years (M = 37.91, SD = 13.43). Participants were administered the HBCT in their home kitchens, with audiovisual recordings taken to enable scoring of total errors and error subtypes (Omissions, Additions, Estimations, Substitutions, Commentary/Questions, Dangerous Behavior, Goal Achievement). Participants also completed a battery of neuropsychological tests, including the Trail Making Test, Hopkins Verbal Learning Test-Revised, Digit Span, Zoo Map test, Modified Stroop Test, and Hayling Sentence Completion Test. After controlling for cooking experience, greater Omissions and Estimation errors, lack of goal achievement, and longer completion time were significantly associated with poorer attention, memory, and executive functioning. These findings indicate that errors on naturalistic tasks arise from deficits in multiple cognitive domains. Assessment of error behavior in a real life setting provides insight into individuals' functional abilities which can guide rehabilitation planning and lifestyle support. PMID:27790099

26 CFR 1.1312-8 - Law applicable in determination of error.

Code of Federal Regulations, 2010 CFR

2010-04-01

... Law applicable in determination of error. The question whether there was an erroneous inclusion... provisions of the internal revenue laws applicable with respect to the year as to which the inclusion.... The fact that the inclusion, exclusion, omission, allowance, disallowance, recognition, or...

Automation Bias: Decision Making and Performance in High-Tech Cockpits

NASA Technical Reports Server (NTRS)

Mosier, Kathleen L.; Skitka, Linda J.; Heers, Susan; Burdick, Mark; Rosekind, Mark R. (Technical Monitor)

1997-01-01

Automated aids and decision support tools are rapidly becoming indispensible tools in high-technology cockpits, and are assuming increasing control of "cognitive" flight tasks, such as calculating fuel-efficient routes, navigating, or detecting and diagnosing system malfunctions and abnormalities. This study was designed to investigate "automation bias," a recently documented factor in the use of automated aids and decision support systems. The term refers to omission and commission errors resulting from the use of automated cues as a heuristic replacement for vigilant information seeking and processing. Glass-cockpit pilots flew flight scenarios involving automation "events," or opportunities for automation-related omission and commission errors. Pilots who perceived themselves as "accountable" for their performance and strategies of interaction with the automation were more likely to double-check automated functioning against other cues, and less likely to commit errors. Pilots were also likely to erroneously "remember" the presence of expected cues when describing their decision-making processes.

Improved Snow Mapping Accuracy with Revised MODIS Snow Algorithm

NASA Technical Reports Server (NTRS)

Riggs, George; Hall, Dorothy K.

2012-01-01

The MODIS snow cover products have been used in over 225 published studies. From those reports, and our ongoing analysis, we have learned about the accuracy and errors in the snow products. Revisions have been made in the algorithms to improve the accuracy of snow cover detection in Collection 6 (C6), the next processing/reprocessing of the MODIS data archive planned to start in September 2012. Our objective in the C6 revision of the MODIS snow-cover algorithms and products is to maximize the capability to detect snow cover while minimizing snow detection errors of commission and omission. While the basic snow detection algorithm will not change, new screens will be applied to alleviate snow detection commission and omission errors, and only the fractional snow cover (FSC) will be output (the binary snow cover area (SCA) map will no longer be included).

Intercontinental height datum connection with GOCE and GPS-levelling data

NASA Astrophysics Data System (ADS)

Gruber, T.; Gerlach, C.; Haagmans, R.

2012-12-01

In this study an attempt is made to establish height system datum connections based upon a gravity field and steady-state ocean circulation explorer (GOCE) gravity field model and a set of global positioning system (GPS) and levelling data. The procedure applied in principle is straightforward. First local geoid heights are obtained point wise from GPS and levelling data. Then the mean of these geoid heights is computed for regions nominally referring to the same height datum. Subsequently, these local mean geoid heights are compared with a mean global geoid from GOCE for the same region. This way one can identify an offset of the local to the global geoid per region. This procedure is applied to a number of regions distributed worldwide. Results show that the vertical datum offset estimates strongly depend on the nature of the omission error, i.e. the signal not represented in the GOCE model. For a smooth gravity field the commission error of GOCE, the quality of the GPS and levelling data and the averaging control the accuracy of the vertical datum offset estimates. In case the omission error does not cancel out in the mean value computation, because of a sub-optimal point distribution or a characteristic behaviour of the omitted part of the geoid signal, one needs to estimate a correction for the omission error from other sources. For areas with dense and high quality ground observations the EGM2008 global model is a good choice to estimate the omission error correction in theses cases. Relative intercontinental height datum offsets are estimated by applying this procedure between the United State of America (USA), Australia and Germany. These are compared to historical values provided in the literature and computed with the same procedure. The results obtained in this study agree on a level of 10 cm to the historical results. The changes mainly can be attributed to the new global geoid information from GOCE, rather than to the ellipsoidal heights or the levelled heights. These historical levelling data are still in use in many countries. This conclusion is supported by other results on the validation of the GOCE models.

Error Types and Error Positions in Neglect Dyslexia: Comparative Analyses in Neglect Patients and Healthy Controls

ERIC Educational Resources Information Center

Weinzierl, Christiane; Kerkhoff, Georg; van Eimeren, Lucia; Keller, Ingo; Stenneken, Prisca

2012-01-01

Unilateral spatial neglect frequently involves a lateralised reading disorder, neglect dyslexia (ND). Reading of single words in ND is characterised by left-sided omissions and substitutions of letters. However, it is unclear whether the distribution of error types and positions within a word shows a unique pattern of ND when directly compared to…

Human Error as an Emergent Property of Action Selection and Task Place-Holding.

PubMed

Tamborello, Franklin P; Trafton, J Gregory

2017-05-01

A computational process model could explain how the dynamic interaction of human cognitive mechanisms produces each of multiple error types. With increasing capability and complexity of technological systems, the potential severity of consequences of human error is magnified. Interruption greatly increases people's error rates, as does the presence of other information to maintain in an active state. The model executed as a software-instantiated Monte Carlo simulation. It drew on theoretical constructs such as associative spreading activation for prospective memory, explicit rehearsal strategies as a deliberate cognitive operation to aid retrospective memory, and decay. The model replicated the 30% effect of interruptions on postcompletion error in Ratwani and Trafton's Stock Trader task, the 45% interaction effect on postcompletion error of working memory capacity and working memory load from Byrne and Bovair's Phaser Task, as well as the 5% perseveration and 3% omission effects of interruption from the UNRAVEL Task. Error classes including perseveration, omission, and postcompletion error fall naturally out of the theory. The model explains post-interruption error in terms of task state representation and priming for recall of subsequent steps. Its performance suggests that task environments providing more cues to current task state will mitigate error caused by interruption. For example, interfaces could provide labeled progress indicators or facilities for operators to quickly write notes about their task states when interrupted.

Evaluation of snow cover and snow depth on the Qinghai-Tibetan Plateau derived from passive microwave remote sensing

NASA Astrophysics Data System (ADS)

Dai, Liyun; Che, Tao; Ding, Yongjian; Hao, Xiaohua

2017-08-01

Snow cover on the Qinghai-Tibetan Plateau (QTP) plays a significant role in the global climate system and is an important water resource for rivers in the high-elevation region of Asia. At present, passive microwave (PMW) remote sensing data are the only efficient way to monitor temporal and spatial variations in snow depth at large scale. However, existing snow depth products show the largest uncertainties across the QTP. In this study, MODIS fractional snow cover product, point, line and intense sampling data are synthesized to evaluate the accuracy of snow cover and snow depth derived from PMW remote sensing data and to analyze the possible causes of uncertainties. The results show that the accuracy of snow cover extents varies spatially and depends on the fraction of snow cover. Based on the assumption that grids with MODIS snow cover fraction > 10 % are regarded as snow cover, the overall accuracy in snow cover is 66.7 %, overestimation error is 56.1 %, underestimation error is 21.1 %, commission error is 27.6 % and omission error is 47.4 %. The commission and overestimation errors of snow cover primarily occur in the northwest and southeast areas with low ground temperature. Omission error primarily occurs in cold desert areas with shallow snow, and underestimation error mainly occurs in glacier and lake areas. With the increase of snow cover fraction, the overestimation error decreases and the omission error increases. A comparison between snow depths measured in field experiments, measured at meteorological stations and estimated across the QTP shows that agreement between observation and retrieval improves with an increasing number of observation points in a PMW grid. The misclassification and errors between observed and retrieved snow depth are associated with the relatively coarse resolution of PMW remote sensing, ground temperature, snow characteristics and topography. To accurately understand the variation in snow depth across the QTP, new algorithms should be developed to retrieve snow depth with higher spatial resolution and should consider the variation in brightness temperatures at different frequencies emitted from ground with changing ground features.

Effects of skilled nursing facility structure and process factors on medication errors during nursing home admission.

PubMed

Lane, Sandi J; Troyer, Jennifer L; Dienemann, Jacqueline A; Laditka, Sarah B; Blanchette, Christopher M

2014-01-01

Older adults are at greatest risk of medication errors during the transition period of the first 7 days after admission and readmission to a skilled nursing facility (SNF). The aim of this study was to evaluate structure- and process-related factors that contribute to medication errors and harm during transition periods at a SNF. Data for medication errors and potential medication errors during the 7-day transition period for residents entering North Carolina SNFs were from the Medication Error Quality Initiative-Individual Error database from October 2006 to September 2007. The impact of SNF structure and process measures on the number of reported medication errors and harm from errors were examined using bivariate and multivariate model methods. A total of 138 SNFs reported 581 transition period medication errors; 73 (12.6%) caused harm. Chain affiliation was associated with a reduction in the volume of errors during the transition period. One third of all reported transition errors occurred during the medication administration phase of the medication use process, where dose omissions were the most common type of error; however, dose omissions caused harm less often than wrong-dose errors did. Prescribing errors were much less common than administration errors but were much more likely to cause harm. Both structure and process measures of quality were related to the volume of medication errors.However, process quality measures may play a more important role in predicting harm from errors during the transition of a resident into an SNF. Medication errors during transition could be reduced by improving both prescribing processes and transcription and documentation of orders.

Medication Administration Errors in an Adult Emergency Department of a Tertiary Health Care Facility in Ghana.

PubMed

Acheampong, Franklin; Tetteh, Ashalley Raymond; Anto, Berko Panyin

2016-12-01

This study determined the incidence, types, clinical significance, and potential causes of medication administration errors (MAEs) at the emergency department (ED) of a tertiary health care facility in Ghana. This study used a cross-sectional nonparticipant observational technique. Study participants (nurses) were observed preparing and administering medication at the ED of a 2000-bed tertiary care hospital in Accra, Ghana. The observations were then compared with patients' medication charts, and identified errors were clarified with staff for possible causes. Of the 1332 observations made, involving 338 patients and 49 nurses, 362 had errors, representing 27.2%. However, the error rate excluding "lack of drug availability" fell to 12.8%. Without wrong time error, the error rate was 22.8%. The 2 most frequent error types were omission (n = 281, 77.6%) and wrong time (n = 58, 16%) errors. Omission error was mainly due to unavailability of medicine, 48.9% (n = 177). Although only one of the errors was potentially fatal, 26.7% were definitely clinically severe. The common themes that dominated the probable causes of MAEs were unavailability, staff factors, patient factors, prescription, and communication problems. This study gives credence to similar studies in different settings that MAEs occur frequently in the ED of hospitals. Most of the errors identified were not potentially fatal; however, preventive strategies need to be used to make life-saving processes such as drug administration in such specialized units error-free.

Decision Making In A High-Tech World: Automation Bias and Countermeasures

NASA Technical Reports Server (NTRS)

Mosier, Kathleen L.; Skitka, Linda J.; Burdick, Mark R.; Heers, Susan T.; Rosekind, Mark R. (Technical Monitor)

1996-01-01

Automated decision aids and decision support systems have become essential tools in many high-tech environments. In aviation, for example, flight management systems computers not only fly the aircraft, but also calculate fuel efficient paths, detect and diagnose system malfunctions and abnormalities, and recommend or carry out decisions. Air Traffic Controllers will soon be utilizing decision support tools to help them predict and detect potential conflicts and to generate clearances. Other fields as disparate as nuclear power plants and medical diagnostics are similarly becoming more and more automated. Ideally, the combination of human decision maker and automated decision aid should result in a high-performing team, maximizing the advantages of additional cognitive and observational power in the decision-making process. In reality, however, the presence of these aids often short-circuits the way that even very experienced decision makers have traditionally handled tasks and made decisions, and introduces opportunities for new decision heuristics and biases. Results of recent research investigating the use of automated aids have indicated the presence of automation bias, that is, errors made when decision makers rely on automated cues as a heuristic replacement for vigilant information seeking and processing. Automation commission errors, i.e., errors made when decision makers inappropriately follow an automated directive, or automation omission errors, i.e., errors made when humans fail to take action or notice a problem because an automated aid fails to inform them, can result from this tendency. Evidence of the tendency to make automation-related omission and commission errors has been found in pilot self reports, in studies using pilots in flight simulations, and in non-flight decision making contexts with student samples. Considerable research has found that increasing social accountability can successfully ameliorate a broad array of cognitive biases and resultant errors. To what extent these effects generalize to performance situations is not yet empirically established. The two studies to be presented represent concurrent efforts, with student and professional pilot samples, to determine the effects of accountability pressures on automation bias and on the verification of the accurate functioning of automated aids. Students (Experiment 1) and commercial pilots (Experiment 2) performed simulated flight tasks using automated aids. In both studies, participants who perceived themselves as accountable for their strategies of interaction with the automation were significantly more likely to verify its correctness, and committed significantly fewer automation-related errors than those who did not report this perception.

Continuous performance test in pediatric obsessive-compulsive disorder and tic disorders: the role of sustained attention.

PubMed

Lucke, Ilse M; Lin, Charlotte; Conteh, Fatmata; Federline, Amanda; Sung, Huyngmo; Specht, Matthew; Grados, Marco A

2015-10-01

Pediatric obsessive-compulsive disorder (OCD) and tic disorders (TD) are often associated with attention-deficit hyperactivity disorder (ADHD). In order to clarify the role of attention and inhibitory control in pediatric OCD and TD, a continuous performance test (CPT) was administered to a cohort of children and adolescents with OCD alone, TD alone, and OCD+TD. A clinical cohort of 48 children and adolescents with OCD alone (n=20), TD alone (n=15), or OCD+TD (n=13) was interviewed clinically and administered the Conners Continuous Performance Test II (CPT-II). The Conners CPT-II is a 14-minute normed computerized test consisting of 6 blocks. It taps into attention, inhibitory control, and sustained attention cognitive domains. Key parameters include errors of omission (distractability), commission (inhibitory control), and variable responding over time (sustained attention). Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) criteria were applied in a best-estimate process to diagnose OCD, TD, ADHD, and anxiety disorders. Children with OCD+TD had more errors of omission (p=0.03), and more hit RT block change (p=0.003) and hit SE block change (p=0.02) than subjects with OCD alone and TD alone. These deficits in sustained attention were associated with younger age and hoarding tendencies. A clinical diagnosis of ADHD in the OCD+TD group also determined worse sustained attention. A deficit in sustained attention, a core marker of ADHD, is also a marker of OCD+TD, compared to OCD alone and TD alone. Biological correlates of sustained attention may serve to uncover the pathophysiology of OCD and TD through genetic and imaging studies.

The effect of methylphenidate on very low frequency electroencephalography oscillations in adult ADHD.

PubMed

Cooper, Ruth E; Skirrow, Caroline; Tye, Charlotte; McLoughlin, Grainne; Rijsdijk, Fruhling; Banaschweski, Tobias; Brandeis, Daniel; Kuntsi, Jonna; Asherson, Philip

2014-04-01

Altered very low-frequency electroencephalographic (VLF-EEG) activity is an endophenotype of ADHD in children and adolescents. We investigated VLF-EEG case-control differences in adult samples and the effects of methylphenidate (MPH). A longitudinal case-control study was conducted examining the effects of MPH on VLF-EEG (.02-0.2Hz) during a cued continuous performance task. 41 untreated adults with ADHD and 47 controls were assessed, and 21 cases followed up after MPH treatment, with a similar follow-up for 38 controls (mean follow-up=9.4months). Cases had enhanced frontal and parietal VLF-EEG and increased omission errors. In the whole sample, increased parietal VLF-EEG correlated with increased omission errors. After controlling for subthreshold comorbid symptoms, VLF-EEG case-control differences and treatment effects remained. Post-treatment, a time by group interaction emerged; VLF-EEG and omission errors reduced to the same level as controls, with decreased inattentive symptoms in cases. Reduced VLF-EEG following MPH treatment provides preliminary evidence that changes in VLF-EEG may relate to MPH treatment effects on ADHD symptoms; and that VLF-EEG may be an intermediate phenotype of ADHD. Further studies of the treatment effect of MPH in larger controlled studies are required to formally evaluate any causal link between MPH, VLF-EEG and ADHD symptoms. Copyright © 2014 Elsevier Inc. All rights reserved.

Medication errors in anesthesia: unacceptable or unavoidable?

PubMed

Dhawan, Ira; Tewari, Anurag; Sehgal, Sankalp; Sinha, Ashish Chandra

Medication errors are the common causes of patient morbidity and mortality. It adds financial burden to the institution as well. Though the impact varies from no harm to serious adverse effects including death, it needs attention on priority basis since medication errors' are preventable. In today's world where people are aware and medical claims are on the hike, it is of utmost priority that we curb this issue. Individual effort to decrease medication error alone might not be successful until a change in the existing protocols and system is incorporated. Often drug errors that occur cannot be reversed. The best way to 'treat' drug errors is to prevent them. Wrong medication (due to syringe swap), overdose (due to misunderstanding or preconception of the dose, pump misuse and dilution error), incorrect administration route, under dosing and omission are common causes of medication error that occur perioperatively. Drug omission and calculation mistakes occur commonly in ICU. Medication errors can occur perioperatively either during preparation, administration or record keeping. Numerous human and system errors can be blamed for occurrence of medication errors. The need of the hour is to stop the blame - game, accept mistakes and develop a safe and 'just' culture in order to prevent medication errors. The newly devised systems like VEINROM, a fluid delivery system is a novel approach in preventing drug errors due to most commonly used medications in anesthesia. Similar developments along with vigilant doctors, safe workplace culture and organizational support all together can help prevent these errors. Copyright © 2016. Published by Elsevier Editora Ltda.

Variation in the pattern of omissions and substitutions of grammatical morphemes in the spontaneous speech of so-called agrammatic patients.

PubMed

Miceli, G; Silveri, M C; Romani, C; Caramazza, A

1989-04-01

We describe the patterns of omissions (and substitutions) of freestanding grammatical morphemes and the patterns of substitutions of bound grammatical morphemes in 20 so-called agrammatic patients. Extreme variation was observed in the patterns of omissions and substitutions of grammatical morphemes, both in terms of the distribution of errors for different grammatical morphemes as well as in terms of the distribution of omissions versus substitutions. Results are discussed in the context of current debates concerning the possibility of a theoretically motivated distinction between the clinical categories of agrammatism and paragrammatism and, more generally, concerning the theoretical usefulness of any clinical category. The conclusion is reached that the observed heterogeneity in the production of grammatical morphemes among putatively agrammatic patients renders the clinical category of agrammatism, and by extension all other clinical categories from the classical classification scheme (e.g., Broca's aphasia, Wernicke's aphasia, and so forth) to more recent classificatory attempts (e.g., surface dyslexia, deep dysgraphia, and so forth), theoretically useless.

Assessment of EGM2008 in Europe using accurate astrogeodetic vertical deflections and omission error estimates from SRTM/DTM2006.0 residual terrain model data

NASA Astrophysics Data System (ADS)

Hirt, C.; Marti, U.; Bürki, B.; Featherstone, W. E.

2010-10-01

We assess the new EGM2008 Earth gravitational model using a set of 1056 astrogeodetic vertical deflections over parts of continental Europe. Our astrogeodetic vertical deflection data set originates from zenith camera observations performed during 1983-2008. This set, which is completely independent from EGM2008, covers, e.g., Switzerland, Germany, Portugal and Greece, and samples a variety of topography - level terrain, medium elevated and rugged Alpine areas. We describe how EGM2008 is used to compute vertical deflections according to Helmert's (surface) definition. Particular attention is paid to estimating the EGM2008 signal omission error from residual terrain model (RTM) data. The RTM data is obtained from the Shuttle Radar Topography Mission (SRTM) elevation model and the DTM2006.0 high degree spherical harmonic reference surface. The comparisons between the astrogeodetic and EGM2008 vertical deflections show an agreement of about 3 arc seconds (root mean square, RMS). Adding omission error estimates from RTM to EGM2008 significantly reduces the discrepancies from the complete European set of astrogeodetic deflections to 1 arc second (RMS). Depending on the region, the RMS errors vary between 0.4 and 1.5 arc seconds. These values not only reflect EGM2008 commission errors, but also short-scale mass-density anomalies not modelled from the RTM data. Given (1) formally stated EGM2008 commission error estimates of about 0.6-0.8 arc seconds for vertical deflections, and (2) that short-scale mass-density anomalies may affect vertical deflections by about 1 arc second, the agreement between EGM2008 and our astrogeodetic deflection data set is very good. Further focus is placed on the investigation of the high-degree spectral bands of EGM2008. As a general conclusion, EGM2008 - enhanced by RTM data - is capable of predicting Helmert vertical deflections at the 1 arc second accuracy level over Europe.

Simulated forecast error and climate drift resulting from the omission of the upper stratosphere in numerical models

NASA Technical Reports Server (NTRS)

Boville, Byron A.; Baumhefner, David P.

1990-01-01

Using an NCAR community climate model, Version I, the forecast error growth and the climate drift resulting from the omission of the upper stratosphere are investigated. In the experiment, the control simulation is a seasonal integration of a medium horizontal general circulation model with 30 levels extending from the surface to the upper mesosphere, while the main experiment uses an identical model, except that only the bottom 15 levels (below 10 mb) are retained. It is shown that both random and systematic errors develop rapidly in the lower stratosphere with some local propagation into the troposphere in the 10-30-day time range. The random growth rate in the troposphere in the case of the altered upper boundary was found to be slightly faster than that for the initial-condition uncertainty alone. However, this is not likely to make a significant impact in operational forecast models, because the initial-condition uncertainty is very large.

37 CFR 201.7 - Cancellation of completed registrations.

Code of Federal Regulations, 2011 CFR

2011-07-01

... or omissions which would generally have been rectified before registration, the Copyright Office will attempt to rectify the error through correspondence with the remitter. Except in those cases enumerated in...

Lessons from aviation - the role of checklists in minimally invasive cardiac surgery.

PubMed

Hussain, S; Adams, C; Cleland, A; Jones, P M; Walsh, G; Kiaii, B

2016-01-01

We describe an adverse event during minimally invasive cardiac surgery that resulted in a multi-disciplinary review of intra-operative errors and the creation of a procedural checklist. This checklist aims to prevent errors of omission and communication failures that result in increased morbidity and mortality. We discuss the application of the aviation - led "threats and errors model" to medical practice and the role of checklists and other strategies aimed at reducing medical errors. © The Author(s) 2015.

20 CFR 200.2 - The general course and method by which the Board's functions are channeled and determined.

Code of Federal Regulations, 2011 CFR

2011-04-01

... to the nearest field office of the Board. That office inspects the applications to detect errors and..., the claimant executes a registration and claim for unemployment insurance benefits (Form UI-3). In... openings, detecting errors and omissions, and noting items requiring investigation. The claim is then...

Prevalence and pattern of prescription errors in a Nigerian kidney hospital.

PubMed

Babatunde, Kehinde M; Akinbodewa, Akinwumi A; Akinboye, Ayodele O; Adejumo, Ademola O

2016-12-01

To determine (i) the prevalence and pattern of prescription errors in our Centre and, (ii) appraise pharmacists' intervention and correction of identified prescription errors. A descriptive, single blinded cross-sectional study. Kidney Care Centre is a public Specialist hospital. The monthly patient load averages 60 General Out-patient cases and 17.4 in-patients. A total of 31 medical doctors (comprising of 2 Consultant Nephrologists, 15 Medical Officers, 14 House Officers), 40 nurses and 24 ward assistants participated in the study. One pharmacist runs the daily call schedule. Prescribers were blinded to the study. Prescriptions containing only galenicals were excluded. An error detection mechanism was set up to identify and correct prescription errors. Life-threatening prescriptions were discussed with the Quality Assurance Team of the Centre who conveyed such errors to the prescriber without revealing the on-going study. Prevalence of prescription errors, pattern of prescription errors, pharmacist's intervention. A total of 2,660 (75.0%) combined prescription errors were found to have one form of error or the other; illegitimacy 1,388 (52.18%), omission 1,221(45.90%), wrong dose 51(1.92%) and no error of style was detected. Life-threatening errors were low (1.1-2.2%). Errors were found more commonly among junior doctors and non-medical doctors. Only 56 (1.6%) of the errors were detected and corrected during the process of dispensing. Prescription errors related to illegitimacy and omissions were highly prevalent. There is a need to improve on patient-to-healthcare giver ratio. A medication quality assurance unit is needed in our hospitals. No financial support was received by any of the authors for this study.

Rates of medical errors and preventable adverse events among hospitalized children following implementation of a resident handoff bundle.

PubMed

Starmer, Amy J; Sectish, Theodore C; Simon, Dennis W; Keohane, Carol; McSweeney, Maireade E; Chung, Erica Y; Yoon, Catherine S; Lipsitz, Stuart R; Wassner, Ari J; Harper, Marvin B; Landrigan, Christopher P

2013-12-04

Handoff miscommunications are a leading cause of medical errors. Studies comprehensively assessing handoff improvement programs are lacking. To determine whether introduction of a multifaceted handoff program was associated with reduced rates of medical errors and preventable adverse events, fewer omissions of key data in written handoffs, improved verbal handoffs, and changes in resident-physician workflow. Prospective intervention study of 1255 patient admissions (642 before and 613 after the intervention) involving 84 resident physicians (42 before and 42 after the intervention) from July-September 2009 and November 2009-January 2010 on 2 inpatient units at Boston Children's Hospital. Resident handoff bundle, consisting of standardized communication and handoff training, a verbal mnemonic, and a new team handoff structure. On one unit, a computerized handoff tool linked to the electronic medical record was introduced. The primary outcomes were the rates of medical errors and preventable adverse events measured by daily systematic surveillance. The secondary outcomes were omissions in the printed handoff document and resident time-motion activity. Medical errors decreased from 33.8 per 100 admissions (95% CI, 27.3-40.3) to 18.3 per 100 admissions (95% CI, 14.7-21.9; P < .001), and preventable adverse events decreased from 3.3 per 100 admissions (95% CI, 1.7-4.8) to 1.5 (95% CI, 0.51-2.4) per 100 admissions (P = .04) following the intervention. There were fewer omissions of key handoff elements on printed handoff documents, especially on the unit that received the computerized handoff tool (significant reductions of omissions in 11 of 14 categories with computerized tool; significant reductions in 2 of 14 categories without computerized tool). Physicians spent a greater percentage of time in a 24-hour period at the patient bedside after the intervention (8.3%; 95% CI 7.1%-9.8%) vs 10.6% (95% CI, 9.2%-12.2%; P = .03). The average duration of verbal handoffs per patient did not change. Verbal handoffs were more likely to occur in a quiet location (33.3%; 95% CI, 14.5%-52.2% vs 67.9%; 95% CI, 50.6%-85.2%; P = .03) and private location (50.0%; 95% CI, 30%-70% vs 85.7%; 95% CI, 72.8%-98.7%; P = .007) after the intervention. Implementation of a handoff bundle was associated with a significant reduction in medical errors and preventable adverse events among hospitalized children. Improvements in verbal and written handoff processes occurred, and resident workflow did not change adversely.

Diagnostic choices and clinical outcomes in octogenarians and nonagenarians with iron-deficiency anemia in the Netherlands.

PubMed

Hamaker, Marije E; Acampo, Tessa; Remijn, Jasper A; van Tuyl, Sebastiaan A C; Pronk, Apollo; van der Zaag, Edwin S; Paling, Heleen A; Smorenburg, Carolien H; de Rooij, Sophia E; van Munster, Barbara C

2013-04-01

To evaluate current clinical practice for octogenarians with iron-deficiency anemia (IDA) by assessing referral patterns, diagnostic choices, clinical consequences of omission of endoscopy, and risks and benefits of IDA-related surgery. Chart review. A regional hospital-based laboratory in the Netherlands between January 2008 and December 2010. All individuals aged 80 and older with newly ascertained IDA. IDA was defined as a hemoglobin level of 11.1 g/dL or less and a ferritin level of 25 μg/L or less. Four hundred seventy-one participants were newly diagnosed with IDA during the study period (median age 85.4), 276 of whom (59%) did not undergo any diagnostic procedures for IDA. A cause of anemia was identified during the initial examination in 50% of the 205 investigated participants, including nine (4%) upper and 37 (18%) lower gastrointestinal malignancies. Another 24 malignancies were identified during follow-up, of which 16 were in the gastrointestinal tract, primarily in participants for whom the initial diagnostic examination was limited or omitted. Perioperative mortality was 15% in individuals with colon cancer. Median survival for participants with colon cancer was 2.2 years, and the survival benefit of surgery over supportive care was not apparent until 1.3 years after ascertainment of IDA. The omission of endoscopy for IDA and the omission of surgery for colon cancer occur frequently in octogenarians and seem appropriate in the presence of significant comorbidity and in cases in which there is limited life expectancy. Further research is needed to determine which baseline factors should guide decision-making to optimize treatment outcomes and quality of life. © 2013, Copyright the Authors Journal compilation © 2013, The American Geriatrics Society.

Pocket guide to transportation, 1999

DOT National Transportation Integrated Search

1998-12-01

Statistics published in this Pocket Guide to Transportation come from many different sources. Some statistics are based on samples and are subject to sampling variability. Statistics may also be subject to omissions and errors in reporting, recording...

Pocket guide to transportation, 2009

DOT National Transportation Integrated Search

2009-01-01

Statistics published in this Pocket Guide to Transportation come from many different sources. Some statistics are based on samples and are subject to sampling variability. Statistics may also be subject to omissions and errors in reporting, recording...

Pocket guide to transportation, 2013.

DOT National Transportation Integrated Search

2013-01-01

Abstract Statistics published in this Pocket Guide to Transportation come from many different sources. Some statistics are based on samples and are subject to sampling variability. Statistics may also be subject to omissions and errors in reporting, ...

Pocket guide to transportation, 2010

DOT National Transportation Integrated Search

2010-01-01

Statistics published in this Pocket Guide to Transportation come from many different sources. Some statistics are based on samples and are subject to sampling variability. Statistics may also be subject to omissions and errors in reporting, recording...

[Error analysis of functional articulation disorders in children].

PubMed

Zhou, Qiao-juan; Yin, Heng; Shi, Bing

2008-08-01

To explore the clinical characteristic of functional articulation disorders in children and provide more evidence for differential diagnosis and speech therapy. 172 children with functional articulation disorders were grouped by age. Children aged 4-5 years were assigned to one group, and those aged 6-10 years were to another group. Their phonological samples were collected and analyzed. In the two groups, substitution and omission (deletion) were the mainly articulation errors in these children, dental consonants were the main wrong sounds, and bilabial and labio-dental were rarely wrong. In age 4-5 group, sequence according to the error frequency from the highest to lowest was dental, velar, lingual, apical, bilabial, and labio-dental. In age 6-10 group, the sequence was dental, lingual, apical, velar, bilabial, labio-dental. Lateral misarticulation and palatalized misarticulation occurred more often in age 6-10 group than age 4-5 group and were only found in lingual and dental consonants in two groups. Misarticulation of functional articulation disorders mainly occurs in dental and rarely in bilabial and labio-dental. Substitution and omission are the most often occurred errors. Lateral misarticulation and palatalized misarticulation occur mainly in lingual and dental consonants.

Threat engagement, disengagement, and sensitivity bias in worry-prone individuals as measured by an emotional go/no-go task.

PubMed

Gole, Markus; Köchel, Angelika; Schäfer, Axel; Schienle, Anne

2012-03-01

The goal of the present study was to investigate a threat engagement, disengagement, and sensitivity bias in individuals suffering from pathological worry. Twenty participants high in worry proneness and 16 control participants low in worry proneness completed an emotional go/no-go task with worry-related threat words and neutral words. Shorter reaction times (i.e., threat engagement bias), smaller omission error rates (i.e., threat sensitivity bias), and larger commission error rates (i.e., threat disengagement bias) emerged only in the high worry group when worry-related words constituted the go-stimuli and neutral words the no-go stimuli. Also, smaller omission error rates as well as larger commission error rates were observed in the high worry group relative to the low worry group when worry-related go stimuli and neutral no-go stimuli were used. The obtained results await further replication within a generalized anxiety disorder sample. Also, further samples should include men as well. Our data suggest that worry-prone individuals are threat-sensitive, engage more rapidly with aversion, and disengage harder. Copyright © 2011 Elsevier Ltd. All rights reserved.

Uses and Misuses of Ted Kaczynski's MMPI.

PubMed

Ben-Porath, Yossef S

2018-05-22

Although case studies can be a helpful didactic aid when teaching personality assessment and illustrating use of a test, they can, of course, not be used as "evidence" that a test "works" or does not work. This article, however, reviews and discusses the far more problematic uses instantiated in a case study of Ted Kaczynski's Minnesota Multiphasic Personality Inventory (MMPI). A series of errors of omission and commission are identified in Butcher, Hass, Greene, and Nelson's ( 2015 ) effort to criticize the MMPI-2-RF. These include not disclosing that Butcher's interpretive Minnesota Report for Forensic Settings indicates that the protocol is invalid, not including most of the MMPI-2 and MMPI-2-RF scores that contradict the authors' assertions, and mischaracterizing the MMPI-2-RF findings. Proper use of a case study is then illustrated by a discussion of diagnostic considerations indicated by the MMPI-2-RF findings.

Scope, completeness, and accuracy of drug information in Wikipedia.

PubMed

Clauson, Kevin A; Polen, Hyla H; Boulos, Maged N Kamel; Dzenowagis, Joan H

2008-12-01

With the advent of Web 2.0 technologies, user-edited online resources such as Wikipedia are increasingly tapped for information. However, there is little research on the quality of health information found in Wikipedia. To compare the scope, completeness, and accuracy of drug information in Wikipedia with that of a free, online, traditionally edited database (Medscape Drug Reference [MDR]). Wikipedia and MDR were assessed on 8 categories of drug information. Questions were constructed and answers were verified with authoritative resources. Wikipedia and MDR were evaluated according to scope (breadth of coverage) and completeness. Accuracy was tracked by factual errors and errors of omission. Descriptive statistics were used to summarize the components. Fisher's exact test was used to compare scope and paired Student's t-test was used to compare current results in Wikipedia with entries 90 days prior to the current access. Wikipedia was able to answer significantly fewer drug information questions (40.0%) compared with MDR (82.5%; p < 0.001). Wikipedia performed poorly regarding information on dosing, with a score of 0% versus the MDR score of 90.0%. Answers found in Wikipedia were 76.0% complete, while MDR provided answers that were 95.5% complete; overall, Wikipedia answers were less complete than those in Medscape (p < 0.001). No factual errors were found in Wikipedia, whereas 4 answers in Medscape conflicted with the answer key; errors of omission were higher in Wikipedia (n = 48) than in MDR (n = 14). There was a marked improvement in Wikipedia over time, as current entries were superior to those 90 days prior (p = 0.024). Wikipedia has a more narrow scope, is less complete, and has more errors of omission than the comparator database. Wikipedia may be a useful point of engagement for consumers, but is not authoritative and should only be a supplemental source of drug information.

Frequency and types of the medication errors in an academic emergency department in Iran: The emergent need for clinical pharmacy services in emergency departments.

PubMed

Zeraatchi, Alireza; Talebian, Mohammad-Taghi; Nejati, Amir; Dashti-Khavidaki, Simin

2013-07-01

Emergency departments (EDs) are characterized by simultaneous care of multiple patients with various medical conditions. Due to a large number of patients with complex diseases, speed and complexity of medication use, working in under-staffing and crowded environment, medication errors are commonly perpetrated by emergency care providers. This study was designed to evaluate the incidence of medication errors among patients attending to an ED in a teaching hospital in Iran. In this cross-sectional study, a total of 500 patients attending to ED were randomly assessed for incidence and types of medication errors. Some factors related to medication errors such as working shift, weekdays and schedule of the educational program of trainee were also evaluated. Nearly, 22% of patients experienced at least one medication error. The rate of medication errors were 0.41 errors per patient and 0.16 errors per ordered medication. The frequency of medication errors was higher in men, middle age patients, first weekdays, night-time work schedules and the first semester of educational year of new junior emergency medicine residents. More than 60% of errors were prescription errors by physicians and the remaining were transcription or administration errors by nurses. More than 35% of the prescribing errors happened during the selection of drug dose and frequency. The most common medication errors by nurses during the administration were omission error (16.2%) followed by unauthorized drug (6.4%). Most of the medication errors happened for anticoagulants and thrombolytics (41.2%) followed by antimicrobial agents (37.7%) and insulin (7.4%). In this study, at least one-fifth of the patients attending to ED experienced medication errors resulting from multiple factors. More common prescription errors happened during ordering drug dose and frequency. More common administration errors included dug omission or unauthorized drug.

Automation bias: decision making and performance in high-tech cockpits.

PubMed

Mosier, K L; Skitka, L J; Heers, S; Burdick, M

1997-01-01

Automated aids and decision support tools are rapidly becoming indispensable tools in high-technology cockpits and are assuming increasing control of"cognitive" flight tasks, such as calculating fuel-efficient routes, navigating, or detecting and diagnosing system malfunctions and abnormalities. This study was designed to investigate automation bias, a recently documented factor in the use of automated aids and decision support systems. The term refers to omission and commission errors resulting from the use of automated cues as a heuristic replacement for vigilant information seeking and processing. Glass-cockpit pilots flew flight scenarios involving automation events or opportunities for automation-related omission and commission errors. Although experimentally manipulated accountability demands did not significantly impact performance, post hoc analyses revealed that those pilots who reported an internalized perception of "accountability" for their performance and strategies of interaction with the automation were significantly more likely to double-check automated functioning against other cues and less likely to commit errors than those who did not share this perception. Pilots were also lilkely to erroneously "remember" the presence of expected cues when describing their decision-making processes.

Computerized assessment of sustained attention: interactive effects of task demand, noise, and anxiety.

PubMed

Ballard, J C

1996-12-01

In a sample of 163 college undergraduates, the effects of task demand, noise, and anxiety on Continuous Performance Test (CPT) errors were evaluated with multiple regression and multivariate analysis of variance. Results indicated significantly more omission errors on the difficult task. Complex interaction effects of noise and self-reported anxiety yielded more omissions in quiet intermittent white noise, particularly for high-anxious subjects performing the difficult task. Anxiety levels tended to increase from pretest to posttest, particularly for low-anxious subjects in the quiet, difficult-task condition, while a decrease was seen for high-anxious subjects in the loud, easy-task condition. Commission errors were unrelated to any predictor variables, suggesting that "attention" cannot be considered a unitary phenomenon. The variety of direct and interactive effects on vigilance performance underscore the need for clinicians to use a variety of measures to assess attentional skills, to avoid diagnosis of attention deficits on the basis of a single computerized task performance, and to rule out anxiety and other contributors to poor vigilance task performance.

Final Rule for Technical Amendments to the Highway and Nonroad Diesel Regulations

EPA Pesticide Factsheets

This action corrects errors and omissions from the previous rules, makes minor changes to the regulations to assist entities with regulatory compliance, and makes technical amendments that resulted from discussions with various diesel stakeholders.

Analysis of Statistical Methods and Errors in the Articles Published in the Korean Journal of Pain

PubMed Central

Yim, Kyoung Hoon; Han, Kyoung Ah; Park, Soo Young

2010-01-01

Background Statistical analysis is essential in regard to obtaining objective reliability for medical research. However, medical researchers do not have enough statistical knowledge to properly analyze their study data. To help understand and potentially alleviate this problem, we have analyzed the statistical methods and errors of articles published in the Korean Journal of Pain (KJP), with the intention to improve the statistical quality of the journal. Methods All the articles, except case reports and editorials, published from 2004 to 2008 in the KJP were reviewed. The types of applied statistical methods and errors in the articles were evaluated. Results One hundred and thirty-nine original articles were reviewed. Inferential statistics and descriptive statistics were used in 119 papers and 20 papers, respectively. Only 20.9% of the papers were free from statistical errors. The most commonly adopted statistical method was the t-test (21.0%) followed by the chi-square test (15.9%). Errors of omission were encountered 101 times in 70 papers. Among the errors of omission, "no statistics used even though statistical methods were required" was the most common (40.6%). The errors of commission were encountered 165 times in 86 papers, among which "parametric inference for nonparametric data" was the most common (33.9%). Conclusions We found various types of statistical errors in the articles published in the KJP. This suggests that meticulous attention should be given not only in the applying statistical procedures but also in the reviewing process to improve the value of the article. PMID:20552071

A randomised controlled trial of cognitive aids for emergency airway equipment preparation in a Paediatric Emergency Department.

PubMed

Long, Elliot; Fitzpatrick, Patrick; Cincotta, Domenic R; Grindlay, Joanne; Barrett, Michael Joseph

2016-01-27

Safety of emergency intubation may be improved by standardising equipment preparation; the efficacy of cognitive aids is unknown. This randomised controlled trial compared no cognitive aid (control) with the use of a checklist or picture template for emergency airway equipment preparation in the Emergency Department of The Royal Children's Hospital, Melbourne. Sixty-three participants were recruited, 21 randomised to each group. Equal numbers of nursing, junior medical, and senior medical staff were included in each group. Compared to controls, the checklist or template group had significantly lower equipment omission rates (median 30% IQR 20-40% control, median 10% IQR 5-10 % checklist, median 10% IQR 5-20% template; p < 0.05). The combined omission rate and sizing error rate was lower using a checklist or template (median 35 % IQR 30-45 % control, median 15% IQR 10-20% checklist, median 15% IQR 10-30% template; p < 0.05). The template group had less variation in equipment location compared to checklist or controls. There was no significant difference in preparation time in controls (mean 3 min 14 s sd 56 s) compared to checklist (mean 3 min 46 s sd 1 min 15 s) or template (mean 3 min 6 s sd 49 s; p = 0.06). Template use reduces variation in airway equipment location during preparation foremergency intubation, with an equivalent reduction in equipment omission rate to the use of a checklist. The use of a template for equipment preparation and a checklist for team, patient, and monitoring preparation may provide the best combination of both cognitive aids. The use of a cognitive aid for emergency airway equipment preparation reduces errors of omission. Template utilisation reduces variation in equipment location. Australian and New Zealand Trials Registry (ACTRN12615000541505).

Writing errors as a result of frontal dysfunction in Japanese patients with amyotrophic lateral sclerosis.

PubMed

Tsuji-Akimoto, Sachiko; Hamada, Shinsuke; Yabe, Ichiro; Tamura, Itaru; Otsuki, Mika; Kobashi, Syoji; Sasaki, Hidenao

2010-12-01

Loss of communication is a critical problem for advanced amyotrophic lateral sclerosis (ALS) patients. This loss of communication is mainly caused by severe dysarthria and disability of the dominant hand. However, reports show that about 50% of ALS patients have mild cognitive dysfunction, and there are a considerable number of case reports on Japanese ALS patients with agraphia. To clarify writing disabilities in non-demented ALS patients, eighteen non-demented ALS patients and 16 controls without neurological disorders were examined for frontal cognitive function and writing ability. To assess writing errors statistically, we scored them on their composition ability with the original writing error index (WEI). The ALS and control groups did not differ significantly with regard to age, years of education, or general cognitive level. Two patients could not write a letter because of disability of the dominant hand. The WEI and results of picture arrangement tests indicated significant impairment in the ALS patients. Auditory comprehension (Western Aphasia Battery; WAB IIC) and kanji dictation also showed mild impairment. Patients' writing errors consisted of both syntactic and letter-writing mistakes. Omission, substitution, displacement, and inappropriate placement of the phonic marks of kana were observed; these features have often been reported in Japanese patients with agraphia resulted from a frontal lobe lesion. The most frequent type of error was an omission of kana, the next most common was a missing subject. Writing errors might be a specific deficit for some non-demented ALS patients.

The test of variables of attention (TOVA): Internal consistency (Q1 vs. Q2 and Q3 vs. Q4) in children with Attention Deficit/Hyperactivity Disorder (ADHD)

USDA-ARS?s Scientific Manuscript database

The internal consistency of the Test of Variables of Attention (TOVA) was examined in a cohort of 6- to 12-year-old children (N = 63) strictly diagnosed with ADHD. The internal consistency of errors of omission (OMM), errors of commission (COM), response time (RT), and response time variability (RTV...

Errors Detection by 5- to 8-Year-Olds Listening to a Wrong French Sequence of Number Words: Music before Lyrics?

ERIC Educational Resources Information Center

Gauderat-Bagault, Laurence; Lehalle, Henri

Children, ages 5 to 8 years (n=71), were required to listen and detect errors out of a partly wrong sequence of tape-recorded French number words from 1 to 100. Children (from several schools near Montpellier, France) were from preschool, grade 1, and grade 2. Results show that wrong syntactic rules were better detected than omissions, whereas…

The relationship between hand hygiene and health care-associated infection: it’s complicated

PubMed Central

McLaws, Mary-Louise

2015-01-01

The reasoning that improved hand hygiene compliance contributes to the prevention of health care-associated infections is widely accepted. It is also accepted that high hand hygiene alone cannot impact formidable risk factors, such as older age, immunosuppression, admission to the intensive care unit, longer length of stay, and indwelling devices. When hand hygiene interventions are concurrently undertaken with other routine or special preventive strategies, there is a potential for these concurrent strategies to confound the effect of the hand hygiene program. The result may be an overestimation of the hand hygiene intervention unless the design of the intervention or analysis controls the effect of the potential confounders. Other epidemiologic principles that may also impact the result of a hand hygiene program include failure to consider measurement error of the content of the hand hygiene program and the measurement error of compliance. Some epidemiological errors in hand hygiene programs aimed at reducing health care-associated infections are inherent and not easily controlled. Nevertheless, the inadvertent omission by authors to report these common epidemiological errors, including concurrent infection prevention strategies, suggests to readers that the effect of hand hygiene is greater than the sum of all infection prevention strategies. Worse still, this omission does not assist evidence-based practice. PMID:25678805

Erring and learning in clinical practice.

PubMed Central

Hurwitz, Brian

2002-01-01

This paper discusses error type their possible consequences and the doctors who make them. There is no single, all-encompassing typology of medical errors. They are frequently multifactorial in origin and use from the mental processes of individuals; from defects in perception, thinking reasoning planning and interpretation and from failures of team-working omissions and poorly executed actions. They also arise from inadequately designed and operated healthcare systems or procedures. The paper considers error-truth relatedness, the approach of UK courts to medical errors, the learning opportunities which flow from error recognition and the need for personal and professional self awareness of clinical fallibilities. PMID:12389767

Left neglect dyslexia: Perseveration and reading error types.

PubMed

Ronchi, Roberta; Algeri, Lorella; Chiapella, Laura; Gallucci, Marcello; Spada, Maria Simonetta; Vallar, Giuseppe

2016-08-01

Right-brain-damaged patients may show a reading disorder termed neglect dyslexia. Patients with left neglect dyslexia omit letters on the left-hand-side (the beginning, when reading left-to-right) part of the letter string, substitute them with other letters, and add letters to the left of the string. The aim of this study was to investigate the pattern of association, if any, between error types in patients with left neglect dyslexia and recurrent perseveration (a productive visuo-motor deficit characterized by addition of marks) in target cancellation. Specifically, we aimed at assessing whether different productive symptoms (relative to the reading and the visuo-motor domains) could be associated in patients with left spatial neglect. Fifty-four right-brain-damaged patients took part in the study: 50 out of the 54 patients showed left spatial neglect, with 27 of them also exhibiting left neglect dyslexia. Neglect dyslexic patients who showed perseveration produced mainly substitution neglect errors in reading. Conversely, omissions were the prevailing reading error pattern in neglect dyslexic patients without perseveration. Addition reading errors were much infrequent. Different functional pathological mechanisms may underlie omission and substitution reading errors committed by right-brain-damaged patients with left neglect dyslexia. One such mechanism, involving the defective stopping of inappropriate responses, may contribute to both recurrent perseveration in target cancellation, and substitution errors in reading. Productive pathological phenomena, together with deficits of spatial attention to events taking place on the left-hand-side of space, shape the manifestations of neglect dyslexia, and, more generally, of spatial neglect. Copyright © 2016 Elsevier Ltd. All rights reserved.

United States History Textbooks: Cloned Mediocrity.

ERIC Educational Resources Information Center

Siler, Carl R.

1990-01-01

Using content analysis, presents a study of 14 U.S. history textbooks. Analyzes textbook treatment of the Declaration of Independence, the atomic bomb, and the Holocaust. Examines nontextual materials. Finds errors of omission, boring writing styles, and a basic similarity between the textbooks. (RW)

Measuring Reading Performance Informally.

ERIC Educational Resources Information Center

Powell, William R.

To improve the accuracy of the informal reading inventory (IRI), a differential set of criteria is necessary for both word recognition and comprehension scores for different levels and reading conditions. In initial evaluation, word recognition scores should reflect only errors of insertions, omissions, mispronunciations, substitiutions, unkown…

A Critique of the Diagnostic Construct Schizophrenia

ERIC Educational Resources Information Center

Wong, Stephen E.

2014-01-01

This article examines problems in the clinical utility of the diagnosis of schizophrenia including reliance on questionable data, arbitrary criteria and categorization, inadequate precision for assessment and treatment evaluation, and omission of information on causal current and historical environmental factors. Some alternatives to the…

Evaluation of the U.S. Geological Survey Landsat burned area essential climate variable across the conterminous U.S. using commercial high-resolution imagery

USGS Publications Warehouse

Vanderhoof, Melanie; Brunner, Nicole M.; Beal, Yen-Ju G.; Hawbaker, Todd J.

2017-01-01

The U.S. Geological Survey has produced the Landsat Burned Area Essential Climate Variable (BAECV) product for the conterminous United States (CONUS), which provides wall-to-wall annual maps of burned area at 30 m resolution (1984–2015). Validation is a critical component in the generation of such remotely sensed products. Previous efforts to validate the BAECV relied on a reference dataset derived from Landsat, which was effective in evaluating the product across its timespan but did not allow for consideration of inaccuracies imposed by the Landsat sensor itself. In this effort, the BAECV was validated using 286 high-resolution images, collected from GeoEye-1, QuickBird-2, Worldview-2 and RapidEye satellites. A disproportionate sampling strategy was utilized to ensure enough burned area pixels were collected. Errors of omission and commission for burned area averaged 22 ± 4% and 48 ± 3%, respectively, across CONUS. Errors were lowest across the western U.S. The elevated error of commission relative to omission was largely driven by patterns in the Great Plains which saw low errors of omission (13 ± 13%) but high errors of commission (70 ± 5%) and potentially a region-growing function included in the BAECV algorithm. While the BAECV reliably detected agricultural fires in the Great Plains, it frequently mapped tilled areas or areas with low vegetation as burned. Landscape metrics were calculated for individual fire events to assess the influence of image resolution (2 m, 30 m and 500 m) on mapping fire heterogeneity. As the spatial detail of imagery increased, fire events were mapped in a patchier manner with greater patch and edge densities, and shape complexity, which can influence estimates of total greenhouse gas emissions and rates of vegetation recovery. The increasing number of satellites collecting high-resolution imagery and rapid improvements in the frequency with which imagery is being collected means greater opportunities to utilize these sources of imagery for Landsat product validation. 

Automated detection of cloud and cloud-shadow in single-date Landsat imagery using neural networks and spatial post-processing

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

Hughes, Michael J.; Hayes, Daniel J

2014-01-01

Use of Landsat data to answer ecological questions is contingent on the effective removal of cloud and cloud shadow from satellite images. We develop a novel algorithm to identify and classify clouds and cloud shadow, \\textsc{sparcs}: Spacial Procedures for Automated Removal of Cloud and Shadow. The method uses neural networks to determine cloud, cloud-shadow, water, snow/ice, and clear-sky membership of each pixel in a Landsat scene, and then applies a set of procedures to enforce spatial rules. In a comparison to FMask, a high-quality cloud and cloud-shadow classification algorithm currently available, \\textsc{sparcs} performs favorably, with similar omission errors for cloudsmore » (0.8% and 0.9%, respectively), substantially lower omission error for cloud-shadow (8.3% and 1.1%), and fewer errors of commission (7.8% and 5.0%). Additionally, textsc{sparcs} provides a measure of uncertainty in its classification that can be exploited by other processes that use the cloud and cloud-shadow detection. To illustrate this, we present an application that constructs obstruction-free composites of images acquired on different dates in support of algorithms detecting vegetation change.« less

An overview of intravenous-related medication administration errors as reported to MEDMARX, a national medication error-reporting program.

PubMed

Hicks, Rodney W; Becker, Shawn C

2006-01-01

Medication errors can be harmful, especially if they involve the intravenous (IV) route of administration. A mixed-methodology study using a 5-year review of 73,769 IV-related medication errors from a national medication error reporting program indicates that between 3% and 5% of these errors were harmful. The leading type of error was omission, and the leading cause of error involved clinician performance deficit. Using content analysis, three themes-product shortage, calculation errors, and tubing interconnectivity-emerge and appear to predispose patients to harm. Nurses often participate in IV therapy, and these findings have implications for practice and patient safety. Voluntary medication error-reporting programs afford an opportunity to improve patient care and to further understanding about the nature of IV-related medication errors.

POPI (Pediatrics: Omission of Prescriptions and Inappropriate Prescriptions): Development of a Tool to Identify Inappropriate Prescribing

PubMed Central

Prot-Labarthe, Sonia; Weil, Thomas; Angoulvant, François; Boulkedid, Rym; Alberti, Corinne; Bourdon, Olivier

2014-01-01

Introduction Rational prescribing for children is an issue for all countries and has been inadequately studied. Inappropriate prescriptions, including drug omissions, are one of the main causes of medication errors in this population. Our aim is to develop a screening tool to identify omissions and inappropriate prescriptions in pediatrics based on French and international guidelines. Methods A selection of diseases was included in the tool using data from social security and hospital statistics. A literature review was done to obtain criteria which could be included in the tool called POPI. A 2-round-Delphi consensus technique was used to establish the content validity of POPI; panelists were asked to rate their level of agreement with each proposition on a 9-point Likert scale and add suggestions if necessary. Results 108 explicit criteria (80 inappropriate prescriptions and 28 omissions) were obtained and submitted to a 16-member expert panel (8 pharmacists, 8 pediatricians hospital-based −50%- or working in community −50%-). Criteria were categorized according to the main physiological systems (gastroenterology, respiratory infections, pain, neurology, dermatology and miscellaneous). Each criterion was accompanied by a concise explanation as to why the practice is potentially inappropriate in pediatrics (including references). Two round of Delphi process were completed via an online questionnaire. 104 out of the 108 criteria submitted to experts were selected after 2 Delphi rounds (79 inappropriate prescriptions and 25 omissions). Discussion Conclusion POPI is the first screening-tool develop to detect inappropriate prescriptions and omissions in pediatrics based on explicit criteria. Inter-user reliability study is necessary before using the tool, and prospective study to assess the effectiveness of POPI is also necessary. PMID:24978045

Notice of omission in the printed edition of Volume 58, Issue 1 Notice of omission in the printed edition of Volume 58, Issue 1

NASA Astrophysics Data System (ADS)

2013-01-01

Due to a production error, the article 'Corrigendum: Task-based evaluation of segmentation algorithms for diffusion-weighted MRI without using a gold standard' by Abhinav K Jha, Matthew A Kupinski, Jeffrey J Rodriguez, Renu M Stephen and Alison T Stopeck was duplicated and the article 'Corrigendum: Complete electrode model in EEG: relationship and differences to the point electrode model' by S Pursiainen, F Lucka and C H Wolters was omitted in the print version of Physics in Medicine & Biology, volume 58, issue 1. The online versions of both articles are not affected. The article 'Corrigendum: Complete electrode model in EEG: relationship and differences to the point electrode model' by S Pursiainen, F Lucka and C H Wolters will be included in the print version of this issue (Physics in Medicine & Biology, volume 58, issue 2.) We apologise unreservedly for this error. Jon Ruffle Publisher

Interaction of DRD4 Methylation and Phthalate Metabolites Affects Continuous Performance Test Performance in ADHD.

PubMed

Kim, Johanna Inhyang; Kim, Jae-Won; Shin, Inkyung; Kim, Bung-Nyun

2018-05-01

We investigated the interaction effect between the methylation of dopamine receptor D4 (DRD4) and phthalate exposure in ADHD on continuous performance test (CPT) variables. Urine concentrations of mono-(2-ethyl-5-hydroxyhexyl) phthalate (MEHHP), mono-(2-ethyl-5-oxohexyl) phthalate (MEOHP), and mono-n-butyl phthalate (MBP) were tested. The methylation status was analyzed for CpG sites of DRD4. Multivariable linear regression models were applied to investigate the interaction effects of methylation and phthalate levels. There was a significant interaction effect of the methylation of CpG26 and CpG28 with the MEHHP level on omission errors in ADHD patients, but not in controls. The post hoc analysis revealed a significant correlation between the MEHHP concentration and omission errors in the methylated group, but not in the unmethylated group. The interaction between the methylation status of CpG sites of DRD4, particularly CpG26 and CpG28, and phthalate metabolite levels affects the attention level in ADHD patients.

Improvement in Patient Transfer Process From the Operating Room to the PICU Using a Lean and Six Sigma-Based Quality Improvement Project.

PubMed

Gleich, Stephen J; Nemergut, Michael E; Stans, Anthony A; Haile, Dawit T; Feigal, Scott A; Heinrich, Angela L; Bosley, Christopher L; Tripathi, Sandeep

2016-08-01

Ineffective and inefficient patient transfer processes can increase the chance of medical errors. Improvements in such processes are high-priority local institutional and national patient safety goals. At our institution, nonintubated postoperative pediatric patients are first admitted to the postanesthesia care unit before transfer to the PICU. This quality improvement project was designed to improve the patient transfer process from the operating room (OR) to the PICU. After direct observation of the baseline process, we introduced a structured, direct OR-PICU transfer process for orthopedic spinal fusion patients. We performed value stream mapping of the process to determine error-prone and inefficient areas. We evaluated primary outcome measures of handoff error reduction and the overall efficiency of patient transfer process time. Staff satisfaction was evaluated as a counterbalance measure. With the introduction of the new direct OR-PICU patient transfer process, the handoff communication error rate improved from 1.9 to 0.3 errors per patient handoff (P = .002). Inefficiency (patient wait time and non-value-creating activity) was reduced from 90 to 32 minutes. Handoff content was improved with fewer information omissions (P < .001). Staff satisfaction significantly improved among nearly all PICU providers. By using quality improvement methodology to design and implement a new direct OR-PICU transfer process with a structured multidisciplinary verbal handoff, we achieved sustained improvements in patient safety and efficiency. Handoff communication was enhanced, with fewer errors and content omissions. The new process improved efficiency, with high staff satisfaction. Copyright © 2016 by the American Academy of Pediatrics.

22 CFR 96.33 - Budget, audit, insurance, and risk assessment requirements.

Code of Federal Regulations, 2010 CFR

2010-04-01

... its governing body, if applicable, for management of its funds. The budget discloses all remuneration (including perquisites) paid to the agency's or person's board of directors, managers, employees, and... determining the type and amount of professional, general, directors' and officers', errors and omissions, and...

12 CFR 205.11 - Procedures for resolving errors.

Code of Federal Regulations, 2010 CFR

2010-01-01

... institution's findings and shall note the consumer's right to request the documents that the institution... transfer; (ii) An incorrect electronic fund transfer to or from the consumer's account; (iii) The omission... made by the financial institution relating to an electronic fund transfer; (v) The consumer's receipt...

24 CFR 320.11 - Insurance coverage.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 24 Housing and Urban Development 2 2013-04-01 2013-04-01 false Insurance coverage. 320.11 Section...-BACKED SECURITIES Pass-Through Type Securities § 320.11 Insurance coverage. The issuer shall maintain, for the benefit of the Association, insurance, errors and omissions, fidelity bond and other coverage...

78 FR 47054 - Proposed Collection; Comment Request for Regulation Project

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-02

... on proposed and/or continuing information collections, as required by the Paperwork Reduction Act of... procedure for monitoring compliance with low-income housing credit requirements; rules to carry out the purposes of section 42 and for correcting administrative errors and omissions; and compliance monitoring...

78 FR 34264 - Technical Corrections to the HIPAA Privacy, Security, and Enforcement Rules

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-07

...-AA03 Technical Corrections to the HIPAA Privacy, Security, and Enforcement Rules AGENCY: Office for... corrections address certain inadvertent errors and omissions in the HIPAA Privacy, Security, and Enforcement... (HHS or ``the Department'') published a final rule to implement changes to the HIPAA Privacy, Security...

Transition year labeling error characterization study. [Kansas, Minnesota, Montana, North Dakota, South Dakota, and Oklahoma

NASA Technical Reports Server (NTRS)

Clinton, N. J. (Principal Investigator)

1980-01-01

Labeling errors made in the large area crop inventory experiment transition year estimates by Earth Observation Division image analysts are identified and quantified. The analysis was made from a subset of blind sites in six U.S. Great Plains states (Oklahoma, Kansas, Montana, Minnesota, North and South Dakota). The image interpretation basically was well done, resulting in a total omission error rate of 24 percent and a commission error rate of 4 percent. The largest amount of error was caused by factors beyond the control of the analysts who were following the interpretation procedures. The odd signatures, the largest error cause group, occurred mostly in areas of moisture abnormality. Multicrop labeling was tabulated showing the distribution of labeling for all crops.

The effects of warning cues and attention-capturing stimuli on the sustained attention to response task.

PubMed

Finkbeiner, Kristin M; Wilson, Kyle M; Russell, Paul N; Helton, William S

2015-04-01

Performance on the sustained attention to response task (SART) is often characterized by a speed-accuracy trade-off, and SART performance may be influenced by strategic factors (Head and Helton Conscious Cogn 22: 913-919, 2013). Previous research indicates a significant difference between reliable and unreliable warning cues on response times and errors (commission and omission), suggesting that SART tasks are influenced by strategic factors (Helton et al. Conscious Cogn 20: 1732-1737, 2011; Exp Brain Res 209: 401-407, 2011). With regards to warning stimuli, we chose to use cute images (exhibiting infantile features) during a SART, as previous literature indicates cute images cause participants to engage attention. If viewing cute things makes the viewer exert more attention than normal, then exposure to cute stimuli during the SART should improve performance if SART performance is a measure of perceptual coupling. Reliable warning cues were shown to reduce both response time and errors of commission, and increase errors of omission, relative to unreliable warning cues. Cuteness of the warning stimuli, however, had no significant effect on SART performance. These results suggest the importance of strategic factors in SART performance, not increased attention, and add to the growing literature which suggests the SART is not a good measure of sustained attention, vigilance or perceptual coupling.

Sustained attention deficits among HIV-positive individuals with comorbid bipolar disorder.

PubMed

Posada, Carolina; Moore, David J; Deutsch, Reena; Rooney, Alexandra; Gouaux, Ben; Letendre, Scott; Grant, Igor; Atkinson, J Hampton

2012-01-01

Difficulties with sustained attention have been found among both persons with HIV infection (HIV+) and bipolar disorder (BD). The authors examined sustained attention among 39 HIV+ individuals with BD (HIV+/BD+) and 33 HIV-infected individuals without BD (HIV+/BD-), using the Conners' Continuous Performance Test-II (CPT-II). A Global Assessment of Functioning (GAF) score was also assigned to each participant as an overall indicator of daily functioning abilities. HIV+/BD+ participants had significantly worse performance on CPT-II omission errors, hit reaction time SE (Hit RT SE), variability of SE, and perseverations than HIV+/BD- participants. When examining CPT-II performance over the six study blocks, both HIV+/BD+ and HIV+/BD- participants evidenced worse performance on scores of commission errors and reaction times as the test progressed. The authors also examined the effect of current mood state (i.e., manic, depressive, euthymic) on CPT-II performance, but no significant differences were observed across the various mood states. HIV+/BD+ participants had significantly worse GAF scores than HIV+/BD- participants, which indicates poorer overall functioning in the dually-affected group; among HIV+/BD+ persons, significant negative correlations were found between GAF scores and CPT-II omission and commission errors, detectability, and perseverations, indicating a possible relationship between decrements in sustained attention and worse daily-functioning outcomes.

Use of Color-Coded Food Photographs for Meal Planning by Adults with Mental Retardation.

