Test of a smock system on CPR primary emergency measures and medical errors during simulated emergencies

Rates of survival of victims of sudden cardiac arrest (SCA) using cardio pulmonary resuscitation (CPR) have shown little improvement over the past three decades. Since registered nurses (RNs) comprise the largest group of healthcare providers in U.S. hospitals, it is essential that they are competent in performing the four primary measures (compression, ventilation, medication administration, and defibrillation) of CPR in order to improve survival rates of SCA patients. The purpose of this experimental study was to test a color-coded SMOCK system on: 1) time to implement emergency patient care measures 2) technical skills performance 3) number of medical errors, and 4) team performance during simulated CPR exercises. The study sample was 260 RNs (M 40 years, SD=11.6) with work experience as an RN (M 7.25 years, SD=9.42).Nurses were allocated to a control or intervention arm consisting of 20 groups of 5-8 RNs per arm for a total of 130 RNs in each arm. Nurses in each study arm were given clinical scenarios requiring emergency CPR. Nurses in the intervention group wore different color labeled aprons (smocks) indicating their role assignment (medications, ventilation, compression, defibrillation, etc) on the code team during CPR. Findings indicated that the intervention using color-labeled smocks for pre-assigned roles had a significant effect on the time nurses started compressions (t=3.03, p=0.005), ventilations (t=2.86, p=0.004) and defibrillations (t=2.00, p=.05) when compared to the controls using the standard of care. In performing technical skills, nurses in the intervention groups performed compressions and ventilations significantly better than those in the control groups. The control groups made significantly (t=-2.61, p=0.013) more total errors (7.55 SD 1.54) than the intervention group (5.60, SD 1.90). There were no significant differences in team performance measures between the groups. Study findings indicate use of colored labeled smocks during CPR emergencies resulted in: shorter times to start emergency CPR; reduced errors; more technical skills completed successfully; and no differences in team performance.

Test of a Smock System on CPR Primary Emergency Measures and Medical Errors During Simulated Emergencies

Rates of survival of victims of sudden cardiac arrest (SCA) using cardio pulmonary resuscitation (CPR) have shown little improvement over the past three decades. Since registered nurses (RNs) comprise the largest group of healthcare providers in U.S. hospitals, it is essential that they are competent in performing the four primary measures (compression, ventilation, medication administration, and defibrillation) of CPR in order to improve survival rates of SCA patients. The purpose of this experimental study was to test a color-coded SMOCK system on:1) time to implement emergency patient care measures 2) technical skills performance 3) number of medical errors, and 4) team performance during simulated CPR exercises. The study sample was 260 RNs (M 40 years, SD=11.6) with work experience as an RN (M 7.25 years, SD=9.42).Nurses were allocated to a control or intervention arm consisting of 20 groups of 5-8 RNs per arm for a total of 130 RNs in each arm. Nurses in each study arm were given clinical scenarios requiring emergency CPR. Nurses in the intervention group wore different color labeled aprons (smocks) indicating their role assignment (medications, ventilation, compression, defibrillation, etc) on the code team during CPR. Findings indicated that the intervention using color-labeled smocks for pre-assigned roles had a significant effect on the time nurses started compressions (t=3.03, p=0.005), ventilations (t=2.86, p=0.004) and defibrillations (t=2.00, p=.05) when compared to the controls using the standard of care. In performing technical skills, nurses in the intervention groups performed compressions and ventilations significantly better than those in the control groups. The control groups made significantly (t=-2.61, p=0.013) more total errors (7.55 SD 1.54) than the intervention group (5.60, SD 1.90). There were no significant differences in team performance measures between the groups. Study findings indicate use of colored labeled smocks during CPR emergencies resulted in: shorter times to start emergency CPR; reduced errors; more technical skills completed successfully; and no differences in team performance.

