Safe eye surgery: non-technical aspects

The traditional training of surgeons focused exclusively on developing knowledge, clinical expertise, and technical (surgical) skills. However, analyses of the reasons for adverse events in surgery have revealed that many underlying causes originate from behavioural or non-technical aspects of performance (eg, poor communication among members of the surgical team) rather than from a lack of surgical (ie, technical) skills. Therefore, technical skills appear to be necessary but not sufficient to ensure patient safety. Paying attention to non-technical skills, such as team working, leadership, situation awareness, decision making, and communication, will increase the likelihood of maintaining high levels of error-free performance. Identification and training of non-technical skills has been developed for high-risk careers, such as civil aviation and nuclear power. Only recently, training in non-technical skills has been adopted by the surgical world and anaesthetists. Non-technical skills need to be tailored to the environment where they are used, and eye surgery has some substantial differences compared with other surgical areas, for example, high volume of surgery, use of local anaesthetics, and very sophisticated equipment. This review highlights the need for identification of the non-technical skills relevant to eye surgeons and promotion of their use in the training of eye surgeons.

Distributed Adaptive Learning Framework for Wide Area Monitoring of Power Systems Integrated with Distributed Generations

This paper presents a preliminary study of developing a novel distributed adaptive real-time learning framework for wide area monitoring of power systems integrated with distributed generations using synchrophasor technology. The framework comprises distributed agents (synchrophasors) for autonomous local condition monitoring and fault detection, and a central unit for generating global view for situation awareness and decision making. Key technologies that can be integrated into this hierarchical distributed learning scheme are discussed to enable real-time information extraction and knowledge discovery for decision making, without explicitly accumulating and storing all raw data by the central unit. Based on this, the configuration of a wide area monitoring system of power systems using synchrophasor technology, and the functionalities for locally installed open-phasor-measurement-units (OpenPMUs) and a central unit are presented. Initial results on anti-islanding protection using the proposed approach are given to illustrate the effectiveness.

Liderazgo, afrontamiento al estrés y toma de decisiones empresariales. una revisión conceptual

El liderazgo basa sus estudios en el análisis de la razón y la emoción, las cuales son dos factores fundamentales para el desarrollo de las personas y la forma como éstas, a través de tácticas propias del liderazgo, demuestran un factor diferenciador entre un equipo de trabajo, creando así, un grupo con unos seguidores y un líder que maneja y soporta la presión de todo el equipo. El estrés es considerado como una tensión que afecta psicológicamente al individuo y adicionalmente produce cambios fisiológicos, que pueden alterar el día a día de las personas en todos los ámbitos de la vida, y el laboral no es la excepción. El estrés puede ser producido por diferentes circunstancias, las cuales son diferentes para cada persona y éstas se presentan en diferentes aspectos de la vida del individuo, es decir, se puede presentar a nivel familiar, educativo, profesional, entre otros dependiendo el individuo que se desee analizar. “… Recibir una calificación reprobatoria en un examen de física, llegar considerablemente tarde a una junta importante, o jugar tiempos extra a muerte súbita en un partido de hockey”. (Hughes, Ginnett, & Curphy, 2007, p. 456) El presente trabajo se enfoca en el estrés laboral, ya que es fundamental para la toma de decisiones, actividad de alta importancia en la gestión directiva, por lo cual se estudiará el efecto que tiene el estrés en la toma de decisiones a niveles empresariales. El estrés laboral ha sido estudiado desde hace más de tres décadas por lo que es posible encontrar definiciones al respecto; McGrath, en 1970 definió el estrés laboral como “el desequilibrio sustancial (percibido) entre la demanda y la capacidad de respuesta del individuo bajo condiciones en las que el fracaso ante esta demanda posee importantes consecuencias (percibidas)”. (Navarro, 2009, p. 86) A partir de esta definición se podría asumir que el estrés laboral tiene un efecto sobre la toma de decisiones sin importar el cargo que el individuo desempeñe. Con el fin de entender y aportar a la administración como disciplina un recurso más para comprender este concepto de la psicología que tiene implicaciones en las organizaciones y en la forma en que los directivos toman decisiones, y así puedan apropiarlas a su diario vivir dentro de las organizaciones, se realizará una monografía que estará basada principalmente en artículos y libros que han introducido este tema anteriormente, pero que no han dado a conocer estos avances a la línea administrativa. Finalmente, con los resultados esperados en esta investigación, aparte de dar a conocer a los administradores los avances de aquellas ciencias sociales existentes anteriormente a la administración y que permiten que el desarrollo administrativo sea mejor, aportando al desarrollo de las capacidades profesionales de los gerentes y empresarios, se espera describir los factores externos que afectan al estrés e identificar cómo éste afecta la toma de decisiones en la dirección.

