17. SOUTHEAST CORNER OF BUILDING 8990 (MASTER SURVEILLANCE AND CONTROL ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

17. SOUTHEAST CORNER OF BUILDING 8990 (MASTER SURVEILLANCE AND CONTROL TOWER). - Loring Air Force Base, Alert Area, Southeastern portion of base, east of southern end of runway, Limestone, Aroostook County, ME

8. DETAIL OF FOLDING DOORS ON NORTH ELEVATION OF BUILDING ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

8. DETAIL OF FOLDING DOORS ON NORTH ELEVATION OF BUILDING 8965 (SECURITY POLICE ENTRY CONTROL BUILDING). - Loring Air Force Base, Alert Area, Southeastern portion of base, east of southern end of runway, Limestone, Aroostook County, ME

INTERIOR OF BUILDING, SHOWING PIPELINES. view TO NORTH Plattsburgh ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

INTERIOR OF BUILDING, SHOWING PIPELINES. view TO NORTH - Plattsburgh Air Force Base, Industrial Wastewater Treatment & Disposal Facility, Off LeMay Road, outside SAC Alert Area, Plattsburgh, Clinton County, NY

17. Missile mural, third flight of stairs. Lyon Whiteman ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

17. Missile mural, third flight of stairs. Lyon - Whiteman Air Force Base, Minuteman Missile Launch Facility Trainer T-12, Northeast of Oscar-01 Missile Alert Facility, Knob Noster, Johnson County, MO

12. Hard HF transmitter antenna, view toward west. Lyon ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

12. Hard HF transmitter antenna, view toward west. Lyon - Whiteman Air Force Base, Oscar O-1 Minuteman Missile Alert Facility, Southeast corner of Twelfth & Vendenberg Avenues, Knob Noster, Johnson County, MO

11. Hard HF receiver antenna, view towards east. Lyon ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

11. Hard HF receiver antenna, view towards east. Lyon - Whiteman Air Force Base, Oscar O-1 Minuteman Missile Alert Facility, Southeast corner of Twelfth & Vendenberg Avenues, Knob Noster, Johnson County, MO

OVERALL VIEW OF CONTROL BUILDING AND SECURITY GATE. VIEW TO ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

OVERALL VIEW OF CONTROL BUILDING AND SECURITY GATE. VIEW TO NORTH. - Plattsburgh Air Force Base, Security Police Entry Control Building, Off Perimeter Road in SAC Alert Area, Plattsburgh, Clinton County, NY

SOUTHEAST (FRONT) AND NORTHEAST (SIDE) ELEVATIONS OF BUILDING. VIEW TO ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

SOUTHEAST (FRONT) AND NORTHEAST (SIDE) ELEVATIONS OF BUILDING. VIEW TO WEST - Plattsburgh Air Force Base, Industrial Wastewater Treatment & Disposal Facility, Off LeMay Road, outside SAC Alert Area, Plattsburgh, Clinton County, NY

NORTHEAST (SIDE) AND NORTHWEST (REAR) ELEVATIONS OF BUILDING. VIEW TO ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

NORTHEAST (SIDE) AND NORTHWEST (REAR) ELEVATIONS OF BUILDING. VIEW TO SOUTH - Plattsburgh Air Force Base, Industrial Wastewater Treatment & Disposal Facility, Off LeMay Road, outside SAC Alert Area, Plattsburgh, Clinton County, NY

SOUTHEAST (FRONT) AND SOUTHWEST (SIDE) ELEVATIONS OF BUILDING. view TO ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

SOUTHEAST (FRONT) AND SOUTHWEST (SIDE) ELEVATIONS OF BUILDING. view TO NORTH - Plattsburgh Air Force Base, Industrial Wastewater Treatment & Disposal Facility, Off LeMay Road, outside SAC Alert Area, Plattsburgh, Clinton County, NY

3. SOUTH ELEVATION OF SECURITY GATE. SAPLING SCULPTURES ON EITHER ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

3. SOUTH ELEVATION OF SECURITY GATE. SAPLING SCULPTURES ON EITHER SIDE OF GATE WERE ADDED BY A LOCAL ARTIST IN AUGUST 1998. - Loring Air Force Base, Alert Area, Southeastern portion of base, east of southern end of runway, Limestone, Aroostook County, ME

18. Topside facility, interior of facility manager's room, view towards ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

18. Topside facility, interior of facility manager's room, view towards west. Lyon - Whiteman Air Force Base, Oscar O-1 Minuteman Missile Alert Facility, Southeast corner of Twelfth & Vendenberg Avenues, Knob Noster, Johnson County, MO

Benefit Value to the Air Force of the GIDEP (Government Industry Data Exchange Program) Alert

DTIC Science & Technology

1984-06-15

cost avoidance within that organization is not the result of the ALERT system . 3-1 b) Designed Life - This is the expected life of the item as...Analytics1 Phase II efforts under contract F33615-S3- C-5098. The main findings of the report are: (1) The system set up to handle Government...slow to issue ALERTs. (4) There is no formally documented system for determining that the Air Force’s warranty rights are being enforced on items

6. VIEW OF AIRFIELD LOOKING SOUTHEAST FROM BUILDING 8200 (CONTROL ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

6. VIEW OF AIRFIELD LOOKING SOUTHEAST FROM BUILDING 8200 (CONTROL TOWER SHOWING ALPHA TAXIWAY AND ALTERNATE RUNWAY (TAXIWAY J) IN FOREGROUND, NORTH-SIDE RUNWAY IN MIDDLE GROUND, AND ALERT AREA WITH ITS TAXIWAY IN BACKGROUND. - Loring Air Force Base, Airfield, Central portion of base, Limestone, Aroostook County, ME

10. 351st Missile Wing Maintenance insignia on wall opposite the ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

10. 351st Missile Wing Maintenance insignia on wall opposite the entrance. Lyon - Whiteman Air Force Base, Minuteman Missile Launch Facility Trainer T-12, Northeast of Oscar-01 Missile Alert Facility, Knob Noster, Johnson County, MO

2. T12, exterior overall view, view from just outside the ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

2. T-12, exterior overall view, view from just outside the security fence looking southeast. Lyon - Whiteman Air Force Base, Minuteman Missile Launch Facility Trainer T-12, Northeast of Oscar-01 Missile Alert Facility, Knob Noster, Johnson County, MO

Neural and Biological Soldier Enhancement: From SciFi to Deployment

DTIC Science & Technology

2009-10-01

and force, extra- and ultra-sensory perception , side-effect free 72-hours unbowed alertness, or brain-based Report Documentation Page Form...Deployment 33 - 2 RTO-MP-HFM-181 augmented reality perception , become conceivable and increasingly within reach. A lot of these extraordinary...visionary or exotic, might severely impact NATO forces´ future performance. In addition, a shift in society´s perception of the parting rule between human

4. VIEW OF SECURITY GATE LOOKING SOUTHWEST FROM ROOF OF ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

4. VIEW OF SECURITY GATE LOOKING SOUTHWEST FROM ROOF OF BUILDING 8970 (CREW READINESS BUILDING) SHOWING BUILDING 8965 (SECURITY POLICE ENTRY CONTROL BUILDING) IN RIGHT MIDDLE GROUND AND BUILDING 8966 (ELECTRIC POWER STATION BUILDING) IN RIGHT FOREGROUND. - Loring Air Force Base, Alert Area, Southeastern portion of base, east of southern end of runway, Limestone, Aroostook County, ME

4. View of the launch closure. Transporter/erector mounts at center, ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

4. View of the launch closure. Transporter/erector mounts at center, security antenna at left, access building at right. View towards south. Lyon - Whiteman Air Force Base, Minuteman Missile Launch Facility Trainer T-12, Northeast of Oscar-01 Missile Alert Facility, Knob Noster, Johnson County, MO

75 FR 57044 - NIOSH List of Antineoplastic and Other Hazardous Drugs in Healthcare Settings 2010

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-17

...-167/ . Background: The NIOSH Alert: Preventing Occupational Exposures to Antineoplastic and Other... the 2004 list in Appendix A of the Alert. This guidance document does not have the force and effect of...

Sleep Deprivation and Sustained Attention Performance: Integrating Mathematical and Cognitive Modeling

DTIC Science & Technology

2009-01-01

Gluck,a David F. Dingesc aAir Force Research Laboratory, Mesa bThe Pennsylvania State University , University Park cUniversity of Pennsylvania School...possible using either model- ing approach in isolation. 2.1. Biomathematical models of alertness Biomathematical models of alertness have been developed...window into the information process- ing mechanisms in the cognitive system and how they may be affected by decreased alert- ness. The next section

Display area, looking north towards the classified storage rooms, D.M. ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

Display area, looking north towards the classified storage rooms, D.M. Logistics and D.O. Offices in northwest corner. Viewing bridge is at upper left, and alert status display at upper right - March Air Force Base, Strategic Air Command, Combat Operations Center, 5220 Riverside Drive, Moreno Valley, Riverside County, CA

44 CFR 208.36 - Reimbursement for Alert.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Reimbursement for Alert. 208.36 Section 208.36 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT... § 208.41 of this part. (4) Food and beverages for Task Force Members and Support Specialists when DHS...

The New Work Force. Trends and Issues Alerts.

ERIC Educational Resources Information Center

Imel, Susan

During the last years of this century, the work force will grow more slowly, becoming older, more female, and more disadvantaged. An increasing number of minority groups and immigrants will enter the work force. Despite public demands for reform, education lags behind in preparing youth for employment. The changing work force has many implications…

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

PubMed

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

2015-06-01

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

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

PubMed Central

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

2017-01-01

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

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

PubMed

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

2017-01-01

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

Electronic search and rescue aids

NASA Technical Reports Server (NTRS)

Trudell, B. J.

1980-01-01

There are two elements to the basic electronic search and rescue problem: a means for immediately alerting potential rescuers and an effective method to guide the rescue forces to the scene of the emergency. An Emergency Locator Transmitter (ELT) used by aircraft or an Emergency Position Indicating Radio Beacon (EPIRB) used by maritime vessels has the capability of providing for both an immediate alert and a homing signal to assist rescue forces in locating the site of the distress. This paper describes the development of ELT/EPIRB systems. Emphasis is placed on the SARSAT project, the COSPAS/SARSAT project, and an experimental 406 MHz ELT/EPIRB system.

The Changing Work Force. Trends and Issues Alerts.

ERIC Educational Resources Information Center

Lankard, Bettina A.

Economic pressures, work force diversity, and advances in technology are changing the nature of work and organizational policy and management. A predicted decline in the annual growth in gross national product is expected to trigger a slowdown in the labor force, especially in occupations that employ workers with only a high school education.…

Main doorway to the display area, straight ahead. Double doors ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

Main doorway to the display area, straight ahead. Double doors with "top secret" alert lights, coded doorbell, and one way mirror. Stairway to second floor and basement is at the left, as well as the secondary entrance at the east part of the north front. View to east - March Air Force Base, Strategic Air Command, Combat Operations Center, 5220 Riverside Drive, Moreno Valley, Riverside County, CA

Wearable PPG sensor based alertness scoring system.

PubMed

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

2017-07-01

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

The Volatile Teenage Labor Market: Labor Force Entry, Exit, and Unemployment Flows.

ERIC Educational Resources Information Center

Smith, Ralph E.; Vanski, Jean E.

1979-01-01

Alerts researchers to the potential value and limitations of the gross flow data published in the Department of Labor's Current Population Survey (CPS). Reports on research which used CPS data to analyze patterns of teenage unemployment and labor force participation. (PR)

KSC-2015-1302

NASA Image and Video Library

2015-02-07

CAPE CANAVERAL, Fla. – Col. D. Jason Cothern, Space Demonstrations Division chief at Kirtland Air Force Base in Albuquerque, New Mexico, listens to a question from a member of the news media during a briefing regarding NOAA’s Deep Space Climate Observatory spacecraft, or DSCOVR. DSCOVR will launch aboard a SpaceX Falcon 9 rocket. The mission is a partnership between NOAA, NASA and the U.S. Air Force. DSCOVR will maintain the nation's real-time solar wind monitoring capabilities which are critical to the accuracy and lead time of NOAA's space weather alerts and forecasts. To learn more about DSCOVR, visit http://www.nesdis.noaa.gov/DSCOVR. Photo credit: NASA/Kim Shiflett

An IDS Alerts Aggregation Algorithm Based on Rough Set Theory

NASA Astrophysics Data System (ADS)

Zhang, Ru; Guo, Tao; Liu, Jianyi

2018-03-01

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

KSC-08pd1386

NASA Image and Video Library

2008-05-14

CAPE CANAVERAL, Fla. -- Off Florida's central east coast, members of the rescue team in a training exercise, known as Mode VIII, stay alert aboard the U.S. Coast Guard cutter Kingfisher, from Port Canaveral, Fla. In support of, and with logistical support from, NASA, USSTRATCOM is hosting a major exercise involving Department of Defense, Department of Homeland Security, search and rescue (SAR) forces, including the 45th Space Wing at Patrick Air Force Base, which support space shuttle astronaut bailout contingency operations, known as Mode VIII. This exercise tests SAR capabilities to locate, recover and provide medical treatment for astronauts following a space shuttle launch phase open-ocean bailout. Participants include members of the U.S. Navy, U.S. Coast Guard, U.S. Air Force, and NASA's Kennedy Space Center and Johnson Space Center. Photo credit: NASA/Dimitri Gerondidakis

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

PubMed Central

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

2014-01-01

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

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

PubMed

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

2014-10-01

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

Female Reproductive Effects of Exposure to Jet Fuel at U.S. Air Force Bases

DTIC Science & Technology

1998-11-01

volunteers during 1997. Volunteers then provided feedback about the process and made suggestions for improvement. This information was used to develop...breath samples were processed in the field by collecting one (1) liter of expired breath in a Tedlar bag which was subsequently introduced onto a...also alert him when samples were obtained thru to menses. The process for returning samples was also facilitated by the provision of a mailing kit

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

PubMed

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

2018-05-09

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

Alcohol Alert. No. 58. Changing the Culture of Campus Drinking

ERIC Educational Resources Information Center

Kington, Raynard

2002-01-01

Drinking on college campuses is more pervasive and destructive than many people realize. The extent of the problem was recently highlighted by an extensive 3-year investigation by the Task Force on College Drinking, commissioned by the National Institute on Alcohol Abuse and Alcoholism (NIAAA). The Task Force reports that alcohol consumption is…

The Changing Adolescent Experience: Societal Trends and the Transition to Adulthood.

ERIC Educational Resources Information Center

Mortimer, Jeylan T.; Larson, Reed W.

The path adolescents take from childhood to adulthood is a product of social, economic, political, and technological forces. These forces may facilitate youths preparation to become healthy adults, or they may leave youth unprepared for adulthood. Knowledgeable projections are vital in shaping the agenda for research; for alerting educators,…

Feature Selection Using Information Gain for Improved Structural-Based Alert Correlation

PubMed Central

Siraj, Maheyzah Md; Zainal, Anazida; Elshoush, Huwaida Tagelsir; Elhaj, Fatin

2016-01-01

Grouping and clustering alerts for intrusion detection based on the similarity of features is referred to as structurally base alert correlation and can discover a list of attack steps. Previous researchers selected different features and data sources manually based on their knowledge and experience, which lead to the less accurate identification of attack steps and inconsistent performance of clustering accuracy. Furthermore, the existing alert correlation systems deal with a huge amount of data that contains null values, incomplete information, and irrelevant features causing the analysis of the alerts to be tedious, time-consuming and error-prone. Therefore, this paper focuses on selecting accurate and significant features of alerts that are appropriate to represent the attack steps, thus, enhancing the structural-based alert correlation model. A two-tier feature selection method is proposed to obtain the significant features. The first tier aims at ranking the subset of features based on high information gain entropy in decreasing order. The‏ second tier extends additional features with a better discriminative ability than the initially ranked features. Performance analysis results show the significance of the selected features in terms of the clustering accuracy using 2000 DARPA intrusion detection scenario-specific dataset. PMID:27893821

Environmental Assessment: For the Testing and Evaluation of Directed Energy System Using Laser Technology, Edwards Air Force Base

DTIC Science & Technology

2006-08-01

restricted for use 14 by DoD, National Aeronautics and Space Administration ( NASA ), and other government agencies. This 15 airspace is over an area...counties in California and 21 extends into Nevada’s Esmeralda County ( NASA 1997a). 22 There are no warning, prohibited, or alert special use airspace...mountains or ridge 13 formations, spot the ground surface ( NASA 1997b). 14 The highest general elevation of the Mojave Desert approaches 4,000

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

NASA Astrophysics Data System (ADS)

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

2014-11-01

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

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

PubMed

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

2017-09-01

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

Personalized and automated remote monitoring of atrial fibrillation.

PubMed

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

2016-03-01

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

The effect of phasic auditory alerting on visual perception.

PubMed

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

2017-08-01

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

INITIATE: An Intelligent Adaptive Alert Environment.

PubMed

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

2015-01-01

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

Utility of de-escalatory confidence-building measures

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

Nation, J.

1989-06-01

This paper evaluates the utility of specific confidence-building de-escalatory measures and pays special attention to the evaluation of measures which place restrictions on or establish procedures for strategic forces. Some measures appear more promising than others. Potentially useful confidence-building measures largely satisfy defined criteria and include the phased return of strategic nuclear forces to peacetime bases and operations, the termination of interference with communications and NTMs (National Technical Means) and the termination of civil defense preparations. Less-promising CBMs include the standing down of supplemental early warning systems, the establishment of SSBN keep-out zones, and decreases in bomber alert rates. Establishmentmore » of SSBN keep-out zones and reduction in bomber rates are difficult to verify, while the standing-down of early warning systems provides little benefit at potentially large costs. Particular confidence-building measures (CBMs) may be most useful in building superpower confidence at specific points in the crisis termination phase. For example, a decrease in strategic bomber alert rates may provide some decrease in perception of the likelihood of war, but its potential costs, particularly in increasing bomber vulnerability, may limit its utility and implementation to the final crisis stages when the risks of re-escalation and surprise attack are lower.« less

Summary of findings from the PIREP-based analyses conducted during the 1988 to 1990 evaluations of TDWR-based and TDWR/LLWAS-based alert services provided to landing/departing pilots

DOT National Transportation Integrated Search

1992-07-01

The Federal Aviation Administration (FAA) is developing the Terminal Doppler Weather Radar (TDWR). Starting in 1985, the TDWR Program conducted a series of evaluations of a TDWR-based alert service to provide wind shear and microburst alerts to landi...

DAIDALUS: Detect and Avoid Alerting Logic for Unmanned Systems

NASA Technical Reports Server (NTRS)

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

2015-01-01

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

Alertness and cognitive control: Testing the early onset hypothesis.

PubMed

Schneider, Darryl W

2018-05-01

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

Sensitivity of stability indices to dealerting

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

Canavan, G.H.

1998-03-01

It is reported that more than 100 former or current heads of state and civilian leaders from around the world, including ex-presidents Jimmy Carter and Mikhail Gorbachev, have signed a statement that calls for removing nuclear weapons from alert status and other measures aimed at the eventual elimination of atomic arsenals--reflecting mounting support for the cause of nuclear bolition. This note uses stability analysis derived from current US and Russian analyses to study the impact of such dealerting on stability, indicating that it could be negative. Dealerting forces removes them from first and second strikes for as long as theymore » are dealerted. If they are dealerted for periods long compared to those involved in the evaluation of first strike stability, dealerting has the same effect as permanent arms reductions, it subtracts them from first and second strikes. Thus, it is conceptually a way of implementing such reductions on an accelerated scale. Dealerting strategic forces has been posited as a stabilizing step towards their abolition. Previous reports have shown that planned START reductions will reduce stability indices by about a factor of two. Dealerting would hasten those reductions. They would also raise the possibility that one side could realert faster than the other. If so, the remobilized forces could be used to damage limit, which would reduce his first strike cost and stability index. The impact of complete demobilization of SSBNs would be an order of magnitude reduction in the overall stability index, to a level set by alert ICBMs. Generally, it would be preferable to maintain any existing strategic forces at the highest level of alert to minimize this effect and to concentrate instead on decreasing their total number.« less

PubMedAlertMe - Standalone Windows-based PubMed SDI Software Application

PubMed Central

Ma’ayan, Avi

2008-01-01

PubMedAlertMe is a Windows-based software system for automatically receiving e-mail alert messages about recent publications listed on PubMed. The e-mail messages contain links to newly available abstracts listed on PubMed describing publications that were selectively returned from a specified list of queries. Links are also provided to directly export citations to EndNote, and links are provided to directly forward articles to colleagues. The program is standalone. Thus, it does not require a remote mail server or user registration. PubMedAlertMe is free software, and can be downloaded from: http://amp.pharm.mssm.edu/PubMedAlertMe/PubMedAlertMe_setup.zip PMID:18402930

Integrating Multiple Space Ground Sensors to Track Volcanic Activity

NASA Technical Reports Server (NTRS)

Chien, Steve; Davies, Ashley; Doubleday, Joshua; Tran, Daniel; Jones, Samuel; Kjartansson, Einar; Thorsteinsson, Hrobjartur; Vogfjord, Kristin; Guomundsson, Magnus; Thordarson, Thor;

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

PubMed Central

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

2016-01-01

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

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

PubMed

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

2018-04-19

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

Public Release of Estimated Impact-Based Earthquake Alerts - An Update to the U.S. Geological Survey PAGER System

NASA Astrophysics Data System (ADS)

Wald, D. J.; Jaiswal, K. S.; Marano, K.; Hearne, M.; Earle, P. S.; So, E.; Garcia, D.; Hayes, G. P.; Mathias, S.; Applegate, D.; Bausch, D.

2010-12-01

The U.S. Geological Survey (USGS) has begun publicly releasing earthquake alerts for significant earthquakes around the globe based on estimates of potential casualties and economic losses. These estimates should significantly enhance the utility of the USGS Prompt Assessment of Global Earthquakes for Response (PAGER) system that has been providing estimated ShakeMaps and computing population exposures to specific shaking intensities since 2007. Quantifying earthquake impacts and communicating loss estimates (and their uncertainties) to the public has been the culmination of several important new and evolving components of the system. First, the operational PAGER system now relies on empirically-based loss models that account for estimated shaking hazard, population exposure, and employ country-specific fatality and economic loss functions derived using analyses of losses due to recent and past earthquakes. In some countries, our empirical loss models are informed in part by PAGER’s semi-empirical and analytical loss models, and building exposure and vulnerability data sets, all of which are being developed in parallel to the empirical approach. Second, human and economic loss information is now portrayed as a supplement to existing intensity/exposure content on both PAGER summary alert (available via cell phone/email) messages and web pages. Loss calculations also include estimates of the economic impact with respect to the country’s gross domestic product. Third, in order to facilitate rapid and appropriate earthquake responses based on our probable loss estimates, in early 2010 we proposed a four-level Earthquake Impact Scale (EIS). Instead of simply issuing median estimates for losses—which can be easily misunderstood and misused—this scale provides ranges of losses from which potential responders can gauge expected overall impact from strong shaking. EIS is based on two complementary criteria: the estimated cost of damage, which is most suitable for U.S. domestic events; and estimated ranges of fatalities, which are generally more appropriate for global events, particularly in earthquake-vulnerable countries. Alert levels are characterized by alerts of green (little or no impact), yellow (regional impact and response), orange (national-scale impact and response), and red (international response). Corresponding fatality thresholds for yellow, orange, and red alert levels are 1, 100, and 1000, respectively. For damage impact, yellow, orange, and red thresholds are triggered when estimated US dollar losses reach 1 million, 100 million, and 1 billion+ levels, respectively. Finally, alerting protocols now explicitly support EIS-based alerts. Critical users can receive PAGER alerts i) based on the EIS-based alert level, in addition to or as an alternative to magnitude and population/intensity exposure-based alerts, and ii) optionally, based on user-selected regions of the world. The essence of PAGER’s impact-based alerting is that actionable loss information is now available in the immediate aftermath of significant earthquakes worldwide based on quantifiable, albeit uncertain, loss estimates provided by the USGS.

The effect of the electronic medical record on nurses' work.

PubMed

Robles, Jane

2009-01-01

The electronic medical record (EMR) is a workplace reality for most nurses. Its advantages include a single consolidated record for each person; capacity for data interfaces and alerts; improved interdisciplinary communication; and evidence-based decision support. EMRs can add to work complexity, by forcing better documentation of previously unrecorded data and/or because of poor design. Well-designed and well-implemented computerized provider order entry (CPOE) systems can streamline nurses' work. Generational differences in acceptance of and facility with EMRs can be addressed through open, healthy communication.

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

PubMed

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

2018-05-15

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

Implementing a Commercial Rule Base as a Medication Order Safety Net

PubMed Central

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

2005-01-01

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

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

NASA Technical Reports Server (NTRS)

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

2016-01-01

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

Alerts Analysis and Visualization in Network-based Intrusion Detection Systems

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

Yang, Dr. Li

2010-08-01

The alerts produced by network-based intrusion detection systems, e.g. Snort, can be difficult for network administrators to efficiently review and respond to due to the enormous number of alerts generated in a short time frame. This work describes how the visualization of raw IDS alert data assists network administrators in understanding the current state of a network and quickens the process of reviewing and responding to intrusion attempts. The project presented in this work consists of three primary components. The first component provides a visual mapping of the network topology that allows the end-user to easily browse clustered alerts. Themore » second component is based on the flocking behavior of birds such that birds tend to follow other birds with similar behaviors. This component allows the end-user to see the clustering process and provides an efficient means for reviewing alert data. The third component discovers and visualizes patterns of multistage attacks by profiling the attacker s behaviors.« less

Conditional Outlier Detection for Clinical Alerting

PubMed Central

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

2010-01-01

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

Conditional outlier detection for clinical alerting.

PubMed

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

2010-11-13

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

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

PubMed

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

2012-08-27

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

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

PubMed Central

2012-01-01

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

Development and implementation of sepsis alert systems

PubMed Central

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

2016-01-01

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

Wireless clinical alerts for physiologic, laboratory and medication data.

PubMed Central

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

2000-01-01

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

Unmanned ground vehicles for integrated force protection

NASA Astrophysics Data System (ADS)

Carroll, Daniel M.; Mikell, Kenneth; Denewiler, Thomas

2004-09-01

The combination of Command and Control (C2) systems with Unmanned Ground Vehicles (UGVs) provides Integrated Force Protection from the Robotic Operation Command Center. Autonomous UGVs are directed as Force Projection units. UGV payloads and fixed sensors provide situational awareness while unattended munitions provide a less-than-lethal response capability. Remote resources serve as automated interfaces to legacy physical devices such as manned response vehicles, barrier gates, fence openings, garage doors, and remote power on/off capability for unmanned systems. The Robotic Operations Command Center executes the Multiple Resource Host Architecture (MRHA) to simultaneously control heterogeneous unmanned systems. The MRHA graphically displays video, map, and status for each resource using wireless digital communications for integrated data, video, and audio. Events are prioritized and the user is prompted with audio alerts and text instructions for alarms and warnings. A control hierarchy of missions and duty rosters support autonomous operations. This paper provides an overview of the key technology enablers for Integrated Force Protection with details on a force-on-force scenario to test and demonstrate concept of operations using Unmanned Ground Vehicles. Special attention is given to development and applications for the Remote Detection Challenge and Response (REDCAR) initiative for Integrated Base Defense.

Outlier Detection for Patient Monitoring and Alerting

PubMed Central

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

2012-01-01

We develop and evaluate a data-driven approach for detecting unusual (anomalous) patient-management decisions using past patient cases stored in electronic health records (EHRs). Our hypothesis is that a patient-management decision that is unusual with respect to past patient care may be due to an error and that it is worthwhile to generate an alert if such a decision is encountered. We evaluate this hypothesis using data obtained from EHRs of 4,486 post-cardiac surgical patients and a subset of 222 alerts generated from the data. We base the evaluation on the opinions of a panel of experts. The results of the study support our hypothesis that the outlier-based alerting can lead to promising true alert rates. We observed true alert rates that ranged from 25% to 66% for a variety of patient-management actions, with 66% corresponding to the strongest outliers. PMID:22944172

Radar-based alert system to operate a sewerage network: relevance and operational effectiveness after several years of use.

PubMed

Faure, D; Payrastre, O; Auchet, P

2005-01-01

Since January 2000, the sewerage network of a very urbanised catchment area in the Greater Nancy Urban Community has been operated according to the alarms generated in real time by a storm alert system using weather radar data. This alert system is based on an automatic identification of intense rain cells in the radar images. This paper presents the characteristics of this alert system and synthesises the main results of two complementary studies realised in 2002 in order to estimate the relevance and the operational effectiveness of the alert system. The first study consisted in an off-line analysis of almost 50,000 intense rain cells detected in four years of historical radar data. The second study was an analysis of the experience feedback after two years of operational use of this alert system. The results of these studies are discussed in function of the initial operational objectives.

Alert Exchange Process Protocol

NASA Technical Reports Server (NTRS)

Groen, Frank

2015-01-01

The National Aeronautics and Space Administration of the United States of America (NASA), and the European Space Agency (ESA), and the Japanese Aerospace Exploration Agency (JAXA), acknowledging that NASA, ESA and JAXA have a mutual interest in exchanging Alerts and Alert Status Lists to enhance the information base for each system participant while fortifying the general level of cooperation between the policy agreement subscribers, and each Party will exchange Alert listings on regular basis and detailed Alert information on a need to know basis to the extent permitted by law.

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

PubMed

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

2015-05-01

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

Report of the Defense Science Board Task Force on Mission Impact of Foreign Influence on DoD Software

DTIC Science & Technology

2007-09-01

Findings______________________________________________________________________ Chinese hackers forced one of its bureaus to cut off Internet access and discard virus -infected...Vulnerability ( IAV ) Management (IAVM) process was created to prepare and rapidly disseminate mitigating actions for potentially critical software...vulnerabilities to DoD Components. IAVM notices have three criticality levels: • IAV Alert (IAVA) – most critical – a vulnerability posing an immediate

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

PubMed Central

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

2014-01-01

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

Medication-related clinical decision support alert overrides in inpatients.

PubMed

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

2018-05-01

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

Alarms about structural alerts.

PubMed

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

2016-08-21

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

Alert generation and cockpit presentation for an integrated microburst alerting system

NASA Technical Reports Server (NTRS)

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

1991-01-01

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

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

PubMed

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

2014-01-01

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

Start and bomber survivability

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

Speed, R.D.

1989-05-01

The survivability of the strategic bombers, while important today, is likely to be viewed as being of even greater importance in the 1990s if the US makes drastic cuts in its strategic forces as proposed in START and possible follow-on treaties. The analysis in this paper indicates that the Soviets with only a few SSBNs could pose a serious threat to the survivability of the strategic bombers (as presently based) if they moved these SSBNs close to the coasts or developed short-time-of-flight trajectories for their SLBMs. In searching for ways to improve bomber survivability, the use of the proposed LPSmore » (Limited Protection System) ABM to defend bomber bases was examined, but found to offer marginal improvement, at best. However, a significant improvement in survivability against even severe threats could be achieved if the alert bomber forces were rebased at a large number (preferably 40 or more) of separate bases distributed in a region in the interior of the country with the closest base being at least 500 nmi from the coasts.« less

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

PubMed

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

2013-06-01

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

Alerts Visualization and Clustering in Network-based Intrusion Detection

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

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

2010-04-01

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

Status of Sundstrand research

NASA Technical Reports Server (NTRS)

Bateman, Don

1991-01-01

Wind shear detection status is presented in the form of view-graphs. The following subject areas are covered: second generation detection (Q-bias, gamma bias, temperature biases, maneuvering flight modulation, and altitude modulation); third generation wind shear detection (use wind shear computation to augment flight path and terrain alerts, modulation of alert thresholds based on wind/terrain data base, incorporate wind shear/terrain alert enhancements from predictive sensor data); and future research and development.

Validity and reliability of clinical prediction rules used to screen for cervical spine injury in alert low-risk patients with blunt trauma to the neck: part 2. A systematic review from the Cervical Assessment and Diagnosis Research Evaluation (CADRE) Collaboration.

PubMed

Moser, N; Lemeunier, N; Southerst, D; Shearer, H; Murnaghan, K; Sutton, D; Côté, P

2018-06-01

To update findings of the 2000-2010 Bone and Joint Decade Task Force on Neck Pain and its Associated Disorders (Neck Pain Task Force) on the validity and reliability of clinical prediction rules used to screen for cervical spine injury in alert low-risk adult patients with blunt trauma to the neck. We searched four databases from 2005 to 2015. Pairs of independent reviewers critically appraised eligible studies using the modified QUADAS-2 and QAREL criteria. We synthesized low risk of bias studies following best evidence synthesis principles. We screened 679 citations; five had a low risk of bias and were included in our synthesis. The sensitivity of the Canadian C-spine rule ranged from 0.90 to 1.00 with negative predictive values ranging from 99 to 100%. Inter-rater reliability of the Canadian C-spine rule varied from k = 0.60 between nurses and physicians to k = 0.93 among paramedics. The inter-rater reliability of the Nexus Low-Risk Criteria was k = 0.53 between resident physicians and faculty physicians. Our review adds new evidence to the Neck Pain Task Force and supports the use of clinical prediction rules in emergency care settings to screen for cervical spine injury in alert low-risk adult patients with blunt trauma to the neck. The Canadian C-spine rule consistently demonstrated excellent sensitivity and negative predictive values. Our review, however, suggests that the reproducibility of the clinical predictions rules varies depending on the examiners level of training and experience.

Evaluation of prescriber responses to pharmacogenomics clinical decision support for thiopurine S-methyltransferase testing.

PubMed

Ubanyionwu, Samuel; Formea, Christine M; Anderson, Benjamin; Wix, Kelly; Dierkhising, Ross; Caraballo, Pedro J

2018-02-15

Results of a study of prescribers' responses to a pharmacogenomics-based clinical decision support (CDS) alert designed to prompt thiopurine S -methyltransferase (TPMT) status testing are reported. A single-center, retrospective, chart review-based study was conducted to evaluate prescriber compliance with a pretest CDS alert that warned of potential thiopurine drug toxicity resulting from deficient TPMT activity due to TPMT gene polymorphism. The CDS alert was triggered when prescribers ordered thiopurine drugs for patients whose records did not indicate TPMT status or when historical thiopurine use was documented in the electronic health record. The alert pop-up also provided a link to online educational resources to guide thiopurine dosing calculations. During the 9-month study period, 500 CDS alerts were generated: in 101 cases (20%), TPMT phenotyping or TPMT genotyping was ordered; in 399 cases (80%), testing was not ordered. Multivariable regression analysis indicated that documentation of historical thiopurine use was the only independent predictor of test ordering. Among the 99 patients tested subsequent to CDS alerts, 70 (71%) had normal TPMT activity, 29 (29%) had intermediate activity, and none had deficient activity. The online resources provided thiopurine dosing recommendations applicable to 24 patients, but only 3 were prescribed guideline-supported doses after CDS alerts. The pretest CDS rule resulted in a large proportion of neglected alerts due to poor alerting accuracy and consequent alert fatigue. Prescriber usage of online thiopurine dosing resources was low. Copyright © 2018 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

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

PubMed Central

Tamblyn, Robyn; Reidel, Kristen; Patel, Vaishali

2012-01-01

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

Prescription order risk factors for pediatric dosing alerts.