ERIC Educational Resources Information Center

Gines, Deon J.; And Others

1990-01-01

Ten adults with mild mental retardation used color-coded food photographs and meal code cards to plan nutritionally balanced meals. Subjects spent an average of nine minutes to plan three meals. Errors, which were primarily omissions, occurred mostly in food groups requiring four servings daily. (JDD)

E-Business Curricula and Cybercrime: A Continuing Error of Omission?

ERIC Educational Resources Information Center

Fusilier, Marcelline; Penrod, Charlie

2013-01-01

The growth of e-business has been accompanied by even faster increases in losses from security breaches, legal problems, and cybercrime. These unnecessary costs inhibit the growth and efficiency of e-business worldwide. Professional education in e-business can help address these problems by providing students with coursework aimed at them. The…

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

Not Available

At the request of the Office of Solid Wastes (OSW), the SAB's Environmental Engineering Committee reviewed a draft Agency guidance for the establishment of Alternate Concentration Limits (ACL) for Resource Conservation and Recovery Act (RCRA) facilities, and two case studies demonstrating applications of the guidance. The Committee identified only obvious technical errors or omissions, which are explained in detail in the report.

Research Quality: Critique of Quantitative Articles in the "Journal of Counseling & Development"

ERIC Educational Resources Information Center

Wester, Kelly L.; Borders, L. DiAnne; Boul, Steven; Horton, Evette

2013-01-01

The purpose of this study was to examine the quality of quantitative articles published in the "Journal of Counseling & Development." Quality concerns arose in regard to omissions of psychometric information of instruments, effect sizes, and statistical power. Type VI and II errors were found. Strengths included stated research…

How to Get JDRP Approval of Career Education Activities.

ERIC Educational Resources Information Center

Hamilton, Jack A.

The purpose of this monograph is to aid practitioners in gaining federal Joint Dissemination Review Panel (JDRP) approval of career education projects. It helps them understand the importance of designing and implementing a sound evaluation from the early stages of the program, alerts them to common errors or omissions that weaken or destroy…

31 CFR 375.12 - How do I submit an offer?

Code of Federal Regulations, 2010 CFR

2010-07-01

... 31 Money and Finance: Treasury 2 2010-07-01 2010-07-01 false How do I submit an offer? 375.12 Section 375.12 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) FISCAL... way for any unauthorized tender submissions or for any delays, errors, or omissions in submitting...

Wilderness Crisis Management. Explore Magazine Technical Series No. 11.

ERIC Educational Resources Information Center

Raffan, James

This paper deals with managing a crisis in a wilderness situation. The terms "crisis" and "turning point" are used to describe what is more traditionally called an accident. Using these terms introduces the idea that crisis events occur as logical consequences of preceding decisions, errors, or omissions, not as the result of…

Decision-making in the colposcopy clinic--a critical analysis.

PubMed

Bornstein, J; Yaakov, Z; Pascal, B; Faktor, J; Baram, A; Zarfati, D; Abramovici, H

1999-08-01

To consider the omission of several diagnostic steps from the management of patients with high-grade squamous intraepithelial lesion (SIL) by analyzing the role of each step on the choice of treatment. Each diagnostic procedure was correlated to the treatment and outcome in 87 women with high-grade SIL. Treatments considered were large loop excision of the transformation zone (LLETZ) cold knife conization, and CO2 laser vaporization. Unsatisfactory colposcopy (P< or =0.01) and positive endocervical curettage (ECC) specimen (P< or =0.01) were essential for choice of treatment. CIN2 diagnoses of the preoperative cervical biopsy were rediagnosed as CIN3 based on the surgical specimen in 57% of the cases. The margins of 33 and 23% of surgical specimens removed by LLETZ or knife conization, respectively, displayed CIN involvement. Forty and 47% of these patients, respectively, later developed recurrent CIN. Omission of colposcopy and ECC could have resulted in sub-optimal treatment in many cases. Excision by LLETZ or knife conization is recommended for cases of CIN2 and CIN3. Follow up is imperative for patients with involvement of the margins.

Abnormal Reward System Activation in Mania

PubMed Central

Abler, Birgit; Greenhouse, Ian; Ongur, Dost; Walter, Henrik; Heckers, Stephan

2008-01-01

Transmission of reward signals is a function of dopamine, a neurotransmitter known to be involved in the mechanism of psychosis. Using functional magnetic resonance imaging (fMRI), we investigated how expectation and receipt of monetary rewards modulate brain activation in patients with bipolar mania and schizophrenia. We studied 12 acutely manic patients with a history of bipolar disorder, 12 patients with a current episode of schizoaffective disorder or schizophrenia and 12 healthy subjects. All patients were treated with dopamine antagonists at the time of the study. Subjects performed a delayed incentive paradigm with monetary reward in the scanner that allowed for investigating effects of expectation, receipt, and omission of rewards. Patients with schizophrenia and healthy control subjects showed the expected activation of dopaminergic brain areas, that is, ventral tegmentum activation upon expectation of monetary rewards and nucleus accumbens activation during receipt vs omission of rewards. In manic patients, however, we did not find a similar pattern of brain activation and the differential signal in the nucleus accumbens upon receipt vs omission of rewards was significantly lower compared to the healthy control subjects. Our findings provide evidence for abnormal function of the dopamine system during receipt or omission of expected rewards in bipolar disorder. These deficits in prediction error processing in acute mania may help to explain symptoms of disinhibition and abnormal goal pursuit regulation. PMID:17987058

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.

Intraindividual variability in inhibitory function in adults with ADHD--an ex-Gaussian approach.

PubMed

Gmehlin, Dennis; Fuermaier, Anselm B M; Walther, Stephan; Debelak, Rudolf; Rentrop, Mirjam; Westermann, Celina; Sharma, Anuradha; Tucha, Lara; Koerts, Janneke; Tucha, Oliver; Weisbrod, Matthias; Aschenbrenner, Steffen

2014-01-01

Attention deficit disorder (ADHD) is commonly associated with inhibitory dysfunction contributing to typical behavioral symptoms like impulsivity or hyperactivity. However, some studies analyzing intraindividual variability (IIV) of reaction times in children with ADHD (cADHD) question a predominance of inhibitory deficits. IIV is a measure of the stability of information processing and provides evidence that longer reaction times (RT) in inhibitory tasks in cADHD are due to only a few prolonged responses which may indicate deficits in sustained attention rather than inhibitory dysfunction. We wanted to find out, whether a slowing in inhibitory functioning in adults with ADHD (aADHD) is due to isolated slow responses. Computing classical RT measures (mean RT, SD), ex-Gaussian parameters of IIV (which allow a better separation of reaction time (mu), variability (sigma) and abnormally slow responses (tau) than classical measures) as well as errors of omission and commission, we examined response inhibition in a well-established GoNogo task in a sample of aADHD subjects without medication and healthy controls matched for age, gender and education. We did not find higher numbers of commission errors in aADHD, while the number of omissions was significantly increased compared with controls. In contrast to increased mean RT, the distributional parameter mu did not document a significant slowing in aADHD. However, subjects with aADHD were characterized by increased IIV throughout the entire RT distribution as indicated by the parameters sigma and tau as well as the SD of reaction time. Moreover, we found a significant correlation between tau and the number of omission errors. Our findings question a primacy of inhibitory deficits in aADHD and provide evidence for attentional dysfunction. The present findings may have theoretical implications for etiological models of ADHD as well as more practical implications for neuropsychological testing in aADHD.

Intraindividual Variability in Inhibitory Function in Adults with ADHD – An Ex-Gaussian Approach

PubMed Central

Gmehlin, Dennis; Fuermaier, Anselm B. M.; Walther, Stephan; Debelak, Rudolf; Rentrop, Mirjam; Westermann, Celina; Sharma, Anuradha; Tucha, Lara; Koerts, Janneke; Tucha, Oliver; Weisbrod, Matthias; Aschenbrenner, Steffen

2014-01-01

Objective Attention deficit disorder (ADHD) is commonly associated with inhibitory dysfunction contributing to typical behavioral symptoms like impulsivity or hyperactivity. However, some studies analyzing intraindividual variability (IIV) of reaction times in children with ADHD (cADHD) question a predominance of inhibitory deficits. IIV is a measure of the stability of information processing and provides evidence that longer reaction times (RT) in inhibitory tasks in cADHD are due to only a few prolonged responses which may indicate deficits in sustained attention rather than inhibitory dysfunction. We wanted to find out, whether a slowing in inhibitory functioning in adults with ADHD (aADHD) is due to isolated slow responses. Methods Computing classical RT measures (mean RT, SD), ex-Gaussian parameters of IIV (which allow a better separation of reaction time (mu), variability (sigma) and abnormally slow responses (tau) than classical measures) as well as errors of omission and commission, we examined response inhibition in a well-established GoNogo task in a sample of aADHD subjects without medication and healthy controls matched for age, gender and education. Results We did not find higher numbers of commission errors in aADHD, while the number of omissions was significantly increased compared with controls. In contrast to increased mean RT, the distributional parameter mu did not document a significant slowing in aADHD. However, subjects with aADHD were characterized by increased IIV throughout the entire RT distribution as indicated by the parameters sigma and tau as well as the SD of reaction time. Moreover, we found a significant correlation between tau and the number of omission errors. Conclusions Our findings question a primacy of inhibitory deficits in aADHD and provide evidence for attentional dysfunction. The present findings may have theoretical implications for etiological models of ADHD as well as more practical implications for neuropsychological testing in aADHD. PMID:25479234

Medication Incidents Involving Antiepileptic Drugs in Canadian Hospitals: A Multi-Incident Analysis.

PubMed

Cheng, Roger; Yang, Yu Daisy; Chan, Matthew; Patel, Tejal

2017-01-01

Medication errors involving antiepileptic drugs (AEDs) are not well studied but have the potential to cause significant harm. We investigated the occurrence of medication incidents in Canadian hospitals that involve AEDs, their severity and contributing factors by analyzing data from two national databases. Our multi-incident analysis revealed that while medication errors were rarely fatal, errors do occur of which some are serious. Medication incidents were most commonly caused by dose omissions, the dose or its frequency being incorrect and the wrong AED being given. Our analysis could augment quality-improvement initiatives by medication safety administrators to reduce AED medication incidents in hospitals.

Mapping gully-affected areas in the region of Taroudannt, Morocco based on Object-Based Image Analysis (OBIA)

NASA Astrophysics Data System (ADS)

d'Oleire-Oltmanns, Sebastian; Marzolff, Irene; Tiede, Dirk; Blaschke, Thomas

2015-04-01

The need for area-wide landform mapping approaches, especially in terms of land degradation, can be ascribed to the fact that within area-wide landform mapping approaches, the (spatial) context of erosional landforms is considered by providing additional information on the physiography neighboring the distinct landform. This study presents an approach for the detection of gully-affected areas by applying object-based image analysis in the region of Taroudannt, Morocco, which is highly affected by gully erosion while simultaneously representing a major region of agro-industry with a high demand of arable land. Various sensors provide readily available high-resolution optical satellite data with a much better temporal resolution than 3D terrain data which lead to the development of an area-wide mapping approach to extract gully-affected areas using only optical satellite imagery. The classification rule-set was developed with a clear focus on virtual spatial independence within the software environment of eCognition Developer. This allows the incorporation of knowledge about the target objects under investigation. Only optical QuickBird-2 satellite data and freely-available OpenStreetMap (OSM) vector data were used as input data. The OSM vector data were incorporated in order to mask out plantations and residential areas. Optical input data are more readily available for a broad range of users compared to terrain data, which is considered to be a major advantage. The methodology additionally incorporates expert knowledge and freely-available vector data in a cyclic object-based image analysis approach. This connects the two fields of geomorphology and remote sensing. The classification results allow conclusions on the current distribution of gullies. The results of the classification were checked against manually delineated reference data incorporating expert knowledge based on several field campaigns in the area, resulting in an overall classification accuracy of 62%. The error of omission accounts for 38% and the error of commission for 16%, respectively. Additionally, a manual assessment was carried out to assess the quality of the applied classification algorithm. The limited error of omission contributes with 23% to the overall error of omission and the limited error of commission contributes with 98% to the overall error of commission. This assessment improves the results and confirms the high quality of the developed approach for area-wide mapping of gully-affected areas in larger regions. In the field of landform mapping, the overall quality of the classification results is often assessed with more than one method to incorporate all aspects adequately.

Institutional Violence in the Everyday Practices of School: The Narrative of a Young Lesbian.

ERIC Educational Resources Information Center

Herr, Kathryn

1999-01-01

Explores the role of institutionalized violence in one young lesbian's decision to drop out of high school. Casting this young woman as a school failure masks the school's unwillingness to interrupt everyday practices (errors of alienation, omission, and repression) that diminished her sense of self and learning capacity. (29 references) (MLH)

The Acquisition of Verbal Inflection in Child Grammars in a Variability Model of Early Morphosyntactic Development: A Biolinguistic Perspective

ERIC Educational Resources Information Center

Rus, Dominik

2010-01-01

This dissertation investigates the acquisition of early verb inflection in child Slovenian from morphosyntactic and morphophonological perspectives. It centers on the phenomenon of root nonfinites, particularly the patterns of omission and substitution errors in verb inflection marking. It argues that every acquisition model needs to account…

17 CFR 45.14 - Reporting of errors and omissions in previously reported data.

Code of Federal Regulations, 2014 CFR

2014-04-01

... Commission, or by the Chief Information Officer pursuant to § 45.13, a swap data repository shall transmit... in paragraph (a) of this section. (c) Unless otherwise approved by the Commission, or by the Chief Information Officer pursuant to § 45.13, each registered entity or swap counterparty reporting corrections to...

17 CFR 45.14 - Reporting of errors and omissions in previously reported data.

Code of Federal Regulations, 2012 CFR

2012-04-01

... Commission, or by the Chief Information Officer pursuant to § 45.13, a swap data repository shall transmit... in paragraph (a) of this section. (c) Unless otherwise approved by the Commission, or by the Chief Information Officer pursuant to § 45.13, each registered entity or swap counterparty reporting corrections to...

17 CFR 45.14 - Reporting of errors and omissions in previously reported data.

Code of Federal Regulations, 2013 CFR

2013-04-01

... Commission, or by the Chief Information Officer pursuant to § 45.13, a swap data repository shall transmit... in paragraph (a) of this section. (c) Unless otherwise approved by the Commission, or by the Chief Information Officer pursuant to § 45.13, each registered entity or swap counterparty reporting corrections to...

Relations between Response Trajectories on the Continuous Performance Test and Teacher-Rated Problem Behaviors in Preschoolers

PubMed Central

Allan, Darcey M.; Lonigan, Christopher J.

2014-01-01

Although both the Continuous Performance Test (CPT) and behavior rating scales are used in both practice and research to assess inattentive and hyperactive/impulsive behaviors, the correlations between performance on the CPT and teachers' ratings are typically only small-to-moderate. This study examined trajectories of performance on a low target-frequency visual CPT in a sample of preschool children and how these trajectories were associated with teacher-ratings of problem behaviors (i.e., inattention, hyperactivity/impulsivity [H/I], and oppositional/defiant behavior). Participants included 399 preschool children (Mean age = 56 months; 49.4% female; 73.7% White/Caucasian). An ADHD-rating scale was completed by teachers, and the CPT was completed by the preschoolers. Results showed that children's performance across four temporal blocks on the CPT was not stable across the duration of the task, with error rates generally increasing from initial to later blocks. The predictive relations of teacher-rated problem behaviors to performance trajectories on the CPT were examined using growth curve models. Higher rates of teacher-reported inattention and H/I were uniquely associated with higher rates of initial omission errors and initial commission errors, respectively. Higher rates of teacher-reported overall problem behaviors were associated with increasing rates of omission but not commission errors during the CPT; however, the relation was not specific to one type of problem behavior. The results of this study indicate that the pattern of errors on the CPT in preschool samples is complex and may be determined by multiple behavioral factors. These findings have implications for the interpretation of CPT performance in young children. PMID:25419645

Prediction error and somatosensory insula activation in women recovered from anorexia nervosa.

PubMed

Frank, Guido K W; Collier, Shaleise; Shott, Megan E; O'Reilly, Randall C

2016-08-01

Previous research in patients with anorexia nervosa showed heightened brain response during a taste reward conditioning task and heightened sensitivity to rewarding and punishing stimuli. Here we tested the hypothesis that individuals recovered from anorexia nervosa would also experience greater brain activation during this task as well as higher sensitivity to salient stimuli than controls. Women recovered from restricting-type anorexia nervosa and healthy control women underwent fMRI during application of a prediction error taste reward learning paradigm. Twenty-four women recovered from anorexia nervosa (mean age 30.3 ± 8.1 yr) and 24 control women (mean age 27.4 ± 6.3 yr) took part in this study. The recovered anorexia nervosa group showed greater left posterior insula activation for the prediction error model analysis than the control group (family-wise error- and small volume-corrected p < 0.05). A group × condition analysis found greater posterior insula response in women recovered from anorexia nervosa than controls for unexpected stimulus omission, but not for unexpected receipt. Sensitivity to punishment was elevated in women recovered from anorexia nervosa. This was a cross-sectional study, and the sample size was modest. Anorexia nervosa after recovery is associated with heightened prediction error-related brain response in the posterior insula as well as greater response to unexpected reward stimulus omission. This finding, together with behaviourally increased sensitivity to punishment, could indicate that individuals recovered from anorexia nervosa are particularly responsive to punishment. The posterior insula processes somatosensory stimuli, including unexpected bodily states, and greater response could indicate altered perception or integration of unexpected or maybe unwanted bodily feelings. Whether those findings develop during the ill state or whether they are biological traits requires further study.

Relations between response trajectories on the continuous performance test and teacher-rated problem behaviors in preschoolers.

PubMed

Allan, Darcey M; Lonigan, Christopher J

2015-06-01

Although both the continuous performance test (CPT) and behavior rating scales are used in both practice and research to assess inattentive and hyperactive/impulsive behaviors, the correlations between performance on the CPT and teachers' ratings are typically only small-to-moderate. This study examined trajectories of performance on a low target-frequency visual CPT in a sample of preschool children and how these trajectories were associated with teacher-ratings of problem behaviors (i.e., inattention, hyperactivity/impulsivity [H/I], and oppositional/defiant behavior). Participants included 399 preschool children (mean age = 56 months; 49.4% female; 73.7% White/Caucasian). An attention deficit/hyperactivity disorder (ADHD) rating scale was completed by teachers, and the CPT was completed by the preschoolers. Results showed that children's performance across 4 temporal blocks on the CPT was not stable across the duration of the task, with error rates generally increasing from initial to later blocks. The predictive relations of teacher-rated problem behaviors to performance trajectories on the CPT were examined using growth curve models. Higher rates of teacher-reported inattention and H/I were uniquely associated with higher rates of initial omission errors and initial commission errors, respectively. Higher rates of teacher-reported overall problem behaviors were associated with increasing rates of omission but not commission errors during the CPT; however, the relation was not specific to 1 type of problem behavior. The results of this study indicate that the pattern of errors on the CPT in preschool samples is complex and may be determined by multiple behavioral factors. These findings have implications for the interpretation of CPT performance in young children. (c) 2015 APA, all rights reserved).

Evaluation of the Combined Effects of Heat and Lighting on the Level of Attention and Reaction Time: Climate Chamber Experiments in Iran.

PubMed

Mohebian, Zohreh; Farhang Dehghan, Somayeh; Dehghan, Habiballah

2018-01-01

Heat exposure and unsuitable lighting are two physical hazardous agents in many workplaces for which there are some evidences regarding their mental effects. The purpose of this study was to assess the combined effect of heat exposure and different lighting levels on the attention rate and reaction time in a climatic chamber. This study was conducted on 33 healthy students (17 M/16 F) with a mean (±SD) age of 22.1 ± 2.3 years. The attention and reaction time test were done by continuous performance test and the RT meter, respectively, in different exposure conditions including the dry temperatures (22°C and 37°C) and lighting levels (200, 500, and 1500 lux). Findings demonstrated that increase in heat and lighting level caused a decrease in average attention percentage and correct responses and increase in commission error, omission error, and response time ( P < 0.05). The average of simple, diagnostic, two-color selective, and two-sound selective reaction times increased after combined exposure to heat and lighting ( P < 0.05). The results of this study indicated that, in job task which requires using cognitive functions like attention, vigilance, concentration, cautiousness, and reaction time, the work environment must be optimized in terms of heat and lighting level.

[Diagnostic Errors in Medicine].

PubMed

Buser, Claudia; Bankova, Andriyana

2015-12-09

The recognition of diagnostic errors in everyday practice can help improve patient safety. The most common diagnostic errors are the cognitive errors, followed by system-related errors and no fault errors. The cognitive errors often result from mental shortcuts, known as heuristics. The rate of cognitive errors can be reduced by a better understanding of heuristics and the use of checklists. The autopsy as a retrospective quality assessment of clinical diagnosis has a crucial role in learning from diagnostic errors. Diagnostic errors occur more often in primary care in comparison to hospital settings. On the other hand, the inpatient errors are more severe than the outpatient errors.

Role of amygdala central nucleus in feature negative discriminations

PubMed Central

Holland, Peter C.

2012-01-01

Consistent with a popular theory of associative learning, the Pearce-Hall (1980) model, the surprising omission of expected events enhances cue associability (the ease with which a cue may enter into new associations), across a wide variety of behavioral training procedures. Furthermore, previous experiments from this laboratory showed that these enhancements are absent in rats with impaired function of the amygdala central nucleus (CeA). A notable exception to these assertions is found in feature negative (FN) discrimination learning, in which a “target” stimulus is reinforced when it is presented alone but nonreinforced when it is presented in compound with another, “feature” stimulus. According to the Pearce-Hall model, reinforcer omission on compound trials should enhance the associability of the feature relative to control training conditions. However, prior experiments have shown no evidence that CeA lesions affect FN discrimination learning. Here we explored this apparent contradiction by evaluating the hypothesis that the surprising omission of an event confers enhanced associability on a cue only if that cue itself generates the disconfirmed prediction. Thus, in a FN discrimination, the surprising omission of the reinforcer on compound trials would enhance the associability of the target stimulus but not that of the feature. Our data confirmed this hypothesis, and showed this enhancement to depend on intact CeA function, as in other procedures. The results are consistent with modern reformulations of both cue and reward processing theories that assign roles for both individual and aggregate error terms in associative learning. PMID:22889308

Silent Expectations: Dynamic Causal Modeling of Cortical Prediction and Attention to Sounds That Weren't.

PubMed

Chennu, Srivas; Noreika, Valdas; Gueorguiev, David; Shtyrov, Yury; Bekinschtein, Tristan A; Henson, Richard

2016-08-10

There is increasing evidence that human perception is realized by a hierarchy of neural processes in which predictions sent backward from higher levels result in prediction errors that are fed forward from lower levels, to update the current model of the environment. Moreover, the precision of prediction errors is thought to be modulated by attention. Much of this evidence comes from paradigms in which a stimulus differs from that predicted by the recent history of other stimuli (generating a so-called "mismatch response"). There is less evidence from situations where a prediction is not fulfilled by any sensory input (an "omission" response). This situation arguably provides a more direct measure of "top-down" predictions in the absence of confounding "bottom-up" input. We applied Dynamic Causal Modeling of evoked electromagnetic responses recorded by EEG and MEG to an auditory paradigm in which we factorially crossed the presence versus absence of "bottom-up" stimuli with the presence versus absence of "top-down" attention. Model comparison revealed that both mismatch and omission responses were mediated by increased forward and backward connections, differing primarily in the driving input. In both responses, modeling results suggested that the presence of attention selectively modulated backward "prediction" connections. Our results provide new model-driven evidence of the pure top-down prediction signal posited in theories of hierarchical perception, and highlight the role of attentional precision in strengthening this prediction. Human auditory perception is thought to be realized by a network of neurons that maintain a model of and predict future stimuli. Much of the evidence for this comes from experiments where a stimulus unexpectedly differs from previous ones, which generates a well-known "mismatch response." But what happens when a stimulus is unexpectedly omitted altogether? By measuring the brain's electromagnetic activity, we show that it also generates an "omission response" that is contingent on the presence of attention. We model these responses computationally, revealing that mismatch and omission responses only differ in the location of inputs into the same underlying neuronal network. In both cases, we show that attention selectively strengthens the brain's prediction of the future. Copyright © 2016 Chennu et al.

Methodological variations and their effects on reported medication administration error rates.

PubMed

McLeod, Monsey Chan; Barber, Nick; Franklin, Bryony Dean

2013-04-01

Medication administration errors (MAEs) are a problem, yet methodological variation between studies presents a potential barrier to understanding how best to increase safety. Using the UK as a case-study, we systematically summarised methodological variations in MAE studies, and their effects on reported MAE rates. Nine healthcare databases were searched for quantitative observational MAE studies in UK hospitals. Methodological variations were analysed and meta-analysis of MAE rates performed using studies that used the same definitions. Odds ratios (OR) were calculated to compare MAE rates between intravenous (IV) and non-IV doses, and between paediatric and adult doses. We identified 16 unique studies reporting three MAE definitions, 44 MAE subcategories and four different denominators. Overall adult MAE rates were 5.6% of a total of 21 533 non-IV opportunities for error (OE) (95% CI 4.6% to 6.7%) and 35% of a total of 154 IV OEs (95% CI 2% to 68%). MAEs were five times more likely in IV than non-IV doses (pooled OR 5.1; 95% CI 3.5 to 7.5). Including timing errors of ±30 min increased the MAE rate from 27% to 69% of 320 IV doses in one study. Five studies were unclear as to whether the denominator included dose omissions; omissions accounted for 0%-13% of IV doses and 1.8%-5.1% of non-IV doses. Wide methodological variations exist even within one country, some with significant effects on reported MAE rates. We have made recommendations for future MAE studies; these may be applied both within and outside the UK.

When Help Becomes Hindrance: Unexpected Errors of Omission and Commission in Eyewitness Memory Resulting from Change Temporal Order at Retrieval?

ERIC Educational Resources Information Center

Dando, Coral J.; Ormerod, Thomas C.; Wilcock, Rachel; Milne, Rebecca

2011-01-01

An experimental mock eyewitness study is reported that compared Free and reverse order recall of an empirically informed scripted crime event. Proponents of reverse order recall suggest it facilitates recovery of script incidental information and increases the total amount of information recalled. However, compared with free recall it was found to…

The Relationship between Intelligence and Performance on the Test of Variables of Attention (TOVA).

ERIC Educational Resources Information Center

Weyandt, Lisa L.; Mitzlaff, Linda; Thomas, Laura

2002-01-01

This study, with 17 young adults with attention deficit hyperactivity disorder (ADHD) and 62 without ADHD, found no significant correlations between full scale IQ and scores on the Test of Variables of Attention (TOVA). However, analysis of variance revealed that subjects with ADHD made more errors of omission on the TOVA than did controls.…

When the mind wanders: age-related differences between young and older adults.

PubMed

Zavagnin, Michela; Borella, Erika; De Beni, Rossana

2014-01-01

Interest in mind wandering (MW) has grown in recent years, but few studies have assessed this phenomenon in older adults. The aim of this study was to assess age-related differences between young, young-old and old-old adults in MW using two versions of the sustained attention to response task (SART), one perceptual and one semantic. Different indicators were examined (i.e., reported MW episodes and behavioral indices of MW such as response time latency and variability, incorrect response and omission errors). The relationship between MW, certain basic mechanisms of cognition (working memory, inhibition and processing speed), cognitive failures and intrusive thoughts in everyday life was also explored. Findings in both versions of the SART indicated that older adults reported a lower frequency of MW episodes than young adults, but some of the behavioral indices of MW (response time variability, incorrect response and omission errors) were higher in old-old adults. This seems to suggest that MW becomes less frequent with aging, but more pervasive and detrimental to performance. Our results also indicated that the role of age and cognitive mechanisms in explaining MW depends on the demands of the SART task considered. Copyright © 2013 Elsevier B.V. All rights reserved.

Hypnosis, hypnotic suggestibility, memory, and involvement in films.

PubMed

Maxwell, Reed; Lynn, Steven Jay; Condon, Liam

2015-05-01

Our research extends studies that have examined the relation between hypnotic suggestibility and experiential involvement and the role of an hypnotic induction in enhancing experiential involvement (e.g., absorption) in engaging tasks. Researchers have reported increased involvement in reading (Baum & Lynn, 1981) and music-listening (Snodgrass & Lynn, 1989) tasks during hypnosis. We predicted a similar effect for film viewing: greater experiential involvement in an emotional (The Champ) versus a non-emotional (Scenes of Toronto) film. We tested 121 participants who completed measures of absorption and trait dissociation and the Harvard Group Scale of Hypnotic Susceptibility and then viewed the two films after either an hypnotic induction or a non-hypnotic task (i.e., anagrams). Experiential involvement varied as a function of hypnotic suggestibility and film clip. Highly suggestible participants reported more state depersonalization than less suggestible participants, and depersonalization was associated with negative affect; however, we observed no significant correlation between hypnotic suggestibility and trait dissociation. Although hypnosis had no effect on memory commission or omission errors, contrary to the hypothesis that hypnosis facilitates absorption in emotionally engaging tasks, the emotional film was associated with more commission and omission errors compared with the non-emotional film. Copyright © 2014 Elsevier Inc. All rights reserved.

Promoting the behaviorological analysis of verbal behavior

PubMed Central

Eshleman, John W.; Vargas, Ernest A.

1988-01-01

An important contribution of radical behavioral science is its analysis of verbal behavior. Slowly but surely an increasing number of efforts verify the propositions explicit or inherent in Skinner's theory of verbal behavior, or apply his analysis to clinical or educational practice. But both the theory and the effort to apply it are met with silence. Such silent neglect simply varies the calumnious attention usually given to behavioristic science. In recent years several papers have called attention to how non-behaviorists have habitually misrepresented the science of behavior and its underlying philosophy of radical behaviorism (Cooke, 1984; DellaLana, 1982; Morris, 1985; Todd, 1987a; Todd & Morris, 1981; Todd & Morris, 1983). These authors offer various solutions. Their preferred strategy stresses an increased effort to disseminate accurate information about behavioristic science to the press and to the world at large. They generally address, however, errors of commission, not omission. Further, their solutions tend to dwell on “processes” instead of “products.” This paper first reviews the problem of misrepresentation of the science. It then addresses the principal error of omission in the psychological literature, and offers a solution based on achieving new products resulting from new verbal behavior technology. PMID:22477561

Subtle persistent working memory and selective attention deficits in women with premenstrual syndrome.

PubMed

Slyepchenko, Anastasiya; Lokuge, Sonali; Nicholls, Brianne; Steiner, Meir; Hall, Geoffrey B C; Soares, Claudio N; Frey, Benicio N

2017-03-01

As a recurrent, cyclical phenomenon, premenstrual syndrome (PMS) affects a significant proportion of women of the reproductive age, and leads to regular monthly days of functional impairment. Symptoms of PMS include somatic and psychological symptoms, such as headaches, sleep disturbances, social withdrawal and mood changes, during the late luteal phase of the menstrual cycle, which alleviate during the follicular phase. This study investigated neurocognitive functioning in women with moderate to severe PMS symptoms (n=13) compared to women with mild/no PMS (n=27) through administration of a battery of neuropsychological tests during the asymptomatic follicular phase of the menstrual cycle. Relative to women with mild/no PMS symptoms, women with moderate to severe PMS showed significantly poorer accuracy and more errors of omission on the N-0-back, as well as more errors of omission on the N-2-back task, indicating the presence of impairment in selective attention and working memory. This study provides evidence of persistent, subtle working memory and selective attention difficulties in those with moderate to severe PMS during the follicular phase of the menstrual cycle. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

Medication prescribing errors in the medical intensive care unit of Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia.

PubMed

Sada, Oumer; Melkie, Addisu; Shibeshi, Workineh

2015-09-16

Medication errors (MEs) are important problems in all hospitalized populations, especially in intensive care unit (ICU). Little is known about the prevalence of medication prescribing errors in the ICU of hospitals in Ethiopia. The aim of this study was to assess medication prescribing errors in the ICU of Tikur Anbessa Specialized Hospital using retrospective cross-sectional analysis of patient cards and medication charts. About 220 patient charts were reviewed with a total of 1311 patient-days, and 882 prescription episodes. 359 MEs were detected; with prevalence of 40 per 100 orders. Common prescribing errors were omission errors 154 (42.89%), 101 (28.13%) wrong combination, 48 (13.37%) wrong abbreviation, 30 (8.36%) wrong dose, wrong frequency 18 (5.01%) and wrong indications 8 (2.23%). The present study shows that medication errors are common in medical ICU of Tikur Anbessa Specialized Hospital. These results suggest future targets of prevention strategies to reduce the rate of medication error.

Mariner-Venus-Mercury optical navigation demonstration - Results and implications for future missions

NASA Technical Reports Server (NTRS)

Acton, C. H., Jr.; Ohtakay, H.

1975-01-01

Optical navigation uses spacecraft television pictures of a target body against a known star background in a process which relates the spacecraft trajectory to the target body. This technology was used in the Mariner-Venus-Mercury mission, with the optical data processed in near-real-time, simulating a mission critical environment. Optical data error sources were identified, and a star location error analysis was carried out. Several methods for selecting limb crossing coordinates were used, and a limb smear compensation was introduced. Omission of planetary aberration corrections was the source of large optical residuals.

A Candide response to Panglossian accusations by Randolph and Dobson: biodiversity buffers disease.

PubMed

Ostfeld, Richard S

2013-09-01

Randolph and Dobson (2012) criticize the dilution effect, which describes the negative relationship between biodiversity and infectious disease risk. Unfortunately, their commentary includes distortions, errors of omission, and errors of commission, which are rebutted herein. Contrary to their claims, the dilution effect is not a 'mantra' that asserts that reduced disease risk is a 'universal' outcome of high diversity. Although universality of the dilution effect has not been claimed, and conditions under which diversity can amplify disease risk have been described, the growing literature indicates that the dilution effect is indeed a widespread phenomenon.

A national physician survey of diagnostic error in paediatrics.

PubMed

Perrem, Lucy M; Fanshawe, Thomas R; Sharif, Farhana; Plüddemann, Annette; O'Neill, Michael B

2016-10-01

This cross-sectional survey explored paediatric physician perspectives regarding diagnostic errors. All paediatric consultants and specialist registrars in Ireland were invited to participate in this anonymous online survey. The response rate for the study was 54 % (n = 127). Respondents had a median of 9-year clinical experience (interquartile range (IQR) 4-20 years). A diagnostic error was reported at least monthly by 19 (15.0 %) respondents. Consultants reported significantly less diagnostic errors compared to trainees (p value = 0.01). Cognitive error was the top-ranked contributing factor to diagnostic error, with incomplete history and examination considered to be the principal cognitive error. Seeking a second opinion and close follow-up of patients to ensure that the diagnosis is correct were the highest-ranked, clinician-based solutions to diagnostic error. Inadequate staffing levels and excessive workload were the most highly ranked system-related and situational factors. Increased access to and availability of consultants and experts was the most highly ranked system-based solution to diagnostic error. We found a low level of self-perceived diagnostic error in an experienced group of paediatricians, at variance with the literature and warranting further clarification. The results identify perceptions on the major cognitive, system-related and situational factors contributing to diagnostic error and also key preventative strategies. • Diagnostic errors are an important source of preventable patient harm and have an estimated incidence of 10-15 %. • They are multifactorial in origin and include cognitive, system-related and situational factors. What is New: • We identified a low rate of self-perceived diagnostic error in contrast to the existing literature. • Incomplete history and examination, inadequate staffing levels and excessive workload are cited as the principal contributing factors to diagnostic error in this study.

An Exit Strategy Not a Winning Strategy? Intelligence Lessons from the British ’Emergency’ in South Arabia, 1963-67

DTIC Science & Technology

2012-12-14

comments came in so thick and fast that capturing them was itself a testing experience! In addition to the above Art of War team, I was very fortunate...via email throughout the research and writing period. Sincere thanks to all; nonetheless, all errors and omissions are my own. Finally, I must pay...

Use of the One-Minute Preceptor as a Teaching Tool in the Gross Anatomy Laboratory

ERIC Educational Resources Information Center

Chan, Lap Ki; Wiseman, Jeffrey

2011-01-01

The one-minute preceptor (OMP) is a time-efficient technique used for teaching in busy clinical settings. It consists of five microskills: (1) get a commitment from the student, (2) probe for supporting evidence, (3) reinforce what was done right, (4) correct errors and fill in omissions, and (5) teach a general rule. It can also be used to…

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

Not Available

The Environmental Engineering Committee conducted a preliminary review of the above document in March 1986, and identified obvious errors or omissions which are explained in detail in its initial report. The Office of Solid Waste asked the Committee to review the final draft ACL guidance when it was ready for publications in the Federal Register. This report represents the Committee's review of the final draft which was found to be well-written and technically sound.

"My Goldfish Name Is Scaley" Is What We Say at Home: Code-Switching--A Potent Tool for Reducing the Achievement Gap in Linguistically Diverse Classrooms.

ERIC Educational Resources Information Center

Wheeler, Rebecca S.; Swords, Rachel

Correctionist models of error, problem, and omission presume that Standard English (SE) is the sole language variety of America. America's classrooms, however, are neither culturally nor linguistically monolithic. Instead, they are diverse, and current teaching metaphors do not reflect the linguistic and cultural realities of the classrooms. This…

Sustained attention performance during sleep deprivation: evidence of state instability

NASA Technical Reports Server (NTRS)

Doran, S. M.; Van Dongen, H. P.; Dinges, D. F.

2001-01-01

Nathaniel Kleitman was the first to observe that sleep deprivation in humans did not eliminate the ability to perform neurobehavioral functions, but it did make it difficult to maintain stable performance for more than a few minutes. To investigate variability in performance as a function of sleep deprivation, n = 13 subjects were tested every 2 hours on a 10-minute, sustained-attention, psychomotor vigilance task (PVT) throughout 88 hours of total sleep deprivation (TSD condition), and compared to a control group of n = 15 subjects who were permitted a 2-hour nap every 12 hours (NAP condition) throughout the 88-hour period. PVT reaction time means and standard deviations increased markedly among subjects and within each individual subject in the TSD condition relative to the NAP condition. TSD subjects also had increasingly greater performance variability as a function of time on task after 18 hours of wakefulness. During sleep deprivation, variability in PVT performance reflected a combination of normal timely responses, errors of omission (i.e., lapses), and errors of commission (i.e., responding when no stimulus was present). Errors of omission and errors of commission were highly intercorrelated across deprivation in the TSD condition (r = 0.85, p = 0.0001), suggesting that performance instability is more likely to include compensatory effort than a lack of motivation. The marked increases in PVT performance variability as sleep loss continued supports the "state instability" hypothesis, which posits that performance during sleep deprivation is increasingly variable due to the influence of sleep initiating mechanisms on the endogenous capacity to maintain attention and alertness, thereby creating an unstable state that fluctuates within seconds and that cannot be characterized as either fully awake or asleep.

Integrating Radarsat-2, Lidar, and Worldview-3 Imagery to maximize detection of forested inundation extent in the Delmarva Peninsula, USA

USGS Publications Warehouse

Vanderhoof, Melanie; Distler, Hayley; Mendiola, Di Ana; Lang, Megan

2017-01-01

Natural variability in surface-water extent and associated characteristics presents a challenge to gathering timely, accurate information, particularly in environments that are dominated by small and/or forested wetlands. This study mapped inundation extent across the Upper Choptank River Watershed on the Delmarva Peninsula, occurring within both Maryland and Delaware. We integrated six quad-polarized Radarsat-2 images, Worldview-3 imagery, and an enhanced topographic wetness index in a random forest model. Output maps were filtered using light detection and ranging (lidar)-derived depressions to maximize the accuracy of forested inundation extent. Overall accuracy within the integrated and filtered model was 94.3%, with 5.5% and 6.0% errors of omission and commission for inundation, respectively. Accuracy of inundation maps obtained using Radarsat-2 alone were likely detrimentally affected by less than ideal angles of incidence and recent precipitation, but were likely improved by targeting the period between snowmelt and leaf-out for imagery collection. Across the six Radarsat-2 dates, filtering inundation outputs by lidar-derived depressions slightly elevated errors of omission for water (+1.0%), but decreased errors of commission (−7.8%), resulting in an average increase of 5.4% in overall accuracy. Depressions were derived from lidar datasets collected under both dry and average wetness conditions. Although antecedent wetness conditions influenced the abundance and total area mapped as depression, the two versions of the depression datasets showed a similar ability to reduce error in the inundation maps. Accurate mapping of surface water is critical to predicting and monitoring the effect of human-induced change and interannual variability on water quantity and quality.

Attentional Control and Subjective Executive Function in Treatment-Naive Adults with Attention Deficit Hyperactivity Disorder

PubMed Central

Grane, Venke Arntsberg; Endestad, Tor; Pinto, Arnfrid Farbu; Solbakk, Anne-Kristin

2014-01-01

We investigated performance-derived measures of executive control, and their relationship with self- and informant reported executive functions in everyday life, in treatment-naive adults with newly diagnosed Attention Deficit Hyperactivity Disorder (ADHD; n = 36) and in healthy controls (n = 35). Sustained attentional control and response inhibition were examined with the Test of Variables of Attention (T.O.V.A.). Delayed responses, increased reaction time variability, and higher omission error rate to Go signals in ADHD patients relative to controls indicated fluctuating levels of attention in the patients. Furthermore, an increment in NoGo commission errors when Go stimuli increased relative to NoGo stimuli suggests reduced inhibition of task-irrelevant stimuli in conditions demanding frequent responding. The ADHD group reported significantly more cognitive and behavioral executive problems than the control group on the Behavior Rating Inventory of Executive Function-Adult Version (BRIEF-A). There were overall not strong associations between task performance and ratings of everyday executive function. However, for the ADHD group, T.O.V.A. omission errors predicted self-reported difficulties on the Organization of Materials scale, and commission errors predicted informant reported difficulties on the same scale. Although ADHD patients endorsed more symptoms of depression and anxiety on the Achenbach System of Empirically Based Assessment (ASEBA) than controls, ASEBA scores were not significantly associated with T.O.V.A. performance scores. Altogether, the results indicate multifaceted alteration of attentional control in adult ADHD, and accompanying subjective difficulties with several aspects of executive function in everyday living. The relationships between the two sets of data were modest, indicating that the measures represent non-redundant features of adult ADHD. PMID:25545156

Attentional control and subjective executive function in treatment-naive adults with Attention Deficit Hyperactivity Disorder.

PubMed

Grane, Venke Arntsberg; Endestad, Tor; Pinto, Arnfrid Farbu; Solbakk, Anne-Kristin

2014-01-01

We investigated performance-derived measures of executive control, and their relationship with self- and informant reported executive functions in everyday life, in treatment-naive adults with newly diagnosed Attention Deficit Hyperactivity Disorder (ADHD; n = 36) and in healthy controls (n = 35). Sustained attentional control and response inhibition were examined with the Test of Variables of Attention (T.O.V.A.). Delayed responses, increased reaction time variability, and higher omission error rate to Go signals in ADHD patients relative to controls indicated fluctuating levels of attention in the patients. Furthermore, an increment in NoGo commission errors when Go stimuli increased relative to NoGo stimuli suggests reduced inhibition of task-irrelevant stimuli in conditions demanding frequent responding. The ADHD group reported significantly more cognitive and behavioral executive problems than the control group on the Behavior Rating Inventory of Executive Function-Adult Version (BRIEF-A). There were overall not strong associations between task performance and ratings of everyday executive function. However, for the ADHD group, T.O.V.A. omission errors predicted self-reported difficulties on the Organization of Materials scale, and commission errors predicted informant reported difficulties on the same scale. Although ADHD patients endorsed more symptoms of depression and anxiety on the Achenbach System of Empirically Based Assessment (ASEBA) than controls, ASEBA scores were not significantly associated with T.O.V.A. performance scores. Altogether, the results indicate multifaceted alteration of attentional control in adult ADHD, and accompanying subjective difficulties with several aspects of executive function in everyday living. The relationships between the two sets of data were modest, indicating that the measures represent non-redundant features of adult ADHD.

Reducing Diagnostic Errors through Effective Communication: Harnessing the Power of Information Technology

PubMed Central

Naik, Aanand Dinkar; Rao, Raghuram; Petersen, Laura Ann

2008-01-01

Diagnostic errors are poorly understood despite being a frequent cause of medical errors. Recent efforts have aimed to advance the "basic science" of diagnostic error prevention by tracing errors to their most basic origins. Although a refined theory of diagnostic error prevention will take years to formulate, we focus on communication breakdown, a major contributor to diagnostic errors and an increasingly recognized preventable factor in medical mishaps. We describe a comprehensive framework that integrates the potential sources of communication breakdowns within the diagnostic process and identifies vulnerable steps in the diagnostic process where various types of communication breakdowns can precipitate error. We then discuss potential information technology-based interventions that may have efficacy in preventing one or more forms of these breakdowns. These possible intervention strategies include using new technologies to enhance communication between health providers and health systems, improve patient involvement, and facilitate management of information in the medical record. PMID:18373151

Towards a Collaborative Filtering Approach to Medication Reconciliation

PubMed Central

Hasan, Sharique; Duncan, George T.; Neill, Daniel B.; Padman, Rema

2008-01-01

A physician’s prescribing decisions depend on knowledge of the patient’s medication list. This knowledge is often incomplete, and errors or omissions could result in adverse outcomes. To address this problem, the Joint Commission recommends medication reconciliation for creating a more accurate list of a patient’s medications. In this paper, we develop techniques for automatic detection of omissions in medication lists, identifying drugs that the patient may be taking but are not on the patient’s medication list. Our key insight is that this problem is analogous to the collaborative filtering framework increasingly used by online retailers to recommend relevant products to customers. The collaborative filtering approach enables a variety of solution techniques, including nearest neighbor and co-occurrence approaches. We evaluate the effectiveness of these approaches using medication data from a long-term care center in the Eastern US. Preliminary results suggest that this framework may become a valuable tool for medication reconciliation. PMID:18998834

Towards a collaborative filtering approach to medication reconciliation.

PubMed

Hasan, Sharique; Duncan, George T; Neill, Daniel B; Padman, Rema

2008-11-06

A physicians prescribing decisions depend on knowledge of the patients medication list. This knowledge is often incomplete, and errors or omissions could result in adverse outcomes. To address this problem, the Joint Commission recommends medication reconciliation for creating a more accurate list of a patients medications. In this paper, we develop techniques for automatic detection of omissions in medication lists, identifying drugs that the patient may be taking but are not on the patients medication list. Our key insight is that this problem is analogous to the collaborative filtering framework increasingly used by online retailers to recommend relevant products to customers. The collaborative filtering approach enables a variety of solution techniques, including nearest neighbor and co-occurrence approaches. We evaluate the effectiveness of these approaches using medication data from a long-term care center in the Eastern US. Preliminary results suggest that this framework may become a valuable tool for medication reconciliation.

Delayed match-to-sample early performance decrement in monkeys after $sup 60$Co irradiation

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

Bruner, A.; Bogo, V.; Jones, R.K.

1975-07-01

Sixteen monkeys were trained on a delayed match-to-sample task (DMTS) based on shock avoidance and irradiated with single, whole-body exposures of from 396 to 2000 rad $sup 60$Co (midbody dose) at between 163 and 233 rad/min. Pre- to post-irradiation performance changes were assessed using a penalty-scaling measure which differentially weighted incorrect responses, response omissions, and error-omission sequences. Thirteen of the animals displayed early performance decrement, including five incapacitations, at lower doses (less than 1000 rad) than heretofore found effective. This was considered a function of task complexity, measurement sensitivity, and gamma effectiveness. The minimum effective midbody dose for inducing decrementmore » using the DMTS task was estimated to be on the order of 500 rad. The nature of early, transient performance decrement seems to reflect more of an inability to perform than an inability to perform correctly. (auth)« less

The challenges in defining and measuring diagnostic error.

PubMed

Zwaan, Laura; Singh, Hardeep

2015-06-01

Diagnostic errors have emerged as a serious patient safety problem but they are hard to detect and complex to define. At the research summit of the 2013 Diagnostic Error in Medicine 6th International Conference, we convened a multidisciplinary expert panel to discuss challenges in defining and measuring diagnostic errors in real-world settings. In this paper, we synthesize these discussions and outline key research challenges in operationalizing the definition and measurement of diagnostic error. Some of these challenges include 1) difficulties in determining error when the disease or diagnosis is evolving over time and in different care settings, 2) accounting for a balance between underdiagnosis and overaggressive diagnostic pursuits, and 3) determining disease diagnosis likelihood and severity in hindsight. We also build on these discussions to describe how some of these challenges can be addressed while conducting research on measuring diagnostic error.

The utility of quantitative electroencephalography and Integrated Visual and Auditory Continuous Performance Test as auxiliary tools for the Attention Deficit Hyperactivity Disorder diagnosis.

PubMed

Kim, JunWon; Lee, YoungSik; Han, DougHyun; Min, KyungJoon; Kim, DoHyun; Lee, ChangWon

2015-03-01

This study investigated the clinical utility of quantitative electroencephalography (QEEG) and the Integrated Visual and Auditory Continuous Performance Test (IVA+CPT) as auxiliary tools for assessing Attention Deficit Hyperactivity Disorder (ADHD). All of 157 subjects were assessed using the Korean version of the Diagnostic Interview Schedule for Children Version IV (DISC-IV). We measured EGG absolute power in 21 channels and conducted IVA+CPT. We analyzed QEEG according to the Hz range: delta (1-4Hz), theta (4-8Hz), slow alpha (8-10Hz), fast alpha (10-13.5Hz), and beta (13.5-30Hz). To remove artifacts, independent component analysis was conducted (ICA), and the tester confirmed the results again. All of the IVA+CPT quotients showed significant differences between the ADHD and control groups. The ADHD group showed significantly increased delta and theta activity compared with the control group. The z-scores of theta were negatively correlated with the scores of IVA+CPT in ADHD combined type, and those of beta were positively correlated. IVA+CPT and QEEG significantly discriminated between ADHD and control groups. The commission error of IVA+CPT showed an accuracy of 82.1%, and the omission error of IVA+CPT showed an accuracy of 78.6%. The IVA+CPT and QEEG are expected to be valuable tools for aiding ADHD diagnosis accurately. Copyright © 2014 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

Neurocognitive effects of aripiprazole in adolescents and young adults with bipolar disorder.

PubMed

Wang, Liang-Jen; Yeh, Chin-Bin; Huang, Yu-Shu; Tang, Ching-Shu; Chou, Wen-Jiun; Chou, Miao-Chun; Chen, Chih-Ken

2012-09-01

Patients with bipolar disorder have neurocognitive impairments, which are associated with poor functional outcomes. This study evaluated the neurocognitive effects of aripiprazole in adolescents and young adults with bipolar disorder. This was a 24-week, observational, prospective study performed in Taiwan. Participants in the study were clinically diagnosed as having bipolar disorder according to the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV). In total, 28 patients participated and were administered aripiprazole. Neurocognitive function was assessed as a change from baseline in the Continuous Performance Test (CPT) and the Wisconsin Card Sorting Test (WCST). The 28 patients had a mean age of 18.5 ± 3.3 years. During the 24-week aripiprazole treatment, these patients had significant improvements in omission score (χ(2) = 7.83, P = 0.050) and detectability scores (χ(2) = 13.79, P = 0.003) in the CPT, and perseverative errors (χ(2) = 17.42, P = 0.001) in the WCST. The WCST perseverative errors scores were significantly associated with general symptom scores in Brief Psychiatric Rating Scale (BPRS) (β = - 1.34, P = 0.024). No significant differences were found between the neurocognitive functions of patients with manic, depressive and mixed episodes from baseline to week 24. Adolescents and young adults with bipolar disorder experienced significant neurocognitive function improvements after treatment with aripiprazole. A randomized, controlled design is warranted to determine whether these improvements are associated with aripiprazole or the course of bipolar disorder.

Diagnostic decision-making and strategies to improve diagnosis.

PubMed

Thammasitboon, Satid; Cutrer, William B

2013-10-01

A significant portion of diagnostic errors arises through cognitive errors resulting from inadequate knowledge, faulty data gathering, and/or faulty verification. Experts estimate that 75% of diagnostic failures can be attributed to clinician diagnostic thinking failure. The cognitive processes that underlie diagnostic thinking of clinicians are complex and intriguing, and it is imperative that clinicians acquire explicit appreciation and application of different cognitive approaches to make decisions better. A dual-process model that unifies many theories of decision-making has emerged as a promising template for understanding how clinicians think and judge efficiently in a diagnostic reasoning process. The identification and implementation of strategies for decreasing or preventing such diagnostic errors has become a growing area of interest and research. Suggested strategies to decrease diagnostic error incidence include increasing clinician's clinical expertise and avoiding inherent cognitive errors to make decisions better. Implementing Interventions focused solely on avoiding errors may work effectively for patient safety issues such as medication errors. Addressing cognitive errors, however, requires equal effort on expanding the individual clinician's expertise. Providing cognitive support to clinicians for robust diagnostic decision-making serves as the final strategic target for decreasing diagnostic errors. Clinical guidelines and algorithms offer another method for streamlining decision-making and decreasing likelihood of cognitive diagnostic errors. Addressing cognitive processing errors is undeniably the most challenging task in reducing diagnostic errors. While many suggested approaches exist, they are mostly based on theories and sciences in cognitive psychology, decision-making, and education. The proposed interventions are primarily suggestions and very few of them have been tested in the actual practice settings. Collaborative research effort is required to effectively address cognitive processing errors. Researchers in various areas, including patient safety/quality improvement, decision-making, and problem solving, must work together to make medical diagnosis more reliable. © 2013 Mosby, Inc. All rights reserved.

Using anecdotal occurrence data for rare or elusive species: the illusion of reality and a call for evidentiary standards

Treesearch

Kevin S. McKelvey; Keith B. Aubry; Michael K. Schwartz

2008-01-01

Anecdotal occurrence data (unverifiable observations of organisms or their sign) and inconclusive physical data are often used to assess the current and historical ranges of rare or elusive species. However, the use of such data for species conservation can lead to large errors of omission and commission, which can influence the allocation of limited funds and the...

Developing a Corrective Action Simulator to Support Decision Making Research and Training

DTIC Science & Technology

2008-05-01

positions, and any time-based simulation injects (e.g., JSTARS reporting tracks, the Engineer reporting a new aircraft bingo time, a threat being active...future instantiations would benefit from migrating to the IMPRINT Pro version. During the course of this development effort the Army Research...initiating corrective action when a subordinate is observed to make an error (of omission or commission) 58 • Benefits of a Corrective

Using anecdotal occurrence data for rare or elusive species: The illusion of reality and a call for evidentiary standards

Treesearch

Kevin S. McKelvey; Keith B. Aubry; Michael K. Schwartz

2008-01-01

Anecdotal occurrence data (unverifiable observations of organisms or their sign) and inconclusive physical data are often used to assess the current and historical ranges of rare or elusive species. However, the use of such data for species conservation can lead to large errors of omission and commission, which can influence the allocation of limited funds and the...

MODIS Snow Cover Mapping Decision Tree Technique: Snow and Cloud Discrimination

NASA Technical Reports Server (NTRS)

Riggs, George A.; Hall, Dorothy K.

2010-01-01

Accurate mapping of snow cover continues to challenge cryospheric scientists and modelers. The Moderate-Resolution Imaging Spectroradiometer (MODIS) snow data products have been used since 2000 by many investigators to map and monitor snow cover extent for various applications. Users have reported on the utility of the products and also on problems encountered. Three problems or hindrances in the use of the MODIS snow data products that have been reported in the literature are: cloud obscuration, snow/cloud confusion, and snow omission errors in thin or sparse snow cover conditions. Implementation of the MODIS snow algorithm in a decision tree technique using surface reflectance input to mitigate those problems is being investigated. The objective of this work is to use a decision tree structure for the snow algorithm. This should alleviate snow/cloud confusion and omission errors and provide a snow map with classes that convey information on how snow was detected, e.g. snow under clear sky, snow tinder cloud, to enable users' flexibility in interpreting and deriving a snow map. Results of a snow cover decision tree algorithm are compared to the standard MODIS snow map and found to exhibit improved ability to alleviate snow/cloud confusion in some situations allowing up to about 5% increase in mapped snow cover extent, thus accuracy, in some scenes.

Simulation-based education with deliberate practice may improve intraoperative handoff skills: a pilot study.

PubMed

Pukenas, Erin W; Dodson, Gregory; Deal, Edward R; Gratz, Irwin; Allen, Elaine; Burden, Amanda R

2014-11-01

To examine the results of simulation-based education with deliberate practice on the acquisition of handoff skills by studying resident intraoperative handoff communication performances. Preinvention and postintervention pilot study. Simulated operating room of a university-affiliated hospital. Resident handoff performances during 27 encounters simulating elective surgery were studied. Ten residents (CA-1, CA-2, and CA-3) participated in a one-day simulation-based handoff course. Each resident repeated simulated handoffs to deliberately practice with an intraoperative handoff checklist. One year later, 7 of the 10 residents participated in simulated intraoperative handoffs. All handoffs were videotaped and later scored for accuracy by trained raters. A handoff assessment tool was used to characterize the type and frequency of communication failures. The percentage of handoff errors and omissions were compared before simulation and postsimulation-based education with deliberate practice and at one year following the course. Initially, the overall communication failure rate, defined as the percentage of handoff omissions plus errors, was 29.7%. After deliberate practice with the intraoperative handoff checklist, the communication failure rate decreased to 16.8%, and decreased further to 13.2% one year after the course. Simulation-based education using deliberate practice may result in improved intraoperative handoff communication and retention of skills at one year. Copyright © 2014 Elsevier Inc. All rights reserved.

Effects of antiepileptic drugs on attention as assessed by a five-choice serial reaction time task in rats.

PubMed

Shannon, Harlan E; Love, Patrick L

2005-12-01

Patients with epilepsy can have impaired cognitive abilities. Antiepileptic drugs (AEDs) may contribute to the cognitive deficits observed in patients with epilepsy, and have been shown to induce cognitive impairments in healthy individuals. However, there are few systematic data on the effects of AEDs on specific cognitive domains. We have previously evaluated a number of AEDs with respect to their effects on working memory. The purpose of the present study was to evaluate the effects of AEDs on attention as measured by five-choice serial reaction time behavior in nonepileptic rats. The GABA-related AEDs triazolam, phenobarbital, and chlordiazepoxide significantly disrupted performance by increasing errors of omission, whereas tiagabine, valproate, and gabapentin did not. The sodium channel blocker carbamazepine increased errors of omission at relatively high doses, whereas the sodium channel blockers phenytoin, topiramate, and lamotrigine were without significant effect. Levetiracetam had no effect on attention. The disruptions produced by triazolam, phenobarbital, chlordiazepoxide, and carbamazepine were similar in magnitude to the effects of the muscarinic cholinergic receptor antagonist scopolamine. The present results indicate that AEDs can disrupt attention, but there are differences among AEDs in the magnitude of the disruption in nonepileptic rats, with drugs that enhance GABA receptor function producing the most consistent disruption of attention.

Relationships of posttraumatic stress symptoms and sleep measures to cognitive performance in young-adult African Americans.

PubMed

Brownlow, Janeese A; Brown, Tyish S Hall; Mellman, Thomas A

2014-04-01

Disturbed sleep is a prominent feature of posttraumatic stress disorder (PTSD). PTSD and disrupted sleep have been independently linked to cognitive deficits; however, synergistic effects of PTSD and poor sleep on cognition have not been investigated. The purpose of this study was to examine the effects of PTSD symptoms and objectively measured disruptions to sleep on cognitive function. Forty-four young-adult African American urban residents comprised the study sample. The Clinician-Administered PTSD Scale (CAPS; Blake et al., 1995) was utilized to determine the severity of PTSD symptoms. Participants underwent 2 consecutive nights of polysomnography. The Automated Neuropsychological Assessment Metrics (Reeves, Winter, Bleiberg, & Kang, ) was utilized to assess sustained attention and the Rey Auditory Verbal Learning Test (Schmidt, ) was used to evaluate verbal memory. PTSD symptom severity, r(42) = .40, p = .007, was significantly associated with omission errors on the sustained attention task, and sleep duration, r(42) = .41, p = .006, and rapid eye movement sleep, r(42) = .43, p = .003, were positively correlated with verbal memory. There was an interaction of PTSD symptom severity and sleep duration on omission errors such that more than 7 hours 12 minutes of sleep mitigated attentional lapses that were associated with PTSD. Copyright © 2014 International Society for Traumatic Stress Studies.

Randomised trial comparing the recording ability of a novel, electronic emergency documentation system with the AHA paper cardiac arrest record.

PubMed

Grigg, Eliot; Palmer, Andrew; Grigg, Jeffrey; Oppenheimer, Peter; Wu, Tim; Roesler, Axel; Nair, Bala; Ross, Brian

2014-10-01

To evaluate the ability of an electronic system created at the University of Washington to accurately document prerecorded VF and pulseless electrical activity (PEA) cardiac arrest scenarios compared with the American Heart Association paper cardiac arrest record. 16 anaesthesiology residents were randomly assigned to view one of two prerecorded, simulated VF and PEA scenarios and asked to document the event with either the paper or electronic system. Each subject then repeated the process with the other video and documentation method. Five types of documentation errors were defined: (1) omission, (2) specification, (3) timing, (4) commission and (5) noise. The mean difference in errors between the paper and electronic methods was analysed using a single factor repeated measures ANOVA model. Compared with paper records, the electronic system omitted 6.3 fewer events (95% CI -10.1 to -2.5, p=0.003), which represents a 28% reduction in omission errors. Users recorded 2.9 fewer noise items (95% CI -5.3 to -0.6, p=0.003) when compared with paper, representing a 36% decrease in redundant or irrelevant information. The rate of timing (Δ=-3.2, 95% CI -9.3 to 3.0, p=0.286) and commission (Δ=-4.4, 95% CI -9.4 to 0.5, p=0.075) errors were similar between the electronic system and paper, while the rate of specification errors were about a third lower for the electronic system when compared with the paper record (Δ=-3.2, 95% CI -6.3 to -0.2, p=0.037). Compared with paper documentation, documentation with the electronic system captured 24% more critical information during a simulated medical emergency without loss in data quality. 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.

Sustainability of protocolized handover of pediatric cardiac surgery patients to the intensive care unit.

PubMed

Chenault, Kristin; Moga, Michael-Alice; Shin, Minah; Petersen, Emily; Backer, Carl; De Oliveira, Gildasio S; Suresh, Santhanam

2016-05-01

Transfer of patient care among clinicians (handovers) is a common source of medical errors. While the immediate efficacy of these initiatives is well documented, sustainability of practice changes that results in better processes of care is largely understudied. The objective of the current investigation was to evaluate the sustainability of a protocolized handover process in pediatric patients from the operating room after cardiac surgery to the intensive care unit. This was a prospective study with direct observation assessment of handover performance conducted in the cardiac ICU (CICU) of a free-standing, tertiary care children's hospital in the United States. Patient transitions from the operating room to the CICU, including the verbal handoff, were directly observed by a single independent observer in all phases of the study. A checklist of key elements identified errors classified as: (1) technical, (2) information omissions, and (3) realized errors. Total number of errors was compared across the different times of the study (preintervention, postintervention, and the current sustainability phase). A total of 119 handovers were studied: 41 preintervention, 38 postintervention, and 40 in the current sustainability phase. The median [Interquartile range (IQR)] number of technical errors was significantly reduced in the sustainability phase compared to the preintervention and postintervention phase, 2 (1-3), 6 (5-7), and 2.5 (2-4), respectively P = 0.0001. Similarly, the median (IQR) number of verbal information omissions was also significantly reduced in the sustainability phase compared to the preintervention and postintervention phases, 1 (1-1), 4 (3-5) and 2 (1-3), respectively. We demonstrate sustainability of an improved handover process using a checklist in children being transferred to the intensive care unit after cardiac surgery. Standardized handover processes can be a sustainable strategy to improve patient safety after pediatric cardiac surgery. © 2016 John Wiley & Sons Ltd.

Impaired sustained attention and altered reactivity to errors in an animal model of prenatal cocaine exposure.

