Can teamwork and situational awareness (SA) in ED resuscitations be improved with a technological cognitive aid? Design and a pilot study of a team situation display.

Effective teamwork in ED resuscitations, including information sharing and situational awareness, could be degraded. Technological cognitive aids can facilitate effective teamwork. OBJECTIVE: This study focused on the design of an ED situation display and pilot test its influence on teamwork and situational awareness during simulated resuscitation scenarios. MATERIAL AND METHODS: The display design consisted of a central area showing the critical dynamic parameters of the interventions with an events time-line below it. Static information was placed at the sides of the display. We pilot tested whether the situation display could lead to higher scores on the Clinical Teamwork Scale (CTS), improved scores on a context-specific Situational Awareness Global Assessment Technique (SAGAT) tool, and team communication patterns that reflect teamwork and situational awareness. RESULTS: Resuscitation teamwork, as measured by the CTS, was overall better with the presence of the situation display as compared with no situation display. Team members discussed interventions more with the situation display compared with not having the situation display. Situational awareness was better with the situation display only in the trauma scenario. DISCUSSION: The situation display could be more effective for certain ED team members and in certain cases. CONCLUSIONS: Overall, this pilot study implies that a situation display could facilitate better teamwork and team communication in the resuscitation event.

Lower pharyngeal wall coarticulation in VCV syllables.

Speech movements of the lower pharyngeal wall were recorded in two subjects using pulsed-echo ultrasound. The focus of the study was the pattern of coarticulation of pharyngeal wall movements. Using nonsense utterances as test material, both anticipatory and carryover coarticulatory effects were observed. The identity of the final vowel in VCV sequences affected the kinematic characteristics of the initial VC transition. Both the amplitude and the duration of the movement between the initial vowel and the consonant were greater when the final vowel was /u/ rather than /a/. Similarly, the initial vowel affected the kinematic characteristics of the final CV transition. The amplitude of the movement from the consonant to the final vowel was greater with the initial vowel /u/ as opposed to /a/. The coarticulatory patterns observed in this study are similar to those previously reported for the tongue dorsum and upper pharynx [Parush et al., J. Acoust. Soc. Am. 74, 1115-1125 (1983); Parush and Ostry, J. Acoust. Soc. Am. 80, 749-756 (1986)].

Superior lateral pharyngeal wall movements in speech.

Medial movements of the lateral pharyngeal wall at the level of the velopharyngeal port were examined by using a computerized ultrasound system. Subjects produced CVNVC sequences involving all combinations of the vowels /a/ and /u/ and the nasal consonants /n/ and /m/. The effects of both vowels on the CVN and NVC gestures (opening and closing of the velopharyngeal port, respectively) were assessed in terms of movement amplitude, duration, and movement onset time. The amplitude of both opening and closing gestures of the lateral pharyngeal wall was less in the context of the vowel /u/ than the vowel /a/. In addition, the onset of the opening gesture towards the nasal consonant was related to the identity of both the initial and the final vowels. The characteristics of the functional coupling of the velum and lateral pharyngeal wall in speech are discussed.

Characteristics of velocity profiles of speech movements.

The control of individual speech gestures was investigated by examining laryngeal and tongue movements during vowel and consonant production. A number of linguistic manipulations known to alter the durational characteristics of speech (i.e., speech rate, lexical stress, and phonemic identity) were tested. In all cases a consistent pattern was observed in the kinematics of the laryngeal and tongue gestures. The ratio of maximum instantaneous velocity to movement amplitude, a kinematic index of mass-normalized stiffness, was found to increase systematically as movement duration decreased. Specifically, the ratio of maximum velocity to movement amplitude varied as a function of a parameter, C, times the reciprocal of movement duration. The conformity of the data to this relation indicates that durational change is accomplished by scalar adjustment of a base velocity form. These findings are consistent with the idea that kinematic change is produced by the specification of articulator stiffness.

A kinematic study of lingual coarticulation in VCV sequences.

Intra-articulator anticipatory and carryover coarticulation were assessed in both temporal and spatial terms. Three subjects produced VCV sequences with velar stop consonants and back vowels. Pulsed ultrasound was used to examine the vertical displacement, duration, and maximum velocity of the tongue dorsum raising (VC transition) and lowering (CV transition) gestures. Anticipatory coarticulation was primarily temporal for two subjects, with decreases in the duration of the VC transition accompanying increases in displacement for the CV transition. Carryover coarticulation was primarily spatial for all three subjects, with decreases in CV displacement and maximum velocity accompanying increases in VC displacement. It is suggested that these intra-articulator patterns can be accounted for in terms of an interaction between the raising gesture and a vowel-specific onset time of the lowering gesture towards the vowel. The implications of this kinematic characterization are discussed.

Similarities in the control of the speech articulators and the limbs: kinematics of tongue dorsum movement in speech.

The kinematics of tongue dorsum movements in speech were studied with pulsed ultrasound to assess similarities in the voluntary control of the speech articulators and the limbs. The stimuli were consonant--vowel syllables in which speech rate and stress were varied. The kinematic patterns for tongue dorsum movements were comparable to those observed in the rapid movement of the arms and hands. The maximum velocity of tongue dorsum raising and lowering was correlated with the extent of the gesture. The slope of the relationship differed for stressed and unstressed vowels but was unaffected by differences in speech rate. At each stress level the correlation between displacement and peak velocity was accompanied by a relatively constant interval from the initiation of the movement to the point of maximum velocity. The data are discussed with reference to systems that can be described with second-order differential equations. The increase in the slope of the displacement/peak-velocity relationship for unstressed versus stressed vowels is suggestive of a tonic increase in articulator stiffness. Variations in displacement are attributed to the level of phasic activity in the muscles producing the gesture.