Guidewire retention following central venous catheterisation: a human factors and safe design investigation.

BACKGROUND: Central Venous Catheterisation (CVC) has occasionally been associated with cases of retained guidewires in patients after surgery. In theory, this is a completely avoidable complication; however, as with any human procedure, operator error leading to guidewires being occasionally retained cannot be fully eliminated. OBJECTIVE: The work described here investigated the issue in an attempt to better understand it both from an operator and a systems perspective, and to ultimately recommend appropriate safe design solutions that reduce guidewire retention errors. METHODS: Nine distinct methods were used: observations of the procedure, a literature review, interviewing CVC end-users, task analysis construction, CVC procedural audits, two human reliability assessments, usability heuristics and a comprehensive solution survey with CVC end-users. RESULTS: The three solutions that operators rated most highly, in terms of both practicality and effectiveness, were: making trainees better aware of the potential guidewire complications and strongly emphasising guidewire removal in CVC training, actively checking that the guidewire is present in the waste tray for disposal, and standardising purchase of central line sets so that differences that may affect chances of guidewire loss is minimised. CONCLUSIONS: Further work to eliminate/engineer out the possibility of guidewires being retained is proposed.

Safe Compositional Network Sketches: NetSketch Tool Implementation

Numerous problems exist that can be modeled as traffic through a network in which constraints exist to regulate flow. Vehicular road travel, computer networks, and cloud based resource distribution, among others all have natural representations in this manner. As these networks grow in size and/or complexity, analysis and certification of the safety invariants becomes increasingly costly. The NetSketch formalism introduces a lightweight verification framework that allows for greater scalability than traditional analysis methods. The NetSketch tool was developed to provide the power of this formalism in an easy to use and intuitive user interface.

A Type System For Safe SN Resource Allocation

snBench is a platform on which novice users compose and deploy distributed Sense and Respond programs for simultaneous execution on a shared, distributed infrastructure. It is a natural imperative that we have the ability to (1) verify the safety/correctness of newly submitted tasks and (2) derive the resource requirements for these tasks such that correct allocation may occur. To achieve these goals we have established a multi-dimensional sized type system for our functional-style Domain Specific Language (DSL) called Sensor Task Execution Plan (STEP). In such a type system data types are annotated with a vector of size attributes (e.g., upper and lower size bounds). Tracking multiple size aspects proves essential in a system in which Images are manipulated as a first class data type, as image manipulation functions may have specific minimum and/or maximum resolution restrictions on the input they can correctly process. Through static analysis of STEP instances we not only verify basic type safety and establish upper computational resource bounds (i.e., time and space), but we also derive and solve data and resource sizing constraints (e.g., Image resolution, camera capabilities) from the implicit constraints embedded in program instances. In fact, the static methods presented here have benefit beyond their application to Image data, and may be extended to other data types that require tracking multiple dimensions (e.g., image "quality", video frame-rate or aspect ratio, audio sampling rate). In this paper we present the syntax and semantics of our functional language, our type system that builds costs and resource/data constraints, and (through both formalism and specific details of our implementation) provide concrete examples of how the constraints and sizing information are used in practice.

Safe Compositional Network Sketches: Tool & Use Cases

NetSketch is a tool that enables the specification of network-flow applications and the certification of desirable safety properties imposed thereon. NetSketch is conceived to assist system integrators in two types of activities: modeling and design. As a modeling tool, it enables the abstraction of an existing system so as to retain sufficient enough details to enable future analysis of safety properties. As a design tool, NetSketch enables the exploration of alternative safe designs as well as the identification of minimal requirements for outsourced subsystems. NetSketch embodies a lightweight formal verification philosophy, whereby the power (but not the heavy machinery) of a rigorous formalism is made accessible to users via a friendly interface. NetSketch does so by exposing tradeoffs between exactness of analysis and scalability, and by combining traditional whole-system analysis with a more flexible compositional analysis approach based on a strongly-typed, Domain-Specific Language (DSL) to specify network configurations at various levels of sketchiness along with invariants that need to be enforced thereupon. In this paper, we overview NetSketch, highlight its salient features, and illustrate how it could be used in applications, including the management/shaping of traffic flows in a vehicular network (as a proxy for CPS applications) and in a streaming media network (as a proxy for Internet applications). In a companion paper, we define the formal system underlying the operation of NetSketch, in particular the DSL behind NetSketch's user-interface when used in "sketch mode", and prove its soundness relative to appropriately-defined notions of validity.