PubMed

Gendle, Mathew H; Strawderman, Myla S; Mactutus, Charles F; Booze, Rosemarie M; Levitsky, David A; Strupp, Barbara J

2003-12-30

Although correlations have been reported between maternal cocaine use and impaired attention in exposed children, interpretation of these findings is complicated by the many risk factors that differentiate cocaine-exposed children from SES-matched controls. For this reason, the present dose-response study (0, 0.5, 1.0, or 3.0 mg/kg cocaine HCl) was designed to explore the effect of prenatal cocaine exposure on visual attention in a rodent model, using an intravenous injection protocol that closely mimics the pharmacokinetic profile and physiological effects of human recreational cocaine use. In adulthood, animals were tested on an attention task in which the duration, location, and onset time of a brief visual cue varied randomly between trials. The 3.0 mg/kg exposed males committed significantly more omission errors than control males during the final 1/3 of each testing session, specifically on trials that followed an error, which implicates impaired sustained attention and increased reactivity to committing an error. During the final 1/3 of each testing session, the 0.5 and 1.0 mg/kg exposed females took longer to enter the testing alcove at trial onset, and failed to enter the alcove more frequently than control females. Because these effects were not seen in other tasks of similar duration and reinforcement density, these findings suggest an impairment of sustained attention. This inference is supported by the finding that the increase in omission errors in the final block of trials in each daily session (relative to earlier in the session) was significantly greater for the 1.0 mg/kg females than for controls, a trend also seen for the 0.5 mg/kg group. Unlike the cocaine-exposed males, who remain engaged in the task when attention is waning, the cocaine-exposed females appear to opt for another strategy; namely, refusing to participate when their ability to sustain attention is surpassed.

Advancing the research agenda for diagnostic error reduction.

PubMed

Zwaan, Laura; Schiff, Gordon D; Singh, Hardeep

2013-10-01

Diagnostic errors remain an underemphasised and understudied area of patient safety research. We briefly summarise the methods that have been used to conduct research on epidemiology, contributing factors and interventions related to diagnostic error and outline directions for future research. Research methods that have studied epidemiology of diagnostic error provide some estimate on diagnostic error rates. However, there appears to be a large variability in the reported rates due to the heterogeneity of definitions and study methods used. Thus, future methods should focus on obtaining more precise estimates in different settings of care. This would lay the foundation for measuring error rates over time to evaluate improvements. Research methods have studied contributing factors for diagnostic error in both naturalistic and experimental settings. Both approaches have revealed important and complementary information. Newer conceptual models from outside healthcare are needed to advance the depth and rigour of analysis of systems and cognitive insights of causes of error. While the literature has suggested many potentially fruitful interventions for reducing diagnostic errors, most have not been systematically evaluated and/or widely implemented in practice. Research is needed to study promising intervention areas such as enhanced patient involvement in diagnosis, improving diagnosis through the use of electronic tools and identification and reduction of specific diagnostic process 'pitfalls' (eg, failure to conduct appropriate diagnostic evaluation of a breast lump after a 'normal' mammogram). The last decade of research on diagnostic error has made promising steps and laid a foundation for more rigorous methods to advance the field.

Quality Issues of Court Reporters and Transcriptionists for Qualitative Research

PubMed Central

Hennink, Monique; Weber, Mary Beth

2015-01-01

Transcription is central to qualitative research, yet few researchers identify the quality of different transcription methods. We described the quality of verbatim transcripts from traditional transcriptionists and court reporters by reviewing 16 transcripts from 8 focus group discussions using four criteria: transcription errors, cost and time of transcription, and effect on study participants. Transcriptionists made fewer errors, captured colloquial dialogue, and errors were largely influenced by the quality of the recording. Court reporters made more errors, particularly in the omission of topical content and contextual detail and were less able to produce a verbatim transcript; however the potential immediacy of the transcript was advantageous. In terms of cost, shorter group discussions favored a transcriptionist and longer groups a court reporter. Study participants reported no effect by either method of recording. Understanding the benefits and limitations of each method of transcription can help researchers select an appropriate method for each study. PMID:23512435

Cognitive aspect of diagnostic errors.

PubMed

Phua, Dong Haur; Tan, Nigel C K

2013-01-01

Diagnostic errors can result in tangible harm to patients. Despite our advances in medicine, the mental processes required to make a diagnosis exhibits shortcomings, causing diagnostic errors. Cognitive factors are found to be an important cause of diagnostic errors. With new understanding from psychology and social sciences, clinical medicine is now beginning to appreciate that our clinical reasoning can take the form of analytical reasoning or heuristics. Different factors like cognitive biases and affective influences can also impel unwary clinicians to make diagnostic errors. Various strategies have been proposed to reduce the effect of cognitive biases and affective influences when clinicians make diagnoses; however evidence for the efficacy of these methods is still sparse. This paper aims to introduce the reader to the cognitive aspect of diagnostic errors, in the hope that clinicians can use this knowledge to improve diagnostic accuracy and patient outcomes.

Burned area detection based on Landsat time series in savannas of southern Burkina Faso

NASA Astrophysics Data System (ADS)

Liu, Jinxiu; Heiskanen, Janne; Maeda, Eduardo Eiji; Pellikka, Petri K. E.

2018-02-01

West African savannas are subject to regular fires, which have impacts on vegetation structure, biodiversity and carbon balance. An efficient and accurate mapping of burned area associated with seasonal fires can greatly benefit decision making in land management. Since coarse resolution burned area products cannot meet the accuracy needed for fire management and climate modelling at local scales, the medium resolution Landsat data is a promising alternative for local scale studies. In this study, we developed an algorithm for continuous monitoring of annual burned areas using Landsat time series. The algorithm is based on burned pixel detection using harmonic model fitting with Landsat time series and breakpoint identification in the time series data. This approach was tested in a savanna area in southern Burkina Faso using 281 images acquired between October 2000 and April 2016. An overall accuracy of 79.2% was obtained with balanced omission and commission errors. This represents a significant improvement in comparison with MODIS burned area product (67.6%), which had more omission errors than commission errors, indicating underestimation of the total burned area. By observing the spatial distribution of burned areas, we found that the Landsat based method misclassified cropland and cloud shadows as burned areas due to the similar spectral response, and MODIS burned area product omitted small and fragmented burned areas. The proposed algorithm is flexible and robust against decreased data availability caused by clouds and Landsat 7 missing lines, therefore having a high potential for being applied in other landscapes in future studies.

The effect of prenatal drug exposure and caregiving context on children's performance on a task of sustained visual attention.

PubMed

Ackerman, John P; Llorente, Antolin M; Black, Maureen M; Ackerman, Claire S; Mayes, Lacy A; Nair, Prasanna

2008-12-01

Three groups of children from low-income, urban environments were examined to determine the effects of prenatal drug exposure (PDE) and caregiving environment on sustained visual attention (SVA) at 7 years of age. Drug-exposed children remaining in maternal care (n = 43), drug-exposed children placed in nonmaternal care (n = 45), and community comparison (CC) children (n = 56) were administered a battery of neurocognitive tests, including the Conners' Continuous Performance Test (CPT). PDE children remaining in maternal care displayed more omission errors than CC children. PDE children in nonmaternal care had intermediate scores that did not differ significantly from PDE children in maternal care or CC children. There were no group differences with respect to commission errors or reaction time. CPT errors of omission and commission were significantly correlated with parent-reported attention problems and academic achievement scores. PDE in the context of care provided by a maternal caregiver with persistent drug use patterns may contribute to problems in children's SVA at school-age. As parental drug abuse can interfere with the provision of early care, children raised in a drug-using context may be highly vulnerable to problems with self-regulation, including sustained attention. SVA problems may contribute to subsequent academic and behavioral problems as demands for concentration and sustained effort increase throughout childhood. Children who have been prenatally exposed to drugs or raised in a drug-using household may benefit from early intervention services to avoid problems in SVA that may interfere with subsequent neurocognitive functioning and academic performance.

Posterior parietal cortex is critical for the encoding, consolidation, and retrieval of a memory that guides attention for learning.

PubMed

Schiffino, Felipe L; Zhou, Vivian; Holland, Peter C

2014-02-01

Within most contemporary learning theories, reinforcement prediction error, the difference between the obtained and expected reinforcer value, critically influences associative learning. In some theories, this prediction error determines the momentary effectiveness of the reinforcer itself, such that the same physical event produces more learning when its presentation is surprising than when it is expected. In other theories, prediction error enhances attention to potential cues for that reinforcer by adjusting cue-specific associability parameters, biasing the processing of those stimuli so that they more readily enter into new associations in the future. A unique feature of these latter theories is that such alterations in stimulus associability must be represented in memory in an enduring fashion. Indeed, considerable data indicate that altered associability may be expressed days after its induction. Previous research from our laboratory identified brain circuit elements critical to the enhancement of stimulus associability by the omission of an expected event, and to the subsequent expression of that altered associability in more rapid learning. Here, for the first time, we identified a brain region, the posterior parietal cortex, as a potential site for a memorial representation of altered stimulus associability. In three experiments using rats and a serial prediction task, we found that intact posterior parietal cortex function was essential during the encoding, consolidation, and retrieval of an associability memory enhanced by surprising omissions. We discuss these new results in the context of our previous findings and additional plausible frontoparietal and subcortical networks. © 2013 Federation of European Neuroscience Societies and John Wiley & Sons Ltd.

Diagnostic Errors in Ambulatory Care: Dimensions and Preventive Strategies

ERIC Educational Resources Information Center

Singh, Hardeep; Weingart, Saul N.

2009-01-01

Despite an increasing focus on patient safety in ambulatory care, progress in understanding and reducing diagnostic errors in this setting lag behind many other safety concerns such as medication errors. To explore the extent and nature of diagnostic errors in ambulatory care, we identified five dimensions of ambulatory care from which errors may…

Missed opportunities for diagnosis: lessons learned from diagnostic errors in primary care.

PubMed

Goyder, Clare R; Jones, Caroline H D; Heneghan, Carl J; Thompson, Matthew J

2015-12-01

Because of the difficulties inherent in diagnosis in primary care, it is inevitable that diagnostic errors will occur. However, despite the important consequences associated with diagnostic errors and their estimated high prevalence, teaching and research on diagnostic error is a neglected area. To ascertain the key learning points from GPs' experiences of diagnostic errors and approaches to clinical decision making associated with these. Secondary analysis of 36 qualitative interviews with GPs in Oxfordshire, UK. Two datasets of semi-structured interviews were combined. Questions focused on GPs' experiences of diagnosis and diagnostic errors (or near misses) in routine primary care and out of hours. Interviews were audiorecorded, transcribed verbatim, and analysed thematically. Learning points include GPs' reliance on 'pattern recognition' and the failure of this strategy to identify atypical presentations; the importance of considering all potentially serious conditions using a 'restricted rule out' approach; and identifying and acting on a sense of unease. Strategies to help manage uncertainty in primary care were also discussed. Learning from previous examples of diagnostic errors is essential if these events are to be reduced in the future and this should be incorporated into GP training. At a practice level, learning points from experiences of diagnostic errors should be discussed more frequently; and more should be done to integrate these lessons nationally to understand and characterise diagnostic errors. © British Journal of General Practice 2015.

Reappraising Defense Organization: An Analysis Based on the Defense Organization Study of 1977-1980,

DTIC Science & Technology

1983-01-01

and Mabel Jobe. Although I am responsible for what appears in these pages, including any errors or omissions, their efforts have contributed...provide planning and military advice to him, the President, and the Congress.ś " The Defense Resource Management Study, directed by Donald B. Rice ...Government Printing Office, 1978). 8. Donald B. Rice , Defense Resource Management Study, Final Report (Washington, DC: US Government Printing Office, 1979

Assessment of Spectral Doppler in Preclinical Ultrasound Using a Small-Size Rotating Phantom

PubMed Central

Yang, Xin; Sun, Chao; Anderson, Tom; Moran, Carmel M.; Hadoke, Patrick W.F.; Gray, Gillian A.; Hoskins, Peter R.

2013-01-01

Preclinical ultrasound scanners are used to measure blood flow in small animals, but the potential errors in blood velocity measurements have not been quantified. This investigation rectifies this omission through the design and use of phantoms and evaluation of measurement errors for a preclinical ultrasound system (Vevo 770, Visualsonics, Toronto, ON, Canada). A ray model of geometric spectral broadening was used to predict velocity errors. A small-scale rotating phantom, made from tissue-mimicking material, was developed. True and Doppler-measured maximum velocities of the moving targets were compared over a range of angles from 10° to 80°. Results indicate that the maximum velocity was overestimated by up to 158% by spectral Doppler. There was good agreement (<10%) between theoretical velocity errors and measured errors for beam-target angles of 50°–80°. However, for angles of 10°–40°, the agreement was not as good (>50%). The phantom is capable of validating the performance of blood velocity measurement in preclinical ultrasound. PMID:23711503

Limits on negative information in language input.

PubMed

Morgan, J L; Travis, L L

1989-10-01

Hirsh-Pasek, Treiman & Schneiderman (1984) and Demetras, Post & Snow (1986) have recently suggested that certain types of parental repetitions and clarification questions may provide children with subtle cues to their grammatical errors. We further investigated this possibility by examining parental responses to inflectional over-regularizations and wh-question auxiliary-verb omission errors in the sets of transcripts from Adam, Eve and Sarah (Brown 1973). These errors were chosen because they are exemplars of overgeneralization, the type of mistake for which negative information is, in theory, most critically needed. Expansions and Clarification Questions occurred more often following ill-formed utterances in Adam's and Eve's input, but not in Sarah's. However, these corrective responses formed only a small proportion of all adult responses following Adam's and Eve's grammatical errors. Moreover, corrective responses appear to drop out of children's input while they continue to make overgeneralization errors. Whereas negative feedback may occasionally be available, in the light of these findings the contention that language input generally incorporates negative information appears to be unfounded.

Using Fault Trees to Advance Understanding of Diagnostic Errors.

PubMed

Rogith, Deevakar; Iyengar, M Sriram; Singh, Hardeep

2017-11-01

Diagnostic errors annually affect at least 5% of adults in the outpatient setting in the United States. Formal analytic techniques are only infrequently used to understand them, in part because of the complexity of diagnostic processes and clinical work flows involved. In this article, diagnostic errors were modeled using fault tree analysis (FTA), a form of root cause analysis that has been successfully used in other high-complexity, high-risk contexts. How factors contributing to diagnostic errors can be systematically modeled by FTA to inform error understanding and error prevention is demonstrated. A team of three experts reviewed 10 published cases of diagnostic error and constructed fault trees. The fault trees were modeled according to currently available conceptual frameworks characterizing diagnostic error. The 10 trees were then synthesized into a single fault tree to identify common contributing factors and pathways leading to diagnostic error. FTA is a visual, structured, deductive approach that depicts the temporal sequence of events and their interactions in a formal logical hierarchy. The visual FTA enables easier understanding of causative processes and cognitive and system factors, as well as rapid identification of common pathways and interactions in a unified fashion. In addition, it enables calculation of empirical estimates for causative pathways. Thus, fault trees might provide a useful framework for both quantitative and qualitative analysis of diagnostic errors. Future directions include establishing validity and reliability by modeling a wider range of error cases, conducting quantitative evaluations, and undertaking deeper exploration of other FTA capabilities. Copyright © 2017 The Joint Commission. Published by Elsevier Inc. All rights reserved.

Clinical Dental Faculty Members' Perceptions of Diagnostic Errors and How to Avoid Them.

PubMed

Nikdel, Cathy; Nikdel, Kian; Ibarra-Noriega, Ana; Kalenderian, Elsbeth; Walji, Muhammad F

2018-04-01

Diagnostic errors are increasingly recognized as a source of preventable harm in medicine, yet little is known about their occurrence in dentistry. The aim of this study was to gain a deeper understanding of clinical dental faculty members' perceptions of diagnostic errors, types of errors that may occur, and possible contributing factors. The authors conducted semi-structured interviews with ten domain experts at one U.S. dental school in May-August 2016 about their perceptions of diagnostic errors and their causes. The interviews were analyzed using an inductive process to identify themes and key findings. The results showed that the participants varied in their definitions of diagnostic errors. While all identified missed diagnosis and wrong diagnosis, only four participants perceived that a delay in diagnosis was a diagnostic error. Some participants perceived that an error occurs only when the choice of treatment leads to harm. Contributing factors associated with diagnostic errors included the knowledge and skills of the dentist, not taking adequate time, lack of communication among colleagues, and cognitive biases such as premature closure based on previous experience. Strategies suggested by the participants to prevent these errors were taking adequate time when investigating a case, forming study groups, increasing communication, and putting more emphasis on differential diagnosis. These interviews revealed differing perceptions of dental diagnostic errors among clinical dental faculty members. To address the variations, the authors recommend adopting shared language developed by the medical profession to increase understanding.

Fourth-Grade Children are Less Accurate in Reporting School Breakfast than School Lunch during 24-Hour Dietary Recalls

PubMed Central

Baxter, Suzanne Domel; Royer, Julie A.; Hardin, James W.; Guinn, Caroline H.; Smith, Albert F.

2008-01-01

Objective To compare reporting accuracy for breakfast and lunch in two studies. Design Children were observed eating school meals and interviewed the following morning about the previous day. Study 1 – 104 children were each interviewed one to three times with ≥25 days separating any two interviews. Study 2 – 121 children were each interviewed once in forward (morning-to-evening) and once in reverse (evening-to-morning) order, separated by ≥29 days. Setting 12 schools. Participants Fourth-grade children. Main Outcome Measures For each meal: food-item variables – observed number, reported number, omission rate, intrusion rate, total inaccuracy; kilocalorie variables – observed, reported, correspondence rate, inflation ratio. Analysis General linear mixed-models. Results For each study, observed and reported numbers of items and kilocalories, and correspondence rate (reporting accuracy), were greater for lunch than breakfast; omission rate, intrusion rate, and inflation ratio (measures of reporting error) were greater for breakfast than lunch. Study 1 – for each meal over interviews, total inaccuracy decreased and correspondence rate increased. Study 2 – for each meal for boys for reverse and girls for forward order, omission rate was lower and correspondence rate was higher. Conclusions and Implications Breakfast was reported less accurately than lunch. Despite improvement over interviews (Study 1) and differences for order × sex (Study 2), reporting accuracy was low for breakfast and lunch. PMID:17493562

Application of the epidemiological model in studying human error in aviation

NASA Technical Reports Server (NTRS)

Cheaney, E. S.; Billings, C. E.

1981-01-01

An epidemiological model is described in conjunction with the analytical process through which aviation occurrence reports are composed into the events and factors pertinent to it. The model represents a process in which disease, emanating from environmental conditions, manifests itself in symptoms that may lead to fatal illness, recoverable illness, or no illness depending on individual circumstances of patient vulnerability, preventive actions, and intervention. In the aviation system the analogy of the disease process is the predilection for error of human participants. This arises from factors in the operating or physical environment and results in errors of commission or omission that, again depending on the individual circumstances, may lead to accidents, system perturbations, or harmless corrections. A discussion of the previous investigations, each of which manifests the application of the epidemiological method, exemplifies its use and effectiveness.

Application of Consider Covariance to the Extended Kalman Filter

NASA Technical Reports Server (NTRS)

Lundberg, John B.

1996-01-01

The extended Kalman filter (EKF) is the basis for many applications of filtering theory to real-time problems where estimates of the state of a dynamical system are to be computed based upon some set of observations. The form of the EKF may vary somewhat from one application to another, but the fundamental principles are typically unchanged among these various applications. As is the case in many filtering applications, models of the dynamical system (differential equations describing the state variables) and models of the relationship between the observations and the state variables are created. These models typically employ a set of constants whose values are established my means of theory or experimental procedure. Since the estimates of the state are formed assuming that the models are perfect, any modeling errors will affect the accuracy of the computed estimates. Note that the modeling errors may be errors of commission (errors in terms included in the model) or omission (errors in terms excluded from the model). Consequently, it becomes imperative when evaluating the performance of real-time filters to evaluate the effect of modeling errors on the estimates of the state.

Securing insurance protection against fraud and abuse liability.

PubMed

Callison, S

1999-07-01

Healthcare organizations concerned about corporate compliance need to review securing appropriate insurance coverage as part of their corporate compliance program. Provider organizations often mistakenly expect that their directors and officers liability (D&O), malpractice, or standard errors and omissions (E&O) insurance policies will cover the cost of Medicare fraud and abuse fines. The insurance industry has developed a specific billing E&O insurance product to cover providers that run afoul of government fraud and abuse statutes.

Diagnostic Error in Correctional Mental Health: Prevalence, Causes, and Consequences.

PubMed

Martin, Michael S; Hynes, Katie; Hatcher, Simon; Colman, Ian

2016-04-01

While they have important implications for inmates and resourcing of correctional institutions, diagnostic errors are rarely discussed in correctional mental health research. This review seeks to estimate the prevalence of diagnostic errors in prisons and jails and explores potential causes and consequences. Diagnostic errors are defined as discrepancies in an inmate's diagnostic status depending on who is responsible for conducting the assessment and/or the methods used. It is estimated that at least 10% to 15% of all inmates may be incorrectly classified in terms of the presence or absence of a mental illness. Inmate characteristics, relationships with staff, and cognitive errors stemming from the use of heuristics when faced with time constraints are discussed as possible sources of error. A policy example of screening for mental illness at intake to prison is used to illustrate when the risk of diagnostic error might be increased and to explore strategies to mitigate this risk. © The Author(s) 2016.

Information-Gathering Patterns Associated with Higher Rates of Diagnostic Error

ERIC Educational Resources Information Center

Delzell, John E., Jr.; Chumley, Heidi; Webb, Russell; Chakrabarti, Swapan; Relan, Anju

2009-01-01

Diagnostic errors are an important source of medical errors. Problematic information-gathering is a common cause of diagnostic errors among physicians and medical students. The objectives of this study were to (1) determine if medical students' information-gathering patterns formed clusters of similar strategies, and if so (2) to calculate the…

Effects of grammatical categories on letter detection in continuous text.

PubMed

Foucambert, Denis; Zuniga, Michael

2012-02-01

The present study focuses on the interplay between the linguistic principles and the psycholinguistic processes involved in reading. Results from 56 participants on a letter detection task reveal that readers do not process all function words in the same manner. Omission rates were highest for function words occupying the head of maximal projections such as complementizers and determiners. Prepositions were shown to occupy an intermediary position between content and function words, with omission rates varying depending on their semantic load. Together these results appear to bolster and offer a finer grained picture of the role of function words within the framework of both the Guidance Organization (Greenberg et al. in Psychon Bull Rev 11(3):428-433, 2004) and Attentional Disengagement (Roy-Charland et al. in Percept Psychophys 69(3):324-337, 2007) reading models. The results of the present study are discussed using an X-bar theory approach with the goal of refining the structural account of letter detection errors.

The omission strategy.

PubMed

DeScioli, Peter; Christner, John; Kurzban, Robert

2011-04-01

People are more willing to bring about morally objectionable outcomes by omission than by commission. Similarly, people condemn others less harshly when a moral offense occurs by omission rather than by commission, even when intentions are controlled. We propose that these two phenomena are related, and that the reduced moral condemnation of omissions causes people to choose omissions in their own behavior to avoid punishment. We report two experiments using an economic game in which one participant (the taker) could take money from another participant (the owner) either by omission or by commission. We manipulated whether or not a third party had the opportunity to punish the taker by reducing the taker's payment. Our results indicated that the frequency of omission increases when punishment is possible. We conclude that people choose omissions to avoid condemnation and that the omission effect is best understood not as a bias, but as a strategy.

An error taxonomy system for analysis of haemodialysis incidents.

PubMed

Gu, Xiuzhu; Itoh, Kenji; Suzuki, Satoshi

2014-12-01

This paper describes the development of a haemodialysis error taxonomy system for analysing incidents and predicting the safety status of a dialysis organisation. The error taxonomy system was developed by adapting an error taxonomy system which assumed no specific specialty to haemodialysis situations. Its application was conducted with 1,909 incident reports collected from two dialysis facilities in Japan. Over 70% of haemodialysis incidents were reported as problems or complications related to dialyser, circuit, medication and setting of dialysis condition. Approximately 70% of errors took place immediately before and after the four hours of haemodialysis therapy. Error types most frequently made in the dialysis unit were omission and qualitative errors. Failures or complications classified to staff human factors, communication, task and organisational factors were found in most dialysis incidents. Device/equipment/materials, medicine and clinical documents were most likely to be involved in errors. Haemodialysis nurses were involved in more incidents related to medicine and documents, whereas dialysis technologists made more errors with device/equipment/materials. This error taxonomy system is able to investigate incidents and adverse events occurring in the dialysis setting but is also able to estimate safety-related status of an organisation, such as reporting culture. © 2014 European Dialysis and Transplant Nurses Association/European Renal Care Association.

Errors in preparation and administration of parenteral drugs in neonatology: evaluation and corrective actions.

PubMed

Hasni, Nesrine; Ben Hamida, Emira; Ben Jeddou, Khouloud; Ben Hamida, Sarra; Ayadi, Imene; Ouahchi, Zeineb; Marrakchi, Zahra

2016-12-01

The medication iatrogenic risk is quite unevaluated in neonatology Objective: Assessment of errors that occurred during the preparation and administration of injectable medicines in a neonatal unit in order to implement corrective actions to reduce the occurrence of these errors. A prospective, observational study was performed in a neonatal unit over a period of one month. The practice of preparing and administering injectable medications were identified through a standardized data collection form. These practices were compared with summaries of the characteristics of each product (RCP) and the bibliography. One hundred preparations were observed of 13 different drugs. 85 errors during preparations and administration steps were detected. These errors were divided into preparation errors in 59% of cases such as changing the dilution protocol (32%), the use of bad solvent (11%) and administration errors in 41% of cases as errors timing of administration (18%) or omission of administration (9%). This study showed a high rate of errors during stages of preparation and administration of injectable drugs. In order to optimize the care of newborns and reduce the risk of medication errors, corrective actions have been implemented through the establishment of a quality assurance system which consisted of the development of injectable drugs preparation procedures, the introduction of a labeling system and staff training.

Semantic error patterns on the Boston Naming Test in normal aging, amnestic mild cognitive impairment, and mild Alzheimer's disease: is there semantic disruption?

PubMed

Balthazar, Marcio Luiz Figueredo; Cendes, Fernando; Damasceno, Benito Pereira

2008-11-01

Naming difficulty is common in Alzheimer's disease (AD), but the nature of this problem is not well established. The authors investigated the presence of semantic breakdown and the pattern of general and semantic errors in patients with mild AD, patients with amnestic mild cognitive impairment (aMCI), and normal controls by examining their spontaneous answers on the Boston Naming Test (BNT) and verifying whether they needed or were benefited by semantic and phonemic cues. The errors in spontaneous answers were classified in four mutually exclusive categories (semantic errors, visual paragnosia, phonological errors, and omission errors), and the semantic errors were further subclassified as coordinate, superordinate, and circumlocutory. Patients with aMCI performed normally on the BNT and needed fewer semantic and phonemic cues than patients with mild AD. After semantic cues, subjects with aMCI and control subjects gave more correct answers than patients with mild AD, but after phonemic cues, there was no difference between the three groups, suggesting that the low performance of patients with AD cannot be completely explained by semantic breakdown. Patterns of spontaneous naming errors and subtypes of semantic errors were similar in the three groups, with decreasing error frequency from coordinate to superordinate to circumlocutory subtypes.

About errors, inaccuracies and sterotypes: Mistakes in media coverage - and how to reduce them

NASA Astrophysics Data System (ADS)

Scherzler, D.

2010-12-01

The main complaint made by scientists about the work of journalists is that there are mistakes and inaccuracies in TV programmes, radio or the print media. This seems to be an important reason why too few researchers want to deal with journalists. Such scientists regularly discover omissions, errors, exaggerations, distortions, stereotypes and sensationalism in the media. Surveys carried out on so-called accuracy research seem to concede this point as well. Errors frequently occur in journalism, and it is the task of the editorial offices to work very hard in order to keep the number of errors as low as possible. On closer inspection some errors, however, turn out to be simplifications and omissions. Both are obligatory in journalism and do not automatically cause factual errors. This paper examines the different kinds of mistakes and misleading information that scientists observe in the mass media. By giving a view from inside the mass media it tries to explain how errors come to exist in the journalist’s working routines. It outlines that the criteria of journalistic quality which scientists and science journalists apply differ substantially. The expectation of many scientists is that good science journalism passes on their results to the public in as “unadulterated” a form as possible. The author suggests, however, that quality criteria for journalism cannot be derived from how true to detail and how comprehensively it reports on science, nor to what extent the journalistic presentation is “correct” in the eyes of the researcher. The paper suggests in its main part that scientists who are contacted or interviewed by the mass media should not accept that errors just happen. On the contrary, they can do a lot to help preventing mistakes that might occur in the journalistic product. The author proposes several strategies how scientists and press information officers could identify possible errors, stereotypes and exaggeration by journalists in advance and how they could anticipate and prevent them to a remarkable extent. At the same time phenomena of the so called media society influence how appropriately science is portrayed by the mass media. So-called medialisation, overload scenarios and monopolistic influences on public opinion are the main terms that will shortly be discussed. A qualitatively demanding presentation of geosciences in the mass media is a goal which means a lot to good journalists as well as to scientists. Therefore, the paper argues, it is important that scientists do get involved when journalists are looking for an interview partner or have a question.

Mapping global surface water inundation dynamics using synergistic information from SMAP, AMSR2 and Landsat

NASA Astrophysics Data System (ADS)

Du, J.; Kimball, J. S.; Galantowicz, J. F.; Kim, S.; Chan, S.; Reichle, R. H.; Jones, L. A.; Watts, J. D.

2017-12-01

A method to monitor global land surface water (fw) inundation dynamics was developed by exploiting the enhanced fw sensitivity of L-band (1.4 GHz) passive microwave observations from the Soil Moisture Active Passive (SMAP) mission. The L-band fw (fwLBand) retrievals were derived using SMAP H-polarization brightness temperature (Tb) observations and predefined L-band reference microwave emissivities for water and land endmembers. Potential soil moisture and vegetation contributions to the microwave signal were represented from overlapping higher frequency Tb observations from AMSR2. The resulting fwLBand global record has high temporal sampling (1-3 days) and 36-km spatial resolution. The fwLBand annual averages corresponded favourably (R=0.84, p<0.001) with a 250-m resolution static global water map (MOD44W) aggregated at the same spatial scale, while capturing significant inundation variations worldwide. The monthly fwLBand averages also showed seasonal inundation changes consistent with river discharge records within six major US river basins. An uncertainty analysis indicated generally reliable fwLBand performance for major land cover areas and under low to moderate vegetation cover, but with lower accuracy for detecting water bodies covered by dense vegetation. Finer resolution (30-m) fwLBand results were obtained for three sub-regions in North America using an empirical downscaling approach and ancillary global Water Occurrence Dataset (WOD) derived from the historical Landsat record. The resulting 30-m fwLBand retrievals showed favourable classification accuracy for water (commission error 31.84%; omission error 28.08%) and land (commission error 0.82%; omission error 0.99%) and seasonal wet and dry periods when compared to independent water maps derived from Landsat-8 imagery. The new fwLBand algorithms and continuing SMAP and AMSR2 operations provide for near real-time, multi-scale monitoring of global surface water inundation dynamics, potentially benefiting hydrological monitoring, flood assessments, and global climate and carbon modeling.

Fix success and accuracy of GPS radio collars in old-growth temperate coniferous forests

USGS Publications Warehouse

Sager-Fradkin, Kimberly A.; Jenkins, Kurt J.; Hoffman, Robert L.; Happe, P.; Beecham, J.; Wright, R.G.

2007-01-01

Global Positioning System (GPS) telemetry is used extensively to study animal distribution and resource selection patterns but is susceptible to biases resulting from data omission and spatial inaccuracies. These data errors may cause misinterpretation of wildlife habitat selection or spatial use patterns. We used both stationary test collars and collared free-ranging American black bears (Ursus americanus) to quantify systemic data loss and location error of GPS telemetry in mountainous, old-growth temperate forests of Olympic National Park, Washington, USA. We developed predictive models of environmental factors that influence the probability of obtaining GPS locations and evaluated the ability of weighting factors derived from these models to mitigate data omission biases from collared bears. We also examined the effects of microhabitat on collar fix success rate and examined collar accuracy as related to elevation changes between successive fixes. The probability of collars successfully obtaining location fixes was positively associated with elevation and unobstructed satellite view and was negatively affected by the interaction of overstory canopy and satellite view. Test collars were 33% more successful at acquiring fixes than those on bears. Fix success rates of collared bears varied seasonally and diurnally. Application of weighting factors to individual collared bear fixes recouped only 6% of lost data and failed to reduce seasonal or diurnal variation in fix success, suggesting that variables not included in our model contributed to data loss. Test collars placed to mimic bear bedding sites received 16% fewer fixes than randomly placed collars, indicating that microhabitat selection may contribute to data loss for wildlife equipped with GPS collars. Horizontal collar errors of >800 m occurred when elevation changes between successive fixes were >400 m. We conclude that significant limitations remain in accounting for data loss and error inherent in using GPS telemetry in coniferous forest ecosystems and that, at present, resource selection patterns of large mammals derived from GPS telemetry should be interpreted cautiously.

Effects of yohimbine and drug cues on impulsivity and attention in cocaine-dependent men and women and sex-matched controls.

PubMed

Moran-Santa Maria, M M; Baker, N L; McRae-Clark, A L; Prisciandaro, J J; Brady, K T

2016-05-01

Deficits in executive function have been associated with risk for relapse. Data from previous studies suggest that relapse may be triggered by stress and drug-paired cues and that there are significant sex differences in the magnitude of these responses. The aim of this study was to examine the impact of the pharmacological stressor and alpha-2 adrenergic receptor antagonist yohimbine and cocaine cues on executive function in cocaine-dependent men and women. In a double-blind placebo controlled cross-over study, cocaine-dependent men (n=12), cocaine-dependent women (n=27), control men (n=31) and control women (n=25) received either yohimbine or placebo prior to two cocaine cue exposure sessions. Participants performed the Connors' Continuous Performance Test II prior to medication/placebo administration and immediately after each cue exposure session Healthy controls had a significant increase in commission errors under the yohimbine condition [RR (95% CI)=1.1 (1.0-1.3), χ(2)1=2.0, p=0.050]. Cocaine-dependent individuals exhibited a significant decrease in omission errors under the yohimbine condition [RR (95% CI)=0.6 (0.4-0.8), χ(2)1=8.6, p=0.003]. Cocaine-dependent women had more omission errors as compared to cocaine-dependent men regardless of treatment [RR (95% CI)=7.2 (3.6-14.7), χ(2)1=30.1, p<0.001]. Cocaine-dependent women exhibited a slower hit reaction time as compared to cocaine-dependent men [Female 354 ± 13 vs. Male 415 ± 14; t89=2.6, p=0.012]. These data add to a growing literature demonstrating significant sex differences in behaviors associated with relapse in cocaine-dependent individuals. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

OROS-methylphenidate efficacy on specific executive functioning deficits in adults with ADHD: a randomized, placebo-controlled cross-over study.

PubMed

Bron, Tannetje I; Bijlenga, Denise; Boonstra, A Marije; Breuk, Minda; Pardoen, Willem F H; Beekman, Aartjan T F; Kooij, J J Sandra

2014-04-01

Attention-deficit/hyperactivity disorder (ADHD) is linked to impaired executive functioning (EF). This is the first study to objectively investigate the effects of a long-acting methylphenidate on neurocognitive test performance of adults with ADHD. Twenty-two adults with ADHD participated in a 6-weeks study examining the effect of osmotic-release oral system methylphenidate (OROS-mph) on continuous performance tests (CPTs; objective measures), and on the self-reported ADHD rating scale (subjective measure) using a randomized, double-blind, placebo-controlled cross-over design. OROS-mph significantly improved reaction time variability (RTV), commission errors (CE) and d-prime (DP) as compared to baseline (Cohen's d>.50), but did not affect hit reaction time (HRT) or omission errors (OE). Compared to placebo, OROS-mph only significantly influenced RTV on one of two CPTs (p<.050). Linear regression analyses showed predictive ability of more beneficial OROS-mph effects in ADHD patients with higher EF severity (RTV: β=.670, t=2.097, p=.042; omission errors (OE): β=-.098, t=-4.759, p<.001), and with more severe ADHD symptoms (RTV: F=6.363, p=.019; HRT: F=3.914, p=.061). Side effects rates were substantially but non-significantly greater for OROS-mph compared to placebo (77% vs. 46%, p=.063). OROS-mph effects indicated RTV as the most sensitive parameter for measuring both neuropsychological and behavioral deficits in adults with ADHD. These findings suggest RTV as an endophenotypic parameter for ADHD symptomatology, and propose CPTs as an objective method for monitoring methylphenidate titration. Copyright © 2014 Elsevier B.V. and ECNP. All rights reserved.

Treatment of Allergic Rhinitis Is Associated with Improved Attention Performance in Children: The Allergic Rhinitis Cohort Study for Kids (ARCO-Kids)

PubMed Central

Han, Doo Hee; Won, Tae-Bin; Kim, Dong-Young; Kim, Jeong-Whun

2014-01-01

Background It has been well known that pediatric allergic rhinitis was associated with poor performance at school due to attention deficit. However, there were no cohort studies for the effect of treatment of allergic rhinitis on attention performance in pediatric population. Thus, the aim of this study was to investigate whether attention performance was improved after treatment in children with allergic rhinitis. Methods In this ARCO-Kids (Allergic Rhinitis Cohort Study for Kids), consecutive pediatric patients with rhinitis symptoms underwent a skin prick test and computerized comprehensive attention test. According to the skin prick test results, the children were diagnosed as allergic rhinitis or non- allergic rhinitis. All of the patients were regularly followed up and treated with oral medication or intranasal corticosteroid sprays. The comprehensive attention tests consisted of sustained and divided attention tasks. Each of the tasks was assessed by the attention score which was calculated by the number of omission and commission errors. The comprehension attention test was repeated after 1 year. Results A total of 797 children with allergic rhinitis and 239 children with non-allergic rhinitis were included. Initially, the attention scores of omission and commission errors on divided attention task were significantly lower in children with allergic rhinitis than in children with non-allergic rhinitis. After 1 year of treatment, children with allergic rhinitis showed improvement in attention: commission error of sustained (95.6±17.0 vs 97.0±16.6) and divided attention task (99.1±15.8 vs 91.8±23.5). Meanwhile, there was no significant difference of attention scores in children with non-allergic rhinitis. Conclusions Our study showed that management of allergic rhinitis might be associated with improvement of attention. PMID:25330316

Integrated Active Fire Retrievals and Biomass Burning Emissions Using Complementary Near-Coincident Ground, Airborne and Spaceborne Sensor Data

NASA Technical Reports Server (NTRS)

Schroeder, Wilfrid; Ellicott, Evan; Ichoku, Charles; Ellison, Luke; Dickinson, Matthew B.; Ottmar, Roger D.; Clements, Craig; Hall, Dianne; Ambrosia, Vincent; Kremens, Robert

2013-01-01

Ground, airborne and spaceborne data were collected for a 450 ha prescribed fire implemented on 18 October 2011 at the Henry W. Coe State Park in California. The integration of various data elements allowed near coincident active fire retrievals to be estimated. The Autonomous Modular Sensor-Wildfire (AMS) airborne multispectral imaging system was used as a bridge between ground and spaceborne data sets providing high quality reference information to support satellite fire retrieval error analyses and fire emissions estimates. We found excellent agreement between peak fire radiant heat flux data (less than 1% error) derived from near-coincident ground radiometers and AMS. Both MODIS and GOES imager active fire products were negatively influenced by the presence of thick smoke, which was misclassified as cloud by their algorithms, leading to the omission of fire pixels beneath the smoke, and resulting in the underestimation of their retrieved fire radiative power (FRP) values for the burn plot, compared to the reference airborne data. Agreement between airborne and spaceborne FRP data improved significantly after correction for omission errors and atmospheric attenuation, resulting in as low as 5 difference between AquaMODIS and AMS. Use of in situ fuel and fire energy estimates in combination with a collection of AMS, MODIS, and GOES FRP retrievals provided a fuel consumption factor of 0.261 kg per MJ, total energy release of 14.5 x 10(exp 6) MJ, and total fuel consumption of 3.8 x 10(exp 6) kg. Fire emissions were calculated using two separate techniques, resulting in as low as 15 difference for various species

Prediction error and somatosensory insula activation in women recovered from anorexia nervosa

PubMed Central

Frank, Guido K.W.; Collier, Shaleise; Shott, Megan E.; O’Reilly, Randall C.

2016-01-01

Background Previous research in patients with anorexia nervosa showed heightened brain response during a taste reward conditioning task and heightened sensitivity to rewarding and punishing stimuli. Here we tested the hypothesis that individuals recovered from anorexia nervosa would also experience greater brain activation during this task as well as higher sensitivity to salient stimuli than controls. Methods Women recovered from restricting-type anorexia nervosa and healthy control women underwent fMRI during application of a prediction error taste reward learning paradigm. Results Twenty-four women recovered from anorexia nervosa (mean age 30.3 ± 8.1 yr) and 24 control women (mean age 27.4 ± 6.3 yr) took part in this study. The recovered anorexia nervosa group showed greater left posterior insula activation for the prediction error model analysis than the control group (family-wise error– and small volume–corrected p < 0.05). A group × condition analysis found greater posterior insula response in women recovered from anorexia nervosa than controls for unexpected stimulus omission, but not for unexpected receipt. Sensitivity to punishment was elevated in women recovered from anorexia nervosa. Limitations This was a cross-sectional study, and the sample size was modest. Conclusion Anorexia nervosa after recovery is associated with heightened prediction error–related brain response in the posterior insula as well as greater response to unexpected reward stimulus omission. This finding, together with behaviourally increased sensitivity to punishment, could indicate that individuals recovered from anorexia nervosa are particularly responsive to punishment. The posterior insula processes somatosensory stimuli, including unexpected bodily states, and greater response could indicate altered perception or integration of unexpected or maybe unwanted bodily feelings. Whether those findings develop during the ill state or whether they are biological traits requires further study. PMID:26836623

At least some errors are randomly generated (Freud was wrong)

NASA Technical Reports Server (NTRS)

Sellen, A. J.; Senders, J. W.

1986-01-01

An experiment was carried out to expose something about human error generating mechanisms. In the context of the experiment, an error was made when a subject pressed the wrong key on a computer keyboard or pressed no key at all in the time allotted. These might be considered, respectively, errors of substitution and errors of omission. Each of seven subjects saw a sequence of three digital numbers, made an easily learned binary judgement about each, and was to press the appropriate one of two keys. Each session consisted of 1,000 presentations of randomly permuted, fixed numbers broken into 10 blocks of 100. One of two keys should have been pressed within one second of the onset of each stimulus. These data were subjected to statistical analyses in order to probe the nature of the error generating mechanisms. Goodness of fit tests for a Poisson distribution for the number of errors per 50 trial interval and for an exponential distribution of the length of the intervals between errors were carried out. There is evidence for an endogenous mechanism that may best be described as a random error generator. Furthermore, an item analysis of the number of errors produced per stimulus suggests the existence of a second mechanism operating on task driven factors producing exogenous errors. Some errors, at least, are the result of constant probability generating mechanisms with error rate idiosyncratically determined for each subject.

Medical Error and Moral Luck.

PubMed

Hubbeling, Dieneke

2016-09-01

This paper addresses the concept of moral luck. Moral luck is discussed in the context of medical error, especially an error of omission that occurs frequently, but only rarely has adverse consequences. As an example, a failure to compare the label on a syringe with the drug chart results in the wrong medication being administered and the patient dies. However, this error may have previously occurred many times with no tragic consequences. Discussions on moral luck can highlight conflicting intuitions. Should perpetrators receive a harsher punishment because of an adverse outcome, or should they be dealt with in the same way as colleagues who have acted similarly, but with no adverse effects? An additional element to the discussion, specifically with medical errors, is that according to the evidence currently available, punishing individual practitioners does not seem to be effective in preventing future errors. The following discussion, using relevant philosophical and empirical evidence, posits a possible solution for the moral luck conundrum in the context of medical error: namely, making a distinction between the duty to make amends and assigning blame. Blame should be assigned on the basis of actual behavior, while the duty to make amends is dependent on the outcome.

Acetaminophen attenuates error evaluation in cortex

PubMed Central

Kam, Julia W.Y.; Heine, Steven J.; Inzlicht, Michael; Handy, Todd C.

2016-01-01

Acetaminophen has recently been recognized as having impacts that extend into the affective domain. In particular, double blind placebo controlled trials have revealed that acetaminophen reduces the magnitude of reactivity to social rejection, frustration, dissonance and to both negatively and positively valenced attitude objects. Given this diversity of consequences, it has been proposed that the psychological effects of acetaminophen may reflect a widespread blunting of evaluative processing. We tested this hypothesis using event-related potentials (ERPs). Sixty-two participants received acetaminophen or a placebo in a double-blind protocol and completed the Go/NoGo task. Participants’ ERPs were observed following errors on the Go/NoGo task, in particular the error-related negativity (ERN; measured at FCz) and error-related positivity (Pe; measured at Pz and CPz). Results show that acetaminophen inhibits the Pe, but not the ERN, and the magnitude of an individual’s Pe correlates positively with omission errors, partially mediating the effects of acetaminophen on the error rate. These results suggest that recently documented affective blunting caused by acetaminophen may best be described as an inhibition of evaluative processing. They also contribute to the growing work suggesting that the Pe is more strongly associated with conscious awareness of errors relative to the ERN. PMID:26892161

Correcting AUC for Measurement Error.

PubMed

Rosner, Bernard; Tworoger, Shelley; Qiu, Weiliang

2015-12-01

Diagnostic biomarkers are used frequently in epidemiologic and clinical work. The ability of a diagnostic biomarker to discriminate between subjects who develop disease (cases) and subjects who do not (controls) is often measured by the area under the receiver operating characteristic curve (AUC). The diagnostic biomarkers are usually measured with error. Ignoring measurement error can cause biased estimation of AUC, which results in misleading interpretation of the efficacy of a diagnostic biomarker. Several methods have been proposed to correct AUC for measurement error, most of which required the normality assumption for the distributions of diagnostic biomarkers. In this article, we propose a new method to correct AUC for measurement error and derive approximate confidence limits for the corrected AUC. The proposed method does not require the normality assumption. Both real data analyses and simulation studies show good performance of the proposed measurement error correction method.

System Related Interventions to Reduce Diagnostic Error: A Narrative Review

PubMed Central

Singh, Hardeep; Graber, Mark L.; Kissam, Stephanie M.; Sorensen, Asta V.; Lenfestey, Nancy F.; Tant, Elizabeth M.; Henriksen, Kerm; LaBresh, Kenneth A.

2013-01-01

Background Diagnostic errors (missed, delayed, or wrong diagnosis) have gained recent attention and are associated with significant preventable morbidity and mortality. We reviewed the recent literature to identify interventions that have been, or could be, implemented to address systems-related factors that contribute directly to diagnostic error. Methods We conducted a comprehensive search using multiple search strategies. We first identified candidate articles in English between 2000 and 2009 from a PubMed search that exclusively evaluated for articles related to diagnostic error or delay. We then sought additional papers from references in the initial dataset, searches of additional databases, and subject matter experts. Articles were included if they formally evaluated an intervention to prevent or reduce diagnostic error; however, we also included papers if interventions were suggested and not tested in order to inform the state-of-the science on the topic. We categorized interventions according to the step in the diagnostic process they targeted: patient-provider encounter, performance and interpretation of diagnostic tests, follow-up and tracking of diagnostic information, subspecialty and referral-related; and patient-specific. Results We identified 43 articles for full review, of which 6 reported tested interventions and 37 contained suggestions for possible interventions. Empirical studies, though somewhat positive, were non-experimental or quasi-experimental and included a small number of clinicians or health care sites. Outcome measures in general were underdeveloped and varied markedly between studies, depending on the setting or step in the diagnostic process involved. Conclusions Despite a number of suggested interventions in the literature, few empirical studies have tested interventions to reduce diagnostic error in the last decade. Advancing the science of diagnostic error prevention will require more robust study designs and rigorous definitions of diagnostic processes and outcomes to measure intervention effects. PMID:22129930

Evaluation of wildlife-habitat relationships data base for predicting bird community composition in central California chaparral and blue oak woodlands

USGS Publications Warehouse

Avery, M.L.; van Riper, Charles

1990-01-01

The California Wildlife-Habitat Relationships (WHR) database can be used to assist resource managers to evaluate effects of habitat manipulations on wildlife. The accuracy of predictions from WHR was evaluated using data from bird surveys conducted during winter and spring 1984 and 1985 in chamise (Adenostema fasciculata) chaparral, mixed chaparral and blue oak (Quercus douglasii) woodland. Considerable variability between habitat types was found for errors both of commission and of omission.

Systematic Asymmetries in Perception and Production of L2 Inflections in Mandarin L2 Learners of English: The Effects of Phonotactics, Salience, and Processing Pressure on Inflectional Variability

ERIC Educational Resources Information Center

Bonner, Timothy E.

2013-01-01

The study of language production by adults who are learning a second language (L2) has received a good deal of attention especially when it comes to omission of inflectional morphemes within L2 utterances. Several explanations have been proposed for these inflectional errors. One explanation is that the L2 learner simply does not have the L2…

The global burden of diagnostic errors in primary care

PubMed Central

Singh, Hardeep; Schiff, Gordon D; Graber, Mark L; Onakpoya, Igho; Thompson, Matthew J

2017-01-01

Diagnosis is one of the most important tasks performed by primary care physicians. The World Health Organization (WHO) recently prioritized patient safety areas in primary care, and included diagnostic errors as a high-priority problem. In addition, a recent report from the Institute of Medicine in the USA, ‘Improving Diagnosis in Health Care’, concluded that most people will likely experience a diagnostic error in their lifetime. In this narrative review, we discuss the global significance, burden and contributory factors related to diagnostic errors in primary care. We synthesize available literature to discuss the types of presenting symptoms and conditions most commonly affected. We then summarize interventions based on available data and suggest next steps to reduce the global burden of diagnostic errors. Research suggests that we are unlikely to find a ‘magic bullet’ and confirms the need for a multifaceted approach to understand and address the many systems and cognitive issues involved in diagnostic error. Because errors involve many common conditions and are prevalent across all countries, the WHO’s leadership at a global level will be instrumental to address the problem. Based on our review, we recommend that the WHO consider bringing together primary care leaders, practicing frontline clinicians, safety experts, policymakers, the health IT community, medical education and accreditation organizations, researchers from multiple disciplines, patient advocates, and funding bodies among others, to address the many common challenges and opportunities to reduce diagnostic error. This could lead to prioritization of practice changes needed to improve primary care as well as setting research priorities for intervention development to reduce diagnostic error. PMID:27530239

Identification of factors associated with diagnostic error in primary care.

PubMed

Minué, Sergio; Bermúdez-Tamayo, Clara; Fernández, Alberto; Martín-Martín, José Jesús; Benítez, Vivian; Melguizo, Miguel; Caro, Araceli; Orgaz, María José; Prados, Miguel Angel; Díaz, José Enrique; Montoro, Rafael

2014-05-12

Missed, delayed or incorrect diagnoses are considered to be diagnostic errors. The aim of this paper is to describe the methodology of a study to analyse cognitive aspects of the process by which primary care (PC) physicians diagnose dyspnoea. It examines the possible links between the use of heuristics, suboptimal cognitive acts and diagnostic errors, using Reason's taxonomy of human error (slips, lapses, mistakes and violations). The influence of situational factors (professional experience, perceived overwork and fatigue) is also analysed. Cohort study of new episodes of dyspnoea in patients receiving care from family physicians and residents at PC centres in Granada (Spain). With an initial expected diagnostic error rate of 20%, and a sampling error of 3%, 384 episodes of dyspnoea are calculated to be required. In addition to filling out the electronic medical record of the patients attended, each physician fills out 2 specially designed questionnaires about the diagnostic process performed in each case of dyspnoea. The first questionnaire includes questions on the physician's initial diagnostic impression, the 3 most likely diagnoses (in order of likelihood), and the diagnosis reached after the initial medical history and physical examination. It also includes items on the physicians' perceived overwork and fatigue during patient care. The second questionnaire records the confirmed diagnosis once it is reached. The complete diagnostic process is peer-reviewed to identify and classify the diagnostic errors. The possible use of heuristics of representativeness, availability, and anchoring and adjustment in each diagnostic process is also analysed. Each audit is reviewed with the physician responsible for the diagnostic process. Finally, logistic regression models are used to determine if there are differences in the diagnostic error variables based on the heuristics identified. This work sets out a new approach to studying the diagnostic decision-making process in PC, taking advantage of new technologies which allow immediate recording of the decision-making process.

Identification of factors associated with diagnostic error in primary care

PubMed Central

2014-01-01

Background Missed, delayed or incorrect diagnoses are considered to be diagnostic errors. The aim of this paper is to describe the methodology of a study to analyse cognitive aspects of the process by which primary care (PC) physicians diagnose dyspnoea. It examines the possible links between the use of heuristics, suboptimal cognitive acts and diagnostic errors, using Reason’s taxonomy of human error (slips, lapses, mistakes and violations). The influence of situational factors (professional experience, perceived overwork and fatigue) is also analysed. Methods Cohort study of new episodes of dyspnoea in patients receiving care from family physicians and residents at PC centres in Granada (Spain). With an initial expected diagnostic error rate of 20%, and a sampling error of 3%, 384 episodes of dyspnoea are calculated to be required. In addition to filling out the electronic medical record of the patients attended, each physician fills out 2 specially designed questionnaires about the diagnostic process performed in each case of dyspnoea. The first questionnaire includes questions on the physician’s initial diagnostic impression, the 3 most likely diagnoses (in order of likelihood), and the diagnosis reached after the initial medical history and physical examination. It also includes items on the physicians’ perceived overwork and fatigue during patient care. The second questionnaire records the confirmed diagnosis once it is reached. The complete diagnostic process is peer-reviewed to identify and classify the diagnostic errors. The possible use of heuristics of representativeness, availability, and anchoring and adjustment in each diagnostic process is also analysed. Each audit is reviewed with the physician responsible for the diagnostic process. Finally, logistic regression models are used to determine if there are differences in the diagnostic error variables based on the heuristics identified. Discussion This work sets out a new approach to studying the diagnostic decision-making process in PC, taking advantage of new technologies which allow immediate recording of the decision-making process. PMID:24884984

Land use in the Paraiba Valley through remotely sensed data. [Brazil

NASA Technical Reports Server (NTRS)

Dejesusparada, N. (Principal Investigator); Lombardo, M. A.; Novo, E. M. L. D.; Niero, M.; Foresti, C.

1980-01-01

A methodology for land use survey was developed and land use modification rates were determined using LANDSAT imagery of the Paraiba Valley (state of Sao Paulo). Both visual and automatic interpretation methods were employed to analyze seven land use classes: urban area, industrial area, bare soil, cultivated area, pastureland, reforestation and natural vegetation. By means of visual interpretation, little spectral differences are observed among those classes. The automatic classification of LANDSAT MSS data using maximum likelihood algorithm shows a 39% average error of omission and a 3.4% error of inclusion for the seven classes. The complexity of land uses in the study area, the large spectral variations of analyzed classes, and the low resolution of LANDSAT data influenced the classification results.

Medication regimens of frail older adults after discharge from home health care

PubMed Central

Lancaster, Rachelle; Marek, Karen Dorman; Bub, Linda Denison; Stetzer, Frank

2015-01-01

The purpose of this study was to examine the number and types of discrepancy errors present after discharge from home health care in older adults at risk for medication management problems following an episode of home healthcare. More than half of the 414 participants had at least one medication discrepancy error (53.2%, n=219) with the participant’s omission of a prescribed medication (n=118, 30.17%) occurring most frequently. The results of this study support the need for home health clinicians to perform frequent assessments of medication regimens to ensure that the older adults are aware of the regimen they are prescribed, and have systems in place to support them in managing their medications. PMID:25268528

How to report and interpret screening test properties: guidelines for driving researchers.

PubMed

Weaver, Bruce; Walter, Stephen D; Bédard, Michel

2014-01-01

One important goal of driving research is the development of a short but valid office-based screening test for fitness to drive of aging drivers. Several candidate tests have been proposed already, and no doubt others will be proposed in the future. It might seem obvious that authors advocating for the adoption of a particular screening test or procedure should report sensitivity, specificity, and other common screening test properties. Unfortunately, driving researchers have frequently failed to report any screening test properties. Others have reported screening test properties but have made basic mistakes such as calculating predictive values of positive and negative tests but reporting them incorrectly as sensitivity and specificity. These omissions and errors suggest that some driving researchers may be unaware of the importance of accurately reporting test properties when proposing a screening procedure and that others may need a refresher on how to calculate and interpret the most common screening test properties. Many good learning resources for screening and diagnostic tests are available, but most of them are intended for students and researchers in medicine, epidemiology, or public health. We hope that this tutorial in a prominent transportation journal will help lead to improved reporting and interpretation of screening test properties in articles that assess the usefulness of potential screening tools for fitness to drive.

Dual Processing and Diagnostic Errors

ERIC Educational Resources Information Center

Norman, Geoff

2009-01-01

In this paper, I review evidence from two theories in psychology relevant to diagnosis and diagnostic errors. "Dual Process" theories of thinking, frequently mentioned with respect to diagnostic error, propose that categorization decisions can be made with either a fast, unconscious, contextual process called System 1 or a slow, analytical,…

Accuracy of manual entry of drug administration data into an anesthesia information management system.

PubMed

Avidan, Alexander; Dotan, Koren; Weissman, Charles; Cohen, Matan J; Levin, Phillip D

2014-11-01

Data on drug administration are entered manually into anesthesia information management systems (AIMS). This study examined whether these data are accurate regarding drug name, dose administered, and time of administration, and whether the stage of anesthesia influences data accuracy. Real-time observational data on drug administration during elective operations were compared with computerized information on drug administration entered by anesthesiologists. A trained observer (K.D.) performed the observations. Data were collected during 57 operations which included 596 separate occasions of drug administration by 22 anesthesiologists. No AIMS records were found for 90 (15.1%) occasions of drug administration (omissions), while there were 11 (1.8%) AIMS records where drug administration was not observed. The AIMS and observer data matched for drug name on 495 of 596 (83.1%) occasions, for dose on 439 of 495 (92.5%) occasions, and for time on 476 of 495 (96.2%) occasions. Amongst the 90 omitted records, 34 (37.8%) were for vasoactive drugs with 24 (27.7%) for small doses of hypnotics. Omissions occurred mostly during maintenance: 50 of 153 (24.6%), followed by induction: 30 of 325 (9.2%) and emergence: 10 of 57 (17.5%) (P < 0.001). Time and dose inaccuracies occurred mainly during induction, followed by maintenance and emergence; time inaccuracies were 7/325 (8.3%), 10/203 (4.9%), and 0/57 (0%), respectively (P = 0.07), and dose inaccuracies were 15/325 (4.6%), 3/203 (1.5%), and 1/57 (1.7%), respectively (P = 0.11). The range of accuracy varies when anesthesiologists manually enter drug administration data into an AIMS. Charting omissions represent the largest cause of inaccuracy, principally by omissions of records for vasopressors and small doses of hypnotic drugs. Manually entered drug administration data are not without errors. Accuracy of entering drug administration data remains the responsibility of the anesthesiologist.

The global burden of diagnostic errors in primary care.

PubMed

Singh, Hardeep; Schiff, Gordon D; Graber, Mark L; Onakpoya, Igho; Thompson, Matthew J

2017-06-01

Diagnosis is one of the most important tasks performed by primary care physicians. The World Health Organization (WHO) recently prioritized patient safety areas in primary care, and included diagnostic errors as a high-priority problem. In addition, a recent report from the Institute of Medicine in the USA, 'Improving Diagnosis in Health Care ', concluded that most people will likely experience a diagnostic error in their lifetime. In this narrative review, we discuss the global significance, burden and contributory factors related to diagnostic errors in primary care. We synthesize available literature to discuss the types of presenting symptoms and conditions most commonly affected. We then summarize interventions based on available data and suggest next steps to reduce the global burden of diagnostic errors. Research suggests that we are unlikely to find a 'magic bullet' and confirms the need for a multifaceted approach to understand and address the many systems and cognitive issues involved in diagnostic error. Because errors involve many common conditions and are prevalent across all countries, the WHO's leadership at a global level will be instrumental to address the problem. Based on our review, we recommend that the WHO consider bringing together primary care leaders, practicing frontline clinicians, safety experts, policymakers, the health IT community, medical education and accreditation organizations, researchers from multiple disciplines, patient advocates, and funding bodies among others, to address the many common challenges and opportunities to reduce diagnostic error. This could lead to prioritization of practice changes needed to improve primary care as well as setting research priorities for intervention development to reduce diagnostic error. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

EPs welcome new focus on reducing diagnostic errors.

PubMed

2015-12-01

Emergency medicine leaders welcome a major new report from the Institute of Medicine (IOM) calling on providers, policy makers, and government agencies to institute changes to reduce the incidence of diagnostic errors. The 369-page report, "Improving Diagnosis in Health Care," states that the rate of diagnostic errors in this country is unacceptably high and offers a long list of recommendations aimed at addressing the problem. These include large, systemic changes that involve improvements in multiple areas, including health information technology (HIT), professional education, teamwork, and payment reform. Further, of particular interest to emergency physicians are recommended changes to the liability system. The authors of the IOM report state that while most people will likely experience a significant diagnostic error in their lifetime, the importance of this problem is under-appreciated. According to conservative estimates, the report says 5% of adults who seek outpatient care each year experience a diagnostic error. The report also notes that research over many decades shows diagnostic errors contribute to roughly 10% of all.deaths. The report says more steps need to be taken to facilitate inter-professional and intra-professional teamwork throughout the diagnostic process. Experts concur with the report's finding that mechanisms need to be developed so that providers receive ongoing feedback on their diagnostic performance.

Tracking Progress in Improving Diagnosis: A Framework for Defining Undesirable Diagnostic Events.

PubMed

Olson, Andrew P J; Graber, Mark L; Singh, Hardeep

2018-01-29

Diagnostic error is a prevalent, harmful, and costly phenomenon. Multiple national health care and governmental organizations have recently identified the need to improve diagnostic safety as a high priority. A major barrier, however, is the lack of standardized, reliable methods for measuring diagnostic safety. Given the absence of reliable and valid measures for diagnostic errors, we need methods to help establish some type of baseline diagnostic performance across health systems, as well as to enable researchers and health systems to determine the impact of interventions for improving the diagnostic process. Multiple approaches have been suggested but none widely adopted. We propose a new framework for identifying "undesirable diagnostic events" (UDEs) that health systems, professional organizations, and researchers could further define and develop to enable standardized measurement and reporting related to diagnostic safety. We propose an outline for UDEs that identifies both conditions prone to diagnostic error and the contexts of care in which these errors are likely to occur. Refinement and adoption of this framework across health systems can facilitate standardized measurement and reporting of diagnostic safety.

[Qualitative evaluation of blood products records in a hospital].

PubMed

Lartigue, B; Catillon, E

2012-02-01

This study aimed at evaluating the qualitative performance of blood products traceability from paper and electronic medical records in a hospital. Quality of date/time documentation was assessed by detection, for 20minutes or more, of chronological errors and inter-source inconsistencies, in a random sample of 168 blood products transfused during 2009. A receipt date/time was confirmed in 52% of paper records; a data entry error was attested in 25% of paper records, and 21% of electronic records. A transfusion date/time was notified in 93% of paper records, with a data entry error in 26% of paper records and 25% of electronic records. The patient medical record held at least one date/time error in 18% and 17%, for receipt and transfusion respectively. Environmental factors (clinical setting, urgency, blood product category) did not contributed to data error rates. Although blood products traceability has good quantitative results, the recorded documentation is not qualitative. In our study, data entry errors are similar in electronic or paper records, but the global failure rate is lesser in electronic records because omissions are controlled. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

Adolescent Gender Differences in Cognitive Control Performance and Functional Connectivity Between Default Mode and Fronto-Parietal Networks Within a Self-Referential Context

PubMed Central

Alarcón, Gabriela; Pfeifer, Jennifer H.; Fair, Damien A.; Nagel, Bonnie J.

2018-01-01

Ineffective reduction of functional connectivity between the default mode network (DMN) and frontoparietal network (FPN) during cognitive control can interfere with performance in healthy individuals—a phenomenon present in psychiatric disorders, such as depression. Here, this mechanism is studied in healthy adolescents by examining gender differences in task-regressed functional connectivity using functional magnetic resonance imaging (MRI) and a novel task designed to place the DMN—supporting self-referential processing (SRP)—and FPN—supporting cognitive control—into conflict. Compared to boys, girls showed stronger functional connectivity between DMN and FPN during cognitive control in an SRP context (n = 40; boys = 20), a context that also elicited more errors of omission in girls. The gender difference in errors of omission was mediated by higher self-reported co-rumination—the extensive and repetitive discussion of problems and focus on negative feelings with a same-gender peer—by girls, compared to boys. These findings indicate that placing internal and external attentional demands in conflict lead to persistent functional connectivity between FPN and DMN in girls, but not boys; however, deficits in performance during this context were explained by co-rumination, such that youth with higher co-rumination displayed the largest performance deficits. Previous research shows that co-rumination predicts depressive symptoms during adolescence; thus, gender differences in the mechanisms involved with transitioning from internal to external processing may be relevant for understanding heightened vulnerability for depression in adolescent girls. PMID:29740292

[Phonological characteristics and rehabilitation training of abnormal velar in children with functional articulation disorders].