PubMed

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

2015-02-01

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

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

PubMed Central

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

2011-01-01

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

The national web-based outbreak rapid alert system in Norway: eight years of experience, 2006-2013.

PubMed

Guzman-Herrador, B; Vold, L; Berg, T; Berglund, T M; Heier, B; Kapperud, G; Lange, H; Nygård, K

2016-01-01

In 2005, the Norwegian Institute of Public Health established a web-based outbreak rapid alert system called Vesuv. The system is used for mandatory outbreak alerts from municipal medical officers, healthcare institutions, and food safety authorities. As of 2013, 1426 outbreaks have been reported, involving 32913 cases. More than half of the outbreaks occurred in healthcare institutions (759 outbreaks, 53·2%). A total of 474 (33·2%) outbreaks were associated with food or drinking water. The web-based rapid alert system has proved to be a helpful tool by enhancing reporting and enabling rapid and efficient information sharing between different authorities at both the local and national levels. It is also an important tool for event-based reporting, as required by the International Health Regulations (IHR) 2005. Collecting information from all the outbreak alerts and reports in a national database is also useful for analysing trends, such as occurrence of certain microorganisms, places or sources of infection, or route of transmission. This can facilitate the identification of specific areas where more general preventive measures are needed.

Prototype Conflict Alerting Logic for Free Flight

NASA Technical Reports Server (NTRS)

Yang, Lee C.; Kuchar, James K.

1997-01-01

This paper discusses the development of a prototype alerting system for a conceptual Free Flight environment. The concept assumes that datalink between aircraft is available and that conflicts are primarily resolved on the flight deck. Four alert stages are generated depending on the likelihood of a conflict. If the conflict is not resolved by the flight crews, Air Traffic Control is notified to take over separation authority. The alerting logic is based on probabilistic analysis through modeling of aircraft sensor and trajectory uncertainties. Monte Carlo simulations were used over a range of encounter situations to determine conflict probability. The four alert stages were then defined based on probability of conflict and on the number of avoidance maneuvers available to the flight crew. Preliminary results from numerical evaluations and from a piloted simulator study at NASA Ames Research Center are summarized.

Conflict Management: Trends and Issues Alerts.

ERIC Educational Resources Information Center

Brown, Bettina Lankard

The dynamics of a diverse work force characterized by organizational change, competition, and complex communication are increasing attention toward finding new ways of avoiding the costly and destructive outcomes of relationship dysfunctions. Litigation and legal negotiation are two of the most expensive ways of conflict resolution; and…

49 CFR 1562.3 - Operating requirements.

Code of Federal Regulations, 2013 CFR

2013-10-01

... minimum, must: (1) Identify and provide contact information for the airport's airport security coordinator... and non-operational hours; and (ii) Alert the aircraft owner(s) and operator(s), the airport operator...) U.S. Armed forces, law enforcement, and aeromedical services aircraft. An individual may operate a U...

49 CFR 1562.3 - Operating requirements.

Code of Federal Regulations, 2011 CFR

2011-10-01

... minimum, must: (1) Identify and provide contact information for the airport's airport security coordinator... and non-operational hours; and (ii) Alert the aircraft owner(s) and operator(s), the airport operator...) U.S. Armed forces, law enforcement, and aeromedical services aircraft. An individual may operate a U...

49 CFR 1562.3 - Operating requirements.

Code of Federal Regulations, 2010 CFR

2010-10-01

... minimum, must: (1) Identify and provide contact information for the airport's airport security coordinator... and non-operational hours; and (ii) Alert the aircraft owner(s) and operator(s), the airport operator...) U.S. Armed forces, law enforcement, and aeromedical services aircraft. An individual may operate a U...

49 CFR 1562.3 - Operating requirements.

Code of Federal Regulations, 2014 CFR

2014-10-01

... minimum, must: (1) Identify and provide contact information for the airport's airport security coordinator... and non-operational hours; and (ii) Alert the aircraft owner(s) and operator(s), the airport operator...) U.S. Armed forces, law enforcement, and aeromedical services aircraft. An individual may operate a U...

49 CFR 1562.3 - Operating requirements.

Code of Federal Regulations, 2012 CFR

2012-10-01

... minimum, must: (1) Identify and provide contact information for the airport's airport security coordinator... and non-operational hours; and (ii) Alert the aircraft owner(s) and operator(s), the airport operator...) U.S. Armed forces, law enforcement, and aeromedical services aircraft. An individual may operate a U...

Visual Alert System

NASA Technical Reports Server (NTRS)

1985-01-01

A visual alert system resulted from circuitry developed by Applied Cybernetics Systems for Langley as part of a space related telemetry system. James Campman, Applied Cybernetics president, left the company and founded Grace Industries, Inc. to manufacture security devices based on the Langley technology. His visual alert system combines visual and audible alerts for hearing impaired people. The company also manufactures an arson detection device called the electronic nose, and is currently researching additional applications of the NASA technology.

Alert management for home healthcare based on home automation analysis.

PubMed

Truong, T T; de Lamotte, F; Diguet, J-Ph; Said-Hocine, F

2010-01-01

Rising healthcare for elder and disabled people can be controlled by offering people autonomy at home by means of information technology. In this paper, we present an original and sensorless alert management solution which performs multimedia and home automation service discrimination and extracts highly regular home activities as sensors for alert management. The results of simulation data, based on real context, allow us to evaluate our approach before application to real data.

Pi-EEWS: a low cost prototype for on-site earthquake early warning system

NASA Astrophysics Data System (ADS)

Pazos, Antonio; Vera, Angel; Morgado, Arturo; Rioja, Carlos; Davila, Jose Martin; Cabieces, Roberto

2017-04-01

The Royal Spanish Navy Observatory (ROA), with the participation of the Cadiz University (UCA), have been developed the ALERTES-SC3 EEWS (regional approach) based on the SeisComP3 software package. This development has been done in the frame of the Spanish ALERT-ES (2011-2013) and ALERTES-RIM (2014-2016) projects, and now a days it is being tested in real time for south Iberia. Additionally, the ALERTES-SC3 system integrates an on-site EEWS software, developed by ROA-UCA, which is running for testing in real time in some seismic broad band stations of the WM network. Regional EEWS are not able to provide alerts in the area closet to the epicentre (blind zone), so a dense on-site EEWS is necessary. As it was mentioned, ALERTES-SC3 inludes the on-site software running on several WM stations but a more dense on-site stations are necessary to cover the blind zones. In order to densify this areas, inside of the "blind zones", a low cost on-site prototype "Pi-EEWS", based on a Raspberry Pi card and low cost acelerometers. In this work the main design ideas, the components and its capabilities will be shown.

Pilot Non-Conformance to Alerting System Commands

NASA Technical Reports Server (NTRS)

Pritchett, Amy R.; Hansman, R. John

1997-01-01

Instances of pilot non-conformance to alerting system commands have been identified in previous studies. Pilot non-conformance changes the final behavior of the system, and therefore may reduce actual performance from that anticipated. A simulator study has examined pilot non-conformance, using the task of collision avoidance during closely spaced parallel approaches as a case study. Consonance between the display and the alerting system was found to significantly improve subject agreement with automatic alerts. Based on these results, a more general discussion of the factors involved in pilot conformance is given, and design guidelines for alerting systems are given.

76 FR 72306 - Federal Housing Administration (FHA) Appraiser Roster: Appraiser Qualifications for Placement on...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-23

... Appraiser Roster regulations by replacing the obsolete references to the Credit Alert Interactive Voice Response System (CAIVRS) with references to its successor, the online-based Credit Alert Verification... propose the elimination references to the Credit Alert Interactive Voice Response System (CAIVRS). On July...

76 FR 41441 - Federal Housing Administration (FHA) Appraiser Roster: Appraiser Qualifications for Placement on...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-14

... the FHA Appraiser Roster by replacing the obsolete references to the Credit Alert Interactive Voice Response System with references to its successor, the online-based Credit Alert Verification Reporting...'s Limited Denial of Participation list, or in HUD's Credit Alert Interactive Voice Response System...

Provider acceptance of an automated electronic alert for acute kidney injury

PubMed Central

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

2016-01-01

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

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

PubMed Central

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

2011-01-01

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

Task Force Resettlement Operation, After Action Report, Fort Chaffee, Arkansas, 7 May 1980-19 February 1982

DTIC Science & Technology

1982-06-09

authority to use non-lethal force must be established at the very beginning of such an operation, especially in light of the limited manpower available to the...references, and accurate interpretations of the law, especially as to jurisdictiopal matters, are critical. RECOMMENDATION: It is reccmmended that in...appropriate. Intensive planning,training/rehearsal, and practice alerts was essential, especially so as units rotated every 60 days. In effect, the

The United States Air Force in Southeast Asia: The War in Northern Laos, 1954-1973

DTIC Science & Technology

1993-01-01

Simultaneously, all 315th Air Division courier flights were canceled; all training was scrubbed ; 0=0 (l) and certain division troop carriers stood alert...Force and scrub it of its national markings. With Defense and State approval, he manned the plane with experienced USAF reconnaissance pilots from...the aegis of Cambodian Prince Norodom Sihanouk. On June 22 they agreed in principle to a tripartite government that would rule Laos until new general

Alerts in mobile healthcare applications: requirements and pilot study.

PubMed

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

2004-06-01

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

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

PubMed Central

Norris, Patrick R.; Dawant, Benoit M.

2002-01-01

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

Evaluation of Helmet Mounted Display Alerting Symbology

NASA Technical Reports Server (NTRS)

DeMaio, Joe; Rutkowski, Michael (Technical Monitor)

2000-01-01

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

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

PubMed

Greibe, Kell

2013-01-01

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

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

PubMed

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

2002-12-01

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

Relationship between alertness, performance, and body temperature in humans

NASA Technical Reports Server (NTRS)

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

2002-01-01

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

"Project ALERT's" Effects on Adolescents' Prodrug Beliefs: A Replication and Extension Study

ERIC Educational Resources Information Center

Clark, Heddy Kovach; Ringwalt, Chris L.; Hanley, Sean; Shamblen, Stephen R.

2010-01-01

This article represents a replication and extension of previous studies of the effects of "Project ALERT", a school-based substance use prevention program, on the prodrug beliefs of adolescents. Specifically, the authors' research examined "Project ALERT's" effects on adolescents' intentions to use substances in the future, beliefs about substance…

Mixed Signals in California: A Mismatch between High Schools and Community Colleges. Policy Alert

ERIC Educational Resources Information Center

National Center for Public Policy and Higher Education, 2008

2008-01-01

"Policy Alert" is a publication series that summarizes important policy findings affecting the future of higher education. This issue is based on an earlier study, "Investigating the Alignment of High School and Community College Assessments in California". The "Policy Alert" summarizes the findings of the study, and…

Monitoring alert and drowsy states by modeling EEG source nonstationarity

NASA Astrophysics Data System (ADS)

Hsu, Sheng-Hsiou; Jung, Tzyy-Ping

2017-10-01

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

Web-based Tsunami Early Warning System: a case study of the 2010 Kepulaunan Mentawai Earthquake and Tsunami

NASA Astrophysics Data System (ADS)

Ulutas, E.; Inan, A.; Annunziato, A.

2012-06-01

This study analyzes the response of the Global Disasters Alerts and Coordination System (GDACS) in relation to a case study: the Kepulaunan Mentawai earthquake and related tsunami, which occurred on 25 October 2010. The GDACS, developed by the European Commission Joint Research Center, combines existing web-based disaster information management systems with the aim to alert the international community in case of major disasters. The tsunami simulation system is an integral part of the GDACS. In more detail, the study aims to assess the tsunami hazard on the Mentawai and Sumatra coasts: the tsunami heights and arrival times have been estimated employing three propagation models based on the long wave theory. The analysis was performed in three stages: (1) pre-calculated simulations by using the tsunami scenario database for that region, used by the GDACS system to estimate the alert level; (2) near-real-time simulated tsunami forecasts, automatically performed by the GDACS system whenever a new earthquake is detected by the seismological data providers; and (3) post-event tsunami calculations using GCMT (Global Centroid Moment Tensor) fault mechanism solutions proposed by US Geological Survey (USGS) for this event. The GDACS system estimates the alert level based on the first type of calculations and on that basis sends alert messages to its users; the second type of calculations is available within 30-40 min after the notification of the event but does not change the estimated alert level. The third type of calculations is performed to improve the initial estimations and to have a better understanding of the extent of the possible damage. The automatic alert level for the earthquake was given between Green and Orange Alert, which, in the logic of GDACS, means no need or moderate need of international humanitarian assistance; however, the earthquake generated 3 to 9 m tsunami run-up along southwestern coasts of the Pagai Islands where 431 people died. The post-event calculations indicated medium-high humanitarian impacts.

UAS Integration in the NAS Project: Detect and Avoid Display UNITED Demo

NASA Technical Reports Server (NTRS)

Roberts, Zachary

2017-01-01

This demo shows the UAS-NAS project's Vigilant Spirit Control Station developed in partnership with the U.S. Air Force Research Lab. Attendees will be able to view encounters and see how the DAA and TCAS II alerting and guidance displays are used to avoid simulated aircraft.

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

PubMed

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

2017-09-01

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

Development of an Alert System to Detect Drug Interactions with Herbal Supplements using Medical Record Data.

PubMed

Archer, Melissa; Proulx, Joshua; Shane-McWhorter, Laura; Bray, Bruce E; Zeng-Treitler, Qing

2014-01-01

While potential medication-to-medication interaction alerting engines exist in many clinical applications, few systems exist to automatically alert on potential medication to herbal supplement interactions. We have developed a preliminary knowledge base and rules alerting engine that detects 259 potential interactions between 9 supplements, 62 cardiac medications, and 19 drug classes. The rules engine takes into consideration 12 patient risk factors and 30 interaction warning signs to help determine which of three different alert levels to categorize each potential interaction. A formative evaluation was conducted with two clinicians to set initial thresholds for each alert level. Additional work is planned add more supplement interactions, risk factors, and warning signs as well as to continue to set and adjust the inputs and thresholds for each potential interaction.

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

PubMed

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

2010-01-01

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

COMESEP: bridging the gap between the SEP, CME, and terrestrial effects scientific communities

NASA Astrophysics Data System (ADS)

Crosby, Norma; Veronig, Astrid; Rodriguez, Luciano; Vrsnak, Bojan; Vennerstrøm, Susanne; Malandraki, Olga; Dalla, Silvia; Srivastava, Nandita

2016-04-01

In the past there has been a tendency for the geomagnetic storm and solar energetic particle (SEP) communities to work in parallel rather than to apply a cross-disciplinary work approach specifically in regard to space weather forecasting. To provide more awareness on the existing links between these communities, as well as further bridge this gap, the three-year EU FP7 COMESEP (COronal Mass Ejections and Solar Energetic Particles: forecasting the space weather impact) project emphasized cross-collaboration between the SEP, coronal mass ejection, and terrestrial effects scientific communities. COMESEP went from basic solar-terrestrial physics research to space weather operations by developing, validating and implementing multi-purpose tools into an operational 24/7 alert service. Launched in November 2013, the COMESEP alert system provides space weather stakeholders geomagnetic storm alerts ("Event based" and "Next 24 hours") and SEP (proton) storm alerts (E > 10 MeV and E > 60 MeV) without human intervention based on the COMESEP definition of risk. COMESEP alerts and forecasts are freely available on the COMESEP alert website (http://www.comesep.eu/alert), as well as disseminated by e-mail to registered users. Acknowledgement: This work has received funding from the European Commission FP7 Project COMESEP (263252).

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

PubMed

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

2018-03-01

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

Ethical Decision Making on the Battlefield: An Analysis of Training for U.S. Army Special Forces

DTIC Science & Technology

1992-06-05

ethics , as they relate to society ( medical ethics , business ethics etc.), and understanding and teaching ethical decision making. For this study... medical issue than an ethical one. The officers were all aware of the need to be alert for signs of stress and emotional wear and tear. They felt...provides adequate train- ing for Special Forces soldiers to make ethical decisions on the battlefield. The value of this study is that it may have an

KSC00padig049

NASA Image and Video Library

2000-10-01

Jan Zysko (left) and Rich Mizell (right) test a Personal Cabin Pressure Altitude Monitor in an altitude chamber at Tyndall Air Force Base in Florida. Zysko invented the pager-sized monitor that alerts wearers of a potentially dangerous or deteriorating cabin pressure altitude condition, which can lead to life-threatening hypoxia. Zysko is chief of the KSC Spaceport Engineering and Technology directorate's data and electronic systems branch. Mizell is a Shuttle processing engineer. The monitor, which has drawn the interest of such organizations as the Federal Aviation Administration for use in commercial airliners and private aircraft, was originally designed to offer Space Shuttle and Space Station crew members added independent notification about any depressurization

KSC-00padig049

NASA Image and Video Library

2000-10-01

Jan Zysko (left) and Rich Mizell (right) test a Personal Cabin Pressure Altitude Monitor in an altitude chamber at Tyndall Air Force Base in Florida. Zysko invented the pager-sized monitor that alerts wearers of a potentially dangerous or deteriorating cabin pressure altitude condition, which can lead to life-threatening hypoxia. Zysko is chief of the KSC Spaceport Engineering and Technology directorate's data and electronic systems branch. Mizell is a Shuttle processing engineer. The monitor, which has drawn the interest of such organizations as the Federal Aviation Administration for use in commercial airliners and private aircraft, was originally designed to offer Space Shuttle and Space Station crew members added independent notification about any depressurization

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

PubMed Central

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

2001-01-01

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

School-Based Drug Prevention among At-Risk Adolescents: Effects of ALERT Plus

ERIC Educational Resources Information Center

Longshore, Douglas; Ellickson, Phyllis L.; McCaffrey, Daniel F.; St. Clair, Patricia A.

2007-01-01

In a recent randomized field trial, Ellickson et al. found the Project ALERT drug prevention curriculum curbed alcohol misuse and tobacco and marijuana use among eighth-grade adolescents. This article reports effects among ninth-grade at-risk adolescents. Comparisons between at-risk girls in ALERT Plus schools (basic curriculum extended to ninth…

Effectiveness of a computerized alert system based on re-testing intervals for limiting the inappropriateness of laboratory test requests.

PubMed

Lippi, Giuseppe; Brambilla, Marco; Bonelli, Patrizia; Aloe, Rosalia; Balestrino, Antonio; Nardelli, Anna; Ceda, Gian Paolo; Fabi, Massimo

2015-11-01

There is consolidated evidence that the burden of inappropriate laboratory test requests is very high, up to 70%. We describe here the function of a computerized alert system linked to the order entry, designed to limit the number of potentially inappropriate laboratory test requests. A computerized alert system based on re-testing intervals and entailing the generation of pop-up alerts when preset criteria of appropriateness for 15 laboratory tests were violated was implemented in two clinical wards of the University Hospital of Parma. The effectiveness of the system for limiting potentially inappropriate tests was monitored for 6months. Overall, 765/3539 (22%) test requests violated the preset criteria of appropriateness and generated the appearance of electronic alert. After alert appearance, 591 requests were annulled (17% of total tests requested and 77% of tests alerted, respectively). The total number of test requests violating the preset criteria of inappropriateness constantly decreased over time (26% in the first three months of implementation versus 17% in the following period; p<0.001). The total financial saving of test withdrawn was 3387 Euros (12.8% of the total test cost) throughout the study period. The results of this study suggest that a computerized alert system may be effective to limit the inappropriateness of laboratory test requests, generating significant economic saving and educating physicians to a more efficient use of laboratory resources. Copyright © 2015 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.

Airborne derivation of microburst alerts from ground-based Terminal Doppler Weather Radar information: A flight evaluation

NASA Technical Reports Server (NTRS)

Hinton, David A.

1993-01-01

An element of the NASA/FAA windshear program is the integration of ground-based microburst information on the flight deck, to support airborne windshear alerting and microburst avoidance. NASA conducted a windshear flight test program in the summer of 1991 during which airborne processing of Terminal Doppler Weather Radar (TDWR) data was used to derive microburst alerts. Microburst information was extracted from TDWR, transmitted to a NASA Boeing 737 in flight via data link, and processed to estimate the windshear hazard level (F-factor) that would be experienced by the aircraft in each microburst. The microburst location and F-factor were used to derive a situation display and alerts. The situation display was successfully used to maneuver the aircraft for microburst penetrations, during which atmospheric 'truth' measurements were made. A total of 19 penetrations were made of TDWR-reported microburst locations, resulting in 18 airborne microburst alerts from the TDWR data and two microburst alerts from the airborne reactive windshear detection system. The primary factors affecting alerting performance were spatial offset of the flight path from the region of strongest shear, differences in TDWR measurement altitude and airplane penetration altitude, and variations in microburst outflow profiles. Predicted and measured F-factors agreed well in penetrations near microburst cores. Although improvements in airborne and ground processing of the TDWR measurements would be required to support an airborne executive-level alerting protocol, the practicality of airborne utilization of TDWR data link data has been demonstrated.

Supporting the patient's role in guideline compliance: a controlled study.

PubMed

Rosenberg, Stephen N; Shnaiden, Tatiana L; Wegh, Arnold A; Juster, Iver A

2008-11-01

Clinical messages alerting physicians to gaps in the care of specific patients have been shown to increase compliance with evidence-based guidelines. This study sought to measure any additional impact on compliance when alerting messages also were sent to patients. For alerts that were generated by computerized clinical rules applied to claims, compliance was determined by subsequent claims evidence (eg, that recommended tests were performed). Compliance was measured in the baseline year and the study year for 4 study group employers (combined membership >100,000) that chose to add patient messaging in the study year, and 28 similar control group employers (combined membership >700,000) that maintained physician messaging but did not add patient messaging. The impact of patient messaging was assessed by comparing changes in compliance from baseline to study year in the 2 groups. Multiple logistic regression was used to control for differences between the groups. Because a given member or physician could receive multiple alerts, generalized estimating equations with clustering by patient and physician were used. Controlling for differences in age, sex, and the severity and types of clinical alerts between the study and control groups, the addition of patient messaging increased compliance by 12.5% (P <.001). This increase was primarily because of improved responses to alerts regarding the need for screening, diagnostic, and monitoring tests. Supplementing clinical alerts to physicians with messages directly to their patients produced a statistically significant increase in compliance with the evidence-based guidelines underlying the alerts.

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

PubMed

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

2017-01-01

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

Impact-based earthquake alerts with the U.S. Geological Survey's PAGER system: what's next?

USGS Publications Warehouse

Wald, D.J.; Jaiswal, K.S.; Marano, K.D.; Garcia, D.; So, E.; Hearne, M.

2012-01-01

In September 2010, the USGS began publicly releasing earthquake alerts for significant earthquakes around the globe based on estimates of potential casualties and economic losses with its Prompt Assessment of Global Earthquakes for Response (PAGER) system. These estimates significantly enhanced the utility of the USGS PAGER system which had been, since 2006, providing estimated population exposures to specific shaking intensities. Quantifying earthquake impacts and communicating estimated losses (and their uncertainties) to the public, the media, humanitarian, and response communities required a new protocol—necessitating the development of an Earthquake Impact Scale—described herein and now deployed with the PAGER system. After two years of PAGER-based impact alerting, we now review operations, hazard calculations, loss models, alerting protocols, and our success rate for recent (2010-2011) events. This review prompts analyses of the strengths, limitations, opportunities, and pressures, allowing clearer definition of future research and development priorities for the PAGER system.

Rapid MODIS-based detection of tree cover loss

NASA Astrophysics Data System (ADS)

Wheeler, David; Guzder-Williams, Brook; Petersen, Rachael; Thau, David

2018-07-01

This paper reports on recent improvements made to the FORMA (Hammer et al., 2014a) data product. The resulting system, FORMA250, is a 250-m alerting system updated daily. FORMA250 alerts are available through Global Forest Watch. These alerts can empower law enforcement officials, government agencies responsible for protecting forests, nongovernmental organizations, companies committed to sustainable forest management practices and supply chains, indigenous groups and forest-dependent communities. In addition, the alerts provide useful information for researchers who study temporal and spatial patterns of forest clearing.

The Simplified Aircraft-Based Paired Approach With the ALAS Alerting Algorithm

NASA Technical Reports Server (NTRS)

Perry, Raleigh B.; Madden, Michael M.; Torres-Pomales, Wilfredo; Butler, Ricky W.

2013-01-01

This paper presents the results of an investigation of a proposed concept for closely spaced parallel runways called the Simplified Aircraft-based Paired Approach (SAPA). This procedure depends upon a new alerting algorithm called the Adjacent Landing Alerting System (ALAS). This study used both low fidelity and high fidelity simulations to validate the SAPA procedure and test the performance of the new alerting algorithm. The low fidelity simulation enabled a determination of minimum approach distance for the worst case over millions of scenarios. The high fidelity simulation enabled an accurate determination of timings and minimum approach distance in the presence of realistic trajectories, communication latencies, and total system error for 108 test cases. The SAPA procedure and the ALAS alerting algorithm were applied to the 750-ft parallel spacing (e.g., SFO 28L/28R) approach problem. With the SAPA procedure as defined in this paper, this study concludes that a 750-ft application does not appear to be feasible, but preliminary results for 1000-ft parallel runways look promising.

An MFC-Based Online Monitoring and Alert System for Activated Sludge Process

PubMed Central

Xu, Gui-Hua; Wang, Yun-Kun; Sheng, Guo-Ping; Mu, Yang; Yu, Han-Qing

2014-01-01

In this study, based on a simple, compact and submersible microbial fuel cell (MFC), a novel online monitoring and alert system with self-diagnosis function was established for the activated sludge (AS) process. Such a submersible MFC utilized organic substrates and oxygen in the AS reactor as the electron donor and acceptor respectively, and could provide an evaluation on the status of the AS reactor and thus give a reliable early warning of potential risks. In order to evaluate the reliability and sensitivity of this online monitoring and alert system, a series of tests were conducted to examine the response of this system to various shocks imposed on the AS reactor. The results indicate that this online monitoring and alert system was highly sensitive to the performance variations of the AS reactor. The stability, sensitivity and repeatability of this online system provide feasibility of being incorporated into current control systems of wastewater treatment plants to real-time monitor, diagnose, alert and control the AS process. PMID:25345502

Case-Based Multi-Sensor Intrusion Detection

NASA Astrophysics Data System (ADS)

Schwartz, Daniel G.; Long, Jidong

2009-08-01

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

One vendor's experience: preliminary development of a reminder system based on the Arden Syntax.

PubMed

Spates, R P; Aller, K C

1994-09-01

This article reviews the efforts of HBO & Company in the production of a first phase clinical alerting system based on the Arden Syntax. The alerting system was integrated with a clinical data repository and clinical workstation to process returning laboratory results. Investigations with expert systems resulted in a C language alerting system. GUI prototyping of an authoring environment led to a Smalltalk language authoring system. Future development is expected to broaden the system scope and address the evolution of the Arden Syntax.

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

PubMed

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

2018-04-01

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

Study to encourage and facilitate industrial investment and involvement in space

NASA Technical Reports Server (NTRS)

Wilson, J. E.

1984-01-01

A simple and efficient means to alert the Director, Space Station Commercialization Task Force (DSCTF) and the equivalent director of a permanent office for the same function, to actions required to assure comprehensive support of the NASA objectives for commercial uses of space during the annual budget cycle is described.

The Mobile Worker in the Flexible Workplace. Trends and Issues Alert No. 10.

ERIC Educational Resources Information Center

Brown, Bettina Lankard

New information technologies, changing work force demographics, rising customer expectations, transnational companies, and cost pressures are altering traditional views of what constitutes a workplace and have given rise to a new trend: the mobile worker in the flexible workplace. Two factors promote acceptance of telework or telecommuting: (1)…

Operational Test and Evaluation Handbook for Aircrew Training Devices. Volume I. Planning and Management.

DTIC Science & Technology

1982-02-01

of i, nd to (! Lvel op an awareness of the T&E roles and responsioi Ii ties Viir~dte various Air Force organizations involved in the T&EC process... mathematical models to determine controller messages and issue controller messages using computer generated speech. AUTOMATED PERFORMANCE ALERTS: Signals

Work Force Education: Beyond Technical Skills. Trends and Issues Alert No. 1.

ERIC Educational Resources Information Center

Imel, Susan

This brief suggests that during the past 2 decades, the skills needed to succeed in the workplace have changed significantly. Technical skills remain important, but, increasingly, employers recognize another category of skills crucial to a worker's ability to work "smarter, not harder." These "soft,""core,""nontechnical,""essential,""generic," and…

KSC-2015-1301

NASA Image and Video Library

2015-02-07

CAPE CANAVERAL, Fla. – A prelaunch briefing at NASA’s Kennedy Space Center in Florida brings media up to date on preparations for the liftoff of NOAA’s Deep Space Climate Observatory spacecraft, or DSCOVR. From left are Michael Curie, moderator, NASA Public Affairs, Stephen Volz, assistant administrator of the NOAA Satellite and Information Service, Tom Berger, director of the NOAA Space Weather Prediction Center, Steven Clarke, NASA Joint Agency Satellite Division director for the agency’s Science Mission Directorate, Col. D. Jason Cothern, Space Demonstrations Division chief at Kirtland Air Force Base in Albuquerque, New Mexico, and Hans Koenigsmann, vice president of mission assurance at SpaceX, and Mike McAleenan, launch weather officer with the U.S. Air Force 45th Weather Squadron. DSCOVR will launch aboard a SpaceX Falcon 9 rocket. The mission is a partnership between NOAA, NASA and the U.S. Air Force. DSCOVR will maintain the nation's real-time solar wind monitoring capabilities which are critical to the accuracy and lead time of NOAA's space weather alerts and forecasts. To learn more about DSCOVR, visit http://www.nesdis.noaa.gov/DSCOVR. Photo credit: NASA/Kim Shiflett

KSC-2015-1300

NASA Image and Video Library

2015-02-07

CAPE CANAVERAL, Fla. – Launch and mission officials prepare for the start of a prelaunch briefing at NASA’s Kennedy Space Center in Florida regarding NOAA’s Deep Space Climate Observatory mission, or DSCOVR. From left are Michael Curie, moderator, NASA Public Affairs, Stephen Volz, assistant administrator of the NOAA Satellite and Information Service, Tom Berger, director of the NOAA Space Weather Prediction Center, Steven Clarke, NASA Joint Agency Satellite Division director for the agency’s Science Mission Directorate, Col. D. Jason Cothern, Space Demonstrations Division chief at Kirtland Air Force Base in Albuquerque, New Mexico, and Hans Koenigsmann, vice president of mission assurance at SpaceX, and Mike McAleenan, launch weather officer with the U.S. Air Force 45th Weather Squadron. DSCOVR will launch aboard a SpaceX Falcon 9 rocket. The mission is a partnership between NOAA, NASA and the U.S. Air Force. DSCOVR will maintain the nation's real-time solar wind monitoring capabilities which are critical to the accuracy and lead time of NOAA's space weather alerts and forecasts. To learn more about DSCOVR, visit http://www.nesdis.noaa.gov/DSCOVR. Photo credit: NASA/Kim Shiflett

Community participation in tsunami early warning system in Pangandaran town

NASA Astrophysics Data System (ADS)

Hadian, Sapari D.; Khadijah, Ute Lies Siti; Saepudin, Encang; Budiono, Agung; Yuliawati, Ayu Krishna

2017-07-01

Disaster-resilient communities are communities capable of anticipating and minimizing destructive forces through adaptation. Disaster is an event very close to the people of Indonesia, especially in the small tourism town of Pangadaran located at West Java, Indonesia. On July 17, 2006, the town was hit by a Mw 7.8 earthquake and tsunami that effected over 300 km of the coastline, where the community suffered losses in which more than 600 people were killed, with run up heights exceeding 20 m. The devastation of the tsunami have made the community more alert and together with the local government and other stakeholder develop an Early Warning System for Tsunami. The study is intended to discover issues on tsunami Early Warning System (EWS), disaster risk reduction measures taken and community participation. The research method used is descriptive and explanatory research. The study describe the Tsunami EWS and community based Disaster Risk Reduction in Pangandaran, the implementation of Tsunami alert/EWS in disaster preparedness and observation of community participation in EWS. Data were gathered by secondary data collection, also primary data through interviews, focus group discussions and field observations. Research resulted in a description of EWS implementation, community participation and recommendation to reduce disaster risk in Pangandaran.

An Obstacle Alerting System for Agricultural Application

NASA Technical Reports Server (NTRS)

DeMaio, Joe

2003-01-01

Wire strikes are a significant cause of helicopter accidents. The aircraft most at risk are aerial applicators. The present study examines the effectiveness of a wire alert delivered by way of the lightbar, a GPS-based guidance system for aerial application. The alert lead-time needed to avoid an invisible wire is compared with that to avoid a visible wire. A flight simulator was configured to simulate an agricultural application helicopter. Two pilots flew simulated spray runs in fields with visible wires, invisible wires, and no wires. The wire alert was effective in reducing wire strikes. A lead-time of 3.5 sec was required for the alert to be effective. The lead- time required was the same whether the pilot could see the wire or not.

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

PubMed

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

2004-11-19

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

Development of an Earthquake Impact Scale

NASA Astrophysics Data System (ADS)

Wald, D. J.; Marano, K. D.; Jaiswal, K. S.