Safe Compositional Network Sketches: The Formal Framework

NetSketch is a tool for the specification of constrained-flow applications and the certification of desirable safety properties imposed thereon. NetSketch is conceived to assist system integrators in two types of activities: modeling and design. As a modeling tool, it enables the abstraction of an existing system while retaining sufficient information about it to carry out future analysis of safety properties. As a design tool, NetSketch enables the exploration of alternative safe designs as well as the identification of minimal requirements for outsourced subsystems. NetSketch embodies a lightweight formal verification philosophy, whereby the power (but not the heavy machinery) of a rigorous formalism is made accessible to users via a friendly interface. NetSketch does so by exposing tradeoffs between exactness of analysis and scalability, and by combining traditional whole-system analysis with a more flexible compositional analysis. The compositional analysis is based on a strongly-typed Domain-Specific Language (DSL) for describing and reasoning about constrained-flow networks at various levels of sketchiness along with invariants that need to be enforced thereupon. In this paper, we define the formal system underlying the operation of NetSketch, in particular the DSL behind NetSketch's user-interface when used in "sketch mode", and prove its soundness relative to appropriately-defined notions of validity. In a companion paper [6], we overview NetSketch, highlight its salient features, and illustrate how it could be used in two applications: the management/shaping of traffic flows in a vehicular network (as a proxy for CPS applications) and in a streaming media network (as a proxy for Internet applications).

Design, construction and testing of an air-cycle refrigeration system for road transport

The environmental attractions of air-cycle refrigeration are considerable. Following a thermodynamic design analysis, an air-cycle demonstrator plant was constructed within the restricted physical envelope of an existing Thermo King SL200 trailer refrigeration unit. This unique plant operated satisfactorily, delivering sustainable cooling for refrigerated trailers using a completely natural and safe working fluid. The full load capacity of the air-cycle unit at -20 °C was 7,8 kW, 8% greater than the equivalent vapour-cycle unit, but the fuel consumption of the air-cycle plant was excessively high. However, at part load operation the disparity in fuel consumption dropped from approximately 200% to around 80%. The components used in the air-cycle demonstrator were not optimised and considerable potential exists for efficiency improvements, possibly to the point where the air-cycle system could rival the efficiency of the standard vapour-cycle system at part-load operation, which represents the biggest proportion of operating time for most units.

Fitness to drive and cannabis: Validation of two blood THCCOOH thresholds to distinguish occasional users from heavy smokers.

Many studies based on either an experimental or an epidemiological approach, have shown that the ability to drive is impaired when the driver is under the influence of cannabis. Baseline performances of heavy users remain impaired even after several weeks of abstinence. Symptoms of cannabis abuse and dependence are generally considered incompatible with safe driving. Recently, it has been shown that traffic safety can be increased by reporting the long-term unfit drivers to the driver licensing authorities and referring the cases for further medical assessment. Evaluation of the frequency of cannabis use is a prerequisite for a reliable medical assessment of the fitness to drive. In a previous paper we advocated the use of two thresholds based on 11-nor-9-carboxy-Δ9-tetrahydrocannabinol (THCCOOH) concentration in whole blood to help to distinguish occasional cannabis users (≤3μg/L) from heavy regular smokers (≥40μg/L). These criteria were established on the basis of results obtained in a controlled cannabis smoking study with placebo, carried out with two groups of young male volunteers; the first group was characterized by a heavy use (≥10 joints/month) while the second group was made up of occasional users smoking at most 1 joint/week. However, to date, these cutoffs have not been adequately assessed under real conditions. Their validity can now be evaluated and confirmed with 146 traffic offenders' real cases in which the whole blood cannabinoid concentrations and the frequency of cannabis use are known. The two thresholds were not challenged by the presence of ethanol (40% of cases) and of other therapeutic and illegal drugs (24%). Thus, we propose the following procedure that can be very useful in the Swiss context but also in other countries with similar traffic policies: if the whole blood THCCOOH concentration is higher than 40μg/L, traffic offenders must be directed first and foremost toward medical assessment of their fitness to drive. This evaluation is not recommended if the THCCOOH concentration is lower than 3μg/L and if the self-rated frequency of cannabis use is less than 1 time/week. A THCCOOH level between these two thresholds cannot be reliably interpreted. In such a case, further medical assessment and follow-up of the fitness to drive are also suggested, but with lower priority.

