Embracing Errors in Simulation-Based Training: The Effect of Error Training on Retention and Transfer of Central Venous Catheter Skills.

PubMed

Gardner, Aimee K; Abdelfattah, Kareem; Wiersch, John; Ahmed, Rami A; Willis, Ross E

2015-01-01

Error management training is an approach that encourages exposure to errors during initial skill acquisition so that learners can be equipped with important error identification, management, and metacognitive skills. The purpose of this study was to determine how an error-focused training program affected performance, retention, and transfer of central venous catheter (CVC) placement skills when compared with traditional training methodologies. Surgical interns (N = 30) participated in a 1-hour session featuring an instructional video and practice performing internal jugular (IJ) and subclavian (SC) CVC placement with guided instruction. All interns underwent baseline knowledge and skill assessment for IJ and SC (pretest) CVC placement; watched a "correct-only" (CO) or "correct + error" (CE) instructional video; practiced for 30 minutes; and were posttested on knowledge and IJ and SC CVC placement. Skill retention and transfer (femoral CVC placement) were assessed 30 days later. All skills tests (pretest, posttest, and transfer) were videorecorded and deidentified for evaluation by a single blinded instructor using a validated 17-item checklist. Both the groups exhibited significant improvements (p < 0.001) in knowledge and skills after the 1-hour training program, but the increase of items achieved on the performance checklist did not differ between conditions (CO: IJ Δ = 35%, SC Δ = 29%; CE: IJ Δ = 36%, subclavian Δ = 33%). However, 1 month later, the CO group exhibited significant declines in skill retention on IJ CVC placement (from 68% at posttraining to 44% at day 30; p < 0.05) and SC CVC placement (from 63% at posttraining to 49% at day 30; p < 0.05), whereas the CE group did not have significant decreases in performance. The CE group performed significantly better on femoral CVC placement (i.e., transfer task; 62% vs 38%; p < 0.01) and on 2 of the 3 complication scenarios (p < 0.05) when compared with the CO group. These data indicate that incorporating error-based activities and discussions into training programs can be beneficial for skill retention and transfer. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Endoscopic non-technical skills team training: the next step in quality assurance of endoscopy training.

PubMed

Matharoo, Manmeet; Haycock, Adam; Sevdalis, Nick; Thomas-Gibson, Siwan

2014-12-14

To investigate whether novel, non-technical skills training for Bowel Cancer Screening (BCS) endoscopy teams enhanced patient safety knowledge and attitudes. A novel endoscopy team training intervention for BCS teams was developed and evaluated as a pre-post intervention study. Four multi-disciplinary BCS teams constituting BCS endoscopist(s), specialist screening practitioners, endoscopy nurses and administrative staff (A) from English BCS training centres participated. No patients were involved in this study. Expert multidisciplinary faculty delivered a single day's training utilising real clinical examples. Pre and post-course evaluation comprised participants' patient safety awareness, attitudes, and knowledge. Global course evaluations were also collected. Twenty-three participants attended and their patient safety knowledge improved significantly from 43%-55% (P ≤ 0.001) following the training intervention. 12/41 (29%) of the safety attitudes items significantly improved in the areas of perceived patient safety knowledge and awareness. The remaining safety attitude items: perceived influence on patient safety, attitudes towards error management, error management actions and personal views following an error were unchanged following training. Both qualitative and quantitative global course evaluations were positive: 21/23 (91%) participants strongly agreed/agreed that they were satisfied with the course. Qualitative evaluation included mandating such training for endoscopy teams outside BCS and incorporating team training within wider endoscopy training. Limitations of the study include no measure of increased patient safety in clinical practice following training. A novel comprehensive training package addressing patient safety, non-technical skills and adverse event analysis was successful in improving multi-disciplinary teams' knowledge and safety attitudes.

Endoscopic non-technical skills team training: The next step in quality assurance of endoscopy training

PubMed Central

Matharoo, Manmeet; Haycock, Adam; Sevdalis, Nick; Thomas-Gibson, Siwan

2014-01-01

AIM: To investigate whether novel, non-technical skills training for Bowel Cancer Screening (BCS) endoscopy teams enhanced patient safety knowledge and attitudes. METHODS: A novel endoscopy team training intervention for BCS teams was developed and evaluated as a pre-post intervention study. Four multi-disciplinary BCS teams constituting BCS endoscopist(s), specialist screening practitioners, endoscopy nurses and administrative staff (A) from English BCS training centres participated. No patients were involved in this study. Expert multidisciplinary faculty delivered a single day’s training utilising real clinical examples. Pre and post-course evaluation comprised participants’ patient safety awareness, attitudes, and knowledge. Global course evaluations were also collected. RESULTS: Twenty-three participants attended and their patient safety knowledge improved significantly from 43%-55% (P ≤ 0.001) following the training intervention. 12/41 (29%) of the safety attitudes items significantly improved in the areas of perceived patient safety knowledge and awareness. The remaining safety attitude items: perceived influence on patient safety, attitudes towards error management, error management actions and personal views following an error were unchanged following training. Both qualitative and quantitative global course evaluations were positive: 21/23 (91%) participants strongly agreed/agreed that they were satisfied with the course. Qualitative evaluation included mandating such training for endoscopy teams outside BCS and incorporating team training within wider endoscopy training. Limitations of the study include no measure of increased patient safety in clinical practice following training. CONCLUSION: A novel comprehensive training package addressing patient safety, non-technical skills and adverse event analysis was successful in improving multi-disciplinary teams’ knowledge and safety attitudes. PMID:25516665

A randomized controlled trial on errorless learning in goal management training: study rationale and protocol

PubMed Central

2013-01-01

Background Many brain-injured patients referred for outpatient rehabilitation have executive deficits, notably difficulties with planning, problem-solving and goal directed behaviour. Goal Management Training (GMT) has proven to be an efficacious cognitive treatment for these problems. GMT entails learning and applying an algorithm, in which daily tasks are subdivided into multiple steps. Main aim of the present study is to examine whether using an errorless learning approach (preventing the occurrence of errors during the acquisition phase of learning) contributes to the efficacy of Goal Management Training in the performance of complex daily tasks. Methods/Design The study is a double blind randomized controlled trial, in which the efficacy of Goal Management Training with an errorless learning approach will be compared with conventional Goal Management Training, based on trial and error learning. In both conditions 32 patients with acquired brain injury of mixed etiology will be examined. Main outcome measure will be the performance on two individually chosen everyday-tasks before and after treatment, using a standardized observation scale and goal attainment scaling. Discussion This is the first study that introduces errorless learning in Goal Management Training. It is expected that the GMT-errorless learning approach will improve the execution of complex daily tasks in brain-injured patients with executive deficits. The study can contribute to a better treatment of executive deficits in cognitive rehabilitation. Trial registration (Dutch Trial Register): http://NTR3567 PMID:23786651

Beyond crisis resource management: new frontiers in human factors training for acute care medicine.

PubMed

Petrosoniak, Andrew; Hicks, Christopher M

2013-12-01

Error is ubiquitous in medicine, particularly during critical events and resuscitation. A significant proportion of adverse events can be attributed to inadequate team-based skills such as communication, leadership, situation awareness and resource utilization. Aviation-based crisis resource management (CRM) training using high-fidelity simulation has been proposed as a strategy to improve team behaviours. This review will address key considerations in CRM training and outline recommendations for the future of human factors education in healthcare. A critical examination of the current literature yields several important considerations to guide the development and implementation of effective simulation-based CRM training. These include defining a priori domain-specific objectives, creating an immersive environment that encourages deliberate practice and transfer-appropriate processing, and the importance of effective team debriefing. Building on research from high-risk industry, we suggest that traditional CRM training may be augmented with new training techniques that promote the development of shared mental models for team and task processes, address the effect of acute stress on team performance, and integrate strategies to improve clinical reasoning and the detection of cognitive errors. The evolution of CRM training involves a 'Triple Threat' approach that integrates mental model theory for team and task processes, training for stressful situations and metacognition and error theory towards a more comprehensive training paradigm, with roots in high-risk industry and cognitive psychology. Further research is required to evaluate the impact of this approach on patient-oriented outcomes.

Error management for musicians: an interdisciplinary conceptual framework

PubMed Central

Kruse-Weber, Silke; Parncutt, Richard

2014-01-01

Musicians tend to strive for flawless performance and perfection, avoiding errors at all costs. Dealing with errors while practicing or performing is often frustrating and can lead to anger and despair, which can explain musicians’ generally negative attitude toward errors and the tendency to aim for flawless learning in instrumental music education. But even the best performances are rarely error-free, and research in general pedagogy and psychology has shown that errors provide useful information for the learning process. Research in instrumental pedagogy is still neglecting error issues; the benefits of risk management (before the error) and error management (during and after the error) are still underestimated. It follows that dealing with errors is a key aspect of music practice at home, teaching, and performance in public. And yet, to be innovative, or to make their performance extraordinary, musicians need to risk errors. Currently, most music students only acquire the ability to manage errors implicitly – or not at all. A more constructive, creative, and differentiated culture of errors would balance error tolerance and risk-taking against error prevention in ways that enhance music practice and music performance. The teaching environment should lay the foundation for the development of such an approach. In this contribution, we survey recent research in aviation, medicine, economics, psychology, and interdisciplinary decision theory that has demonstrated that specific error-management training can promote metacognitive skills that lead to better adaptive transfer and better performance skills. We summarize how this research can be applied to music, and survey-relevant research that is specifically tailored to the needs of musicians, including generic guidelines for risk and error management in music teaching and performance. On this basis, we develop a conceptual framework for risk management that can provide orientation for further music education and musicians at all levels. PMID:25120501

Error management for musicians: an interdisciplinary conceptual framework.

PubMed

Kruse-Weber, Silke; Parncutt, Richard

2014-01-01

Musicians tend to strive for flawless performance and perfection, avoiding errors at all costs. Dealing with errors while practicing or performing is often frustrating and can lead to anger and despair, which can explain musicians' generally negative attitude toward errors and the tendency to aim for flawless learning in instrumental music education. But even the best performances are rarely error-free, and research in general pedagogy and psychology has shown that errors provide useful information for the learning process. Research in instrumental pedagogy is still neglecting error issues; the benefits of risk management (before the error) and error management (during and after the error) are still underestimated. It follows that dealing with errors is a key aspect of music practice at home, teaching, and performance in public. And yet, to be innovative, or to make their performance extraordinary, musicians need to risk errors. Currently, most music students only acquire the ability to manage errors implicitly - or not at all. A more constructive, creative, and differentiated culture of errors would balance error tolerance and risk-taking against error prevention in ways that enhance music practice and music performance. The teaching environment should lay the foundation for the development of such an approach. In this contribution, we survey recent research in aviation, medicine, economics, psychology, and interdisciplinary decision theory that has demonstrated that specific error-management training can promote metacognitive skills that lead to better adaptive transfer and better performance skills. We summarize how this research can be applied to music, and survey-relevant research that is specifically tailored to the needs of musicians, including generic guidelines for risk and error management in music teaching and performance. On this basis, we develop a conceptual framework for risk management that can provide orientation for further music education and musicians at all levels.

[Innovative training for enhancing patient safety. Safety culture and integrated concepts].

PubMed

Rall, M; Schaedle, B; Zieger, J; Naef, W; Weinlich, M

2002-11-01

Patient safety is determined by the performance safety of the medical team. Errors in medicine are amongst the leading causes of death of hospitalized patients. These numbers call for action. Backgrounds, methods and new forms of training are introduced in this article. Concepts from safety research are transformed to the field of emergency medical treatment. Strategies from realistic patient simulator training sessions and innovative training concepts are discussed. The reasons for the high numbers of errors in medicine are not due to a lack of medical knowledge, but due to human factors and organisational circumstances. A first step towards an improved patient safety is to accept this. We always need to be prepared that errors will occur. A next step would be to separate "error" from guilt (culture of blame) allowing for a real analysis of accidents and establishment of meaningful incident reporting systems. Concepts with a good success record from aviation like "crew resource management" (CRM) training have been adapted my medicine and are ready to use. These concepts require theoretical education as well as practical training. Innovative team training sessions using realistic patient simulator systems with video taping (for self reflexion) and interactive debriefing following the sessions are very promising. As the need to reduce error rates in medicine is very high and the reasons, methods and training concepts are known, we are urged to implement these new training concepts widely and consequently. To err is human - not to counteract it is not.

Implementing an error disclosure coaching model: A multicenter case study.

PubMed

White, Andrew A; Brock, Douglas M; McCotter, Patricia I; Shannon, Sarah E; Gallagher, Thomas H

2017-01-01

National guidelines call for health care organizations to provide around-the-clock coaching for medical error disclosure. However, frontline clinicians may not always seek risk managers for coaching. As part of a demonstration project designed to improve patient safety and reduce malpractice liability, we trained multidisciplinary disclosure coaches at 8 health care organizations in Washington State. The training was highly rated by participants, although not all emerged confident in their coaching skill. This multisite intervention can serve as a model for other organizations looking to enhance existing disclosure capabilities. Success likely requires cultural change and repeated practice opportunities for coaches. © 2017 American Society for Healthcare Risk Management of the American Hospital Association.

Airline Crew Training

NASA Technical Reports Server (NTRS)

1989-01-01

The discovery that human error has caused many more airline crashes than mechanical malfunctions led to an increased emphasis on teamwork and coordination in airline flight training programs. Human factors research at Ames Research Center has produced two crew training programs directed toward more effective operations. Cockpit Resource Management (CRM) defines areas like decision making, workload distribution, communication skills, etc. as essential in addressing human error problems. In 1979, a workshop led to the implementation of the CRM program by United Airlines, and later other airlines. In Line Oriented Flight Training (LOFT), crews fly missions in realistic simulators while instructors induce emergency situations requiring crew coordination. This is followed by a self critique. Ames Research Center continues its involvement with these programs.

Understanding the Impact of Training on Performance

DTIC Science & Technology

2014-05-01

learning argue that this method encourages metacognitive activity and self -regulation of learning; which, in turn, can aid the development of adaptable...Frese, M. (2005). Self -regulation in error management training: Emotion control and metacognition as mediators of performance effects. Journal...on aptitude by treatment interactions that indicate the effectiveness of training interventions can differ depending on trainee aptitude for self

Error framing effects on performance: cognitive, motivational, and affective pathways.

PubMed

Steele-Johnson, Debra; Kalinoski, Zachary T

2014-01-01

Our purpose was to examine whether positive error framing, that is, making errors salient and cuing individuals to see errors as useful, can benefit learning when task exploration is constrained. Recent research has demonstrated the benefits of a newer approach to training, that is, error management training, that includes the opportunity to actively explore the task and framing errors as beneficial to learning complex tasks (Keith & Frese, 2008). Other research has highlighted the important role of errors in on-the-job learning in complex domains (Hutchins, 1995). Participants (N = 168) from a large undergraduate university performed a class scheduling task. Results provided support for a hypothesized path model in which error framing influenced cognitive, motivational, and affective factors which in turn differentially affected performance quantity and quality. Within this model, error framing had significant direct effects on metacognition and self-efficacy. Our results suggest that positive error framing can have beneficial effects even when tasks cannot be structured to support extensive exploration. Whereas future research can expand our understanding of error framing effects on outcomes, results from the current study suggest that positive error framing can facilitate learning from errors in real-time performance of tasks.

Integrating Safety in the Aviation System: Interdepartmental Training for Pilots and Maintenance Technicians

NASA Technical Reports Server (NTRS)

Mattson, Marifran; Petrin, Donald A.; Young, John P.

2001-01-01

The study of human factors has had a decisive impact on the aviation industry. However, the entire aviation system often is not considered in researching, training, and evaluating human factors issues especially with regard to safety. In both conceptual and practical terms, we argue for the proactive management of human error from both an individual and organizational systems perspective. The results of a multidisciplinary research project incorporating survey data from professional pilots and maintenance technicians and an exploratory study integrating students from relevant disciplines are reported. Survey findings suggest that latent safety errors may occur during the maintenance discrepancy reporting process because pilots and maintenance technicians do not effectively interact with one another. The importance of interdepartmental or cross-disciplinary training for decreasing these errors and increasing safety is discussed as a primary implication.

Learning from Past Classification Errors: Exploring Methods for Improving the Performance of a Deep Learning-based Building Extraction Model through Quantitative Analysis of Commission Errors for Optimal Sample Selection

NASA Astrophysics Data System (ADS)

Swan, B.; Laverdiere, M.; Yang, L.

2017-12-01

In the past five years, deep Convolutional Neural Networks (CNN) have been increasingly favored for computer vision applications due to their high accuracy and ability to generalize well in very complex problems; however, details of how they function and in turn how they may be optimized are still imperfectly understood. In particular, their complex and highly nonlinear network architecture, including many hidden layers and self-learned parameters, as well as their mathematical implications, presents open questions about how to effectively select training data. Without knowledge of the exact ways the model processes and transforms its inputs, intuition alone may fail as a guide to selecting highly relevant training samples. Working in the context of improving a CNN-based building extraction model used for the LandScan USA gridded population dataset, we have approached this problem by developing a semi-supervised, highly-scalable approach to select training samples from a dataset of identified commission errors. Due to the large scope this project, tens of thousands of potential samples could be derived from identified commission errors. To efficiently trim those samples down to a manageable and effective set for creating additional training sample, we statistically summarized the spectral characteristics of areas with rates of commission errors at the image tile level and grouped these tiles using affinity propagation. Highly representative members of each commission error cluster were then used to select sites for training sample creation. The model will be incrementally re-trained with the new training data to allow for an assessment of how the addition of different types of samples affects the model performance, such as precision and recall rates. By using quantitative analysis and data clustering techniques to select highly relevant training samples, we hope to improve model performance in a manner that is resource efficient, both in terms of training process and in sample creation.

Crew resource management: using aviation techniques to improve operating room safety.

PubMed

Ricci, Michael A; Brumsted, John R

2012-04-01

Since the publication of the Institute of Medicine report estimating nearly 100,000 deaths per year from medical errors, hospitals and physicians have a renewed focus upon error reduction. We implemented a surgical crew resource management (CRM) program for all operating room (OR) personnel. In our academic medical center, 19,000 procedures per year are performed in 27 operating rooms. Mandatory CRM training was implemented for all peri-operative personnel. Aviation techniques introduced included a pre-operative checklist and brief, post-operative debrief, read and initial files, and various other aviation-based techniques. Compliance with conduct of the brief/debrief was monitored as well as wrong-site surgeries and retained foreign body events. The malpractice insurance database for claims was also queried for the period prior to and after training. Initial training was accomplished for 517 people, including all anesthesiologists, surgeons, nurses, technicians, and OR assistants. Pre-operative briefing increased from 6.7 to 99% within 4 mo. Wrong site surgeries and retained foreign bodies decreased from a high of seven in 2007 to none in 2008, but, after 14 mo without additional training, these rose to five in 2009. Malpractice expenses (payouts and legal fees) totaled $793,000 (2003-2007), but have been zero since 2008. CRM training and implementation had an impact on reducing the incidence of wrong site surgery and retained foreign bodies in our operating rooms. However, constant reinforcement and refresher training is necessary for sustained results. Though no one technique can prevent all errors, CRM can effect culture change, producing a safer environment.

Analyzing human errors in flight mission operations

NASA Technical Reports Server (NTRS)

Bruno, Kristin J.; Welz, Linda L.; Barnes, G. Michael; Sherif, Josef

1993-01-01

A long-term program is in progress at JPL to reduce cost and risk of flight mission operations through a defect prevention/error management program. The main thrust of this program is to create an environment in which the performance of the total system, both the human operator and the computer system, is optimized. To this end, 1580 Incident Surprise Anomaly reports (ISA's) from 1977-1991 were analyzed from the Voyager and Magellan projects. A Pareto analysis revealed that 38 percent of the errors were classified as human errors. A preliminary cluster analysis based on the Magellan human errors (204 ISA's) is presented here. The resulting clusters described the underlying relationships among the ISA's. Initial models of human error in flight mission operations are presented. Next, the Voyager ISA's will be scored and included in the analysis. Eventually, these relationships will be used to derive a theoretically motivated and empirically validated model of human error in flight mission operations. Ultimately, this analysis will be used to make continuous process improvements continuous process improvements to end-user applications and training requirements. This Total Quality Management approach will enable the management and prevention of errors in the future.

General purpose architecture for intelligent computer-aided training

NASA Technical Reports Server (NTRS)

Loftin, R. Bowen (Inventor); Wang, Lui (Inventor); Baffes, Paul T. (Inventor); Hua, Grace C. (Inventor)

1994-01-01

An intelligent computer-aided training system having a general modular architecture is provided for use in a wide variety of training tasks and environments. It is comprised of a user interface which permits the trainee to access the same information available in the task environment and serves as a means for the trainee to assert actions to the system; a domain expert which is sufficiently intelligent to use the same information available to the trainee and carry out the task assigned to the trainee; a training session manager for examining the assertions made by the domain expert and by the trainee for evaluating such trainee assertions and providing guidance to the trainee which are appropriate to his acquired skill level; a trainee model which contains a history of the trainee interactions with the system together with summary evaluative data; an intelligent training scenario generator for designing increasingly complex training exercises based on the current skill level contained in the trainee model and on any weaknesses or deficiencies that the trainee has exhibited in previous interactions; and a blackboard that provides a common fact base for communication between the other components of the system. Preferably, the domain expert contains a list of 'mal-rules' which typifies errors that are usually made by novice trainees. Also preferably, the training session manager comprises an intelligent error detection means and an intelligent error handling means. The present invention utilizes a rule-based language having a control structure whereby a specific message passing protocol is utilized with respect to tasks which are procedural or step-by-step in structure. The rules can be activated by the trainee in any order to reach the solution by any valid or correct path.

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

Decision Making Training in the Mission Operations Directorate

NASA Technical Reports Server (NTRS)

O'Keefe, William S.

2013-01-01

At JSC, we train our new flight controllers on a set of team skills that we call Space Flight Resource Management (SFRM). SFRM is akin to Crew Resource Management for the airlines and trains flight controllers to work as an effective team to reduce errors and improve safety. We have developed this training over the years with the assistance of Ames Research Center, Wyle Labs and University of Central Florida. One of the skills we teach is decision making/ problem solving (DM/PS). We teach DM/PS first in several classroom sessions, reinforce it in several part task training environments, and finally practice it in full-mission, full-team simulations. What I am proposing to talk about is this training flow: its content and how we teach it.

Physician assistants and the disclosure of medical error.

PubMed

Brock, Douglas M; Quella, Alicia; Lipira, Lauren; Lu, Dave W; Gallagher, Thomas H

2014-06-01

Evolving state law, professional societies, and national guidelines, including those of the American Medical Association and Joint Commission, recommend that patients receive transparent communication when a medical error occurs. Recommendations for error disclosure typically consist of an explanation that an error has occurred, delivery of an explicit apology, an explanation of the facts around the event, its medical ramifications and how care will be managed, and a description of how similar errors will be prevented in the future. Although error disclosure is widely endorsed in the medical and nursing literature, there is little discussion of the unique role that the physician assistant (PA) might play in these interactions. PAs are trained in the medical model and technically practice under the supervision of a physician. They are also commonly integrated into interprofessional health care teams in surgical and urgent care settings. PA practice is characterized by widely varying degrees of provider autonomy. How PAs should collaborate with physicians in sensitive error disclosure conversations with patients is unclear. With the number of practicing PAs growing rapidly in nearly all domains of medicine, their role in the error disclosure process warrants exploration. The authors call for educational societies and accrediting agencies to support policy to establish guidelines for PA disclosure of error. They encourage medical and PA researchers to explore and report best-practice disclosure roles for PAs. Finally, they recommend that PA educational programs implement trainings in disclosure skills, and hospitals and supervising physicians provide and support training for practicing PAs.

Exploring Senior Residents' Intraoperative Error Management Strategies: A Potential Measure of Performance Improvement.

PubMed

Law, Katherine E; Ray, Rebecca D; D'Angelo, Anne-Lise D; Cohen, Elaine R; DiMarco, Shannon M; Linsmeier, Elyse; Wiegmann, Douglas A; Pugh, Carla M

The study aim was to determine whether residents' error management strategies changed across 2 simulated laparoscopic ventral hernia (LVH) repair procedures after receiving feedback on their initial performance. We hypothesize that error detection and recovery strategies would improve during the second procedure without hands-on practice. Retrospective review of participant procedural performances of simulated laparoscopic ventral herniorrhaphy. A total of 3 investigators reviewed procedure videos to identify surgical errors. Errors were deconstructed. Error management events were noted, including error identification and recovery. Residents performed the simulated LVH procedures during a course on advanced laparoscopy. Participants had 30 minutes to complete a LVH procedure. After verbal and simulator feedback, residents returned 24 hours later to perform a different, more difficult simulated LVH repair. Senior (N = 7; postgraduate year 4-5) residents in attendance at the course participated in this study. In the first LVH procedure, residents committed 121 errors (M = 17.14, standard deviation = 4.38). Although the number of errors increased to 146 (M = 20.86, standard deviation = 6.15) during the second procedure, residents progressed further in the second procedure. There was no significant difference in the number of errors committed for both procedures, but errors shifted to the late stage of the second procedure. Residents changed the error types that they attempted to recover (χ 2 5 =24.96, p<0.001). For the second procedure, recovery attempts increased for action and procedure errors, but decreased for strategy errors. Residents also recovered the most errors in the late stage of the second procedure (p < 0.001). Residents' error management strategies changed between procedures following verbal feedback on their initial performance and feedback from the simulator. Errors and recovery attempts shifted to later steps during the second procedure. This may reflect residents' error management success in the earlier stages, which allowed further progression in the second simulation. Incorporating error recognition and management opportunities into surgical training could help track residents' learning curve and provide detailed, structured feedback on technical and decision-making skills. Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Use of simulation to assess electronic health record safety in the intensive care unit: a pilot study

PubMed Central

March, Christopher A; Steiger, David; Scholl, Gretchen; Mohan, Vishnu; Hersh, William R; Gold, Jeffrey A

2013-01-01

Objective To establish the role of high-fidelity simulation training to test the efficacy and safety of the electronic health record (EHR)–user interface within the intensive care unit (ICU) environment. Design Prospective pilot study. Setting Medical ICU in an academic medical centre. Participants Postgraduate medical trainees. Interventions A 5-day-simulated ICU patient was developed in the EHR including labs, hourly vitals, medication administration, ventilator settings, nursing and notes. Fourteen medical issues requiring recognition and subsequent changes in management were included. Issues were chosen based on their frequency of occurrence within the ICU and their ability to test different aspects of the EHR–user interface. ICU residents, blinded to the presence of medical errors within the case, were provided a sign-out and given 10 min to review the case in the EHR. They then presented the case with their management suggestions to an attending physician. Participants were graded on the number of issues identified. All participants were provided with immediate feedback upon completion of the simulation. Primary and secondary outcomes To determine the frequency of error recognition in an EHR simulation. To determine factors associated with improved performance in the simulation. Results 38 participants including 9 interns, 10 residents and 19 fellows were tested. The average error recognition rate was 41% (range 6–73%), which increased slightly with the level of training (35%, 41% and 50% for interns, residents, and fellows, respectively). Over-sedation was the least-recognised error (16%); poor glycemic control was most often recognised (68%). Only 32% of the participants recognised inappropriate antibiotic dosing. Performance correlated with the total number of screens used (p=0.03). Conclusions Despite development of comprehensive EHRs, there remain significant gaps in identifying dangerous medical management issues. This gap remains despite high levels of medical training, suggesting that EHR-specific training may be beneficial. Simulation provides a novel tool in order to both identify these gaps as well as foster EHR-specific training. PMID:23578685

Enhancing U.S. Army Aircrew Coordination Training

DTIC Science & Technology

2003-05-01

while decreasing the errors that lead to accidents. ACT and Crew/Cockpit Resource Management ( CRM ) programs were instituted in the 1980’s, first in...Both courses contain a fully integrated Data Management System that tracks student demographics, provides graphic feedback displays during evaluation...2 1 Appendix A Objectives, Basic Qualities, and Risk Management ...................... A-1 Appendix B Performance Evaluation Checklist

Making Management Skills a Core Component of Medical Education.

PubMed

Myers, Christopher G; Pronovost, Peter J

2017-05-01

Physicians are being called upon to engage in greater leadership and management in increasingly complex and dynamic health care organizations. Yet, management skills are largely undeveloped in medical education. Without formal management training in the medical curriculum, physicians are left to cultivate their leadership and management abilities through a haphazard array of training programs or simply through trial and error, with consequences that may range from frustration among staff to reduced quality of care and increased risk of patient harm. To address this issue, the authors posit that medical education needs a more systematic focus on topics related to management and organization, such as individual decision making, interpersonal communication, team knowledge sharing, and organizational culture. They encourage medical schools to partner with business school faculty or other organizational scholars to offer a "Management 101" course in the medical curriculum to provide physicians-in-training with an understanding of these topics and raise the quality of physician leadership and management in modern health care organizations.

Integrating team resource management program into staff training improves staff's perception and patient safety in organ procurement and transplantation: the experience in a university-affiliated medical center in Taiwan.

PubMed

Hsu, Ya-Chi; Jerng, Jih-Shuin; Chang, Ching-Wen; Chen, Li-Chin; Hsieh, Ming-Yuan; Huang, Szu-Fen; Liu, Yueh-Ping; Hung, Kuan-Yu

2014-08-11

The process involved in organ procurement and transplantation is very complex that requires multidisciplinary coordination and teamwork. To prevent error during the processes, teamwork education and training might play an important role. We wished to evaluate the efficacy of implementing a Team Resource Management (TRM) program on patient safety and the behaviors of the team members involving in the process. We implemented a TRM training program for the organ procurement and transplantation team members of the National Taiwan University Hospital (NTUH), a teaching medical center in Taiwan. This 15-month intervention included TRM education and training courses for the healthcare workers, focused group skill training for the procurement and transplantation team members, video demonstration and training, and case reviews with feedbacks. Teamwork culture was evaluated and all procurement and transplantation cases were reviewed to evaluate the application of TRM skills during the actual processes. During the intervention period, a total of 34 staff members participated the program, and 67 cases of transplantations were performed. Teamwork framework concept was the most prominent dimension that showed improvement from the participants for training. The team members showed a variety of teamwork behaviors during the process of procurement and transplantation during the intervention period. Of note, there were two potential donors with a positive HIV result, for which the procurement processed was timely and successfully terminated by the team. None of the recipients was transplanted with an infected organ. No error in communication or patient identification was noted during review of the case records. Implementation of a Team Resource Management program improves the teamwork culture as well as patient safety in organ procurement and transplantation.

Integrating team resource management program into staff training improves staff’s perception and patient safety in organ procurement and transplantation: the experience in a university-affiliated medical center in Taiwan

PubMed Central

2014-01-01

Background The process involved in organ procurement and transplantation is very complex that requires multidisciplinary coordination and teamwork. To prevent error during the processes, teamwork education and training might play an important role. We wished to evaluate the efficacy of implementing a Team Resource Management (TRM) program on patient safety and the behaviors of the team members involving in the process. Methods We implemented a TRM training program for the organ procurement and transplantation team members of the National Taiwan University Hospital (NTUH), a teaching medical center in Taiwan. This 15-month intervention included TRM education and training courses for the healthcare workers, focused group skill training for the procurement and transplantation team members, video demonstration and training, and case reviews with feedbacks. Teamwork culture was evaluated and all procurement and transplantation cases were reviewed to evaluate the application of TRM skills during the actual processes. Results During the intervention period, a total of 34 staff members participated the program, and 67 cases of transplantations were performed. Teamwork framework concept was the most prominent dimension that showed improvement from the participants for training. The team members showed a variety of teamwork behaviors during the process of procurement and transplantation during the intervention period. Of note, there were two potential donors with a positive HIV result, for which the procurement processed was timely and successfully terminated by the team. None of the recipients was transplanted with an infected organ. No error in communication or patient identification was noted during review of the case records. Conclusion Implementation of a Team Resource Management program improves the teamwork culture as well as patient safety in organ procurement and transplantation. PMID:25115403

Crew resource management training within the automotive industry: does it work?

PubMed

Marquardt, Nicki; Robelski, Swantje; Hoeger, Rainer

2010-04-01

This article presents the development, implementation, and evaluation of a crew resource management (CRM) training program specifically designed for employees within the automotive industry. The central objective of this training program was to improve communication, teamwork, and stress management skills as well to increase the workers' situational awareness of potential errors that can occur during the production process. Participants in the training program of this study were 80 employees, all of whom were working in a production unit for gearbox manufacturing. Effectiveness of the CRM training course was evaluated two times (1 month and 6 months after the training program). The results showed a significant improvement in a wide range of CRM-relevant categories, especially in teamwork-related attitudes, in addition to an increase in the workers' situational awareness after the training program. On the basis of the results, it can be stated that CRM training, which was originally developed for the aviation industry, can be transferred to the automotive industry. However, because of the lack of behavioral observations, these effects are limited to CRM attitudes and knowledge changes. Several recommendations for future research and training development in the field of human factors training are made.

Error detection and reduction in blood banking.

PubMed

Motschman, T L; Moore, S B

1996-12-01

Error management plays a major role in facility process improvement efforts. By detecting and reducing errors, quality and, therefore, patient care improve. It begins with a strong organizational foundation of management attitude with clear, consistent employee direction and appropriate physical facilities. Clearly defined critical processes, critical activities, and SOPs act as the framework for operations as well as active quality monitoring. To assure that personnel can detect an report errors they must be trained in both operational duties and error management practices. Use of simulated/intentional errors and incorporation of error detection into competency assessment keeps employees practiced, confident, and diminishes fear of the unknown. Personnel can clearly see that errors are indeed used as opportunities for process improvement and not for punishment. The facility must have a clearly defined and consistently used definition for reportable errors. Reportable errors should include those errors with potentially harmful outcomes as well as those errors that are "upstream," and thus further away from the outcome. A well-written error report consists of who, what, when, where, why/how, and follow-up to the error. Before correction can occur, an investigation to determine the underlying cause of the error should be undertaken. Obviously, the best corrective action is prevention. Correction can occur at five different levels; however, only three of these levels are directed at prevention. Prevention requires a method to collect and analyze data concerning errors. In the authors' facility a functional error classification method and a quality system-based classification have been useful. An active method to search for problems uncovers them further upstream, before they can have disastrous outcomes. In the continual quest for improving processes, an error management program is itself a process that needs improvement, and we must strive to always close the circle of quality assurance. Ultimately, the goal of better patient care will be the reward.

Simulation-based crisis resource management training for pediatric critical care medicine: a review for instructors.

PubMed

Cheng, Adam; Donoghue, Aaron; Gilfoyle, Elaine; Eppich, Walter

2012-03-01

To review the essential elements of crisis resource management and provide a resource for instructors by describing how to use simulation-based training to teach crisis resource management principles in pediatric acute care contexts. A MEDLINE-based literature source. OUTLINE OF REVIEW: This review is divided into three main sections: Background, Principles of Crisis Resource Management, and Tools and Resources. The background section provides the brief history and definition of crisis resource management. The next section describes all the essential elements of crisis resource management, including leadership and followership, communication, teamwork, resource use, and situational awareness. This is followed by a review of evidence supporting the use of simulation-based crisis resource management training in health care. The last section provides the resources necessary to develop crisis resource management training using a simulation-based approach. This includes a description of how to design pediatric simulation scenarios, how to effectively debrief, and a list of potential assessment tools that instructors can use to evaluate crisis resource management performance during simulation-based training. Crisis resource management principles form the foundation for efficient team functioning and subsequent error reduction in high-stakes environments such as acute care pediatrics. Effective instructor training is required for those programs wishing to teach these principles using simulation-based learning. Dissemination and integration of these principles into pediatric critical care practice has the potential for a tremendous impact on patient safety and outcomes.

Crew resource management training in the intensive care unit. A multisite controlled before-after study.

PubMed

Kemper, Peter F; de Bruijne, Martine; van Dyck, Cathy; So, Ralph L; Tangkau, Peter; Wagner, Cordula

2016-08-01

There is a growing awareness today that adverse events in the intensive care unit (ICU) are more often caused by problems related to non-technical skills than by a lack of technical, or clinical, expertise. Team training, such as crew resource management (CRM), aims to improve these non-technical skills. The present study evaluated the effectiveness of CRM in the ICU. Six ICUs participated in a paired controlled trial, with one pretest and two post-test measurements (after 3 and 12 months). Three ICUs received CRM training and were compared with a matched control unit. The 2-day classroom-based training was delivered to multidisciplinary groups (ie, ICU physicians, nurses, managers). All levels of Kirkpatrick's evaluation framework were assessed using a mixed method design, including questionnaires, observations and routinely administered patient outcome data. Level I-reaction: participants were very positive directly after the training. Level II-learning: attitudes towards behaviour aimed at optimising situational awareness were relatively high at baseline and remained stable. Level III-behaviour: self-reported behaviour aimed at optimising situational awareness improved in the intervention group. No changes were found in observed explicit professional oral communication. Level IV-organisation: patient outcomes were unaffected. Error management culture and job satisfaction improved in the intervention group. Patient safety culture improved in both control and intervention units. We can conclude that CRM, as delivered in the present study, does not change behaviour or patient outcomes by itself, yet changes how participants think about errors and risks. This indicates that CRM requires a combination with other initiatives in order to improve clinical outcomes. 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/

Effects of Hip Strengthening on Neuromuscular Control, Hip Strength, and Self-Reported Functional Deficits in Individuals With Chronic Ankle Instability.

PubMed

Smith, Brent I; Curtis, Denice; Docherty, Carrie L

2018-06-12

Deficits in ankle and hip strength and lower-extremity postural control are associated with chronic ankle instability (CAI). Following strength training, muscle groups demonstrate increased strength. This change is partially credited to improved neuromuscular control, and many studies have investigated ankle protocols for subjects with CAI. The effects of isolating hip musculature in strength training protocols in this population are not well understood. To examine the effects of hip strengthening on clinical and self-reported outcomes in patients with CAI. Prospective randomized controlled clinical trial. Athletic training facility. Twenty-six participants with CAI (12 males and 14 females; age = 20.9 [1.5] y, height = 170.0 [12.7] cm, and mass = 77.5 [17.5] kg) were randomly assigned to training or control groups. Participants completed either 4 weeks of supervised hip strengthening (resistance bands 3 times a week) or no intervention. Participants were assessed on 4 clinical measures (Star Excursion Balance Test in the anterior, posteromedial, and posterolateral directions; Balance Error Scoring System; hip external rotation strength; and hip abduction strength) and a patient-reported measure (the Foot and Ankle Ability Measure activities of daily living and sports subscales) before and after the 4-week training period. The training group displayed significantly improved posttest measures compared with the control group for hip abduction strength (training: 446.3 [77.4] N, control: 314.7 [49.6] N, P < .01); hip external rotation strength (training: 222.1 [48.7] N, control: 169.4 [34.6] N, P < .01); Star Excursion Balance Test reach in the anterior (training: 93.1% [7.4%], control: 90.2% [7.9%], P < .01), posteromedial (training: 96.3% [8.9%], control: 88.0% [8.8%], P < .01), and posterolateral (training: 95.4% [11.1%], control: 86.6% [9.6%], P < .01) directions; Balance Error Scoring System total errors (training: 9.9 [6.3] errors, control: 21.2 [6.3] errors, P < .01); and the Foot and Ankle Ability Measure-sports score (training: 88.0 [12.6], control: 84.8 [10.9], P < .01). Improved clinical and patient-reported outcomes in the training group suggest hip strengthening is beneficial in the management and prevention of recurrent symptoms associated with CAI.

The Transition From Event Reports to Measurable Organizational Impact: Workshop Proceedings Report

DTIC Science & Technology

2014-03-01

Airlines Colin Drury - - - - - - - - - - - - - Applied Ergonomics Douglas Farrow - - - - - - - - - - - - - - - FAA AFS-280 Terry Gober... cost , at their Seattle location. Also, Boeing supports presentations regarding MEDA at international conferences, which greatly increased the number...approach to a true safety culture involves human factors and error management training that includes management; a Just Policy and accountability , an

Improving pneumonia case-management in Benin: a randomized trial of a multi-faceted intervention to support health worker adherence to Integrated Management of Childhood Illness guidelines

PubMed Central

Osterholt, Dawn M; Onikpo, Faustin; Lama, Marcel; Deming, Michael S; Rowe, Alexander K

2009-01-01

Background Pneumonia is a leading cause of death among children under five years of age. The Integrated Management of Childhood Illness strategy can improve the quality of care for pneumonia and other common illnesses in developing countries, but adherence to these guidelines could be improved. We evaluated an intervention in Benin to support health worker adherence to the guidelines after training, focusing on pneumonia case management. Methods We conducted a randomized trial. After a health facility survey in 1999 to assess health care quality before Integrated Management of Childhood Illness training, health workers received training plus either study supports (job aids, non-financial incentives and supervision of workers and supervisors) or "usual" supports. Follow-up surveys were conducted in 2001, 2002 and 2004. Outcomes were indicators of health care quality for Integrated Management-defined pneumonia. Further analyses included a graphical pathway analysis and multivariable logistic regression modelling to identify factors influencing case-management quality. Results We observed 301 consultations of children with non-severe pneumonia that were performed by 128 health workers in 88 public and private health facilities. Although outcomes improved in both intervention and control groups, we found no statistically significant difference between groups. However, training proceeded slowly, and low-quality care from untrained health workers diluted intervention effects. Per-protocol analyses suggested that health workers with training plus study supports performed better than those with training plus usual supports (20.4 and 19.2 percentage-point improvements for recommended treatment [p = 0.08] and "recommended or adequate" treatment [p = 0.01], respectively). Both groups tended to perform better than untrained health workers. Analyses of treatment errors revealed that incomplete assessment and difficulties processing clinical findings led to missed pneumonia diagnoses, and missed diagnoses led to inadequate treatment. Increased supervision frequency was associated with better care (odds ratio for recommended treatment = 2.1 [95% confidence interval: 1.1-3.9] per additional supervisory visit). Conclusion Integrated Management of Childhood Illness training was useful, but insufficient, to achieve high-quality pneumonia case management. Our study supports led to additional improvements, although large gaps in performance still remained. A simple graphical pathway analysis can identify specific, common errors that health workers make in the case-management process; this information could be used to target quality improvement activities, such as supervision (ClinicalTrials.gov number NCT00510679). PMID:19712484

Simulation Based Training Improves Airway Management for Helicopter EMS Teams

NASA Technical Reports Server (NTRS)

Dhindsa, Harinder S.; Reid, Renee; Murray, David; Lovelady, James; Powell, Katie; Sayles, Jeff; Stevenson, Christopher; Baker, Kathy; Solada, Brian; Carroll, Scott;

Do Old Errors Always Lead to New Truths? A Randomized Controlled Trial of Errorless Goal Management Training in Brain-Injured Patients.

PubMed

Bertens, Dirk; Kessels, Roy P C; Fiorenzato, Eleonora; Boelen, Danielle H E; Fasotti, Luciano

2015-09-01

Both errorless learning (EL) and Goal Management Training (GMT) have been shown effective cognitive rehabilitation methods aimed at optimizing the performance on everyday skills after brain injury. We examine whether a combination of EL and GMT is superior to traditional GMT for training complex daily tasks in brain-injured patients with executive dysfunction. This was an assessor-blinded randomized controlled trial conducted in 67 patients with executive impairments due to brain injury of non-progressive nature (minimal post-onset time: 3 months), referred for outpatient rehabilitation. Individually selected everyday tasks were trained using 8 sessions of an experimental combination of EL and GMT or via conventional GMT, which follows a trial-and-error approach. Primary outcome measure was everyday task performance assessed after treatment compared to baseline. Goal attainment scaling, rated by both trainers and patients, was used as secondary outcome measure. EL-GMT improved everyday task performance significantly more than conventional GMT (adjusted difference 15.43, 95% confidence interval [CI] [4.52, 26.35]; Cohen's d=0.74). Goal attainment, as scored by the trainers, was significantly higher after EL-GMT compared to conventional GMT (mean difference 7.34, 95% CI [2.99, 11.68]; Cohen's d=0.87). The patients' goal attainment scores did not differ between the two treatment arms (mean difference 3.51, 95% CI [-1.41, 8.44]). Our study is the first to show that preventing the occurrence of errors during executive strategy training enhances the acquisition of everyday activities. A combined EL-GMT intervention is a valuable contribution to cognitive rehabilitation in clinical practice.

Team Performance and Error Management in Chinese and American Simulated Flight Crews: The Role of Cultural and Individual Differences

NASA Technical Reports Server (NTRS)

Davis, Donald D.; Bryant, Janet L.; Tedrow, Lara; Liu, Ying; Selgrade, Katherine A.; Downey, Heather J.

2005-01-01

This report describes results of a study conducted for NASA-Langley Research Center. This study is part of a program of research conducted for NASA-LARC that has focused on identifying the influence of national culture on the performance of flight crews. We first reviewed the literature devoted to models of teamwork and team performance, crew resource management, error management, and cross-cultural psychology. Davis (1999) reported the results of this review and presented a model that depicted how national culture could influence teamwork and performance in flight crews. The second study in this research program examined accident investigations of foreign airlines in the United States conducted by the National Transportation Safety Board (NTSB). The ability of cross-cultural values to explain national differences in flight outcomes was examined. Cultural values were found to covary in a predicted way with national differences, but the absence of necessary data in the NTSB reports and limitations in the research method that was used prevented a clear understanding of the causal impact of cultural values. Moreover, individual differences such as personality traits were not examined in this study. Davis and Kuang (2001) report results of this second study. The research summarized in the current report extends this previous research by directly assessing cultural and individual differences among students from the United States and China who were trained to fly in a flight simulator using desktop computer workstations. The research design used in this study allowed delineation of the impact of national origin, cultural values, personality traits, cognitive style, shared mental model, and task workload on teamwork, error management and flight outcomes. We briefly review the literature that documents the importance of teamwork and error management and its impact on flight crew performance. We next examine teamwork and crew resource management training designed to improve teamwork. This is followed by discussion of the potential influence of national culture on teamwork and crew resource management. We then examine the influence of other individual and team differences, such as personality traits, cognitive style, shared mental model, and task workload. We provide a heuristic model that depicts the influence of national culture and individual differences on teamwork, error management and flight outcomes. The results demonstrate the usefulness of the model for future research.

Human factors of advanced technology (glass cockpit) transport aircraft

NASA Technical Reports Server (NTRS)

Wiener, Earl L.

1989-01-01

A three-year study of airline crews at two U.S. airlines who were flying an advanced technology aircraft, the Boeing 757 is discussed. The opinions and experiences of these pilots as they view the advanced, automated features of this aircraft, and contrast them with previous models they have flown are discussed. Training for advanced automation; (2) cockpit errors and error reduction; (3) management of cockpit workload; and (4) general attitudes toward cockpit automation are emphasized. The limitations of the air traffic control (ATC) system on the ability to utilize the advanced features of the new aircraft are discussed. In general the pilots are enthusiastic about flying an advanced technology aircraft, but they express mixed feelings about the impact of automation on workload, crew errors, and ability to manage the flight.

Software platform for managing the classification of error- related potentials of observers

NASA Astrophysics Data System (ADS)

Asvestas, P.; Ventouras, E.-C.; Kostopoulos, S.; Sidiropoulos, K.; Korfiatis, V.; Korda, A.; Uzunolglu, A.; Karanasiou, I.; Kalatzis, I.; Matsopoulos, G.

2015-09-01

Human learning is partly based on observation. Electroencephalographic recordings of subjects who perform acts (actors) or observe actors (observers), contain a negative waveform in the Evoked Potentials (EPs) of the actors that commit errors and of observers who observe the error-committing actors. This waveform is called the Error-Related Negativity (ERN). Its detection has applications in the context of Brain-Computer Interfaces. The present work describes a software system developed for managing EPs of observers, with the aim of classifying them into observations of either correct or incorrect actions. It consists of an integrated platform for the storage, management, processing and classification of EPs recorded during error-observation experiments. The system was developed using C# and the following development tools and frameworks: MySQL, .NET Framework, Entity Framework and Emgu CV, for interfacing with the machine learning library of OpenCV. Up to six features can be computed per EP recording per electrode. The user can select among various feature selection algorithms and then proceed to train one of three types of classifiers: Artificial Neural Networks, Support Vector Machines, k-nearest neighbour. Next the classifier can be used for classifying any EP curve that has been inputted to the database.

Monitoring Student Immunization, Screening, and Training Records for Clinical Compliance: An Innovative Use of the Institutional Learning Management System.

PubMed

Elting, Julie Kientz

2017-12-13

Clinical compliance for nursing students is a complex process mandating them to meet facility employee occupational health requirements for immunization, screening, and training prior to patient contact. Nursing programs monitor clinical compliance with in-house management of student records, either paper or electronic, or by contracting with a vendor specializing in online record tracking. Regardless of method, the nursing program remains fully accountable for student preparation and bears the consequences of errors. This article describes how the institution's own learning management system can be used as an accurate, cost-neutral, user-friendly, and Federal Educational Rights Protection Act-compliant clinical compliance system.

Review of medication errors that are new or likely to occur more frequently with electronic medication management systems.

PubMed

Van de Vreede, Melita; McGrath, Anne; de Clifford, Jan

2018-05-14

Objective. The aim of the present study was to identify and quantify medication errors reportedly related to electronic medication management systems (eMMS) and those considered likely to occur more frequently with eMMS. This included developing a new classification system relevant to eMMS errors. Methods. Eight Victorian hospitals with eMMS participated in a retrospective audit of reported medication incidents from their incident reporting databases between May and July 2014. Site-appointed project officers submitted deidentified incidents they deemed new or likely to occur more frequently due to eMMS, together with the Incident Severity Rating (ISR). The authors reviewed and classified incidents. Results. There were 5826 medication-related incidents reported. In total, 93 (47 prescribing errors, 46 administration errors) were identified as new or potentially related to eMMS. Only one ISR2 (moderate) and no ISR1 (severe or death) errors were reported, so harm to patients in this 3-month period was minimal. The most commonly reported error types were 'human factors' and 'unfamiliarity or training' (70%) and 'cross-encounter or hybrid system errors' (22%). Conclusions. Although the results suggest that the errors reported were of low severity, organisations must remain vigilant to the risk of new errors and avoid the assumption that eMMS is the panacea to all medication error issues. What is known about the topic? eMMS have been shown to reduce some types of medication errors, but it has been reported that some new medication errors have been identified and some are likely to occur more frequently with eMMS. There are few published Australian studies that have reported on medication error types that are likely to occur more frequently with eMMS in more than one organisation and that include administration and prescribing errors. What does this paper add? This paper includes a new simple classification system for eMMS that is useful and outlines the most commonly reported incident types and can inform organisations and vendors on possible eMMS improvements. The paper suggests a new classification system for eMMS medication errors. What are the implications for practitioners? The results of the present study will highlight to organisations the need for ongoing review of system design, refinement of workflow issues, staff education and training and reporting and monitoring of errors.

Cognitive decision errors and organization vulnerabilities in nuclear power plant safety management: Modeling using the TOGA meta-theory framework

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

Cappelli, M.; Gadomski, A. M.; Sepiellis, M.

In the field of nuclear power plant (NPP) safety modeling, the perception of the role of socio-cognitive engineering (SCE) is continuously increasing. Today, the focus is especially on the identification of human and organization decisional errors caused by operators and managers under high-risk conditions, as evident by analyzing reports on nuclear incidents occurred in the past. At present, the engineering and social safety requirements need to enlarge their domain of interest in such a way to include all possible losses generating events that could be the consequences of an abnormal state of a NPP. Socio-cognitive modeling of Integrated Nuclear Safetymore » Management (INSM) using the TOGA meta-theory has been discussed during the ICCAP 2011 Conference. In this paper, more detailed aspects of the cognitive decision-making and its possible human errors and organizational vulnerability are presented. The formal TOGA-based network model for cognitive decision-making enables to indicate and analyze nodes and arcs in which plant operators and managers errors may appear. The TOGA's multi-level IPK (Information, Preferences, Knowledge) model of abstract intelligent agents (AIAs) is applied. In the NPP context, super-safety approach is also discussed, by taking under consideration unexpected events and managing them from a systemic perspective. As the nature of human errors depends on the specific properties of the decision-maker and the decisional context of operation, a classification of decision-making using IPK is suggested. Several types of initial situations of decision-making useful for the diagnosis of NPP operators and managers errors are considered. The developed models can be used as a basis for applications to NPP educational or engineering simulators to be used for training the NPP executive staff. (authors)« less

Aviation's Normal Operations Safety Audit: a safety management and educational tool for health care? Results of a small-scale trial.

PubMed

Bennett, Simon A

2017-01-01

A National Health Service (NHS) contingent liability for medical error claims of over £26 billion. To evaluate the safety management and educational benefits of adapting aviation's Normal Operations Safety Audit (NOSA) to health care. In vivo research, a NOSA was performed by medical students at an English NHS Trust. After receiving training from the author, the students spent 6 days gathering data under his supervision. The data revealed a threat-rich environment, where errors - some consequential - were made (359 threats and 86 errors were recorded over 2 weeks). The students claimed that the exercise improved their observational, investigative, communication, teamworking and other nontechnical skills. NOSA is potentially an effective safety management and educational tool for health care. It is suggested that 1) the UK General Medical Council mandates that all medical students perform a NOSA in fulfillment of their degree; 2) the participating NHS Trusts be encouraged to act on students' findings; and 3) the UK Department of Health adopts NOSA as a cornerstone risk assessment and management tool.

Performance Errors in Weight Training and Their Correction.

ERIC Educational Resources Information Center

Downing, John H.; Lander, Jeffrey E.

2002-01-01

Addresses general performance errors in weight training, also discussing each category of error separately. The paper focuses on frequency and intensity, incorrect training velocities, full range of motion, and symmetrical training. It also examines specific errors related to the bench press, squat, military press, and bent- over and seated row…

Fire in operating theatres: DaSH-ing to the rescue.

PubMed

Wilson, Liam; Farooq, Omer

2018-01-01

Operating theatres are dynamic environments that require multi professional team interactions. Effective team working is essential for efficient delivery of safe patient care. A fire in the operating theatre is a rare but potentially life threatening event for both patients and staff. A rapid and cohesive response from theatre and allied staff including porters, fire safety officer etc is paramount. We delivered a training session that utilised in situ simulation (simulation in workplace). After conducting needs analysis, learning objectives were agreed. After thorough planning, the date and location of the training session were identified. Contingency plans were put in place to ensure that patient care was not compromised at any point. To ensure success, checklists for faculty were devised and adhered to. A medium fidelity manikin with live monitoring was used. The first part of the scenario involved management of a surgical emergency by theatre staff. The second part involved management of a fire in the operating theatre while an emergency procedure was being undertaken. To achieve maximum learning potential, debriefing was provided immediately after each part of the scenario. A fire safety officer was present as a content expert. Latent errors (hidden errors in the workplace, staff knowledge etc) were identified. Malfunctioning of theatre floor windows and staff unawareness about the location of an evacuation site were some of the identified latent errors. Thorough feedback to address these issues was provided to the participants on the day. A detailed report of the training session was given to the relevant departments. This resulted in the equipment faults being rectified. The training session was a very positive experience and helped not only in improving participants' knowledge, behaviour and confidence but also it made system and environment better equipped.

Carbon dioxide emission prediction using support vector machine

NASA Astrophysics Data System (ADS)

Saleh, Chairul; Rachman Dzakiyullah, Nur; Bayu Nugroho, Jonathan

2016-02-01

In this paper, the SVM model was proposed for predict expenditure of carbon (CO2) emission. The energy consumption such as electrical energy and burning coal is input variable that affect directly increasing of CO2 emissions were conducted to built the model. Our objective is to monitor the CO2 emission based on the electrical energy and burning coal used from the production process. The data electrical energy and burning coal used were obtained from Alcohol Industry in order to training and testing the models. It divided by cross-validation technique into 90% of training data and 10% of testing data. To find the optimal parameters of SVM model was used the trial and error approach on the experiment by adjusting C parameters and Epsilon. The result shows that the SVM model has an optimal parameter on C parameters 0.1 and 0 Epsilon. To measure the error of the model by using Root Mean Square Error (RMSE) with error value as 0.004. The smallest error of the model represents more accurately prediction. As a practice, this paper was contributing for an executive manager in making the effective decision for the business operation were monitoring expenditure of CO2 emission.

Shin splints. Diagnosis, management, prevention.

PubMed

Moore, M P

1988-01-01

Our knowledge of the etiology of shin splints is incomplete. Biomechanical abnormalities are likely to be major factors in predisposing certain persons to such injury. Also, training errors are major etiologic factors. Because shin splints result from mechanical overload of various elements of the musculoskeletal system of the leg that exceed their adaptive remodeling capacity, rest and recovery should be emphasized as an important aspect of sports training. Accurate and prompt diagnosis reduces the severity and duration of the injury. Management should consist of measures to reduce inflammation and pain and to identify possible biomechanical factors that may be correctable by strengthening and flexibility exercises or by the use of an orthotic device.

Resident training in microbiology.

PubMed

Haller, Barbara L

2007-06-01

To meet the challenges of diagnosis and management of infectious diseases, clinical pathology residents must receive comprehensive training in microbiology, learn to think critically, develop problem-solving skills, and take active roles as laboratory consultants. Residents well trained in clinical microbiology become capable laboratory professionals, developing cost-effective testing strategies, decreasing risk for medical errors, and improving patient care. Newer methods for diagnosing infectious disease, such as real-time polymerase chain reaction, microarrays for pathogen detection, and rapid assays for antigen or antibody detection, have become standard. Knowledge of infectious disease principles, drug therapeutic options, and drug resistance is also important. Suggestions for training and for assessing resident competency in clinical microbiology are presented.

[Prospective assessment of medication errors in critically ill patients in a university hospital].

PubMed

Salazar L, Nicole; Jirón A, Marcela; Escobar O, Leslie; Tobar, Eduardo; Romero, Carlos

2011-11-01

Critically ill patients are especially vulnerable to medication errors (ME) due to their severe clinical situation and the complexities of their management. To determine the frequency and characteristics of ME and identify shortcomings in the processes of medication management in an Intensive Care Unit. During a 3 months period, an observational prospective and randomized study was carried out in the ICU of a university hospital. Every step of patient's medication management (prescription, transcription, dispensation, preparation and administration) was evaluated by an external trained professional. Steps with higher frequency of ME and their therapeutic groups involved were identified. Medications errors were classified according to the National Coordinating Council for Medication Error Reporting and Prevention. In 52 of 124 patients evaluated, 66 ME were found in 194 drugs prescribed. In 34% of prescribed drugs, there was at least 1 ME during its use. Half of ME occurred during medication administration, mainly due to problems in infusion rates and schedule times. Antibacterial drugs had the highest rate of ME. We found a 34% rate of ME per drug prescribed, which is in concordance with international reports. The identification of those steps more prone to ME in the ICU, will allow the implementation of an intervention program to improve the quality and security of medication management.

Intraoperative crisis resource management during a non-intubated video-assisted thoracoscopic surgery

PubMed Central

Gálvez, Carlos; Rivera-Cogollos, María Jesus; Galiana-Ivars, María; Bolufer, Sergio; Martínez-Adsuar, Francisco

2015-01-01

The management of surgical and medical intraoperative emergencies are included in the group of high acuity (high potential severity of an event and the patient impact) and low opportunity (the frequency in which the team is required to manage the event). This combination places the patient into a situation where medical errors could happen more frequently. Although medical error are ubiquitous and inevitable we should try to establish the necessary knowledge, skills and attitudes needed for effective team performance and to guide the development of a critical event. This strategy would probably reduce the incidence of error and improve decision-making. The way to apply it comes from the application of the management of critical events in the airline industry. Its use in a surgical environment is through the crisis resource management (CRM) principles. The CRM tries to develop all the non-technical skills necessary in a critical situation, but not only that, also includes all the tools needed to prevent them. The purpose of this special issue is to appraise and summarize the design, implementation, and efficacy of simulation-based CRM training programs for a specific surgery such as the non-intubated video-assisted thoracoscopic surgery. PMID:26046052

Identifying the latent failures underpinning medication administration errors: an exploratory study.

PubMed

Lawton, Rebecca; Carruthers, Sam; Gardner, Peter; Wright, John; McEachan, Rosie R C

2012-08-01

The primary aim of this article was to identify the latent failures that are perceived to underpin medication errors. The study was conducted within three medical wards in a hospital in the United Kingdom. The study employed a cross-sectional qualitative design. Interviews were conducted with 12 nurses and eight managers. Interviews were transcribed and subject to thematic content analysis. A two-step inter-rater comparison tested the reliability of the themes. Ten latent failures were identified based on the analysis of the interviews. These were ward climate, local working environment, workload, human resources, team communication, routine procedures, bed management, written policies and procedures, supervision and leadership, and training. The discussion focuses on ward climate, the most prevalent theme, which is conceptualized here as interacting with failures in the nine other organizational structures and processes. This study is the first of its kind to identify the latent failures perceived to underpin medication errors in a systematic way. The findings can be used as a platform for researchers to test the impact of organization-level patient safety interventions and to design proactive error management tools and incident reporting systems in hospitals. © Health Research and Educational Trust.

42 CFR 424.44 - Time limits for filing claims.

Code of Federal Regulations, 2010 CFR

2010-10-01

... must be delivered to the intermediary or carrier as appropriate: (1) On or before December 31 of the... of the calendar year. (b) Extension of filing time because of error or misrepresentation. (1) The... diabetes self-management training. CMS makes payment in half-hour increments to an entity for the...

Personal protective equipment for the Ebola virus disease: A comparison of 2 training programs.

PubMed

Casalino, Enrique; Astocondor, Eugenio; Sanchez, Juan Carlos; Díaz-Santana, David Enrique; Del Aguila, Carlos; Carrillo, Juan Pablo

2015-12-01

Personal protective equipment (PPE) for preventing Ebola virus disease (EVD) includes basic PPE (B-PPE) and enhanced PPE (E-PPE). Our aim was to compare conventional training programs (CTPs) and reinforced training programs (RTPs) on the use of B-PPE and E-PPE. Four groups were created, designated CTP-B, CTP-E, RTP-B, and RTP-E. All groups received the same theoretical training, followed by 3 practical training sessions. A total of 120 students were included (30 per group). In all 4 groups, the frequency and number of total errors and critical errors decreased significantly over the course of the training sessions (P < .01). The RTP was associated with a greater reduction in the number of total errors and critical errors (P < .0001). During the third training session, we noted an error frequency of 7%-43%, a critical error frequency of 3%-40%, 0.3-1.5 total errors, and 0.1-0.8 critical errors per student. The B-PPE groups had the fewest errors and critical errors (P < .0001). Our results indicate that both training methods improved the student's proficiency, that B-PPE appears to be easier to use than E-PPE, that the RTP achieved better proficiency for both PPE types, and that a number of students are still potentially at risk for EVD contamination despite the improvements observed during the training. Copyright © 2015 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Outcome of 7-S, TQM technique for healthcare waste management.

PubMed

Ullah, Junaid Habib; Ahmed, Rashid; Malik, Javed Iqbal; Khan, M Amanullah

2011-12-01

To assess the present waste management system of healthcare facilities (HCFs) attached with Shalamar Hospital, Lahore by applying the 7-S technique of Total Quality Management (TQM) and to find out the outcome after imparting training. Interventional quasi-experimental study. The Shalamar Hospital, Lahore, Punjab, Pakistan, November, 2009 to November, 2010. Mckinsey's 7-S, technique of TQM was applied to assess the 220 HCFs from Lahore, Gujranwala and Sheikhupura districts for segregation, collection, transportation and disposal (SCTD) of hospital waste. Direct interview method was applied. Trainings were provided in each institution. After one year action period, the status of four areas of concern was compared before and after training. The parameters studied were segregation, collection, transportation and disposal systems in the 220 HCFs. Each of these were further elaborated by strategy, structure, system, staff, skill, style and stakeholder/shared value factors. Standard error of difference of proportion was applied to assess significance using 95% confidence level. There was marked improvement in all these areas ranging from 20% to 77% following a training program of 3 months. In case of disposal of the waste strategy, structure and system an increase of 60%, 65% and 75% was observed after training. The 7-S technique played a vital role in assessing the hospital waste management system. Training for the healthcare workers played a significant role in healthcare facilities.

Aviation safety and automation technology for subsonic transports

NASA Technical Reports Server (NTRS)

Albers, James A.

1991-01-01

Discussed here are aviation safety human factors and air traffic control (ATC) automation research conducted at the NASA Ames Research Center. Research results are given in the areas of flight deck and ATC automations, displays and warning systems, crew coordination, and crew fatigue and jet lag. Accident investigation and an incident reporting system that is used to guide the human factors research is discussed. A design philosophy for human-centered automation is given, along with an evaluation of automation on advanced technology transports. Intelligent error tolerant systems such as electronic checklists are discussed along with design guidelines for reducing procedure errors. The data on evaluation of Crew Resource Management (CRM) training indicates highly significant positive changes in appropriate flight deck behavior and more effective use of available resources for crew members receiving the training.

TeamSTEPPS for health care risk managers: Improving teamwork and communication.

PubMed

Cooke, Marcia

2016-07-01

Ineffective communication among the health care team is a leading cause of errors in the patient care setting. Studies assessing training related to communication and teamwork in the clinical team are prevalent, however, teamwork training at the administrative level is lacking. This includes individuals in leadership positions such as health care risk managers. The purpose was to determine the impact of an educational intervention on the knowledge and attitudes related to communication and teamwork in the health care risk management population. The educational intervention was an adaptation of a national teamwork training program and incorporated didactic content as well as video vignettes and small group activities. Measurement of knowledge and attitudes were used to determine the impact of the education program. Knowledge and attitudes were assessed pre- and postcourse. Findings indicate that teamwork education tailored to the needs of the specific audience resulted in knowledge gained and improved attitudes toward the components of teamwork. The attitudes that most significantly improved were related to team structure and situation monitoring. There was no improvement in participants' attitudes toward leadership, mutual support, and communication. Team training has been shown to improve safety culture, patient satisfaction, and clinical outcomes. Including risk managers in training on teamwork, communication, and collaboration can serve to foster a common language among clinicians and management. In addition, a measurement related to implementation in the health care setting may yield insight into the impact of training. Qualitative measurement may allow the researcher to delve deeper into how these health care facilities are using team training interventions. © 2016 American Society for Healthcare Risk Management of the American Hospital Association.

On-Error Training (Book Excerpt).

ERIC Educational Resources Information Center

Fukuda, Ryuji

1985-01-01

This excerpt from "Managerial Engineering: Techniques for Improving Quality and Productivity in the Workplace" describes the development, objectives, and use of On-Error Training (OET), a method which trains workers to learn from their errors. Also described is New Joharry's Window, a performance-error data analysis technique used in…

More explicit communication after classroom-based crew resource management training: results of a pragmatic trial.

PubMed

Verbeek-van Noord, Inge; de Bruijne, Martine C; Twisk, Jos W R; van Dyck, Cathy; Wagner, Cordula

2015-02-01

Aviation-based crew resource management trainings to optimize non-technical skills among professionals are often suggested for health care as a way to increase patient safety. Our aim was to evaluate the effect of a 2-day classroom-based crew resource management (CRM) training at emergency departments (EDs) on explicit professional oral communication (EPOC; non-technical skills). A pragmatic controlled before-after trial was conducted. Four EDs of general teaching hospitals were recruited (two intervention and two control departments). ED nurses and ED doctors were observed on their non-technical skills by means of a validated observation tool (EPOC). Our main outcome measure was the amount of EPOC observed per interaction in 30 minutes direct observations. Three outcome measures from EPOC were analysed: human interaction, anticipation on environment and an overall EPOC score. Linear and logistic mixed model analyses were performed. Models were corrected for the outcome measurement at baseline, days between training and observation, patient safety culture and error management culture at baseline. A statistically significant increase after the training was found on human interaction (β=0.27, 95% CI 0.08-0.49) and the overall EPOC score (β=0.25, 95% CI 0.06-0.43), but not for anticipation on environment (OR=1.19, 95% CI .45-3.15). This means that approximately 25% more explicit communication was shown after CRM training. We found an increase in the use of CRM skills after classroom-based crew resource management training. This study adds to the body of evidence that CRM trainings have the potential to increase patient safety by reducing communication flaws, which play an important role in health care-related adverse events. © 2014 John Wiley & Sons, Ltd.

Aviation’s Normal Operations Safety Audit: a safety management and educational tool for health care? Results of a small-scale trial

PubMed Central

Bennett, Simon A

2017-01-01

Background A National Health Service (NHS) contingent liability for medical error claims of over £26 billion. Objectives To evaluate the safety management and educational benefits of adapting aviation’s Normal Operations Safety Audit (NOSA) to health care. Methods In vivo research, a NOSA was performed by medical students at an English NHS Trust. After receiving training from the author, the students spent 6 days gathering data under his supervision. Results The data revealed a threat-rich environment, where errors – some consequential – were made (359 threats and 86 errors were recorded over 2 weeks). The students claimed that the exercise improved their observational, investigative, communication, teamworking and other nontechnical skills. Conclusion NOSA is potentially an effective safety management and educational tool for health care. It is suggested that 1) the UK General Medical Council mandates that all medical students perform a NOSA in fulfillment of their degree; 2) the participating NHS Trusts be encouraged to act on students’ findings; and 3) the UK Department of Health adopts NOSA as a cornerstone risk assessment and management tool. PMID:28860881

Effects of Contextual Sight-Singing and Aural Skills Training on Error-Detection Abilities.

ERIC Educational Resources Information Center

Sheldon, Deborah A.

1998-01-01

Examines the effects of contextual sight-singing and ear training on pitch and rhythm error detection abilities among undergraduate instrumental music education majors. Shows that additional training produced better error detection, particularly with rhythm errors and in one-part examples. Maintains that differences attributable to texture were…

Navigating towards improved surgical safety using aviation-based strategies.

PubMed

Kao, Lillian S; Thomas, Eric J

2008-04-01

Safety practices in the aviation industry are being increasingly adapted to healthcare in an effort to reduce medical errors and patient harm. However, caution should be applied in embracing these practices because of limited experience in surgical disciplines, lack of rigorous research linking these practices to outcome, and fundamental differences between the two industries. Surgeons should have an in-depth understanding of the principles and data supporting aviation-based safety strategies before routinely adopting them. This paper serves as a review of strategies adapted to improve surgical safety, including the following: implementation of crew resource management in training operative teams; incorporation of simulation in training of technical and nontechnical skills; and analysis of contributory factors to errors using surveys, behavioral marker systems, human factors analysis, and incident reporting. Avenues and challenges for future research are also discussed.

What errors do peer reviewers detect, and does training improve their ability to detect them?

PubMed

Schroter, Sara; Black, Nick; Evans, Stephen; Godlee, Fiona; Osorio, Lyda; Smith, Richard

2008-10-01

To analyse data from a trial and report the frequencies with which major and minor errors are detected at a general medical journal, the types of errors missed and the impact of training on error detection. 607 peer reviewers at the BMJ were randomized to two intervention groups receiving different types of training (face-to-face training or a self-taught package) and a control group. Each reviewer was sent the same three test papers over the study period, each of which had nine major and five minor methodological errors inserted. BMJ peer reviewers. The quality of review, assessed using a validated instrument, and the number and type of errors detected before and after training. The number of major errors detected varied over the three papers. The interventions had small effects. At baseline (Paper 1) reviewers found an average of 2.58 of the nine major errors, with no notable difference between the groups. The mean number of errors reported was similar for the second and third papers, 2.71 and 3.0, respectively. Biased randomization was the error detected most frequently in all three papers, with over 60% of reviewers rejecting the papers identifying this error. Reviewers who did not reject the papers found fewer errors and the proportion finding biased randomization was less than 40% for each paper. Editors should not assume that reviewers will detect most major errors, particularly those concerned with the context of study. Short training packages have only a slight impact on improving error detection.

The effects of training on errors of perceived direction in perspective displays

NASA Technical Reports Server (NTRS)

Tharp, Gregory K.; Ellis, Stephen R.

1990-01-01

An experiment was conducted to determine the effects of training on the characteristic direction errors that are observed when subjects estimate exocentric directions on perspective displays. Changes in five subjects' perceptual errors were measured during a training procedure designed to eliminate the error. The training was provided by displaying to each subject both the sign and the direction of his judgment error. The feedback provided by the error display was found to decrease but not eliminate the error. A lookup table model of the source of the error was developed in which the judgement errors were attributed to overestimates of both the pitch and the yaw of the viewing direction used to produce the perspective projection. The model predicts the quantitative characteristics of the data somewhat better than previous models did. A mechanism is proposed for the observed learning, and further tests of the model are suggested.

The effectiveness of robotic training depends on motor task characteristics.

PubMed

Marchal-Crespo, Laura; Rappo, Nicole; Riener, Robert

2017-12-01

Previous research suggests that the effectiveness of robotic training depends on the motor task to be learned. However, it is still an open question which specific task's characteristics influence the efficacy of error-modulating training strategies. Motor tasks can be classified based on the time characteristics of the task, in particular the task's duration (discrete vs. continuous). Continuous tasks require movements without distinct beginning or end. Discrete tasks require fast movements that include well-defined postures at the beginning and the end. We developed two games, one that requires a continuous movement-a tracking task-and one that requires discrete movements-a fast reaching task. We conducted an experiment with thirty healthy subjects to evaluate the effectiveness of three error-modulating training strategies-no guidance, error amplification (i.e., repulsive forces proportional to errors) and haptic guidance-on self-reported motivation and learning of the continuous and discrete games. Training with error amplification resulted in better motor learning than haptic guidance, besides the fact that error amplification reduced subjects' interest/enjoyment and perceived competence during training. Only subjects trained with error amplification improved their performance after training the discrete game. In fact, subjects trained without guidance improved the performance in the continuous game significantly more than in the discrete game, probably because the continuous task required greater attentional levels. Error-amplifying training strategies have a great potential to provoke better motor learning in continuous and discrete tasks. However, their long-lasting negative effects on motivation might limit their applicability in intense neurorehabilitation programs.