2009-12-01

With the advent of the USGS Prompt Assessment of Global Earthquakes for Response (PAGER) system, domestic (U.S.) and international earthquake responders are reconsidering their automatic alert and activation levels as well as their response procedures. To help facilitate rapid and proportionate earthquake response, we propose and describe an Earthquake Impact Scale (EIS) founded on two alerting criteria. One, based on the estimated cost of damage, is most suitable for domestic events; the other, based on estimated ranges of fatalities, is more appropriate for most global events. Simple thresholds, derived from the systematic analysis of past earthquake impact and response levels, turn out to be quite effective in communicating predicted impact and response level of an event, characterized by alerts of green (little or no impact), yellow (regional impact and response), orange (national-scale impact and response), and red (major disaster, necessitating international response). Corresponding fatality thresholds for yellow, orange, and red alert levels are 1, 100, and 1000, respectively. For damage impact, yellow, orange, and red thresholds are triggered by estimated losses exceeding 1M, 10M, and $1B, respectively. The rationale for a dual approach to earthquake alerting stems from the recognition that relatively high fatalities, injuries, and homelessness dominate in countries where vernacular building practices typically lend themselves to high collapse and casualty rates, and it is these impacts that set prioritization for international response. In contrast, it is often financial and overall societal impacts that trigger the level of response in regions or countries where prevalent earthquake resistant construction practices greatly reduce building collapse and associated fatalities. Any newly devised alert protocols, whether financial or casualty based, must be intuitive and consistent with established lexicons and procedures. In this analysis, we make an attempt at both simple and intuitive color-coded alerting criterion; yet, we preserve the necessary uncertainty measures by which one can gauge the likelihood for the alert to be over- or underestimated.

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

NASA Astrophysics Data System (ADS)

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

2015-04-01

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

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

NASA Technical Reports Server (NTRS)

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

1997-01-01

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

Validation of the CME Geomagnetic Forecast Alerts Under the COMESEP Alert System

NASA Astrophysics Data System (ADS)

Dumbović, Mateja; Srivastava, Nandita; Rao, Yamini K.; Vršnak, Bojan; Devos, Andy; Rodriguez, Luciano

2017-08-01

Under the European Union 7th Framework Programme (EU FP7) project Coronal Mass Ejections and Solar Energetic Particles (COMESEP, http://comesep.aeronomy.be), an automated space weather alert system has been developed to forecast solar energetic particles (SEP) and coronal mass ejection (CME) risk levels at Earth. The COMESEP alert system uses the automated detection tool called Computer Aided CME Tracking (CACTus) to detect potentially threatening CMEs, a drag-based model (DBM) to predict their arrival, and a CME geoeffectiveness tool (CGFT) to predict their geomagnetic impact. Whenever CACTus detects a halo or partial halo CME and issues an alert, the DBM calculates its arrival time at Earth and the CGFT calculates its geomagnetic risk level. The geomagnetic risk level is calculated based on an estimation of the CME arrival probability and its likely geoeffectiveness, as well as an estimate of the geomagnetic storm duration. We present the evaluation of the CME risk level forecast with the COMESEP alert system based on a study of geoeffective CMEs observed during 2014. The validation of the forecast tool is made by comparing the forecasts with observations. In addition, we test the success rate of the automatic forecasts (without human intervention) against the forecasts with human intervention using advanced versions of the DBM and CGFT (independent tools available at the Hvar Observatory website, http://oh.geof.unizg.hr). The results indicate that the success rate of the forecast in its current form is unacceptably low for a realistic operation system. Human intervention improves the forecast, but the false-alarm rate remains unacceptably high. We discuss these results and their implications for possible improvement of the COMESEP alert system.

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

PubMed

Pfeiffer, Yvonne; Schwappach, David

2016-01-01

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

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

PubMed Central

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

2016-01-01

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

Cockpit display of hazardous weather information

NASA Technical Reports Server (NTRS)

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

1991-01-01

Information transfer and display issues associated with the dissemination of hazardous weather warnings are studied in the context of wind shear alerts. Operational and developmental wind shear detection systems are briefly reviewed. The July 11, 1988 microburst events observed as part of the Denver Terminal Doppler Weather Radar (TDWR) operational evaluation are analyzed in terms of information transfer and the effectiveness of the microburst alerts. Information transfer, message content and display issues associated with microburst alerts generated from ground based sources (Doppler Radar, Low Level Wind Shear Alert System, and Pilot Reports) are evaluated by means fo pilot opinion surveys and part task simulator studies.

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

PubMed Central

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

2014-01-01

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

KSC-2015-1316

NASA Image and Video Library

2015-02-08

Gaseous oxygen vents away from the SpaceX Falcon 9 rocket standing at Space Launch Complex 40 at Florida’s Cape Canaveral Air Force Station during the first launch attempt for NOAA’s Deep Space Climate Observatory spacecraft, or DSCOVR. The mission is a partnership between NOAA, NASA and the U.S. Air Force. DSCOVR will maintain the nation's real-time solar wind monitoring capabilities which are critical to the accuracy and lead time of NOAA's space weather alerts and forecasts. To learn more about DSCOVR, visit http://www.nesdis.noaa.gov/DSCOVR. Photo credit: NASA/Ben Smegelsky

KSC-2015-1307

NASA Image and Video Library

2015-02-08

CAPE CANAVERAL, Fla. – The SpaceX Falcon 9 rocket set to launch NOAA’s Deep Space Climate Observatory spacecraft, or DSCOVR, is flanked by lightning masts at Space Launch Complex 40 at Cape Canaveral Air Force Station in Florida. DSCOVR is a partnership between NOAA, NASA and the U.S. Air Force. DSCOVR will maintain the nation's real-time solar wind monitoring capabilities which are critical to the accuracy and lead time of NOAA's space weather alerts and forecasts. To learn more about DSCOVR, visit http://www.nesdis.noaa.gov/DSCOVR. Photo credit: NASA/Kim Shiflett

KSC-2015-1305

NASA Image and Video Library

2015-02-08

CAPE CANAVERAL, Fla. – The SpaceX Falcon 9 rocket set to launch NOAA’s Deep Space Climate Observatory spacecraft, or DSCOVR, awaits liftoff at 6:10 p.m. EST from Space Launch Complex 40 at Cape Canaveral Air Force Station in Florida. DSCOVR is a partnership between NOAA, NASA and the U.S. Air Force. DSCOVR will maintain the nation's real-time solar wind monitoring capabilities which are critical to the accuracy and lead time of NOAA's space weather alerts and forecasts. To learn more about DSCOVR, visit http://www.nesdis.noaa.gov/DSCOVR. Photo credit: NASA/Kim Shiflett

KSC-2015-1315

NASA Image and Video Library

2015-02-08

The SpaceX Falcon 9 rocket set to launch NOAA’s Deep Space Climate Observatory spacecraft, or DSCOVR, stands at Space Launch Complex 40 at Florida’s Cape Canaveral Air Force Station during the mission’s first launch attempt. The mission is a partnership between NOAA, NASA and the U.S. Air Force. DSCOVR will maintain the nation's real-time solar wind monitoring capabilities which are critical to the accuracy and lead time of NOAA's space weather alerts and forecasts. To learn more about DSCOVR, visit http://www.nesdis.noaa.gov/DSCOVR. Photo credit: NASA/Ben Smegelsky

KSC-2015-1309

NASA Image and Video Library

2015-02-08

CAPE CANAVERAL, Fla. – The SpaceX Falcon 9 rocket set to launch NOAA’s Deep Space Climate Observatory spacecraft, or DSCOVR, awaits liftoff at 6:10 p.m. EST from Space Launch Complex 40 at Cape Canaveral Air Force Station in Florida. DSCOVR is a partnership between NOAA, NASA and the U.S. Air Force. DSCOVR will maintain the nation's real-time solar wind monitoring capabilities which are critical to the accuracy and lead time of NOAA's space weather alerts and forecasts. To learn more about DSCOVR, visit http://www.nesdis.noaa.gov/DSCOVR. Photo credit: NASA/Kim Shiflett

DSCOVR Spacecraft Arrival, Offload, & Unpacking

NASA Image and Video Library

2014-11-20

Workers align NOAA’s Deep Space Climate Observatory spacecraft, or DSCOVR, wrapped in plastic, onto a portable work stand at the Astrotech payload processing facility in Titusville, Florida, near Kennedy Space Center. DSCOVR is a partnership between NOAA, NASA and the U.S. Air Force. DSCOVR will maintain the nation's real-time solar wind monitoring capabilities which are critical to the accuracy and lead time of NOAA's space weather alerts and forecasts. Launch is currently scheduled for January 2015 aboard a SpaceX Falcon 9 v 1.1 launch vehicle from Cape Canaveral Air Force Station, Florida.

DSCOVR Satellite Deploy & Light Test

NASA Image and Video Library

2014-11-24

Workers deploy the solar arrays on NOAA’s Deep Space Climate Observatory spacecraft, or DSCOVR, in the Building 1 high bay at the Astrotech payload processing facility in Titusville, Florida, near Kennedy Space Center. DSCOVR is a partnership between NOAA, NASA and the U.S. Air Force. DSCOVR will maintain the nation's real-time solar wind monitoring capabilities which are critical to the accuracy and lead time of NOAA's space weather alerts and forecasts. Launch is targeted for early 2015 aboard a SpaceX Falcon 9 v 1.1 launch vehicle from Cape Canaveral Air Force Station, Florida.

DSCOVR Satellite Deploy & Light Test

NASA Image and Video Library

2014-11-24

The solar arrays on NOAA’s Deep Space Climate Observatory spacecraft, or DSCOVR, are unfurled in the Building 1 high bay at the Astrotech payload processing facility in Titusville, Florida, near Kennedy Space Center. DSCOVR is a partnership between NOAA, NASA and the U.S. Air Force. DSCOVR will maintain the nation's real-time solar wind monitoring capabilities which are critical to the accuracy and lead time of NOAA's space weather alerts and forecasts. Launch is targeted for early 2015 aboard a SpaceX Falcon 9 v 1.1 launch vehicle from Cape Canaveral Air Force Station, Florida.

A Line in the Sand a Historical Study of Border Security During Insurgencies and Lessons for the Contemporary Afghan-Pakistan Frontier

DTIC Science & Technology

2009-04-03

day, the border force ploughed a ten-metre strip inside the barricade to allow trackers to assess the size of any groups that successfully crossed the...managed to breach the line, but once alerted, the French forces rapidly encircled the insurgents. After a week of fighting, the French killed or...camels in the Western Dhofar. During the next two days, Strikemasters accounted for over two-hundred camels killed .44 From 1974, the SAF enhanced their

DSCOVR Spacecraft Arrival, Offload, & Unpacking

NASA Image and Video Library

2014-11-20

Preparations are underway to remove a protective shipping container from around NOAA’s Deep Space Climate Observatory spacecraft, or DSCOVR, at the Astrotech payload processing facility in Titusville, Florida, near Kennedy Space Center. DSCOVR is a partnership between NOAA, NASA and the U.S. Air Force. DSCOVR will maintain the nation's real-time solar wind monitoring capabilities which are critical to the accuracy and lead time of NOAA's space weather alerts and forecasts. Launch is currently scheduled for January 2015 aboard a SpaceX Falcon 9 v 1.1 launch vehicle from Cape Canaveral Air Force Station, Florida.

DSCOVR Spacecraft Arrival, Offload, & Unpacking

NASA Image and Video Library

2014-11-20

NOAA’s Deep Space Climate Observatory spacecraft, or DSCOVR, enclosed in a protective shipping container, is delivered by truck to the Astrotech payload processing facility in Titusville, Florida, near Kennedy Space Center. DSCOVR is a partnership between NOAA, NASA and the U.S. Air Force. DSCOVR will maintain the nation's real-time solar wind monitoring capabilities which are critical to the accuracy and lead time of NOAA's space weather alerts and forecasts. Launch is currently scheduled for January 2015 aboard a SpaceX Falcon 9 v 1.1 launch vehicle from Cape Canaveral Air Force Station, Florida.

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

PubMed

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

2014-01-01

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

Detection and Alert of muscle fatigue considering a Surface Electromyography Chaotic Model

NASA Astrophysics Data System (ADS)

Herrera, V.; Romero, J. F.; Amestegui, M.

2011-03-01

This work propose a detection and alert algorithm for muscle fatigue in paraplegic patients undergoing electro-therapy sessions. The procedure is based on a mathematical chaotic model emulating physiological signals and Continuous Wavelet Transform (CWT). The chaotic model developed is based on a logistic map that provides suitable data accomplishing some physiological signal class patterns. The CWT was applied to signals generated by the model and the resulting vector was obtained through Total Wavelet Entropy (TWE). In this sense, the presented work propose a viable and practical alert and detection algorithm for muscle fatigue.

Impact of an emergency department electronic sepsis surveillance system on patient mortality and length of stay.

PubMed

Austrian, Jonathan S; Jamin, Catherine T; Doty, Glenn R; Blecker, Saul

2018-05-01

The purpose of this study was to determine whether an electronic health record-based sepsis alert system could improve quality of care and clinical outcomes for patients with sepsis. We performed a patient-level interrupted time series study of emergency department patients with severe sepsis or septic shock between January 2013 and April 2015. The intervention, introduced in February 2014, was a system of interruptive sepsis alerts triggered by abnormal vital signs or laboratory results. Primary outcomes were length of stay (LOS) and in-hospital mortality; other outcomes included time to first lactate and blood cultures prior to antibiotics. We also assessed sensitivity, positive predictive value (PPV), and clinician response to the alerts. Mean LOS for patients with sepsis decreased from 10.1 to 8.6 days (P < .001) following alert introduction. In adjusted time series analysis, the intervention was associated with a decreased LOS of 16% (95% CI, 5%-25%; P = .007, with significance of α = 0.006) and no change thereafter (0%; 95% CI, -2%, 2%). The sepsis alert system had no effect on mortality or other clinical or process measures. The intervention had a sensitivity of 80.4% and a PPV of 14.6%. Alerting based on simple laboratory and vital sign criteria was insufficient to improve sepsis outcomes. Alert fatigue due to the low PPV is likely the primary contributor to these results. A more sophisticated algorithm for sepsis identification is needed to improve outcomes.

A Comparative Analysis of the Snort and Suricata Intrusion-Detection Systems

DTIC Science & Technology

2011-09-01

Category: Test Rules Test #6: Simple LFI Attack 43 Snort True Positive: Snort generated an alert based on the ‘/etc/ passwd ’ string passed...through an HTTP command. Suricata True Positive: Suricata generated an alert based on the ‘/etc/ passwd ’ string passed through an HTTP command

Will We All Be Portfolio Workers? Trends and Issues Alerts.

ERIC Educational Resources Information Center

Kerka, Sandra

The world of stable, long-term employment is coming to an end. Part-time, contingent, and contract workers now account for more than 35% of the U.S. work force. It has been suggested that individuals will become "portfolio workers" with "portfolio careers." Individuals will maintain portfolios of their skills, abilities, and achievements and will…

On the Horizon. The Environmental Scanning Newsletter for Leaders in Higher Education, 1992-1993.

ERIC Educational Resources Information Center

Morrison, James L., Ed.

1993-01-01

This document consists of the preview issue and first five issues of a new newsletter designed to alert members of the higher education community to driving forces and potential developments in the macroenvironment that constitute threats or opportunities to colleges and universities. It reports news from the social, technological, economic,…

Instrument for the measurement and determination of chemical pulse column parameters

DOEpatents

Marchant, Norman J.; Morgan, John P.

1990-01-01

An instrument for monitoring and measuring pneumatic driving force pulse parameters applied to chemical separation pulse columns obtains real time pulse frequency and root mean square amplitude values, calculates column inch values and compares these values against preset limits to alert column operators to the variations of pulse column operational parameters beyond desired limits.

Experiences with the MANA simulation tool

DTIC Science & Technology

2006-08-01

ALERT and FAVS simulations. Also, agents in these simulations needed to conduct careful formation fighting while following established CF doctrine...simulations auraient dû pouvoir se déplacer en formation , suivant la doctrine établie des Forces canadiennes. Cependant, des comportements d’une...29 Annex C – Alternative approach to inter-squad coordination of retreat.................................. 32 List of acronyms

Alert Workplace From Healthcare Workers' Perspective: Behavioral and Environmental Strategies to Improve Vigilance and Alertness in Healthcare Settings.

PubMed

Sagah Zadeh, Rana; Shepley, Mardelle; Sadatsafavi, Hessam; Owora, Arthur Hamie; Krieger, Ana C

2018-04-01

This study aims to identify the behavioral and environmental strategies that healthcare workers view as helpful for managing sleepiness, improving alertness, and therefore optimizing workplace safety. Reduced alertness is a common issue in healthcare work environments and is associated with impaired cognitive performance and decision-making ability as well as increased errors and injuries. We surveyed 136 healthcare professionals at a primary care clinic, an acute care hospital, and a mental health clinic. Nonstructured, semistructured, and structured questionnaires were used to elicit relevant information which was analyzed using qualitative content analysis and logistic regression models, respectively. In order by frequency of endorsement: dietary intervention; physical mobility; cognitive, sensory, or social stimulation; personal lifestyle strategies; and rest/nap opportunities were reported as behavioral strategies used to address workplace alertness. Compared to other environmental features, daylight and thermal comfort were perceived to be more important to addressing workplace alertness ( p < .05). By optimizing the physical environment and organizational policies and providing education programs, we have an opportunity to support healthcare professionals in managing sleepiness and maintaining alertness at work. In addition, such system level interventions may reduce unhealthy choices such as frequent caffeine intake to keep alert. The development of multidisciplinary evidence-based guidelines is needed to address sleepiness and alertness to improve workplace safety in healthcare facilities.

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

PubMed

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

2016-03-01

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

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

PubMed

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

2018-06-07

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

Geodetic Finite-Fault-based Earthquake Early Warning Performance for Great Earthquakes Worldwide

NASA Astrophysics Data System (ADS)

Ruhl, C. J.; Melgar, D.; Grapenthin, R.; Allen, R. M.

2017-12-01

GNSS-based earthquake early warning (EEW) algorithms estimate fault-finiteness and unsaturated moment magnitude for the largest, most damaging earthquakes. Because large events are infrequent, algorithms are not regularly exercised and insufficiently tested on few available datasets. The Geodetic Alarm System (G-larmS) is a GNSS-based finite-fault algorithm developed as part of the ShakeAlert EEW system in the western US. Performance evaluations using synthetic earthquakes offshore Cascadia showed that G-larmS satisfactorily recovers magnitude and fault length, providing useful alerts 30-40 s after origin time and timely warnings of ground motion for onshore urban areas. An end-to-end test of the ShakeAlert system demonstrated the need for GNSS data to accurately estimate ground motions in real-time. We replay real data from several subduction-zone earthquakes worldwide to demonstrate the value of GNSS-based EEW for the largest, most damaging events. We compare predicted ground acceleration (PGA) from first-alert-solutions with those recorded in major urban areas. In addition, where applicable, we compare observed tsunami heights to those predicted from the G-larmS solutions. We show that finite-fault inversion based on GNSS-data is essential to achieving the goals of EEW.

Alertness function of thalamus in conflict adaptation.

PubMed

Wang, Xiangpeng; Zhao, Xiaoyue; Xue, Gui; Chen, Antao

2016-05-15

Conflict adaptation reflects the ability to improve current conflict resolution based on previously experienced conflict, which is crucial for our goal-directed behaviors. In recent years, the roles of alertness are attracting increasing attention when discussing the generation of conflict adaptation. However, due to the difficulty of manipulating alertness, very limited progress has been made in this line. Inspired by that color may affect alertness, we manipulated background color of experimental task and found that conflict adaptation significantly presented in gray and red backgrounds but did not in blue background. Furthermore, behavioral and functional magnetic resonance imaging results revealed that the modulation of color on conflict adaptation was implemented through changing alertness level. In particular, blue background eliminated conflict adaptation by damping the alertness regulating function of thalamus and the functional connectivity between thalamus and inferior frontal gyrus (IFG). In contrast, in gray and red backgrounds where alertness levels are typically high, the thalamus and the right IFG functioned normally and conflict adaptations were significant. Therefore, the alertness function of thalamus is determinant to conflict adaptation, and thalamus and right IFG are crucial nodes of the neural circuit subserving this ability. Present findings provide new insights into the neural mechanisms of conflict adaptation. Copyright © 2016 Elsevier Inc. All rights reserved.

Using activity-based monitoring systems to detect dairy cows in oestrus: a field evaluation.

PubMed

Dela Rue, B T; Kamphuis, C; Burke, C R; Jago, J G

2014-03-01

To assess the use and performance of activity-based oestrus detection systems (ODS) on two commercial dairy farms using a gold standard based on profiles of concentrations of progesterone in milk, artificial insemination (AI) records and pregnancy diagnosis results. Two activity-based ODS were evaluated in mature cows on two large pasture-grazed dairy farms (>500 cows) over the first 3 weeks of AI. Farm 1 (n=286 cows) used a leg-mounted device and cows were drafted automatically based on activity alerts. Decisions regarding AI were then made based on tail-paint and cow history for these cows. Farm 2 (n=345 cows) used a collar-mounted device and activity alerts were used in conjunction with other information, before the farmer manually selected cows for AI. The gold standard to define the timing of oestrus was based on profiles of concentrations of progesterone in milk measured twice-weekly, used in conjunction with AI records and pregnancy diagnosis results. Sensitivity and positive predictive value (PPV) were calculated for the activity-based ODS data only, and then for AI decisions, against the gold standard. Farm 1 had 195 confirmed oestrus events and 209 activity alerts were generated. The sensitivity of the activity-based ODS was 89.2% with a PPV of 83.3%. Using tail-paint and cow history to confirm activity-based alerts 175 cows were inseminated, resulting in a sensitivity of 89.2% and an improved PPV of 99.4%. Farm 2 had 343 confirmed oestrus events, and 726 alerts were generated by the activity-based ODS, giving a sensitivity of 69.7% with a PPV of 32.9%. A total of 386 cows had AI records, giving a sensitivity of 81.3% and PPV of 72.3%. The two activity-based ODS were used differently on-farm; one automatically selecting cows and the other supporting the manual selection of cows in oestrus. Only one achieved a performance level suggested to be acceptable as a stand-alone ODS. Use of additional tools, such as observation of tail paint to confirm activity-based oestrus alerts before AI, substantially improved the PPV. A well performing activity-based ODS can be a valuable tool in identifying cows in oestrus prior to visual confirmation of oestrus status. However the performance of these ODS technologies varies considerably.

Nonpharmaceutical Interventions for Pandemic Influenza, National and Community Measures

PubMed Central

2006-01-01

The World Health Organization's recommended pandemic influenza interventions, based on limited data, vary by transmission pattern, pandemic phase, and illness severity and extent. In the pandemic alert period, recommendations include isolation of patients and quarantine of contacts, accompanied by antiviral therapy. During the pandemic period, the focus shifts to delaying spread and reducing effects through population-based measures. Ill persons should remain home when they first become symptomatic, but forced isolation and quarantine are ineffective and impractical. If the pandemic is severe, social distancing measures such as school closures should be considered. Nonessential domestic travel to affected areas should be deferred. Hand and respiratory hygiene should be routine; mask use should be based on setting and risk, and contaminated household surfaces should be disinfected. Additional research and field assessments during pandemics are essential to update recommendations. Legal authority and procedures for implementing interventions should be understood in advance and should respect cultural differences and human rights. PMID:16494723

Comparative analytics of infusion pump data across multiple hospital systems.

PubMed

Catlin, Ann Christine; Malloy, William X; Arthur, Karen J; Gaston, Cindy; Young, James; Fernando, Sudheera; Fernando, Ruchith

2015-02-15

A Web-based analytics system for conducting inhouse evaluations and cross-facility comparisons of alert data generated by smart infusion pumps is described. The Infusion Pump Informatics (IPI) project, a collaborative effort led by research scientists at Purdue University, was launched in 2009 to provide advanced analytics and tools for workflow analyses to assist hospitals in determining the significance of smart-pump alerts and reducing nuisance alerts. The IPI system allows facility-specific analyses of alert patterns and trends, as well as cross-facility comparisons of alert data uploaded by more than 55 participating institutions using different types of smart pumps. Tools accessible through the IPI portal include (1) charts displaying aggregated or breakout data on the top drugs associated with alerts, numbers of alerts per device or care area, and override-to-alert ratios, (2) investigative reports that can be used to characterize and analyze pump-programming errors in a variety of ways (e.g., by drug, by infusion type, by time of day), and (3) "drill-down" workflow analytics enabling users to evaluate alert patterns—both internally and in relation to patterns at other hospitals—in a quick and efficient stepwise fashion. The formation of the IPI analytics system to support a community of hospitals has been successful in providing sophisticated tools for member facilities to review, investigate, and efficiently analyze smart-pump alert data, not only within a member facility but also across other member facilities, to further enhance smart pump drug library design. Copyright © 2015 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

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

PubMed

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

2012-01-01

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

Structure-activity relationships for skin sensitization: recent improvements to Derek for Windows.

PubMed

Langton, Kate; Patlewicz, Grace Y; Long, Anthony; Marchant, Carol A; Basketter, David A

2006-12-01

Derek for Windows (DfW) is a knowledge-based expert system that predicts the toxicity of a chemical from its structure. Its predictions are based in part on alerts that describe structural features or toxicophores associated with toxicity. Recently, improvements have been made to skin sensitization alerts within the DfW knowledge base in collaboration with Unilever. These include modifications to the alerts describing the skin sensitization potential of aldehydes, 1,2-diketones, and isothiazolinones and consist of enhancements to the toxicophore definition, the mechanistic classification, and the extent of supporting evidence provided. The outcomes from this collaboration demonstrate the importance of updating and refining computer models for the prediction of skin sensitization as new information from experimental and theoretical studies becomes available.

Wireless Sensor Node for Autonomous Monitoring and Alerts in Remote Environments

NASA Technical Reports Server (NTRS)

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

2015-01-01

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

Participatory design for drug-drug interaction alerts.

PubMed

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

2015-01-01

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

Validation of the CME Geomagnetic forecast alerts under COMESEP alert system

NASA Astrophysics Data System (ADS)

Dumbovic, Mateja; Srivastava, Nandita; Khodia, Yamini; Vršnak, Bojan; Devos, Andy; Rodriguez, Luciano

2017-04-01

An automated space weather alert system has been developed under the EU FP7 project COMESEP (COronal Mass Ejections and Solar Energetic Particles: http://comesep.aeronomy.be) to forecast solar energetic particles (SEP) and coronal mass ejection (CME) risk levels at Earth. COMESEP alert system uses automated detection tool CACTus to detect potentially threatening CMEs, drag-based model (DBM) to predict their arrival and CME geo-effectiveness tool (CGFT) to predict their geomagnetic impact. Whenever CACTus detects a halo or partial halo CME and issues an alert, DBM calculates its arrival time at Earth and CGFT calculates its geomagnetic risk level. Geomagnetic risk level is calculated based on an estimation of the CME arrival probability and its likely geo-effectiveness, as well as an estimate of the geomagnetic-storm duration. We present the evaluation of the CME risk level forecast with COMESEP alert system based on a study of geo-effective CMEs observed during 2014. The validation of the forecast tool is done by comparing the forecasts with observations. In addition, we test the success rate of the automatic forecasts (without human intervention) against the forecasts with human intervention using advanced versions of DBM and CGFT (self standing tools available at Hvar Observatory website: http://oh.geof.unizg.hr). The results implicate that the success rate of the forecast is higher with human intervention and using more advanced tools. This work has received funding from the European Commission FP7 Project COMESEP (263252). We acknowledge the support of Croatian Science Foundation under the project 6212 „Solar and Stellar Variability".

KSC-2015-1299

NASA Image and Video Library

2015-02-07

CAPE CANAVERAL, Fla. – A prelaunch briefing at NASA’s Kennedy Space Center in Florida brings media up to date on preparations for the liftoff of NOAA’s Deep Space Climate Observatory spacecraft, or DSCOVR. From left are Michael Curie, moderator, NASA Public Affairs, Stephen Volz, assistant administrator of the NOAA Satellite and Information Service, Tom Berger, director of the NOAA Space Weather Prediction Center, Steven Clarke, NASA Joint Agency Satellite Division director for the agency’s Science Mission Directorate, Col. D. Jason Cothern, Space Demonstrations Division chief at Kirtland Air Force Base in Albuquerque, New Mexico, and Hans Koenigsmann, vice president of mission assurance at SpaceX. DSCOVR will launch aboard a SpaceX Falcon 9 rocket. The mission is a partnership between NOAA, NASA and the U.S. Air Force. DSCOVR will maintain the nation's real-time solar wind monitoring capabilities which are critical to the accuracy and lead time of NOAA's space weather alerts and forecasts. To learn more about DSCOVR, visit http://www.nesdis.noaa.gov/DSCOVR. Photo credit: NASA/Jim Grossman

Implementation of a simple electronic transfusion alert system decreases inappropriate ordering of packed red blood cells and plasma in a multi-hospital health care system.

PubMed

Smith, Matthew; Triulzi, Darrell J; Yazer, Mark H; Rollins-Raval, Marian A; Waters, Jonathan H; Raval, Jay S

2014-12-01

Prescriber adherence to institutional blood component ordering guidelines can be low. The goal of this study was to decrease red blood cell (RBC) and plasma orders that did not meet institutional transfusion guidelines by using data within the laboratory information system to trigger alerts in the computerized order entry (CPOE) system at the time of order entry. At 10 hospitals within a regional health care system, discernment rules were created for RBC and plasma orders utilizing transfusion triggers of hemoglobin <8 gm/dl and INR >1.6, respectively, with subsequent alert generation that appears within the CPOE system when a prescriber attempts to order RBCs or plasma on a patient whose antecedent laboratory values do not suggest that a transfusion is indicated. Orders and subsequent alerts were tracked for RBCs and plasma over evaluation periods of 15 and 10 months, respectively, along with the hospital credentials of the ordering health care providers (physician or nurse). Alerts triggered which were heeded remained steady and averaged 11.3% for RBCs and 19.6% for plasma over the evaluation periods. Overall, nurses and physicians canceled statistically identical percentages of alerted RBC (10.9% vs. 11.5%; p = 0.78) and plasma (21.3% vs. 18.7%; p = 0.22) orders. Implementing a simple evidence-based transfusion alert system at the time of order entry decreased non-evidence based transfusion orders by both nurse and physician providers. Copyright © 2014 Elsevier Ltd. All rights reserved.

Feature-based alert correlation in security systems using self organizing maps

NASA Astrophysics Data System (ADS)

Kumar, Munesh; Siddique, Shoaib; Noor, Humera

2009-04-01

The security of the networks has been an important concern for any organization. This is especially important for the defense sector as to get unauthorized access to the sensitive information of an organization has been the prime desire for cyber criminals. Many network security techniques like Firewall, VPN Concentrator etc. are deployed at the perimeter of network to deal with attack(s) that occur(s) from exterior of network. But any vulnerability that causes to penetrate the network's perimeter of defense, can exploit the entire network. To deal with such vulnerabilities a system has been evolved with the purpose of generating an alert for any malicious activity triggered against the network and its resources, termed as Intrusion Detection System (IDS). The traditional IDS have still some deficiencies like generating large number of alerts, containing both true and false one etc. By automatically classifying (correlating) various alerts, the high-level analysis of the security status of network can be identified and the job of network security administrator becomes much easier. In this paper we propose to utilize Self Organizing Maps (SOM); an Artificial Neural Network for correlating large amount of logged intrusion alerts based on generic features such as Source/Destination IP Addresses, Port No, Signature ID etc. The different ways in which alerts can be correlated by Artificial Intelligence techniques are also discussed. . We've shown that the strategy described in the paper improves the efficiency of IDS by better correlating the alerts, leading to reduced false positives and increased competence of network administrator.

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

PubMed

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

2016-06-02

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

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

PubMed Central

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

2016-01-01

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

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

PubMed

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

2016-01-01

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

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

PubMed Central

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

2011-01-01

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

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

PubMed

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

2011-11-30

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

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

NASA Technical Reports Server (NTRS)

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

2015-01-01

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

Carbamates and ICH M7 classification: Making use of expert knowledge.

PubMed

Hemingway, Rachel; Fowkes, Adrian; Williams, Richard V

2017-06-01

Carbamates are widely used in the chemical industry so understanding their toxicity is important to safety assessment. Carbamates have been associated with certain toxicities resulting in publication of structural alerts, including alerts for mutagenicity. Structural alerts for bacterial mutagenicity can be used in combination with statistical systems to enable ICH M7 classification, which allows assessment of the genotoxic risk posed by pharmaceutical impurities. This study tested a hypothetical bacterial mutagenicity alert for carbamates and examined the impact it would have on ICH M7 classifications using (Q)SAR predictions from the expert rule-based system Derek Nexus and the statistical-based system Sarah Nexus. Public datasets have a low prevalence of mutagenic carbamates, which highlighted that systems containing an alert for carbamates perform poorly for achieving correct ICH M7 classifications. Carbamates are commonly used as protecting groups and proprietary datasets containing such compounds were also found to have a low prevalence of mutagenic compounds. Expert review of the mutagenic compounds established that mutagenicity was often only observed under certain (non-standard) conditions and more generally that the Ames test may be a poor predictor for the risk of carcinogenicity posed by chemicals in this class. Overall a structural alert for the in vitro bacterial mutagenesis of carbamates does not benefit workflows for assigning ICH M7 classification to impurities. Crown Copyright © 2017. Published by Elsevier Inc. All rights reserved.

Gender Equity in Vocational Education. Trends and Issues Alerts.

ERIC Educational Resources Information Center

Kerka, Sandra

Women now represent 45% of the work force, and 74% of all 25- to 54-year-old women now work. Despite these statistics, women are still clustered in 20 of 400 occupational categories, and 70% of female secondary vocational students are preparing for low-wage jobs. These statistics, coupled with the findings of research on self-esteem and identity…

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

NASA Technical Reports Server (NTRS)

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

2003-01-01

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

Chewing Gum: Cognitive Performance, Mood, Well-Being, and Associated Physiology

PubMed Central

Allen, Andrew P.; Smith, Andrew P.

2015-01-01

Recent evidence has indicated that chewing gum can enhance attention, as well as promoting well-being and work performance. Four studies (two experiments and two intervention studies) examined the robustness of and mechanisms for these effects. Study 1 investigated the acute effect of gum on mood in the absence of task performance. Study 2 examined the effect of rate and force of chewing on mood and attention performance. Study 3 assessed the effects of chewing gum during one working day on well-being and performance, as well as postwork mood and cognitive performance. In Study 4, performance and well-being were reported throughout the workday and at the end of the day, and heart rate and cortisol were measured. Under experimental conditions, gum was associated with higher alertness regardless of whether performance tasks were completed and altered sustained attention. Rate of chewing and subjective force of chewing did not alter mood but had some limited effects on attention. Chewing gum during the workday was associated with higher productivity and fewer cognitive problems, raised cortisol levels in the morning, and did not affect heart rate. The results emphasise that chewing gum can attenuate reductions in alertness, suggesting that chewing gum enhances worker performance. PMID:26075253

Ghana: capacity-building workshops for lawyers and judges.