Financing road transport infrastructure

In the UK, public expenditure on transport infrastructure is nearly £6 billion for the past few years. Over £500 million per year were spent on bridge assessment and strengthening and reducing the backlog of road requiring maintenance. A further £200 million a year will be spent on keeping the safe operation of the network and efficiently through day to day maintenance, lighting and signing . The Department of Transport is planning to extend private sector experience in road management and operation by introducing Design, Build, Finance and Operate (DBFO) This paper investigates the different ways of financing road transport infrastructure including road pricing, private finance in transport infrastructure, the role of the private sector, Design, Build, Finance and Operate (DBFO) schemes, the benefits and problems of such schemes. The paper considers planning gain as a means of financing transport infrastructure with examples of developers to fund link road building and improvements to the local planning system

Risky attitudes towards road use in pre-drivers

Motor vehicle accidents are one of the principal causes of adolescent disability or mortality and male drivers are more likely to be involved in road accidents than female drivers. In part such associations between driver age and sex have been linked to differences in risky behaviour (e.g. speed, violations) and individual characteristics (e.g. sensation seeking, deviant behaviour). The aim of this research is to determine whether associations between risky road user behaviour and individual characteristics are a function of driver behaviour or whether they are intrinsic and measurable in individuals too young to drive. Five hundred and sixty-seven pre-driver students aged 11-16 from three secondary schools completed questionnaires measuring enthusiasm for speed, sensation seeking, deviant behaviour and attitudes towards driver violations. Boys reported more risky attitudes than girls for all measures. Associations between sensation seeking, deviant behaviour and attitudes towards risky road use were present from early adolescence and were strongest around age 14, before individuals learn to drive. Risky attitudes towards road use are associated with individual characteristics and are observed in adolescents long before they learn to drive. Safe attitudes towards road use and driver behaviour should be promoted from childhood in order to be effective. (C) 2007 Elsevier Ltd. All rights reserved.

Road and Traffic Signs Recognition using Vector Machines

Intelligent Transportation System (ITS) is a system that builds a safe, effective and integrated transportation environment based on advanced technologies. Road signs detection and recognition is an important part of ITS, which offer ways to collect the real time traffic data for processing at a central facility.This project is to implement a road sign recognition model based on AI and image analysis technologies, which applies a machine learning method, Support Vector Machines, to recognize road signs. We focus on recognizing seven categories of road sign shapes and five categories of speed limit signs. Two kinds of features, binary image and Zernike moments, are used for representing the data to the SVM for training and test. We compared and analyzed the performances of SVM recognition model using different features and different kernels. Moreover, the performances using different recognition models, SVM and Fuzzy ARTMAP, are observed.

Road Sign Recognition based onInvariant Features using SupportVector Machine

Since last two decades researches have been working on developing systems that can assistsdrivers in the best way possible and make driving safe. Computer vision has played a crucialpart in design of these systems. With the introduction of vision techniques variousautonomous and robust real-time traffic automation systems have been designed such asTraffic monitoring, Traffic related parameter estimation and intelligent vehicles. Among theseautomatic detection and recognition of road signs has became an interesting research topic.The system can assist drivers about signs they don’t recognize before passing them.Aim of this research project is to present an Intelligent Road Sign Recognition System basedon state-of-the-art technique, the Support Vector Machine. The project is an extension to thework done at ITS research Platform at Dalarna University [25]. Focus of this research work ison the recognition of road signs under analysis. When classifying an image its location, sizeand orientation in the image plane are its irrelevant features and one way to get rid of thisambiguity is to extract those features which are invariant under the above mentionedtransformation. These invariant features are then used in Support Vector Machine forclassification. Support Vector Machine is a supervised learning machine that solves problemin higher dimension with the help of Kernel functions and is best know for classificationproblems.

Road network and GPS tracking with data processing and quality assessment

GPS technology has been embedded into portable, low-cost electronic devices nowadays to track the movements of mobile objects. This implication has greatly impacted the transportation field by creating a novel and rich source of traffic data on the road network. Although the promise offered by GPS devices to overcome problems like underreporting, respondent fatigue, inaccuracies and other human errors in data collection is significant; the technology is still relatively new that it raises many issues for potential users. These issues tend to revolve around the following areas: reliability, data processing and the related application. This thesis aims to study the GPS tracking form the methodological, technical and practical aspects. It first evaluates the reliability of GPS based traffic data based on data from an experiment containing three different traffic modes (car, bike and bus) traveling along the road network. It then outline the general procedure for processing GPS tracking data and discuss related issues that are uncovered by using real-world GPS tracking data of 316 cars. Thirdly, it investigates the influence of road network density in finding optimal location for enhancing travel efficiency and decreasing travel cost. The results show that the geographical positioning is reliable. Velocity is slightly underestimated, whereas altitude measurements are unreliable.Post processing techniques with auxiliary information is found necessary and important when solving the inaccuracy of GPS data. The densities of the road network influence the finding of optimal locations. The influence will stabilize at a certain level and do not deteriorate when the node density is higher.