Improvement of the Error-detection Mechanism in Adults with Dyslexia Following Reading Acceleration Training.

PubMed

Horowitz-Kraus, Tzipi

2016-05-01

The error-detection mechanism aids in preventing error repetition during a given task. Electroencephalography demonstrates that error detection involves two event-related potential components: error-related and correct-response negativities (ERN and CRN, respectively). Dyslexia is characterized by slow, inaccurate reading. In particular, individuals with dyslexia have a less active error-detection mechanism during reading than typical readers. In the current study, we examined whether a reading training programme could improve the ability to recognize words automatically (lexical representations) in adults with dyslexia, thereby resulting in more efficient error detection during reading. Behavioural and electrophysiological measures were obtained using a lexical decision task before and after participants trained with the reading acceleration programme. ERN amplitudes were smaller in individuals with dyslexia than in typical readers before training but increased following training, as did behavioural reading scores. Differences between the pre-training and post-training ERN and CRN components were larger in individuals with dyslexia than in typical readers. Also, the error-detection mechanism as represented by the ERN/CRN complex might serve as a biomarker for dyslexia and be used to evaluate the effectiveness of reading intervention programmes. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Space Flight Resource Management for ISS Operations

NASA Technical Reports Server (NTRS)

Schmidt, Lacey L.; Slack, Kelley; Holland, Albert; Huning, Therese; O'Keefe, William; Sipes, Walter E.

2010-01-01

Although the astronaut training flow for the International Space Station (ISS) spans 2 years, each astronaut or cosmonaut often spends most of their training alone. Rarely is it operationally feasible for all six ISS crewmembers to train together, even more unlikely that crewmembers can practice living together before launch. Likewise, ISS Flight Controller training spans 18 months of learning to manage incredibly complex systems remotely in plug-and-play ground teams that have little to no exposure to crewmembers before a mission. How then do all of these people quickly become a team - a team that must respond flexibly yet decisively to a variety of situations? The answer implemented at NASA is Space Flight Resource Management (SFRM), the so-called "soft skills" or team performance skills. Based on Crew Resource Management, SFRM was developed first for shuttle astronauts and focused on managing human errors during time-critical events (Rogers, et al. 2002). Given the nature of life on ISS, the scope of SFRM for ISS broadened to include teamwork during prolonged and routine operations (O'Keefe, 2008). The ISS SFRM model resembles a star with one competency for each point: Communication, Cross-Culture, Teamwork, Decision Making, Team Care, Leadership/Followership, Conflict Management, and Situation Awareness. These eight competencies were developed with international participation by the Human Behavior and Performance Training Working Group. Over the last two years, these competencies have been used to build a multi-modal SFRM training flow for astronaut candidates and flight controllers that integrates team performance skills into the practice of technical skills. Preliminary results show trainee skill increases as the flow progresses; and participants find the training invaluable to performing well and staying healthy during ISS operations. Future development of SFRM training will aim to help support indirect handovers as ISS operations evolve further with the retirement of the Space Shuttle Program.

Virtual reality and medicine--from the cockpit to the operating room: are we there yet?

PubMed

Saied, Nahel

2005-01-01

Teaching medicine to medical students, physicians in training and nurses is a challenging task that has remained unchanged for decades. The airline industry has achieved a great deal of safety and quality in a technically challenging environment. Many believe that their outstanding achievement is due to team training and crew resource management using simulators and dedicated training programs. Many experts in the medical profession believe that adopting the same strategies in teaching medical students and trainees could achieve significant reductions in medical errors and improve the quality of patient care. This article explores the role of teaching medicine using virtual reality in a multitude of medical specialties and outlines the use of simulation training at Saint Louis University.

Defining and Measuring Decision-Making for the Management of Trauma Patients.

PubMed

Madani, Amin; Gips, Amanda; Razek, Tarek; Deckelbaum, Dan L; Mulder, David S; Grushka, Jeremy R

Effective management of trauma patients is heavily dependent on sound judgment and decision-making. Yet, current methods for training and assessing these advanced cognitive skills are subjective, lack standardization, and are prone to error. This qualitative study aims to define and characterize the cognitive and interpersonal competencies required to optimally manage injured patients. Cognitive and hierarchical task analyses for managing unstable trauma patients were performed using qualitative methods to map the thoughts, behaviors, and practices that characterize expert performance. Trauma team leaders and board-certified trauma surgeons participated in semistructured interviews that were transcribed verbatim. Data were supplemented with content from published literature and prospectively collected field notes from observations of the trauma team during trauma activations. The data were coded and analyzed using grounded theory by 2 independent reviewers. A framework was created based on 14 interviews with experts (lasting 1-2 hours each), 35 field observations (20 [57%] blunt; 15 [43%] penetrating; median Injury Severity Score 20 [13-25]), and 15 literary sources. Experts included 11 trauma surgeons and 3 emergency physicians from 7 Level 1 academic institutions in North America (median years in practice: 12 [8-17]). Twenty-nine competencies were identified, including 17 (59%) related to situation awareness, 6 (21%) involving decision-making, and 6 (21%) requiring interpersonal skills. Of 40 potential errors that were identified, root causes were mapped to errors in situation awareness (20 [50%]), decision-making (10 [25%]), or interpersonal skills (10 [25%]). This study defines cognitive and interpersonal competencies that are essential for the management of trauma patients. This framework may serve as the basis for novel curricula to train and assess decision-making skills, and to develop quality-control metrics to improve team and individual performance. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Defense Logistics Agency Disposition Services Afghanistan Disposal Process Needed Improvement

DTIC Science & Technology

2013-11-08

audit, and management was proactive in correcting the deficiencies we identified. DLA DS eliminated backlogs, identified and corrected system ...problems, provided additional system training, corrected coding errors, added personnel to key positions, addressed scale issues, submitted debit...Service Automated Information System to the Reutilization Business Integration2 (RBI) solution. The implementation of RBI in Afghanistan occurred in

75 FR 30742 - Modification of the Process for Requesting a Waiver of the Mandatory Separation Age of 56 for Air...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-02

... Control Specialists would no longer be required to certify they have not been involved in an operational error (OE), operational deviation (OD), or runway incursion in the past 5 years. The proposed change... references to employee identification, training record entries, performance management, and return-to-duty...

Building a simulation-based crisis resource management course for emergency medicine, phase 1: Results from an interdisciplinary needs assessment survey.

PubMed

Hicks, Christopher M; Bandiera, Glen W; Denny, Christopher J

2008-11-01

Emergency department (ED) resuscitation requires the coordinated efforts of an interdisciplinary team. Human errors are common and have a negative impact on patient safety. Although crisis resource management (CRM) skills are utilized in other clinical domains, most emergency medicine (EM) caregivers currently receive no formal CRM training. The objectives were to compile and compare attitudes toward CRM training among EM staff physicians, nurses, and residents at two Canadian academic teaching hospitals. Emergency physicians (EPs), residents, and nurses were asked to complete a Web survey that included Likert scales and short answer questions. Focus groups and pilot testing were used to inform survey development. Thematic content analysis was performed on the qualitative data set and compared to quantitative results. The response rate was 75.7% (N = 84). There was strong consensus regarding the importance of core CRM principles (i.e., effective communication, team leadership, resource utilization, problem-solving, situational awareness) in ED resuscitation. Problems with coordinating team actions (58.8%), communication (69.6%), and establishing priorities (41.3%) were among factors implicated in adverse events. Interdisciplinary collaboration (95.1%), efficiency of patient care (83.9%), and decreased medical error (82.6%) were proposed benefits of CRM training. Communication between disciplines is a barrier to effective ED resuscitation for 94.4% of nurses and 59.7% of EPs (p = 0.008). Residents reported a lack of exposure to (64.3%), yet had interest in (96.4%) formal CRM education using human patient simulation. Nurses rate communication as a barrier to teamwork more frequently than physicians. EM residents are keen to learn CRM skills. An opportunity exists to create a novel interdisciplinary CRM curriculum to improve EM team performance and mitigate human error.

Lessons from Crew Resource Management for Cardiac Surgeons.

PubMed

Marvil, Patrick; Tribble, Curt

2017-04-30

Crew resource management (CRM) describes a system developed in the late 1970s in response to a series of deadly commercial aviation crashes. This system has been universally adopted in commercial and military aviation and is now an integral part of aviation culture. CRM is an error mitigation strategy developed to reduce human error in situations in which teams operate in complex, high-stakes environments. Over time, the principles of this system have been applied and utilized in other environments, particularly in medical areas dealing with high-stakes outcomes requiring optimal teamwork and communication. While the data from formal studies on the effectiveness of formal CRM training in medical environments have reported mixed results, it seems clear that some of these principles should have value in the practice of cardiovascular surgery.

Understanding adverse events: human factors.

PubMed Central

Reason, J

1995-01-01

(1) Human rather than technical failures now represent the greatest threat to complex and potentially hazardous systems. This includes healthcare systems. (2) Managing the human risks will never be 100% effective. Human fallibility can be moderated, but it cannot be eliminated. (3) Different error types have different underlying mechanisms, occur in different parts of the organisation, and require different methods of risk management. The basic distinctions are between: Slips, lapses, trips, and fumbles (execution failures) and mistakes (planning or problem solving failures). Mistakes are divided into rule based mistakes and knowledge based mistakes. Errors (information-handling problems) and violations (motivational problems) Active versus latent failures. Active failures are committed by those in direct contact with the patient, latent failures arise in organisational and managerial spheres and their adverse effects may take a long time to become evident. (4) Safety significant errors occur at all levels of the system, not just at the sharp end. Decisions made in the upper echelons of the organisation create the conditions in the workplace that subsequently promote individual errors and violations. Latent failures are present long before an accident and are hence prime candidates for principled risk management. (5) Measures that involve sanctions and exhortations (that is, moralistic measures directed to those at the sharp end) have only very limited effectiveness, especially so in the case of highly trained professionals. (6) Human factors problems are a product of a chain of causes in which the individual psychological factors (that is, momentary inattention, forgetting, etc) are the last and least manageable links. Attentional "capture" (preoccupation or distraction) is a necessary condition for the commission of slips and lapses. Yet, its occurrence is almost impossible to predict or control effectively. The same is true of the factors associated with forgetting. States of mind contributing to error are thus extremely difficult to manage; they can happen to the best of people at any time. (7) People do not act in isolation. Their behaviour is shaped by circumstances. The same is true for errors and violations. The likelihood of an unsafe act being committed is heavily influenced by the nature of the task and by the local workplace conditions. These, in turn, are the product of "upstream" organisational factors. Great gains in safety can ve achieved through relatively small modifications of equipment and workplaces. (8) Automation and increasing advanced equipment do not cure human factors problems, they merely relocate them. In contrast, training people to work effectively in teams costs little, but has achieved significant enhancements of human performance in aviation. (9) Effective risk management depends critically on a confidential and preferable anonymous incident monitoring system that records the individual, task, situational, and organisational factors associated with incidents and near misses. (10) Effective risk management means the simultaneous and targeted deployment of limited remedial resources at different levels of the system: the individual or team, the task, the situation, and the organisation as a whole. PMID:10151618

Forecasting air quality time series using deep learning.

PubMed

Freeman, Brian S; Taylor, Graham; Gharabaghi, Bahram; Thé, Jesse

2018-04-13

This paper presents one of the first applications of deep learning (DL) techniques to predict air pollution time series. Air quality management relies extensively on time series data captured at air monitoring stations as the basis of identifying population exposure to airborne pollutants and determining compliance with local ambient air standards. In this paper, 8 hr averaged surface ozone (O 3 ) concentrations were predicted using deep learning consisting of a recurrent neural network (RNN) with long short-term memory (LSTM). Hourly air quality and meteorological data were used to train and forecast values up to 72 hours with low error rates. The LSTM was able to forecast the duration of continuous O 3 exceedances as well. Prior to training the network, the dataset was reviewed for missing data and outliers. Missing data were imputed using a novel technique that averaged gaps less than eight time steps with incremental steps based on first-order differences of neighboring time periods. Data were then used to train decision trees to evaluate input feature importance over different time prediction horizons. The number of features used to train the LSTM model was reduced from 25 features to 5 features, resulting in improved accuracy as measured by Mean Absolute Error (MAE). Parameter sensitivity analysis identified look-back nodes associated with the RNN proved to be a significant source of error if not aligned with the prediction horizon. Overall, MAE's less than 2 were calculated for predictions out to 72 hours. Novel deep learning techniques were used to train an 8-hour averaged ozone forecast model. Missing data and outliers within the captured data set were replaced using a new imputation method that generated calculated values closer to the expected value based on the time and season. Decision trees were used to identify input variables with the greatest importance. The methods presented in this paper allow air managers to forecast long range air pollution concentration while only monitoring key parameters and without transforming the data set in its entirety, thus allowing real time inputs and continuous prediction.

[From aviation to surgery: the challenge of safety].

PubMed

Suva, D; Haller, G; Lübbeke-Wolff, A; Macheret, F; Kindler, V; Hoffmeyer, P

2011-03-23

Medical errors result in 44,000 to 98,000 deaths per year in the United States of America. Within the surgical specialties, half of these errors occur in the operating room. The origin of these errors is multifactorial, and is generally associated with problems in communication and teamwork. In order to improve safety in the operating room, many hospitals now propose to the medical staff "crew resource management" (CRM) training programs inspired by the aviation industry. This approach favors a better utilization of surgical checklists, improves efficiency during chirurgical interventions, and reduces patient mortality. In October 2009 we introduced a CRM course within the department of surgery at the Geneva University Hospitals. We are presenting this program as well as the first results following its application.

A comparative study of two hazard handling training methods for novice drivers.

PubMed

Wang, Y B; Zhang, W; Salvendy, G

2010-10-01

The effectiveness of two hazard perception training methods, simulation-based error training (SET) and video-based guided error training (VGET), for novice drivers' hazard handling performance was tested, compared, and analyzed. Thirty-two novice drivers participated in the hazard perception training. Half of the participants were trained using SET by making errors and/or experiencing accidents while driving with a desktop simulator. The other half were trained using VGET by watching prerecorded video clips of errors and accidents that were made by other people. The two groups had exposure to equal numbers of errors for each training scenario. All the participants were tested and evaluated for hazard handling on a full cockpit driving simulator one week after training. Hazard handling performance and hazard response were measured in this transfer test. Both hazard handling performance scores and hazard response distances were significantly better for the SET group than the VGET group. Furthermore, the SET group had more metacognitive activities and intrinsic motivation. SET also seemed more effective in changing participants' confidence, but the result did not reach the significance level. SET exhibited a higher training effectiveness of hazard response and handling than VGET in the simulated transfer test. The superiority of SET might benefit from the higher levels of metacognition and intrinsic motivation during training, which was observed in the experiment. Future research should be conducted to assess whether the advantages of error training are still effective under real road conditions.

Which non-technical skills do junior doctors require to prescribe safely? A systematic review.

PubMed

Dearden, Effie; Mellanby, Edward; Cameron, Helen; Harden, Jeni

2015-12-01

Prescribing errors are a major source of avoidable morbidity and mortality. Junior doctors write most in-hospital prescriptions and are the least experienced members of the healthcare team. This puts them at high risk of error and makes them attractive targets for interventions to improve prescription safety. Error analysis has shown a background of complex environments with multiple contributory conditions. Similar conditions in other high risk industries, such as aviation, have led to an increased understanding of so-called human factors and the use of non-technical skills (NTS) training to try to reduce error. To date no research has examined the NTS required for safe prescribing. The aim of this review was to develop a prototype NTS taxonomy for safe prescribing, by junior doctors, in hospital settings. A systematic search identified 14 studies analyzing prescribing behaviours and errors by junior doctors. Framework analysis was used to extract data from the studies and identify behaviours related to categories of NTS that might be relevant to safe and effective prescribing performance by junior doctors. Categories were derived from existing literature and inductively from the data. A prototype taxonomy of relevant categories (situational awareness, decision making, communication and team working, and task management) and elements was constructed. This prototype will form the basis of future work to create a tool that can be used for training and assessment of medical students and junior doctors to reduce prescribing error in the future. © 2015 The British Pharmacological Society.

The Influence of Training Phase on Error of Measurement in Jump Performance.

PubMed

Taylor, Kristie-Lee; Hopkins, Will G; Chapman, Dale W; Cronin, John B

2016-03-01

The purpose of this study was to calculate the coefficients of variation in jump performance for individual participants in multiple trials over time to determine the extent to which there are real differences in the error of measurement between participants. The effect of training phase on measurement error was also investigated. Six subjects participated in a resistance-training intervention for 12 wk with mean power from a countermovement jump measured 6 d/wk. Using a mixed-model meta-analysis, differences between subjects, within-subject changes between training phases, and the mean error values during different phases of training were examined. Small, substantial factor differences of 1.11 were observed between subjects; however, the finding was unclear based on the width of the confidence limits. The mean error was clearly higher during overload training than baseline training, by a factor of ×/÷ 1.3 (confidence limits 1.0-1.6). The random factor representing the interaction between subjects and training phases revealed further substantial differences of ×/÷ 1.2 (1.1-1.3), indicating that on average, the error of measurement in some subjects changes more than in others when overload training is introduced. The results from this study provide the first indication that within-subject variability in performance is substantially different between training phases and, possibly, different between individuals. The implications of these findings for monitoring individuals and estimating sample size are discussed.

Training in Trauma Surgery

PubMed Central

Reilly, Patrick M.; Schwab, C William; Haut, Elliott R.; Gracias, Vicente H.; Dabrowski, G Paul; Gupta, Rajan; Pryor, John P.; Kauder, Donald R.

2003-01-01

Objective: To describe outcomes from a clinical trauma surgical education program that places the board-eligible/board-certified fellow in the role of the attending surgeon (fellow-in-exception [FIE]) during the latter half of a 2-year trauma/surgical critical care fellowship. Summary Background Data: National discussions have begun to explore the question of optimal methods for postresidency training in surgery. Few objective studies are available to evaluate current training models. Methods: We analyzed provider-specific data from both our trauma registry and performance improvement (PI) databases. In addition, we performed TRISS analysis when all data were available. Registry and PI data were analyzed as 2 groups (faculty trauma surgeons and FIEs) to determine experience, safety, and trends in errors. We also surveyed graduate fellows using a questionnaire that evaluated perceptions of training and experience on a 6-point Likert scale. Results: During a 4-year period 7,769 trauma patients were evaluated, of which 46.3% met criteria to be submitted to the PA Trauma Outcome Study (PTOS, ie, more severe injury). The faculty group saw 5,885 patients (2,720 PTOS); the FIE group saw 1,884 patients (879 PTOS). The groups were similar in respect to mechanism of injury (74% blunt; 26% penetrating both groups) and injury severity (mean ISS faculty 10.0; FIEs 9.5). When indexed to patient contacts, FIEs did more operations than the faculty group (28.4% versus 25.6%; P < 0.05). Death rates were similar between groups (faculty 10.5%; FIEs 10.0%). Analysis of deaths using PI and TRISS data failed to demonstrate differences between the groups. Analysis of provider-specific errors demonstrated a slightly higher rate for FIEs when compared with faculty when indexed to PTOS cases (4.1% versus 2.1%; P < 0.01). For both groups, errors in management were more common than errors in technique. Twenty-one (91%) of twenty-three surveys were returned. Fellows’ feelings of preparedness to manage complex trauma patients improved during the fellowship (mean 3.2 prior to fellowship versus 4.5 after first year versus 5.8 after FIE year; P < 0.05 by ANOVA). Eighty percent rated the FIE educational experience “great -5” or “exceptional– 6.” Eighty-five percent consider the current structure of the fellowship (with FIE year) as ideal. Ninety percent would repeat the fellowship. Conclusion: The educational experience and training improvement offered by the inclusion of a FIE period during a trauma fellowship is exceptional. Patient outcomes are unchanged. The potential for an increased error rate is present during this period of clinical autonomy and must be addressed when designing the methods of supervision of care to assure concurrent senior staff review. PMID:14530731

Obstetric skills drills: evaluation of teaching methods.

PubMed

Birch, L; Jones, N; Doyle, P M; Green, P; McLaughlin, A; Champney, C; Williams, D; Gibbon, K; Taylor, K

2007-11-01

To determine the most effective method of delivering training to staff on the management of an obstetric emergency. The research was conducted in a District General Hospital in the UK, delivering approximately 3500 women per year. Thirty-six staff, comprising of junior and senior medical and midwifery staff were included as research subjects. Each of the staff members were put into one of six multi-professional teams. Effectively, this gave six teams, each comprising of six members. Three teaching methods were employed. Lecture based teaching (LBT), simulation based teaching (SBT) or a combination of these two (LAS). Each team of staff were randomly allocated to undertake a full day of training in the management of Post Partum Haemorrhage utilising one of these three teaching methods. Team knowledge and performance were assessed pre-training, post training and at three months later. In addition to this assessment of knowledge and performance, qualitative semi-structured interviews were carried out with 50% of the original cohort one year after the training, to explore anxiety, confidence, communication, knowledge retention, enjoyment and transferable skills. All teams improved in their performance and knowledge. The teams taught using simulation only (SBT) were the only group to demonstrate sustained improvement in clinical management of the case, confidence, communication skills and knowledge. However, the study did not have enough power to reach statistical significance. The SBT group reported transferable skills and less anxiety in subsequent emergencies. SBT and LAS reported improved multidisciplinary communication. Although tiring, the SBT was enjoyed the most. Obstetrics is a high risk speciality, in which emergencies are to some extent, inevitable. Training staff to manage these emergencies is a fundamental principal of risk management. Traditional risk management strategies based on incident reporting and event analysis are reactive and not always effective. Simulation based training is an appropriate proactive approach to reducing errors and risk in obstetrics, improving teamwork and communication, whilst giving the student a multiplicity of transferable skills to improve their performance.

The Iatroref study: medical errors are associated with symptoms of depression in ICU staff but not burnout or safety culture.

PubMed

Garrouste-Orgeas, Maité; Perrin, Marion; Soufir, Lilia; Vesin, Aurélien; Blot, François; Maxime, Virginie; Beuret, Pascal; Troché, Gilles; Klouche, Kada; Argaud, Laurent; Azoulay, Elie; Timsit, Jean-François

2015-02-01

Staff behaviours to optimise patient safety may be influenced by burnout, depression and strength of the safety culture. We evaluated whether burnout, symptoms of depression and safety culture affected the frequency of medical errors and adverse events (selected using Delphi techniques) in ICUs. Prospective, observational, multicentre (31 ICUs) study from August 2009 to December 2011. Burnout, depression symptoms and safety culture were evaluated using the Maslach Burnout Inventory (MBI), CES-Depression scale and Safety Attitudes Questionnaire, respectively. Of 1,988 staff members, 1,534 (77.2 %) participated. Frequencies of medical errors and adverse events were 804.5/1,000 and 167.4/1,000 patient-days, respectively. Burnout prevalence was 3 or 40 % depending on the definition (severe emotional exhaustion, depersonalisation and low personal accomplishment; or MBI score greater than -9). Depression symptoms were identified in 62/330 (18.8 %) physicians and 188/1,204 (15.6 %) nurses/nursing assistants. Median safety culture score was 60.7/100 [56.8-64.7] in physicians and 57.5/100 [52.4-61.9] in nurses/nursing assistants. Depression symptoms were an independent risk factor for medical errors. Burnout was not associated with medical errors. The safety culture score had a limited influence on medical errors. Other independent risk factors for medical errors or adverse events were related to ICU organisation (40 % of ICU staff off work on the previous day), staff (specific safety training) and patients (workload). One-on-one training of junior physicians during duties and existence of a hospital risk-management unit were associated with lower risks. The frequency of selected medical errors in ICUs was high and was increased when staff members had symptoms of depression.

The Hinton train disaster.

PubMed

Smiley, A M

1990-10-01

In February of 1986 a head-on collision occurred between a freight train and a passenger train in western Canada killing 23 people and causing over $30 million of damage. A Commission of Inquiry appointed by the Canadian government concluded that human error was the major reason for the collision. This report discusses the factors contributing to the human error: mainly poor work-rest schedules, the monotonous nature of the train driving task, insufficient information about train movements, and the inadequate backup systems in case of human error.

Creating a Successful Training Program for Frontline Staff: The University of Minnesota's Integrated Student Services Model

ERIC Educational Resources Information Center

Peterson, Heather L.; Otto, Carrie L.

2011-01-01

Successfully preparing frontline counseling staff in an integrated student services model is a challenge--one that management staff in One Stop Student Services at the University of Minnesota, Twin Cities (UMTC) have been fine-tuning for almost ten years. The effort has required collaboration across units in a series of trial and error attempts…

Managing emergencies and abnormal situations in air traffic control (part II): teamwork strategies.

PubMed

Malakis, Stathis; Kontogiannis, Tom; Kirwan, Barry

2010-07-01

Team performance has been studied in many safety-critical organizations including aviation, nuclear power plant, offshore oil platforms and health organizations. This study looks into teamwork strategies that air traffic controllers employ to manage emergencies and abnormal situations. Two field studies were carried out in the form of observations of simulator training in emergency and unusual scenarios of novices and experienced controllers. Teamwork strategies covered aspects of team orientation and coordination, information exchange, change management and error handling. Several performance metrics were used to rate the efficiency of teamwork and test the construct validity of a prototype model of teamwork. This is a companion study to an earlier investigation of taskwork strategies in the same field (part I) and contributes to the development of a generic model for Taskwork and Teamwork strategies in Emergencies in Air traffic Management (T(2)EAM). Suggestions are made on how to use T(2)EAM to develop training programs, assess team performance and improve mishap investigations. Copyright 2010 Elsevier Ltd. All rights reserved.

[Human factors and crisis resource management: improving patient safety].

PubMed

Rall, M; Oberfrank, S

2013-10-01

A continuing high number of patients suffer harm from medical treatment. In 60-70% of the cases the sources of harm can be attributed to the field of human factors (HFs) and teamwork; nevertheless, those topics are still neither part of medical education nor of basic and advanced training even though it has been known for many years and it has meanwhile also been demonstrated for surgical specialties that training in human factors and teamwork considerably reduces surgical mortality.Besides the medical field, the concept of crisis resource management (CRM) has already proven its worth in many other industries by improving teamwork and reducing errors in the domain of human factors. One of the best ways to learn about CRM and HFs is realistic simulation team training with well-trained instructors in CRM and HF. The educational concept of the HOTT (hand over team training) courses for trauma room training offered by the DGU integrates these elements based on the current state of science. It is time to establish such training for all medical teams in emergency medicine and operative care. Accompanying safety measures, such as the development of a positive culture of safety in every department and the use of effective critical incident reporting systems (CIRs) should be pursued.

Learning a locomotor task: with or without errors?

PubMed

Marchal-Crespo, Laura; Schneider, Jasmin; Jaeger, Lukas; Riener, Robert

2014-03-04

Robotic haptic guidance is the most commonly used robotic training strategy to reduce performance errors while training. However, research on motor learning has emphasized that errors are a fundamental neural signal that drive motor adaptation. Thus, researchers have proposed robotic therapy algorithms that amplify movement errors rather than decrease them. However, to date, no study has analyzed with precision which training strategy is the most appropriate to learn an especially simple task. In this study, the impact of robotic training strategies that amplify or reduce errors on muscle activation and motor learning of a simple locomotor task was investigated in twenty two healthy subjects. The experiment was conducted with the MAgnetic Resonance COmpatible Stepper (MARCOS) a special robotic device developed for investigations in the MR scanner. The robot moved the dominant leg passively and the subject was requested to actively synchronize the non-dominant leg to achieve an alternating stepping-like movement. Learning with four different training strategies that reduce or amplify errors was evaluated: (i) Haptic guidance: errors were eliminated by passively moving the limbs, (ii) No guidance: no robot disturbances were presented, (iii) Error amplification: existing errors were amplified with repulsive forces, (iv) Noise disturbance: errors were evoked intentionally with a randomly-varying force disturbance on top of the no guidance strategy. Additionally, the activation of four lower limb muscles was measured by the means of surface electromyography (EMG). Strategies that reduce or do not amplify errors limit muscle activation during training and result in poor learning gains. Adding random disturbing forces during training seems to increase attention, and therefore improve motor learning. Error amplification seems to be the most suitable strategy for initially less skilled subjects, perhaps because subjects could better detect their errors and correct them. Error strategies have a great potential to evoke higher muscle activation and provoke better motor learning of simple tasks. Neuroimaging evaluation of brain regions involved in learning can provide valuable information on observed behavioral outcomes related to learning processes. The impacts of these strategies on neurological patients need further investigations.

The Effects of Discrete-Trial Training Commission Errors on Learner Outcomes: An Extension

ERIC Educational Resources Information Center

Jenkins, Sarah R.; Hirst, Jason M.; DiGennaro Reed, Florence D.

2015-01-01

We conducted a parametric analysis of treatment integrity errors during discrete-trial training and investigated the effects of three integrity conditions (0, 50, or 100 % errors of commission) on performance in the presence and absence of programmed errors. The presence of commission errors impaired acquisition for three of four participants.…

Panel Resource Management (PRM) Implementation and Effects within Safety Review Panel Settings and Dynamics

NASA Technical Reports Server (NTRS)

Taylor, Robert W.; Nash, Sally K.

2007-01-01

While technical training and advanced degree's assure proficiency at specific tasks within engineering disciplines, they fail to address the potential for communication breakdown and decision making errors familiar to multicultural environments where language barriers, intimidating personalities and interdisciplinary misconceptions exist. In an effort to minimize these pitfalls to effective panel review, NASA's lead safety engineers to the ISS Safety Review Panel (SRP), and Payload Safety Review Panel (PSRP) initiated training with their engineers, in conjunction with the panel chairs, and began a Panel Resource Management (PRM) program. The intent of this program focuses on the ability to reduce the barriers inhibiting effective participation from all panel attendees by bolstering participants confidence levels through increased communication skills, situational awareness, debriefing, and a better technical understanding of requirements and systems.

[Preclinical and clinical management after mass disaster : Experiences from the train collision in Bad Aibling on 9 February 2016].

PubMed

Regel, G; Bracht, M; Huth, M; Maier, K J; Böcker, W

2016-06-01

Mass casualty incidents (MCI) in this day and age represent a special challenge, which initially require on-site coordination and logistics and then a professional distribution of victims (triage) to surrounding hospitals. Technical, logistical and even specialist errors can impair this flow of events. It therefore seems advisable to make a detailed analysis of every MCI. In this article the railway incident from 9 February 2016 is analyzed taking the preclinical and clinical cirumstances into consideration and conclusions for future management are drawn. As a special entity it could be determined that fixed table units in passenger trains represent a particularly dangerous hazard and in many instances in this analysis led to characteristic abdominal and thoracic injuries.

Initial Experience of an Anesthesiology-based Service for Perioperative Management of Pacemakers and Implantable Cardioverter Defibrillators.

PubMed

Rooke, G Alec; Lombaard, Stefan A; Van Norman, Gail A; Dziersk, Jörg; Natrajan, Krishna M; Larson, Lyle W; Poole, Jeanne E

2015-11-01

Management of cardiovascular implantable electronic devices (CIEDs), including pacemakers and implantable cardioverter defibrillators, for surgical procedures is challenging due to the increasing number of patients with CIEDs and limited availability of trained providers. At the authors' institution, a small group of anesthesiologists were trained to interrogate CIEDs, devise a management plan, and perform preoperative and postoperative programming and device testing whenever necessary. Patients undergoing surgery between October 1, 2009 and June 30, 2013 at the University of Washington Medical Center were included in a retrospective chart review to determine the number of devices actively managed by the Electrophysiology/Cardiology Service (EPCS) versus the Anesthesiology Device Service (ADS), changes in workload over time, surgical case delays due to device management, and errors and problems encountered in device programming. The EPCS managed 254 CIEDs, the ADS managed 548, and 227 by neither service. Over time, the ADS providers managed an increasing percentage of devices with decreasing supervision from the EPCS. Only two CIEDs managed by the ADS required immediate assistance from the EPCS. Patients who were unstable postoperatively were referred to the EPCS. Although numerous issues in programming were encountered, primarily when restoring demand pacing after programming asynchronous pacing for surgery, no patient harm resulted from ADS or EPCS management of CIEDs. An ADS can provide safe CIED management for surgery, but it requires specialized provider training and strong support from the EPCS. Due to the complexity of CIED management, an ADS will likely only be feasible in high-volume settings.

Decay in blood loss estimation skills after web-based didactic training.

PubMed

Toledo, Paloma; Eosakul, Stanley T; Goetz, Kristopher; Wong, Cynthia A; Grobman, William A

2012-02-01

Accuracy in blood loss estimation has been shown to improve immediately after didactic training. The objective of this study was to evaluate retention of blood loss estimation skills 9 months after a didactic web-based training. Forty-four participants were recruited from a cohort that had undergone web-based training and testing in blood loss estimation. The web-based posttraining test, consisting of pictures of simulated blood loss, was repeated 9 months after the initial training and testing. The primary outcome was the difference in accuracy of estimated blood loss (percent error) at 9 months compared with immediately posttraining. At the 9-month follow-up, the median error in estimation worsened to -34.6%. Although better than the pretraining error of -47.8% (P = 0.003), the 9-month error was significantly less accurate than the immediate posttraining error of -13.5% (P = 0.01). Decay in blood loss estimation skills occurs by 9 months after didactic training.

Early self-managed focal sensorimotor rehabilitative training enhances functional mobility and sensorimotor function in patients following total knee replacement: a controlled clinical trial.

PubMed

Moutzouri, Maria; Gleeson, Nigel; Coutts, Fiona; Tsepis, Elias; John, Gliatis

2018-02-01

To assess the effects of early self-managed focal sensorimotor training compared to functional exercise training after total knee replacement on functional mobility and sensorimotor function. A single-blind controlled clinical trial. University Hospital of Rion, Greece. A total of 52 participants following total knee replacement. The primary outcome was the Timed Up and Go Test and the secondary outcomes were balance, joint position error, the Knee Outcome Survey Activities of Daily Living Scale, and pain. Patients were assessed on three separate occasions (presurgery, 8 weeks post surgery, and 14 weeks post surgery). Participants were randomized to either focal sensorimotor exercise training (experimental group) or functional exercise training (control group). Both groups received a 12-week home-based programme prescribed for 3-5 sessions/week (35-45 minutes). Consistently greater improvements ( F 2,98  = 4.3 to 24.8; P < 0.05) in group mean scores favour the experimental group compared to the control group: Timed Up and Go (7.8 ± 2.9 seconds vs. 4.6 ± 2.6 seconds); balance (2.1 ± 0.9° vs. 0.7 ± 1.2°); joint position error (13.8 ± 7.3° vs. 6.2 ± 9.1°); Knee Outcome Survey Activities of Daily Living Scale (44.2 ± 11.3 vs. 26.1 ± 11.4); and pain (5.9 ± 1.3 cm vs. 4.6 ± 1.1 cm). Patterns of improvement for the experimental group over time were represented by a relative effect size range of 1.3-6.5. Overall, the magnitude of improvements in functional mobility and sensorimotor function endorses using focal sensorimotor training as an effective mode of rehabilitation following knee replacement.

Construction of multi-agent mobile robots control system in the problem of persecution with using a modified reinforcement learning method based on neural networks

NASA Astrophysics Data System (ADS)

Patkin, M. L.; Rogachev, G. N.

2018-02-01

A method for constructing a multi-agent control system for mobile robots based on training with reinforcement using deep neural networks is considered. Synthesis of the management system is proposed to be carried out with reinforcement training and the modified Actor-Critic method, in which the Actor module is divided into Action Actor and Communication Actor in order to simultaneously manage mobile robots and communicate with partners. Communication is carried out by sending partners at each step a vector of real numbers that are added to the observation vector and affect the behaviour. Functions of Actors and Critic are approximated by deep neural networks. The Critics value function is trained by using the TD-error method and the Actor’s function by using DDPG. The Communication Actor’s neural network is trained through gradients received from partner agents. An environment in which a cooperative multi-agent interaction is present was developed, computer simulation of the application of this method in the control problem of two robots pursuing two goals was carried out.

Effect of Error Augmentation on Brain Activation and Motor Learning of a Complex Locomotor Task

PubMed Central

Marchal-Crespo, Laura; Michels, Lars; Jaeger, Lukas; López-Olóriz, Jorge; Riener, Robert

2017-01-01

Up to date, the functional gains obtained after robot-aided gait rehabilitation training are limited. Error augmenting strategies have a great potential to enhance motor learning of simple motor tasks. However, little is known about the effect of these error modulating strategies on complex tasks, such as relearning to walk after a neurologic accident. Additionally, neuroimaging evaluation of brain regions involved in learning processes could provide valuable information on behavioral outcomes. We investigated the effect of robotic training strategies that augment errors—error amplification and random force disturbance—and training without perturbations on brain activation and motor learning of a complex locomotor task. Thirty-four healthy subjects performed the experiment with a robotic stepper (MARCOS) in a 1.5 T MR scanner. The task consisted in tracking a Lissajous figure presented on a display by coordinating the legs in a gait-like movement pattern. Behavioral results showed that training without perturbations enhanced motor learning in initially less skilled subjects, while error amplification benefited better-skilled subjects. Training with error amplification, however, hampered transfer of learning. Randomly disturbing forces induced learning and promoted transfer in all subjects, probably because the unexpected forces increased subjects' attention. Functional MRI revealed main effects of training strategy and skill level during training. A main effect of training strategy was seen in brain regions typically associated with motor control and learning, such as, the basal ganglia, cerebellum, intraparietal sulcus, and angular gyrus. Especially, random disturbance and no perturbation lead to stronger brain activation in similar brain regions than error amplification. Skill-level related effects were observed in the IPS, in parts of the superior parietal lobe (SPL), i.e., precuneus, and temporal cortex. These neuroimaging findings indicate that gait-like motor learning depends on interplay between subcortical, cerebellar, and fronto-parietal brain regions. An interesting observation was the low activation observed in the brain's reward system after training with error amplification compared to training without perturbations. Our results suggest that to enhance learning of a locomotor task, errors should be augmented based on subjects' skill level. The impacts of these strategies on motor learning, brain activation, and motivation in neurological patients need further investigation. PMID:29021739

An intelligent training system for space shuttle flight controllers

NASA Technical Reports Server (NTRS)

Loftin, R. Bowen; Wang, Lui; Baffes, Paul; Hua, Grace

1988-01-01

An autonomous intelligent training system which integrates expert system technology with training/teaching methodologies is described. The system was designed to train Mission Control Center (MCC) Flight Dynamics Officers (FDOs) to deploy a certain type of satellite from the Space Shuttle. The Payload-assist module Deploys/Intelligent Computer-Aided Training (PD/ICAT) system consists of five components: a user interface, a domain expert, a training session manager, a trainee model, and a training scenario generator. The interface provides the trainee with information of the characteristics of the current training session and with on-line help. The domain expert (DeplEx for Deploy Expert) contains the rules and procedural knowledge needed by the FDO to carry out the satellite deploy. The DeplEx also contains mal-rules which permit the identification and diagnosis of common errors made by the trainee. The training session manager (TSM) examines the actions of the trainee and compares them with the actions of DeplEx in order to determine appropriate responses. A trainee model is developed for each individual using the system. The model includes a history of the trainee's interactions with the training system and provides evaluative data on the trainee's current skill level. A training scenario generator (TSG) designs appropriate training exercises for each trainee based on the trainee model and the training goals. All of the expert system components of PD/ICAT communicate via a common blackboard. The PD/ICAT is currently being tested. Ultimately, this project will serve as a vehicle for developing a general architecture for intelligent training systems together with a software environment for creating such systems.

An intelligent training system for space shuttle flight controllers

NASA Technical Reports Server (NTRS)

Loftin, R. Bowen; Wang, Lui; Baffles, Paul; Hua, Grace

1988-01-01

An autonomous intelligent training system which integrates expert system technology with training/teaching methodologies is described. The system was designed to train Mission Control Center (MCC) Flight Dynamics Officers (FDOs) to deploy a certain type of satellite from the Space Shuttle. The Payload-assist module Deploys/Intelligent Computer-Aided Training (PD/ICAT) system consists of five components: a user interface, a domain expert, a training session manager, a trainee model, and a training scenario generator. The interface provides the trainee with information of the characteristics of the current training session and with on-line help. The domain expert (Dep1Ex for Deploy Expert) contains the rules and procedural knowledge needed by the FDO to carry out the satellite deploy. The Dep1Ex also contains mal-rules which permit the identification and diagnosis of common errors made by the trainee. The training session manager (TSM) examines the actions of the trainee and compares them with the actions of Dep1Ex in order to determine appropriate responses. A trainee model is developed for each individual using the system. The model includes a history of the trainee's interactions with the training system and provides evaluative data on the trainee's current skill level. A training scenario generator (TSG) designs appropriate training exercises for each trainee based on the trainee model and the training goals. All of the expert system components of PD/ICAT communicate via a common blackboard. The PD/ICAT is currently being tested. Ultimately, this project will serve as a vehicle for developing a general architecture for intelligent training systems together with a software environment for creating such systems.

Answering questions at the point of care: do residents practice EBM or manage information sources?

PubMed

McCord, Gary; Smucker, William D; Selius, Brian A; Hannan, Scott; Davidson, Elliot; Schrop, Susan Labuda; Rao, Vinod; Albrecht, Paula

2007-03-01

To determine the types of information sources that evidence-based medicine (EBM)-trained, family medicine residents use to answer clinical questions at the point of care, to assess whether the sources are evidence-based, and to provide suggestions for more effective information-management strategies in residency training. In 2005, trained medical students directly observed (for two half-days per physician) how 25 third-year family medicine residents retrieved information to answer clinical questions arising at the point of care and documented the type and name of each source, the retrieval location, and the estimated time spent consulting the source. An end-of-study questionnaire asked 37 full-time faculty and the participating residents about the best information sources available, subscriptions owned, why they use a personal digital assistant (PDA) to practice medicine, and their experience in preventing medical errors using a PDA. Forty-four percent of questions were answered by attending physicians, 23% by consulting PDAs, and 20% from books. Seventy-two percent of questions were answered within two minutes. Residents rated UptoDate as the best source for evidence-based information, but they used this source only five times. PDAs were used because of ease of use, time factors, and accessibility. All examples of medical errors discovered or prevented with PDA programs were medication related. None of the participants' residencies required the use of a specific medical information resource. The results support the Agency for Health Care Research and Quality's call for medical system improvements at the point of care. Additionally, it may be necessary to teach residents better information-management skills in addition to EBM skills.

Predicting and interpreting identification errors in military vehicle training using multidimensional scaling.

PubMed

Bohil, Corey J; Higgins, Nicholas A; Keebler, Joseph R

2014-01-01

We compared methods for predicting and understanding the source of confusion errors during military vehicle identification training. Participants completed training to identify main battle tanks. They also completed card-sorting and similarity-rating tasks to express their mental representation of resemblance across the set of training items. We expected participants to selectively attend to a subset of vehicle features during these tasks, and we hypothesised that we could predict identification confusion errors based on the outcomes of the card-sort and similarity-rating tasks. Based on card-sorting results, we were able to predict about 45% of observed identification confusions. Based on multidimensional scaling of the similarity-rating data, we could predict more than 80% of identification confusions. These methods also enabled us to infer the dimensions receiving significant attention from each participant. This understanding of mental representation may be crucial in creating personalised training that directs attention to features that are critical for accurate identification. Participants completed military vehicle identification training and testing, along with card-sorting and similarity-rating tasks. The data enabled us to predict up to 84% of identification confusion errors and to understand the mental representation underlying these errors. These methods have potential to improve training and reduce identification errors leading to fratricide.

How Trainees Would Disclose Medical Errors: Educational Implications for Training Programs

PubMed Central

White, Andrew A.; Bell, Sigall K.; Krauss, Melissa J; Garbutt, Jane; Dunagan, W. Claiborne; Fraser, Victoria J.; Levinson, Wendy; Larson, Eric B.; Gallagher, Thomas H.

2012-01-01

Background Disclosing harmful errors to patients is recommended, but appears to be uncommon. Understanding how trainees disclose errors and how those practices evolve during training could help educators design programs to address this gap. Purpose To determine how trainees would disclose medical errors. Methods A survey of 758 trainees (488 students and 270 residents) in internal medicine at two academic medical centers. Surveys depicted one of two harmful error scenarios that varied by how apparent the error would be to the patient. We measured attitudes and disclosure content using scripted responses. Results Trainees reported their intent to disclose the error as “definitely” (43%) “probably” (47%) “only if asked by patient” (9%), and “definitely not” (1%). Trainees were more likely to disclose obvious errors in comparison with ones patients were unlikely to recognize (55% vs. 30%, P<0.01). Respondents varied widely in what information they would disclose. Fifty percent of trainees chose statements explicitly stating an error occurred rather than only an adverse event. Regarding apologies, trainees were split between a general expression of regret (52%) and an explicit apology (46%). Respondents at higher levels of training were less likely to use explicit apologies (Trend P<0.01). Prior disclosure training was associated with increased willingness to disclose errors (OR 1.40, P=0.03). Conclusions Trainees may not be prepared to disclose medical errors to patients, and worrisome trends in trainee apology practices were observed across levels of training. Medical educators should intensify efforts to enhance trainees’ skills at meeting patients’ expectations for open disclosure of harmful medical errors. PMID:21401685

Gradual training reduces practice difficulty while preserving motor learning of a novel locomotor task.

PubMed

Sawers, Andrew; Hahn, Michael E

2013-08-01

Motor learning strategies that increase practice difficulty and the size of movement errors are thought to facilitate motor learning. In contrast to this, gradual training minimizes movement errors and reduces practice difficulty by incrementally introducing task requirements, yet remains as effective as sudden training and its large movement errors for learning novel reaching tasks. While attractive as a locomotor rehabilitation strategy, it remains unknown whether the efficacy of gradual training extends to learning locomotor tasks and their unique requirements. The influence of gradual vs. sudden training on learning a locomotor task, asymmetric split belt treadmill walking, was examined by assessing whole body sagittal plane kinematics during 24 hour retention and transfer performance following either gradual or sudden training. Despite less difficult and less specific practice for the gradual cohort on day 1, gradual training resulted in equivalent motor learning of the novel locomotor task as sudden training when assessed by retention and transfer a day later. This suggests that large movement errors and increased practice difficulty may not be necessary for learning novel locomotor tasks. Further, gradual training may present a viable locomotor rehabilitation strategy avoiding large movement errors that could limit or impair improvements in locomotor performance. Copyright © 2013 Elsevier B.V. All rights reserved.

Pilot training: What can surgeons learn from it?

PubMed

Sommer, Kai-Jörg

2014-03-01

To provide healthcare professionals with an insight into training in aviation and its possible transfer into surgery. From research online and into company archives, relevant publications and information were identified. Current airline pilot training consists of two categories, basic training and type-rating. Training methods comprise classroom instruction, computer-based training and practical training, in either the aircraft or a flight-training device, which ranges from a fixed-base flight-training device to a full flight simulator. Pilot training not only includes technical and procedural instruction, but also training in non-technical skills like crisis management, decision-making, leadership and communication. Training syllabuses, training devices and instructors are internationally standardized and these standards are legally binding. Re-qualification and recurrent training are mandatory at all stages of a pilot's and instructor's career. Surgeons and pilots have much in common, i.e., they work in a 'real-time' three-dimensional environment under high physiological and psychological stress, operating expensive equipment, and the ultimate cost for error is measured in human lives. However, their training differs considerably. Transferring these well-tried aviation methods into healthcare will make surgical training more efficient, more effective and ultimately safer.

Medical Team Training Improves Team Performance: AOA Critical Issues.

PubMed

Carpenter, James E; Bagian, James P; Snider, Rebecca G; Jeray, Kyle J

2017-09-20

Effective teamwork and communication can decrease medical errors in environments where the culture of safety is enhanced. Health care can benefit from programs that are based on teamwork, as in other high-stress industries (e.g., aviation), with crew resource management programs, simulator use, and utilization of checklists. Medical team training (MTT) with a strong leadership commitment was used at our institution to focus specifically on creating open, yet structured, communication in operating rooms. Training included the 3 phases of the World Health Organization protocol to organize communication and briefings: preoperative verification, preincision briefing, and debriefing at or near the end of the surgical case. This training program led to measured improvements in job satisfaction and compliance with checklist tasks, and identified opportunities to improve training sessions. MTT provides the potential for sustainable change and a positive impact on the environment of the operating room.

SU-F-T-251: The Quality Assurance for the Heavy Patient Load Department in the Developing Country: The Primary Experience of An Entire Workflow QA Process Management in Radiotherapy

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

Xie, J; Wang, J; Peng, J

Purpose: To implement an entire workflow quality assurance (QA) process in the radiotherapy department and to reduce the error rates of radiotherapy based on the entire workflow management in the developing country. Methods: The entire workflow QA process management starts from patient registration to the end of last treatment including all steps through the entire radiotherapy process. Error rate of chartcheck is used to evaluate the the entire workflow QA process. Two to three qualified senior medical physicists checked the documents before the first treatment fraction of every patient. Random check of the treatment history during treatment was also performed.more » A total of around 6000 patients treatment data before and after implementing the entire workflow QA process were compared from May, 2014 to December, 2015. Results: A systemic checklist was established. It mainly includes patient’s registration, treatment plan QA, information exporting to OIS(Oncology Information System), documents of treatment QAand QA of the treatment history. The error rate derived from the chart check decreases from 1.7% to 0.9% after our the entire workflow QA process. All checked errors before the first treatment fraction were corrected as soon as oncologist re-confirmed them and reinforce staff training was accordingly followed to prevent those errors. Conclusion: The entire workflow QA process improved the safety, quality of radiotherapy in our department and we consider that our QA experience can be applicable for the heavily-loaded radiotherapy departments in developing country.« less

Error and Uncertainty Analysis for Ecological Modeling and Simulation

DTIC Science & Technology

2001-12-01

management (LRAM) accounting for environmental, training, and economic factors. In the ELVS methodology, soil erosion status is used as a quantitative...Monte-Carlo approach. The optimization is realized through economic functions or on decision constraints, such as, unit sample cost, number of samples... nitrate flux to the Gulf of Mexico. Nature (Brief Communication) 414: 166-167. (Uncertainty analysis done with SERDP software) Gertner, G., G

Comparing the Effectiveness of Error-Correction Strategies in Discrete Trial Training

ERIC Educational Resources Information Center

Turan, Michelle K.; Moroz, Lianne; Croteau, Natalie Paquet

2012-01-01

Error-correction strategies are essential considerations for behavior analysts implementing discrete trial training with children with autism. The research literature, however, is still lacking in the number of studies that compare and evaluate error-correction procedures. The purpose of this study was to compare two error-correction strategies:…

Sleep quality, posttraumatic stress, depression, and human errors in train drivers: a population-based nationwide study in South Korea.

PubMed

Jeon, Hong Jin; Kim, Ji-Hae; Kim, Bin-Na; Park, Seung Jin; Fava, Maurizio; Mischoulon, David; Kang, Eun-Ho; Roh, Sungwon; Lee, Dongsoo

2014-12-01

Human error is defined as an unintended error that is attributable to humans rather than machines, and that is important to avoid to prevent accidents. We aimed to investigate the association between sleep quality and human errors among train drivers. Cross-sectional. Population-based. A sample of 5,480 subjects who were actively working as train drivers were recruited in South Korea. The participants were 4,634 drivers who completed all questionnaires (response rate 84.6%). None. The Pittsburgh Sleep Quality Index (PSQI), the Center for Epidemiologic Studies Depression Scale (CES-D), the Impact of Event Scale-Revised (IES-R), the State-Trait Anxiety Inventory (STAI), and the Korean Occupational Stress Scale (KOSS). Of 4,634 train drivers, 349 (7.5%) showed more than one human error per 5 y. Human errors were associated with poor sleep quality, higher PSQI total scores, short sleep duration at night, and longer sleep latency. Among train drivers with poor sleep quality, those who experienced severe posttraumatic stress showed a significantly higher number of human errors than those without. Multiple logistic regression analysis showed that human errors were significantly associated with poor sleep quality and posttraumatic stress, whereas there were no significant associations with depression, trait and state anxiety, and work stress after adjusting for age, sex, education years, marital status, and career duration. Poor sleep quality was found to be associated with more human errors in train drivers, especially in those who experienced severe posttraumatic stress. © 2014 Associated Professional Sleep Societies, LLC.

High fidelity simulation based team training in urology: a preliminary interdisciplinary study of technical and nontechnical skills in laparoscopic complications management.

PubMed

Lee, Jason Y; Mucksavage, Phillip; Canales, Cecilia; McDougall, Elspeth M; Lin, Sharon

2012-04-01

Simulation based team training provides an opportunity to develop interdisciplinary communication skills and address potential medical errors in a high fidelity, low stakes environment. We evaluated the implementation of a novel simulation based team training scenario and assessed the technical and nontechnical performance of urology and anesthesiology residents. Urology residents were randomly paired with anesthesiology residents to participate in a simulation based team training scenario involving the management of 2 scripted critical events during laparoscopic radical nephrectomy, including the vasovagal response to pneumoperitoneum and renal vein injury during hilar dissection. A novel kidney surgical model and a high fidelity mannequin simulator were used for the simulation. A debriefing session followed each simulation based team training scenario. Assessments of technical and nontechnical performance were made using task specific checklists and global rating scales. A total of 16 residents participated, of whom 94% rated the simulation based team training scenario as useful for communication skill training. Also, 88% of urology residents believed that the kidney surgical model was useful for technical skill training. Urology resident training level correlated with technical performance (p=0.004) and blood loss during renal vein injury management (p=0.022) but not with nontechnical performance. Anesthesia resident training level correlated with nontechnical performance (p=0.036). Urology residents consistently rated themselves higher on nontechnical performance than did faculty (p=0.033). Anesthesia residents did not differ in the self-assessment of nontechnical performance compared to faculty assessments. Residents rated the simulation based team training scenario as useful for interdisciplinary communication skill training. Urology resident training level correlated with technical performance but not with nontechnical performance. Urology residents consistently overestimated their nontechnical performance. Copyright © 2012 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Medicines management: an interview study of nurses at a secure psychiatric hospital.

PubMed

Haw, Camilla; Stubbs, Jean; Dickens, Geoff

2015-02-01

To explore mental health nurses' knowledge, attitudes and clinical judgement concerning medicines management in an inpatient setting with a view to enhancing training. Medicines management is a key role of mental health nurses, but little research has been conducted into their training needs. An exploratory mixed-methods design was used involving individual interviews with participants to investigate their responses to hypothetical medicine administration scenarios. Interviews were held with a convenience sample of 50 Registered Nurses working in a specialist mental health hospital between November 2012-February 2013. Participants were presented with clinical vignettes describing eight scenarios they might encounter as part of their medicines management role and asked about how they would respond. Responses were assessed by two independent raters against ten quality standards underpinning the vignettes. The median number of responses that were judged to demonstrate adequate awareness of associated quality standards was 4 (range 1-7), indicating that many participants did not appear to be aware of, or compliant with, current UK medicines management guidance and local policy. Many would not report a 'near miss' or medicines administration error. There was a lack of awareness of guidance on verbal prescribing, consent to treatment rules and the administration of off-label/unlicensed drugs. Past year attendance on a medicines management course, time since registration and self-reported knowledge of national standards for medicines administration did not discriminate between total score on the 10 quality standards. The medicines management training needs of participants appeared not to be fully met by the existing learning sources. The use of vignettes to assess nurses' training needs requires evaluation in other settings. © 2014 John Wiley & Sons Ltd.

The effects of error augmentation on learning to walk on a narrow balance beam.

PubMed

Domingo, Antoinette; Ferris, Daniel P

2010-10-01

Error augmentation during training has been proposed as a means to facilitate motor learning due to the human nervous system's reliance on performance errors to shape motor commands. We studied the effects of error augmentation on short-term learning of walking on a balance beam to determine whether it had beneficial effects on motor performance. Four groups of able-bodied subjects walked on a treadmill-mounted balance beam (2.5-cm wide) before and after 30 min of training. During training, two groups walked on the beam with a destabilization device that augmented error (Medium and High Destabilization groups). A third group walked on a narrower beam (1.27-cm) to augment error (Narrow). The fourth group practiced walking on the 2.5-cm balance beam (Wide). Subjects in the Wide group had significantly greater improvements after training than the error augmentation groups. The High Destabilization group had significantly less performance gains than the Narrow group in spite of similar failures per minute during training. In a follow-up experiment, a fifth group of subjects (Assisted) practiced with a device that greatly reduced catastrophic errors (i.e., stepping off the beam) but maintained similar pelvic movement variability. Performance gains were significantly greater in the Wide group than the Assisted group, indicating that catastrophic errors were important for short-term learning. We conclude that increasing errors during practice via destabilization and a narrower balance beam did not improve short-term learning of beam walking. In addition, the presence of qualitatively catastrophic errors seems to improve short-term learning of walking balance.

Culture and error in space: implications from analog environments.

PubMed

Helmreich, R L

2000-09-01

An ongoing study investigating national, organizational, and professional cultures in aviation and medicine is described. Survey data from 26 nations on 5 continents show highly significant national differences regarding appropriate relationships between leaders and followers, in group vs. individual orientation, and in values regarding adherence to rules and procedures. These findings replicate earlier research on dimensions of national culture. Data collected also isolate significant operational issues in multi-national flight crews. While there are no better or worse cultures, these cultural differences have operational implications for the way crews function in an international space environment. The positive professional cultures of pilots and physicians exhibit a high enjoyment of the job and professional pride. However, a negative component was also identified characterized by a sense of personal invulnerability regarding the effects of stress and fatigue on performance. This misperception of personal invulnerability has operational implications such as failures in teamwork and increased probability of error. A second component of the research examines team error in operational environments. From observational data collected during normal flight operations, new models of threat and error and their management were developed that can be generalized to operations in space and other socio-technological domains. Five categories of crew error are defined and their relationship to training programs in team performance, known generically as Crew Resource Management, is described. The relevance of these data for future spaceflight is discussed.

SU-F-E-09: Respiratory Signal Prediction Based On Multi-Layer Perceptron Neural Network Using Adjustable Training Samples

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

Sun, W; Jiang, M; Yin, F

Purpose: Dynamic tracking of moving organs, such as lung and liver tumors, under radiation therapy requires prediction of organ motions prior to delivery. The shift of moving organ may change a lot due to huge transform of respiration at different periods. This study aims to reduce the influence of that changes using adjustable training signals and multi-layer perceptron neural network (ASMLP). Methods: Respiratory signals obtained using a Real-time Position Management(RPM) device were used for this study. The ASMLP uses two multi-layer perceptron neural networks(MLPs) to infer respiration position alternately and the training sample will be updated with time. Firstly, amore » Savitzky-Golay finite impulse response smoothing filter was established to smooth the respiratory signal. Secondly, two same MLPs were developed to estimate respiratory position from its previous positions separately. Weights and thresholds were updated to minimize network errors according to Leverberg-Marquart optimization algorithm through backward propagation method. Finally, MLP 1 was used to predict 120∼150s respiration position using 0∼120s training signals. At the same time, MLP 2 was trained using 30∼150s training signals. Then MLP is used to predict 150∼180s training signals according to 30∼150s training signals. The respiration position is predicted as this way until it was finished. Results: In this experiment, the two methods were used to predict 2.5 minute respiratory signals. For predicting 1s ahead of response time, correlation coefficient was improved from 0.8250(MLP method) to 0.8856(ASMLP method). Besides, a 30% improvement of mean absolute error between MLP(0.1798 on average) and ASMLP(0.1267 on average) was achieved. For predicting 2s ahead of response time, correlation coefficient was improved from 0.61415 to 0.7098.Mean absolute error of MLP method(0.3111 on average) was reduced by 35% using ASMLP method(0.2020 on average). Conclusion: The preliminary results demonstrate that the ASMLP respiratory prediction method is more accurate than MLP method and can improve the respiration forecast accuracy.« less

Exploration of Two Training Paradigms Using Forced Induced Weight Shifting With the Tethered Pelvic Assist Device to Reduce Asymmetry in Individuals After Stroke: Case Reports.

PubMed

Bishop, Lauri; Khan, Moiz; Martelli, Dario; Quinn, Lori; Stein, Joel; Agrawal, Sunil

2017-10-01

Many robotic devices in rehabilitation incorporate an assist-as-needed haptic guidance paradigm to promote training. This error reduction model, while beneficial for skill acquisition, could be detrimental for long-term retention. Error augmentation (EA) models have been explored as alternatives. A robotic Tethered Pelvic Assist Device has been developed to study force application to the pelvis on gait and was used here to induce weight shift onto the paretic (error reduction) or nonparetic (error augmentation) limb during treadmill training. The purpose of these case reports is to examine effects of training with these two paradigms to reduce load force asymmetry during gait in two individuals after stroke (>6 mos). Participants presented with baseline gait asymmetry, although independent community ambulators. Participants underwent 1-hr trainings for 3 days using either the error reduction or error augmentation model. Outcomes included the Borg rating of perceived exertion scale for treatment tolerance and measures of force and stance symmetry. Both participants tolerated training. Force symmetry (measured on treadmill) improved from pretraining to posttraining (36.58% and 14.64% gains), however, with limited transfer to overground gait measures (stance symmetry gains of 9.74% and 16.21%). Training with the Tethered Pelvic Assist Device device proved feasible to improve force symmetry on the treadmill irrespective of training model. Future work should consider methods to increase transfer to overground gait.

Inspection error and its adverse effects - A model with implications for practitioners

NASA Technical Reports Server (NTRS)

Collins, R. D., Jr.; Case, K. E.; Bennett, G. K.

1978-01-01

Inspection error has clearly been shown to have adverse effects upon the results desired from a quality assurance sampling plan. These effects upon performance measures have been well documented from a statistical point of view. However, little work has been presented to convince the QC manager of the unfavorable cost consequences resulting from inspection error. This paper develops a very general, yet easily used, mathematical cost model. The basic format of the well-known Guthrie-Johns model is used. However, it is modified as required to assess the effects of attributes sampling errors of the first and second kind. The economic results, under different yet realistic conditions, will no doubt be of interest to QC practitioners who face similar problems daily. Sampling inspection plans are optimized to minimize economic losses due to inspection error. Unfortunately, any error at all results in some economic loss which cannot be compensated for by sampling plan design; however, improvements over plans which neglect the presence of inspection error are possible. Implications for human performance betterment programs are apparent, as are trade-offs between sampling plan modification and inspection and training improvements economics.

Differences in medication knowledge and risk of errors between graduating nursing students and working registered nurses: comparative study.

PubMed

Simonsen, Bjoerg O; Daehlin, Gro K; Johansson, Inger; Farup, Per G

2014-11-21

Nurses experience insufficient medication knowledge; particularly in drug dose calculations, but also in drug management and pharmacology. The weak knowledge could be a result of deficiencies in the basic nursing education, or lack of continuing maintenance training during working years. The aim of this study was to compare the medication knowledge, certainty and risk of error between graduating bachelor students in nursing and experienced registered nurses. Bachelor students in closing term and registered nurses with at least one year job experience underwent a multiple choice test in pharmacology, drug management and drug dose calculations: 3x14 questions with 3-4 alternative answers (score 0-42). Certainty of each answer was recorded with score 0-3, 0-1 indicating need for assistance. Risk of error was scored 1-3, where 3 expressed high risk: being certain that a wrong answer was correct. The results are presented as mean and (SD). Participants were 243 graduating students (including 29 men), aged 28.2 (7.6) years, and 203 registered nurses (including 16 men), aged 42.0 (9.3) years and with a working experience of 12.4 years (9.2). The knowledge among the nurses was found to be superior to that of the students: 68.9%(8.0) and 61.5%(7.8) correct answers, respectively, (p < 0.001). The difference was largest in drug management and dose calculations. The improvement occurred during the first working year. The nurses expressed higher degree of certainty and the risk of error was lower, both overall and for each topic (p < 0.01). Low risk of error was associated with high knowledge and high sense of coping (p < 0.001). The medication knowledge among experienced nurses was superior to bachelor students in nursing, but nevertheless insufficient. As much as 25% of the answers to the drug management questions would lead to high risk of error. More emphasis should be put into the basic nursing education and in the introduction to medication procedures in clinical practice to improve the nurses' medication knowledge and reduce the risk of error.

A method of teaching critical care skills to undergraduate student midwives using the Maternal-Acute Illness Management (M-AIM) training day.

PubMed

McCarthy, Rose; Nuttall, Janet; Smith, Joyce; Hollins Martin, Caroline J

2014-11-01

The most recent Confidential Enquiry into Maternal Deaths (CMACE, 2011) identified human errors, specifically those of midwives and obstetricians/doctors as a fundamental component in contributing to maternal death in the U.K. This paper discusses these findings and outlines a project to provide training in Maternal-Acute Illness Management (M-AIM) to final year student midwives. Contents of the program are designed to educate and simulate AIM skills and increase confidence and clinical ability in early recognition, management and referral of the acutely ill woman. An outline of the Maternal-AIM program delivered at the University of Salford (Greater Manchester, UK) is presented to illustrate how this particular institution has responded to a perceived need voiced by local midwifery leaders. It is proposed that developing this area of expertise in the education system will better prepare student midwives for contemporary midwifery practice. Crown Copyright © 2014. Published by Elsevier Ltd. All rights reserved.

Failing to Fix What is Found: Risk Accommodation in the Oil and Gas Industry.

PubMed

Stackhouse, Madelynn R D; Stewart, Robert

2017-01-01

The present program of research synthesizes the findings from three studies in line with two goals. First, the present research explores how the oil and gas industry is performing at risk mitigation in terms of finding and fixing errors when they occur. Second, the present research explores what factors in the work environment relate to a risk-accommodating environment. Study 1 presents a descriptive evaluation of high-consequence incidents at 34 oil and gas companies over a 12-month period (N = 873), especially in terms of those companies' effectiveness at investigating and fixing errors. The analysis found that most investigations were fair in terms of quality (mean = 75.50%), with a smaller proportion that were weak (mean = 11.40%) or strong (mean = 13.24%). Furthermore, most companies took at least one corrective action for high-consequence incidents, but few of these corrective actions were confirmed as having been completed (mean = 13.77%). In fact, most corrective actions were secondary interim administrative controls (e.g., having a safety meeting) rather than fair or strong controls (e.g., training, engineering elimination). Study 2a found that several environmental factors explain the 56.41% variance in safety, including management's disengagement from safety concerns, finding and fixing errors, safety management system effectiveness, training, employee safety, procedures, and a production-over-safety culture. Qualitative results from Study 2b suggest that a compliance-based culture of adhering to liability concerns, out-group blame, and a production-over-safety orientation may all impede safety effectiveness. © 2016 Society for Risk Analysis.

Validation of the ICU-DaMa tool for automatically extracting variables for minimum dataset and quality indicators: The importance of data quality assessment.

PubMed

Sirgo, Gonzalo; Esteban, Federico; Gómez, Josep; Moreno, Gerard; Rodríguez, Alejandro; Blanch, Lluis; Guardiola, Juan José; Gracia, Rafael; De Haro, Lluis; Bodí, María

2018-04-01

Big data analytics promise insights into healthcare processes and management, improving outcomes while reducing costs. However, data quality is a major challenge for reliable results. Business process discovery techniques and an associated data model were used to develop data management tool, ICU-DaMa, for extracting variables essential for overseeing the quality of care in the intensive care unit (ICU). To determine the feasibility of using ICU-DaMa to automatically extract variables for the minimum dataset and ICU quality indicators from the clinical information system (CIS). The Wilcoxon signed-rank test and Fisher's exact test were used to compare the values extracted from the CIS with ICU-DaMa for 25 variables from all patients attended in a polyvalent ICU during a two-month period against the gold standard of values manually extracted by two trained physicians. Discrepancies with the gold standard were classified into plausibility, conformance, and completeness errors. Data from 149 patients were included. Although there were no significant differences between the automatic method and the manual method, we detected differences in values for five variables, including one plausibility error and two conformance and completeness errors. Plausibility: 1) Sex, ICU-DaMa incorrectly classified one male patient as female (error generated by the Hospital's Admissions Department). Conformance: 2) Reason for isolation, ICU-DaMa failed to detect a human error in which a professional misclassified a patient's isolation. 3) Brain death, ICU-DaMa failed to detect another human error in which a professional likely entered two mutually exclusive values related to the death of the patient (brain death and controlled donation after circulatory death). Completeness: 4) Destination at ICU discharge, ICU-DaMa incorrectly classified two patients due to a professional failing to fill out the patient discharge form when thepatients died. 5) Length of continuous renal replacement therapy, data were missing for one patient because the CRRT device was not connected to the CIS. Automatic generation of minimum dataset and ICU quality indicators using ICU-DaMa is feasible. The discrepancies were identified and can be corrected by improving CIS ergonomics, training healthcare professionals in the culture of the quality of information, and using tools for detecting and correcting data errors. Copyright © 2018 Elsevier B.V. All rights reserved.

Fatigue Management Strategies for the Stratospheric Observatory for Infrared Astronomy

NASA Technical Reports Server (NTRS)

Bendrick, Gregg

2012-01-01

Operation of the Stratospheric Observatory for Infrared Astronomy entails a great deal of night-time work, with the potential for both acute and chronic sleep loss, as well as circadian rhythm dysynchrony. Such fatigue can result in performance decrements, with an increased risk of operator error. The NASA Dryden Flight Research Center manages this fatigue risk by means of a layered approach, to include: 1) Education and Training 2) Work Schedule Scoring 3) Obtained Sleep Metrics 4) Workplace and Operational Mitigations and 5) Incident or Accident Investigation. Specifically, quantitative estimation of the work schedule score, as well as the obtained sleep metric, allows Supervisors and Managers to better manage the risk of fatigue within the context of mission requirements.

Psychophysiological and other factors affecting human performance in accident prevention and investigation. [Comparison of aviation with other industries

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

Klinestiver, L.R.

Psychophysiological factors are not uncommon terms in the aviation incident/accident investigation sequence where human error is involved. It is highly suspect that the same psychophysiological factors may also exist in the industrial arena where operator personnel function; but, there is little evidence in literature indicating how management and subordinates cope with these factors to prevent or reduce accidents. It is apparent that human factors psychophysological training is quite evident in the aviation industry. However, while the industrial arena appears to analyze psychophysiological factors in accident investigations, there is little evidence that established training programs exist for supervisors and operator personnel.

Using an external surrogate for predictor model training in real-time motion management of lung tumors.

PubMed

Rottmann, Joerg; Berbeco, Ross

2014-12-01

Precise prediction of respiratory motion is a prerequisite for real-time motion compensation techniques such as beam, dynamic couch, or dynamic multileaf collimator tracking. Collection of tumor motion data to train the prediction model is required for most algorithms. To avoid exposure of patients to additional dose from imaging during this procedure, the feasibility of training a linear respiratory motion prediction model with an external surrogate signal is investigated and its performance benchmarked against training the model with tumor positions directly. The authors implement a lung tumor motion prediction algorithm based on linear ridge regression that is suitable to overcome system latencies up to about 300 ms. Its performance is investigated on a data set of 91 patient breathing trajectories recorded from fiducial marker tracking during radiotherapy delivery to the lung of ten patients. The expected 3D geometric error is quantified as a function of predictor lookahead time, signal sampling frequency and history vector length. Additionally, adaptive model retraining is evaluated, i.e., repeatedly updating the prediction model after initial training. Training length for this is gradually increased with incoming (internal) data availability. To assess practical feasibility model calculation times as well as various minimum data lengths for retraining are evaluated. Relative performance of model training with external surrogate motion data versus tumor motion data is evaluated. However, an internal-external motion correlation model is not utilized, i.e., prediction is solely driven by internal motion in both cases. Similar prediction performance was achieved for training the model with external surrogate data versus internal (tumor motion) data. Adaptive model retraining can substantially boost performance in the case of external surrogate training while it has little impact for training with internal motion data. A minimum adaptive retraining data length of 8 s and history vector length of 3 s achieve maximal performance. Sampling frequency appears to have little impact on performance confirming previously published work. By using the linear predictor, a relative geometric 3D error reduction of about 50% was achieved (using adaptive retraining, a history vector length of 3 s and with results averaged over all investigated lookahead times and signal sampling frequencies). The absolute mean error could be reduced from (2.0 ± 1.6) mm when using no prediction at all to (0.9 ± 0.8) mm and (1.0 ± 0.9) mm when using the predictor trained with internal tumor motion training data and external surrogate motion training data, respectively (for a typical lookahead time of 250 ms and sampling frequency of 15 Hz). A linear prediction model can reduce latency induced tracking errors by an average of about 50% in real-time image guided radiotherapy systems with system latencies of up to 300 ms. Training a linear model for lung tumor motion prediction with an external surrogate signal alone is feasible and results in similar performance as training with (internal) tumor motion. Particularly for scenarios where motion data are extracted from fluoroscopic imaging with ionizing radiation, this may alleviate the need for additional imaging dose during the collection of model training data.

Does Educator Training or Experience Affect the Quality of Multiple-Choice Questions?