PubMed

2004-08-01

In 2004, AIDS Alert Ghana (an Accra-based NGO) commenced a series of two-day workshops to enhance the capacity of lawyers and judges to respond to HIV/AIDS. The workshops are organized by the AIDS Alert Law Project (AALP).

Transitioning the Defense Automated Neurobehavioral Assessment (DANA) to Operational Use

DTIC Science & Technology

2013-10-01

science concentrates on CONUS-based studies such as testing DANA in clinical drug, fatigue/alertness, concussion and/or depression protocols. The...operationally deployed into the military. 15. SUBJECT TERMS neurocognitive, assessment, NCAT, concussion , mTBI, mild traumatic brain injury, psychological...concentrate)on)CONUS@based)studies)such)as)testing) DANA)in)clinical)drug,)fatigue/alertness,) concussion )and/or)depression)protocols.))The) second

Dynamic malware containment under an epidemic model with alert

NASA Astrophysics Data System (ADS)

Zhang, Tianrui; Yang, Lu-Xing; Yang, Xiaofan; Wu, Yingbo; Tang, Yuan Yan

2017-03-01

Alerting at the early stage of malware invasion turns out to be an important complement to malware detection and elimination. This paper addresses the issue of how to dynamically contain the prevalence of malware at a lower cost, provided alerting is feasible. A controlled epidemic model with alert is established, and an optimal control problem based on the epidemic model is formulated. The optimality system for the optimal control problem is derived. The structure of an optimal control for the proposed optimal control problem is characterized under some conditions. Numerical examples show that the cost-efficiency of an optimal control strategy can be enhanced by adjusting the upper and lower bounds on admissible controls.

KSC-2015-1304

NASA Image and Video Library

2015-02-07

CAPE CANAVERAL, Fla. – Mike McAleenan, launch weather officer with the U.S. Air Force 45th Weather Squadron, provides an on the launch-day forecast during a briefing regarding NOAA’s Deep Space Climate Observatory spacecraft, or DSCOVR. DSCOVR will launch aboard a SpaceX Falcon 9 rocket. The mission is a partnership between NOAA, NASA and the U.S. Air Force. DSCOVR will maintain the nation's real-time solar wind monitoring capabilities which are critical to the accuracy and lead time of NOAA's space weather alerts and forecasts. To learn more about DSCOVR, visit http://www.nesdis.noaa.gov/DSCOVR. Photo credit: NASA/Kim Shiflett

KSC-2015-1306

NASA Image and Video Library

2015-02-08

CAPE CANAVERAL, Fla. – The payload fairing protecting NOAA’s Deep Space Climate Observatory spacecraft, or DSCOVR, tops the SpaceX Falcon 9 rocket set to lift off at 6:10 p.m. EST from Space Launch Complex 40 at Cape Canaveral Air Force Station in Florida. DSCOVR is a partnership between NOAA, NASA and the U.S. Air Force. DSCOVR will maintain the nation's real-time solar wind monitoring capabilities which are critical to the accuracy and lead time of NOAA's space weather alerts and forecasts. To learn more about DSCOVR, visit http://www.nesdis.noaa.gov/DSCOVR. Photo credit: NASA/Kim Shiflett

DSCOVR Spacecraft Arrival, Offload, & Unpacking

NASA Image and Video Library

2014-11-20

Workers remove the plastic cover from NOAA’s Deep Space Climate Observatory spacecraft, or DSCOVR, in the high bay of Building 1 at the Astrotech payload processing facility in Titusville, Florida, near Kennedy Space Center. DSCOVR is a partnership between NOAA, NASA and the U.S. Air Force. DSCOVR will maintain the nation's real-time solar wind monitoring capabilities which are critical to the accuracy and lead time of NOAA's space weather alerts and forecasts. Launch is currently scheduled for January 2015 aboard a SpaceX Falcon 9 v 1.1 launch vehicle from Cape Canaveral Air Force Station, Florida.

DSCOVR Satellite Deploy & Light Test

NASA Image and Video Library

2014-11-24

Workers conduct a light test on the solar arrays on NOAA’s Deep Space Climate Observatory spacecraft, or DSCOVR, in the Building 1 high bay at the Astrotech payload processing facility in Titusville, Florida, near Kennedy Space Center. DSCOVR is a partnership between NOAA, NASA and the U.S. Air Force. DSCOVR will maintain the nation's real-time solar wind monitoring capabilities which are critical to the accuracy and lead time of NOAA's space weather alerts and forecasts. Launch is targeted for early 2015 aboard a SpaceX Falcon 9 v 1.1 launch vehicle from Cape Canaveral Air Force Station, Florida.

DSCOVR Spacecraft Arrival, Offload, & Unpacking

NASA Image and Video Library

2014-11-20

Preparations are underway to lift NOAA’s Deep Space Climate Observatory spacecraft, or DSCOVR, wrapped in plastic, from its transportation pallet at the Astrotech payload processing facility in Titusville, Florida, near Kennedy Space Center. DSCOVR is a partnership between NOAA, NASA and the U.S. Air Force. DSCOVR will maintain the nation's real-time solar wind monitoring capabilities which are critical to the accuracy and lead time of NOAA's space weather alerts and forecasts. Launch is currently scheduled for January 2015 aboard a SpaceX Falcon 9 v 1.1 launch vehicle from Cape Canaveral Air Force Station, Florida.

DSCOVR Spacecraft Arrival, Offload, & Unpacking

NASA Image and Video Library

2014-11-20

NOAA’s Deep Space Climate Observatory spacecraft, or DSCOVR, has been uncovered and is ready for processing in the high bay of Building 1 at the Astrotech payload processing facility in Titusville, Florida, near Kennedy Space Center. DSCOVR is a partnership between NOAA, NASA and the U.S. Air Force. DSCOVR will maintain the nation's real-time solar wind monitoring capabilities which are critical to the accuracy and lead time of NOAA's space weather alerts and forecasts. Launch is currently scheduled for January 2015 aboard a SpaceX Falcon 9 v 1.1 launch vehicle from Cape Canaveral Air Force Station, Florida.

DSCOVR Spacecraft Arrival, Offload, & Unpacking

NASA Image and Video Library

2014-11-20

A lifting device is attached to NOAA’s Deep Space Climate Observatory spacecraft, or DSCOVR, wrapped in plastic, to remove it from its transportation pallet at the Astrotech payload processing facility in Titusville, Florida, near Kennedy Space Center. DSCOVR is a partnership between NOAA, NASA and the U.S. Air Force. DSCOVR will maintain the nation's real-time solar wind monitoring capabilities which are critical to the accuracy and lead time of NOAA's space weather alerts and forecasts. Launch is currently scheduled for January 2015 aboard a SpaceX Falcon 9 v 1.1 launch vehicle from Cape Canaveral Air Force Station, Florida.

DSCOVR Spacecraft Arrival, Offload, & Unpacking

NASA Image and Video Library

2014-11-20

NOAA’s Deep Space Climate Observatory spacecraft, or DSCOVR, wrapped in plastic, comes into view as the protective shipping container is lifted from around the spacecraft at the Astrotech payload processing facility in Titusville, Florida, near Kennedy Space Center. DSCOVR is a partnership between NOAA, NASA and the U.S. Air Force. DSCOVR will maintain the nation's real-time solar wind monitoring capabilities which are critical to the accuracy and lead time of NOAA's space weather alerts and forecasts. Launch is currently scheduled for January 2015 aboard a SpaceX Falcon 9 v 1.1 launch vehicle from Cape Canaveral Air Force Station, Florida.

DSCOVR Spacecraft Arrival, Offload, & Unpacking

NASA Image and Video Library

2014-11-20

NOAA’s Deep Space Climate Observatory spacecraft, or DSCOVR, wrapped in plastic, is transferred from its transportation pallet to a portable work stand at the Astrotech payload processing facility in Titusville, Florida, near Kennedy Space Center. DSCOVR is a partnership between NOAA, NASA and the U.S. Air Force. DSCOVR will maintain the nation's real-time solar wind monitoring capabilities which are critical to the accuracy and lead time of NOAA's space weather alerts and forecasts. Launch is currently scheduled for January 2015 aboard a SpaceX Falcon 9 v 1.1 launch vehicle from Cape Canaveral Air Force Station, Florida.

Investigating the association of alerts from a national mortality surveillance system with subsequent hospital mortality in England: an interrupted time series analysis.

PubMed

Cecil, Elizabeth; Bottle, Alex; Esmail, Aneez; Wilkinson, Samantha; Vincent, Charles; Aylin, Paul P

2018-05-04

To investigate the association between alerts from a national hospital mortality surveillance system and subsequent trends in relative risk of mortality. There is increasing interest in performance monitoring in the NHS. Since 2007, Imperial College London has generated monthly mortality alerts, based on statistical process control charts and using routinely collected hospital administrative data, for all English acute NHS hospital trusts. The impact of this system has not yet been studied. We investigated alerts sent to Acute National Health Service hospital trusts in England in 2011-2013. We examined risk-adjusted mortality (relative risk) for all monitored diagnosis and procedure groups at a hospital trust level for 12 months prior to an alert and 23 months post alert. We used an interrupted time series design with a 9-month lag to estimate a trend prior to a mortality alert and the change in trend after, using generalised estimating equations. On average there was a 5% monthly increase in relative risk of mortality during the 12 months prior to an alert (95% CI 4% to 5%). Mortality risk fell, on average by 61% (95% CI 56% to 65%), during the 9-month period immediately following an alert, then levelled to a slow decline, reaching on average the level of expected mortality within 18 months of the alert. Our results suggest an association between an alert notification and a reduction in the risk of mortality, although with less lag time than expected. It is difficult to determine any causal association. A proportion of alerts may be triggered by random variation alone and subsequent falls could simply reflect regression to the mean. Findings could also indicate that some hospitals are monitoring their own mortality statistics or other performance information, taking action prior to alert notification. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Management of Patient-Reported Outcome (PRO) Alerts in Clinical Trials: A Cross Sectional Survey.

PubMed

Kyte, Derek; Ives, Jonathan; Draper, Heather; Calvert, Melanie

2016-01-01

Assessment of patient-reported outcomes (PROs) provides valuable information to inform patient-centered care, but may also reveal 'PRO alerts': psychological distress or physical symptoms that may require an immediate response. Ad-hoc management of PRO alerts in clinical trials may result in suboptimal patient care or potentially bias trial results. To gain greater understanding of current practice in PRO alert management we conducted a national survey of personnel involved in clinical trials with a PRO endpoint. We conducted a national cross-sectional survey of 767 UK-based research nurses, data managers/coordinators, trial managers and chief/principal investigators involved in clinical trials using PROs. Respondents were self-selected volunteers from a non-randomised sample of eligible individuals recruited via 55 UK Clinical Research Collaboration Registered Clinical Trials Units and 19 Comprehensive Local Research Networks. Questions centred on the proportion of trial personnel encountering alerts, how staff responded to PRO alerts and whether current guidance was deemed sufficient to support research personnel. We undertook descriptive analyses of the quantitative data and directed thematic analysis of free-text comments. 20% of research nurses did not view completed PRO questionnaires and were not in a position to discover alerts, 39-50% of the remaining respondent group participants reported encountering PRO alerts. Of these, 83% of research nurses and 54% of data managers/trial coordinators reported taking action to assist the trial participant, but less than half were able to record the intervention in the trial documentation. Research personnel reported current PRO alert guidance/training was insufficient. Research personnel are intermittently exposed to PRO alerts. Some intervene to help trial participants, but are not able to record this intervention in the trial documentation, risking co-intervention bias. Other staff do not check PRO information during the trial, meaning alerts may remain undiscovered, or do not respond to alerts if they are inadvertently encountered; both of which may impact on patient safety. Guidance is needed to support PRO alert management that protects the interests of trial participants whilst avoiding potential bias.

Improving Recognition of Pediatric Severe Sepsis in the Emergency Department: Contributions of a Vital Sign-Based Electronic Alert and Bedside Clinician Identification.

PubMed

Balamuth, Fran; Alpern, Elizabeth R; Abbadessa, Mary Kate; Hayes, Katie; Schast, Aileen; Lavelle, Jane; Fitzgerald, Julie C; Weiss, Scott L; Zorc, Joseph J

2017-12-01

Recognition of pediatric sepsis is a key clinical challenge. We evaluate the performance of a sepsis recognition process including an electronic sepsis alert and bedside assessment in a pediatric emergency department (ED). This was a cohort study with quality improvement intervention in a pediatric ED. Exposure was a positive electronic sepsis alert, defined as elevated pulse rate or hypotension, concern for infection, and at least one of the following: abnormal capillary refill, abnormal mental status, or high-risk condition. A positive electronic sepsis alert prompted team assessment or huddle to determine need for sepsis protocol. Clinicians could initiate team assessment or huddle according to clinical concern without positive electronic sepsis alert. Severe sepsis outcome defined as activation of the sepsis protocol in the ED or development of severe sepsis requiring ICU admission within 24 hours. There were 182,509 ED visits during the study period, with 86,037 before electronic sepsis alert implementation and 96,472 afterward, and 1,112 (1.2%) positive electronic sepsis alerts. Overall, 326 patients (0.3%) were treated for severe sepsis within 24 hours. Test characteristics of the electronic sepsis alert alone to detect severe sepsis were sensitivity 86.2% (95% confidence interval [CI] 82.0% to 89.5%), specificity 99.1% (95% CI 99.0% to 99.2%), positive predictive value 25.4% (95% CI 22.8% to 28.0%), and negative predictive value 100% (95% CI 99.9% to 100%). Inclusion of the clinician screen identified 43 additional electronic sepsis alert-negative children, with severe sepsis sensitivity 99.4% (95% CI 97.8% to 99.8%) and specificity 99.1% (95% CI 99.1% to 99.2%). Electronic sepsis alert implementation increased ED sepsis detection from 83% to 96%. Electronic sepsis alert for severe sepsis demonstrated good sensitivity and high specificity. Addition of clinician identification of electronic sepsis alert-negative patients further improved sensitivity. Implementation of the electronic sepsis alert was associated with improved recognition of severe sepsis. Copyright © 2017 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

Fetal size in mid- and late pregnancy is related to infant alertness: the generation R study.

PubMed

Henrichs, Jens; Schenk, Jacqueline J; Schmidt, Henk G; Arends, Lidia R; Steegers, Eric A P; Hofman, Albert; Jaddoe, Vincent W V; Verhulst, Frank C; Tiemeier, Henning

2009-03-01

The vulnerability for behavioral problems is partly shaped in fetal life. Numerous studies have related indicators of intrauterine growth, for example, birth weight and body size, to behavioral development. We investigated whether fetal size in mid- and late pregnancy is related to infant irritability and alertness. In a population-based birth cohort of 4,255 singleton full-term infants ultrasound measurements of fetal head and abdominal circumference in mid- and late pregnancy were performed. Infant irritability and alertness scores were obtained by the Mother and Baby Scales at 3 months and z-standardized. Multiple linear regression analyses revealed curvilinear associations (inverted J-shape) of measures of fetal size in both mid- and late pregnancy with infant alertness. Fetal size characteristics were not associated with infant irritability. These results suggest that alterations of intrauterine growth affecting infant alertness are already detectable from mid-pregnancy onwards.

Airport Traffic Conflict Detection and Resolution Algorithm Evaluation

NASA Technical Reports Server (NTRS)

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

2016-01-01

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

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

PubMed Central

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

2012-01-01

Objective To present a framework for combining implicit knowledge acquisition from multiple experts with machine learning and to evaluate this framework in the context of anemia alerts. Materials and Methods Five internal medicine residents reviewed 18 anemia alerts, while ‘talking aloud’. They identified features that were reviewed by two or more physicians to determine appropriate alert level, etiology and treatment recommendation. Based on these features, data were extracted from 100 randomly-selected anemia cases for a training set and an additional 82 cases for a test set. Two staff internists assigned an alert level, etiology and treatment recommendation before and after reviewing the entire electronic medical record. The training set of 118 cases (100 plus 18) and the test set of 82 cases were explored using RIDOR and JRip algorithms. Results The feature set was sufficient to assess 93% of anemia cases (intraclass correlation for alert level before and after review of the records by internists 1 and 2 were 0.92 and 0.95, respectively). High-precision classifiers were constructed to identify low-level alerts (precision p=0.87, recall R=0.4), iron deficiency (p=1.0, R=0.73), and anemia associated with kidney disease (p=0.87, R=0.77). Discussion It was possible to identify low-level alerts and several conditions commonly associated with chronic anemia. This approach may reduce the number of clinically unimportant alerts. The study was limited to anemia alerts. Furthermore, clinicians were aware of the study hypotheses potentially biasing their evaluation. Conclusion Implicit knowledge acquisition, collaborative filtering and machine learning were combined automatically to induce clinically meaningful and precise decision rules. PMID:22744961

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

PubMed

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

2016-01-01

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

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

PubMed

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

2013-12-01

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

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

NASA Astrophysics Data System (ADS)

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

2012-04-01

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

The National Nonindigenous Aquatic Species Database

USGS Publications Warehouse

Neilson, Matthew E.; Fuller, Pamela L.

2012-01-01

The U.S. Geological Survey (USGS) Nonindigenous Aquatic Species (NAS) Program maintains a database that monitors, records, and analyzes sightings of nonindigenous aquatic plant and animal species throughout the United States. The program is based at the USGS Wetland and Aquatic Research Center in Gainesville, Florida.The initiative to maintain scientific information on nationwide occurrences of nonindigenous aquatic species began with the Aquatic Nuisance Species Task Force, created by Congress in 1990 to provide timely information to natural resource managers. Since then, the NAS database has been a clearinghouse of information for confirmed sightings of nonindigenous, also known as nonnative, aquatic species throughout the Nation. The database is used to produce email alerts, maps, summary graphs, publications, and other information products to support natural resource managers.

SIOP for Perestroika. Research report

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

Szafranski, R.

1990-04-01

The pursuit of greater stability through arms reductions is an important component of perestroika. Assuming strategic weapons reductions, the general nuclear war plan, the Single Integrated Operational Plan (SIOP), will change to employ fewer nuclear arms. If stability and threat reduction are authentic goals, the composition of nuclear offensive forces and the SIOP alert force will evolve accordingly. Greater reliance will likely be placed on bombers. The United States and the Soviet Union can use the opportunity provided by perestroika to agree that the only legitimate role of nuclear weapons is to deter nuclear weapons by threatening nuclear reprisal ormore » punishment. Both sides can then share a strategic catechism that would allow them to move toward small reprisal forces.« less

The COMESEP Alert System

NASA Astrophysics Data System (ADS)

Crosby, Norma; Veronig, Astrid; Rodriguez, Luciano; Vrsnak, Bojan; Vennerstrom, Susanne; Malandraki, Olga; Dalla, Silvia; Srivastava, Nandita; Hesse, Michael; Odstrcil, Dusan; Robbrecht, Eva

2014-05-01

Tools for forecasting geomagnetic storms and solar energetic particle (SEP) radiation storms have been developed under the three-year EU FP7 COMESEP (COronal Mass Ejections and Solar Energetic Particles) collaborative project. To enhance our understanding of the 3D kinematics and interplanetary propagation of coronal mass ejections (CMEs), the structure, propagation and evolution of CMEs have been investigated. In parallel, the sources and propagation of SEPs have been examined and modeled. During the third year of the COMESEP project the produced tools have been validated and implemented into an operational space weather alert system. The COMESEP Alert System provides notifications for the space weather community. To achieve this the system relies on both models and data, the latter including near real-time data as well as historical data. Geomagnetic and SEP radiation storm alerts are based on the COMESEP definition of risk. The COMESEP Alert System has recently been launched. Receiving COMESEP alerts are free of charge, but registration is required. For more information see the project website (http://www.comesep.eu/). This work has received funding from the European Commission FP7 Project COMESEP (263252).

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

NASA Astrophysics Data System (ADS)

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

2006-05-01

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

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

PubMed Central

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

2015-01-01

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

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

PubMed

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

2015-01-01

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

The Explosive Universe with Gaia

NASA Astrophysics Data System (ADS)

Wyrzykowski, Łukasz; Hodgkin, Simon T.; Blagorodnova, Nadejda; Belokurov, Vasily

2014-01-01

The Gaia mission will observe the entire sky for 5 years providing ultra-precise astrometric, photometric and spectroscopic measurements for a billion stars in the Galaxy. Hence, naturally, Gaia becomes an all-sky multi-epoch photometric survey, which will monitor and detect variability with millimag precision as well as new transient sources such as supernovae, novae, microlensing events, tidal disruption events, asteroids, among others. Gaia data-flow allows for quick detections of anomalies within 24-48h after the observation. Such near-real-time survey will be able to detect about 6000 supernovae brighter than 19 mag up to redshifts of Z 0.15. The on-board low-resolution (R 100) spectrograph will allow for early and robust classification of transients and minimise the false-alert rate, even providing the estimates on redshift for supernovae. Gaia will also offer a unique possibility for detecting astrometric shifts in microlensing events, which, combined with Gaia's and ground-based photometry, will provide unique mass measurements of lenses, constrains on the dark matter content in the Milky Way and possible detections of free floating black holes. Alerts from Gaia will be publicly available soon after the detection is verified and tested. First alerts are expected early in 2014 and those will be used for ground-based verification. All facilities are invited to join the verification and the follow-up effort. Alerts will be published on a web page, via Skyalert.org and via emailing list. Each alert will contain coordinates, Gaia light curve and low-resolution spectra, classification and cross-matching results. More information on the Gaia Science Alerts can be found here: http://www.ast.cam.ac.uk/ioa/wikis/gsawgwiki/ The full version of the poster is available here: http://www.ast.cam.ac.uk/ioa/wikis/gsawgwiki/images/1/13/GaiaAlertsPosterIAUS298.pdf

Auditory decision aiding in supervisory control of multiple unmanned aerial vehicles.

PubMed

Donmez, Birsen; Cummings, M L; Graham, Hudson D

2009-10-01

This article is an investigation of the effectiveness of sonifications, which are continuous auditory alerts mapped to the state of a monitored task, in supporting unmanned aerial vehicle (UAV) supervisory control. UAV supervisory control requires monitoring a UAV across multiple tasks (e.g., course maintenance) via a predominantly visual display, which currently is supported with discrete auditory alerts. Sonification has been shown to enhance monitoring performance in domains such as anesthesiology by allowing an operator to immediately determine an entity's (e.g., patient) current and projected states, and is a promising alternative to discrete alerts in UAV control. However, minimal research compares sonification to discrete alerts, and no research assesses the effectiveness of sonification for monitoring multiple entities (e.g., multiple UAVs). The authors conducted an experiment with 39 military personnel, using a simulated setup. Participants controlled single and multiple UAVs and received sonifications or discrete alerts based on UAV course deviations and late target arrivals. Regardless of the number of UAVs supervised, the course deviation sonification resulted in reactions to course deviations that were 1.9 s faster, a 19% enhancement, compared with discrete alerts. However, course deviation sonifications interfered with the effectiveness of discrete late arrival alerts in general and with operator responses to late arrivals when supervising multiple vehicles. Sonifications can outperform discrete alerts when designed to aid operators to predict future states of monitored tasks. However, sonifications may mask other auditory alerts and interfere with other monitoring tasks that require divided attention. This research has implications for supervisory control display design.

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

PubMed

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

2015-06-01

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

Successful ShakeAlert Performance for the Napa Quake

NASA Astrophysics Data System (ADS)

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

2014-12-01

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

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

PubMed

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

2014-09-01

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

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

PubMed

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

2017-08-23

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

SPILL ALERT DEVICE FOR EARTH DAM FAILURE WARNING

EPA Science Inventory

A spill alert device for determining earth dam safety based on the monitoring of the acoustic emissions generated in a deforming soil mass was developed and field-tested. The acoustic emissions are related to the basic mechanisms from which soils derive their strength. Laboratory...

FAB (Functionally Alert Behavior Strategies) to Improve Self-Control

ERIC Educational Resources Information Center

Pagano, John

2015-01-01

This paper describes the FAB (Functionally Alert Behavior) Strategies approach to improve behavior in children and adolescents with complex behavioral challenges. FAB Strategies include evidence-based environmental adaptations, sensory modulation, positive behavioral support, and physical self-regulation strategies. FAB Strategies can be used by…

Drowsiness/alertness algorithm development and validation using synchronized EEG and cognitive performance to individualize a generalized model

PubMed Central

Johnson, Robin R.; Popovic, Djordje P.; Olmstead, Richard E.; Stikic, Maja; Levendowski, Daniel J.; Berka, Chris

2011-01-01

A great deal of research over the last century has focused on drowsiness/alertness detection, as fatigue-related physical and cognitive impairments pose a serious risk to public health and safety. Available drowsiness/alertness detection solutions are unsatisfactory for a number of reasons: 1) lack of generalizability, 2) failure to address individual variability in generalized models, and/or 3) they lack a portable, un-tethered application. The current study aimed to address these issues, and determine if an individualized electroencephalography (EEG) based algorithm could be defined to track performance decrements associated with sleep loss, as this is the first step in developing a field deployable drowsiness/alertness detection system. The results indicated that an EEG-based algorithm, individualized using a series of brief "identification" tasks, was able to effectively track performance decrements associated with sleep deprivation. Future development will address the need for the algorithm to predict performance decrements due to sleep loss, and provide field applicability. PMID:21419826

Drowsiness/alertness algorithm development and validation using synchronized EEG and cognitive performance to individualize a generalized model.

PubMed

Johnson, Robin R; Popovic, Djordje P; Olmstead, Richard E; Stikic, Maja; Levendowski, Daniel J; Berka, Chris

2011-05-01

A great deal of research over the last century has focused on drowsiness/alertness detection, as fatigue-related physical and cognitive impairments pose a serious risk to public health and safety. Available drowsiness/alertness detection solutions are unsatisfactory for a number of reasons: (1) lack of generalizability, (2) failure to address individual variability in generalized models, and/or (3) lack of a portable, un-tethered application. The current study aimed to address these issues, and determine if an individualized electroencephalography (EEG) based algorithm could be defined to track performance decrements associated with sleep loss, as this is the first step in developing a field deployable drowsiness/alertness detection system. The results indicated that an EEG-based algorithm, individualized using a series of brief "identification" tasks, was able to effectively track performance decrements associated with sleep deprivation. Future development will address the need for the algorithm to predict performance decrements due to sleep loss, and provide field applicability. Copyright © 2011 Elsevier B.V. All rights reserved.

Examining Lead Exposures in California through State-Issued Health Alerts for Food Contamination and an Exposure-Based Candy Testing Program.

PubMed

Handley, Margaret A; Nelson, Kali; Sanford, Eric; Clarity, Cassidy; Emmons-Bell, Sophia; Gorukanti, Anuhandra; Kennelly, Patrick

2017-10-26

In California, the annual number of children under age 6 y of age with blood lead levels (BLL) ≥10μg/dL is estimated at over 1,000 cases, and up to 10,000 cases when BLL between 4.5 and 9.5 μg/dL are included. State-issued health alerts for food contamination provide one strategy for tracking sources of food-related lead exposures. As well, California passed legislation in 2006 for the Food and Drug Branch (FDB) of the state health department to test and identify lead in candy. This report presents health alert data from California over a 14-y period, compares data before and after the candy testing program began, and examines country of origin, ZIP code data, and time from candy testing to release of health alerts for lead-contaminated candies for 2011-2012. After 2007, health alerts issued for lead in candy and food increased significantly. Analysis of candy-testing data indicated that multiple counties and ZIP codes were affected. Seventeen candies with high lead concentrations were identified, resulting in rapid dissemination (<2wk) of health alerts to local health departments and community clinicians and to the public. Surveillance of lead exposures from state-based food and candy testing programs provides an opportunity to identify and immediately act to remove nonpaint sources of lead affecting children. https://doi.org/10.1289/EHP2582.

Intellectual Property Rights of Faculty in the Digital Age--Evolution or Dissolution in 21st Century Academia?

ERIC Educational Resources Information Center

Aaron, Lynn S.; Roche, Catherine M.

2015-01-01

Unforeseen forces are at work in higher education today. The purpose of this article is to explore the issues involved in the changing landscape. Decisions are and will be made that impact the intellectual property rights of faculty. It is important to be cognizant of the factors involved and alert to possible ramifications. The basics of the…

Exploring the heavy air pollution in Beijing in the fourth quarter of 2015: assessment of environmental benefits for red alerts

NASA Astrophysics Data System (ADS)

Nie, Teng; Nie, Lei; Zhou, Zhen; Wang, Zhanshan; Xue, Yifeng; Gao, Jiajia; Wu, Xiaoqing; Fan, Shoubin; Cheng, Linglong

2018-06-01

In recent years, Beijing has experienced severe air pollution which has caused widespread public concern. Compared to the same period in 2014, the first three quarters of 2015 exhibited significantly improved air quality. However, the air quality sharply declined in the fourth quarter of 2015, especially in November and December. During that time, Beijing issued the first red alert for severe air pollution in history. In total, 2 red alerts, 3 orange alerts, 3 yellow alerts, and 3 blue alerts were issued based on the adoption of relatively temporary emergency control measures to mitigate air pollution. This study explored the reasons for these variations in air quality and assessed the effectiveness of emergency alerts in addressing severe air pollution. A synthetic analysis of emission variations and meteorological conditions was performed to better understand these extreme air pollution episodes in the fourth quarter of 2015. The results showed that compared to those in the same period in 2014, the daily average emissions of air pollutants decreased in the fourth quarter of 2015. However, the emission levels of primary pollutants were still relatively high, which was the main intrinsic cause of haze episodes, and unfavorable meteorological conditions represented important external factors. Emergency control measures for heavy air pollution were implemented during this red alert period, decreasing the emissions of primary air pollutants by approximately 36% and the PM2.5 concentration by 11%‒21%.

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

PubMed Central

Badran, Hani; Grad, Roland

2015-01-01

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

Advantages and disadvantages of educational email alerts for family physicians: viewpoint.

PubMed

Badran, Hani; Pluye, Pierre; Grad, Roland

2015-02-27

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

Cockpit display of hazardous weather information

NASA Technical Reports Server (NTRS)

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

1990-01-01

Information transfer and display issues associated with the dissemination of hazardous weather warnings are studied in the context of windshear alerts. Operational and developmental windshear detection systems are briefly reviewed. The July 11, 1988 microburst events observed as part of the Denver Terminal Doppler Weather Radar (TDWR) operational evaluation are analyzed in terms of information transfer and the effectiveness of the microburst alerts. Information transfer, message content and display issues associated with microburst alerts generated from ground based sources are evaluated by means of pilot opinion surveys and part task simulator studies.

Cockpit display of hazardous weather information

NASA Technical Reports Server (NTRS)

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

1989-01-01

Information transfer and display issues associated with the dissemination of hazardous-weather warnings are studied in the context of wind-shear alerts. Operational and developmental wind-shear detection systems are briefly reviewed. The July 11, 1988 microburst events observed as part of the Denver TDWR operational evaluation are analyzed in terms of information transfer and the effectiveness of the microburst alerts. Information transfer, message content, and display issues associated with microburst alerts generated from ground-based sources (Doppler radars, LLWAS, and PIREPS) are evaluated by means of pilot opinion surveys and part-task simulator studies.

Rapid deployable global sensing hazard alert system

DOEpatents

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

2015-04-28

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

Impact of real-time electronic alerting of acute kidney injury on therapeutic intervention and progression of RIFLE class.

PubMed

Colpaert, Kirsten; Hoste, Eric A; Steurbaut, Kristof; Benoit, Dominique; Van Hoecke, Sofie; De Turck, Filip; Decruyenaere, Johan

2012-04-01

To evaluate whether a real-time electronic alert system or "AKI sniffer," which is based on the RIFLE classification criteria (Risk, Injury and Failure), would have an impact on therapeutic interventions and acute kidney injury progression. Prospective intervention study. Surgical and medical intensive care unit in a tertiary care hospital. A total of 951 patients having in total 1,079 admission episodes were admitted during the study period (prealert control group: 227, alert group: 616, and postalert control group: 236). Three study phases were compared: A 1.5-month prealert control phase in which physicians were blinded for the acute kidney injury sniffer and a 3-month intervention phase with real-time alerting of worsening RIFLE class through the Digital Enhanced Cordless Technology telephone system followed by a second 1.5-month postalert control phase. A total of 2593 acute kidney injury alerts were recorded with a balanced distribution over all study phases. Most acute kidney injury alerts were RIFLE class risk (59.8%) followed by RIFLE class injury (34.1%) and failure (6.1%). A higher percentage of patients in the alert group received therapeutic intervention within 60 mins after the acute kidney injury alert (28.7% in alert group vs. 7.9% and 10.4% in the pre- and postalert control groups, respectively, p μ .001). In the alert group, more patients received fluid therapy (23.0% vs. 4.9% and 9.2%, p μ .01), diuretics (4.2% vs. 2.6% and 0.8%, p μ .001), or vasopressors (3.9% vs. 1.1% and 0.8%, p μ .001). Furthermore, these patients had a shorter time to intervention (p μ .001). A higher proportion of patients in the alert group showed return to a baseline kidney function within 8 hrs after an acute kidney injury alert "from normal to risk" compared with patients in the control group (p = .048). The real-time alerting of every worsening RIFLE class by the acute kidney injury sniffer increased the number and timeliness of early therapeutic interventions. The borderline significant improvement of short-term renal outcome in the RIFLE class risk patients needs to be confirmed in a large multicenter trial.

Protocol-driven remote monitoring of cardiac resynchronization therapy as part of a heart failure disease management strategy.