Design and evaluation of a consulting system for database design

Database design is a difficult problem for non-expert designers. It is desirable to assist such designers during the problem solving process by means of a knowledge based (KB) system. A number of prototype KB systems have been proposed, however there are many shortcomings. Few have incorporated sufficient expertise in modeling relationships, particularly higher order relationships. There has been no empirical study that experimentally tested the effectiveness of any of these KB tools. Problem solving behavior of non-experts, whom the systems were intended to assist, has not been one of the bases for system design. In this project a consulting system for conceptual database design that addresses the above short comings was developed and empirically validated.^ The system incorporates (a) findings on why non-experts commit errors and (b) heuristics for modeling relationships. Two approaches to knowledge base implementation--system restrictiveness and decisional guidance--were used and compared in this project. The Restrictive approach is proscriptive and limits the designer's choices at various design phases by forcing him/her to follow a specific design path. The Guidance system approach which is less restrictive, provides context specific, informative and suggestive guidance throughout the design process. The main objectives of the study are to evaluate (1) whether the knowledge-based system is more effective than a system without the knowledge-base and (2) which knowledge implementation--restrictive or guidance--strategy is more effective. To evaluate the effectiveness of the knowledge base itself, the two systems were compared with a system that does not incorporate the expertise (Control).^ The experimental procedure involved the student subjects solving a task without using the system (pre-treatment task) and another task using one of the three systems (experimental task). The experimental task scores of those subjects who performed satisfactorily in the pre-treatment task were analyzed. Results are (1) The knowledge based approach to database design support lead to more accurate solutions than the control system; (2) No significant difference between the two KB approaches; (3) Guidance approach led to best performance; and (4) The subjects perceived the Restrictive system easier to use than the Guidance system. ^

Investigative interviewing and memory: How accurate are interviewers recollections of investigative interviews?

Contrary to interviewing guidelines, a considerable portion of witness interviews are not recorded. Investigators’ memory, their interview notes, and any subsequent interview reports therefore become important pieces of evidence; the accuracy of interviewers’ memory or such reports is therefore of crucial importance when interviewers testify in court regarding witness interviews. A detailed recollection of the actual exchange during such interviews and how information was elicited from the witness will allow for a better assessment of statement veracity in court. ^ Two studies were designed to examine interviewers’ memory for a prior witness interview. Study One varied interviewer note-taking and type of subsequent interview report written by interviewers by including a sample of undergraduates and implementing a two-week delay between interview and recall. Study Two varied levels of interviewing experience in addition to report type and note-taking by comparing experienced police interviewers to a student sample. Participants interviewed a mock witness about a crime, while taking notes or not, and wrote an interview report two weeks later (Study One) or immediately after (Study Two). Interview reports were written either in a summarized format, which asked interviewers for a summary of everything that occurred during the interview, or verbatim format, which asked interviewers to record in transcript format the questions they asked and the witness’s responses. Interviews were videotaped and transcribed. Transcriptions were compared to interview reports to score for accuracy and omission of interview content. ^ Results from both studies indicate that much interview information is lost between interview and report especially after a two-week delay. The majority of information reported by interviewers is accurate, although even interviewers who recalled information immediately after still reported a troubling amount of inaccurate information. Note-taking was found to increase accuracy and completeness of interviewer reports especially after a two week delay. Report type only influenced recall of interviewer questions. Experienced police interviewers were not any better at recalling a prior witness interview than student interviewers. Results emphasize the need to record witness interviews to allow for more accurate and complete interview reconstruction by interviewers, even if interview notes are available. ^

Comparison of repeated and two non-repeated readings conditions on reading abilities of students with emotional and/or behavioral disabilities

Students with emotional and/or behavioral disorders (EBD)present considerable academic challenges along with emotional and/or behavioral problems. In terms of reading, these students typically perform one-to-two years below grade level (Kauffman, 2001). Given the strong correlation between reading failure and school failure and overall success (Scott & Shearer-Lingo, 2002), finding effective approaches to reading instruction is imperative for these students (Staubitz, Cartledge, Yurick, & Lo, 2005). This study used an alternating treatments design to comparethe effects of three conditions on the reading fluency, errors, and comprehension of four, sixth-grade students with EBD who were struggling readers. Specifically, the following were compared: (a) Repeated readings in which participants repeatedly read a passage of about 100-150 words, three times, (b) Non-repeated readings in which participants sequentially read an original passage of about 100-150 words once, and (c) Equivalent non-repeated readings in which participants sequentially read a passage of about 300-450 words, equivalent to the number of words in the repeated readings condition. Also examined were the effects of the three repeated readings practice trials per sessions on reading fluency and errors. The reading passage difficulty and length established prior to commencing were used for all participants throughout the standard phase. During the enhanced phase, the reading levels were increased 6 months for all participants, and for two (the advanced readers), the length of the reading passages was increased by 50%, allowing for comparisons under more rigorous conditions. The results indicate that overall repeated readings had the best outcome across the standard and enhanced phases for increasing readers’ fluency, reducing their errors per minute, and supporting fluency answers to literal comprehension questions correctly as compared to non-repeated and equivalent non-repeated conditions. When comparing nonrepeated and equivalent non-repeated readings,there were mixed results. Under the enhanced phases, the positive effects of repeated readings were more demonstrative. Additional research is needed to compare the effects of repeated and equivalent non-repeated readings across other populations of students with disabilities or varying learning styles. This research should include collecting repeated readings practice trial data for fluency and errors to further analyze the immediate effects of repeatedly reading a passage.