PubMed

Webb, Emily M; Phuong, Jonathan S; Naeger, David M

2015-10-01

Physicians receive little training on proper multiple-choice question (MCQ) writing methods. Well-constructed MCQs follow rules, which ensure that a question tests what it is intended to test. Questions that break these are described as "flawed." We examined whether the prevalence of flawed questions differed significantly between those with or without prior training in question writing and between those with different levels of educator experience. We assessed 200 unedited MCQs from a question bank for our senior medical student radiology elective: an equal number of questions (50) were written by faculty with previous training in MCQ writing, other faculty, residents, and medical students. Questions were scored independently by two readers for the presence of 11 distinct flaws described in the literature. Questions written by faculty with MCQ writing training had significantly fewer errors: mean 0.4 errors per question compared to a mean of 1.5-1.7 errors per question for the other groups (P < .001). There were no significant differences in the total number of errors between the untrained faculty, residents, and students (P values .35-.91). Among trained faculty 17/50 questions (34%) were flawed, whereas other faculty wrote 38/50 (76%) flawed questions, residents 37/50 (74%), and students 44/50 (88%). Trained question writers' higher performance was mainly manifest in the reduced frequency of five specific errors. Faculty with training in effective MCQ writing made fewer errors in MCQ construction. Educator experience alone had no effect on the frequency of flaws; faculty without dedicated training, residents, and students performed similarly. Copyright © 2015 AUR. Published by Elsevier Inc. All rights reserved.

Compound Stimulus Presentation Does Not Deepen Extinction in Human Causal Learning

PubMed Central

Griffiths, Oren; Holmes, Nathan; Westbrook, R. Fred

2017-01-01

Models of associative learning have proposed that cue-outcome learning critically depends on the degree of prediction error encountered during training. Two experiments examined the role of error-driven extinction learning in a human causal learning task. Target cues underwent extinction in the presence of additional cues, which differed in the degree to which they predicted the outcome, thereby manipulating outcome expectancy and, in the absence of any change in reinforcement, prediction error. These prediction error manipulations have each been shown to modulate extinction learning in aversive conditioning studies. While both manipulations resulted in increased prediction error during training, neither enhanced extinction in the present human learning task (one manipulation resulted in less extinction at test). The results are discussed with reference to the types of associations that are regulated by prediction error, the types of error terms involved in their regulation, and how these interact with parameters involved in training. PMID:28232809

Identification and Remediation of Phonological and Motor Errors in Acquired Sound Production Impairment

PubMed Central

Gagnon, Bernadine; Miozzo, Michele

2017-01-01

Purpose This study aimed to test whether an approach to distinguishing errors arising in phonological processing from those arising in motor planning also predicts the extent to which repetition-based training can lead to improved production of difficult sound sequences. Method Four individuals with acquired speech production impairment who produced consonant cluster errors involving deletion were examined using a repetition task. We compared the acoustic details of productions with deletion errors in target consonant clusters to singleton consonants. Changes in accuracy over the course of the study were also compared. Results Two individuals produced deletion errors consistent with a phonological locus of the errors, and 2 individuals produced errors consistent with a motoric locus of the errors. The 2 individuals who made phonologically driven errors showed no change in performance on a repetition training task, whereas the 2 individuals with motoric errors improved in their production of both trained and untrained items. Conclusions The results extend previous findings about a metric for identifying the source of sound production errors in individuals with both apraxia of speech and aphasia. In particular, this work may provide a tool for identifying predominant error types in individuals with complex deficits. PMID:28655044

[Management of medication errors in general medical practice: Study in a pluriprofessionnal health care center].

PubMed

Pourrain, Laure; Serin, Michel; Dautriche, Anne; Jacquetin, Fréderic; Jarny, Christophe; Ballenecker, Isabelle; Bahous, Mickaël; Sgro, Catherine

2018-06-07

Medication errors are the most frequent medical care adverse events in France. Their management process used in hospital remains poorly applied in primary ambulatory care. The main objective of our study was to assess medication error management in general ambulatory practice. The secondary objectives were the characterization of the errors and the analysis of their root causes in order to implement corrective measures. The study was performed in a pluriprofessionnal health care house, applying the stages and tools validated by the French high health authority, that we previously adapted to ambulatory medical cares. During the 3 months study 4712 medical consultations were performed and we collected 64 medication errors. Most of affected patients were at the extreme ages of life (9,4 % before 9 years and 64 % after 70 years). Medication errors occurred at home in 39,1 % of cases, at pluriprofessionnal health care house (25,0 %) or at drugstore (17,2 %). They led to serious clinical consequences (classified as major, critical or catastrophic) in 17,2 % of cases. Drug induced adverse effects occurred in 5 patients, 3 of them needing hospitalization (1 patient recovered, 1 displayed sequelae and 1 died). In more than half of cases, the errors occurred at prescribing stage. The most frequent type of errors was the use of a wrong drug, different from that indicated for the patient (37,5 %) and poor treatment adherence (18,75 %). The systemic reported causes were a care process dysfunction (in coordination or procedure), the health care action context (patient home, not planned act, professional overwork), human factors such as patient and professional condition. The professional team adherence to the study was excellent. Our study demonstrates, for the first time in France, that medication errors management in ambulatory general medical care can be implemented in a pluriprofessionnal health care house with two conditions: the presence of a trained team coordinator, and the use of validated adapted and simple processes and tools. This study also shows that medications errors in general practice are specific of the care process organization. We identified vulnerable points, as transferring and communication between home and care facilities or conversely, medical coordination and involvement of the patient himself in his care. Copyright © 2018 Société française de pharmacologie et de thérapeutique. Published by Elsevier Masson SAS. All rights reserved.

Can an online clinical data management service help in improving data collection and data quality in a developing country setting?

PubMed

Wildeman, Maarten A; Zandbergen, Jeroen; Vincent, Andrew; Herdini, Camelia; Middeldorp, Jaap M; Fles, Renske; Dalesio, Otilia; van der Donk, Emile; Tan, I Bing

2011-08-08

Data collection by electronic medical record (EMR) systems have been proven to be helpful in data collection for scientific research and in improving healthcare. For a multi-centre trial in Indonesia and the Netherlands a web based system was selected to enable all participating centres to easily access data. This study assesses whether the introduction of a clinical trial data management service (CTDMS) composed of electronic case report forms (eCRF) can result in effective data collection and treatment monitoring. Data items entered were checked for inconsistencies automatically when submitted online. The data were divided into primary and secondary data items. We analysed both the total number of errors and the change in error rate, for both primary and secondary items, over the first five month of the trial. In the first five months 51 patients were entered. The primary data error rate was 1.6%, whilst that for secondary data was 2.7% against acceptable error rates for analysis of 1% and 2.5% respectively. The presented analysis shows that after five months since the introduction of the CTDMS the primary and secondary data error rates reflect acceptable levels of data quality. Furthermore, these error rates were decreasing over time. The digital nature of the CTDMS, as well as the online availability of that data, gives fast and easy insight in adherence to treatment protocols. As such, the CTDMS can serve as a tool to train and educate medical doctors and can improve treatment protocols.

Evolving approaches to management of quality in clinical microbiology.

PubMed Central

Bartlett, R C; Mazens-Sullivan, M; Tetreault, J Z; Lobel, S; Nivard, J

1994-01-01

Quality management in clinical microbiology began in the 1960s. Both government and professional societies introduced programs for proficiency testing and laboratory inspection and accreditation. Many laboratory scientists and pathologists were independently active and creative in expanding efforts to monitor and improve practices. The initial emphasis was placed on intralaboratory process. Later, attention was shifted to physician ordering, specimen collection, reporting, and use of information. Quality management in the laboratory depends in large part on the monitoring of indicators that provide some evidence of how laboratory resources are being used and how the information benefits patient care. Continuous quality improvement should be introduced. This consists of a more thorough assessment of doing the right things versus the wrong things in terms of customer demand and satisfaction and studying the cumulative effect of error when responsibility is passed from one person to another. Prevention of error is accomplished more through effective training and continuing education than through surveillance. Also, this system will force more conscious attention to meeting the expectations of the many customers that must be satisfied by laboratory services, including patients, physicians, third-party payers, and managed-care organizations. PMID:8118791

Multiple Intravenous Infusions Phase 2b: Laboratory Study

PubMed Central

Pinkney, Sonia; Fan, Mark; Chan, Katherine; Koczmara, Christine; Colvin, Christopher; Sasangohar, Farzan; Masino, Caterina; Easty, Anthony; Trbovich, Patricia

2014-01-01

Background Administering multiple intravenous (IV) infusions to a single patient via infusion pump occurs routinely in health care, but there has been little empirical research examining the risks associated with this practice or ways to mitigate those risks. Objectives To identify the risks associated with multiple IV infusions and assess the impact of interventions on nurses’ ability to safely administer them. Data Sources and Review Methods Forty nurses completed infusion-related tasks in a simulated adult intensive care unit, with and without interventions (i.e., repeated-measures design). Results Errors were observed in completing common tasks associated with the administration of multiple IV infusions, including the following (all values from baseline, which was current practice): setting up and programming multiple primary continuous IV infusions (e.g., 11.7% programming errors) identifying IV infusions (e.g., 7.7% line-tracing errors) managing dead volume (e.g., 96.0% flush rate errors following IV syringe dose administration) setting up a secondary intermittent IV infusion (e.g., 11.3% secondary clamp errors) administering an IV pump bolus (e.g., 11.5% programming errors) Of 10 interventions tested, 6 (1 practice, 3 technology, and 2 educational) significantly decreased or even eliminated errors compared to baseline. Limitations The simulation of an adult intensive care unit at 1 hospital limited the ability to generalize results. The study results were representative of nurses who received training in the interventions but had little experience using them. The longitudinal effects of the interventions were not studied. Conclusions Administering and managing multiple IV infusions is a complex and risk-prone activity. However, when a patient requires multiple IV infusions, targeted interventions can reduce identified risks. A combination of standardized practice, technology improvements, and targeted education is required. PMID:26316919

Pre-Test and Post-Test Applications to Shape the Education of Phlebotomists in A Quality Management Program: An Experience in a Training Hospital

PubMed Central

Keşapli, Mustafa; Aydin, Özgür; Esen, Hatice; Yeğin, Ayşenur; Güngör, Faruk; Yilmaz, Necat

2016-01-01

Summary Background After the introduction of modern laboratory instruments and information systems, preanalytic phase is the new field of battle. Errors in preanalytical phase account for approximately half of total errors in clinical laboratory. The objective of this study was to share an experience of an education program that was believed to be successful in decreasing the number of rejected samples received from the Emergency Department (ED). Methods An education program about laboratory procedures, quality requirements in the laboratory, patient and health-care worker safety was planned by the quality team to be performed on 36 people who were responsible for sample collection in the ED. A questionary which included 11 questions about the preanalytic phase was applied to all the attendees before and after training. The number of rejected samples per million was discovered with right proportion account over the number of accepted and rejected samples to laboratory after and before the training period. Results Most of the attendees were nurses (n: 22/55%), with over 12 years of experience in general and 2–4 years experience in the ED. Knowledge level of the attendees was calculated before training as 58.9% and after training as 91.8%. While the total rate of sample rejection before training was 2.35% (sigma value 3.37–3.50), the rate after training was 1.56% (sigma value 3.62–3.75). Conclusions Increasing the knowledge of staff has a direct positive impact on the preanalytic phase. The application of a pre-test was observed to be a feasible tool to shape group specific education programs. PMID:28356887

Pre-Test and Post-Test Applications to Shape the Education of Phlebotomists in A Quality Management Program: An Experience in a Training Hospital.

PubMed

Aykal, Güzin; Keşapli, Mustafa; Aydin, Özgür; Esen, Hatice; Yeğin, Ayşenur; Güngör, Faruk; Yilmaz, Necat

2016-09-01

After the introduction of modern laboratory instruments and information systems, preanalytic phase is the new field of battle. Errors in preanalytical phase account for approximately half of total errors in clinical laboratory. The objective of this study was to share an experience of an education program that was believed to be successful in decreasing the number of rejected samples received from the Emergency Department (ED). An education program about laboratory procedures, quality requirements in the laboratory, patient and health-care worker safety was planned by the quality team to be performed on 36 people who were responsible for sample collection in the ED. A questionary which included 11 questions about the preanalytic phase was applied to all the attendees before and after training. The number of rejected samples per million was discovered with right proportion account over the number of accepted and rejected samples to laboratory after and before the training period. Most of the attendees were nurses (n: 22/55%), with over 12 years of experience in general and 2-4 years experience in the ED. Knowledge level of the attendees was calculated before training as 58.9% and after training as 91.8%. While the total rate of sample rejection before training was 2.35% (sigma value 3.37-3.50), the rate after training was 1.56% (sigma value 3.62-3.75). Increasing the knowledge of staff has a direct positive impact on the preanalytic phase. The application of a pre-test was observed to be a feasible tool to shape group specific education programs.

Multitasking simulation: Present application and future directions.

PubMed

Adams, Traci Nicole; Rho, Jason C

2017-02-01

The Accreditation Council for Graduate Medical Education lists multi-tasking as a core competency in several medical specialties due to increasing demands on providers to manage the care of multiple patients simultaneously. Trainees often learn multitasking on the job without any formal curriculum, leading to high error rates. Multitasking simulation training has demonstrated success in reducing error rates among trainees. Studies of multitasking simulation demonstrate that this type of simulation is feasible, does not hinder the acquisition of procedural skill, and leads to better performance during subsequent periods of multitasking. Although some healthcare agencies have discouraged multitasking due to higher error rates among multitasking providers, it cannot be eliminated entirely in settings such as the emergency department in which providers care for more than one patient simultaneously. Simulation can help trainees to identify situations in which multitasking is inappropriate, while preparing them for situations in which multitasking is inevitable.

Comparison of Procedures for Dual and Triple Closely Spaced Parallel Runways

NASA Technical Reports Server (NTRS)

Verma, Savita; Ballinger, Deborah; Subramanian Shobana; Kozon, Thomas

2012-01-01

A human-in-the-loop high fidelity flight simulation experiment was conducted, which investigated and compared breakout procedures for Very Closely Spaced Parallel Approaches (VCSPA) with two and three runways. To understand the feasibility, usability and human factors of two and three runway VCSPA, data were collected and analyzed on the dependent variables of breakout cross track error and pilot workload. Independent variables included number of runways, cause of breakout and location of breakout. Results indicated larger cross track error and higher workload using three runways as compared to 2-runway operations. Significant interaction effects involving breakout cause and breakout location were also observed. Across all conditions, cross track error values showed high levels of breakout trajectory accuracy and pilot workload remained manageable. Results suggest possible avenues of future adaptation for adopting these procedures (e.g., pilot training), while also showing potential promise of the concept.

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.

Fatigue proofing: The role of protective behaviours in mediating fatigue-related risk in a defence aviation environment.

PubMed

Dawson, Drew; Cleggett, Courtney; Thompson, Kirrilly; Thomas, Matthew J W

2017-02-01

In the military or emergency services, operational requirements and/or community expectations often preclude formal prescriptive working time arrangements as a practical means of reducing fatigue-related risk. In these environments, workers sometimes employ adaptive or protective behaviours informally to reduce the risk (i.e. likelihood or consequence) associated with a fatigue-related error. These informal behaviours enable employees to reduce risk while continuing to work while fatigued. In this study, we documented the use of informal protective behaviours in a group of defence aviation personnel including flight crews. Semi-structured interviews were conducted to determine whether and which protective behaviours were used to mitigate fatigue-related error. The 18 participants were from aviation-specific trades and included aircrew (pilots and air-crewman) and aviation maintenance personnel (aeronautical engineers and maintenance personnel). Participants identified 147 ways in which they and/or others act to reduce the likelihood or consequence of a fatigue-related error. These formed seven categories of fatigue-reduction strategies. The two most novel categories are discussed in this paper: task-related and behaviour-based strategies. Broadly speaking, these results indicate that fatigued military flight and maintenance crews use protective 'fatigue-proofing' behaviours to reduce the likelihood and/or consequence of fatigue-related error and were aware of the potential benefits. It is also important to note that these behaviours are not typically part of the formal safety management system. Rather, they have evolved spontaneously as part of the culture around protecting team performance under adverse operating conditions. When compared with previous similar studies, aviation personnel were more readily able to understand the idea of fatigue proofing than those from a fire-fighting background. These differences were thought to reflect different cultural attitudes toward error and formal training using principles of Crew Resource Management and Threat and Error Management. Copyright © 2015 Elsevier Ltd. All rights reserved.

Organizational safety culture and medical error reporting by Israeli nurses.

PubMed

Kagan, Ilya; Barnoy, Sivia

2013-09-01

To investigate the association between patient safety culture (PSC) and the incidence and reporting rate of medical errors by Israeli nurses. Self-administered structured questionnaires were distributed to a convenience sample of 247 registered nurses enrolled in training programs at Tel Aviv University (response rate = 91%). The questionnaire's three sections examined the incidence of medication mistakes in clinical practice, the reporting rate for these errors, and the participants' views and perceptions of the safety culture in their workplace at three levels (organizational, departmental, and individual performance). Pearson correlation coefficients, t tests, and multiple regression analysis were used to analyze the data. Most nurses encountered medical errors from a daily to a weekly basis. Six percent of the sample never reported their own errors, while half reported their own errors "rarely or sometimes." The level of PSC was positively and significantly correlated with the error reporting rate. PSC, place of birth, error incidence, and not having an academic nursing degree were significant predictors of error reporting, together explaining 28% of variance. This study confirms the influence of an organizational safety climate on readiness to report errors. Senior healthcare executives and managers can make a major impact on safety culture development by creating and promoting a vision and strategy for quality and safety and fostering their employees' motivation to implement improvement programs at the departmental and individual level. A positive, carefully designed organizational safety culture can encourage error reporting by staff and so improve patient safety. © 2013 Sigma Theta Tau International.

Evaluation of robotic training forces that either enhance or reduce error in chronic hemiparetic stroke survivors.

PubMed

Patton, James L; Stoykov, Mary Ellen; Kovic, Mark; Mussa-Ivaldi, Ferdinando A

2006-01-01

This investigation is one in a series of studies that address the possibility of stroke rehabilitation using robotic devices to facilitate "adaptive training." Healthy subjects, after training in the presence of systematically applied forces, typically exhibit a predictable "after-effect." A critical question is whether this adaptive characteristic is preserved following stroke so that it might be exploited for restoring function. Another important question is whether subjects benefit more from training forces that enhance their errors than from forces that reduce their errors. We exposed hemiparetic stroke survivors and healthy age-matched controls to a pattern of disturbing forces that have been found by previous studies to induce a dramatic adaptation in healthy individuals. Eighteen stroke survivors made 834 movements in the presence of a robot-generated force field that pushed their hands proportional to its speed and perpendicular to its direction of motion--either clockwise or counterclockwise. We found that subjects could adapt, as evidenced by significant after-effects. After-effects were not correlated with the clinical scores that we used for measuring motor impairment. Further examination revealed that significant improvements occurred only when the training forces magnified the original errors, and not when the training forces reduced the errors or were zero. Within this constrained experimental task we found that error-enhancing therapy (as opposed to guiding the limb closer to the correct path) to be more effective than therapy that assisted the subject.

Obstetric simulation as a risk control strategy: course design and evaluation.

PubMed

Gardner, Roxane; Walzer, Toni B; Simon, Robert; Raemer, Daniel B

2008-01-01

Patient safety initiatives aimed at reducing medical errors and adverse events are being implemented in Obstetrics. The Controlled Risk Insurance Company (CRICO), Risk Management Foundation (RMF) of the Harvard Medical Institutions pursued simulation as an anesthesia risk control strategy. Encouraged by their success, CRICO/RMF promoted simulation-based team training as a risk control strategy for obstetrical providers. We describe the development, implementation, and evaluation of an obstetric simulation-based team training course grounded in crisis resource management (CRM) principles. We pursued systematic design of course development, implementation, and evaluation in 3 phases, including a 1-year or more posttraining follow-up with self-assessment questionnaires. The course was highly rated overall by participants immediately after the course and 1-year or more after the course. Most survey responders reported having experienced a critical clinical event since the course and that various aspects of their teamwork had significantly or somewhat improved as a result of the course. Most (86%) reported CRM principles as useful for obstetric faculty and most (59%) recommended repeating the simulation course every 2 years. A simulation-based team-training course for obstetric clinicians was developed and is a central component of CRICO/RMF's obstetric risk management incentive program that provides a 10% reduction in annual obstetrical malpractice premiums. The course was highly regarded immediately and 1 year or more after completing the course. Most survey responders reported improved teamwork and communication in managing a critical obstetric event in the interval since taking the course. Simulation-based CRM training can serve as a strategy for mitigating adverse perinatal events.

Human Factors in Training

NASA Technical Reports Server (NTRS)

Barshi, Immanuel; Byme, Vicky; Arsintescu, Lucia

2008-01-01

Future space missions will be significantly longer than current Shuttle missions and new systems will be more complex than current systems. Increasing communication delays between crews and Earth-based support means that astronauts need to be prepared to handle the unexpected on their own. As crews become more autonomous, their potential span of control and required expertise must grow to match their autonomy. It is not possible to train for every eventuality ahead of time on the ground, or to maintain trained skills across long intervals of disuse. To adequately prepare NASA personnel for these challenges, new training approaches, methodologies, and tools are required. This research project aims at developing these training capabilities. Training efforts in FY07 strongly focused on crew medical training, but also began exploring how Space Flight Resource Management training for Mission Operations Directorate (MOD) Flight Controllers could be integrated with systems training for optimal Mission Control Center operations. Beginning in January 2008, the training research effort will include team training prototypes and tools. The Training Task addresses Program risks that lie at the intersection of the following three risks identified by the Project: 1) Risk associated with poor task design; 2) Risk of error due to inadequate information; 3) Risk associated with reduced safety and efficiency due to poor human factors design.

Effects of auditory radio interference on a fine, continuous, open motor skill.

PubMed

Lazar, J M; Koceja, D M; Morris, H H

1995-06-01

The effects of human speech on a fine, continuous, and open motor skill were examined. A tape of auditory human radio traffic was injected into a tank gunnery simulator during each training session for 4 wk. of training for 3 hr. a week. The dependent variables were identification time, fire time, kill time, systems errors, and acquisition errors. These were measured by the Unit Conduct Of Fire Trainer (UCOFT). The interference was interjected into the UCOFT Tank Table VIII gunnery test. A Solomon four-group design was used. A 2 x 2 analysis of variance was used to assess whether interference gunnery training resulted in improvements in interference posttest scores. During the first three weeks of training, the interference group committed 106% more systems errors and 75% more acquisition errors than the standard group. The interference training condition was associated with a significant improvement from pre- to posttest of 44% in over-all UCOFT scores; however, when examined on the posttest the standard training did not improve performance significantly over the same period. It was concluded that auditory radio interference degrades performance of this fine, continuous, open motor skill, and interference training appears to abate the effects of this degradation.

Real-time tumor motion estimation using respiratory surrogate via memory-based learning

NASA Astrophysics Data System (ADS)

Li, Ruijiang; Lewis, John H.; Berbeco, Ross I.; Xing, Lei

2012-08-01

Respiratory tumor motion is a major challenge in radiation therapy for thoracic and abdominal cancers. Effective motion management requires an accurate knowledge of the real-time tumor motion. External respiration monitoring devices (optical, etc) provide a noninvasive, non-ionizing, low-cost and practical approach to obtain the respiratory signal. Due to the highly complex and nonlinear relations between tumor and surrogate motion, its ultimate success hinges on the ability to accurately infer the tumor motion from respiratory surrogates. Given their widespread use in the clinic, such a method is critically needed. We propose to use a powerful memory-based learning method to find the complex relations between tumor motion and respiratory surrogates. The method first stores the training data in memory and then finds relevant data to answer a particular query. Nearby data points are assigned high relevance (or weights) and conversely distant data are assigned low relevance. By fitting relatively simple models to local patches instead of fitting one single global model, it is able to capture highly nonlinear and complex relations between the internal tumor motion and external surrogates accurately. Due to the local nature of weighting functions, the method is inherently robust to outliers in the training data. Moreover, both training and adapting to new data are performed almost instantaneously with memory-based learning, making it suitable for dynamically following variable internal/external relations. We evaluated the method using respiratory motion data from 11 patients. The data set consists of simultaneous measurement of 3D tumor motion and 1D abdominal surface (used as the surrogate signal in this study). There are a total of 171 respiratory traces, with an average peak-to-peak amplitude of ∼15 mm and average duration of ∼115 s per trace. Given only 5 s (roughly one breath) pretreatment training data, the method achieved an average 3D error of 1.5 mm and 95th percentile error of 3.4 mm on unseen test data. The average 3D error was further reduced to 1.4 mm when the model was tuned to its optimal setting for each respiratory trace. In one trace where a few outliers are present in the training data, the proposed method achieved an error reduction of as much as ∼50% compared with the best linear model (1.0 mm versus 2.1 mm). The memory-based learning technique is able to accurately capture the highly complex and nonlinear relations between tumor and surrogate motion in an efficient manner (a few milliseconds per estimate). Furthermore, the algorithm is particularly suitable to handle situations where the training data are contaminated by large errors or outliers. These desirable properties make it an ideal candidate for accurate and robust tumor gating/tracking using respiratory surrogates.

Can aviation-based team training elicit sustainable behavioral change?

PubMed

Sax, Harry C; Browne, Patrick; Mayewski, Raymond J; Panzer, Robert J; Hittner, Kathleen C; Burke, Rebecca L; Coletta, Sandra

2009-12-01

To quantify effects of aviation-based crew resource management training on patient safety-related behaviors and perceived personal empowerment. Prospective study of checklist use, error self-reporting, and a 10-point safety empowerment survey after participation in a crew resource management training intervention. Seven hundred twenty-two-bed university hospital; 247-bed affiliated community hospital. There were 857 participants, the majority of whom were nurses (50%), followed by ancillary personnel (28%) and physicians (22%). Preoperative checklist use over time; number and type of entries on a Web-based incident reporting system; and measurement of degree of empowerment (1-5 scale) on a 10-point survey of safety attitudes and actions given prior to, immediately after, and a minimum of 2 months after training. Since 2003, 10 courses trained 857 participants in multiple disciplines. Preoperative checklist use rose (75% in 2003, 86% in 2004, 94% in 2005, 98% in 2006, and 100% in 2007). Self-initiated reports increased from 709 per quarter in 2002 to 1481 per quarter in 2008. The percentage of reports related to environment as opposed to actual events increased from 15.9% prior to training to 20.3% subsequently (P < .01). Perceived self-empowerment, creating a culture of safety, rose by an average of 0.5 point in all 10 realms immediately posttraining (mean [SD] rating, 3.0 [0.07] vs 3.5 [0.05]; P < .05). This was maintained after a minimum of 2 months. There was a trend toward a hierarchical effect with participants less comfortable confronting incompetence in a physician (mean [SD] rating, 3.1 [0.8]) than in nurses or technicians (mean [SD] rating, 3.4 [0.7] for both) (P>.05). Crew resource management programs can influence personal behaviors and empowerment. Effects may take years to be ingrained into the culture.

Exploring human error in military aviation flight safety events using post-incident classification systems.

PubMed

Hooper, Brionny J; O'Hare, David P A

2013-08-01

Human error classification systems theoretically allow researchers to analyze postaccident data in an objective and consistent manner. The Human Factors Analysis and Classification System (HFACS) framework is one such practical analysis tool that has been widely used to classify human error in aviation. The Cognitive Error Taxonomy (CET) is another. It has been postulated that the focus on interrelationships within HFACS can facilitate the identification of the underlying causes of pilot error. The CET provides increased granularity at the level of unsafe acts. The aim was to analyze the influence of factors at higher organizational levels on the unsafe acts of front-line operators and to compare the errors of fixed-wing and rotary-wing operations. This study analyzed 288 aircraft incidents involving human error from an Australasian military organization occurring between 2001 and 2008. Action errors accounted for almost twice (44%) the proportion of rotary wing compared to fixed wing (23%) incidents. Both classificatory systems showed significant relationships between precursor factors such as the physical environment, mental and physiological states, crew resource management, training and personal readiness, and skill-based, but not decision-based, acts. The CET analysis showed different predisposing factors for different aspects of skill-based behaviors. Skill-based errors in military operations are more prevalent in rotary wing incidents and are related to higher level supervisory processes in the organization. The Cognitive Error Taxonomy provides increased granularity to HFACS analyses of unsafe acts.

Private pilot judgment training in flight school settings.

DOT National Transportation Integrated Search

1987-05-01

Pilot judgment errors have long been recognized as an important factor in aviation accidents. Previous studies have demonstrated that specialized training procedures can significantly reduce the number of decisional errors made by newly certified pri...

Crew resource management in the ICU: the need for culture change.

PubMed

Haerkens, Marck Htm; Jenkins, Donald H; van der Hoeven, Johannes G

2012-08-22

Intensive care frequently results in unintentional harm to patients and statistics don't seem to improve. The ICU environment is especially unforgiving for mistakes due to the multidisciplinary, time-critical nature of care and vulnerability of the patients. Human factors account for the majority of adverse events and a sound safety climate is therefore essential. This article reviews the existing literature on aviation-derived training called Crew Resource Management (CRM) and discusses its application in critical care medicine. CRM focuses on teamwork, threat and error management and blame free discussion of human mistakes. Though evidence is still scarce, the authors consider CRM to be a promising tool for culture change in the ICU setting, if supported by leadership and well-designed follow-up.

Descent advisor preliminary field test

NASA Technical Reports Server (NTRS)

Green, Steven M.; Vivona, Robert A.; Sanford, Beverly

1995-01-01

A field test of the Descent Advisor (DA) automation tool was conducted at the Denver Air Route Traffic Control Center in September 1994. DA is being developed to assist Center controllers in the efficient management and control of arrival traffic. DA generates advisories, based on trajectory predictions, to achieve accurate meter-fix arrival times in a fuel efficient manner while assisting the controller with the prediction and resolution of potential conflicts. The test objectives were to evaluate the accuracy of DA trajectory predictions for conventional- and flight-management-system-equipped jet transports, to identify significant sources of trajectory prediction error, and to investigate procedural and training issues (both air and ground) associated with DA operations. Various commercial aircraft (97 flights total) and a Boeing 737-100 research aircraft participated in the test. Preliminary results from the primary test set of 24 commercial flights indicate a mean DA arrival time prediction error of 2.4 sec late with a standard deviation of 13.1 sec. This paper describes the field test and presents preliminary results for the commercial flights.

The corticospinal responses of metronome-paced, but not self-paced strength training are similar to motor skill training.

PubMed

Leung, Michael; Rantalainen, Timo; Teo, Wei-Peng; Kidgell, Dawson

2017-12-01

The corticospinal responses to skill training may be different to strength training, depending on how the strength training is performed. It was hypothesised that the corticospinal responses would not be different following skill training and metronome-paced strength training (MPST), but would differ when compared with self-paced strength training (SPST). Corticospinal excitability, short-interval intra-cortical inhibition (SICI) and strength and tracking error were measured at baseline and 2 and 4 weeks. Participants (n = 44) were randomly allocated to visuomotor tracking, MPST, SPST or a control group. MPST increased strength by 7 and 18%, whilst SPST increased strength by 12 and 26% following 2 and 4 weeks of strength training. There were no changes in strength following skill training. Skill training reduced tracking error by 47 and 58% at 2 and 4 weeks. There were no changes in tracking error following SPST; however, tracking error reduced by 24% following 4 weeks of MPST. Corticospinal excitability increased by 40% following MPST and by 29% following skill training. There was no change in corticospinal excitability following 4 weeks of SPST. Importantly, the magnitude of change between skill training and MPST was not different. SICI decreased by 41 and 61% following 2 and 4 weeks of MPST, whilst SICI decreased by 41 and 33% following 2 and 4 weeks of skill training. Again, SPST had no effect on SICI at 2 and 4 weeks. There was no difference in the magnitude of SICI reduction between skill training and MPST. This study adds new knowledge regarding the corticospinal responses to skill and MPST, showing they are similar but different when compared with SPST.

Preparing data for analysis using microsoft Excel.

PubMed

Elliott, Alan C; Hynan, Linda S; Reisch, Joan S; Smith, Janet P

2006-09-01

A critical component essential to good research is the accurate and efficient collection and preparation of data for analysis. Most medical researchers have little or no training in data management, often causing not only excessive time spent cleaning data but also a risk that the data set contains collection or recording errors. The implementation of simple guidelines based on techniques used by professional data management teams will save researchers time and money and result in a data set better suited to answer research questions. Because Microsoft Excel is often used by researchers to collect data, specific techniques that can be implemented in Excel are presented.

Long-term neuromuscular training and ankle joint position sense.

PubMed

Kynsburg, A; Pánics, G; Halasi, T

2010-06-01

Preventive effect of proprioceptive training is proven by decreasing injury incidence, but its proprioceptive mechanism is not. Major hypothesis: the training has a positive long-term effect on ankle joint position sense in athletes of a high-risk sport (handball). Ten elite-level female handball-players represented the intervention group (training-group), 10 healthy athletes of other sports formed the control-group. Proprioceptive training was incorporated into the regular training regimen of the training-group. Ankle joint position sense function was measured with the "slope-box" test, first described by Robbins et al. Testing was performed one day before the intervention and 20 months later. Mean absolute estimate errors were processed for statistical analysis. Proprioceptive sensory function improved regarding all four directions with a high significance (p<0.0001; avg. mean estimate error improvement: 1.77 degrees). This was also highly significant (p< or =0.0002) in each single directions, with avg. mean estimate error improvement between 1.59 degrees (posterior) and 2.03 degrees (anterior). Mean absolute estimate errors at follow-up (2.24 degrees +/-0.88 degrees) were significantly lower than in uninjured controls (3.29 degrees +/-1.15 degrees) (p<0.0001). Long-term neuromuscular training has improved ankle joint position sense function in the investigated athletes. This joint position sense improvement can be one of the explanations for injury rate reduction effect of neuromuscular training.

Identifying presence of correlated errors in GRACE monthly harmonic coefficients using machine learning algorithms

NASA Astrophysics Data System (ADS)

Piretzidis, Dimitrios; Sra, Gurveer; Karantaidis, George; Sideris, Michael G.

2017-04-01

A new method for identifying correlated errors in Gravity Recovery and Climate Experiment (GRACE) monthly harmonic coefficients has been developed and tested. Correlated errors are present in the differences between monthly GRACE solutions, and can be suppressed using a de-correlation filter. In principle, the de-correlation filter should be implemented only on coefficient series with correlated errors to avoid losing useful geophysical information. In previous studies, two main methods of implementing the de-correlation filter have been utilized. In the first one, the de-correlation filter is implemented starting from a specific minimum order until the maximum order of the monthly solution examined. In the second one, the de-correlation filter is implemented only on specific coefficient series, the selection of which is based on statistical testing. The method proposed in the present study exploits the capabilities of supervised machine learning algorithms such as neural networks and support vector machines (SVMs). The pattern of correlated errors can be described by several numerical and geometric features of the harmonic coefficient series. The features of extreme cases of both correlated and uncorrelated coefficients are extracted and used for the training of the machine learning algorithms. The trained machine learning algorithms are later used to identify correlated errors and provide the probability of a coefficient series to be correlated. Regarding SVMs algorithms, an extensive study is performed with various kernel functions in order to find the optimal training model for prediction. The selection of the optimal training model is based on the classification accuracy of the trained SVM algorithm on the same samples used for training. Results show excellent performance of all algorithms with a classification accuracy of 97% - 100% on a pre-selected set of training samples, both in the validation stage of the training procedure and in the subsequent use of the trained algorithms to classify independent coefficients. This accuracy is also confirmed by the external validation of the trained algorithms using the hydrology model GLDAS NOAH. The proposed method meet the requirement of identifying and de-correlating only coefficients with correlated errors. Also, there is no need of applying statistical testing or other techniques that require prior de-correlation of the harmonic coefficients.

The influence of cognitive load on transfer with error prevention training methods: a meta-analysis.

PubMed

Hutchins, Shaun D; Wickens, Christopher D; Carolan, Thomas F; Cumming, John M

2013-08-01

The objective was to conduct research synthesis for the U.S.Army on the effectiveness of two error prevention training strategies (training wheels and scaffolding) on the transfer of training. Motivated as part of an ongoing program of research on training effectiveness, the current work presents some of the program's research into the effects on transfer of error prevention strategies during training from a cognitive load perspective. Based on cognitive load theory, two training strategies were hypothesized to reduce intrinsic load by supporting learners early in acquisition during schema development. A transfer ratio and Hedges' g were used in the two meta-analyses conducted on transfer studies employing the two training strategies. Moderators relevant to cognitive load theory and specific to the implemented strategies were examined.The transfer ratio was the ratio of treatment transfer performance to control transfer. Hedges' g was used in comparing treatment and control group standardized mean differences. Both effect sizes were analyzed with versions of sample weighted fixed effect models. Analysis of the training wheels strategy suggests a transfer benefit. The observed benefit was strongest when the training wheels were a worked example coupled with a principle-based prompt. Analysis of the scaffolding data also suggests a transfer benefit for the strategy. Both training wheels and scaffolding demonstrated positive transfer as training strategies.As error prevention techniques, both support the intrinsic load--reducing implications of cognitive load theory. The findings are applicable to the development of instructional design guidelines in professional skill-based organizations such as the military.

Reducing cognitive skill decay and diagnostic error: theory-based practices for continuing education in health care.

PubMed

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 cognitive reasoning skills in the clinical education, organizational training, and human factors literatures suggest that continuing education plays a critical role in mitigating and managing diagnostic skill decay. Recent models also underscore the role of system level factors (eg, cognitive decision support tools, just-in-time training opportunities) in supporting clinical reasoning process. The purpose of this manuscript is to offer a multidisciplinary review of cognitive models of clinical decision making skills in order to provide a list of best practices for supporting continuous improvement and maintenance of cognitive diagnostic processes through continuing education. Copyright © 2012 The Alliance for Continuing Education in the Health Professions, the Society for Academic Continuing Medical Education, and the Council on CME, Association for Hospital Medical Education.

Training of Working Memory Impacts Neural Processing of Vocal Pitch Regulation

PubMed Central

Li, Weifeng; Guo, Zhiqiang; Jones, Jeffery A.; Huang, Xiyan; Chen, Xi; Liu, Peng; Chen, Shaozhen; Liu, Hanjun

2015-01-01

Working memory training can improve the performance of tasks that were not trained. Whether auditory-motor integration for voice control can benefit from working memory training, however, remains unclear. The present event-related potential (ERP) study examined the impact of working memory training on the auditory-motor processing of vocal pitch. Trained participants underwent adaptive working memory training using a digit span backwards paradigm, while control participants did not receive any training. Before and after training, both trained and control participants were exposed to frequency-altered auditory feedback while producing vocalizations. After training, trained participants exhibited significantly decreased N1 amplitudes and increased P2 amplitudes in response to pitch errors in voice auditory feedback. In addition, there was a significant positive correlation between the degree of improvement in working memory capacity and the post-pre difference in P2 amplitudes. Training-related changes in the vocal compensation, however, were not observed. There was no systematic change in either vocal or cortical responses for control participants. These findings provide evidence that working memory training impacts the cortical processing of feedback errors in vocal pitch regulation. This enhanced cortical processing may be the result of increased neural efficiency in the detection of pitch errors between the intended and actual feedback. PMID:26553373

Simulation-based medical education: an ethical imperative.

PubMed

Ziv, Amitai; Wolpe, Paul Root; Small, Stephen D; Glick, Shimon

2006-01-01

Medical training must at some point use live patients to hone the skills of health professionals. But there is also an obligation to provide optimal treatment and to ensure patients' safety and well-being. Balancing these 2 needs represents a fundamental ethical tension in medical education. Simulation-based learning can help mitigate this tension by developing health professionals' knowledge, skills, and attitudes while protecting patients from unnecessary risk. Simulation-based training has been institutionalized in other high-hazard professions, such as aviation, nuclear power, and the military, to maximize training safety and minimize risk. Health care has lagged behind in simulation applications for a number of reasons, including cost, lack of rigorous proof of effect, and resistance to change. Recently, the international patient safety movement and the U.S. federal policy agenda have created a receptive atmosphere for expanding the use of simulators in medical training, stressing the ethical imperative to "first do no harm" in the face of validated, large epidemiological studies describing unacceptable preventable injuries to patients as a result of medical management. Four themes provide a framework for an ethical analysis of simulation-based medical education: best standards of care and training, error management and patient safety, patient autonomy, and social justice and resource allocation. These themes are examined from the perspectives of patients, learners, educators, and society. The use of simulation wherever feasible conveys a critical educational and ethical message to all: patients are to be protected whenever possible and they are not commodities to be used as conveniences of training.

Simulation-based medical education: an ethical imperative.

PubMed

Ziv, Amitai; Wolpe, Paul Root; Small, Stephen D; Glick, Shimon

2003-08-01

Medical training must at some point use live patients to hone the skills of health professionals. But there is also an obligation to provide optimal treatment and to ensure patients' safety and well-being. Balancing these two needs represents a fundamental ethical tension in medical education. Simulation-based learning can help mitigate this tension by developing health professionals' knowledge, skills, and attitudes while protecting patients from unnecessary risk. Simulation-based training has been institutionalized in other high-hazard professions, such as aviation, nuclear power, and the military, to maximize training safety and minimize risk. Health care has lagged behind in simulation applications for a number of reasons, including cost, lack of rigorous proof of effect, and resistance to change. Recently, the international patient safety movement and the U.S. federal policy agenda have created a receptive atmosphere for expanding the use of simulators in medical training, stressing the ethical imperative to "first do no harm" in the face of validated, large epidemiological studies describing unacceptable preventable injuries to patients as a result of medical management. Four themes provide a framework for an ethical analysis of simulation-based medical education: best standards of care and training, error management and patient safety, patient autonomy, and social justice and resource allocation. These themes are examined from the perspectives of patients, learners, educators, and society. The use of simulation wherever feasible conveys a critical educational and ethical message to all: patients are to be protected whenever possible and they are not commodities to be used as conveniences of training.

An experimental study of interstitial lung tissue classification in HRCT images using ANN and role of cost functions

NASA Astrophysics Data System (ADS)

Dash, Jatindra K.; Kale, Mandar; Mukhopadhyay, Sudipta; Khandelwal, Niranjan; Prabhakar, Nidhi; Garg, Mandeep; Kalra, Naveen

2017-03-01

In this paper, we investigate the effect of the error criteria used during a training phase of the artificial neural network (ANN) on the accuracy of the classifier for classification of lung tissues affected with Interstitial Lung Diseases (ILD). Mean square error (MSE) and the cross-entropy (CE) criteria are chosen being most popular choice in state-of-the-art implementations. The classification experiment performed on the six interstitial lung disease (ILD) patterns viz. Consolidation, Emphysema, Ground Glass Opacity, Micronodules, Fibrosis and Healthy from MedGIFT database. The texture features from an arbitrary region of interest (AROI) are extracted using Gabor filter. Two different neural networks are trained with the scaled conjugate gradient back propagation algorithm with MSE and CE error criteria function respectively for weight updation. Performance is evaluated in terms of average accuracy of these classifiers using 4 fold cross-validation. Each network is trained for five times for each fold with randomly initialized weight vectors and accuracies are computed. Significant improvement in classification accuracy is observed when ANN is trained by using CE (67.27%) as error function compared to MSE (63.60%). Moreover, standard deviation of the classification accuracy for the network trained with CE (6.69) error criteria is found less as compared to network trained with MSE (10.32) criteria.

Standardized training in nurse model travel clinics.

PubMed

Sofarelli, Theresa A; Ricks, Jane H; Anand, Rahul; Hale, Devon C

2011-01-01

International travel plays a significant role in the emergence and redistribution of major human diseases. The importance of travel medicine clinics for preventing morbidity and mortality has been increasingly appreciated, although few studies have thus far examined the management and staff training strategies that result in successful travel-clinic operations. Here, we describe an example of travel-clinic operation and management coordinated through the University of Utah School of Medicine, Division of Infectious Diseases. This program, which involves eight separate clinics distributed statewide, functions both to provide patient consult and care services, as well as medical provider training and continuing medical education (CME). Initial training, the use of standardized forms and protocols, routine chart reviews and monthly continuing education meetings are the distinguishing attributes of this program. An Infectious Disease team consisting of one medical doctor (MD) and a physician assistant (PA) act as consultants to travel nurses who comprise the majority of clinic staff. Eight clinics distributed throughout the state of Utah serve approximately 6,000 travelers a year. Pre-travel medical services are provided by 11 nurses, including 10 registered nurses (RNs) and 1 licensed practical nurse (LPN). This trained nursing staff receives continuing travel medical education and participate in the training of new providers. All nurses have completed a full training program and 7 of the 11 (64%) of clinic nursing staff serve more than 10 patients a week. Quality assurance measures show that approximately 0.5% of charts reviewed contain a vaccine or prescription error which require patient notification for correction. Using an initial training program, standardized patient intake forms, vaccine and prescription protocols, preprinted prescriptions, and regular CME, highly trained nurses at travel clinics are able to provide standardized pre-travel care to international travelers originating from Utah. © 2010 International Society of Travel Medicine.

Spiral-bevel geometry and gear train precision

NASA Technical Reports Server (NTRS)

Litvin, F. L.; Coy, J. J.

1983-01-01

A new aproach to the solution of determination of surface principal curvatures and directions is proposed. Direct relationships between the principal curvatures and directions of the tool surface and those of the principal curvatures and directions of generated gear surface are obtained. The principal curvatures and directions of geartooth surface are obtained without using the complicated equations of these surfaces. A general theory of the train kinematical errors exerted by manufacturing and assembly errors is discussed. Two methods for the determination of the train kinematical errors can be worked out: (1) with aid of a computer, and (2) with a approximate method. Results from noise and vibration measurement conducted on a helicopter transmission are used to illustrate the principals contained in the theory of kinematic errors.

Graduate Students' Administration and Scoring Errors on the WISC-IV: Reducing Inaccuracies with Training and Experience

ERIC Educational Resources Information Center

Alper, Jaclyn

2012-01-01

A total of 52 Wechsler Intelligence Scale for Children, Fourth Edition (WISC-IV) protocols, administered by graduate students were examined to obtain data on the type and frequency of examiner errors, the impact of errors on resultant test scores as well as improvement rate over the course of two years in training. Findings were consistent with…

Effect of stress management interventions on job stress among nurses working in critical care units.

PubMed

Light Irin, C; Bincy, R

2012-01-01

Stress in nurses affects their health and increases absenteeism, attrition rate, injury claims, infection rates and errors in treating patients. This in turn significantly increases the cost of employment in healthcare units. Proper management of stress ensures greater efficiency at work place and improved wellbeing of the employee. Therefore, a pre-experimental study was conducted among 30 Critical Care Unit nurses working inMedical College Hospital, Thiruvananthapuram, (Kerala) to assess the effect of stress management interventions such as Job Stress Awareness, Assertiveness Training, Time Management, andProgressive Muscle Relaxation on job stress. The results showed that caring for patients, general job requirements and workload were the major sources of stress for the nurses. The level of severe stress was reduced from 60 percent to 20 percent during post-test. The Stress Management Interventions were statistically effective in reducing the stress of nurses at p<0.001 level.

Enhancing the Flight Safety Culture Through Training

NASA Technical Reports Server (NTRS)

Kanki, Barbara G.; Rosekind, Mark R. (Technical Monitor)

1996-01-01

In the 1970's, flight safety professionals became profoundly concerned about the prevalence of crew-caused accidents and incidents, and the role of human error in flight operations. As result, they initiated a change in the flight safety culture which has grown to significant proportions today. At the heart of the evolution were crew concepts such as flightdeck management, crew coordination, and cockpit resource management, concepts which seemed to target critical deficiencies. In themselves, the concepts were not new but their incorporation into training as a direct means of changing the flight safety culture was an untried, almost 'grassroots' approach. The targeted crew concepts and skills were not an integral part of the typical training program; the methods, curriculum, media, and even course content itself, would have to be developed and implemented from the bottom up. A familiar truism in the pilot culture is that you should 'Train the way you fly; Fly the way you train'. In short, training was expected to provide the pilot with practical operational skills that were consistent with the performance standards they were required to maintain and the operational demands they met on a daily basis. In short, one could not simply command crews to use good CRM; one would have to research and define these skills operationally as well as develop and implement a consistent and effective training program. Furthermore, one would need active support and collaboration among the research, industry and government communities in order to ensure acceptance and continued commitment. Additional information is contained in the original extended abstract.

Understanding the visual skills and strategies of train drivers in the urban rail environment.

PubMed

Naweed, Anjum; Balakrishnan, Ganesh

2014-01-01

Due to the growth of information in the urban rail environment, there is a need to better understand the ergonomics profile underpinning the visual behaviours in train drivers. The aim of this study was to examine the tasks and activities of urban/metropolitan passenger train drivers in order to better understand the nature of the visual demands in their task activities. Data were collected from 34 passenger train drivers in four different Australian states. The research approach used a novel participative ergonomics methodology that fused interviews and observations with generative tools. Data analysis was conducted thematically. Results suggested participants did not so much drive their trains, as manage the intensity of visually demanding work held in their environment. The density of this information and the opacity of the task, invoked an ergonomics profile more closely aligned with diagnostic and error detection than actual train regulation. The paper discusses the relative proportion of strategies corresponding with specific tasks, the visual-perceptual load in substantive activities, and the requisite visual skills behoving navigation in the urban rail environment. These findings provide the basis for developing measures of complexity to further specify the visual demands in passenger train driving.

Factors associated with disclosure of medical errors by housestaff.

PubMed

Kronman, Andrea C; Paasche-Orlow, Michael; Orlander, Jay D

2012-04-01

Attributes of the organisational culture of residency training programmes may impact patient safety. Training environments are complex, composed of clinical teams, residency programmes, and clinical units. We examined the relationship between residents' perceptions of their training environment and disclosure of or apology for their worst error. Anonymous, self-administered surveys were distributed to Medicine and Surgery residents at Boston Medical Center in 2005. Surveys asked residents to describe their worst medical error, and to answer selected questions from validated surveys measuring elements of working environments that promote learning from error. Subscales measured the microenvironments of the clinical team, residency programme, and clinical unit. Univariate and bivariate statistical analyses examined relationships between trainee characteristics, their perceived learning environment(s), and their responses to the error. Out of 109 surveys distributed to residents, 99 surveys were returned (91% overall response rate), two incomplete surveys were excluded, leaving 97: 61% internal medicine, 39% surgery, 59% male residents. While 31% reported apologising for the situation associated with the error, only 17% reported disclosing the error to patients and/or family. More male residents disclosed the error than female residents (p=0.04). Surgery residents scored higher on the subscales of safety culture pertaining to the residency programme (p=0.02) and managerial commitment to safety (p=0.05). Our Medical Culture Summary score was positively associated with disclosure (p=0.04) and apology (p=0.05). Factors in the learning environments of residents are associated with responses to medical errors. Organisational safety culture can be measured, and used to evaluate environmental attributes of clinical training that are associated with disclosure of, and apology for, medical error.

Improving Exercise Performance with an Accelerometer-Based Smartphone App: A Randomized Controlled Trial.

PubMed

Bittel, Daniel C; Bittel, Adam J; Williams, Christine; Elazzazi, Ashraf

2017-05-01

Proper exercise form is critical for the safety and efficacy of therapeutic exercise. This research examines if a novel smartphone application, designed to monitor and provide real-time corrections during resistance training, can reduce performance errors and elicit a motor learning response. Forty-two participants aged 18 to 65 years were randomly assigned to treatment and control groups. Both groups were tested for the number of movement errors made during a 10-repetition set completed at baseline, immediately after, and 1 to 2 weeks after a single training session of knee extensions. The treatment group trained with real-time, smartphone-generated feedback, whereas the control subjects did not. Group performance (number of errors) was compared across test sets using a 2-factor mixed-model analysis of variance. No differences were observed between groups for age, sex, or resistance training experience. There was a significant interaction between test set and group. The treatment group demonstrated fewer errors on posttests 1 and 2 compared with pretest (P < 0.05). There was no reduction in the number of errors on any posttest for control subjects. Smartphone apps, such as the one used in this study, may enhance patient supervision, safety, and exercise efficacy across rehabilitation settings. A single training session with the app promoted motor learning and improved exercise performance.

Underlying risk factors for prescribing errors in long-term aged care: a qualitative study.

PubMed

Tariq, Amina; Georgiou, Andrew; Raban, Magdalena; Baysari, Melissa Therese; Westbrook, Johanna

2016-09-01

To identify system-related risk factors perceived to contribute to prescribing errors in Australian long-term care settings, that is, residential aged care facilities (RACFs). The study used qualitative methods to explore factors that contribute to unsafe prescribing in RACFs. Data were collected at three RACFs in metropolitan Sydney, Australia between May and November 2011. Participants included RACF managers, doctors, pharmacists and RACF staff actively involved in prescribing-related processes. Methods included non-participant observations (74 h), in-depth semistructured interviews (n=25) and artefact analysis. Detailed process activity models were developed for observed prescribing episodes supplemented by triangulated analysis using content analysis methods. System-related factors perceived to increase the risk of prescribing errors in RACFs were classified into three overarching themes: communication systems, team coordination and staff management. Factors associated with communication systems included limited point-of-care access to information, inadequate handovers, information storage across different media (paper, electronic and memory), poor legibility of charts, information double handling, multiple faxing of medication charts and reliance on manual chart reviews. Team factors included lack of established lines of responsibility, inadequate team communication and limited participation of doctors in multidisciplinary initiatives like medication advisory committee meetings. Factors related to staff management and workload included doctors' time constraints and their accessibility, lack of trained RACF staff and high RACF staff turnover. The study highlights several system-related factors including laborious methods for exchanging medication information, which often act together to contribute to prescribing errors. Multiple interventions (eg, technology systems, team communication protocols) are required to support the collaborative nature of RACF prescribing. 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/

Action errors, error management, and learning in organizations.

PubMed

Frese, Michael; Keith, Nina

2015-01-03

Every organization is confronted with errors. Most errors are corrected easily, but some may lead to negative consequences. Organizations often focus on error prevention as a single strategy for dealing with errors. Our review suggests that error prevention needs to be supplemented by error management--an approach directed at effectively dealing with errors after they have occurred, with the goal of minimizing negative and maximizing positive error consequences (examples of the latter are learning and innovations). After defining errors and related concepts, we review research on error-related processes affected by error management (error detection, damage control). Empirical evidence on positive effects of error management in individuals and organizations is then discussed, along with emotional, motivational, cognitive, and behavioral pathways of these effects. Learning from errors is central, but like other positive consequences, learning occurs under certain circumstances--one being the development of a mind-set of acceptance of human error.

Prevalence and types of preanalytical error in hematology laboratory of a tertiary care hospital in South India.

PubMed

Arul, Pitchaikaran; Pushparaj, Magesh; Pandian, Kanmani; Chennimalai, Lingasamy; Rajendran, Karthika; Selvaraj, Eniya; Masilamani, Suresh

2018-01-01

An important component of laboratory medicine is preanalytical phase. Since laboratory report plays a major role in patient management, more importance should be given to the quality of laboratory tests. The present study was undertaken to find the prevalence and types of preanalytical errors at a tertiary care hospital in South India. In this cross-sectional study, a total of 118,732 samples ([62,474 outpatient department [OPD] and 56,258 inpatient department [IPD]) were received in hematology laboratory. These samples were analyzed for preanalytical errors such as misidentification, incorrect vials, inadequate samples, clotted samples, diluted samples, and hemolyzed samples. The overall prevalence of preanalytical errors found was 513 samples, which is 0.43% of the total number of samples received. The most common preanalytical error observed was inadequate samples followed by clotted samples. Overall frequencies (both OPD and IPD) of preanalytical errors such as misidentification, incorrect vials, inadequate samples, clotted samples, diluted samples, and hemolyzed samples were 0.02%, 0.05%, 0.2%, 0.12%, 0.02%, and 0.03%, respectively. The present study concluded that incorrect phlebotomy techniques due to lack of awareness is the main reason for preanalytical errors. This can be avoided by proper communication and coordination between laboratory and wards, proper training and continuing medical education programs for laboratory and paramedical staffs, and knowledge of the intervening factors that can influence laboratory results.

Crisis resource management training for an anaesthesia faculty: a new approach to continuing education.

PubMed

Blum, Richard H; Raemer, Daniel B; Carroll, John S; Sunder, Neelakantan; Felstein, David M; Cooper, Jeffrey B

2004-01-01

Human error and system failures continue to play a substantial role in adverse outcomes in health care. Anaesthesia crisis resource management addresses many patient safety issues by teaching behavioural skills for critical events but it has not been systematically utilized to teach experienced faculty. An anaesthesia crisis resource management course was created for the faculty of our medical school's anaesthesia teaching programmes. The course objectives were to understand and improve participants' proficiency in crisis resource management (CRM) skills and to learn skills for debriefing residents after critical events. Through surveys, measurement objectives assessed acceptance, utility and need for recurrent training immediately post-course. These were measured again approximately 1 year later along with self-perceived changes in the management of difficult or critical events. The highly rated course was well received in terms of overall course quality, realism, debriefings and didactic presentation. Course usefulness, CRM principles, debriefing skills and communication were highly rated immediately post-course and 1 year later. Approximately half of the faculty staff reported a difficult or critical event following the course; of nine self-reported CRM performance criteria surveyed all claimed improvement in their CRM non-technical skills. A unique and highly rated anaesthesia faculty course was created; participation made the faculty staff eligible for malpractice premium reductions. Self-reported CRM behaviours in participants' most significant difficult or critical events indicated an improvement in performance. These data provide indirect evidence supporting the contention that this type of training should be more widely promoted, although more definitive measures of improved outcomes are needed.

Comparison of haptic guidance and error amplification robotic trainings for the learning of a timing-based motor task by healthy seniors.

PubMed

Bouchard, Amy E; Corriveau, Hélène; Milot, Marie-Hélène

2015-01-01

With age, a decline in the temporal aspect of movement is observed such as a longer movement execution time and a decreased timing accuracy. Robotic training can represent an interesting approach to help improve movement timing among the elderly. Two types of robotic training-haptic guidance (HG; demonstrating the correct movement for a better movement planning and improved execution of movement) and error amplification (EA; exaggerating movement errors to have a more rapid and complete learning) have been positively used in young healthy subjects to boost timing accuracy. For healthy seniors, only HG training has been used so far where significant and positive timing gains have been obtained. The goal of the study was to evaluate and compare the impact of both HG and EA robotic trainings on the improvement of seniors' movement timing. Thirty-two healthy seniors (mean age 68 ± 4 years) learned to play a pinball-like game by triggering a one-degree-of-freedom hand robot at the proper time to make a flipper move and direct a falling ball toward a randomly positioned target. During HG and EA robotic trainings, the subjects' timing errors were decreased and increased, respectively, based on the subjects' timing errors in initiating a movement. Results showed that only HG training benefited learning, but the improvement did not generalize to untrained targets. Also, age had no influence on the efficacy of HG robotic training, meaning that the oldest subjects did not benefit more from HG training than the younger senior subjects. Using HG to teach the correct timing of movement seems to be a good strategy to improve motor learning for the elderly as for younger people. However, more studies are needed to assess the long-term impact of HG robotic training on improvement in movement timing.

Laparoscopic surgical box model training for surgical trainees with no prior laparoscopic experience.

PubMed

Nagendran, Myura; Toon, Clare D; Davidson, Brian R; Gurusamy, Kurinchi Selvan

2014-01-17

Surgical training has traditionally been one of apprenticeship, where the surgical trainee learns to perform surgery under the supervision of a trained surgeon. This is time consuming, costly, and of variable effectiveness. Training using a box model physical simulator - either a video box or a mirrored box - is an option to supplement standard training. However, the impact of this modality on trainees with no prior laparoscopic experience is unknown. To compare the benefits and harms of box model training versus no training, another box model, animal model, or cadaveric model training for surgical trainees with no prior laparoscopic experience. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and Science Citation Index Expanded to May 2013. We included all randomised clinical trials comparing box model trainers versus no training in surgical trainees with no prior laparoscopic experience. We also included trials comparing different methods of box model training. Two authors independently identified trials and collected data. We analysed the data with both the fixed-effect and the random-effects models using Review Manager for analysis. For each outcome, we calculated the standardised mean difference (SMD) with 95% confidence intervals (CI) based on intention-to-treat analysis whenever possible. Twenty-five trials contributed data to the quantitative synthesis in this review. All but one trial were at high risk of bias. Overall, 16 trials (464 participants) provided data for meta-analysis of box training (248 participants) versus no supplementary training (216 participants). All the 16 trials in this comparison used video trainers. Overall, 14 trials (382 participants) provided data for quantitative comparison of different methods of box training. There were no trials comparing box model training versus animal model or cadaveric model training. Box model training versus no training: The meta-analysis showed that the time taken for task completion was significantly shorter in the box trainer group than the control group (8 trials; 249 participants; SMD -0.48 seconds; 95% CI -0.74 to -0.22). Compared with the control group, the box trainer group also had lower error score (3 trials; 69 participants; SMD -0.69; 95% CI -1.21 to -0.17), better accuracy score (3 trials; 73 participants; SMD 0.67; 95% CI 0.18 to 1.17), and better composite performance scores (SMD 0.65; 95% CI 0.42 to 0.88). Three trials reported movement distance but could not be meta-analysed as they were not in a format for meta-analysis. There was significantly lower movement distance in the box model training compared with no training in one trial, and there were no significant differences in the movement distance between the two groups in the other two trials. None of the remaining secondary outcomes such as mortality and morbidity were reported in the trials when animal models were used for assessment of training, error in movements, and trainee satisfaction. Different methods of box training: One trial (36 participants) found significantly shorter time taken to complete the task when box training was performed using a simple cardboard box trainer compared with the standard pelvic trainer (SMD -3.79 seconds; 95% CI -4.92 to -2.65). There was no significant difference in the time taken to complete the task in the remaining three comparisons (reverse alignment versus forward alignment box training; box trainer suturing versus box trainer drills; and single incision versus multiport box model training). There were no significant differences in the error score between the two groups in any of the comparisons (box trainer suturing versus box trainer drills; single incision versus multiport box model training; Z-maze box training versus U-maze box training). The only trial that reported accuracy score found significantly higher accuracy score with Z-maze box training than U-maze box training (1 trial; 16 participants; SMD 1.55; 95% CI 0.39 to 2.71). One trial (36 participants) found significantly higher composite score with simple cardboard box trainer compared with conventional pelvic trainer (SMD 0.87; 95% CI 0.19 to 1.56). Another trial (22 participants) found significantly higher composite score with reverse alignment compared with forward alignment box training (SMD 1.82; 95% CI 0.79 to 2.84). There were no significant differences in the composite score between the intervention and control groups in any of the remaining comparisons. None of the secondary outcomes were adequately reported in the trials. The results of this review are threatened by both risks of systematic errors (bias) and risks of random errors (play of chance). Laparoscopic box model training appears to improve technical skills compared with no training in trainees with no previous laparoscopic experience. The impacts of this decreased time on patients and healthcare funders in terms of improved outcomes or decreased costs are unknown. There appears to be no significant differences in the improvement of technical skills between different methods of box model training. Further well-designed trials of low risk of bias and random errors are necessary. Such trials should assess the impacts of box model training on surgical skills in both the short and long term, as well as clinical outcomes when the trainee becomes competent to operate on patients.

Simulation for ward processes of surgical care.

PubMed

Pucher, Philip H; Darzi, Ara; Aggarwal, Rajesh

2013-07-01

The role of simulation in surgical education, initially confined to technical skills and procedural tasks, increasingly includes training nontechnical skills including communication, crisis management, and teamwork. Research suggests that many preventable adverse events can be attributed to nontechnical error occurring within a ward context. Ward rounds represent the primary point of interaction between patient and physician but take place without formalized training or assessment. The simulated ward should provide an environment in which processes of perioperative care can be performed safely and realistically, allowing multidisciplinary assessment and training of full ward rounds. We review existing literature and describe our experience in setting up our ward simulator. We examine the facilities, equipment, cost, and personnel required for establishing a surgical ward simulator and consider the scenario development, assessment, and feedback tools necessary to integrate it into a surgical curriculum. Copyright © 2013 Elsevier Inc. All rights reserved.

Crew decision making under stress

NASA Technical Reports Server (NTRS)

Orasanu, J.

1992-01-01

Flight crews must make decisions and take action when systems fail or emergencies arise during flight. These situations may involve high stress. Full-missiion flight simulation studies have shown that crews differ in how effectively they cope in these circumstances, judged by operational errors and crew coordination. The present study analyzed the problem solving and decision making strategies used by crews led by captains fitting three different personality profiles. Our goal was to identify more and less effective strategies that could serve as the basis for crew selection or training. Methods: Twelve 3-member B-727 crews flew a 5-leg mission simulated flight over 1 1/2 days. Two legs included 4 abnormal events that required decisions during high workload periods. Transcripts of videotapes were analyzed to describe decision making strategies. Crew performance (errors and coordination) was judged on-line and from videotapes by check airmen. Results: Based on a median split of crew performance errors, analyses to date indicate a difference in general strategy between crews who make more or less errors. Higher performance crews showed greater situational awareness - they responded quickly to cues and interpreted them appropriately. They requested more decision relevant information and took into account more constraints. Lower performing crews showed poorer situational awareness, planning, constraint sensitivity, and coordination. The major difference between higher and lower performing crews was that poorer crews made quick decisions and then collected information to confirm their decision. Conclusion: Differences in overall crew performance were associated with differences in situational awareness, information management, and decision strategy. Captain personality profiles were associated with these differences, a finding with implications for crew selection and training.

Continuing professional development training needs of medical laboratory personnel in Botswana

PubMed Central

2014-01-01

Background Laboratory professionals are expected to maintain their knowledge on the most recent advances in laboratory testing and continuing professional development (CPD) programs can address this expectation. In developing countries, accessing CPD programs is a major challenge for laboratory personnel, partly due to their limited availability. An assessment was conducted among clinical laboratory workforce in Botswana to identify and prioritize CPD training needs as well as preferred modes of CPD delivery. Methods A self-administered questionnaire was disseminated to medical laboratory scientists and technicians registered with the Botswana Health Professions Council. Questions were organized into domains of competency related to (i) quality management systems, (ii) technical competence, (iii) laboratory management, leadership, and coaching, and (iv) pathophysiology, data interpretation, and research. Participants were asked to rank their self-perceived training needs using a 3-point scale in order of importance (most, moderate, and least). Furthermore, participants were asked to select any three preferences for delivery formats for the CPD. Results Out of 350 questionnaires that were distributed, 275 were completed and returned giving an overall response rate of 79%. The most frequently selected topics for training in rank order according to key themes were (mean, range) (i) quality management systems, most important (79%, 74–84%); (ii) pathophysiology, data interpretation, and research (68%, 52–78%); (iii) technical competence (65%, 44–73%); and (iv) laboratory management, leadership, and coaching (60%, 37–77%). The top three topics selected by the participants were (i) quality systems essentials for medical laboratory, (ii) implementing a quality management system, and (iii) techniques to identify and control sources of error in laboratory procedures. The top three preferred CPD delivery modes, in rank order, were training workshops, hands-on workshops, and internet-based learning. Journal clubs at the workplace was the least preferred method of delivery of CPD credits. Conclusions CPD programs to be developed should focus on topics that address quality management systems, case studies, competence assessment, and customer care. The findings from this survey can also inform medical laboratory pre-service education curriculum. PMID:25134431

Assessing achievement in nephrology training: using clinic chart audits to quantitatively screen competency.

PubMed

Yuan, Christina M; Prince, Lisa K; Zwettler, Amy J; Nee, Robert; Oliver, James D; Abbott, Kevin C

2014-11-01

Entrustable professional activities (EPAs) are complex tasks representing vital physician functions in multiple competencies, used to demonstrate trainee development along milestones. Managing a nephrology outpatient clinic has been proposed as an EPA for nephrology fellowship training. Retrospective cohort study of nephrology fellow outpatient clinic performance using a previously validated chart audit tool. Outpatient encounter chart audits for training years 2008-2009 through 2012-2013, corresponding to participation in the Nephrology In-Training Examination (ITE). A median of 7 auditors (attending nephrologists) audited a mean of 1,686±408 (SD) charts per year. 18 fellows were audited; 12, in both of their training years. Proportion of chart audit and quality indicator deficiencies. Longitudinal deficiency and ITE performance. Among fellows audited in both their training years, chart audit deficiencies were fewer in the second versus the first year (5.4%±2.0% vs 17.3%±7.0%; P<0.001) and declined between the first and second halves of the first year (22.2%±6.4% vs 12.3%±9.5%; P=0.002). Most deficiencies were omission errors, regardless of training year. Quality indicator deficiencies for hypertension and chronic kidney disease-associated anemia recognition and management were fewer during the second year (P<0.001). Yearly audit deficiencies ≥5% were associated with an ITE score less than the 25th percentile for second-year fellows (P=0.03), with no significant association for first-year fellows. Auditor-reported deficiencies declined between the first and second halves of the year (17.0% vs 11.1%; P<0.001), with a stable positive/neutral comment rate (17.3% vs 17.8%; P=0.6), suggesting that the decline was not due to auditor fatigue. Retrospective design and small trainee numbers. Managing a nephrology outpatient clinic is an EPA. The chart audit tool was used to assess longitudinal fellow performance in managing a nephrology outpatient clinic. Failure to progress may be quantitatively identified and remediated. The tool identifies deficiencies in all 6 competencies, not just medical knowledge, the primary focus of the ITE and the nephrology subspecialty board examination. Published by Elsevier Inc.

Iterative random vs. Kennard-Stone sampling for IR spectrum-based classification task using PLS2-DA

NASA Astrophysics Data System (ADS)

Lee, Loong Chuen; Liong, Choong-Yeun; Jemain, Abdul Aziz

2018-04-01

External testing (ET) is preferred over auto-prediction (AP) or k-fold-cross-validation in estimating more realistic predictive ability of a statistical model. With IR spectra, Kennard-stone (KS) sampling algorithm is often used to split the data into training and test sets, i.e. respectively for model construction and for model testing. On the other hand, iterative random sampling (IRS) has not been the favored choice though it is theoretically more likely to produce reliable estimation. The aim of this preliminary work is to compare performances of KS and IRS in sampling a representative training set from an attenuated total reflectance - Fourier transform infrared spectral dataset (of four varieties of blue gel pen inks) for PLS2-DA modeling. The `best' performance achievable from the dataset is estimated with AP on the full dataset (APF, error). Both IRS (n = 200) and KS were used to split the dataset in the ratio of 7:3. The classic decision rule (i.e. maximum value-based) is employed for new sample prediction via partial least squares - discriminant analysis (PLS2-DA). Error rate of each model was estimated repeatedly via: (a) AP on full data (APF, error); (b) AP on training set (APS, error); and (c) ET on the respective test set (ETS, error). A good PLS2-DA model is expected to produce APS, error and EVS, error that is similar to the APF, error. Bearing that in mind, the similarities between (a) APS, error vs. APF, error; (b) ETS, error vs. APF, error and; (c) APS, error vs. ETS, error were evaluated using correlation tests (i.e. Pearson and Spearman's rank test), using series of PLS2-DA models computed from KS-set and IRS-set, respectively. Overall, models constructed from IRS-set exhibits more similarities between the internal and external error rates than the respective KS-set, i.e. less risk of overfitting. In conclusion, IRS is more reliable than KS in sampling representative training set.

Adaptive local linear regression with application to printer color management.

PubMed

Gupta, Maya R; Garcia, Eric K; Chin, Erika

2008-06-01

Local learning methods, such as local linear regression and nearest neighbor classifiers, base estimates on nearby training samples, neighbors. Usually, the number of neighbors used in estimation is fixed to be a global "optimal" value, chosen by cross validation. This paper proposes adapting the number of neighbors used for estimation to the local geometry of the data, without need for cross validation. The term enclosing neighborhood is introduced to describe a set of neighbors whose convex hull contains the test point when possible. It is proven that enclosing neighborhoods yield bounded estimation variance under some assumptions. Three such enclosing neighborhood definitions are presented: natural neighbors, natural neighbors inclusive, and enclosing k-NN. The effectiveness of these neighborhood definitions with local linear regression is tested for estimating lookup tables for color management. Significant improvements in error metrics are shown, indicating that enclosing neighborhoods may be a promising adaptive neighborhood definition for other local learning tasks as well, depending on the density of training samples.

Crew resource management in the ICU: the need for culture change

PubMed Central

2012-01-01

Intensive care frequently results in unintentional harm to patients and statistics don’t seem to improve. The ICU environment is especially unforgiving for mistakes due to the multidisciplinary, time-critical nature of care and vulnerability of the patients. Human factors account for the majority of adverse events and a sound safety climate is therefore essential. This article reviews the existing literature on aviation-derived training called Crew Resource Management (CRM) and discusses its application in critical care medicine. CRM focuses on teamwork, threat and error management and blame free discussion of human mistakes. Though evidence is still scarce, the authors consider CRM to be a promising tool for culture change in the ICU setting, if supported by leadership and well-designed follow-up. PMID:22913855

Supervised local error estimation for nonlinear image registration using convolutional neural networks

NASA Astrophysics Data System (ADS)

Eppenhof, Koen A. J.; Pluim, Josien P. W.

2017-02-01

Error estimation in medical image registration is valuable when validating, comparing, or combining registration methods. To validate a nonlinear image registration method, ideally the registration error should be known for the entire image domain. We propose a supervised method for the estimation of a registration error map for nonlinear image registration. The method is based on a convolutional neural network that estimates the norm of the residual deformation from patches around each pixel in two registered images. This norm is interpreted as the registration error, and is defined for every pixel in the image domain. The network is trained using a set of artificially deformed images. Each training example is a pair of images: the original image, and a random deformation of that image. No manually labeled ground truth error is required. At test time, only the two registered images are required as input. We train and validate the network on registrations in a set of 2D digital subtraction angiography sequences, such that errors up to eight pixels can be estimated. We show that for this range of errors the convolutional network is able to learn the registration error in pairs of 2D registered images at subpixel precision. Finally, we present a proof of principle for the extension to 3D registration problems in chest CTs, showing that the method has the potential to estimate errors in 3D registration problems.

