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A trust model IMPACTS (intention, measurability, performance, adaptivity, communication, transparency, and security) has been conceptualized to build human trust in autonomous systems. A system must exhibit the seven critical characteristics to gain and maintain its human partner’s trust towards an effective and collaborative team in achieving common goals. The IMPACTS model guided a design of an intelligent adaptive decision aid for dynamic target engagement processes in a human-autonomy interaction context. Positive feedback from subject matter experts who participated in a large-scale exercise controlling multiple unmanned assets indicated the decision aid’s effectiveness. It also demonstrated the IMPACTS model’s utility as a design principle for enabling trust between a human-autonomy team.

Background Video-laryngoscopy has proven valuable in management and training of difficult airways. We evaluate the Yann tube, a novel bi-directional articulable endotracheal tube and video stylet combination, together with video-laryngoscopy in a simulation setting to determine if it improves management and education of difficult airways. Methods We evaluated the Yann tube (with video-laryngoscopy) against direct and video-laryngoscopy alone across four simulated airway scenarios, and measured time and attempts to successful intubation, percentage-of-glottic-opening (POGO) score, and Cormack-Lehane grading. Afterward, we surveyed participant subjective experiences. Results There were 32 participants of varying experience. Pharyngeal obstruction was the only airway scenario where the Yann tube was significantly slower than video-laryngoscopy alone (37s vs 27s; p Conclusions Although the Yann tube did not significantly improve successful first pass intubation, it did not significantly take longer to perform, and improved airway visualization in certain difficult airway scenarios. The use of simulation also enhanced education and understanding of airway anatomy for novice intubators.

Background: Bandemia, defined as a band count >10%, is indicative of underlying infection and is increasingly being used for early detection of sepsis. While an absolute band level has been linked to worse outcomes, its trend has not been extensively studied as a prognostic marker. In this study, we assessed patients admitted to the ICU with sepsis or septic shock and evaluated the correlation between bandemia trends and clinical trajectory among these patients. Methods: This study was a retrospective chart review. Band counts, serum lactate levels, and SOFA scores at 0 and 72 h after admission to the ICU were collected. Patients were risk stratified into groups depending on their SOFA trends, and corresponding band trends and serum lactate levels were compared. Results: 134 patients were included for analysis. There was a statistically significant decrease in bandemia trends for patients with a reduction in SOFA scores [median (IQR)−4.5 (−11, 0); p < 0.0001], and a statistically significant increase in bandemia trends for patients with worsening SOFA scores [median (IQR) 4 (0, 8); p = 0.0007]. Conclusion: Early trends of serum band levels in patients with sepsis or septic shock may help to predict a clinical trajectory and overall prognosis. More investigation is warranted as to whether incorporating bandemia trends, when used in conjunction with other known markers such as lactate levels, may help to guide bedside clinical decisions such as risk stratification, tailored therapies, and ultimately improve outcomes.

Aging biology is a promising and burgeoning research area that can yield dual-purpose pathways and protein targets that may impact multiple diseases, while retarding or possibly even reversing age-associated processes. One widely used approach to classify a multiplicity of mechanisms driving the aging process is the hallmarks of aging. In addition to the classic nine hallmarks of aging, processes such as extracellular matrix stiffness, chronic inflammation and activation of retrotransposons are also often considered, given their strong association with aging. In this study, we used a variety of target identification and prioritization techniques offered by the AI-powered PandaOmics platform, to propose a list of promising novel aging-associated targets that may be used for drug discovery. We also propose a list of more classical targets that may be used for drug repurposing within each hallmark of aging. Most of the top targets generated by this comprehensive analysis play a role in inflammation and extracellular matrix stiffness, highlighting the relevance of these processes as therapeutic targets in aging and age-related diseases. Overall, our study reveals both high confidence and novel targets associated with multiple hallmarks of aging and demonstrates application of the PandaOmics platform to target discovery across multiple disease areas.

Background In 2014, the Accreditation Council for Graduate Medical Education (ACGME) formally mandated trainee (resident and fellow) participation in health care quality improvement (QI) projects as one of the Clinical Learning Environment Review (CLER) Pathways to Excellence. Subsequent national reviews showed large variations in how QI education is conducted, as well as a significant mismatch between educational and organizational goals. Objective We developed a web-based platform to engage trainees in QI that better aligned with best practice methodology and matched identified institutional priorities. Methods A needs assessment survey was distributed to trainees to understand the obstacles to compliance with ACGME QI requirements. Based on the results, a web-based clearinghouse, called the QI Platform, was developed and launched in July 2016, and utilization was analyzed in February 2019. Results A total of 196 of 440 needs assessment surveys (45%) were completed. Themes extracted from surveys to identify barriers in QI participation included difficulties designing projects, lack of mentorship or expert support, and difficulty engaging an interprofessional team. Over 2.5 years, 151 projects were registered on the platform. Of these, 17 (11%) were collaborative entries. At the time of analysis, 166 of 437 trainees (38%) were listed as participants in active QI projects. A total of 22 projects were archived as complete, and 68 incomplete projects were reassigned to the “Ideas” section as works in progress after lead trainee graduation. Conclusions An institutional QI Platform clearinghouse for GME QI projects was feasible to develop and maintain, and it appeared acceptable to most GME programs and trainees for recording and tracking QI projects, and linking these to hospital QI priorities.