PubMed

Lina, Xu; Feng, Li; Yanyun, Zhang; Nan, Gao; Mingfang, Hu

2016-12-01

To explore the phonological characteristics and rehabilitation training of abnormal velar in patients with functional articulation disorders (FAD). Eighty-seven patients with FAD were observed of the phonological characteristics of velar. Seventy-two patients with abnormal velar accepted speech training. The correlation and simple linear regression analysis were carried out on abnormal velar articulation and age. The articulation disorder of /g/ mainly showed replacement by /d/, /b/ or omission. /k/ mainly showed replacement by /d/, /t/, /g/, /p/, /b/. /h/ mainly showed replacement by /g/, /f/, /p/, /b/ or omission. The common erroneous articulation forms of /g/, /k/, /h/ were fronting of tongue and replacement by bilabial consonants. When velar combined with vowels contained /a/ and /e/, the main error was fronting of tongue. When velar combined with vowels contained /u/, the errors trended to be replacement by bilabial consonants. After 3 to 10 times of speech training, the number of erroneous words decreased to (6.24±2.61) from (40.28±6.08) before the speech training was established, the difference was statistically significant (Z=-7.379, P=0.000). The number of erroneous words was negatively correlated with age (r=-0.691, P=0.000). The result of simple linear regression analysis showed that the determination coefficient was 0.472. The articulation disorder of velar mainly shows replacement, varies with the vowels. The targeted rehabilitation training hereby established is significantly effective. Age plays an important role in the outcome of velar.

Adolescent Gender Differences in Cognitive Control Performance and Functional Connectivity Between Default Mode and Fronto-Parietal Networks Within a Self-Referential Context.

PubMed

Alarcón, Gabriela; Pfeifer, Jennifer H; Fair, Damien A; Nagel, Bonnie J

2018-01-01

Ineffective reduction of functional connectivity between the default mode network (DMN) and frontoparietal network (FPN) during cognitive control can interfere with performance in healthy individuals-a phenomenon present in psychiatric disorders, such as depression. Here, this mechanism is studied in healthy adolescents by examining gender differences in task-regressed functional connectivity using functional magnetic resonance imaging (MRI) and a novel task designed to place the DMN-supporting self-referential processing (SRP)-and FPN-supporting cognitive control-into conflict. Compared to boys, girls showed stronger functional connectivity between DMN and FPN during cognitive control in an SRP context ( n = 40; boys = 20), a context that also elicited more errors of omission in girls. The gender difference in errors of omission was mediated by higher self-reported co-rumination-the extensive and repetitive discussion of problems and focus on negative feelings with a same-gender peer-by girls, compared to boys. These findings indicate that placing internal and external attentional demands in conflict lead to persistent functional connectivity between FPN and DMN in girls, but not boys; however, deficits in performance during this context were explained by co-rumination, such that youth with higher co-rumination displayed the largest performance deficits. Previous research shows that co-rumination predicts depressive symptoms during adolescence; thus, gender differences in the mechanisms involved with transitioning from internal to external processing may be relevant for understanding heightened vulnerability for depression in adolescent girls.

Critical Care Performance in a Simulated Military Aircraft Cabin Environment.

PubMed

McNeill, Margaret M

2018-04-01

Critical Care Air Transport Teams care for 5% to 10% of injured patients who are transported on military aircraft to definitive treatment facilities. Little is known about how the aeromedical evacuation environment affects care. To determine the effects of 2 stressors of flight, altitude-induced hypoxia and aircraft noise, and to examine the contributions of fatigue and clinical experience on cognitive and physiological performance of the Critical Care Air Transport Team. This repeated measures 2 × 2 × 4 factorial study included 60 military nurses. The participants completed a simulated patient care scenario under aircraft cabin noise and altitude conditions. Differences in cognitive and physiological performance were analyzed using repeated measures analysis of variance. A multiple regression model was developed to determine the independent contributions of fatigue and clinical experience. Critical care scores ( P = .02) and errors and omissions ( P = .047) were negatively affected by noise. Noise was associated with increased respiratory rate ( P = .02). Critical care scores ( P < .001) and errors and omissions ( P = .002) worsened with altitude-induced hypoxemia. Heart rate and respiratory rate increased with altitude-induced hypoxemia; oxygen saturation decreased ( P < .001 for all 3 variables). In a simulated military aircraft environment, the care of critically ill patients was significantly affected by noise and altitude-induced hypoxemia. The participants did not report much fatigue and experience did not play a role, contrary to most findings in the literature. ©2018 American Association of Critical-Care Nurses.

Differential effects of psychomotor stimulants on attentional performance in rats: nicotine, amphetamine, caffeine and methylphenidate.

PubMed

Bizarro, L; Patel, S; Murtagh, C; Stolerman, I P

2004-05-01

Nicotine can improve attentional performance in the rat as assessed by a modified five-choice serial reaction time task (5-CSRTT), but it is not known if the effect is shared with other psychomotor stimulants. This study compared the effects of nicotine, amphetamine, caffeine and methylphenidate on performance in the 5-CSRTT and determined whether presenting stimuli at unpredictable times by using variable inter-trial intervals (ITI) influenced the sensitivity of the task to the drugs. One group of male hooded rats was trained to obtain food reinforcers by nose-poking in response to 1 s light stimuli presented randomly in one of five apertures, with fixed ITI; for a second group of rats, ITI varied randomly (n=12 per group). As observed previously, nicotine (tested in doses of 0.05-0.2 mg/kg) produced dose-related improvements in accuracy, reduced omission errors and response latencies, but increased anticipatory responding. Amphetamine (0.1-0.8 mg/kg) and methylphenidate (2.5-10 mg/kg) increased accuracy and reduced response latency, and decreased anticipatory responding. Caffeine (2.5-20 mg/kg) did not improve performance except at a small dose that decreased omission errors only. Training at different levels of stimulus predictability influenced performance in the undrugged state but had little impact on profiles of responses to the drugs. The findings with methylphenidate support the potential value of the 5-CSRTT for testing drugs that may be useful in the treatment of attention deficit hyperactivity disorder.

Exploring Situational Awareness in Diagnostic Errors in Primary Care

PubMed Central

Singh, Hardeep; Giardina, Traber Davis; Petersen, Laura A.; Smith, Michael; Wilson, Lindsey; Dismukes, Key; Bhagwath, Gayathri; Thomas, Eric J.

2013-01-01

Objective Diagnostic errors in primary care are harmful but poorly studied. To facilitate understanding of diagnostic errors in real-world primary care settings using electronic health records (EHRs), this study explored the use of the Situational Awareness (SA) framework from aviation human factors research. Methods A mixed-methods study was conducted involving reviews of EHR data followed by semi-structured interviews of selected providers from two institutions in the US. The study population included 380 consecutive patients with colorectal and lung cancers diagnosed between February 2008 and January 2009. Using a pre-tested data collection instrument, trained physicians identified diagnostic errors, defined as lack of timely action on one or more established indications for diagnostic work-up for lung and colorectal cancers. Twenty-six providers involved in cases with and without errors were interviewed. Interviews probed for providers' lack of SA and how this may have influenced the diagnostic process. Results Of 254 cases meeting inclusion criteria, errors were found in 30 (32.6%) of 92 lung cancer cases and 56 (33.5%) of 167 colorectal cancer cases. Analysis of interviews related to error cases revealed evidence of lack of one of four levels of SA applicable to primary care practice: information perception, information comprehension, forecasting future events, and choosing appropriate action based on the first three levels. In cases without error, the application of the SA framework provided insight into processes involved in attention management. Conclusions A framework of SA can help analyze and understand diagnostic errors in primary care settings that use EHRs. PMID:21890757

Evaluating the prevalence and impact of examiner errors on the Wechsler scales of intelligence: A meta-analysis.

PubMed

Styck, Kara M; Walsh, Shana M

2016-01-01

The purpose of the present investigation was to conduct a meta-analysis of the literature on examiner errors for the Wechsler scales of intelligence. Results indicate that a mean of 99.7% of protocols contained at least 1 examiner error when studies that included a failure to record examinee responses as an error were combined and a mean of 41.2% of protocols contained at least 1 examiner error when studies that ignored errors of omission were combined. Furthermore, graduate student examiners were significantly more likely to make at least 1 error on Wechsler intelligence test protocols than psychologists. However, psychologists made significantly more errors per protocol than graduate student examiners regardless of the inclusion or exclusion of failure to record examinee responses as errors. On average, 73.1% of Full-Scale IQ (FSIQ) scores changed as a result of examiner errors, whereas 15.8%-77.3% of scores on the Verbal Comprehension Index (VCI), Perceptual Reasoning Index (PRI), Working Memory Index (WMI), and Processing Speed Index changed as a result of examiner errors. In addition, results suggest that examiners tend to overestimate FSIQ scores and underestimate VCI scores. However, no strong pattern emerged for the PRI and WMI. It can be concluded that examiner errors occur frequently and impact index and FSIQ scores. Consequently, current estimates for the standard error of measurement of popular IQ tests may not adequately capture the variance due to the examiner. (c) 2016 APA, all rights reserved).

Are health care provider organizations ready to tackle diagnostic error? A survey of Leapfrog-participating hospitals.

PubMed

Newman-Toker, David E; Austin, J Matthew; Derk, Jordan; Danforth, Melissa; Graber, Mark L

2017-06-27

A 2015 National Academy of Medicine report on improving diagnosis in health care made recommendations for direct action by hospitals and health systems. Little is known about how health care provider organizations are addressing diagnostic safety/quality. This study is an anonymous online survey of safety professionals from US hospitals and health systems in July-August 2016. The survey was sent to those attending a Leapfrog Group webinar on misdiagnosis (n=188). The instrument was focused on knowledge, attitudes, and capability to address diagnostic errors at the institutional level. Overall, 61 (32%) responded, including community hospitals (42%), integrated health networks (25%), and academic centers (21%). Awareness was high, but commitment and capability were low (31% of leaders understand the problem; 28% have sufficient safety resources; and 25% have made diagnosis a top institutional safety priority). Ongoing efforts to improve diagnostic safety were sparse and mostly included root cause analysis and peer review feedback around diagnostic errors. The top three barriers to addressing diagnostic error were lack of awareness of the problem, lack of measures of diagnostic accuracy and error, and lack of feedback on diagnostic performance. The top two tools viewed as critically important for locally tackling the problem were routine feedback on diagnostic performance and culture change to emphasize diagnostic safety. Although hospitals and health systems appear to be aware of diagnostic errors as a major safety imperative, most organizations (even those that appear to be making a strong commitment to patient safety) are not yet doing much to improve diagnosis. Going forward, efforts to activate health care organizations will be essential to improving diagnostic safety.

75 FR 78897 - Definition of Omission From Gross Income

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-17

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Medicine, psychiatry and euthanasia: an argument against mandatory psychiatric review.

PubMed

Parker, M

2000-04-01

The paper critically appraises the argument that requests for active assistance to die should be subject to mandatory psychiatric assessment. The argument for mandatory psychiatric assessment is usually supported by an appeal to the need for safeguards against errors and omissions in both the diagnosis of psychiatric conditions affecting the terminally ill and the exploration of the meanings of their requests. This intuitively appealing view is challenged through a broader analysis which examines connections between medicine's traditional adherence to the moral distinction between acts and omissions and the following issues: the historical relationship between medical practice and dying, the recent development of research into treatment-withdrawal decisions, the scientific status of psychiatry, the logic of rationality and decision-making competence. The analysis reveals a number of hitherto unexamined and unacknowledged influences which would make psychiatric review of requests for assisted death a much less objective and impartial process than is assumed. Mandatory psychiatric review is an instance of the medicalisation of death and dying which could abridge the freedom of certain individuals to make decisions about their deaths.

Acetaminophen attenuates error evaluation in cortex.

PubMed

Randles, Daniel; Kam, Julia W Y; Heine, Steven J; Inzlicht, Michael; Handy, Todd C

2016-06-01

Acetaminophen has recently been recognized as having impacts that extend into the affective domain. In particular, double blind placebo controlled trials have revealed that acetaminophen reduces the magnitude of reactivity to social rejection, frustration, dissonance and to both negatively and positively valenced attitude objects. Given this diversity of consequences, it has been proposed that the psychological effects of acetaminophen may reflect a widespread blunting of evaluative processing. We tested this hypothesis using event-related potentials (ERPs). Sixty-two participants received acetaminophen or a placebo in a double-blind protocol and completed the Go/NoGo task. Participants' ERPs were observed following errors on the Go/NoGo task, in particular the error-related negativity (ERN; measured at FCz) and error-related positivity (Pe; measured at Pz and CPz). Results show that acetaminophen inhibits the Pe, but not the ERN, and the magnitude of an individual's Pe correlates positively with omission errors, partially mediating the effects of acetaminophen on the error rate. These results suggest that recently documented affective blunting caused by acetaminophen may best be described as an inhibition of evaluative processing. They also contribute to the growing work suggesting that the Pe is more strongly associated with conscious awareness of errors relative to the ERN. © The Author (2016). Published by Oxford University Press. For Permissions, please email: journals.permissions@oup.com.

Saccadic movement deficiencies in adults with ADHD tendencies.

PubMed

Lee, Yun-Jeong; Lee, Sangil; Chang, Munseon; Kwak, Ho-Wan

2015-12-01

The goal of the present study was to explore deficits in gaze detection and emotional value judgment during a saccadic eye movement task in adults with attention deficit/hyperactivity disorder (ADHD) tendencies. Thirty-two participants, consisting of 16 ADHD tendencies and 16 controls, were recruited from a pool of 243 university students. Among the many problems in adults with ADHDs, our research focused on the deficits in the processing of nonverbal cues, such as gaze direction and the emotional value of others' faces. In Experiment 1, a cue display containing a face with emotional value and gaze direction was followed by a target display containing two faces located on the left and right side of the display. The participant's task was to make an anti-saccade opposite to the gaze direction if the cue face was not emotionally neutral. ADHD tendencies showed more overall errors than controls in making anti-saccades. Based on the hypothesis that the exposure duration of the cue display in Experiment 1 may have been too long, we presented the cue and target display simultaneously to prevent participants from preparing saccades in advance. Participants in Experiment 2 were asked to make either a pro-saccade or an anti-saccade depending on the emotional value of the central cue face. Interestingly, significant group differences were observed for errors of omission and commission. In addition, a significant three-way interaction among groups, cue emotion, and target gaze direction suggests that the emotional recognition and gaze control systems might somehow be interconnected. The result also shows that ADHDs are more easily distracted by a task-irrelevant gaze direction. Taken together, these results suggest that tasks requiring both response inhibition (anti-saccade) and gaze-emotion recognition might be useful in developing a diagnostic test for discriminating adults with ADHDs from healthy adults.

Video registration of trauma team performance in the emergency department: the results of a 2-year analysis in a Level 1 trauma center.

PubMed

Lubbert, Pieter H W; Kaasschieter, Edgar G; Hoorntje, Lidewij E; Leenen, Loek P H

2009-12-01

Trauma teams responsible for the first response to patients with multiple injuries upon arrival in a hospital consist of medical specialists or resident physicians. We hypothesized that 24-hour video registration in the trauma room would allow for precise evaluation of team functioning and deviations from Advanced Trauma Life Support (ATLS) protocols. We analyzed all video registrations of trauma patients who visited the emergency room of a Level I trauma center in the Netherlands between September 1, 2000, and September 1, 2002. Analysis was performed with a score list based on ATLS protocols. From a total of 1,256 trauma room presentations, we found a total of 387 video registrations suitable for analysis. The majority of patients had an injury severity score lower than 17 (264 patients), whereas 123 patients were classified as multiple injuries (injury severity score >or=17). Errors in team organization (omission of prehospital report, no evident leadership, unorganized resuscitation, not working according to protocol, and no continued supervision of the patient) lead to significantly more deviations in the treatment than when team organization was uncomplicated. Video registration of diagnostic and therapeutic procedures by a multidisciplinary trauma team facilitates an accurate analysis of possible deviations from protocol. In addition to identifying technical errors, the role of the team leader can clearly be analyzed and related to team actions. Registration strongly depends on availability of video tapes, timely started registration, and hardware functioning. The results from this study were used to develop a training program for trauma teams in our hospital that specifically focuses on the team leader's functioning.

Prepopulated radiology report templates: a prospective analysis of error rate and turnaround time.

PubMed

Hawkins, C M; Hall, S; Hardin, J; Salisbury, S; Towbin, A J

2012-08-01

Current speech recognition software allows exam-specific standard reports to be prepopulated into the dictation field based on the radiology information system procedure code. While it is thought that prepopulating reports can decrease the time required to dictate a study and the overall number of errors in the final report, this hypothesis has not been studied in a clinical setting. A prospective study was performed. During the first week, radiologists dictated all studies using prepopulated standard reports. During the second week, all studies were dictated after prepopulated reports had been disabled. Final radiology reports were evaluated for 11 different types of errors. Each error within a report was classified individually. The median time required to dictate an exam was compared between the 2 weeks. There were 12,387 reports dictated during the study, of which, 1,173 randomly distributed reports were analyzed for errors. There was no difference in the number of errors per report between the 2 weeks; however, radiologists overwhelmingly preferred using a standard report both weeks. Grammatical errors were by far the most common error type, followed by missense errors and errors of omission. There was no significant difference in the median dictation time when comparing studies performed each week. The use of prepopulated reports does not alone affect the error rate or dictation time of radiology reports. While it is a useful feature for radiologists, it must be coupled with other strategies in order to decrease errors.

Linear and non-linear analyses of Conner's Continuous Performance Test-II discriminate adult patients with attention deficit hyperactivity disorder from patients with mood and anxiety disorders.

PubMed

Fasmer, Ole Bernt; Mjeldheim, Kristin; Førland, Wenche; Hansen, Anita L; Syrstad, Vigdis Elin Giæver; Oedegaard, Ketil J; Berle, Jan Øystein

2016-08-11

Attention Deficit Hyperactivity Disorder (ADHD) is a heterogeneous disorder. Therefore it is important to look for factors that can contribute to better diagnosis and classification of these patients. The aims of the study were to characterize adult psychiatric out-patients with a mixture of mood, anxiety and attentional problems using an objective neuropsychological test of attention combined with an assessment of mood instability. Newly referred patients (n = 99; aged 18-65 years) requiring diagnostic evaluation of ADHD, mood or anxiety disorders were recruited, and were given a comprehensive diagnostic evaluation including the self-report form of the cyclothymic temperament scale and Conner's Continuous Performance Test II (CPT-II). In addition to the traditional measures from this test we have extracted raw data and analysed time series using linear and non-linear mathematical methods. Fifty patients fulfilled criteria for ADHD, while 49 did not, and were given other psychiatric diagnoses (clinical controls). When compared to the clinical controls the ADHD patients had more omission and commission errors, and higher reaction time variability. Analyses of response times showed higher values for skewness in the ADHD patients, and lower values for sample entropy and symbolic dynamics. Among the ADHD patients 59 % fulfilled criteria for a cyclothymic temperament, and this group had higher reaction time variability and lower scores on complexity than the group without this temperament. The CPT-II is a useful instrument in the assessment of ADHD in adult patients. Additional information from this test was obtained by analyzing response times using linear and non-linear methods, and this showed that ADHD patients with a cyclothymic temperament were different from those without this temperament.

Investigating the Link Between Radiologists Gaze, Diagnostic Decision, and Image Content

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

Tourassi, Georgia; Voisin, Sophie; Paquit, Vincent C

2013-01-01

Objective: To investigate machine learning for linking image content, human perception, cognition, and error in the diagnostic interpretation of mammograms. Methods: Gaze data and diagnostic decisions were collected from six radiologists who reviewed 20 screening mammograms while wearing a head-mounted eye-tracker. Texture analysis was performed in mammographic regions that attracted radiologists attention and in all abnormal regions. Machine learning algorithms were investigated to develop predictive models that link: (i) image content with gaze, (ii) image content and gaze with cognition, and (iii) image content, gaze, and cognition with diagnostic error. Both group-based and individualized models were explored. Results: By poolingmore » the data from all radiologists machine learning produced highly accurate predictive models linking image content, gaze, cognition, and error. Merging radiologists gaze metrics and cognitive opinions with computer-extracted image features identified 59% of the radiologists diagnostic errors while confirming 96.2% of their correct diagnoses. The radiologists individual errors could be adequately predicted by modeling the behavior of their peers. However, personalized tuning appears to be beneficial in many cases to capture more accurately individual behavior. Conclusions: Machine learning algorithms combining image features with radiologists gaze data and diagnostic decisions can be effectively developed to recognize cognitive and perceptual errors associated with the diagnostic interpretation of mammograms.« less

Prenatal drug exposure and selective attention in preschoolers.

PubMed

Noland, Julia S; Singer, Lynn T; Short, Elizabeth J; Minnes, Sonia; Arendt, Robert E; Kirchner, H Lester; Bearer, Cynthia

2005-01-01

Deficits in sustained attention and impulsivity have previously been demonstrated in preschoolers prenatally exposed to cocaine. We assessed an additional component of attention, selective attention, in a large, poly-substance cocaine-exposed cohort of 4 year olds and their at-risk comparison group. Employing postpartum maternal report and biological assay, we assigned children to overlapping exposed and complementary control groups for maternal use of cocaine, alcohol, marijuana, and cigarettes. Maternal pregnancy use of cocaine and use of cigarettes were both associated with increased commission errors, indicative of inferior selective attention. Severity of maternal use of marijuana during pregnancy was positively correlated with omission errors, suggesting impaired sustained attention. Substance exposure effects were independent of maternal postpartum psychological distress, birth mother cognitive functioning, current caregiver functioning, other substance exposures and child concurrent verbal IQ.

Insight solutions are correct more often than analytic solutions

PubMed Central

Salvi, Carola; Bricolo, Emanuela; Kounios, John; Bowden, Edward; Beeman, Mark

2016-01-01

How accurate are insights compared to analytical solutions? In four experiments, we investigated how participants’ solving strategies influenced their solution accuracies across different types of problems, including one that was linguistic, one that was visual and two that were mixed visual-linguistic. In each experiment, participants’ self-judged insight solutions were, on average, more accurate than their analytic ones. We hypothesised that insight solutions have superior accuracy because they emerge into consciousness in an all-or-nothing fashion when the unconscious solving process is complete, whereas analytic solutions can be guesses based on conscious, prematurely terminated, processing. This hypothesis is supported by the finding that participants’ analytic solutions included relatively more incorrect responses (i.e., errors of commission) than timeouts (i.e., errors of omission) compared to their insight responses. PMID:27667960

Protected values: no omission bias and no framing effects.

PubMed

Tanner, Carmen; Medin, Douglas L

2004-02-01

Previous studies have suggested that people holding protected values (PVs) show a bias against harmful acts, as opposed to harmful omissions (omission bias). In the present study, we (1) investigated the relationship between PVs and acts versus omissions in risky choices, using a paradigm in which act and omission biases were presented in a symmetrical manner, and (2) examined whether people holding PVs respond differently to framing manipulations. Participants were given environmental scenarios and were asked to make choices between actions and omissions. Both the framing of the outcomes (positive vs. negative) and the outcome certainty (risky vs. certain) were manipulated. In contrast to previous studies, PVs were linked to preferences for acts, rather than for omissions. PVs were more likely to be associated with moral obligations to act than with moral prohibitions against action. Strikingly, people with strong PVs were immune to framing; participants with few PVs showed robust framing effects.

Omission bias and perceived intention in children and adults.

PubMed

Hayashi, Hajimu

2015-06-01

Omission bias refers to the tendency to judge acts of commission as morally worse than equivalent acts of omission. Children aged 7-8 and 11-12 years, as well as adults, made moral judgements about acts of commission and omission in two conditions in which the protagonist obtained a self-directed benefit. In the antisocial condition, the other person was harmed; in the selfish condition, the other person was not harmed. The results showed that adults and both age groups of children judged that the agent who did something (act of commission) was morally worse than the agent who did nothing (omission) for both antisocial and selfish conditions, although this judgement tendency was clearer in the selfish condition than in the antisocial condition. Agent intention was held constant across commission and omission, but most participants rated the intention of the agent who did something as stronger than that of the agent who did nothing. These results suggest that omission bias occurs regardless of differences in age and situation. In addition, perceived intention appears to change in conjunction with omission bias. © 2015 The British Psychological Society.

Stimulus- and response-reinforcer contingencies in autoshaping, operant, classical, and omission training procedures in rats.

PubMed

Atnip, G W

1977-07-01

Separate groups of rats received 500 trials of lever-press training under autoshaping (food delivery followed 10-second lever presentations, or occurred immediately following a response); operant conditioning (responding was necessary for food delivery); and classical conditioning (food followed lever presentations regardless of responding). Each group then received 500 trials on an omission procedure in which food was omitted on trials with a response. Another group received 1000 trials on the omission procedure, and a fifth group, random control, received 1000 uncorrelated presentations of lever and food. The autoshaping, operant, and classical groups reached high response levels by the end of initial training. Acquisition was fastest in the autoshaping group. Responding remained consistently low in the control group. The omission group responded at a level between the control group and the other three groups. During omission training, responding in these three groups declined to the omission-group level. During omission training, the rats continued contacting the lever frequently after lever pressing had declined. Response maintenance under omission training seems not to require topographic similarity between the response and reinforcer-elicited consummatory behaviors.

Stimulus- and response-reinforcer contingencies in autoshaping, operant, classical, and omission training procedures in rats

PubMed Central

Atnip, Gilbert W.

1977-01-01

Separate groups of rats received 500 trials of lever-press training under autoshaping (food delivery followed 10-second lever presentations, or occurred immediately following a response); operant conditioning (responding was necessary for food delivery); and classical conditioning (food followed lever presentations regardless of responding). Each group then received 500 trials on an omission procedure in which food was omitted on trials with a response. Another group received 1000 trials on the omission procedure, and a fifth group, random control, received 1000 uncorrelated presentations of lever and food. The autoshaping, operant, and classical groups reached high response levels by the end of initial training. Acquisition was fastest in the autoshaping group. Responding remained consistently low in the control group. The omission group responded at a level between the control group and the other three groups. During omission training, responding in these three groups declined to the omission-group level. During omission training, the rats continued contacting the lever frequently after lever pressing had declined. Response maintenance under omission training seems not to require topographic similarity between the response and reinforcer-elicited consummatory behaviors. PMID:16812014

Art of War Papers: An Exit Strategy not a Winning Strategy? Intelligence Lessons Learned from the British Emergency in South Arabia, 1963-67

DTIC Science & Technology

2014-04-01

addition to the above Art of War team, I was very fortunate to have support from Professor Daniel Marston, the author Mr Jonathan Walker, Brigadier...Sincere thanks to all; nonetheless, all errors and omissions are my own. Finally, I must pay tribute to all the British Servicemen, and Policemen, who...militar- ies —especially in the field of intelligence in a hostile environment. The war in South Arabia was fought by a western force with local allies

Gamma-ray bursts from cusps on superconducting cosmic strings at large redshifts

NASA Technical Reports Server (NTRS)

Paczynski, Bohdan

1988-01-01

Babul et al. (1987) proposed that some gamma-ray bursts may be caused by energy released at the cusps of oscillating loops made of superconducting cosmic strings. It is claimed that there were some errors and omissions in that work, which are claimed to be corrected in the present paper. Arguments are presented, that given certain assumptions, the cusps on oscillating superconducting cosmic strings produce highly collimated and energetic electromagnetic bursts and that a fair fraction of electromagnetic energy is likely to come out as gamma rays.

Diagnostic Error in Stroke-Reasons and Proposed Solutions.

PubMed

Bakradze, Ekaterina; Liberman, Ava L

2018-02-13

We discuss the frequency of stroke misdiagnosis and identify subgroups of stroke at high risk for specific diagnostic errors. In addition, we review common reasons for misdiagnosis and propose solutions to decrease error. According to a recent report by the National Academy of Medicine, most people in the USA are likely to experience a diagnostic error during their lifetimes. Nearly half of such errors result in serious disability and death. Stroke misdiagnosis is a major health care concern, with initial misdiagnosis estimated to occur in 9% of all stroke patients in the emergency setting. Under- or missed diagnosis (false negative) of stroke can result in adverse patient outcomes due to the preclusion of acute treatments and failure to initiate secondary prevention strategies. On the other hand, the overdiagnosis of stroke can result in inappropriate treatment, delayed identification of actual underlying disease, and increased health care costs. Young patients, women, minorities, and patients presenting with non-specific, transient, or posterior circulation stroke symptoms are at increased risk of misdiagnosis. Strategies to decrease diagnostic error in stroke have largely focused on early stroke detection via bedside examination strategies and a clinical decision rules. Targeted interventions to improve the diagnostic accuracy of stroke diagnosis among high-risk groups as well as symptom-specific clinical decision supports are needed. There are a number of open questions in the study of stroke misdiagnosis. To improve patient outcomes, existing strategies to improve stroke diagnostic accuracy should be more broadly adopted and novel interventions devised and tested to reduce diagnostic errors.

42 CFR 6.6 - Covered acts and omissions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 1 2010-10-01 2010-10-01 false Covered acts and omissions. 6.6 Section 6.6 Public... CLAIMS ACT COVERAGE OF CERTAIN GRANTEES AND INDIVIDUALS § 6.6 Covered acts and omissions. (a) Only acts and omissions occurring on and after the effective date of the Secretary's determination under § 6.5...

Understanding diagnostic errors in medicine: a lesson from aviation

PubMed Central

Singh, H; Petersen, L A; Thomas, E J

2006-01-01

The impact of diagnostic errors on patient safety in medicine is increasingly being recognized. Despite the current progress in patient safety research, the understanding of such errors and how to prevent them is inadequate. Preliminary research suggests that diagnostic errors have both cognitive and systems origins. Situational awareness is a model that is primarily used in aviation human factors research that can encompass both the cognitive and the systems roots of such errors. This conceptual model offers a unique perspective in the study of diagnostic errors. The applicability of this model is illustrated by the analysis of a patient whose diagnosis of spinal cord compression was substantially delayed. We suggest how the application of this framework could lead to potential areas of intervention and outline some areas of future research. It is possible that the use of such a model in medicine could help reduce errors in diagnosis and lead to significant improvements in patient care. Further research is needed, including the measurement of situational awareness and correlation with health outcomes. PMID:16751463

The Combined Effects of Measurement Error and Omitting Confounders in the Single-Mediator Model

PubMed Central

Fritz, Matthew S.; Kenny, David A.; MacKinnon, David P.

2016-01-01

Mediation analysis requires a number of strong assumptions be met in order to make valid causal inferences. Failing to account for violations of these assumptions, such as not modeling measurement error or omitting a common cause of the effects in the model, can bias the parameter estimates of the mediated effect. When the independent variable is perfectly reliable, for example when participants are randomly assigned to levels of treatment, measurement error in the mediator tends to underestimate the mediated effect, while the omission of a confounding variable of the mediator to outcome relation tends to overestimate the mediated effect. Violations of these two assumptions often co-occur, however, in which case the mediated effect could be overestimated, underestimated, or even, in very rare circumstances, unbiased. In order to explore the combined effect of measurement error and omitted confounders in the same model, the impact of each violation on the single-mediator model is first examined individually. Then the combined effect of having measurement error and omitted confounders in the same model is discussed. Throughout, an empirical example is provided to illustrate the effect of violating these assumptions on the mediated effect. PMID:27739903

Retention-error patterns in complex alphanumeric serial-recall tasks.

PubMed

Mathy, Fabien; Varré, Jean-Stéphane

2013-01-01

We propose a new method based on an algorithm usually dedicated to DNA sequence alignment in order to both reliably score short-term memory performance on immediate serial-recall tasks and analyse retention-error patterns. There can be considerable confusion on how performance on immediate serial list recall tasks is scored, especially when the to-be-remembered items are sampled with replacement. We discuss the utility of sequence-alignment algorithms to compare the stimuli to the participants' responses. The idea is that deletion, substitution, translocation, and insertion errors, which are typical in DNA, are also typical putative errors in short-term memory (respectively omission, confusion, permutation, and intrusion errors). We analyse four data sets in which alphanumeric lists included a few (or many) repetitions. After examining the method on two simple data sets, we show that sequence alignment offers 1) a compelling method for measuring capacity in terms of chunks when many regularities are introduced in the material (third data set) and 2) a reliable estimator of individual differences in short-term memory capacity. This study illustrates the difficulty of arriving at a good measure of short-term memory performance, and also attempts to characterise the primary factors underpinning remembering and forgetting.

Using medication list--problem list mismatches as markers of potential error.

PubMed Central

Carpenter, James D.; Gorman, Paul N.

2002-01-01

The goal of this project was to specify and develop an algorithm that will check for drug and problem list mismatches in an electronic medical record (EMR). The algorithm is based on the premise that a patient's problem list and medication list should agree, and a mismatch may indicate medication error. Successful development of this algorithm could mean detection of some errors, such as medication orders entered into a wrong patient record, or drug therapy omissions, that are not otherwise detected via automated means. Additionally, mismatches may identify opportunities to improve problem list integrity. To assess the concept's feasibility, this study compared medications listed in a pharmacy information system with findings in an online nursing adult admission assessment, serving as a proxy for the problem list. Where drug and problem list mismatches were discovered, examination of the patient record confirmed the mismatch, and identified any potential causes. Evaluation of the algorithm in diabetes treatment indicates that it successfully detects both potential medication error and opportunities to improve problem list completeness. This algorithm, once fully developed and deployed, could prove a valuable way to improve the patient problem list, and could decrease the risk of medication error. PMID:12463796

Evaluation of drug administration errors in a teaching hospital

PubMed Central

2012-01-01

Background Medication errors can occur at any of the three steps of the medication use process: prescribing, dispensing and administration. We aimed to determine the incidence, type and clinical importance of drug administration errors and to identify risk factors. Methods Prospective study based on disguised observation technique in four wards in a teaching hospital in Paris, France (800 beds). A pharmacist accompanied nurses and witnessed the preparation and administration of drugs to all patients during the three drug rounds on each of six days per ward. Main outcomes were number, type and clinical importance of errors and associated risk factors. Drug administration error rate was calculated with and without wrong time errors. Relationship between the occurrence of errors and potential risk factors were investigated using logistic regression models with random effects. Results Twenty-eight nurses caring for 108 patients were observed. Among 1501 opportunities for error, 415 administrations (430 errors) with one or more errors were detected (27.6%). There were 312 wrong time errors, ten simultaneously with another type of error, resulting in an error rate without wrong time error of 7.5% (113/1501). The most frequently administered drugs were the cardiovascular drugs (425/1501, 28.3%). The highest risks of error in a drug administration were for dermatological drugs. No potentially life-threatening errors were witnessed and 6% of errors were classified as having a serious or significant impact on patients (mainly omission). In multivariate analysis, the occurrence of errors was associated with drug administration route, drug classification (ATC) and the number of patient under the nurse's care. Conclusion Medication administration errors are frequent. The identification of its determinants helps to undertake designed interventions. PMID:22409837

Evaluation of drug administration errors in a teaching hospital.

PubMed

Berdot, Sarah; Sabatier, Brigitte; Gillaizeau, Florence; Caruba, Thibaut; Prognon, Patrice; Durieux, Pierre

2012-03-12

Medication errors can occur at any of the three steps of the medication use process: prescribing, dispensing and administration. We aimed to determine the incidence, type and clinical importance of drug administration errors and to identify risk factors. Prospective study based on disguised observation technique in four wards in a teaching hospital in Paris, France (800 beds). A pharmacist accompanied nurses and witnessed the preparation and administration of drugs to all patients during the three drug rounds on each of six days per ward. Main outcomes were number, type and clinical importance of errors and associated risk factors. Drug administration error rate was calculated with and without wrong time errors. Relationship between the occurrence of errors and potential risk factors were investigated using logistic regression models with random effects. Twenty-eight nurses caring for 108 patients were observed. Among 1501 opportunities for error, 415 administrations (430 errors) with one or more errors were detected (27.6%). There were 312 wrong time errors, ten simultaneously with another type of error, resulting in an error rate without wrong time error of 7.5% (113/1501). The most frequently administered drugs were the cardiovascular drugs (425/1501, 28.3%). The highest risks of error in a drug administration were for dermatological drugs. No potentially life-threatening errors were witnessed and 6% of errors were classified as having a serious or significant impact on patients (mainly omission). In multivariate analysis, the occurrence of errors was associated with drug administration route, drug classification (ATC) and the number of patient under the nurse's care. Medication administration errors are frequent. The identification of its determinants helps to undertake designed interventions.

Characteristics of pediatric chemotherapy medication errors in a national error reporting database.

PubMed

Rinke, Michael L; Shore, Andrew D; Morlock, Laura; Hicks, Rodney W; Miller, Marlene R

2007-07-01

Little is known regarding chemotherapy medication errors in pediatrics despite studies suggesting high rates of overall pediatric medication errors. In this study, the authors examined patterns in pediatric chemotherapy errors. The authors queried the United States Pharmacopeia MEDMARX database, a national, voluntary, Internet-accessible error reporting system, for all error reports from 1999 through 2004 that involved chemotherapy medications and patients aged <18 years. Of the 310 pediatric chemotherapy error reports, 85% reached the patient, and 15.6% required additional patient monitoring or therapeutic intervention. Forty-eight percent of errors originated in the administering phase of medication delivery, and 30% originated in the drug-dispensing phase. Of the 387 medications cited, 39.5% were antimetabolites, 14.0% were alkylating agents, 9.3% were anthracyclines, and 9.3% were topoisomerase inhibitors. The most commonly involved chemotherapeutic agents were methotrexate (15.3%), cytarabine (12.1%), and etoposide (8.3%). The most common error types were improper dose/quantity (22.9% of 327 cited error types), wrong time (22.6%), omission error (14.1%), and wrong administration technique/wrong route (12.2%). The most common error causes were performance deficit (41.3% of 547 cited error causes), equipment and medication delivery devices (12.4%), communication (8.8%), knowledge deficit (6.8%), and written order errors (5.5%). Four of the 5 most serious errors occurred at community hospitals. Pediatric chemotherapy errors often reached the patient, potentially were harmful, and differed in quality between outpatient and inpatient areas. This study indicated which chemotherapeutic agents most often were involved in errors and that administering errors were common. Investigation is needed regarding targeted medication administration safeguards for these high-risk medications. Copyright (c) 2007 American Cancer Society.

The Greenwich Photo-heliographic Results (1874 - 1976): Initial Corrections to the Printed Publications

NASA Astrophysics Data System (ADS)

Erwin, E. H.; Coffey, H. E.; Denig, W. F.; Willis, D. M.; Henwood, R.; Wild, M. N.

2013-11-01

A new sunspot and faculae digital dataset for the interval 1874 - 1955 has been prepared under the auspices of the NOAA National Geophysical Data Center (NGDC). This digital dataset contains measurements of the positions and areas of both sunspots and faculae published initially by the Royal Observatory, Greenwich, and subsequently by the Royal Greenwich Observatory (RGO), under the title Greenwich Photo-heliographic Results ( GPR) , 1874 - 1976. Quality control (QC) procedures based on logical consistency have been used to identify the more obvious errors in the RGO publications. Typical examples of identifiable errors are North versus South errors in specifying heliographic latitude, errors in specifying heliographic (Carrington) longitude, errors in the dates and times, errors in sunspot group numbers, arithmetic errors in the summation process, and the occasional omission of solar ephemerides. Although the number of errors in the RGO publications is remarkably small, an initial table of necessary corrections is provided for the interval 1874 - 1917. Moreover, as noted in the preceding companion papers, the existence of two independently prepared digital datasets, which both contain information on sunspot positions and areas, makes it possible to outline a preliminary strategy for the development of an even more accurate digital dataset. Further work is in progress to generate an extremely reliable sunspot digital dataset, based on the long programme of solar observations supported first by the Royal Observatory, Greenwich, and then by the Royal Greenwich Observatory.

Extraction of tidal channel networks from airborne scanning laser altimetry

NASA Astrophysics Data System (ADS)

Mason, David C.; Scott, Tania R.; Wang, Hai-Jing

Tidal channel networks are important features of the inter-tidal zone, and play a key role in tidal propagation and in the evolution of salt marshes and tidal flats. The study of their morphology is currently an active area of research, and a number of theories related to networks have been developed which require validation using dense and extensive observations of network forms and cross-sections. The conventional method of measuring networks is cumbersome and subjective, involving manual digitisation of aerial photographs in conjunction with field measurement of channel depths and widths for selected parts of the network. This paper describes a semi-automatic technique developed to extract networks from high-resolution LiDAR data of the inter-tidal zone. A multi-level knowledge-based approach has been implemented, whereby low-level algorithms first extract channel fragments based mainly on image properties then a high-level processing stage improves the network using domain knowledge. The approach adopted at low level uses multi-scale edge detection to detect channel edges, then associates adjacent anti-parallel edges together to form channels. The higher level processing includes a channel repair mechanism. The algorithm may be extended to extract networks from aerial photographs as well as LiDAR data. Its performance is illustrated using LiDAR data of two study sites, the River Ems, Germany and the Venice Lagoon. For the River Ems data, the error of omission for the automatic channel extractor is 26%, partly because numerous small channels are lost because they fall below the edge threshold, though these are less than 10 cm deep and unlikely to be hydraulically significant. The error of commission is lower, at 11%. For the Venice Lagoon data, the error of omission is 14%, but the error of commission is 42%, due partly to the difficulty of interpreting channels in these natural scenes. As a benchmark, previous work has shown that this type of algorithm specifically designed for extracting tidal networks from LiDAR data is able to achieve substantially improved results compared with those obtained using standard algorithms for drainage network extraction from Digital Terrain Models.

Commentary: Reducing diagnostic errors: another role for checklists?

PubMed

Winters, Bradford D; Aswani, Monica S; Pronovost, Peter J

2011-03-01

Diagnostic errors are a widespread problem, although the true magnitude is unknown because they cannot currently be measured validly. These errors have received relatively little attention despite alarming estimates of associated harm and death. One promising intervention to reduce preventable harm is the checklist. This intervention has proven successful in aviation, in which situations are linear and deterministic (one alarm goes off and a checklist guides the flight crew to evaluate the cause). In health care, problems are multifactorial and complex. A checklist has been used to reduce central-line-associated bloodstream infections in intensive care units. Nevertheless, this checklist was incorporated in a culture-based safety program that engaged and changed behaviors and used robust measurement of infections to evaluate progress. In this issue, Ely and colleagues describe how three checklists could reduce the cognitive biases and mental shortcuts that underlie diagnostic errors, but point out that these tools still need to be tested. To be effective, they must reduce diagnostic errors (efficacy) and be routinely used in practice (effectiveness). Such tools must intuitively support how the human brain works, and under time pressures, clinicians rarely think in conditional probabilities when making decisions. To move forward, it is necessary to accurately measure diagnostic errors (which could come from mapping out the diagnostic process as the medication process has done and measuring errors at each step) and pilot test interventions such as these checklists to determine whether they work.

Correlation of patient entry rates and physician documentation errors in dictated and handwritten emergency treatment records.

PubMed

Dawdy, M R; Munter, D W; Gilmore, R A

1997-03-01

This study was designed to examine the relationship between patient entry rates (a measure of physician work load) and documentation errors/omissions in both handwritten and dictated emergency treatment records. The study was carried out in two phases. Phase I examined handwritten records and Phase II examined dictated and transcribed records. A total of 838 charts for three common chief complaints (chest pain, abdominal pain, asthma/chronic obstructive pulmonary disease) were retrospectively reviewed and scored for the presence or absence of 11 predetermined criteria. Patient entry rates were determined by reviewing the emergency department patient registration logs. The data were analyzed using simple correlation and linear regression analysis. A positive correlation was found between patient entry rates and documentation errors in handwritten charts. No such correlation was found in the dictated charts. We conclude that work load may negatively affect documentation accuracy when charts are handwritten. However, the use of dictation services may minimize or eliminate this effect.

Measured and predicted rotor performance for the SERI advanced wind turbine blades

NASA Astrophysics Data System (ADS)

Tangler, J.; Smith, B.; Kelley, N.; Jager, D.

1992-02-01

Measured and predicted rotor performance for the Solar Energy Research Institute (SERI) advanced wind turbine blades were compared to assess the accuracy of predictions and to identify the sources of error affecting both predictions and measurements. An awareness of these sources of error contributes to improved prediction and measurement methods that will ultimately benefit future rotor design efforts. Propeller/vane anemometers were found to underestimate the wind speed in turbulent environments such as the San Gorgonio Pass wind farm area. Using sonic or cup anemometers, good agreement was achieved between predicted and measured power output for wind speeds up to 8 m/sec. At higher wind speeds an optimistic predicted power output and the occurrence of peak power at wind speeds lower than measurements resulted from the omission of turbulence and yaw error. In addition, accurate two-dimensional (2-D) airfoil data prior to stall and a post stall airfoil data synthesization method that reflects three-dimensional (3-D) effects were found to be essential for accurate performance prediction.

Reaction time, impulsivity, and attention in hyperactive children and controls: a video game technique.

PubMed

Mitchell, W G; Chavez, J M; Baker, S A; Guzman, B L; Azen, S P

1990-07-01

Maturation of sustained attention was studied in a group of 52 hyperactive elementary school children and 152 controls using a microcomputer-based test formatted to resemble a video game. In nonhyperactive children, both simple and complex reaction time decreased with age, as did variability of response time. Omission errors were extremely infrequent on simple reaction time and decreased with age on the more complex tasks. Commission errors had an inconsistent relationship with age. Hyperactive children were slower, more variable, and made more errors on all segments of the game than did controls. Both motor speed and calculated mental speed were slower in hyperactive children, with greater discrepancy for responses directed to the nondominant hand, suggesting that a selective right hemisphere deficit may be present in hyperactives. A summary score (number of individual game scores above the 95th percentile) of 4 or more detected 60% of hyperactive subjects with a false positive rate of 5%. Agreement with the Matching Familiar Figures Test was 75% in the hyperactive group.

Piloting Medication Histories in a Pediatric Postanesthesia Care Unit.

PubMed

Lake, Nathan; Nawer, Humaira; Wagner, Deborah

2018-05-18

Develop a medication history process for pediatric postanesthesia care unit (PACU) patients to identify discrepancies between home and inpatient medications and prevent medication errors. Pilot an evidence-based practice change to perform PACU medication histories. Inpatients or surgical admissions to general care units at a pediatric tertiary care 348-bed hospital ages 2-18 years were included. Parents/guardians were asked about their child's prescription and over-the-counter medications, allergies, and adherence. Data included patient age, surgery, medication categories, and error classifications. Information was compared to the patient's medical record. From June to July 2016, 75 medication histories were performed, covering 44.6% of eligible cases within the period. Seventy-four discrepancies were found, the most frequent being omission. The medication category with the most errors was vitamins/herbals/supplements. The workflow designed assessed discrepancy frequency and type in surgical patients' medication lists when transitioning from the PACU to general care units. Copyright © 2018 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.

Evaluation of spatial filtering on the accuracy of wheat area estimate

NASA Technical Reports Server (NTRS)

Dejesusparada, N. (Principal Investigator); Moreira, M. A.; Chen, S. C.; Delima, A. M.

1982-01-01

A 3 x 3 pixel spatial filter for postclassification was used for wheat classification to evaluate the effects of this procedure on the accuracy of area estimation using LANDSAT digital data obtained from a single pass. Quantitative analyses were carried out in five test sites (approx 40 sq km each) and t tests showed that filtering with threshold values significantly decreased errors of commission and omission. In area estimation filtering improved the overestimate of 4.5% to 2.7% and the root-mean-square error decreased from 126.18 ha to 107.02 ha. Extrapolating the same procedure of automatic classification using spatial filtering for postclassification to the whole study area, the accuracy in area estimate was improved from the overestimate of 10.9% to 9.7%. It is concluded that when single pass LANDSAT data is used for crop identification and area estimation the postclassification procedure using a spatial filter provides a more accurate area estimate by reducing classification errors.

Association between workarounds and medication administration errors in bar-code-assisted medication administration in hospitals.

PubMed

van der Veen, Willem; van den Bemt, Patricia M L A; Wouters, Hans; Bates, David W; Twisk, Jos W R; de Gier, Johan J; Taxis, Katja; Duyvendak, Michiel; Luttikhuis, Karen Oude; Ros, Johannes J W; Vasbinder, Erwin C; Atrafi, Maryam; Brasse, Bjorn; Mangelaars, Iris

2018-04-01

To study the association of workarounds with medication administration errors using barcode-assisted medication administration (BCMA), and to determine the frequency and types of workarounds and medication administration errors. A prospective observational study in Dutch hospitals using BCMA to administer medication. Direct observation was used to collect data. Primary outcome measure was the proportion of medication administrations with one or more medication administration errors. Secondary outcome was the frequency and types of workarounds and medication administration errors. Univariate and multivariate multilevel logistic regression analysis were used to assess the association between workarounds and medication administration errors. Descriptive statistics were used for the secondary outcomes. We included 5793 medication administrations for 1230 inpatients. Workarounds were associated with medication administration errors (adjusted odds ratio 3.06 [95% CI: 2.49-3.78]). Most commonly, procedural workarounds were observed, such as not scanning at all (36%), not scanning patients because they did not wear a wristband (28%), incorrect medication scanning, multiple medication scanning, and ignoring alert signals (11%). Common types of medication administration errors were omissions (78%), administration of non-ordered drugs (8.0%), and wrong doses given (6.0%). Workarounds are associated with medication administration errors in hospitals using BCMA. These data suggest that BCMA needs more post-implementation evaluation if it is to achieve the intended benefits for medication safety. In hospitals using barcode-assisted medication administration, workarounds occurred in 66% of medication administrations and were associated with large numbers of medication administration errors.

Empirically Defined Patterns of Executive Function Deficits in Schizophrenia and Their Relation to Everyday Functioning: A Person-Centered Approach

PubMed Central

Iampietro, Mary; Giovannetti, Tania; Drabick, Deborah A. G.; Kessler, Rachel K.

2013-01-01

Executive function (EF) deficits in schizophrenia (SZ) are well documented, although much less is known about patterns of EF deficits and their association to differential impairments in everyday functioning. The present study empirically defined SZ groups based on measures of various EF abilities and then compared these EF groups on everyday action errors. Participants (n=45) completed various subtests from the Delis–Kaplan Executive Function System (D-KEFS) and the Naturalistic Action Test (NAT), a performance-based measure of everyday action that yields scores reflecting total errors and a range of different error types (e.g., omission, perseveration). Results of a latent class analysis revealed three distinct EF groups, characterized by (a) multiple EF deficits, (b) relatively spared EF, and (c) perseverative responding. Follow-up analyses revealed that the classes differed significantly on NAT total errors, total commission errors, and total perseveration errors; the two classes with EF impairment performed comparably on the NAT but performed worse than the class with relatively spared EF. In sum, people with SZ demonstrate variable patterns of EF deficits, and distinct aspects of these EF deficit patterns (i.e., poor mental control abilities) may be associated with everyday functioning capabilities. PMID:23035705

Differential impact of methylphenidate and atomoxetine on sustained attention in youth with attention-deficit/hyperactivity disorder.

PubMed

Bédard, Anne-Claude V; Stein, Mark A; Halperin, Jeffrey M; Krone, Beth; Rajwan, Estrella; Newcorn, Jeffrey H

2015-01-01

This study examined the effects of atomoxetine (ATX) and OROS methylphenidate (MPH) on laboratory measures of inhibitory control and attention in youth with attention-deficit/hyperactivity disorder (ADHD). It was hypothesized that performance would be improved by both treatments, but response profiles would differ because the medications work via different mechanisms. One hundred and two youth (77 male; mean age = 10.5 ± 2.7 years) with ADHD received ATX (1.4 ± 0.5 mg/kg) and MPH (52.4 ± 16.6 mg) in a randomized, double-blind, crossover design. Medication was titrated in 4-6-week blocks separated by a 2-week placebo washout. Inhibitory control and attention measures were obtained at baseline, following washout, and at the end of each treatment using Conners' Continuous Performance Test II (CPT-II), which provided age-adjusted T-scores for reaction time (RT), reaction time variability (RT variability), and errors. Repeated-measures analyses of variance were performed, with Time (premedication, postmedication) and Treatment type (ATX, MPH) entered as within-subject factors. Data from the two treatment blocks were checked for order effects and combined if order effects were not present. Clinicaltrials.gov: NCT00183391. Main effects for Time on RT (p = .03), RTSD (p = .001), and omission errors (p = .01) were significant. A significant Drug × Time interaction indicated that MPH improved RT, RTSD, and omission errors more than ATX (p < .05). Changes in performance with treatment did not correlate with changes in ADHD symptoms. MPH has greater effects than ATX on CPT measures of sustained attention in youth with ADHD. However, the dissociation of cognitive and behavioral change with treatment indicates that CPT measures cannot be considered proxies for symptomatic improvement. Further research on the dissociation of cognitive and behavioral endpoints for ADHD is indicated. © 2014 The Authors. Journal of Child Psychology and Psychiatry. © 2014 Association for Child and Adolescent Mental Health.

The effect of methylphenidate on Internet video game play in children with attention-deficit/hyperactivity disorder.

PubMed

Han, Doug Hyun; Lee, Young Sik; Na, Churl; Ahn, Jee Young; Chung, Un Sun; Daniels, Melissa A; Haws, Charlotte A; Renshaw, Perry F

2009-01-01

A number of studies about attention-deficit/hyperactivity disorder (ADHD) and Internet video game play have examined the prefrontal cortex and dopaminergic system. Stimulants such as methylphenidate (MPH), given to treat ADHD, and video game play have been found to increase synaptic dopamine. We hypothesized that MPH treatment would reduce Internet use in subjects with co-occurring ADHD and Internet video game addictions. Sixty-two children (52 males and 10 females), drug-naive, diagnosed with ADHD, and Internet video game players, participated in this study. At the beginning of the study and after 8 weeks of treatment with Concerta (OROS methylphenidate HCl, Seoul, Korea), participants were assessed with Young's Internet Addiction Scale, Korean version (YIAS-K), Korean DuPaul's ADHD Rating Scale, and the Visual Continuous Performance Test. Their Internet usage time was also recorded. After 8 weeks of treatment, the YIAS-K scores and Internet usage times were significantly reduced. The changes in the YIAS-K scores between the baseline and 8-week assessments were positively correlated with the changes in total and inattention scores from the Korean DuPaul's ADHD Rating Scale, as well as omission errors from the Visual Continuous Performance Test. There was also a significant difference in the number of omission errors among non-Internet-addicted, mildly Internet addicted, and severely Internet addicted participants. We suggest that Internet video game playing might be a means of self-medication for children with ADHD. In addition, we cautiously suggest that MPH might be evaluated as a potential treatment of Internet addiction.

Application of the Convolution Formalism to the Ocean Tide Potential: Results from the Gravity and Recovery and Climate Experiment (GRACE)

NASA Technical Reports Server (NTRS)

Desai, S. D.; Yuan, D. -N.

2006-01-01

A computationally efficient approach to reducing omission errors in ocean tide potential models is derived and evaluated using data from the Gravity Recovery and Climate Experiment (GRACE) mission. Ocean tide height models are usually explicitly available at a few frequencies, and a smooth unit response is assumed to infer the response across the tidal spectrum. The convolution formalism of Munk and Cartwright (1966) models this response function with a Fourier series. This allows the total ocean tide height, and therefore the total ocean tide potential, to be modeled as a weighted sum of past, present, and future values of the tide-generating potential. Previous applications of the convolution formalism have usually been limited to tide height models, but we extend it to ocean tide potential models. We use luni-solar ephemerides to derive the required tide-generating potential so that the complete spectrum of the ocean tide potential is efficiently represented. In contrast, the traditionally adopted harmonic model of the ocean tide potential requires the explicit sum of the contributions from individual tidal frequencies. It is therefore subject to omission errors from neglected frequencies and is computationally more intensive. Intersatellite range rate data from the GRACE mission are used to compare convolution and harmonic models of the ocean tide potential. The monthly range rate residual variance is smaller by 4-5%, and the daily residual variance is smaller by as much as 15% when using the convolution model than when using a harmonic model that is defined by twice the number of parameters.

Perceptual and response-dependent profiles of attention in children with ADHD.

PubMed

Caspersen, Ida Dyhr; Petersen, Anders; Vangkilde, Signe; Plessen, Kerstin Jessica; Habekost, Thomas

2017-05-01

Attention-deficit hyperactivity disorder (ADHD) is a complex developmental neuropsychiatric disorder, characterized by inattentiveness, impulsivity, and hyperactivity. Recent literature suggests a potential core deficit underlying these behaviors may involve inefficient processing when contextual stimulation is low. In order to specify this inefficiency, the aim of the present study was to disentangle perceptual and response-based deficits of attention by supplementing classic reaction time (RT) measures with an accuracy-only test. Moreover, it was explored whether ADHD symptom severity was systematically related to perceptual and response-based processes. We applied an RT-independent paradigm (Bundesen, 1990) and a sustained attention task (Dockree et al., 2006) to test visual attention in 24 recently diagnosed, medication-naïve children with ADHD, 14 clinical controls with pervasive developmental disorder, and 57 healthy controls. Outcome measures included perceptual processing speed, capacity of visual short-term memory, and errors of commission and omission. Children with ADHD processed information abnormally slow (d = 0.92), and performed poorly on RT variability and response stability (d's ranging from 0.60 to 1.08). In the ADHD group only, slowed visual processing speed was significantly related to response lapses (omission errors). This correlation was not explained by behavioral ratings of ADHD severity. Based on combined assessment of perceptual and response-dependent variables of attention, the present study demonstrates a specific cognitive profile in children with ADHD. This profile distinguishes the disorder at a basic level of attentional functioning, and may define subgroups of children with ADHD in a way that is more sensitive than clinical rating scales. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Cognitive deficits in obese persons with and without binge eating disorder. Investigation using a mental flexibility task.

PubMed

Mobbs, Olivia; Iglesias, Katia; Golay, Alain; Van der Linden, Martial

2011-08-01

Studies suggest that cognitive deficits and attentional biases play a role in the development and maintenance of obesity and eating disorders. In this study, we simultaneously examine attentional biases, as well as inhibitory control and mental flexibility, which are keys to controlling unwanted behaviors and thoughts in obese patients with and without binge eating disorder. 16 obese patients with binge eating disorder and 16 patients without binge eating disorder were compared with 16 normal-weight controls on a "food/body-mental flexibility task", which allows the investigation of inhibitory control, mental flexibility and attention for stimuli related to the body and food. All obese patients made significantly more errors (i.e., pressing a key when a distracter displayed) and more omissions (i.e., not pressing a key when a target displayed) than controls in both food and body sections of the task. Obese participants with binge eating disorder made significantly more errors and omissions than those without binge eating disorder. No difference between groups was found concerning mental flexibility and cognitive biases for food- and body-related targets. These results suggest that obese patients have a general inhibition problem and difficulty focusing attention, which do not depend on the types of stimuli processed. The results also suggest that these cognitive deficits are more severe in obese patients with binge eating disorder, which indicates that there is a continuum of increasing inhibition and cognitive problems with increasingly disordered eating. These cognitive deficits may contribute to problematic eating behaviors. Copyright © 2011 Elsevier Ltd. All rights reserved.

Dieting and Food Cue-Related Working Memory Performance.

PubMed

Meule, Adrian

2016-01-01

Executive functioning (e.g., working memory) is tightly intertwined with self-regulation. For example, food cue-elicited craving has been found to impair working memory performance. Furthermore, current dieters have been found to show lower working memory performance than non-dieters. Recent research, however, suggests that it is crucial to consider dieting success in addition to current dieting status or restrained eating in order to reveal cognitive mechanisms that are associated with successful eating-related self-regulation. The current study investigated food cue-related working memory performance as a function of dieting status and dieting success in female students. Participants performed an n -back task with pictures of food and neutral objects. Reaction time in response to food pictures was slower than in response to neutral pictures, whereas omission errors did not differ between picture types. Current food craving was increased after performing the food block, but not after the neutral block. There was an indirect effect of current dieting status on higher food craving after the food block, which was mediated by slower reaction time to food vs. neutral pictures. Furthermore, higher dieting success was associated with fewer omission errors in the food vs. neutral block in current dieters. There were no relationships of restrained eating with current food craving and task performance. Results further highlight the need to differentiate between successful and unsuccessful dieting in addition to current dieting status or restrained eating when examining possible mechanisms of overeating or successful restraint. Although palatable food cues induce food craving regardless of dieting success, they may boost executive functioning in successful dieters, which helps them to overcome these temptations.

Prevalence and cost of hospital medical errors in the general and elderly United States populations.

PubMed

Mallow, Peter J; Pandya, Bhavik; Horblyuk, Ruslan; Kaplan, Harold S

2013-12-01

The primary objective of this study was to quantify the differences in the prevalence rate and costs of hospital medical errors between the general population and an elderly population aged ≥65 years. Methods from an actuarial study of medical errors were modified to identify medical errors in the Premier Hospital Database using data from 2009. Visits with more than four medical errors were removed from the population to avoid over-estimation of cost. Prevalence rates were calculated based on the total number of inpatient visits. There were 3,466,596 total inpatient visits in 2009. Of these, 1,230,836 (36%) occurred in people aged ≥ 65. The prevalence rate was 49 medical errors per 1000 inpatient visits in the general cohort and 79 medical errors per 1000 inpatient visits for the elderly cohort. The top 10 medical errors accounted for more than 80% of the total in the general cohort and the 65+ cohort. The most costly medical error for the general population was postoperative infection ($569,287,000). Pressure ulcers were most costly ($347,166,257) in the elderly population. This study was conducted with a hospital administrative database, and assumptions were necessary to identify medical errors in the database. Further, there was no method to identify errors of omission or misdiagnoses within the database. This study indicates that prevalence of hospital medical errors for the elderly is greater than the general population and the associated cost of medical errors in the elderly population is quite substantial. Hospitals which further focus their attention on medical errors in the elderly population may see a significant reduction in costs due to medical errors as a disproportionate percentage of medical errors occur in this age group.

Ten-year results of quality assurance in radiotherapy chart round.

PubMed

Taghavi Bayat, Bardia; Gill, Suki; Siva, Shankar; Tai, Keen Hun; Joon, Michael Lim; Foroudi, Farshad

2013-04-23

The Royal Australian and New Zealand College of Radiologists (RANZCR) initiated a unique instrument to audit the quality of patient notes and radiotherapy prescriptions. We present our experience collected over ten years from the use of the RANZCR audit instrument. In this study, the results of data collected prospectively from January 1999 to June 2009 through the audit instrument were assessed. Radiotherapy chart rounds were held weekly in the uro-oncology tumour stream and real time feedback was provided. Electronic medical records were retrospectively assessed in September 2009 to see if any omissions were subsequently corrected. In total 2597 patients were audited. One hundred and thirty seven (5%) patients had one hundred and ninety nine omissions in documentation or radiotherapy prescription. In 79% of chart rounds no omissions were found at all, in 12% of chart rounds one omission was found and in 9% of chart rounds two or more omissions were found. Out of 199 omissions, 95% were of record keeping and 2% were omissions in the treatment prescription. Of omissions, 152 (76%) were unfiled investigation results of which 77 (51%) were subsequently corrected. Real-time audit with feedback is an effective tool in assessing the standards of radiotherapy documentation in our department, and also probably contributed to the high level of attentiveness. A large proportion of omissions were investigation results, which highlights the need for an improved system of retrieval of investigation results in the radiation oncology department.

Using voluntary reports from physicians to learn from diagnostic errors in emergency medicine.

PubMed

Okafor, Nnaemeka; Payne, Velma L; Chathampally, Yashwant; Miller, Sara; Doshi, Pratik; Singh, Hardeep

2016-04-01

Diagnostic errors are common in the emergency department (ED), but few studies have comprehensively evaluated their types and origins. We analysed incidents reported by ED physicians to determine disease conditions, contributory factors and patient harm associated with ED-related diagnostic errors. Between 1 March 2009 and 31 December 2013, ED physicians reported 509 incidents using a department-specific voluntary incident-reporting system that we implemented at two large academic hospital-affiliated EDs. For this study, we analysed 209 incidents related to diagnosis. A quality assurance team led by an ED physician champion reviewed each incident and interviewed physicians when necessary to confirm the presence/absence of diagnostic error and to determine the contributory factors. We generated descriptive statistics quantifying disease conditions involved, contributory factors and patient harm from errors. Among the 209 incidents, we identified 214 diagnostic errors associated with 65 unique diseases/conditions, including sepsis (9.6%), acute coronary syndrome (9.1%), fractures (8.6%) and vascular injuries (8.6%). Contributory factors included cognitive (n=317), system related (n=192) and non-remedial (n=106). Cognitive factors included faulty information verification (41.3%) and faulty information processing (30.6%) whereas system factors included high workload (34.4%) and inefficient ED processes (40.1%). Non-remediable factors included atypical presentation (31.3%) and the patients' inability to provide a history (31.3%). Most errors (75%) involved multiple factors. Major harm was associated with 34/209 (16.3%) of reported incidents. Most diagnostic errors in ED appeared to relate to common disease conditions. While sustaining diagnostic error reporting programmes might be challenging, our analysis reveals the potential value of such systems in identifying targets for improving patient safety in the ED. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Diagnosis is a team sport - partnering with allied health professionals to reduce diagnostic errors.