Text Classification for Assisting Moderators in Online Health Communities

PubMed Central

Huh, Jina; Yetisgen-Yildiz, Meliha; Pratt, Wanda

2013-01-01

Objectives Patients increasingly visit online health communities to get help on managing health. The large scale of these online communities makes it impossible for the moderators to engage in all conversations; yet, some conversations need their expertise. Our work explores low-cost text classification methods to this new domain of determining whether a thread in an online health forum needs moderators’ help. Methods We employed a binary classifier on WebMD’s online diabetes community data. To train the classifier, we considered three feature types: (1) word unigram, (2) sentiment analysis features, and (3) thread length. We applied feature selection methods based on χ2 statistics and under sampling to account for unbalanced data. We then performed a qualitative error analysis to investigate the appropriateness of the gold standard. Results Using sentiment analysis features, feature selection methods, and balanced training data increased the AUC value up to 0.75 and the F1-score up to 0.54 compared to the baseline of using word unigrams with no feature selection methods on unbalanced data (0.65 AUC and 0.40 F1-score). The error analysis uncovered additional reasons for why moderators respond to patients’ posts. Discussion We showed how feature selection methods and balanced training data can improve the overall classification performance. We present implications of weighing precision versus recall for assisting moderators of online health communities. Our error analysis uncovered social, legal, and ethical issues around addressing community members’ needs. We also note challenges in producing a gold standard, and discuss potential solutions for addressing these challenges. Conclusion Social media environments provide popular venues in which patients gain health-related information. Our work contributes to understanding scalable solutions for providing moderators’ expertise in these large-scale, social media environments. PMID:24025513

Safe patient care - safety culture and risk management in otorhinolaryngology.

PubMed

St Pierre, Michael

2013-12-13

Safety culture is positioned at the heart of an organization's vulnerability to error because of its role in framing organizational awareness to risk and in providing and sustaining effective strategies of risk management. Safety related attitudes of leadership and management play a crucial role in the development of a mature safety culture ("top-down process"). A type marker for organizational culture and thus a predictor for an organization's maturity in respect to safety is information flow and in particular an organization's general way of coping with information that suggests anomaly. As all values and beliefs, relationships, learning, and other aspects of organizational safety culture are about sharing and processing information, safety culture has been termed "informed culture". An informed culture is free of blame and open for information provided by incidents. "Incident reporting systems" are the backbone of a reporting culture, where good information flow is likely to support and encourage other kinds of cooperative behavior, such as problem solving, innovation, and inter-departmental bridging. Another facet of an informed culture is the free flow of information during perioperative patient care. The World Health Organization's safe surgery checklist" is the most prevalent example of a standardized information exchange aimed at preventing patient harm due to information deficit. In routine tasks mandatory standard operating procedures have gained widespread acceptance in guaranteeing the highest possible process quality. Technical and non-technical skills of healthcare professionals are the decisive human resource for an efficient and safe delivery of patient care and the avoidance of errors. The systematic enhancement of staff qualification by providing training opportunities can be a major investment in patient safety. In recent years several otorhinolaryngology departments have started to incorporate stimulation based team trainings into their curriculum.

[Safe patient care: safety culture and risk management in otorhinolaryngology].

PubMed

St Pierre, M

2013-04-01

Safety culture is positioned at the heart of an organisation's vulnerability to error because of its role in framing organizational awareness to risk and in providing and sustaining effective strategies of risk management. Safety related attitudes of leadership and management play a crucial role in the development of a mature safety culture ("top-down process"). A type marker for organizational culture and thus a predictor for an organizations maturity in respect to safety is information flow and in particular an organization's general way of coping with information that suggests anomaly. As all values and beliefs, relationships, learning, and other aspects of organizational safety culture are about sharing and processing information, safety culture has been termed "informed culture". An informed culture is free of blame and open for information provided by incidents. "Incident reporting systems" are the backbone of a reporting culture, where good information flow is likely to support and encourage other kinds of cooperative behavior, such as problem solving, innovation, and inter-departmental bridging. Another facet of an informed culture is the free flow of information during perioperative patient care. The World Health Organisation's "safe surgery checklist" is the most prevalent example of a standardized information exchange aimed at preventing patient harm due to information deficit. In routine tasks mandatory standard operating procedures have gained widespread acceptance in guaranteeing the highest possible process quality.Technical and non-technical skills of healthcare professionals are the decisive human resource for an efficient and safe delivery of patient care and the avoidance of errors. The systematic enhancement of staff qualification by providing training opportunities can be a major investment in patient safety. In recent years several otorhinolaryngology departments have started to incorporate simulation based team trainings into their curriculum. © Georg Thieme Verlag KG Stuttgart · New York.

Evidence Report: Risk of Performance Errors Due to Training Deficiencies

NASA Technical Reports Server (NTRS)

Barshi, Immanuel

2012-01-01

The Risk of Performance Errors Due to Training Deficiencies is identified by the National Aeronautics and Space Administration (NASA) Human Research Program (HRP) as a recognized risk to human health and performance in space. The HRP Program Requirements Document (PRD) defines these risks. This Evidence Report provides a summary of the evidence that has been used to identify and characterize this risk. Given that training content, timing, intervals, and delivery methods must support crew task performance, and given that training paradigms will be different for long-duration missions with increased crew autonomy, there is a risk that operators will lack the skills or knowledge necessary to complete critical tasks, resulting in flight and ground crew errors and inefficiencies, failed mission and program objectives, and an increase in crew injuries.

A biologically inspired neural model for visual and proprioceptive integration including sensory training.

PubMed

Saidi, Maryam; Towhidkhah, Farzad; Gharibzadeh, Shahriar; Lari, Abdolaziz Azizi

2013-12-01

Humans perceive the surrounding world by integration of information through different sensory modalities. Earlier models of multisensory integration rely mainly on traditional Bayesian and causal Bayesian inferences for single causal (source) and two causal (for two senses such as visual and auditory systems), respectively. In this paper a new recurrent neural model is presented for integration of visual and proprioceptive information. This model is based on population coding which is able to mimic multisensory integration of neural centers in the human brain. The simulation results agree with those achieved by casual Bayesian inference. The model can also simulate the sensory training process of visual and proprioceptive information in human. Training process in multisensory integration is a point with less attention in the literature before. The effect of proprioceptive training on multisensory perception was investigated through a set of experiments in our previous study. The current study, evaluates the effect of both modalities, i.e., visual and proprioceptive training and compares them with each other through a set of new experiments. In these experiments, the subject was asked to move his/her hand in a circle and estimate its position. The experiments were performed on eight subjects with proprioception training and eight subjects with visual training. Results of the experiments show three important points: (1) visual learning rate is significantly more than that of proprioception; (2) means of visual and proprioceptive errors are decreased by training but statistical analysis shows that this decrement is significant for proprioceptive error and non-significant for visual error, and (3) visual errors in training phase even in the beginning of it, is much less than errors of the main test stage because in the main test, the subject has to focus on two senses. The results of the experiments in this paper is in agreement with the results of the neural model simulation.

Adoption of health information exchange by emergency physicians at three urban academic medical centers.

PubMed

Genes, N; Shapiro, J; Vaidya, S; Kuperman, G

2011-01-01

Emergency physicians are trained to make decisions quickly and with limited patient information. Health Information Exchange (HIE) has the potential to improve emergency care by bringing relevant patient data from non-affiliated organizations to the bedside. NYCLIX (New York CLinical Information eXchange) offers HIE functionality among multiple New York metropolitan area provider organizations and has pilot users in several member emergency departments (EDs). We conducted semi-structured interviews at three participating EDs with emergency physicians trained to use NYCLIX. Among "users" with > 1 login, responses to questions regarding typical usage scenarios, successful retrieval of data, and areas for improving the interface were recorded. Among "non-users" with ≤1 login, questions about NYCLIX accessibility and utility were asked. Both groups were asked to recall items from prior training regarding data sources and availability. Eighteen NYCLIX pilot users, all board certified emergency physicians, were interviewed. Of the 14 physicians with more than one login ,half estimated successful retrieval of HIE data affecting patient care. Four non-users (one login or less) cited forgotten login information as a major reason for non-use. Though both groups made errors, users were more likely to recall true NYCLIX member sites and data elements than non-users. Improvements suggested as likely to facilitate usage included a single automated login to both the ED information system (EDIS) and HIE, and automatic notification of HIE data availability in the EDIS All respondents reported satisfaction with their training. Integrating HIE into existing ED workflows remains a challenge, though a substantial fraction of users report changes in management based on HIE data. Though interviewees believed their training was adequate, significant errors in their understanding of available NYCLIX data elements and participating sites persist.

Reduction of errors during practice facilitates fundamental movement skill learning in children with intellectual disabilities.

PubMed

Capio, C M; Poolton, J M; Sit, C H P; Eguia, K F; Masters, R S W

2013-04-01

Children with intellectual disabilities (ID) have been found to have inferior motor proficiencies in fundamental movement skills (FMS). This study examined the effects of training the FMS of overhand throwing by manipulating the amount of practice errors. Participants included 39 children with ID aged 4-11 years who were allocated into either an error-reduced (ER) training programme or a more typical programme in which errors were frequent (error-strewn, ES). Throwing movement form, throwing accuracy, and throwing frequency during free play were evaluated. The ER programme improved movement form, and increased throwing activity during free play to a greater extent than the ES programme. Furthermore, ER learners were found to be capable of engaging in a secondary cognitive task while manifesting robust throwing accuracy performance. The findings support the use of movement skills training programmes that constrain practice errors in children with ID, suggesting that such approach results in improved performance and heightened movement engagement in free play. © 2012 The Authors. Journal of Intellectual Disability Research © 2012 Blackwell Publishing Ltd.

A combined intervention to reduce interruptions during medication preparation and double-checking: a pilot-study evaluating the impact of staff training and safety vests.

PubMed

Huckels-Baumgart, Saskia; Niederberger, Milena; Manser, Tanja; Meier, Christoph R; Meyer-Massetti, Carla

2017-10-01

The aim was to evaluate the impact of staff training and wearing safety vests as a combined intervention on interruptions during medication preparation and double-checking. Interruptions and errors during the medication process are common and an important issue for patient safety in the hospital setting. We performed a pre- and post-intervention pilot-study using direct structured observation of 26 nurses preparing and double-checking 431 medication doses (225 pre-intervention and 206 post-intervention) for 36 patients (21 pre-intervention and 15 post-intervention). With staff training and the introduction of safety vests, the interruption rate during medication preparation was reduced from 36.8 to 28.3 interruptions per hour and during double-checking from 27.5 to 15 interruptions per hour. This pilot-study showed that the frequency of interruptions decreased during the critical tasks of medication preparation and double-checking after the introduction of staff training and wearing safety vests as part of a quality improvement process. Nursing management should acknowledge interruptions as an important factor potentially influencing medication safety. Unnecessary interruptions can be successfully reduced by considering human and system factors and increasing both staff and nursing managers' awareness of 'interruptive communication practices' and implementing physical barriers. This is the first pilot-study specifically evaluating the impact of staff training and wearing safety vests on the reduction of interruptions during medication preparation and double-checking. © 2017 John Wiley & Sons Ltd.

Reducing patient identification errors related to glucose point-of-care testing.

PubMed

Alreja, Gaurav; Setia, Namrata; Nichols, James; Pantanowitz, Liron

2011-01-01

Patient identification (ID) errors in point-of-care testing (POCT) can cause test results to be transferred to the wrong patient's chart or prevent results from being transmitted and reported. Despite the implementation of patient barcoding and ongoing operator training at our institution, patient ID errors still occur with glucose POCT. The aim of this study was to develop a solution to reduce identification errors with POCT. Glucose POCT was performed by approximately 2,400 clinical operators throughout our health system. Patients are identified by scanning in wristband barcodes or by manual data entry using portable glucose meters. Meters are docked to upload data to a database server which then transmits data to any medical record matching the financial number of the test result. With a new model, meters connect to an interface manager where the patient ID (a nine-digit account number) is checked against patient registration data from admission, discharge, and transfer (ADT) feeds and only matched results are transferred to the patient's electronic medical record. With the new process, the patient ID is checked prior to testing, and testing is prevented until ID errors are resolved. When averaged over a period of a month, ID errors were reduced to 3 errors/month (0.015%) in comparison with 61.5 errors/month (0.319%) before implementing the new meters. Patient ID errors may occur with glucose POCT despite patient barcoding. The verification of patient identification should ideally take place at the bedside before testing occurs so that the errors can be addressed in real time. The introduction of an ADT feed directly to glucose meters reduced patient ID errors in POCT.

Reducing patient identification errors related to glucose point-of-care testing

PubMed Central

Alreja, Gaurav; Setia, Namrata; Nichols, James; Pantanowitz, Liron

2011-01-01

Background: Patient identification (ID) errors in point-of-care testing (POCT) can cause test results to be transferred to the wrong patient's chart or prevent results from being transmitted and reported. Despite the implementation of patient barcoding and ongoing operator training at our institution, patient ID errors still occur with glucose POCT. The aim of this study was to develop a solution to reduce identification errors with POCT. Materials and Methods: Glucose POCT was performed by approximately 2,400 clinical operators throughout our health system. Patients are identified by scanning in wristband barcodes or by manual data entry using portable glucose meters. Meters are docked to upload data to a database server which then transmits data to any medical record matching the financial number of the test result. With a new model, meters connect to an interface manager where the patient ID (a nine-digit account number) is checked against patient registration data from admission, discharge, and transfer (ADT) feeds and only matched results are transferred to the patient's electronic medical record. With the new process, the patient ID is checked prior to testing, and testing is prevented until ID errors are resolved. Results: When averaged over a period of a month, ID errors were reduced to 3 errors/month (0.015%) in comparison with 61.5 errors/month (0.319%) before implementing the new meters. Conclusion: Patient ID errors may occur with glucose POCT despite patient barcoding. The verification of patient identification should ideally take place at the bedside before testing occurs so that the errors can be addressed in real time. The introduction of an ADT feed directly to glucose meters reduced patient ID errors in POCT. PMID:21633490

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

Putting into practice error management theory: Unlearning and learning to manage action errors in construction.

PubMed

Love, Peter E D; Smith, Jim; Teo, Pauline

2018-05-01

Error management theory is drawn upon to examine how a project-based organization, which took the form of a program alliance, was able to change its established error prevention mindset to one that enacted a learning mindfulness that provided an avenue to curtail its action errors. The program alliance was required to unlearn its existing routines and beliefs to accommodate the practices required to embrace error management. As a result of establishing an error management culture the program alliance was able to create a collective mindfulness that nurtured learning and supported innovation. The findings provide a much-needed context to demonstrate the relevance of error management theory to effectively address rework and safety problems in construction projects. The robust theoretical underpinning that is grounded in practice and presented in this paper provides a mechanism to engender learning from errors, which can be utilized by construction organizations to improve the productivity and performance of their projects. Copyright © 2018 Elsevier Ltd. All rights reserved.

Fast temporal neural learning using teacher forcing

NASA Technical Reports Server (NTRS)

Toomarian, Nikzad (Inventor); Bahren, Jacob (Inventor)

1992-01-01

A neural network is trained to output a time dependent target vector defined over a predetermined time interval in response to a time dependent input vector defined over the same time interval by applying corresponding elements of the error vector, or difference between the target vector and the actual neuron output vector, to the inputs of corresponding output neurons of the network as corrective feedback. This feedback decreases the error and quickens the learning process, so that a much smaller number of training cycles are required to complete the learning process. A conventional gradient descent algorithm is employed to update the neural network parameters at the end of the predetermined time interval. The foregoing process is repeated in repetitive cycles until the actual output vector corresponds to the target vector. In the preferred embodiment, as the overall error of the neural network output decreasing during successive training cycles, the portion of the error fed back to the output neurons is decreased accordingly, allowing the network to learn with greater freedom from teacher forcing as the network parameters converge to their optimum values. The invention may also be used to train a neural network with stationary training and target vectors.

Fast temporal neural learning using teacher forcing

NASA Technical Reports Server (NTRS)

Toomarian, Nikzad (Inventor); Bahren, Jacob (Inventor)

1995-01-01

A neural network is trained to output a time dependent target vector defined over a predetermined time interval in response to a time dependent input vector defined over the same time interval by applying corresponding elements of the error vector, or difference between the target vector and the actual neuron output vector, to the inputs of corresponding output neurons of the network as corrective feedback. This feedback decreases the error and quickens the learning process, so that a much smaller number of training cycles are required to complete the learning process. A conventional gradient descent algorithm is employed to update the neural network parameters at the end of the predetermined time interval. The foregoing process is repeated in repetitive cycles until the actual output vector corresponds to the target vector. In the preferred embodiment, as the overall error of the neural network output decreasing during successive training cycles, the portion of the error fed back to the output neurons is decreased accordingly, allowing the network to learn with greater freedom from teacher forcing as the network parameters converge to their optimum values. The invention may also be used to train a neural network with stationary training and target vectors.

Risk managers, physicians, and disclosure of harmful medical errors.

PubMed

Loren, David J; Garbutt, Jane; Dunagan, W Claiborne; Bommarito, Kerry M; Ebers, Alison G; Levinson, Wendy; Waterman, Amy D; Fraser, Victoria J; Summy, Elizabeth A; Gallagher, Thomas H

2010-03-01

Physicians are encouraged to disclose medical errors to patients, which often requires close collaboration between physicians and risk managers. An anonymous national survey of 2,988 healthcare facility-based risk managers was conducted between November 2004 and March 2005, and results were compared with those of a previous survey (conducted between July 2003 and March 2004) of 1,311 medical physicians in Washington and Missouri. Both surveys included an error-disclosure scenario for an obvious and a less obvious error with scripted response options. More risk managers than physicians were aware that an error-reporting system was present at their hospital (81% versus 39%, p < .001) and believed that mechanisms to inform physicians about errors in their hospital were adequate (51% versus 17%, p < .001). More risk managers than physicians strongly agreed that serious errors should be disclosed to patients (70% versus 49%, p < .001). Across both error scenario, risk managers were more likely than physicians to definitely recommend that the error be disclosed (76% versus 50%, p < .001) and to provide full details about how the error would be prevented in the future (62% versus 51%, p < .001). However, physicians were more likely than risk managers to provide a full apology recognizing the harm caused by the error (39% versus 21%, p < .001). Risk managers have more favorable attitudes about disclosing errors to patients compared with physicians but are less supportive of providing a full apology. These differences may create conflicts between risk managers and physicians regarding disclosure. Health care institutions should promote greater collaboration between these two key participants in disclosure conversations.

Interferometric correction system for a numerically controlled machine

DOEpatents

Burleson, Robert R.

1978-01-01

An interferometric correction system for a numerically controlled machine is provided to improve the positioning accuracy of a machine tool, for example, for a high-precision numerically controlled machine. A laser interferometer feedback system is used to monitor the positioning of the machine tool which is being moved by command pulses to a positioning system to position the tool. The correction system compares the commanded position as indicated by a command pulse train applied to the positioning system with the actual position of the tool as monitored by the laser interferometer. If the tool position lags the commanded position by a preselected error, additional pulses are added to the pulse train applied to the positioning system to advance the tool closer to the commanded position, thereby reducing the lag error. If the actual tool position is leading in comparison to the commanded position, pulses are deleted from the pulse train where the advance error exceeds the preselected error magnitude to correct the position error of the tool relative to the commanded position.

A Review of Models and Procedures for Synthetic Validation for Entry-Level Army Jobs

DTIC Science & Technology

1988-12-01

demonstrated that training judges to avoid various types of rating errors is successful. Ivancevich (1979), for example, found that extensive discussion of...judges. Personnel Psychology, 39, 337-344. Ivancevich , J. M. (1979). Longitudinal study of the effects of rater training on psychometric error in

The Relationship Between Technical Errors and Decision Making Skills in the Junior Resident

PubMed Central

Nathwani, J. N.; Fiers, R.M.; Ray, R.D.; Witt, A.K.; Law, K. E.; DiMarco, S.M.; Pugh, C.M.

2017-01-01

Objective The purpose of this study is to co-evaluate resident technical errors and decision-making capabilities during placement of a subclavian central venous catheter (CVC). We hypothesize that there will be significant correlations between scenario based decision making skills, and technical proficiency in central line insertion. We also predict residents will have problems in anticipating common difficulties and generating solutions associated with line placement. Design Participants were asked to insert a subclavian central line on a simulator. After completion, residents were presented with a real life patient photograph depicting CVC placement and asked to anticipate difficulties and generate solutions. Error rates were analyzed using chi-square tests and a 5% expected error rate. Correlations were sought by comparing technical errors and scenario based decision making. Setting This study was carried out at seven tertiary care centers. Participants Study participants (N=46) consisted of largely first year research residents that could be followed longitudinally. Second year research and clinical residents were not excluded. Results Six checklist errors were committed more often than anticipated. Residents performed an average of 1.9 errors, significantly more than the 1 error, at most, per person expected (t(44)=3.82, p<.001). The most common error was performance of the procedure steps in the wrong order (28.5%, P<.001). Some of the residents (24%) had no errors, 30% committed one error, and 46 % committed more than one error. The number of technical errors committed negatively correlated with the total number of commonly identified difficulties and generated solutions (r(33)= −.429, p=.021, r(33)= −.383, p=.044 respectively). Conclusions Almost half of the surgical residents committed multiple errors while performing subclavian CVC placement. The correlation between technical errors and decision making skills suggests a critical need to train residents in both technique and error management. ACGME Competencies Medical Knowledge, Practice Based Learning and Improvement, Systems Based Practice PMID:27671618

The association between frequency of self-reported medical errors and anesthesia trainee supervision: a survey of United States anesthesiology residents-in-training.

PubMed

De Oliveira, Gildasio S; Rahmani, Rod; Fitzgerald, Paul C; Chang, Ray; McCarthy, Robert J

2013-04-01

Poor supervision of physician trainees can be detrimental not only to resident education but also to patient care and safety. Inadequate supervision has been associated with more frequent deaths of patients under the care of junior residents. We hypothesized that residents reporting more medical errors would also report lower quality of supervision scores than the ones with lower reported medical errors. The primary objective of this study was to evaluate the association between the frequency of medical errors reported by residents and their perceived quality of faculty supervision. A cross-sectional nationwide survey was sent to 1000 residents randomly selected from anesthesiology training departments across the United States. Residents from 122 residency programs were invited to participate, the median (interquartile range) per institution was 7 (4-11). Participants were asked to complete a survey assessing demography, perceived quality of faculty supervision, and perceived causes of inadequate perceived supervision. Responses to the statements "I perform procedures for which I am not properly trained," "I make mistakes that have negative consequences for the patient," and "I have made a medication error (drug or incorrect dose) in the last year" were used to assess error rates. Average supervision scores were determined using the De Oliveira Filho et al. scale and compared among the frequency of self-reported error categories using the Kruskal-Wallis test. Six hundred four residents responded to the survey (60.4%). Forty-five (7.5%) of the respondents reported performing procedures for which they were not properly trained, 24 (4%) reported having made mistakes with negative consequences to patients, and 16 (3%) reported medication errors in the last year having occurred multiple times or often. Supervision scores were inversely correlated with the frequency of reported errors for all 3 questions evaluating errors. At a cutoff value of 3, supervision scores demonstrated an overall accuracy (area under the curve) (99% confidence interval) of 0.81 (0.73-0.86), 0.89 (0.77-0.95), and 0.93 (0.77-0.98) for predicting a response of multiple times or often to the question of performing procedures for which they were not properly trained, reported mistakes with negative consequences to patients, and reported medication errors in the last year, respectively. Anesthesiology trainees who reported a greater incidence of medical errors with negative consequences to patients and drug errors also reported lower scores for supervision by faculty. Our findings suggest that further studies of the association between supervision and patient safety are warranted. (Anesth Analg 2013;116:892-7).

The Design of Model-Based Training Programs

NASA Technical Reports Server (NTRS)

Polson, Peter; Sherry, Lance; Feary, Michael; Palmer, Everett; Alkin, Marty; McCrobie, Dan; Kelley, Jerry; Rosekind, Mark (Technical Monitor)

1997-01-01

This paper proposes a model-based training program for the skills necessary to operate advance avionics systems that incorporate advanced autopilots and fight management systems. The training model is based on a formalism, the operational procedure model, that represents the mission model, the rules, and the functions of a modem avionics system. This formalism has been defined such that it can be understood and shared by pilots, the avionics software, and design engineers. Each element of the software is defined in terms of its intent (What?), the rationale (Why?), and the resulting behavior (How?). The Advanced Computer Tutoring project at Carnegie Mellon University has developed a type of model-based, computer aided instructional technology called cognitive tutors. They summarize numerous studies showing that training times to a specified level of competence can be achieved in one third the time of conventional class room instruction. We are developing a similar model-based training program for the skills necessary to operation the avionics. The model underlying the instructional program and that simulates the effects of pilots entries and the behavior of the avionics is based on the operational procedure model. Pilots are given a series of vertical flightpath management problems. Entries that result in violations, such as failure to make a crossing restriction or violating the speed limits, result in error messages with instruction. At any time, the flightcrew can request suggestions on the appropriate set of actions. A similar and successful training program for basic skills for the FMS on the Boeing 737-300 was developed and evaluated. The results strongly support the claim that the training methodology can be adapted to the cockpit.

Descent Advisor Preliminary Field Test

NASA Technical Reports Server (NTRS)

Green, Steven M.; Vivona, Robert A.; Sanford, Beverly

1995-01-01

A field test of the Descent Advisor (DA) automation tool was conducted at the Denver Air Route Traffic Control Center in September 1994. DA is being developed to assist Center controllers in the efficient management and control of arrival traffic. DA generates advisories, based on trajectory predictions, to achieve accurate meter-fix arrival times in a fuel efficient manner while assisting the controller with the prediction and resolution of potential conflicts. The test objectives were: (1) to evaluate the accuracy of DA trajectory predictions for conventional and flight-management system equipped jet transports, (2) to identify significant sources of trajectory prediction error, and (3) to investigate procedural and training issues (both air and ground) associated with DA operations. Various commercial aircraft (97 flights total) and a Boeing 737-100 research aircraft participated in the test. Preliminary results from the primary test set of 24 commercial flights indicate a mean DA arrival time prediction error of 2.4 seconds late with a standard deviation of 13.1 seconds. This paper describes the field test and presents preliminary results for the commercial flights.

That's why it's a 5-year program: resident acquisition of anorectal disease management competence.

PubMed

Miller, Seth; Sohn, Vance; Causey, Marlin Wayne; Martin, Matthew; Brown, Tommy; Steele, Scott

2012-04-01

Although surgical residents are expected to be proficient in the diagnosis and management of anorectal pathology upon graduation, there is little data related to the timing and degree of proficiency acquired during training. Prospective study of new patients presenting to a colorectal surgical clinic for evaluation of anorectal complaints over a 3-y period. Trainees performed an initial evaluation and recorded their exam findings, diagnosis, and treatment plan. A separate evaluation by a staff colorectal surgeon was performed, with results compared by an independent reviewer. A total of 236 patient evaluations were included. The accuracy of referral diagnosis was significantly better when originated from a surgeon than from all other referral sources (91.7% versus 59.1%, P = 0.031). The most common conditions were internal hemorrhoids (25%), anal fissures (22%), and external hemorrhoids (19.5%). Internal hemorrhoids were most commonly misdiagnosed as external hemorrhoids (58%). Anal fissures were missed 38% of the time, and were most often given the diagnosis of internal hemorrhoids (45%). Residents also demonstrated difficulty in identifying thrombosis in external hemorrhoids, with a 45% error rate. Medical students and residents had an overall correct primary diagnosis of 69.5%; however, there was a significant improvement in the accuracy of diagnosis from medical students and interns to upper level residents (62.9% versus 81.2%, P = 0.003). Medical treatment plans agreed between resident and staff in 74%, the surgical management agreed in 62%, and overall the residents had the correct diagnosis and corresponding treatment plan in 44%. Additional adjunctive procedures were proposed in 66 patients with residents stating the correct adjunct in 79%. The most frequently missed adjuncts were endorectal ultrasound (34%) and colonoscopy (28%). Surgical trainees demonstrated significant deficiencies in the ability to evaluate and manage anorectal pathology; however, marked improvement occurred with time in training. Common areas of misdiagnosis and therapeutic errors were identified which could aid in curriculum development. Published by Elsevier Inc.

Human Factors in Training

NASA Technical Reports Server (NTRS)

Barshi, Immanuel; Byrne, Vicky; Arsintescu, Lucia; Connell, Erin

2010-01-01

Future space missions will be significantly longer than current shuttle missions and new systems will be more complex than current systems. Increasing communication delays between crews and Earth-based support means that astronauts need to be prepared to handle the unexpected on their own. As crews become more autonomous, their potential span of control and required expertise must grow to match their autonomy. It is not possible to train for every eventuality ahead of time on the ground, or to maintain trained skills across long intervals of disuse. To adequately prepare NASA personnel for these challenges, new training approaches, methodologies, and tools are required. This research project aims at developing these training capabilities. By researching established training principles, examining future needs, and by using current practices in space flight training as test beds, both in Flight Controller and Crew Medical domains, this research project is mitigating program risks and generating templates and requirements to meet future training needs. Training efforts in Fiscal Year 09 (FY09) strongly focused on crew medical training, but also began exploring how Space Flight Resource Management training for Mission Operations Directorate (MOD) Flight Controllers could be integrated with systems training for optimal Mission Control Center (MCC) operations. The Training Task addresses Program risks that lie at the intersection of the following three risks identified by the Project: 1) Risk associated with poor task design; 2) Risk of error due to inadequate information; and 3) Risk associated with reduced safety and efficiency due to poor human factors design.

Human Factors in Training

NASA Technical Reports Server (NTRS)

Barshi, Immanuel; Byrne, Vicky; Arsintescu, Lucia; Connell, Erin; Sandor, Aniko

2009-01-01

Future space missions will be significantly longer than current shuttle missions and new systems will be more complex than current systems. Increasing communication delays between crews and Earth-based support means that astronauts need to be prepared to handle the unexpected on their own. As crews become more autonomous, their potential span of control and required expertise must grow to match their autonomy. It is not possible to train for every eventuality ahead of time on the ground, or to maintain trained skills across long intervals of disuse. To adequately prepare NASA personnel for these challenges, new training approaches, methodologies, and tools are required. This research project aims at developing these training capabilities. By researching established training principles, examining future needs, and by using current practices in space flight training as test beds, both in Flight Controller and Crew Medical domains, this research project is mitigating program risks and generating templates and requirements to meet future training needs. Training efforts in Fiscal Year 08 (FY08) strongly focused on crew medical training, but also began exploring how Space Flight Resource Management training for Mission Operations Directorate (MOD) Flight Controllers could be integrated with systems training for optimal Mission Control Center (MCC) operations. The Training Task addresses Program risks that lie at the intersection of the following three risks identified by the Project: (1) Risk associated with poor task design (2) Risk of error due to inadequate information (3) Risk associated with reduced safety and efficiency due to poor human factors design

An educational and audit tool to reduce prescribing error in intensive care.

PubMed

Thomas, A N; Boxall, E M; Laha, S K; Day, A J; Grundy, D

2008-10-01

To reduce prescribing errors in an intensive care unit by providing prescriber education in tutorials, ward-based teaching and feedback in 3-monthly cycles with each new group of trainee medical staff. Prescribing audits were conducted three times in each 3-month cycle, once pretraining, once post-training and a final audit after 6 weeks. The audit information was fed back to prescribers with their correct prescribing rates, rates for individual error types and total error rates together with anonymised information about other prescribers' error rates. The percentage of prescriptions with errors decreased over each 3-month cycle (pretraining 25%, 19%, (one missing data point), post-training 23%, 6%, 11%, final audit 7%, 3%, 5% (p<0.0005)). The total number of prescriptions and error rates varied widely between trainees (data collection one; cycle two: range of prescriptions written: 1-61, median 18; error rate: 0-100%; median: 15%). Prescriber education and feedback reduce manual prescribing errors in intensive care.

Evaluating the technique of using inhalation device in COPD and bronchial asthma patients.

PubMed

Arora, Piyush; Kumar, Lokender; Vohra, Vikram; Sarin, Rohit; Jaiswal, Anand; Puri, M M; Rathee, Deepti; Chakraborty, Pitambar

2014-07-01

In asthma management, poor handling of inhalation devices and wrong inhalation technique are associated with decreased medication delivery and poor disease control. The key to overcome the drawbacks in inhalation technique is to make patients familiar with issues related to correct use and performance of these medical devices. The objective of this study was to evaluate and analyse technique of use of the inhalation device used by patients of COPD and Bronchial Asthma. A total of 300 cases of BA or COPD patients using different types of inhalation devices were included in this observational study. Data were captured using a proforma and were analysed using SPSS version 15.0. Out of total 300 enrolled patients, 247 (82.3%) made at least one error. Maximum errors observed in subjects using MDI (94.3%), followed by DPI (82.3%), MDI with Spacer (78%) while Nebulizer users (70%) made least number of errors (p = 0.005). Illiterate patients showed 95.2% error while post-graduate and professionals showed 33.3%. This difference was statistically significant (p < 0.001). Self-educated patients committed 100% error, while those trained by a doctor made 56.3% error. Majority of patients using inhalation devices made errors while using the device. Proper education to patients on correct usage may not only improve control of the symptoms of the disease but might also allow dose reduction in long term. Copyright © 2014 Elsevier Ltd. All rights reserved.

Recursive least-squares learning algorithms for neural networks

NASA Astrophysics Data System (ADS)

Lewis, Paul S.; Hwang, Jenq N.

1990-11-01

This paper presents the development of a pair of recursive least squares (ItLS) algorithms for online training of multilayer perceptrons which are a class of feedforward artificial neural networks. These algorithms incorporate second order information about the training error surface in order to achieve faster learning rates than are possible using first order gradient descent algorithms such as the generalized delta rule. A least squares formulation is derived from a linearization of the training error function. Individual training pattern errors are linearized about the network parameters that were in effect when the pattern was presented. This permits the recursive solution of the least squares approximation either via conventional RLS recursions or by recursive QR decomposition-based techniques. The computational complexity of the update is 0(N2) where N is the number of network parameters. This is due to the estimation of the N x N inverse Hessian matrix. Less computationally intensive approximations of the ilLS algorithms can be easily derived by using only block diagonal elements of this matrix thereby partitioning the learning into independent sets. A simulation example is presented in which a neural network is trained to approximate a two dimensional Gaussian bump. In this example RLS training required an order of magnitude fewer iterations on average (527) than did training with the generalized delta rule (6 1 BACKGROUND Artificial neural networks (ANNs) offer an interesting and potentially useful paradigm for signal processing and pattern recognition. The majority of ANN applications employ the feed-forward multilayer perceptron (MLP) network architecture in which network parameters are " trained" by a supervised learning algorithm employing the generalized delta rule (GDIt) [1 2]. The GDR algorithm approximates a fixed step steepest descent algorithm using derivatives computed by error backpropagatiori. The GDII algorithm is sometimes referred to as the backpropagation algorithm. However in this paper we will use the term backpropagation to refer only to the process of computing error derivatives. While multilayer perceptrons provide a very powerful nonlinear modeling capability GDR training can be very slow and inefficient. In linear adaptive filtering the analog of the GDR algorithm is the leastmean- squares (LMS) algorithm. Steepest descent-based algorithms such as GDR or LMS are first order because they use only first derivative or gradient information about the training error to be minimized. To speed up the training process second order algorithms may be employed that take advantage of second derivative or Hessian matrix information. Second order information can be incorporated into MLP training in different ways. In many applications especially in the area of pattern recognition the training set is finite. In these cases block learning can be applied using standard nonlinear optimization techniques [3 4 5].

The running athlete: stress fractures, osteitis pubis, and snapping hips.

PubMed

Henning, P Troy

2014-03-01

Pelvic stress fractures, osteitis pubis, and snapping hip syndrome account for a portion of the overuse injuries that can occur in the running athlete. PUBMED SEARCHES WERE PERFORMED FOR EACH ENTITY USING THE FOLLOWING KEYWORDS: snapping hip syndrome, coxa sultans, pelvic stress fracture, and osteitis pubis from 2008 to 2013. Topic reviews, case reports, case series, and randomized trials were included for review. Clinical review. Level 4. Collectively, 188 articles were identified. Of these, 58 were included in this review. Based on the available evidence, the majority of these overuse injuries can be managed non-operatively. Primary treatment should include removal from offending activity, normalizing regional muscle strength/length imbalances and nutritional deficiencies, and mitigating training errors through proper education of the athlete and training staff. C.

Individualized Cognitive Modeling for Close-Loop Task Mitigation

NASA Technical Reports Server (NTRS)

Zhang, Guangfan; Xu, Roger; Wang, Wei; Li, Jiang; Schnell, Tom; Keller, Mike

2010-01-01

An accurate real-time operator functional state assessment makes it possible to perform task management, minimize risks, and improve mission performance. In this paper, we discuss the development of an individualized operator functional state assessment model that identifies states likely leading to operational errors. To address large individual variations, we use two different approaches to build a model for each individual using its data as well as data from subjects with similar responses. If a subject's response is similar to that of the individual of interest in a specific functional state, all the training data from this subject will be used to build the individual model. The individualization methods have been successfully verified and validated with a driving test data set provided by University of Iowa. With the individualized models, the mean squared error can be significantly decreased (by around 20%).

Human Factors and Ergonomics for the Dental Profession.

PubMed

Ross, Al

2016-09-01

This paper proposes that the science of Human Factors and Ergonomics (HFE) is suitable for wide application in dental education, training and practice to improve safety, quality and efficiency. Three areas of interest are highlighted. First it is proposed that individual and team Non-Technical Skills (NTS), such as communication, leadership and stress management can improve error rates and efficiency of procedures. Secondly, in a physically and technically challenging environment, staff can benefit from ergonomic principles which examine design in supporting safe work. Finally, examination of organizational human factors can help anticipate stressors and plan for flexible responses to multiple, variable demands, and fluctuating resources. Clinical relevance: HFE is an evidence-based approach to reducing error rates and procedural complications, and avoiding problems associated with stress and fatigue. Improved teamwork and organizational planning and efficiency can impact directly on patient outcomes.

Facilitating a just and trusting culture.

PubMed

Pattison, Jill; Kline, Theresa

2015-01-01

The purpose of this paper is to identify managerial and organizational characteristics and behaviors that facilitate the fostering of a just and trusting culture within the healthcare system. Two studies were conducted. The initial qualitative one was used to identify themes based on interviews with health care workers that facilitate a just and trusting culture. The quantitative one used a policy-capturing design to determine which factors were most likely to predict outcomes of manager and organizational trust. The factors of violation type (ability vs integrity), providing an explanation or not, blame vs no blame by manager, and blame vs no blame by organization were all significant predictors of perceptions of trust. Limitations to the generalizability of findings included both a small and non-representative sample from one health care region. The present findings can be useful in developing training systems for managers and organizational executive teams for managing medical error events in a manner that will help develop a just and trusting culture. A just and trusting culture should enhance the likelihood of reporting medical errors. Improved reporting, in turn, should enhance patient safety. This is the first field study experimentally manipulating aspects of organizational trust within the health care sector. The use of policy-capturing is a unique feature that sheds light into the decision-making of health care workers as to the efficaciousness of particular managerial and organizational characteristics that impact a just and trusting culture.

Human-simulation-based learning to prevent medication error: A systematic review.

PubMed

Sarfati, Laura; Ranchon, Florence; Vantard, Nicolas; Schwiertz, Vérane; Larbre, Virginie; Parat, Stéphanie; Faudel, Amélie; Rioufol, Catherine

2018-01-31

In the past 2 decades, there has been an increasing interest in simulation-based learning programs to prevent medication error (ME). To improve knowledge, skills, and attitudes in prescribers, nurses, and pharmaceutical staff, these methods enable training without directly involving patients. However, best practices for simulation for healthcare providers are as yet undefined. By analysing the current state of experience in the field, the present review aims to assess whether human simulation in healthcare helps to reduce ME. A systematic review was conducted on Medline from 2000 to June 2015, associating the terms "Patient Simulation," "Medication Errors," and "Simulation Healthcare." Reports of technology-based simulation were excluded, to focus exclusively on human simulation in nontechnical skills learning. Twenty-one studies assessing simulation-based learning programs were selected, focusing on pharmacy, medicine or nursing students, or concerning programs aimed at reducing administration or preparation errors, managing crises, or learning communication skills for healthcare professionals. The studies varied in design, methodology, and assessment criteria. Few demonstrated that simulation was more effective than didactic learning in reducing ME. This review highlights a lack of long-term assessment and real-life extrapolation, with limited scenarios and participant samples. These various experiences, however, help in identifying the key elements required for an effective human simulation-based learning program for ME prevention: ie, scenario design, debriefing, and perception assessment. The performance of these programs depends on their ability to reflect reality and on professional guidance. Properly regulated simulation is a good way to train staff in events that happen only exceptionally, as well as in standard daily activities. By integrating human factors, simulation seems to be effective in preventing iatrogenic risk related to ME, if the program is well designed. © 2018 John Wiley & Sons, Ltd.

Less Pain, More Gain: Rapid Skill Development Using "Old Way New Way"

ERIC Educational Resources Information Center

Baxter, Paul; Lyndon, Harry; Dole, Shelley; Battistutta, Diana

2004-01-01

This study addresses an issue of global concern in skills training, namely, the rapid and permanent eradication of persistent habit errors, and bad or unsafe working practices. This article offers an alternative human factors explanation for the profound difficulties and low transfer of training experienced during error pattern retraining, and the…

Patient safety education to change medical students' attitudes and sense of responsibility.

PubMed

Roh, Hyerin; Park, Seok Ju; Kim, Taekjoong

2015-01-01

This study examined changes in the perceptions and attitudes as well as the sense of individual and collective responsibility in medical students after they received patient safety education. A three-day patient safety curriculum was implemented for third-year medical students shortly before entering their clerkship. Before and after training, we administered a questionnaire, which was analysed quantitatively. Additionally, we asked students to answer questions about their expected behaviours in response to two case vignettes. Their answers were analysed qualitatively. There was improvement in students' concepts of patient safety after training. Before training, they showed good comprehension of the inevitability of error, but most students blamed individuals for errors and expressed a strong sense of individual responsibility. After training, students increasingly attributed errors to system dysfunction and reported more self-confidence in speaking up about colleagues' errors. However, due to the hierarchical culture, students still described difficulties communicating with senior doctors. Patient safety education effectively shifted students' attitudes towards systems-based thinking and increased their sense of collective responsibility. Strategies for improving superior-subordinate communication within a hierarchical culture should be added to the patient safety curriculum.

Reliability of anthropometric measurements in European preschool children: the ToyBox-study.

PubMed

De Miguel-Etayo, P; Mesana, M I; Cardon, G; De Bourdeaudhuij, I; Góźdź, M; Socha, P; Lateva, M; Iotova, V; Koletzko, B V; Duvinage, K; Androutsos, O; Manios, Y; Moreno, L A

2014-08-01

The ToyBox-study aims to develop and test an innovative and evidence-based obesity prevention programme for preschoolers in six European countries: Belgium, Bulgaria, Germany, Greece, Poland and Spain. In multicentre studies, anthropometric measurements using standardized procedures that minimize errors in the data collection are essential to maximize reliability of measurements. The aim of this paper is to describe the standardization process and reliability (intra- and inter-observer) of height, weight and waist circumference (WC) measurements in preschoolers. All technical procedures and devices were standardized and centralized training was given to the fieldworkers. At least seven children per country participated in the intra- and inter-observer reliability testing. Intra-observer technical error ranged from 0.00 to 0.03 kg for weight and from 0.07 to 0.20 cm for height, with the overall reliability being above 99%. A second training was organized for WC due to low reliability observed in the first training. Intra-observer technical error for WC ranged from 0.12 to 0.71 cm during the first training and from 0.05 to 1.11 cm during the second training, and reliability above 92% was achieved. Epidemiological surveys need standardized procedures and training of researchers to reduce measurement error. In the ToyBox-study, very good intra- and-inter-observer agreement was achieved for all anthropometric measurements performed. © 2014 World Obesity.

Sample Training Based Wildfire Segmentation by 2D Histogram θ-Division with Minimum Error

PubMed Central

Dong, Erqian; Sun, Mingui; Jia, Wenyan; Zhang, Dengyi; Yuan, Zhiyong

2013-01-01

A novel wildfire segmentation algorithm is proposed with the help of sample training based 2D histogram θ-division and minimum error. Based on minimum error principle and 2D color histogram, the θ-division methods were presented recently, but application of prior knowledge on them has not been explored. For the specific problem of wildfire segmentation, we collect sample images with manually labeled fire pixels. Then we define the probability function of error division to evaluate θ-division segmentations, and the optimal angle θ is determined by sample training. Performances in different color channels are compared, and the suitable channel is selected. To further improve the accuracy, the combination approach is presented with both θ-division and other segmentation methods such as GMM. Our approach is tested on real images, and the experiments prove its efficiency for wildfire segmentation. PMID:23878526

Reducing errors benefits the field-based learning of a fundamental movement skill in children.

PubMed

Capio, C M; Poolton, J M; Sit, C H P; Holmstrom, M; Masters, R S W

2013-03-01

Proficient fundamental movement skills (FMS) are believed to form the basis of more complex movement patterns in sports. This study examined the development of the FMS of overhand throwing in children through either an error-reduced (ER) or error-strewn (ES) training program. Students (n = 216), aged 8-12 years (M = 9.16, SD = 0.96), practiced overhand throwing in either a program that reduced errors during practice (ER) or one that was ES. ER program reduced errors by incrementally raising the task difficulty, while the ES program had an incremental lowering of task difficulty. Process-oriented assessment of throwing movement form (Test of Gross Motor Development-2) and product-oriented assessment of throwing accuracy (absolute error) were performed. Changes in performance were examined among children in the upper and lower quartiles of the pretest throwing accuracy scores. ER training participants showed greater gains in movement form and accuracy, and performed throwing more effectively with a concurrent secondary cognitive task. Movement form improved among girls, while throwing accuracy improved among children with low ability. Reduced performance errors in FMS training resulted in greater learning than a program that did not restrict errors. Reduced cognitive processing costs (effective dual-task performance) associated with such approach suggest its potential benefits for children with developmental conditions. © 2011 John Wiley & Sons A/S.

Sensorimotor Learning of Acupuncture Needle Manipulation Using Visual Feedback

PubMed Central

Jung, Won-Mo; Lim, Jinwoong; Lee, In-Seon; Park, Hi-Joon; Wallraven, Christian; Chae, Younbyoung

2015-01-01

Objective Humans can acquire a wide variety of motor skills using sensory feedback pertaining to discrepancies between intended and actual movements. Acupuncture needle manipulation involves sophisticated hand movements and represents a fundamental skill for acupuncturists. We investigated whether untrained students could improve their motor performance during acupuncture needle manipulation using visual feedback (VF). Methods Twenty-one untrained medical students were included, randomly divided into concurrent (n = 10) and post-trial (n = 11) VF groups. Both groups were trained in simple lift/thrusting techniques during session 1, and in complicated lift/thrusting techniques in session 2 (eight training trials per session). We compared the motion patterns and error magnitudes of pre- and post-training tests. Results During motion pattern analysis, both the concurrent and post-trial VF groups exhibited greater improvements in motion patterns during the complicated lifting/thrusting session. In the magnitude error analysis, both groups also exhibited reduced error magnitudes during the simple lifting/thrusting session. For the training period, the concurrent VF group exhibited reduced error magnitudes across all training trials, whereas the post-trial VF group was characterized by greater error magnitudes during initial trials, which gradually reduced during later trials. Conclusions Our findings suggest that novices can improve the sophisticated hand movements required for acupuncture needle manipulation using sensorimotor learning with VF. Use of two types of VF can be beneficial for untrained students in terms of learning how to manipulate acupuncture needles, using either automatic or cognitive processes. PMID:26406248

How well does multiple OCR error correction generalize?

NASA Astrophysics Data System (ADS)

Lund, William B.; Ringger, Eric K.; Walker, Daniel D.

2013-12-01

As the digitization of historical documents, such as newspapers, becomes more common, the need of the archive patron for accurate digital text from those documents increases. Building on our earlier work, the contributions of this paper are: 1. in demonstrating the applicability of novel methods for correcting optical character recognition (OCR) on disparate data sets, including a new synthetic training set, 2. enhancing the correction algorithm with novel features, and 3. assessing the data requirements of the correction learning method. First, we correct errors using conditional random fields (CRF) trained on synthetic training data sets in order to demonstrate the applicability of the methodology to unrelated test sets. Second, we show the strength of lexical features from the training sets on two unrelated test sets, yielding a relative reduction in word error rate on the test sets of 6.52%. New features capture the recurrence of hypothesis tokens and yield an additional relative reduction in WER of 2.30%. Further, we show that only 2.0% of the full training corpus of over 500,000 feature cases is needed to achieve correction results comparable to those using the entire training corpus, effectively reducing both the complexity of the training process and the learned correction model.

Risk management: correct patient and specimen identification in a surgical pathology laboratory. The experience of Infermi Hospital, Rimini, Italy.

PubMed

Fabbretti, G

2010-06-01

Because of its complex nature, surgical pathology practice is prone to error. In this report, we describe our methods for reducing error as much as possible during the pre-analytical and analytical phases. This was achieved by revising procedures, and by using computer technology and automation. Most mistakes are the result of human error in the identification and matching of patient and samples. To avoid faulty data interpretation, we employed a new comprehensive computer system that acquires all patient ID information directly from the hospital's database with a remote order entry; it also provides label and request forms via-Web where clinical information is required before sending the sample. Both patient and sample are identified directly and immediately at the site where the surgical procedures are performed. Barcode technology is used to input information at every step and automation is used for sample blocks and slides to avoid errors that occur when information is recorded or transferred by hand. Quality control checks occur at every step of the process to ensure that none of the steps are left to chance and that no phase is dependent on a single operator. The system also provides statistical analysis of errors so that new strategies can be implemented to avoid repetition. In addition, the staff receives frequent training on avoiding errors and new developments. The results have been shown promising results with a very low error rate (0.27%). None of these compromised patient health and all errors were detected before the release of the diagnosis report.

Decreasing scoring errors on Wechsler Scale Vocabulary, Comprehension, and Similarities subtests: a preliminary study.

PubMed

Linger, Michele L; Ray, Glen E; Zachar, Peter; Underhill, Andrea T; LoBello, Steven G

2007-10-01

Studies of graduate students learning to administer the Wechsler scales have generally shown that training is not associated with the development of scoring proficiency. Many studies report on the reduction of aggregated administration and scoring errors, a strategy that does not highlight the reduction of errors on subtests identified as most prone to error. This study evaluated the development of scoring proficiency specifically on the Wechsler (WISC-IV and WAIS-III) Vocabulary, Comprehension, and Similarities subtests during training by comparing a set of 'early test administrations' to 'later test administrations.' Twelve graduate students enrolled in an intelligence-testing course participated in the study. Scoring errors (e.g., incorrect point assignment) were evaluated on the students' actual practice administration test protocols. Errors on all three subtests declined significantly when scoring errors on 'early' sets of Wechsler scales were compared to those made on 'later' sets. However, correcting these subtest scoring errors did not cause significant changes in subtest scaled scores. Implications for clinical instruction and future research are discussed.

State of Simulation in Healthcare Education: An Initial Survey in Beijing

PubMed Central

Zhao, Zichen; Niu, Pengfei; Ji, Xiang

2017-01-01

Background and Objectives: In 2013, medical error was the third leading cause of death in the United States.1 In China, as in the case with the United States, training and assessment are developing as a strategy to reduce the occurrence of such errors. The objective of this study was to assess the current state of the use of simulation-based training in Beijing and to explore the barriers to further development. Methods: This study included hospitals in Beijing accredited by the Standardized Residency Training (SRT) program. The questionnaire was designed online and distributed to the SRT management departments by e-mail or instant message. Results: Thirty hospitals were invited to participate in this survey, and 15 responses were completed and met the inclusion criteria. Task trainers (15/15), full-scale mannequins (14/15), standardized patients (12/15), and virtual reality workstations (11/15) were the most common types of simulation modalities available for use. Among the given specialties for SRT, the availability of simulation courses was 2/2 for pediatric internal medicine, 1/1 for pediatric surgery, 10/11 for surgery, 11/14 for internal medicine, 7/9 for anesthesiology, 6/8 for emergency medicine, and 3/9 for obstetrics/gynecology. Of the 13 institutions with available simulation curricula, 12/13 had simulation focused on proficiency-based skill training, 11/13 had medical knowledge learning, 10/13 had skill competency assessment. The main targeted trainees in these hospitals were residents (or postgraduate residents) and medical students (or interns). The top 2 barriers were the shortage of sustainable financial resources (12/15) and advocacy from their institutional authorities (7/15). Conclusion: It is evident that there is a need for more development of training facilities, and for training the “trainers” and administrators. Financial funding, curricular design, and research seem to be crucial for building a long-term, sustainable, effective program. PMID:28144123

State of Simulation in Healthcare Education: An Initial Survey in Beijing.

PubMed

Zhao, Zichen; Niu, Pengfei; Ji, Xiang; Sweet, Robert M

2017-01-01

In 2013, medical error was the third leading cause of death in the United States. 1 In China, as in the case with the United States, training and assessment are developing as a strategy to reduce the occurrence of such errors. The objective of this study was to assess the current state of the use of simulation-based training in Beijing and to explore the barriers to further development. This study included hospitals in Beijing accredited by the Standardized Residency Training (SRT) program. The questionnaire was designed online and distributed to the SRT management departments by e-mail or instant message. Thirty hospitals were invited to participate in this survey, and 15 responses were completed and met the inclusion criteria. Task trainers (15/15), full-scale mannequins (14/15), standardized patients (12/15), and virtual reality workstations (11/15) were the most common types of simulation modalities available for use. Among the given specialties for SRT, the availability of simulation courses was 2/2 for pediatric internal medicine, 1/1 for pediatric surgery, 10/11 for surgery, 11/14 for internal medicine, 7/9 for anesthesiology, 6/8 for emergency medicine, and 3/9 for obstetrics/gynecology. Of the 13 institutions with available simulation curricula, 12/13 had simulation focused on proficiency-based skill training, 11/13 had medical knowledge learning, 10/13 had skill competency assessment. The main targeted trainees in these hospitals were residents (or postgraduate residents) and medical students (or interns). The top 2 barriers were the shortage of sustainable financial resources (12/15) and advocacy from their institutional authorities (7/15). It is evident that there is a need for more development of training facilities, and for training the "trainers" and administrators. Financial funding, curricular design, and research seem to be crucial for building a long-term, sustainable, effective program.

Improving patient safety through better teamwork: how effective are different methods of simulation debriefing? Protocol for a pragmatic, prospective and randomised study

PubMed Central

Freytag, Julia; Stroben, Fabian; Hautz, Wolf E; Eisenmann, Dorothea; Kämmer, Juliane E

2017-01-01

Introduction Medical errors have an incidence of 9% and may lead to worse patient outcome. Teamwork training has the capacity to significantly reduce medical errors and therefore improve patient outcome. One common framework for teamwork training is crisis resource management, adapted from aviation and usually trained in simulation settings. Debriefing after simulation is thought to be crucial to learning teamwork-related concepts and behaviours but it remains unclear how best to debrief these aspects. Furthermore, teamwork-training sessions and studies examining education effects on undergraduates are rare. The study aims to evaluate the effects of two teamwork-focused debriefings on team performance after an extensive medical student teamwork training. Methods and analyses A prospective experimental study has been designed to compare a well-established three-phase debriefing method (gather–analyse–summarise; the GAS method) to a newly developed and more structured debriefing approach that extends the GAS method with TeamTAG (teamwork techniques analysis grid). TeamTAG is a cognitive aid listing preselected teamwork principles and descriptions of behavioural anchors that serve as observable patterns of teamwork and is supposed to help structure teamwork-focused debriefing. Both debriefing methods will be tested during an emergency room teamwork-training simulation comprising six emergency medicine cases faced by 35 final-year medical students in teams of five. Teams will be randomised into the two debriefing conditions. Team performance during simulation and the number of principles discussed during debriefing will be evaluated. Learning opportunities, helpfulness and feasibility will be rated by participants and instructors. Analyses will include descriptive, inferential and explorative statistics. Ethics and dissemination The study protocol was approved by the institutional office for data protection and the ethics committee of Charité Medical School Berlin and registered under EA2/172/16. All students will participate voluntarily and will sign an informed consent after receiving written and oral information about the study. Results will be published. PMID:28667224

Human error and crew resource management failures in Naval aviation mishaps: a review of U.S. Naval Safety Center data, 1990-96.

PubMed

Wiegmann, D A; Shappell, S A

1999-12-01

The present study examined the role of human error and crew-resource management (CRM) failures in U.S. Naval aviation mishaps. All tactical jet (TACAIR) and rotary wing Class A flight mishaps between fiscal years 1990-1996 were reviewed. Results indicated that over 75% of both TACAIR and rotary wing mishaps were attributable, at least in part, to some form of human error of which 70% were associated with aircrew human factors. Of these aircrew-related mishaps, approximately 56% involved at least one CRM failure. These percentages are very similar to those observed prior to the implementation of aircrew coordination training (ACT) in the fleet, suggesting that the initial benefits of the program have not persisted and that CRM failures continue to plague Naval aviation. Closer examination of these CRM-related mishaps suggest that the type of flight operations (preflight, routine, emergency) do play a role in the etiology of CRM failures. A larger percentage of CRM failures occurred during non-routine or extremis flight situations when TACAIR mishaps were considered. In contrast, a larger percentage of rotary wing CRM mishaps involved failures that occurred during routine flight operations. These findings illustrate the complex etiology of CRM failures within Naval aviation and support the need for ACT programs tailored to the unique problems faced by specific communities in the fleet.

A telemonitoring tool based on serious games addressing money management skills for people with intellectual disability.

PubMed

Lopez-Basterretxea, Asier; Mendez-Zorrilla, Amaia; Garcia-Zapirain, Begonya

2014-02-25

This article presents a telemonitoring tool based on computer games, aimed at money management skill improvement for people with Intellectual Disabilities (ID). The presented tool is divided into two parts: on one hand, some training activities related to payments and currency discrimination based on Serious Games are proposed to the user using a multitouch device. On the other hand, the psychologists and specialist who work with them, can access to the Serious Games results using an online application in order to evaluate their evolution. The results are measured according to the number of errors they have during the proposed activities, the time they need to complete them and the score. The article show the results of an experiment made with a clinical sample of 12 users with ID between 12 and 15 years, taking into account that all of them are capable of correct oral communication and they do not have severe physical coordination problems. Only two users completed all the games without errors. Males obtained a mean of 28.25 errors, whereas females obtained a mean of 17.75. The results show significant difference between the selection of games 1, 2 or 3, because all of them prefer the game 1 related with "Payments" probably because it permits more interaction using the multitouch device. The authors also made a qualitative evaluation and the results have been very promising and satisfactory.

Sensory training with vibration-induced kinesthetic illusions improves proprioceptive integration in patients with Parkinson's disease.

PubMed

Ribot-Ciscar, Edith; Aimonetti, Jean-Marc; Azulay, Jean-Philippe

2017-12-15

The present study investigates whether proprioceptive training, based on kinesthetic illusions, can help in re-educating the processing of muscle proprioceptive input, which is impaired in patients with Parkinson's disease (PD). The processing of proprioceptive input before and after training was evaluated by determining the error in the amplitude of voluntary dorsiflexion ankle movement (20°), induced by applying a vibration on the tendon of the gastrocnemius-soleus muscle (a vibration-induced movement error). The training consisted of the subjects focusing their attention upon a series of illusory movements of the ankle. Eleven PD patients and eleven age-matched control subjects were tested. Before training, vibration reduced dorsiflexion amplitude in controls by 4.3° (P<0.001); conversely, vibration was inefficient in PD's movement amplitude (reduction of 2.1°, P=0.20). After training, vibration significantly reduced the estimated movement amplitude in PD patients by 5.3° (P=0.01). This re-emergence of a vibration-induced error leads us to conclude that proprioceptive training, based on kinesthetic illusions, is a simple means for re-educating the processing of muscle proprioceptive input in PD patients. Such complementary training should be included in rehabilitation programs that presently focus on improving balance and motor performance. Copyright © 2017 Elsevier B.V. All rights reserved.

High-Fidelity Contrast Reaction Simulation Training: Performance Comparison of Faculty, Fellows, and Residents.

PubMed

Pfeifer, Kyle; Staib, Lawrence; Arango, Jennifer; Kirsch, John; Arici, Mel; Kappus, Liana; Pahade, Jay

2016-01-01

Reactions to contrast material are uncommon in diagnostic radiology, and vary in clinical presentation from urticaria to life-threatening anaphylaxis. Prior studies have demonstrated a high error rate in contrast reaction management, with smaller studies using simulation demonstrating variable data on effectiveness. We sought to assess the effectiveness of high-fidelity simulation in teaching contrast reaction management for residents, fellows, and attendings. A 20-question multiple-choice test assessing contrast reaction knowledge, with Likert-scale questions assessing subjective comfort levels of management of contrast reactions, was created. Three simulation scenarios that represented a moderate reaction, a severe reaction, and a contrast reaction mimic were completed in a one-hour period in a simulation laboratory. All participants completed a pretest and a posttest at one month. A six-month delayed posttest was given, but was optional for all participants. A total of 150 radiologists participated (residents = 52; fellows = 24; faculty = 74) in the pretest and posttest; and 105 participants completed the delayed posttest (residents = 31; fellows = 17; faculty = 57). A statistically significant increase was found in the one-month posttest (P < .00001) and the six-month posttest scores (P < .00001) and Likert scores (P < .001) assessing comfort level in managing all contrast reactions, compared with the pretest. Test scores and comfort level for moderate and severe reactions significantly decreased at six months, compared with the one-month posttest (P < .05). High-fidelity simulation is an effective learning tool, allowing practice of "high-acuity" situation management in a nonthreatening environment; the simulation training resulted in significant improvement in test scores, as well as an increase in subjective comfort in management of reactions, across all levels of training. A six-month refresher course is suggested, to maintain knowledge and comfort level in contrast reaction management. Copyright © 2016 American College of Radiology. Published by Elsevier Inc. All rights reserved.

[Efficacy of decoding training for children with difficulty reading hiragana].

PubMed

Uchiyama, Hitoshi; Tanaka, Daisuke; Seki, Ayumi; Wakamiya, Eiji; Hirasawa, Noriko; Iketani, Naotake; Kato, Ken; Koeda, Tatsuya

2013-05-01

The present study aimed to clarify the efficacy of decoding training focusing on the correspondence between written symbols and their readings for children with difficulty reading hiragana (Japanese syllabary). Thirty-five children with difficulty reading hiragana were selected from among 367 first-grade elementary school students using a reading aloud test and were then divided into intervention (n=15) and control (n=20) groups. The intervention comprised 5 minutes of decoding training each day for a period of 3 weeks using an original program on a personal computer. Reading time and number of reading errors in the reading aloud test were compared between the groups. The intervention group showed a significant shortening of reading time (F(1,33)=5.40, p<0.05, two-way ANOVA) compared to the control group. However, no significant difference in the number of errors was observed between the two groups. Ten children in the control group who wished to participate in the decoding training were included in an additional study;as a result, improvement of the number of reading errors was observed (t= 2.863, p< 0.05, paired t test), but there was no improvement in reading time. Decoding training was found to be effective for improving both reading time and reading errors in children with difficulty reading hiragana.

Efficient probabilistic inference in generic neural networks trained with non-probabilistic feedback.

PubMed

Orhan, A Emin; Ma, Wei Ji

2017-07-26

Animals perform near-optimal probabilistic inference in a wide range of psychophysical tasks. Probabilistic inference requires trial-to-trial representation of the uncertainties associated with task variables and subsequent use of this representation. Previous work has implemented such computations using neural networks with hand-crafted and task-dependent operations. We show that generic neural networks trained with a simple error-based learning rule perform near-optimal probabilistic inference in nine common psychophysical tasks. In a probabilistic categorization task, error-based learning in a generic network simultaneously explains a monkey's learning curve and the evolution of qualitative aspects of its choice behavior. In all tasks, the number of neurons required for a given level of performance grows sublinearly with the input population size, a substantial improvement on previous implementations of probabilistic inference. The trained networks develop a novel sparsity-based probabilistic population code. Our results suggest that probabilistic inference emerges naturally in generic neural networks trained with error-based learning rules.Behavioural tasks often require probability distributions to be inferred about task specific variables. Here, the authors demonstrate that generic neural networks can be trained using a simple error-based learning rule to perform such probabilistic computations efficiently without any need for task specific operations.

Evaluation of a parallel implementation of the learning portion of the backward error propagation neural network: experiments in artifact identification.

PubMed Central

Sittig, D. F.; Orr, J. A.

1991-01-01

Various methods have been proposed in an attempt to solve problems in artifact and/or alarm identification including expert systems, statistical signal processing techniques, and artificial neural networks (ANN). ANNs consist of a large number of simple processing units connected by weighted links. To develop truly robust ANNs, investigators are required to train their networks on huge training data sets, requiring enormous computing power. We implemented a parallel version of the backward error propagation neural network training algorithm in the widely portable parallel programming language C-Linda. A maximum speedup of 4.06 was obtained with six processors. This speedup represents a reduction in total run-time from approximately 6.4 hours to 1.5 hours. We conclude that use of the master-worker model of parallel computation is an excellent method for obtaining speedups in the backward error propagation neural network training algorithm. PMID:1807607

AveBoost2: Boosting for Noisy Data

NASA Technical Reports Server (NTRS)

Oza, Nikunj C.

2004-01-01

AdaBoost is a well-known ensemble learning algorithm that constructs its constituent or base models in sequence. A key step in AdaBoost is constructing a distribution over the training examples to create each base model. This distribution, represented as a vector, is constructed to be orthogonal to the vector of mistakes made by the pre- vious base model in the sequence. The idea is to make the next base model's errors uncorrelated with those of the previous model. In previous work, we developed an algorithm, AveBoost, that constructed distributions orthogonal to the mistake vectors of all the previous models, and then averaged them to create the next base model s distribution. Our experiments demonstrated the superior accuracy of our approach. In this paper, we slightly revise our algorithm to allow us to obtain non-trivial theoretical results: bounds on the training error and generalization error (difference between training and test error). Our averaging process has a regularizing effect which, as expected, leads us to a worse training error bound for our algorithm than for AdaBoost but a superior generalization error bound. For this paper, we experimented with the data that we used in both as originally supplied and with added label noise-a small fraction of the data has its original label changed. Noisy data are notoriously difficult for AdaBoost to learn. Our algorithm's performance improvement over AdaBoost is even greater on the noisy data than the original data.

Are we under-utilizing the talents of primary care personnel? A job analytic examination

PubMed Central

Hysong, Sylvia J; Best, Richard G; Moore, Frank I

2007-01-01

Background Primary care staffing decisions are often made unsystematically, potentially leading to increased costs, dissatisfaction, turnover, and reduced quality of care. This article aims to (1) catalogue the domain of primary care tasks, (2) explore the complexity associated with these tasks, and (3) examine how tasks performed by different job titles differ in function and complexity, using Functional Job Analysis to develop a new tool for making evidence-based staffing decisions. Methods Seventy-seven primary care personnel from six US Department of Veterans Affairs (VA) Medical Centers, representing six job titles, participated in two-day focus groups to generate 243 unique task statements describing the content of VA primary care. Certified job analysts rated tasks on ten dimensions representing task complexity, skills, autonomy, and error consequence. Two hundred and twenty-four primary care personnel from the same clinics then completed a survey indicating whether they performed each task. Tasks were catalogued using an adaptation of an existing classification scheme; complexity differences were tested via analysis of variance. Results Objective one: Task statements were categorized into four functions: service delivery (65%), administrative duties (15%), logistic support (9%), and workforce management (11%). Objective two: Consistent with expectations, 80% of tasks received ratings at or below the mid-scale value on all ten scales. Objective three: Service delivery and workforce management tasks received higher ratings on eight of ten scales (multiple functional complexity dimensions, autonomy, human error consequence) than administrative and logistic support tasks. Similarly, tasks performed by more highly trained job titles received higher ratings on six of ten scales than tasks performed by lower trained job titles. Contrary to expectations, the distribution of tasks across functions did not significantly vary by job title. Conclusion Primary care personnel are not being utilized to the extent of their training; most personnel perform many tasks that could reasonably be performed by personnel with less training. Primary care clinics should use evidence-based information to optimize job-person fit, adjusting clinic staff mix and allocation of work across staff to enhance efficiency and effectiveness. PMID:17397534

Development of automatic body condition scoring using a low-cost 3-dimensional Kinect camera.

PubMed

Spoliansky, Roii; Edan, Yael; Parmet, Yisrael; Halachmi, Ilan

2016-09-01

Body condition scoring (BCS) is a farm-management tool for estimating dairy cows' energy reserves. Today, BCS is performed manually by experts. This paper presents a 3-dimensional algorithm that provides a topographical understanding of the cow's body to estimate BCS. An automatic BCS system consisting of a Kinect camera (Microsoft Corp., Redmond, WA) triggered by a passive infrared motion detector was designed and implemented. Image processing and regression algorithms were developed and included the following steps: (1) image restoration, the removal of noise; (2) object recognition and separation, identification and separation of the cows; (3) movie and image selection, selection of movies and frames that include the relevant data; (4) image rotation, alignment of the cow parallel to the x-axis; and (5) image cropping and normalization, removal of irrelevant data, setting the image size to 150×200 pixels, and normalizing image values. All steps were performed automatically, including image selection and classification. Fourteen individual features per cow, derived from the cows' topography, were automatically extracted from the movies and from the farm's herd-management records. These features appear to be measurable in a commercial farm. Manual BCS was performed by a trained expert and compared with the output of the training set. A regression model was developed, correlating the features with the manual BCS references. Data were acquired for 4 d, resulting in a database of 422 movies of 101 cows. Movies containing cows' back ends were automatically selected (389 movies). The data were divided into a training set of 81 cows and a test set of 20 cows; both sets included the identical full range of BCS classes. Accuracy tests gave a mean absolute error of 0.26, median absolute error of 0.19, and coefficient of determination of 0.75, with 100% correct classification within 1 step and 91% correct classification within a half step for BCS classes. Results indicated good repeatability, with all standard deviations under 0.33. The algorithm is independent of the background and requires 10 cows for training with approximately 30 movies of 4 s each. Copyright © 2016 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Transferring Aviation Practices into Clinical Medicine for the Promotion of High Reliability.

PubMed

Powell-Dunford, Nicole; McPherson, Mark K; Pina, Joseph S; Gaydos, Steven J

2017-05-01

Aviation is a classic example of a high reliability organization (HRO)-an organization in which catastrophic events are expected to occur without control measures. As health care systems transition toward high reliability, aviation practices are increasingly transferred for clinical implementation. A PubMed search using the terms aviation, crew resource management, and patient safety was undertaken. Manuscripts authored by physician pilots and accident investigation regulations were analyzed. Subject matter experts involved in adoption of aviation practices into the medical field were interviewed. A PubMed search yielded 621 results with 22 relevant for inclusion. Improved clinical outcomes were noted in five research trials in which aviation practices were adopted, particularly with regard to checklist usage and crew resource-management training. Effectiveness of interventions was influenced by intensity of application, leadership involvement, and provision of staff training. The usefulness of incorporating mishap investigation techniques has not been established. Whereas aviation accident investigation is highly standardized, the investigation of medical error is characterized by variation. The adoption of aviation practices into clinical medicine facilitates an evolution toward high reliability. Evidence for the efficacy of the checklist and crew resource-management training is robust. Transference of aviation accident investigation practices is preliminary. A standardized, independent investigation process could facilitate the development of a safety culture commensurate with that achieved in the aviation industry.Powell-Dunford N, McPherson MK, Pina JS, Gaydos SJ. Transferring aviation practices into clinical medicine for the promotion of high reliability. Aerosp Med Hum Perform. 2017; 88(5):487-491.

Does Wechsler Intelligence Scale administration and scoring proficiency improve during assessment training?

PubMed

Platt, Tyson L; Zachar, Peter; Ray, Glen E; Lobello, Steven G; Underhill, Andrea T

2007-04-01

Studies have found that Wechsler scale administration and scoring proficiency is not easily attained during graduate training. These findings may be related to methodological issues. Using a single-group repeated measures design, this study documents statistically significant, though modest, error reduction on the WAIS-III and WISC-III during a graduate course in assessment. The study design does not permit the isolation of training factors related to error reduction, or assessment of whether error reduction is a function of mere practice. However, the results do indicate that previous study findings of no or inconsistent improvement in scoring proficiency may have been the result of methodological factors. Implications for teaching individual intelligence testing and further research are discussed.

Using incident reports to inform the prevention of medication administration errors.

PubMed

Härkänen, Marja; Saano, Susanna; Vehviläinen-Julkunen, Katri

2017-11-01

To describe ways of preventing medication administration errors based on reporters' views expressed in medication administration incident reports. Medication administration errors are very common, and nurses play important roles in committing and in preventing such errors. Thus far, incident reporters' perceptions of how to prevent medication administration errors have rarely been analysed. This is a qualitative, descriptive study using an inductive content analysis of the incident reports related to medication administration errors (n = 1012). These free-text descriptions include reporters' views on preventing the reoccurrence of medication administration errors. The data were collected from two hospitals in Finland and pertain to incidents that were reported between 1 January 2013 and 31 December 2014. Reporters' views on preventing medication administration errors were divided into three main categories related to individuals (health professionals), teams and organisations. The following categories related to individuals in preventing medication administration errors were identified: (1) accuracy and preciseness; (2) verification; and (3) following the guidelines, responsibility and attitude towards work. The team categories were as follows: (1) distribution of work; (2) flow of information and cooperation; and (3) documenting and marking the drug information. The categories related to organisation were as follows: (1) work environment; (2) resources; (3) training; (4) guidelines; and (5) development of the work. Health professionals should administer medication with a high moral awareness and an attempt to concentrate on the task. Nonetheless, the system should support health professionals by providing a reasonable work environment and encouraging collaboration among the providers to facilitate the safe administration of medication. Although there are numerous approaches to supporting medication safety, approaches that support the ability of individual health professionals to manage daily medications should be prioritised. © 2017 John Wiley & Sons Ltd.