Communication mechanisms and middleware for distributed video surveillance

A new generation of advanced surveillance systems is being conceived as a collection of multi-sensor components such as video, audio and mobile robots interacting in a cooperating manner to enhance situation awareness capabilities to assist surveillance personnel. The prominent issues that these systems face are: the improvement of existing intelligent video surveillance systems, the inclusion of wireless networks, the use of low power sensors, the design architecture, the communication between different components, the fusion of data emerging from different type of sensors, the location of personnel (providers and consumers) and the scalability of the system. This paper focuses on the aspects pertaining to real-time distributed architecture and scalability. For example, to meet real-time requirements, these systems need to process data streams in concurrent environments, designed by taking into account scheduling and synchronisation. The paper proposes a framework for the design of visual surveillance systems based on components derived from the principles of Real Time Networks/Data Oriented Requirements Implementation Scheme (RTN/DORIS). It also proposes the implementation of these components using the well-known middleware technology Common Object Request Broker Architecture (CORBA). Results using this architecture for video surveillance are presented through an implemented prototype.

Is a contained fire less risky than a going fire? Career and volunteer firefighters

Since fighting fires can pose a great risk to the lives of firefighters, it is important to understand how they perceive risks in dynamic wildfire situations. The aim of the current study was to determine whether career and volunteer firefighters differ in their perception of the risk of a going vs. contained fire and whether descriptions of a fire as either going or contained affected perceptions of risk. It was expected that career firefighters would rate a contained fire as significantly riskier than would volunteer firefighters. The sample consisted of 55 career and 84 volunteer CFA Victorian firefighters (134 males and 5 females). An ambiguous wildfire scenario was presented and described as either going or contained and risk ratings were recorded. Two-way ANOVA results showed that career firefighters rated a going fire as equally risky as a contained fire. On the other hand, volunteer firefighters perceived a fire described as contained to be significantly less risky than a fire described as going, despite the fact that the same fireground conditions were described in both cases. It was concluded that a framing effect had occurred and that career firefighters demonstrated a higher level of situation awareness than volunteer firefighters due to their heightened levels of risk perception when exposed to contained wildfire scenarios. A practical implication of the current research is that those conducting firefighting briefings need to be aware of possible framing effects in the way information is presented to firefighters and need to ensure that all briefings make risks cognitively salient to firefighters.

Undergraduate nursing students' performance in recognising and responding to sudden patient deterioration in high psychological fidelity simulated environments: an Australian multi-centre study

Objectives
This paper reports the quantitative findings of the first phase of a larger program of ongoing research: Feedback Incorporating Review and Simulation Techniques to Act on Clinical Trends (FIRST2ACTTM). It specifically aims to identify the characteristics that may predict primary outcome measures of clinical performance, teamwork and situation awareness in the management of deteriorating patients.

Design
Mixed-method multi-centre study.

Setting
High fidelity simulated acute clinical environment in three Australian universities.

Participants
A convenience sample of 97 final year nursing students enrolled in an undergraduate Bachelor of Nursing or combined Bachelor of Nursing degree were included in the study.

Method
In groups of three, participants proceeded through three phases: (i) pre-briefing and completion of a multi-choice question test, (ii) three video-recorded simulated clinical scenarios where actors substituted real patients with deteriorating conditions, and (iii) post-scenario debriefing. Clinical performance, teamwork and situation awareness were evaluated, using a validated standard checklist (OSCE), Team Emergency Assessment Measure (TEAM) score sheet and Situation Awareness Global Assessment Technique (SAGAT). A Modified Angoff technique was used to establish cut points for clinical performance.

