The benefit of context for facial composite construction.

Purpose - The aim of this study was to investigate whether the presence of a whole-face context during facial composite production facilitates construction of facial composite images. Design/Methodology - In Experiment 1, constructors viewed a celebrity face and then developed a facial composite using PRO-fit in one of two conditions: either the full-face was visible while facial features were selected, or only the feature currently being selected was visible. The composites were named by different participants. We then replicated the study using a more forensically-valid procedure: In Experiment 2 non-football fans viewed an image of a premiership footballer and 24 hours later constructed a composite of the face with a trained software operator. The resulting composites were named by football fans. Findings - In both studies we found that presence of the facial context promoted more identifiable facial composite images. Research limitations/implications – Though this study uses current software in an unconventional way, this was necessary to avoid error arising from between-system differences. Practical implications - Results confirm that composite software should have the whole-face context visible to witnesses throughout construction. Though some software systems do this, there remain others that present features in isolation and these findings show that these systems are unlikely to be optimal. Originality/value - This is the first study to demonstrate the importance of a full-face context for the construction of facial composite images. Results are valuable to police forces and developers of composite software.

Development of process control methodology for tracking the quality and safety of pain, agitation and sedation management in critical care units

Objective: To develop sedation, pain, and agitation quality measures using process control methodology and evaluate their properties in clinical practice. Design: A Sedation Quality Assessment Tool was developed and validated to capture data for 12-hour periods of nursing care. Domains included pain/discomfort and sedation-agitation behaviors; sedative, analgesic, and neuromuscular blocking drug administration; ventilation status; and conditions potentially justifying deep sedation. Predefined sedation-related adverse events were recorded daily. Using an iterative process, algorithms were developed to describe the proportion of care periods with poor limb relaxation, poor ventilator synchronization, unnecessary deep sedation, agitation, and an overall optimum sedation metric. Proportion charts described processes over time (2 monthly intervals) for each ICU. The numbers of patients treated between sedation-related adverse events were described with G charts. Automated algorithms generated charts for 12 months of sequential data. Mean values for each process were calculated, and variation within and between ICUs explored qualitatively. Setting: Eight Scottish ICUs over a 12-month period. Patients: Mechanically ventilated patients. Interventions: None. Measurements and Main Results: The Sedation Quality Assessment Tool agitation-sedation domains correlated with the Richmond Sedation Agitation Scale score (Spearman [rho] = 0.75) and were reliable in clinician-clinician (weighted kappa; [kappa] = 0.66) and clinician-researcher ([kappa] = 0.82) comparisons. The limb movement domain had fair correlation with Behavioral Pain Scale ([rho] = 0.24) and was reliable in clinician-clinician ([kappa] = 0.58) and clinician-researcher ([kappa] = 0.45) comparisons. Ventilator synchronization correlated with Behavioral Pain Scale ([rho] = 0.54), and reliability in clinician-clinician ([kappa] = 0.29) and clinician-researcher ([kappa] = 0.42) comparisons was fair-moderate. Eight hundred twenty-five patients were enrolled (range, 59-235 across ICUs), providing 12,385 care periods for evaluation (range 655-3,481 across ICUs). The mean proportion of care periods with each quality metric varied between ICUs: excessive sedation 12-38%; agitation 4-17%; poor relaxation 13-21%; poor ventilator synchronization 8-17%; and overall optimum sedation 45-70%. Mean adverse event intervals ranged from 1.5 to 10.3 patients treated. The quality measures appeared relatively stable during the observation period. Conclusions: Process control methodology can be used to simultaneously monitor multiple aspects of pain-sedation-agitation management within ICUs. Variation within and between ICUs could be used as triggers to explore practice variation, improve quality, and monitor this over time