PubMed

Smeets, Christophe J P; Verbrugge, Frederik H; Vranken, Julie; Van der Auwera, Jo; Mullens, Wilfried; Dupont, Matthias; Grieten, Lars; De Cannière, Hélène; Lanssens, Dorien; Vandenberk, Thijs; Storms, Valerie; Thijs, Inge M; Vandervoort, Pieter

2018-06-01

Cardiac resynchronisation therapy (CRT) is an established treatment for heart failure (HF) with reduced ejection fraction. CRT devices are equipped with remote monitoring functions, which are pivotal in the detection of device problems, but may also facilitate disease management. The aim of this study was to provide a comprehensive overview of the clinical interventions taken based on remote monitoring. This is a single centre observational study of consecutive CRT patients (n = 192) participating in protocol-driven remote follow-up. Incoming technical- and disease-related alerts were analysed together with subsequently triggered interventions. During 34 ± 13 months of follow-up, 1372 alert-containing notifications were received (2.53 per patient-year of follow-up), comprising 1696 unique alerts (3.12 per patient-year of follow-up). In 60%, notifications resulted in a phone contact. Technical alerts constituted 8% of incoming alerts (0.23 per patient-year of follow-up). Rhythm (1.43 per patient-year of follow-up) and bioimpedance alerts (0.98 per patient-year of follow-up) were the most frequent disease-related alerts. Notifications included a rhythm alert in 39%, which triggered referral to the emergency room (4%), outpatient cardiology clinic (36%) or general practitioner (7%), or resulted in medication changes (13%). Sole bioimpedance notifications resulted in a telephone contact in 91%, which triggered outpatient evaluation in 8% versus medication changes in 10%. Clinical outcome was excellent with 97% 1-year survival. Remote CRT follow-up resulted in 0.23 technical- versus 2.64 disease-related alerts annually. Rhythm and bioimpedance notifications constituted the majority of incoming notifications which triggered an actual intervention in 22% and 15% of cases, respectively.

A trial of a real-time alert for clinical deterioration in patients hospitalized on general medical wards.

PubMed

Bailey, Thomas C; Chen, Yixin; Mao, Yi; Lu, Chenyang; Hackmann, Gregory; Micek, Scott T; Heard, Kevin M; Faulkner, Kelly M; Kollef, Marin H

2013-05-01

With limited numbers of intensive care unit (ICU) beds available, increasing patient acuity is expected to contribute to episodes of inpatient deterioration on general wards. To prospectively validate a predictive algorithm for clinical deterioration in general-medical ward patients, and to conduct a trial of real-time alerts based on this algorithm. Randomized, controlled crossover study. Academic center with patients hospitalized on 8 general wards between July 2007 and December 2011. Real-time alerts were generated by an algorithm designed to predict the need for ICU transfer using electronically available data. The alerts were sent by text page to the nurse manager on intervention wards. Intensive care unit transfer, hospital mortality, and hospital length of stay. Patients meeting the alert threshold were at nearly 5.3-fold greater risk of ICU transfer (95% confidence interval [CI]: 4.6-6.0) than those not satisfying the alert threshold (358 of 2353 [15.2%] vs 512 of 17678 [2.9%]). Patients with alerts were at 8.9-fold greater risk of death (95% CI: 7.4-10.7) than those without alerts (244 of 2353 [10.4%] vs 206 of 17678 [1.2%]). Among patients identified by the early warning system, there were no differences in the proportion of patients who were transferred to the ICU or who died in the intervention group as compared with the control group. Real-time alerts were highly specific for clinical deterioration resulting in ICU transfer and death, and were associated with longer hospital length of stay. However, an intervention notifying a nurse of the risk did not result in improvement in these outcomes. Copyright © 2013 Society of Hospital Medicine.

Innovative Software Tools Measure Behavioral Alertness

NASA Technical Reports Server (NTRS)

2014-01-01

To monitor astronaut behavioral alertness in space, Johnson Space Center awarded Philadelphia-based Pulsar Informatics Inc. SBIR funding to develop software to be used onboard the International Space Station. Now used by the government and private companies, the technology has increased revenues for the firm by an average of 75 percent every year.

Developing, Implementing, and Assessing an Early Alert System

ERIC Educational Resources Information Center

Tampke, Dale R.

2013-01-01

Early alert systems offer institutions systematic approaches to identifying and intervening with students exhibiting at-risk behaviors. Many of these systems rely on a common format for student referral to central receiving point. Systems at larger institutions often use web-based technology to allow for a scalable (available campus wide) approach…

Behavioral and Brain Measures of Phasic Alerting Effects on Visual Attention.

PubMed

Wiegand, Iris; Petersen, Anders; Finke, Kathrin; Bundesen, Claus; Lansner, Jon; Habekost, Thomas

2017-01-01

In the present study, we investigated effects of phasic alerting on visual attention in a partial report task, in which half of the displays were preceded by an auditory warning cue. Based on the computational Theory of Visual Attention (TVA), we estimated parameters of spatial and non-spatial aspects of visual attention and measured event-related lateralizations (ERLs) over visual processing areas. We found that the TVA parameter sensory effectiveness a , which is thought to reflect visual processing capacity, significantly increased with phasic alerting. By contrast, the distribution of visual processing resources according to task relevance and spatial position, as quantified in parameters top-down control α and spatial bias w index , was not modulated by phasic alerting. On the electrophysiological level, the latencies of ERLs in response to the task displays were reduced following the warning cue. These results suggest that phasic alerting facilitates visual processing in a general, unselective manner and that this effect originates in early stages of visual information processing.

KSC-2015-1308

NASA Image and Video Library

2015-02-08

CAPE CANAVERAL, Fla. – CAPE CANAVERAL, Fla. – Backdropped by a blue sky streaked with white clouds, the SpaceX Falcon 9 rocket set to launch NOAA’s Deep Space Climate Observatory spacecraft, or DSCOVR, is flanked by lightning masts at Space Launch Complex 40 at Cape Canaveral Air Force Station in Florida. DSCOVR is a partnership between NOAA, NASA and the U.S. Air Force. DSCOVR will maintain the nation's real-time solar wind monitoring capabilities which are critical to the accuracy and lead time of NOAA's space weather alerts and forecasts. To learn more about DSCOVR, visit http://www.nesdis.noaa.gov/DSCOVR. Photo credit: NASA/Kim Shiflett

DSCOVR Spacecraft Arrival, Offload, & Unpacking

NASA Image and Video Library

2014-11-20

NOAA’s newly arrived Deep Space Climate Observatory spacecraft, or DSCOVR, wrapped in plastic and secured onto a portable work stand, is delivered to the high bay of Building 1 at the Astrotech payload processing facility in Titusville, Florida, near Kennedy Space Center. DSCOVR is a partnership between NOAA, NASA and the U.S. Air Force. DSCOVR will maintain the nation's real-time solar wind monitoring capabilities which are critical to the accuracy and lead time of NOAA's space weather alerts and forecasts. Launch is currently scheduled for January 2015 aboard a SpaceX Falcon 9 v 1.1 launch vehicle from Cape Canaveral Air Force Station, Florida.

DSCOVR Spacecraft Arrival, Offload, & Unpacking

NASA Image and Video Library

2014-11-20

Workers are on hand to receive NOAA’s Deep Space Climate Observatory spacecraft, or DSCOVR, wrapped in plastic and secured onto a portable work stand, into the high bay of Building 1 at the Astrotech payload processing facility in Titusville, Florida, near Kennedy Space Center. DSCOVR is a partnership between NOAA, NASA and the U.S. Air Force. DSCOVR will maintain the nation's real-time solar wind monitoring capabilities which are critical to the accuracy and lead time of NOAA's space weather alerts and forecasts. Launch is currently scheduled for January 2015 aboard a SpaceX Falcon 9 v 1.1 launch vehicle from Cape Canaveral Air Force Station, Florida.

DSCOVR Spacecraft Arrival, Offload, & Unpacking

NASA Image and Video Library

2014-11-20

The truck delivering NOAA’s Deep Space Climate Observatory spacecraft, or DSCOVR, enclosed in a protective shipping container, backs up to the door of the airlock of Building 2 at the Astrotech payload processing facility in Titusville, Florida, near Kennedy Space Center. DSCOVR is a partnership between NOAA, NASA and the U.S. Air Force. DSCOVR will maintain the nation's real-time solar wind monitoring capabilities which are critical to the accuracy and lead time of NOAA's space weather alerts and forecasts. Launch is currently scheduled for January 2015 aboard a SpaceX Falcon 9 v 1.1 launch vehicle from Cape Canaveral Air Force Station, Florida.

DSCOVR Spacecraft Arrival, Offload, & Unpacking

NASA Image and Video Library

2014-11-20

Workers transfer NOAA’s Deep Space Climate Observatory spacecraft, or DSCOVR, wrapped in plastic and secured onto a portable work stand, from the airlock of Building 2 to the high bay of Building 1 at the Astrotech payload processing facility in Titusville, Florida, near Kennedy Space Center. DSCOVR is a partnership between NOAA, NASA and the U.S. Air Force. DSCOVR will maintain the nation's real-time solar wind monitoring capabilities which are critical to the accuracy and lead time of NOAA's space weather alerts and forecasts. Launch is currently scheduled for January 2015 aboard a SpaceX Falcon 9 v 1.1 launch vehicle from Cape Canaveral Air Force Station, Florida.

A randomized trial of automated electronic alerts demonstrating improved reimbursable anesthesia time documentation.

PubMed

Freundlich, Robert E; Barnet, Caryn S; Mathis, Michael R; Shanks, Amy M; Tremper, Kevin K; Kheterpal, Sachin

2013-03-01

To investigate whether alerting providers to errors results in improved documentation of reimbursable anesthesia care. Prospective randomized controlled trial. Operating room (OR) of a university hospital. Anesthesia cases were evaluated to determine whether they met the definition for appropriate anesthesia start time over 4 separate, 45-day calendar cycles: the pre-study period, study period, immediate post-study period, and 3-year follow-up period. During the study period, providers were randomly assigned to either a control or an alert group. Providers in the alert cohort received an automated alphanumeric page if the anesthesia start time occurred concurrently with the patient entering the OR, or more than 30 minutes before entering the OR. Three years after the intervention period, overall compliance was analyzed to assess learned behavior. Baseline compliance was 33% ± 5%. During the intervention period, providers in the alert group showed 87% ± 6% compliance compared with 41% ± 7% compliance in the control group (P < 0.001). Long-term follow-up after cessation of the alerts showed 85% ± 4% compliance. Automated electronic reminders for time-based billing charges are effective and result in improved ongoing reimbursement. Copyright © 2013 Elsevier Inc. All rights reserved.

The Common Alerting Protocol (CAP) adaption in National Early Warning Alerting Systems of China

NASA Astrophysics Data System (ADS)

Li, Chao

2017-04-01

The Common Alerting Protocol (CAP) [1] is an XML-based data format for exchanging public warnings and emergencies between alerting technologies. In China, from local communities to entire nations, there was a patchwork of specialized hazard public alerting systems. And each system was often designed just for certain emergency situations and for certain communications media. Application took place in the NEWAS (National Early Warning Alerting Systems) [2]project where CAP serves as central message to integrate all kind of hazard situations, including the natural calamity, accident disaster, public health emergency , social safety etc. Officially operated on May 2015, NEWAS now has completed docking work with 14 departments including civil administration, safety supervision, forestry, land, water conservancy, earthquake, traffic, meteorology, agriculture, tourism, food and drug supervision, public security and oceanic administration. Thus, several items in CAP has been modified, redefined and extended according to the various grading standards and publishing strategies, as well as the characteristics of Chinese Geocoding. NEWAS successfully delivers information to end users through 4 levels (i.e. State, province, prefecture and county) structure and by various means. [1] CAP, http://www.oasis-emergency.org/cap [2] http://www.12379.cn/

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

PubMed

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

2018-08-01

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

Satellite Alert Facility at Cape Canaveral Air Force Station. Environmental Assessment

DTIC Science & Technology

2005-09-01

binthifolius Raddi), Cogon grass (Imperata cylindrical), and Australian pine (Casuarina equisetifolia). The management of invasive plant species may be...circle). The proposed and secondary alternative sites consist only of mowed grass . A photograph of the proposed action site is also included in...indigenous to the Florida coastline. The proposed and secondary alternative sites for the proposed ac- tion are located on mowed grass ; no natural

Maritime Action Groups: The Expeditionary Building Block of the Future

DTIC Science & Technology

1993-03-10

attack submarine, and an alert P-3 aircraft. Captain Robert Crawshaw , USN, Commodore of the initial Sixth Fleet Maritime Action Group emphasizes that...services and our coalition partners. Captain Crawshaw stated that: -the MAG operates as a single force exercising with allied navies throughout the...Less intimidating than a carrier battle group, the MAG has been received eagerly by allied navies throughout the Mediterranean.’ Captain Crawshaw and

Military Review: Training the Force.

DTIC Science & Technology

1991-01-01

attack birds move in, it realizes the reserve must finish the fight. TF Sa- is over.., the senior controller calls "change of ber is alerted to recycle ...concentrate on field S1 must then take the casualties and recycle exerise performance alone, measwing it them as replacements. objectively against a...degenerate into a formal rehash of military history and the causes and consequences of common places and a plodding through trivia , tension between

The Evolution of NATO with Four Plausible Threat Scenarios

DTIC Science & Technology

1987-08-01

were political changes as well. The evolution of British political institutions, and especially the widening of the franchise by electoral reform, had...countries. King Edward, in particular, excited the French imagination. In his con- tact with French statesmen, Edward made clear his desire for an...such as the Mitteland Kanal, British lines of communication and the Teuto- burger Wald before making contact. With Soviet air forces alert against

Massachusetts wants a tougher federal oil spill control plan

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

Not Available

Massachusetts wants a tougher federal oil spill control plan and has petitioned the U.S. Council on Environmental Quality (CEQ). The present oil spill contingency plan is inadequate, according to M. Dukakis (Gov. Mass.). The Massachusetts plan, which CEQ officials view favorably, would extend responsibility to the 200 mi fishing limit, provide for protection of birds, and set up an oil strike force on 24 hr alert.

Latin America Report No. 2722.

DTIC Science & Technology

1983-08-11

private business owners and officials of state agencies, and that the trip was intended to increase exports to that socialist country. Carlos Cleri...officers of the armed forces and AFNE board members. The ceremony began with the words of the head of AFNE, Vice Adm Carlos Toriaschi (ret.), who pointed...Commercial Exporting Companies, Carlos Sehbe. According to him, the state-controlled companies "are not alert but they are advancing with monopolistic

Sleep, alertness and alertness management among commercial airline pilots on short-haul and long-haul flights.

PubMed

Sallinen, Mikael; Sihvola, Maria; Puttonen, Sampsa; Ketola, Kimmo; Tuori, Antti; Härmä, Mikko; Kecklund, Göran; Åkerstedt, Torbjörn

2017-01-01

Airline pilots' sleep and on-duty alertness are important focus areas in commercial aviation. Until now, studies pertaining to this topic have mainly focused on specific characteristics of flights and thus a comprehensive picture of the matter is not well established. In addition, research knowledge of what airline pilots actually do to maintain their alertness while being on duty is scarce. To address these gaps in research knowledge, we conducted a field study on a representative sample of the airline pilots of a medium-sized airline. The sample consisted of 90 pilots, of whom 30 flew long-haul (LH) routes, 30 short-haul (SH) routes, and 30 flew both. A total of 86 pilots completed the measurements that lasted for almost two months per pilot. The measurements resulted in a total of 965 flight duty periods (FDPs) including SH flights and 627 FDPs including LH flights. During the measurement periods, sleep was measured by a diary and actigraphs, on-duty alertness by the Karolinska Sleepiness Scale (KSS) in all flight phases, and on-duty alertness management strategies by the diary. Results showed that SH and LH FDPs covering the whole domicile night (00:00-06:00 at home base) were most consistently associated with reduced sleep-wake ratio and subjective alertness. Approximately every 3rd FDP falling into this category involved a reduced sleep-wake ratio (1:3 or lower) and every 2nd a reduced level of subjective alertness (KSS rating 8-9 in at least one flight phase). The corresponding frequencies for the SH and LH FDPs that partly covered the domicile night were every 10th and every 5th FDP and for the pure non-night FDPs every 30th and every 36th FDP, respectively. The results also showed that the pilots tended to increase the use of effective on-duty alertness management strategies (consuming alertness-promoting products and taking strategic naps) in connection with the FDPs that overlapped the domicile night. Finally, the results showed that the frequency of flights involving reduced subjective alertness depended on how alertness was assessed. If it was assessed solely in the flight phase just before starting the landing procedures (top of descent) the phenomenon was less frequent than if the preceding cruise phase was also taken into account. Our results suggest that FDPs covering the whole domicile night should be prioritised over the other FDPs in fatigue management, regardless of whether an FDP is a short-haul or a long-haul. In addition, the identification of fatigue in flight operations requires one to assess pilots' alertness across all flight phases, not only at ToD. Due to limitations in our data, these conclusions can, however, be generalise to only LH FDPs during which pilots can be expected to be well acclimatised to the local time at their home base and SH night FDPs that include at least 3h of flying in the cruise phase. Copyright © 2016 Elsevier Ltd. All rights reserved.

Lay persons alerted by mobile application system initiate earlier cardio-pulmonary resuscitation: A comparison with SMS-based system notification.

PubMed

Caputo, Maria Luce; Muschietti, Sandro; Burkart, Roman; Benvenuti, Claudio; Conte, Giulio; Regoli, François; Mauri, Romano; Klersy, Catherine; Moccetti, Tiziano; Auricchio, Angelo

2017-05-01

We compared the time to initiation of cardiopulmonary resuscitation (CPR) by lay responders and/or first responders alerted either via Short Message Service (SMS) or by using a mobile application-based alert system (APP). The Ticino Registry of Cardiac Arrest collects all data about out-of-hospital cardiac arrests (OHCAs) occurring in the Canton of Ticino. At the time of a bystander's call, the EMS dispatcher sends one ambulance and alerts the first-responders network made up of police officers or fire brigade equipped with an automatic external defibrillator, the so called "traditional" first responders, and - if the scene was considered safe - lay responders as well. We evaluated the time from call to arrival of traditional first responders and/or lay responders when alerted either via SMS or the new developed mobile APP. Over the study period 593 OHCAs have occurred. Notification to the first responders network was sent via SMS in 198 cases and via mobile APP in 134 cases. Median time to first responder/lay responder arrival on scene was significantly reduced by the APP-based system (3.5 [2.8-5.2]) compared to the SMS-based system (5.6 [4.2-8.5] min, p 0.0001). The proportion of lay responders arriving first on the scene significantly increased (70% vs. 15%, p<0.01) with the APP. Earlier arrival of a first responder or of a lay responder determined a higher survival rate. The mobile APP system is highly efficient in the recruitment of first responders, significantly reducing the time to the initiation of CPR thus increasing survival rates. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

Decreased functional connectivity and structural deficit in alertness network with right-sided temporal lobe epilepsy.

PubMed

Gao, Yujun; Zheng, Jinou; Li, Yaping; Guo, Danni; Wang, Mingli; Cui, Xiangxiang; Ye, Wei

2018-04-01

Patients with temporal lobe epilepsy (TLE) often suffer from alertness alterations. However, specific regions connected with alertness remain controversial, and whether these regions have structural impairment is also elusive. This study aimed to investigate the characteristics and neural mechanisms underlying the functions and structures of alertness network in patients with right-sided temporal lobe epilepsy (rTLE) by performing the attentional network test (ANT), resting-state functional magnetic resonance imaging (R-SfMRI), and diffusion tensor imaging (DTI).A total of 47 patients with rTLE and 34 healthy controls underwent ANT, R-SfMRI, and DTI scan. The seed-based functional connectivity (FC) method and deterministic tractography were used to analyze the data.Patients with rTLE had longer reaction times in the no-cue and double-cue conditions. However, no differences were noted in the alertness effect between the 2 groups. The patient group had lower FC compared with the control group in the right inferior parietal lobe (IPL), amygdala, and insula. Structural deficits were found in the right parahippocampal gyrus, superior temporal pole, insula, and amygdala in the patient group compared with the control group. Also significantly negative correlations were observed between abnormal fractional anisotropy (between the right insula and the superior temporal pole) and illness duration in the patients with rTLE.The findings of this study suggested abnormal intrinsic and phasic alertness, decreased FC, and structural deficits within the alerting network in the rTLE. This study provided new insights into the mechanisms of alertness alterations in rTLE.

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

NASA Astrophysics Data System (ADS)

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

2005-05-01

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

Effect of an obesity best practice alert on physician documentation and referral practices.

PubMed

Fitzpatrick, Stephanie L; Dickins, Kirsten; Avery, Elizabeth; Ventrelle, Jennifer; Shultz, Aaron; Kishen, Ekta; Rothschild, Steven

2017-12-01

The Centers for Medicare & Medicaid Services Electronic Health Record Meaningful Use Incentive Program requires physicians to document body mass index (BMI) and a follow-up treatment plan for adult patients with BMI ≥ 25. To examine the effect of a best practice alert on physician documentation of obesity-related care and referrals to weight management treatment, in a cluster-randomized design, 14 primary care clinics at an academic medical center were randomized to best practice alert intervention (n = 7) or comparator (n = 7). The alert was triggered when both height and weight were entered and BMI was ≥30. Both intervention and comparator clinics could document meaningful use by selecting a nutrition education handout within the alert. Intervention clinics could also select a referral option from the list of clinic and community-based weight management programs embedded in the alert. Main outcomes were proportion of eligible patients with (1) obesity-related documentation and (2) referral. There were 26,471 total primary care encounters with 12,981 unique adult patients with BMI ≥ 30 during the 6-month study period. Documentation doubled (17 to 33%) with implementation of the alert. However, intervention clinics were not significantly more likely to refer patients to weight management than comparator clinics (2.8 vs. 1.3%, p = 0.07). Although the alert was associated with increased physician meaningful use compliance, it was not an effective strategy for improving patient access to weight management services. Further research is needed to understand system-level characteristics that influence obesity management in primary care.

CERN alerter—RSS based system for information broadcast to all CERN offices

NASA Astrophysics Data System (ADS)

Otto, R.

2008-07-01

Nearly every large organization uses a tool to broadcast messages and information across the internal campus (messages like alerts announcing interruption in services or just information about upcoming events). These tools typically allow administrators (operators) to send 'targeted' messages which are sent only to specific groups of users or computers, e/g only those located in a specified building or connected to a particular computing service. CERN has a long history of such tools: CERNVMS's SPM_quotMESSAGE command, Zephyr [2] and the most recent the NICE Alerter based on the NNTP protocol. The NICE Alerter used on all Windows-based computers had to be phased out as a consequence of phasing out NNTP at CERN. The new solution to broadcast information messages on the CERN campus continues to provide the service based on cross-platform technologies, hence minimizing custom developments and relying on commercial software as much as possible. The new system, called CERN Alerter, is based on RSS (Really Simple Syndication) [9] for the transport protocol and uses Microsoft SharePoint as the backend for database and posting interface. The windows-based client relies on Internet Explorer 7.0 with custom code to trigger the window pop-ups and the notifications for new events. Linux and Mac OS X clients could also rely on any RSS readers to subscribe to targeted notifications. The paper covers the architecture and implementation aspects of the new system.

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

PubMed Central

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

2016-01-01

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

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

PubMed Central

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

2015-01-01

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

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

PubMed

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

2015-08-20

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

Earthquake Early Warning ShakeAlert System: Testing and certification platform

USGS Publications Warehouse

Cochran, Elizabeth S.; Kohler, Monica D.; Given, Douglas; Guiwits, Stephen; Andrews, Jennifer; Meier, Men-Andrin; Ahmad, Mohammad; Henson, Ivan; Hartog, Renate; Smith, Deborah

2017-01-01

Earthquake early warning systems provide warnings to end users of incoming moderate to strong ground shaking from earthquakes. An earthquake early warning system, ShakeAlert, is providing alerts to beta end users in the western United States, specifically California, Oregon, and Washington. An essential aspect of the earthquake early warning system is the development of a framework to test modifications to code to ensure functionality and assess performance. In 2016, a Testing and Certification Platform (TCP) was included in the development of the Production Prototype version of ShakeAlert. The purpose of the TCP is to evaluate the robustness of candidate code that is proposed for deployment on ShakeAlert Production Prototype servers. TCP consists of two main components: a real‐time in situ test that replicates the real‐time production system and an offline playback system to replay test suites. The real‐time tests of system performance assess code optimization and stability. The offline tests comprise a stress test of candidate code to assess if the code is production ready. The test suite includes over 120 events including local, regional, and teleseismic historic earthquakes, recentering and calibration events, and other anomalous and potentially problematic signals. Two assessments of alert performance are conducted. First, point‐source assessments are undertaken to compare magnitude, epicentral location, and origin time with the Advanced National Seismic System Comprehensive Catalog, as well as to evaluate alert latency. Second, we describe assessment of the quality of ground‐motion predictions at end‐user sites by comparing predicted shaking intensities to ShakeMaps for historic events and implement a threshold‐based approach that assesses how often end users initiate the appropriate action, based on their ground‐shaking threshold. TCP has been developed to be a convenient streamlined procedure for objectively testing algorithms, and it has been designed with flexibility to accommodate significant changes in development of new or modified system code. It is expected that the TCP will continue to evolve along with the ShakeAlert system, and the framework we describe here provides one example of how earthquake early warning systems can be evaluated.

Development of the Runway Incursion Advisory and Alerting System (RIAAS): Research Summary

NASA Technical Reports Server (NTRS)

Jones, Denise R. (Technical Monitor); Cassell, Rick

2005-01-01

This report summarizes research conducted on an aircraft based Runway Incursion Advisory and Alerting System (RIAAS) developed under a cooperative agreement between Rannoch Corporation and the NASA Langley Research Center. A summary of RIAAS is presented along with results from simulation and flight testing, safety benefits, and key technical issues.

Cabin Pressure Monitors Notify Pilots to Save Lives

NASA Technical Reports Server (NTRS)

2015-01-01

In 2013, San Diego-based Aviation Technology Inc. obtained an exclusive license for the technology behind the cabin pressure monitor invented at Kennedy Space Center and built its own version of the product. The Alt Alert is designed to save lives by alerting aircraft pilots and crews when cabin pressure becomes dangerously low.

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

PubMed

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

2004-04-01

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

A Markov game theoretic data fusion approach for cyber situational awareness

NASA Astrophysics Data System (ADS)

Shen, Dan; Chen, Genshe; Cruz, Jose B., Jr.; Haynes, Leonard; Kruger, Martin; Blasch, Erik

2007-04-01

This paper proposes an innovative data-fusion/ data-mining game theoretic situation awareness and impact assessment approach for cyber network defense. Alerts generated by Intrusion Detection Sensors (IDSs) or Intrusion Prevention Sensors (IPSs) are fed into the data refinement (Level 0) and object assessment (L1) data fusion components. High-level situation/threat assessment (L2/L3) data fusion based on Markov game model and Hierarchical Entity Aggregation (HEA) are proposed to refine the primitive prediction generated by adaptive feature/pattern recognition and capture new unknown features. A Markov (Stochastic) game method is used to estimate the belief of each possible cyber attack pattern. Game theory captures the nature of cyber conflicts: determination of the attacking-force strategies is tightly coupled to determination of the defense-force strategies and vice versa. Also, Markov game theory deals with uncertainty and incompleteness of available information. A software tool is developed to demonstrate the performance of the high level information fusion for cyber network defense situation and a simulation example shows the enhanced understating of cyber-network defense.

Education and Training Module in Alertness Management

NASA Technical Reports Server (NTRS)

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

2006-01-01

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

A randomised, clinical trial comparing the effectiveness of hospital and community-based reminder systems for increasing uptake of influenza and pneumococcal vaccine in hospitalised patients aged 65 years and over.

PubMed

MacIntyre, C R; Kainer, M A; Brown, G V

2003-01-01

Hospitalisation represents an opportunity to identify unimmunised people at risk for the complications of influenza and pneumococcal disease. We conducted a randomised controlled trial of two strategies to increase uptake of influenza and pneumococcal vaccines in eligible, hospitalised subjects aged 65 years or more, admitted between May and September 1998 to a Melbourne hospital. Unvaccinated participants were allocated randomly to alert systems for hospital staff or community general practitioners (GPs). Follow-up occurred at 1 and 3 months. The baseline vaccination rates were 70% for influenza (426/606) and 41% (248/606) for pneumococcal disease. For unvaccinated subjects, the hospital alert resulted in 67% uptake compared to 55% following a GP alert for pneumococcal vaccine; and 63% in hospital compared to 53% following a GP alert for influenza vaccine. Although there was a trend toward a higher uptake in hospital, neither of these differences was statistically significant. The majority (75%) of vaccinations following a GP alert occurred within 1 month of discharge. Despite hospital and community-based reminder systems, there are still significant missed opportunities for vaccination. We did not demonstrate significant differences between hospital and GP reminder systems, but there was a trend towards higher uptake with opportunistic vaccination in hospital. Copyright 2003 S. Karger AG, Basel

A novel active heads-up display for driver assistance.

PubMed

Doshi, Anup; Cheng, Shinko Yuanhsien; Trivedi, Mohan Manubhai

2009-02-01

In this paper, we introduce a novel laser-based wide-area heads-up windshield display which is capable of actively interfacing with a human as part of a driver assistance system. The dynamic active display (DAD) is a unique prototype interface that presents safety-critical visual icons to the driver in a manner that minimizes the deviation of his or her gaze direction without adding to unnecessary visual clutter. As part of an automotive safety system, the DAD presents alerts in the field of view of the driver only if necessary, which is based upon the state and pose of the driver, vehicle, and environment. This paper examines the effectiveness of DAD through a comprehensive comparative experimental evaluation of a speed compliance driver assistance system, which is implemented on a vehicular test bed. Three different types of display protocols for assisting a driver to comply with speed limits are tested on actual roadways, and these are compared with a conventional dashboard display. Given the inclination, drivers who are given an overspeed warning alert reduced the time required to slow down to the speed limit by 38% (p < 0.01) as compared with the drivers not given the alert. Additionally, certain alerts decreased distraction levels by reducing the time spent looking away from the road by 63% (p < 0.01). Ultimately, these alerts demonstrate the utility and promise of the DAD system.

An approach for representing sensor data to validate alerts in Ambient Assisted Living.

PubMed

Muñoz, Andrés; Serrano, Emilio; Villa, Ana; Valdés, Mercedes; Botía, Juan A

2012-01-01

The mainstream of research in Ambient Assisted Living (AAL) is devoted to developing intelligent systems for processing the data collected through artificial sensing. Besides, there are other elements that must be considered to foster the adoption of AAL solutions in real environments. In this paper we focus on the problem of designing interfaces among caregivers and AAL systems. We present an alert management tool that supports carers in their task of validating alarms raised by the system. It generates text-based explanations--obtained through an argumentation process--of the causes leading to alarm activation along with graphical sensor information and 3D models, thus offering complementary types of information. Moreover, a guideline to use the tool when validating alerts is also provided. Finally, the functionality of the proposed tool is demonstrated through two real cases of alert.

Un-Alerted Smoke and Fire: Checklist Content and Intended Crew Response

NASA Technical Reports Server (NTRS)

Burian, Barbara K.

2015-01-01

An in-flight smoke or fire event is an emergency unlike almost any other. The early cues for un-alerted conditions, such as air conditioning smoke or fire, are often ambiguous and elusive. The checklists crews use for these conditions must help them respond quickly and effectively and must guide their decisions. Ten years ago an industry committee developed a template to guide the content of Part 121 checklists for un-alerted smoke and fire events. This template is based upon a new philosophy about how crews should use the checklists and respond to the events. To determine the degree to which current un-alerted checklists of in-flight smoke or fire comply or are consistent with the guidance outlined in the template, I collected and analysed checklists from North American air carriers.

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

PubMed Central

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

2017-01-01

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

Terminal - Tactical Separation Assured Flight Environment (T-TSafe)

NASA Technical Reports Server (NTRS)

Verma, Savita Arora; Tang, Huabin; Ballinger, Debbi

2011-01-01

The Tactical Separation Assured Flight Environment (TSAFE) has been previously tested as a conflict detection and resolution tool in the en-route phase of flight. Fast time simulations of a terminal version of this tool called Terminal TSAFE (T-TSAFE) have shown promise over the current conflict detection tools. It has shown to have fewer false alerts (as low as 2 per hour) and better prediction to conflict time than Conflict Alert. The tool will be tested in the simulated terminal area of Los Angeles International Airport, in a Human-in-the-loop experiment to identify controller procedures and information requirements. The simulation will include comparisons of T-TSAFE with NASA's version of Conflict Alert. Also, some other variables such as altitude entry by the controller, which improve T-TSAFE's predictions for conflict detection, will be tested. T-TSAFE integrates features of current conflict detection tools such as Automated Terminal Proximity Alert used to alleviate compression errors in the final approach phase. Based on fast-time simulation analysis, the anticipated benefits of T-TSAFE over Conflict Alert include reduced false/missed alerts and increased time to predicted loss of separation. Other metrics that will be used to evaluate the tool's impact on the controller include controller intervention, workload, and situation awareness.

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

PubMed Central

Guevara, Rainer Dane; Rantz, Marilyn

2015-01-01

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

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

PubMed

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

2018-01-01

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

Air/ground wind shear information integration: Flight test results

NASA Technical Reports Server (NTRS)

Hinton, David A.

1992-01-01

An element of the NASA/FAA wind shear program is the integration of ground-based microburst information on the flight deck, to support airborne wind shear alerting and microburst avoidance. NASA conducted a wind shear flight test program in the summer of 1991 during which airborne processing of Terminal Doppler Weather Radar (TDWR) data was used to derive microburst alerts. High level microburst products were extracted from TDWR, transmitted to a NASA Boeing 737 in flight via data link, and processed to estimate the wind shear hazard level (F-factor) that would be experienced by the aircraft in the core of each microburst. The microburst location and F-factor were used to derive a situation display and alerts. The situation display was successfully used to maneuver the aircraft for microburst penetrations, during which in situ 'truth' measurements were made. A total of 19 penetrations were made of TDWR-reported microburst locations, resulting in 18 airborne microburst alerts from the TDWR data and two microburst alerts from the airborne in situ measurements. The primary factors affecting alerting performance were spatial offset of the flight path from the region of strongest shear, differences in TDWR measurement altitude and airplane penetration altitude, and variations in microburst outflow profiles. Predicted and measured F-factors agreed well in penetrations near microburst cores. Although improvements in airborne and ground processing of the TDWR measurement would be required to support an airborne executive-level alerting protocol, the feasibility of airborne utilization of TDWR data link data has been demonstrated.

The DOPA decarboxylase (DDC) gene is associated with alerting attention.