Results
Student teams engaged in 97 simulation experiences across the three scenarios and achieved a level of clinical performance consistent with the experts' identified pass level point in only 9 (1%) of the simulation experiences. Knowledge was significantly associated with overall teamwork (p = .034), overall situation awareness (p = .05) and clinical performance in two of the three scenarios (p = .032 cardiac and p = .006 shock). Situation awareness scores of scenario team leaders were low overall, with an average total score of 41%.

Conclusions
Final year undergraduate nursing students may have difficulty recognising and responding appropriately to patient deterioration. Improving pre-requisite knowledge, rehearsal of first response and team management strategies need to be a key component of undergraduate nursing students' education and ought to specifically address clinical performance, teamwork and situation awareness.

Towards a resilience management framework for complex enterprise systems upgrade implementation

The lack of knowledge of how resilience management supports enterprise system (ES) projects accounts for the failure of firms to leverage their investments in costly ES implementations. Using a structured-pragmatic- situational (SPS) case study research approach, this paper reports on an investigation into the resilience management of a large utility company as it implemented an ES upgrade. Drawing on the literature and on the case study findings, we developed a process-based resilience management framework that involves three strategies (developing situation awareness, demystifying threats, and executing restoration plans) and four organisational capabilities that transform resilience management concepts into practices. We identified the crucial phases of ES upgrade implementation and developed indicators for how different strategies and capabilities of resilience management can assist managers at different stages of an ES upgrade. This research advances the state of existing knowledge by providing specific and verifiable propositions for attaining a state of resilience, the knowledge being grounded in the empirical reality of a case study. Moreover, the framework offers ES practitioners a roadmap to better identify appropriate responses and levels of preparedness.

Managing women with acute physiological deterioration: student midwives performance in a simulated setting

OBJECTIVE: Midwives' ability to manage maternal deterioration and 'failure to rescue' are of concern with questions over knowledge, clinical skills and the implications for maternal morbidity and, mortality rates. In a simulated setting our objective was to assess student midwives' ability to assess, and manage maternal deterioration using measures of knowledge, situation awareness and skill, performance. METHODS: An exploratory quantitative analysis of student performance based upon performance, ratings derived from knowledge tests and observational ratings. During 2010 thirty-five student, midwives attended a simulation laboratory completing a knowledge questionnaire and two video, recorded simulated scenarios. Patient actresses wearing a 'birthing suit' simulated deteriorating, women with post-partum and ante-partum haemorrhage (PPH and APH). Situation awareness was, measured at the end of each scenario. Applicable descriptive and inferential statistical tests were, applied to the data. FINDINGS: The mean total knowledge score was 75% (range 46-91%) with low skill performance, means for both scenarios 54% (range 39-70%). There was no difference in performance between the scenarios, however performance of key observations decreased as the women deteriorated; with significant reductions in key vital signs such as blood pressure and blood loss measurements. Situation, awareness scores were also low (54%) with awareness decreasing significantly (t(32)=2.247, p=0.032), in the second and more difficult APH scenario. CONCLUSION: Whilst knowledge levels were generally good, skills were generally poor and decreased as the women deteriorated. Such failures to apply knowledge in emergency stressful situations may be resolved by repetitive high stakes and high fidelity simulation.