Adverse event (AE) reporting is a key component of patient safety and physicians are known to underreport. The authors hypothesized that integrating AE reporting into a mobile application used in daily physician workflow would increase physician reporting of AEs. After integrating AE reporting into a free-text mobile application used for daily workflow, the change in AE reporting by physicians was analyzed using Mann-Whitney U tests. AE reporting by physicians increased more than 37-fold (21 to 806; U = 7.5, P < .0001). AE reporting by physicians as a proportion of all AE reports received increased 120-fold (from 0.1% to 12% of all reports, U = 10, P < .0001). Integrating AE reporting into a free-text mobile application used in daily physician workflow markedly increased their reporting of AEs. This approach shifted time burden from physicians to quality officers. Implementation should be coupled with physician education about identifying AEs and content to include in reports.

An experiment was conducted to investigate the effects of automation and role allocation on performance in a simulated picture compilation task with fourteen two-person student teams. In the absence of automation support, the system integrated sensor information. In the presence of automation support, the system both integrated sensor information and identified contacts. Roles were assigned either based on warfare domain or geographical sectors. Results showed that human-automation system performance was similar in two automation conditions, but participants were slower in classifying tracks and overall classified fewer tracks when the automation was present. We conclude that working with automation may lead to degraded team performance due to complacency and additional task complexity.

A study was conducted to examine the operational use of multi-sensor data fusion for military airborne intelligence, surveillance and reconnaissance. Participants performed a simulated picture compilation task wherein they had to identify all ships and planes in their area of operation using various sensors. One group performed the task using only native sensor data. The second group had imperfect data fusion to help them resolve the kinematic information, but they still had to identify each contact. The results indicated that data fusion automation improved the identification of ships and planes over the native sensor group. However, over time, map clutter continually increased for the group with fusion automation, surpassing the clutter for the native sensor group. The results suggest that while multi-sensor data fusion has benefits for picture compilation, dealing with plot clutter from false and spurious tracks is a key concern. Interface suggestions are provided to mitigate the effects.

We conducted two experiments to examine the effect of providing automation support and communicating the limitations of the automation on team performance in a simulated navy environment. Two-person teams engaged with a picture compilation task with or without automation support. In the first experiment, there was no explicit explanations provided regarding the automation’s limitations. In the second experiment, limitations of the automation were communicated to the participants verbally. A comparison of two experiments revealed that participants classified fewer contacts when the automation support was present. Moreover, communicating the limitations of automation resulted in even fewer classifications than when no information was provided. Possible reasons for these results include confusion created by the additional information and reprioritization. These results highlight the complexity of delivering automation transparency to operators in safety-critical environments. We conclude that automation transparency should be carefully designed and delivered to avoid negative impacts on performance.

The COVID-19 pandemic has forced the health care industry to develop dynamic protocols to maximize provider safety as aerosolizing procedures, specifically intubation, increase the risk of contracting SARS-CoV-2. The authors sought to create a quality improvement framework to ensure safe practices for intubating providers, and describe a multidisciplinary model developed at an academic tertiary care facility centered on rapid-cycle improvements and real-time gap analysis to track adherence to COVID-19 intubation safety protocols. The model included an Intubation Safety Checklist, a standardized documentation template for intubations, obtaining real-time feedback, and weekly multidisciplinary team meetings to review data and implement improvements. This study captured 68 intubations in suspected COVID-19 patients and demonstrated high personal protective equipment compliance at the institution, but also identified areas for process improvement. Overall, the authors posit that an interdisciplinary workgroup and the integration of standardized processes can be used to enhance intubation safety among providers during the COVID-19 pandemic.

Background: Health care workers treating Coronavirus disease 2019 (COVID-19) patients face significant stressors such as caring for critically ill and dying patients, physically demanding care requiring new degrees of personal protective equipment use, risk of contracting the disease, and putting loved ones at risk. This study investigates the stress impact from COVID-19 exposure and how nurses and medical providers (eg, physicians, nurse practitioners, physician assistants) experience these challenges differently. Methods: An electronic, self-administered questionnaire was sent to all hospital staff over 6 weeks surveying exposure to COVID-19 patients and degree of stress caused by this exposure. Responses from medical providers and nurses were analyzed for significant contributors to stress levels, as well as comparing responses from medical providers versus nurses. Results: Stress levels from increased risk of disease contraction while on the job, fear of transmitting it to family or friends, and the resulting social stigma were highest in medical staff during the COVID-19 pandemic. Compared with medical providers, nurses had nearly 4 times the odds of considering job resignation due to COVID-19. However, most health care workers (77.4% of medical providers and 52.9% of nurses) strongly agreed or agreed with the statements indicating high levels of altruism in their desire to treat COVID-19 patients. Conclusion: The significant stress burden placed on nurses likely contributes to increased thoughts of job resignation. However, health care providers displayed high levels of altruism during this time of extreme crisis, despite their personal risks of caring for COVID-19 patients.