PubMed

Thomas, Dana B; Newman-Toker, David E

2016-06-01

Diagnostic errors are the most common, most costly, and most catastrophic of medical errors. Interdisciplinary teamwork has been shown to reduce harm from therapeutic errors, but sociocultural barriers may impact the engagement of allied health professionals (AHPs) in the diagnostic process. A qualitative case study of the experience at a single institution around involvement of an AHP in the diagnostic process for acute dizziness and vertigo. We detail five diagnostic error cases in which the input of a physical therapist was central to correct diagnosis. We further describe evolution of the sociocultural milieu at the institution as relates to AHP engagement in diagnosis. Five patients with acute vestibular symptoms were initially misdiagnosed by physicians and then correctly diagnosed based on input from a vestibular physical therapist. These included missed labyrinthine concussion and post-traumatic benign paroxysmal positional vertigo (BPPV); BPPV called gastroenteritis; BPPV called stroke; stroke called BPPV; and multiple sclerosis called BPPV. As a consequence of surfacing these diagnostic errors, initial resistance to physical therapy input to aid medical diagnosis has gradually declined, creating a more collaborative environment for 'team diagnosis' of patients with dizziness and vertigo at the institution. Barriers to AHP engagement in 'team diagnosis' include sociocultural norms that establish medical diagnosis as something reserved only for physicians. Drawing attention to the valuable diagnostic contributions of AHPs may help facilitate cultural change. Future studies should seek to measure diagnostic safety culture and then implement proven strategies to breakdown sociocultural barriers that inhibit effective teamwork and transdisciplinary diagnosis.

Diagnosis is a team sport - partnering with allied health professionals to reduce diagnostic errors: A case study on the role of a vestibular therapist in diagnosing dizziness.

PubMed

Thomas, Dana B; Newman-Toker, David E

2016-06-01

Diagnostic errors are the most common, most costly, and most catastrophic of medical errors. Interdisciplinary teamwork has been shown to reduce harm from therapeutic errors, but sociocultural barriers may impact the engagement of allied health professionals (AHPs) in the diagnostic process. A qualitative case study of the experience at a single institution around involvement of an AHP in the diagnostic process for acute dizziness and vertigo. We detail five diagnostic error cases in which the input of a physical therapist was central to correct diagnosis. We further describe evolution of the sociocultural milieu at the institution as relates to AHP engagement in diagnosis. Five patients with acute vestibular symptoms were initially misdiagnosed by physicians and then correctly diagnosed based on input from a vestibular physical therapist. These included missed labyrinthine concussion and post-traumatic benign paroxysmal positional vertigo (BPPV); BPPV called gastroenteritis; BPPV called stroke; stroke called BPPV; and multiple sclerosis called BPPV. As a consequence of surfacing these diagnostic errors, initial resistance to physical therapy input to aid medical diagnosis has gradually declined, creating a more collaborative environment for 'team diagnosis' of patients with dizziness and vertigo at the institution. Barriers to AHP engagement in 'team diagnosis' include sociocultural norms that establish medical diagnosis as something reserved only for physicians. Drawing attention to the valuable diagnostic contributions of AHPs may help facilitate cultural change. Future studies should seek to measure diagnostic safety culture and then implement proven strategies to breakdown sociocultural barriers that inhibit effective teamwork and transdisciplinary diagnosis.

Problems and Progress regarding Sex Bias and Omission in Neuroscience Research

PubMed Central

Will, Tyler R.; Proaño, Stephanie B.; Thomas, Anly M.; Kunz, Lindsey M.; Thompson, Kelly C.; Ginnari, Laura A.; Jones, Clay H.; Lucas, Sarah-Catherine; Reavis, Elizabeth M.

2017-01-01

Neuroscience research has historically ignored female animals. This neglect comes in two general forms. The first is sex bias, defined as favoring one sex over another; in this case, male over female. The second is sex omission, which is the lack of reporting sex. The recognition of this phenomenon has generated fierce debate across the sciences. Here we test whether sex bias and omission are still present in the neuroscience literature, whether studies employing both males and females neglect sex as an experimental variable, and whether sex bias and omission differs between animal models and journals. To accomplish this, we analyzed the largest-ever number of neuroscience articles for sex bias and omission: 6636 articles using mice or rats in 6 journals published from 2010 to 2014. Sex omission is declining, as increasing numbers of articles report sex. Sex bias remains present, as increasing numbers of articles report the sole use of males. Articles using both males and females are also increasing, but few report assessing sex as an experimental variable. Sex bias and omission varies substantially by animal model and journal. These findings are essential for understanding the complex status of sex bias and omission in neuroscience research and may inform effective decisions regarding policy action. PMID:29134192

A bibliography of references to avian cholera

USGS Publications Warehouse

Wilson, Sonoma S.

1979-01-01

Mrs. Wilson has made a genuine effort to include in this bibliography every significant reference to avian cholera since Louis Pasteur's articles appeared in 1880, although she recognizes the likelihood that a few have been overlooked. New listings have been added throughout 1978, but comprehensive coverage of the literature cannot be claimed beyond June of that year.Textbook accounts, because they are generally summaries of work published elsewhere, are excluded. Papers dealing primarily with the biology of Pasteurella multocida, as opposed to the disease it induces in birds, are also excluded, unless they report information of diagnostic usefulness. Short abstracts are not included unless the journals in which they are published are more widely available than those in which the complete articles appear or they are English summaries of foreign language articles.In compiling this bibliography, Mrs. Wilson has made extensive use of Biological Abstracts, the Pesticide Documentation Bulletin, and printouts generated by Bibliographic Retrieval Services, Inc. The "Literature Cited" sections of textbooks and journal articles pertinent to the subject were sources of many additional references. Regardless of the origin of the citation, its accuracy was confirmed by comparison with the original publication, except in those few instances (marked with an asterisk) when the journal was not on the shelves of the libraries accessible to us.The author will be grateful to users of the bibliography who point out errors or omissions.Wayne I. JensenMicrobiologist In Charge

[Responsibility due to medication errors in France: a study based on SHAM insurance data].

PubMed

Theissen, A; Orban, J-C; Fuz, F; Guerin, J-P; Flavin, P; Albertini, S; Maricic, S; Saquet, D; Niccolai, P

2015-03-01

The safe medication practices at the hospital constitute a major public health problem. Drug supply chain is a complex process, potentially source of errors and damages for the patient. SHAM insurances are the biggest French provider of medical liability insurances and a relevant source of data on the health care complications. The main objective of the study was to analyze the type and cause of medication errors declared to SHAM and having led to a conviction by a court. We did a retrospective study on insurance claims provided by SHAM insurances with a medication error and leading to a condemnation over a 6-year period (between 2005 and 2010). Thirty-one cases were analysed, 21 for scheduled activity and 10 for emergency activity. Consequences of claims were mostly serious (12 deaths, 14 serious complications, 5 simple complications). The types of medication errors were a drug monitoring error (11 cases), an administration error (5 cases), an overdose (6 cases), an allergy (4 cases), a contraindication (3 cases) and an omission (2 cases). Intravenous route of administration was involved in 19 of 31 cases (61%). The causes identified by the court expert were an error related to service organization (11), an error related to medical practice (11) or nursing practice (13). Only one claim was due to the hospital pharmacy. The claim related to drug supply chain is infrequent but potentially serious. These data should help strengthen quality approach in risk management. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

Being a Victim of Medical Error in Brazil: An (Un)Real Dilemma

PubMed Central

Mendonça, Vitor Silva; Custódio, Eda Marconi

2016-01-01

Medical error stems from inadequate professional conduct that is capable of producing harm to life or exacerbating the health of another, whether through act or omission. This situation has become increasingly common in Brazil and worldwide. In this study, the aim was to understand what being the victim of medical error is like and to investigate the circumstances imposed on this condition of victims in Brazil. A semi-structured interview was conducted with twelve people who had gone through situations of medical error in their lives, creating a space for narratives of their experiences and deep reflection on the phenomenon. The concept of medical error has a negative connotation, often being associated with the incompetence of a medical professional. Medical error in Brazil is demonstrated by low-quality professional performance and represents the current reality of the country because of the common lack of respect and consideration for patients. Victims often remark on their loss of identity, as their social functions have been interrupted and they do not expect to regain such. It was found, however, little assumption of error in the involved doctors’ discourses and attitudes, which felt a need to judge the medical conduct in an attempt to assert their rights. Medical error in Brazil presents a punitive character and is little discussed in medical and scientific circles. The stigma of medical error is closely connected to the value and cultural judgments of the country, making it difficult to accept, both by victims and professionals. PMID:27403461

Effectiveness of Toyota process redesign in reducing thyroid gland fine-needle aspiration error.

PubMed

Raab, Stephen S; Grzybicki, Dana Marie; Sudilovsky, Daniel; Balassanian, Ronald; Janosky, Janine E; Vrbin, Colleen M

2006-10-01

Our objective was to determine whether the Toyota Production System process redesign resulted in diagnostic error reduction for patients who underwent cytologic evaluation of thyroid nodules. In this longitudinal, nonconcurrent cohort study, we compared the diagnostic error frequency of a thyroid aspiration service before and after implementation of error reduction initiatives consisting of adoption of a standardized diagnostic terminology scheme and an immediate interpretation service. A total of 2,424 patients underwent aspiration. Following terminology standardization, the false-negative rate decreased from 41.8% to 19.1% (P = .006), the specimen nondiagnostic rate increased from 5.8% to 19.8% (P < .001), and the sensitivity increased from 70.2% to 90.6% (P < .001). Cases with an immediate interpretation had a lower noninterpretable specimen rate than those without immediate interpretation (P < .001). Toyota process change led to significantly fewer diagnostic errors for patients who underwent thyroid fine-needle aspiration.

Dual processing and diagnostic errors.

PubMed

Norman, Geoff

2009-09-01

In this paper, I review evidence from two theories in psychology relevant to diagnosis and diagnostic errors. "Dual Process" theories of thinking, frequently mentioned with respect to diagnostic error, propose that categorization decisions can be made with either a fast, unconscious, contextual process called System 1 or a slow, analytical, conscious, and conceptual process, called System 2. Exemplar theories of categorization propose that many category decisions in everyday life are made by unconscious matching to a particular example in memory, and these remain available and retrievable individually. I then review studies of clinical reasoning based on these theories, and show that the two processes are equally effective; System 1, despite its reliance in idiosyncratic, individual experience, is no more prone to cognitive bias or diagnostic error than System 2. Further, I review evidence that instructions directed at encouraging the clinician to explicitly use both strategies can lead to consistent reduction in error rates.

Cognitive function at rest and during exercise following breakfast omission.

PubMed

Komiyama, Takaaki; Sudo, Mizuki; Okuda, Naoki; Yasuno, Tetsuhiko; Kiyonaga, Akira; Tanaka, Hiroaki; Higaki, Yasuki; Ando, Soichi

2016-04-01

It has been suggested that breakfast omission, as opposed to breakfast consumption, has the detrimental effects on cognitive function. However, the effects of acute exercise following breakfast omission on cognitive function are poorly understood, particularly during exercise. The purpose of this study was to examine the interactive effects of breakfast and exercise on cognitive function. Ten participants completed cognitive tasks at rest and during exercise in the breakfast consumption or omission conditions. Blood glucose concentration was measured immediately after each cognitive task. We used cognitive tasks to assess working memory [Spatial Delayed Response (DR) task] and executive function [Go/No-Go (GNG) task]. The participants cycled ergometer for 30 min while keeping their heart rate at 140 beats·min(-1). Accuracy of the GNG task was lower at rest in the breakfast omission condition than that in the breakfast consumption condition (Go trial: P=0.012; No-Go trial: P=0.028). However, exercise improved accuracy of the Go trial in the breakfast omission condition (P=0.013). Reaction time in the Go trial decreased during exercise relative to rest in both conditions (P=0.002), and the degree of decreases in reaction time was not different between conditions (P=0.448). Exercise and breakfast did not affect the accuracy of the Spatial DR task. The present results indicate that breakfast omission impairs executive function, but acute exercise improved executive function even after breakfast omission. It appears that beneficial effects of acute exercise on cognitive function are intact following breakfast omission. Copyright © 2016 Elsevier Inc. All rights reserved.

Learning from adverse incidents involving medical devices.

PubMed

Amoore, John; Ingram, Paula

While an adverse event involving a medical device is often ascribed to either user error or device failure, the causes are typically multifactorial. A number of incidents involving medical devices are explored using this approach to investigate the various causes of the incident and the protective barriers that minimised or prevented adverse consequences. User factors, including mistakes, omissions and lack of training, conspired with background factors--device controls and device design, storage conditions, hidden device damage and physical layout of equipment when in use--to cause the adverse events. Protective barriers that prevented or minimised the consequences included staff vigilance, operating procedures and alarms.

Spatial resolution requirements for automated cartographic road extraction

USGS Publications Warehouse

Benjamin, S.; Gaydos, L.

1990-01-01

Ground resolution requirements for detection and extraction of road locations in a digitized large-scale photographic database were investigated. A color infrared photograph of Sunnyvale, California was scanned, registered to a map grid, and spatially degraded to 1- to 5-metre resolution pixels. Road locations in each data set were extracted using a combination of image processing and CAD programs. These locations were compared to a photointerpretation of road locations to determine a preferred pixel size for the extraction method. Based on road pixel omission error computations, a 3-metre pixel resolution appears to be the best choice for this extraction method. -Authors

Relationships between Dietary Intake and Cognitive Function in Healthy Korean Children and Adolescents

PubMed Central

Kim, Jin Young; Kang, Seung Wan

2017-01-01

Background It has long been theorized that a relatively robust dietary intake impacts cognitive function. The aim of the study was to explore dietary intake and cognitive function in healthy Korean children and adolescents. Methods Three hundred and seventeen healthy children with no previous diagnosis of neurologic or psychiatric disorders were evaluated (167 girls and 150 boys with a mean age of 11.8 ± 3.3 years). Analysis indicators including food frequency questionnaires (FFQs) consisting of 76 items and neurocognitive tests including symbol digit modalities (SDMT), verbal memory, visual memory, shift attention, reasoning, and digit span (forward and backward) tests were observed and recorded. Results The standard deviation in reaction time was significantly shorter in girls than in boys (p < 0.05). Verbal memory and SDMT percentile results were significantly higher in girls than in boys (p < 0.05). Vitamin C and potassium intake showed positive correlation with SDMT results (p < 0.05). Vitamin B1 intake showed positive correlation with the results of digit span forward tasks and SDMT (p < 0.01). Vitamin B6 intake showed positive correlation with the results of digit span forward tasks (p < 0.01). The consumption of noodles showed negative correlation with verbal memory, SDMT, shift attention, and reasoning test results (p < 0.05). The consumption of fast food showed negative correlation with SDMT and reasoning test results (p < 0.05). The consumption of Coca-Cola showed negative correlation with the results of verbal memory tests (p < 0.05). The consumption of mushrooms showed positive correlation with visual memory and reasoning test results (p < 0.05). The consumption of nuts showed positive correlation with SDMT results (p < 0.01). Omission errors were negatively correlated with the intake of protein, vitamin B1, vitamin B2, niacin, and vitamin B6 (p < 0.05), as well as with vitamin D and zinc intake (p < 0.01). Reaction time showed positive correlation with caffeine intake (p < 0.05). Omission errors were positively correlated with the consumption of rice and ramyeon (p < 0.01). Reaction time showed positive correlation with the consumption of snacks (p < 0.05). Standard deviations in reaction times showed positive correlation with the consumption of rice (p < 0.01), snacks, and chocolate (p < 0.05). Omission errors were negatively correlated with the consumption of rice with mixed grains (p < 0.01) and eggs (p < 0.05). Conclusion The relationship between dietary intake and cognitive function is generally better observed in girls than in boys. The consumption of healthy foods is correlated with good cognitive function. These results suggest that diet is closely related to cognitive function, even in healthy children and adolescents. PMID:28261556

Relationships between Dietary Intake and Cognitive Function in Healthy Korean Children and Adolescents.

PubMed

Kim, Jin Young; Kang, Seung Wan

2017-01-01

It has long been theorized that a relatively robust dietary intake impacts cognitive function. The aim of the study was to explore dietary intake and cognitive function in healthy Korean children and adolescents. Three hundred and seventeen healthy children with no previous diagnosis of neurologic or psychiatric disorders were evaluated (167 girls and 150 boys with a mean age of 11.8 ± 3.3 years). Analysis indicators including food frequency questionnaires (FFQs) consisting of 76 items and neurocognitive tests including symbol digit modalities (SDMT), verbal memory, visual memory, shift attention, reasoning, and digit span (forward and backward) tests were observed and recorded. The standard deviation in reaction time was significantly shorter in girls than in boys (p < 0.05). Verbal memory and SDMT percentile results were significantly higher in girls than in boys (p < 0.05). Vitamin C and potassium intake showed positive correlation with SDMT results (p < 0.05). Vitamin B1 intake showed positive correlation with the results of digit span forward tasks and SDMT (p < 0.01). Vitamin B6 intake showed positive correlation with the results of digit span forward tasks (p < 0.01). The consumption of noodles showed negative correlation with verbal memory, SDMT, shift attention, and reasoning test results (p < 0.05). The consumption of fast food showed negative correlation with SDMT and reasoning test results (p < 0.05). The consumption of Coca-Cola showed negative correlation with the results of verbal memory tests (p < 0.05). The consumption of mushrooms showed positive correlation with visual memory and reasoning test results (p < 0.05). The consumption of nuts showed positive correlation with SDMT results (p < 0.01). Omission errors were negatively correlated with the intake of protein, vitamin B1, vitamin B2, niacin, and vitamin B6 (p < 0.05), as well as with vitamin D and zinc intake (p < 0.01). Reaction time showed positive correlation with caffeine intake (p < 0.05). Omission errors were positively correlated with the consumption of rice and ramyeon (p < 0.01). Reaction time showed positive correlation with the consumption of snacks (p < 0.05). Standard deviations in reaction times showed positive correlation with the consumption of rice (p < 0.01), snacks, and chocolate (p < 0.05). Omission errors were negatively correlated with the consumption of rice with mixed grains (p < 0.01) and eggs (p < 0.05). The relationship between dietary intake and cognitive function is generally better observed in girls than in boys. The consumption of healthy foods is correlated with good cognitive function. These results suggest that diet is closely related to cognitive function, even in healthy children and adolescents.

Single-channel autocorrelation functions: the effects of time interval omission.

PubMed Central

Ball, F G; Sansom, M S

1988-01-01

We present a general mathematical framework for analyzing the dynamic aspects of single channel kinetics incorporating time interval omission. An algorithm for computing model autocorrelation functions, incorporating time interval omission, is described. We show, under quite general conditions, that the form of these autocorrelations is identical to that which would be obtained if time interval omission was absent. We also show, again under quite general conditions, that zero correlations are necessarily a consequence of the underlying gating mechanism and not an artefact of time interval omission. The theory is illustrated by a numerical study of an allosteric model for the gating mechanism of the locust muscle glutamate receptor-channel. PMID:2455553

Errors in imaging patients in the emergency setting

PubMed Central

Reginelli, Alfonso; Lo Re, Giuseppe; Midiri, Federico; Muzj, Carlo; Romano, Luigia; Brunese, Luca

2016-01-01

Emergency and trauma care produces a “perfect storm” for radiological errors: uncooperative patients, inadequate histories, time-critical decisions, concurrent tasks and often junior personnel working after hours in busy emergency departments. The main cause of diagnostic errors in the emergency department is the failure to correctly interpret radiographs, and the majority of diagnoses missed on radiographs are fractures. Missed diagnoses potentially have important consequences for patients, clinicians and radiologists. Radiologists play a pivotal role in the diagnostic assessment of polytrauma patients and of patients with non-traumatic craniothoracoabdominal emergencies, and key elements to reduce errors in the emergency setting are knowledge, experience and the correct application of imaging protocols. This article aims to highlight the definition and classification of errors in radiology, the causes of errors in emergency radiology and the spectrum of diagnostic errors in radiography, ultrasonography and CT in the emergency setting. PMID:26838955

Errors in imaging patients in the emergency setting.

PubMed

Pinto, Antonio; Reginelli, Alfonso; Pinto, Fabio; Lo Re, Giuseppe; Midiri, Federico; Muzj, Carlo; Romano, Luigia; Brunese, Luca

2016-01-01

Emergency and trauma care produces a "perfect storm" for radiological errors: uncooperative patients, inadequate histories, time-critical decisions, concurrent tasks and often junior personnel working after hours in busy emergency departments. The main cause of diagnostic errors in the emergency department is the failure to correctly interpret radiographs, and the majority of diagnoses missed on radiographs are fractures. Missed diagnoses potentially have important consequences for patients, clinicians and radiologists. Radiologists play a pivotal role in the diagnostic assessment of polytrauma patients and of patients with non-traumatic craniothoracoabdominal emergencies, and key elements to reduce errors in the emergency setting are knowledge, experience and the correct application of imaging protocols. This article aims to highlight the definition and classification of errors in radiology, the causes of errors in emergency radiology and the spectrum of diagnostic errors in radiography, ultrasonography and CT in the emergency setting.

Mapping forest canopy gaps using air-photo interpretation and ground surveys

USGS Publications Warehouse

Fox, T.J.; Knutson, M.G.; Hines, R.K.

2000-01-01

Canopy gaps are important structural components of forested habitats for many wildlife species. Recent improvements in the spatial accuracy of geographic information system tools facilitate accurate mapping of small canopy features such as gaps. We compared canopy-gap maps generated using ground survey methods with those derived from air-photo interpretation. We found that maps created from high-resolution air photos were more accurate than those created from ground surveys. Errors of omission were 25.6% for the ground-survey method and 4.7% for the air-photo method. One variable of inter est in songbird research is the distance from nests to gap edges. Distances from real and simulated nests to gap edges were longer using the ground-survey maps versus the air-photo maps, indicating that gap omission could potentially bias the assessment of spatial relationships. If research or management goals require location and size of canopy gaps and specific information about vegetation structure, we recommend a 2-fold approach. First, canopy gaps can be located and the perimeters defined using 1:15,000-scale or larger aerial photographs and the methods we describe. Mapped gaps can then be field-surveyed to obtain detailed vegetation data.

Heavy-flavor parton distributions without heavy-flavor matching prescriptions

NASA Astrophysics Data System (ADS)

Bertone, Valerio; Glazov, Alexandre; Mitov, Alexander; Papanastasiou, Andrew S.; Ubiali, Maria

2018-04-01

We show that the well-known obstacle for working with the zero-mass variable flavor number scheme, namely, the omission of O(1) mass power corrections close to the conventional heavy flavor matching point (HFMP) μ b = m, can be easily overcome. For this it is sufficient to take advantage of the freedom in choosing the position of the HFMP. We demonstrate that by choosing a sufficiently large HFMP, which could be as large as 10 times the mass of the heavy quark, one can achieve the following improvements: 1) above the HFMP the size of missing power corrections O(m) is restricted by the value of μ b and, therefore, the error associated with their omission can be made negligible; 2) additional prescriptions for the definition of cross-sections are not required; 3) the resummation accuracy is maintained and 4) contrary to the common lore we find that the discontinuity of α s and pdfs across thresholds leads to improved continuity in predictions for observables. We have considered a large set of proton-proton and electron-proton collider processes, many through NNLO QCD, that demonstrate the broad applicability of our proposal.

Cognitive control in children with learning disabilities: neuromarker for deficient executive functions.

PubMed

Alahmadi, Nsreen A

2017-08-02

The neural underpinnings of learning disabilities (LD) are still not known. Recent discussions focus over whether domain-specific and/or domain-unspecific reasons might be responsible for LD either alone or in combination with each other. This study applied standard nonverbal Go-NoGo tasks (visual continuous performance test) to LD and healthy control children to examine whether they show deficient executive functions. During this Go-NoGo task, electroencephalogram was measured in addition to reaction times, hits, omissions, and commissions to the Go and NoGo stimuli. It was shown that children with LD reacted slower with variable responses to Go stimuli and made more omission errors in comparison with the healthy control children. The analysis of the event-related potential indicated that the deficient behavior in this task is associated with smaller - and in part nonexistent - P3d amplitudes. This neural activation indicates a different neural activation pattern during action inhibition in LD children. The neural networks involved in controlling action inhibition are mostly located in frontal brain areas, for which it has been shown that children with LD show neural activation deficiencies. This is possibly a consequence of a maturational delay of the frontal cortex.

Improving specialist drug prescribing in primary care using task and error analysis: an observational study.

PubMed

Chana, Narinder; Porat, Talya; Whittlesea, Cate; Delaney, Brendan

2017-03-01

Electronic prescribing has benefited from computerised clinical decision support systems (CDSSs); however, no published studies have evaluated the potential for a CDSS to support GPs in prescribing specialist drugs. To identify potential weaknesses and errors in the existing process of prescribing specialist drugs that could be addressed in the development of a CDSS. Semi-structured interviews with key informants followed by an observational study involving GPs in the UK. Twelve key informants were interviewed to investigate the use of CDSSs in the UK. Nine GPs were observed while performing case scenarios depicting requests from hospitals or patients to prescribe a specialist drug. Activity diagrams, hierarchical task analysis, and systematic human error reduction and prediction approach analyses were performed. The current process of prescribing specialist drugs by GPs is prone to error. Errors of omission due to lack of information were the most common errors, which could potentially result in a GP prescribing a specialist drug that should only be prescribed in hospitals, or prescribing a specialist drug without reference to a shared care protocol. Half of all possible errors in the prescribing process had a high probability of occurrence. A CDSS supporting GPs during the process of prescribing specialist drugs is needed. This could, first, support the decision making of whether or not to undertake prescribing, and, second, provide drug-specific parameters linked to shared care protocols, which could reduce the errors identified and increase patient safety. © British Journal of General Practice 2017.

Errors, error detection, error correction and hippocampal-region damage: data and theories.

PubMed

MacKay, Donald G; Johnson, Laura W

2013-11-01

This review and perspective article outlines 15 observational constraints on theories of errors, error detection, and error correction, and their relation to hippocampal-region (HR) damage. The core observations come from 10 studies with H.M., an amnesic with cerebellar and HR damage but virtually no neocortical damage. Three studies examined the detection of errors planted in visual scenes (e.g., a bird flying in a fish bowl in a school classroom) and sentences (e.g., I helped themselves to the birthday cake). In all three experiments, H.M. detected reliably fewer errors than carefully matched memory-normal controls. Other studies examined the detection and correction of self-produced errors, with controls for comprehension of the instructions, impaired visual acuity, temporal factors, motoric slowing, forgetting, excessive memory load, lack of motivation, and deficits in visual scanning or attention. In these studies, H.M. corrected reliably fewer errors than memory-normal and cerebellar controls, and his uncorrected errors in speech, object naming, and reading aloud exhibited two consistent features: omission and anomaly. For example, in sentence production tasks, H.M. omitted one or more words in uncorrected encoding errors that rendered his sentences anomalous (incoherent, incomplete, or ungrammatical) reliably more often than controls. Besides explaining these core findings, the theoretical principles discussed here explain H.M.'s retrograde amnesia for once familiar episodic and semantic information; his anterograde amnesia for novel information; his deficits in visual cognition, sentence comprehension, sentence production, sentence reading, and object naming; and effects of aging on his ability to read isolated low frequency words aloud. These theoretical principles also explain a wide range of other data on error detection and correction and generate new predictions for future test. Copyright © 2013 Elsevier Ltd. All rights reserved.

Interceptive Beam Diagnostics - Signal Creation and Materials Interactions

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

Plum, Michael; Spallation Neutron Source, Oak Ridge National Laboratory, P.O. Box 2008, Oak Ridge, TN

2004-11-10

The focus of this tutorial will be on interceptive beam diagnostics such as wire scanners, screens, and harps. We will start with an overview of the various ways beams interact with materials to create signals useful for beam diagnostics systems. We will then discuss the errors in a harp or wire scanner profile measurement caused by errors in wire position, number of samples, and signal errors. Finally we will apply our results to two design examples-the SNS wire scanner system and the SNS target harp.

Educational agenda for diagnostic error reduction

PubMed Central

Trowbridge, Robert L; Dhaliwal, Gurpreet; Cosby, Karen S

2013-01-01

Diagnostic errors are a major patient safety concern. Although the majority of diagnostic errors are partially attributable to cognitive mistakes, the most effective means of improving clinician cognition in order to achieve gains in diagnostic reliability are unclear. We propose a tripartite educational agenda for improving diagnostic performance among students, residents and practising physicians. This agenda includes strengthening the metacognitive abilities of clinicians, fostering intuitive reasoning and increasing awareness of the role of systems in the diagnostic process. The evidence supporting initiatives in each of these realms is reviewed and a course of future implementation and study is proposed. The barriers to designing and implementing this agenda are substantial and include limited evidence supporting these initiatives and the challenges of changing the practice patterns of practising physicians. Implementation will need to be accompanied by rigorous evaluation. PMID:23764435

Characteristics of the acquisition of sonorant consonants orthography in Brazilian children from a São Paulo municipality.

PubMed

Vaz, Suellen; Pezarini, Isabela de Oliveira; Paschoal, Larissa; Chacon, Lourenço

2015-01-01

To describe the spelling performance of children with regard to the record of sonorant consonants in Brazilian Portuguese language, to verify if the errors in their records were influenced by the accent in the word, and to categorize the kinds of errors found. For this current survey, 801 text productions were selected as a result of the development of 14 different thematic proposals, prepared by 76 children from the first grade of primary school, in 2001, coming from two schools of a city from São Paulo, Brazil. Of these productions, all words with sonorant consonants in a syllabic position of simple onset were selected. They were then organized as they appeared as pre-tonic, tonic, and post-tonic syllables, unstressed and tonic monosyllables. The following was observed: the number of hits was extremely higher than that of errors; higher occurrence of errors in non-accented syllables; higher occurrence of phonological substitutions followed by omissions and, at last, orthographic substitutions; and higher number of substitutions that involved graphemes referring to the sonorant class. Considering the distribution of orthographic data between hits and errors, as well as their relationship with phonetic-phonological aspects, may contribute to the comprehension of school difficulties, which are usually found in the first years of literacy instruction.

Anatomy of an error: a bidirectional state model of task engagement/disengagement and attention-related errors.

PubMed

Allan Cheyne, J; Solman, Grayden J F; Carriere, Jonathan S A; Smilek, Daniel

2009-04-01

We present arguments and evidence for a three-state attentional model of task engagement/disengagement. The model postulates three states of mind-wandering: occurrent task inattention, generic task inattention, and response disengagement. We hypothesize that all three states are both causes and consequences of task performance outcomes and apply across a variety of experimental and real-world tasks. We apply this model to the analysis of a widely used GO/NOGO task, the Sustained Attention to Response Task (SART). We identify three performance characteristics of the SART that map onto the three states of the model: RT variability, anticipations, and omissions. Predictions based on the model are tested, and largely corroborated, via regression and lag-sequential analyses of both successful and unsuccessful withholding on NOGO trials as well as self-reported mind-wandering and everyday cognitive errors. The results revealed theoretically consistent temporal associations among the state indicators and between these and SART errors as well as with self-report measures. Lag analysis was consistent with the hypotheses that temporal transitions among states are often extremely abrupt and that the association between mind-wandering and performance is bidirectional. The bidirectional effects suggest that errors constitute important occasions for reactive mind-wandering. The model also enables concrete phenomenological, behavioral, and physiological predictions for future research.

Managing the Risk of Command File Errors

NASA Technical Reports Server (NTRS)

Meshkat, Leila; Bryant, Larry W.

2013-01-01

Command File Error (CFE), as defined by the Jet Propulsion Laboratory's (JPL) Mission Operations Assurance (MOA) is, regardless of the consequence on the spacecraft, either: an error in a command file sent to the spacecraft, an error in the process for developing and delivering a command file to the spacecraft, or the omission of a command file that should have been sent to the spacecraft. The risk consequence of a CFE can be mission ending and thus a concern to space exploration projects during their mission operations. A CFE during space mission operations is often the symptom of some kind of imbalance or inadequacy within the system that comprises the hardware & software used for command generation and the human experts involved in this endeavour. As we move into an era of enhanced collaboration with other NASA centers and commercial partners, these systems become more and more complex and hence it is all the more important to formally model and analyze CFEs in order to manage the risk of CFEs. Here we will provide a summary of the ongoing efforts at JPL in this area and also explain some more recent developments in the area of developing quantitative models for the purpose of managing CFE's.

Assessment of Nonverbal and Verbal Apraxia in Patients with Parkinson's Disease

PubMed Central

Olchik, Maira Rozenfeld; Shumacher Shuh, Artur Francisco; Rieder, Carlos R. M.

2015-01-01

Objective. To assess the presence of nonverbal and verbal apraxia in patients with Parkinson's disease (PD) and analyze the correlation between these conditions and patient age, education, duration of disease, and PD stage, as well as evaluate the correlation between the two types of apraxia and the frequency and types of verbal apraxic errors made by patients in the sample. Method. This was an observational prevalence study. The sample comprised 45 patients with PD seen at the Movement Disorders Clinic of the Clinical Hospital of Porto Alegre, Brazil. Patients were evaluated using the Speech Apraxia Assessment Protocol and PD stages were classified according to the Hoehn and Yahr scale. Results. The rate of nonverbal apraxia and verbal apraxia in the present sample was 24.4%. Verbal apraxia was significantly correlated with education (p ≤ 0.05). The most frequent types of verbal apraxic errors were omissions (70.8%). The analysis of manner and place of articulation showed that most errors occurred during the production of trill (57.7%) and dentoalveolar (92%) phonemes, consecutively. Conclusion. Patients with PD presented nonverbal and verbal apraxia and made several verbal apraxic errors. Verbal apraxia was correlated with education levels. PMID:26543663

Dynamic diagnostics of the error fields in tokamaks

NASA Astrophysics Data System (ADS)

Pustovitov, V. D.

2007-07-01

The error field diagnostics based on magnetic measurements outside the plasma is discussed. The analysed methods rely on measuring the plasma dynamic response to the finite-amplitude external magnetic perturbations, which are the error fields and the pre-programmed probing pulses. Such pulses can be created by the coils designed for static error field correction and for stabilization of the resistive wall modes, the technique developed and applied in several tokamaks, including DIII-D and JET. Here analysis is based on the theory predictions for the resonant field amplification (RFA). To achieve the desired level of the error field correction in tokamaks, the diagnostics must be sensitive to signals of several Gauss. Therefore, part of the measurements should be performed near the plasma stability boundary, where the RFA effect is stronger. While the proximity to the marginal stability is important, the absolute values of plasma parameters are not. This means that the necessary measurements can be done in the diagnostic discharges with parameters below the nominal operating regimes, with the stability boundary intentionally lowered. The estimates for ITER are presented. The discussed diagnostics can be tested in dedicated experiments in existing tokamaks. The diagnostics can be considered as an extension of the 'active MHD spectroscopy' used recently in the DIII-D tokamak and the EXTRAP T2R reversed field pinch.

Looking for trouble? Diagnostics expanding disease and producing patients.

PubMed

Hofmann, Bjørn

2018-05-23

Novel tests give great opportunities for earlier and more precise diagnostics. At the same time, new tests expand disease, produce patients, and cause unnecessary harm in overdiagnosis and overtreatment. How can we evaluate diagnostics to obtain the benefits and avoid harm? One way is to pay close attention to the diagnostic process and its core concepts. Doing so reveals 3 errors that expand disease and increase overdiagnosis. The first error is to decouple diagnostics from harm, eg, by diagnosing insignificant conditions. The second error is to bypass proper validation of the relationship between test indicator and disease, eg, by introducing biomarkers for Alzheimer's disease before the tests are properly validated. The third error is to couple the name of disease to insignificant or indecisive indicators, eg, by lending the cancer name to preconditions, such as ductal carcinoma in situ. We need to avoid these errors to promote beneficial testing, bar harmful diagnostics, and evade unwarranted expansion of disease. Accordingly, we must stop identifying and testing for conditions that are only remotely associated with harm. We need more stringent verification of tests, and we must avoid naming indicators and indicative conditions after diseases. If not, we will end like ancient tragic heroes, succumbing because of our very best abilities. © 2018 John Wiley & Sons, Ltd.

Incorporating Yearly Derived Winter Wheat Maps Into Winter Wheat Yield Forecasting Model

NASA Technical Reports Server (NTRS)

Skakun, S.; Franch, B.; Roger, J.-C.; Vermote, E.; Becker-Reshef, I.; Justice, C.; Santamaría-Artigas, A.

2016-01-01

Wheat is one of the most important cereal crops in the world. Timely and accurate forecast of wheat yield and production at global scale is vital in implementing food security policy. Becker-Reshef et al. (2010) developed a generalized empirical model for forecasting winter wheat production using remote sensing data and official statistics. This model was implemented using static wheat maps. In this paper, we analyze the impact of incorporating yearly wheat masks into the forecasting model. We propose a new approach of producing in season winter wheat maps exploiting satellite data and official statistics on crop area only. Validation on independent data showed that the proposed approach reached 6% to 23% of omission error and 10% to 16% of commission error when mapping winter wheat 2-3 months before harvest. In general, we found a limited impact of using yearly winter wheat masks over a static mask for the study regions.

Building a genome database using an object-oriented approach.

PubMed

Barbasiewicz, Anna; Liu, Lin; Lang, B Franz; Burger, Gertraud

2002-01-01

GOBASE is a relational database that integrates data associated with mitochondria and chloroplasts. The most important data in GOBASE, i. e., molecular sequences and taxonomic information, are obtained from the public sequence data repository at the National Center for Biotechnology Information (NCBI), and are validated by our experts. Maintaining a curated genomic database comes with a towering labor cost, due to the shear volume of available genomic sequences and the plethora of annotation errors and omissions in records retrieved from public repositories. Here we describe our approach to increase automation of the database population process, thereby reducing manual intervention. As a first step, we used Unified Modeling Language (UML) to construct a list of potential errors. Each case was evaluated independently, and an expert solution was devised, and represented as a diagram. Subsequently, the UML diagrams were used as templates for writing object-oriented automation programs in the Java programming language.

Compounds in different aphasia categories: a study on picture naming.

PubMed

Semenza, Carlo; De Pellegrin, Serena; Battel, Irene; Garzon, Martina; Meneghello, Francesca; Chiarelli, Valentina

2011-12-01

This study investigated the production of compounds in Italian-speaking patients affected by different aphasia categories (i.e., Broca's, Wernicke's, and anomic aphasia) in a confrontation naming task. Questions of theoretical interest concerning the processing of compounds within the framework of the "lemma theory" as well as the role of morphological productivity in compound processing are addressed. Results indicate that all persons with aphasia retain knowledge of the morphological status of words, even when they fail to retrieve the corresponding phonological form (the "compound effect"). A difference was found among aphasia categories in the type of errors produced (omission vs. substitution) and in the position (first or second) of these errors within the compound words. In Broca's aphasia, the first component is omitted more frequently than the second one, but only in verb-noun compounds. Anomic and Wernicke's aphasia, unlike in Broca's aphasia, seem to retain sensitivity to morphological productivity.

Lost in the mall: misrepresentations and misunderstandings.

PubMed

Loftus, Elizabeth F

1999-01-01

Readers of Ethics and Behavior have been treated to a misrepresentation of my research on planting false memories, to a misstatement of the actual empirical finidngs, and to a distortion of the history of the development of the idea for this line of research. The partisan essay by Crook and Dean which appears in this issue ("'Lost in a Shopping Mall' -- A Breach of Professional Ethics") is disturbing not only because of its errors, exaggerations, and omissions, but because, in some instances, the quality of the argument makes one wonder whether these were innocent mistakes or a deliberate attempt to distort my work. Some of these errors can be explained by simple lack of scientific competence. However, others are sufficiently bizarre that they cast doubt on the process that led to the acceptance of a manuscript written by an individual who has continually made her animosity toward me very publicly known (e.g., Boerner, 1996; Neimark, 1996).

Patient Summary and medicines reconciliation: application of the ISO/CEN EN 13606 standard in clinical practice.

PubMed

Farfán Sedano, Francisco J; Terrón Cuadrado, Marta; Castellanos Clemente, Yolanda; Serrano Balazote, Pablo; Moner Cano, David; Robles Viejo, Montserrat

2011-01-01

The comparison of the patient's current medication list with the medication being ordered when admitted to Hospital, identifying omissions, duplications, dosing errors, and potential interactions, constitutes the core process of medicines reconciliation. Access to the medication the patient is taking at home could be unfeasible as this information is frequently stored in various locations and in diverse proprietary formats. The lack of interoperability between those information systems, namely the Primary Care and the Specialized Electronic Health Records (EHRs), facilitates medication errors and endangers patient safety. Thus, the development of a Patient Summary that includes clinical data from different electronic systems will allow doctors access to relevant information enabling a safer and more efficient assistance. Such a collection of data from heterogeneous and distributed systems has been achieved in this Project through the construction of a federated view based on the ISO/CEN EN13606 Standard for architecture and communication of EHRs.

Autoshaping, random control, and omission training in the rat1

PubMed Central

Locurto, Charles; Terrace, H. S.; Gibbon, John

1976-01-01

The role of the stimulus-reinforcer contingency in the development and maintenance of lever contact responding was studied in hooded rats. In Experiment I, three groups of experimentally naive rats were trained either on autoshaping, omission training, or a random-control procedure. Subjects trained by the autoshaping procedure responded more consistently than did either random-control or omission-trained subjects. The probability of at least one lever contact per trial was slightly higher in subjects trained by the omission procedure than by the random-control procedure. However, these differences were not maintained during extended training, nor were they evident in total lever-contact frequencies. When omission and random-control subjects were switched to the autoshaping condition, lever contacts increased in all animals, but a pronounced retardation was observed in omission subjects relative to the random-control subjects. In addition, subjects originally exposed to the random-control procedure, and later switched to autoshaping, acquired more rapidly than naive subjects that were exposed only on the autoshaping procedure. In Experiment II, subjects originally trained by an autoshaping procedure were exposed either to an omission, a random-control, or an extinction procedure. No differences were observed among the groups either in the rate at which lever contacts decreased or in the frequency of lever contacts at the end of training. These data implicate prior experience in the interpretation of omission-training effects and suggest limitations in the influence of stimulus-reinforcer relations in autoshaping. PMID:16811960

Autoshaping, random control, and omission training in the rat.

PubMed

Locurto, C; Terrace, H S; Gibbon, J

1976-11-01

The role of the stimulus-reinforcer contingency in the development and maintenance of lever contact responding was studied in hooded rats. In Experiment I, three groups of experimentally naive rats were trained either on autoshaping, omission training, or a random-control procedure. Subjects trained by the autoshaping procedure responded more consistently than did either random-control or omission-trained subjects. The probability of at least one lever contact per trial was slightly higher in subjects trained by the omission procedure than by the random-control procedure. However, these differences were not maintained during extended training, nor were they evident in total lever-contact frequencies. When omission and random-control subjects were switched to the autoshaping condition, lever contacts increased in all animals, but a pronounced retardation was observed in omission subjects relative to the random-control subjects. In addition, subjects originally exposed to the random-control procedure, and later switched to autoshaping, acquired more rapidly than naive subjects that were exposed only on the autoshaping procedure. In Experiment II, subjects originally trained by an autoshaping procedure were exposed either to an omission, a random-control, or an extinction procedure. No differences were observed among the groups either in the rate at which lever contacts decreased or in the frequency of lever contacts at the end of training. These data implicate prior experience in the interpretation of omission-training effects and suggest limitations in the influence of stimulus-reinforcer relations in autoshaping.

48 CFR 925.901 - Omission of the audit clause.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Omission of the audit clause. 925.901 Section 925.901 Federal Acquisition Regulations System DEPARTMENT OF ENERGY SOCIOECONOMIC PROGRAMS FOREIGN ACQUISITION Additional Foreign Acquisition Clauses 925.901 Omission of the audit clause...

Use of low-altitude aerial photography to identify submersed aquatic macrophytes

USGS Publications Warehouse

Schloesser, Donald W.; Manny, Bruce A.; Brown, Charles L.; Jaworski, Eugene

1987-01-01

The feasibility of using low-altitude aerial photography to identify beds of submersed macrophytes is demonstrated. True color aerial photos and collateral ground survey information for submersed aquatic macrophyte beds at 10 sites in the St.Clair-Detroit River system were obtained in September 1978. Using the photos and collateral ground survey information, a dichotomous key was developed for the identification of six classes - beds of five genera of macrophytes and one substrate type. A test was prepared to determine how accurately photo interpreters could identify the six classes. The test required an interpreter to examine an unlabeled, outlined area on photographs and identify it using the key. Six interpreters were tested. One pair of interpreters was trained in the interpretation of a variety of aerial photos, a second pair had field experience in the collection and identification of submersed macrophytes in the river system, and a third pair had neither training in the interpretation of aerial photos nor field experience. The criteria that we developed were applied equally well by the interpretors, regardless of their training or experience. Overall accuracy (i.e., omission errors) of all six classes combined was 68% correct, whereas, overall accuracy of individual classes ranged from 50 to 100% correct. Mapping accuracy (i.e. omission and commission errors) of individual classes ranged from 36 to 75%. Although the key developed for this study has only limited application outside the context of the data and sites examined in this study, it is concluded that low-altitude aerial photography, together with limited amounts of collateral ground survey information, can be used to economically identify beds of submersed macrophytes in the St. Clair-Detroit River system and other similar water bodies.

Data collection outcomes comparing paper forms with PDA forms in an office-based patient survey.

PubMed

Galliher, James M; Stewart, Thomas V; Pathak, Paramod K; Werner, James J; Dickinson, L Miriam; Hickner, John M

2008-01-01

We compared the completeness of data collection using paper forms and using electronic forms loaded on handheld computers in an office-based patient interview survey conducted within the American Academy of Family Physicians National Research Network. We asked 19 medical assistants and nurses in family practices to administer a survey about pneumococcal immunizations to 60 older adults each, 30 using paper forms and 30 using electronic forms on handheld computers. By random assignment, the interviewers used either the paper or electronic form first. Using multilevel analyses adjusted for patient characteristics and clustering of forms by practice, we analyzed the completeness of the data. A total of 1,003 of the expected 1,140 forms were returned to the data center. The overall return rate was better for paper forms (537 of 570, 94%) than for electronic forms (466 of 570, 82%) because of technical difficulties experienced with electronic data collection and stolen or lost handheld computers. Errors of omission on the returned forms, however, were more common using paper forms. Of the returned forms, only 3% of those gathered electronically had errors of omission, compared with 35% of those gathered on paper. Similarly, only 0.04% of total survey items were missing on the electronic forms, compared with 3.5% of the survey items using paper forms. Although handheld computers produced more complete data than the paper method for the returned forms, they were not superior because of the large amount of missing data due to technical difficulties with the hand-held computers or loss or theft. Other hardware solutions, such as tablet computers or cell phones linked via a wireless network directly to a Web site, may be better electronic solutions for the future.

Effects of Passion Flower Extract, as an Add-On Treatment to Sertraline, on Reaction Time in Patients ‎with Generalized Anxiety Disorder: A Double-Blind Placebo-Controlled Study

PubMed Central

Nojoumi, Mandana; Ghaeli, Padideh; Salimi, Samrand; Sharifi, Ali; Raisi, Firoozeh

2016-01-01

Objective: Because of functional impairment caused by generalized anxiety disorder and due to cognitive side ‎effects of many anti-anxiety agents, in this study we aimed to evaluate the influence of Passion ‎flower standardized extract on reaction time in patients with generalized anxiety disorder.‎ Method: Thirty patients aged 18 to 50 years of age, who were diagnosed with generalized anxiety disorder and ‎fulfilled the study criteria, entered this double-blind placebo-controlled study. Reaction time was ‎measured at baseline and after one month of treatment using computerized software. Correct ‎responses, omission and substitution errors and the mean time of correct responses (reaction time) in ‎both visual and auditory tests were collected. The analysis was performed between the two groups ‎and within each group utilizing SPSS PASW- statics, Version 18. P-value less than 0.05 was ‎considered statistically significant.‎ Results: All the participants were initiated on Sertraline 50 mg/day, and the dosage was increased to 100 ‎mg / day after two weeks. Fourteen patients received Pasipy (Passion Flower) 15 drops three times ‎daily and 16 received placebo concurrently. Inter-group comparison proved no significant difference ‎in any of the test items between assortments while a significant decline was observed in auditory ‎omission errors in passion flower group after on month of treatment using intra-group analysis.‎‎ Conclusion: This study noted that passion flower might be suitable as an add-on in the treatment of generalized ‎anxiety disorder with low side effects. Further studies with longer duration are recommended to ‎confirm the results of this study.‎ PMID:27928252

Attentive processes, blood lactate and CrossFit®.

PubMed

Perciavalle, Valentina; Marchetta, Nunzio Salvatore; Giustiniani, Salvatore; Borbone, Carlo; Perciavalle, Vincenzo; Petralia, Maria Cristina; Buscemi, Andrea; Coco, Marinella

2016-11-01

To analyze the influences of blood lactate produced during a specific session of CrossFit® on intensity and selectivity of attention. The first was evaluated by measuring the reaction time and the second by analyzing divided attention with a dual task. Fifteen male professionals of CrossFit® volunteered in the study. The training session was the Workout Of the Day (WOD) called 15.5, marked as: 27-21-15-9 repetitions (without recovery) in term of calories measured by using a rowing ergometer (e.g. 27 rowed calories) and in term of barbell full squats (raising a weight of 43 kg for men and of 29.5 kg for women). Blood lactate, blood glucose, reaction time, execution time of a dual task, number of errors and number of omissions were measured at rest, at the conclusion of the session and 15 minutes after its end. The levels of the blood lactate before the start of the session were considerably higher than those which normally occur at rest (<2 mmol /L), with a mean value of 4.5 mmol /l (± 1.99 SD). At the end of the workout session the blood lactate exhibited a significant increase, reaching a mean value of 13.8 mmol /l (± 1.18 SD) and then returning to values similar to the initial ones after 15 minutes. Blood glucose did not exhibit any statistically significant differences during the session. Reaction time, execution time, number of errors and number of omissions exhibited a significant worsening concomitantly with the increase in blood lactate. Athletes practicing CrossFit®, with high levels of blood lactate even at rest, should consequently have attentional performances somewhat limited.

Effects of Passion Flower Extract, as an Add-On Treatment to Sertraline, on Reaction Time in Patients ‎with Generalized Anxiety Disorder: A Double-Blind Placebo-Controlled Study.

PubMed

Nojoumi, Mandana; Ghaeli, Padideh; Salimi, Samrand; Sharifi, Ali; Raisi, Firoozeh

2016-07-01

Objective: Because of functional impairment caused by generalized anxiety disorder and due to cognitive side ‎effects of many anti-anxiety agents, in this study we aimed to evaluate the influence of Passion ‎flower standardized extract on reaction time in patients with generalized anxiety disorder.‎ Method: Thirty patients aged 18 to 50 years of age, who were diagnosed with generalized anxiety disorder and ‎fulfilled the study criteria, entered this double-blind placebo-controlled study. Reaction time was ‎measured at baseline and after one month of treatment using computerized software. Correct ‎responses, omission and substitution errors and the mean time of correct responses (reaction time) in ‎both visual and auditory tests were collected. The analysis was performed between the two groups ‎and within each group utilizing SPSS PASW- statics, Version 18. P-value less than 0.05 was ‎considered statistically significant.‎ Results: All the participants were initiated on Sertraline 50 mg/day, and the dosage was increased to 100 ‎mg / day after two weeks. Fourteen patients received Pasipy (Passion Flower) 15 drops three times ‎daily and 16 received placebo concurrently. Inter-group comparison proved no significant difference ‎in any of the test items between assortments while a significant decline was observed in auditory ‎omission errors in passion flower group after on month of treatment using intra-group analysis.‎‎ Conclusion: This study noted that passion flower might be suitable as an add-on in the treatment of generalized ‎anxiety disorder with low side effects. Further studies with longer duration are recommended to ‎confirm the results of this study.‎.

Heuristics and Cognitive Error in Medical Imaging.

PubMed

Itri, Jason N; Patel, Sohil H

2018-05-01

The field of cognitive science has provided important insights into mental processes underlying the interpretation of imaging examinations. Despite these insights, diagnostic error remains a major obstacle in the goal to improve quality in radiology. In this article, we describe several types of cognitive bias that lead to diagnostic errors in imaging and discuss approaches to mitigate cognitive biases and diagnostic error. Radiologists rely on heuristic principles to reduce complex tasks of assessing probabilities and predicting values into simpler judgmental operations. These mental shortcuts allow rapid problem solving based on assumptions and past experiences. Heuristics used in the interpretation of imaging studies are generally helpful but can sometimes result in cognitive biases that lead to significant errors. An understanding of the causes of cognitive biases can lead to the development of educational content and systematic improvements that mitigate errors and improve the quality of care provided by radiologists.

Error Consistency in Acquired Apraxia of Speech with Aphasia: Effects of the Analysis Unit

ERIC Educational Resources Information Center

Haley, Katarina L.; Cunningham, Kevin T.; Eaton, Catherine Torrington; Jacks, Adam

2018-01-01

Purpose: Diagnostic recommendations for acquired apraxia of speech (AOS) have been contradictory concerning whether speech sound errors are consistent or variable. Studies have reported divergent findings that, on face value, could argue either for or against error consistency as a diagnostic criterion. The purpose of this study was to explain…

[Cognitive errors in diagnostic decision making].

PubMed

Gäbler, Martin

2017-10-01

Approximately 10-15% of our diagnostic decisions are faulty and may lead to unfavorable and dangerous outcomes, which could be avoided. These diagnostic errors are mainly caused by cognitive biases in the diagnostic reasoning process.Our medical diagnostic decision-making is based on intuitive "System 1" and analytical "System 2" diagnostic decision-making and can be deviated by unconscious cognitive biases.These deviations can be positively influenced on a systemic and an individual level. For the individual, metacognition (internal withdrawal from the decision-making process) and debiasing strategies, such as verification, falsification and rule out worst-case scenarios, can lead to improved diagnostic decisions making.

45 CFR 1177.13 - Omissions not a defense.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 45 Public Welfare 3 2011-10-01 2011-10-01 false Omissions not a defense. 1177.13 Section 1177.13 Public Welfare Regulations Relating to Public Welfare (Continued) NATIONAL FOUNDATION ON THE ARTS AND THE HUMANITIES NATIONAL ENDOWMENT FOR THE HUMANITIES CLAIMS COLLECTION § 1177.13 Omissions not a defense. Failure...

45 CFR 1177.13 - Omissions not a defense.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 3 2010-10-01 2010-10-01 false Omissions not a defense. 1177.13 Section 1177.13 Public Welfare Regulations Relating to Public Welfare (Continued) NATIONAL FOUNDATION ON THE ARTS AND THE HUMANITIES NATIONAL ENDOWMENT FOR THE HUMANITIES CLAIMS COLLECTION § 1177.13 Omissions not a defense. Failure...

75 FR 45685 - Self-Regulatory Organizations; Financial Industry Regulatory Authority, Inc.; Notice of Filing of...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-03

... list (see current List 7 titled Misrepresentation/Omissions, List 9 titled Negligence/Breach of... claims alleging misrepresentation/ omissions (see current List 8, Item 1), negligence/breach of fiduciary... claims alleging misrepresentation/ omission (see current List 8, Item 2), negligence/breach of fiduciary...

Is there an omission effect in prosocial behavior? A laboratory experiment on passive vs. active generosity

PubMed Central

Gärtner, Manja

2017-01-01

We investigate whether individuals are more prone to act selfishly if they can passively allow for an outcome to be implemented (omission) rather than having to make an active choice (commission). In most settings, active and passive choice alternatives differ in terms of factors such as the presence of a suggested option, costs of taking an action, and awareness. We isolate the omission effect from confounding factors in three experiments, and find no evidence that the distinction between active and passive choices has an independent effect on the propensity to implement selfish outcomes. This suggests that increased selfishness through omission, as observed in various economic choice situations, is driven by other factors than a preference for selfish omissions. PMID:28248979

Age trends for failures of sustained attention.

PubMed

Carriere, Jonathan S A; Cheyne, J Allan; Solman, Grayden J F; Smilek, Daniel

2010-09-01

Recent research has revealed an age-related reduction in errors in a sustained attention task, suggesting that sustained attention abilities improve with age. Such results seem paradoxical in light of the well-documented age-related declines in cognitive performance. In the present study, performance on the sustained attention to response task (SART) was assessed in a supplemented archival sample of 638 individuals between 14 and 77 years old. SART errors and response speed appeared to decline in a linear fashion as a function of age throughout the age span studied. In contrast, other measures of sustained attention (reaction time coefficient of variation), anticipation, and omissions) showed a decrease early in life and then remained unchanged for the rest of the life span. Thus, sustained attention shows improvements with maturation in early adulthood but then does not change with aging in older adults. On the other hand, aging across the entire life span leads to a more strategic (i.e., slower) response style that reduces the overt and critical consequences (i.e., SART errors) of momentary task disengagement. (c) 2010 APA, all rights reserved.

An audit on the reporting of critical results in a tertiary institute.

PubMed

Rensburg, Megan A; Nutt, Louise; Zemlin, Annalise E; Erasmus, Rajiv T

2009-03-01

Critical result reporting is a requirement for accreditation by accreditation bodies worldwide. Accurate, prompt communication of results to the clinician by the laboratory is of extreme importance. Repeating of the critical result by the recipient has been used as a means to improve the accuracy of notification. Our objective was to assess the accuracy of notification of critical chemical pathology laboratory results telephoned out to clinicians/clinical areas. We hypothesize that read-back of telephoned critical laboratory results by the recipient may improve the accuracy of the notification. This was a prospective study, where all critical results telephoned by chemical pathologists and registrars at Tygerberg Hospital were monitored for one month. The recipient was required to repeat the result (patient name, folder number and test results). Any error, as well as the designation of the recipient was logged. Of 472 outgoing telephone calls, 51 errors were detected (error rate 10.8%). Most errors were made when recording the folder number (64.7%), with incorrect patient name being the lowest (5.9%). Calls to the clinicians had the highest error rate (20%), most of them being the omission of recording folder numbers. Our audit highlights the potential errors during the post-analytical phase of laboratory testing. The importance of critical result reporting is still poorly recognized in South Africa. Implementation of a uniform accredited practice for communication of critical results can reduce error and improve patient safety.

Incidence of patient safety events and process-related human failures during intra-hospital transportation of patients: retrospective exploration from the institutional incident reporting system.

PubMed

Yang, Shu-Hui; Jerng, Jih-Shuin; Chen, Li-Chin; Li, Yu-Tsu; Huang, Hsiao-Fang; Wu, Chao-Ling; Chan, Jing-Yuan; Huang, Szu-Fen; Liang, Huey-Wen; Sun, Jui-Sheng

2017-11-03

Intra-hospital transportation (IHT) might compromise patient safety because of different care settings and higher demand on the human operation. Reports regarding the incidence of IHT-related patient safety events and human failures remain limited. To perform a retrospective analysis of IHT-related events, human failures and unsafe acts. A hospital-wide process for the IHT and database from the incident reporting system in a medical centre in Taiwan. All eligible IHT-related patient safety events between January 2010 to December 2015 were included. Incidence rate of IHT-related patient safety events, human failure modes, and types of unsafe acts. There were 206 patient safety events in 2 009 013 IHT sessions (102.5 per 1 000 000 sessions). Most events (n=148, 71.8%) did not involve patient harm, and process events (n=146, 70.9%) were most common. Events at the location of arrival (n=101, 49.0%) were most frequent; this location accounted for 61.0% and 44.2% of events with patient harm and those without harm, respectively (p<0.001). Of the events with human failures (n=186), the most common related process step was the preparation of the transportation team (n=91, 48.9%). Contributing unsafe acts included perceptual errors (n=14, 7.5%), decision errors (n=56, 30.1%), skill-based errors (n=48, 25.8%), and non-compliance (n=68, 36.6%). Multivariate analysis showed that human failure found in the arrival and hand-off sub-process (OR 4.84, p<0.001) was associated with increased patient harm, whereas the presence of omission (OR 0.12, p<0.001) was associated with less patient harm. This study shows a need to reduce human failures to prevent patient harm during intra-hospital transportation. We suggest that the transportation team pay specific attention to the sub-process at the location of arrival and prevent errors other than omissions. Long-term monitoring of IHT-related events is also warranted. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

The Effects of Sleep on Emotional Target Detection Performance: A Novel iPad-Based Pediatric Game

PubMed Central

Colonna, Annalisa; Smith, Anna B.; Smith, Stuart; VanDenEshof, Kirandeep; Orgill, Jane; Gringras, Paul; Pal, Deb K.

2018-01-01

Background: Consolidation of learning occurs during sleep but when it is disturbed there may be an adverse impact upon these functions. While research has focused upon how sleep affects cognition in adulthood, the effects of disrupted sleep are likely to impact more heavily on learning among children and adolescents. We aimed to investigate whether a night’s sleep impacts upon executive function compared with an equivalent wakefulness period. We also wanted to know whether restricting sleep would reduce these effects on performance. To investigate this issue in children, we adapted existing research methods to make them more suitable for this population. Methods: Using a cross-over trial design, 22 children aged 7–14 completed an updated but previously validated, continuous performance task (CPT) designed to be appealing to children, containing emotional and neutral targets and presented on an iPad. We measured omission and commission errors, mean and variability of reaction times (RTs) immediately and after a delay spent in the following three ways: 11-h intervals of unrestricted and restricted sleep in the style of a ‘sleepover’ and daytime wakefulness. We examined differences in immediate and delayed testing for each dependent variable. Both sleep nights were spent in a specialist sleep lab where polysomnography data were recorded. Results: While there were no significant main effects of sleep condition, as expected we observed significantly faster and more accurate performance in delayed compared with immediate testing across all conditions for omission errors, RT and variability of RT. Importantly, we saw a significant interaction for commission errors to emotional targets (p = 0.034): while they were comparable across all conditions during immediate testing, for delayed testing there were significantly more errors after wakefulness compared with unrestricted sleep (p = 0.019) and at a trend level for restricted sleep (p = 0.063). Performance improvement after restricted sleep was inversely correlated with sleep opportunity time (p = 0.03), total sleep time (p = 0.01) and total non-REM time (p = 0.005). Conclusion: This tool, designed to be simple to use and appealing to children, revealed a preserving effect of typical and disrupted sleep periods on performance during an emotionally themed target detection task compared with an equivalent wakefulness period. PMID:29563887

31 CFR 10.21 - Knowledge of client's omission.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 31 Money and Finance: Treasury 1 2010-07-01 2010-07-01 false Knowledge of client's omission. 10.21... § 10.21 Knowledge of client's omission. A practitioner who, having been retained by a client with respect to a matter administered by the Internal Revenue Service, knows that the client has not complied...

7 CFR 1.51 - Claims based on negligence, wrongful act or omission.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 1 2010-01-01 2010-01-01 false Claims based on negligence, wrongful act or omission. 1.51 Section 1.51 Agriculture Office of the Secretary of Agriculture ADMINISTRATIVE REGULATIONS Claims § 1.51 Claims based on negligence, wrongful act or omission. (a) Authority of the Department...

Reducing Cognitive Skill Decay and Diagnostic Error: Theory-Based Practices for Continuing Education in Health Care

ERIC Educational Resources Information Center

Weaver, Sallie J.; Newman-Toker, David E.; Rosen, Michael A.

2012-01-01

Missed, delayed, or wrong diagnoses can have a severe impact on patients, providers, and the entire health care system. One mechanism implicated in such diagnostic errors is the deterioration of cognitive diagnostic skills that are used rarely or not at all over a prolonged period of time. Existing evidence regarding maintenance of effective…

[The factors affecting the results of mechanical jaundice management].

PubMed

Malkov, I S; Shaimardanov, R Sh; Korobkov, V N; Filippov, V A; Khisamiev, I G

To improve the results of obstructive jaundice management by rational diagnostic and treatment strategies. Outcomes of 820 patients with obstructive jaundice syndrome were analyzed. Diagnostic and tactical mistakes were made at pre-hospital stage in 143 (17.4%) patients and in 105 (12.8%) at hospital stage. Herewith, in 53 (6.5%) cases the errors were observed at all stages. Retrospective analysis of severe postoperative complications and lethal outcomes in patients with obstructive jaundice showed that in 23.8% of cases they were explained by diagnostic and tactical mistakes at various stages of examination and treatment. We developed an algorithm for obstructive jaundice management to reduce the number of diagnostic and tactical errors, a reduction in the frequency of diagnostic and tactical errors. It reduced the number of postoperative complications up to 16.5% and mortality rate to 3.0%.