Mathematical models of human paralyzed muscle after long-term training.

PubMed

Law, L A Frey; Shields, R K

2007-01-01

Spinal cord injury (SCI) results in major musculoskeletal adaptations, including muscle atrophy, faster contractile properties, increased fatigability, and bone loss. The use of functional electrical stimulation (FES) provides a method to prevent paralyzed muscle adaptations in order to sustain force-generating capacity. Mathematical muscle models may be able to predict optimal activation strategies during FES, however muscle properties further adapt with long-term training. The purpose of this study was to compare the accuracy of three muscle models, one linear and two nonlinear, for predicting paralyzed soleus muscle force after exposure to long-term FES training. Further, we contrasted the findings between the trained and untrained limbs. The three models' parameters were best fit to a single force train in the trained soleus muscle (N=4). Nine additional force trains (test trains) were predicted for each subject using the developed models. Model errors between predicted and experimental force trains were determined, including specific muscle force properties. The mean overall error was greatest for the linear model (15.8%) and least for the nonlinear Hill Huxley type model (7.8%). No significant error differences were observed between the trained versus untrained limbs, although model parameter values were significantly altered with training. This study confirmed that nonlinear models most accurately predict both trained and untrained paralyzed muscle force properties. Moreover, the optimized model parameter values were responsive to the relative physiological state of the paralyzed muscle (trained versus untrained). These findings are relevant for the design and control of neuro-prosthetic devices for those with SCI.

Error estimation of deformable image registration of pulmonary CT scans using convolutional neural networks.

PubMed

Eppenhof, Koen A J; Pluim, Josien P W

2018-04-01

Error estimation in nonlinear medical image registration is a nontrivial problem that is important for validation of registration methods. We propose a supervised method for estimation of registration errors in nonlinear registration of three-dimensional (3-D) images. The method is based on a 3-D convolutional neural network that learns to estimate registration errors from a pair of image patches. By applying the network to patches centered around every voxel, we construct registration error maps. The network is trained using a set of representative images that have been synthetically transformed to construct a set of image pairs with known deformations. The method is evaluated on deformable registrations of inhale-exhale pairs of thoracic CT scans. Using ground truth target registration errors on manually annotated landmarks, we evaluate the method's ability to estimate local registration errors. Estimation of full domain error maps is evaluated using a gold standard approach. The two evaluation approaches show that we can train the network to robustly estimate registration errors in a predetermined range, with subvoxel accuracy. We achieved a root-mean-square deviation of 0.51 mm from gold standard registration errors and of 0.66 mm from ground truth landmark registration errors.

Changing roles in community health care: Delegation of insulin injections to health care support workers.

PubMed

Dutton, Julie; McCaskill, Kelly; Alton, Sarah; Levesley, Maria; Hemingway, Cath; Farndon, Lisa

2018-01-02

Diabetes is a common long-term condition affecting many people many of whom require support with their insulin injections at home. These injections are often carried out by community nurses if individuals are unable to self-manage their condition. This paper describes a pilot project where health care support workers were trained to administer insulin at home for suitable patients. Four patients took part in the pilot study and two support workers were trained to give the insulin injections. The project was evaluated well by all those who took part. It freed up 80 hours of nursing time while also providing the support workers with an extended scope of practice and associated increased in job satisfaction. No untoward medication errors were reported as a result of this initiative. This project will now be rolled out to the wider nursing teams with a staggered approach to the delivery of the training to ensure there is not a detrimental effect on patient care.

Using a site-specific technical error to establish training responsiveness: a preliminary explorative study.

PubMed

Weatherwax, Ryan M; Harris, Nigel K; Kilding, Andrew E; Dalleck, Lance C

2018-01-01

Even though cardiorespiratory fitness (CRF) training elicits numerous health benefits, not all individuals have positive training responses following a structured CRF intervention. It has been suggested that the technical error (TE), a combination of biological variability and measurement error, should be used to establish specific training responsiveness criteria to gain further insight on the effectiveness of the training program. To date, most training interventions use an absolute change or a TE from previous findings, which do not take into consideration the training site and equipment used to establish training outcomes or the specific cohort being evaluated. The purpose of this investigation was to retrospectively analyze training responsiveness of two CRF training interventions using two common criteria and a site-specific TE. Sixteen men and women completed two maximal graded exercise tests and verification bouts to identify maximal oxygen consumption (VO 2 max) and establish a site-specific TE. The TE was then used to retrospectively analyze training responsiveness in comparison to commonly used criteria: percent change of >0% and >+5.6% in VO 2 max. The TE was found to be 7.7% for relative VO 2 max. χ 2 testing showed significant differences in all training criteria for each intervention and pooled data from both interventions, except between %Δ >0 and %Δ >+7.7% in one of the investigations. Training nonresponsiveness ranged from 11.5% to 34.6%. Findings from the present study support the utility of site-specific TE criterion to quantify training responsiveness. A similar methodology of establishing a site-specific and even cohort specific TE should be considered to establish when true cardiorespiratory training adaptations occur.

Errors in Bibliographic Citations: A Continuing Problem.

ERIC Educational Resources Information Center

Sweetland, James H.

1989-01-01

Summarizes studies examining citation errors and illustrates errors resulting from a lack of standardization, misunderstanding of foreign languages, failure to examine the document cited, and general lack of training in citation norms. It is argued that the failure to detect and correct citation errors is due to diffusion of responsibility in the…

An Ensemble System Based on Hybrid EGARCH-ANN with Different Distributional Assumptions to Predict S&P 500 Intraday Volatility

NASA Astrophysics Data System (ADS)

Lahmiri, S.; Boukadoum, M.

2015-10-01

Accurate forecasting of stock market volatility is an important issue in portfolio risk management. In this paper, an ensemble system for stock market volatility is presented. It is composed of three different models that hybridize the exponential generalized autoregressive conditional heteroscedasticity (GARCH) process and the artificial neural network trained with the backpropagation algorithm (BPNN) to forecast stock market volatility under normal, t-Student, and generalized error distribution (GED) assumption separately. The goal is to design an ensemble system where each single hybrid model is capable to capture normality, excess skewness, or excess kurtosis in the data to achieve complementarity. The performance of each EGARCH-BPNN and the ensemble system is evaluated by the closeness of the volatility forecasts to realized volatility. Based on mean absolute error and mean of squared errors, the experimental results show that proposed ensemble model used to capture normality, skewness, and kurtosis in data is more accurate than the individual EGARCH-BPNN models in forecasting the S&P 500 intra-day volatility based on one and five-minute time horizons data.

Designing to Control Flight Crew Errors

NASA Technical Reports Server (NTRS)

Schutte, Paul C.; Willshire, Kelli F.

1997-01-01

It is widely accepted that human error is a major contributing factor in aircraft accidents. There has been a significant amount of research in why these errors occurred, and many reports state that the design of flight deck can actually dispose humans to err. This research has led to the call for changes in design according to human factors and human-centered principles. The National Aeronautics and Space Administration's (NASA) Langley Research Center has initiated an effort to design a human-centered flight deck from a clean slate (i.e., without constraints of existing designs.) The effort will be based on recent research in human-centered design philosophy and mission management categories. This design will match the human's model of the mission and function of the aircraft to reduce unnatural or non-intuitive interfaces. The product of this effort will be a flight deck design description, including training and procedures, and a cross reference or paper trail back to design hypotheses, and an evaluation of the design. The present paper will discuss the philosophy, process, and status of this design effort.

Error management in blood establishments: results of eight years of experience (2003–2010) at the Croatian Institute of Transfusion Medicine

PubMed Central

Vuk, Tomislav; Barišić, Marijan; Očić, Tihomir; Mihaljević, Ivanka; Šarlija, Dorotea; Jukić, Irena

2012-01-01

Background. Continuous and efficient error management, including procedures from error detection to their resolution and prevention, is an important part of quality management in blood establishments. At the Croatian Institute of Transfusion Medicine (CITM), error management has been systematically performed since 2003. Materials and methods. Data derived from error management at the CITM during an 8-year period (2003–2010) formed the basis of this study. Throughout the study period, errors were reported to the Department of Quality Assurance. In addition to surveys and the necessary corrective activities, errors were analysed and classified according to the Medical Event Reporting System for Transfusion Medicine (MERS-TM). Results. During the study period, a total of 2,068 errors were recorded, including 1,778 (86.0%) in blood bank activities and 290 (14.0%) in blood transfusion services. As many as 1,744 (84.3%) errors were detected before issue of the product or service. Among the 324 errors identified upon release from the CITM, 163 (50.3%) errors were detected by customers and reported as complaints. In only five cases was an error detected after blood product transfusion however without any harmful consequences for the patients. All errors were, therefore, evaluated as “near miss” and “no harm” events. Fifty-two (2.5%) errors were evaluated as high-risk events. With regards to blood bank activities, the highest proportion of errors occurred in the processes of labelling (27.1%) and blood collection (23.7%). With regards to blood transfusion services, errors related to blood product issuing prevailed (24.5%). Conclusion. This study shows that comprehensive management of errors, including near miss errors, can generate data on the functioning of transfusion services, which is a precondition for implementation of efficient corrective and preventive actions that will ensure further improvement of the quality and safety of transfusion treatment. PMID:22395352

Electronic Inventory Systems and Barcode Technology: Impact on Pharmacy Technical Accuracy and Error Liability

PubMed Central

Oldland, Alan R.; May, Sondra K.; Barber, Gerard R.; Stolpman, Nancy M.

2015-01-01

Purpose: To measure the effects associated with sequential implementation of electronic medication storage and inventory systems and product verification devices on pharmacy technical accuracy and rates of potential medication dispensing errors in an academic medical center. Methods: During four 28-day periods of observation, pharmacists recorded all technical errors identified at the final visual check of pharmaceuticals prior to dispensing. Technical filling errors involving deviations from order-specific selection of product, dosage form, strength, or quantity were documented when dispensing medications using (a) a conventional unit dose (UD) drug distribution system, (b) an electronic storage and inventory system utilizing automated dispensing cabinets (ADCs) within the pharmacy, (c) ADCs combined with barcode (BC) verification, and (d) ADCs and BC verification utilized with changes in product labeling and individualized personnel training in systems application. Results: Using a conventional UD system, the overall incidence of technical error was 0.157% (24/15,271). Following implementation of ADCs, the comparative overall incidence of technical error was 0.135% (10/7,379; P = .841). Following implementation of BC scanning, the comparative overall incidence of technical error was 0.137% (27/19,708; P = .729). Subsequent changes in product labeling and intensified staff training in the use of BC systems was associated with a decrease in the rate of technical error to 0.050% (13/26,200; P = .002). Conclusions: Pharmacy ADCs and BC systems provide complementary effects that improve technical accuracy and reduce the incidence of potential medication dispensing errors if this technology is used with comprehensive personnel training. PMID:25684799

Electronic inventory systems and barcode technology: impact on pharmacy technical accuracy and error liability.

PubMed

Oldland, Alan R; Golightly, Larry K; May, Sondra K; Barber, Gerard R; Stolpman, Nancy M

2015-01-01

To measure the effects associated with sequential implementation of electronic medication storage and inventory systems and product verification devices on pharmacy technical accuracy and rates of potential medication dispensing errors in an academic medical center. During four 28-day periods of observation, pharmacists recorded all technical errors identified at the final visual check of pharmaceuticals prior to dispensing. Technical filling errors involving deviations from order-specific selection of product, dosage form, strength, or quantity were documented when dispensing medications using (a) a conventional unit dose (UD) drug distribution system, (b) an electronic storage and inventory system utilizing automated dispensing cabinets (ADCs) within the pharmacy, (c) ADCs combined with barcode (BC) verification, and (d) ADCs and BC verification utilized with changes in product labeling and individualized personnel training in systems application. Using a conventional UD system, the overall incidence of technical error was 0.157% (24/15,271). Following implementation of ADCs, the comparative overall incidence of technical error was 0.135% (10/7,379; P = .841). Following implementation of BC scanning, the comparative overall incidence of technical error was 0.137% (27/19,708; P = .729). Subsequent changes in product labeling and intensified staff training in the use of BC systems was associated with a decrease in the rate of technical error to 0.050% (13/26,200; P = .002). Pharmacy ADCs and BC systems provide complementary effects that improve technical accuracy and reduce the incidence of potential medication dispensing errors if this technology is used with comprehensive personnel training.

Artificial neural networks as alternative tool for minimizing error predictions in manufacturing ultradeformable nanoliposome formulations.

PubMed

León Blanco, José M; González-R, Pedro L; Arroyo García, Carmen Martina; Cózar-Bernal, María José; Calle Suárez, Marcos; Canca Ortiz, David; Rabasco Álvarez, Antonio María; González Rodríguez, María Luisa

2018-01-01

This work was aimed at determining the feasibility of artificial neural networks (ANN) by implementing backpropagation algorithms with default settings to generate better predictive models than multiple linear regression (MLR) analysis. The study was hypothesized on timolol-loaded liposomes. As tutorial data for ANN, causal factors were used, which were fed into the computer program. The number of training cycles has been identified in order to optimize the performance of the ANN. The optimization was performed by minimizing the error between the predicted and real response values in the training step. The results showed that training was stopped at 10 000 training cycles with 80% of the pattern values, because at this point the ANN generalizes better. Minimum validation error was achieved at 12 hidden neurons in a single layer. MLR has great prediction ability, with errors between predicted and real values lower than 1% in some of the parameters evaluated. Thus, the performance of this model was compared to that of the MLR using a factorial design. Optimal formulations were identified by minimizing the distance among measured and theoretical parameters, by estimating the prediction errors. Results indicate that the ANN shows much better predictive ability than the MLR model. These findings demonstrate the increased efficiency of the combination of ANN and design of experiments, compared to the conventional MLR modeling techniques.

Kinematic precision of gear trains

NASA Technical Reports Server (NTRS)

Litvin, F. L.; Goldrich, R. N.; Coy, J. J.; Zaretsky, E. V.

1982-01-01

Kinematic precision is affected by errors which are the result of either intentional adjustments or accidental defects in manufacturing and assembly of gear trains. A method for the determination of kinematic precision of gear trains is described. The method is based on the exact kinematic relations for the contact point motions of the gear tooth surfaces under the influence of errors. An approximate method is also explained. Example applications of the general approximate methods are demonstrated for gear trains consisting of involute (spur and helical) gears, circular arc (Wildhaber-Novikov) gears, and spiral bevel gears. Gear noise measurements from a helicopter transmission are presented and discussed with relation to the kinematic precision theory.

Prediction of protein tertiary structure from sequences using a very large back-propagation neural network

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

Liu, X.; Wilcox, G.L.

1993-12-31

We have implemented large scale back-propagation neural networks on a 544 node Connection Machine, CM-5, using the C language in MIMD mode. The program running on 512 processors performs backpropagation learning at 0.53 Gflops, which provides 76 million connection updates per second. We have applied the network to the prediction of protein tertiary structure from sequence information alone. A neural network with one hidden layer and 40 million connections is trained to learn the relationship between sequence and tertiary structure. The trained network yields predicted structures of some proteins on which it has not been trained given only their sequences.more » Presentation of the Fourier transform of the sequences accentuates periodicity in the sequence and yields good generalization with greatly increased training efficiency. Training simulations with a large, heterologous set of protein structures (111 proteins from CM-5 time) to solutions with under 2% RMS residual error within the training set (random responses give an RMS error of about 20%). Presentation of 15 sequences of related proteins in a testing set of 24 proteins yields predicted structures with less than 8% RMS residual error, indicating good apparent generalization.« less

Human-robot cooperative movement training: learning a novel sensory motor transformation during walking with robotic assistance-as-needed.

PubMed

Emken, Jeremy L; Benitez, Raul; Reinkensmeyer, David J

2007-03-28

A prevailing paradigm of physical rehabilitation following neurologic injury is to "assist-as-needed" in completing desired movements. Several research groups are attempting to automate this principle with robotic movement training devices and patient cooperative algorithms that encourage voluntary participation. These attempts are currently not based on computational models of motor learning. Here we assume that motor recovery from a neurologic injury can be modelled as a process of learning a novel sensory motor transformation, which allows us to study a simplified experimental protocol amenable to mathematical description. Specifically, we use a robotic force field paradigm to impose a virtual impairment on the left leg of unimpaired subjects walking on a treadmill. We then derive an "assist-as-needed" robotic training algorithm to help subjects overcome the virtual impairment and walk normally. The problem is posed as an optimization of performance error and robotic assistance. The optimal robotic movement trainer becomes an error-based controller with a forgetting factor that bounds kinematic errors while systematically reducing its assistance when those errors are small. As humans have a natural range of movement variability, we introduce an error weighting function that causes the robotic trainer to disregard this variability. We experimentally validated the controller with ten unimpaired subjects by demonstrating how it helped the subjects learn the novel sensory motor transformation necessary to counteract the virtual impairment, while also preventing them from experiencing large kinematic errors. The addition of the error weighting function allowed the robot assistance to fade to zero even though the subjects' movements were variable. We also show that in order to assist-as-needed, the robot must relax its assistance at a rate faster than that of the learning human. The assist-as-needed algorithm proposed here can limit error during the learning of a dynamic motor task. The algorithm encourages learning by decreasing its assistance as a function of the ongoing progression of movement error. This type of algorithm is well suited for helping people learn dynamic tasks for which large kinematic errors are dangerous or discouraging, and thus may prove useful for robot-assisted movement training of walking or reaching following neurologic injury.

Microcomputer Nurse-Practitioner Protocols

PubMed Central

Way, Anthony B.; Rowley, Blair A.; White, Melanie A.

1982-01-01

We have developed a set of protocols on a microcomputer to assist in the management of a geographically isolated nurse practitioner. If a mid-level practitioner is supervised by a physician, some system is needed to ensure that approved care is being provided. The currently available paper-based protocols do not adequately serve all the needs for training, auditing, and record keeping. Conversely, adequate systems based on large computers are not feasible for small clinics. We have therefore developed a microcomputer-based system of protocols for a small rural nurse-practitioner's clinic. Our programs are designed for direct use by the practitioners while the patient is in the clinic. The user is given immediate feedback about any errors. The supervisor is later provided with a summary of the protocol uses and errors, and a copy of any erroneous records. The system appears to be easy to use by the nurse practitioner. The protocols are quickly learned and auditing is facilitated.

Mobile Phone Application for Supporting Persons with Higher Brain Dysfunctions

NASA Astrophysics Data System (ADS)

Nakayama, Tsuyoshi; Miyaji, Yuka; Kato, Seishi; Sakurada, Nobuhisa; Ueda, Noriyuki; Nomura, Takayuki; Okaya, Kazunori; Uematsu, Hiroshi; Kimura, Eiji

This paper shows a mobile phone application for supporting persons with higher brain dysfunction (HBD) such as a cognitive disorder, a memory disorder, and an attention-deficit disorder. This application serves them as a schedule manager, an alarm and an instructor of work sequences. The development concept of this application is easy handling and simple display, because persons with HBD are easily bewildered by complex procedures in the work. Five persons with HBD participated in the experiments for assessing the application at the vocational training place. The use of the application resulted in the drastic decrease of the number of errors and the increase of the System Usability Score, indicating that the developed application is useful for persons with HBD especially in performing vocational training tasks such as the use of database software on PC.

The Running Athlete

PubMed Central

Henning, P. Troy

2014-01-01

Context: Pelvic stress fractures, osteitis pubis, and snapping hip syndrome account for a portion of the overuse injuries that can occur in the running athlete. Evidence Acquisition: PubMed searches were performed for each entity using the following keywords: snapping hip syndrome, coxa sultans, pelvic stress fracture, and osteitis pubis from 2008 to 2013. Topic reviews, case reports, case series, and randomized trials were included for review. Study Design: Clinical review. Level of Evidence: Level 4. Results: Collectively, 188 articles were identified. Of these, 58 were included in this review. Conclusion: Based on the available evidence, the majority of these overuse injuries can be managed non-operatively. Primary treatment should include removal from offending activity, normalizing regional muscle strength/length imbalances and nutritional deficiencies, and mitigating training errors through proper education of the athlete and training staff. Strength of Recommendation Taxonomy: C PMID:24587861

Selection of Hidden Layer Neurons and Best Training Method for FFNN in Application of Long Term Load Forecasting

NASA Astrophysics Data System (ADS)

Singh, Navneet K.; Singh, Asheesh K.; Tripathy, Manoj

2012-05-01

For power industries electricity load forecast plays an important role for real-time control, security, optimal unit commitment, economic scheduling, maintenance, energy management, and plant structure planning etc. A new technique for long term load forecasting (LTLF) using optimized feed forward artificial neural network (FFNN) architecture is presented in this paper, which selects optimal number of neurons in the hidden layer as well as the best training method for the case study. The prediction performance of proposed technique is evaluated using mean absolute percentage error (MAPE) of Thailand private electricity consumption and forecasted data. The results obtained are compared with the results of classical auto-regressive (AR) and moving average (MA) methods. It is, in general, observed that the proposed method is prediction wise more accurate.

The Impact of Patient Safety Training on Oral and Maxillofacial Surgery Residents' Attitudes and Knowledge: A Mixed Method Case Study

ERIC Educational Resources Information Center

Buhrow, Suzanne

2013-01-01

It is estimated that in the United States, more than 40,000 patients are injured each day because of preventable medical errors. Patient safety experts and graduate medical education accreditation leaders recognize that medical education reform must include the integration of safety training focused on error causation, system engineering, and…

Resident Physicians' Clinical Training and Error Rate: The Roles of Autonomy, Consultation, and Familiarity with the Literature

ERIC Educational Resources Information Center

Naveh, Eitan; Katz-Navon, Tal; Stern, Zvi

2015-01-01

Resident physicians' clinical training poses unique challenges for the delivery of safe patient care. Residents face special risks of involvement in medical errors since they have tremendous responsibility for patient care, yet they are novice practitioners in the process of learning and mastering their profession. The present study explores…

Workshop-based methodology to understand the risks in grain export inspection and certification.

PubMed

Wilson, John R; Vaegen-Lloyd, Jo-Roxy; Caponecchia, Carlo

2009-07-01

Much of the human factors contribution in risk assessment and risk management has been focused on systems or product safety; the profession has a much smaller research base regarding risks to do with regulation, certification and public policy, for example. This paper discusses an explicitly human factors contribution to understanding and managing risk for the inspection and export certification of grain and plant products in Australia. Training and awareness workshops, incorporating elements of focus groups, were run for 12 groups of staff and managers from the government department concerned. As well as training in risk management the workshops were used to come to an understanding of the work of the inspectors and other staff, to identify the sources of risk to the successful completion of their work and to develop the basis for a risk assessment framework and tool. The paper is methodological in focus and describes the development and running of the workshops and explains how a human factors oriented risk register was developed on the basis of identification of potential threats and errors in the system. Whilst the contribution of ergonomics is increasingly important as regards safety risk assessment, professionals have been less active as regards business, public policy and even engineering risk. This paper describes an approach within which a new domain was studied and the risks of all kinds identified, preparatory to development of a risk assessment tool.

Human Factors in Training - Space Flight Resource Management Training

NASA Technical Reports Server (NTRS)

Bryne, Vicky; Connell, Erin; Barshi, Immanuel; Arsintescu, L.

2009-01-01

Accidents and incidents show that high workload-induced stress and poor teamwork skills lead to performance decrements and errors. Research on teamwork shows that effective teams are able to adapt to stressful situations, and to reduce workload by using successful strategies for communication and decision making, and through dynamic redistribution of tasks among team members. Furthermore, superior teams are able to recognize signs and symptoms of workload-induced stress early, and to adapt their coordination and communication strategies to the high workload, or stress conditions. Mission Control Center (MCC) teams often face demanding situations in which they must operate as an effective team to solve problems with crew and vehicle during onorbit operations. To be successful as a team, flight controllers (FCers) must learn effective teamwork strategies. Such strategies are the focus of Space Flight Resource Management (SFRM) training. SFRM training in MOD has been structured to include some classroom presentations of basic concepts and case studies, with the assumption that skill development happens in mission simulation. Integrated mission simulations do provide excellent opportunities for FCers to practice teamwork, but also require extensive technical knowledge of vehicle systems, mission operations, and crew actions. Such technical knowledge requires lengthy training. When SFRM training is relegated to integrated simulations, FCers can only practice SFRM after they have already mastered the technical knowledge necessary for these simulations. Given the centrality of teamwork to the success of MCC, holding SFRM training till late in the flow is inefficient. But to be able to train SFRM earlier in the flow, the training cannot rely on extensive mission-specific technical knowledge. Hence, the need for a generic SFRM training framework that would allow FCers to develop basic teamwork skills which are mission relevant, but without the required mission knowledge. Work on SFRM training has been conducted in collaboration with the Expedition Vehicle Division at the Mission Operations Directorate (MOD) and with United Space Alliance (USA) which provides training to Flight Controllers. The space flight resource management training work is part of the Human Factors in Training Directed Research Project (DRP) of the Space Human Factors Engineering (SHFE) Project under the Space Human Factors and Habitability (SHFH) Element of the Human Research Program (HRP). Human factors researchers at the Ames Research Center have been investigating team work and distributed decision making processes to develop a generic SFRM training framework for flight controllers. The work proposed for FY10 continues to build on this strong collaboration with MOD and the USA Training Group as well as previous research in relevant domains such as aviation. In FY10, the work focuses on documenting and analyzing problem solving strategies and decision making processes used in MCC by experienced FCers.

Communication Research in Aviation and Space Operations: Symptoms and Strategies of Crew Coordination

NASA Technical Reports Server (NTRS)

Kanki, Barbara G.; Hart, Sandra G. (Technical Monitor)

1994-01-01

The day-to-day operators of today's aerospace systems work under increasing pressures to accomplish more with less. They work in operational systems which are complex, technology-based, and high-risk; in which incidents and accidents have far-reaching and costly consequences. For these and other reasons, there is concern that the safety net formerly built upon redundant systems and abundant resources may become overburdened. Although we know that human ingenuity can overcome incredible odds, human nature can also fail in unpredictable ways. Over the last 20 years, a large percentage of aviation accidents and incidents have been attributed to human errors rather than hardware or environmental factors alone. A class of errors have been identified which are not due to a lack of individual, technical competencies. Rather, they are due to the failure of teams to utilize readily available resources or information in a timely fashion. These insights began a training revolution in the aviation industry called Cockpit Resource Management, which later became known as Crew Resource Management (CRM) as its concepts and applications extended to teams beyond the flightdeck. Then, as now, communication has been a cornerstone in CRM training since crew coordination and resource management largely resides within information transfer processes--both within flightcrews, and between flightcrews and the ground operations teams that support them. The research I will describe takes its roots in CRM history as we began to study communication processes in order to discover symptoms of crew coordination problems, as well as strategies of effective crew management. On the one hand, communication is often the means or the tool by which team members manage their resources, solve problems, maintain situational awareness and procedural discipline. Conversely, it is the lack of planning and resource management, loss of vigilance and situational awareness, and non-standard communications that are implicated in accidents and incidents. NASA/Ames Crew Factors researchers have been developing a model of effective crew coordination in order to understand the sources of performance breakdowns, and to develop effective solutions and interventions. Because communication is a primary mechanism by which information is received and transmitted, and because it is observable behavior, we focus on these group processes in order to identify patterns of communication that distinguish effective from less effective crew performance. Since a prime objective is to develop training recommendations for enhancing communication skills, we interpret our findings in the context of relevant task and environmental conditions, role and procedural constraints, and the normal real-time parameters of flight operations. Another research objective is to consider how communication and coordination can be enhanced through design. For example, flight deck and hardware design as well as procedural and software design may greatly influence the efficiency with which crews communicate and coordinate their work. In addition, teams and tasks may be designed, organized, and trained so that team interactions with each other are based upon appropriately shared knowledge, procedures and situation awareness. In short, we are interested in enhancing communication practices through (1) the training of specific communication skills, and (2) the design of equipment, tasks, procedures, and teams that optimize smooth, unambiguous communication processes. Two examples of communication research will be described; one in aviation and one in space operations. The first example is a high-fidelity full mission simulation study which investigates the affect of flightdeck automation on crew coordination and communication (contrasting crew performance in the DC-9 vs. MD88). Additional information is contained in the original extended abstract.

Design, development, and evaluation of an online virtual emergency department for training trauma teams.

PubMed

Youngblood, Patricia; Harter, Phillip M; Srivastava, Sakti; Moffett, Shannon; Heinrichs, Wm LeRoy; Dev, Parvati

2008-01-01

Training interdisciplinary trauma teams to work effectively together using simulation technology has led to a reduction in medical errors in emergency department, operating room, and delivery room contexts. High-fidelity patient simulators (PSs)-the predominant method for training healthcare teams-are expensive to develop and implement and require that trainees be present in the same place at the same time. In contrast, online computer-based simulators are more cost effective and allow simultaneous participation by students in different locations and time zones. In this pilot study, the researchers created an online virtual emergency department (Virtual ED) for team training in crisis management, and compared the effectiveness of the Virtual ED with the PS. We hypothesized that there would be no difference in learning outcomes for graduating medical students trained with each method. In this pilot study, we used a pretest-posttest control group, experimental design in which 30 subjects were randomly assigned to either the Virtual ED or the PS system. In the Virtual ED each subject logged into the online environment and took the role of a team member. Four-person teams worked together in the Virtual ED, communicating in real time with live voice over Internet protocol, to manage computer-controlled patients who exhibited signs and symptoms of physical trauma. Each subject had the opportunity to be the team leader. The subjects' leadership behavior as demonstrated in both a pretest case and a posttest case was assessed by 3 raters, using a behaviorally anchored scale. In the PS environment, 4-person teams followed the same research protocol, using the same clinical scenarios in a Simulation Center. Guided by the Emergency Medicine Crisis Resource Management curriculum, both the Virtual ED and the PS groups applied the basic principles of team leadership and trauma management (Advanced Trauma Life Support) to manage 6 trauma cases-a pretest case, 4 training cases, and a posttest case. The subjects in each group were assessed individually with the same simulation method that they used for the training cases. Subjects who used either the Virtual ED or the PS showed significant improvement in performance between pretest and posttest cases (P < 0.05). In addition, there was no significant difference in subjects' performance between the 2 types of simulation, suggesting that the online Virtual ED may be as effective for learning team skills as the PS, the method widely used in Simulation Centers. Data on usability and attitudes toward both simulation methods as learning tools were equally positive. This study shows the potential value of using virtual learning environments for developing medical students' and resident physicians' team leadership and crisis management skills.

Error affect inoculation for a complex decision-making task.

PubMed

Tabernero, Carmen; Wood, Robert E

2009-05-01

Individuals bring knowledge, implicit theories, and goal orientations to group meetings. Group decisions arise out of the exchange of these orientations. This research explores how a trainee's exploratory and deliberate process (an incremental theory and learning goal orientation) impacts the effectiveness of individual and group decision-making processes. The effectiveness of this training program is compared with another program that included error affect inoculation (EAI). Subjects were 40 Spanish Policemen in a training course. They were distributed in two training conditions for an individual and group decision-making task. In one condition, individuals received the Self-Guided Exploration plus Deliberation Process instructions, which emphasised exploring the options and testing hypotheses. In the other condition, individuals also received instructions based on Error Affect Inoculation (EAI), which emphasised positive affective reactions to errors and mistakes when making decisions. Results show that the quality of decisions increases when the groups share their reasoning. The AIE intervention promotes sharing information, flexible initial viewpoints, and improving the quality of group decisions. Implications and future directions are discussed.

The immediate effects of therapeutic keyboard music playing for finger training in adults undergoing hand rehabilitation.

PubMed

Zhang, Xiaoying; Liu, Songhuai; Yang, Degang; Du, Liangjie; Wang, Ziyuan

2016-08-01

[Purpose] The purpose of this study was to examine the immediate effects of therapeutic keyboard music playing on the finger function of subjects' hands through measurements of the joint position error test, surface electromyography, probe reaction time, and writing time. [Subjects and Methods] Ten subjects were divided randomly into experimental and control groups. The experimental group used therapeutic keyboard music playing and the control group used grip training. All subjects were assessed and evaluated by the joint position error test, surface electromyography, probe reaction time, and writing time. [Results] After accomplishing therapeutic keyboard music playing and grip training, surface electromyography of the two groups showed no significant change, but joint position error test, probe reaction time, and writing time obviously improved. [Conclusion] These results suggest that therapeutic keyboard music playing is an effective and novel treatment for improving joint position error test scores, probe reaction time, and writing time, and it should be promoted widely in clinics.

Nonlinear calibration for petroleum water content measurement using PSO

NASA Astrophysics Data System (ADS)

Li, Mingbao; Zhang, Jiawei

2008-10-01

A new algorithmic for strapdown inertial navigation system (SINS) state estimation based on neural networks is introduced. In training strategy, the error vector and its delay are introduced. This error vector is made of the position and velocity difference between the estimations of system and the outputs of GPS. After state prediction and state update, the states of the system are estimated. After off-line training, the network can approach the status switching of SINS and after on-line training, the state estimate precision can be improved further by reducing network output errors. Then the network convergence is discussed. In the end, several simulations with different noise are given. The results show that the neural network state estimator has lower noise sensitivity and better noise immunity than Kalman filter.

Linear discriminant analysis with misallocation in training samples

NASA Technical Reports Server (NTRS)

Chhikara, R. (Principal Investigator); Mckeon, J.

1982-01-01

Linear discriminant analysis for a two-class case is studied in the presence of misallocation in training samples. A general appraoch to modeling of mislocation is formulated, and the mean vectors and covariance matrices of the mixture distributions are derived. The asymptotic distribution of the discriminant boundary is obtained and the asymptotic first two moments of the two types of error rate given. Certain numerical results for the error rates are presented by considering the random and two non-random misallocation models. It is shown that when the allocation procedure for training samples is objectively formulated, the effect of misallocation on the error rates of the Bayes linear discriminant rule can almost be eliminated. If, however, this is not possible, the use of Fisher rule may be preferred over the Bayes rule.

The Automation-by-Expertise-by-Training Interaction.

PubMed

Strauch, Barry

2017-03-01

I introduce the automation-by-expertise-by-training interaction in automated systems and discuss its influence on operator performance. Transportation accidents that, across a 30-year interval demonstrated identical automation-related operator errors, suggest a need to reexamine traditional views of automation. I review accident investigation reports, regulator studies, and literature on human computer interaction, expertise, and training and discuss how failing to attend to the interaction of automation, expertise level, and training has enabled operators to commit identical automation-related errors. Automated systems continue to provide capabilities exceeding operators' need for effective system operation and provide interfaces that can hinder, rather than enhance, operator automation-related situation awareness. Because of limitations in time and resources, training programs do not provide operators the expertise needed to effectively operate these automated systems, requiring them to obtain the expertise ad hoc during system operations. As a result, many do not acquire necessary automation-related system expertise. Integrating automation with expected operator expertise levels, and within training programs that provide operators the necessary automation expertise, can reduce opportunities for automation-related operator errors. Research to address the automation-by-expertise-by-training interaction is needed. However, such research must meet challenges inherent to examining realistic sociotechnical system automation features with representative samples of operators, perhaps by using observational and ethnographic research. Research in this domain should improve the integration of design and training and, it is hoped, enhance operator performance.

Frequency of data extraction errors and methods to increase data extraction quality: a methodological review.

PubMed

Mathes, Tim; Klaßen, Pauline; Pieper, Dawid

2017-11-28

Our objective was to assess the frequency of data extraction errors and its potential impact on results in systematic reviews. Furthermore, we evaluated the effect of different extraction methods, reviewer characteristics and reviewer training on error rates and results. We performed a systematic review of methodological literature in PubMed, Cochrane methodological registry, and by manual searches (12/2016). Studies were selected by two reviewers independently. Data were extracted in standardized tables by one reviewer and verified by a second. The analysis included six studies; four studies on extraction error frequency, one study comparing different reviewer extraction methods and two studies comparing different reviewer characteristics. We did not find a study on reviewer training. There was a high rate of extraction errors (up to 50%). Errors often had an influence on effect estimates. Different data extraction methods and reviewer characteristics had moderate effect on extraction error rates and effect estimates. The evidence base for established standards of data extraction seems weak despite the high prevalence of extraction errors. More comparative studies are needed to get deeper insights into the influence of different extraction methods.

Evidence Report: Risk of Performance Errors Due to Training Deficiencies

NASA Technical Reports Server (NTRS)

Barshi, Immanuel; Dempsey, Donna L.

2016-01-01

Substantial evidence supports the claim that inadequate training leads to performance errors. Barshi and Loukopoulos (2012) demonstrate that even a task as carefully developed and refined over many years as operating an aircraft can be significantly improved by a systematic analysis, followed by improved procedures and improved training (see also Loukopoulos, Dismukes, & Barshi, 2009a). Unfortunately, such a systematic analysis of training needs rarely occurs during the preliminary design phase, when modifications are most feasible. Training is often seen as a way to compensate for deficiencies in task and system design, which in turn increases the training load. As a result, task performance often suffers, and with it, the operators suffer and so does the mission. On the other hand, effective training can indeed compensate for such design deficiencies, and can even go beyond to compensate for failures of our imagination to anticipate all that might be needed when we send our crew members to go where no one else has gone before. Much of the research literature on training is motivated by current training practices aimed at current training needs. Although there is some experience with operations in extreme environments on Earth, there is no experience with long-duration space missions where crews must practice semi-autonomous operations, where ground support must accommodate significant communication delays, and where so little is known about the environment. Thus, we must develop robust methodologies and tools to prepare our crews for the unknown. The research necessary to support such an endeavor does not currently exist, but existing research does reveal general challenges that are relevant to long-duration, high-autonomy missions. The evidence presented here describes issues related to the risk of performance errors due to training deficiencies. Contributing factors regarding training deficiencies may pertain to organizational process and training programs for spaceflight, such as when training programs are inadequate or unavailable. Furthermore, failure to match between tasks on the one hand, and learning and memory abilities on the other hand is a contributing factor, especially when individuals' relative efficiency with which new information is acquired, and adjustments made in behavior or thinking, are inconsistent with mission demands. Thus, if training deficiencies are present, the likelihood of errors or of the inability to successfully complete a task increases. What's more, the overall risk to the crew, the vehicle, and the mission increases.

Towards a Framework for Managing Risk Associated with Technology-Induced Error.

PubMed

Borycki, Elizabeth M; Kushniruk, Andre W

2017-01-01

Health information technologies (HIT) promised to streamline and modernize healthcare processes. However, a growing body of research has indicated that if such technologies are not designed, implemented or maintained properly this may lead to an increased incidence of new types of errors which the authors have referred to as "technology-induced errors". In this paper, framework is presented that can be used to manage HIT risk. The framework considers the reduction of technology-induced errors at different stages by managing risks associated with the implementation of HIT. Frameworks that allow health information technology managers to employ proactive and preventative approaches that can be used to manage the risks associated with technology-induced errors are critical to improving HIT safety and managing risk associated with implementing new technologies.

Simulation-based education for building clinical teams

PubMed Central

Marshall, Stuart D; Flanagan, Brendan

2010-01-01

Failure to work as an effective team is commonly cited as a cause of adverse events and errors in emergency medicine. Until recently, individual knowledge and skills in managing emergencies were taught, without reference to the additional skills required to work as part of a team. Team training courses are now becoming commonplace, however their strategies and modes of delivery are varied. Just as different delivery methods of traditional education can result in different levels of retention and transfer to the real world, the same is true in team training of the material in different ways in traditional forms of education may lead to different levels of retention and transfer to the real world, the same is true in team training. As team training becomes more widespread, the effectiveness of different modes of delivery including the role of simulation-based education needs to be clearly understood. This review examines the basis of team working in emergency medicine, and the components of an effective emergency medical team. Lessons from other domains with more experience in team training are discussed, as well as the variations from these settings that can be observed in medical contexts. Methods and strategies for team training are listed, and experiences in other health care settings as well as emergency medicine are assessed. Finally, best practice guidelines for the development of team training programs in emergency medicine are presented. PMID:21063559

[Critical incidents].

PubMed

Scheidegger, D

2005-03-01

In medicine real severe mishaps are rare. On the other hand critical incidents are frequent. Anonymous critical incident reporting systems allow us to learn from these mishaps. This learning process will make our daily clinical work safer Unfortunately, before these systems can be used efficiently our professional culture has to be changed. Everyone in medicine has to admit that errors do occur to see the need for an open discussion. If we really want to learn from errors, we cannot punish the individual, who reported his or her mistake. The interest is primarily in what has happened and why it has happened and not who has committed this mistake. The cause for critical incidents in medicine is in over 80% the human factor Poor communication, work under enormous stress, conflicts and hierarchies are the main cause. This has been known for many years, therefore have already 15 years ago high-tech industries, like e.g. aviation, started to invest in special courses on team training. Medicine is a typical profession were until now only the individual performance decided about the professional career Communication, conflict management, stress management, decision making, risk management, team and team resource management were subjects that have never been taught during our preor postgraduate education. These points are the most important ones for an optimal teamwork. A multimodular course designed together with Swissair (Human Aspect Development medical, HADmedical) helps to cover, as in aviation, the soft factor and behavioural education in medicine and to prepare professionals in health care to work as a real team.

The Grapefruit: An Alternative Arthroscopic Tool Skill Platform.

PubMed

Molho, David A; Sylvia, Stephen M; Schwartz, Daniel L; Merwin, Sara L; Levy, I Martin

2017-08-01

To establish the construct validity of an arthroscopic training model that teaches arthroscopic tool skills including triangulation, grasping, precision biting, implant delivery and ambidexterity and uses a whole grapefruit for its training platform. For the grapefruit training model (GTM), an arthroscope and arthroscopic instruments were introduced through portals cut in the grapefruit skin of a whole prepared grapefruit. After institutional review board approval, participants performed a set of tasks inside the grapefruit. Performance for each component was assessed by recording errors, achievement of criteria, and time to completion. A total of 19 medical students, orthopaedic surgery residents, and fellowship-trained orthopaedic surgeons were included in the analysis and were divided into 3 groups based on arthroscopic experience. One-way analysis of variance (ANOVA) and the post hoc Tukey test were used for statistical analysis. One-way ANOVA showed significant differences in both time to completion and errors between groups, F(2, 16) = 16.10, P < .001; F(2, 16) = 17.43, P < .001. Group A had a longer time to completion and more errors than group B (P = .025, P = .019), and group B had a longer time to completion and more errors than group C (P = .023, P = .018). The GTM is an easily assembled and an alternative arthroscopic training model that bridges the gap between box trainers, cadavers, and virtual reality simulators. Our findings suggest construct validity when evaluating its use for teaching the basic arthroscopic tool skills. As such, it is a useful addition to the arthroscopic training toolbox. There is a need for validated low-cost arthroscopic training models that are easily accessible. Copyright © 2017 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

CATTS (Computer Assisted Teacher Training System) Technology in Analyzing Observational Data from Public School Classrooms: A Study of Interactive Tactics and Decisions of Teachers.

ERIC Educational Resources Information Center

Lynch, William W.

Prompting of reading errors is a common pattern of teaching behavior occurring in reading groups. Teachers' tactics in responding to pupil errors during oral reading in public school classrooms were analyzed with the assistance of the technology of the Computer Assisted Teacher Training System (CATTS) to formulate hypotheses about teacher decision…

Classification of echolocation clicks from odontocetes in the Southern California Bight.

PubMed

Roch, Marie A; Klinck, Holger; Baumann-Pickering, Simone; Mellinger, David K; Qui, Simon; Soldevilla, Melissa S; Hildebrand, John A

2011-01-01

This study presents a system for classifying echolocation clicks of six species of odontocetes in the Southern California Bight: Visually confirmed bottlenose dolphins, short- and long-beaked common dolphins, Pacific white-sided dolphins, Risso's dolphins, and presumed Cuvier's beaked whales. Echolocation clicks are represented by cepstral feature vectors that are classified by Gaussian mixture models. A randomized cross-validation experiment is designed to provide conditions similar to those found in a field-deployed system. To prevent matched conditions from inappropriately lowering the error rate, echolocation clicks associated with a single sighting are never split across the training and test data. Sightings are randomly permuted before assignment to folds in the experiment. This allows different combinations of the training and test data to be used while keeping data from each sighting entirely in the training or test set. The system achieves a mean error rate of 22% across 100 randomized three-fold cross-validation experiments. Four of the six species had mean error rates lower than the overall mean, with the presumed Cuvier's beaked whale clicks showing the best performance (<2% error rate). Long-beaked common and bottlenose dolphins proved the most difficult to classify, with mean error rates of 53% and 68%, respectively.

Radar detection with the Neyman-Pearson criterion using supervised-learning-machines trained with the cross-entropy error

NASA Astrophysics Data System (ADS)

Jarabo-Amores, María-Pilar; la Mata-Moya, David de; Gil-Pita, Roberto; Rosa-Zurera, Manuel

2013-12-01

The application of supervised learning machines trained to minimize the Cross-Entropy error to radar detection is explored in this article. The detector is implemented with a learning machine that implements a discriminant function, which output is compared to a threshold selected to fix a desired probability of false alarm. The study is based on the calculation of the function the learning machine approximates to during training, and the application of a sufficient condition for a discriminant function to be used to approximate the optimum Neyman-Pearson (NP) detector. In this article, the function a supervised learning machine approximates to after being trained to minimize the Cross-Entropy error is obtained. This discriminant function can be used to implement the NP detector, which maximizes the probability of detection, maintaining the probability of false alarm below or equal to a predefined value. Some experiments about signal detection using neural networks are also presented to test the validity of the study.

How we used a patient visit tracker tool to advance experiential learning in systems-based practice and quality improvement in a medical student clinic.

PubMed

Chen, Chen Amy; Park, Ryan J; Hegde, John V; Jun, Tomi; Christman, Mitalee P; Yoo, Sun M; Yamasaki, Alisa; Berhanu, Aaron; Vohra-Khullar, Pamela; Remus, Kristin; Schwartzstein, Richard M; Weinstein, Amy R

2016-01-01

Poorly designed healthcare systems increase costs and preventable medical errors. To address these issues, systems-based practice (SBP) education provides future physicians with the tools to identify systemic errors and implement quality improvement (QI) initiatives to enhance the delivery of cost-effective, safe and multi-disciplinary care. Although SBP education is being implemented in residency programs and is mandated by the Accreditation Council for Graduate Medical Education (ACGME) as one of its core competencies, it has largely not been integrated into undergraduate medical education. We propose that Medical Student-Faculty Collaborative Clinics (MSFCCs) may be the ideal environment in which to train medical students in SBPs and QI initiatives, as they allow students to play pivotal roles in project development, administration, and management. Here we describe a process of experiential learning that was developed within a newly established MSFCC, which challenged students to identify inefficiencies, implement interventions, and track the results. After identifying bottlenecks in clinic operations, our students designed a patient visit tracker tool to monitor clinic flow and implemented solutions to decrease patient visit times. Our model allowed students to drive their own active learning in a practical clinical setting, providing early and unique training in crucial QI skills.

Skill transfer from symmetric and asymmetric bimanual training using a robotic system to single limb performance

PubMed Central

2012-01-01

Background Humans are capable of fast adaptation to new unknown dynamics that affect their movements. Such motor learning is also believed to be an important part of motor rehabilitation. Bimanual training can improve post-stroke rehabilitation outcome and is associated with interlimb coordination between both limbs. Some studies indicate partial transfer of skills among limbs of healthy individuals. Another aspect of bimanual training is the (a)symmetry of bimanual movements and how these affect motor learning and possibly post-stroke rehabilitation. Methods A novel bimanual 2-DOF robotic system was used for both bimanual and unimanual reaching movements. 35 young healthy adults participated in the study. They were divided into 5 test groups that performed movements under different conditions (bimanual or unimanual movements and symmetric or asymmetric bimanual arm loads). The subjects performed a simple tracking exercise with the bimanual system. The exercise was developed to stimulate motor learning by applying a velocity-dependent disturbance torque to the handlebar. Each subject performed 255 trials divided into three phases: baseline without disturbance torque, training phase with disturbance torque and evaluation phase with disturbance torque. Results Performance was assessed with the maximal values of rotation errors of the handlebar. After exposure to disturbance torque, the errors decreased for both unimanual and bimanual training. Errors in unimanual evaluation following the bimanual training phase were not significantly different from errors in unimanual evaluation following unimanual training. There was no difference in performance following symmetric or asymmetric training. Changing the arm force symmetry during bimanual movements from asymmetric to symmetric had little influence on performance. Conclusions Subjects could adapt to an unknown disturbance torque that was changing the dynamics of the movements. The learning effect was present during both unimanual and bimanual training. Transfer of learned skills from bimanual training to unimanual movements was also observed, as bimanual training also improved single limb performance with the dominant arm. Changes of force symmetry did not have an effect on motor learning. As motor learning is believed to be an important mechanism of rehabilitation, our findings could be tested for future post-stroke rehabilitation systems. PMID:22805223

Development of Predictive Energy Management Strategies for Hybrid Electric Vehicles

NASA Astrophysics Data System (ADS)

Baker, David

Studies have shown that obtaining and utilizing information about the future state of vehicles can improve vehicle fuel economy (FE). However, there has been a lack of research into the impact of real-world prediction error on FE improvements, and whether near-term technologies can be utilized to improve FE. This study seeks to research the effect of prediction error on FE. First, a speed prediction method is developed, and trained with real-world driving data gathered only from the subject vehicle (a local data collection method). This speed prediction method informs a predictive powertrain controller to determine the optimal engine operation for various prediction durations. The optimal engine operation is input into a high-fidelity model of the FE of a Toyota Prius. A tradeoff analysis between prediction duration and prediction fidelity was completed to determine what duration of prediction resulted in the largest FE improvement. Results demonstrate that 60-90 second predictions resulted in the highest FE improvement over the baseline, achieving up to a 4.8% FE increase. A second speed prediction method utilizing simulated vehicle-to-vehicle (V2V) communication was developed to understand if incorporating near-term technologies could be utilized to further improve prediction fidelity. This prediction method produced lower variation in speed prediction error, and was able to realize a larger FE improvement over the local prediction method for longer prediction durations, achieving up to 6% FE improvement. This study concludes that speed prediction and prediction-informed optimal vehicle energy management can produce FE improvements with real-world prediction error and drive cycle variability, as up to 85% of the FE benefit of perfect speed prediction was achieved with the proposed prediction methods.

Empowering family physicians to impart proper inhaler teaching to patients with chronic obstructive pulmonary disease and asthma

PubMed Central

Leung, Janice M; Bhutani, Mohit; Leigh, Richard; Pelletier, Dan; Good, Cathy; Sin, Don D

2015-01-01

BACKGROUND: Patients with chronic obstructive pulmonary disease (COPD) and asthma depend on inhalers for management, but critical errors committed during inhaler use can limit drug effectiveness. Outpatient education in inhaler technique remains inconsistent due to limited resources and inadequate provider knowledge. OBJECTIVE: To determine whether a simple, two-session inhaler education program can improve physician attitudes toward inhaler teaching in primary care practice. METHODS: An inhaler education program with small-group hands-on device training was instituted for family physicians (FP) in British Columbia and Alberta. Sessions were spaced one to three months apart. All critical errors were corrected in the first session. Questionnaires surveying current inhaler teaching practices and attitudes toward inhaler teaching were distributed to physicians before and after the program. RESULTS: Forty-one (60%) of a total 68 participating FPs completed both before and after program questionnaires. Before the program, only 20 (49%) reported providing some form of inhaler teaching in their practices, and only four (10%) felt fully competent to teach patients inhaler technique. After the program, 40 (98%) rated their inhaler teaching as good to excellent. Thirty-four (83%) reported providing inhaler teaching in their practices, either by themselves or by an allied health care professional they had personally trained. All stated they could teach inhaler technique within 5 min. Observation of FPs during the second session by certified respiratory educators found that none made critical errors and all had excellent technique. CONCLUSION: A physician inhaler education program can improve attitudes toward inhaler teaching and facilitate implementation in clinical practices. PMID:26436910

Early crisis nontechnical skill teaching in residency leads to long-term skill retention and improved performance during crises: A prospective, nonrandomized controlled study.

PubMed

Doumouras, Aristithes G; Engels, Paul T

2017-07-01

Medical error is common in crises, and the majority of observed errors are nontechnical in nature. The long-term impact of teaching crisis nontechnical skills to residents has not been evaluated. The objective of this study was to determine the effect of simulation-based teaching of crisis nontechnical skills compared to controls one year after initial teaching. This was a prospective study using both historical controls and a before-and-after methodology to evaluate the effect of a high-fidelity simulation curriculum that used crisis resource management principles to teach nontechnical skills. Postgraduate year 2 and 3 residents were invited to take part in a prospective training course over 2 years. The primary outcome was leader performance evaluated by expert raters using the previously validated 7-point Ottawa Global Rating Scale. Overall, 23 residents performed 30 simulations over the 2 years with the intervention group of 7 residents being assessed in both years. After adjustment, the postgraduate year 3 intervention group who received training the previous year had significantly higher overall performance scores than all postgraduate year 2 scores (1.09 95% confidence interval 0.70-1.47, P < .001) and the historical postgraduate year 3 cohort who received no prior training (1.20, 95% confidence interval 0.37-2.03, P = .005). There was no decay of skills noted over the course of the study. Postgraduate year 3 residents who had prior training had significantly improved crisis performance compared to historical postgraduate year 3 controls and untrained postgraduate year 2 residents. There were no significant differences between the crisis performance of postgraduate year 2 residents and the untrained postgraduate year 3 controls. This confirms the beneficial effect and long-term retention after crisis nontechnical skill training. Copyright © 2016 Elsevier Inc. All rights reserved.

Evaluation of a Risk Awareness Perception Training Program on Novice Teen Driver Behavior at Left-Turn Intersections.

PubMed

McDonald, Catherine C; Kandadai, Venk; Loeb, Helen; Seacrist, Thomas; Lee, Yi-Ching; Bonfiglio, Dana; Fisher, Donald L; Winston, Flaura K

Collisions at left turn intersections are among the most prevalent types of teen driver serious crashes, with inadequate surveillance as a key factor. Risk awareness perception training (RAPT) has shown effectiveness in improving hazard anticipation for latent hazards. The goal of this study was to determine if RAPT version 3 (RAPT-3) improved intersection turning behaviors among novice teen drivers when the hazards were not latent and frequent glancing to multiple locations at the intersection was needed. Teens aged 16-18 with ≤180 days of licensure were randomly assigned to: 1) an intervention group (n=18) that received RAPT-3 (Trained); or 2) a control group (n=19) that received no training (Untrained). Both groups completed RAPT-3 Baseline Assessment and the Trained group completed RAPT-3 Training and RAPT-3 Post Assessment. Training effects were evaluated on a driving simulator. Simulator ( gap selection errors and collisions ) and eye tracker ( traffic check errors) metrics from six left-turn stop sign controlled intersections in the Simulated Driving Assessment (SDA) were analyzed. The Trained group scored significantly higher in RAPT-3 Post Assessment than RAPT-3 Baseline Assessment (p< 0.0001). There were no significant differences in either traffic check and gap selection errors or collisions among Trained and Untrained teens in the SDA. Though Trained teens learned about hazard anticipation related to latent hazards, learning did not translate to performance differences in left-turn stop sign controlled intersections where the hazards were not latent. Our findings point to further research to better understand the challenges teens have with left turn intersections.

Original and Mirror Face Images and Minimum Squared Error Classification for Visible Light Face Recognition.

PubMed

Wang, Rong

2015-01-01

In real-world applications, the image of faces varies with illumination, facial expression, and poses. It seems that more training samples are able to reveal possible images of the faces. Though minimum squared error classification (MSEC) is a widely used method, its applications on face recognition usually suffer from the problem of a limited number of training samples. In this paper, we improve MSEC by using the mirror faces as virtual training samples. We obtained the mirror faces generated from original training samples and put these two kinds of samples into a new set. The face recognition experiments show that our method does obtain high accuracy performance in classification.

Kinematic precision of gear trains

NASA Technical Reports Server (NTRS)

Litvin, F. L.; Goldrich, R. N.; Coy, J. J.; Zaretsky, E. V.

1983-01-01

Kinematic precision is affected by errors which are the result of either intentional adjustments or accidental defects in manufacturing and assembly of gear trains. A method for the determination of kinematic precision of gear trains is described. The method is based on the exact kinematic relations for the contact point motions of the gear tooth surfaces under the influence of errors. An approximate method is also explained. Example applications of the general approximate methods are demonstrated for gear trains consisting of involute (spur and helical) gears, circular arc (Wildhaber-Novikov) gears, and spiral bevel gears. Gear noise measurements from a helicopter transmission are presented and discussed with relation to the kinematic precision theory. Previously announced in STAR as N82-32733

Management of digital eye strain.

PubMed

Coles-Brennan, Chantal; Sulley, Anna; Young, Graeme

2018-05-23

Digital eye strain, an emerging public health issue, is a condition characterised by visual disturbance and/or ocular discomfort related to the use of digital devices and resulting from a range of stresses on the ocular environment. This review aims to provide an overview of the extensive literature on digital eye strain research with particular reference to the clinical management of symptoms. As many as 90 per cent of digital device users experience symptoms of digital eye strain. Many studies suggest that the following factors are associated with digital eye strain: uncorrected refractive error (including presbyopia), accommodative and vergence anomalies, altered blinking pattern (reduced rate and incomplete blinking), excessive exposure to intense light, closer working distance, and smaller font size. Since a symptom may be caused by one or more factors, a holistic approach should be adopted. The following management strategies have been suggested: (i) appropriate correction of refractive error, including astigmatism and presbyopia; (ii) management of vergence anomalies, with the aim of inducing or leaving a small amount of heterophoria (~1.5 Δ Exo); (iii) blinking exercise/training to maintain normal blinking pattern; (iv) use of lubricating eye drops (artificial tears) to help alleviate dry eye-related symptoms; (v) contact lenses with enhanced comfort, particularly at end-of-day and in challenging environments; (vi) prescription of colour filters in all vision correction options, especially blue light-absorbing filters; and (vii) management of accommodative anomalies. Prevention is the main strategy for management of digital eye strain, which involves: (i) ensuring an ergonomic work environment and practice (through patient education and the implementation of ergonomic workplace policies); and (ii) visual examination and eye care to treat visual disorders. Special consideration is needed for people at a high risk of digital eye strain, such as computer workers and contact lens wearers. © 2018 Optometry Australia.

Factors associated with reporting of medication errors by Israeli nurses.

PubMed

Kagan, Ilya; Barnoy, Sivia

2008-01-01

This study investigated medication error reporting among Israeli nurses, the relationship between nurses' personal views about error reporting, and the impact of the safety culture of the ward and hospital on this reporting. Nurses (n = 201) completed a questionnaire related to different aspects of error reporting (frequency, organizational norms of dealing with errors, and personal views on reporting). The higher the error frequency, the more errors went unreported. If the ward nurse manager corrected errors on the ward, error self-reporting decreased significantly. Ward nurse managers have to provide good role models.

A Telemonitoring Tool based on Serious Games Addressing Money Management Skills for People with Intellectual Disability

PubMed Central

Lopez-Basterretxea, Asier; Mendez-Zorrilla, Amaia; Garcia-Zapirain, Begonya

2014-01-01

This article presents a telemonitoring tool based on computer games, aimed at money management skill improvement for people with Intellectual Disabilities (ID). The presented tool is divided into two parts: on one hand, some training activities related to payments and currency discrimination based on Serious Games are proposed to the user using a multitouch device. On the other hand, the psychologists and specialist who work with them, can access to the Serious Games results using an online application in order to evaluate their evolution. The results are measured according to the number of errors they have during the proposed activities, the time they need to complete them and the score. The article show the results of an experiment made with a clinical sample of 12 users with ID between 12 and 15 years, taking into account that all of them are capable of correct oral communication and they do not have severe physical coordination problems. Only two users completed all the games without errors. Males obtained a mean of 28.25 errors, whereas females obtained a mean of 17.75. The results show significant difference between the selection of games 1, 2 or 3, because all of them prefer the game 1 related with “Payments” probably because it permits more interaction using the multitouch device. The authors also made a qualitative evaluation and the results have been very promising and satisfactory. PMID:24573223

Operator Variability in Scan Positioning is a Major Component of HR-pQCT Precision Error and is Reduced by Standardized Training

PubMed Central

Bonaretti, Serena; Vilayphiou, Nicolas; Chan, Caroline Mai; Yu, Andrew; Nishiyama, Kyle; Liu, Danmei; Boutroy, Stephanie; Ghasem-Zadeh, Ali; Boyd, Steven K.; Chapurlat, Roland; McKay, Heather; Shane, Elizabeth; Bouxsein, Mary L.; Black, Dennis M.; Majumdar, Sharmila; Orwoll, Eric S.; Lang, Thomas F.; Khosla, Sundeep; Burghardt, Andrew J.

2017-01-01

Introduction HR-pQCT is increasingly used to assess bone quality, fracture risk and anti-fracture interventions. The contribution of the operator has not been adequately accounted in measurement precision. Operators acquire a 2D projection (“scout view image”) and define the region to be scanned by positioning a “reference line” on a standard anatomical landmark. In this study, we (i) evaluated the contribution of positioning variability to in vivo measurement precision, (ii) measured intra- and inter-operator positioning variability, and (iii) tested if custom training software led to superior reproducibility in new operators compared to experienced operators. Methods To evaluate the operator in vivo measurement precision we compared precision errors calculated in 64 co-registered and non-co-registered scan-rescan images. To quantify operator variability, we developed software that simulates the positioning process of the scanner’s software. Eight experienced operators positioned reference lines on scout view images designed to test intra- and inter-operator reproducibility. Finally, we developed modules for training and evaluation of reference line positioning. We enrolled 6 new operators to participate in a common training, followed by the same reproducibility experiments performed by the experienced group. Results In vivo precision errors were up to three-fold greater (Tt.BMD and Ct.Th) when variability in scan positioning was included. Inter-operator precision errors were significantly greater than short-term intra-operator precision (p<0.001). New trained operators achieved comparable intra-operator reproducibility to experienced operators, and lower inter-operator reproducibility (p<0.001). Precision errors were significantly greater for the radius than for the tibia. Conclusion Operator reference line positioning contributes significantly to in vivo measurement precision and is significantly greater for multi-operator datasets. Inter-operator variability can be significantly reduced using a systematic training platform, now available online (http://webapps.radiology.ucsf.edu/refline/). PMID:27475931

It Pays to Go Off-Track: Practicing with Error-Augmenting Haptic Feedback Facilitates Learning of a Curve-Tracing Task

PubMed Central

Williams, Camille K.; Tremblay, Luc; Carnahan, Heather

2016-01-01

Researchers in the domain of haptic training are now entering the long-standing debate regarding whether or not it is best to learn a skill by experiencing errors. Haptic training paradigms provide fertile ground for exploring how various theories about feedback, errors and physical guidance intersect during motor learning. Our objective was to determine how error minimizing, error augmenting and no haptic feedback while learning a self-paced curve-tracing task impact performance on delayed (1 day) retention and transfer tests, which indicate learning. We assessed performance using movement time and tracing error to calculate a measure of overall performance – the speed accuracy cost function. Our results showed that despite exhibiting the worst performance during skill acquisition, the error augmentation group had significantly better accuracy (but not overall performance) than the error minimization group on delayed retention and transfer tests. The control group’s performance fell between that of the two experimental groups but was not significantly different from either on the delayed retention test. We propose that the nature of the task (requiring online feedback to guide performance) coupled with the error augmentation group’s frequent off-target experience and rich experience of error-correction promoted information processing related to error-detection and error-correction that are essential for motor learning. PMID:28082937

Correction of a Technical Error in the Golf Swing: Error Amplification Versus Direct Instruction.

PubMed

Milanese, Chiara; Corte, Stefano; Salvetti, Luca; Cavedon, Valentina; Agostini, Tiziano

2016-01-01

Performance errors drive motor learning for many tasks. The authors' aim was to determine which of two strategies, method of amplification of error (MAE) or direct instruction (DI), would be more beneficial for error correction during a full golfing swing with a driver. Thirty-four golfers were randomly assigned to one of three training conditions (MAE, DI, and control). Participants were tested in a practice session in which each golfer performed 7 pretraining trials, 6 training-intervention trials, and 7 posttraining trials; and a retention test after 1 week. An optoeletronic motion capture system was used to measure the kinematic parameters of each golfer's performance. Results showed that MAE is an effective strategy for correcting the technical errors leading to a rapid improvement in performance. These findings could have practical implications for sport psychology and physical education because, while practice is obviously necessary for improving learning, the efficacy of the learning process is essential in enhancing learners' motivation and sport enjoyment.

Gating of neural error signals during motor learning

PubMed Central

Kimpo, Rhea R; Rinaldi, Jacob M; Kim, Christina K; Payne, Hannah L; Raymond, Jennifer L

2014-01-01

Cerebellar climbing fiber activity encodes performance errors during many motor learning tasks, but the role of these error signals in learning has been controversial. We compared two motor learning paradigms that elicited equally robust putative error signals in the same climbing fibers: learned increases and decreases in the gain of the vestibulo-ocular reflex (VOR). During VOR-increase training, climbing fiber activity on one trial predicted changes in cerebellar output on the next trial, and optogenetic activation of climbing fibers to mimic their encoding of performance errors was sufficient to implant a motor memory. In contrast, during VOR-decrease training, there was no trial-by-trial correlation between climbing fiber activity and changes in cerebellar output, and climbing fiber activation did not induce VOR-decrease learning. Our data suggest that the ability of climbing fibers to induce plasticity can be dynamically gated in vivo, even under conditions where climbing fibers are robustly activated by performance errors. DOI: http://dx.doi.org/10.7554/eLife.02076.001 PMID:24755290

Processor register error correction management

DOEpatents

Bose, Pradip; Cher, Chen-Yong; Gupta, Meeta S.

2016-12-27

Processor register protection management is disclosed. In embodiments, a method of processor register protection management can include determining a sensitive logical register for executable code generated by a compiler, generating an error-correction table identifying the sensitive logical register, and storing the error-correction table in a memory accessible by a processor. The processor can be configured to generate a duplicate register of the sensitive logical register identified by the error-correction table.

Evaluation of Phantom-Based Education System for Acupuncture Manipulation

PubMed Central

Lee, In-Seon; Lee, Ye-Seul; Park, Hi-Joon; Lee, Hyejung; Chae, Younbyoung

2015-01-01

Background Although acupuncture manipulation has been regarded as one of the important factors in clinical outcome, it has been difficult to train novice students to become skillful experts due to a lack of adequate educational program and tools. Objectives In the present study, we investigated whether newly developed phantom acupoint tools would be useful to practice-naïve acupuncture students for practicing the three different types of acupuncture manipulation to enhance their skills. Methods We recruited 12 novice students and had them practice acupuncture manipulations on the phantom acupoint (5% agarose gel). We used the Acusensor 2 and compared their acupuncture manipulation techniques, for which the target criteria were depth and time factors, at acupoint LI11 in the human body before and after 10 training sessions. The outcomes were depth of needle insertion, depth error from target criterion, time of rotating, lifting, and thrusting, time error from target criteria and the time ratio. Results After 10 training sessions, the students showed significantly improved outcomes in depth of needle, depth error (rotation, reducing lifting/thrusting), thumb-forward time error, thumb-backward time error (rotation), and lifting time (reinforcing lifting/thrusting). Conclusions The phantom acupoint tool could be useful in a phantom-based education program for acupuncture-manipulation training for students. For advanced education programs for acupuncture manipulation, we will need to collect additional information, such as patient responses, acupoint-specific anatomical characteristics, delicate tissue-like modeling, haptic and visual feedback, and data from an acupuncture practice simulator. PMID:25689598

Artificial intelligence modeling of cadmium(II) biosorption using rice straw

NASA Astrophysics Data System (ADS)

Nasr, Mahmoud; Mahmoud, Alaa El Din; Fawzy, Manal; Radwan, Ahmed

2017-05-01

The biosorption efficiency of Cd2+ using rice straw was investigated at room temperature (25 ± 4 °C), contact time (2 h) and agitation rate (5 Hz). Experiments studied the effect of three factors, biosorbent dose BD (0.1 and 0.5 g/L), pH (2 and 7) and initial Cd2+ concentration X (10 and 100 mg/L) at two levels "low" and "high". Results showed that, a variation in X from high to low revealed 31 % increase in the Cd2+ biosorption. However, a discrepancy in pH and BD from low to high achieved 28.60 and 23.61 % increase in the removal of Cd2+, respectively. From 23 factorial design, the effects of BD, pH and X achieved p value equals to 0.2248, 0.1881 and 0.1742, respectively, indicating that the influences are in the order X > pH > BD. Similarly, an adaptive neuro-fuzzy inference system indicated that X is the most influential with training and checking errors of 10.87 and 17.94, respectively. This trend was followed by "pH" with training error (15.80) and checking error (17.39), after that BD with training error (16.09) and checking error (16.29). A feed-forward back-propagation neural network with a configuration 3-6-1 achieved correlation ( R) of 0.99 (training), 0.82 (validation) and 0.97 (testing). Thus, the proposed network is capable of predicting Cd2+ biosorption with high accuracy, while the most significant variable was X.

Evaluation of phantom-based education system for acupuncture manipulation.

PubMed

Lee, In-Seon; Lee, Ye-Seul; Park, Hi-Joon; Lee, Hyejung; Chae, Younbyoung

2015-01-01

Although acupuncture manipulation has been regarded as one of the important factors in clinical outcome, it has been difficult to train novice students to become skillful experts due to a lack of adequate educational program and tools. In the present study, we investigated whether newly developed phantom acupoint tools would be useful to practice-naïve acupuncture students for practicing the three different types of acupuncture manipulation to enhance their skills. We recruited 12 novice students and had them practice acupuncture manipulations on the phantom acupoint (5% agarose gel). We used the Acusensor 2 and compared their acupuncture manipulation techniques, for which the target criteria were depth and time factors, at acupoint LI11 in the human body before and after 10 training sessions. The outcomes were depth of needle insertion, depth error from target criterion, time of rotating, lifting, and thrusting, time error from target criteria and the time ratio. After 10 training sessions, the students showed significantly improved outcomes in depth of needle, depth error (rotation, reducing lifting/thrusting), thumb-forward time error, thumb-backward time error (rotation), and lifting time (reinforcing lifting/thrusting). The phantom acupoint tool could be useful in a phantom-based education program for acupuncture-manipulation training for students. For advanced education programs for acupuncture manipulation, we will need to collect additional information, such as patient responses, acupoint-specific anatomical characteristics, delicate tissue-like modeling, haptic and visual feedback, and data from an acupuncture practice simulator.

[Medication error management climate and perception for system use according to construction of medication error prevention system].

PubMed

Kim, Myoung Soo

2012-08-01

The purpose of this cross-sectional study was to examine current status of IT-based medication error prevention system construction and the relationships among system construction, medication error management climate and perception for system use. The participants were 124 patient safety chief managers working for 124 hospitals with over 300 beds in Korea. The characteristics of the participants, construction status and perception of systems (electric pharmacopoeia, electric drug dosage calculation system, computer-based patient safety reporting and bar-code system) and medication error management climate were measured in this study. The data were collected between June and August 2011. Descriptive statistics, partial Pearson correlation and MANCOVA were used for data analysis. Electric pharmacopoeia were constructed in 67.7% of participating hospitals, computer-based patient safety reporting systems were constructed in 50.8%, electric drug dosage calculation systems were in use in 32.3%. Bar-code systems showed up the lowest construction rate at 16.1% of Korean hospitals. Higher rates of construction of IT-based medication error prevention systems resulted in greater safety and a more positive error management climate prevailed. The supportive strategies for improving perception for use of IT-based systems would add to system construction, and positive error management climate would be more easily promoted.

The emerging role of national academies in surgical training: an inspiring environment for increasing the quality of health care in breast cancer management.

PubMed

Yilmaz, Osman Cem; Cantürk, Nuh Zafer; Kebudi, Abut; Güler, Sertaç Ata; Erkek, Ahmet; Rezai, Mahdi; Güllüoğlu, Bahadir M

2014-06-01

Medical education, both graduate and postgraduate, is given at medical schools and affiliated teaching hospitals. The training at these institutions is necessary and valuable. In each field of the medical profession, the relevant science is being developed and changed constantly. Training of medical staff and auxilliary professionals must be adaptable to changes in the field. Also, the development of standards for the diagnosis and treatment of diseases is important. Independent institutions, called academies, serve an extremely useful task in the continuing further training that needs to be adjusted according to individual needs. Academies are independent and free from bureaucracies. Standardized records are uniform and comparable at these institutions. Both patients and medical staff receive training from these institutions. In this way, a high standard is provided in medicine, error rates are decreased and patient satisfaction is increased. Breast cancer, the most common tumor in women, is a serious cause of morbidity and mortality. The European Institute of Oncology (EIO) in Milan, Italy and the European Academy of Senology in Duesseldorf, Germany play important roles in establishing the standards of breast care. They provide substantial training for physicians to achieve high quality in breast cancer management. SENATURK (Senoloji Akademisi, Turkish Academy of Senology) was established in 2010 in Istanbul, Turkey. Both national and international scientists and physicians including eminent senologists are currently faculty members of this young organization. SENATURK collaborates with other institutions in Europe. Its missions include developing training programs for each level of the profession, as well as developing data recording systems and electronic learning tools for breast cancer prevention, diagnosis, treatment, rehabilitation and palliation. Briefly, SENATURK plays a significant role as the opinion leader on every aspect of health care related to conditions and diseases of the breast.