PubMed

Zhu, Bi; Chen, Chuansheng; Moyzis, Robert K; Dong, Qi; Chen, Chunhui; He, Qinghua; Li, Jin; Li, Jun; Lei, Xuemei; Lin, Chongde

2013-06-03

DOPA decarboxylase (DDC) is involved in the synthesis of dopamine, norepinephrine and serotonin. It has been suggested that genes involved in the dopamine, norepinephrine, and cholinergic systems play an essential role in the efficiency of human attention networks. Attention refers to the cognitive process of obtaining and maintaining the alert state, orienting to sensory events, and regulating the conflicts of thoughts and behavior. The present study tested seven single nucleotide polymorphisms (SNPs) within the DDC gene for association with attention, which was assessed by the Attention Network Test to detect three networks of attention, including alerting, orienting, and executive attention, in a healthy Han Chinese sample (N=451). Association analysis for individual SNPs indicated that four of the seven SNPs (rs3887825, rs7786398, rs10499695, and rs6969081) were significantly associated with alerting attention. Haplotype-based association analysis revealed that alerting was associated with the haplotype G-A-T for SNPs rs7786398-rs10499695-rs6969081. These associations remained significant after correcting for multiple testing by max(T) permutation. No association was found for orienting and executive attention. This study provides the first evidence for the involvement of the DDC gene in alerting attention. A better understanding of the genetic basis of distinct attention networks would allow us to develop more effective diagnosis, treatment, and prevention of deficient or underdeveloped alerting attention as well as its related prevalent neuropsychiatric disorders. Copyright © 2012 Elsevier Inc. All rights reserved.

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

PubMed

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

2016-04-01

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

Operationalizing Cyberspace for Today’s Combat Air Force

DTIC Science & Technology

2010-04-01

rootkit techniques to run inside common Windows services (sometimes bundled with fake antivirus software ) or in Windows safe mode, and it can hide...has shifted to downloading other malware, with its main focus on fake alerts and rogue antivirus software . 5. TR/Dldr.Agent.JKH - Compromised U.S...patch, software update, or security breech away from failure. In short, what works AU/ACSC/SIMMONS/AY10 5 today, may not work tomorrow; this fact

Event-based internet biosurveillance: relation to epidemiological observation

PubMed Central

2012-01-01

Background The World Health Organization (WHO) collects and publishes surveillance data and statistics for select diseases, but traditional methods of gathering such data are time and labor intensive. Event-based biosurveillance, which utilizes a variety of Internet sources, complements traditional surveillance. In this study we assess the reliability of Internet biosurveillance and evaluate disease-specific alert criteria against epidemiological data. Methods We reviewed and compared WHO epidemiological data and Argus biosurveillance system data for pandemic (H1N1) 2009 (April 2009 – January 2010) from 8 regions and 122 countries to: identify reliable alert criteria among 15 Argus-defined categories; determine the degree of data correlation for disease progression; and assess timeliness of Internet information. Results Argus generated a total of 1,580 unique alerts; 5 alert categories generated statistically significant (p < 0.05) correlations with WHO case count data; the sum of these 5 categories was highly correlated with WHO case data (r = 0.81, p < 0.0001), with expected differences observed among the 8 regions. Argus reported first confirmed cases on the same day as WHO for 21 of the first 64 countries reporting cases, and 1 to 16 days (average 1.5 days) ahead of WHO for 42 of those countries. Conclusion Confirmed pandemic (H1N1) 2009 cases collected by Argus and WHO methods returned consistent results and confirmed the reliability and timeliness of Internet information. Disease-specific alert criteria provide situational awareness and may serve as proxy indicators to event progression and escalation in lieu of traditional surveillance data; alerts may identify early-warning indicators to another pandemic, preparing the public health community for disease events. PMID:22709988

Development and use of active clinical decision support for preemptive pharmacogenomics

PubMed Central

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

2014-01-01

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

Helping the Child with a Cleft Palate in Your Classroom.

ERIC Educational Resources Information Center

Moran, Michael J.; Pentz, Arthur L.

1995-01-01

Guidelines for teachers of a student with a cleft palate include understand the physical problem; know what kind of speech problem to expect; be alert to the possibility of language-based learning difficulties; watch for signs of hearing loss; be alert to socialization problems; help the student make up work; and avoid self-fulfilling prophecies.…

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

PubMed Central

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

2016-01-01

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

Effectiveness of a real-time clinical decision support system for computerized physician order entry of plasma orders.

PubMed

Yazer, Mark H; Triulzi, Darrell J; Reddy, Vivek; Waters, Jonathan H

2013-12-01

We investigated the effect of implementing adaptive plasma ordering criteria in the computerized physician order entry (CPOE) system, with alerts that were automatically generated if the recipient's antecedent international normalized ratio (INR) did not meet the institutional criteria. In a regional health care system consisting of 11 hospitals using a common CPOE, data on the number of plasma orders and alerts that were generated were collected over a 4-month period before prescribers were required to select an indication for plasma. When adaptive ordering was implemented prescribers had to choose from prepopulated indications for plasma: INR of 1.6 or greater with bleeding, INR of 1.6 or greater before an invasive procedure, therapeutic exchange, massive transfusion, and other. Regardless of the antecedent INR the alert did not trigger if massive transfusion or plasmapheresis was selected. Information on prescribers and recipients was collected during this 5-month period. In the 4-month period before the adaptive alerts were implemented, 42.9% of the plasma orders generated an alert; in the 5-month period thereafter the alert rate was significantly lower at 27.9% (p < 0.0001). The percentage of heeded alerts increased during the adaptive alert period (24.3% vs. 17.1%, respectively, p = 0.004). A significant percentage (45%) of other plasma orders were for periprocedure or bleeding patients whose antecedent INR was less than 1.6. There were significant differences in prescriber specialties among those who ordered plasma using the other indication compared to all plasma orders. Electronic interventions improve compliance with plasma guidelines but as implemented are not sufficient to completely curtail non-evidence-based ordering. © 2013 American Association of Blood Banks.

DiAlert: a prevention program for overweight first degree relatives of type 2 diabetes patients: results of a pilot study to test feasibility and acceptability.

PubMed

Heideman, Wieke H; de Wit, Maartje; Middelkoop, Barend J C; Nierkens, Vera; Stronks, Karien; Verhoeff, Arnoud P; Snoek, Frank J

2012-09-27

Prevalence of type 2 diabetes mellitus is increasing due to lifestyle changes, particularly affecting those genetically at risk. We developed DiAlert as a targeted group-based intervention aimed to promote intrinsic motivation and action planning for lifestyle changes and weight loss in first degree relatives of patients with type 2 diabetes mellitus.The main objective of the pilot of the DiAlert intervention was to assess fidelity, feasibility and acceptability prior to starting the randomized controlled trial. Individuals with a family history of type 2 diabetes mellitus were self-identified and screened for eligibility. DiAlert consists of two group sessions. Feasibility, fidelity, acceptability and self-reported perceptions and behavioral determinants were evaluated in a pre-post study using questionnaires and observations. Determinants of behavior change were analyzed using paired-samples t tests and Wilcoxon signed rank tests. DiAlert was delivered to two groups of first degree relatives of patients with type 2 diabetes mellitus (N = 9 and N = 12). Feasibility and fidelity were confirmed. Overall, the DiAlert group sessions were positively evaluated (8.0 on a scale of 1 to 10) by participants. The intervention did not impact perceived susceptibility or worry about personal diabetes risk. Action planning with regard to changing diet and physical activity increased. DiAlert proved feasible and was well-accepted by participants. Positive trends in action planning indicate increased likelihood of actual behavior change following DiAlert. Testing the effectiveness in a randomized controlled trial is imperative. Netherlands National Trial Register (NTR): NTR2036.

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

PubMed Central

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

2014-01-01

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

TALON: the telescope alert operation network system: intelligent linking of distributed autonomous robotic telescopes

NASA Astrophysics Data System (ADS)

White, Robert R.; Wren, James; Davis, Heath R.; Galassi, Mark; Starr, Daniel; Vestrand, W. T.; Wozniak, P.

2004-09-01

The internet has brought about great change in the astronomical community, but this interconnectivity is just starting to be exploited for use in instrumentation. Utilizing the internet for communicating between distributed astronomical systems is still in its infancy, but it already shows great potential. Here we present an example of a distributed network of telescopes that performs more efficiently in synchronous operation than as individual instruments. RAPid Telescopes for Optical Response (RAPTOR) is a system of telescopes at LANL that has intelligent intercommunication, combined with wide-field optics, temporal monitoring software, and deep-field follow-up capability all working in closed-loop real-time operation. The Telescope ALert Operations Network (TALON) is a network server that allows intercommunication of alert triggers from external and internal resources and controls the distribution of these to each of the telescopes on the network. TALON is designed to grow, allowing any number of telescopes to be linked together and communicate. Coupled with an intelligent alert client at each telescope, it can analyze and respond to each distributed TALON alert based on the telescopes needs and schedule.

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

PubMed

Shalev, Nir; Humphreys, Glyn; Demeyere, Nele

2016-11-01

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

Physical properties and depth of cure of a new short fiber reinforced composite.

PubMed

Garoushi, Sufyan; Säilynoja, Eija; Vallittu, Pekka K; Lassila, Lippo

2013-08-01

To determine the physical properties and curing depth of a new short fiber composite intended for posterior large restorations (everX Posterior) in comparison to different commercial posterior composites (Alert, TetricEvoCeram Bulk Fill, Voco X-tra base, SDR, Venus Bulk Fill, SonicFill, Filtek Bulk Fill, Filtek Superme, and Filtek Z250). In addition, length of fiber fillers of composite XENIUS base compared to the previously introduced composite Alert has been measured. The following properties were examined according to ISO standard 4049: flexural strength, flexural modulus, fracture toughness, polymerization shrinkage and depth of cure. The mean and standard deviation were determined and all results were statistically analyzed with analysis of variance ANOVA (a=0.05). XENIUS base composite exhibited the highest fracture toughness (4.6MPam(1/2)) and flexural strength (124.3MPa) values and the lower shrinkage strain (0.17%) among the materials tested. Alert composite revealed the highest flexural modulus value (9.9GPa), which was not significantly different from XENIUS base composite (9.5GPa). Depth of cure of XENIUS base (4.6mm) was similar than those of bulk fill composites and higher than other hybrid composites. The length of fiber fillers in XENIUS base was longer (1.3-2mm) than in Alert (20-60μm). The new short fiber composite differed significantly in its physical properties compared to other materials tested. This suggests that the latter could be used in high-stress bearing areas. Copyright © 2013 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.

KSC-2015-1240

NASA Image and Video Library

2015-01-18

CAPE CANAVERAL, Fla. – Preparations to launch NOAA’s Deep Space Climate Observatory spacecraft, or DSCOVR, near completion in the Building 1 high bay of the Astrotech payload processing facility in Titusville, Florida, near Kennedy Space Center. DSCOVR is a partnership between NOAA, NASA and the U.S. Air Force. DSCOVR will maintain the nation's real-time solar wind monitoring capabilities which are critical to the accuracy and lead time of NOAA's space weather alerts and forecasts. Launch is targeted for no earlier than Feb. 8 aboard a SpaceX Falcon 9 v 1.1 launch vehicle from Cape Canaveral Air Force Station, Florida. To learn more about DSCOVR, visit http://www.nesdis.noaa.gov/DSCOVR. Photo credit: NASA/Kim Shiflett

KSC-2014-4580

NASA Image and Video Library

2014-11-24

CAPE CANAVERAL, Fla. – Workers conduct a light test on the solar arrays on NOAA’s Deep Space Climate Observatory spacecraft, or DSCOVR, in the Building 1 high bay at the Astrotech payload processing facility in Titusville, Florida, near Kennedy Space Center. DSCOVR is a partnership between NOAA, NASA and the U.S. Air Force. DSCOVR will maintain the nation's real-time solar wind monitoring capabilities which are critical to the accuracy and lead time of NOAA's space weather alerts and forecasts. Launch is targeted for early 2015 aboard a SpaceX Falcon 9 v 1.1 launch vehicle from Cape Canaveral Air Force Station, Florida. To learn more about DSCOVR, visit http://www.nesdis.noaa.gov/DSCOVR. Photo credit: NASA/Ben Smegelsky

KSC-2014-4578

NASA Image and Video Library

2014-11-24

CAPE CANAVERAL, Fla. – The solar arrays on NOAA’s Deep Space Climate Observatory spacecraft, or DSCOVR, are unfurled in the Building 1 high bay at the Astrotech payload processing facility in Titusville, Florida, near Kennedy Space Center. DSCOVR is a partnership between NOAA, NASA and the U.S. Air Force. DSCOVR will maintain the nation's real-time solar wind monitoring capabilities which are critical to the accuracy and lead time of NOAA's space weather alerts and forecasts. Launch is targeted for early 2015 aboard a SpaceX Falcon 9 v 1.1 launch vehicle from Cape Canaveral Air Force Station, Florida. To learn more about DSCOVR, visit http://www.nesdis.noaa.gov/DSCOVR. Photo credit: NASA/Ben Smegelsky

KSC-2014-4582

NASA Image and Video Library

2014-11-24

CAPE CANAVERAL, Fla. – Workers conduct a light test on the solar arrays on NOAA’s Deep Space Climate Observatory spacecraft, or DSCOVR, in the Building 1 high bay at the Astrotech payload processing facility in Titusville, Florida, near Kennedy Space Center. DSCOVR is a partnership between NOAA, NASA and the U.S. Air Force. DSCOVR will maintain the nation's real-time solar wind monitoring capabilities which are critical to the accuracy and lead time of NOAA's space weather alerts and forecasts. Launch is targeted for early 2015 aboard a SpaceX Falcon 9 v 1.1 launch vehicle from Cape Canaveral Air Force Station, Florida. To learn more about DSCOVR, visit http://www.nesdis.noaa.gov/DSCOVR. Photo credit: NASA/Ben Smegelsky

KSC-2014-4581

NASA Image and Video Library

2014-11-24

CAPE CANAVERAL, Fla. – Workers conduct a light test on the solar arrays on NOAA’s Deep Space Climate Observatory spacecraft, or DSCOVR, in the Building 1 high bay at the Astrotech payload processing facility in Titusville, Florida, near Kennedy Space Center. DSCOVR is a partnership between NOAA, NASA and the U.S. Air Force. DSCOVR will maintain the nation's real-time solar wind monitoring capabilities which are critical to the accuracy and lead time of NOAA's space weather alerts and forecasts. Launch is targeted for early 2015 aboard a SpaceX Falcon 9 v 1.1 launch vehicle from Cape Canaveral Air Force Station, Florida. To learn more about DSCOVR, visit http://www.nesdis.noaa.gov/DSCOVR. Photo credit: NASA/Ben Smegelsky

KSC-2015-1241

NASA Image and Video Library

2015-01-18

CAPE CANAVERAL, Fla. – Preparations to launch NOAA’s Deep Space Climate Observatory spacecraft, or DSCOVR, near completion in the Building 1 high bay of the Astrotech payload processing facility in Titusville, Florida, near Kennedy Space Center. DSCOVR is a partnership between NOAA, NASA and the U.S. Air Force. DSCOVR will maintain the nation's real-time solar wind monitoring capabilities which are critical to the accuracy and lead time of NOAA's space weather alerts and forecasts. Launch is targeted for no earlier than Feb. 8 aboard a SpaceX Falcon 9 v 1.1 launch vehicle from Cape Canaveral Air Force Station, Florida. To learn more about DSCOVR, visit http://www.nesdis.noaa.gov/DSCOVR. Photo credit: NASA/Kim Shiflett

KSC-2014-4568

NASA Image and Video Library

2014-11-20

CAPE CANAVERAL, Fla. – NOAA’s Deep Space Climate Observatory spacecraft, or DSCOVR, has been uncovered and is ready for processing in the high bay of Building 1 at the Astrotech payload processing facility in Titusville, Florida, near Kennedy Space Center. DSCOVR is a partnership between NOAA, NASA and the U.S. Air Force. DSCOVR will maintain the nation's real-time solar wind monitoring capabilities which are critical to the accuracy and lead time of NOAA's space weather alerts and forecasts. Launch is currently scheduled for January 2015 aboard a SpaceX Falcon 9 v 1.1 launch vehicle from Cape Canaveral Air Force Station, Florida. To learn more about DSCOVR, visit http://www.nesdis.noaa.gov/DSCOVR. Photo credit: NASA/Kim Shiflett

KSC-2015-1239

NASA Image and Video Library

2015-01-18

CAPE CANAVERAL, Fla. – Preparations to launch NOAA’s Deep Space Climate Observatory spacecraft, or DSCOVR, near completion in the Building 1 high bay of the Astrotech payload processing facility in Titusville, Florida, near Kennedy Space Center. DSCOVR is a partnership between NOAA, NASA and the U.S. Air Force. DSCOVR will maintain the nation's real-time solar wind monitoring capabilities which are critical to the accuracy and lead time of NOAA's space weather alerts and forecasts. Launch is targeted for no earlier than Feb. 8 aboard a SpaceX Falcon 9 v 1.1 launch vehicle from Cape Canaveral Air Force Station, Florida. To learn more about DSCOVR, visit http://www.nesdis.noaa.gov/DSCOVR. Photo credit: NASA/Kim Shiflett

KSC-2014-4547

NASA Image and Video Library

2014-11-20

CAPE CANAVERAL, Fla. – A lifting device is attached to NOAA’s Deep Space Climate Observatory spacecraft, or DSCOVR, wrapped in plastic, to remove it from its transportation pallet at the Astrotech payload processing facility in Titusville, Florida, near Kennedy Space Center. DSCOVR is a partnership between NOAA, NASA and the U.S. Air Force. DSCOVR will maintain the nation's real-time solar wind monitoring capabilities which are critical to the accuracy and lead time of NOAA's space weather alerts and forecasts. Launch is currently scheduled for January 2015 aboard a SpaceX Falcon 9 v 1.1 launch vehicle from Cape Canaveral Air Force Station, Florida. To learn more about DSCOVR, visit http://www.nesdis.noaa.gov/DSCOVR. Photo credit: NASA/Kim Shiflett

Diffusion Barriers, Mechanical Forces, and the Biophysics of Phagocytosis.

PubMed

Ostrowski, Philip P; Grinstein, Sergio; Freeman, Spencer A

2016-07-25

Phagocytes recognize and eliminate pathogens, alert other tissues of impending threats, and provide a link between innate and adaptive immunity. They also maintain tissue homeostasis, consuming dead cells without causing alarm. The receptor engagement, signal transduction, and cytoskeletal rearrangements underlying phagocytosis are paradigmatic of other immune responses and bear similarities to macropinocytosis and cell migration. We discuss how the glycocalyx restricts access to phagocytic receptors, the processes that enable receptor engagement and clustering, and the remodeling of the actin cytoskeleton that controls the mobility of membrane proteins and lipids and provides the mechanical force propelling the phagocyte membrane toward and around the phagocytic prey. Copyright © 2016 Elsevier Inc. All rights reserved.

DSCOVR Spacecraft Arrival, Offload, & Unpacking

NASA Image and Video Library

2014-11-20

Workers monitor NOAA’s Deep Space Climate Observatory spacecraft, or DSCOVR, wrapped in plastic and secured onto a portable work stand, as it travels between the airlock of Building 2 to the high bay of Building 1 at the Astrotech payload processing facility in Titusville, Florida, near Kennedy Space Center. DSCOVR is a partnership between NOAA, NASA and the U.S. Air Force. DSCOVR will maintain the nation's real-time solar wind monitoring capabilities which are critical to the accuracy and lead time of NOAA's space weather alerts and forecasts. Launch is currently scheduled for January 2015 aboard a SpaceX Falcon 9 v 1.1 launch vehicle from Cape Canaveral Air Force Station, Florida.

Using scenario analysis to determine managed care strategy.

PubMed

Krentz, S E; Gish, R S

2000-09-01

In today's volatile healthcare environment, traditional planning tools are inadequate to guide financial managers of provider organizations in developing managed care strategies. These tools often disregard the uncertainty surrounding market forces such as employee benefit structure, the future of Medicare managed care, and the impact of consumer behavior. Scenario analysis overcomes this limitation by acknowledging the uncertain healthcare environment and articulating a set of plausible alternative futures, thus supplying financial executives with the perspective to craft strategies that can improve the market position of their organizations. By being alert for trigger points that might signal the rise of a specific scenario, financial managers can increase their preparedness for changes in market forces.

KSC-2014-4548

NASA Image and Video Library

2014-11-20

CAPE CANAVERAL, Fla. – NOAA’s Deep Space Climate Observatory spacecraft, or DSCOVR, wrapped in plastic, is transferred from its transportation pallet to a portable work stand at the Astrotech payload processing facility in Titusville, Florida, near Kennedy Space Center. DSCOVR is a partnership between NOAA, NASA and the U.S. Air Force. DSCOVR will maintain the nation's real-time solar wind monitoring capabilities which are critical to the accuracy and lead time of NOAA's space weather alerts and forecasts. Launch is currently scheduled for January 2015 aboard a SpaceX Falcon 9 v 1.1 launch vehicle from Cape Canaveral Air Force Station, Florida. To learn more about DSCOVR, visit http://www.nesdis.noaa.gov/DSCOVR. Photo credit: NASA/Kim Shiflett

Modeling, Analyzing, and Mitigating Dissonance Between Alerting Systems

NASA Technical Reports Server (NTRS)

Song, Lixia; Kuchar, James K.

2003-01-01

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

An Approach for Representing Sensor Data to Validate Alerts in Ambient Assisted Living

PubMed Central

Muñoz, Andrés; Serrano, Emilio; Villa, Ana; Valdés, Mercedes; Botía, Juan A.

2012-01-01

The mainstream of research in Ambient Assisted Living (AAL) is devoted to developing intelligent systems for processing the data collected through artificial sensing. Besides, there are other elements that must be considered to foster the adoption of AAL solutions in real environments. In this paper we focus on the problem of designing interfaces among caregivers and AAL systems. We present an alert management tool that supports carers in their task of validating alarms raised by the system. It generates text-based explanations—obtained through an argumentation process—of the causes leading to alarm activation along with graphical sensor information and 3D models, thus offering complementary types of information. Moreover, a guideline to use the tool when validating alerts is also provided. Finally, the functionality of the proposed tool is demonstrated through two real cases of alert. PMID:22778642

Nintendo Wii Fit-Based Sleepiness Testing is Not Impaired by Contagious Sleepiness.

PubMed

Tietäväinen, Aino; Kuvaldina, Maria; Hæggström, Edward

2018-06-01

Sleep deprivation may cause accidents, and it has deteriorating effects on health. A measurement of postural steadiness by a portable and affordable Nintendo Wii Fit balance board can be used to quantify a person's alertness. At work, people are under the influence of their environment-often other people-that may affect their alertness. This work investigates whether sleep deprivation among people is "contagious," as quantified by sway measures. We measured 21 volunteers' postural steadiness while alert and sleep deprived. During the measurements, a screen placed in front of the participants showed a footage of either alert or sleep-deprived faces. We found a significant difference between the day time and night time steadiness, but found no effect resulting from watching footage of sleep-deprived people. This finding shows that a posturographic sleepiness tester quantifies physiological sleep deprivation, and is insensitive to the influence of social factors.

Brewer spectrophotometer measurements in the Canadian Arctic

NASA Technical Reports Server (NTRS)

Kerr, J. B.; Evans, W. F. J.

1988-01-01

In the winters of 1987 and 1988 measurements were conducted with the Brewer Spectrophotometer at Alert (82.5 N) and Resolute (74.5 N). The measurements were conducted as part of our Canadian Program to search for an Arctic Ozone Hole (CANOZE). Ozone measurements were conducted in the months of December, January and February using the moon as a light source. The total ozone measurements will be compared with ozonesonde profiles, from ECC sondes, flown once per week from Alert and Resolute. A modified Brewer Spectrophotometer was used in a special study to search for chlorine dioxide at Alert in March 1987. Ground based observations at Saskatoon in February and at Alert in March 1987 failed to detect any measureable chlorine dioxide. Interference from another absorbing gas, which we speculate may be nitrous acid, prevented the measurements at the low levels of chlorine dioxide detected in the Southern Hemisphere by Solomon et al.

Dopamine in motivational control: rewarding, aversive, and alerting

PubMed Central

Bromberg-Martin, Ethan S.; Matsumoto, Masayuki; Hikosaka, Okihide

2010-01-01

SUMMARY Midbrain dopamine neurons are well known for their strong responses to rewards and their critical role in positive motivation. It has become increasingly clear, however, that dopamine neurons also transmit signals related to salient but non-rewarding experiences such as aversive and alerting events. Here we review recent advances in understanding the reward and non-reward functions of dopamine. Based on this data, we propose that dopamine neurons come in multiple types that are connected with distinct brain networks and have distinct roles in motivational control. Some dopamine neurons encode motivational value, supporting brain networks for seeking, evaluation, and value learning. Others encode motivational salience, supporting brain networks for orienting, cognition, and general motivation. Both types of dopamine neurons are augmented by an alerting signal involved in rapid detection of potentially important sensory cues. We hypothesize that these dopaminergic pathways for value, salience, and alerting cooperate to support adaptive behavior. PMID:21144997

Performance of Two Resin-Containing Blood Culture Media in Detection of Bloodstream Infections and in Direct Matrix-Assisted Laser Desorption Ionization–Time of Flight Mass Spectrometry (MALDI-TOF MS) Broth Assays for Isolate Identification: Clinical Comparison of the BacT/Alert Plus and Bactec Plus Systems

PubMed Central

Fiori, Barbara; D'Inzeo, Tiziana; Di Florio, Viviana; De Maio, Flavio; De Angelis, Giulia; Giaquinto, Alessia; Campana, Lara; Tanzarella, Eloisa; Tumbarello, Mario; Antonelli, Massimo; Spanu, Teresa

2014-01-01

We compared the clinical performances of the BacT/Alert Plus (bioMérieux) and Bactec Plus (Becton Dickinson) aerobic and anaerobic blood culture (BC) media with adsorbent polymeric beads. Patients ≥16 years old with suspected bloodstream infections (BSIs) were enrolled in intensive care units and infectious disease wards. A single 40-ml blood sample was collected from each and used to inoculate (10 ml/bottle) one set of BacT/Alert Plus cultures and one set of Bactec Plus cultures, each set consisting of one aerobic and one anaerobic bottle. Cultures were incubated ≤5 days in the BacT/Alert 3D and Bactec FX instruments, respectively. A total of 128 unique BSI episodes were identified based on the recovery of clinically significant growth in 212 aerobic cultures (106 BacT/Alert and 106 Bactec) and 151 anaerobic cultures (82 BacT/Alert and 69 Bactec). The BacT/Alert aerobic medium had higher recovery rates for Gram-positive cocci (P = 0.024), whereas the Bactec aerobic medium was superior for recovery of Gram-negative bacilli (P = 0.006). BacT/Alert anaerobic medium recovery rates exceeded those of the Bactec anaerobic medium for total organisms (P = 0.003), Gram-positive cocci (P = 0.013), and Escherichia coli (P = 0.030). In terms of capacity for diagnosing the 128 septic episodes, the BacT/Alert and Bactec sets were comparable, although the former sets diagnosed more BSIs caused by Gram-positive cocci (P = 0.008). They also allowed earlier identification of coagulase-negative staphylococcal growth (mean, 2.8 h; P = 0.003) and growth in samples from patients not on antimicrobial therapy that yielded positive results (mean, 1.3 h; P < 0.001). Similarly high percentages of microorganisms in BacT/Alert and Bactec cultures (93.8% and 93.3%, respectively) were identified by direct matrix-assisted laser desorption ionization–time of flight mass spectrometry assay of BC broths. The BacT/Alert Plus media line appears to be a reliable, timesaving tool for routine detection of BSIs in the population we studied, although further studies are needed to evaluate their performance in other settings. PMID:25031441

A radar-based regional extreme rainfall analysis to derive the thresholds for a novel automatic alert system in Switzerland

NASA Astrophysics Data System (ADS)

Panziera, Luca; Gabella, Marco; Zanini, Stefano; Hering, Alessandro; Germann, Urs; Berne, Alexis

2016-06-01

This paper presents a regional extreme rainfall analysis based on 10 years of radar data for the 159 regions adopted for official natural hazard warnings in Switzerland. Moreover, a nowcasting tool aimed at issuing heavy precipitation regional alerts is introduced. The two topics are closely related, since the extreme rainfall analysis provides the thresholds used by the nowcasting system for the alerts. Warm and cold seasons' monthly maxima of several statistical quantities describing regional rainfall are fitted to a generalized extreme value distribution in order to derive the precipitation amounts corresponding to sub-annual return periods for durations of 1, 3, 6, 12, 24 and 48 h. It is shown that regional return levels exhibit a large spatial variability in Switzerland, and that their spatial distribution strongly depends on the duration of the aggregation period: for accumulations of 3 h and shorter, the largest return levels are found over the northerly alpine slopes, whereas for longer durations the southern Alps exhibit the largest values. The inner alpine chain shows the lowest values, in agreement with previous rainfall climatologies. The nowcasting system presented here is aimed to issue heavy rainfall alerts for a large variety of end users, who are interested in different precipitation characteristics and regions, such as, for example, small urban areas, remote alpine catchments or administrative districts. The alerts are issued not only if the rainfall measured in the immediate past or forecast in the near future exceeds some predefined thresholds but also as soon as the sum of past and forecast precipitation is larger than threshold values. This precipitation total, in fact, has primary importance in applications for which antecedent rainfall is as important as predicted one, such as urban floods early warning systems. The rainfall fields, the statistical quantity representing regional rainfall and the frequency of alerts issued in case of continuous threshold exceedance are some of the configurable parameters of the tool. The analysis of the urban flood which occurred in the city of Schaffhausen in May 2013 suggests that this alert tool might have complementary skill with respect to radar-based thunderstorm nowcasting systems for storms which do not show a clear convective signature.

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

PubMed Central

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

1997-01-01

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

Use of a Web-Based Academic Alert System for Identification of Underachieving Students at an Urban Research Institution

ERIC Educational Resources Information Center

Donnelly, John E.

2010-01-01

Early alert strategies are an increasingly common way to address students' ongoing needs for greater academic and social engagement by enabling a positive campus environment and appropriate academic support; Kuh et al. find these to be necessary engagement conditions. Young and Fry show the benefits of student metacognition, or awareness of…

Can surveillance systems identify and avert adverse drug events? A prospective evaluation of a commercial application.

PubMed

Jha, Ashish K; Laguette, Julia; Seger, Andrew; Bates, David W

2008-01-01

Computerized monitors can effectively detect and potentially prevent adverse drug events (ADEs). Most monitors have been developed in large academic hospitals and are not readily usable in other settings. We assessed the ability of a commercial program to identify and prevent ADEs in a community hospital. and Measurement We prospectively evaluated the commercial application in a community-based hospital. We examined the frequency and types of alerts produced, how often they were associated with ADEs and potential ADEs, and the potential financial impact of monitoring for ADEs. Among 2,407 patients screened, the application generated 516 high priority alerts. We were able to review 266 alerts at the time they were generated and among these, 30 (11.3%) were considered substantially important to warrant contacting the physician caring for the patient. These 30 alerts were associated with 4 ADEs and 11 potential ADEs. In all 15 cases, the responsible physician was unaware of the event, leading to a change in clinical care in 14 cases. Overall, 23% of high priority alerts were associated with an ADE (95% confidence interval [CI] 12% to 34%) and another 15% were associated with a potential ADE (95% CI 6% to 24%). Active surveillance used approximately 1.5 hours of pharmacist time daily. A commercially available, computer-based ADE detection tool was effective at identifying ADEs. When used as part of an active surveillance program, it can have an impact on preventing or ameliorating ADEs.

Standard Anatomic Terminologies: Comparison for Use in a Health Information Exchange–Based Prior Computed Tomography (CT) Alerting System

PubMed Central

Lowry, Tina; Vreeman, Daniel J; Loo, George T; Delman, Bradley N; Thum, Frederick L; Slovis, Benjamin H; Shapiro, Jason S

2017-01-01

Background A health information exchange (HIE)–based prior computed tomography (CT) alerting system may reduce avoidable CT imaging by notifying ordering clinicians of prior relevant studies when a study is ordered. For maximal effectiveness, a system would alert not only for prior same CTs (exams mapped to the same code from an exam name terminology) but also for similar CTs (exams mapped to different exam name terminology codes but in the same anatomic region) and anatomically proximate CTs (exams in adjacent anatomic regions). Notification of previous same studies across an HIE requires mapping of local site CT codes to a standard terminology for exam names (such as Logical Observation Identifiers Names and Codes [LOINC]) to show that two studies with different local codes and descriptions are equivalent. Notifying of prior similar or proximate CTs requires an additional mapping of exam codes to anatomic regions, ideally coded by an anatomic terminology. Several anatomic terminologies exist, but no prior studies have evaluated how well they would support an alerting use case. Objective The aim of this study was to evaluate the fitness of five existing standard anatomic terminologies to support similar or proximate alerts of an HIE-based prior CT alerting system. Methods We compared five standard anatomic terminologies (Foundational Model of Anatomy, Systematized Nomenclature of Medicine Clinical Terms, RadLex, LOINC, and LOINC/Radiological Society of North America [RSNA] Radiology Playbook) to an anatomic framework created specifically for our use case (Simple ANatomic Ontology for Proximity or Similarity [SANOPS]), to determine whether the existing terminologies could support our use case without modification. On the basis of an assessment of optimal terminology features for our purpose, we developed an ordinal anatomic terminology utility classification. We mapped samples of 100 random and the 100 most frequent LOINC CT codes to anatomic regions in each terminology, assigned utility classes for each mapping, and statistically compared each terminology’s utility class rankings. We also constructed seven hypothetical alerting scenarios to illustrate the terminologies’ differences. Results Both RadLex and the LOINC/RSNA Radiology Playbook anatomic terminologies ranked significantly better (P<.001) than the other standard terminologies for the 100 most frequent CTs, but no terminology ranked significantly better than any other for 100 random CTs. Hypothetical scenarios illustrated instances where no standard terminology would support appropriate proximate or similar alerts, without modification. Conclusions LOINC/RSNA Radiology Playbook and RadLex’s anatomic terminologies appear well suited to support proximate or similar alerts for commonly ordered CTs, but for less commonly ordered tests, modification of the existing terminologies with concepts and relations from SANOPS would likely be required. Our findings suggest SANOPS may serve as a framework for enhancing anatomic terminologies in support of other similar use cases. PMID:29242174

Improving safety and operational efficiency in residential care settings with WiFi-based localization.