Innovative Man Machine Interfaces In Aeronautics

The research activity focused on the study, design and evaluation of innovative human-machine interfaces based on virtual three-dimensional environments. It is based on the brain electrical activities recorded in real time through the electrical impulses emitted by the brain waves of the user. The achieved target is to identify and sort in real time the different brain states and adapt the interface and/or stimuli to the corresponding emotional state of the user. The setup of an experimental facility based on an innovative experimental methodology for “man in the loop" simulation was established. It allowed involving during pilot training in virtually simulated flights, both pilot and flight examiner, in order to compare the subjective evaluations of this latter to the objective measurements of the brain activity of the pilot. This was done recording all the relevant information versus a time-line. Different combinations of emotional intensities obtained, led to an evaluation of the current situational awareness of the user. These results have a great implication in the current training methodology of the pilots, and its use could be extended as a tool that can improve the evaluation of a pilot/crew performance in interacting with the aircraft when performing tasks and procedures, especially in critical situations. This research also resulted in the design of an interface that adapts the control of the machine to the situation awareness of the user. The new concept worked on, aimed at improving the efficiency between a user and the interface, and gaining capacity by reducing the user’s workload and hence improving the system overall safety. This innovative research combining emotions measured through electroencephalography resulted in a human-machine interface that would have three aeronautical related applications: • An evaluation tool during the pilot training; • An input for cockpit environment; • An adaptation tool of the cockpit automation.

Computerized provider order entry adoption: implications for clinical workflow.

OBJECTIVE: To identify and describe unintended adverse consequences related to clinical workflow when implementing or using computerized provider order entry (CPOE) systems. METHODS: We analyzed qualitative data from field observations and formal interviews gathered over a three-year period at five hospitals in three organizations. Five multidisciplinary researchers worked together to identify themes related to the impacts of CPOE systems on clinical workflow. RESULTS: CPOE systems can affect clinical work by 1) introducing or exposing human/computer interaction problems, 2) altering the pace, sequencing, and dynamics of clinical activities, 3) providing only partial support for the work activities of all types of clinical personnel, 4) reducing clinical situation awareness, and 5) poorly reflecting organizational policy and procedure. CONCLUSIONS: As CPOE systems evolve, those involved must take care to mitigate the many unintended adverse effects these systems have on clinical workflow. Workflow issues resulting from CPOE can be mitigated by iteratively altering both clinical workflow and the CPOE system until a satisfactory fit is achieved.

E-Flow: A communication system for user notification in dynamic evacuation scenarios

Most of the current evacuation plans are based on static signaling, fixed monitoring infrastructure, and limited user notification and feedback mechanisms. These facts lead to lower situation awareness, in the case event of an emergency, such as blocked emergency exits, while delaying the reaction time of individuals. In this context, we introduce the E-Flow communication system, which improves the user awareness by integrating personal, mobile and fixed devices with the existing monitoring infrastructure. Our system broadens the notification and monitoring alternatives, in real time, among, safety staff, end-users and evacuation related devices, such as sensors and actuators.

Tailoring reveals information requirements: the case of anaesthesia alarms

We discuss the phenomenon of system tailoring in the context of data from an observational study of anaesthesia. We found that anaesthetists tailor their monitoring equipment so that the auditory alarms are more informative. However, the occurrence of tailoring by anaesthetists in the operating theatre was infrequent, even though the flexibility to tailor exists on many of the patient monitoring systems used in the study. We present an influence diagram to explain how alarm tailoring can increase situation awareness in the operating theatre but why factors inhibiting tailoring prevent widespread use. Extending the influence diagram, we discuss ways that more informative displays could achieve the results sought by anaesthetists when they tailor their alarm systems. In particular, we argue that we should improve our designs rather than simply provide more flexible tailoring systems. because users often find tailoring a complex task. We conclude that properly designed auditory displays may benefit anaesthetists in achieving greater patient situation awareness and that designers should consider carefully how factors promoting and inhibiting tailoring will affect the end-users' likelihood of conducting tailoring. (C) 2004 Elsevier B.V. All rights reserved.

The influence of memory for prior instances on performance in a conflict detection task

In 3 experiments, the authors examined the role of memory for prior instances for making relative judgments in conflict detection. Participants saw pairs of aircraft either repeatedly conflict with each other or pass safely before being tested on new aircraft pairs, which varied in similarity to the training pairs. Performance was influenced by the similarity between aircraft pairs. Detection time was faster when a conflict pair resembled a pair that had repeatedly conflicted. Detection time was slower, and participants missed conflicts, when a conflict pair resembled a pair that had repeatedly passed safely. The findings identify aircraft features that are used as inputs into the memory decision process and provide an indication of the processes involved in the use of memory for prior instances to make relative judgments.