A study of stock market linkages between the US and frontier countries

My dissertation investigates the financial linkages and transmission of economic shocks between the US and the smallest emerging markets (frontier markets). The first chapter sets up an empirical model that examines the impact of US market returns and conditional volatility on the returns and conditional volatilities of twenty-one frontier markets. The model is estimated via maximum likelihood; utilizes the GARCH model of errors, and is applied to daily country data from the MSCI Barra. We find limited, but statistically significant exposure of Frontier markets to shocks from the US. Our results suggest that it is not the lagged US market returns that have impact; rather it is the expected US market returns that influence frontier market returns The second chapter sets up an empirical time-varying parameter (TVP) model to explore the time-variation in the impact of mean US returns on mean Frontier market returns. The model utilizes the Kalman filter algorithm as well as the GARCH model of errors and is applied to daily country data from the MSCI Barra. The TVP model detects statistically significant time-variation in the impact of US returns and low, but statistically and quantitatively important impact of US market conditional volatility. The third chapter studies the risk-return relationship in twenty Frontier country stock markets by setting up an international version of the intertemporal capital asset pricing model. The systematic risk in this model comes from covariance of Frontier market stock index returns with world returns. Both the systematic risk and risk premium are time-varying in our model. We also incorporate own country variances as additional determinants of Frontier country returns. Our results suggest statistically significant impact of both world and own country risk in explaining Frontier country returns. Time-variation in the world risk premium is also found to be statistically significant for most Frontier market returns. However, own country risk is found to be quantitatively more important.

Effects of worked examples and algebra problem -solving skill on error and cognitive load

This study determined the levels of algebra problem solving skill at which worked examples promoted learning of further problem solving skill and reduction of cognitive load in college developmental algebra students. Problem solving skill was objectively measured as error production; cognitive load was subjectively measured as perceived mental effort. ^ Sixty-three Ss were pretested, received homework of worked examples or mass problem solving, and posttested. Univarate ANCOVA (covariate = previous grade) were performed on the practice and posttest data. The factors used in the analysis were practice strategy (worked examples vs. mass problem solving) and algebra problem solving skill (low vs. moderate vs. high). Students in the practice phase who studied worked examples exhibited (a) fewer errors and reduced cognitive load, at moderate skill; (b) neither fewer errors nor reduced cognitive load, at low skill; and (c) only reduced cognitive load, at high skill. In the posttest, only cognitive load was reduced. ^ The results suggested that worked examples be emphasized for developmental students with moderate problem solving skill. Areas for further research were discussed. ^