Building validation tools for knowledge-based systems

NASA Technical Reports Server (NTRS)

Stachowitz, R. A.; Chang, C. L.; Stock, T. S.; Combs, J. B.

1987-01-01

The Expert Systems Validation Associate (EVA), a validation system under development at the Lockheed Artificial Intelligence Center for more than a year, provides a wide range of validation tools to check the correctness, consistency and completeness of a knowledge-based system. A declarative meta-language (higher-order language), is used to create a generic version of EVA to validate applications written in arbitrary expert system shells. The architecture and functionality of EVA are presented. The functionality includes Structure Check, Logic Check, Extended Structure Check (using semantic information), Extended Logic Check, Semantic Check, Omission Check, Rule Refinement, Control Check, Test Case Generation, Error Localization, and Behavior Verification.

A model of serial order problems in fluent, stuttered and agrammatic speech.

PubMed

Howell, Peter

2007-10-01

Many models of speech production have attempted to explain dysfluent speech. Most models assume that the disruptions that occur when speech is dysfluent arise because the speakers make errors while planning an utterance. In this contribution, a model of the serial order of speech is described that does not make this assumption. It involves the coordination or 'interlocking' of linguistic planning and execution stages at the language-speech interface. The model is examined to determine whether it can distinguish two forms of dysfluent speech (stuttered and agrammatic speech) that are characterized by iteration and omission of whole words and parts of words.

A critique of Lilienfeld et al.'s (2000) "The scientific status of projective techniques".

PubMed

Hibbard, Stephen

2003-06-01

Lilienfeld, Wood, and Garb (2000) published a largely negative critique of the validity and reliability of projective methods, concentrating on the Comprehensive System for the Rorschach (Exner, 1993), 3 systems for coding the Thematic Apperception Test (TAT; Murray, 1943) cards, and human figure drawings. This article is an effort to document and correct what I perceive as errors of omission and commission in the Lilienfeld et al. article. When projective measures are viewed in the light of these corrections, the evidence for the validity and clinical usefulness of the Rorschach and TAT methods is more robust than Lilienfeld et al. represented.

Visible infrared spin-scan radiometers (VISSR) for the Geostationary Operational Environmental Satellite (GOES) B and C application

NASA Technical Reports Server (NTRS)

1977-01-01

Two visible infrared spin scan radiometer (VISSR) instruments provided for the Geostationary Operational Environmental Satellite B and C (GOES B and C) spacecrafts are described. The instruments are identical to those supplied previously are summarized. A significant number of changes primarily involving corrections of drawing errors and omissions were also performed. All electrical changes were breadboarded (where complexity required this), were incorporated into the test module, and subjected to verification of proper operation throughout fall instrument temperature range. Evaluation of the changes also included design operating safety margins to account for component variations and life.

[Cognitive dysfunction in patients with subclinical hypothyroidism].

PubMed

Fernandes, Robertta Soares Miranda; Alvarenga, Nathália Bueno; Silva, Tamara Inácio da; Rocha, Felipe Filardi da

2011-04-01

Evaluate neuropsychological changes in patients with subclinical hypothyroidism (SH). Cross-sectional study comparing the results of the neuropsychological evaluation of 89 SH patients and 178 individuals without thyroid disease. The participants underwent the following neuropsychological assessment: Conner's Continuous Performance Test (CPT-II), Iowa Gambling Task, Stroop Test, Wisconsin Card Sorting Test (WCST), Verbal Fluency Test (semantic and phonologic categories) and Rey Auditory Verbal Learning Test. Among the neuropsychological tests, patients showed worse performance only in cognitive flexibility (WCST) and the ability to maintain sustained attention (omission errors on the CPT-II). These losses can cause detriments in the daily lives of patients, constituting potential treatment indications.

Hydrological modelling of the Chaohe Basin in China: Statistical model formulation and Bayesian inference

NASA Astrophysics Data System (ADS)

Yang, Jing; Reichert, Peter; Abbaspour, Karim C.; Yang, Hong

2007-07-01

SummaryCalibration of hydrologic models is very difficult because of measurement errors in input and response, errors in model structure, and the large number of non-identifiable parameters of distributed models. The difficulties even increase in arid regions with high seasonal variation of precipitation, where the modelled residuals often exhibit high heteroscedasticity and autocorrelation. On the other hand, support of water management by hydrologic models is important in arid regions, particularly if there is increasing water demand due to urbanization. The use and assessment of model results for this purpose require a careful calibration and uncertainty analysis. Extending earlier work in this field, we developed a procedure to overcome (i) the problem of non-identifiability of distributed parameters by introducing aggregate parameters and using Bayesian inference, (ii) the problem of heteroscedasticity of errors by combining a Box-Cox transformation of results and data with seasonally dependent error variances, (iii) the problems of autocorrelated errors, missing data and outlier omission with a continuous-time autoregressive error model, and (iv) the problem of the seasonal variation of error correlations with seasonally dependent characteristic correlation times. The technique was tested with the calibration of the hydrologic sub-model of the Soil and Water Assessment Tool (SWAT) in the Chaohe Basin in North China. The results demonstrated the good performance of this approach to uncertainty analysis, particularly with respect to the fulfilment of statistical assumptions of the error model. A comparison with an independent error model and with error models that only considered a subset of the suggested techniques clearly showed the superiority of the approach based on all the features (i)-(iv) mentioned above.

Comparison of medication safety effectiveness among nine critical access hospitals.

PubMed

Cochran, Gary L; Haynatzki, Gleb

2013-12-15

The rates of medication errors across three different medication dispensing and administration systems frequently used in critical access hospitals (CAHs) were analyzed. Nine CAHs agreed to participate in this prospective study and were assigned to one of three groups based on similarities in their medication-use processes: (1) less than 10 hours per week of onsite pharmacy support and no bedside barcode system, (2) onsite pharmacy support for 40 hours per week and no bedside barcode system, and (3) onsite pharmacy support for 40 or more hours per week with a bedside barcode system. Errors were characterized by severity, phase of origination, type, and cause. Characteristics of the medication being administered and a number of best practices were collected for each medication pass. Logistic regression was used to identify significant predictors of errors. A total of 3103 medication passes were observed. More medication errors originated in hospitals that had onsite pharmacy support for less than 10 hours per week and no bedside barcode system than in other types of hospitals. A bedside barcode system had the greatest impact on lowering the odds of an error reaching the patient. Wrong dose and omission were common error types. Human factors and communication were the two most frequently identified causes of error for all three systems. Medication error rates were lower in CAHs with 40 or more hours per week of onsite pharmacy support with or without a bedside barcode system compared with hospitals with less than 10 hours per week of pharmacy support and no bedside barcode system.

Benefit-risk Evaluation for Diagnostics: A Framework (BED-FRAME).

PubMed

Evans, Scott R; Pennello, Gene; Pantoja-Galicia, Norberto; Jiang, Hongyu; Hujer, Andrea M; Hujer, Kristine M; Manca, Claudia; Hill, Carol; Jacobs, Michael R; Chen, Liang; Patel, Robin; Kreiswirth, Barry N; Bonomo, Robert A

2016-09-15

The medical community needs systematic and pragmatic approaches for evaluating the benefit-risk trade-offs of diagnostics that assist in medical decision making. Benefit-Risk Evaluation of Diagnostics: A Framework (BED-FRAME) is a strategy for pragmatic evaluation of diagnostics designed to supplement traditional approaches. BED-FRAME evaluates diagnostic yield and addresses 2 key issues: (1) that diagnostic yield depends on prevalence, and (2) that different diagnostic errors carry different clinical consequences. As such, evaluating and comparing diagnostics depends on prevalence and the relative importance of potential errors. BED-FRAME provides a tool for communicating the expected clinical impact of diagnostic application and the expected trade-offs of diagnostic alternatives. BED-FRAME is a useful fundamental supplement to the standard analysis of diagnostic studies that will aid in clinical decision making. © The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

Assessing primary care data quality.

PubMed

Lim, Yvonne Mei Fong; Yusof, Maryati; Sivasampu, Sheamini

2018-04-16

Purpose The purpose of this paper is to assess National Medical Care Survey data quality. Design/methodology/approach Data completeness and representativeness were computed for all observations while other data quality measures were assessed using a 10 per cent sample from the National Medical Care Survey database; i.e., 12,569 primary care records from 189 public and private practices were included in the analysis. Findings Data field completion ranged from 69 to 100 per cent. Error rates for data transfer from paper to web-based application varied between 0.5 and 6.1 per cent. Error rates arising from diagnosis and clinical process coding were higher than medication coding. Data fields that involved free text entry were more prone to errors than those involving selection from menus. The authors found that completeness, accuracy, coding reliability and representativeness were generally good, while data timeliness needs to be improved. Research limitations/implications Only data entered into a web-based application were examined. Data omissions and errors in the original questionnaires were not covered. Practical implications Results from this study provided informative and practicable approaches to improve primary health care data completeness and accuracy especially in developing nations where resources are limited. Originality/value Primary care data quality studies in developing nations are limited. Understanding errors and missing data enables researchers and health service administrators to prevent quality-related problems in primary care data.

Disambiguating ventral striatum fMRI-related bold signal during reward prediction in schizophrenia

PubMed Central

Morris, R W; Vercammen, A; Lenroot, R; Moore, L; Langton, J M; Short, B; Kulkarni, J; Curtis, J; O'Donnell, M; Weickert, C S; Weickert, T W

2012-01-01

Reward detection, surprise detection and prediction-error signaling have all been proposed as roles for the ventral striatum (vStr). Previous neuroimaging studies of striatal function in schizophrenia have found attenuated neural responses to reward-related prediction errors; however, as prediction errors represent a discrepancy in mesolimbic neural activity between expected and actual events, it is critical to examine responses to both expected and unexpected rewards (URs) in conjunction with expected and UR omissions in order to clarify the nature of ventral striatal dysfunction in schizophrenia. In the present study, healthy adults and people with schizophrenia were tested with a reward-related prediction-error task during functional magnetic resonance imaging to determine whether schizophrenia is associated with altered neural responses in the vStr to rewards, surprise prediction errors or all three factors. In healthy adults, we found neural responses in the vStr were correlated more specifically with prediction errors than to surprising events or reward stimuli alone. People with schizophrenia did not display the normal differential activation between expected and URs, which was partially due to exaggerated ventral striatal responses to expected rewards (right vStr) but also included blunted responses to unexpected outcomes (left vStr). This finding shows that neural responses, which typically are elicited by surprise, can also occur to well-predicted events in schizophrenia and identifies aberrant activity in the vStr as a key node of dysfunction in the neural circuitry used to differentiate expected and unexpected feedback in schizophrenia. PMID:21709684

Reward positivity: Reward prediction error or salience prediction error?

PubMed

Heydari, Sepideh; Holroyd, Clay B

2016-08-01

The reward positivity is a component of the human ERP elicited by feedback stimuli in trial-and-error learning and guessing tasks. A prominent theory holds that the reward positivity reflects a reward prediction error signal that is sensitive to outcome valence, being larger for unexpected positive events relative to unexpected negative events (Holroyd & Coles, 2002). Although the theory has found substantial empirical support, most of these studies have utilized either monetary or performance feedback to test the hypothesis. However, in apparent contradiction to the theory, a recent study found that unexpected physical punishments also elicit the reward positivity (Talmi, Atkinson, & El-Deredy, 2013). The authors of this report argued that the reward positivity reflects a salience prediction error rather than a reward prediction error. To investigate this finding further, in the present study participants navigated a virtual T maze and received feedback on each trial under two conditions. In a reward condition, the feedback indicated that they would either receive a monetary reward or not and in a punishment condition the feedback indicated that they would receive a small shock or not. We found that the feedback stimuli elicited a typical reward positivity in the reward condition and an apparently delayed reward positivity in the punishment condition. Importantly, this signal was more positive to the stimuli that predicted the omission of a possible punishment relative to stimuli that predicted a forthcoming punishment, which is inconsistent with the salience hypothesis. © 2016 Society for Psychophysiological Research.

The effect of rainfall measurement uncertainties on rainfall-runoff processes modelling.

PubMed

Stransky, D; Bares, V; Fatka, P

2007-01-01

Rainfall data are a crucial input for various tasks concerning the wet weather period. Nevertheless, their measurement is affected by random and systematic errors that cause an underestimation of the rainfall volume. Therefore, the general objective of the presented work was to assess the credibility of measured rainfall data and to evaluate the effect of measurement errors on urban drainage modelling tasks. Within the project, the methodology of the tipping bucket rain gauge (TBR) was defined and assessed in terms of uncertainty analysis. A set of 18 TBRs was calibrated and the results were compared to the previous calibration. This enables us to evaluate the ageing of TBRs. A propagation of calibration and other systematic errors through the rainfall-runoff model was performed on experimental catchment. It was found that the TBR calibration is important mainly for tasks connected with the assessment of peak values and high flow durations. The omission of calibration leads to up to 30% underestimation and the effect of other systematic errors can add a further 15%. The TBR calibration should be done every two years in order to catch up the ageing of TBR mechanics. Further, the authors recommend to adjust the dynamic test duration proportionally to generated rainfall intensity.

Influence of ECG measurement accuracy on ECG diagnostic statements.

PubMed

Zywietz, C; Celikag, D; Joseph, G

1996-01-01

Computer analysis of electrocardiograms (ECGs) provides a large amount of ECG measurement data, which may be used for diagnostic classification and storage in ECG databases. Until now, neither error limits for ECG measurements have been specified nor has their influence on diagnostic statements been systematically investigated. An analytical method is presented to estimate the influence of measurement errors on the accuracy of diagnostic ECG statements. Systematic (offset) errors will usually result in an increase of false positive or false negative statements since they cause a shift of the working point on the receiver operating characteristics curve. Measurement error dispersion broadens the distribution function of discriminative measurement parameters and, therefore, usually increases the overlap between discriminative parameters. This results in a flattening of the receiver operating characteristics curve and an increase of false positive and false negative classifications. The method developed has been applied to ECG conduction defect diagnoses by using the proposed International Electrotechnical Commission's interval measurement tolerance limits. These limits appear too large because more than 30% of false positive atrial conduction defect statements and 10-18% of false intraventricular conduction defect statements could be expected due to tolerated measurement errors. To assure long-term usability of ECG measurement databases, it is recommended that systems provide its error tolerance limits obtained on a defined test set.

Reexamining our bias against heuristics.

PubMed

McLaughlin, Kevin; Eva, Kevin W; Norman, Geoff R

2014-08-01

Using heuristics offers several cognitive advantages, such as increased speed and reduced effort when making decisions, in addition to allowing us to make decision in situations where missing data do not allow for formal reasoning. But the traditional view of heuristics is that they trade accuracy for efficiency. Here the authors discuss sources of bias in the literature implicating the use of heuristics in diagnostic error and highlight the fact that there are also data suggesting that under certain circumstances using heuristics may lead to better decisions that formal analysis. They suggest that diagnostic error is frequently misattributed to the use of heuristics and propose an alternative view whereby content knowledge is the root cause of diagnostic performance and heuristics lie on the causal pathway between knowledge and diagnostic error or success.

Errors in nonword repetition: bridging short- and long-term memory.

PubMed

Santos, F H; Bueno, O F A; Gathercole, S E

2006-03-01

According to the working memory model, the phonological loop is the component of working memory specialized in processing and manipulating limited amounts of speech-based information. The Children's Test of Nonword Repetition (CNRep) is a suitable measure of phonological short-term memory for English-speaking children, which was validated by the Brazilian Children's Test of Pseudoword Repetition (BCPR) as a Portuguese-language version. The objectives of the present study were: i) to investigate developmental aspects of the phonological memory processing by error analysis in the nonword repetition task, and ii) to examine phoneme (substitution, omission and addition) and order (migration) errors made in the BCPR by 180 normal Brazilian children of both sexes aged 4-10, from preschool to 4th grade. The dominant error was substitution [F(3,525) = 180.47; P < 0.0001]. The performance was age-related [F(4,175) = 14.53; P < 0.0001]. The length effect, i.e., more errors in long than in short items, was observed [F(3,519) = 108.36; P < 0.0001]. In 5-syllable pseudowords, errors occurred mainly in the middle of the stimuli, before the syllabic stress [F(4,16) = 6.03; P = 0.003]; substitutions appeared more at the end of the stimuli, after the stress [F(12,48) = 2.27; P = 0.02]. In conclusion, the BCPR error analysis supports the idea that phonological loop capacity is relatively constant during development, although school learning increases the efficiency of this system. Moreover, there are indications that long-term memory contributes to holding memory trace. The findings were discussed in terms of distinctiveness, clustering and redintegration hypotheses.

[Errors in bibliographic references in the Revista Española de Anestesiología y Reanimación: retrospective study of 1994].

PubMed

Avila, F J; Pensado, A; Esteva, C

1996-05-01

To evaluate the accuracy of bibliographic references in REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION (REDAR) and compare it with other Spanish and international journals. One hundred references were selected at random from those published in REDAR during 1994. A citation was considered correct if there were no differences between it and the original article in any of 6 standard citation times, and if it complied with REDAR citation style. A citation was considered incorrect if there were in fact differences or if REDAR style was not followed. Errors that interfered with direct access to the original were considered serious. Also considered serious were the omission of the first author. Some type of error was detected in 53.9% of the references. Twelve contained a serious error, which on 5 occasions impeded finding the original article and on 6 occasions made direct access difficult. The first author was missing in 1 citation. Errors were found, in order of decreasing frequency, in authors, article titles, journal title, volume, pages and year. A single error was found in 28 citations, 2 were found in 12, 3 were found in 2 and more than 3 were found in 1. REDAR's rate of error in references is comparable to the rates of other Spanish journal, but it is nearly double that of international journals in anesthesiology with higher impact factors (Anesthesiology, Canadian Journal of Anaesthesia). An effort must be made by authors and editors to remedy the situation.

Residents' numeric inputting error in computerized physician order entry prescription.

PubMed

Wu, Xue; Wu, Changxu; Zhang, Kan; Wei, Dong

2016-04-01

Computerized physician order entry (CPOE) system with embedded clinical decision support (CDS) can significantly reduce certain types of prescription error. However, prescription errors still occur. Various factors such as the numeric inputting methods in human computer interaction (HCI) produce different error rates and types, but has received relatively little attention. This study aimed to examine the effects of numeric inputting methods and urgency levels on numeric inputting errors of prescription, as well as categorize the types of errors. Thirty residents participated in four prescribing tasks in which two factors were manipulated: numeric inputting methods (numeric row in the main keyboard vs. numeric keypad) and urgency levels (urgent situation vs. non-urgent situation). Multiple aspects of participants' prescribing behavior were measured in sober prescribing situations. The results revealed that in urgent situations, participants were prone to make mistakes when using the numeric row in the main keyboard. With control of performance in the sober prescribing situation, the effects of the input methods disappeared, and urgency was found to play a significant role in the generalized linear model. Most errors were either omission or substitution types, but the proportion of transposition and intrusion error types were significantly higher than that of the previous research. Among numbers 3, 8, and 9, which were the less common digits used in prescription, the error rate was higher, which was a great risk to patient safety. Urgency played a more important role in CPOE numeric typing error-making than typing skills and typing habits. It was recommended that inputting with the numeric keypad had lower error rates in urgent situation. An alternative design could consider increasing the sensitivity of the keys with lower frequency of occurrence and decimals. To improve the usability of CPOE, numeric keyboard design and error detection could benefit from spatial incidence of errors found in this study. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

The effect of the electronic transmission of prescriptions on dispensing errors and prescription enhancements made in English community pharmacies: a naturalistic stepped wedge study

PubMed Central

Franklin, Bryony Dean; Reynolds, Matthew; Sadler, Stacey; Hibberd, Ralph; Avery, Anthony J; Armstrong, Sarah J; Mehta, Rajnikant; Boyd, Matthew J; Barber, Nick

2014-01-01

Objectives To compare prevalence and types of dispensing errors and pharmacists’ labelling enhancements, for prescriptions transmitted electronically versus paper prescriptions. Design Naturalistic stepped wedge study. Setting 15 English community pharmacies. Intervention Electronic transmission of prescriptions between prescriber and pharmacy. Main outcome measures Prevalence of labelling errors, content errors and labelling enhancements (beneficial additions to the instructions), as identified by researchers visiting each pharmacy. Results Overall, we identified labelling errors in 5.4% of 16 357 dispensed items, and content errors in 1.4%; enhancements were made for 13.6%. Pharmacists also edited the label for a further 21.9% of electronically transmitted items. Electronically transmitted prescriptions had a higher prevalence of labelling errors (7.4% of 3733 items) than other prescriptions (4.8% of 12 624); OR 1.46 (95% CI 1.21 to 1.76). There was no difference for content errors or enhancements. The increase in labelling errors was mainly accounted for by errors (mainly at one pharmacy) involving omission of the indication, where specified by the prescriber, from the label. A sensitivity analysis in which these cases (n=158) were not considered errors revealed no remaining difference between prescription types. Conclusions We identified a higher prevalence of labelling errors for items transmitted electronically, but this was predominantly accounted for by local practice in a single pharmacy, independent of prescription type. Community pharmacists made labelling enhancements to about one in seven dispensed items, whether electronically transmitted or not. Community pharmacists, prescribers, professional bodies and software providers should work together to agree how items should be dispensed and labelled to best reap the benefits of electronically transmitted prescriptions. Community pharmacists need to ensure their computer systems are promptly updated to help reduce errors. PMID:24742778

The effect of the electronic transmission of prescriptions on dispensing errors and prescription enhancements made in English community pharmacies: a naturalistic stepped wedge study.

PubMed

Franklin, Bryony Dean; Reynolds, Matthew; Sadler, Stacey; Hibberd, Ralph; Avery, Anthony J; Armstrong, Sarah J; Mehta, Rajnikant; Boyd, Matthew J; Barber, Nick

2014-08-01

To compare prevalence and types of dispensing errors and pharmacists' labelling enhancements, for prescriptions transmitted electronically versus paper prescriptions. Naturalistic stepped wedge study. 15 English community pharmacies. Electronic transmission of prescriptions between prescriber and pharmacy. Prevalence of labelling errors, content errors and labelling enhancements (beneficial additions to the instructions), as identified by researchers visiting each pharmacy. Overall, we identified labelling errors in 5.4% of 16,357 dispensed items, and content errors in 1.4%; enhancements were made for 13.6%. Pharmacists also edited the label for a further 21.9% of electronically transmitted items. Electronically transmitted prescriptions had a higher prevalence of labelling errors (7.4% of 3733 items) than other prescriptions (4.8% of 12,624); OR 1.46 (95% CI 1.21 to 1.76). There was no difference for content errors or enhancements. The increase in labelling errors was mainly accounted for by errors (mainly at one pharmacy) involving omission of the indication, where specified by the prescriber, from the label. A sensitivity analysis in which these cases (n=158) were not considered errors revealed no remaining difference between prescription types. We identified a higher prevalence of labelling errors for items transmitted electronically, but this was predominantly accounted for by local practice in a single pharmacy, independent of prescription type. Community pharmacists made labelling enhancements to about one in seven dispensed items, whether electronically transmitted or not. Community pharmacists, prescribers, professional bodies and software providers should work together to agree how items should be dispensed and labelled to best reap the benefits of electronically transmitted prescriptions. Community pharmacists need to ensure their computer systems are promptly updated to help reduce errors. 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.

Medical errors in primary care clinics – a cross sectional study

PubMed Central

2012-01-01

Background Patient safety is vital in patient care. There is a lack of studies on medical errors in primary care settings. The aim of the study is to determine the extent of diagnostic inaccuracies and management errors in public funded primary care clinics. Methods This was a cross-sectional study conducted in twelve public funded primary care clinics in Malaysia. A total of 1753 medical records were randomly selected in 12 primary care clinics in 2007 and were reviewed by trained family physicians for diagnostic, management and documentation errors, potential errors causing serious harm and likelihood of preventability of such errors. Results The majority of patient encounters (81%) were with medical assistants. Diagnostic errors were present in 3.6% (95% CI: 2.2, 5.0) of medical records and management errors in 53.2% (95% CI: 46.3, 60.2). For management errors, medication errors were present in 41.1% (95% CI: 35.8, 46.4) of records, investigation errors in 21.7% (95% CI: 16.5, 26.8) and decision making errors in 14.5% (95% CI: 10.8, 18.2). A total of 39.9% (95% CI: 33.1, 46.7) of these errors had the potential to cause serious harm. Problems of documentation including illegible handwriting were found in 98.0% (95% CI: 97.0, 99.1) of records. Nearly all errors (93.5%) detected were considered preventable. Conclusions The occurrence of medical errors was high in primary care clinics particularly with documentation and medication errors. Nearly all were preventable. Remedial intervention addressing completeness of documentation and prescriptions are likely to yield reduction of errors. PMID:23267547

Reducing diagnostic errors in medicine: what's the goal?

PubMed

Graber, Mark; Gordon, Ruthanna; Franklin, Nancy

2002-10-01

This review considers the feasibility of reducing or eliminating the three major categories of diagnostic errors in medicine: "No-fault errors" occur when the disease is silent, presents atypically, or mimics something more common. These errors will inevitably decline as medical science advances, new syndromes are identified, and diseases can be detected more accurately or at earlier stages. These errors can never be eradicated, unfortunately, because new diseases emerge, tests are never perfect, patients are sometimes noncompliant, and physicians will inevitably, at times, choose the most likely diagnosis over the correct one, illustrating the concept of necessary fallibility and the probabilistic nature of choosing a diagnosis. "System errors" play a role when diagnosis is delayed or missed because of latent imperfections in the health care system. These errors can be reduced by system improvements, but can never be eliminated because these improvements lag behind and degrade over time, and each new fix creates the opportunity for novel errors. Tradeoffs also guarantee system errors will persist, when resources are just shifted. "Cognitive errors" reflect misdiagnosis from faulty data collection or interpretation, flawed reasoning, or incomplete knowledge. The limitations of human processing and the inherent biases in using heuristics guarantee that these errors will persist. Opportunities exist, however, for improving the cognitive aspect of diagnosis by adopting system-level changes (e.g., second opinions, decision-support systems, enhanced access to specialists) and by training designed to improve cognition or cognitive awareness. Diagnostic error can be substantially reduced, but never eradicated.

An examination of "nonleadership": from laissez-faire leadership to leader reward omission and punishment omission.

PubMed

Hinkin, Timothy R; Schriesheim, Chester A

2008-11-01

Laissez-faire leadership has received much less attention than have the 3 transactional leadership dimensions of the Multifactor Leadership Questionnaire (MLQ). However, laissez-faire leadership has shown strong negative relationships with various leadership criteria, and the absence of leadership (laissez-faire leadership) may be just as important as is the presence of other types of leadership. This article focuses on a single type of laissez-faire leadership (i.e., the lack of response to subordinate performance). Using a reinforcement perspective, the authors developed measures and examined the effects of the lack of performance-contingent reinforcement in 2 forms: reward omission (leader nonreinforcement of good subordinate performance) and punishment omission (leader nonreinforcement of poor subordinate performance). They found strong evidence in support of the construct validity of the new measures and found that omission was related to follower satisfaction with the leader, subordinate-rated leader effectiveness, subordinate-perceived role clarity, and supervisor-rated subordinate performance. (PsycINFO Database Record (c) 2008 APA, all rights reserved).

Diagnostic Reasoning and Cognitive Biases of Nurse Practitioners.

PubMed

Lawson, Thomas N

2018-04-01

Diagnostic reasoning is often used colloquially to describe the process by which nurse practitioners and physicians come to the correct diagnosis, but a rich definition and description of this process has been lacking in the nursing literature. A literature review was conducted with theoretical sampling seeking conceptual insight into diagnostic reasoning. Four common themes emerged: Cognitive Biases and Debiasing Strategies, the Dual Process Theory, Diagnostic Error, and Patient Harm. Relevant cognitive biases are discussed, followed by debiasing strategies and application of the dual process theory to reduce diagnostic error and harm. The accuracy of diagnostic reasoning of nurse practitioners may be improved by incorporating these items into nurse practitioner education and practice. [J Nurs Educ. 2018;57(4):203-208.]. Copyright 2018, SLACK Incorporated.

Philosophy of science and the diagnostic process.

PubMed

Willis, Brian H; Beebee, Helen; Lasserson, Daniel S

2013-10-01

This is an overview of the principles that underpin philosophy of science and how they may provide a framework for the diagnostic process. Although philosophy dates back to antiquity, it is only more recently that philosophers have begun to enunciate the scientific method. Since Aristotle formulated deduction, other modes of reasoning including induction, inference to best explanation, falsificationism, theory-laden observations and Bayesian inference have emerged. Thus, rather than representing a single overriding dogma, the scientific method is a toolkit of ideas and principles of reasoning. Here we demonstrate that the diagnostic process is an example of science in action and is therefore subject to the principles encompassed by the scientific method. Although a number of the different forms of reasoning are used readily by clinicians in practice, without a clear understanding of their pitfalls and the assumptions on which they are based, it leaves doctors open to diagnostic error. We conclude by providing a case example from the medico-legal literature in which diagnostic errors were made, to illustrate how applying the scientific method may mitigate the chance for diagnostic error.

Semiautomated object-based classification of rain-induced landslides with VHR multispectral images on Madeira Island

NASA Astrophysics Data System (ADS)

Heleno, Sandra; Matias, Magda; Pina, Pedro; Sousa, António Jorge

2016-04-01

A method for semiautomated landslide detection and mapping, with the ability to separate source and run-out areas, is presented in this paper. It combines object-based image analysis and a support vector machine classifier and is tested using a GeoEye-1 multispectral image, sensed 3 days after a major damaging landslide event that occurred on Madeira Island (20 February 2010), and a pre-event lidar digital terrain model. The testing is developed in a 15 km2 wide study area, where 95 % of the number of landslides scars are detected by this supervised approach. The classifier presents a good performance in the delineation of the overall landslide area, with commission errors below 26 % and omission errors below 24 %. In addition, fair results are achieved in the separation of the source from the run-out landslide areas, although in less illuminated slopes this discrimination is less effective than in sunnier, east-facing slopes.

Number Frequency in L1 Differentially Affects Immediate Serial Recall of Numbers in L2 Between Beginning and Intermediate Learners.

PubMed

Sumioka, Norihiko; Williams, Atsuko; Yamada, Jun

2016-12-01

A list number recall test in English (L2) was administered to both Japanese (L1) students with beginning-level English proficiency who attended evening high school and Japanese college students with intermediate-level English proficiency. The major findings were that, only for the high school group, the small numbers 1 and 2 in middle positions of lists were recalled better than the large numbers 8 and 9 and there was a significant correlation between number frequency in Japanese and recall performance. Equally intriguing was that in both groups for adjacent transposition errors, smaller numbers tended to appear in the first position and large numbers in the second; also, omission errors were commonly seen for larger numbers. These phenomena are interpreted as reflecting frequency and/or frequency-related effects. Briefly discussed were the bilingual short-term memory system, effects of number value, generality and implications of the findings, and weaknesses of the study.

Theoretical study of the design of a catalyst for para to ortho hydrogen conversion

NASA Technical Reports Server (NTRS)

Coffman, Robert E.

1992-01-01

The theory of Petzinger and Scalapino (1973) was thoroughly reviewed, and all of the basic equations for paramagnetic para to ortho hydrogen catalysis re-derived. There are only a few minor phase errors and errors of omission in the description of the theory. Three models (described by Petzinger and Scalapino) for the rate of para to ortho H2 catalysis were worked out, and uniform agreement obtained to within a constant factor of 2 pi. The analytical methods developed in the course of this study were then extended to two new models, which more adequately describe the process of surface catalysis including transfer of hydrogen molecules onto and off of the surface. All five equations for the para to ortho catalytic rate of conversion are described. The two new equations describe the catalytic rate for these models: H2 on the surface is a 2-D gas with lifetime tau; and H2 on the surface is a 2-D liquid undergoing Brownian motion (diffusion) with surface lifetime tau.

Older adults encode--but do not always use--perceptual details: intentional versus unintentional effects of detail on memory judgments.

PubMed

Koutstaal, Wilma

2003-03-01

Investigations of memory deficits in older individuals have concentrated on their increased likelihood of forgetting events or details of events that were actually encountered (errors of omission). However, mounting evidence demonstrates that normal cognitive aging also is associated with an increased propensity for errors of commission--shown in false alarms or false recognition. The present study examined the origins of this age difference. Older and younger adults each performed three types of memory tasks in which details of encountered items might influence performance. Although older adults showed greater false recognition of related lures on a standard (identical) old/new episodic recognition task, older and younger adults showed parallel effects of detail on repetition priming and meaning-based episodic recognition (decreased priming and decreased meaning-based recognition for different relative to same exemplars). The results suggest that the older adults encoded details but used them less effectively than the younger adults in the recognition context requiring their deliberate, controlled use.

Quantitative neuroanatomy for connectomics in Drosophila

PubMed Central

Schneider-Mizell, Casey M; Gerhard, Stephan; Longair, Mark; Kazimiers, Tom; Li, Feng; Zwart, Maarten F; Champion, Andrew; Midgley, Frank M; Fetter, Richard D; Saalfeld, Stephan; Cardona, Albert

2016-01-01

Neuronal circuit mapping using electron microscopy demands laborious proofreading or reconciliation of multiple independent reconstructions. Here, we describe new methods to apply quantitative arbor and network context to iteratively proofread and reconstruct circuits and create anatomically enriched wiring diagrams. We measured the morphological underpinnings of connectivity in new and existing reconstructions of Drosophila sensorimotor (larva) and visual (adult) systems. Synaptic inputs were preferentially located on numerous small, microtubule-free 'twigs' which branch off a single microtubule-containing 'backbone'. Omission of individual twigs accounted for 96% of errors. However, the synapses of highly connected neurons were distributed across multiple twigs. Thus, the robustness of a strong connection to detailed twig anatomy was associated with robustness to reconstruction error. By comparing iterative reconstruction to the consensus of multiple reconstructions, we show that our method overcomes the need for redundant effort through the discovery and application of relationships between cellular neuroanatomy and synaptic connectivity. DOI: http://dx.doi.org/10.7554/eLife.12059.001 PMID:26990779

Multi-Method Assessment of ADHD Characteristics in Preschool Children: Relations between Measures

PubMed Central

Sims, Darcey M.; Lonigan, Christopher J.

2011-01-01

Several forms of assessment tools, including behavioral rating scales and objective tests such as the Continuous Performance Test (CPT), can be used to measure inattentive and hyperactive/impulsive behaviors associated with Attention-Deficit/Hyperactivity Disorder (ADHD). However, research with school-age children has shown that the correlations between parent ratings, teacher ratings, and scores on objective measures of ADHD-characteristic behaviors are modest at best. In this study, we examined the relations between parent and teacher ratings of ADHD and CPT scores in a sample of 65 preschoolers ranging from 50 to 72 months of age. No significant associations between teacher and parent ratings of ADHD were found. Parent-ratings of both inattention and hyperactivity/impulsivity accounted for variance in CPT omission errors but not CPT commission errors. Teacher ratings showed evidence of convergent and discriminant validity when entered simultaneously in a hierarchical regression. These tools may be measuring different aspects of inattention and hyperactivity/impulsivity. PMID:22518069

Statistical separability and classification of land use classes using image-100. [Brazil

NASA Technical Reports Server (NTRS)

Dejesusparada, N. (Principal Investigator); Kumar, R.; Niero, M.

1977-01-01

The author has identified the following significant results. The statistical separability of land use classes in the subsets of one to four spectral channels was investigated. Using ground observations and aerial photography, the MSS data of LANDSAT were analyzed with the Image-100. In the subsets of one to three spectral channels, channel 4, channel 4 & 7, and channels 4, 5, & 7 were found to be the best choices (ch.4 - 0.5 to 0.6 microns, ch. 5 - 0.6 to 0.7 microns, ch. 6 - 0.7 to 0.8 microns, and ch. 7 - 0.8 to 1.1 microns). For the single cell option of the Image-100, the errors of omission varied from 5% for the industrial class to 46% for the institutional class. The errors of commission varied from 11% for the commercial class to 39% for the industrial class. On the whole, the sample classifier gave considerably more accurate results compared to the single cell or multicell option.

The Sensitivity of Adverse Event Cost Estimates to Diagnostic Coding Error

PubMed Central

Wardle, Gavin; Wodchis, Walter P; Laporte, Audrey; Anderson, Geoffrey M; Baker, Ross G

2012-01-01

Objective To examine the impact of diagnostic coding error on estimates of hospital costs attributable to adverse events. Data Sources Original and reabstracted medical records of 9,670 complex medical and surgical admissions at 11 hospital corporations in Ontario from 2002 to 2004. Patient specific costs, not including physician payments, were retrieved from the Ontario Case Costing Initiative database. Study Design Adverse events were identified among the original and reabstracted records using ICD10-CA (Canadian adaptation of ICD10) codes flagged as postadmission complications. Propensity score matching and multivariate regression analysis were used to estimate the cost of the adverse events and to determine the sensitivity of cost estimates to diagnostic coding error. Principal Findings Estimates of the cost of the adverse events ranged from $16,008 (metabolic derangement) to $30,176 (upper gastrointestinal bleeding). Coding errors caused the total cost attributable to the adverse events to be underestimated by 16 percent. The impact of coding error on adverse event cost estimates was highly variable at the organizational level. Conclusions Estimates of adverse event costs are highly sensitive to coding error. Adverse event costs may be significantly underestimated if the likelihood of error is ignored. PMID:22091908

More on the Liang Bua finds and modern human cretins.

PubMed

Oxnard, Charles; Obendorf, Peter J; Kefford, Ben J; Dennison, John

2012-12-01

Brown (2012: LB1 and LB6 Homo floresiensis are not modern human (Homo sapiens) cretins, Journal of Human Evolution) makes errors of fact, omission and interpretation. Brown's comments refer, among others, to (1) delayed growth and development indicated by unfused epiphyses, (2) postcranial limb proportions: limbs to trunk, between limbs, and within limbs, (3) postcranial bone torsions and angles, (4) postcranial robusticity, real and apparent, (5) skull features, and (6) cretinism on Flores. In each of these areas, much information about cretins is incorrect and much information (Oxnard et al., 2010) comparing the Liang Bua remains with cretins is ignored. Copyright © 2012 Elsevier GmbH. All rights reserved.

Documentation for the machine-readable version of the SAO-HD-GC-DM cross index version 1983

NASA Technical Reports Server (NTRS)

Roman, N. G.; Warren, W. H., Jr.; Schofield, N., Jr.

1983-01-01

An updated and extended machine readable version of the Smithsonian Astrophysical Observatory star catalog (SAO) is described. A correction of all errors which were found since preparation of the original catalog which resulted from misidentifications and omissions of components in multiple star systems and missing Durchmusterung numbers (the common identifier) in the SAO Catalog are included and component identifications from the Index of Visual Double Stars (IDS) are appended to all multiple SAO entries with the same DM numbers, and lower case letter identifiers for supplemental BD stars are added. A total of 11,398 individual corrections and data additions is incorporated into the present version of the cross index.

Passive acquisition of CLIPS rules

NASA Technical Reports Server (NTRS)

Kovarik, Vincent J., Jr.

1991-01-01

The automated acquisition of knowledge by machine has not lived up to expectations, and knowledge engineering remains a human intensive task. Part of the reason for the lack of success is the difference in the cognitive focus of the expert. The expert must shift his or her focus from the subject domain to that of the representation environment. In doing so this cognitive shift introduces opportunity for errors and omissions. Presented here is work that observes the expert interact with a simulation of the domain. The system logs changes in the simulation objects and the expert's actions in response to those changes. This is followed by the application of inductive reasoning to move the domain specific rules observed to general domain rules.

The use of a contextual, modal and psychological classification of medication errors in the emergency department: a retrospective descriptive study.

PubMed

Cabilan, C J; Hughes, James A; Shannon, Carl

2017-12-01

To describe the contextual, modal and psychological classification of medication errors in the emergency department to know the factors associated with the reported medication errors. The causes of medication errors are unique in every clinical setting; hence, error minimisation strategies are not always effective. For this reason, it is fundamental to understand the causes specific to the emergency department so that targeted strategies can be implemented. Retrospective analysis of reported medication errors in the emergency department. All voluntarily staff-reported medication-related incidents from 2010-2015 from the hospital's electronic incident management system were retrieved for analysis. Contextual classification involved the time, place and the type of medications involved. Modal classification pertained to the stage and issue (e.g. wrong medication, wrong patient). Psychological classification categorised the errors in planning (knowledge-based and rule-based errors) and skill (slips and lapses). There were 405 errors reported. Most errors occurred in the acute care area, short-stay unit and resuscitation area, during the busiest shifts (0800-1559, 1600-2259). Half of the errors involved high-alert medications. Many of the errors occurred during administration (62·7%), prescribing (28·6%) and commonly during both stages (18·5%). Wrong dose, wrong medication and omission were the issues that dominated. Knowledge-based errors characterised the errors that occurred in prescribing and administration. The highest proportion of slips (79·5%) and lapses (76·1%) occurred during medication administration. It is likely that some of the errors occurred due to the lack of adherence to safety protocols. Technology such as computerised prescribing, barcode medication administration and reminder systems could potentially decrease the medication errors in the emergency department. There was a possibility that some of the errors could be prevented if safety protocols were adhered to, which highlights the need to also address clinicians' attitudes towards safety. Technology can be implemented to help minimise errors in the ED, but this must be coupled with efforts to enhance the culture of safety. © 2017 John Wiley & Sons Ltd.

Clinical decision-making: heuristics and cognitive biases for the ophthalmologist.

PubMed

Hussain, Ahsen; Oestreicher, James

Diagnostic errors have a significant impact on health care outcomes and patient care. The underlying causes and development of diagnostic error are complex with flaws in health care systems, as well as human error, playing a role. Cognitive biases and a failure of decision-making shortcuts (heuristics) are human factors that can compromise the diagnostic process. We describe these mechanisms, their role with the clinician, and provide clinical scenarios to highlight the various points at which biases may emerge. We discuss strategies to modify the development and influence of these processes and the vulnerability of heuristics to provide insight and improve clinical outcomes. Copyright © 2017 Elsevier Inc. All rights reserved.

Evaluating the Performance Diagnostic Checklist-Human Services to Assess Incorrect Error-Correction Procedures by Preschool Paraprofessionals

ERIC Educational Resources Information Center

Bowe, Melissa; Sellers, Tyra P.

2018-01-01

The Performance Diagnostic Checklist-Human Services (PDC-HS) has been used to assess variables contributing to undesirable staff performance. In this study, three preschool teachers completed the PDC-HS to identify the factors contributing to four paraprofessionals' inaccurate implementation of error-correction procedures during discrete trial…

Analysis of Students' Error in Learning of Quadratic Equations

ERIC Educational Resources Information Center

Zakaria, Effandi; Ibrahim; Maat, Siti Mistima

2010-01-01

The purpose of the study was to determine the students' error in learning quadratic equation. The samples were 30 form three students from a secondary school in Jambi, Indonesia. Diagnostic test was used as the instrument of this study that included three components: factorization, completing the square and quadratic formula. Diagnostic interview…

The Causes of Errors in Clinical Reasoning: Cognitive Biases, Knowledge Deficits, and Dual Process Thinking.

PubMed

Norman, Geoffrey R; Monteiro, Sandra D; Sherbino, Jonathan; Ilgen, Jonathan S; Schmidt, Henk G; Mamede, Silvia

2017-01-01

Contemporary theories of clinical reasoning espouse a dual processing model, which consists of a rapid, intuitive component (Type 1) and a slower, logical and analytical component (Type 2). Although the general consensus is that this dual processing model is a valid representation of clinical reasoning, the causes of diagnostic errors remain unclear. Cognitive theories about human memory propose that such errors may arise from both Type 1 and Type 2 reasoning. Errors in Type 1 reasoning may be a consequence of the associative nature of memory, which can lead to cognitive biases. However, the literature indicates that, with increasing expertise (and knowledge), the likelihood of errors decreases. Errors in Type 2 reasoning may result from the limited capacity of working memory, which constrains computational processes. In this article, the authors review the medical literature to answer two substantial questions that arise from this work: (1) To what extent do diagnostic errors originate in Type 1 (intuitive) processes versus in Type 2 (analytical) processes? (2) To what extent are errors a consequence of cognitive biases versus a consequence of knowledge deficits?The literature suggests that both Type 1 and Type 2 processes contribute to errors. Although it is possible to experimentally induce cognitive biases, particularly availability bias, the extent to which these biases actually contribute to diagnostic errors is not well established. Educational strategies directed at the recognition of biases are ineffective in reducing errors; conversely, strategies focused on the reorganization of knowledge to reduce errors have small but consistent benefits.

Automation: Decision Aid or Decision Maker?

NASA Technical Reports Server (NTRS)

Skitka, Linda J.

1998-01-01

This study clarified that automation bias is something unique to automated decision making contexts, and is not the result of a general tendency toward complacency. By comparing performance on exactly the same events on the same tasks with and without an automated decision aid, we were able to determine that at least the omission error part of automation bias is due to the unique context created by having an automated decision aid, and is not a phenomena that would occur even if people were not in an automated context. However, this study also revealed that having an automated decision aid did lead to modestly improved performance across all non-error events. Participants in the non- automated condition responded with 83.68% accuracy, whereas participants in the automated condition responded with 88.67% accuracy, across all events. Automated decision aids clearly led to better overall performance when they were accurate. People performed almost exactly at the level of reliability as the automation (which across events was 88% reliable). However, also clear, is that the presence of less than 100% accurate automated decision aids creates a context in which new kinds of errors in decision making can occur. Participants in the non-automated condition responded with 97% accuracy on the six "error" events, whereas participants in the automated condition had only a 65% accuracy rate when confronted with those same six events. In short, the presence of an AMA can lead to vigilance decrements that can lead to errors in decision making.

Identification of Hypertension Management-related Errors in a Personal Digital Assistant-based Clinical Log for Nurses in Advanced Practice Nurse Training.

PubMed

Lee, Nam-Ju; Cho, Eunhee; Bakken, Suzanne

2010-03-01

The purposes of this study were to develop a taxonomy for detection of errors related to hypertension management and to apply the taxonomy to retrospectively analyze the documentation of nurses in Advanced Practice Nurse (APN) training. We developed the Hypertension Diagnosis and Management Error Taxonomy and applied it in a sample of adult patient encounters (N = 15,862) that were documented in a personal digital assistant-based clinical log by registered nurses in APN training. We used Standard Query Language queries to retrieve hypertension-related data from the central database. The data were summarized using descriptive statistics. Blood pressure was documented in 77.5% (n = 12,297) of encounters; 21% had high blood pressure values. Missed diagnosis, incomplete diagnosis and misdiagnosis rates were 63.7%, 6.8% and 7.5% respectively. In terms of treatment, the omission rates were 17.9% for essential medications and 69.9% for essential patient teaching. Contraindicated anti-hypertensive medications were documented in 12% of encounters with co-occurring diagnoses of hypertension and asthma. The Hypertension Diagnosis and Management Error Taxonomy was useful for identifying errors based on documentation in a clinical log. The results provide an initial understanding of the nature of errors associated with hypertension diagnosis and management of nurses in APN training. The information gained from this study can contribute to educational interventions that promote APN competencies in identification and management of hypertension as well as overall patient safety and informatics competencies. Copyright © 2010 Korean Society of Nursing Science. Published by . All rights reserved.

Morpho-syntactic processing of Arabic plurals after aphasia: dissecting lexical meaning from morpho-syntax within word boundaries.

PubMed

Khwaileh, Tariq; Body, Richard; Herbert, Ruth

2015-01-01

Within the domain of inflectional morpho-syntax, differential processing of regular and irregular forms has been found in healthy speakers and in aphasia. One view assumes that irregular forms are retrieved as full entities, while regular forms are compiled on-line. An alternative view holds that a single mechanism oversees regular and irregular forms. Arabic offers an opportunity to study this phenomenon, as Arabic nouns contain a consonantal root, delivering lexical meaning, and a vocalic pattern, delivering syntactic information, such as gender and number. The aim of this study is to investigate morpho-syntactic processing of regular (sound) and irregular (broken) Arabic plurals in patients with morpho-syntactic impairment. Three participants with acquired agrammatic aphasia produced plural forms in a picture-naming task. We measured overall response accuracy, then analysed lexical errors and morpho-syntactic errors, separately. Error analysis revealed different patterns of morpho-syntactic errors depending on the type of pluralization (sound vs broken). Omissions formed the vast majority of errors in sound plurals, while substitution was the only error mechanism that occurred in broken plurals. The dissociation was statistically significant for retrieval of morpho-syntactic information (vocalic pattern) but not for lexical meaning (consonantal root), suggesting that the participants' selective impairment was an effect of the morpho-syntax of plurals. These results suggest that irregular plurals forms are stored, while regular forms are derived. The current findings support the findings from other languages and provide a new analysis technique for data from languages with non-concatenative morpho-syntax.

ARTICULATION DISORDERS IN SERBIAN LANGUAGE IN CHILDREN WITH SPEECH PATHOLOGY.

PubMed

Dmitrić, Tanja; Veselinović, Mila; Mitrović, Slobodan M

2015-01-01

Articulation is the result of speech organs and it means clean, clear and distinct pronunciation of voices in words. A prospective study included 24 children between 5 and 15 years of age, of both sexes. All children were monolingual, Serbian being their native language. The quality of articulation was tested with Triage articulation test. Neither omission nor distortion of plosives was observed in any of them, whereas substitution of plosives occurred in 12% of patients. Omission of affricates was not observed in any of the subjects, but substitution and distortion occurred in 29%, and 76% of subjects, respectively. Omission of fricatives was found in 29% subjects, substitution in 52%, and distortion in 82% of subjects. Omission and distortion of nasals was not recorded in any of the subjects, and substitution occurred in 6% of children. Omission of laterals was observed in 6%, substitution in 46% and distortion in 52% of subjects with articulation disorders. Discussion and Articulation disorders were observed not only in children diagnosed with dyslalia but in those with dysphasia and stuttering as well. Children with speech disorders articulate vowels best, then nasals and plosives. Articulation of fricatives and laterals was found to be most severely deviated, including all three disorders, i.e. substitution, omission and distortion. Spasms of speech muscles and vegetative reactions were also observed in this study, but only in children with stuttering.

Prevalence of sleep disorders and their relationship with core symptoms of inattention and hyperactivity in children with attention-deficit/hyperactivity disorder.

PubMed

Vélez-Galarraga, Rosario; Guillén-Grima, Francisco; Crespo-Eguílaz, Nerea; Sánchez-Carpintero, Rocío

2016-11-01

To determine the prevalence of sleep disorders in children with attention-deficit/hyperactivity disorder (ADHD) and in a control population. To examine the relationship between sleep disorders and symptoms of inattention, hyperactivity/impulsiveness and executive dysfunction. We studied 126 children with ADHD and 1036 control children aged between 5 and 18 years old. Caregivers completed the Pediatric Sleep Questionnaire and the ADHD Rating Scale (ADHD-RS). Children with ADHD were subsequently assessed for executive function with the Conner's Continuous Performance Test (CPT) or with AULA Nesplora. Children with ADHD slept less at night and were more likely to display sleep-related rhythmic movements. Children in the ADHD group who were under 12 years old and who had total ADHD-RS scores over the 90th percentile had more difficulty falling asleep than other children; there was also a relationship between total ADHD-RS scores over the 90th percentile and certain parasomnias in the control population. There was a correlation between shorter duration of night-time sleep and omission errors in children who were 12 or older and who were under pharmacological treatment for ADHD. Bedtime resistance and difficulty falling sleep were more frequent in children with ADHD whose symptoms were not treated pharmacologically, than in children receiving treatment. Symptoms of inattention and hyperactivity are correlated with impaired sleep duration and quality; specifically, there is an association between ADHD symptoms and problems falling asleep and parasomnias, however, the current study does not address the nature and direction of causality. Children with ADHD and receiving methylphenidate had fewer sleep disorders, suggesting that, at least in some children, stimulant treatment is associated with improvement of some aspects of sleep. Shorter sleep duration in adolescents under pharmacological treatment for ADHD tended to result in more errors of omission, suggesting that it is important to promote good sleep habits in this population. Copyright © 2016 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.

[Medication reconciliation at hospital admission: Results and identification of target patients].

PubMed

San José Ruiz, B; Serrano De Lucas, L; López-Giménez, L R; Baza Martínez, B; Sautua Larreategi, S; Bustinza Txertudi, A; Sebastián Leza, Á; Chirivella Ramón, M T; Fonseca Legrand, J L; de Miguel Cascon, M

2016-06-01

To quantify and to classify the discrepancies between the admission treatment and the usual patient treatment. To determine the variables that predict those patients that will have more benefit from medication reconciliation. A prospective medication reconciliation study was conducted in the Vascular Surgery Unit from March 2014 to December 2014. When the patients were admitted to the Vascular Surgery Unit, they were informed about the study and asked to prepare information about their chronic treatment. The pharmacist then checked their clinical records, outpatient prescriptions, and also interviewed the patient, obtaining the best pharmacotherapeutic history available. The discrepancies with the admission treatment were written into the patient electronic clinical records. Finally, the physician classified the discrepancies, and changed the treatment, if needed. The statistical analysis included a comparison between patients with and without a non-justified discrepancy (NJD). The statistically different characteristics were used to plot Receiver Operating Characteristic curves, in order to determine the sensitivity and the specificity of these variables to select patients with discrepancies. A total of 380 patients were included. There were 845 non-justified, 600 justified non-documented, and 439 justified documented discrepancies. At least one NJD was identified in 293 patients (77%), with 65 patients (17%) having only justified discrepancies, and 22 patients (6%) having no discrepancies. NJD were: different dose, route or schedule (51%), omission (39%), wrong drug (8%) and commission (2%). The variables associated with discrepancies were number of chronic medications drugs and provider of information. In most studies, omission is the most frequent error. In contrast, in our study the most frequent error is different dose, route, or schedule. The variable that allows selecting patients at higher risk of discrepancies is the number of chronic drugs. This risk is also increased if the patients are not the manager of their own medication. Copyright © 2016 SECA. Published by Elsevier Espana. All rights reserved.

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

Ray, L.; Hoffmann, G.W.; Thaler, R.M.

The treatment of the Coulomb interaction in the multiple scattering theories of Kerman-McManus-Thaler and Watson is examined in detail. By neglecting virtual Coulomb excitations, the lowest order Coulomb term in the Watson optical potential is shown to be a convolution of the point Coulomb interaction with the distributed nuclear charge, while the equivalent Kerman-McManus-Thaler Coulomb potential is obtained from an averaged, single-particle Coulombic T matrix. The Kerman-McManus-Thaler Coulomb potential is expressed as the Watson Coulomb term plus additional Coulomb-nuclear and Coulomb-Coulomb cross terms, and the omission of the extra terms in usual Kerman-McManus-Thaler applications leads to negative infinite total reactionmore » cross section predictions and incorrect pure Coulomb scattering limits. Approximations are presented which eliminate these anomalies. Using the two-potential formula, the full projectile-nucleus T matrix is separated into two terms, one resulting from the distributed nuclear charge and the other being a Coulomb distorted nuclear T matrix. It is shown that the error resulting from the omission of the Kerman-McManus-Thaler Coulomb terms is effectively removed when the pure Coulomb T matrix in Kerman-McManus-Thaler is replaced by the analogous quantity in the Watson approach. Using the various approximations, theoretical angular distributions are obtained for 800 MeV p+/sup 208/Pb elastic scattering and compared with experimental data.« less

Effects of MDMA on olfactory memory and reversal learning in rats

PubMed Central

Hawkey, Andrew; April, L. Brooke; Galizio, Mark

2014-01-01

The effects of acute and sub-chronic MDMA were assessed using a procedure designed to test rodent working memory capacity: the odor span task (OST). Rats were trained to select an odor that they had not previously encountered within the current session, and the number of odors to remember was incremented up to 24 during the course of each session. In order to separate drug effects on the OST from more general performance impairment, a simple olfactory discrimination was also assessed in each session. In Experiment 1, acute doses of MDMA were administered prior to select sessions. MDMA impaired memory span in a dose-dependent fashion, but impairment was seen only at doses (1.8 and 3.0 mg/kg) that also increased response omissions on both the simple discrimination and the OST. In Experiment 2, a sub-chronic regimen of MDMA (10.0 mg/kg, twice daily over four days) was administered after OST training. There was no evidence of reduced memory span following sub-chronic MDMA, but a temporary increase in omission errors on the OST was observed. In addition, rats exposed to sub-chronic MDMA showed delayed learning when the simple discrimination was reversed. Overall, the disruptive effects of both acute and sub-chronic MDMA appeared to be due to non-mnemonic processes, rather than effects on specific memory functions. PMID:25017644

Educational Diagnostic Assessment.

ERIC Educational Resources Information Center

Bejar, Isaac I.

1984-01-01

Approaches proposed for educational diagnostic assessment are reviewed and identified as deficit assessment and error analysis. The development of diagnostic instruments may require a reexamination of existing psychometric models and development of alternative ones. The psychometric and content demands of diagnostic assessment all but require test…

RETRACTED: Poly-pathway model, a novel approach to simulate multiple metabolic states by reaction network-based model - Application to amino acid depletion in CHO cell culture.

PubMed

Hagrot, Erika; Oddsdóttir, Hildur Æsa; Hosta, Joan Gonzalez; Jacobsen, Elling W; Chotteau, Véronique

2016-06-20

This article has been retracted: please see Elsevier Policy on Article Withdrawal (https://www.elsevier.com/about/our-business/policies/article-withdrawal). The authors of the paper wish to retract the paper due to the discovery of a calculation error in the processing of the raw data. The discovered error concerns the calculation of the specific uptake/secretion rates for several metabolites in one of the experimental conditions, i.e. glutamine omission (called Q0). In other words, in Figure 2, the variations of the metabolic fluxes for the condition Q0 are not correct. When this error is corrected, the resulting mathematical model changes (in particular for the results associated with Q0 conditions), several figures and tables are modified, and the interpretation of the fluxes in Q0 has to be slightly modified. Therefore the authors wish to retract the article. However, the error does not affect the modelling approach or the methodology presented in the article. Therefore, a revised version with the correct data has since been published: http://www.sciencedirect.com/science/article/pii/S0168165617302663. We apologize to the scientific community for the need to retract the article and the inconvenience caused. Copyright © 2016 The Authors. Published by Elsevier B.V. All rights reserved.

Virtual design and construction of plumbing systems

NASA Astrophysics Data System (ADS)

Filho, João Bosco P. Dantas; Angelim, Bruno Maciel; Guedes, Joana Pimentel; de Castro, Marcelo Augusto Farias; Neto, José de Paula Barros

2016-12-01

Traditionally, the design coordination process is carried out by overlaying and comparing 2D drawings made by different project participants. Detecting information errors from a composite drawing is especially challenging and error prone. This procedure usually leaves many design errors undetected until construction begins, and typically lead to rework. Correcting conflict issues, which were not identified during design and coordination phase, reduces the overall productivity for everyone involved in the construction process. The identification of construction issues in the field generate Request for Information (RFIs) that is one of delays causes. The application of Virtual Design and Construction (VDC) tools to the coordination processes can bring significant value to architecture, structure, and mechanical, electrical, and plumbing (MEP) designs in terms of a reduced number of errors undetected and requests for information. This paper is focused on evaluating requests for information (RFI) associated with water/sanitary facilities of a BIM model. Thus, it is expected to add improvements of water/sanitary facility designs, as well as to assist the virtual construction team to notice and identify design problems. This is an exploratory and descriptive research. A qualitative methodology is used. This study adopts RFI's classification in six analyzed categories: correction, omission, validation of information, modification, divergence of information and verification. The results demonstrate VDC's contribution improving the plumbing system designs. Recommendations are suggested to identify and avoid these RFI types in plumbing system design process or during virtual construction.

High IQ May "Mask" the Diagnosis of ADHD by Compensating for Deficits in Executive Functions in Treatment-Naïve Adults With ADHD.

PubMed

Milioni, Ana Luiza Vidal; Chaim, Tiffany Moukbel; Cavallet, Mikael; de Oliveira, Nathalya Moleda; Annes, Marco; Dos Santos, Bernardo; Louzã, Mario; da Silva, Maria Aparecida; Miguel, Carmen Silvia; Serpa, Mauricio Henriques; Zanetti, Marcus V; Busatto, Geraldo; Cunha, Paulo Jannuzzi

2017-04-01

To evaluate and compare the performance of adults with ADHD with high and standard IQ in executive functions (EF) tasks. We investigated the neuropsychological performance of 51 adults with ADHD, compared with 33 healthy controls (HC) while performing a wide battery of neuropsychological tests that measure executive functioning. Adults with clinical diagnosis of ADHD were divided into two groups according to their IQ level (IQ ≥ 110-ADHD group with more elevated IQ, and IQ < 110-ADHD group with standard IQ). The ADHD group with standard IQ presented a worse executive functioning compared with the HC group in the following measures: Stroop 2 ( p = .000) and 3 ( p = .000), Trail Making Test (TMT) B ( p = .005), Wisconsin Card-Sorting Test (WCST)-perseverative errors ( p = .022) and failures to maintain set ( p = .020), Continuous Performance Test (CPT)-omission errors ( p = .005) and commission errors ( p = .000), and Frontal Assessment Battery (FAB)-conceptualization ( p = .016). The ADHD group with more elevated IQ presented only impairments in the CPT-commission errors ( p = .019) when compared with the control group. Adults with ADHD and more elevated IQ show less evidence of executive functioning deficits compared with those with ADHD and standard IQ, suggesting that a higher degree of intellectual efficiency may compensate deficits in executive functions, leading to problems in establishing a precise clinical diagnosis.

The current and ideal state of anatomic pathology patient safety.

PubMed

Raab, Stephen Spencer

2014-01-01

An anatomic pathology diagnostic error may be secondary to a number of active and latent technical and/or cognitive components, which may occur anywhere along the total testing process in clinical and/or laboratory domains. For the pathologist interpretive steps of diagnosis, we examine Kahneman's framework of slow and fast thinking to explain different causes of error in precision (agreement) and in accuracy (truth). The pathologist cognitive diagnostic process involves image pattern recognition and a slow thinking error may be caused by the application of different rationally-constructed mental maps of image criteria/patterns by different pathologists. This type of error is partly related to a system failure in standardizing the application of these maps. A fast thinking error involves the flawed leap from image pattern to incorrect diagnosis. In the ideal state, anatomic pathology systems would target these cognitive error causes as well as the technical latent factors that lead to error.

Virtual-reality-based attention assessment of ADHD: ClinicaVR: Classroom-CPT versus a traditional continuous performance test.

PubMed

Neguț, Alexandra; Jurma, Anda Maria; David, Daniel

2017-08-01

Virtual-reality-based assessment may be a good alternative to classical or computerized neuropsychological assessment due to increased ecological validity. ClinicaVR: Classroom-CPT (VC) is a neuropsychological test embedded in virtual reality that is designed to assess attention deficits in children with attention deficit hyperactivity disorder (ADHD) or other conditions associated with impaired attention. The present study aimed to (1) investigate the diagnostic validity of VC in comparison to a traditional continuous performance test (CPT), (2) explore the task difficulty of VC, (3) address the effect of distractors on the performance of ADHD participants and typically-developing (TD) controls, and (4) compare the two measures on cognitive absorption. A total of 33 children diagnosed with ADHD and 42 TD children, aged between 7 and 13 years, participated in the study and were tested with a traditional CPT or with VC, along with several cognitive measures and an adapted version of the Cognitive Absorption Scale. A mixed multivariate analysis of covariance (MANCOVA) revealed that the children with ADHD performed worse on correct responses had more commissions and omissions errors than the TD children, as well as slower target reaction times . The results showed significant differences between performance in the virtual environment and the traditional computerized one, with longer reaction times in virtual reality. The data analysis highlighted the negative influence of auditory distractors on attention performance in the case of the children with ADHD, but not for the TD children. Finally, the two measures did not differ on the cognitive absorption perceived by the children.