Iatrogenic Errors during Root Canal Instrumentation Performed by Dental Students

PubMed Central

Hendi, Seyedeh Sareh; Karkehabadi, Hamed; Eskandarloo, Amir

2018-01-01

Introduction: The present study was set to investigate the training quality and its association with the quality of root canal therapy performed by fifth year dentistry students. Methods and Materials: A total number of 432 records of endodontic treatment performed by fifth year dentistry students were qualified to be further investigated. Radiographs were assessed by two independent endodontists. Apical transportation, apical perforation, gouging, ledge formation, and the quality of temporary restoration were error types investigated in the present study. Results: the prevalence of apical transportation, ledge formation, and apical perforation errors were significantly higher in molars in comparison with other types of teeth. The most prevalent type of error was the apical transportation, which was significantly higher in mandibular teeth. There was no significant differences among teeth in terms of other types of errors. Conclusion: The quality of training provided for dentistry students should be improved and endodontic curriculum should be modified. PMID:29692848

Parent-implemented picture exchange communication system (PECS) training: an analysis of YouTube videos.

PubMed

Jurgens, Anneke; Anderson, Angelika; Moore, Dennis W

2012-01-01

To investigate the integrity with which parents and carers implement PECS in naturalistic settings, utilizing a sample of videos obtained from YouTube. Twenty-one YouTube videos meeting selection criteria were identified. The videos were reviewed for instances of seven implementer errors and, where appropriate, presence of a physical prompter. Forty-three per cent of videos and 61% of PECS exchanges contained errors in parent implementation of specific teaching strategies of the PECS training protocol. Vocal prompts, incorrect error correction and the absence of timely reinforcement occurred most frequently, while gestural prompts, insistence on speech, incorrect use of the open hand prompt and not waiting for the learner to initiate occurred less frequently. Results suggest that parents engage in vocal prompting and incorrect use of the 4-step error correction strategy when using PECS with their children, errors likely to result in prompt dependence.

Using video recording to identify management errors in pediatric trauma resuscitation.

PubMed

Oakley, Ed; Stocker, Sergio; Staubli, Georg; Young, Simon

2006-03-01

To determine the ability of video recording to identify management errors in trauma resuscitation and to compare this method with medical record review. The resuscitation of children who presented to the emergency department of the Royal Children's Hospital between February 19, 2001, and August 18, 2002, for whom the trauma team was activated was video recorded. The tapes were analyzed, and management was compared with Advanced Trauma Life Support guidelines. Deviations from these guidelines were recorded as errors. Fifty video recordings were analyzed independently by 2 reviewers. Medical record review was undertaken for a cohort of the most seriously injured patients, and errors were identified. The errors detected with the 2 methods were compared. Ninety resuscitations were video recorded and analyzed. An average of 5.9 errors per resuscitation was identified with this method (range: 1-12 errors). Twenty-five children (28%) had an injury severity score of >11; there was an average of 2.16 errors per patient in this group. Only 10 (20%) of these errors were detected in the medical record review. Medical record review detected an additional 8 errors that were not evident on the video recordings. Concordance between independent reviewers was high, with 93% agreement. Video recording is more effective than medical record review in detecting management errors in pediatric trauma resuscitation. Management errors in pediatric trauma resuscitation are common and often involve basic resuscitation principles. Resuscitation of the most seriously injured children was associated with fewer errors. Video recording is a useful adjunct to trauma resuscitation auditing.

Development of a residency program in radiation oncology physics: an inverse planning approach.

PubMed

Khan, Rao F H; Dunscombe, Peter B

2016-03-08

Over the last two decades, there has been a concerted effort in North America to organize medical physicists' clinical training programs along more structured and formal lines. This effort has been prompted by the Commission on Accreditation of Medical Physics Education Programs (CAMPEP) which has now accredited about 90 residency programs. Initially the accreditation focused on standardized and higher quality clinical physics training; the development of rounded professionals who can function at a high level in a multidisciplinary environment was recognized as a priority of a radiation oncology physics residency only lately. In this report, we identify and discuss the implementation of, and the essential components of, a radiation oncology physics residency designed to produce knowledgeable and effective clinical physicists for today's safety-conscious and collaborative work environment. Our approach is that of inverse planning, by now familiar to all radiation oncology physicists, in which objectives and constraints are identified prior to the design of the program. Our inverse planning objectives not only include those associated with traditional residencies (i.e., clinical physics knowledge and critical clinical skills), but also encompass those other attributes essential for success in a modern radiation therapy clinic. These attributes include formal training in management skills and leadership, teaching and communication skills, and knowledge of error management techniques and patient safety. The constraints in our optimization exercise are associated with the limited duration of a residency and the training resources available. Without compromising the knowledge and skills needed for clinical tasks, we have successfully applied the model to the University of Calgary's two-year residency program. The program requires 3840 hours of overall commitment from the trainee, of which 7%-10% is spent in obtaining formal training in nontechnical "soft skills".

Autogenic-feedback training improves pilot performance during emergency flying conditions

NASA Technical Reports Server (NTRS)

Kellar, Michael A.; Folen, Raymond A.; Cowings, Patricia S.; Toscano, William B.; Hisert, Glen L.

1994-01-01

Studies have shown that autonomous mode behavior is one cause of aircraft fatalities due to pilot error. In such cases, the pilot is in a high state of psychological and physiological arousal and tends to focus on one problem, while ignoring more critical information. This study examined the effect of training in physiological self-recognition and regulation, as a means of improving crew cockpit performance. Seventeen pilots were assigned to the treatment and control groups matched for accumulated flight hours. The treatment group comprised three pilots of HC-130 Hercules aircraft and four HH-65 Dolphin helicopter pilots; the control group comprised three pilots of HC-130's and six Dolphin helicopter pilots. During an initial flight, physiological data were recorded for each crew member and individual crew performance was rated by an instructor pilot. Eight crewmembers were then taught to regulate their own physiological response levels using Autogenic-Feedback Training (AFT). The remaining subjects received no training. During a second flight, treatment subjects showed significant improvement in performance, while controls did not improve. The results indicate that AFT management of high states of physiological arousal may improve pilot performance during emergency flying conditions.

Autogenic-feedback training improves pilot performance during emergency flying conditions

NASA Technical Reports Server (NTRS)

Kellar, Michael A.; Folen, Raymond A.; Cowings, Patricia S.; Toscano, William B.; Hisert, Glen L.

1993-01-01

Studies have shown that autonomous mode behavior is one cause of aircraft fatalities due to pilot error. In such cases, the pilot is in a high state of psychological and physiological arousal and tends to focus on one problem, while ignoring more critical information. The effect of training in physiological self-recognition and regulation, as a means of improving crew cockpit performance was examined. Seventeen pilots were assigned to the treatment and control groups matched for accumulated flight hours. The treatment group comprised four pilots of HC-130 Hercules aircraft and four HH-65 Dolphin helicopter pilots; the control group comprised three pilots of HC-130's and six Dolphin helicopter pilots. During an initial flight physiological data were recorded for each crewmember and individual crew performance and rated by an instructor pilot. Eight crewmembers were then taught to regulate their own physiological response levels using Autogenic-Feedback Training (AFT). The remaining subjects received no training. During a second flight, treatment subjects showed significant improvement in performance, while controls did not improve. The results indicate that AFT management of high states of physiological arousal may improve pilot performance during emergency flying conditions.

Autogenic Feedback Training Exercise and pilot performance: enhanced functioning under search-and-rescue flying conditions.

PubMed

Cowings, P S; Kellar, M A; Folen, R A; Toscano, W B; Burge, J D

2001-01-01

Studies have shown that autonomous mode behavior is one cause of aircraft fatalities due to pilot error. In such cases, the pilot is in a high state of psychological and physiological arousal and tends to focus on one problem, while ignoring more critical information. This study examined the effect of training in physiological self-recognition and regulation, as a means of improving crew cockpit performance. Seventeen pilots were assigned to the treatment and control groups matched for accumulated flight hours. The treatment group contained 4 pilots from HC-130 Hercules aircraft and 4 HH-65 Dolphin helicopter pilots; the control group contained 3 pilots of HC-130s and 6 helicopter pilots. During an initial flight, physiological data were recorded on each crewmember and an instructor pilot rated individual crew performance. Eight crewmembers were then taught to regulate their own physiological response levels using Autogenic-Feedback Training Exercise (AFTE). The remaining participants received no training. During a second flight, treatment participants showed significant improvement in performance (rated by the same instructor pilot as in pretests) while controls did not improve. The results indicate that AFTE management of high states of physiological arousal may improve pilot performance during emergency flying conditions.

Autogenic Feedback Training Exercise and pilot performance: enhanced functioning under search-and-rescue flying conditions

NASA Technical Reports Server (NTRS)

Cowings, P. S.; Kellar, M. A.; Folen, R. A.; Toscano, W. B.; Burge, J. D.

2001-01-01

Studies have shown that autonomous mode behavior is one cause of aircraft fatalities due to pilot error. In such cases, the pilot is in a high state of psychological and physiological arousal and tends to focus on one problem, while ignoring more critical information. This study examined the effect of training in physiological self-recognition and regulation, as a means of improving crew cockpit performance. Seventeen pilots were assigned to the treatment and control groups matched for accumulated flight hours. The treatment group contained 4 pilots from HC-130 Hercules aircraft and 4 HH-65 Dolphin helicopter pilots; the control group contained 3 pilots of HC-130s and 6 helicopter pilots. During an initial flight, physiological data were recorded on each crewmember and an instructor pilot rated individual crew performance. Eight crewmembers were then taught to regulate their own physiological response levels using Autogenic-Feedback Training Exercise (AFTE). The remaining participants received no training. During a second flight, treatment participants showed significant improvement in performance (rated by the same instructor pilot as in pretests) while controls did not improve. The results indicate that AFTE management of high states of physiological arousal may improve pilot performance during emergency flying conditions.

Trauma Non-Technical Training (TNT-2): the development, piloting and multilevel assessment of a simulation-based, interprofessional curriculum for team-based trauma resuscitation.

PubMed

Doumouras, Aristithes G; Keshet, Itay; Nathens, Avery B; Ahmed, Najma; Hicks, Christopher M

2014-10-01

Medical error is common during trauma resuscitations. Most errors are nontechnical, stemming from ineffective team leadership, nonstandardized communication among team members, lack of global situational awareness, poor use of resources and inappropriate triage and prioritization. We developed an interprofessional, simulation-based trauma team training curriculum for Canadian surgical trainees. Here we discuss its piloting and evaluation.

A comparison of intraverbal training procedures for children with autism.

PubMed

Kodak, Tiffany; Fuchtman, Rashea; Paden, Amber

2012-01-01

We compared the effectiveness of three training procedures, echoic and tact prompting plus error correction and a cues-pause-point (CPP) procedure, for increasing intraverbals in 2 children with autism. We also measured echoic behavior that may have interfered with appropriate question answering. Results indicated that echoic prompting with error correction was most effective and the CPP procedure was least effective for increasing intraverbals and decreasing echoic behavior.

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.

An Evaluation Of Holograms In Training And As Job Performance Aids

NASA Astrophysics Data System (ADS)

Frey, Allan H.

1986-08-01

Experimentation was carried out to evaluate holograms for use in training and as job aids. Holograms were compared against line drawings and photographs as methods of presenting visual information needed to accomplish a number of tasks. The dependent variables were assembly speed and assembly errors with people unstressed, assembly speed and assembly errors with people stressed, the percentage of discovered errors in assemblies, the number of correct assemblies misidentified as erroneous, and information extraction. Holograms generally were as good as or better visual aids than either photographs or line drawings. The use of holograms tends to reduce errors rather than speed assembly time in the assembly tasks used in these experiments. They also enhance the discovery of errors when the subject is attempting to locate assembly errors in a construction. The results of this experimentation suggest that serious consideration should be given to the use of holography in the development of job aids and in training. Besides these advantages for job aids, other advantages we found are that when page formated information is stored in man-readable holograms they are still useable when scratched or damaged even when similarly damaged microfilm is unuseable. Holography can also be used to store man and machine readable data simultaneously. Such storage would provide simplified backup in the event of machine failure, and it would permit the development of compatible machine and manual systems for job aid applications.

Prediction error and trace dominance determine the fate of fear memories after post-training manipulations

PubMed Central

Alfei, Joaquín M.; Ferrer Monti, Roque I.; Molina, Victor A.; Bueno, Adrián M.

2015-01-01

Different mnemonic outcomes have been observed when associative memories are reactivated by CS exposure and followed by amnestics. These outcomes include mere retrieval, destabilization–reconsolidation, a transitional period (which is insensitive to amnestics), and extinction learning. However, little is known about the interaction between initial learning conditions and these outcomes during a reinforced or nonreinforced reactivation. Here we systematically combined temporally specific memories with different reactivation parameters to observe whether these four outcomes are determined by the conditions established during training. First, we validated two training regimens with different temporal expectations about US arrival. Then, using Midazolam (MDZ) as an amnestic agent, fear memories in both learning conditions were submitted to retraining either under identical or different parameters to the original training. Destabilization (i.e., susceptibly to MDZ) occurred when reactivation was reinforced, provided the occurrence of a temporal prediction error about US arrival. In subsequent experiments, both treatments were systematically reactivated by nonreinforced context exposure of different lengths, which allowed to explore the interaction between training and reactivation lengths. These results suggest that temporal prediction error and trace dominance determine the extent to which reactivation produces the different outcomes. PMID:26179232

A forecasting model for dengue incidence in the District of Gampaha, Sri Lanka.

PubMed

Withanage, Gayan P; Viswakula, Sameera D; Nilmini Silva Gunawardena, Y I; Hapugoda, Menaka D

2018-04-24

Dengue is one of the major health problems in Sri Lanka causing an enormous social and economic burden to the country. An accurate early warning system can enhance the efficiency of preventive measures. The aim of the study was to develop and validate a simple accurate forecasting model for the District of Gampaha, Sri Lanka. Three time-series regression models were developed using monthly rainfall, rainy days, temperature, humidity, wind speed and retrospective dengue incidences over the period January 2012 to November 2015 for the District of Gampaha, Sri Lanka. Various lag times were analyzed to identify optimum forecasting periods including interactions of multiple lags. The models were validated using epidemiological data from December 2015 to November 2017. Prepared models were compared based on Akaike's information criterion, Bayesian information criterion and residual analysis. The selected model forecasted correctly with mean absolute errors of 0.07 and 0.22, and root mean squared errors of 0.09 and 0.28, for training and validation periods, respectively. There were no dengue epidemics observed in the district during the training period and nine outbreaks occurred during the forecasting period. The proposed model captured five outbreaks and correctly rejected 14 within the testing period of 24 months. The Pierce skill score of the model was 0.49, with a receiver operating characteristic of 86% and 92% sensitivity. The developed weather based forecasting model allows warnings of impending dengue outbreaks and epidemics in advance of one month with high accuracy. Depending upon climatic factors, the previous month's dengue cases had a significant effect on the dengue incidences of the current month. The simple, precise and understandable forecasting model developed could be used to manage limited public health resources effectively for patient management, vector surveillance and intervention programmes in the district.

[Improving the continuous care process in primary care during weekends and holidays: redesigning and FMEA].

PubMed

Cañada Dorado, A; Cárdenas Valladolid, J; Espejo Matorrales, F; García Ferradal, I; Sastre Páez, S; Vicente Martín, I

2010-01-01

To describe a project carried out in order to improve the process of Continuous Health Care (CHC) on Saturdays and bank holidays in Primary Care, area number 4, Madrid. The aim of this project was to guarantee a safe and error-free service to patients receiving home health care on weekends. The urgent need for improving CHC process was identified by the Risk Management Functional Unit (RMFU) of the area. In addition, some complaints had been received from the nurses involved in the process as well as from their patients. A SWOT (Strengths, Weaknesses, Opportunities and Threats) analysis performed in 2009 highlighted a number of problems with the process. As a result, a project for improvement was drawn up, to be implemented in the following stages: 1. Redesigning and improving the existing process. 2. Application of failure mode and effect analysis (FMEA) to the new process. 3. Follow up, managing and leading the project. 4. Nurse training. 5. Implementing the process in the whole area. 6. CHC nurse satisfaction surveys. After carrying out this project, the efficiency and level of automation improved considerably. Since implementation of the process enhancement measures, no complaints have been received from patients and surveys show that CHC nurse satisfaction has improved. By using FMEA, errors were given priority and enhancement steps were taken in order to: Inform professionals, back-up personnel and patients about the process. Improve the specialist follow-up report. Provide training in ulcer patient care. The process enhancement, and especially its automation, has resulted in a significant step forward toward achieving greater patient safety. FMEA was a useful tool, which helped in taking some important actions. Finally, CHC nurse satisfaction has clearly improved. Copyright © 2009 SECA. Published by Elsevier Espana. All rights reserved.

Digital Paper Technologies for Topographical Applications

DTIC Science & Technology

2011-09-19

measures examine were training time for each method, time for entry offeatures, procedural errors, handwriting recognition errors, and user preference...time for entry of features, procedural errors, handwriting recognition errors, and user preference. For these metrics, temporal association was...checkbox, text restricted to a specific list of values, etc.) that provides constraints to the handwriting recognizer. When the user fills out the form

Interactional Processes of Handling Errors in Vocational School: Students Attending to Changes in Vocational Practices

ERIC Educational Resources Information Center

Jonasson, Charlotte

2015-01-01

Making errors is an inevitable part of work and learning situations. Recent research has shown that errors can provide important learning opportunities, in particular in education or training, where there may be ample time and support to learn from them. Yet, more knowledge is needed of how learning from errors is developed through interactional…

Human-robot cooperative movement training: Learning a novel sensory motor transformation during walking with robotic assistance-as-needed

PubMed Central

Emken, Jeremy L; Benitez, Raul; Reinkensmeyer, David J

2007-01-01

Background A prevailing paradigm of physical rehabilitation following neurologic injury is to "assist-as-needed" in completing desired movements. Several research groups are attempting to automate this principle with robotic movement training devices and patient cooperative algorithms that encourage voluntary participation. These attempts are currently not based on computational models of motor learning. Methods Here we assume that motor recovery from a neurologic injury can be modelled as a process of learning a novel sensory motor transformation, which allows us to study a simplified experimental protocol amenable to mathematical description. Specifically, we use a robotic force field paradigm to impose a virtual impairment on the left leg of unimpaired subjects walking on a treadmill. We then derive an "assist-as-needed" robotic training algorithm to help subjects overcome the virtual impairment and walk normally. The problem is posed as an optimization of performance error and robotic assistance. The optimal robotic movement trainer becomes an error-based controller with a forgetting factor that bounds kinematic errors while systematically reducing its assistance when those errors are small. As humans have a natural range of movement variability, we introduce an error weighting function that causes the robotic trainer to disregard this variability. Results We experimentally validated the controller with ten unimpaired subjects by demonstrating how it helped the subjects learn the novel sensory motor transformation necessary to counteract the virtual impairment, while also preventing them from experiencing large kinematic errors. The addition of the error weighting function allowed the robot assistance to fade to zero even though the subjects' movements were variable. We also show that in order to assist-as-needed, the robot must relax its assistance at a rate faster than that of the learning human. Conclusion The assist-as-needed algorithm proposed here can limit error during the learning of a dynamic motor task. The algorithm encourages learning by decreasing its assistance as a function of the ongoing progression of movement error. This type of algorithm is well suited for helping people learn dynamic tasks for which large kinematic errors are dangerous or discouraging, and thus may prove useful for robot-assisted movement training of walking or reaching following neurologic injury. PMID:17391527

Needs assessment for simulation training in neuroendoscopy: a Canadian national survey.

PubMed

Haji, Faizal A; Dubrowski, Adam; Drake, James; de Ribaupierre, Sandrine

2013-02-01

In recent years, dramatic changes in surgical education have increased interest in simulation-based training for complex surgical skills. This is particularly true for endoscopic third ventriculostomy (ETV), given the potential for serious intraoperative errors arising from surgical inexperience. However, prior to simulator development, a thorough assessment of training needs is essential to ensure development of educationally relevant platforms. The purpose of this study was to conduct a national needs assessment addressing specific goals of instruction, to guide development of simulation platforms, training curricula, and assessment metrics for ETV. Canadian neurosurgeons performing ETV were invited to participate in a structured online questionnaire regarding the procedural steps for ETV, the frequency and significance of intraoperative errors committed while learning the technique, and simulation training modules of greatest potential educational benefit. Descriptive data analysis was completed for both quantitative and qualitative responses. Thirty-two (55.2%) of 58 surgeons completed the survey. All believed that virtual reality simulation training for ETV would be a valuable addition to clinical training. Selection of ventriculostomy site, navigation within the ventricles, and performance of the ventriculostomy ranked as the most important steps to simulate. Technically inadequate ventriculostomy and inappropriate fenestration site selection were ranked as the most frequent/significant errors. A standard ETV module was thought to be most beneficial for resident training. To inform the development of a simulation-based training program for ETV, the authors have conducted a national needs assessment. The results provide valuable insight to inform key design elements necessary to construct an educationally relevant device and educational program.

Spirometry training courses: Content, delivery and assessment - a position statement from the Australian and New Zealand Society of Respiratory Science.

PubMed

Swanney, Maureen P; O'Dea, Christopher A; Ingram, Emily R; Rodwell, Leanne T; Borg, Brigitte M

2017-10-01

Spirometry training courses are provided by health services and training organizations to enable widespread use of spirometry testing for patient care or for monitoring health. The primary outcome of spirometry training courses should be to enable participants to perform spirometry to international best practice, including testing of subjects, quality assurance and interpretation of results. Where valid results are not achieved or quality assurance programmes identify errors in devices, participants need to be able to adequately manage these issues in accordance with best practice. It is important that potential participants are confident in the integrity of the course they attend and that the course meets their expectations in terms of training. This position statement lists the content that the Australian and New Zealand Society of Respiratory Science (ANZSRS) has identified as required in a spirometry training course to adequately meet the primary outcomes mentioned above. The content requirements outlined in this position statement are based on the current international spirometry standards set out by the American Thoracic Society and European Respiratory Society. Furthermore, recommendations around course delivery for theoretical and practical elements of spirometry testing and post-course assessment are outlined in this statement. © 2017 The Authors. Respirology published by John Wiley & Sons Australia, Ltd on behalf of Asian Pacific Society of Respirology.

Nurses' role in medication safety.

PubMed

Choo, Janet; Hutchinson, Alison; Bucknall, Tracey

2010-10-01

To explore the nurse's role in the process of medication management and identify the challenges associated with safe medication management in contemporary clinical practice. Medication errors have been a long-standing factor affecting consumer safety. The nursing profession has been identified as essential to the promotion of patient safety. A review of literature on medication errors and the use of electronic prescribing in medication errors. Medication management requires a multidisciplinary approach and interdisciplinary communication is essential to reduce medication errors. Information technologies can help to reduce some medication errors through eradication of transcription and dosing errors. Nurses must play a major role in the design of computerized medication systems to ensure a smooth transition to such as system. The nurses' roles in medication management cannot be over-emphasized. This is particularly true when designing a computerized medication system. The adoption of safety measures during decision making that parallel those of the aviation industry safety procedures can provide some strategies to prevent medication error. Innovations in information technology offer potential mechanisms to avert adverse events in medication management for nurses. © 2010 The Authors. Journal compilation © 2010 Blackwell Publishing Ltd.

The effectiveness of risk management program on pediatric nurses' medication error.

PubMed

Dehghan-Nayeri, Nahid; Bayat, Fariba; Salehi, Tahmineh; Faghihzadeh, Soghrat

2013-09-01

Medication therapy is one of the most complex and high-risk clinical processes that nurses deal with. Medication error is the most common type of error that brings about damage and death to patients, especially pediatric ones. However, these errors are preventable. Identifying and preventing undesirable events leading to medication errors are the main risk management activities. The aim of this study was to investigate the effectiveness of a risk management program on the pediatric nurses' medication error rate. This study is a quasi-experimental one with a comparison group. In this study, 200 nurses were recruited from two main pediatric hospitals in Tehran. In the experimental hospital, we applied the risk management program for a period of 6 months. Nurses of the control hospital did the hospital routine schedule. A pre- and post-test was performed to measure the frequency of the medication error events. SPSS software, t-test, and regression analysis were used for data analysis. After the intervention, the medication error rate of nurses at the experimental hospital was significantly lower (P < 0.001) and the error-reporting rate was higher (P < 0.007) compared to before the intervention and also in comparison to the nurses of the control hospital. Based on the results of this study and taking into account the high-risk nature of the medical environment, applying the quality-control programs such as risk management can effectively prevent the occurrence of the hospital undesirable events. Nursing mangers can reduce the medication error rate by applying risk management programs. However, this program cannot succeed without nurses' cooperation.

Deterministic convergence of chaos injection-based gradient method for training feedforward neural networks.

PubMed

Zhang, Huisheng; Zhang, Ying; Xu, Dongpo; Liu, Xiaodong

2015-06-01

It has been shown that, by adding a chaotic sequence to the weight update during the training of neural networks, the chaos injection-based gradient method (CIBGM) is superior to the standard backpropagation algorithm. This paper presents the theoretical convergence analysis of CIBGM for training feedforward neural networks. We consider both the case of batch learning as well as the case of online learning. Under mild conditions, we prove the weak convergence, i.e., the training error tends to a constant and the gradient of the error function tends to zero. Moreover, the strong convergence of CIBGM is also obtained with the help of an extra condition. The theoretical results are substantiated by a simulation example.

Comprehensive analysis of a medication dosing error related to CPOE.

PubMed

Horsky, Jan; Kuperman, Gilad J; Patel, Vimla L

2005-01-01

This case study of a serious medication error demonstrates the necessity of a comprehensive methodology for the analysis of failures in interaction between humans and information systems. The authors used a novel approach to analyze a dosing error related to computer-based ordering of potassium chloride (KCl). The method included a chronological reconstruction of events and their interdependencies from provider order entry usage logs, semistructured interviews with involved clinicians, and interface usability inspection of the ordering system. Information collected from all sources was compared and evaluated to understand how the error evolved and propagated through the system. In this case, the error was the product of faults in interaction among human and system agents that methods limited in scope to their distinct analytical domains would not identify. The authors characterized errors in several converging aspects of the drug ordering process: confusing on-screen laboratory results review, system usability difficulties, user training problems, and suboptimal clinical system safeguards that all contributed to a serious dosing error. The results of the authors' analysis were used to formulate specific recommendations for interface layout and functionality modifications, suggest new user alerts, propose changes to user training, and address error-prone steps of the KCl ordering process to reduce the risk of future medication dosing errors.

Improving patient safety through better teamwork: how effective are different methods of simulation debriefing? Protocol for a pragmatic, prospective and randomised study.

PubMed

Freytag, Julia; Stroben, Fabian; Hautz, Wolf E; Eisenmann, Dorothea; Kämmer, Juliane E

2017-06-30

Medical errors have an incidence of 9% and may lead to worse patient outcome. Teamwork training has the capacity to significantly reduce medical errors and therefore improve patient outcome. One common framework for teamwork training is crisis resource management, adapted from aviation and usually trained in simulation settings. Debriefing after simulation is thought to be crucial to learning teamwork-related concepts and behaviours but it remains unclear how best to debrief these aspects. Furthermore, teamwork-training sessions and studies examining education effects on undergraduates are rare. The study aims to evaluate the effects of two teamwork-focused debriefings on team performance after an extensive medical student teamwork training. A prospective experimental study has been designed to compare a well-established three-phase debriefing method (gather-analyse-summarise; the GAS method ) to a newly developed and more structured debriefing approach that extends the GAS method with TeamTAG (teamwork techniques analysis grid). TeamTAG is a cognitive aid listing preselected teamwork principles and descriptions of behavioural anchors that serve as observable patterns of teamwork and is supposed to help structure teamwork-focused debriefing. Both debriefing methods will be tested during an emergency room teamwork-training simulation comprising six emergency medicine cases faced by 35 final-year medical students in teams of five. Teams will be randomised into the two debriefing conditions. Team performance during simulation and the number of principles discussed during debriefing will be evaluated. Learning opportunities, helpfulness and feasibility will be rated by participants and instructors. Analyses will include descriptive, inferential and explorative statistics. The study protocol was approved by the institutional office for data protection and the ethics committee of Charité Medical School Berlin and registered under EA2/172/16. All students will participate voluntarily and will sign an informed consent after receiving written and oral information about the study. Results will be published. © 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.

Improving the quality of preclinical research echocardiography: Observations, training and guidelines for measurement.

PubMed

Donner, Daniel G; Kiriazis, Helen; Du, Xiao-Jun; Marwick, Thomas H; McMullen, Julie R

2018-04-20

Informal training in preclinical research may be a contributor to the poor reproducibility of preclinical cardiology research and low rates of translation into clinical research and practice. Mouse echocardiography is a widely used technique to assess cardiac structure and function in drug intervention studies using disease models. The inter-observer variability (IOV) of clinical echocardiographic measurements has been shown to improve with formalized training, but preclinical echocardiography lacks similarly critical standardization of training. The aims of this investigation were to assess the IOV of echocardiographic measurements from studies in mice, and address any technical impediments to reproducibility by implementing standardized guidelines through formalized training. In this prospective, single-site, observational cohort study, 13 scientists performing preclinical echocardiographic image analysis were assessed for measurement of short-axis M-mode-derived dimensions and calculated left ventricular mass (LVMass). Ten M-mode images of mouse hearts acquired and analyzed by an expert researcher with a spectrum of LVMass were selected for assessment, and validated by autopsy weight. Following the initial observation, a structured formal training program was introduced, and accuracy and reproducibility were re-evaluated. Mean absolute percentage error (MAPE) for Expert-calculated LVMass was 6{plus minus}4% compared to autopsy LVMass, and 25{plus minus}21% for participants before training. Standardized formal training improved participant MAPE by approximately 30% relative to expert-calculated LVMass (p<0.001). Participants initially categorized with high-range error (25-45%) improved to low-moderate error ranges (<15-25%). This report reveals an example of technical skill training insufficiency likely endemic to preclinical research and provides validated guidelines for echocardiographic measurement for adaptation to formalized in-training programs.

Trainee and training issues.

PubMed

Redfern, Nancy; Bartley, Catherine

2006-12-01

This chapter deals with the obligations of trainers and trainees to each other, the responsibilities of the programme and the conflicts of providing a service while training. Management of trainees with differing needs, such as those working part-time or returning to training after sickness, is reviewed. Assessment of performance and the obligation of consultants to identify, manage and support struggling trainees are discussed. Ethical discussion is based on the principles of autonomy, non-maleficence, beneficence, and justice to which fidelity is added. Case studies illustrating the application of ethical principles to work and decision-making are presented to stimulate debate. Opinions vary as to which principle carries more weight in individual cases, and how best to balance the conflicting requirements of the parties involved (patient, trainee,.trainer, employer, society). For all healthcare practitioners, the needs of patients remain our first concern. Acting in a consequentialist way, we must "maximise the good" and minimise the attendant harms in training. However, deontology states that certain sacrosanct rules and principles should never be breached. Doctors must abide by the duties of a doctor described in Good Medical Practice, maintaining standards in a way that ensures professional qualifications are respected. For the patient, there are advantages and disadvantages to receiving care in an educational setting. A 'teaching environment' tends to encourage and maintain high standards of practice from senior clinicians, but it also exposes patients to new learners, who are less efficient and polished and perhaps more prone to make errors. Learning has to fit round and complement the clinical and emotional needs of patients.

Crisis Resources for Emergency Workers (CREW II): results of a pilot study and simulation-based crisis resource management course for emergency medicine residents.

PubMed

Hicks, Christopher M; Kiss, Alex; Bandiera, Glen W; Denny, Christopher J

2012-11-01

Emergency department resuscitation requires the coordinated efforts of an interdisciplinary team. Aviation-based crisis resource management (CRM) training can improve safety and performance during complex events. We describe the development, piloting, and multilevel evaluation of "Crisis Resources for Emergency Workers" (CREW), a simulation-based CRM curriculum for emergency medicine (EM) residents. Curriculum development was informed by an a priori needs assessment survey. We constructed a 1-day course using simulated resuscitation scenarios paired with focused debriefing sessions. Attitudinal shifts regarding team behaviours were assessed using the Human Factors Attitude Survey (HFAS). A subset of 10 residents participated in standardized pre- and postcourse simulated resuscitation scenarios to quantify the effect of CREW training on our primary outcome of CRM performance. Pre/post scenarios were videotaped and scored by two blinded reviewers using a validated behavioural rating scale, the Ottawa CRM Global Rating Scale (GRS). Postcourse survey responses were highly favourable, with the majority of participants reporting that CREW training can reduce errors and improve patient safety. There was a nonsignificant trend toward improved team-based attitudes as assessed by the HFAS (p  =  0.210). Postcourse performance demonstrated a similar trend toward improved scores in all categories on the Ottawa GRS (p  =  0.16). EM residents find simulation-based CRM instruction to be useful, effective, and highly relevant to their practice. Trends toward improved performance and attitudes may have arisen because our study was underpowered to detect a difference. Future efforts should focus on interdisciplinary training and recruiting a larger sample size.

A COMPARISON OF INTRAVERBAL TRAINING PROCEDURES FOR CHILDREN WITH AUTISM

PubMed Central

Kodak, Tiffany; Fuchtman, Rashea; Paden, Amber

2012-01-01

We compared the effectiveness of three training procedures, echoic and tact prompting plus error correction and a cues-pause-point (CPP) procedure, for increasing intraverbals in 2 children with autism. We also measured echoic behavior that may have interfered with appropriate question answering. Results indicated that echoic prompting with error correction was most effective and the CPP procedure was least effective for increasing intraverbals and decreasing echoic behavior. PMID:22403459

Learning Data Set Influence on Identification Accuracy of Gas Turbine Neural Network Model

NASA Astrophysics Data System (ADS)

Kuznetsov, A. V.; Makaryants, G. M.

2018-01-01

There are many gas turbine engine identification researches via dynamic neural network models. It should minimize errors between model and real object during identification process. Questions about training data set processing of neural networks are usually missed. This article presents a study about influence of data set type on gas turbine neural network model accuracy. The identification object is thermodynamic model of micro gas turbine engine. The thermodynamic model input signal is the fuel consumption and output signal is the engine rotor rotation frequency. Four types input signals was used for creating training and testing data sets of dynamic neural network models - step, fast, slow and mixed. Four dynamic neural networks were created based on these types of training data sets. Each neural network was tested via four types test data sets. In the result 16 transition processes from four neural networks and four test data sets from analogous solving results of thermodynamic model were compared. The errors comparison was made between all neural network errors in each test data set. In the comparison result it was shown error value ranges of each test data set. It is shown that error values ranges is small therefore the influence of data set types on identification accuracy is low.

Virtual reality simulation for the optimization of endovascular procedures: current perspectives.

PubMed

Rudarakanchana, Nung; Van Herzeele, Isabelle; Desender, Liesbeth; Cheshire, Nicholas J W

2015-01-01

Endovascular technologies are rapidly evolving, often requiring coordination and cooperation between clinicians and technicians from diverse specialties. These multidisciplinary interactions lead to challenges that are reflected in the high rate of errors occurring during endovascular procedures. Endovascular virtual reality (VR) simulation has evolved from simple benchtop devices to full physic simulators with advanced haptics and dynamic imaging and physiological controls. The latest developments in this field include the use of fully immersive simulated hybrid angiosuites to train whole endovascular teams in crisis resource management and novel technologies that enable practitioners to build VR simulations based on patient-specific anatomy. As our understanding of the skills, both technical and nontechnical, required for optimal endovascular performance improves, the requisite tools for objective assessment of these skills are being developed and will further enable the use of VR simulation in the training and assessment of endovascular interventionalists and their entire teams. Simulation training that allows deliberate practice without danger to patients may be key to bridging the gap between new endovascular technology and improved patient outcomes.

User type certification for advanced flight control systems

NASA Technical Reports Server (NTRS)

Gilson, Richard D.; Abbott, David W.

1994-01-01

Advanced avionics through flight management systems (FMS) coupled with autopilots can now precisely control aircraft from takeoff to landing. Clearly, this has been the most important improvement in aircraft since the jet engine. Regardless of the eventual capabilities of this technology, it is doubtful that society will soon accept pilotless airliners with the same aplomb they accept driverless passenger trains. Flight crews are still needed to deal with inputing clearances, taxiing, in-flight rerouting, unexpected weather decisions, and emergencies; yet it is well known that the contribution of human errors far exceed those of current hardware or software systems. Thus human errors remain, and are even increasing in percentage as the largest contributor to total system error. Currently, the flight crew is regulated by a layered system of certification: by operation, e.g., airline transport pilot versus private pilot; by category, e.g., airplane versus helicopter; by class, e.g., single engine land versus multi-engine land; and by type (for larger aircraft and jet powered aircraft), e.g., Boeing 767 or Airbus A320. Nothing in the certification process now requires an in-depth proficiency with specific types of avionics systems despite their prominent role in aircraft control and guidance.

Psychotherapy in the overall management strategy for social anxiety disorder.

PubMed

Shear, M K; Beidel, D C

1998-01-01

Cognitive-behavioral therapies (CBTs) are effective treatments for social anxiety disorder/social phobia. Although a variety of procedures are included under the term cognitive-behavioral treatment, it is, however, clear that the key factor influencing treatment outcome for social anxiety disorder is exposure to feared situations. Two formalized CBT programs are cognitive-behavioral group therapy (CBGT) and social effectiveness training (SET). They both involve exposure, but differ in that CBGT focuses on correction of cognitive errors, whereas SET uses social skills training in addition to exposure to feared social situations. CBGT is more efficacious than a psychological placebo and has shown efficacy comparable to that of phenelzine in a double-blind, placebo-controlled study. The onset of effect of phenelzine was more rapid, whereas the effect of CBGT was more sustained. The major component of SET, imaginal and/or in vivo exposure, has been demonstrated to be more effective than pill placebo or the beta-blocker atenolol. Many questions remain regarding CBT strategies and their place in the overall management of patients with social anxiety disorder. Depending upon the particular patient profile, various combinations of drug and/or CBT may prove to be the optimal treatment strategy.

Pitfalls in penetrating thoracic trauma (lessons we learned the hard way...).

PubMed

Degiannis, Elias; Zinn, Richard Joseph

2008-10-01

The majority of patients with penetrating thoracic trauma are managed non-operatively. Those requiring surgery usually go to theater with physiological instability. The critical condition of these patients coupled with the rarity of penetrating thoracic trauma in most European countries makes their surgical management challenging for the occasional trauma surgeon, who is usually trained as a general surgeon. Most general surgeons have a general knowledge of basic cardiothoracic operative surgery, knowledge originating from their training years and possibly enhanced by reading operative surgery textbooks. Unfortunately, the details included in most of these books are not extensive enough to provide him with enough armamentaria to tackle the difficult case. In this anatomical region, their operative dexterity and knowledge cannot be compared to that of their cardiothoracic colleagues, something that is taken for granted in their cardiothoracic trauma textbooks. Techniques that are considered basic and easy by the cardiothoracic surgeons can be unfamiliar and difficult to general surgeons. Knowing the danger points and the pitfalls that will be encountered in cardiothoracic trauma surgery will help them to avoid intraoperative errors and improve patient outcome. The purpose of this manuscript is to highlight the commonly encountered pitfalls by trauma surgeons operating on penetrating trauma to the chest.

Assessment of a model for achieving competency in administration and scoring of the WAIS-IV in post-graduate psychology students.

PubMed

Roberts, Rachel M; Davis, Melissa C

2015-01-01

There is a need for an evidence-based approach to training professional psychologists in the administration and scoring of standardized tests such as the Wechsler Adult Intelligence Scale (WAIS) due to substantial evidence that these tasks are associated with numerous errors that have the potential to significantly impact clients' lives. Twenty three post-graduate psychology students underwent training in using the WAIS-IV according to a best-practice teaching model that involved didactic teaching, independent study of the test manual, and in-class practice with teacher supervision and feedback. Video recordings and test protocols from a role-played test administration were analyzed for errors according to a comprehensive checklist with self, peer, and faculty member reviews. 91.3% of students were rated as having demonstrated competency in administration and scoring. All students were found to make errors, with substantially more errors being detected by the faculty member than by self or peers. Across all subtests, the most frequent errors related to failure to deliver standardized instructions verbatim from the manual. The failure of peer and self-reviews to detect the majority of the errors suggests that novice feedback (self or peers) may be ineffective to eliminate errors and the use of more senior peers may be preferable. It is suggested that involving senior trainees, recent graduates and/or experienced practitioners in the training of post-graduate students may have benefits for both parties, promoting a peer-learning and continuous professional development approach to the development and maintenance of skills in psychological assessment.

Degradation analysis in the estimation of photometric redshifts from non-representative training sets

NASA Astrophysics Data System (ADS)

Rivera, J. D.; Moraes, B.; Merson, A. I.; Jouvel, S.; Abdalla, F. B.; Abdalla, M. C. B.

2018-07-01

We perform an analysis of photometric redshifts estimated by using a non-representative training sets in magnitude space. We use the ANNz2 and GPz algorithms to estimate the photometric redshift both in simulations and in real data from the Sloan Digital Sky Survey (DR12). We show that for the representative case, the results obtained by using both algorithms have the same quality, using either magnitudes or colours as input. In order to reduce the errors when estimating the redshifts with a non-representative training set, we perform the training in colour space. We estimate the quality of our results by using a mock catalogue which is split samples cuts in the r band between 19.4 < r < 20.8. We obtain slightly better results with GPz on single point z-phot estimates in the complete training set case, however the photometric redshifts estimated with ANNz2 algorithm allows us to obtain mildly better results in deeper r-band cuts when estimating the full redshift distribution of the sample in the incomplete training set case. By using a cumulative distribution function and a Monte Carlo process, we manage to define a photometric estimator which fits well the spectroscopic distribution of galaxies in the mock testing set, but with a larger scatter. To complete this work, we perform an analysis of the impact on the detection of clusters via density of galaxies in a field by using the photometric redshifts obtained with a non-representative training set.

Degradation analysis in the estimation of photometric redshifts from non-representative training sets

NASA Astrophysics Data System (ADS)

Rivera, J. D.; Moraes, B.; Merson, A. I.; Jouvel, S.; Abdalla, F. B.; Abdalla, M. C. B.

2018-04-01

We perform an analysis of photometric redshifts estimated by using a non-representative training sets in magnitude space. We use the ANNz2 and GPz algorithms to estimate the photometric redshift both in simulations as well as in real data from the Sloan Digital Sky Survey (DR12). We show that for the representative case, the results obtained by using both algorithms have the same quality, either using magnitudes or colours as input. In order to reduce the errors when estimating the redshifts with a non-representative training set, we perform the training in colour space. We estimate the quality of our results by using a mock catalogue which is split samples cuts in the r-band between 19.4 < r < 20.8. We obtain slightly better results with GPz on single point z-phot estimates in the complete training set case, however the photometric redshifts estimated with ANNz2 algorithm allows us to obtain mildly better results in deeper r-band cuts when estimating the full redshift distribution of the sample in the incomplete training set case. By using a cumulative distribution function and a Monte-Carlo process, we manage to define a photometric estimator which fits well the spectroscopic distribution of galaxies in the mock testing set, but with a larger scatter. To complete this work, we perform an analysis of the impact on the detection of clusters via density of galaxies in a field by using the photometric redshifts obtained with a non-representative training set.

Comparative Effectiveness of Hands-on Versus Computer Simulation-Based Training for Contrast Media Reactions and Teamwork Skills.

PubMed

Wang, Carolyn L; Chinnugounder, Sankar; Hippe, Daniel S; Zaidi, Sadaf; O'Malley, Ryan B; Bhargava, Puneet; Bush, William H

2017-01-01

To assess the performance of interprofessional teams of radiologists, technologists, and nurses trained with high-fidelity hands-on (HO) simulation and computer-based (CB) simulation training for contrast reaction management (CR) and teamwork skills (TS). Nurses, technologists, and radiology residents were randomized into 11 teams of three (one of each). Six teams underwent HO training and five underwent CB training for CR and TS. Participants took written tests before and after training and were further tested using a high-fidelity simulation scenario. HO and CB groups scored similarly on all written tests and each showed improvement after training (P = .002 and P = .018, respectively). During the final scenario test, HO teams tended to receive higher grades than CB teams on CR (95% versus 81%, P = .17) and made fewer errors in epinephrine administration (0/6 versus 2/5, P = .18). HO and CB teams scored similarly on TS (51% versus 52%, P = .66), but overall scores were lower for TS than for CR skills in both the HO (P = .03) and CB teams (P = .06). HO training was more highly rated than CB as an effective educational tool (P = .01) and for effectiveness at teaching CR and team communication skills (P = .02). High-fidelity simulation can be used to both train and test interprofessional teams of radiologists, technologists, and nurses for both CR and TS and is more highly rated as an effective educational tool by participants than similar CB training. However, a single session of either type of training may be inadequate for mastering TS. Copyright © 2016 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Team safety and innovation by learning from errors in long-term care settings.

PubMed

Buljac-Samardžić, Martina; van Woerkom, Marianne; Paauwe, Jaap

2012-01-01

Team safety and team innovation are underexplored in the context of long-term care. Understanding the issues requires attention to how teams cope with error. Team managers could have an important role in developing a team's error orientation and managing team membership instabilities. The aim of this study was to examine the impact of team member stability, team coaching, and a team's error orientation on team safety and innovation. A cross-sectional survey method was employed within 2 long-term care organizations. Team members and team managers received a survey that measured safety and innovation. Team members assessed member stability, team coaching, and team error orientation (i.e., problem-solving and blaming approach). The final sample included 933 respondents from 152 teams. Stable teams and teams with managers who take on the role of coach are more likely to adopt a problem-solving approach and less likely to adopt a blaming approach toward errors. Both error orientations are related to team member ratings of safety and innovation, but only the blaming approach is (negatively) related to manager ratings of innovation. Differences between members' and managers' ratings of safety are greater in teams with relatively high scores for the blaming approach and relatively low scores for the problem-solving approach. Team coaching was found to be positively related to innovation, especially in unstable teams. Long-term care organizations that wish to enhance team safety and innovation should encourage a problem-solving approach and discourage a blaming approach. Team managers can play a crucial role in this by coaching team members to see errors as sources of learning and improvement and ensuring that individuals will not be blamed for errors.

Selection of neural network structure for system error correction of electro-optical tracker system with horizontal gimbal

NASA Astrophysics Data System (ADS)

Liu, Xing-fa; Cen, Ming

2007-12-01

Neural Network system error correction method is more precise than lest square system error correction method and spheric harmonics function system error correction method. The accuracy of neural network system error correction method is mainly related to the frame of Neural Network. Analysis and simulation prove that both BP neural network system error correction method and RBF neural network system error correction method have high correction accuracy; it is better to use RBF Network system error correction method than BP Network system error correction method for little studying stylebook considering training rate and neural network scale.

Emergency management training program: Guide to good practice

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

Not Available

1991-07-01

The Emergency Management Training Program Guide to Good Practice is a project of the Training Resources and Data Exchange (TRADE) Emergency Management Issues Special Interest Group (EMI SIG). EMI SIG members expressed interest in a resource to assist in development of a comprehensive emergency management training program. This publication provides guidelines, methods, and materials for EMI SIG members to use, assisting in complete and effective emergency management programs. The purposes of the Emergency Management Training Program Guide to Good Practice are: Provide guidance in the development and management of Emergency Management (EM) training programs; Assist EM trainers to incorporate componentsmore » of the DOE Emergency Management System philosophy of planning, preparedness, readiness assurance, and response into EM training programs; Help EM training managers meet EM training requirements and conditions established by current regulations and policies; Supplement other TRADE EMI SIG documents and complement individual facility training documents. This program is designed for emergency management personnel who are responsible for providing or overseeing EM training but who do not necessarily possess expertise in developing training. It provides good practices from the manager`s point of view on how to produce, administer, and document facility EM training programs in the spirit of the DOE EM system philosophy. Basic guidance is also included for personnel who design, develop, deliver, and/or evaluate EM training programs or parts. This guidance includes key points of EM training programs and identifies other documents that contain useful and/or more detailed training information.« less

Automatic training and reliability estimation for 3D ASM applied to cardiac MRI segmentation

NASA Astrophysics Data System (ADS)

Tobon-Gomez, Catalina; Sukno, Federico M.; Butakoff, Constantine; Huguet, Marina; Frangi, Alejandro F.

2012-07-01

Training active shape models requires collecting manual ground-truth meshes in a large image database. While shape information can be reused across multiple imaging modalities, intensity information needs to be imaging modality and protocol specific. In this context, this study has two main purposes: (1) to test the potential of using intensity models learned from MRI simulated datasets and (2) to test the potential of including a measure of reliability during the matching process to increase robustness. We used a population of 400 virtual subjects (XCAT phantom), and two clinical populations of 40 and 45 subjects. Virtual subjects were used to generate simulated datasets (MRISIM simulator). Intensity models were trained both on simulated and real datasets. The trained models were used to segment the left ventricle (LV) and right ventricle (RV) from real datasets. Segmentations were also obtained with and without reliability information. Performance was evaluated with point-to-surface and volume errors. Simulated intensity models obtained average accuracy comparable to inter-observer variability for LV segmentation. The inclusion of reliability information reduced volume errors in hypertrophic patients (EF errors from 17 ± 57% to 10 ± 18% LV MASS errors from -27 ± 22 g to -14 ± 25 g), and in heart failure patients (EF errors from -8 ± 42% to -5 ± 14%). The RV model of the simulated images needs further improvement to better resemble image intensities around the myocardial edges. Both for real and simulated models, reliability information increased segmentation robustness without penalizing accuracy.

Automatic training and reliability estimation for 3D ASM applied to cardiac MRI segmentation.

PubMed

Tobon-Gomez, Catalina; Sukno, Federico M; Butakoff, Constantine; Huguet, Marina; Frangi, Alejandro F

2012-07-07

Training active shape models requires collecting manual ground-truth meshes in a large image database. While shape information can be reused across multiple imaging modalities, intensity information needs to be imaging modality and protocol specific. In this context, this study has two main purposes: (1) to test the potential of using intensity models learned from MRI simulated datasets and (2) to test the potential of including a measure of reliability during the matching process to increase robustness. We used a population of 400 virtual subjects (XCAT phantom), and two clinical populations of 40 and 45 subjects. Virtual subjects were used to generate simulated datasets (MRISIM simulator). Intensity models were trained both on simulated and real datasets. The trained models were used to segment the left ventricle (LV) and right ventricle (RV) from real datasets. Segmentations were also obtained with and without reliability information. Performance was evaluated with point-to-surface and volume errors. Simulated intensity models obtained average accuracy comparable to inter-observer variability for LV segmentation. The inclusion of reliability information reduced volume errors in hypertrophic patients (EF errors from 17 ± 57% to 10 ± 18%; LV MASS errors from -27 ± 22 g to -14 ± 25 g), and in heart failure patients (EF errors from -8 ± 42% to -5 ± 14%). The RV model of the simulated images needs further improvement to better resemble image intensities around the myocardial edges. Both for real and simulated models, reliability information increased segmentation robustness without penalizing accuracy.

Training to estimate blood glucose and to form associations with initial hunger

PubMed Central

Ciampolini, Mario; Bianchi, Riccardo

2006-01-01

Background The will to eat is a decision associated with conditioned responses and with unconditioned body sensations that reflect changes in metabolic biomarkers. Here, we investigate whether this decision can be delayed until blood glucose is allowed to fall to low levels, when presumably feeding behavior is mostly unconditioned. Following such an eating pattern might avoid some of the metabolic risk factors that are associated with high glycemia. Results In this 7-week study, patients were trained to estimate their blood glucose at meal times by associating feelings of hunger with glycemic levels determined by standard blood glucose monitors and to eat only when glycemia was < 85 mg/dL. At the end of the 7-week training period, estimated and measured glycemic values were found to be linearly correlated in the trained group (r = 0.82; p = 0.0001) but not in the control (untrained) group (r = 0.10; p = 0.40). Fewer subjects in the trained group were hungry than those in the control group (p = 0.001). The 18 hungry subjects of the trained group had significantly lower glucose levels (80.1 ± 6.3 mg/dL) than the 42 hungry control subjects (89.2 ± 10.2 mg/dL; p = 0.01). Moreover, the trained hungry subjects estimated their glycemia (78.1 ± 6.7 mg/dL; estimation error: 3.2 ± 2.4% of the measured glycemia) more accurately than the control hungry subjects (75.9 ± 9.8 mg/dL; estimation error: 16.7 ± 11.0%; p = 0.0001). Also the estimation error of the entire trained group (4.7 ± 3.6%) was significantly lower than that of the control group (17.1 ± 11.5%; p = 0.0001). A value of glycemia at initial feelings of hunger was provisionally identified as 87 mg/dL. Below this level, estimation showed lower error in both trained (p = 0.04) and control subjects (p = 0.001). Conclusion Subjects could be trained to accurately estimate their blood glucose and to recognize their sensations of initial hunger at low glucose concentrations. These results suggest that it is possible to make a behavioral distinction between unconditioned and conditioned hunger, and to achieve a cognitive will to eat by training. PMID:17156448

Patterns of technical error among surgical malpractice claims: an analysis of strategies to prevent injury to surgical patients.

PubMed

Regenbogen, Scott E; Greenberg, Caprice C; Studdert, David M; Lipsitz, Stuart R; Zinner, Michael J; Gawande, Atul A

2007-11-01

To identify the most prevalent patterns of technical errors in surgery, and evaluate commonly recommended interventions in light of these patterns. The majority of surgical adverse events involve technical errors, but little is known about the nature and causes of these events. We examined characteristics of technical errors and common contributing factors among closed surgical malpractice claims. Surgeon reviewers analyzed 444 randomly sampled surgical malpractice claims from four liability insurers. Among 258 claims in which injuries due to error were detected, 52% (n = 133) involved technical errors. These technical errors were further analyzed with a structured review instrument designed by qualitative content analysis. Forty-nine percent of the technical errors caused permanent disability; an additional 16% resulted in death. Two-thirds (65%) of the technical errors were linked to manual error, 9% to errors in judgment, and 26% to both manual and judgment error. A minority of technical errors involved advanced procedures requiring special training ("index operations"; 16%), surgeons inexperienced with the task (14%), or poorly supervised residents (9%). The majority involved experienced surgeons (73%), and occurred in routine, rather than index, operations (84%). Patient-related complexities-including emergencies, difficult or unexpected anatomy, and previous surgery-contributed to 61% of technical errors, and technology or systems failures contributed to 21%. Most technical errors occur in routine operations with experienced surgeons, under conditions of increased patient complexity or systems failure. Commonly recommended interventions, including restricting high-complexity operations to experienced surgeons, additional training for inexperienced surgeons, and stricter supervision of trainees, are likely to address only a minority of technical errors. Surgical safety research should instead focus on improving decision-making and performance in routine operations for complex patients and circumstances.

Iatrogenic disease management: moderating medication errors and risks in a pharmacy benefit management environment.

PubMed

Nair, Vinit; Salmon, J Warren; Kaul, Alan F

2007-12-01

Disease Management (DM) programs have advanced to address costly chronic disease patterns in populations. This is in part due to the programs' significant clinical and economical value, coupled with interest by pharmaceutical manufacturers, managed care organizations, and pharmacy benefit management firms. While cost containment realizations for many such interventions have been less than anticipated, this article explores potentials in marrying Medication Error Risk Reduction into DM programs within managed care environments. Medication errors are an emergent serious problem now gaining attention in US health policy. They represent a failure within population-based health programs because they remain significant cost drivers. Therefore, medication errors should be addressed in an organized fashion, with DM being a worthy candidate for piggybacking such programs to achieve the best synergistic effects.

Targeting latent function: Encouraging effective encoding for successful memory training and transfer

PubMed Central

Lustig, Cindy; Flegal, Kristin E.

2009-01-01

Cognitive training programs for older adults often result in improvements at the group level. However, there are typically large age and individual differences in the size of training benefits. These differences may be related to the degree to which participants implement the processes targeted by the training program. To test this possibility, we tested older adults in a memory-training procedure either under specific strategy instructions designed to encourage semantic, integrative encoding, or in a condition that encouraged time and attention to encoding but allowed participants to choose their own strategy. Both conditions improved the performance of old-old adults relative to an earlier study (Bissig & Lustig, 2007) and reduced self-reports of everyday memory errors. Performance in the strategy-instruction group was related to pre-existing ability, performance in the strategy-choice group was not. The strategy-choice group performed better on a laboratory transfer test of recognition memory, and training performance was correlated with reduced everyday memory errors. Training programs that target latent but inefficiently-used abilities while allowing flexibility in bringing those abilities to bear may best promote effective training and transfer. PMID:19140647

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Classifying nursing errors in clinical management within an Australian hospital.

PubMed

Tran, D T; Johnson, M

2010-12-01

Although many classification systems relating to patient safety exist, no taxonomy was identified that classified nursing errors in clinical management. To develop a classification system for nursing errors relating to clinical management (NECM taxonomy) and to describe contributing factors and patient consequences. We analysed 241 (11%) self-reported incidents relating to clinical management in nursing in a metropolitan hospital. Descriptive analysis of numeric data and content analysis of text data were undertaken to derive the NECM taxonomy, contributing factors and consequences for patients. Clinical management incidents represented 1.63 incidents per 1000 occupied bed days. The four themes of the NECM taxonomy were nursing care process (67%), communication (22%), administrative process (5%), and knowledge and skill (6%). Half of the incidents did not cause any patient harm. Contributing factors (n=111) included the following: patient clinical, social conditions and behaviours (27%); resources (22%); environment and workload (18%); other health professionals (15%); communication (13%); and nurse's knowledge and experience (5%). The NECM taxonomy provides direction to clinicians and managers on areas in clinical management that are most vulnerable to error, and therefore, priorities for system change management. Any nurses who wish to classify nursing errors relating to clinical management could use these types of errors. This study informs further research into risk management behaviour, and self-assessment tools for clinicians. Globally, nurses need to continue to monitor and act upon patient safety issues. © 2010 The Authors. International Nursing Review © 2010 International Council of Nurses.

TRAINING ERRORS AND RUNNING RELATED INJURIES: A SYSTEMATIC REVIEW

PubMed Central

Buist, Ida; Sørensen, Henrik; Lind, Martin; Rasmussen, Sten

2012-01-01

Purpose: The purpose of this systematic review was to examine the link between training characteristics (volume, duration, frequency, and intensity) and running related injuries. Methods: A systematic search was performed in PubMed, Web of Science, Embase, and SportDiscus. Studies were included if they examined novice, recreational, or elite runners between the ages of 18 and 65. Exposure variables were training characteristics defined as volume, distance or mileage, time or duration, frequency, intensity, speed or pace, or similar terms. The outcome of interest was Running Related Injuries (RRI) in general or specific RRI in the lower extremity or lower back. Methodological quality was evaluated using quality assessment tools of 11 to 16 items. Results: After examining 4561 titles and abstracts, 63 articles were identified as potentially relevant. Finally, nine retrospective cohort studies, 13 prospective cohort studies, six case-control studies, and three randomized controlled trials were included. The mean quality score was 44.1%. Conflicting results were reported on the relationships between volume, duration, intensity, and frequency and RRI. Conclusion: It was not possible to identify which training errors were related to running related injuries. Still, well supported data on which training errors relate to or cause running related injuries is highly important for determining proper prevention strategies. If methodological limitations in measuring training variables can be resolved, more work can be conducted to define training and the interactions between different training variables, create several hypotheses, test the hypotheses in a large scale prospective study, and explore cause and effect relationships in randomized controlled trials. Level of evidence: 2a PMID:22389869

Image Augmentation for Object Image Classification Based On Combination of Pre-Trained CNN and SVM

NASA Astrophysics Data System (ADS)

Shima, Yoshihiro

2018-04-01

Neural networks are a powerful means of classifying object images. The proposed image category classification method for object images combines convolutional neural networks (CNNs) and support vector machines (SVMs). A pre-trained CNN, called Alex-Net, is used as a pattern-feature extractor. Alex-Net is pre-trained for the large-scale object-image dataset ImageNet. Instead of training, Alex-Net, pre-trained for ImageNet is used. An SVM is used as trainable classifier. The feature vectors are passed to the SVM from Alex-Net. The STL-10 dataset are used as object images. The number of classes is ten. Training and test samples are clearly split. STL-10 object images are trained by the SVM with data augmentation. We use the pattern transformation method with the cosine function. We also apply some augmentation method such as rotation, skewing and elastic distortion. By using the cosine function, the original patterns were left-justified, right-justified, top-justified, or bottom-justified. Patterns were also center-justified and enlarged. Test error rate is decreased by 0.435 percentage points from 16.055% by augmentation with cosine transformation. Error rates are increased by other augmentation method such as rotation, skewing and elastic distortion, compared without augmentation. Number of augmented data is 30 times that of the original STL-10 5K training samples. Experimental test error rate for the test 8k STL-10 object images was 15.620%, which shows that image augmentation is effective for image category classification.

The Effects of Combining Videogame Dancing and Pelvic Floor Training to Improve Dual-Task Gait and Cognition in Women with Mixed-Urinary Incontinence.

PubMed

Fraser, Sarah A; Elliott, Valerie; de Bruin, Eling D; Bherer, Louis; Dumoulin, Chantal

2014-06-01

Many women over 65 years of age suffer from mixed urinary incontinence (MUI) and executive function (EF) deficits. Both incontinence and EF declines increase fall risk. The current study assessed EF and dual-task gait after a multicomponent intervention that combined pelvic floor muscle (PFM) training and videogame dancing (VGD). Baseline (Pre1), pretraining (Pre2), and post-training (Post) neuropsychological and dual-task gait assessments were completed by 23 women (mean age, 70.4 years) with MUI. During the dual-task, participants walked and performed an auditory n-back task. From Pre2 to Post, all women completed 12 weeks of combined PFM and VGD training. After training (Pre2 to Post), the number of errors in the Inhibition/Switch Stroop condition decreased significantly, the Trail Making Test difference score improved marginally, and the number of n-back errors during dual-task gait significantly decreased. A subgroup analysis based on continence improvements (pad test) revealed that only those subjects who improved in the pad test had significantly reduced numbers of n-back errors during dual-task gait. The results of this study suggest that a multicomponent intervention can improve EFs and the dual-task gait of older women with MUI. Future research is needed to determine if the training-induced improvements in these factors reduce fall risk.

Hardware-Efficient On-line Learning through Pipelined Truncated-Error Backpropagation in Binary-State Networks

PubMed Central

Mostafa, Hesham; Pedroni, Bruno; Sheik, Sadique; Cauwenberghs, Gert

2017-01-01

Artificial neural networks (ANNs) trained using backpropagation are powerful learning architectures that have achieved state-of-the-art performance in various benchmarks. Significant effort has been devoted to developing custom silicon devices to accelerate inference in ANNs. Accelerating the training phase, however, has attracted relatively little attention. In this paper, we describe a hardware-efficient on-line learning technique for feedforward multi-layer ANNs that is based on pipelined backpropagation. Learning is performed in parallel with inference in the forward pass, removing the need for an explicit backward pass and requiring no extra weight lookup. By using binary state variables in the feedforward network and ternary errors in truncated-error backpropagation, the need for any multiplications in the forward and backward passes is removed, and memory requirements for the pipelining are drastically reduced. Further reduction in addition operations owing to the sparsity in the forward neural and backpropagating error signal paths contributes to highly efficient hardware implementation. For proof-of-concept validation, we demonstrate on-line learning of MNIST handwritten digit classification on a Spartan 6 FPGA interfacing with an external 1Gb DDR2 DRAM, that shows small degradation in test error performance compared to an equivalently sized binary ANN trained off-line using standard back-propagation and exact errors. Our results highlight an attractive synergy between pipelined backpropagation and binary-state networks in substantially reducing computation and memory requirements, making pipelined on-line learning practical in deep networks. PMID:28932180

Hardware-Efficient On-line Learning through Pipelined Truncated-Error Backpropagation in Binary-State Networks.

PubMed

Mostafa, Hesham; Pedroni, Bruno; Sheik, Sadique; Cauwenberghs, Gert

2017-01-01

Artificial neural networks (ANNs) trained using backpropagation are powerful learning architectures that have achieved state-of-the-art performance in various benchmarks. Significant effort has been devoted to developing custom silicon devices to accelerate inference in ANNs. Accelerating the training phase, however, has attracted relatively little attention. In this paper, we describe a hardware-efficient on-line learning technique for feedforward multi-layer ANNs that is based on pipelined backpropagation. Learning is performed in parallel with inference in the forward pass, removing the need for an explicit backward pass and requiring no extra weight lookup. By using binary state variables in the feedforward network and ternary errors in truncated-error backpropagation, the need for any multiplications in the forward and backward passes is removed, and memory requirements for the pipelining are drastically reduced. Further reduction in addition operations owing to the sparsity in the forward neural and backpropagating error signal paths contributes to highly efficient hardware implementation. For proof-of-concept validation, we demonstrate on-line learning of MNIST handwritten digit classification on a Spartan 6 FPGA interfacing with an external 1Gb DDR2 DRAM, that shows small degradation in test error performance compared to an equivalently sized binary ANN trained off-line using standard back-propagation and exact errors. Our results highlight an attractive synergy between pipelined backpropagation and binary-state networks in substantially reducing computation and memory requirements, making pipelined on-line learning practical in deep networks.

Emergency management training program: Guide to good practice

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

Not Available

1991-07-01

The Emergency Management Training Program Guide to Good Practice is a project of the Training Resources and Data Exchange (TRADE) Emergency Management Issues Special Interest Group (EMI SIG). EMI SIG members expressed interest in a resource to assist in development of a comprehensive emergency management training program. This publication provides guidelines, methods, and materials for EMI SIG members to use, assisting in complete and effective emergency management programs. The purposes of the Emergency Management Training Program Guide to Good Practice are: Provide guidance in the development and management of Emergency Management (EM) training programs; Assist EM trainers to incorporate componentsmore » of the DOE Emergency Management System philosophy of planning, preparedness, readiness assurance, and response into EM training programs; Help EM training managers meet EM training requirements and conditions established by current regulations and policies; Supplement other TRADE EMI SIG documents and complement individual facility training documents. This program is designed for emergency management personnel who are responsible for providing or overseeing EM training but who do not necessarily possess expertise in developing training. It provides good practices from the manager's point of view on how to produce, administer, and document facility EM training programs in the spirit of the DOE EM system philosophy. Basic guidance is also included for personnel who design, develop, deliver, and/or evaluate EM training programs or parts. This guidance includes key points of EM training programs and identifies other documents that contain useful and/or more detailed training information.« less

Visual error augmentation enhances learning in three dimensions.

PubMed

Sharp, Ian; Huang, Felix; Patton, James

2011-09-02

Because recent preliminary evidence points to the use of Error augmentation (EA) for motor learning enhancements, we visually enhanced deviations from a straight line path while subjects practiced a sensorimotor reversal task, similar to laparoscopic surgery. Our study asked 10 healthy subjects in two groups to perform targeted reaching in a simulated virtual reality environment, where the transformation of the hand position matrix was a complete reversal--rotated 180 degrees about an arbitrary axis (hence 2 of the 3 coordinates are reversed). Our data showed that after 500 practice trials, error-augmented-trained subjects reached the desired targets more quickly and with lower error (differences of 0.4 seconds and 0.5 cm Maximum Perpendicular Trajectory deviation) when compared to the control group. Furthermore, the manner in which subjects practiced was influenced by the error augmentation, resulting in more continuous motions for this group and smaller errors. Even with the extreme sensory discordance of a reversal, these data further support that distorted reality can promote more complete adaptation/learning when compared to regular training. Lastly, upon removing the flip all subjects quickly returned to baseline rapidly within 6 trials.

How safe is deep sedation or general anesthesia while providing dental care?

PubMed

Bennett, Jeffrey D; Kramer, Kyle J; Bosack, Robert C

2015-09-01

Deep sedation and general anesthesia are administered daily in dental offices, most commonly by oral and maxillofacial surgeons and dentist anesthesiologists. The goal of deep sedation or general anesthesia is to establish a safe environment in which the patient is comfortable and cooperative. This requires meticulous care in which the practitioner balances the patient's depth of sedation and level of responsiveness while maintaining airway integrity, ventilation, and cardiovascular hemodynamics. Using the available data and informational reports, the authors estimate that the incidence of death and brain injury associated with deep sedation or general anesthesia administered by all dentists most likely exceeds 1 per month. Airway compromise is a significant contributing factor to anesthetic complications. The American Society of Anesthesiology closed claim analysis also concluded that human error contributed highly to anesthetic mishaps. The establishment of a patient safety database for anesthetic management in dentistry would allow for a more complete assessment of morbidity and mortality that could direct efforts to further increase safe anesthetic care. Deep sedation and general anesthesia can be safely administered in the dental office. Optimization of patient care requires appropriate patient selection, selection of appropriate anesthetic agents, utilization of appropriate monitoring, and a highly trained anesthetic team. Achieving a highly trained anesthetic team requires emergency management preparation that can foster decision making, leadership, communication, and task management. Copyright © 2015 American Dental Association. Published by Elsevier Inc. All rights reserved.

Recovering real money with a contract management system.

PubMed

Lang, Kevin; Williams, Bethany

2003-12-01

A payment error here, a payment error there--pretty soon, you're talking about real money. Contract and underpayment management systems can pay for themselves by unearthing tiny errors that add up to a lot of lost cash.

Using beta binomials to estimate classification uncertainty for ensemble models.

PubMed

Clark, Robert D; Liang, Wenkel; Lee, Adam C; Lawless, Michael S; Fraczkiewicz, Robert; Waldman, Marvin

2014-01-01

Quantitative structure-activity (QSAR) models have enormous potential for reducing drug discovery and development costs as well as the need for animal testing. Great strides have been made in estimating their overall reliability, but to fully realize that potential, researchers and regulators need to know how confident they can be in individual predictions. Submodels in an ensemble model which have been trained on different subsets of a shared training pool represent multiple samples of the model space, and the degree of agreement among them contains information on the reliability of ensemble predictions. For artificial neural network ensembles (ANNEs) using two different methods for determining ensemble classification - one using vote tallies and the other averaging individual network outputs - we have found that the distribution of predictions across positive vote tallies can be reasonably well-modeled as a beta binomial distribution, as can the distribution of errors. Together, these two distributions can be used to estimate the probability that a given predictive classification will be in error. Large data sets comprised of logP, Ames mutagenicity, and CYP2D6 inhibition data are used to illustrate and validate the method. The distributions of predictions and errors for the training pool accurately predicted the distribution of predictions and errors for large external validation sets, even when the number of positive and negative examples in the training pool were not balanced. Moreover, the likelihood of a given compound being prospectively misclassified as a function of the degree of consensus between networks in the ensemble could in most cases be estimated accurately from the fitted beta binomial distributions for the training pool. Confidence in an individual predictive classification by an ensemble model can be accurately assessed by examining the distributions of predictions and errors as a function of the degree of agreement among the constituent submodels. Further, ensemble uncertainty estimation can often be improved by adjusting the voting or classification threshold based on the parameters of the error distribution. Finally, the profiles for models whose predictive uncertainty estimates are not reliable provide clues to that effect without the need for comparison to an external test set.

The importance of expert feedback during endovascular simulator training.

PubMed

Boyle, Emily; O'Keeffe, Dara A; Naughton, Peter A; Hill, Arnold D K; McDonnell, Ciaran O; Moneley, Daragh

2011-07-01

Complex endovascular skills are difficult to obtain in the clinical environment. Virtual reality (VR) simulator training is a valuable addition to current training curricula, but is there a benefit in the absence of expert trainers? Eighteen endovascular novices performed a renal artery angioplasty/stenting (RAS) on the Vascular Interventional Surgical Trainer simulator. They were randomized into three groups: Group A (n = 6, control), no performance feedback; Group B (n = 6, nonexpert feedback), feedback after every procedure from a nonexpert facilitator; and Group C (n = 6, expert feedback), feedback after every procedure from a consultant vascular surgeon. Each trainee completed RAS six times. Simulator-measured performance metrics included procedural and fluoroscopy time, contrast volume, accuracy of balloon placement, and handling errors. Clinical errors were also measured by blinded video assessment. Data were analyzed using SPSS version 15. A clear learning curve was observed across the six trials. There were no significant differences between the three groups for the general performance metrics, but Group C made fewer errors than Groups A (P = .009) or B (P = .004). Video-based error assessment showed that Groups B and C performed better than Group A (P = .002 and P = .000, respectively). VR simulator training for novices can significantly improve general performance in the absence of expert trainers. Procedure-specific qualitative metrics are improved with expert feedback, but nonexpert facilitators can also enhance the quality of training and may represent a valuable alternative to expert clinical faculty. Copyright © 2011 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

Learning Through Experience: Influence of Formal and Informal Training on Medical Error Disclosure Skills in Residents.