Safety in road crossing of children with cerebral palsy

Aim: Children with cerebral palsy (CP) are regularly confronted with physical constraints during locomotion. Because abnormalities in motor control are often related to perceptual deficits, the aim of this study was to find out whether children with CP were able to walk across a road as safely as their non-handicapped peers. Method: Ten children with CP and 10 non-handicapped children aged 4-14 y were asked to cross a simulated road if they felt the situation was safe. Results: With respect to safety and accuracy of crossings, the behaviour of children with CP was comparable with that of non-handicapped children. However, a closer examination of children's individual crossing behaviour showed considerable differences within the CP group. In contrast to children with damage to the left hemisphere, children with damage to the right hemisphere made unsafe decisions and did not compensate for them by increasing walking speed.Conclusion: the differences in unsafe behaviour and in the ability to compensate for it within the group of children with CP might be related to damage to specific regions of the brain that are involved in the processing of spatial or temporal information.

Mortality from road traffic accidents in Switzerland: longitudinal and spatial analyses

Road traffic accidents (RTA) are an important cause of premature death. We examined socio-demographic and geographical determinants of RTA mortality in Switzerland by linking 2000 census data to RTA mortality records 2000-2005 (ICD-10 codes V00-V99). Data from 5.5 million residents aged 18-94 years, 1744 study areas, and 1620 RTA deaths were analyzed, including 978 deaths (60.4%) in motor vehicle occupants, 254 (15.7%) in motorcyclists, 107 (6.6%) in cyclists, and 259 (16.0%) in pedestrians. Weibull survival models and Bayesian methods were used to calculate hazard ratios (HR), and standardized mortality ratios (SMR) across study areas. Adjusted HR comparing women with men ranged from 0.04 (95% CI 0.02-0.07) in motorcyclists to 0.43 (95% CI 0.32-0.56) in pedestrians. There was a u-shaped relationship with age in motor vehicle occupants and motorcyclists. In cyclists and pedestrians, mortality increased after age 55 years. Mortality was higher in individuals with primary education (HR 1.53; 95% CI 1.29-1.81), and higher in single (HR 1.24; 95% CI 1.05-1.46), widowed (HR 1.31; 95% CI 1.05-1.65) and divorced individuals (HR 1.62; 95% CI 1.33-1.97), compared to persons with tertiary education or married persons. The association with education was particularly strong for pedestrians (HR 1.87; 95% CI 1.20-2.91). RTA mortality increased with decreasing population density of study areas for motor vehicle occupants (test for trend p<0.0001) and motorcyclists (p=0.0021) but not for cyclists (p=0.39) or pedestrians (p=0.29). SMR standardized for socio-demographic and geographical variables ranged from 82 to 190. Prevention efforts should aim to reduce inequities across socio-demographic and educational groups, and across geographical areas, with interventions targeted at high-risk groups and areas, and different traffic users, including pedestrians.

Can a novel web-based computer test predict poor simulated driving performance? A pilot study with healthy and cognitive-impaired participants

BACKGROUND Driving a car is a complex instrumental activity of daily living and driving performance is very sensitive to cognitive impairment. The assessment of driving-relevant cognition in older drivers is challenging and requires reliable and valid tests with good sensitivity and specificity to predict safe driving. Driving simulators can be used to test fitness to drive. Several studies have found strong correlation between driving simulator performance and on-the-road driving. However, access to driving simulators is restricted to specialists and simulators are too expensive, large, and complex to allow easy access to older drivers or physicians advising them. An easily accessible, Web-based, cognitive screening test could offer a solution to this problem. The World Wide Web allows easy dissemination of the test software and implementation of the scoring algorithm on a central server, allowing generation of a dynamically growing database with normative values and ensures that all users have access to the same up-to-date normative values. OBJECTIVE In this pilot study, we present the novel Web-based Bern Cognitive Screening Test (wBCST) and investigate whether it can predict poor simulated driving performance in healthy and cognitive-impaired participants. METHODS The wBCST performance and simulated driving performance have been analyzed in 26 healthy younger and 44 healthy older participants as well as in 10 older participants with cognitive impairment. Correlations between the two tests were calculated. Also, simulated driving performance was used to group the participants into good performers (n=70) and poor performers (n=10). A receiver-operating characteristic analysis was calculated to determine sensitivity and specificity of the wBCST in predicting simulated driving performance. RESULTS The mean wBCST score of the participants with poor simulated driving performance was reduced by 52%, compared to participants with good simulated driving performance (P<.001). The area under the receiver-operating characteristic curve was 0.80 with a 95% confidence interval 0.68-0.92. CONCLUSIONS When selecting a 75% test score as the cutoff, the novel test has 83% sensitivity, 70% specificity, and 81% efficiency, which are good values for a screening test. Overall, in this pilot study, the novel Web-based computer test appears to be a promising tool for supporting clinicians in fitness-to-drive assessments of older drivers. The Web-based distribution and scoring on a central computer will facilitate further evaluation of the novel test setup. We expect that in the near future, Web-based computer tests will become a valid and reliable tool for clinicians, for example, when assessing fitness to drive in older drivers.