Evaluation of the Geopotential value for the Local Vertical Datum of China using GRACE/GOCE GGMs and GPS/Leveling Data

NASA Astrophysics Data System (ADS)

He, Lin; Li, Jiancheng; Chu, Yonghai; Zhang, Tengxu

2017-04-01

National height reference systems have conventionally been linked to the coastal local mean sea level, observed at one tide gauge, such as the China national height datum 1985. Due to the effect of the local sea surface topography, the reference level surface of local datum is inconsistent with the global datum or other local datum. In order to unify or connect the local datum to the global height datum, it is necessary to obtain the zero-height geopotential value of local datum or the height offset with respect to the global datum. The GRACE and GOCE satellite mission are promising for purposes of unification of local vertical datums because they have brought a significant improvement in modeling of low-frequency or rather medium-frequency part of the Earth's static gravity field in the past ten years. The focus of this work is directed to the evaluation of most available Global Geopotential Models (GGMs) from GOCE and GRACE, both satellite only as well as combined ones. From the evaluation with the 649 GPS/Levelling benchmarks (BMs) in China, the GOCE/GRACE GGMs provide the accuracy at 42-52cm level, up to their max degree and order. The latest release 5 DIR, TIM GGMs improve the accuracies by 6-10cm compared to the release 1 models. The DIR_R1 is based on the fewer GOCE data performs equally well with the DIR_R4 and DIR_R5 model, this is attributed to the fact that during its development which used a priori information from EIGEN-51C. The zero-height geopotential value W0LVD for the China Local Vertical Datum (LVD) is 62636855.1606m2s-2 from the originally GOCE/GRACE GGMs. Taking into account the GPS/Levelling data contains the full spectral information, and the GOCE-only or GRACE-GOCE combined model are limited to the long wavelengths. To improve the accuracy of the GGMs, it is indispensable to account for the remaining signal above this maximum degree, known as the omission error of the GGM. The effect of GRACE/GOCE omission error is investigated by extending the models with the high-resolution gravity field model EGM2008. In China, the effect of the GRACE/GOCE GGMs omission error is at the decimeter level. The combined GGMs (up to 2160 degree and order) could provide an accuracy at 20cm level, which is better than that from EGM2008. Meanwhile, if an appropriate degree and order is chosen for the GOCE-only or GRACE-GOCE combined GGMs to connect with the EGM2008, the extended GGMs provide an accuracy at 16cm level. From the extended GGMs, the geopotential value W0LVD determined for the China local vertical datum is 62636853.4351 m2s-2 indicates a bias of about 2.5649 m2/s-2 compared to the conventional value of 62,636,856.0 m2s-2. This is support by National key research and development program No:2016YFB0501702. Keywords: Global Geopotential Models; GRACE; GOCE; GPS/Levelling; zero-height geopotential

Investigating the Association of Eye Gaze Pattern and Diagnostic Error in Mammography

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

Voisin, Sophie; Pinto, Frank M; Xu, Songhua

2013-01-01

The objective of this study was to investigate the association between eye-gaze patterns and the diagnostic accuracy of radiologists for the task of assessing the likelihood of malignancy of mammographic masses. Six radiologists (2 expert breast imagers and 4 Radiology residents of variable training) assessed the likelihood of malignancy of 40 biopsy-proven mammographic masses (20 malignant and 20 benign) on a computer monitor. Eye-gaze data were collected using a commercial remote eye-tracker. Upon reviewing each mass, the radiologists were also asked to provide their assessment regarding the probability of malignancy of the depicted mass as well as a rating regardingmore » the perceived difficulty of the diagnostic task. The collected data were analyzed using established algorithms and various quantitative metrics were extracted to characterize the recorded gaze patterns. The extracted metrics were correlated with the radiologists diagnostic decisions and perceived complexity scores. Results showed that the visual gaze pattern of radiologists varies substantially, not only depending on their experience level but also among individuals. However, some eye gaze metrics appear to correlate with diagnostic error and perceived complexity more consistently. These results suggest that although gaze patterns are generally associated with diagnostic error and the human perceived difficulty of the diagnostic task, there are substantially individual differences that are not explained simply by the experience level of the individual performing the diagnostic task.« less

Polygenetic Karsted Hardground Omission Surfaces in Lower Silurian Neritic Limestones: a Signature of Early Paleozoic Calcite Seas

NASA Astrophysics Data System (ADS)

James, Noel P.; Desrochers, André; Kyser, Kurt T.

2015-04-01

Exquisitely preserved and well-exposed rocky paleoshoreline omission surfaces in Lower Silurian Chicotte Formation limestones on Anticosti Island, Quebec, are interpreted to be the product of combined marine and meteoric diagenesis. The different omission features include; 1) planar erosional bedding tops, 2) scalloped erosional surfaces, 3) knobs, ridges, and swales at bedding contacts, and 4) paleoscarps. An interpretation is proposed that relates specific omission surface styles to different diagenetic-depositional processes that took place in separate terrestrial-peritidal-shallow neritic zones. Such processes were linked to fluctuations in relative sea level with specific zones of diagenesis such as; 1) karst corrosion, 2) peritidal erosion, 3) subtidal seawater flushing and cementation, and 4) shallow subtidal deposition. Most surfaces are interpreted to have been the result of initial extensive shallow-water synsedimentary lithification that were, as sea level fell, altered by exposure and subaerial corrosion, only to be buried by sediments as sea level rose again. This succession was repeated several times resulting in a suite of recurring polyphase omission surfaces through many meters of stratigraphic section. Synsedimentary cloudy marine cements are well preserved and are thus interpreted to have been calcitic originally. Aragonite components are rare and thought to have to have been dissolved just below the Silurian seafloor. Large molluscs that survived such seafloor removal were nonetheless leached and the resultant megamoulds were filled with synsedimentary calcite cement. These Silurian inner neritic-strandline omission surfaces are temporally unique. They are part of a suite of marine omission surfaces that are mostly found in early Paleozoic neritic carbonate sedimentary rocks. These karsted hardgrounds formed during a calcite-sea time of elevated marine carbonate saturation and extensive marine cement precipitation. The contemporaneous greenhouse atmosphere was supercharged with CO2 leading to profound surface karst under strongly acid rain. Younger peritidal omission surfaces, although potentially formed during aragonite or calcite sea times, would have been subject to very different terrestrial diagenetic process with lower atmospheric pCO2 values but increasingly complex biogenic soils producing dissimilar alteration features.

Medication errors as malpractice-a qualitative content analysis of 585 medication errors by nurses in Sweden.

PubMed

Björkstén, Karin Sparring; Bergqvist, Monica; Andersén-Karlsson, Eva; Benson, Lina; Ulfvarson, Johanna

2016-08-24

Many studies address the prevalence of medication errors but few address medication errors serious enough to be regarded as malpractice. Other studies have analyzed the individual and system contributory factor leading to a medication error. Nurses have a key role in medication administration, and there are contradictory reports on the nurses' work experience in relation to the risk and type for medication errors. All medication errors where a nurse was held responsible for malpractice (n = 585) during 11 years in Sweden were included. A qualitative content analysis and classification according to the type and the individual and system contributory factors was made. In order to test for possible differences between nurses' work experience and associations within and between the errors and contributory factors, Fisher's exact test was used, and Cohen's kappa (k) was performed to estimate the magnitude and direction of the associations. There were a total of 613 medication errors in the 585 cases, the most common being "Wrong dose" (41 %), "Wrong patient" (13 %) and "Omission of drug" (12 %). In 95 % of the cases, an average of 1.4 individual contributory factors was found; the most common being "Negligence, forgetfulness or lack of attentiveness" (68 %), "Proper protocol not followed" (25 %), "Lack of knowledge" (13 %) and "Practice beyond scope" (12 %). In 78 % of the cases, an average of 1.7 system contributory factors was found; the most common being "Role overload" (36 %), "Unclear communication or orders" (30 %) and "Lack of adequate access to guidelines or unclear organisational routines" (30 %). The errors "Wrong patient due to mix-up of patients" and "Wrong route" and the contributory factors "Lack of knowledge" and "Negligence, forgetfulness or lack of attentiveness" were more common in less experienced nurses. The experienced nurses were more prone to "Practice beyond scope of practice" and to make errors in spite of "Lack of adequate access to guidelines or unclear organisational routines". Medication errors regarded as malpractice in Sweden were of the same character as medication errors worldwide. A complex interplay between individual and system factors often contributed to the errors.

Precise signal amplitude retrieval for a non-homogeneous diagnostic beam using complex interferometry approach

NASA Astrophysics Data System (ADS)

Krupka, M.; Kalal, M.; Dostal, J.; Dudzak, R.; Juha, L.

2017-08-01

Classical interferometry became widely used method of active optical diagnostics. Its more advanced version, allowing reconstruction of three sets of data from just one especially designed interferogram (so called complex interferogram) was developed in the past and became known as complex interferometry. Along with the phase shift, which can be also retrieved using classical interferometry, the amplitude modifications of the probing part of the diagnostic beam caused by the object under study (to be called the signal amplitude) as well as the contrast of the interference fringes can be retrieved using the complex interferometry approach. In order to partially compensate for errors in the reconstruction due to imperfections in the diagnostic beam intensity structure as well as for errors caused by a non-ideal optical setup of the interferometer itself (including the quality of its optical components), a reference interferogram can be put to a good use. This method of interferogram analysis of experimental data has been successfully implemented in practice. However, in majority of interferometer setups (especially in the case of the ones employing the wavefront division) the probe and the reference part of the diagnostic beam would feature different intensity distributions over their respective cross sections. This introduces additional error into the reconstruction of the signal amplitude and the fringe contrast, which cannot be resolved using the reference interferogram only. In order to deal with this error it was found that additional separately recorded images of the intensity distribution of the probe and the reference part of the diagnostic beam (with no signal present) are needed. For the best results a sufficient shot-to-shot stability of the whole diagnostic system is required. In this paper, efficiency of the complex interferometry approach for obtaining the highest possible accuracy of the signal amplitude reconstruction is verified using the computer generated complex and reference interferograms containing artificially introduced intensity variations in the probe and the reference part of the diagnostic beam. These sets of data are subsequently analyzed and the errors of the signal amplitude reconstruction are evaluated.

Should learners reason one step at a time? A randomised trial of two diagnostic scheme designs.

PubMed

Blissett, Sarah; Morrison, Deric; McCarty, David; Sibbald, Matthew

2017-04-01

Making a diagnosis can be difficult for learners as they must integrate multiple clinical variables. Diagnostic schemes can help learners with this complex task. A diagnostic scheme is an algorithm that organises possible diagnoses by assigning signs or symptoms (e.g. systolic murmur) to groups of similar diagnoses (e.g. aortic stenosis and aortic sclerosis) and provides distinguishing features to help discriminate between similar diagnoses (e.g. carotid pulse). The current literature does not identify whether scheme layouts should guide learners to reason one step at a time in a terminally branching scheme or weigh multiple variables simultaneously in a hybrid scheme. We compared diagnostic accuracy, perceptual errors and cognitive load using two scheme layouts for cardiac auscultation. Focused on the task of identifying murmurs on Harvey, a cardiopulmonary simulator, 86 internal medicine residents used two scheme layouts. The terminally branching scheme organised the information into single variable decisions. The hybrid scheme combined single variable decisions with a chart integrating multiple distinguishing features. Using a crossover design, participants completed one set of murmurs (diastolic or systolic) with either the terminally branching or the hybrid scheme. The second set of murmurs was completed with the other scheme. A repeated measures manova was performed to compare diagnostic accuracy, perceptual errors and cognitive load between the scheme layouts. There was a main effect of the scheme layout (Wilks' λ = 0.841, F 3,80 = 5.1, p = 0.003). Use of a terminally branching scheme was associated with increased diagnostic accuracy (65 versus 53%, p = 0.02), fewer perceptual errors (0.61 versus 0.98 errors, p = 0.001) and lower cognitive load (3.1 versus 3.5/7, p = 0.023). The terminally branching scheme was associated with improved diagnostic accuracy, fewer perceptual errors and lower cognitive load, suggesting that terminally branching schemes are effective for improving diagnostic accuracy. These findings can inform the design of schemes and other clinical decision aids. © 2017 John Wiley & Sons Ltd and The Association for the Study of Medical Education.

Predicting diagnostic error in Radiology via eye-tracking and image analytics: Application in mammography

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

Voisin, Sophie; Pinto, Frank M; Morin-Ducote, Garnetta

2013-01-01

Purpose: The primary aim of the present study was to test the feasibility of predicting diagnostic errors in mammography by merging radiologists gaze behavior and image characteristics. A secondary aim was to investigate group-based and personalized predictive models for radiologists of variable experience levels. Methods: The study was performed for the clinical task of assessing the likelihood of malignancy of mammographic masses. Eye-tracking data and diagnostic decisions for 40 cases were acquired from 4 Radiology residents and 2 breast imaging experts as part of an IRB-approved pilot study. Gaze behavior features were extracted from the eye-tracking data. Computer-generated and BIRADsmore » images features were extracted from the images. Finally, machine learning algorithms were used to merge gaze and image features for predicting human error. Feature selection was thoroughly explored to determine the relative contribution of the various features. Group-based and personalized user modeling was also investigated. Results: Diagnostic error can be predicted reliably by merging gaze behavior characteristics from the radiologist and textural characteristics from the image under review. Leveraging data collected from multiple readers produced a reasonable group model (AUC=0.79). Personalized user modeling was far more accurate for the more experienced readers (average AUC of 0.837 0.029) than for the less experienced ones (average AUC of 0.667 0.099). The best performing group-based and personalized predictive models involved combinations of both gaze and image features. Conclusions: Diagnostic errors in mammography can be predicted reliably by leveraging the radiologists gaze behavior and image content.« less

31 CFR 8.34 - Knowledge of client's omission.

Code of Federal Regulations, 2013 CFR

2013-07-01

... client's omission. Each attorney, certified public accountant, or enrolled practitioner who knows that a..., affidavit, or other paper which the law requires the client to execute, shall advise the client promptly of...

31 CFR 8.34 - Knowledge of client's omission.

Code of Federal Regulations, 2012 CFR

2012-07-01

... client's omission. Each attorney, certified public accountant, or enrolled practitioner who knows that a..., affidavit, or other paper which the law requires the client to execute, shall advise the client promptly of...

31 CFR 8.34 - Knowledge of client's omission.

Code of Federal Regulations, 2014 CFR

2014-07-01

... client's omission. Each attorney, certified public accountant, or enrolled practitioner who knows that a..., affidavit, or other paper which the law requires the client to execute, shall advise the client promptly of...

31 CFR 8.34 - Knowledge of client's omission.

Code of Federal Regulations, 2011 CFR

2011-07-01

... client's omission. Each attorney, certified public accountant, or enrolled practitioner who knows that a..., affidavit, or other paper which the law requires the client to execute, shall advise the client promptly of...

Bayesian Network Structure Learning for Urban Land Use Classification from Landsat ETM+ and Ancillary Data

NASA Astrophysics Data System (ADS)

Park, M.; Stenstrom, M. K.

2004-12-01

Recognizing urban information from the satellite imagery is problematic due to the diverse features and dynamic changes of urban landuse. The use of Landsat imagery for urban land use classification involves inherent uncertainty due to its spatial resolution and the low separability among land uses. To resolve the uncertainty problem, we investigated the performance of Bayesian networks to classify urban land use since Bayesian networks provide a quantitative way of handling uncertainty and have been successfully used in many areas. In this study, we developed the optimized networks for urban land use classification from Landsat ETM+ images of Marina del Rey area based on USGS land cover/use classification level III. The networks started from a tree structure based on mutual information between variables and added the links to improve accuracy. This methodology offers several advantages: (1) The network structure shows the dependency relationships between variables. The class node value can be predicted even with particular band information missing due to sensor system error. The missing information can be inferred from other dependent bands. (2) The network structure provides information of variables that are important for the classification, which is not available from conventional classification methods such as neural networks and maximum likelihood classification. In our case, for example, bands 1, 5 and 6 are the most important inputs in determining the land use of each pixel. (3) The networks can be reduced with those input variables important for classification. This minimizes the problem without considering all possible variables. We also examined the effect of incorporating ancillary data: geospatial information such as X and Y coordinate values of each pixel and DEM data, and vegetation indices such as NDVI and Tasseled Cap transformation. The results showed that the locational information improved overall accuracy (81%) and kappa coefficient (76%), and lowered the omission and commission errors compared with using only spectral data (accuracy 71%, kappa coefficient 62%). Incorporating DEM data did not significantly improve overall accuracy (74%) and kappa coefficient (66%) but lowered the omission and commission errors. Incorporating NDVI did not much improve the overall accuracy (72%) and k coefficient (65%). Including Tasseled Cap transformation reduced the accuracy (accuracy 70%, kappa 61%). Therefore, additional information from the DEM and vegetation indices was not useful as locational ancillary data.

Validation of the USGS Landsat Burned Area Essential Climate Variable (BAECV) across the conterminous United States

USGS Publications Warehouse

Vanderhoof, Melanie; Fairaux, Nicole; Beal, Yen-Ju G.; Hawbaker, Todd J.

2017-01-01

The Landsat Burned Area Essential Climate Variable (BAECV), developed by the U.S. Geological Survey (USGS), capitalizes on the long temporal availability of Landsat imagery to identify burned areas across the conterminous United States (CONUS) (1984–2015). Adequate validation of such products is critical for their proper usage and interpretation. Validation of coarse-resolution products often relies on independent data derived from moderate-resolution sensors (e.g., Landsat). Validation of Landsat products, in turn, is challenging because there is no corresponding source of high-resolution, multispectral imagery that has been systematically collected in space and time over the entire temporal extent of the Landsat archive. Because of this, comparison between high-resolution images and Landsat science products can help increase user's confidence in the Landsat science products, but may not, alone, be adequate. In this paper, we demonstrate an approach to systematically validate the Landsat-derived BAECV product. Burned area extent was mapped for Landsat image pairs using a manually trained semi-automated algorithm that was manually edited across 28 path/rows and five different years (1988, 1993, 1998, 2003, 2008). Three datasets were independently developed by three analysts and the datasets were integrated on a pixel by pixel basis in which at least one to all three analysts were required to agree a pixel was burned. We found that errors within our Landsat reference dataset could be minimized by using the rendition of the dataset in which pixels were mapped as burned if at least two of the three analysts agreed. BAECV errors of omission and commission for the detection of burned pixels averaged 42% and 33%, respectively for CONUS across all five validation years. Errors of omission and commission were lowest across the western CONUS, for example in the shrub and scrublands of the Arid West (31% and 24%, respectively), and highest in the grasslands and agricultural lands of the Great Plains in central CONUS (62% and 57%, respectively). The BAECV product detected most (> 65%) fire events > 10 ha across the western CONUS (Arid and Mountain West ecoregions). Our approach and results demonstrate that a thorough validation of Landsat science products can be completed with independent Landsat-derived reference data, but could be strengthened by the use of complementary sources of high-resolution data.

Medication self-management skills and cognitive impairment in older adults hospitalized for heart failure: A cross-sectional study.

PubMed

Howell, Erik H; Senapati, Alpana; Hsich, Eileen; Gorodeski, Eiran Z

2017-01-01

Cognitive impairment is highly prevalent among older adults (aged ≥65 years) hospitalized for heart failure and has been associated with poor outcomes. Poor medication self-management skills have been associated with poor outcomes in this population as well. The presence and extent of an association between cognitive impairment and poor medication self-management skills in this population has not been clearly defined. We assessed the cognition of consecutive older adults hospitalized for heart failure, in relation to their medication self-management skills. We conducted a cross-sectional study of older adults (aged ≥65 years) who were hospitalized for heart failure and were being discharged home. Prior to discharge, we assessed cognition using the Mini-Cog. We also tested patients' ability to read a pill bottle label, open a pill bottle safety cap, and allocate mock pills to a pill box. Pill allocation performance was assessed quantitatively (counts of errors of omission and commission) and qualitatively (patterns suggestive of knowledge-based mistakes, rule-based mistakes, or skill-based slips). Of 55 participants, 22% were found to have cognitive impairment. Patients with cognitive impairment tended to be older as compared to those without cognitive impairment (mean age = 81 vs 76 years, p = NS). Patients with cognitive impairment had a higher prevalence of inability to read pill bottle label (prevalence ratio = 5.8, 95% confidence interval = 3.2-10.5, p = 0.001) and inability to open pill bottle safety cap (prevalence ratio = 3.3, 95% confidence interval = 1.3-8.4, p = 0.03). While most patients (65%) had pill-allocation errors regardless of cognition, those patients with cognitive impairment tended to have more errors of omission (mean number of errors = 48 vs 23, p = 0.006), as well as more knowledge-based mistakes (75% vs 40%, p = 0.03). There is an association between cognitive impairment and poor medication self-management skills. Medication taking failures due to poor medication self-management skills may be part of the pathway linking cognitive impairment to poor post-discharge outcomes among patients with heart failure transitioning from hospital to home.

Design of a verifiable subset for HAL/S

NASA Technical Reports Server (NTRS)

Browne, J. C.; Good, D. I.; Tripathi, A. R.; Young, W. D.

1979-01-01

An attempt to evaluate the applicability of program verification techniques to the existing programming language, HAL/S is discussed. HAL/S is a general purpose high level language designed to accommodate the software needs of the NASA Space Shuttle project. A diversity of features for scientific computing, concurrent and real-time programming, and error handling are discussed. The criteria by which features were evaluated for inclusion into the verifiable subset are described. Individual features of HAL/S with respect to these criteria are examined and justification for the omission of various features from the subset is provided. Conclusions drawn from the research are presented along with recommendations made for the use of HAL/S with respect to the area of program verification.

Lessons for pediatric anesthesia from audit and incident reporting.

PubMed

Bell, Graham

2011-07-01

This review will attempt to put the various systems that allow clinicians to assess errors, omissions, or avoidable incidents into context and where possible, look for areas that deserve more or less attention and resource specifically for those of us who practice pediatric anesthesia. Different approaches will be contrasted with respect to their outputs in terms of positive impact on the practice of anesthesia. These approaches include audits by governmental organizations, national representative bodies, specialist societies, commissioned boards of inquiry, medicolegal sources, and police force investigations. Implementation strategies are considered alongside the reports as the reports cannot be considered end points themselves. Specific areas where pediatric anesthetics has failed to address recurring risk through any currently available tools will be highlighted. © 2011 Blackwell Publishing Ltd.

Should we confirm our clinical diagnostic certainty by autopsies?

PubMed

Podbregar, M; Voga, G; Krivec, B; Skale, R; Pareznik, R; Gabrscek, L

2001-11-01

To evaluate the frequency of diagnostic errors assessed by autopsies. Retrospective review of medical and pathological records in an 11-bed closed medical intensive care unit (ICU) at a 860-bed general hospital. Patients who died in the ICU between January 1998 and December 1999. Medical diagnoses were rated into three levels of clinical diagnostic certainty: complete certainty (group L1), minor diagnostic uncertainty (group L2), and major diagnostic uncertainty (group L3). The patients were divided into three error groups: group A, the autopsy confirmed the clinical diagnosis; group B, the autopsy demonstrated a new relevant diagnosis which would probably not have influenced the therapy and outcome; group C, the autopsy demonstrated a new relevant diagnosis which would probably have changed the therapy and outcome. The overall mortality was 20.3% (270/1331 patients). Autopsies were performed in 126 patients (46.9% of deaths), more often in younger patients (66.6+/-13.9 years vs 72.7+/-12.0 years, p<0.001), in patients with shorter ICU stay (4.7+/-5.6 days vs 6.7+/-8.7 days, p=0.054), and in patients in group L3 without chronic diseases (15/126 vs 1/144, p<0.001). Fatal but potentially treatable errors [group C, 12 patients (9.5%)] were found in 8.7%, 10.0%, and 10.5% of patients in groups L1, L2, and L3, respectively (NS between groups). An ICU length of stay shorter than 24 h was not related to the frequency of group C errors. Autopsies are performed more often in younger patients without chronic disease and in patients with a low clinical diagnostic certainty. No level of clinical diagnostic certainty could predict the pathological findings.

A fast Monte Carlo EM algorithm for estimation in latent class model analysis with an application to assess diagnostic accuracy for cervical neoplasia in women with AGC

PubMed Central

Kang, Le; Carter, Randy; Darcy, Kathleen; Kauderer, James; Liao, Shu-Yuan

2013-01-01

In this article we use a latent class model (LCM) with prevalence modeled as a function of covariates to assess diagnostic test accuracy in situations where the true disease status is not observed, but observations on three or more conditionally independent diagnostic tests are available. A fast Monte Carlo EM (MCEM) algorithm with binary (disease) diagnostic data is implemented to estimate parameters of interest; namely, sensitivity, specificity, and prevalence of the disease as a function of covariates. To obtain standard errors for confidence interval construction of estimated parameters, the missing information principle is applied to adjust information matrix estimates. We compare the adjusted information matrix based standard error estimates with the bootstrap standard error estimates both obtained using the fast MCEM algorithm through an extensive Monte Carlo study. Simulation demonstrates that the adjusted information matrix approach estimates the standard error similarly with the bootstrap methods under certain scenarios. The bootstrap percentile intervals have satisfactory coverage probabilities. We then apply the LCM analysis to a real data set of 122 subjects from a Gynecologic Oncology Group (GOG) study of significant cervical lesion (S-CL) diagnosis in women with atypical glandular cells of undetermined significance (AGC) to compare the diagnostic accuracy of a histology-based evaluation, a CA-IX biomarker-based test and a human papillomavirus (HPV) DNA test. PMID:24163493

Difference in Perseverative Errors during a Visual Attention Task with Auditory Distractors in Alpha-9 Nicotinic Receptor Subunit Wild Type and Knock-Out Mice.

PubMed

Jorratt, Pascal; Delano, Paul H; Delgado, Carolina; Dagnino-Subiabre, Alexies; Terreros, Gonzalo

2017-01-01

The auditory efferent system is a neural network that originates in the auditory cortex and projects to the cochlear receptor through olivocochlear (OC) neurons. Medial OC neurons make cholinergic synapses with outer hair cells (OHCs) through nicotinic receptors constituted by α9 and α10 subunits. One of the physiological functions of the α9 nicotinic receptor subunit (α9-nAChR) is the suppression of auditory distractors during selective attention to visual stimuli. In a recent study we demonstrated that the behavioral performance of alpha-9 nicotinic receptor knock-out (KO) mice is altered during selective attention to visual stimuli with auditory distractors since they made less correct responses and more omissions than wild type (WT) mice. As the inhibition of the behavioral responses to irrelevant stimuli is an important mechanism of the selective attention processes, behavioral errors are relevant measures that can reflect altered inhibitory control. Errors produced during a cued attention task can be classified as premature, target and perseverative errors. Perseverative responses can be considered as an inability to inhibit the repetition of an action already planned, while premature responses can be considered as an index of the ability to wait or retain an action. Here, we studied premature, target and perseverative errors during a visual attention task with auditory distractors in WT and KO mice. We found that α9-KO mice make fewer perseverative errors with longer latencies than WT mice in the presence of auditory distractors. In addition, although we found no significant difference in the number of target error between genotypes, KO mice made more short-latency target errors than WT mice during the presentation of auditory distractors. The fewer perseverative error made by α9-KO mice could be explained by a reduced motivation for reward and an increased impulsivity during decision making with auditory distraction in KO mice.

The impact of lidar elevation uncertainty on mapping intertidal habitats on barrier islands

USGS Publications Warehouse

Enwright, Nicholas M.; Wang, Lei; Borchert, Sinéad M.; Day, Richard H.; Feher, Laura C.; Osland, Michael J.

2018-01-01

While airborne lidar data have revolutionized the spatial resolution that elevations can be realized, data limitations are often magnified in coastal settings. Researchers have found that airborne lidar can have a vertical error as high as 60 cm in densely vegetated intertidal areas. The uncertainty of digital elevation models is often left unaddressed; however, in low-relief environments, such as barrier islands, centimeter differences in elevation can affect exposure to physically demanding abiotic conditions, which greatly influence ecosystem structure and function. In this study, we used airborne lidar elevation data, in situ elevation observations, lidar metadata, and tide gauge information to delineate low-lying lands and the intertidal wetlands on Dauphin Island, a barrier island along the coast of Alabama, USA. We compared three different elevation error treatments, which included leaving error untreated and treatments that used Monte Carlo simulations to incorporate elevation vertical uncertainty using general information from lidar metadata and site-specific Real-Time Kinematic Global Position System data, respectively. To aid researchers in instances where limited information is available for error propagation, we conducted a sensitivity test to assess the effect of minor changes to error and bias. Treatment of error with site-specific observations produced the fewest omission errors, although the treatment using the lidar metadata had the most well-balanced results. The percent coverage of intertidal wetlands was increased by up to 80% when treating the vertical error of the digital elevation models. Based on the results from the sensitivity analysis, it could be reasonable to use error and positive bias values from literature for similar environments, conditions, and lidar acquisition characteristics in the event that collection of site-specific data is not feasible and information in the lidar metadata is insufficient. The methodology presented in this study should increase efficiency and enhance results for habitat mapping and analyses in dynamic, low-relief coastal environments.

Imperfect practice makes perfect: error management training improves transfer of learning.

PubMed

Dyre, Liv; Tabor, Ann; Ringsted, Charlotte; Tolsgaard, Martin G

2017-02-01

Traditionally, trainees are instructed to practise with as few errors as possible during simulation-based training. However, transfer of learning may improve if trainees are encouraged to commit errors. The aim of this study was to assess the effects of error management instructions compared with error avoidance instructions during simulation-based ultrasound training. Medical students (n = 60) with no prior ultrasound experience were randomised to error management training (EMT) (n = 32) or error avoidance training (EAT) (n = 28). The EMT group was instructed to deliberately make errors during training. The EAT group was instructed to follow the simulator instructions and to commit as few errors as possible. Training consisted of 3 hours of simulation-based ultrasound training focusing on fetal weight estimation. Simulation-based tests were administered before and after training. Transfer tests were performed on real patients 7-10 days after the completion of training. Primary outcomes were transfer test performance scores and diagnostic accuracy. Secondary outcomes included performance scores and diagnostic accuracy during the simulation-based pre- and post-tests. A total of 56 participants completed the study. On the transfer test, EMT group participants attained higher performance scores (mean score: 67.7%, 95% confidence interval [CI]: 62.4-72.9%) than EAT group members (mean score: 51.7%, 95% CI: 45.8-57.6%) (p < 0.001; Cohen's d = 1.1, 95% CI: 0.5-1.7). There was a moderate improvement in diagnostic accuracy in the EMT group compared with the EAT group (16.7%, 95% CI: 10.2-23.3% weight deviation versus 26.6%, 95% CI: 16.5-36.7% weight deviation [p = 0.082; Cohen's d = 0.46, 95% CI: -0.06 to 1.0]). No significant interaction effects between group and performance improvements between the pre- and post-tests were found in either performance scores (p = 0.25) or diagnostic accuracy (p = 0.09). The provision of error management instructions during simulation-based training improves the transfer of learning to the clinical setting compared with error avoidance instructions. Rather than teaching to avoid errors, the use of errors for learning should be explored further in medical education theory and practice. © 2016 John Wiley & Sons Ltd and The Association for the Study of Medical Education.

Common omissions and misconceptions of wave propagation in turbulence: discussion.

PubMed

Charnotskii, Mikhail

2012-05-01

This review paper addresses typical mistakes and omissions that involve theoretical research and modeling of optical propagation through atmospheric turbulence. We discuss the disregard of some general properties of narrow-angle propagation in refractive random media, the careless use of simplified models of turbulence, and omissions in the calculations of the second moment of the propagating wave. We also review some misconceptions regarding short-exposure imaging, propagation of polarized waves, and calculations of the scintillation index of the beam waves. © 2012 Optical Society of America

Omission P3 after voluntary action indexes the formation of action-driven prediction.

PubMed

Kimura, Motohiro; Takeda, Yuji

2018-02-01

When humans frequently experience a certain sensory effect after a certain action, a bidirectional association between neural representations of the action and the sensory effect is rapidly acquired, which enables action-driven prediction of the sensory effect. The present study aimed to test whether or not omission P3, an event-related brain potential (ERP) elicited by the sudden omission of a sensory effect, is sensitive to the formation of action-driven prediction. For this purpose, we examined how omission P3 is affected by the number of possible visual effects. In four separate blocks (1-, 2-, 4-, and 8-stimulus blocks), participants successively pressed a right button at an interval of about 1s. In all blocks, each button press triggered a bar on a display (a bar with square edges, 85%; a bar with round edges, 5%), but occasionally did not (sudden omission of a visual effect, 10%). Participants were required to press a left button when a bar with round edges appeared. In the 1-stimulus block, the orientation of the bar was fixed throughout the block; in the 2-, 4-, and 8-stimulus blocks, the orientation was randomly varied among two, four, and eight possibilities, respectively. Omission P3 in the 1-stimulus block was greater than those in the 2-, 4-, and 8-stimulus blocks; there were no significant differences among the 2-, 4-, and 8-stimulus blocks. This binary pattern nicely fits the limitation in the acquisition of action-effect association; although an association between an action and one visual effect is easily acquired, associations between an action and two or more visual effects cannot be acquired concurrently. Taken together, the present results suggest that omission P3 is highly sensitive to the formation of action-driven prediction. Copyright © 2017 Elsevier B.V. All rights reserved.

Patient views and correlates of radiotherapy omission in a population-based sample of older women with favorable-prognosis breast cancer.

PubMed

Shumway, Dean A; Griffith, Kent A; Hawley, Sarah T; Wallner, Lauren P; Ward, Kevin C; Hamilton, Ann S; Morrow, Monica; Katz, Steven J; Jagsi, Reshma

2018-04-18

The omission of radiotherapy (RT) after lumpectomy is a reasonable option for many older women with favorable-prognosis breast cancer. In the current study, we sought to evaluate patient perspectives regarding decision making about RT. Women aged 65 to 79 years with AJCC 7th edition stage I and II breast cancer who were reported to the Georgia and Los Angeles County Surveillance, Epidemiology, and End Results registries were surveyed (response rate, 70%) regarding RT decisions, the rationale for omitting RT, decision-making values, and understanding of disease recurrence risk. We also surveyed their corresponding surgeons (response rate, 77%). Patient characteristics associated with the omission of RT were evaluated using multilevel, multivariable logistic regression, accounting for patient clustering within surgeons. Of 999 patients, 135 omitted RT (14%). Older age, lower tumor grade, and having estrogen receptor-positive disease each were found to be strongly associated with omission of RT in multivariable analyses, whereas the number of comorbidities was not. Non-English speakers were more likely to omit RT (adjusted odds ratio, 5.9; 95% confidence interval, 1.4-24.5). The most commonly reported reasons for RT omission were that a physician advised the patient that it was not needed (54% of patients who omitted RT) and patient choice (41%). Risk of local disease recurrence was overestimated by all patients: by approximately 2-fold among those who omitted RT and by approximately 8-fold among those who received RT. The risk of distant disease recurrence was overestimated by approximately 3-fold on average. To some extent, decisions regarding RT omission are appropriately influenced by patient age, tumor grade, and estrogen receptor status, but do not appear to be optimally tailored according to competing comorbidities. Many women who are candidates for RT omission overestimate their risk of disease recurrence. Cancer 2018. © 2018 American Cancer Society. © 2018 American Cancer Society.

29 CFR 15.41 - Allowable claims.

Code of Federal Regulations, 2011 CFR

2011-07-01

... omission which gave rise to the claim took place at the center to which the student involved was assigned..., finds the claim to be a proper charge against the United States resulting from an act or omission of a...

Athletic Participation and Seat Belt Omission among U.S. High School Students

PubMed Central

Melnick, Merrill J.; Miller, Kathleen E.; Sabo, Donald F.; Barnes, Grace M.; Farrell, Michael P.

2013-01-01

Although seat belts save lives, adolescents may be disproportionately likely to omit their use. Using data from the 1997 Youth Risk Behavior Survey, a national survey of over 16,000 U.S. public and private high school students, we employed a series of logical regression analyses to examine cross-sectional associations between past-year athletic participation and regular seat belt omission. Controlling for the effects of gender, age, race, parental education, and school urbanicity, student athletes were significantly less likely than nonathletes to report seat belt omission. Separate gender-specific analyses showed that this effect was significant for girls but only marginally significant for boys; in addition, the effect was strongest for adolescents who participated on three or more school or community sports teams. Possible explanations for the relationship between athletic participation and seat belt omission, including Jessor’s problem behavior syndrome, prosocial sport subcultures, and sensation seeking, are considered. PMID:19797539

Stereotyping by Omission: Eliminate the Negative, Accentuate the Positive

PubMed Central

Bergsieker, Hilary B.; Leslie, Lisa M.; Constantine, Vanessa S.; Fiske, Susan T.

2014-01-01

Communicators, motivated by strategic self-presentation, selectively underreport negative content in describing their impressions of individuals and stereotypes of groups, particularly for targets whom they view ambivalently with respect to warmth and competence. Communicators avoid overtly inaccurate descriptions, preferring to omit negative information and emphasize positive information about mixed individual targets (Study 1). With more public audiences, communicators increasingly prefer negativity omission to complete accuracy (Study 2), a process driven by self-presentation concerns (Study 3), and moderated by bidimensional ambivalence. Similarly, in an extension of the Princeton Trilogy studies, reported stereotypes of ethnic and national outgroups systematically omitted negative dimensions over 75 years—as anti-prejudice norms intensified—while neutral and positive stereotype dimensions remained constant (Study 4). Multiple assessment methods confirm this stereotyping-by-omission phenomenon (Study 5). Implications of negativity omission for innuendo and stereotype stagnation are discussed. PMID:22448889

Athletic participation and seatbelt omission among u.s. High school students.

PubMed

Melnick, Merrill J; Miller, Kathleen E; Sabo, Donald F; Barnes, Grace M; Farrell, Michael P

2010-02-01

Although seatbelts save lives, adolescents may be disproportionately likely to omit their use. Using data from the 1997 Youth Risk Behavior Survey, a national survey of more than 16,000 U.S. public and private high school students, the authors employed a series of logistic regression analyses to examine cross-sectional associations between past year athletic participation and regular seatbelt omission. Controlling for the effects of gender, age, race, parental education, and school urbanicity, student athletes were significantly less likely than nonathletes to report seatbelt omission. Separate gender-specific analyses showed that this effect was significant for girls but only marginally significant for boys; in addition, the effect was strongest for adolescents who participated on three or more school or community sports teams. Possible explanations for the relationship between athletic participation and seatbelt omission, including Jessor's problem behavior syndrome, prosocial sport subcultures, and sensation seeking, are considered.

MERIS (Medical Error Reporting Information System) as an innovative patient safety intervention: a health policy perspective.

PubMed

Riga, Marina; Vozikis, Athanassios; Pollalis, Yannis; Souliotis, Kyriakos

2015-04-01

The economic crisis in Greece poses the necessity to resolve problems concerning both the spiralling cost and the quality assurance in the health system. The detection and the analysis of patient adverse events and medical errors are considered crucial elements of this course. The implementation of MERIS embodies a mandatory module, which adopts the trigger tool methodology for measuring adverse events and medical errors an intensive care unit [ICU] environment, and a voluntary one with web-based public reporting methodology. A pilot implementation of MERIS running in a public hospital identified 35 adverse events, with approx. 12 additional hospital days and an extra healthcare cost of €12,000 per adverse event or of about €312,000 per annum for ICU costs only. At the same time, the voluntary module unveiled 510 reports on adverse events submitted by citizens or patients. MERIS has been evaluated as a comprehensive and effective system; it succeeded in detecting the main factors that cause adverse events and discloses severe omissions of the Greek health system. MERIS may be incorporated and run efficiently nationally, adapted to the needs and peculiarities of each hospital or clinic. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Dysgraphia in Patients with Primary Lateral Sclerosis: A Speech-Based Rehearsal Deficit?

PubMed Central

Zago, S.; Poletti, B.; Corbo, M.; Adobbati, L.; Silani, V.

2008-01-01

The present study aims to demonstrate that errors when writing are more common than expected in patients affected by primary lateral sclerosis (PLS) with severe dysarthria or complete mutism, independent of spasticity. Sixteen patients meeting Pringle’s et al. [34] criteria for PLS underwent standard neuropsychological tasks and evaluation of writing. We assessed writing abilities in spelling through dictation in which a set of words, non-words and short phrases were presented orally and by composing words using a set of preformed letters. Finally, a written copying task was performed with the same words. Relative to controls, PLS patients made a greater number of spelling errors in all writing conditions, but not in copy task. The error types included: omissions, transpositions, insertions and letter substitutions. These were equally distributed on the writing task and the composition of words with a set of preformed letters. This pattern of performance is consistent with a spelling impairment. The results are consistent with the concept that written production is critically dependent on the subvocal articulatory mechanism of rehearsal, perhaps at the level of retaining the sequence of graphemes in a graphemic buffer. In PLS patients a disturbance in rehearsal opportunity may affect the correct sequencing/assembly of an orthographic representation in the written process. PMID:19096141

Preliteracy Speech Sound Production Skill and Linguistic Characteristics of Grade 3 Spellings: A Study Using the Templin Archive

PubMed Central

Masterson, Julie J.; Preston, Jonathan L.

2015-01-01

Purpose This archival investigation examined the relationship between preliteracy speech sound production skill (SSPS) and spelling in Grade 3 using a dataset in which children's receptive vocabulary was generally within normal limits, speech therapy was not provided until Grade 2, and phonological awareness instruction was discouraged at the time data were collected. Method Participants (N = 250), selected from the Templin Archive (Templin, 2004), varied on prekindergarten SSPS. Participants' real word spellings in Grade 3 were evaluated using a metric of linguistic knowledge, the Computerized Spelling Sensitivity System (Masterson & Apel, 2013). Relationships between kindergarten speech error types and later spellings also were explored. Results Prekindergarten children in the lowest SPSS (7th percentile) scored poorest among articulatory subgroups on both individual spelling elements (phonetic elements, junctures, and affixes) and acceptable spelling (using relatively more omissions and illegal spelling patterns). Within the 7th percentile subgroup, there were no statistical spelling differences between those with mostly atypical speech sound errors and those with mostly typical speech sound errors. Conclusions Findings were consistent with predictions from dual route models of spelling that SSPS is one of many variables associated with spelling skill and that children with impaired SSPS are at risk for spelling difficulty. PMID:26380965

Increased impulsivity in response to food cues after sleep loss in healthy young men

PubMed Central

Cedernaes, Jonathan; Brandell, Jon; Ros, Olof; Broman, Jan-Erik; Hogenkamp, Pleunie S; Schiöth, Helgi B; Benedict, Christian

2014-01-01

Objective To investigate whether acute total sleep deprivation (TSD) leads to decreased cognitive control when food cues are presented during a task requiring active attention, by assessing the ability to cognitively inhibit prepotent responses. Methods Fourteen males participated in the study on two separate occasions in a randomized, crossover within-subject design: one night of TSD versus normal sleep (8.5 hours). Following each nighttime intervention, hunger ratings and morning fasting plasma glucose concentrations were assessed before performing a go/no-go task. Results Following TSD, participants made significantly more commission errors when they were presented “no-go” food words in the go/no-go task, as compared with their performance following sleep (+56%; P<0.05). In contrast, response time and omission errors to “go” non-food words did not differ between the conditions. Self-reported hunger after TSD was increased without changes in fasting plasma glucose. The increase in hunger did not correlate with the TSD-induced commission errors. Conclusions Our results suggest that TSD impairs cognitive control also in response to food stimuli in healthy young men. Whether such loss of inhibition or impulsiveness is food cue-specific as seen in obesity—thus providing a mechanism through which sleep disturbances may promote obesity development—warrants further investigation. PMID:24839251

Reducing Diagnostic Error with Computer-Based Clinical Decision Support

ERIC Educational Resources Information Center

Greenes, Robert A.

2009-01-01

Information technology approaches to delivering diagnostic clinical decision support (CDS) are the subject of the papers to follow in the proceedings. These will address the history of CDS and present day approaches (Miller), evaluation of diagnostic CDS methods (Friedman), and the role of clinical documentation in supporting diagnostic decision…

Observer error structure in bull trout redd counts in Montana streams: Implications for inference on true redd numbers

USGS Publications Warehouse

Muhlfeld, Clint C.; Taper, Mark L.; Staples, David F.; Shepard, Bradley B.

2006-01-01

Despite the widespread use of redd counts to monitor trends in salmonid populations, few studies have evaluated the uncertainties in observed counts. We assessed the variability in redd counts for migratory bull trout Salvelinus confluentus among experienced observers in Lion and Goat creeks, which are tributaries to the Swan River, Montana. We documented substantially lower observer variability in bull trout redd counts than did previous studies. Observer counts ranged from 78% to 107% of our best estimates of true redd numbers in Lion Creek and from 90% to 130% of our best estimates in Goat Creek. Observers made both errors of omission and errors of false identification, and we modeled this combination by use of a binomial probability of detection and a Poisson count distribution of false identifications. Redd detection probabilities were high (mean = 83%) and exhibited no significant variation among observers (SD = 8%). We applied this error structure to annual redd counts in the Swan River basin (1982–2004) to correct for observer error and thus derived more accurate estimates of redd numbers and associated confidence intervals. Our results indicate that bias in redd counts can be reduced if experienced observers are used to conduct annual redd counts. Future studies should assess both sources of observer error to increase the validity of using redd counts for inferring true redd numbers in different basins. This information will help fisheries biologists to more precisely monitor population trends, identify recovery and extinction thresholds for conservation and recovery programs, ascertain and predict how management actions influence distribution and abundance, and examine effects of recovery and restoration activities.

Medication safety in the home care setting: Development and piloting of a Critical Incident Reporting System

PubMed

Meyer-Massetti, Carla; Krummenacher, Evelyne; Hedinger-Grogg, Barbara; Luterbacher, Stephan; Hersberger, Kurt E

2016-09-01

Background: While drug-related problems are among the most frequent adverse events in health care, little is known about their type and prevalence in home care in the current literature. The use of a Critical Incident Reporting System (CIRS), known as an economic and efficient tool to record medication errors for subsequent analysis, is widely implemented in inpatient care, but less established in ambulatory care. Recommendations on a possible format are scarce. A manual CIRS was developed based on the literature and subsequently piloted and implemented in a Swiss home care organization. Aim: The aim of this work was to implement a critical incident reporting system specifically for medication safety in home care. Results: The final CIRS form was well accepted among staff. Requiring limited resources, it allowed preliminary identification and trending of medication errors in home care. The most frequent error reports addressed medication preparation at the patients’ home, encompassing the following errors: omission (30 %), wrong dose (17.5 %) and wrong time (15 %). The most frequent underlying causes were related to working conditions (37.9 %), lacking attention (68.2 %), time pressure (22.7 %) and interruptions by patients (9.1 %). Conclusions: A manual CIRS allowed efficient data collection and subsequent analysis of medication errors in order to plan future interventions for improvement of medication safety. The development of an electronic CIRS would allow a reduction of the expenditure of time regarding data collection and analysis. In addition, it would favour the development of a national CIRS network among home care institutions.

Predicting diagnostic error in radiology via eye-tracking and image analytics: Preliminary investigation in mammography

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

Voisin, Sophie; Tourassi, Georgia D.; Pinto, Frank

2013-10-15

Purpose: The primary aim of the present study was to test the feasibility of predicting diagnostic errors in mammography by merging radiologists’ gaze behavior and image characteristics. A secondary aim was to investigate group-based and personalized predictive models for radiologists of variable experience levels.Methods: The study was performed for the clinical task of assessing the likelihood of malignancy of mammographic masses. Eye-tracking data and diagnostic decisions for 40 cases were acquired from four Radiology residents and two breast imaging experts as part of an IRB-approved pilot study. Gaze behavior features were extracted from the eye-tracking data. Computer-generated and BIRADS imagesmore » features were extracted from the images. Finally, machine learning algorithms were used to merge gaze and image features for predicting human error. Feature selection was thoroughly explored to determine the relative contribution of the various features. Group-based and personalized user modeling was also investigated.Results: Machine learning can be used to predict diagnostic error by merging gaze behavior characteristics from the radiologist and textural characteristics from the image under review. Leveraging data collected from multiple readers produced a reasonable group model [area under the ROC curve (AUC) = 0.792 ± 0.030]. Personalized user modeling was far more accurate for the more experienced readers (AUC = 0.837 ± 0.029) than for the less experienced ones (AUC = 0.667 ± 0.099). The best performing group-based and personalized predictive models involved combinations of both gaze and image features.Conclusions: Diagnostic errors in mammography can be predicted to a good extent by leveraging the radiologists’ gaze behavior and image content.« less

Object-based image analysis for cadastral mapping using satellite images

NASA Astrophysics Data System (ADS)

Kohli, D.; Crommelinck, S.; Bennett, R.; Koeva, M.; Lemmen, C.

2017-10-01

Cadasters together with land registry form a core ingredient of any land administration system. Cadastral maps comprise of the extent, ownership and value of land which are essential for recording and updating land records. Traditional methods for cadastral surveying and mapping often prove to be labor, cost and time intensive: alternative approaches are thus being researched for creating such maps. With the advent of very high resolution (VHR) imagery, satellite remote sensing offers a tremendous opportunity for (semi)-automation of cadastral boundaries detection. In this paper, we explore the potential of object-based image analysis (OBIA) approach for this purpose by applying two segmentation methods, i.e. MRS (multi-resolution segmentation) and ESP (estimation of scale parameter) to identify visible cadastral boundaries. Results show that a balance between high percentage of completeness and correctness is hard to achieve: a low error of commission often comes with a high error of omission. However, we conclude that the resulting segments/land use polygons can potentially be used as a base for further aggregation into tenure polygons using participatory mapping.

Harmonization of forest disturbance datasets of the conterminous USA from 1986 to 2011

USGS Publications Warehouse

Soulard, Christopher E.; Acevedo, William; Cohen, Warren B.; Yang, Zhiqiang; Stehman, Stephen V.; Taylor, Janis L.

2017-01-01

Several spatial forest disturbance datasets exist for the conterminous USA. The major problem with forest disturbance mapping is that variability between map products leads to uncertainty regarding the actual rate of disturbance. In this article, harmonized maps were produced from multiple data sources (i.e., Global Forest Change, LANDFIRE Vegetation Disturbance, National Land Cover Database, Vegetation Change Tracker, and Web-Enabled Landsat Data). The harmonization process involved fitting common class ontologies and determining spatial congruency to produce forest disturbance maps for four time intervals (1986–1992, 1992–2001, 2001–2006, and 2006–2011). Pixels mapped as disturbed for two or more datasets were labeled as disturbed in the harmonized maps. The primary advantage gained by harmonization was improvement in commission error rates relative to the individual disturbance products. Disturbance omission errors were high for both harmonized and individual forest disturbance maps due to underlying limitations in mapping subtle disturbances with Landsat classification algorithms. To enhance the value of the harmonized disturbance products, we used fire perimeter maps to add information on the cause of disturbance.

Comparison of remote sensing image processing techniques to identify tornado damage areas from Landsat TM data

USGS Publications Warehouse

Myint, S.W.; Yuan, M.; Cerveny, R.S.; Giri, C.P.

2008-01-01

Remote sensing techniques have been shown effective for large-scale damage surveys after a hazardous event in both near real-time or post-event analyses. The paper aims to compare accuracy of common imaging processing techniques to detect tornado damage tracks from Landsat TM data. We employed the direct change detection approach using two sets of images acquired before and after the tornado event to produce a principal component composite images and a set of image difference bands. Techniques in the comparison include supervised classification, unsupervised classification, and objectoriented classification approach with a nearest neighbor classifier. Accuracy assessment is based on Kappa coefficient calculated from error matrices which cross tabulate correctly identified cells on the TM image and commission and omission errors in the result. Overall, the Object-oriented Approach exhibits the highest degree of accuracy in tornado damage detection. PCA and Image Differencing methods show comparable outcomes. While selected PCs can improve detection accuracy 5 to 10%, the Object-oriented Approach performs significantly better with 15-20% higher accuracy than the other two techniques. ?? 2008 by MDPI.

Benchmark data on the separability among crops in the southern San Joaquin Valley of California

NASA Technical Reports Server (NTRS)

Morse, A.; Card, D. H.

1984-01-01

Landsat MSS data were input to a discriminant analysis of 21 crops on each of eight dates in 1979 using a total of 4,142 fields in southern Fresno County, California. The 21 crops, which together account for over 70 percent of the agricultural acreage in the southern San Joaquin Valley, were analyzed to quantify the spectral separability, defined as omission error, between all pairs of crops. On each date the fields were segregated into six groups based on the mean value of the MSS7/MSS5 ratio, which is correlated with green biomass. Discriminant analysis was run on each group on each date. The resulting contingency tables offer information that can be profitably used in conjunction with crop calendars to pick the best dates for a classification. The tables show expected percent correct classification and error rates for all the crops. The patterns in the contingency tables show that the percent correct classification for crops generally increases with the amount of greenness in the fields being classified. However, there are exceptions to this general rule, notably grain.

Comparison of Remote Sensing Image Processing Techniques to Identify Tornado Damage Areas from Landsat TM Data

PubMed Central

Myint, Soe W.; Yuan, May; Cerveny, Randall S.; Giri, Chandra P.

2008-01-01

Remote sensing techniques have been shown effective for large-scale damage surveys after a hazardous event in both near real-time or post-event analyses. The paper aims to compare accuracy of common imaging processing techniques to detect tornado damage tracks from Landsat TM data. We employed the direct change detection approach using two sets of images acquired before and after the tornado event to produce a principal component composite images and a set of image difference bands. Techniques in the comparison include supervised classification, unsupervised classification, and object-oriented classification approach with a nearest neighbor classifier. Accuracy assessment is based on Kappa coefficient calculated from error matrices which cross tabulate correctly identified cells on the TM image and commission and omission errors in the result. Overall, the Object-oriented Approach exhibits the highest degree of accuracy in tornado damage detection. PCA and Image Differencing methods show comparable outcomes. While selected PCs can improve detection accuracy 5 to 10%, the Object-oriented Approach performs significantly better with 15-20% higher accuracy than the other two techniques. PMID:27879757

[Pre-hospital treatment of ophidian accidents: review, update, and current problems].

PubMed

Gil-Alarcón, Guillermo; Sánchez-Villegas, María Del Carmen; Hugo Reynoso, Víctor

2011-01-01

Mythic, out-dated, ambiguous and sometimes iatrogenic procedures, still remain in pre-hospital and hospital ophidian accident treatment. Errors, omissions and ignorance make ophidian accidents appear more dangerous than they truly are, resulting in a general public contempt toward snakes. Here we present an updated review of current knowledge on pre-hospital and hospital treatment of ophidian bite incidents, including indications, recommendations and logic errors. We describe an appropriate treatment for native Mexican poisonous snakebites using fabotherapics, based on our experience. Adequate initial pre-hospital and hospital management is crucial for a successful outcome of this medical emergency. We describe the state of the art in snake bite research discussing those procedures where research is needed to implement them either by the patient, first responders, paramedics and doctors. We suggest proposals to achieve even more efficient management of fabotherapics based on support networks. Finally, we emphasize prevention as the main subject of venom bite treatment, as it is always more adequate and economic to invest in prevention than to spend on mitigation during emergency and recovery.

Inflectional and derivational morphological spelling abilities of children with Specific Language Impairment

PubMed Central

Critten, Sarah; Connelly, Vincent; Dockrell, Julie E.; Walter, Kirsty

2014-01-01

Children with Specific Language Impairment (SLI) are known to have difficulties with spelling but the factors that underpin these difficulties, are a matter of debate. The present study investigated the impact of oral language and literacy on the bound morpheme spelling abilities of children with SLI. Thirty-three children with SLI (9–10 years) and two control groups, one matched for chronological age (CA) and one for language and spelling age (LA) (aged 6–8 years) were given dictated spelling tasks of 24 words containing inflectional morphemes and 18 words containing derivational morphemes. There were no significant differences between the SLI group and their LA matches in accuracy or error patterns for inflectional morphemes. By contrast when spelling derivational morphemes the SLI group was less accurate and made proportionately more omissions and phonologically implausible errors than both control groups. Spelling accuracy was associated with phonological awareness and reading; reading performance significantly predicted the ability to spell both inflectional and derivational morphemes. The particular difficulties experienced by the children with SLI for derivational morphemes are considered in relation to reading and oral language. PMID:25221533

Inflectional and derivational morphological spelling abilities of children with Specific Language Impairment.

PubMed

Critten, Sarah; Connelly, Vincent; Dockrell, Julie E; Walter, Kirsty

2014-01-01

Children with Specific Language Impairment (SLI) are known to have difficulties with spelling but the factors that underpin these difficulties, are a matter of debate. The present study investigated the impact of oral language and literacy on the bound morpheme spelling abilities of children with SLI. Thirty-three children with SLI (9-10 years) and two control groups, one matched for chronological age (CA) and one for language and spelling age (LA) (aged 6-8 years) were given dictated spelling tasks of 24 words containing inflectional morphemes and 18 words containing derivational morphemes. There were no significant differences between the SLI group and their LA matches in accuracy or error patterns for inflectional morphemes. By contrast when spelling derivational morphemes the SLI group was less accurate and made proportionately more omissions and phonologically implausible errors than both control groups. Spelling accuracy was associated with phonological awareness and reading; reading performance significantly predicted the ability to spell both inflectional and derivational morphemes. The particular difficulties experienced by the children with SLI for derivational morphemes are considered in relation to reading and oral language.

Harmonization of forest disturbance datasets of the conterminous USA from 1986 to 2011.

PubMed

Soulard, Christopher E; Acevedo, William; Cohen, Warren B; Yang, Zhiqiang; Stehman, Stephen V; Taylor, Janis L

2017-04-01

Several spatial forest disturbance datasets exist for the conterminous USA. The major problem with forest disturbance mapping is that variability between map products leads to uncertainty regarding the actual rate of disturbance. In this article, harmonized maps were produced from multiple data sources (i.e., Global Forest Change, LANDFIRE Vegetation Disturbance, National Land Cover Database, Vegetation Change Tracker, and Web-Enabled Landsat Data). The harmonization process involved fitting common class ontologies and determining spatial congruency to produce forest disturbance maps for four time intervals (1986-1992, 1992-2001, 2001-2006, and 2006-2011). Pixels mapped as disturbed for two or more datasets were labeled as disturbed in the harmonized maps. The primary advantage gained by harmonization was improvement in commission error rates relative to the individual disturbance products. Disturbance omission errors were high for both harmonized and individual forest disturbance maps due to underlying limitations in mapping subtle disturbances with Landsat classification algorithms. To enhance the value of the harmonized disturbance products, we used fire perimeter maps to add information on the cause of disturbance.

Attention impairment in childhood absence epilepsy: an impulsivity problem?

PubMed

Cerminara, Caterina; D'Agati, Elisa; Casarelli, Livia; Kaunzinger, Ivo; Lange, Klaus W; Pitzianti, Mariabernarda; Parisi, Pasquale; Tucha, Oliver; Curatolo, Paolo

2013-05-01

Although attention problems have often been described in children with childhood absence epilepsy (CAE), the use of different methodological approaches, neuropsychological tests, and heterogeneous experimental groups has prevented identification of the selective areas of attention deficit in this population. In this study, we investigated several components of attention in children with CAE using a unique computerized test battery for attention performance. Participants included 24 patients with CAE and 24 controls matched for age and sex. They were tested with a computerized test battery, which included the following tasks: selective attention, impulsivity, focused attention, divided attention, alertness, and vigilance. Compared with healthy controls, patients with CAE made more commission errors in the Go/No-Go task and more omission errors in the divided attention task. Childhood absence epilepsy patients also showed decreased reaction times in measures of selective attention and a great variability of reaction times in alertness and Go/No-Go tasks. Our findings suggest that patients with CAE were impaired in tonic and phasic alertness, divided attention, selective attention, and impulsivity. Copyright © 2013 Elsevier Inc. All rights reserved.

The ex-Gaussian distribution of reaction times in adolescents with attention-deficit/hyperactivity disorder.

PubMed

Gu, Shoou-Lian Hwang; Gau, Susan Shur-Fen; Tzang, Shyh-Weir; Hsu, Wen-Yau

2013-11-01

We investigated the three parameters (mu, sigma, tau) of ex-Gaussian distribution of RT derived from the Conners' continuous performance test (CCPT) and examined the moderating effects of the energetic factors (the inter-stimulus intervals (ISIs) and Blocks) among these three parameters, especially tau, an index describing the positive skew of RT distribution. We assessed 195 adolescents with DSM-IV ADHD, and 90 typically developing (TD) adolescents, aged 10-16. Participants and their parents received psychiatric interviews to confirm the diagnosis of ADHD and other psychiatric disorders. Participants also received intelligence (WISC-III) and CCPT assessments. We found that participants with ADHD had a smaller mu, and larger tau. As the ISI/Block increased, the magnitude of group difference in tau increased. Among the three ex-Gaussian parameters, tau was positively associated with omission errors, and mu was negatively associated with commission errors. The moderating effects of ISIs and Blocks on tau parameters suggested that the ex-Gaussian parameters could offer more information about the attention state in vigilance task, especially in ADHD. Copyright © 2013 Elsevier Ltd. All rights reserved.

TMS evidence for a selective role of the precuneus in source memory retrieval.

PubMed

Bonnì, Sonia; Veniero, Domenica; Mastropasqua, Chiara; Ponzo, Viviana; Caltagirone, Carlo; Bozzali, Marco; Koch, Giacomo

2015-04-01

The posteromedial cortex including the precuneus (PC) is thought to be involved in episodic memory retrieval. Here we used continuous theta burst stimulation (cTBS) to disentangle the role of the precuneus in the recognition memory process in a sample of healthy subjects. During the encoding phase, subjects were presented with a series of colored pictures. Afterwards, during the retrieval phase, all previously presented items and a sample of new pictures were presented in black, and subjects were asked to indicate whether each item was new or old, and in the latter case to indicate the associated color. cTBS was delivered over PC, posterior parietal cortex (PPC) and vertex before the retrieval phase. The data were analyzed in terms of hits, false alarms, source errors and omissions. cTBS over the precuneus, but not over the PPC or the vertex, induced a selective decrease in source memory errors, indicating an improvement in context retrieval. All the other accuracy measurements were unchanged. These findings suggest a direct implication of the precuneus in successful context-dependent retrieval. Copyright © 2015 Elsevier B.V. All rights reserved.

First measurements of error fields on W7-X using flux surface mapping

DOE PAGES

Lazerson, Samuel A.; Otte, Matthias; Bozhenkov, Sergey; ...

2016-08-03

Error fields have been detected and quantified using the flux surface mapping diagnostic system on Wendelstein 7-X (W7-X). A low-field 'more » $${\\rlap{-}\\ \\iota} =1/2$$ ' magnetic configuration ($${\\rlap{-}\\ \\iota} =\\iota /2\\pi $$ ), sensitive to error fields, was developed in order to detect their presence using the flux surface mapping diagnostic. In this configuration, a vacuum flux surface with rotational transform of n/m = 1/2 is created at the mid-radius of the vacuum flux surfaces. If no error fields are present a vanishingly small n/m = 5/10 island chain should be present. Modeling indicates that if an n = 1 perturbing field is applied by the trim coils, a large n/m = 1/2 island chain will be opened. This island chain is used to create a perturbation large enough to be imaged by the diagnostic. Phase and amplitude scans of the applied field allow the measurement of a small $$\\sim 0.04$$ m intrinsic island chain with a $${{130}^{\\circ}}$$ phase relative to the first module of the W7-X experiment. Lastly, these error fields are determined to be small and easily correctable by the trim coil system.« less

A real-time diagnostic and performance monitor for UNIX. M.S. Thesis

NASA Technical Reports Server (NTRS)

Dong, Hongchao

1992-01-01

There are now over one million UNIX sites and the pace at which new installations are added is steadily increasing. Along with this increase, comes a need to develop simple efficient, effective and adaptable ways of simultaneously collecting real-time diagnostic and performance data. This need exists because distributed systems can give rise to complex failure situations that are often un-identifiable with single-machine diagnostic software. The simultaneous collection of error and performance data is also important for research in failure prediction and error/performance studies. This paper introduces a portable method to concurrently collect real-time diagnostic and performance data on a distributed UNIX system. The combined diagnostic/performance data collection is implemented on a distributed multi-computer system using SUN4's as servers. The approach uses existing UNIX system facilities to gather system dependability information such as error and crash reports. In addition, performance data such as CPU utilization, disk usage, I/O transfer rate and network contention is also collected. In the future, the collected data will be used to identify dependability bottlenecks and to analyze the impact of failures on system performance.

Evaluating concentration estimation errors in ELISA microarray experiments

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

Daly, Don S.; White, Amanda M.; Varnum, Susan M.