PubMed

Wong, Brian M; Coffey, Maitreya; Nousiainen, Markku T; Brydges, Ryan; McDonald-Blumer, Heather; Atkinson, Adelle; Levinson, Wendy; Stroud, Lynfa

2017-02-01

Residents' attitudes toward error disclosure have improved over time. It is unclear whether this has been accompanied by improvements in disclosure skills. To measure the disclosure skills of internal medicine (IM), paediatrics, and orthopaedic surgery residents, and to explore resident perceptions of formal versus informal training in preparing them for disclosure in real-world practice. We assessed residents' error disclosure skills using a structured role play with a standardized patient in 2012-2013. We compared disclosure skills across programs using analysis of variance. We conducted a multiple linear regression, including data from a historical cohort of IM residents from 2005, to investigate the influence of predictor variables on performance: training program, cohort year, and prior disclosure training and experience. We conducted a qualitative descriptive analysis of data from semistructured interviews with residents to explore resident perceptions of formal versus informal disclosure training. In a comparison of disclosure skills for 49 residents, there was no difference in overall performance across specialties (4.1 to 4.4 of 5, P  = .19). In regression analysis, only the current cohort was significantly associated with skill: current residents performed better than a historical cohort of 42 IM residents ( P  < .001). Qualitative analysis identified the importance of both formal (workshops, morbidity and mortality rounds) and informal (role modeling, debriefing) activities in preparation for disclosure in real-world practice. Residents across specialties have similar skills in disclosure of errors. Residents identified role modeling and a strong local patient safety culture as key facilitators for disclosure.

Role-modeling and medical error disclosure: a national survey of trainees.

PubMed

Martinez, William; Hickson, Gerald B; Miller, Bonnie M; Doukas, David J; Buckley, John D; Song, John; Sehgal, Niraj L; Deitz, Jennifer; Braddock, Clarence H; Lehmann, Lisa Soleymani

2014-03-01

To measure trainees' exposure to negative and positive role-modeling for responding to medical errors and to examine the association between that exposure and trainees' attitudes and behaviors regarding error disclosure. Between May 2011 and June 2012, 435 residents at two large academic medical centers and 1,187 medical students from seven U.S. medical schools received anonymous, electronic questionnaires. The questionnaire asked respondents about (1) experiences with errors, (2) training for responding to errors, (3) behaviors related to error disclosure, (4) exposure to role-modeling for responding to errors, and (5) attitudes regarding disclosure. Using multivariate regression, the authors analyzed whether frequency of exposure to negative and positive role-modeling independently predicted two primary outcomes: (1) attitudes regarding disclosure and (2) nontransparent behavior in response to a harmful error. The response rate was 55% (884/1,622). Training on how to respond to errors had the largest independent, positive effect on attitudes (standardized effect estimate, 0.32, P < .001); negative role-modeling had the largest independent, negative effect (standardized effect estimate, -0.26, P < .001). Positive role-modeling had a positive effect on attitudes (standardized effect estimate, 0.26, P < .001). Exposure to negative role-modeling was independently associated with an increased likelihood of trainees' nontransparent behavior in response to an error (OR 1.37, 95% CI 1.15-1.64; P < .001). Exposure to role-modeling predicts trainees' attitudes and behavior regarding the disclosure of harmful errors. Negative role models may be a significant impediment to disclosure among trainees.

Do errors matter? Errorless and errorful learning in anomic picture naming.

PubMed

McKissock, Stephen; Ward, Jamie

2007-06-01

Errorless training methods significantly improve learning in memory-impaired patients relative to errorful training procedures. However, the validity of this technique for acquiring linguistic information in aphasia has rarely been studied. This study contrasts three different treatment conditions over an 8 week period for rehabilitating picture naming in anomia: (1) errorless learning in which pictures are shown and the experimenter provides the name, (2) errorful learning with feedback in which the patient is required to generate a name but the correct name is then supplied by the experimenter, and (3) errorful learning in which no feedback is given. These conditions are compared to an untreated set of matched words. Both errorless and errorful learning with feedback conditions led to significant improvement at a 2-week and 12-14-week retest (errorful without feedback and untreated words were similar). The results suggest that it does not matter whether anomic patients are allowed to make errors in picture naming or not (unlike in memory impaired individuals). What does matter is that a correct response is given as feedback. The results also question the widely held assumption that it is beneficial for a patient to attempt to retrieve a word, given that our errorless condition involved no retrieval effort and had the greatest benefits.

Research on wind field algorithm of wind lidar based on BP neural network and grey prediction

NASA Astrophysics Data System (ADS)

Chen, Yong; Chen, Chun-Li; Luo, Xiong; Zhang, Yan; Yang, Ze-hou; Zhou, Jie; Shi, Xiao-ding; Wang, Lei

2018-01-01

This paper uses the BP neural network and grey algorithm to forecast and study radar wind field. In order to reduce the residual error in the wind field prediction which uses BP neural network and grey algorithm, calculating the minimum value of residual error function, adopting the residuals of the gray algorithm trained by BP neural network, using the trained network model to forecast the residual sequence, using the predicted residual error sequence to modify the forecast sequence of the grey algorithm. The test data show that using the grey algorithm modified by BP neural network can effectively reduce the residual value and improve the prediction precision.

Cryotherapy does not impair shoulder joint position sense.

PubMed

Dover, Geoffrey; Powers, Michael E

2004-08-01

To determine the effects of a cryotherapy treatment on shoulder proprioception. Crossover design with repeated measures. University athletic training and sports medicine research laboratory. Thirty healthy subjects (15 women, 15 men). A 30-minute cryotherapy treatment. Joint position sense was measured in the dominant shoulder by using an inclinometer before and after receiving 30 minutes of either no ice or a 1-kg ice bag application. Skin temperature was measured below the tip of the acromion process and recorded every 5 minutes for the entire 30 minutes and immediately after testing. Three different types of error scores were calculated for data analyses and used to determine proprioception. Separate analyses of absolute, constant, and variable error failed to identify changes in shoulder joint proprioception as a function of the cryotherapy application. Application of an ice bag to the shoulder does not impair joint position sense. The control of proprioception at the shoulder may be more complex than at other joints in the body. Clinical implications may involve modifying rehabilitation considerations when managing shoulder injuries.

Translating teamwork behaviours from aviation to healthcare: development of behavioural markers for neonatal resuscitation

PubMed Central

Thomas, E; Sexton, J; Helmreich, R

2004-01-01

Improving teamwork in healthcare may help reduce and manage errors. This paper takes a step toward that goal by (1) proposing a set of teamwork behaviours, or behavioural markers, for neonatal resuscitation; (2) presenting a data form for recording observations about these markers; and (3) comparing and contrasting different sets of teamwork behaviours that have been developed for healthcare. Data from focus groups of neonatal providers, surveys, and video recordings of neonatal resuscitations were used to identify some new teamwork behaviours, to translate existing aviation team behaviours to this setting, and to develop a data collection form. This behavioural marker audit form for neonatal resuscitation lists and defines 10 markers that describe specific, observable behaviours seen during the resuscitation of newborn infants. These markers are compared with those developed by other groups. Future research should determine the relations among these behaviours and errors, and test their usefulness in measuring the impact of team training interventions. PMID:15465957

Machine learning enhanced optical distance sensor

NASA Astrophysics Data System (ADS)

Amin, M. Junaid; Riza, N. A.

2018-01-01

Presented for the first time is a machine learning enhanced optical distance sensor. The distance sensor is based on our previously demonstrated distance measurement technique that uses an Electronically Controlled Variable Focus Lens (ECVFL) with a laser source to illuminate a target plane with a controlled optical beam spot. This spot with varying spot sizes is viewed by an off-axis camera and the spot size data is processed to compute the distance. In particular, proposed and demonstrated in this paper is the use of a regularized polynomial regression based supervised machine learning algorithm to enhance the accuracy of the operational sensor. The algorithm uses the acquired features and corresponding labels that are the actual target distance values to train a machine learning model. The optimized training model is trained over a 1000 mm (or 1 m) experimental target distance range. Using the machine learning algorithm produces a training set and testing set distance measurement errors of <0.8 mm and <2.2 mm, respectively. The test measurement error is at least a factor of 4 improvement over our prior sensor demonstration without the use of machine learning. Applications for the proposed sensor include industrial scenario distance sensing where target material specific training models can be generated to realize low <1% measurement error distance measurements.

Filling in the gaps of predeployment fleet surgical team training using a team-centered approach.

PubMed

Hoang, Tuan N; Kang, Jeff; Laporta, Anthony J; Makler, Vyacheslav I; Chalut, Carissa

2013-01-01

Teamwork and successful communication are essential parts of any medical specialty, especially in the trauma setting. U.S. Navy physicians developed a course for deploying fleet surgical teams to reinforce teamwork, communication, and baseline knowledge of trauma management. The course combines 22 hours of classroom didactics along with 28 hours of hands-on simulation and cadaver-based laboratories to reinforce classroom concepts. It culminates in a 6-hour, multiwave exercise of multiple, critically injured victims of a mass casualty and uses the ?Cut Suit? (Human Worn Partial Task Surgical Simulator; Strategic Operations), which enables performance of multiple realistic surgical procedures as encountered on real casualties. Participants are graded on time taken from initial patient encounter to disposition and the number of errors made. Pre- and post-training written examinations are also given. The course is graded based on participants? evaluation of the course. The majority of the participants indicated that the course promoted teamwork, enhanced knowledge, and gave confidence. Only 51.72% of participants felt confident in dealing with trauma patients before the course, while 82.76% felt confident afterward (p = .01). Both the time spent on each patient and the number of errors made also decreased after course completion. The course was successful in improving teamwork, communication and base knowledge of all the team members. 2013.

Proceedings of the Symposium on Training of Nuclear Facility Personnel (8th, Gatlinburg, Tennessee, April 24-27, 1989).

ERIC Educational Resources Information Center

Oak Ridge National Lab., TN.

Education-related titles among the 56 papers are "Panel Discussion: Plant Expectation of Training" (Sellman, Zach, Cross); "Managing Training AT&T" (Solomon); "Training Management Systems" (Waylett); "Managing the Training Function" (Wiggin); "Training Management" (Newton); Three Alternative Simulation Systems for Training Nuclear Power Plant…

Voluntary Medication Error Reporting by ED Nurses: Examining the Association With Work Environment and Social Capital.

PubMed

Farag, Amany; Blegen, Mary; Gedney-Lose, Amalia; Lose, Daniel; Perkhounkova, Yelena

2017-05-01

Medication errors are one of the most frequently occurring errors in health care settings. The complexity of the ED work environment places patients at risk for medication errors. Most hospitals rely on nurses' voluntary medication error reporting, but these errors are under-reported. The purpose of this study was to examine the relationship among work environment (nurse manager leadership style and safety climate), social capital (warmth and belonging relationships and organizational trust), and nurses' willingness to report medication errors. A cross-sectional descriptive design using a questionnaire with a convenience sample of emergency nurses was used. Data were analyzed using descriptive, correlation, Mann-Whitney U, and Kruskal-Wallis statistics. A total of 71 emergency nurses were included in the study. Emergency nurses' willingness to report errors decreased as the nurses' years of experience increased (r = -0.25, P = .03). Their willingness to report errors increased when they received more feedback about errors (r = 0.25, P = .03) and when their managers used a transactional leadership style (r = 0.28, P = .01). ED nurse managers can modify their leadership style to encourage error reporting. Timely feedback after an error report is particularly important. Engaging experienced nurses to understand error root causes could increase voluntary error reporting. Published by Elsevier Inc.

The impact of video games on training surgeons in the 21st century.

PubMed

Rosser, James C; Lynch, Paul J; Cuddihy, Laurie; Gentile, Douglas A; Klonsky, Jonathan; Merrell, Ronald

2007-02-01

Video games have become extensively integrated into popular culture. Anecdotal observations of young surgeons suggest that video game play contributes to performance excellence in laparoscopic surgery. Training benefits for surgeons who play video games should be quantifiable. There is a potential link between video game play and laparoscopic surgical skill and suturing. Cross-sectional analysis of the performance of surgical residents and attending physicians participating in the Rosser Top Gun Laparoscopic Skills and Suturing Program (Top Gun). Three different video game exercises were performed, and surveys were completed to assess past experience with video games and current level of play, and each subject's level of surgical training, number of laparoscopic cases performed, and number of years in medical practice. Academic medical center and surgical training program. Thirty-three residents and attending physicians participating in Top Gun from May 10 to August 24, 2002. The primary outcome measures were compared between participants' laparoscopic skills and suturing capability, video game scores, and video game experience. Past video game play in excess of 3 h/wk correlated with 37% fewer errors (P<.02) and 27% faster completion (P<.03). Overall Top Gun score (time and errors) was 33% better (P<.005) for video game players and 42% better (P<.01) if they played more than 3 h/wk. Current video game players made 32% fewer errors (P=.04), performed 24% faster (P<.04), and scored 26% better overall (time and errors) (P<.005) than their nonplaying colleagues. When comparing demonstrated video gaming skills, those in the top tertile made 47% fewer errors, performed 39% faster, and scored 41% better (P<.001 for all) on the overall Top Gun score. Regression analysis also indicated that video game skill and past video game experience are significant predictors of demonstrated laparoscopic skills. Video game skill correlates with laparoscopic surgical skills. Training curricula that include video games may help thin the technical interface between surgeons and screen-mediated applications, such as laparoscopic surgery. Video games may be a practical teaching tool to help train surgeons.

Psychophysiological Approach To Support Of Cosmonauts Performance Reliability

NASA Astrophysics Data System (ADS)

Nechaev, A. P.

Space flight factors may effect negatively on psychophysiological state (PPS) and work capacity of crewmembers, lead to errors in tasks performance. Such errors cannot be entirely prevented during "crew-spacecraft" system designing and/or crewmembers training as they are consequence of a human "psychophysiological troubles". In the present investigation we paid special attention to work and rest schedule (WRS) intensity due to sleep-wake rhythm disturbances and crewmembers overload may cause PPS aggravation. By methods of the correlation analysis of the data collected during 9 "Mir" missions (18 Russian cosmonauts, 226 flight weeks) the significant (p<0.05) interrelations between WRS intensity and cosmonauts PPS as well as between cosmonauts PPS and crewmembers errors (CE) frequency have been established. It allows to consider WRS intensity as "the controlling factor" in relation to crewmember's PPS. Quantitative characteristics of these interrelations have been also determined. This findings have been used for development of algorithm of crewmember's PPS management with the purpose of decrease in CE frequency. The algorithm can be briefly described in the following kind. On the basis of the analysis of crew forthcoming work experts should assess WRS intensity, possible crewmembers PPS alterations, and expected CE frequency. If CE frequency is allowable the management may be limited to recommendations that operative vigilance increase. If CE frequency is higher allowable it is necessary to carry out the measures on crewmembers PPS normalization by means of decrease in WRS intensity. The algorithm is intended for use in the on-ground expert system of psychophysiological support of cosmonauts performance.

In vivo versus simulation training: an interactional analysis of range and type of training exemplars.

PubMed Central

Neef, N A; Lensbower, J; Hockersmith, I; DePalma, V; Gray, K

1990-01-01

We analyzed the role of the range of variation in training exemplars as a contextual variable influencing the effects of in vivo versus simulation training in producing generalized responding. Four mentally retarded adults received single case instruction, followed by general case instruction, on washing machine and dryer use; one task was taught using actual appliances (in vivo) and the other using simulation. In vivo and simulation training were counterbalanced across the two tasks for the 2 subject pairs, using a within-subjects Latin square design. With both paradigms, more errors were made after single case than after general case instruction during probe sessions with untrained washing machines and dryers. These results suggest that generalization errors were affected by the range of training exemplars and not by the use of simulated versus natural training stimuli. Although both general case simulation and general case in vivo training facilitated generalized performance of laundry skills, an analysis of training time and costs indicated that the former approach was more efficient. The study illustrates a methodology for studying complex interactions and guiding decisions on the optimal use of instructional alternatives. PMID:2074236

Operational Interventions to Maintenance Error

NASA Technical Reports Server (NTRS)

Kanki, Barbara G.; Walter, Diane; Dulchinos, VIcki

1997-01-01

A significant proportion of aviation accidents and incidents are known to be tied to human error. However, research of flight operational errors has shown that so-called pilot error often involves a variety of human factors issues and not a simple lack of individual technical skills. In aircraft maintenance operations, there is similar concern that maintenance errors which may lead to incidents and accidents are related to a large variety of human factors issues. Although maintenance error data and research are limited, industry initiatives involving human factors training in maintenance have become increasingly accepted as one type of maintenance error intervention. Conscientious efforts have been made in re-inventing the team7 concept for maintenance operations and in tailoring programs to fit the needs of technical opeRAtions. Nevertheless, there remains a dual challenge: 1) to develop human factors interventions which are directly supported by reliable human error data, and 2) to integrate human factors concepts into the procedures and practices of everyday technical tasks. In this paper, we describe several varieties of human factors interventions and focus on two specific alternatives which target problems related to procedures and practices; namely, 1) structured on-the-job training and 2) procedure re-design. We hope to demonstrate that the key to leveraging the impact of these solutions comes from focused interventions; that is, interventions which are derived from a clear understanding of specific maintenance errors, their operational context and human factors components.

Reduction of Maintenance Error Through Focused Interventions

NASA Technical Reports Server (NTRS)

Kanki, Barbara G.; Walter, Diane; Rosekind, Mark R. (Technical Monitor)

1997-01-01

It is well known that a significant proportion of aviation accidents and incidents are tied to human error. In flight operations, research of operational errors has shown that so-called "pilot error" often involves a variety of human factors issues and not a simple lack of individual technical skills. In aircraft maintenance operations, there is similar concern that maintenance errors which may lead to incidents and accidents are related to a large variety of human factors issues. Although maintenance error data and research are limited, industry initiatives involving human factors training in maintenance have become increasingly accepted as one type of maintenance error intervention. Conscientious efforts have been made in re-inventing the "team" concept for maintenance operations and in tailoring programs to fit the needs of technical operations. Nevertheless, there remains a dual challenge: to develop human factors interventions which are directly supported by reliable human error data, and to integrate human factors concepts into the procedures and practices of everyday technical tasks. In this paper, we describe several varieties of human factors interventions and focus on two specific alternatives which target problems related to procedures and practices; namely, 1) structured on-the-job training and 2) procedure re-design. We hope to demonstrate that the key to leveraging the impact of these solutions comes from focused interventions; that is, interventions which are derived from a clear understanding of specific maintenance errors, their operational context and human factors components.

14 CFR 135.330 - Crew resource management training.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 14 Aeronautics and Space 3 2014-01-01 2014-01-01 false Crew resource management training. 135.330... § 135.330 Crew resource management training. (a) Each certificate holder must have an approved crew resource management training program that includes initial and recurrent training. The training program...

14 CFR 135.330 - Crew resource management training.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 14 Aeronautics and Space 3 2012-01-01 2012-01-01 false Crew resource management training. 135.330... § 135.330 Crew resource management training. (a) Each certificate holder must have an approved crew resource management training program that includes initial and recurrent training. The training program...

14 CFR 135.330 - Crew resource management training.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 14 Aeronautics and Space 3 2013-01-01 2013-01-01 false Crew resource management training. 135.330... § 135.330 Crew resource management training. (a) Each certificate holder must have an approved crew resource management training program that includes initial and recurrent training. The training program...

Using lean "automation with a human touch" to improve medication safety: a step closer to the "perfect dose".

PubMed

Ching, Joan M; Williams, Barbara L; Idemoto, Lori M; Blackmore, C Craig

2014-08-01

Virginia Mason Medical Center (Seattle) employed the Lean concept of Jidoka (automation with a human touch) to plan for and deploy bar code medication administration (BCMA) to hospitalized patients. Integrating BCMA technology into the nursing work flow with minimal disruption was accomplished using three steps ofJidoka: (1) assigning work to humans and machines on the basis of their differing abilities, (2) adapting machines to the human work flow, and (3) monitoring the human-machine interaction. Effectiveness of BCMA to both reinforce safe administration practices and reduce medication errors was measured using the Collaborative Alliance for Nursing Outcomes (CALNOC) Medication Administration Accuracy Quality Study methodology. Trained nurses observed a total of 16,149 medication doses for 3,617 patients in a three-year period. Following BCMA implementation, the number of safe practice violations decreased from 54.8 violations/100 doses (January 2010-September 2011) to 29.0 violations/100 doses (October 2011-December 2012), resulting in an absolute risk reduction of 25.8 violations/100 doses (95% confidence interval [CI]: 23.7, 27.9, p < .001). The number of medication errors decreased from 5.9 errors/100 doses at baseline to 3.0 errors/100 doses after BCMA implementation (absolute risk reduction: 2.9 errors/100 doses [95% CI: 2.2, 3.6,p < .001]). The number of unsafe administration practices (estimate, -5.481; standard error 1.133; p < .001; 95% CI: -7.702, -3.260) also decreased. As more hospitals respond to health information technology meaningful use incentives, thoughtful, methodical, and well-managed approaches to technology deployment are crucial. This work illustrates how Jidoka offers opportunities for a smooth transition to new technology.

Statistical learning from nonrecurrent experience with discrete input variables and recursive-error-minimization equations

NASA Astrophysics Data System (ADS)

Carter, Jeffrey R.; Simon, Wayne E.

1990-08-01

Neural networks are trained using Recursive Error Minimization (REM) equations to perform statistical classification. Using REM equations with continuous input variables reduces the required number of training experiences by factors of one to two orders of magnitude over standard back propagation. Replacing the continuous input variables with discrete binary representations reduces the number of connections by a factor proportional to the number of variables reducing the required number of experiences by another order of magnitude. Undesirable effects of using recurrent experience to train neural networks for statistical classification problems are demonstrated and nonrecurrent experience used to avoid these undesirable effects. 1. THE 1-41 PROBLEM The statistical classification problem which we address is is that of assigning points in ddimensional space to one of two classes. The first class has a covariance matrix of I (the identity matrix) the covariance matrix of the second class is 41. For this reason the problem is known as the 1-41 problem. Both classes have equal probability of occurrence and samples from both classes may appear anywhere throughout the ddimensional space. Most samples near the origin of the coordinate system will be from the first class while most samples away from the origin will be from the second class. Since the two classes completely overlap it is impossible to have a classifier with zero error. The minimum possible error is known as the Bayes error and

Associations between task, training and social environmental factors and error types involved in rail incidents and accidents.

PubMed

Read, Gemma J M; Lenné, Michael G; Moss, Simon A

2012-09-01

Rail accidents can be understood in terms of the systemic and individual contributions to their causation. The current study was undertaken to determine whether errors and violations are more often associated with different local and organisational factors that contribute to rail accidents. The Contributing Factors Framework (CFF), a tool developed for the collection and codification of data regarding rail accidents and incidents, was applied to a sample of investigation reports. In addition, a more detailed categorisation of errors was undertaken. Ninety-six investigation reports into Australian accidents and incidents occurring between 1999 and 2008 were analysed. Each report was coded independently by two experienced coders. Task demand factors were significantly more often associated with skill-based errors, knowledge and training deficiencies significantly associated with mistakes, and violations significantly linked to social environmental factors. Copyright © 2012 Elsevier Ltd. All rights reserved.

A 5 year longitudinal study of water quality for final rinsing in the single chamber washer-disinfector with a reverse osmosis plant.

PubMed

Uetera, Yushi; Kishii, Kozue; Yasuhara, Hiroshi; Kumada, Naohito; Moriya, Kyoji; Saito, Ryoichi; Okazaki, Mitsuhiro; Misawa, Yoshiki; Kawamura, Kunio

2013-01-01

This report deals with the construction and management of the reverse osmosis (RO) water system for final rinsing of surgical instruments in the washer-disinfector. Numerous operational challenges were encountered in our RO water system and these were analyzed utilizing the Ishikawa Fishbone diagram. The aim was to find potential problems and promote preventive system management for RO water. It was found that the measures that existed were inappropriate for preventing contamination in the heat-labile RO water system. The storage tank was found to be significantly contaminated and had to be replaced with a new one equipped with a sampling port and water drainage system. Additional filters and an UV treatment lamp were installed. The whole system disinfection started 1.5 years later using a peracetic acid-based compound after confirming the material compatibility. Operator errors were found when a new water engineer took over the duty from his predecessor. It was also found that there were some deficiencies in the standard operating procedures (SOPs), and that on-the-job training was not enough. The water engineer failed to disinfect the sampling port and water drainage system. The RO membrane had been used for 4 years, even though the SOP standard specified changing it as every 3 years. Various bacteria, such as Rothia mucilaginosa, were cultured from the RO water sampled from the equipment. Because Rothia mucilaginosa is a resident in the oral cavity and upper respiratory tract, it is believed that the bacteria were introduced into the system by the maintenance personnel or working environment. Therefore, the presence of R. mucilaginosa implied the failure of sanitary maintenance procedures. This study suggests that water systems should be designed based on the plans for profound system maintenance. It also suggests that SOP and on-the job training are essential to avoid any operator errors. These results must be carefully considered when either constructing new RO systems or performing maintenance and periodical examination of the equipment. Reverse osmosis (RO) water is used for final rinsing in our washer-disinfector. The authors used the Ishikawa Fishbone diagram to clarify the critical points for optimizing RO water quality. There existed no measures to prevent contamination in the heat-labile RO water system. The storage tank was significantly contaminated and had to be replaced with a new one equipped with a sampling port and water drainage system. Additional filters and an UV treatment lamp were installed. The whole system disinfection started 1.5 years later using a peracetic acid-based compound after confirming the material compatibility. Operator errors occurred when a new water engineer took over the duty from his predecessor. There were neither standard operating procedures (SOPs) nor on-the-job training. The new water engineer had failed to disinfect the sampling port and water drainage system. Rothia mucilaginosa was cultured from the RO water. It is a resident in the oral cavity and upper respiratory tract. This implied the possible failure of sanitary procedures in the system maintenance. The Ishikawa Fishbone diagram was useful for this study. It suggests that water systems should be designed with plans for system maintenance taken into account. It also suggests that SOP and on-the job training are essential in order to avoid operator errors.

[Evaluation of professional development of Cambodian male nurses specializing in anesthesia and intensive care, trained through humanitarian care programs].

PubMed

Pinosa, C; Gagnayre, R

1998-01-01

To assess the working conditions of Cambodian male nurses specialised in anaesthesia and intensive care (NSAIs), degree of satisfaction, whether training was suited to the Cambodian needs and practical application of training. Prospective survey. Two training years including 30 NSAIs. External assessors evaluated working conditions, practice of anaesthesia, analysed logbooks and theatre reports, organised semi-directive interviews and examinations using clinical cases. Out of the 30 NSAIs, 28 had an appointment, mainly in anaesthesia (80% of their activity) and three-quarters of them felt that their skills were appreciated by their superiors. Seventeen had some form of responsibility in the management of a department. For the administration of an anaesthetic, 13 NSAIs of the second year had achieved an acceptable level of performance and resolved effectively 85% of the submitted cases. Twenty-two NSAIs reported difficulty in applying techniques learned during their training to real working conditions. The causes were poor equipment, poor organisation and poor relations with the hierarchy. The latter cause decreased the capacity to take appropriate decisions, which was the most common error made by the second year NSAIs. Finally, as their wages remained unchanged, 19 out of the 28 NSAIs were obliged to look for an additional source of income. This survey shows the medium-term effectiveness of an NSAI training programme basing on teaching and public health principles and organised in the humanitarian aid sector.

GIS-based groundwater potential analysis using novel ensemble weights-of-evidence with logistic regression and functional tree models.

PubMed

Chen, Wei; Li, Hui; Hou, Enke; Wang, Shengquan; Wang, Guirong; Panahi, Mahdi; Li, Tao; Peng, Tao; Guo, Chen; Niu, Chao; Xiao, Lele; Wang, Jiale; Xie, Xiaoshen; Ahmad, Baharin Bin

2018-09-01

The aim of the current study was to produce groundwater spring potential maps using novel ensemble weights-of-evidence (WoE) with logistic regression (LR) and functional tree (FT) models. First, a total of 66 springs were identified by field surveys, out of which 70% of the spring locations were used for training the models and 30% of the spring locations were employed for the validation process. Second, a total of 14 affecting factors including aspect, altitude, slope, plan curvature, profile curvature, stream power index (SPI), topographic wetness index (TWI), sediment transport index (STI), lithology, normalized difference vegetation index (NDVI), land use, soil, distance to roads, and distance to streams was used to analyze the spatial relationship between these affecting factors and spring occurrences. Multicollinearity analysis and feature selection of the correlation attribute evaluation (CAE) method were employed to optimize the affecting factors. Subsequently, the novel ensembles of the WoE, LR, and FT models were constructed using the training dataset. Finally, the receiver operating characteristic (ROC) curves, standard error, confidence interval (CI) at 95%, and significance level P were employed to validate and compare the performance of three models. Overall, all three models performed well for groundwater spring potential evaluation. The prediction capability of the FT model, with the highest AUC values, the smallest standard errors, the narrowest CIs, and the smallest P values for the training and validation datasets, is better compared to those of other models. The groundwater spring potential maps can be adopted for the management of water resources and land use by planners and engineers. Copyright © 2018 Elsevier B.V. All rights reserved.

Demand Forecasting: An Evaluation of DODs Accuracy Metric and Navys Procedures

DTIC Science & Technology

2016-06-01

inventory management improvement plan, mean of absolute scaled error, lead time adjusted squared error, forecast accuracy, benchmarking, naïve method...Manager JASA Journal of the American Statistical Association LASE Lead-time Adjusted Squared Error LCI Life Cycle Indicator MA Moving Average MAE...Mean Squared Error xvi NAVSUP Naval Supply Systems Command NDAA National Defense Authorization Act NIIN National Individual Identification Number

Determination of heat capacity of ionic liquid based nanofluids using group method of data handling technique

NASA Astrophysics Data System (ADS)

Sadi, Maryam

2018-01-01

In this study a group method of data handling model has been successfully developed to predict heat capacity of ionic liquid based nanofluids by considering reduced temperature, acentric factor and molecular weight of ionic liquids, and nanoparticle concentration as input parameters. In order to accomplish modeling, 528 experimental data points extracted from the literature have been divided into training and testing subsets. The training set has been used to predict model coefficients and the testing set has been applied for model validation. The ability and accuracy of developed model, has been evaluated by comparison of model predictions with experimental values using different statistical parameters such as coefficient of determination, mean square error and mean absolute percentage error. The mean absolute percentage error of developed model for training and testing sets are 1.38% and 1.66%, respectively, which indicate excellent agreement between model predictions and experimental data. Also, the results estimated by the developed GMDH model exhibit a higher accuracy when compared to the available theoretical correlations.

Disinfection of reusable elastomeric respirators by health care workers: a feasibility study and development of standard operating procedures.

PubMed

Bessesen, Mary T; Adams, Jill C; Radonovich, Lewis; Anderson, Judith

2015-06-01

This was a feasibility study in a Department of Veterans Affairs Medical Center to develop a standard operating procedure (SOP) to be used by health care workers to disinfect reusable elastomeric respirators under pandemic conditions. Registered and licensed practical nurses, nurse practitioners, aides, clinical technicians, and physicians took part in the study. Health care worker volunteers were provided with manufacturers' cleaning and disinfection instructions and all necessary supplies. They were observed and filmed. SOPs were developed, based on these observations, and tested on naïve volunteer health care workers. Error rates using manufacturers' instructions and SOPs were compared. When using respirator manufacturers' cleaning and disinfection instructions, without specific training or supervision, all subjects made multiple errors. When using the SOPs developed in the study, without specific training or guidance, naïve health care workers disinfected respirators with zero errors. Reusable facial protective equipment may be disinfected by health care workers with minimal training using SOPs. Published by Elsevier Inc.

Clinicians and product sales representatives: developing a relationship that works.

PubMed

Harbit, Maryanne Drake; Driggers, Zola S

2002-02-01

In today's healthcare climate, clinicians in any specialty may be required to make product selections for their practice. The skills necessary to negotiate the world of sales include information about how sales relationships are conducted, product evaluations, negotiation management, and time management. Because these skills are not taught in traditional healthcare training programs, clinicians often learn these skills through trial and error. Credible and resourceful clinical experts have current information and a working knowledge about products that are available for patients. An excellent resource for this information is the product sales representative. Literature providing information for clinicians on how to establish and maintain productive relationships with medical product representatives is scarce. This article will explain what issues to address in discussions and negotiations with product representatives. Common pitfalls that often result from not understanding the agenda of the sales representative are identified. By employing the suggested strategies, a mutually beneficial relationship can be fostered.

Patient-Centered Mobile Health Data Management Solution for the German Health Care System (The DataBox Project).

PubMed

Brinker, Titus Josef; Rudolph, Stefanie; Richter, Daniela; von Kalle, Christof

2018-05-11

This article describes the DataBox project which offers a perspective of a new health data management solution in Germany. DataBox was initially conceptualized as a repository of individual lung cancer patient data (structured and unstructured). The patient is the owner of the data and is able to share his or her data with different stakeholders. Data is transferred, displayed, and stored online, but not archived. In the long run, the project aims at replacing the conventional method of paper- and storage-device-based handling of data for all patients in Germany, leading to better organization and availability of data which reduces duplicate diagnostic procedures, treatment errors, and enables the training as well as usage of artificial intelligence algorithms on large datasets. ©Titus Josef Brinker, Stefanie Rudolph, Daniela Richter, Christof von Kalle. Originally published in JMIR Cancer (http://cancer.jmir.org), 11.05.2018.

Average capacity of the ground to train communication link of a curved track in the turbulence of gamma-gamma distribution

NASA Astrophysics Data System (ADS)

Yang, Yanqiu; Yu, Lin; Zhang, Yixin

2017-04-01

A model of the average capacity of optical wireless communication link with pointing errors for the ground-to-train of the curved track is established based on the non-Kolmogorov. By adopting the gamma-gamma distribution model, we derive the average capacity expression for this channel. The numerical analysis reveals that heavier fog reduces the average capacity of link. The strength of atmospheric turbulence, the variance of pointing errors, and the covered track length need to be reduced for the larger average capacity of link. The normalized beamwidth and the average signal-to-noise ratio (SNR) of the turbulence-free link need to be increased. We can increase the transmit aperture to expand the beamwidth and enhance the signal intensity, thereby decreasing the impact of the beam wander accordingly. As the system adopting the automatic tracking of beam at the receiver positioned on the roof of the train, for eliminating the pointing errors caused by beam wander and train vibration, the equivalent average capacity of the channel will achieve a maximum value. The impact of the non-Kolmogorov spectral index's variation on the average capacity of link can be ignored.

Joint Base Langley-Eustis

Science.gov Websites

Advanced Environmental Management Training (AEM) Advanced Environmental Management Phase I Training (AEM Phase I) Leadership Environmental Management and Competency Training (LEMAC) Basic Environmental Management Training (BEMA) Environmental Training Information Fort Eustis Chapel Fort Eustis Command Judge

Training for Community Development Personnel in India.

ERIC Educational Resources Information Center

Makhija, H. R.

The book traces the development of training schemes in India for community development workers. It is divided into four parts which deal with: origin and growth of the Community Development Training Programme; problems encountered and the process of solutions through trial and error; major reorganization of the initial program and the research…

Student Self-Assessment and Faculty Assessment of Performance in an Interprofessional Error Disclosure Simulation Training Program.

PubMed

Poirier, Therese I; Pailden, Junvie; Jhala, Ray; Ronald, Katie; Wilhelm, Miranda; Fan, Jingyang

2017-04-01

Objectives. To conduct a prospective evaluation for effectiveness of an error disclosure assessment tool and video recordings to enhance student learning and metacognitive skills while assessing the IPEC competencies. Design. The instruments for assessing performance (planning, communication, process, and team dynamics) in interprofessional error disclosure were developed. Student self-assessment of performance before and after viewing the recordings of their encounters were obtained. Faculty used a similar instrument to conduct real-time assessments. An instrument to assess achievement of the Interprofessional Education Collaborative (IPEC) core competencies was developed. Qualitative data was reviewed to determine student and faculty perceptions of the simulation. Assessment. The interprofessional simulation training involved a total of 233 students (50 dental, 109 nursing and 74 pharmacy). Use of video recordings made a significant difference in student self-assessment for communication and process categories of error disclosure. No differences in student self-assessments were noted among the different professions. There were differences among the family member affects for planning and communication for both pre-video and post-video data. There were significant differences between student self-assessment and faculty assessment for all paired comparisons, except communication in student post-video self-assessment. Students' perceptions of achievement of the IPEC core competencies were positive. Conclusion. The use of assessment instruments and video recordings may have enhanced students' metacognitive skills for assessing performance in interprofessional error disclosure. The simulation training was effective in enhancing perceptions on achievement of IPEC core competencies. This enhanced assessment process appeared to enhance learning about the skills needed for interprofessional error disclosure.

Student Self-Assessment and Faculty Assessment of Performance in an Interprofessional Error Disclosure Simulation Training Program

PubMed Central

Pailden, Junvie; Jhala, Ray; Ronald, Katie; Wilhelm, Miranda; Fan, Jingyang

2017-01-01

Objectives. To conduct a prospective evaluation for effectiveness of an error disclosure assessment tool and video recordings to enhance student learning and metacognitive skills while assessing the IPEC competencies. Design. The instruments for assessing performance (planning, communication, process, and team dynamics) in interprofessional error disclosure were developed. Student self-assessment of performance before and after viewing the recordings of their encounters were obtained. Faculty used a similar instrument to conduct real-time assessments. An instrument to assess achievement of the Interprofessional Education Collaborative (IPEC) core competencies was developed. Qualitative data was reviewed to determine student and faculty perceptions of the simulation. Assessment. The interprofessional simulation training involved a total of 233 students (50 dental, 109 nursing and 74 pharmacy). Use of video recordings made a significant difference in student self-assessment for communication and process categories of error disclosure. No differences in student self-assessments were noted among the different professions. There were differences among the family member affects for planning and communication for both pre-video and post-video data. There were significant differences between student self-assessment and faculty assessment for all paired comparisons, except communication in student post-video self-assessment. Students’ perceptions of achievement of the IPEC core competencies were positive. Conclusion. The use of assessment instruments and video recordings may have enhanced students’ metacognitive skills for assessing performance in interprofessional error disclosure. The simulation training was effective in enhancing perceptions on achievement of IPEC core competencies. This enhanced assessment process appeared to enhance learning about the skills needed for interprofessional error disclosure. PMID:28496274

Contributions of the cerebellum and the motor cortex to acquisition and retention of motor memories

PubMed Central

Herzfeld, David J.; Pastor, Damien; Haith, Adrian M.; Rossetti, Yves; Shadmehr, Reza; O’Shea, Jacinta

2014-01-01

We investigated the contributions of the cerebellum and the motor cortex (M1) to acquisition and retention of human motor memories in a force field reaching task. We found that anodal transcranial direct current stimulation (tDCS) of the cerebellum, a technique that is thought to increase neuronal excitability, increased the ability to learn from error and form an internal model of the field, while cathodal cerebellar stimulation reduced this error-dependent learning. In addition, cathodal cerebellar stimulation disrupted the ability to respond to error within a reaching movement, reducing the gain of the sensory-motor feedback loop. By contrast, anodal M1 stimulation had no significant effects on these variables. During sham stimulation, early in training the acquired motor memory exhibited rapid decay in error-clamp trials. With further training the rate of decay decreased, suggesting that with training the motor memory was transformed from a labile to a more stable state. Surprisingly, neither cerebellar nor M1 stimulation altered these decay patterns. Participants returned 24 hours later and were re-tested in error-clamp trials without stimulation. The cerebellar group that had learned the task with cathodal stimulation exhibited significantly impaired retention, and retention was not improved by M1 anodal stimulation. In summary, non-invasive cerebellar stimulation resulted in polarity-dependent up- or down-regulation of error-dependent motor learning. In addition, cathodal cerebellar stimulation during acquisition impaired the ability to retain the motor memory overnight. Thus, in the force field task we found a critical role for the cerebellum in both formation of motor memory and its retention. PMID:24816533

Analysis of dynamic behavior of multiple-stage planetary gear train used in wind driven generator.

PubMed

Wang, Jungang; Wang, Yong; Huo, Zhipu

2014-01-01

A dynamic model of multiple-stage planetary gear train composed of a two-stage planetary gear train and a one-stage parallel axis gear is proposed to be used in wind driven generator to analyze the influence of revolution speed and mesh error on dynamic load sharing characteristic based on the lumped parameter theory. Dynamic equation of the model is solved using numerical method to analyze the uniform load distribution of the system. It is shown that the load sharing property of the system is significantly affected by mesh error and rotational speed; load sharing coefficient and change rate of internal and external meshing of the system are of obvious difference from each other. The study provides useful theoretical guideline for the design of the multiple-stage planetary gear train of wind driven generator.

Analysis of Dynamic Behavior of Multiple-Stage Planetary Gear Train Used in Wind Driven Generator

PubMed Central

Wang, Jungang; Wang, Yong; Huo, Zhipu

2014-01-01

A dynamic model of multiple-stage planetary gear train composed of a two-stage planetary gear train and a one-stage parallel axis gear is proposed to be used in wind driven generator to analyze the influence of revolution speed and mesh error on dynamic load sharing characteristic based on the lumped parameter theory. Dynamic equation of the model is solved using numerical method to analyze the uniform load distribution of the system. It is shown that the load sharing property of the system is significantly affected by mesh error and rotational speed; load sharing coefficient and change rate of internal and external meshing of the system are of obvious difference from each other. The study provides useful theoretical guideline for the design of the multiple-stage planetary gear train of wind driven generator. PMID:24511295

Improving Pathologists' Communication Skills.

PubMed

Dintzis, Suzanne

2016-08-01

The 2015 Institute of Medicine report on diagnostic error has placed a national spotlight on the importance of improving communication among clinicians and between clinicians and patients [1]. The report emphasizes the critical role that communication plays in patient safety and outlines ways that pathologists can support this process. Despite recognition of communication as an essential element in patient care, pathologists currently undergo limited (if any) formal training in communication skills. To address this gap, we at the University of Washington Medical Center developed communication training with the goal of establishing best practice procedures for effective pathology communication. The course includes lectures, role playing, and simulated clinician-pathologist interactions for training and evaluation of pathology communication performance. Providing communication training can help create reliable communication pathways that anticipate and address potential barriers and errors before they happen. © 2016 American Medical Association. All Rights Reserved.

Experience of automation failures in training: effects on trust, automation bias, complacency and performance.

PubMed

Sauer, Juergen; Chavaillaz, Alain; Wastell, David

2016-06-01

This work examined the effects of operators' exposure to various types of automation failures in training. Forty-five participants were trained for 3.5 h on a simulated process control environment. During training, participants either experienced a fully reliable, automatic fault repair facility (i.e. faults detected and correctly diagnosed), a misdiagnosis-prone one (i.e. faults detected but not correctly diagnosed) or a miss-prone one (i.e. faults not detected). One week after training, participants were tested for 3 h, experiencing two types of automation failures (misdiagnosis, miss). The results showed that automation bias was very high when operators trained on miss-prone automation encountered a failure of the diagnostic system. Operator errors resulting from automation bias were much higher when automation misdiagnosed a fault than when it missed one. Differences in trust levels that were instilled by the different training experiences disappeared during the testing session. Practitioner Summary: The experience of automation failures during training has some consequences. A greater potential for operator errors may be expected when an automatic system failed to diagnose a fault than when it failed to detect one.

Targeting latent function: encouraging effective encoding for successful memory training and transfer.

PubMed

Lustig, Cindy; Flegal, Kristin E

2008-12-01

Cognitive training programs for older adults often result in improvements at the group level. However, there are typically large age and individual differences in the size of training benefits. These differences may be related to the degree to which participants implement the processes targeted by the training program. To test this possibility, we tested older adults in a memory-training procedure either under specific strategy instructions designed to encourage semantic, integrative encoding, or in a condition that encouraged time and attention to encoding but allowed participants to choose their own strategy. Both conditions improved the performance of old-old adults relative to an earlier study (D. Bissig & C. Lustig, 2007) and reduced self-reports of everyday memory errors. Performance in the strategy-instruction group was related to preexisting ability; performance in the strategy?choice group was not. The strategy-choice group performed better on a laboratory transfer test of recognition memory, and training performance was correlated with reduced everyday memory errors. Training programs that target participants' latent but inefficiently used abilities while allowing flexibility in bringing those abilities to bear may best promote effective training and transfer. Copyright (c) 2009 APA, all rights reserved.

Assessing the predictors for training in management amongst hospital managers and chief executive officers: a cross-sectional study of hospitals in Abuja, Nigeria.

PubMed

Ochonma, Ogbonnia Godfrey; Nwatu, Stephen Ikechukwu

2018-06-14

There is a compelling need for management training amongst hospital managers in Nigeria mostly because management was never a part of the curricula in medical schools and this has resulted in their deficiencies in effective policymaking, planning and bottom line management. There has been no study to the best of our knowledge on the need and likely factors that may influence the acquisition of such training by hospital managers and this in effect was the reason for this study. Data for this study came from a cross-sectional survey distributed amongst management staff in twenty five (25) hospitals that were purposively selected. One hundred and twenty five (125) questionnaires were distributed, out of which one hundred and four (104) were answered and returned giving a response rate of 83.2%. Descriptive and Inferential statistics were used to summarize the results. Decisions were made at 5% level of significance. A binary logistic regression was performed on the data to predict the logit of being formally and informally trained in health management. These statistical techniques were done using the IBM SPSS version 20. The result revealed a high level of formal and informal trainings amongst the respondent managers. In formal management training, only few had no training (27.9%) while in informal management training, all had obtained a form of training of which in-service training predominates (84.6%). Most of the administrators/managers also had the intention of attending healthcare management programme within the next five years (62.5%). Socio-demographically, age (p = .032) and academic qualification (p < .001) had significant influence on training. Number of hospital beds (p < .001) and number of staff (p < .001) including managers' current designation (p < .001) also had significant influence on training. Our work did establish the critical need for both formal and informal trainings in health management for health care managers. Emphasis on training should be directed at younger managers who are the least likely to acquire such trainings, the smaller and private hospitals who are less likely to encourage such trainings amongst their staff and the least educated amongst health managers.

Relationship between Recent Flight Experience and Pilot Error General Aviation Accidents

NASA Astrophysics Data System (ADS)

Nilsson, Sarah J.

Aviation insurance agents and fixed-base operation (FBO) owners use recent flight experience, as implied by the 90-day rule, to measure pilot proficiency in physical airplane skills, and to assess the likelihood of a pilot error accident. The generally accepted premise is that more experience in a recent timeframe predicts less of a propensity for an accident, all other factors excluded. Some of these aviation industry stakeholders measure pilot proficiency solely by using time flown within the past 90, 60, or even 30 days, not accounting for extensive research showing aeronautical decision-making and situational awareness training decrease the likelihood of a pilot error accident. In an effort to reduce the pilot error accident rate, the Federal Aviation Administration (FAA) has seen the need to shift pilot training emphasis from proficiency in physical airplane skills to aeronautical decision-making and situational awareness skills. However, current pilot training standards still focus more on the former than on the latter. The relationship between pilot error accidents and recent flight experience implied by the FAA's 90-day rule has not been rigorously assessed using empirical data. The intent of this research was to relate recent flight experience, in terms of time flown in the past 90 days, to pilot error accidents. A quantitative ex post facto approach, focusing on private pilots of single-engine general aviation (GA) fixed-wing aircraft, was used to analyze National Transportation Safety Board (NTSB) accident investigation archival data. The data were analyzed using t-tests and binary logistic regression. T-tests between the mean number of hours of recent flight experience of tricycle gear pilots involved in pilot error accidents (TPE) and non-pilot error accidents (TNPE), t(202) = -.200, p = .842, and conventional gear pilots involved in pilot error accidents (CPE) and non-pilot error accidents (CNPE), t(111) = -.271, p = .787, indicate there is no statistically significant relationship between groups. Binary logistic regression indicate that recent flight experience does not reliably distinguish between pilot error and non-pilot error accidents for TPE/TNPE, chi2 = 0.040 (df=1, p = .841) and CPE/CNPE, chi2= 0.074 (df =1, p = .786). Future research could focus on different pilot populations, and to broaden the scope, analyze several years of data.

Evaluating segmentation error without ground truth.

PubMed

Kohlberger, Timo; Singh, Vivek; Alvino, Chris; Bahlmann, Claus; Grady, Leo

2012-01-01

The automatic delineation of the boundaries of organs and other anatomical structures is a key component of many medical image processing systems. In this paper we present a generic learning approach based on a novel space of segmentation features, which can be trained to predict the overlap error and Dice coefficient of an arbitrary organ segmentation without knowing the ground truth delineation. We show the regressor to be much stronger a predictor of these error metrics than the responses of probabilistic boosting classifiers trained on the segmentation boundary. The presented approach not only allows us to build reliable confidence measures and fidelity checks, but also to rank several segmentation hypotheses against each other during online usage of the segmentation algorithm in clinical practice.

Older Adults with Mild Cognitive Impairments Show Less Driving Errors after a Multiple Sessions Simulator Training Program but Do Not Exhibit Long Term Retention.

PubMed

Teasdale, Normand; Simoneau, Martin; Hudon, Lisa; Germain Robitaille, Mathieu; Moszkowicz, Thierry; Laurendeau, Denis; Bherer, Louis; Duchesne, Simon; Hudon, Carol

2016-01-01

The driving performance of individuals with mild cognitive impairment (MCI) is suboptimal when compared to healthy older adults. It is expected that the driving will worsen with the progression of the cognitive decline and thus, whether or not these individuals should continue to drive is a matter of debate. The aim of the study was to provide support to the claim that individuals with MCI can benefit from a training program and improve their overall driving performance in a driving simulator. Fifteen older drivers with MCI participated in five training sessions in a simulator (over a 21-day period) and in a 6-month recall session. During training, they received automated auditory feedback on their performance when an error was noted about various maneuvers known to be suboptimal in MCI individuals (for instance, weaving, omitting to indicate a lane change, to verify a blind spot, or to engage in a visual search before crossing an intersection). The number of errors was compiled for eight different maneuvers for all sessions. For the initial five sessions, a gradual and significant decrease in the number of errors was observed, indicating learning and safer driving. The level of performance, however, was not maintained at the 6-month recall session. Nevertheless, the initial learning observed opens up possibilities to undertake more regular interventions to maintain driving skills and safe driving in MCI individuals.

Vision-based mobile robot navigation through deep convolutional neural networks and end-to-end learning

NASA Astrophysics Data System (ADS)

Zhang, Yachu; Zhao, Yuejin; Liu, Ming; Dong, Liquan; Kong, Lingqin; Liu, Lingling

2017-09-01

In contrast to humans, who use only visual information for navigation, many mobile robots use laser scanners and ultrasonic sensors along with vision cameras to navigate. This work proposes a vision-based robot control algorithm based on deep convolutional neural networks. We create a large 15-layer convolutional neural network learning system and achieve the advanced recognition performance. Our system is trained from end to end to map raw input images to direction in supervised mode. The images of data sets are collected in a wide variety of weather conditions and lighting conditions. Besides, the data sets are augmented by adding Gaussian noise and Salt-and-pepper noise to avoid overfitting. The algorithm is verified by two experiments, which are line tracking and obstacle avoidance. The line tracking experiment is proceeded in order to track the desired path which is composed of straight and curved lines. The goal of obstacle avoidance experiment is to avoid the obstacles indoor. Finally, we get 3.29% error rate on the training set and 5.1% error rate on the test set in the line tracking experiment, 1.8% error rate on the training set and less than 5% error rate on the test set in the obstacle avoidance experiment. During the actual test, the robot can follow the runway centerline outdoor and avoid the obstacle in the room accurately. The result confirms the effectiveness of the algorithm and our improvement in the network structure and train parameters

A role for midline and intralaminar thalamus in the associative blocking of Pavlovian fear conditioning.

PubMed

Sengupta, Auntora; McNally, Gavan P

2014-01-01

Fear learning occurs in response to positive prediction error, when the expected outcome of a conditioning trial exceeds that predicted by the conditioned stimuli present. This role for error in Pavlovian association formation is best exemplified by the phenomenon of associative blocking, whereby prior fear conditioning of conditioned stimulus (CS) A is able to prevent learning to CSB when they are conditioned in compound. The midline and intralaminar thalamic nuclei (MIT) are well-placed to contribute to fear prediction error because they receive extensive projections from the midbrain periaqueductal gray-which has a key role in fear prediction error-and project extensively to prefrontal cortex and amygdala. Here we used an associative blocking design to study the role of MIT in fear learning. In Stage I rats were trained to fear CSA via pairings with shock. In Stage II rats received compound fear conditioning of CSAB paired with shock. On test, rats that received Stage I training expressed less fear to CSB relative to control rats that did not receive this training. Microinjection of bupivacaine into MIT prior to Stage II training had no effect on the expression of fear during Stage II and had no effect on fear learning in controls, but prevented associative blocking and so enabled fear learning to CSB. These results show an important role for MIT in predictive fear learning and are discussed with reference to previous findings implicating the midline and posterior intralaminar thalamus in fear learning and fear responding.

Quantifying Biomass from Point Clouds by Connecting Representations of Ecosystem Structure

NASA Astrophysics Data System (ADS)

Hendryx, S. M.; Barron-Gafford, G.

2017-12-01

Quantifying terrestrial ecosystem biomass is an essential part of monitoring carbon stocks and fluxes within the global carbon cycle and optimizing natural resource management. Point cloud data such as from lidar and structure from motion can be effective for quantifying biomass over large areas, but significant challenges remain in developing effective models that allow for such predictions. Inference models that estimate biomass from point clouds are established in many environments, yet, are often scale-dependent, needing to be fitted and applied at the same spatial scale and grid size at which they were developed. Furthermore, training such models typically requires large in situ datasets that are often prohibitively costly or time-consuming to obtain. We present here a scale- and sensor-invariant framework for efficiently estimating biomass from point clouds. Central to this framework, we present a new algorithm, assignPointsToExistingClusters, that has been developed for finding matches between in situ data and clusters in remotely-sensed point clouds. The algorithm can be used for assessing canopy segmentation accuracy and for training and validating machine learning models for predicting biophysical variables. We demonstrate the algorithm's efficacy by using it to train a random forest model of above ground biomass in a shrubland environment in Southern Arizona. We show that by learning a nonlinear function to estimate biomass from segmented canopy features we can reduce error, especially in the presence of inaccurate clusterings, when compared to a traditional, deterministic technique to estimate biomass from remotely measured canopies. Our random forest on cluster features model extends established methods of training random forest regressions to predict biomass of subplots but requires significantly less training data and is scale invariant. The random forest on cluster features model reduced mean absolute error, when evaluated on all test data in leave one out cross validation, by 40.6% from deterministic mesquite allometry and 35.9% from the inferred ecosystem-state allometric function. Our framework should allow for the inference of biomass more efficiently than common subplot methods and more accurately than individual tree segmentation methods in densely vegetated environments.

Precision electronic speed controller for an alternating-current motor

DOEpatents

Bolie, V.W.

A high precision controller for an alternating-current multi-phase electrical motor that is subject to a large inertial load. The controller was developed for controlling, in a neutron chopper system, a heavy spinning rotor that must be rotated in phase-locked synchronism with a reference pulse train that is representative of an ac power supply signal having a meandering line frequency. The controller includes a shaft revolution sensor which provides a feedback pulse train representative of the actual speed of the motor. An internal digital timing signal generator provides a reference signal which is compared with the feedback signal in a computing unit to provide a motor control signal. The motor control signal is a weighted linear sum of a speed error voltage, a phase error voltage, and a drift error voltage, each of which is computed anew with each revolution of the motor shaft. The speed error signal is generated by a novel vernier-logic circuit which is drift-free and highly sensitive to small speed changes. The phase error is also computed by digital logic, with adjustable sensitivity around a 0 mid-scale value. The drift error signal, generated by long-term counting of the phase error, is used to compensate for any slow changes in the average friction drag on the motor. An auxillary drift-byte status sensor prevents any disruptive overflow or underflow of the drift-error counter. An adjustable clocked-delay unit is inserted between the controller and the source of the reference pulse train to permit phase alignment of the rotor to any desired offset angle. The stator windings of the motor are driven by two amplifiers which are provided with input signals having the proper quadrature relationship by an exciter unit consisting of a voltage controlled oscillator, a binary counter, a pair of read-only memories, and a pair of digital-to-analog converters.

Reducing visual deficits caused by refractive errors in school and preschool children: results of a pilot school program in the Andean region of Apurimac, Peru.

PubMed

Latorre-Arteaga, Sergio; Gil-González, Diana; Enciso, Olga; Phelan, Aoife; García-Muñoz, Angel; Kohler, Johannes

2014-01-01

Refractive error is defined as the inability of the eye to bring parallel rays of light into focus on the retina, resulting in nearsightedness (myopia), farsightedness (Hyperopia) or astigmatism. Uncorrected refractive error in children is associated with increased morbidity and reduced educational opportunities. Vision screening (VS) is a method for identifying children with visual impairment or eye conditions likely to lead to visual impairment. To analyze the utility of vision screening conducted by teachers and to contribute to a better estimation of the prevalence of childhood refractive errors in Apurimac, Peru. Design : A pilot vision screening program in preschool (Group I) and elementary school children (Group II) was conducted with the participation of 26 trained teachers. Children whose visual acuity was<6/9 [20/30] (Group I) and ≤ 6/9 (Group II) in one or both eyes, measured with the Snellen Tumbling E chart at 6 m, were referred for a comprehensive eye exam. Specificity and positive predictive value to detect refractive error were calculated against clinical examination. Program assessment with participants was conducted to evaluate outcomes and procedures. A total sample of 364 children aged 3-11 were screened; 45 children were examined at Centro Oftalmológico Monseñor Enrique Pelach (COMEP) Eye Hospital. Prevalence of refractive error was 6.2% (Group I) and 6.9% (Group II); specificity of teacher vision screening was 95.8% and 93.0%, while positive predictive value was 59.1% and 47.8% for each group, respectively. Aspects highlighted to improve the program included extending training, increasing parental involvement, and helping referred children to attend the hospital. Prevalence of refractive error in children is significant in the region. Vision screening performed by trained teachers is a valid intervention for early detection of refractive error, including screening of preschool children. Program sustainability and improvements in education and quality of life resulting from childhood vision screening require further research.

Simulation techniques for estimating error in the classification of normal patterns

NASA Technical Reports Server (NTRS)

Whitsitt, S. J.; Landgrebe, D. A.

1974-01-01

Methods of efficiently generating and classifying samples with specified multivariate normal distributions were discussed. Conservative confidence tables for sample sizes are given for selective sampling. Simulation results are compared with classified training data. Techniques for comparing error and separability measure for two normal patterns are investigated and used to display the relationship between the error and the Chernoff bound.

Effect of proprioception training on knee joint position sense in female team handball players.

PubMed

Pánics, G; Tállay, A; Pavlik, A; Berkes, I

2008-06-01

A number of studies have shown that proprioception training can reduce the risk of injuries in pivoting sports, but the mechanism is not clearly understood. To determine the contributing effects of propioception on knee joint position sense among team handball players. Prospective cohort study. Two professional female handball teams were followed prospectively for the 2005-6 season. 20 players in the intervention team followed a prescribed proprioceptive training programme while 19 players in the control team did not have a specific propioceptive training programme. The coaches recorded all exposures of the individual players. The location and nature of injuries were recorded. Joint position sense (JPS) was measured by a goniometer on both knees in three angle intervals, testing each angle five times. Assessments were performed before and after the season by the same examiner for both teams. In the intervention team a third assessment was also performed during the season. Complete data were obtained for 15 subjects in the intervention team and 16 in the control team. Absolute error score, error of variation score and SEM were calculated and the results of the intervention and control teams were compared. The proprioception sensory function of the players in the intervention team was significantly improved between the assessments made at the start and the end of the season (mean (SD) absolute error 9.78-8.21 degrees (7.19-6.08 degrees ) vs 3.61-4.04 degrees (3.71-3.20 degrees ), p<0.05). No improvement was seen in the sensory function in the control team between the start and the end of the season (mean (SD) absolute error 6.31-6.22 degrees (6.12-3.59 degrees ) vs 6.13-6.69 degrees (7.46-6.49 degrees ), p>0.05). This is the first study to show that proprioception training improves the joint position sense in elite female handball players. This may explain the effect of neuromuscular training in reducing the injury rate.

An Instructor's Diagnostic Aid for Feedback in Training.

ERIC Educational Resources Information Center

Andrews, Dee H.; Uliano, Kevin C.

1988-01-01

Instructor's Diagnostic Aid for Feedback in Training (IDAFT) is a computer-assisted method based on error analysis, domains of learning, and events of instruction. Its use with Navy team instructors is currently being explored. (JOW)

5 CFR 930.301 - Information systems security awareness training program.

Code of Federal Regulations, 2012 CFR

2012-01-01

... training in system/application life cycle management, risk management, and contingency planning. (4) Chief... security management, system/application life cycle management, risk management, and contingency planning... management; and management and implementation level training in system/application life cycle management...

Effects of brief training on use of automated external defibrillators by people without medical expertise.

PubMed

Mitchell, K Blake; Gugerty, Leo; Muth, Eric

2008-04-01

This study examined the effect of three types of brief training on the use of automatic external defibrillators (AEDs) by 43 lay users. Because AEDs were recently approved for home use, brief training for nonprofessional users needs investigation. During training, the exposure training group read an article about AEDs that provided no information on how to operate them; the low-training group inspected the AED and read the operating instructions in the paper-based manual but was not allowed to use the device; and the high-training group watched a training video and performed a mock resuscitation using the AED but no manikin. All participants returned 2 weeks later and performed a surprise simulated AED resuscitation on a manikin. Most participants in each training group met criteria of minimally acceptable performance during the simulated manikin resuscitation, as measured by time to first shock, pad placement accuracy, and safety check performance. All participants who committed errors were able to successfully recover from them to complete the resuscitation. Compared with exposure training, the low and high training had a beneficial effect on time to first shock and errors. Untrained users were able to adequately use this AED, demonstrating walk-up-and-use usability, but additional brief training improved user performance. This study demonstrated the importance of providing high-quality but brief training for home AED users. In conjunction with other findings, the current study helps demonstrate the need for well-designed training for consumer medical devices.

Procrastination at work and time management training.

PubMed

Van Eerde, Wendelien

2003-09-01

The author examined the impact of time management training on self-reported procrastination. In an intervention study, 37 employees attended a 1 1/2-day time management training seminar. A control group of employees (n = 14) who were awaiting training also participated in the study to control for expectancy effects. One month after undergoing time management training, trainees reported a significant decrease in avoidance behavior and worry and an increase in their ability to manage time. The results suggest that time management training is helpful in lessening worry and procrastination at work.

Radiation-Hardened Solid-State Drive

NASA Technical Reports Server (NTRS)

Sheldon, Douglas J.

2010-01-01

A method is provided for a radiationhardened (rad-hard) solid-state drive for space mission memory applications by combining rad-hard and commercial off-the-shelf (COTS) non-volatile memories (NVMs) into a hybrid architecture. The architecture is controlled by a rad-hard ASIC (application specific integrated circuit) or a FPGA (field programmable gate array). Specific error handling and data management protocols are developed for use in a rad-hard environment. The rad-hard memories are smaller in overall memory density, but are used to control and manage radiation-induced errors in the main, and much larger density, non-rad-hard COTS memory devices. Small amounts of rad-hard memory are used as error buffers and temporary caches for radiation-induced errors in the large COTS memories. The rad-hard ASIC/FPGA implements a variety of error-handling protocols to manage these radiation-induced errors. The large COTS memory is triplicated for protection, and CRC-based counters are calculated for sub-areas in each COTS NVM array. These counters are stored in the rad-hard non-volatile memory. Through monitoring, rewriting, regeneration, triplication, and long-term storage, radiation-induced errors in the large NV memory are managed. The rad-hard ASIC/FPGA also interfaces with the external computer buses.

Validation Relaxation: A Quality Assurance Strategy for Electronic Data Collection

PubMed Central

Gordon, Nicholas; Griffiths, Thomas; Kraemer, John D; Siedner, Mark J

2017-01-01

Background The use of mobile devices for data collection in developing world settings is becoming increasingly common and may offer advantages in data collection quality and efficiency relative to paper-based methods. However, mobile data collection systems can hamper many standard quality assurance techniques due to the lack of a hardcopy backup of data. Consequently, mobile health data collection platforms have the potential to generate datasets that appear valid, but are susceptible to unidentified database design flaws, areas of miscomprehension by enumerators, and data recording errors. Objective We describe the design and evaluation of a strategy for estimating data error rates and assessing enumerator performance during electronic data collection, which we term “validation relaxation.” Validation relaxation involves the intentional omission of data validation features for select questions to allow for data recording errors to be committed, detected, and monitored. Methods We analyzed data collected during a cluster sample population survey in rural Liberia using an electronic data collection system (Open Data Kit). We first developed a classification scheme for types of detectable errors and validation alterations required to detect them. We then implemented the following validation relaxation techniques to enable data error conduct and detection: intentional redundancy, removal of “required” constraint, and illogical response combinations. This allowed for up to 11 identifiable errors to be made per survey. The error rate was defined as the total number of errors committed divided by the number of potential errors. We summarized crude error rates and estimated changes in error rates over time for both individuals and the entire program using logistic regression. Results The aggregate error rate was 1.60% (125/7817). Error rates did not differ significantly between enumerators (P=.51), but decreased for the cohort with increasing days of application use, from 2.3% at survey start (95% CI 1.8%-2.8%) to 0.6% at day 45 (95% CI 0.3%-0.9%; OR=0.969; P<.001). The highest error rate (84/618, 13.6%) occurred for an intentional redundancy question for a birthdate field, which was repeated in separate sections of the survey. We found low error rates (0.0% to 3.1%) for all other possible errors. Conclusions A strategy of removing validation rules on electronic data capture platforms can be used to create a set of detectable data errors, which can subsequently be used to assess group and individual enumerator error rates, their trends over time, and categories of data collection that require further training or additional quality control measures. This strategy may be particularly useful for identifying individual enumerators or systematic data errors that are responsive to enumerator training and is best applied to questions for which errors cannot be prevented through training or software design alone. Validation relaxation should be considered as a component of a holistic data quality assurance strategy. PMID:28821474

Validation Relaxation: A Quality Assurance Strategy for Electronic Data Collection.

PubMed

Kenny, Avi; Gordon, Nicholas; Griffiths, Thomas; Kraemer, John D; Siedner, Mark J

2017-08-18

The use of mobile devices for data collection in developing world settings is becoming increasingly common and may offer advantages in data collection quality and efficiency relative to paper-based methods. However, mobile data collection systems can hamper many standard quality assurance techniques due to the lack of a hardcopy backup of data. Consequently, mobile health data collection platforms have the potential to generate datasets that appear valid, but are susceptible to unidentified database design flaws, areas of miscomprehension by enumerators, and data recording errors. We describe the design and evaluation of a strategy for estimating data error rates and assessing enumerator performance during electronic data collection, which we term "validation relaxation." Validation relaxation involves the intentional omission of data validation features for select questions to allow for data recording errors to be committed, detected, and monitored. We analyzed data collected during a cluster sample population survey in rural Liberia using an electronic data collection system (Open Data Kit). We first developed a classification scheme for types of detectable errors and validation alterations required to detect them. We then implemented the following validation relaxation techniques to enable data error conduct and detection: intentional redundancy, removal of "required" constraint, and illogical response combinations. This allowed for up to 11 identifiable errors to be made per survey. The error rate was defined as the total number of errors committed divided by the number of potential errors. We summarized crude error rates and estimated changes in error rates over time for both individuals and the entire program using logistic regression. The aggregate error rate was 1.60% (125/7817). Error rates did not differ significantly between enumerators (P=.51), but decreased for the cohort with increasing days of application use, from 2.3% at survey start (95% CI 1.8%-2.8%) to 0.6% at day 45 (95% CI 0.3%-0.9%; OR=0.969; P<.001). The highest error rate (84/618, 13.6%) occurred for an intentional redundancy question for a birthdate field, which was repeated in separate sections of the survey. We found low error rates (0.0% to 3.1%) for all other possible errors. A strategy of removing validation rules on electronic data capture platforms can be used to create a set of detectable data errors, which can subsequently be used to assess group and individual enumerator error rates, their trends over time, and categories of data collection that require further training or additional quality control measures. This strategy may be particularly useful for identifying individual enumerators or systematic data errors that are responsive to enumerator training and is best applied to questions for which errors cannot be prevented through training or software design alone. Validation relaxation should be considered as a component of a holistic data quality assurance strategy. ©Avi Kenny, Nicholas Gordon, Thomas Griffiths, John D Kraemer, Mark J Siedner. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 18.08.2017.

14 CFR 121.404 - Compliance dates: Crew and dispatcher resource management training.

Code of Federal Regulations, 2010 CFR

2010-01-01

... approved crew resource management (CRM) or dispatcher resource management (DRM) initial training, as... resource management training. 121.404 Section 121.404 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION... § 121.404 Compliance dates: Crew and dispatcher resource management training. After March 19, 1998, no...

Individualised training to address variability of radiologists' performance

NASA Astrophysics Data System (ADS)

Sun, Shanghua; Taylor, Paul; Wilkinson, Louise; Khoo, Lisanne

2008-03-01

Computer-based tools are increasingly used for training and the continuing professional development of radiologists. We propose an adaptive training system to support individualised learning in mammography, based on a set of real cases, which are annotated with educational content by experienced breast radiologists. The system has knowledge of the strengths and weakness of each radiologist's performance: each radiologist is assessed to compute a profile showing how they perform on different sets of cases, classified by type of abnormality, breast density, and perceptual difficulty. We also assess variability in cognitive aspects of image perception, classifying errors made by radiologists as errors of search, recognition or decision. This is a novel element in our approach. The profile is used to select cases to present to the radiologist. The intelligent and flexible presentation of these cases distinguishes our system from existing training tools. The training cases are organised and indexed by an ontology we have developed for breast radiologist training, which is consistent with the radiologists' profile. Hence, the training system is able to select appropriate cases to compose an individualised training path, addressing the variability of the radiologists' performance. A substantial part of the system, the ontology has been evaluated on a large number of cases, and the training system is under implementation for further evaluation.

Planning Training Loads for the 400 M Hurdles in Three-Month Mesocycles using Artificial Neural Networks.

PubMed

Przednowek, Krzysztof; Iskra, Janusz; Wiktorowicz, Krzysztof; Krzeszowski, Tomasz; Maszczyk, Adam

2017-12-01

This paper presents a novel approach to planning training loads in hurdling using artificial neural networks. The neural models performed the task of generating loads for athletes' training for the 400 meters hurdles. All the models were calculated based on the training data of 21 Polish National Team hurdlers, aged 22.25 ± 1.96, competing between 1989 and 2012. The analysis included 144 training plans that represented different stages in the annual training cycle. The main contribution of this paper is to develop neural models for planning training loads for the entire career of a typical hurdler. In the models, 29 variables were used, where four characterized the runner and 25 described the training process. Two artificial neural networks were used: a multi-layer perceptron and a network with radial basis functions. To assess the quality of the models, the leave-one-out cross-validation method was used in which the Normalized Root Mean Squared Error was calculated. The analysis shows that the method generating the smallest error was the radial basis function network with nine neurons in the hidden layer. Most of the calculated training loads demonstrated a non-linear relationship across the entire competitive period. The resulting model can be used as a tool to assist a coach in planning training loads during a selected training period.

Planning Training Loads for the 400 M Hurdles in Three-Month Mesocycles using Artificial Neural Networks

PubMed Central

Iskra, Janusz; Wiktorowicz, Krzysztof; Krzeszowski, Tomasz; Maszczyk, Adam

2017-01-01

Abstract This paper presents a novel approach to planning training loads in hurdling using artificial neural networks. The neural models performed the task of generating loads for athletes’ training for the 400 meters hurdles. All the models were calculated based on the training data of 21 Polish National Team hurdlers, aged 22.25 ± 1.96, competing between 1989 and 2012. The analysis included 144 training plans that represented different stages in the annual training cycle. The main contribution of this paper is to develop neural models for planning training loads for the entire career of a typical hurdler. In the models, 29 variables were used, where four characterized the runner and 25 described the training process. Two artificial neural networks were used: a multi-layer perceptron and a network with radial basis functions. To assess the quality of the models, the leave-one-out cross-validation method was used in which the Normalized Root Mean Squared Error was calculated. The analysis shows that the method generating the smallest error was the radial basis function network with nine neurons in the hidden layer. Most of the calculated training loads demonstrated a non-linear relationship across the entire competitive period. The resulting model can be used as a tool to assist a coach in planning training loads during a selected training period. PMID:29339998

The role of semantic complexity in treatment of naming deficits: training semantic categories in fluent aphasia by controlling exemplar typicality.

PubMed

Kiran, Swathi; Thompson, Cynthia K

2003-06-01

The effect of typicality of category exemplars on naming was investigated using a single subject experimental design across participants and behaviors in 4 patients with fluent aphasia. Participants received a semantic feature treatment to improve naming of either typical or atypical items within semantic categories, while generalization was tested to untrained items of the category. The order of typicality and category trained was counterbalanced across participants. Results indicated that patients trained on naming of atypical exemplars demonstrated generalization to naming of intermediate and typical items. However, patients trained on typical items demonstrated no generalized naming effect to intermediate or atypical examples. Furthermore, analysis of errors indicated an evolution of errors throughout training, from those with no apparent relationship to the target to primarily semantic and phonemic paraphasias. Performance on standardized language tests also showed changes as a function of treatment. Theoretical and clinical implications regarding the impact of considering semantic complexity on rehabilitation of naming deficits in aphasia are discussed.

The role of semantic complexity in treatment of naming deficits: training semantic categories in fluent aphasia by controlling exemplar typicality.