Physicians routinely rely on nontechnical skills—including leadership ability, managerial skills and financial considerations—when delivering patient care. Efficient practice management is a commonplace expectation of attending anesthesiologists, but there is no uniform residency training to foster the expertise required to succeed in this endeavor. The purpose of this study is to evaluate a novel practice management course for anesthesiology residents. METHODS: Senior anesthesiology residents (Clinical Anesthesia-3) at The George Washington University were eligible to participate in a 1-month Ambulatory Anesthesiology–Practice Management Rotation focusing on the acquisition of nontechnical skills and knowledge applicable to becoming an effective clinical leader. The rotation included 1-week service as operating room manager, completion of an online module, assigned readings with follow-up discussions, and completion of a billing and reimbursement exercise. The interventions, in aggregate, were measured with a preknowledge and a postknowledge test. RESULTS: Twelve residents out of 14 (86%) completed the preknowledge and postknowledge tests. Residents scored significantly higher on the postcourse exam (61.49%, SD 18.65%) than the pretest (42.7%, SD 12.7%) (P < .004). CONCLUSION: A curriculum designed to develop the practice management skills required of a physician anesthesiologist is feasible and effective at improving knowledge within a 1-month, senior resident rotation.

Introduction The COVID-19 pandemic has resulted in an increased use of Powered Air Purifying Respirators (PAPRs), by health care providers to mitigate the risk of viral transmission, especially for aerosol-generating procedures. In this study, we evaluate communication devices that could be used concurrently with PAPRs to promote improved communication. Methods We tested two devices, a Bluetooth earpiece and a throat microphone that operated over mobile networks, against a control scenario in a simulated operating room environment with participants donning PAPRs. Participants read a short paragraph to each other, transcribed short phrases, and evaluated the scenarios according to speech intelligibility, ease of use, and comfort. Results There were 30 participants of varying PAPR experience. The Bluetooth headset had the most accurate transcriptions, followed by control, and lastly the neckpiece (94.7%vs 88.4%vs 76%, p Conclusion Communication devices have the potential to bridge but also worsen communications barriers between providers donning PAPRs.

Strategies to combat auditory overload were studied. Normal-hearing males were tested in a sound isolated room in a mock-up of a military land vehicle. Two tasks were presented concurrently, in quiet and vehicle noise. For Task 1 dichotic phrases were delivered over a communications headset. Participants encoded only those beginning with a preassigned call sign (Baron or Charlie). For Task 2, they agreed or disagreed with simple equations presented either over loudspeakers, as text on the laptop monitor, in both the audio and the visual modalities, or not at all. Accuracy was significantly better by 20% on Task 2 when the equations were presented visually or audiovisually. Scores were at least 78% correct for dichotic phrases presented over the headset, with a right ear advantage of 7%, given the 5 dB speech-to-noise ratio. The left ear disadvantage was particularly apparent in noise, where the interaural difference was 12%. Relatively lower scores in the left ear, in noise, were observed for phrases beginning with Charlie. These findings underscore the benefit of delivering higher priority communications to the dominant ear, the importance of selecting speech sounds that are resilient to noise masking, and the advantage of using text in cases of degraded audio.

Blue force tracking (BFT) is a military technology that provides positional awareness of friendly forces on a digital map through global positioning system (GPS) technology. For dismounted soldiers, having readily available information on the location of friendly forces can be critical for mission success. However, GPS can report positions that are spatially inaccurate. The present study required 36 military participants to lead a team through a simulated mission in a virtual environment. The mission required the participant to find and support friendly forces engaged in a firefight with enemy forces. Participants had a digital map, an unreliable BFT device, or a perfectly reliable BFT device. The results indicated that participants using BFT engaged enemy forces more quickly, used their BFT to gain a wider scope of their environment, and had lower workload. For most measures, there were no significant differences between reliable and unreliable BFT, suggesting that even an unreliable BFT can provide benefits to soldier performance.

Automated target recognition (ATR) technologies are designed to help operators detect and identify potential threats. However, ATRs can generate a high number of false alarms (FA), resulting in low operator trust and potential automation disuse. In this study, we examined whether lowering the level of automation (LOA) of ATR could reduce FAs and support automation compliance and reliance. Participants performed a visual search for a target with or without the help of ATR. The ATR operated at three LOAs and two levels of reliability. The results suggested that the lowest LOA resulted in greater automation compliance and reliance. Operators also performed better in one measure of diagnostic accuracy under the low automation condition. The findings suggest that operating ATR at lower LOAs provide an effective method for improving ATR use and for detecting potential threats.

Supervisory control of uninhabited aerial vehicles requires vigilance, also termed sustained attention. This pilot study investigated the efficacy of short duration vibrotactile signals presented o...