Design and evaluation of a consulting system for database design

Database design is a difficult problem for non-expert designers. It is desirable to assist such designers during the problem solving process by means of a knowledge based (KB) system. Although a number of prototype KB systems have been proposed, there are many shortcomings. Firstly, few have incorporated sufficient expertise in modeling relationships, particularly higher order relationships. Secondly, there does not seem to be any published empirical study that experimentally tested the effectiveness of any of these KB tools. Thirdly, problem solving behavior of non-experts, whom the systems were intended to assist, has not been one of the bases for system design. In this project, a consulting system, called CODA, for conceptual database design that addresses the above short comings was developed and empirically validated. More specifically, the CODA system incorporates (a) findings on why non-experts commit errors and (b) heuristics for modeling relationships. Two approaches to knowledge base implementation were used and compared in this project, namely system restrictiveness and decisional guidance (Silver 1990). The Restrictive system uses a proscriptive approach and limits the designer's choices at various design phases by forcing him/her to follow a specific design path. The Guidance system approach, which is less restrictive, involves providing context specific, informative and suggestive guidance throughout the design process. Both the approaches would prevent erroneous design decisions. The main objectives of the study are to evaluate (1) whether the knowledge-based system is more effective than the system without a knowledge-base and (2) which approach to knowledge implementation - whether Restrictive or Guidance - is more effective. To evaluate the effectiveness of the knowledge base itself, the systems were compared with a system that does not incorporate the expertise (Control). An experimental procedure using student subjects was used to test the effectiveness of the systems. The subjects solved a task without using the system (pre-treatment task) and another task using one of the three systems, viz. Control, Guidance or Restrictive (experimental task). Analysis of experimental task scores of those subjects who performed satisfactorily in the pre-treatment task revealed that the knowledge based approach to database design support lead to more accurate solutions than the control system. Among the two KB approaches, Guidance approach was found to lead to better performance when compared to the Control system. It was found that the subjects perceived the Restrictive system easier to use than the Guidance system.

Investigative Interviewing and Memory: How Accurate Are Interviewers’ Recollections of Investigative Interviews?

Contrary to interviewing guidelines, a considerable portion of witness interviews are not recorded. Investigators’ memory, their interview notes, and any subsequent interview reports therefore become important pieces of evidence; the accuracy of interviewers’ memory or such reports is therefore of crucial importance when interviewers testify in court regarding witness interviews. A detailed recollection of the actual exchange during such interviews and how information was elicited from the witness will allow for a better assessment of statement veracity in court. Two studies were designed to examine interviewers’ memory for a prior witness interview. Study One varied interviewer note-taking and type of subsequent interview report written by interviewers by including a sample of undergraduates and implementing a two-week delay between interview and recall. Study Two varied levels of interviewing experience in addition to report type and note-taking by comparing experienced police interviewers to a student sample. Participants interviewed a mock witness about a crime, while taking notes or not, and wrote an interview report two weeks later (Study One) or immediately after (Study Two). Interview reports were written either in a summarized format, which asked interviewers for a summary of everything that occurred during the interview, or verbatim format, which asked interviewers to record in transcript format the questions they asked and the witness’s responses. Interviews were videotaped and transcribed. Transcriptions were compared to interview reports to score for accuracy and omission of interview content. Results from both studies indicate that much interview information is lost between interview and report especially after a two-week delay. The majority of information reported by interviewers is accurate, although even interviewers who recalled information immediately after still reported a troubling amount of inaccurate information. Note-taking was found to increase accuracy and completeness of interviewer reports especially after a two week delay. Report type only influenced recall of interviewer questions. Experienced police interviewers were not any better at recalling a prior witness interview than student interviewers. Results emphasize the need to record witness interviews to allow for more accurate and complete interview reconstruction by interviewers, even if interview notes are available.

An integrated framework for ensuring the quality of software design

Software development is an extremely complex process, during which human errors are introduced and result in faulty software systems. It is highly desirable and important that these errors can be prevented and detected as early as possible. Software architecture design is a high-level system description, which embodies many system features and properties that are eventually implemented in the final operational system. Therefore, methods for modeling and analyzing software architecture descriptions can help prevent and reveal human errors and thus improve software quality. Furthermore, if an analyzed software architecture description can be used to derive a partial software implementation, especially when the derivation can be automated, significant benefits can be gained with regard to both the system quality and productivity. This dissertation proposes a framework for an integrated analysis on both of the design and implementation. To ensure the desirable properties of the architecture model, we apply formal verification by using the model checking technique. To ensure the desirable properties of the implementation, we develop a methodology and the associated tool to translate an architecture specification into an implementation written in the combination of Arch-Java/Java/AspectJ programming languages. The translation is semi-automatic so that many manual programming errors can be prevented. Furthermore, the translation inserting monitoring code into the implementation such that runtime verification can be performed, this provides additional assurance for the quality of the implementation. Moreover, validations for the translations from architecture model to program are provided. Finally, several case studies are experimented and presented.