Enzyme-linked immunosorbent assay (ELISA) is a standard immunoassay to predict a protein concentration in a sample. Deploying ELISA in a microarray format permits simultaneous prediction of the concentrations of numerous proteins in a small sample. These predictions, however, are uncertain due to processing error and biological variability. Evaluating prediction error is critical to interpreting biological significance and improving the ELISA microarray process. Evaluating prediction error must be automated to realize a reliable high-throughput ELISA microarray system. Methods: In this paper, we present a statistical method based on propagation of error to evaluate prediction errors in the ELISA microarray process. Althoughmore » propagation of error is central to this method, it is effective only when comparable data are available. Therefore, we briefly discuss the roles of experimental design, data screening, normalization and statistical diagnostics when evaluating ELISA microarray prediction errors. We use an ELISA microarray investigation of breast cancer biomarkers to illustrate the evaluation of prediction errors. The illustration begins with a description of the design and resulting data, followed by a brief discussion of data screening and normalization. In our illustration, we fit a standard curve to the screened and normalized data, review the modeling diagnostics, and apply propagation of error.« less

Quality and Safety in Health Care, Part XIV: The External Environment and Research for Diagnostic Processes.

PubMed

Harolds, Jay A

2016-09-01

The work system in which diagnosis takes place is affected by the external environment, which includes requirements such as certification, accreditation, and regulations. How errors are reported, malpractice, and the system for payment are some other aspects of the external environment. Improving the external environment is expected to decrease errors in diagnosis. More research on improving the diagnostic process is needed.

Automated detection of heuristics and biases among pathologists in a computer-based system.

PubMed

Crowley, Rebecca S; Legowski, Elizabeth; Medvedeva, Olga; Reitmeyer, Kayse; Tseytlin, Eugene; Castine, Melissa; Jukic, Drazen; Mello-Thoms, Claudia

2013-08-01

The purpose of this study is threefold: (1) to develop an automated, computer-based method to detect heuristics and biases as pathologists examine virtual slide cases, (2) to measure the frequency and distribution of heuristics and errors across three levels of training, and (3) to examine relationships of heuristics to biases, and biases to diagnostic errors. The authors conducted the study using a computer-based system to view and diagnose virtual slide cases. The software recorded participant responses throughout the diagnostic process, and automatically classified participant actions based on definitions of eight common heuristics and/or biases. The authors measured frequency of heuristic use and bias across three levels of training. Biases studied were detected at varying frequencies, with availability and search satisficing observed most frequently. There were few significant differences by level of training. For representativeness and anchoring, the heuristic was used appropriately as often or more often than it was used in biased judgment. Approximately half of the diagnostic errors were associated with one or more biases. We conclude that heuristic use and biases were observed among physicians at all levels of training using the virtual slide system, although their frequencies varied. The system can be employed to detect heuristic use and to test methods for decreasing diagnostic errors resulting from cognitive biases.

Fourth-grade children's dietary recall accuracy is influenced by retention interval (target period and interview time).

PubMed

Baxter, Suzanne Domel; Hardin, James W; Guinn, Caroline H; Royer, Julie A; Mackelprang, Alyssa J; Smith, Albert F

2009-05-01

For a 24-hour dietary recall, two possible target periods are the prior 24 hours (24 hours immediately preceding the interview time) and previous day (midnight to midnight of the day before the interview), and three possible interview times are morning, afternoon, and evening. Target period and interview time determine the retention interval (elapsed time between to-be-reported meals and the interview), which, along with intervening meals, can influence reporting accuracy. The effects of target period and interview time on children's accuracy for reporting school meals during 24-hour dietary recalls were investigated. DESIGN AND SUBJECTS/SETTING: During the 2004-2005, 2005-2006, and 2006-2007 school years in Columbia, SC, each of 374 randomly selected fourth-grade children (96% African American) was observed eating two consecutive school meals (breakfast and lunch) and interviewed to obtain a 24-hour dietary recall using one of six conditions defined by crossing two target periods with three interview times. Each condition had 62 or 64 children (half boys). Accuracy for reporting school meals was quantified by calculating rates for omissions (food items observed eaten but unreported) and intrusions (food items reported eaten but unobserved); a measure of total inaccuracy combined errors for reporting food items and amounts. For each accuracy measure, analysis of variance was conducted with target period, interview time, their interaction, sex, interviewer, and school year in the model. There was a target-period effect and a target-period by interview-time interaction on omission rates, intrusion rates, and total inaccuracy (six P values <0.004). For prior-24-hour recalls compared to previous-day recalls, and for prior-24-hour recalls in the afternoon and evening compared to previous-day recalls in the afternoon and evening, omission rates were better by one third, intrusion rates were better by one half, and total inaccuracy was better by one third. To enhance children's dietary recall accuracy, target periods and interview times that minimize the retention interval should be chosen.

Using a detailed uncertainty analysis to adjust mapped rates of forest disturbance derived from Landsat time series data (Invited)

NASA Astrophysics Data System (ADS)

Cohen, W. B.; Yang, Z.; Stehman, S.; Huang, C.; Healey, S. P.

2013-12-01

Forest ecosystem process models require spatially and temporally detailed disturbance data to accurately predict fluxes of carbon or changes in biodiversity over time. A variety of new mapping algorithms using dense Landsat time series show great promise for providing disturbance characterizations at an annual time step. These algorithms provide unprecedented detail with respect to timing, magnitude, and duration of individual disturbance events, and causal agent. But all maps have error and disturbance maps in particular can have significant omission error because many disturbances are relatively subtle. Because disturbance, although ubiquitous, can be a relatively rare event spatially in any given year, omission errors can have a great impact on mapped rates. Using a high quality reference disturbance dataset, it is possible to not only characterize map errors but also to adjust mapped disturbance rates to provide unbiased rate estimates with confidence intervals. We present results from a national-level disturbance mapping project (the North American Forest Dynamics project) based on the Vegetation Change Tracker (VCT) with annual Landsat time series and uncertainty analyses that consist of three basic components: response design, statistical design, and analyses. The response design describes the reference data collection, in terms of the tool used (TimeSync), a formal description of interpretations, and the approach for data collection. The statistical design defines the selection of plot samples to be interpreted, whether stratification is used, and the sample size. Analyses involve derivation of standard agreement matrices between the map and the reference data, and use of inclusion probabilities and post-stratification to adjust mapped disturbance rates. Because for NAFD we use annual time series, both mapped and adjusted rates are provided at an annual time step from ~1985-present. Preliminary evaluations indicate that VCT captures most of the higher intensity disturbances, but that many of the lower intensity disturbances (thinnings, stress related to insects and disease, etc.) are missed. Because lower intensity disturbances are a large proportion of the total set of disturbances, adjusting mapped disturbance rates to include these can be important for inclusion in ecosystem process models. The described statistical disturbance rate adjustments are aspatial in nature, such that the basic underlying map is unchanged. For spatially explicit ecosystem modeling, such adjustments, although important, can be difficult to directly incorporate. One approach for improving the basic underlying map is an ensemble modeling approach that uses several different complementary maps, each derived from a different algorithm and having their own strengths and weaknesses relative to disturbance magnitude and causal agent of disturbance. We will present results from a pilot study associated with the Landscape Change Monitoring System (LCMS), an emerging national-level program that builds upon NAFD and the well-established Monitoring Trends in Burn Severity (MTBS) program.

Detecting intentional insulin omission for weight loss in girls with type 1 diabetes mellitus.

PubMed

Pinhas-Hamiel, Orit; Hamiel, Uri; Greenfield, Yuval; Boyko, Valentina; Graph-Barel, Chana; Rachmiel, Marianna; Lerner-Geva, Liat; Reichman, Brian

2013-12-01

Intentional insulin omission is a unique inappropriate compensatory behavior that occurs in patients with type 1 diabetes mellitus, mostly in females, who omit or restrict their required insulin doses in order to lose weight. Diagnosis of this underlying disorder is difficult. We aimed to use clinical and laboratory criteria to create an algorithm to assist in the detection of intentional insulin omission. The distribution of HbA1c levels from 287 (181 females) patients with type 1 diabetes were used as reference. Data from 26 patients with type 1 diabetes and intentional insulin omission were analysed. The Weka (Waikato Environment for Knowledge Analysis) machine learning software, decision tree classifier with 10-fold cross validation was used to developed prediction models. Model performance was assessed by cross-validation in a further 43 patients. Adolescents with intentional insulin omission were discriminated by: female sex, HbA1c>9.2%, more than 20% of HbA1c measurements above the 90th percentile, the mean of 3 highest delta HbA1c z-scores>1.28, current age and age at diagnosis. The models developed showed good discrimination (sensitivity and specificity 0.88 and 0.74, respectively). The external test dataset revealed good performance of the model with a sensitivity and specificity of 1.00 and 0.97, respectively. Using data mining methods we developed a clinical prediction model to determine an individual's probability of intentionally omitting insulin. This model provides a decision support system for the detection of intentional insulin omission for weight loss in adolescent females with type 1 diabetes mellitus. Copyright © 2013 Wiley Periodicals, Inc.

Omission of surgery in elderly patients with early stage breast cancer.

PubMed

Hamaker, Marije E; Bastiaannet, Esther; Evers, Dorothea; Water, Willemien van de; Smorenburg, Carolien H; Maartense, Ed; Zeilemaker, Anneke M; Liefers, Gerrit-Jan; Geest, Lydia van der; de Rooij, Sophia E; van Munster, Barbara C; Portielje, Johanneke E A

2013-02-01

To assess national trends over time in surgery for elderly patients with resectable breast cancer (BC) and to evaluate clinical outcome and cause of death after the omission of surgery in a regional cohort of elderly patients. National trends in 1995-2005 were calculated using cancer registry data. In addition, a chart review was performed in a cohort of patients aged ≥ 75 years, with early stage BC but no primary surgery, diagnosed at five Dutch hospitals in 1990-2005. Patient characteristics, comorbidity and reason for the omission of surgery were collected from the chart. Cause of death was retrieved from death certificate data registered at Statistics Netherlands. Omission of surgery increased significantly over time for patients aged 80 years and older (p<0.05). Of the 187 patients in the regional cohort (median age 85.9 years (range 75.0-97.7), 174 (92%) received hormonal therapy. Omission of surgery was at the patient's request in 59 patients (32%). Of the 178 patients that died during follow-up, 60 patients (34%) died of BC. For 81 patients (45%), BC was not clinically relevant at the time of death. Median overall survival was 2.3 years (range 0.2-10.7) and did not differ between BC and other causes of death (p=0.9). Omission of surgery for elderly patients with resectable BC has increased significantly over the past decade; instead patients often received primary endocrine treatment. Although this may appear an effective alternative to surgery, the potential for a longer term negative impact on disease control and quality of life deserves further investigation. Copyright © 2012 Elsevier Ltd. All rights reserved.

Advanced error diagnostics of the CMAQ and Chimere modelling systems within the AQMEII3 model evaluation framework

NASA Astrophysics Data System (ADS)

Solazzo, Efisio; Hogrefe, Christian; Colette, Augustin; Garcia-Vivanco, Marta; Galmarini, Stefano

2017-09-01

The work here complements the overview analysis of the modelling systems participating in the third phase of the Air Quality Model Evaluation International Initiative (AQMEII3) by focusing on the performance for hourly surface ozone by two modelling systems, Chimere for Europe and CMAQ for North America. The evaluation strategy outlined in the course of the three phases of the AQMEII activity, aimed to build up a diagnostic methodology for model evaluation, is pursued here and novel diagnostic methods are proposed. In addition to evaluating the base case simulation in which all model components are configured in their standard mode, the analysis also makes use of sensitivity simulations in which the models have been applied by altering and/or zeroing lateral boundary conditions, emissions of anthropogenic precursors, and ozone dry deposition. To help understand of the causes of model deficiencies, the error components (bias, variance, and covariance) of the base case and of the sensitivity runs are analysed in conjunction with timescale considerations and error modelling using the available error fields of temperature, wind speed, and NOx concentration. The results reveal the effectiveness and diagnostic power of the methods devised (which remains the main scope of this study), allowing the detection of the timescale and the fields that the two models are most sensitive to. The representation of planetary boundary layer (PBL) dynamics is pivotal to both models. In particular, (i) the fluctuations slower than ˜ 1.5 days account for 70-85 % of the mean square error of the full (undecomposed) ozone time series; (ii) a recursive, systematic error with daily periodicity is detected, responsible for 10-20 % of the quadratic total error; (iii) errors in representing the timing of the daily transition between stability regimes in the PBL are responsible for a covariance error as large as 9 ppb (as much as the standard deviation of the network-average ozone observations in summer in both Europe and North America); (iv) the CMAQ ozone error has a weak/negligible dependence on the errors in NO2, while the error in NO2 significantly impacts the ozone error produced by Chimere; (v) the response of the models to variations of anthropogenic emissions and boundary conditions show a pronounced spatial heterogeneity, while the seasonal variability of the response is found to be less marked. Only during the winter season does the zeroing of boundary values for North America produce a spatially uniform deterioration of the model accuracy across the majority of the continent.

Analysis of urban area land cover using SEASAT Synthetic Aperture Radar data

NASA Technical Reports Server (NTRS)

Henderson, F. M. (Principal Investigator)

1980-01-01

Digitally processed SEASAT synthetic aperture raar (SAR) imagery of the Denver, Colorado urban area was examined to explore the potential of SAR data for mapping urban land cover and the compatability of SAR derived land cover classes with the United States Geological Survey classification system. The imagery is examined at three different scales to determine the effect of image enlargement on accuracy and level of detail extractable. At each scale the value of employing a simplistic preprocessing smoothing algorithm to improve image interpretation is addressed. A visual interpretation approach and an automated machine/visual approach are employed to evaluate the feasibility of producing a semiautomated land cover classification from SAR data. Confusion matrices of omission and commission errors are employed to define classification accuracies for each interpretation approach and image scale.

Guidelines to the Practice of Anesthesia - Revised Edition 2018.

PubMed

Dobson, Gregory; Chong, Matthew; Chow, Lorraine; Flexman, Alana; Kurrek, Matthew; Laflamme, Claude; Lagacé, Annie; Stacey, Shean; Thiessen, Barton

2018-01-01

The Guidelines to the Practice of Anesthesia Revised Edition 2018 (the Guidelines) were prepared by the Canadian Anesthesiologists' Society (CAS), which reserves the right to determine their publication and distribution. The Guidelines are subject to revision and updated versions are published annually. The Guidelines to the Practice of Anesthesia Revised Edition 2018 supersedes all previously published versions of this document. Although the CAS encourages Canadian anesthesiologists to adhere to its practice guidelines to ensure high-quality patient care, the CAS cannot guarantee any specific patient outcome. Anesthesiologists should exercise their own professional judgement in determining the proper course of action for any patient's circumstances. The CAS assumes no responsibility or liability for any error or omission arising from the use of any information contained in its Guidelines to the Practice of Anesthesia.

On the design of classifiers for crop inventories

NASA Technical Reports Server (NTRS)

Heydorn, R. P.; Takacs, H. C.

1986-01-01

Crop proportion estimators that use classifications of satellite data to correct, in an additive way, a given estimate acquired from ground observations are discussed. A linear version of these estimators is optimal, in terms of minimum variance, when the regression of the ground observations onto the satellite observations in linear. When this regression is not linear, but the reverse regression (satellite observations onto ground observations) is linear, the estimator is suboptimal but still has certain appealing variance properties. In this paper expressions are derived for those regressions which relate the intercepts and slopes to conditional classification probabilities. These expressions are then used to discuss the question of classifier designs that can lead to low-variance crop proportion estimates. Variance expressions for these estimates in terms of classifier omission and commission errors are also derived.

LSA SAF Meteosat FRP Products: Part 2 - Evaluation and demonstration of use in the Copernicus Atmosphere Monitoring Service (CAMS)

NASA Astrophysics Data System (ADS)

Roberts, G.; Wooster, M. J.; Xu, W.; Freeborn, P. H.; Morcrette, J.-J.; Jones, L.; Benedetti, A.; Kaiser, J.

2015-06-01

Characterising the dynamics of landscape scale wildfires at very high temporal resolutions is best achieved using observations from Earth Observation (EO) sensors mounted onboard geostationary satellites. As a result, a number of operational active fire products have been developed from the data of such sensors. An example of which are the Fire Radiative Power (FRP) products, the FRP-PIXEL and FRP-GRID products, generated by the Land Surface Analysis Satellite Applications Facility (LSA SAF) from imagery collected by the Spinning Enhanced Visible and Infrared Imager (SEVIRI) on-board the Meteosat Second Generation (MSG) series of geostationary EO satellites. The processing chain developed to deliver these FRP products detects SEVIRI pixels containing actively burning fires and characterises their FRP output across four geographic regions covering Europe, part of South America and northern and southern Africa. The FRP-PIXEL product contains the highest spatial and temporal resolution FRP dataset, whilst the FRP-GRID product contains a spatio-temporal summary that includes bias adjustments for cloud cover and the non-detection of low FRP fire pixels. Here we evaluate these two products against active fire data collected by the Moderate Resolution Imaging Spectroradiometer (MODIS), and compare the results to those for three alternative active fire products derived from SEVIRI imagery. The FRP-PIXEL product is shown to detect a substantially greater number of active fire pixels than do alternative SEVIRI-based products, and comparison to MODIS on a per-fire basis indicates a strong agreement and low bias in terms of FRP values. However, low FRP fire pixels remain undetected by SEVIRI, with errors of active fire pixel detection commission and omission compared to MODIS ranging between 9-13 and 65-77% respectively in Africa. Higher errors of omission result in greater underestimation of regional FRP totals relative to those derived from simultaneously collected MODIS data, ranging from 35% over the Northern Africa region to 89% over the European region. High errors of active fire omission and FRP underestimation are found over Europe and South America, and result from SEVIRI's larger pixel area over these regions. An advantage of using FRP for characterising wildfire emissions is the ability to do so very frequently and in near real time (NRT). To illustrate the potential of this approach, wildfire fuel consumption rates derived from the SEVIRI FRP-PIXEL product are used to characterise smoke emissions of the 2007 Peloponnese wildfires within the European Centre for Medium-Range Weather Forecasting (ECMWF) Integrated Forecasting System (IFS), as a demonstration of what can be achieved when using geostationary active fire data within the Copernicus Atmosphere Monitoring System (CAMS). Qualitative comparison of the modelled smoke plumes with MODIS optical imagery illustrates that the model captures the temporal and spatial dynamics of the plume very well, and that high temporal resolution emissions estimates such as those available from geostationary orbit are important for capturing the sub-daily variability in smoke plume parameters such as aerosol optical depth (AOD), which are increasingly less well resolved using daily or coarser temporal resolution emissions datasets. Quantitative comparison of modelled AOD with coincident MODIS and AERONET AOD indicates that the former is overestimated by ∼ 20-30%, but captures the observed AOD dynamics with a high degree of fidelity. The case study highlights the potential of using geostationary FRP data to drive fire emissions estimates for use within atmospheric transport models such as those currently implemented as part of the Monitoring Atmospheric Composition and Climate (MACC) programme within the CAMS.

MFP scanner motion characterization using self-printed target

NASA Astrophysics Data System (ADS)

Kim, Minwoong; Bauer, Peter; Wagner, Jerry K.; Allebach, Jan P.

2015-01-01

Multifunctional printers (MFP) are products that combine the functions of a printer, scanner, and copier. Our goal is to help customers to be able to easily diagnose scanner or print quality issues with their products by developing an automated diagnostic system embedded in the product. We specifically focus on the characterization of scanner motions, which may be defective due to irregular movements of the scan-head. The novel design of our test page and two-stage diagnostic algorithm are described in this paper. The most challenging issue is to evaluate the scanner performance properly when both printer and scanner units contribute to the motion errors. In the first stage called the uncorrected-print-error-stage, aperiodic and periodic motion behaviors are characterized in both the spatial and frequency domains. Since it is not clear how much of the error is contributed by each unit, the scanned input is statistically analyzed in the second stage called the corrected-print-error-stage. Finally, the described diagnostic algorithms output the estimated scan error and print error separately as RMS values of the displacement of the scan and print lines, respectively, from their nominal positions in the scanner or printer motion direction. We validate our test page design and approaches by ground truth obtained from a high-precision, chrome-on-glass reticle manufactured using semiconductor chip fabrication technologies.

Decision Making for Borderline Cases in Pass/Fail Clinical Anatomy Courses: The Practical Value of the Standard Error of Measurement and Likelihood Ratio in a Diagnostic Test

ERIC Educational Resources Information Center

Severo, Milton; Silva-Pereira, Fernanda; Ferreira, Maria Amelia

2013-01-01

Several studies have shown that the standard error of measurement (SEM) can be used as an additional “safety net” to reduce the frequency of false-positive or false-negative student grading classifications. Practical examinations in clinical anatomy are often used as diagnostic tests to admit students to course final examinations. The aim of this…

48 CFR 2825.901 - Omission of audit clause.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 6 2010-10-01 2010-10-01 true Omission of audit clause. 2825.901 Section 2825.901 Federal Acquisition Regulations System DEPARTMENT OF JUSTICE Socioeconomic... in by the contracting activity's legal counsel prior to being approved by the authorized agency...

Toward the development of a rational scale in the use of human-figure drawings as a kindergarten screening measure.

PubMed

Goldman, R K; Velasco, M M

1980-04-01

The Draw-A-Person Test was individually administered to 120 kindergartners from diverse socioeconomic backgrounds, ranging in age from 4 yr. and 10 mo. to 6 yr. and 4 mo. This study was conducted to validate and expand Goldman and Warren's earlier work (1976) on the development of a rational scale for use as a kindergarten screening measure. Correlational analyses corroborate the earlier findings that body-part omissions are the most predictive items of emotional high risk. Factor analyses of the current data also replicate earlier findings in which two underlying cohesive factors emerged. The first factor has high loadings on peripheral body-part omissions; the second factor has high loadings on central body-part omission. The results suggest that an interchangeable number of body-part omissions together, rather than any one item, predict high emotional risk. Structural and content characteristics do not contribute significantly to the development of a kindergarten screening measure.

Identification of character-impact odorants in a cola-flavored carbonated beverage by quantitative analysis and omission studies of aroma reconstitution models.

PubMed

Lorjaroenphon, Yaowapa; Cadwallader, Keith R

2015-01-28

Thirty aroma-active components of a cola-flavored carbonated beverage were quantitated by stable isotope dilution assays, and their odor activity values (OAVs) were calculated. The OAV results revealed that 1,8-cineole, (R)-(-)-linalool, and octanal made the greatest contribution to the overall aroma of the cola. A cola aroma reconstitution model was constructed by adding 20 high-purity standards to an aqueous sucrose-phosphoric acid solution. The results of headspace solid-phase microextraction and sensory analyses were used to adjust the model to better match authentic cola. The rebalanced model was used as a complete model for the omission study. Sensory results indicated that omission of a group consisting of methyleugenol, (E)-cinnamaldehyde, eugenol, and (Z)- and (E)-isoeugenols differed from the complete model, while omission of the individual components of this group did not differ from the complete model. These results indicate that a balance of numerous odorants is responsible for the characteristic aroma of cola-flavored carbonated beverages.

Beyond Correctness: Development and Validation of Concept-Based Categorical Scoring Rubrics for Diagnostic Purposes

ERIC Educational Resources Information Center

Arieli-Attali, Meirav; Liu, Ying

2016-01-01

Diagnostic assessment approaches intend to provide fine-grained reports of what students know and can do, focusing on their areas of strengths and weaknesses. However, current application of such diagnostic approaches is limited by the scoring method for item responses; important diagnostic information, such as type of errors and strategy use is…

Measures to Improve Diagnostic Safety in Clinical Practice

PubMed Central

Singh, Hardeep; Graber, Mark L; Hofer, Timothy P

2016-01-01

Timely and accurate diagnosis is foundational to good clinical practice and an essential first step to achieving optimal patient outcomes. However, a recent Institute of Medicine report concluded that most of us will experience at least one diagnostic error in our lifetime. The report argues for efforts to improve the reliability of the diagnostic process through better measurement of diagnostic performance. The diagnostic process is a dynamic team-based activity that involves uncertainty, plays out over time, and requires effective communication and collaboration among multiple clinicians, diagnostic services, and the patient. Thus, it poses special challenges for measurement. In this paper, we discuss how the need to develop measures to improve diagnostic performance could move forward at a time when the scientific foundation needed to inform measurement is still evolving. We highlight challenges and opportunities for developing potential measures of “diagnostic safety” related to clinical diagnostic errors and associated preventable diagnostic harm. In doing so, we propose a starter set of measurement concepts for initial consideration that seem reasonably related to diagnostic safety, and call for these to be studied and further refined. This would enable safe diagnosis to become an organizational priority and facilitate quality improvement. Health care systems should consider measurement and evaluation of diagnostic performance as essential to timely and accurate diagnosis and to the reduction of preventable diagnostic harm. PMID:27768655

Quantifying mineral abundances of complex mixtures by coupling spectral deconvolution of SWIR spectra (2.1-2.4 μm) and regression tree analysis

USGS Publications Warehouse

Mulder, V.L.; Plotze, Michael; de Bruin, Sytze; Schaepman, Michael E.; Mavris, C.; Kokaly, Raymond F.; Egli, Markus

2013-01-01

This paper presents a methodology for assessing mineral abundances of mixtures having more than two constituents using absorption features in the 2.1-2.4 μm wavelength region. In the first step, the absorption behaviour of mineral mixtures is parameterised by exponential Gaussian optimisation. Next, mineral abundances are predicted by regression tree analysis using these parameters as inputs. The approach is demonstrated on a range of prepared samples with known abundances of kaolinite, dioctahedral mica, smectite, calcite and quartz and on a set of field samples from Morocco. The latter contained varying quantities of other minerals, some of which did not have diagnostic absorption features in the 2.1-2.4 μm region. Cross validation showed that the prepared samples of kaolinite, dioctahedral mica, smectite and calcite were predicted with a root mean square error (RMSE) less than 9 wt.%. For the field samples, the RMSE was less than 8 wt.% for calcite, dioctahedral mica and kaolinite abundances. Smectite could not be well predicted, which was attributed to spectral variation of the cations within the dioctahedral layered smectites. Substitution of part of the quartz by chlorite at the prediction phase hardly affected the accuracy of the predicted mineral content; this suggests that the method is robust in handling the omission of minerals during the training phase. The degree of expression of absorption components was different between the field sample and the laboratory mixtures. This demonstrates that the method should be calibrated and trained on local samples. Our method allows the simultaneous quantification of more than two minerals within a complex mixture and thereby enhances the perspectives of spectral analysis for mineral abundances.

Evaluation of Hand Written and Computerized Out-Patient Prescriptions in Urban Part of Central Gujarat.

PubMed

Joshi, Anuradha; Buch, Jatin; Kothari, Nitin; Shah, Nishal

2016-06-01

Prescription order is an important therapeutic transaction between physician and patient. A good quality prescription is an extremely important factor for minimizing errors in dispensing medication and it should be adherent to guidelines for prescription writing for benefit of the patient. To evaluate frequency and type of prescription errors in outpatient prescriptions and find whether prescription writing abides with WHO standards of prescription writing. A cross-sectional observational study was conducted at Anand city. Allopathic private practitioners practising at Anand city of different specialities were included in study. Collection of prescriptions was started a month after the consent to minimize bias in prescription writing. The prescriptions were collected from local pharmacy stores of Anand city over a period of six months. Prescriptions were analysed for errors in standard information, according to WHO guide to good prescribing. Descriptive analysis was performed to estimate frequency of errors, data were expressed as numbers and percentage. Total 749 (549 handwritten and 200 computerised) prescriptions were collected. Abundant omission errors were identified in handwritten prescriptions e.g., OPD number was mentioned in 6.19%, patient's age was mentioned in 25.50%, gender in 17.30%, address in 9.29% and weight of patient mentioned in 11.29%, while in drug items only 2.97% drugs were prescribed by generic name. Route and Dosage form was mentioned in 77.35%-78.15%, dose mentioned in 47.25%, unit in 13.91%, regimens were mentioned in 72.93% while signa (direction for drug use) in 62.35%. Total 4384 errors out of 549 handwritten prescriptions and 501 errors out of 200 computerized prescriptions were found in clinicians and patient details. While in drug item details, total number of errors identified were 5015 and 621 in handwritten and computerized prescriptions respectively. As compared to handwritten prescriptions, computerized prescriptions appeared to be associated with relatively lower rates of error. Since out-patient prescription errors are abundant and often occur in handwritten prescriptions, prescribers need to adapt themselves to computerized prescription order entry in their daily practice.

Evaluation of Hand Written and Computerized Out-Patient Prescriptions in Urban Part of Central Gujarat

PubMed Central

Buch, Jatin; Kothari, Nitin; Shah, Nishal

2016-01-01

Introduction Prescription order is an important therapeutic transaction between physician and patient. A good quality prescription is an extremely important factor for minimizing errors in dispensing medication and it should be adherent to guidelines for prescription writing for benefit of the patient. Aim To evaluate frequency and type of prescription errors in outpatient prescriptions and find whether prescription writing abides with WHO standards of prescription writing. Materials and Methods A cross-sectional observational study was conducted at Anand city. Allopathic private practitioners practising at Anand city of different specialities were included in study. Collection of prescriptions was started a month after the consent to minimize bias in prescription writing. The prescriptions were collected from local pharmacy stores of Anand city over a period of six months. Prescriptions were analysed for errors in standard information, according to WHO guide to good prescribing. Statistical Analysis Descriptive analysis was performed to estimate frequency of errors, data were expressed as numbers and percentage. Results Total 749 (549 handwritten and 200 computerised) prescriptions were collected. Abundant omission errors were identified in handwritten prescriptions e.g., OPD number was mentioned in 6.19%, patient’s age was mentioned in 25.50%, gender in 17.30%, address in 9.29% and weight of patient mentioned in 11.29%, while in drug items only 2.97% drugs were prescribed by generic name. Route and Dosage form was mentioned in 77.35%-78.15%, dose mentioned in 47.25%, unit in 13.91%, regimens were mentioned in 72.93% while signa (direction for drug use) in 62.35%. Total 4384 errors out of 549 handwritten prescriptions and 501 errors out of 200 computerized prescriptions were found in clinicians and patient details. While in drug item details, total number of errors identified were 5015 and 621 in handwritten and computerized prescriptions respectively. Conclusion As compared to handwritten prescriptions, computerized prescriptions appeared to be associated with relatively lower rates of error. Since out-patient prescription errors are abundant and often occur in handwritten prescriptions, prescribers need to adapt themselves to computerized prescription order entry in their daily practice. PMID:27504305

When do latent class models overstate accuracy for diagnostic and other classifiers in the absence of a gold standard?

PubMed

Spencer, Bruce D

2012-06-01

Latent class models are increasingly used to assess the accuracy of medical diagnostic tests and other classifications when no gold standard is available and the true state is unknown. When the latent class is treated as the true class, the latent class models provide measures of components of accuracy including specificity and sensitivity and their complements, type I and type II error rates. The error rates according to the latent class model differ from the true error rates, however, and empirical comparisons with a gold standard suggest the true error rates often are larger. We investigate conditions under which the true type I and type II error rates are larger than those provided by the latent class models. Results from Uebersax (1988, Psychological Bulletin 104, 405-416) are extended to accommodate random effects and covariates affecting the responses. The results are important for interpreting the results of latent class analyses. An error decomposition is presented that incorporates an error component from invalidity of the latent class model. © 2011, The International Biometric Society.

The incomplete angler: effects created by visual omission.

PubMed

Findlay, John M

2008-01-01

The Fisherman, a picture painted by Jean-Louis Forain, demonstrates an interesting interaction between low and high level perceptual processing. The isolation and tranquillity of the fisherman in the picture are enhanced by the absence of his reflection, yet perceivers are rarely aware of the omission.

Prevalence of Pre-Analytical Errors in Clinical Chemistry Diagnostic Labs in Sulaimani City of Iraqi Kurdistan

PubMed Central

2017-01-01

Background Laboratory testing is roughly divided into three phases: a pre-analytical phase, an analytical phase and a post-analytical phase. Most analytical errors have been attributed to the analytical phase. However, recent studies have shown that up to 70% of analytical errors reflect the pre-analytical phase. The pre-analytical phase comprises all processes from the time a laboratory request is made by a physician until the specimen is analyzed at the lab. Generally, the pre-analytical phase includes patient preparation, specimen transportation, specimen collection and storage. In the present study, we report the first comprehensive assessment of the frequency and types of pre-analytical errors at the Sulaimani diagnostic labs in Iraqi Kurdistan. Materials and Methods Over 2 months, 5500 venous blood samples were observed in 10 public diagnostic labs of Sulaimani City. The percentages of rejected samples and types of sample inappropriateness were evaluated. The percentage of each of the following pre-analytical errors were recorded: delay in sample transportation, clotted samples, expired reagents, hemolyzed samples, samples not on ice, incorrect sample identification, insufficient sample, tube broken in centrifuge, request procedure errors, sample mix-ups, communication conflicts, misinterpreted orders, lipemic samples, contaminated samples and missed physician’s request orders. The difference between the relative frequencies of errors observed in the hospitals considered was tested using a proportional Z test. In particular, the survey aimed to discover whether analytical errors were recorded and examine the types of platforms used in the selected diagnostic labs. Results The analysis showed a high prevalence of improper sample handling during the pre-analytical phase. In appropriate samples, the percentage error was as high as 39%. The major reasons for rejection were hemolyzed samples (9%), incorrect sample identification (8%) and clotted samples (6%). Most quality control schemes at Sulaimani hospitals focus only on the analytical phase, and none of the pre-analytical errors were recorded. Interestingly, none of the labs were internationally accredited; therefore, corrective actions are needed at these hospitals to ensure better health outcomes. Internal and External Quality Assessment Schemes (EQAS) for the pre-analytical phase at Sulaimani clinical laboratories should be implemented at public hospitals. Furthermore, lab personnel, particularly phlebotomists, need continuous training on the importance of sample quality to obtain accurate test results. PMID:28107395

Prevalence of Pre-Analytical Errors in Clinical Chemistry Diagnostic Labs in Sulaimani City of Iraqi Kurdistan.

PubMed

Najat, Dereen

2017-01-01

Laboratory testing is roughly divided into three phases: a pre-analytical phase, an analytical phase and a post-analytical phase. Most analytical errors have been attributed to the analytical phase. However, recent studies have shown that up to 70% of analytical errors reflect the pre-analytical phase. The pre-analytical phase comprises all processes from the time a laboratory request is made by a physician until the specimen is analyzed at the lab. Generally, the pre-analytical phase includes patient preparation, specimen transportation, specimen collection and storage. In the present study, we report the first comprehensive assessment of the frequency and types of pre-analytical errors at the Sulaimani diagnostic labs in Iraqi Kurdistan. Over 2 months, 5500 venous blood samples were observed in 10 public diagnostic labs of Sulaimani City. The percentages of rejected samples and types of sample inappropriateness were evaluated. The percentage of each of the following pre-analytical errors were recorded: delay in sample transportation, clotted samples, expired reagents, hemolyzed samples, samples not on ice, incorrect sample identification, insufficient sample, tube broken in centrifuge, request procedure errors, sample mix-ups, communication conflicts, misinterpreted orders, lipemic samples, contaminated samples and missed physician's request orders. The difference between the relative frequencies of errors observed in the hospitals considered was tested using a proportional Z test. In particular, the survey aimed to discover whether analytical errors were recorded and examine the types of platforms used in the selected diagnostic labs. The analysis showed a high prevalence of improper sample handling during the pre-analytical phase. In appropriate samples, the percentage error was as high as 39%. The major reasons for rejection were hemolyzed samples (9%), incorrect sample identification (8%) and clotted samples (6%). Most quality control schemes at Sulaimani hospitals focus only on the analytical phase, and none of the pre-analytical errors were recorded. Interestingly, none of the labs were internationally accredited; therefore, corrective actions are needed at these hospitals to ensure better health outcomes. Internal and External Quality Assessment Schemes (EQAS) for the pre-analytical phase at Sulaimani clinical laboratories should be implemented at public hospitals. Furthermore, lab personnel, particularly phlebotomists, need continuous training on the importance of sample quality to obtain accurate test results.

Stimulus-dependent modulation of visual neglect in a touch-screen cancellation task.

PubMed

Keller, Ingo; Volkening, Katharina; Garbacenkaite, Ruta

2015-05-01

Patients with left-sided neglect frequently show omissions and repetitive behavior on cancellation tests. Using a touch-screen-based cancellation task, we tested how visual feedback and distracters influence the number of omissions and perseverations. Eighteen patients with left-sided visual neglect and 18 healthy controls performed four different cancellation tasks on an iPad touch screen: no feedback (the display did not change during the task), visual feedback (touched targets changed their color from black to green), visual feedback with distracters (20 distracters were evenly embedded in the display; detected targets changed their color from black to green), vanishing targets (touched targets disappeared from the screen). Except for the condition with vanishing targets, neglect patients had significantly more omissions and perseverations than healthy controls in the remaining three subtests. Both conditions providing feedback by changing the target color showed the highest number of omissions. Erasure of targets nearly diminished omissions completely. The highest rate of perseverations was observed in the no-feedback condition. The implementation of distracters led to a moderate number of perseverations. Visual feedback without distracters and vanishing targets abolished perseverations nearly completely. Visual feedback and the presence of distracters aggravated hemispatial neglect. This finding is compatible with impaired disengagement from the ipsilesional side as an important factor of visual neglect. Improvement of cancellation behavior with vanishing targets could have therapeutic implications. (c) 2015 APA, all rights reserved).

Affective-associative two-process theory: a neurocomputational account of partial reinforcement extinction effects.

PubMed

Lowe, Robert; Almér, Alexander; Billing, Erik; Sandamirskaya, Yulia; Balkenius, Christian

2017-12-01

The partial reinforcement extinction effect (PREE) is an experimentally established phenomenon: behavioural response to a given stimulus is more persistent when previously inconsistently rewarded than when consistently rewarded. This phenomenon is, however, controversial in animal/human learning theory. Contradictory findings exist regarding when the PREE occurs. One body of research has found a within-subjects PREE, while another has found a within-subjects reversed PREE (RPREE). These opposing findings constitute what is considered the most important problem of PREE for theoreticians to explain. Here, we provide a neurocomputational account of the PREE, which helps to reconcile these seemingly contradictory findings of within-subjects experimental conditions. The performance of our model demonstrates how omission expectancy, learned according to low probability reward, comes to control response choice following discontinuation of reward presentation (extinction). We find that a PREE will occur when multiple responses become controlled by omission expectation in extinction, but not when only one omission-mediated response is available. Our model exploits the affective states of reward acquisition and reward omission expectancy in order to differentially classify stimuli and differentially mediate response choice. We demonstrate that stimulus-response (retrospective) and stimulus-expectation-response (prospective) routes are required to provide a necessary and sufficient explanation of the PREE versus RPREE data and that Omission representation is key for explaining the nonlinear nature of extinction data.

Diagnostic grade wireless ECG monitoring.

PubMed

Garudadri, Harinath; Chi, Yuejie; Baker, Steve; Majumdar, Somdeb; Baheti, Pawan K; Ballard, Dan

2011-01-01

In remote monitoring of Electrocardiogram (ECG), it is very important to ensure that the diagnostic integrity of signals is not compromised by sensing artifacts and channel errors. It is also important for the sensors to be extremely power efficient to enable wearable form factors and long battery life. We present an application of Compressive Sensing (CS) as an error mitigation scheme at the application layer for wearable, wireless sensors in diagnostic grade remote monitoring of ECG. In our previous work, we described an approach to mitigate errors due to packet losses by projecting ECG data to a random space and recovering a faithful representation using sparse reconstruction methods. Our contributions in this work are twofold. First, we present an efficient hardware implementation of random projection at the sensor. Second, we validate the diagnostic integrity of the reconstructed ECG after packet loss mitigation. We validate our approach on MIT and AHA databases comprising more than 250,000 normal and abnormal beats using EC57 protocols adopted by the Food and Drug Administration (FDA). We show that sensitivity and positive predictivity of a state-of-the-art ECG arrhythmia classifier is essentially invariant under CS based packet loss mitigation for both normal and abnormal beats even at high packet loss rates. In contrast, the performance degrades significantly in the absence of any error mitigation scheme, particularly for abnormal beats such as Ventricular Ectopic Beats (VEB).

29 CFR 790.18 - “Administrative practice or enforcement policy.”

Code of Federal Regulations, 2011 CFR

2011-07-01

... Faith Reliance on Administrative Regulations, Etc. § 790.18 “Administrative practice or enforcement... employee, because of reliance in good faith on an administrative practice or enforcement policy only (1... acts or omissions led the employer to believe in good faith that such acts or omissions were not...

29 CFR 790.18 - “Administrative practice or enforcement policy.”

Code of Federal Regulations, 2013 CFR

2013-07-01

... Faith Reliance on Administrative Regulations, Etc. § 790.18 “Administrative practice or enforcement... employee, because of reliance in good faith on an administrative practice or enforcement policy only (1... acts or omissions led the employer to believe in good faith that such acts or omissions were not...

29 CFR 790.18 - “Administrative practice or enforcement policy.”

Code of Federal Regulations, 2012 CFR

2012-07-01

... Faith Reliance on Administrative Regulations, Etc. § 790.18 “Administrative practice or enforcement... employee, because of reliance in good faith on an administrative practice or enforcement policy only (1... acts or omissions led the employer to believe in good faith that such acts or omissions were not...

Principles of Economics without the Prince of Denmark

ERIC Educational Resources Information Center

Phipps, Barbara J.; Strom, Robert J.; Baumol, William J.

2012-01-01

In most introductory textbooks on principles of economics, discussion of the theory or practice of entrepreneurship is almost entirely absent. This omission is striking, given the important role in economic growth that economists assign to the entrepreneur. While there are plausible explanations for this omission, new research suggests the…

Children's Omission of Prepositions in English and Icelandic

ERIC Educational Resources Information Center

Nicholas, Katrina Elizabeth

2011-01-01

The purpose of this dissertation is to empirically test the hypothesis that children's omission of functional elements reflects performance factors (McKee, 1994; McKee & Iwasaki, 2001), rather than lack of knowledge (Felix, 1987; Radford, 1990, 1995; Tomasello, 2000). The multi-level production system treats content and function morphemes…

43 CFR 5462.2 - Prohibited acts.

Code of Federal Regulations, 2011 CFR

2011-10-01

... § 5462.2 Prohibited acts. (a) The acts or omissions listed in paragraph (b) of this section apply only to... permit held by the purchaser responsible for such acts or omissions may be canceled. (b) The following activities are prohibited: (1) Cutting, removing, or otherwise damaging any timber, tree, or other vegetative...

43 CFR 5462.2 - Prohibited acts.

Code of Federal Regulations, 2012 CFR

2012-10-01

... § 5462.2 Prohibited acts. (a) The acts or omissions listed in paragraph (b) of this section apply only to... permit held by the purchaser responsible for such acts or omissions may be canceled. (b) The following activities are prohibited: (1) Cutting, removing, or otherwise damaging any timber, tree, or other vegetative...

43 CFR 5462.2 - Prohibited acts.

Code of Federal Regulations, 2013 CFR

2013-10-01

... § 5462.2 Prohibited acts. (a) The acts or omissions listed in paragraph (b) of this section apply only to... permit held by the purchaser responsible for such acts or omissions may be canceled. (b) The following activities are prohibited: (1) Cutting, removing, or otherwise damaging any timber, tree, or other vegetative...

43 CFR 5462.2 - Prohibited acts.

Code of Federal Regulations, 2014 CFR

2014-10-01

... § 5462.2 Prohibited acts. (a) The acts or omissions listed in paragraph (b) of this section apply only to... permit held by the purchaser responsible for such acts or omissions may be canceled. (b) The following activities are prohibited: (1) Cutting, removing, or otherwise damaging any timber, tree, or other vegetative...

Minding the Absent: Arguments for the Full Competence Hypothesis.

ERIC Educational Resources Information Center

Borer, Hagit; Rohrbacher, Bernhard

2002-01-01

Suggests that the systematic omission of functional material by young children, contrary to current beliefs, argues for the presence of functional structure,because in the absence of such structure what is expected is not a systematic omission of functional material but rather its random use. (Author/VWL)

How common are cognitive errors in cases presented at emergency medicine resident morbidity and mortality conferences?

PubMed

Chu, David; Xiao, Jane; Shah, Payal; Todd, Brett

2018-06-20

Cognitive errors are a major contributor to medical error. Traditionally, medical errors at teaching hospitals are analyzed in morbidity and mortality (M&M) conferences. We aimed to describe the frequency of cognitive errors in relation to the occurrence of diagnostic and other error types, in cases presented at an emergency medicine (EM) resident M&M conference. We conducted a retrospective study of all cases presented at a suburban US EM residency monthly M&M conference from September 2011 to August 2016. Each case was reviewed using the electronic medical record (EMR) and notes from the M&M case by two EM physicians. Each case was categorized by type of primary medical error that occurred as described by Okafor et al. When a diagnostic error occurred, the case was reviewed for contributing cognitive and non-cognitive factors. Finally, when a cognitive error occurred, the case was classified into faulty knowledge, faulty data gathering or faulty synthesis, as described by Graber et al. Disagreements in error type were mediated by a third EM physician. A total of 87 M&M cases were reviewed; the two reviewers agreed on 73 cases, and 14 cases required mediation by a third reviewer. Forty-eight cases involved diagnostic errors, 47 of which were cognitive errors. Of these 47 cases, 38 involved faulty synthesis, 22 involved faulty data gathering and only 11 involved faulty knowledge. Twenty cases contained more than one type of cognitive error. Twenty-nine cases involved both a resident and an attending physician, while 17 cases involved only an attending physician. Twenty-one percent of the resident cases involved all three cognitive errors, while none of the attending cases involved all three. Forty-one percent of the resident cases and only 6% of the attending cases involved faulty knowledge. One hundred percent of the resident cases and 94% of the attending cases involved faulty synthesis. Our review of 87 EM M&M cases revealed that cognitive errors are commonly involved in cases presented, and that these errors are less likely due to deficient knowledge and more likely due to faulty synthesis. M&M conferences may therefore provide an excellent forum to discuss cognitive errors and how to reduce their occurrence.

Association of grey matter changes with stability and flexibility of prediction in akinetic-rigid Parkinson's disease.

PubMed

Trempler, Ima; Binder, Ellen; El-Sourani, Nadiya; Schiffler, Patrick; Tenberge, Jan-Gerd; Schiffer, Anne-Marike; Fink, Gereon R; Schubotz, Ricarda I

2018-06-01

Parkinson's disease (PD), which is caused by degeneration of dopaminergic neurons in the midbrain, results in a heterogeneous clinical picture including cognitive decline. Since the phasic signal of dopamine neurons is proposed to guide learning by signifying mismatches between subjects' expectations and external events, we here investigated whether akinetic-rigid PD patients without mild cognitive impairment exhibit difficulties in dealing with either relevant (requiring flexibility) or irrelevant (requiring stability) prediction errors. Following our previous study on flexibility and stability in prediction (Trempler et al. J Cogn Neurosci 29(2):298-309, 2017), we then assessed whether deficits would correspond with specific structural alterations in dopaminergic regions as well as in inferior frontal cortex, medial prefrontal cortex, and the hippocampus. Twenty-one healthy controls and twenty-one akinetic-rigid PD patients on and off medication performed a task which required to serially predict upcoming items. Switches between predictable sequences had to be indicated via button press, whereas sequence omissions had to be ignored. Independent of the disease, midbrain volume was related to a general response bias to unexpected events, whereas right putamen volume correlated with the ability to discriminate between relevant and irrelevant prediction errors. However, patients compared with healthy participants showed deficits in stabilisation against irrelevant prediction errors, associated with thickness of right inferior frontal gyrus and left medial prefrontal cortex. Flexible updating due to relevant prediction errors was also affected in patients compared with controls and associated with right hippocampus volume. Dopaminergic medication influenced behavioural performance across, but not within the patients. Our exploratory study warrants further research on deficient prediction error processing and its structural correlates as a core of cognitive symptoms occurring already in early stages of the disease.

Interactions of task and subject variables among continuous performance tests.

PubMed

Denney, Colin B; Rapport, Mark D; Chung, Kyong-Mee

2005-04-01

Contemporary models of working memory suggest that target paradigm (TP) and target density (TD) should interact as influences on error rates derived from continuous performance tests (CPTs). The present study evaluated this hypothesis empirically in a typically developing, ethnically diverse sample of children. The extent to which scores based on different combinations of these task parameters showed different patterns of relationship to age, intelligence, and gender was also assessed. Four continuous performance tests were derived by combining two target paradigms (AX and repeated letter target stimuli) with two levels of target density (8.3% and 33%). Variations in mean omission (OE) and commission (CE) error rates were examined within and across combinations of TP and TD. In addition, a nested series of structural equation models was utilized to examine patterns of relationship among error rates, age, intelligence, and gender. Target paradigm and target density interacted as influences on error rates. Increasing density resulted in higher OE and CE rates for the AX paradigm. In contrast, the high density condition yielded a decline in OE rates accompanied by a small increase in CEs using the repeated letter CPT. Target paradigms were also distinguishable on the basis of age when using OEs as the performance measure, whereas combinations of age and intelligence distinguished between density levels but not target paradigms using CEs as the dependent measure. Different combinations of target paradigm and target density appear to yield scores that are conceptually and psychometrically distinguishable. Consequently, developmentally appropriate interpretation of error rates across tasks may require (a) careful analysis of working memory and attentional resources required for successful performance, and (b) normative data bases that are differently stratified with respect to combinations of age and intelligence.

New Insights into Handling Missing Values in Environmental Epidemiological Studies

PubMed Central

Roda, Célina; Nicolis, Ioannis; Momas, Isabelle; Guihenneuc, Chantal

2014-01-01

Missing data are unavoidable in environmental epidemiologic surveys. The aim of this study was to compare methods for handling large amounts of missing values: omission of missing values, single and multiple imputations (through linear regression or partial least squares regression), and a fully Bayesian approach. These methods were applied to the PARIS birth cohort, where indoor domestic pollutant measurements were performed in a random sample of babies' dwellings. A simulation study was conducted to assess performances of different approaches with a high proportion of missing values (from 50% to 95%). Different simulation scenarios were carried out, controlling the true value of the association (odds ratio of 1.0, 1.2, and 1.4), and varying the health outcome prevalence. When a large amount of data is missing, omitting these missing data reduced statistical power and inflated standard errors, which affected the significance of the association. Single imputation underestimated the variability, and considerably increased risk of type I error. All approaches were conservative, except the Bayesian joint model. In the case of a common health outcome, the fully Bayesian approach is the most efficient approach (low root mean square error, reasonable type I error, and high statistical power). Nevertheless for a less prevalent event, the type I error is increased and the statistical power is reduced. The estimated posterior distribution of the OR is useful to refine the conclusion. Among the methods handling missing values, no approach is absolutely the best but when usual approaches (e.g. single imputation) are not sufficient, joint modelling approach of missing process and health association is more efficient when large amounts of data are missing. PMID:25226278

Effects of low-level sarin and cyclosarin exposure and Gulf War Illness on brain structure and function: a study at 4T.

PubMed

Chao, Linda L; Abadjian, Linda; Hlavin, Jennifer; Meyerhoff, Deiter J; Weiner, Michael W

2011-12-01

More than 100,000 US troops were potentially exposed to chemical warfare agents sarin (GB) and cyclosarin (GF) when an ammunition dump at Khamisiyah, Iraq was destroyed during the 1991 Persian Gulf War (GW). We previously found reduced total gray matter (GM) volume in 40 GW veterans with suspected GB/GF exposure relative to 40 matched, unexposed GW veterans on a 1.5T MR scanner. In this study, we reexamine the relationship between GB/GF exposure and volumetric measurements of gross neuroanatomical structures in a different cohort of GW veterans on a 4T MR scanner. Neuropsychological and magnetic resonance imaging (MRI) data from a cross sectional study on Gulf War Illness performed between 2005 and 2010 were used in this study. 4T MRI data were analyzed using automated image processing techniques that produced volumetric measurements of gray matter (GM), white matter (WM) and cerebrospinal fluid (CSF). Binary comparisons of 64 GB/GF exposed veterans and 64 'matched', unexposed veterans revealed reduced GM (p=0.03) and WM (p=0.03) volumes in the exposed veterans. Behaviorally, exposed veterans committed more errors of omission (p=0.02) and tended to have slower responses (p=0.05) than unexposed veterans on the Continuous Performance Test (CPT), a measure sustained and selective attention. Regression analyses confirmed that GB/GF exposure status predicted GM (β=-0.11, p=0.02) and WM (β=-0.14, p=0.03) volumes, and number of CPT omission errors (β=0.22, p=0.02) over and above potentially confounding demographic, clinical, and psychosocial variables. There was no dose-response relationship between estimated levels of GB/GF exposure and brain volume. However, we did find an effect of Gulf War Illness/Chronic Multisymptom Illness on both GM and WM volume in the GB/GF exposed veterans. These findings confirm previous reports by our group and others of central nervous system pathology in GW veterans with suspected exposure to low levels of GB/GF two decades after the exposure. Copyright © 2011 Elsevier Inc. All rights reserved.

Filtering Airborne LIDAR Data by AN Improved Morphological Method Based on Multi-Gradient Analysis

NASA Astrophysics Data System (ADS)

Li, Y.

2013-05-01

The technology of airborne Light Detection And Ranging (LIDAR) is capable of acquiring dense and accurate 3D geospatial data. Although many related efforts have been made by a lot of researchers in the last few years, LIDAR data filtering is still a challenging task, especially for area with high relief or hybrid geographic features. In order to address the bare-ground extraction from LIDAR point clouds of complex landscapes, a novel morphological filtering algorithm is proposed based on multi-gradient analysis in terms of the characteristic of LIDAR data distribution in this paper. Firstly, point clouds are organized by an index mesh. Then, the multigradient of each point is calculated using the morphological method. And, objects are removed gradually by choosing some points to carry on an improved opening operation constrained by multi-gradient iteratively. 15 sample data provided by ISPRS Working Group III/3 are employed to test the filtering algorithm proposed. These sample data include those environments that may lead to filtering difficulty. Experimental results show that filtering algorithm proposed by this paper is of high adaptability to various scenes including urban and rural areas. Omission error, commission error and total error can be simultaneously controlled in a relatively small interval. This algorithm can efficiently remove object points while preserves ground points to a great degree.

Reporting Errors in Siblings’ Survival Histories and Their Impact on Adult Mortality Estimates: Results From a Record Linkage Study in Senegal

PubMed Central

Helleringer, Stéphane; Pison, Gilles; Kanté, Almamy M.; Duthé, Géraldine; Andro, Armelle

2014-01-01

Estimates of adult mortality in countries with limited vital registration (e.g., sub-Saharan Africa) are often derived from information about the survival of a respondent’s siblings. We evaluated the completeness and accuracy of such data through a record linkage study conducted in Bandafassi, located in southeastern Senegal. We linked at the individual level retrospective siblings’ survival histories (SSH) reported by female respondents (n = 268) to prospective mortality data and genealogies collected through a health and demographic surveillance system (HDSS). Respondents often reported inaccurate lists of siblings. Additions to these lists were uncommon, but omissions were frequent: respondents omitted 3.8 % of their live sisters, 9.1 % of their deceased sisters, and 16.6 % of their sisters who had migrated out of the DSS area. Respondents underestimated the age at death of the siblings they reported during the interview, particularly among siblings who had died at older ages (≥45 years). Restricting SSH data to person-years and events having occurred during a recent reference period reduced list errors but not age and date errors. Overall, SSH data led to a 20 % underestimate of 45q15 relative to HDSS data. Our study suggests new quality improvement strategies for SSH data and demonstrates the potential use of HDSS data for the validation of “unconventional” demographic techniques. PMID:24493063

Increased impulsivity in response to food cues after sleep loss in healthy young men.

PubMed

Cedernaes, Jonathan; Brandell, Jon; Ros, Olof; Broman, Jan-Erik; Hogenkamp, Pleunie S; Schiöth, Helgi B; Benedict, Christian

2014-08-01

To investigate whether acute total sleep deprivation (TSD) leads to decreased cognitive control when food cues are presented during a task requiring active attention, by assessing the ability to cognitively inhibit prepotent responses. Fourteen males participated in the study on two separate occasions in a randomized, crossover within-subject design: one night of TSD versus normal sleep (8.5 hours). Following each nighttime intervention, hunger ratings and morning fasting plasma glucose concentrations were assessed before performing a go/no-go task. Following TSD, participants made significantly more commission errors when they were presented "no-go" food words in the go/no-go task, as compared with their performance following sleep (+56%; P<0.05). In contrast, response time and omission errors to "go" non-food words did not differ between the conditions. Self-reported hunger after TSD was increased without changes in fasting plasma glucose. The increase in hunger did not correlate with the TSD-induced commission errors. Our results suggest that TSD impairs cognitive control also in response to food stimuli in healthy young men. Whether such loss of inhibition or impulsiveness is food cue-specific as seen in obesity-thus providing a mechanism through which sleep disturbances may promote obesity development-warrants further investigation. Copyright © 2014 The Authors Obesity published by Wiley Periodicals, Inc. on behalf of The Obesity Society (TOS).

Reporting errors in siblings' survival histories and their impact on adult mortality estimates: results from a record linkage study in Senegal.

PubMed

Helleringer, Stéphane; Pison, Gilles; Kanté, Almamy M; Duthé, Géraldine; Andro, Armelle

2014-04-01

Estimates of adult mortality in countries with limited vital registration (e.g., sub-Saharan Africa) are often derived from information about the survival of a respondent's siblings. We evaluated the completeness and accuracy of such data through a record linkage study conducted in Bandafassi, located in southeastern Senegal. We linked at the individual level retrospective siblings' survival histories (SSH) reported by female respondents (n = 268) to prospective mortality data and genealogies collected through a health and demographic surveillance system (HDSS). Respondents often reported inaccurate lists of siblings. Additions to these lists were uncommon, but omissions were frequent: respondents omitted 3.8 % of their live sisters, 9.1 % of their deceased sisters, and 16.6 % of their sisters who had migrated out of the DSS area. Respondents underestimated the age at death of the siblings they reported during the interview, particularly among siblings who had died at older ages (≥45 years). Restricting SSH data to person-years and events having occurred during a recent reference period reduced list errors but not age and date errors. Overall, SSH data led to a 20 % underestimate of 45 q 15 relative to HDSS data. Our study suggests new quality improvement strategies for SSH data and demonstrates the potential use of HDSS data for the validation of "unconventional" demographic techniques.

Numerical simulation of a low-lying barrier island's morphological response to Hurricane Katrina

USGS Publications Warehouse

Lindemer, C.A.; Plant, N.G.; Puleo, J.A.; Thompson, D.M.; Wamsley, T.V.

2010-01-01

Tropical cyclones that enter or form in the Gulf of Mexico generate storm surge and large waves that impact low-lying coastlines along the Gulf Coast. The Chandeleur Islands, located 161. km east of New Orleans, Louisiana, have endured numerous hurricanes that have passed nearby. Hurricane Katrina (landfall near Waveland MS, 29 Aug 2005) caused dramatic changes to the island elevation and shape. In this paper the predictability of hurricane-induced barrier island erosion and accretion is evaluated using a coupled hydrodynamic and morphodynamic model known as XBeach. Pre- and post-storm island topography was surveyed with an airborne lidar system. Numerical simulations utilized realistic surge and wave conditions determined from larger-scale hydrodynamic models. Simulations included model sensitivity tests with varying grid size and temporal resolutions. Model-predicted bathymetry/topography and post-storm survey data both showed similar patterns of island erosion, such as increased dissection by channels. However, the model under predicted the magnitude of erosion. Potential causes for under prediction include (1) errors in the initial conditions (the initial bathymetry/topography was measured three years prior to Katrina), (2) errors in the forcing conditions (a result of our omission of storms prior to Katrina and/or errors in Katrina storm conditions), and/or (3) physical processes that were omitted from the model (e.g., inclusion of sediment variations and bio-physical processes). ?? 2010.

Performance evaluation of a dynamic telepathology system (Panoptiq™) in the morphologic assessment of peripheral blood film abnormalities.

PubMed

Goswami, R; Pi, D; Pal, J; Cheng, K; Hudoba De Badyn, M

2015-06-01

The study evaluated the performance of a dynamic imaging telepathology system (Panoptiq(™) ) as a diagnostic aid to the identification of peripheral blood film (PBF) abnormalities. The study assumed a laboratory personnel working in a clinical laboratory were operating the telepathology system to seek diagnostic opinion from an external consulting hematopathologist. The study examined 100 blood films, encompassing 23 different hematological diseases, reactive or normal cases. The study revealed that with real-time image transmission in live scanning mode of operation, the telepathology system was able to aid reviewers in achieving excellent accuracy, that is correct interpretation of morphologic abnormalities obtained in 83/84 of the hematologic diseases and 12/12 of the reactive/normal conditions (Sensitivity: 0.99; Specificity: 1.00). In contrast, when only saved static images in digital capture mode of operation were reviewed remotely, interpretative omissions occurred in 8/84 of the hematologic diseases and 0/12 of the reactive/normal conditions (Sensitivity: 0.91; Specificity: 1.00). It is hypothesized that real-time operator-reviewer communication during live scanning played an important role in the identification of key morphologic abnormalities for review. Our study showed the Panoptiq system can be adopted reliably as a dynamic telepathology tool in aiding community laboratories in the triage of PBF cases for external diagnostic consultation. © 2014 John Wiley & Sons Ltd.

Disorders Related to Use of Psychoactive Substances in DSM-5: Changes and Challenges.

PubMed

Bhad, Roshan; Lal, Rakesh; Balhara, Yatan Pal Singh

2015-01-01

In the most recent edition of Diagnostic and Statistical Manual (DSM) that is DSM-5 many modifications have been made in substance use disorder section. These include changes in terminology; sections and categories; diagnostic criteria; threshold for diagnosis; severity; and specifier. Additionally, there have been certain additions and omissions from the earlier version. Critical evaluation of the changes made to the section on disorders related to use of psychoactive substances in India context has not been published so far. The current paper presents a critique of the changes made to the substance use disorder section in DSM-5. The rationale for these changes put forth by DSM-5 work group on substance related disorders have been discussed. Additionally, attempt has been made to highlight the possible future challenges consequent to the current nosological revision for substance use disorder category. Overall DSM-5 seems to be promising in fulfilling its goal of DSM-ICD harmonisation and movement towards an internationally compatible and practical diagnostic system for mental health disorders. It has increased the scope of addiction by inclusion of behavioural addiction. It has also tried to balance the categorical and dimensional approach to diagnosis. However, the real test of this newer edition of one of the most commonly used nosological systems will be during clinical care and research. This will help address the debatable issues regarding the changes that DSM-5 brings with it.

"First, know thyself": cognition and error in medicine.

PubMed

Elia, Fabrizio; Aprà, Franco; Verhovez, Andrea; Crupi, Vincenzo

2016-04-01

Although error is an integral part of the world of medicine, physicians have always been little inclined to take into account their own mistakes and the extraordinary technological progress observed in the last decades does not seem to have resulted in a significant reduction in the percentage of diagnostic errors. The failure in the reduction in diagnostic errors, notwithstanding the considerable investment in human and economic resources, has paved the way to new strategies which were made available by the development of cognitive psychology, the branch of psychology that aims at understanding the mechanisms of human reasoning. This new approach led us to realize that we are not fully rational agents able to take decisions on the basis of logical and probabilistically appropriate evaluations. In us, two different and mostly independent modes of reasoning coexist: a fast or non-analytical reasoning, which tends to be largely automatic and fast-reactive, and a slow or analytical reasoning, which permits to give rationally founded answers. One of the features of the fast mode of reasoning is the employment of standardized rules, termed "heuristics." Heuristics lead physicians to correct choices in a large percentage of cases. Unfortunately, cases exist wherein the heuristic triggered fails to fit the target problem, so that the fast mode of reasoning can lead us to unreflectively perform actions exposing us and others to variable degrees of risk. Cognitive errors arise as a result of these cases. Our review illustrates how cognitive errors can cause diagnostic problems in clinical practice.

29 CFR 15.41 - Allowable claims.

Code of Federal Regulations, 2010 CFR

2010-07-01

... persons or property arising out of an act or omission of a student enrolled in the Job Corps may be... omission which gave rise to the claim took place at the center to which the student involved was assigned, or (ii) If the student involved was not within the geographical limits of his hometown and was within...

7 CFR 1.51 - Claims based on negligence, wrongful act or omission.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 7 Agriculture 1 2013-01-01 2013-01-01 false Claims based on negligence, wrongful act or omission. 1.51 Section 1.51 Agriculture Office of the Secretary of Agriculture ADMINISTRATIVE REGULATIONS... Department of Agriculture (USDA) may, subject to the provisions of the FTCA and DOJ regulations, consider...

Assessing Plural Morphology in Children Acquiring /S/-Leniting Dialects of Spanish

ERIC Educational Resources Information Center

Miller, Karen

2014-01-01

Purpose: To examine the production of plural morphology in children acquiring a dialect of Spanish with syllable-final /s/ lenition with the goal of comparing how plural marker omissions in the speech of these children compare with plural marker omissions in children with language impairment acquiring other varieties of Spanish. Method: Three…