PubMed

Kiran, Swathi; Thompson, Cynthia K

2003-08-01

The effect of typicality of category exemplars on naming was investigated using a single subject experimental design across participants and behaviors in 4 patients with fluent aphasia. Participants received a semantic feature treatment to improve naming of either typical or atypical items within semantic categories, while generalization was tested to untrained items of the category. The order of typicality and category trained was counterbalanced across participants. Results indicated that patients trained on naming of atypical exemplars demonstrated generalization to naming of intermediate and typical items. However, patients trained on typical items demonstrated no generalized naming effect to intermediate or atypical examples. Furthermore, analysis of errors indicated an evolution of errors throughout training, from those with no apparent relationship to the target to primarily semantic and phonemic paraphasias. Performance on standardized language tests also showed changes as a function of treatment. Theoretical and clinical implications regarding the impact of considering semantic complexity on rehabilitation of naming deficits in aphasia are discussed.

[Development of a training program for Japanese dyslexic children and its short-term efficacy].

PubMed

Wakamiya, Eiji; Takeshita, Takashi; Nakanishi, Makoto; Mizuta, Mekumi; Kurimoto, Naoko; Okumura, Tomohito; Tamai, Hiroshi; Koeda, Tatsuya; Inagaki, Masumi

2013-07-01

The purpose of this study is to develop a computer training program of reading for the Japanese dyslexic children and to examine its short-term efficacy on their reading and writing abilities. Fifteen dyslexic children underwent two sets of training programs, one for single-hiragana and non-word reading, and the other for the reading of real words, in which each hiragana was followed by the correctly read sound. Subjects were required to use a given program for five minutes a day for three weeks, switching to the other program after a three-week interval. Four kinds of reading test and one writing test were done at the beginning and end of each program period. The averages reading speeds increased, and the single-hiragana reading error average was lower after the training. Hiragana-writing errors also decreased, even though no writing procedure was involved in the programs. The results indicate the usefulness of these training programs as an early intervention of reading and writing for the Japanese dyslexic children.

Minimising human error in malaria rapid diagnosis: clarity of written instructions and health worker performance.

PubMed

Rennie, Waverly; Phetsouvanh, Rattanaxay; Lupisan, Socorro; Vanisaveth, Viengsay; Hongvanthong, Bouasy; Phompida, Samlane; Alday, Portia; Fulache, Mila; Lumagui, Richard; Jorgensen, Pernille; Bell, David; Harvey, Steven

2007-01-01

The usefulness of rapid diagnostic tests (RDT) in malaria case management depends on the accuracy of the diagnoses they provide. Despite their apparent simplicity, previous studies indicate that RDT accuracy is highly user-dependent. As malaria RDTs will frequently be used in remote areas with little supervision or support, minimising mistakes is crucial. This paper describes the development of new instructions (job aids) to improve health worker performance, based on observations of common errors made by remote health workers and villagers in preparing and interpreting RDTs, in the Philippines and Laos. Initial preparation using the instructions provided by the manufacturer was poor, but improved significantly with the job aids (e.g. correct use both of the dipstick and cassette increased in the Philippines by 17%). However, mistakes in preparation remained commonplace, especially for dipstick RDTs, as did mistakes in interpretation of results. A short orientation on correct use and interpretation further improved accuracy, from 70% to 80%. The results indicate that apparently simple diagnostic tests can be poorly performed and interpreted, but provision of clear, simple instructions can reduce these errors. Preparation of appropriate instructions and training as well as monitoring of user behaviour are an essential part of rapid test implementation.

Human factors engineering and design validation for the redesigned follitropin alfa pen injection device.

PubMed

Mahony, Mary C; Patterson, Patricia; Hayward, Brooke; North, Robert; Green, Dawne

2015-05-01

To demonstrate, using human factors engineering (HFE), that a redesigned, pre-filled, ready-to-use, pre-asembled follitropin alfa pen can be used to administer prescribed follitropin alfa doses safely and accurately. A failure modes and effects analysis identified hazards and harms potentially caused by use errors; risk-control measures were implemented to ensure acceptable device use risk management. Participants were women with infertility, their significant others, and fertility nurse (FN) professionals. Preliminary testing included 'Instructions for Use' (IFU) and pre-validation studies. Validation studies used simulated injections in a representative use environment; participants received prior training on pen use. User performance in preliminary testing led to IFU revisions and a change to outer needle cap design to mitigate needle stick potential. In the first validation study (49 users, 343 simulated injections), in the FN group, one observed critical use error resulted in a device design modification and another in an IFU change. A second validation study tested the mitigation strategies; previously reported use errors were not repeated. Through an iterative process involving a series of studies, modifications were made to the pen design and IFU. Simulated-use testing demonstrated that the redesigned pen can be used to administer follitropin alfa effectively and safely.

Managing the patient identification crisis in healthcare and laboratory medicine.

PubMed

Lippi, Giuseppe; Mattiuzzi, Camilla; Bovo, Chiara; Favaloro, Emmanuel J

2017-07-01

Identification errors have emerged as critical issues in health care, as testified by the ample scientific literature on this argument. Despite available evidence suggesting that the frequency of misidentification in vitro laboratory diagnostic testing may be relatively low compared to that of other laboratory errors (i.e., usually comprised between 0.01 and 0.1% of all specimens received), the potential adverse consequences remain particularly worrying, wherein 10-20% of these errors not only would translate into serious harm for the patient, but may also erode considerable human and economic resources, so that the entire healthcare system should be re-engineered to act proactively and limiting the burden of this important problem. The most important paradigms for reducing the chance of misidentification in healthcare entail the widespread use of more than two unique patient identifiers, the accurate education and training of healthcare personnel, the delivery of more resources for patient safety (i.e., implementation of safer technological tools), and the use of customized solutions according to local organization and resources. Moreover, after weighing advantages and drawbacks, labeling blood collection tubes before and not after venipuncture may be considered a safer practice for safeguarding patient safety and optimizing phlebotomist's activity. Copyright © 2017 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.

Nurses' attitude and intention of medication administration error reporting.

PubMed

Hung, Chang-Chiao; Chu, Tsui-Ping; Lee, Bih-O; Hsiao, Chia-Chi

2016-02-01

The Aims of this study were to explore the effects of nurses' attitudes and intentions regarding medication administration error reporting on actual reporting behaviours. Underreporting of medication errors is still a common occurrence. Whether attitude and intention towards medication administration error reporting connect to actual reporting behaviours remain unclear. This study used a cross-sectional design with self-administered questionnaires, and the theory of planned behaviour was used as the framework for this study. A total of 596 staff nurses who worked in general wards and intensive care units in a hospital were invited to participate in this study. The researchers used the instruments measuring nurses' attitude, nurse managers' and co-workers' attitude, report control, and nurses' intention to predict nurses' actual reporting behaviours. Data were collected from September-November 2013. Path analyses were used to examine the hypothesized model. Of the 596 nurses invited to participate, 548 (92%) completed and returned a valid questionnaire. The findings indicated that nurse managers' and co-workers' attitudes are predictors for nurses' attitudes towards medication administration error reporting. Nurses' attitudes also influenced their intention to report medication administration errors; however, no connection was found between intention and actual reporting behaviour. The findings reflected links among colleague perspectives, nurses' attitudes, and intention to report medication administration errors. The researchers suggest that hospitals should increase nurses' awareness and recognition of error occurrence. Regardless of nurse managers' and co-workers' attitudes towards medication administration error reporting, nurses are likely to report medication administration errors if they detect them. Management of medication administration errors should focus on increasing nurses' awareness and recognition of error occurrence. © 2015 John Wiley & Sons Ltd.

A case for safety leadership team training of hospital managers.

PubMed

Singer, Sara J; Hayes, Jennifer; Cooper, Jeffrey B; Vogt, Jay W; Sales, Michael; Aristidou, Angela; Gray, Garry C; Kiang, Mathew V; Meyer, Gregg S

2011-01-01

Delivering safe patient care remains an elusive goal. Resolving problems in complex organizations like hospitals requires managers to work together. Safety leadership training that encourages managers to exercise learning-oriented, team-based leadership behaviors could promote systemic problem solving and enhance patient safety. Despite the need for such training, few programs teach multidisciplinary groups of managers about specific behaviors that can enhance their role as leadership teams in the realm of patient safety. The aims of this study were to describe a learning-oriented, team-based, safety leadership training program composed of reinforcing exercises and to provide evidence confirming the need for such training and demonstrating behavior change among management groups after training. Twelve groups of managers from an academic medical center based in the Northeast United States were randomly selected to participate in the program and exposed to its customized, experience-based, integrated, multimodal curriculum. We extracted data from transcripts of four training sessions over 15 months with groups of managers about the need for the training in these groups and change in participants' awareness, professional behaviors, and group activity. Training transcripts confirmed the need for safety leadership team training and provided evidence of the potential for training to increase targeted behaviors. The training increased awareness and use of leadership behaviors among many managers and led to new routines and coordinated effort among most management groups. Enhanced learning-oriented leadership often helped promote a learning orientation in managers' work areas. Team-based training that promotes specific learning-oriented leader behaviors can promote behavioral change among multidisciplinary groups of hospital managers.

Millennials Invading: Building Training for Today's Admissions Counselors

ERIC Educational Resources Information Center

Barnds, W. Kent

2009-01-01

As chief admissions officer at two small colleges, the author has been responsible, in part, for ensuring that entry-level admissions counselors are trained properly. He learned through trial and error, and has adapted his methods to be increasingly sensitive to the learning curve of new employees. His thoughts about training new admissions…

Effects of Perceptual Training on the Salience of Information in a Recall Problem.

ERIC Educational Resources Information Center

West, Robin L.; Odom, Richard D.

1979-01-01

Kindergarten children were given a salience-assessment task to determine each child's salience hierarchy for the dimensions of form, color, and position, and each was provided perceptual training with his/her least salient dimension. Training promoted fewer errors in recall in comparison to control group subjects. (RH)

Introduction to cognitive processes of expert pilots.

PubMed

Adams, R J; Ericsson, A E

2000-10-01

This report addresses the historical problem that a very high percentage of accidents have been classified as involving "pilot error." Through extensive research since 1977, the Federal Aviation Administration determined that the predominant underlying cause of these types of accidents involved decisional problems or cognitive information processing. To attack these problems, Aeronautical Decision Making (ADM) training materials were developed and tested for ten years. Since the publication of the ADM training manuals in 1987, significant reductions in human performance error (HPE) accidents have been documented both in the U.S. and world wide. However, shortcomings have been observed in the use of these materials for recurrency training and in their relevance to more experienced pilots. The following discussion defines the differences between expert and novice decision makers from a cognitive information processing perspective, correlates the development of expert pilot cognitive processes with training and experience, and reviews accident scenarios which exemplify those processes. This introductory material is a necessary prerequisite to an understanding of how to formulate expert pilot decision making training innovations; and, to continue the record of improved safety through ADM training.

Applied Cognitive Models of Behavior and Errors Patterns

DTIC Science & Technology

2017-09-01

methods offer an opportunity to deliver good , effective introductory and basic training , thus potentially enabling a single human instructor to train ...emergency medical technician (EMT) domain, which offers a standardized curriculum on which we can create training scenarios. 2. Develop...complexity of software integration and limited access to physical devices can result in commitment to a de- sign that turns out to not offer many training

Little room for error in Canada's postgraduate training system

PubMed Central

Robertson, S

1997-01-01

Although the majority of physicians entering residency training in Canada will enjoy fulfilling careers in their chosen specialty, today's postgraduate training system has its critics. Among them are the new graduates who are not satisfied with the residency positions offered to them and practising physicians who would like to re-enter the system to train in a new specialty but find themselves locked out. PMID:9068578

Low colony counts of asymptomatic group B streptococcus bacteriuria: a survey of practice patterns.

PubMed

Aungst, Matthew; King, Jeremy; Steele, Andrew; Gordon, Michael

2004-10-01

The purpose of this study was to survey expert opinion on the management of low colony counts (< 100,000 colony forming units/mL) of asymptomatic group B streptococcus (GBS) bacteriuria discovered in the first trimester. A survey was sent to the 241 senior obstetricians affiliated with each of the Obstetrics and Gynecology training programs in the United States on July 10, 2002. Surveys received by the deadline (September 1, 2002) were included in the dataset. Eighty-five completed surveys were returned for a response rate of 35%. Seventy-seven percent reported treating low colony counts of asymptomatic GBS bacteriuria in the first trimester at the time of diagnosis, whereas 23% stated they did not treat prior to labor (margin of error 7.5% with 95% confidence). Nine percent stated that their institution had a written protocol for the treatment of low colony counts of asymptomatic GBS bacteriuria. Two physicians indicated that they screened for asymptomatic GBS bacteriuria at 28 weeks. Currently, no generally accepted protocol for the management of low colony counts of asymptomatic GBS bacteriuria exists. This survey indicates that most of the responding senior obstetricians at United States training programs treat low colony counts of asymptomatic GBS bacteriuria in the first trimester.

Asymmetric generalization in adaptation to target displacement errors in humans and in a neural network model.

PubMed

Westendorff, Stephanie; Kuang, Shenbing; Taghizadeh, Bahareh; Donchin, Opher; Gail, Alexander

2015-04-01

Different error signals can induce sensorimotor adaptation during visually guided reaching, possibly evoking different neural adaptation mechanisms. Here we investigate reach adaptation induced by visual target errors without perturbing the actual or sensed hand position. We analyzed the spatial generalization of adaptation to target error to compare it with other known generalization patterns and simulated our results with a neural network model trained to minimize target error independent of prediction errors. Subjects reached to different peripheral visual targets and had to adapt to a sudden fixed-amplitude displacement ("jump") consistently occurring for only one of the reach targets. Subjects simultaneously had to perform contralateral unperturbed saccades, which rendered the reach target jump unnoticeable. As a result, subjects adapted by gradually decreasing reach errors and showed negative aftereffects for the perturbed reach target. Reach errors generalized to unperturbed targets according to a translational rather than rotational generalization pattern, but locally, not globally. More importantly, reach errors generalized asymmetrically with a skewed generalization function in the direction of the target jump. Our neural network model reproduced the skewed generalization after adaptation to target jump without having been explicitly trained to produce a specific generalization pattern. Our combined psychophysical and simulation results suggest that target jump adaptation in reaching can be explained by gradual updating of spatial motor goal representations in sensorimotor association networks, independent of learning induced by a prediction-error about the hand position. The simulations make testable predictions about the underlying changes in the tuning of sensorimotor neurons during target jump adaptation. Copyright © 2015 the American Physiological Society.

Asymmetric generalization in adaptation to target displacement errors in humans and in a neural network model

PubMed Central

Westendorff, Stephanie; Kuang, Shenbing; Taghizadeh, Bahareh; Donchin, Opher

2015-01-01

Different error signals can induce sensorimotor adaptation during visually guided reaching, possibly evoking different neural adaptation mechanisms. Here we investigate reach adaptation induced by visual target errors without perturbing the actual or sensed hand position. We analyzed the spatial generalization of adaptation to target error to compare it with other known generalization patterns and simulated our results with a neural network model trained to minimize target error independent of prediction errors. Subjects reached to different peripheral visual targets and had to adapt to a sudden fixed-amplitude displacement (“jump”) consistently occurring for only one of the reach targets. Subjects simultaneously had to perform contralateral unperturbed saccades, which rendered the reach target jump unnoticeable. As a result, subjects adapted by gradually decreasing reach errors and showed negative aftereffects for the perturbed reach target. Reach errors generalized to unperturbed targets according to a translational rather than rotational generalization pattern, but locally, not globally. More importantly, reach errors generalized asymmetrically with a skewed generalization function in the direction of the target jump. Our neural network model reproduced the skewed generalization after adaptation to target jump without having been explicitly trained to produce a specific generalization pattern. Our combined psychophysical and simulation results suggest that target jump adaptation in reaching can be explained by gradual updating of spatial motor goal representations in sensorimotor association networks, independent of learning induced by a prediction-error about the hand position. The simulations make testable predictions about the underlying changes in the tuning of sensorimotor neurons during target jump adaptation. PMID:25609106

Management Training, Yes! Excellence?

ERIC Educational Resources Information Center

Davis, Gary E.

1990-01-01

Management training programs are a necessity for transportation supervisors. Basic and advanced training programs are available through associations for business officials and university fleet management training programs. (MLF)

76 FR 3831 - Crew Resource Management Training for Crewmembers in Part 135 Operations

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-21

... training in the use of crew resource management principles, as appropriate for their operation. This final...; Amendment No.: 135-122] RIN 2120-AJ32 Crew Resource Management Training for Crewmembers in Part 135... include in their training programs crew resource management training for crewmembers, including pilots and...

Medical errors; causes, consequences, emotional response and resulting behavioral change

PubMed Central

Bari, Attia; Khan, Rehan Ahmed; Rathore, Ahsan Waheed

2016-01-01

Objective: To determine the causes of medical errors, the emotional and behavioral response of pediatric medicine residents to their medical errors and to determine their behavior change affecting their future training. Methods: One hundred thirty postgraduate residents were included in the study. Residents were asked to complete questionnaire about their errors and responses to their errors in three domains: emotional response, learning behavior and disclosure of the error. The names of the participants were kept confidential. Data was analyzed using SPSS version 20. Results: A total of 130 residents were included. Majority 128(98.5%) of these described some form of error. Serious errors that occurred were 24(19%), 63(48%) minor, 24(19%) near misses,2(2%) never encountered an error and 17(12%) did not mention type of error but mentioned causes and consequences. Only 73(57%) residents disclosed medical errors to their senior physician but disclosure to patient’s family was negligible 15(11%). Fatigue due to long duty hours 85(65%), inadequate experience 66(52%), inadequate supervision 58(48%) and complex case 58(45%) were common causes of medical errors. Negative emotions were common and were significantly associated with lack of knowledge (p=0.001), missing warning signs (p=<0.001), not seeking advice (p=0.003) and procedural complications (p=0.001). Medical errors had significant impact on resident’s behavior; 119(93%) residents became more careful, increased advice seeking from seniors 109(86%) and 109(86%) started paying more attention to details. Intrinsic causes of errors were significantly associated with increased information seeking behavior and vigilance (p=0.003) and (p=0.01) respectively. Conclusion: Medical errors committed by residents have inadequate disclosure to senior physicians and result in negative emotions but there was positive change in their behavior, which resulted in improvement in their future training and patient care. PMID:27375682

Terminal iterative learning control based station stop control of a train

NASA Astrophysics Data System (ADS)

Hou, Zhongsheng; Wang, Yi; Yin, Chenkun; Tang, Tao

2011-07-01

The terminal iterative learning control (TILC) method is introduced for the first time into the field of train station stop control and three TILC-based algorithms are proposed in this study. The TILC-based train station stop control approach utilises the terminal stop position error in previous braking process to update the current control profile. The initial braking position, or the braking force, or their combination is chosen as the control input, and corresponding learning law is developed. The terminal stop position error of each algorithm is guaranteed to converge to a small region related with the initial offset of braking position with rigorous analysis. The validity of the proposed algorithms is verified by illustrative numerical examples.

Development of a residency program in radiation oncology physics: an inverse planning approach

PubMed Central

Dunscombe, Peter B.

2016-01-01

Over the last two decades, there has been a concerted effort in North America to organize medical physicists’ clinical training programs along more structured and formal lines. This effort has been prompted by the Commission on Accreditation of Medical Physics Education Programs (CAMPEP) which has now accredited about 90 residency programs. Initially the accreditation focused on standardized and higher quality clinical physics training; the development of rounded professionals who can function at a high level in a multidisciplinary environment was recognized as a priority of a radiation oncology physics residency only lately. In this report, we identify and discuss the implementation of, and the essential components of, a radiation oncology physics residency designed to produce knowledgeable and effective clinical physicists for today's safety‐conscious and collaborative work environment. Our approach is that of inverse planning, by now familiar to all radiation oncology physicists, in which objectives and constraints are identified prior to the design of the program. Our inverse planning objectives not only include those associated with traditional residencies (i.e., clinical physics knowledge and critical clinical skills), but also encompass those other attributes essential for success in a modern radiation therapy clinic. These attributes include formal training in management skills and leadership, teaching and communication skills, and knowledge of error management techniques and patient safety. The constraints in our optimization exercise are associated with the limited duration of a residency and the training resources available. Without compromising the knowledge and skills needed for clinical tasks, we have successfully applied the model to the University of Calgary's two‐year residency program. The program requires 3840 hours of overall commitment from the trainee, of which 7%–10% is spent in obtaining formal training in nontechnical “soft skills”. PACS number(s): 01.40 Di, 01.40.gb, 87.10‐e PMID:27074469

Training Attention Improves Decision Making in Individuals with Elevated Self-Reported Depressive Symptoms

PubMed Central

Cooper, Jessica A.; Gorlick, Marissa A.; Denny, Taylor; Worthy, Darrell A.; Beevers, Christopher G.; Maddox, W. Todd

2013-01-01

Depression is often characterized by attentional biases toward negative items and away from positive items, which likely affects reward and punishment processing. Recent work reported that training attention away from negative stimuli reduced this bias and reduced depressive symptoms. However, the effect of attention training on subsequent learning has yet to be explored. In the current study, participants were required to learn to maximize reward during decision-making. Undergraduates with elevated self-reported depressive symptoms received attention training toward positive stimuli prior to performing the decision-making task (n=20; active training). The active training group was compared to two groups: undergraduates with elevated self-reported depressive symptoms who received placebo training (n=22; placebo training) and control subjects with low levels of depressive symptoms (n=33; non-depressive control). The placebo-training depressive group performed worse and switched between options more than non-depressive controls on the reward maximization task. However, depressives that received active training performed as well as non-depressive controls. Computational modeling indicated that the placebo-trained group learned more from negative than from positive prediction errors, leading to more frequent switching. The non-depressive control and active training depressive groups showed similar learning from positive and negative prediction errors, leading to less frequent switching and better performance. Our results indicate that individuals with elevated depressive symptoms are impaired at reward maximization, but that the deficit can be improved with attention training toward positive stimuli. PMID:24197612

Training attention improves decision making in individuals with elevated self-reported depressive symptoms.

PubMed

Cooper, Jessica A; Gorlick, Marissa A; Denny, Taylor; Worthy, Darrell A; Beevers, Christopher G; Maddox, W Todd

2014-06-01

Depression is often characterized by attentional biases toward negative items and away from positive items, which likely affects reward and punishment processing. Recent work has reported that training attention away from negative stimuli reduced this bias and reduced depressive symptoms. However, the effect of attention training on subsequent learning has yet to be explored. In the present study, participants were required to learn to maximize reward during decision making. Undergraduates with elevated self-reported depressive symptoms received attention training toward positive stimuli prior to performing the decision-making task (n = 20; active training). The active-training group was compared to two other groups: undergraduates with elevated self-reported depressive symptoms who received placebo training (n = 22; placebo training) and a control group with low levels of depressive symptoms (n = 33; nondepressive control). The placebo-training depressive group performed worse and switched between options more than did the nondepressive controls on the reward maximization task. However, depressives that received active training performed as well as the nondepressive controls. Computational modeling indicated that the placebo-trained group learned more from negative than from positive prediction errors, leading to more frequent switching. The nondepressive control and active-training depressive groups showed similar learning from positive and negative prediction errors, leading to less-frequent switching and better performance. Our results indicate that individuals with elevated depressive symptoms are impaired at reward maximization, but that the deficit can be improved with attention training toward positive stimuli.

A neural network for noise correlation classification

NASA Astrophysics Data System (ADS)

Paitz, Patrick; Gokhberg, Alexey; Fichtner, Andreas

2018-02-01

We present an artificial neural network (ANN) for the classification of ambient seismic noise correlations into two categories, suitable and unsuitable for noise tomography. By using only a small manually classified data subset for network training, the ANN allows us to classify large data volumes with low human effort and to encode the valuable subjective experience of data analysts that cannot be captured by a deterministic algorithm. Based on a new feature extraction procedure that exploits the wavelet-like nature of seismic time-series, we efficiently reduce the dimensionality of noise correlation data, still keeping relevant features needed for automated classification. Using global- and regional-scale data sets, we show that classification errors of 20 per cent or less can be achieved when the network training is performed with as little as 3.5 per cent and 16 per cent of the data sets, respectively. Furthermore, the ANN trained on the regional data can be applied to the global data, and vice versa, without a significant increase of the classification error. An experiment where four students manually classified the data, revealed that the classification error they would assign to each other is substantially larger than the classification error of the ANN (>35 per cent). This indicates that reproducibility would be hampered more by human subjectivity than by imperfections of the ANN.

Measuring the Accuracy of Simple Evolving Connectionist System with Varying Distance Formulas

NASA Astrophysics Data System (ADS)

Al-Khowarizmi; Sitompul, O. S.; Suherman; Nababan, E. B.

2017-12-01

Simple Evolving Connectionist System (SECoS) is a minimal implementation of Evolving Connectionist Systems (ECoS) in artificial neural networks. The three-layer network architecture of the SECoS could be built based on the given input. In this study, the activation value for the SECoS learning process, which is commonly calculated using normalized Hamming distance, is also calculated using normalized Manhattan distance and normalized Euclidean distance in order to compare the smallest error value and best learning rate obtained. The accuracy of measurement resulted by the three distance formulas are calculated using mean absolute percentage error. In the training phase with several parameters, such as sensitivity threshold, error threshold, first learning rate, and second learning rate, it was found that normalized Euclidean distance is more accurate than both normalized Hamming distance and normalized Manhattan distance. In the case of beta fibrinogen gene -455 G/A polymorphism patients used as training data, the highest mean absolute percentage error value is obtained with normalized Manhattan distance compared to normalized Euclidean distance and normalized Hamming distance. However, the differences are very small that it can be concluded that the three distance formulas used in SECoS do not have a significant effect on the accuracy of the training results.

Performance of Vascular Exposure and Fasciotomy Among Surgical Residents Before and After Training Compared With Experts.

PubMed

Mackenzie, Colin F; Garofalo, Evan; Puche, Adam; Chen, Hegang; Pugh, Kristy; Shackelford, Stacy; Tisherman, Samuel; Henry, Sharon; Bowyer, Mark W

2017-06-01

Surgical patient outcomes are related to surgeon skills. To measure resident surgeon technical and nontechnical skills for trauma core competencies before and after training and up to 18 months later and to compare resident performance with the performance of expert traumatologists. This longitudinal study performed from May 1, 2013, through February 29, 2016, at Maryland State Anatomy Board cadaver laboratories included 40 surgical residents and 10 expert traumatologists. Performance was measured during extremity vascular exposures and lower extremity fasciotomy in fresh cadavers before and after taking the Advanced Surgical Skills for Exposure in Trauma (ASSET) course. The primary outcome variable was individual procedure score (IPS), with secondary outcomes of IPSs on 5 components of technical and nontechnical skills, Global Rating Scale scores, errors, and time to complete the procedure. Two trained evaluators located in the same laboratory evaluated performance with a standardized script and mobile touch-screen data collection. Thirty-eight (95%) of 40 surgical residents (mean [SD] age, 31 [2.9] years) who were evaluated before and within 4 weeks of ASSET training completed follow-up evaluations 12 to 18 months later (mean [SD], 14 [2.7] months). The experts (mean [SD] age, 52 [10.0] years) were significantly older and had a longer (mean [SD], 46 [16.3] months) interval since taking the ASSET course (both P < .001). Overall resident cohort performance improved with increased anatomy knowledge, correct procedural steps, and decreased errors from 60% to 19% after the ASSET course regardless of clinical year of training (P < .001). For 21 of 40 residents (52%), correct vascular procedural steps plotted against anatomy knowledge (the 2 IPS components most improved with training) indicates the resident's performance was within 1 nearest-neighbor classifier of experts after ASSET training. Five residents had no improvement with training. The Trauma Readiness Index for experts (mean [SD], 74 [4]) was significantly different compared with the trained residents (mean [SD], 48 [7] before training vs 63 [7] after training [P = .004] and vs 64 [6] 14 months later [P = .002]). Critical errors that might lead to patient death were identified by pretraining IPS decile of less than 0.5. At follow-up, frequency of resident critical errors was no different from experts. The IPSs ranged from 31.6% to 76.9% among residents for core trauma competency procedures. Modeling revealed that interval experience, rather than time since training, affected skill retention up to 18 months later. Only 4 experts and 16 residents (40%) adequately decompressed and confirmed entry into all 4 lower extremity compartments. This study found that ASSET training improved resident procedural skills for up to 18 months. Performance was highly variable. Interval experience after training affected performance. Pretraining skill identified competency of residents vs experts. Extremity vascular and fasciotomy performance evaluations suggest the need for specific anatomical training interventions in residents with IPS deciles less than 0.5.

Wheel speed management control system for spacecraft

NASA Technical Reports Server (NTRS)

Goodzeit, Neil E. (Inventor); Linder, David M. (Inventor)

1991-01-01

A spacecraft attitude control system uses at least four reaction wheels. In order to minimize reaction wheel speed and therefore power, a wheel speed management system is provided. The management system monitors the wheel speeds and generates a wheel speed error vector. The error vector is integrated, and the error vector and its integral are combined to form a correction vector. The correction vector is summed with the attitude control torque command signals for driving the reaction wheels.

Opioid receptors regulate blocking and overexpectation of fear learning in conditioned suppression.

PubMed

Arico, Carolyn; McNally, Gavan P

2014-04-01

Endogenous opioids play an important role in prediction error during fear learning. However, the evidence for this role has been obtained almost exclusively using the species-specific defense response of freezing as the measure of learned fear. It is unknown whether opioid receptors regulate predictive fear learning when other measures of learned fear are used. Here, we used conditioned suppression as the measure of learned fear to assess the role of opioid receptors in fear learning. Experiment 1a studied associative blocking of fear learning. Rats in an experimental group received conditioned stimulus A (CSA) + training in Stage I and conditioned stimulus A and B (CSAB) + training in Stage II, whereas rats in a control group received only CSAB + training in Stage II. The prior fear conditioning of CSA blocked fear learning to conditioned stimulus B (CSB) in the experimental group. In Experiment 1b, naloxone (4 mg/kg) administered before Stage II prevented this blocking, thereby enabling normal fear learning to CSB. Experiment 2a studied overexpectation of fear. Rats received CSA + training and CSB + training in Stage I, and then rats in the experimental group received CSAB + training in Stage II whereas control rats did not. The Stage II compound training of CSAB reduced fear to CSA and CSB on test. In Experiment 2b, naloxone (4 mg/kg) administered before Stage II prevented this overexpectation. These results show that opioid receptors regulate Pavlovian fear learning, augmenting learning in response to positive prediction error and impairing learning in response to negative prediction error, when fear is assessed via conditioned suppression. These effects are identical to those observed when freezing is used as the measure of learned fear. These findings show that the role for opioid receptors in regulating fear learning extends across multiple measures of learned fear.

Evaluating Behaviorally Oriented Aviation Maintenance Resource Management (MRM) Training and Programs: Methods, Results, and Conclusions

NASA Technical Reports Server (NTRS)

Taylor, James C.; Thomas, Robert L., III

2003-01-01

Assessment of the impact of Aviation Resource Management Programs on aviation culture and performance has compelled a considerable body of research (Taylor & Robertson, 1995; Taylor, 1998; Taylor & Patankar, 2001). In recent years new methods have been applied to the problem of maintenance error precipitated by factors such as the need for self-assessment of communication and trust. The present study - 2002 -- is an extension of that past work. This research project was designed as the conclusion of a larger effort to help understand, evaluate and validate the impact of Maintenance Resource Management (MRM) training programs, and other MRM interventions on participant attitudes, opinions, behaviors, and ultimately on enhanced safety performance. It includes research and development of evaluation methodology as well as examination of psychological constructs and correlates of maintainer performance. In particular, during 2002, three issues were addressed. First, the evaluation of two (independent & different) MRM programs for changing behaviors was undertaken. In one case we were able to further apply the approach to measuring written communication developed during 2001 (Taylor, 2002; Taylor & Thomas, 2003). Second, the MRM/TOQ surveys were made available for completion on the internet. The responses from these on-line surveys were automatically linked to a results calculator (like the one developed and described in Taylor, 2002) to aid industry users in analyzing and evaluating their local survey data on the internet. Third, the main trends and themes from our research about MRM programs over the past dozen years were reviewed.

Development of the KOSMS management simulation training system and its application

NASA Astrophysics Data System (ADS)

Takatsu, Yoshiki

The use of games which simulate actual corporate management has recently become more common and is now utilized in various ways for in-house corporate training courses. KOSMS (Kobe Steel Management Simulation System), a training system designed to help improve the management skills of senior management staff, is a unique management simulation training system in which the participants, using personal computers, must make decisions concerning a variety of management activities, in simulated competition with other corporations. This report outlines the KOSMS system, and describes the basic structure and detailed contents of the management simulation models, and actual application of the KOSMS management simulation training.

[What Surgeons Should Know about Risk Management].

PubMed

Strametz, R; Tannheimer, M; Rall, M

2017-02-01

Background: The fact that medical treatment is associated with errors has long been recognized. Based on the principle of "first do no harm", numerous efforts have since been made to prevent such errors or limit their impact. However, recent statistics show that these measures do not sufficiently prevent grave mistakes with serious consequences. Preventable mistakes such as wrong patient or wrong site surgery still frequently occur in error statistics. Methods: Based on insight from research on human error, in due consideration of recent legislative regulations in Germany, the authors give an overview of the clinical risk management tools needed to identify risks in surgery, analyse their causes, and determine adequate measures to manage those risks depending on their relevance. The use and limitations of critical incident reporting systems (CIRS), safety checklists and crisis resource management (CRM) are highlighted. Also the rationale for IT systems to support the risk management process is addressed. Results/Conclusion: No single tool of risk management can be effective as a standalone instrument, but unfolds its effect only when embedded in a superordinate risk management system, which integrates tailor-made elements to increase patient safety into the workflows of each organisation. Competence in choosing adequate tools, effective IT systems to support the risk management process as well as leadership and commitment to constructive handling of human error are crucial components to establish a safety culture in surgery. Georg Thieme Verlag KG Stuttgart · New York.

Obligation towards medical errors disclosure at a tertiary care hospital in Dubai, UAE

PubMed Central

Zaghloul, Ashraf Ahmad; Rahman, Syed Azizur; Abou El-Enein, Nagwa Younes

2016-01-01

OBJECTIVE: The study aimed to identify healthcare providers’ obligation towards medical errors disclosure as well as to study the association between the severity of the medical error and the intention to disclose the error to the patients and their families. DESIGN: A cross-sectional study design was followed to identify the magnitude of disclosure among healthcare providers in different departments at a randomly selected tertiary care hospital in Dubai. SETTING AND PARTICIPANTS: The total sample size accounted for 106 respondents. Data were collected using a questionnaire composed of two sections namely; demographic variables of the respondents and a section which included variables relevant to medical error disclosure. RESULTS: Statistical analysis yielded significant association between the obligation to disclose medical errors with male healthcare providers (X2 = 5.1), and being a physician (X2 = 19.3). Obligation towards medical errors disclosure was significantly associated with those healthcare providers who had not committed any medical errors during the past year (X2 = 9.8), and any type of medical error regardless the cause, extent of harm (X2 = 8.7). Variables included in the binary logistic regression model were; status (Exp β (Physician) = 0.39, 95% CI 0.16–0.97), gender (Exp β (Male) = 4.81, 95% CI 1.84–12.54), and medical errors during the last year (Exp β (None) = 2.11, 95% CI 0.6–2.3). CONCLUSION: Education and training of physicians about disclosure conversations needs to start as early as medical school. Like the training in other competencies required of physicians, education in communicating about medical errors could help reduce physicians’ apprehension and make them more comfortable with disclosure conversations. PMID:27567766

[Risk Management: concepts and chances for public health].

PubMed

Palm, Stefan; Cardeneo, Margareta; Halber, Marco; Schrappe, Matthias

2002-01-15

Errors are a common problem in medicine and occur as a result of a complex process involving many contributing factors. Medical errors significantly reduce the safety margin for the patient and contribute additional costs in health care delivery. In most cases adverse events cannot be attributed to a single underlying cause. Therefore an effective risk management strategy must follow a system approach, which is based on counting and analysis of near misses. The development of defenses against the undesired effects of errors should be the main focus rather than asking the question "Who blundered?". Analysis of near misses (which in this context can be compared to indicators) offers several methodological advantages as compared to the analysis of errors and adverse events. Risk management is an integral element of quality management.

Comparison of error-based and errorless learning for people with severe traumatic brain injury: study protocol for a randomized control trial.

PubMed

Ownsworth, Tamara; Fleming, Jennifer; Tate, Robyn; Shum, David H K; Griffin, Janelle; Schmidt, Julia; Lane-Brown, Amanda; Kendall, Melissa; Chevignard, Mathilde

2013-11-05

Poor skills generalization poses a major barrier to successful outcomes of rehabilitation after traumatic brain injury (TBI). Error-based learning (EBL) is a relatively new intervention approach that aims to promote skills generalization by teaching people internal self-regulation skills, or how to anticipate, monitor and correct their own errors. This paper describes the protocol of a study that aims to compare the efficacy of EBL and errorless learning (ELL) for improving error self-regulation, behavioral competency, awareness of deficits and long-term outcomes after TBI. This randomized, controlled trial (RCT) has two arms (EBL and ELL); each arm entails 8 × 2 h training sessions conducted within the participants' homes. The first four sessions involve a meal preparation activity, and the final four sessions incorporate a multitasking errand activity. Based on a sample size estimate, 135 participants with severe TBI will be randomized into either the EBL or ELL condition. The primary outcome measure assesses error self-regulation skills on a task related to but distinct from training. Secondary outcomes include measures of self-monitoring and self-regulation, behavioral competency, awareness of deficits, role participation and supportive care needs. Assessments will be conducted at pre-intervention, post-intervention, and at 6-months post-intervention. This study seeks to determine the efficacy and long-term impact of EBL for training internal self-regulation strategies following severe TBI. In doing so, the study will advance theoretical understanding of the role of errors in task learning and skills generalization. EBL has the potential to reduce the length and costs of rehabilitation and lifestyle support because the techniques could enhance generalization success and lifelong application of strategies after TBI. ACTRN12613000585729.

The 'Soil Cover App' - a new tool for fast determination of dead and living biomass on soil

NASA Astrophysics Data System (ADS)

Bauer, Thomas; Strauss, Peter; Riegler-Nurscher, Peter; Prankl, Johann; Prankl, Heinrich

2017-04-01

Worldwide many agricultural practices aim on soil protection strategies using living or dead biomass as soil cover. Especially for the case when management practices are focusing on soil erosion mitigation the effectiveness of these practices is directly driven by the amount of soil coverleft on the soil surface. Hence there is a need for quick and reliable methods of soil cover estimation not only for living biomass but particularly for dead biomass (mulch). Available methods for the soil cover measurement are either subjective, depending on an educated guess or time consuming, e.g., if the image is analysed manually at grid points. We therefore developed a mobile application using an algorithm based on entangled forest classification. The final output of the algorithm gives classified labels for each pixel of the input image as well as the percentage of each class which are living biomass, dead biomass, stones and soil. Our training dataset consisted of more than 250 different images and their annotated class information. Images have been taken in a set of different environmental conditions such as light, soil coverages from between 0% to 100%, different materials such as living plants, residues, straw material and stones. We compared the results provided by our mobile application with a data set of 180 images that had been manually annotated A comparison between both methods revealed a regression slope of 0.964 with a coefficient of determination R2 = 0.92, corresponding to an average error of about 4%. While average error of living plant classification was about 3%, dead residue classification resulted in an 8% error. Thus the new mobile application tool offers a fast and easy way to obtain information on the protective potential of a particular agricultural management site.

The ethics and practical importance of defining, distinguishing and disclosing nursing errors: a discussion paper.

PubMed

Johnstone, Megan-Jane; Kanitsaki, Olga

2006-03-01

Nurses globally are required and expected to report nursing errors. As is clearly demonstrated in the international literature, fulfilling this requirement is not, however, without risks. In this discussion paper, the notion of 'nursing error', the practical and moral importance of defining, distinguishing and disclosing nursing errors and how a distinct definition of 'nursing error' fits with the new 'system approach' to human-error management in health care are critiqued. Drawing on international literature and two key case exemplars from the USA and Australia, arguments are advanced to support the view that although it is 'right' for nurses to report nursing errors, it will be very difficult for them to do so unless a non-punitive approach to nursing-error management is adopted.

Automated contouring error detection based on supervised geometric attribute distribution models for radiation therapy: A general strategy

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

Chen, Hsin-Chen; Tan, Jun; Dolly, Steven

2015-02-15

Purpose: One of the most critical steps in radiation therapy treatment is accurate tumor and critical organ-at-risk (OAR) contouring. Both manual and automated contouring processes are prone to errors and to a large degree of inter- and intraobserver variability. These are often due to the limitations of imaging techniques in visualizing human anatomy as well as to inherent anatomical variability among individuals. Physicians/physicists have to reverify all the radiation therapy contours of every patient before using them for treatment planning, which is tedious, laborious, and still not an error-free process. In this study, the authors developed a general strategy basedmore » on novel geometric attribute distribution (GAD) models to automatically detect radiation therapy OAR contouring errors and facilitate the current clinical workflow. Methods: Considering the radiation therapy structures’ geometric attributes (centroid, volume, and shape), the spatial relationship of neighboring structures, as well as anatomical similarity of individual contours among patients, the authors established GAD models to characterize the interstructural centroid and volume variations, and the intrastructural shape variations of each individual structure. The GAD models are scalable and deformable, and constrained by their respective principal attribute variations calculated from training sets with verified OAR contours. A new iterative weighted GAD model-fitting algorithm was developed for contouring error detection. Receiver operating characteristic (ROC) analysis was employed in a unique way to optimize the model parameters to satisfy clinical requirements. A total of forty-four head-and-neck patient cases, each of which includes nine critical OAR contours, were utilized to demonstrate the proposed strategy. Twenty-nine out of these forty-four patient cases were utilized to train the inter- and intrastructural GAD models. These training data and the remaining fifteen testing data sets were separately employed to test the effectiveness of the proposed contouring error detection strategy. Results: An evaluation tool was implemented to illustrate how the proposed strategy automatically detects the radiation therapy contouring errors for a given patient and provides 3D graphical visualization of error detection results as well. The contouring error detection results were achieved with an average sensitivity of 0.954/0.906 and an average specificity of 0.901/0.909 on the centroid/volume related contouring errors of all the tested samples. As for the detection results on structural shape related contouring errors, an average sensitivity of 0.816 and an average specificity of 0.94 on all the tested samples were obtained. The promising results indicated the feasibility of the proposed strategy for the detection of contouring errors with low false detection rate. Conclusions: The proposed strategy can reliably identify contouring errors based upon inter- and intrastructural constraints derived from clinically approved contours. It holds great potential for improving the radiation therapy workflow. ROC and box plot analyses allow for analytically tuning of the system parameters to satisfy clinical requirements. Future work will focus on the improvement of strategy reliability by utilizing more training sets and additional geometric attribute constraints.« less

Randomized controlled trial on the effects of training in the use of closed-circuit television on reading performance.

PubMed

Burggraaff, Marloes C; van Nispen, Ruth M A; Hoeben, Frank P; Knol, Dirk L; van Rens, Ger H M B

2012-04-24

To investigate the effectiveness of training in the use of closed-circuit television (CCTV) on reading performance in visually impaired patients. In a multicenter masked randomized controlled trial, 122 patients were randomized either to a treatment group that received usual delivery instructions from the CCTV supplier combined with concise outpatient standardized training, or to a control group that received delivery instructions only. The main outcome measure was reading performance, which was obtained by measuring reading acuity, reading speed, reading errors, column-tracking time, and technical reading, approximately two weeks after patients had received their CCTV and 3 months later. Videotapes of all measurements were rated by two investigators. Training effects were analyzed with linear mixed modeling. There were no statistically significant differences in results between the treatment and control group. However, introducing a CCTV increased reading acuity (mean difference [MD] 0.93 logRAD; P < 0.01) and maximum reading speed (MD 15 wpm; P < 0.01), and decreased the number of errors (MD 0.33; P = 0.04), compared to reading without CCTV. Average reading speed (P = 0.05), number of errors (P = 0.04), and column-tracking time (P = 0.01) improved over time. Prescribing a CCTV and the delivery instructions by the supplier seemed sufficient to improve reading performance. Additional training in the use of this device did not result in further improvement. Based on these results, outpatient low-vision rehabilitation centers may consider reallocating part of the training resources into other evidence-based rehabilitation programs. (trialregister.nl number, NTR1031.).

On the statistical assessment of classifiers using DNA microarray data

PubMed Central

Ancona, N; Maglietta, R; Piepoli, A; D'Addabbo, A; Cotugno, R; Savino, M; Liuni, S; Carella, M; Pesole, G; Perri, F

2006-01-01

Background In this paper we present a method for the statistical assessment of cancer predictors which make use of gene expression profiles. The methodology is applied to a new data set of microarray gene expression data collected in Casa Sollievo della Sofferenza Hospital, Foggia – Italy. The data set is made up of normal (22) and tumor (25) specimens extracted from 25 patients affected by colon cancer. We propose to give answers to some questions which are relevant for the automatic diagnosis of cancer such as: Is the size of the available data set sufficient to build accurate classifiers? What is the statistical significance of the associated error rates? In what ways can accuracy be considered dependant on the adopted classification scheme? How many genes are correlated with the pathology and how many are sufficient for an accurate colon cancer classification? The method we propose answers these questions whilst avoiding the potential pitfalls hidden in the analysis and interpretation of microarray data. Results We estimate the generalization error, evaluated through the Leave-K-Out Cross Validation error, for three different classification schemes by varying the number of training examples and the number of the genes used. The statistical significance of the error rate is measured by using a permutation test. We provide a statistical analysis in terms of the frequencies of the genes involved in the classification. Using the whole set of genes, we found that the Weighted Voting Algorithm (WVA) classifier learns the distinction between normal and tumor specimens with 25 training examples, providing e = 21% (p = 0.045) as an error rate. This remains constant even when the number of examples increases. Moreover, Regularized Least Squares (RLS) and Support Vector Machines (SVM) classifiers can learn with only 15 training examples, with an error rate of e = 19% (p = 0.035) and e = 18% (p = 0.037) respectively. Moreover, the error rate decreases as the training set size increases, reaching its best performances with 35 training examples. In this case, RLS and SVM have error rates of e = 14% (p = 0.027) and e = 11% (p = 0.019). Concerning the number of genes, we found about 6000 genes (p < 0.05) correlated with the pathology, resulting from the signal-to-noise statistic. Moreover the performances of RLS and SVM classifiers do not change when 74% of genes is used. They progressively reduce up to e = 16% (p < 0.05) when only 2 genes are employed. The biological relevance of a set of genes determined by our statistical analysis and the major roles they play in colorectal tumorigenesis is discussed. Conclusions The method proposed provides statistically significant answers to precise questions relevant for the diagnosis and prognosis of cancer. We found that, with as few as 15 examples, it is possible to train statistically significant classifiers for colon cancer diagnosis. As for the definition of the number of genes sufficient for a reliable classification of colon cancer, our results suggest that it depends on the accuracy required. PMID:16919171

A Technological Innovation to Reduce Prescribing Errors Based on Implementation Intentions: The Acceptability and Feasibility of MyPrescribe.

PubMed

Keyworth, Chris; Hart, Jo; Thoong, Hong; Ferguson, Jane; Tully, Mary

2017-08-01

Although prescribing of medication in hospitals is rarely an error-free process, prescribers receive little feedback on their mistakes and ways to change future practices. Audit and feedback interventions may be an effective approach to modifying the clinical practice of health professionals, but these may pose logistical challenges when used in hospitals. Moreover, such interventions are often labor intensive. Consequently, there is a need to develop effective and innovative interventions to overcome these challenges and to improve the delivery of feedback on prescribing. Implementation intentions, which have been shown to be effective in changing behavior, link critical situations with an appropriate response; however, these have rarely been used in the context of improving prescribing practices. Semistructured qualitative interviews were conducted to evaluate the acceptability and feasibility of providing feedback on prescribing errors via MyPrescribe, a mobile-compatible website informed by implementation intentions. Data relating to 200 prescribing errors made by 52 junior doctors were collected by 11 hospital pharmacists. These errors were populated into MyPrescribe, where prescribers were able to construct their own personalized action plans. Qualitative interviews with a subsample of 15 junior doctors were used to explore issues regarding feasibility and acceptability of MyPrescribe and their experiences of using implementation intentions to construct prescribing action plans. Framework analysis was used to identify prominent themes, with findings mapped to the behavioral components of the COM-B model (capability, opportunity, motivation, and behavior) to inform the development of future interventions. MyPrescribe was perceived to be effective in providing opportunities for critical reflection on prescribing errors and to complement existing training (such as junior doctors' e-portfolio). The participants were able to provide examples of how they would use "If-Then" plans for patient management. Technology, as opposed to other methods of learning (eg, traditional "paper based" learning), was seen as a positive advancement for continued learning. MyPrescribe was perceived as an acceptable and feasible learning tool for changing prescribing practices, with participants suggesting that it would make an important addition to medical prescribers' training in reflective practice. MyPrescribe is a novel theory-based technological innovation that provides the platform for doctors to create personalized implementation intentions. Applying the COM-B model allows for a more detailed understanding of the perceived mechanisms behind prescribing practices and the ways in which interventions aimed at changing professional practice can be implemented. ©Chris Keyworth, Jo Hart, Hong Thoong, Jane Ferguson, Mary Tully. Originally published in JMIR Human Factors (http://humanfactors.jmir.org), 01.08.2017.

A Technological Innovation to Reduce Prescribing Errors Based on Implementation Intentions: The Acceptability and Feasibility of MyPrescribe

PubMed Central

Hart, Jo; Thoong, Hong; Ferguson, Jane; Tully, Mary

2017-01-01

Background Although prescribing of medication in hospitals is rarely an error-free process, prescribers receive little feedback on their mistakes and ways to change future practices. Audit and feedback interventions may be an effective approach to modifying the clinical practice of health professionals, but these may pose logistical challenges when used in hospitals. Moreover, such interventions are often labor intensive. Consequently, there is a need to develop effective and innovative interventions to overcome these challenges and to improve the delivery of feedback on prescribing. Implementation intentions, which have been shown to be effective in changing behavior, link critical situations with an appropriate response; however, these have rarely been used in the context of improving prescribing practices. Objective Semistructured qualitative interviews were conducted to evaluate the acceptability and feasibility of providing feedback on prescribing errors via MyPrescribe, a mobile-compatible website informed by implementation intentions. Methods Data relating to 200 prescribing errors made by 52 junior doctors were collected by 11 hospital pharmacists. These errors were populated into MyPrescribe, where prescribers were able to construct their own personalized action plans. Qualitative interviews with a subsample of 15 junior doctors were used to explore issues regarding feasibility and acceptability of MyPrescribe and their experiences of using implementation intentions to construct prescribing action plans. Framework analysis was used to identify prominent themes, with findings mapped to the behavioral components of the COM-B model (capability, opportunity, motivation, and behavior) to inform the development of future interventions. Results MyPrescribe was perceived to be effective in providing opportunities for critical reflection on prescribing errors and to complement existing training (such as junior doctors’ e-portfolio). The participants were able to provide examples of how they would use “If-Then” plans for patient management. Technology, as opposed to other methods of learning (eg, traditional “paper based” learning), was seen as a positive advancement for continued learning. Conclusions MyPrescribe was perceived as an acceptable and feasible learning tool for changing prescribing practices, with participants suggesting that it would make an important addition to medical prescribers’ training in reflective practice. MyPrescribe is a novel theory-based technological innovation that provides the platform for doctors to create personalized implementation intentions. Applying the COM-B model allows for a more detailed understanding of the perceived mechanisms behind prescribing practices and the ways in which interventions aimed at changing professional practice can be implemented. PMID:28765104

Medical professional liability insurance and its relation to medical error and healthcare risk management for the practicing physician.

PubMed

Abbott, Richard L; Weber, Paul; Kelley, Betsy

2005-12-01

To review the history and current issues surrounding medical professional liability insurance and its relationship to medical error and healthcare risk management. Focused literature review and authors' experience. Medical professional liability insurance issues are reviewed in association with the occurrence of medical error and the role of healthcare risk management. The rising frequency and severity of claims and lawsuits incurred by physicians, as well as escalating defense costs, have dramatically increased over the past several years and have resulted in accelerated efforts to reduce medical errors and control practice risk for physicians. Medical error reduction and improved patient outcomes are closely linked to the goals of the medical risk manager by reducing exposure to adverse medical events. Management of professional liability risk by the physician-led malpractice insurance company not only protects the economic viability of physicians, but also addresses patient safety concerns. Physician-owned malpractice liability insurance companies will continue to be the dominant providers of insurance for practicing physicians and will serve as the primary source for loss prevention and risk management services. To succeed in the marketplace, the emergence and importance of the risk manager and incorporation of risk management principles throughout the professional liability company has become crucial to the financial stability and success of the insurance company. The risk manager provides the necessary advice and support requested by physicians to minimize medical liability risk in their daily practice.

Awareness and knowledge among internal medicine house-staff for dose adjustment of commonly used medications in patients with CKD.

PubMed

Surana, Sikander; Kumar, Neeru; Vasudeva, Amita; Shaikh, Gulvahid; Jhaveri, Kenar D; Shah, Hitesh; Malieckal, Deepa; Fogel, Joshua; Sidhu, Gurwinder; Rubinstein, Sofia

2017-01-17

Drug dosing errors result in adverse patient outcomes and are more common in patients with chronic kidney disease (CKD). As internists treat the majority of patients with CKD, we study if Internal Medicine house-staff have awareness and knowledge about the correct dosage of commonly used medications for those with CKD. A cross-sectional survey was performed and included 341 participants. The outcomes were the awareness of whether a medication needs dose adjustment in patients with CKD and whether there was knowledge for the level of glomerular filtration rate (GFR) a medication needs to be adjusted. The overall pattern for all post-graduate year (PGY) groups in all medication classes was a lack of awareness and knowledge. For awareness, there were statistically significant increased mean differences for PGY2 and PGY3 as compared to PGY1 for allergy, endocrine, gastrointestinal, and rheumatologic medication classes but not for analgesic, cardiovascular, and neuropsychotropic medication classes. For knowledge, there were statistically significant increased mean differences for PGY2 and PGY3 as compared to PGY1 for allergy, cardiovascular, endocrine, and gastrointestinal, medication classes but not for analgesic, neuropsychotropic, and rheumatologic medication classes. Internal Medicine house-staff across all levels of training demonstrated poor awareness and knowledge for many medication classes in CKD patients. Internal Medicine house-staff should receive more nephrology exposure and formal didactic educational training during residency to better manage complex treatment regimens and prevent medication dosing errors.

42 CFR 410.141 - Outpatient diabetes self-management training.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 2 2012-10-01 2012-10-01 false Outpatient diabetes self-management training. 410... HUMAN SERVICES MEDICARE PROGRAM SUPPLEMENTARY MEDICAL INSURANCE (SMI) BENEFITS Outpatient Diabetes Self-Management Training and Diabetes Outcome Measurements § 410.141 Outpatient diabetes self-management training...

42 CFR 410.141 - Outpatient diabetes self-management training.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 2 2011-10-01 2011-10-01 false Outpatient diabetes self-management training. 410... HUMAN SERVICES MEDICARE PROGRAM SUPPLEMENTARY MEDICAL INSURANCE (SMI) BENEFITS Outpatient Diabetes Self-Management Training and Diabetes Outcome Measurements § 410.141 Outpatient diabetes self-management training...

42 CFR 410.141 - Outpatient diabetes self-management training.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 2 2014-10-01 2014-10-01 false Outpatient diabetes self-management training. 410... HUMAN SERVICES MEDICARE PROGRAM SUPPLEMENTARY MEDICAL INSURANCE (SMI) BENEFITS Outpatient Diabetes Self-Management Training and Diabetes Outcome Measurements § 410.141 Outpatient diabetes self-management training...

42 CFR 410.141 - Outpatient diabetes self-management training.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 2 2013-10-01 2013-10-01 false Outpatient diabetes self-management training. 410... HUMAN SERVICES MEDICARE PROGRAM SUPPLEMENTARY MEDICAL INSURANCE (SMI) BENEFITS Outpatient Diabetes Self-Management Training and Diabetes Outcome Measurements § 410.141 Outpatient diabetes self-management training...

42 CFR 410.141 - Outpatient diabetes self-management training.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Outpatient diabetes self-management training. 410... HUMAN SERVICES MEDICARE PROGRAM SUPPLEMENTARY MEDICAL INSURANCE (SMI) BENEFITS Outpatient Diabetes Self-Management Training and Diabetes Outcome Measurements § 410.141 Outpatient diabetes self-management training...

Error Management Practices Interacting with National and Organizational Culture: The Case of Two State University Departments in Turkey

ERIC Educational Resources Information Center

Göktürk, Söheyda; Bozoglu, Oguzhan; Günçavdi, Gizem

2017-01-01

Purpose: Elements of national and organizational cultures can contribute much to the success of error management in organizations. Accordingly, this study aims to consider how errors were approached in two state university departments in Turkey in relation to their specific organizational and national cultures. Design/methodology/approach: The…

Erreurs grammaticales: Comment s'entrainer a les depister (Grammatical Errors: Learning How to Track Them Down).

ERIC Educational Resources Information Center

Straalen-Sanderse, Wilma van; And Others

1986-01-01

Following an experiment which revealed that production of grammatically correct sentences and correction of grammatically problematic sentences in French are essentially different skills, a progressive training method for finding and correcting grammatical errors was developed. (MSE)

The Development of a Novel Perfused Cadaver Model With Dynamic Vital Sign Regulation and Real-World Scenarios to Teach Surgical Skills and Error Management.

PubMed

Minneti, Michael; Baker, Craig J; Sullivan, Maura E

The landscape of graduate medical education has changed dramatically over the past decade and the traditional apprenticeship model has undergone scrutiny and modifications. The mandate of the 80-hour work-week, the introduction of integrated residency programs, increased global awareness about patient safety along with financial constraints have spurred changes in graduate educational practices. In addition, new technologies, more complex procedures, and a host of external constraints have changed where and how we teach technical and procedural skills. Simulation-based training has been embraced by the surgical community and has quickly become an essential component of most residency programs as a method to add efficacy to the traditional learning model. The purpose of this paper is twofold: (1) to describe the development of a perfused cadaver model with dynamic vital sign regulation, and (2) to assess the impact of a curriculum using this model and real world scenarios to teach surgical skills and error management. By providing a realistic training environment our aim is to enhance the acquisition of surgical skills and provide a more thorough assessment of resident performance. Twenty-six learners participated in the scenarios. Qualitative data showed that participants felt that the simulation model was realistic, and that participating in the scenarios helped them gain new knowledge, learn new surgical techniques and increase their confidence performing the skill in a clinical setting. Identifying the importance of both technical and nontechnical skills in surgical education has hastened the need for more realistic simulators and environments in which they are placed. Team members should be able to interact in ways that allow for a global display of their skills thus helping to provide a more comprehensive assessment by faculty and learners. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

The effectiveness of the error reporting promoting program on the nursing error incidence rate in Korean operating rooms.

PubMed

Kim, Myoung-Soo; Kim, Jung-Soon; Jung, In Sook; Kim, Young Hae; Kim, Ho Jung

2007-03-01

The purpose of this study was to develop and evaluate an error reporting promoting program(ERPP) to systematically reduce the incidence rate of nursing errors in operating room. A non-equivalent control group non-synchronized design was used. Twenty-six operating room nurses who were in one university hospital in Busan participated in this study. They were stratified into four groups according to their operating room experience and were allocated to the experimental and control groups using a matching method. Mann-Whitney U Test was used to analyze the differences pre and post incidence rates of nursing errors between the two groups. The incidence rate of nursing errors decreased significantly in the experimental group compared to the pre-test score from 28.4% to 15.7%. The incidence rate by domains, it decreased significantly in the 3 domains-"compliance of aseptic technique", "management of document", "environmental management" in the experimental group while it decreased in the control group which was applied ordinary error-reporting method. Error-reporting system can make possible to hold the errors in common and to learn from them. ERPP was effective to reduce the errors of recognition-related nursing activities. For the wake of more effective error-prevention, we will be better to apply effort of risk management along the whole health care system with this program.

Training complexity is not decisive factor for improving adaptation to visual sensory conflict.

PubMed

Yang, Yang; Pu, Fang; Li, Shuyu; Li, Yan; Li, Deyu; Fan, Yubo

2012-01-01

Ground-based preflight training utilizing unusual visual stimuli is useful for decreasing the susceptibility to space motion sickness (SMS). The effectiveness of the sensorimotor adaptation training is affected by the training tasks, but what kind of task is more effective remains unknown. Whether the complexity is the decisive factor to consider for designing the training and if other factors are more important need to be analyzed. The results from the analysis can help to optimize the preflight training tasks for astronauts. Twenty right-handed subjects were asked to draw the right path of 45° rotated maze before and after 30 min training. Subjects wore an up-down reversing prism spectacle in test and training sessions. Two training tasks were performed: drawing the right path of the horizontal maze (complex task but with different orientation feature) and drawing the L-shape lines (easy task with same orientation feature). The error rate and the executing time were measured during the test. Paired samples t test was used to compare the effects of the two training tasks. After each training, the error rate and the executing time were significantly decreased. However, the training effectiveness of the easy task was better as the test was finished more quickly and accurately. The complexity is not always the decisive factor for designing the adaptation training task, e.g. the orientation feature is more important in this study. In order to accelerate the adaptation and to counter SMS, the task for astronauts preflight adaptation training could be simple activities with the key features.

Pharmacogenetic excitation of dorsomedial prefrontal cortex restores fear prediction error.

PubMed

Yau, Joanna Oi-Yue; McNally, Gavan P

2015-01-07

Pavlovian conditioning involves encoding the predictive relationship between a conditioned stimulus (CS) and an unconditioned stimulus, so that synaptic plasticity and learning is instructed by prediction error. Here we used pharmacogenetic techniques to show a causal relation between activity of rat dorsomedial prefrontal cortex (dmPFC) neurons and fear prediction error. We expressed the excitatory hM3Dq designer receptor exclusively activated by a designer drug (DREADD) in dmPFC and isolated actions of prediction error by using an associative blocking design. Rats were trained to fear the visual CS (CSA) in stage I via pairings with footshock. Then in stage II, rats received compound presentations of visual CSA and auditory CS (CSB) with footshock. This prior fear conditioning of CSA reduced the prediction error during stage II to block fear learning to CSB. The group of rats that received AAV-hSYN-eYFP vector that was treated with clozapine-N-oxide (CNO; 3 mg/kg, i.p.) before stage II showed blocking when tested in the absence of CNO the next day. In contrast, the groups that received AAV-hSYN-hM3Dq and AAV-CaMKIIα-hM3Dq that were treated with CNO before stage II training did not show blocking; learning toward CSB was restored. This restoration of prediction error and fear learning was specific to the injection of CNO because groups that received AAV-hSYN-hM3Dq and AAV-CaMKIIα-hM3Dq that were injected with vehicle before stage II training did show blocking. These effects were not attributable to the DREADD manipulation enhancing learning or arousal, increasing fear memory strength or asymptotic levels of fear learning, or altering fear memory retrieval. Together, these results identify a causal role for dmPFC in a signature of adaptive behavior: using the past to predict future danger and learning from errors in these predictions. Copyright © 2015 the authors 0270-6474/15/350074-10$15.00/0.

Managerial attitude to the implementation of quality management systems in Lithuanian support treatment and nursing hospitals.

PubMed

Buciuniene, Ilona; Malciankina, Sonata; Lydeka, Zigmas; Kazlauskaite, Ruta

2006-09-20

The regulations of the Quality Management System (QMS) implementation in health care organizations were approved by the Lithuanian Ministry of Health in 1998. Following the above regulations, general managers of health care organizations had to initiate the QMS implementation in hospitals. As no research on the QMS implementation has been carried out in Lithuanian support treatment and nursing hospitals since, the objective of this study is to assess its current stage from a managerial perspective. A questionnaire survey of general managers of Lithuanian support treatment and nursing hospitals was carried out in the period of January through March 2005. Majority of the items included in the questionnaire were measured on a seven-point Likert scale. During the survey, a total of 72 questionnaires was distributed, out of which 58 filled-in ones were returned (response rate 80.6 per cent; standard sampling error 0.029 at 95 per cent level of confidence). Quality Management Systems were found operating in 39.7 per cent of support treatment and nursing hospitals and currently under implementation in 46.6 per cent of hospitals (13.7% still do not have it). The mean of the respondents' perceived QMS significance is 5.8 (on a seven-point scale). The most critical issues related to the QMS implementation include procedure development (5.5), lack of financial resources (5.4) and information (5.1), and development of work guidelines (4.6), while improved responsibility and power sharing (5.2), better service quality (5.1) and higher patient satisfaction (5.1) were perceived by the respondents as the key QMS benefits. The level of satisfaction with the QMS among the management of the surveyed hospitals is mediocre (3.6). However it was found to be higher among respondents who were more competent in quality management, were familiar with ISO 9000 standards, and had higher numbers of employees trained in quality management. QMSs are perceived to be successfully running in one third of the Lithuanian support treatment and nursing hospitals. Its current implementation stage is dependent on the hospital size - the bigger the hospital the more success it meets in the QMS implementation. As to critical Quality Management (QM) issues, hospitals tend to encounter such major problems as lack of financial resources, information and training, as well as difficulties in procedure development. On the other hand, the key factors that assist to the success of the QMS implementation comprise managerial awareness of the QMS significance and the existence of employee training systems and audit groups in hospitals.

Decision Aids for Multiple-Decision Disease Management as Affected by Weather Input Errors

USDA-ARS?s Scientific Manuscript database

Many disease management decision support systems (DSS) rely, exclusively or in part, on weather inputs to calculate an indicator for disease hazard. Error in the weather inputs, typically due to forecasting, interpolation or estimation from off-site sources, may affect model calculations and manage...

Development of a training program to support health care professionals to deliver the SPACE for COPD self-management program

PubMed Central

Blackmore, Claire; Johnson-Warrington, Vicki L; Williams, Johanna EA; Apps, Lindsay D; Young, Hannah ML; Bourne, Claire LA; Singh, Sally J

2017-01-01

Background With the growing burden of COPD and associated morbidity and mortality, a need for self-management has been identified. The Self-management Programme of Activity, Coping and Education for Chronic Obstructive Pulmonary Disease (SPACE for COPD) manual was developed to support self-management in COPD patients. Currently, there is no literature available regarding health care professionals’ training needs when supporting patients with COPD on self-management. Aim This study sought to identify these needs to inform, design and develop a training program for health care professionals being trained to deliver a self-management program in COPD. Methods Fourteen health care professionals from both primary and secondary care COPD services participated in face-to-face semistructured interviews. Thematic analysis was used to produce a framework and identify training needs and views on delivery of the SPACE for COPD self-management program. Components of training were web-based knowledge training, with pre-and posttraining knowledge questionnaires, and a 1-day program to introduce the self-management manual. Feedback was given after training to guide the development of the training program. Results Health care professionals were able to identify areas where they required increased knowledge to support patients. This was overwhelming in aspects of COPD seen to be outside of their current clinical role. Skills in goal setting and behavioral change were not elicited as a training need, suggesting a lack of understanding of components of supporting self-management. An increase in knowledge of COPD was demonstrated following the training program. Conclusion Both knowledge and skill gaps existed in those who would deliver self-management. Analysis of this has enabled a training program to be designed to address these gaps and enable health care professionals to support patients in self-management. PMID:28652720

Development of a training program to support health care professionals to deliver the SPACE for COPD self-management program.

PubMed

Blackmore, Claire; Johnson-Warrington, Vicki L; Williams, Johanna Ea; Apps, Lindsay D; Young, Hannah Ml; Bourne, Claire LA; Singh, Sally J

2017-01-01

With the growing burden of COPD and associated morbidity and mortality, a need for self-management has been identified. The Self-management Programme of Activity, Coping and Education for Chronic Obstructive Pulmonary Disease (SPACE for COPD) manual was developed to support self-management in COPD patients. Currently, there is no literature available regarding health care professionals' training needs when supporting patients with COPD on self-management. This study sought to identify these needs to inform, design and develop a training program for health care professionals being trained to deliver a self-management program in COPD. Fourteen health care professionals from both primary and secondary care COPD services participated in face-to-face semistructured interviews. Thematic analysis was used to produce a framework and identify training needs and views on delivery of the SPACE for COPD self-management program. Components of training were web-based knowledge training, with pre-and posttraining knowledge questionnaires, and a 1-day program to introduce the self-management manual. Feedback was given after training to guide the development of the training program. Health care professionals were able to identify areas where they required increased knowledge to support patients. This was overwhelming in aspects of COPD seen to be outside of their current clinical role. Skills in goal setting and behavioral change were not elicited as a training need, suggesting a lack of understanding of components of supporting self-management. An increase in knowledge of COPD was demonstrated following the training program. Both knowledge and skill gaps existed in those who would deliver self-management. Analysis of this has enabled a training program to be designed to address these gaps and enable health care professionals to support patients in self-management.

Training and Required Reading Management Tool

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

Nelson, Jerel

2009-08-13

This tool manages training and required reading for groups, facilities, etc – abilities beyond the site training systems. TRRMTool imports training data from controlled site data sources/systems and provides greater management and reporting. Clients have been able to greatly reduce the time and effort required to manage training, have greater accuracy, foster individual accountability, and be proactive in verifying training of support personnel, to maintain compliance.

[Aspects of economic responsibility in health care].

PubMed

Hauke, Eugen

2007-01-01

According to the final consensus of a panel of intense discussions, the health care system should/can not be excluded from the economic laws of efficiency. Appropriate adaptation of various methods and instruments of economics make these tools applicable for use in the health care system. Due to errors in the implementation of economic methods, though, the question arises who is economically responsible in the health care system. The answer is found at three different levels of the health care system. The physician plays a leading role, both personally and professionally, in being primarily responsible for the direct medical treatment of the patient. The physician's dependence, however, on the health care system reduces his independence, which markedly affects his decision-making and treatment. Management of and in health care institutions is largely independent of the profession learned. Managers and physicians acting as managers must be appropriately and duly educated in the necessary specific talents and knowledge. The organisation of a health care system should also be reserved for trained specialists where the physicians as well as other professionals are obliged to acquire the skills necessary.

Error Discounting in Probabilistic Category Learning

PubMed Central

Craig, Stewart; Lewandowsky, Stephan; Little, Daniel R.

2011-01-01

Some current theories of probabilistic categorization assume that people gradually attenuate their learning in response to unavoidable error. However, existing evidence for this error discounting is sparse and open to alternative interpretations. We report two probabilistic-categorization experiments that investigated error discounting by shifting feedback probabilities to new values after different amounts of training. In both experiments, responding gradually became less responsive to errors, and learning was slowed for some time after the feedback shift. Both results are indicative of error discounting. Quantitative modeling of the data revealed that adding a mechanism for error discounting significantly improved the fits of an exemplar-based and a rule-based associative learning model, as well as of a recency-based model of categorization. We conclude that error discounting is an important component of probabilistic learning. PMID:21355666

Barriers to Medical Error Reporting for Physicians and Nurses.

PubMed

Soydemir, Dilek; Seren Intepeler, Seyda; Mert, Hatice

2017-10-01

The purpose of the study was to determine what barriers to error reporting exist for physicians and nurses. The study, of descriptive qualitative design, was conducted with physicians and nurses working at a training and research hospital. In-depth interviews were held with eight physicians and 15 nurses, a total of 23 participants. Physicians and nurses do not choose to report medical errors that they experience or witness. When barriers to error reporting were examined, it was seen that there were four main themes involved: fear, the attitude of administration, barriers related to the system, and the employees' perceptions of error. It is important in terms of preventing medical errors to identify the barriers that keep physicians and nurses from reporting errors.

Comparison of Anxiety Management Training and Desensitization in Reducing Test and Other Anxieties.

ERIC Educational Resources Information Center

Deffenbacher, Jerry L.; Shelton, John L.

1978-01-01

Effects of systematic desensitization and anxiety management training in reducing test anxiety and generalizing to other anxieties were compared. Both desensitization and anxiety management training produced significant reduction of text anxiety, but by follow-up, anxiety management training produced significantly more test-anxiety reduction on…

Management Communication Training: The Need for Long-Term Effectiveness Studies.

ERIC Educational Resources Information Center

Mattox, Robert J.; Smith, Robert L.

Currently, training programs for management are an integral part of most organizations. One of the concerns about training programs has been the lack of research supporting change in management training. Recently, counselors have become involved in Human Resources Management (HRM). Organizations have been criticized for making few attempts to…

Management of high-risk perioperative systems.

PubMed

Dain, Steven

2006-06-01

The perioperative system is a complex system that requires people, materials, and processes to come together in a highly ordered and timely manner. However, when working in this high-risk system, even well-organized, knowledgeable, vigilant, and well-intentioned individuals will eventually make errors. All systems need to be evaluated on a continual basis to reduce the risk of errors, make errors more easily recognizable, and provide methods for error mitigation. A simple approach to risk management that may be applied in clinical medicine is discussed.

Hospitality Management Education and Training.

ERIC Educational Resources Information Center

Brotherton, Bob, Ed.; And Others

1995-01-01

Seven articles on hospitality management training discuss the following: computerized management games for restaurant manager training, work placement, real-life exercises, management information systems in hospitality degree programs, modular programming, service quality concepts in the curriculum, and General National Vocational Qualifications…

Perceptions of U.S. Navy Medical Reservists Recalled for Operation Desert Storm

DTIC Science & Technology

1992-10-01

operational training? .69 your recall assignment in leadership / management training? .69 your recall assignment in general military training? .67 your recall...uniforms, chain of command, etc.) 1 2 3 4 5 21. Leadership / Management Training (LMET, command excellence seminars, etc.) 1 2 3 4 5 22. Based on your recall...through 4" for 4th-highest priority.) Clinical/Professional Skills Training Operational Training _ General Military Training Leadership / Management Training