The Effects of Repeated Readings on Reading Abilities of English Language Learners with Specific Learning Disabilities

This study evaluates the effects of repeated readings on the reading fluency and comprehension of 4 third through fifth grade English Language Learners (ELLs) with Specific Learning Disabilities (SLD). The results indicate gains in fluency, a decrease in errors, and an increase in correct answers to literal comprehension questions.

A Hydrological Budget (2002–2008) for a Large Subtropical Wetland Ecosystem Indicates Marine Groundwater Discharge Accompanies Diminished Freshwater Flow

Water budget parameters are estimated for Shark River Slough (SRS), the main drainage within Everglades National Park (ENP) from 2002 to 2008. Inputs to the water budget include surface water inflows and precipitation while outputs consist of evapotranspiration, discharge to the Gulf of Mexico and seepage losses due to municipal wellfield extraction. The daily change in volume of SRS is equated to the difference between input and outputs yielding a residual term consisting of component errors and net groundwater exchange. Results predict significant net groundwater discharge to the SRS peaking in June and positively correlated with surface water salinity at the mangrove ecotone, lagging by 1 month. Precipitation, the largest input to the SRS, is offset by ET (the largest output); thereby highlighting the importance of increasing fresh water inflows into ENP for maintaining conditions in terrestrial, estuarine, and marine ecosystems of South Florida.

A method for enhancing digital information displayed to computer users with visual refractive errors via spatial and spectral processing

This research pursued the conceptualization, implementation, and verification of a system that enhances digital information displayed on an LCD panel to users with visual refractive errors. The target user groups for this system are individuals who have moderate to severe visual aberrations for which conventional means of compensation, such as glasses or contact lenses, does not improve their vision. This research is based on a priori knowledge of the user's visual aberration, as measured by a wavefront analyzer. With this information it is possible to generate images that, when displayed to this user, will counteract his/her visual aberration. The method described in this dissertation advances the development of techniques for providing such compensation by integrating spatial information in the image as a means to eliminate some of the shortcomings inherent in using display devices such as monitors or LCD panels. Additionally, physiological considerations are discussed and integrated into the method for providing said compensation. In order to provide a realistic sense of the performance of the methods described, they were tested by mathematical simulation in software, as well as by using a single-lens high resolution CCD camera that models an aberrated eye, and finally with human subjects having various forms of visual aberrations. Experiments were conducted on these systems and the data collected from these experiments was evaluated using statistical analysis. The experimental results revealed that the pre-compensation method resulted in a statistically significant improvement in vision for all of the systems. Although significant, the improvement was not as large as expected for the human subject tests. Further analysis suggest that even under the controlled conditions employed for testing with human subjects, the characterization of the eye may be changing. This would require real-time monitoring of relevant variables (e.g. pupil diameter) and continuous adjustment in the pre-compensation process to yield maximum viewing enhancement.

A method for enhancing digital information displayed to computer users with visual refractive errors via spatial and spectral processing

This research pursued the conceptualization, implementation, and verification of a system that enhances digital information displayed on an LCD panel to users with visual refractive errors. The target user groups for this system are individuals who have moderate to severe visual aberrations for which conventional means of compensation, such as glasses or contact lenses, does not improve their vision. This research is based on a priori knowledge of the user's visual aberration, as measured by a wavefront analyzer. With this information it is possible to generate images that, when displayed to this user, will counteract his/her visual aberration. The method described in this dissertation advances the development of techniques for providing such compensation by integrating spatial information in the image as a means to eliminate some of the shortcomings inherent in using display devices such as monitors or LCD panels. Additionally, physiological considerations are discussed and integrated into the method for providing said compensation. In order to provide a realistic sense of the performance of the methods described, they were tested by mathematical simulation in software, as well as by using a single-lens high resolution CCD camera that models an aberrated eye, and finally with human subjects having various forms of visual aberrations. Experiments were conducted on these systems and the data collected from these experiments was evaluated using statistical analysis. The experimental results revealed that the pre-compensation method resulted in a statistically significant improvement in vision for all of the systems. Although significant, the improvement was not as large as expected for the human subject tests. Further analysis suggest that even under the controlled conditions employed for testing with human subjects, the characterization of the eye may be changing. This would require real-time monitoring of relevant variables (e.g. pupil diameter) and continuous adjustment in the pre-compensation process to yield maximum viewing enhancement.