PubMed

Doshi-Velez, Finale; Li, William; Battat, Yoni; Charrow, Ben; Curtis, Dorothy; Curthis, Dorothy; Park, Jun-geun; Hemachandra, Sachithra; Velez, Javier; Walsh, Cynthia; Fredette, Don; Reimer, Bryan; Roy, Nicholas; Teller, Seth

2012-07-01

To assess the effectiveness of a wireless network (WiFi-based) localization system (devices mounted on resident wheelchairs) in decreasing caretaker time spent searching for residents and providing alerts of residents going outdoors in a skilled nursing facility. A controlled study over two 2-month periods approved by the institutional review board. A long-term skilled nursing facility in Massachusetts specializing in multiple sclerosis previously instrumented with wireless network infrastructure. Nineteen residents and 9 staff members at the facility for the first 2-month period; 9 residents and 3 staff members at the facility for the second 2-month period. Software was installed on 4 staff computers to display the locations of residents enrolled in the study. This software was made available to enrolled staff for the second half of the first 2-month period and the entirety of the second 2-month study. In the second 2-month study, the software was modified to provide alerts if any 1 of 9 participating "high-risk"' residents went outdoors, and the accuracy of the alert system was evaluated. In the first 2-month study, 9 staff members recorded the amount of time it took them to locate participating residents (as and when needed during the course of their daily activities). In the second 2-month study, 3 staff members recorded whether outdoor-alerts correctly identified a resident leaving the building or if it was a false alarm. In both phases, participating staff members made frequent use of the system (44 searches and 215 outdoor alerts). Overall, the localization information decreased the average time needed to find residents by about two-thirds (from 311.1 seconds to 110.9 seconds). For outdoor alerts, the system had a false-alarm rate of 9.1% (under normal facility operations); systematic tests of the outdoor-alert system carried out by the authors had a false-negative, or missed-alarm, rate of 1.7%. Using timely resident location information can provide significant gains for both operational efficiency (finding residents) and enhanced resident safety (outdoor alerts). This approach may provide an inexpensive alternative for facilities that have sufficient wireless infrastructure; future work should assess its effectiveness in additional settings. Copyright © 2012 American Medical Directors Association. Published by Elsevier Inc. All rights reserved.

2B-Alert Web: An Open-Access Tool for Predicting the Effects of Sleep/Wake Schedules and Caffeine Consumption on Neurobehavioral Performance.

PubMed

Reifman, Jaques; Kumar, Kamal; Wesensten, Nancy J; Tountas, Nikolaos A; Balkin, Thomas J; Ramakrishnan, Sridhar

2016-12-01

Computational tools that predict the effects of daily sleep/wake amounts on neurobehavioral performance are critical components of fatigue management systems, allowing for the identification of periods during which individuals are at increased risk for performance errors. However, none of the existing computational tools is publicly available, and the commercially available tools do not account for the beneficial effects of caffeine on performance, limiting their practical utility. Here, we introduce 2B-Alert Web, an open-access tool for predicting neurobehavioral performance, which accounts for the effects of sleep/wake schedules, time of day, and caffeine consumption, while incorporating the latest scientific findings in sleep restriction, sleep extension, and recovery sleep. We combined our validated Unified Model of Performance and our validated caffeine model to form a single, integrated modeling framework instantiated as a Web-enabled tool. 2B-Alert Web allows users to input daily sleep/wake schedules and caffeine consumption (dosage and time) to obtain group-average predictions of neurobehavioral performance based on psychomotor vigilance tasks. 2B-Alert Web is accessible at: https://2b-alert-web.bhsai.org. The 2B-Alert Web tool allows users to obtain predictions for mean response time, mean reciprocal response time, and number of lapses. The graphing tool allows for simultaneous display of up to seven different sleep/wake and caffeine schedules. The schedules and corresponding predicted outputs can be saved as a Microsoft Excel file; the corresponding plots can be saved as an image file. The schedules and predictions are erased when the user logs off, thereby maintaining privacy and confidentiality. The publicly accessible 2B-Alert Web tool is available for operators, schedulers, and neurobehavioral scientists as well as the general public to determine the impact of any given sleep/wake schedule, caffeine consumption, and time of day on performance of a group of individuals. This evidence-based tool can be used as a decision aid to design effective work schedules, guide the design of future sleep restriction and caffeine studies, and increase public awareness of the effects of sleep amounts, time of day, and caffeine on alertness. © 2016 Associated Professional Sleep Societies, LLC.

Quality-improvement analytics for intravenous infusion pumps.

PubMed

Skledar, Susan J; Niccolai, Cynthia S; Schilling, Dennis; Costello, Susan; Mininni, Nicolette; Ervin, Kelly; Urban, Alana

2013-04-15

The implementation of a smart-pump continuous quality-improvement (CQI) program across a large health system is described, with an emphasis on key metrics for outcomes analyses and program refinement. Three years ago, the University of Pittsburgh Medical Center health system launched a CQI initiative to help ensure the safe use of 6000 smart pumps in its 14 inpatient facilities. A centralized team led by pharmacists is responsible for the retrieval and interpretation of smart-pump data, which is continuously transmitted to a main server. CQI findings are regularly posted on the health system's interdisciplinary intranet. Monitored metrics include rates of compliance with preprogrammed infusion limits, the top 20 drugs involved in alerts, drugs associated with alert-override rates of ≥90%, numbers of alerts by infusion type, nurse responses to alerts, and alert rate per drug library update. Based on the collected CQI data and site-specific requests, four systemwide updates of the smart-pump drug library were performed during the first 18 months of the program, reducing "nuisance alerts" by about 10% per update cycle and enabling targeted interventions to reduce rapid-infusion errors, other adverse drug events (ADEs), and pump-programming workarounds. Over one 12-month period, bedside alerts prompted nurses to reprogram or cancel continuous infusions an average of 400 times per month, potentially averting i.v. medication ADEs. A smart-pump CQI program is an effective tool for enhancing the safety of i.v. medication administration. The ongoing refinement of the drug library through the development and implementation of key interventions promotes the growth and sustainability of the smart-pump initiative systemwide.

INITIAL EXPLORATION OF NEWLY IMPLEMENTED PUBLIC HEALTH POLICY USING GEOGRAPHIC INFORMATION SYSTEMS: THE CASE OF A U.S. SILVER ALERT PROGRAM.

PubMed

Yamashita, Takashi; Carr, Dawn C; Brown, J Scott

2014-01-01

Public health policies are designed for specific subsets of the population. Evidence that a policy is effectively designed should be based on whether it effectively addresses its mission. A critical factor is determining whether utilization patterns reflect the mission and the efficacy of public health policies, particularly during early stages of implementation. We assert that utilization patterns can be effectively assessed using geographic information systems (GIS). This paper uses the Silver Alert program, a recently implemented public health policy, as a case for how and why GIS can be used to examine utilization patterns. GIS are employed to visualize and spatially analyze a new health policy--North Carolina's Silver Alert policy. We use visualized data and spatial statistics to assess utilization patterns and mission adherence. Results show disproportionate utilization patterns of the Silver Alert policy. In particular, an outstanding number of Silver Alerts were used in Wake County and its surrounding counties, which are both the political and media center of North Carolina. Other counties, including populous counties, had few if any alerts. Findings suggest that the North Carolina's Silver Alert policy needs to be adjusted to more effectively address its mission. We identify several factors that need further examination prior to a statewide evaluation. From this case study, we propose ways future programs, particularly the introduction of the Affordable Care Act (ACA) in 2014, might use GIS to examine utilization patterns as a means to better understand whether and in what ways the health care needs of the public are being met with such a policy.

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

PubMed Central

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

2015-01-01

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

High Frontier, The Journal for Space & Missile Professionals. Volume 5, Number 2

DTIC Science & Technology

2009-02-01

Institute of Space Law. He also taught management theory for Cerro Coso Com- munity College and Golden Gate University. Mr. Rendleman has been awarded the...nation must not place its sovereignty at risk or forfeit its cur- rent warfighting advantages. To present an effective deterrence, the portrait of...bombers on alert, the preponderance of reliance and risk then moves to the submarine force, essentially requiring the US to rely upon a single nuclear

The Impact of Technology on the Command, Control, and Organizational Structure of Insurgent Groups

DTIC Science & Technology

2005-06-17

like cell phones , the Internet, and satellite television, have brought the world closer and have introduced ideas, customs, and cultures to a...has allowed people to stay in contact with organizations and individuals like never before. Cell phones , pagers, and palm pilots allow the user to...with some success by past insurgencies. It is already known that insurgents use cell phones to alert forces of enemy movement and to detonate improvised

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

PubMed Central

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

2011-01-01

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

Microcontroller based driver alertness detection systems to detect drowsiness

NASA Astrophysics Data System (ADS)

Adenin, Hasibah; Zahari, Rahimi; Lim, Tiong Hoo

2018-04-01

The advancement of embedded system for detecting and preventing drowsiness in a vehicle is a major challenge for road traffic accident systems. To prevent drowsiness while driving, it is necessary to have an alert system that can detect a decline in driver concentration and send a signal to the driver. Studies have shown that traffc accidents usually occur when the driver is distracted while driving. In this paper, we have reviewed a number of detection systems to monitor the concentration of a car driver and propose a portable Driver Alertness Detection System (DADS) to determine the level of concentration of the driver based on pixelated coloration detection technique using facial recognition. A portable camera will be placed at the front visor to capture facial expression and the eye activities. We evaluate DADS using 26 participants and have achieved 100% detection rate with good lighting condition and a low detection rate at night.

iFall: an Android application for fall monitoring and response.

PubMed

Sposaro, Frank; Tyson, Gary

2009-01-01

Injuries due to falls are among the leading causes of hospitalization in elderly persons, often resulting in a rapid decline in quality of life or death. Rapid response can improve the patients outcome, but this is often lacking when the injured person lives alone and the nature of the injury complicates calling for help. This paper presents an alert system for fall detection using common commercially available electronic devices to both detect the fall and alert authorities. We use an Android-based smart phone with an integrated tri-axial accelerometer. Data from the accelerometer is evaluated with several threshold based algorithms and position data to determine a fall. The threshold is adaptive based on user provided parameters such as: height, weight, and level of activity. The algorithm adapts to unique movements that a phone experiences as opposed to similar systems which require users to mount accelerometers to their chest or trunk. If a fall is suspected a notification is raised requiring the user's response. If the user does not respond, the system alerts pre-specified social contacts with an informational message via SMS. If a contact responds the system commits an audible notification, automatically connects, and enables the speakerphone. If a social contact confirms a fall, an appropriate emergency service is alerted. Our system provides a realizable, cost effective solution to fall detection using a simple graphical interface while not overwhelming the user with uncomfortable sensors.

[Automated detection of estrus and mastitis in dairy cows].

PubMed

de Mol, R M

2001-02-15

The development and test of detection models for oestrus and mastitis in dairy cows is described in a PhD thesis that was defended in Wageningen on June 5, 2000. These models were based on sensors for milk yield, milk temperature, electrical conductivity of milk, and cow activity and concentrate intake, and on combined processing of the sensor data. The models alert farmers to cows that need attention, because of possible oestrus or mastitis. A first detection model for cows, milked twice a day, was based on time series models for the sensor variables. A time series model describes the dependence between successive observations. The parameters of the time series models were fitted on-line for each cow after each milking by means of a Kalman filter, a mathematical method to estimate the state of a system on-line. The Kalman filter gives the best estimate of the current state of a system based on all preceding observations. This model was tested for 2 years on two experimental farms, and under field conditions on four farms over several years. A second detection model, for cow milked in an automatic milking system (AMS), was based on a generalization of the first model. Two data sets (one small, one large) were used for testing. The results for oestrus detection were good for both models. The results for mastitis detection were varying (in some cases good, in other cases moderate). Fuzzy logic was used to classify mastitis and oestrus alerts with both detection models, to reduce the number of false positive alerts. Fuzzy logic makes approximate reasoning possible, where statements can be partly true or false. Input for the fuzzy logic model were alerts from the detection models and additional information. The number of false positive alerts decreased considerably, while the number of detected cases remained at the same level. These models make automated detection possible in practice.

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

PubMed

Asanowicz, Dariusz; Marzecová, Anna

2017-05-01

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

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

PubMed

Heymann, D L; Rodier, G R

2001-12-01

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

TALON - The Telescope Alert Operation Network System : intelligent linking of distributed autonomous robotic telescopes

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

White, R. R.; Wren, J.; Davis, H. R.

2004-01-01

The internet has brought about great change in the astronomical community, but this interconnectivity is just starting to be exploited for use in instrumentation. Utilizing the internet for communicating between distributed astronomical systems is still in its infancy, but it already shows great potential. Here we present an example of a distributed network of telescopes that performs more efficienfiy in synchronous operation than as individual instruments. RAPid Telescopes for Optical Response (RAPTOR) is a system of telescopes at LANL that has intelligent intercommunication, combined with wide-field optics, temporal monitoring software, and deep-field follow-up capability all working in closed-loop real-time operation.more » The Telescope ALert Operations Network (TALON) is a network server that allows intercommunication of alert triggers from external and internal resources and controls the distribution of these to each of the telescopes on the network. TALON is designed to grow, allowing any number of telescopes to be linked together and communicate. Coupled with an intelligent alert client at each telescope, it can analyze and respond to each distributed TALON alert based on the telescopes needs and schedule.« less

Alertness and cognitive control: Toward a spatial grouping hypothesis.

PubMed

Schneider, Darryl W

2018-05-01

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

The feasibility, acceptability and preliminary testing of a novel, low-tech intervention to improve pre-hospital data recording for pre-alert and handover to the Emergency Department.

PubMed

Fitzpatrick, David; Maxwell, Douglas; Craigie, Alan

2018-06-25

Poor communication during patient handover is recognised internationally as a root cause of a significant proportion of preventable deaths. Data used in handover is not always easily recorded using ambulance based tablets, particularly in time-critical cases. Paramedics have therefore developed pragmatic workarounds (writing on gloves or scrap paper) to record these data. However, such practices can conflict with policy, data recorded can be variable, easily lost and negatively impact on handover quality. This study aimed to measure the feasibility and acceptability of a novel, low tech intervention, designed to support clinical information recording and delivery during pre-alert and handover within the pre-hospital and ED setting. A simple pre and post-test design was used with a historical control. Eligible participants included all ambulance clinicians based at one large city Ambulance Station (n = 69) and all nursing and physician staff (n = 99) based in a city Emergency Department. Twenty five (36%) ambulance clinicians responded to the follow-up survey. Most felt both the pre-alert and handover components of the card were either 'useful-very useful' (n = 23 (92%); and n = 18 (72%) respectively. Nineteen (76%) used the card to record clinical information and almost all (n = 23 (92%) felt it 'useful' to 'very useful' in supporting pre-alert. Similarly, 65% (n = 16) stated they 'often' or 'always' used the card to support handover. For pre-alert information there were improvements in the provision of 8/11 (72.7%) clinical variables. ​ Results from the post-test survey measuring ED staff (n = 37) perceptions of handover demonstrated small (p < 0.05) improvements in handover in 3/5 domains measured. This novel low-tech intervention was highly acceptable to ambulance clinician participants, improving their data recording and information exchange processes. However, further well conducted studies are required to test the impact of this intervention on information exchange during pre-alert and handover.

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

PubMed Central

Bentley, Claire L; Mountain, Gail A

2017-01-01

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

Brain-computer interface for alertness estimation and improving

NASA Astrophysics Data System (ADS)

Hramov, Alexander; Maksimenko, Vladimir; Hramova, Marina

2018-02-01

Using wavelet analysis of the signals of electrical brain activity (EEG), we study the processes of neural activity, associated with perception of visual stimuli. We demonstrate that the brain can process visual stimuli in two scenarios: (i) perception is characterized by destruction of the alpha-waves and increase in the high-frequency (beta) activity, (ii) the beta-rhythm is not well pronounced, while the alpha-wave energy remains unchanged. The special experiments show that the motivation factor initiates the first scenario, explained by the increasing alertness. Based on the obtained results we build the brain-computer interface and demonstrate how the degree of the alertness can be estimated and controlled in real experiment.

Managing the Alert Process at NewYork-Presbyterian Hospital

PubMed Central

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

2005-01-01

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

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

PubMed

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

2017-11-01

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

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

PubMed

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

2015-12-01

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

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

PubMed

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

2017-11-01

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

Performance of two resin-containing blood culture media in detection of bloodstream infections and in direct matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) broth assays for isolate identification: clinical comparison of the BacT/Alert Plus and Bactec Plus systems.

PubMed

Fiori, Barbara; D'Inzeo, Tiziana; Di Florio, Viviana; De Maio, Flavio; De Angelis, Giulia; Giaquinto, Alessia; Campana, Lara; Tanzarella, Eloisa; Tumbarello, Mario; Antonelli, Massimo; Sanguinetti, Maurizio; Spanu, Teresa

2014-10-01

We compared the clinical performances of the BacT/Alert Plus (bioMérieux) and Bactec Plus (Becton Dickinson) aerobic and anaerobic blood culture (BC) media with adsorbent polymeric beads. Patients ≥ 16 years old with suspected bloodstream infections (BSIs) were enrolled in intensive care units and infectious disease wards. A single 40-ml blood sample was collected from each and used to inoculate (10 ml/bottle) one set of BacT/Alert Plus cultures and one set of Bactec Plus cultures, each set consisting of one aerobic and one anaerobic bottle. Cultures were incubated ≤ 5 days in the BacT/Alert 3D and Bactec FX instruments, respectively. A total of 128 unique BSI episodes were identified based on the recovery of clinically significant growth in 212 aerobic cultures (106 BacT/Alert and 106 Bactec) and 151 anaerobic cultures (82 BacT/Alert and 69 Bactec). The BacT/Alert aerobic medium had higher recovery rates for Gram-positive cocci (P = 0.024), whereas the Bactec aerobic medium was superior for recovery of Gram-negative bacilli (P = 0.006). BacT/Alert anaerobic medium recovery rates exceeded those of the Bactec anaerobic medium for total organisms (P = 0.003), Gram-positive cocci (P = 0.013), and Escherichia coli (P = 0.030). In terms of capacity for diagnosing the 128 septic episodes, the BacT/Alert and Bactec sets were comparable, although the former sets diagnosed more BSIs caused by Gram-positive cocci (P = 0.008). They also allowed earlier identification of coagulase-negative staphylococcal growth (mean, 2.8 h; P = 0.003) and growth in samples from patients not on antimicrobial therapy that yielded positive results (mean, 1.3 h; P < 0.001). Similarly high percentages of microorganisms in BacT/Alert and Bactec cultures (93.8% and 93.3%, respectively) were identified by direct matrix-assisted laser desorption ionization-time of flight mass spectrometry assay of BC broths. The BacT/Alert Plus media line appears to be a reliable, timesaving tool for routine detection of BSIs in the population we studied, although further studies are needed to evaluate their performance in other settings. Copyright © 2014, American Society for Microbiology. All Rights Reserved.

KSC-2014-4545

NASA Image and Video Library

2014-11-20

CAPE CANAVERAL, Fla. – NOAA’s Deep Space Climate Observatory spacecraft, or DSCOVR, wrapped in plastic, comes into view as the protective shipping container is lifted from around the spacecraft at the Astrotech payload processing facility in Titusville, Florida, near Kennedy Space Center. DSCOVR is a partnership between NOAA, NASA and the U.S. Air Force. DSCOVR will maintain the nation's real-time solar wind monitoring capabilities which are critical to the accuracy and lead time of NOAA's space weather alerts and forecasts. Launch is currently scheduled for January 2015 aboard a SpaceX Falcon 9 v 1.1 launch vehicle from Cape Canaveral Air Force Station, Florida. To learn more about DSCOVR, visit http://www.nesdis.noaa.gov/DSCOVR. Photo credit: NASA/Kim Shiflett

KSC-2014-4555

NASA Image and Video Library

2014-11-20

CAPE CANAVERAL, Fla. – Workers are on hand to receive NOAA’s Deep Space Climate Observatory spacecraft, or DSCOVR, wrapped in plastic and secured onto a portable work stand, into the high bay of Building 1 at the Astrotech payload processing facility in Titusville, Florida, near Kennedy Space Center. DSCOVR is a partnership between NOAA, NASA and the U.S. Air Force. DSCOVR will maintain the nation's real-time solar wind monitoring capabilities which are critical to the accuracy and lead time of NOAA's space weather alerts and forecasts. Launch is currently scheduled for January 2015 aboard a SpaceX Falcon 9 v 1.1 launch vehicle from Cape Canaveral Air Force Station, Florida. To learn more about DSCOVR, visit http://www.nesdis.noaa.gov/DSCOVR. Photo credit: NASA/Kim Shiflett

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

PubMed

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

2015-03-01

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

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

PubMed

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

2010-01-01

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

Demographic Shifts in the United States Air Force: 1994-2007

DTIC Science & Technology

2008-02-15

experience includes F-15C, F-15E, A-10, F-16, RC-135, RQ-4 “Global Hawk”, MQ-9 “Predator” and U-2. He is married to the former Deanna Pacansky of...manpower is relied upon to keep this operational tempo, the retention of personnel in whom the USAF invested heavily through training and equipping will...continue to examine the demographics of both the US and USAF population to be alert to possible changes as they affect recruitment, retention , and

Safety management of a complex R and D ground operating system

NASA Technical Reports Server (NTRS)

Connors, J. F.; Maurer, R. A.

1975-01-01

A perspective on safety program management was developed for a complex R&D operating system, such as the NASA-Lewis Research Center. Using a systems approach, hazardous operations are subjected to third-party reviews by designated-area safety committees and are maintained under safety permit controls. To insure personnel alertness, emergency containment forces and employees are trained in dry-run emergency simulation exercises. The keys to real safety effectiveness are top management support and visibility of residual risks.

Safety management of a complex R&D ground operating system

NASA Technical Reports Server (NTRS)

Connors, J. F.; Maurer, R. A.

1975-01-01

A perspective on safety program management has been developed for a complex R&D operating system, such as the NASA-Lewis Research Center. Using a systems approach, hazardous operations are subjected to third-party reviews by designated area safety committees and are maintained under safety permit controls. To insure personnel alertness, emergency containment forces and employees are trained in dry-run emergency simulation exercises. The keys to real safety effectiveness are top management support and visibility of residual risks.

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

PubMed Central

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

2013-01-01

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

Developing software to "track and catch" missed follow-up of abnormal test results in a complex sociotechnical environment.

PubMed

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

2013-01-01

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

Evaluating Post-Earthquake Building Safety Using Economical MEMS Seismometers.

PubMed

Hsu, Ting-Yu; Yin, Ren-Cheng; Wu, Yih-Min

2018-05-05

The earthquake early warning (EEW)-research group at National Taiwan University has been developing a microelectromechanical system-based accelerometer called “P-Alert”, designed for issuing EEWs. The main advantage of P-Alert is that it is a relatively economical seismometer. However, because of the expensive nature of commercial hardware for structural health monitoring (SHM) systems, the application of SHM to buildings remains limited. To determine the performance of P-Alert for evaluating post-earthquake building safety, we conducted a series of steel-frame shaking table tests with incremental damage. We used the fragility curves of different damage levels and the interstory drift ratios (calculated by the measured acceleration of each story using double integration and a filter) to gauge the potential damage levels. We concluded that the acceptable detection of damage for an entire building is possible. With improvements to the synchronization of the P-Alert sensors, we also anticipate a damage localization feature for the stories of a building.

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

USGS Publications Warehouse

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

2013-01-01

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

Are Substance Use Prevention Programs More Effective in Schools Making Adequate Yearly Progress? A Study of Project ALERT

ERIC Educational Resources Information Center

Clark, Heddy Kovach; Ringwalt, Chris L.; Shamblen, Stephen R.; Hanley, Sean M.; Flewelling, Robert L.

2011-01-01

This exploratory study sought to determine if a popular school-based drug prevention program might be effective in schools that are making adequate yearly progress (AYP). Thirty-four schools with grades 6 through 8 in 11 states were randomly assigned either to receive Project ALERT (n = 17) or to a control group (n = 17); of these, 10 intervention…

Do e-mail alerts of new research increase knowledge translation? A "Nephrology Now" randomized control trial.

PubMed

Tanna, Gemini V; Sood, Manish M; Schiff, Jeffrey; Schwartz, Daniel; Naimark, David M

2011-01-01

As the volume of medical literature increases exponentially, maintaining current clinical practice is becoming more difficult. Multiple, Internet-based journal clubs and alert services have recently emerged. The purpose of this study is to determine whether the use of the e-mail alert service, Nephrology Now, increases knowledge translation regarding current nephrology literature. Nephrology Now is a nonprofit, monthly e-mail alert service that highlights clinically relevant articles in nephrology. In 2007-2008, the authors randomized 1,683 subscribers into two different groups receiving select intervention articles, and then they used an online survey to assess both groups on their familiarity with the articles and their acquisition of knowledge. Of the randomized subscribers, 803 (47.7%) completed surveys, and the two groups had a similar number of responses (401 and 402, respectively). The authors noted no differences in baseline characteristics between the two groups. Familiarity increased as a result of the Nephrology Now alerts (0.23 ± 0.087 units on a familiarity scale; 95% confidence interval [CI]: 0.06-0.41; P = .007) especially in physicians (multivariate odds ratio 1.83; P = .0002). No detectable improvement in knowledge occurred (0.03 ± 0.083 units on a knowledge scale; 95% CI: -0.13 to 0.20; P = .687). An e-mail alert service of new literature improved a component of knowledge translation--familiarity--but not knowledge acquisition in a large, randomized, international population.

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

PubMed

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

2017-06-01

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

Augmented real-time navigation with critical structure proximity alerts for endoscopic skull base surgery.

PubMed

Dixon, Benjamin J; Daly, Michael J; Chan, Harley; Vescan, Allan; Witterick, Ian J; Irish, Jonathan C

2014-04-01

Image-guided surgery (IGS) systems are frequently utilized during cranial base surgery to aid in orientation and facilitate targeted surgery. We wished to assess the performance of our recently developed localized intraoperative virtual endoscopy (LIVE)-IGS prototype in a preclinical setting prior to deployment in the operating room. This system combines real-time ablative instrument tracking, critical structure proximity alerts, three-dimensional virtual endoscopic views, and intraoperative cone-beam computed tomographic image updates. Randomized-controlled trial plus qualitative analysis. Skull base procedures were performed on 14 cadaver specimens by seven fellowship-trained skull base surgeons. Each subject performed two endoscopic transclival approaches; one with LIVE-IGS and one using a conventional IGS system in random order. National Aeronautics and Space Administration Task Load Index (NASA-TLX) scores were documented for each dissection, and a semistructured interview was recorded for qualitative assessment. The NASA-TLX scores for mental demand, effort, and frustration were significantly reduced with the LIVE-IGS system in comparison to conventional navigation (P < .05). The system interface was judged to be intuitive and most useful when there was a combination of high spatial demand, reduced or absent surface landmarks, and proximity to critical structures. The development of auditory icons for proximity alerts during the trial better informed the surgeon while limiting distraction. The LIVE-IGS system provided accurate, intuitive, and dynamic feedback to the operating surgeon. Further refinements to proximity alerts and visualization settings will enhance orientation while limiting distraction. The system is currently being deployed in a prospective clinical trial in skull base surgery. © 2013 The American Laryngological, Rhinological and Otological Society, Inc.

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

PubMed Central

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

2010-01-01

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

The 2014 Mw 6.0 Napa Earthquake, California: Observations from Real-time GPS-enhanced Earthquake Early Warning

NASA Astrophysics Data System (ADS)

Johanson, I. A.; Grapenthin, R.; Allen, R. M.

2014-12-01

Recently, progress has been made to demonstrate feasibility and benefits of including real-time GPS (rtGPS) in earthquake early warning and rapid response systems. While most concepts have yet to be integrated into operational environments, the Berkeley Seismological Laboratory is currently running an rtGPS based finite fault inversion scheme in true real-time, which is triggered by the seismic-based ShakeAlert system and then sends updated earthquake alerts to a test receiver. The Geodetic Alarm System (G-larmS) was online and responded to the 2014 Mw6.0 South Napa earthquake in California. We review G-larmS' performance during this event and for 13 aftershocks, and we present rtGPS observations and real-time modeling results for the main shock. The first distributed slip model and a magnitude estimate of Mw5.5 were available 24 s after the event origin time, which could be reduced to 14 s after a bug fix (~8 s S-wave travel time, ~6 s data latency). The system continued to re-estimate the magnitude once every second: it increased to Mw5.9 3 s after the first alert and stabilized at Mw5.8 after 15 s. G-larmS' solutions for the subsequent small magnitude aftershocks demonstrate that Mw~6.0 is the current limit for alert updates to contribute back to the seismic-based early warning system.

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

PubMed

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

2013-12-01

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

Design and evaluation of a personal digital assistant- based alerting service for clinicians.

PubMed

Johnson, E Diane; Pancoast, Paul E; Mitchell, Joyce A; Shyu, Chi-Ren

2004-10-01

This study describes the system architecture and user acceptance of a suite of programs that deliver information about newly updated library resources to clinicians' personal digital assistants (PDAs). Participants received headlines delivered to their PDAs alerting them to new books, National Guideline Clearinghouse guidelines, Cochrane Reviews, and National Institutes of Health (NIH) Clinical Alerts, as well as updated content in UpToDate, Harrison's Online, Scientific American Medicine, and Clinical Evidence. Participants could request additional information for any of the headlines, and the information was delivered via e-mail during their next synchronization. Participants completed a survey at the conclusion of the study to gauge their opinions about the service. Of the 816 headlines delivered to the 16 study participants' PDAs during the project, Scientific American Medicine generated the highest proportion of headline requests at 35%. Most users of the PDA Alerts software reported that they learned about new medical developments sooner than they otherwise would have, and half reported that they learned about developments that they would not have heard about at all. While some users liked the PDA platform for receiving headlines, it seemed that a Web database that allowed tailored searches and alerts could be configured to satisfy both PDA-oriented and e-mail-oriented users.

Machine-learning-based Brokers for Real-time Classification of the LSST Alert Stream

NASA Astrophysics Data System (ADS)

Narayan, Gautham; Zaidi, Tayeb; Soraisam, Monika D.; Wang, Zhe; Lochner, Michelle; Matheson, Thomas; Saha, Abhijit; Yang, Shuo; Zhao, Zhenge; Kececioglu, John; Scheidegger, Carlos; Snodgrass, Richard T.; Axelrod, Tim; Jenness, Tim; Maier, Robert S.; Ridgway, Stephen T.; Seaman, Robert L.; Evans, Eric Michael; Singh, Navdeep; Taylor, Clark; Toeniskoetter, Jackson; Welch, Eric; Zhu, Songzhe; The ANTARES Collaboration

2018-05-01

The unprecedented volume and rate of transient events that will be discovered by the Large Synoptic Survey Telescope (LSST) demand that the astronomical community update its follow-up paradigm. Alert-brokers—automated software system to sift through, characterize, annotate, and prioritize events for follow-up—will be critical tools for managing alert streams in the LSST era. The Arizona-NOAO Temporal Analysis and Response to Events System (ANTARES) is one such broker. In this work, we develop a machine learning pipeline to characterize and classify variable and transient sources only using the available multiband optical photometry. We describe three illustrative stages of the pipeline, serving the three goals of early, intermediate, and retrospective classification of alerts. The first takes the form of variable versus transient categorization, the second a multiclass typing of the combined variable and transient data set, and the third a purity-driven subtyping of a transient class. Although several similar algorithms have proven themselves in simulations, we validate their performance on real observations for the first time. We quantitatively evaluate our pipeline on sparse, unevenly sampled, heteroskedastic data from various existing observational campaigns, and demonstrate very competitive classification performance. We describe our progress toward adapting the pipeline developed in this work into a real-time broker working on live alert streams from time-domain surveys.

Design and evaluation of a personal digital assistant–based alerting service for clinicians*†

PubMed Central

Johnson, E. Diane; Pancoast, Paul E.; Mitchell, Joyce A.; Shyu, Chi-Ren

2004-01-01

Purpose: This study describes the system architecture and user acceptance of a suite of programs that deliver information about newly updated library resources to clinicians' personal digital assistants (PDAs). Description: Participants received headlines delivered to their PDAs alerting them to new books, National Guideline Clearinghouse guidelines, Cochrane Reviews, and National Institutes of Health (NIH) Clinical Alerts, as well as updated content in UpToDate, Harrison's Online, Scientific American Medicine, and Clinical Evidence. Participants could request additional information for any of the headlines, and the information was delivered via email during their next synchronization. Participants completed a survey at the conclusion of the study to gauge their opinions about the service. Results/Outcome: Of the 816 headlines delivered to the 16 study participants' PDAs during the project, Scientific American Medicine generated the highest proportion of headline requests at 35%. Most users of the PDA Alerts software reported that they learned about new medical developments sooner than they otherwise would have, and half reported that they learned about developments that they would not have heard about at all. While some users liked the PDA platform for receiving headlines, it seemed that a Web database that allowed tailored searches and alerts could be configured to satisfy both PDA-oriented and email-oriented users. PMID:15494759

A graphical workstation based part-task flight simulator for preliminary rapid evaluation of advanced displays

NASA Technical Reports Server (NTRS)

Wanke, Craig; Kuchar, James; Hahn, Edward; Pritchett, A.; Hansman, R. John

1994-01-01

Advances in avionics and display technology are significantly changing the cockpit environment in current transport aircraft. The MIT Aeronautical Systems Lab (ASL) developed a part-task flight simulator specifically to study the effects of these new technologies on flight crew situational awareness and performance. The simulator is based on a commercially-available graphics workstation, and can be rapidly reconfigured to meet the varying demands of experimental studies. The simulator was successfully used to evaluate graphical microbursts alerting displays, electronic instrument approach plates, terrain awareness and alerting displays, and ATC routing amendment delivery through digital datalinks.

Did Your Evidence-Base Program Work? Share the News! CLUES #5/6: Assess and Alert.

PubMed

Yonkaitis, Catherine F; Maughan, Erin D

2018-07-01

The work of the school nurse does not end with the institution of an evidence-based intervention. The steps of EBP tell us that we must "Assess" the effectiveness of an intervention to determine if it is having the desired effect. When we find success in our EBP changes we must come full circle and share or "Alert" stakeholders and other school nurses by disseminating our work. School nurses can share their success through written and oral presentations to insure that we add to our collective school nursing knowledge.

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

PubMed

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

2018-01-01

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

Best practices: an electronic drug alert program to improve safety in an accountable care environment.

PubMed

Griesbach, Sara; Lustig, Adam; Malsin, Luanne; Carley, Blake; Westrich, Kimberly D; Dubois, Robert W

2015-04-01

The accountable care organization (ACO), one of the most promising and talked about new models of care, focuses on improving communication and care transitions by tying potential shared savings to specific clinical and financial benchmarks. An important factor in meeting these benchmarks is an ACO's ability to manage medications in an environment where medical and pharmacy care has been integrated. The program described in this article highlights the critical components of Marshfield Clinic's Drug Safety Alert Program (DSAP), which focuses on prioritizing and communicating safety issues related to medications with the goal of reducing potential adverse drug events. Once the medication safety concern is identified, it is reviewed to evaluate whether an alert warrants sending prescribers a communication that identifies individual patients or a general communication to all physicians describing the safety concern. Instead of basing its decisions regarding clinician notification about drug alerts on subjective criteria, the Marshfield Clinic's DSAP uses an internally developed scoring system. The scoring system includes criteria developed from previous drug alerts, such as level of evidence, size of population affected, severity of adverse event identified or targeted, litigation risk, available alternatives, and potential for duration of medication use. Each of the 6 criteria is assigned a weight and is scored based upon the content and severity of the alert received.  In its first 12 months, the program targeted 6 medication safety concerns involving the following medications: topiramate, glyburide, simvastatin, citalopram, pioglitazone, and lovastatin. Baseline and follow-up prescribing data were gathered on the targeted medications. Follow-up review of prescribing data demonstrated that the DSAP provided quality up-to-date safety information that led to changes in drug therapy and to decreases in potential adverse drug events. In aggregate, nearly 10,000 total potential adverse drug events were identified with baseline data from the DSAP initiatives, and nearly 8,000 were resolved by changes in prescribing.  Implications and additional thoughts from The Working Group on Optimizing Medication Therapy in Value-Based Healthcare were provided for the following categories: leveraging electronic health records, importance of data collection and reassessment, preventing alert fatigue utilizing various techniques, relevance to ACO quality measurement, and limitations of a retrospective system. While health information technologies have been recognized as a cornerstone for an ACO's success, additional research is needed on comparing these types of technological innovations. Future research should focus on reviewing comparable scoring criteria and alert systems utilized in a variety of ACOs. In addition, an examination of different data mining procedures used within different electronic health record platforms would prove useful to ACOs looking to improve the care of not only the subpopulations with specific metrics associated with them, but their patient population as a whole. The authors also highlight the need for additional research on health information exchanges, including the cost and resource requirements needed to successfully participate in these types of networks.

Commercial Mobile Alert Service (CMAS) Alerting Pipeline Taxonomy

DTIC Science & Technology

2012-03-01

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

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

DTIC Science & Technology

2014-03-01

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

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

PubMed

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

2015-09-01

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

76 FR 80780 - Review of the Emergency Alert System

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-27

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

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

PubMed

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

2017-09-01

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

A clinical decision support system algorithm for intravenous to oral antibiotic switch therapy: validity, clinical relevance and usefulness in a three-step evaluation study.

PubMed

Akhloufi, H; Hulscher, M; van der Hoeven, C P; Prins, J M; van der Sijs, H; Melles, D C; Verbon, A

2018-04-26

To evaluate a clinical decision support system (CDSS) based on consensus-based intravenous to oral switch criteria, which identifies intravenous to oral switch candidates. A three-step evaluation study of a stand-alone CDSS with electronic health record interoperability was performed at the Erasmus University Medical Centre in the Netherlands. During the first step, we performed a technical validation. During the second step, we determined the sensitivity, specificity, negative predictive value and positive predictive value in a retrospective cohort of all hospitalized adult patients starting at least one therapeutic antibacterial drug between 1 and 16 May 2013. ICU, paediatric and psychiatric wards were excluded. During the last step the clinical relevance and usefulness was prospectively assessed by reports to infectious disease specialists. An alert was considered clinically relevant if antibiotics could be discontinued or switched to oral therapy at the time of the alert. During the first step, one technical error was found. The second step yielded a positive predictive value of 76.6% and a negative predictive value of 99.1%. The third step showed that alerts were clinically relevant in 53.5% of patients. For 43.4% it had already been decided to discontinue or switch the intravenous antibiotics by the treating physician. In 10.1%, the alert resulted in advice to change antibiotic policy and was considered useful. This prospective cohort study shows that the alerts were clinically relevant in >50% (n = 449) and useful in 10% (n = 85). The CDSS needs to be evaluated in hospitals with varying activity of infectious disease consultancy services as this probably influences usefulness.

Earthquake impact scale

USGS Publications Warehouse

Wald, D.J.; Jaiswal, K.S.; Marano, K.D.; Bausch, D.

2011-01-01

With the advent of the USGS prompt assessment of global earthquakes for response (PAGER) system, which rapidly assesses earthquake impacts, U.S. and international earthquake responders are reconsidering their automatic alert and activation levels and response procedures. To help facilitate rapid and appropriate earthquake response, an Earthquake Impact Scale (EIS) is proposed on the basis of two complementary criteria. On the basis of the estimated cost of damage, one is most suitable for domestic events; the other, on the basis of estimated ranges of fatalities, is generally more appropriate for global events, particularly in developing countries. Simple thresholds, derived from the systematic analysis of past earthquake impact and associated response levels, are quite effective in communicating predicted impact and response needed after an event through alerts of green (little or no impact), yellow (regional impact and response), orange (national-scale impact and response), and red (international response). Corresponding fatality thresholds for yellow, orange, and red alert levels are 1, 100, and 1,000, respectively. For damage impact, yellow, orange, and red thresholds are triggered by estimated losses reaching $1M, $100M, and $1B, respectively. The rationale for a dual approach to earthquake alerting stems from the recognition that relatively high fatalities, injuries, and homelessness predominate in countries in which local building practices typically lend themselves to high collapse and casualty rates, and these impacts lend to prioritization for international response. In contrast, financial and overall societal impacts often trigger the level of response in regions or countries in which prevalent earthquake resistant construction practices greatly reduce building collapse and resulting fatalities. Any newly devised alert, whether economic- or casualty-based, should be intuitive and consistent with established lexicons and procedures. Useful alerts should also be both specific (although allowably uncertain) and actionable. In this analysis, an attempt is made at both simple and intuitive color-coded alerting criteria; yet the necessary uncertainty measures by which one can gauge the likelihood for the alert to be over- or underestimated are preserved. The essence of the proposed impact scale and alerting is that actionable loss information is now available in the immediate aftermath of significant earthquakes worldwide on the basis of quantifiable loss estimates. Utilizing EIS, PAGER's rapid loss estimates can adequately recommend alert levels and suggest appropriate response protocols, despite the uncertainties; demanding or awaiting observations or loss estimates with a high level of accuracy may increase the losses. ?? 2011 American Society of Civil Engineers.

Treatment of Narcolepsy and other Hypersomnias of Central Origin

PubMed Central

Wise, Merrill S.; Arand, Donna L.; Auger, R. Robert; Brooks, Stephen N.; Watson, Nathaniel F.

2007-01-01

Objective: The purpose of this paper is to summarize current knowledge about treatment of narcolepsy and other hypersomnias of central origin. Methods: The task force performed a systematic and comprehensive review of the relevant literature and graded the evidence using the Oxford grading system. This paper discusses the strengths and limitations of the available evidence regarding treatment of these conditions, and summarizes key information about safety of these medications. Our findings provide the foundation for development of evidence-based practice parameters on this topic by the Standards of Practice Committee of the American Academy of Sleep Medicine. Results: The majority of recent papers in this field provide information about use of modafinil or sodium oxybate for treatment of sleepiness associated with narcolepsy. Several large randomized, placebo-controlled studies indicate that modafinil and sodium oxybate are effective for treatment of hypersomnia due to narcolepsy. We identified no studies that report direct comparison of these newer medications versus traditional stimulants, or that indicate what proportion of patients treated initially with these medications require transition to traditional stimulants or to combination therapy to achieve adequate alertness. As with the traditional stimulants, modafinil and sodium oxybate provide, at best, only moderate improvement in alertness rather than full restoration of alertness in patients with narcolepsy. Several large randomized placebo-controlled studies demonstrate that sodium oxybate is effective for treatment of cataplexy associated with narcolepsy, and earlier studies provide limited data to support the effectiveness of fluoxetine and tricyclic antidepressants for treatment of cataplexy. Our findings indicate that very few reports provide information regarding treatment of special populations such as children, older adults, and pregnant or breastfeeding women. The available literature provides a modest amount of information about improvement in quality of life in association with treatment, patient preferences among the different medications, or patient compliance. Conclusion: Several recent studies provide evidence that modafinil and sodium oxybate are effective for treatment of hypersomnia due to narcolepsy. No studies were identified that report direct comparison of these newer medications with traditional stimulants. Despite significant advances in understanding the pathophysiology of narcolepsy, we do not have an ideal treatment to restore full and sustained alertness. Future investigations should be directed toward development of more effective and better tolerated therapies, and primary prevention. Citation: Wise MS; Arand DL; Auger RR; Brooks SN; Watson NF. Treatment of Narcolepsy and other Hypersomnias of Central Origin. SLEEP 2007;30(12):1712-1727. PMID:18246981

NOAA Weather Wire Service

Science.gov Websites

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

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

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-11

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

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

PubMed Central

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

2015-01-01

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

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

PubMed

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

2016-02-01

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

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

PubMed Central

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

2013-01-01

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

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

PubMed Central

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

2018-01-01

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

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

PubMed

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

2017-11-01

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

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

PubMed

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

2017-02-01

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

KSC-2014-4553

NASA Image and Video Library

2014-11-20

CAPE CANAVERAL, Fla. – Workers monitor NOAA’s Deep Space Climate Observatory spacecraft, or DSCOVR, wrapped in plastic and secured onto a portable work stand, as it travels between the airlock of Building 2 to the high bay of Building 1 at the Astrotech payload processing facility in Titusville, Florida, near Kennedy Space Center. DSCOVR is a partnership between NOAA, NASA and the U.S. Air Force. DSCOVR will maintain the nation's real-time solar wind monitoring capabilities which are critical to the accuracy and lead time of NOAA's space weather alerts and forecasts. Launch is currently scheduled for January 2015 aboard a SpaceX Falcon 9 v 1.1 launch vehicle from Cape Canaveral Air Force Station, Florida. To learn more about DSCOVR, visit http://www.nesdis.noaa.gov/DSCOVR. Photo credit: NASA/Kim Shiflett

KSC-2014-4552

NASA Image and Video Library

2014-11-20

CAPE CANAVERAL, Fla. – Workers transfer NOAA’s Deep Space Climate Observatory spacecraft, or DSCOVR, wrapped in plastic and secured onto a portable work stand, from the airlock of Building 2 to the high bay of Building 1 at the Astrotech payload processing facility in Titusville, Florida, near Kennedy Space Center. DSCOVR is a partnership between NOAA, NASA and the U.S. Air Force. DSCOVR will maintain the nation's real-time solar wind monitoring capabilities which are critical to the accuracy and lead time of NOAA's space weather alerts and forecasts. Launch is currently scheduled for January 2015 aboard a SpaceX Falcon 9 v 1.1 launch vehicle from Cape Canaveral Air Force Station, Florida. To learn more about DSCOVR, visit http://www.nesdis.noaa.gov/DSCOVR. Photo credit: NASA/Kim Shiflett

Use and Perceived Benefits of Handheld Computer-based Clinical References

PubMed Central

Rothschild, Jeffrey M.; Fang, Edward; Liu, Vincent; Litvak, Irina; Yoon, Cathy; Bates, David W.

2006-01-01

Objective Clinicians are increasingly using handheld computers (HC) during patient care. We sought to assess the role of HC-based clinical reference software in medical practice by conducting a survey and assessing actual usage behavior. Design During a 2-week period in February 2005, 3600 users of a HC-based clinical reference application were asked by e-mail to complete a survey and permit analysis of their usage patterns. The software includes a pharmacopeia, an infectious disease reference, a medical diagnostic and therapeutic reference and transmits medical alerts and other notifications during HC synchronizations. Software usage data were captured during HC synchronization for the 4 weeks prior to survey completion. Measurements Survey responses and software usage data. Results The survey response rate was 42% (n = 1501). Physicians reported using the clinical reference software for a mean of 4 years and 39% reported using the software during more than half of patient encounters. Physicians who synchronized their HC during the data collection period (n = 1249; 83%) used the pharmacopeia for unique drug lookups a mean of 6.3 times per day (SD 12.4). The majority of users (61%) believed that in the prior 4 weeks, use of the clinical reference prevented adverse drug events or medication errors 3 or more times. Physicians also believed that alerts and other notifications improved patient care if they were public health warnings (e.g. about influenza), new immunization guidelines or drug alert warnings (e.g. rofecoxib withdrawal). Conclusion Current adopters of HC-based medical references use these tools frequently, and found them to improve patient care and be valuable in learning of recent alerts and warnings. PMID:16929041

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

PubMed

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

2017-09-01

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

Effect of air quality alerts on human health: a regression discontinuity analysis in Toronto, Canada.

PubMed

Chen, Hong; Li, Qiongsi; Kaufman, Jay S; Wang, Jun; Copes, Ray; Su, Yushan; Benmarhnia, Tarik

2018-01-01

Ambient air pollution is a major health risk globally. To reduce adverse health effects on days when air pollution is high, government agencies worldwide have implemented air quality alert programmes. Despite their widespread use, little is known about whether these programmes produce any observable public-health benefits. We assessed the effectiveness of such programmes using a quasi-experimental approach. We assembled a population-based cohort comprising all individuals who resided in the city of Toronto (Ontario, Canada) from 2003 to 2012 (about 2·6 million people). We ascertained seven health outcomes known to be affected by short-term elevation of air pollution, using provincial health administrative databases. These health outcomes were cardiovascular-related mortality, respiratory-related mortality, and hospital admissions or emergency-department visits for acute myocardial infarction, heart failure, stroke, asthma, and chronic obstructive pulmonary disease (COPD). We applied a regression discontinuity design to assess the effectiveness of an intervention (ie, the air quality alert programme). To quantify the effect of the air quality alert programme, we estimated for each outcome both the absolute rate difference and the rate ratio attributable to programme eligibility (by intention-to-treat analysis) and the alerts themselves (by two-stage regression approach), respectively. Between Jan 1, 2003, and Dec 31, 2012, on average between three and 27 daily cardiovascular or respiratory events were reported in Toronto (depending on the outcome). Alert announcements reduced asthma-related emergency-department visits by 4·73 cases per 1 000 000 people per day (95% CI 0·55-9·38), or in relative terms by 25% (95% CI 1-47). Programme eligibility also led to 2·05 (95% CI 0·07-4·00) fewer daily emergency-department visits for asthma. We did not detect a significant reduction in any other health outcome as a result of alert announcements or programme eligibility. However, a non-significant trend was noted towards decreased asthma-related and COPD-related admissions. In this population-based cohort, the air quality alert programme was related to some reductions in respiratory morbidity, but not any other health outcome examined. This finding suggests that issuing air quality alerts alone has a limited effect on public health and that implementing enforced public actions to reduce air pollution on high pollution days could be warranted. Together with accumulating evidence of substantial burden from long-term air pollution exposure, this study underscores the need for further strengthening of global efforts that can lead to long-term improvement of overall air quality. Public Health Ontario, Canadian Institutes for Health Research. Copyright © 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.

Mechanical evidence that flamingos can support their body on one leg with little active muscular force.

PubMed

Chang, Young-Hui; Ting, Lena H

2017-05-01

Flamingos (Phoenicopteridae) often stand and sleep on one leg for long periods, but it is unknown how much active muscle contractile force they use for the mechanical demands of standing on one leg: body weight support and maintaining balance. First, we demonstrated that flamingo cadavers could passively support body weight on one leg without any muscle activity while adopting a stable, unchanging, joint posture resembling that seen in live flamingos. By contrast, the cadaveric flamingo could not be stably held in a two-legged pose, suggesting a greater necessity for active muscle force to stabilize two-legged versus one-legged postures. Our results suggest that flamingos engage a passively engaged gravitational stay apparatus (proximally located) for weight support during one-legged standing. Second, we discovered that live flamingos standing on one leg have markedly reduced body sway during quiescent versus alert behaviours, with the point of force application directly under the distal joint, reducing the need for muscular joint torque. Taken together, our results highlight the possibility that flamingos stand for long durations on one leg without exacting high muscular forces and, thus, with little energetic expenditure. © 2017 The Author(s).

Hemochromatosis

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Comparison of Two Sepsis Recognition Methods in a Pediatric Emergency Department

PubMed Central

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

2015-01-01

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

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

PubMed

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

2015-11-01

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

16 CFR 613.1 - Duration of active duty alerts.

Code of Federal Regulations, 2011 CFR

2011-01-01

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

16 CFR 613.1 - Duration of active duty alerts.

Code of Federal Regulations, 2010 CFR

2010-01-01

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

16 CFR 613.1 - Duration of active duty alerts.

Code of Federal Regulations, 2012 CFR

2012-01-01

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

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

Code of Federal Regulations, 2010 CFR

2010-10-01

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

IP telephony based danger alert communication system and its implementation

NASA Astrophysics Data System (ADS)

Rezac, Filip; Safarik, Jakub; Voznak, Miroslav; Tomala, Karel; Partila, Pavol

2013-05-01

This article discusses a danger alert system created as a part of the research project at Department of Telecommunications of Technical University of Ostrava. The aim of the system is to distribute pre-recorded voice messages in order to alert the called party in danger. This article describes individual technologies, which the application uses for its operation as well as issues relating to hardware requirements and transfer line bandwidth load. The article also describes new algorithms, which had to be developed in order to ensure the reliability of the system. Our intent is focused on disaster management, the message, which should be delivered within specified time span, is typed in the application and text-to-speech module ensures its transformation to a speech format, after that a particular scenario or warned area is selected and a target group is automatically unloaded. For this purpose, we have defined XML format for delivery of phone numbers which are located in the target area and these numbers are obtained from mobile BTS's (Base transmission stations). The benefit of such communication compared to others, is the fact, that it uses a phone call and, therefore, it is possible to get feedback who accepted the message and to improve efficiency of alert system. Finally, the list of unanswered calls is exported and these users can be informed via SMS.

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

PubMed Central

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

1996-01-01

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

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

PubMed

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

2011-01-01

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

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

PubMed Central

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

2011-01-01

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

A Prototype External Event Broker for LSST

NASA Astrophysics Data System (ADS)

Elan Alvarez, Gabriella; Stassun, Keivan; Burger, Dan; Siverd, Robert; Cox, Donald

2015-01-01

LSST plans to have an alerts system that will automatically identify various types of "events" appearing in the LSST data stream. These events will include things such as supernovae, moving objects, and many other types, and it is expected that there will be millions of events nightly. It is expected that there may be tens of millions of events each night. To help the LSST community parse and make full advantage of the LSST alerts stream, we are working to design an external "events alert broker" that will generate real-time notification of LSST events to users and/or robotic telescope facilities based on user-specified criteria. For example, users will be able to specify that they wish to be notified immediately via text message of urgent events, such as GRB counterparts, or notified only occasionally in digest form of less time-sensitive events, such as eclipsing binaries. This poster will summarize results from a survey of scientists for the most important features that such an alerts notification service needs to provide, and will present a preliminary design for our external event broker.

Real-Time Mapping alert system; user's manual

USGS Publications Warehouse

Torres, L.A.

1996-01-01

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

Phasic alertness cues modulate visual processing speed in healthy aging.

PubMed

Haupt, Marleen; Sorg, Christian; Napiórkowski, Natan; Finke, Kathrin

2018-05-31

Warning signals temporarily increase the rate of visual information in younger participants and thus optimize perception in critical situations. It is unclear whether such important preparatory processes are preserved in healthy aging. We parametrically assessed the effects of auditory alertness cues on visual processing speed and their time course using a whole report paradigm based on the computational Theory of Visual Attention. We replicated prior findings of significant alerting benefits in younger adults. In conditions with short cue-target onset asynchronies, this effect was baseline-dependent. As younger participants with high baseline speed did not show a profit, an inverted U-shaped function of phasic alerting and visual processing speed was implied. Older adults also showed a significant cue-induced benefit. Bayesian analyses indicated that the cueing benefit on visual processing speed was comparably strong across age groups. Our results indicate that in aging individuals, comparable to younger ones, perception is active and increased expectancy of the appearance of a relevant stimulus can increase the rate of visual information uptake. Copyright © 2018 Elsevier Inc. All rights reserved.

Geo-targeted Weather Alerts Coming to Millions of Mobile Devices

NASA Astrophysics Data System (ADS)

Gerber, M.

2011-12-01

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

Automated External Defibrillator

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Thrombocythemia and Thrombocytosis

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von Willebrand Disease

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Chest X-Ray

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What Is Cardiomyopathy?

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Long QT Syndrome

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Percutaneous Coronary Intervention

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What is Hemophilia?

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Thrombotic Thrombocytopenic Purpura

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What Is Anemia?

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Cardiac CT Scan

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Coronary Calcium Scan

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Patent Ductus Arteriosus

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What is Bronchoscopy?

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

PubMed

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

2015-06-01

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

Holter and Event Monitors

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CHEMICAL SAFETY ALERTS-

EPA Science Inventory

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

What Is Heart Failure?

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What Is Bronchopulmonary Dysplasia?

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What Is Cardiac Catheterization?

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What Is a Ventilator?

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What Are Sleep Studies?

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What Are the Lungs?

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What Is Sudden Cardiac Arrest?

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Blood and Bone Marrow Transplant?

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What Is Respiratory Distress Syndrome?

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What Is a Heart Transplant?

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What is Broken Heart Syndrome

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ARDS (Acute Respiratory Distress Syndrome)

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What Are Bone Marrow Tests?

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Auditory alert systems with enhanced detectability

NASA Technical Reports Server (NTRS)

Begault, Durand R. (Inventor)

2008-01-01

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

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

NASA Astrophysics Data System (ADS)

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

2011-06-01

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

Enhanced Low Dose Rate Effects in Bipolar Circuits: A New Hardness Assurance Problem for NASA

NASA Technical Reports Server (NTRS)

Johnston, A.; Barnes, C.

1995-01-01

Many bipolar integrated circuits are much more susceptible to ionizing radiation at low dose rates than they are at high dose rates typically used for radiation parts testing. Since the low dose rate is equivalent to that seen in space, the standard lab test no longer can be considered conservative and has caused the Air Force to issue an alert. Although a reliable radiation hardness assurance test has not yet been designed, possible mechanisms for low dose rate enhancement and hardness assurance tests are discussed.

A graphical workstation based part-task flight simulator for preliminary rapid evaluation of advanced displays

NASA Technical Reports Server (NTRS)

Wanke, Craig; Kuchar, James; Hahn, Edward; Pritchett, Amy; Hansman, R. J.

1992-01-01

Advances in avionics and display technology are significantly changing the cockpit environment in current transport aircraft. The MIT Aeronautical Systems Lab (ASL) has developed a part-task flight simulator specifically to study the effects of these new technologies on flight crew situational awareness and performance. The simulator is based on a commercially-available graphics workstation, and can be rapidly reconfigured to meet the varying demands of experimental studies. The simulator has been successfully used to evaluate graphical microburst alerting displays, electronic instrument approach plates, terrain awareness and alerting displays, and ATC routing amendment delivery through digital datalinks.

47 CFR 10.300 - Alert aggregator. [Reserved

Code of Federal Regulations, 2013 CFR

2013-10-01

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

47 CFR 10.300 - Alert aggregator. [Reserved

Code of Federal Regulations, 2014 CFR

2014-10-01

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

49 CFR 229.140 - Alerters.

Code of Federal Regulations, 2012 CFR

2012-10-01

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

What Is a Total Artificial Heart?

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What Is a Ventricular Assist Device?

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Alerting or Somnogenic Light: Pick Your Color.

PubMed

Bourgin, Patrice; Hubbard, Jeffrey

2016-08-01

In mammals, light exerts pervasive effects on physiology and behavior in two ways: indirectly through clock synchronization and the phase adjustment of circadian rhythms, and directly through the promotion of alertness and sleep, respectively, in diurnal and nocturnal species. A recent report by Pilorz and colleagues describes an even more complex role for the acute effects of light. In mice, blue light acutely causes behavioral arousal, whereas green wavelengths promote sleep. These opposing effects are mediated by melanopsin-based phototransduction through different neural pathways. These findings reconcile nocturnal and diurnal species through a common alerting response to blue light. One can hypothesize that the opposite responses to natural polychromatic light in night- or day-active animals may reflect higher sensitivity of nocturnal species to green, and diurnals to blue wavelengths, resulting in hypnogenic and alerting effects, respectively. Additional questions remain to be clarified. How do different light wavelengths affect other behaviors such as mood and cognition? How do those results apply to humans? How does light pose either a risk or benefit, depending on whether one needs to be asleep or alert? Indeed, in addition to timing, luminance levels, and light exposure duration, these findings stress the need to understand how best to adapt the color spectrum of light to our needs and to take this into account for the design of daily lighting concepts-a key challenge for today's society, especially with the emergence of LED light technology.

Risk management, or just a different risk?

PubMed

Freer, Y; Lyon, A

2006-09-01

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

Visual perception affected by motivation and alertness controlled by a noninvasive brain-computer interface.

PubMed

Maksimenko, Vladimir A; Runnova, Anastasia E; Zhuravlev, Maksim O; Makarov, Vladimir V; Nedayvozov, Vladimir; Grubov, Vadim V; Pchelintceva, Svetlana V; Hramov, Alexander E; Pisarchik, Alexander N

2017-01-01

The influence of motivation and alertness on brain activity associated with visual perception was studied experimentally using the Necker cube, which ambiguity was controlled by the contrast of its ribs. The wavelet analysis of recorded multichannel electroencephalograms (EEG) allowed us to distinguish two different scenarios while the brain processed the ambiguous stimulus. The first scenario is characterized by a particular destruction of alpha rhythm (8-12 Hz) with a simultaneous increase in beta-wave activity (20-30 Hz), whereas in the second scenario, the beta rhythm is not well pronounced while the alpha-wave energy remains unchanged. The experiments were carried out with a group of financially motivated subjects and another group of unpaid volunteers. It was found that the first scenario occurred mainly in the motivated group. This can be explained by the increased alertness of the motivated subjects. The prevalence of the first scenario was also observed in a group of subjects to whom images with higher ambiguity were presented. We believe that the revealed scenarios can occur not only during the perception of bistable images, but also in other perceptual tasks requiring decision making. The obtained results may have important applications for monitoring and controlling human alertness in situations which need substantial attention. On the base of the obtained results we built a brain-computer interface to estimate and control the degree of alertness in real time.

Randomized control trial of computer-based training targeting alertness in older adults: the ALERT trial protocol.

PubMed

VanVleet, Thomas; Voss, Michelle; Dabit, Sawsan; Mitko, Alex; DeGutis, Joseph

2018-05-03

Healthy aging is associated with a decline in multiple functional domains including perception, attention, short and long-term memory, reasoning, decision-making, as well as cognitive and motor control functions; all of which are significantly modulated by an individual's level of alertness. The control of alertness also significantly declines with age and contributes to increased lapses of attention in everyday life, ranging from minor memory slips to a lack of vigilance and increased risk of falls or motor-vehicle accidents. Several experimental behavioral therapies designed to remediate age-related cognitive decline have been developed, but differ widely in content, method and dose. Preliminary studies demonstrate that Tonic and Phasic Alertness Training (TAPAT) can improve executive functions in older adults and may be a useful adjunct treatment to enhance benefits gained in other clinically validated treatments. The purpose of the current trial (referred to as the Attention training for Learning Enhancement and Resilience Trial or ALERT) is to compare TAPAT to an active control training condition, include a larger sample of patients, and assess both cognitive and functional outcomes. We will employ a multi-site, longitudinal, blinded randomized controlled trial (RCT) design with a target sample of 120 patients with age-related cognitive decline. Patients will be asked to complete 36 training sessions remotely (30 min/day, 5 days a week, over 3 months) of either the experimental TAPAT training program or an active control computer games condition. Patients will be assessed on a battery of cognitive and functional outcomes at four time points, including: a) immediately before training, b) halfway through training, c) within forty-eight hours post completion of total training, and d) after a three-month no-contact period post completion of total training, to assess the longevity of potential training effects. The strengths of this protocol are that it tests an innovative, in-home administered treatment that targets a fundamental deficit in adults with age-related cognitive decline; employs highly sensitive computer-based assessments of cognition as well as functional abilities, and incorporates a large sample size in an RCT design. ClinicalTrials.gov identifier: NCT02416401.

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

NASA Technical Reports Server (NTRS)

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

2016-01-01

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

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

PubMed Central

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

2016-01-01

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

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

PubMed

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

2017-05-01

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

47 CFR 10.300 - Alert aggregator. [Reserved

Code of Federal Regulations, 2010 CFR

2010-10-01

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

47 CFR 10.300 - Alert aggregator. [Reserved

Code of Federal Regulations, 2012 CFR

2012-10-01

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

47 CFR 10.300 - Alert aggregator. [Reserved

Code of Federal Regulations, 2011 CFR

2011-10-01

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

Aspirin to Prevent a First Heart Attack or Stroke

MedlinePlus

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Analysis of sex differences in preadmission management of ST-segment elevation (STEMI) myocardial infarction.

PubMed

Greenberg, Marna Rayl; Miller, Andrew C; Mackenzie, Richard S; Richardson, David M; Ahnert, Amy M; Sclafani, Mia J; Jozefick, Jennifer L; Goyke, Terrence E; Rupp, Valerie A; Burmeister, David B

2012-10-01

Many reports suggest gender disparity in cardiac care as a contributor to the increased mortality among women with heart disease. We sought to identify gender differences in the management of Myocardial Infarction (MI) Alert-activated ST-segment elevation myocardial infarction (STEMI) patients that may have resulted from prehospital initiation. A retrospective database was created for MI Alert STEMI patients who presented to the emergency department (ED) of an academic community hospital with 74,000 annual visits from April 2000 through December 2008. Included were patients meeting criteria for an MI Alert (an institutional clinical practice guideline designed to expedite cardiac catheterization for STEMI patients). Data points (before and after initiation of a prehospital alert protocol) were compared and used as markers of therapy: time to ECG, receiving β-blockers, and time to the catheterization laboratory (cath lab). Differences in categorical variables by patient sex were assessed using the χ(2) test. Medians were estimated as the measure of central tendency. Quantile regression models were used to assess differences in median times between subgroups. A total of 1231 MI Alert charts were identified and analyzed. The majority of the study population were male (70%), arrived at the ED via ambulance (60.1%), and were taking a β-blocker (67.8%) or aspirin (91.6%) at the time of the ED admission. Female patients were more likely than male patients to arrive at the ED via ambulance (65.9% vs 57.6%, respectively; P = 0.014). The median age of female patients was 68 years, whereas male patients were significantly younger (median age, 59 years; P < 0.001). The proportion of patients currently taking a β-blocker or low-dose aspirin did not vary by gender. Overall, 78.2% of the MI Alert patients arriving at the ED were MI2 (alert initiated by ED physician), and this did not vary by gender (P = 0.33). A total of 1064 MI Alert patients went to the cath lab: 766 male patients (88.9%) and 298 female patients (80.8%). Overall, the median time to cath lab arrival was 79 minutes for men and 81 minutes for women (P = 0.38). Overall, the median time to cath lab arrival significantly decreased from MI1 to MI3, (P(trend) < 0.001). For prehospital-initiated alerts (MI3), the median time to cath lab arrival was the same for men and women (64 minutes; P = 1.0). For hospital-initiated alerts, time to cath lab arrival was 82 minutes for male patients and 84 minutes for female patients (P = 0.38). Prehospital activation of the process decreased the time to the cath lab by 19 minutes (P < 0.001; 95% CI, 13.2-24.8). No significant gender differences were apparent in the STEMI patients analyzed, whether the MI Alert was initiated in the ED or prehospital initiated. Initiating prehospital-based alerts significantly decreased the time to the cath lab. Copyright © 2012 Elsevier HS Journals, Inc. All rights reserved.

Classification of AT2018bym as a Type I Superluminous Supernova

NASA Astrophysics Data System (ADS)

Blanchard, P.; Gomez, S.; Berger, E.; Nicholl, M.; Kattner, S.; Weiner, B.

2018-06-01

AT2018bym = ATLAS18ohj = MLS180520:184313+451228 = ZTF18aapgrxo was announced to the TNS by ATLAS (Tonry et al. 2011; ATel #8680) with a detection on 10 May 2018 UT and was detected even earlier by CRTS (Drake et al. 2009) on 5 May 2018 UT. We selected this event for spectroscopic follow up based on its ZTF data (Bellm & Kulkarni 2017; ATel #11266) as available through the ZTF Alert Archive (https://ztf.uw.edu/alerts/public/).

Drug allergy passport and other documentation for patients with drug hypersensitivity - An ENDA/EAACI Drug Allergy Interest Group Position Paper.

PubMed

Brockow, K; Aberer, W; Atanaskovic-Markovic, M; Bavbek, S; Bircher, A; Bilo, B; Blanca, M; Bonadonna, P; Burbach, G; Calogiuri, G; Caruso, C; Celik, G; Cernadas, J; Chiriac, A; Demoly, P; Oude Elberink, J N G; Fernandez, J; Gomes, E; Garvey, L H; Gooi, J; Gotua, M; Grosber, M; Kauppi, P; Kvedariene, V; Laguna, J J; Makowska, J S; Mosbech, H; Nakonechna, A; Papadopolous, N G; Ring, J; Romano, A; Rockmann, H; Sargur, R; Sedlackova, L; Sigurdardottir, S; Schnyder, B; Storaas, T; Torres, M; Zidarn, M; Terreehorst, I

2016-11-01

The strongest and best-documented risk factor for drug hypersensitivity (DH) is the history of a previous reaction. Accidental exposures to drugs may lead to severe or even fatal reactions in sensitized patients. Preventable prescription errors are common. They are often due to inadequate medical history or poor risk assessment of recurrence of drug reaction. Proper documentation is essential information for the doctor to make sound therapeutic decision. The European Network on Drug Allergy and Drug Allergy Interest Group of the European Academy of Allergy and Clinical Immunology have formed a task force and developed a drug allergy passport as well as general guidelines of drug allergy documentation. A drug allergy passport, a drug allergy alert card, a certificate, and a discharge letter after medical evaluation are adequate means to document DH in a patient. They are to be handed to the patient who is advised to carry the documentation at all times especially when away from home. A drug allergy passport should at least contain information on the culprit drug(s) including international nonproprietary name, clinical manifestations including severity, diagnostic measures, potential cross-reactivity, alternative drugs to prescribe, and where more detailed information can be obtained from the issuer. It should be given to patients only after full allergy workup. In the future, electronic prescription systems with alert functions will become more common and should include the same information as in paper-based documentation. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.