On the Interplay of Data and Cognitive Bias in Crisis Information Management: An Exploratory Study on Epidemic Response.

Humanitarian crises, such as the 2014 West Africa Ebola epidemic, challenge information management and thereby threaten the digital resilience of the responding organizations. Crisis information management (CIM) is characterised by the urgency to respond despite the uncertainty of the situation. Coupled with high stakes, limited resources and a high cognitive load, crises are prone to induce biases in the data and the cognitive processes of analysts and decision-makers. When biases remain undetected and untreated in CIM, they may lead to decisions based on biased information, increasing the risk of an inefficient response. Literature suggests that crisis response needs to address the initial uncertainty and possible biases by adapting to new and better information as it becomes available. However, we know little about whether adaptive approaches mitigate the interplay of data and cognitive biases. We investigated this question in an exploratory, three-stage experiment on epidemic response. Our participants were experienced practitioners in the fields of crisis decision-making and information analysis. We found that analysts fail to successfully debias data, even when biases are detected, and that this failure can be attributed to undervaluing debiasing efforts in favor of rapid results. This failure leads to the development of biased information products that are conveyed to decision-makers, who consequently make decisions based on biased information. Confirmation bias reinforces the reliance on conclusions reached with biased data, leading to a vicious cycle, in which biased assumptions remain uncorrected. We suggest mindful debiasing as a possible counter-strategy against these bias effects in CIM.

Human subject evaluation of the controlled resistance exercise device (C-red) for spaceflight.

Resistance exercise is an effective countermeasure to the muscle and bone atrophy associated with the unloading experienced during spaceflight. Long duration spaceflight will require compact exercise devices that are capable of delivering sufficient loading to prevent physiological losses while meeting strict mass and volume requirements. Accordingly, a controlled resistance exercise device (C-RED), developed as an advanced exercise concept for NASA, uses an electric motor for resistance and is programmed to simulate inertial loading based on barbell acceleration and desired resistance mass. The barbell acts as a movable pulley increasing efficiency by doubling the created load. Human subject testing of the functionality of the device was conducted in a laboratory at NASA’s Johnson Space Center. Subjects performed ten resistance exercises typically used by astronauts at three freely chosen load levels. The results indicate that subjects were able to perform all exercises with resistance loads that were typical to those used in the gymnasium with loads ranges of 4-1600 N, and bilateral symmetry of ground reaction force was quantified for the deadlift. A survey also was given to each subject to allow the users to express their opinions regarding the device. The subject questionnaire showed that the dumbbell attachment exercises were preferred to the barbell exercises. The positive preliminary results indicate promise for the device.

Automated testing of the controlled resistance exercise device (C-red) for spaceflight.

Resistance exercise is an effective countermeasure to the muscle and bone atrophy associated with the unloading experienced during spaceflight. Accordingly, the Controlled Resistance Exercise Device (C-RED) developed for NASA uses an electric motor for resistance and capitalizes upon a two-to-one mechanical advantage by loading only one side of the barbell. While this allows for a reduction in the required motor size and weight, the ground reaction force from previous human subject studies has shown higher loads on the motor side, which could be accentuated by the person’s unilateral strength bias or lifting technique. Therefore, an automated testing system was developed to test the bilateral symmetry of only the device without human bias. In addition, the effect of the winching material (cord or strap) on the bilateral symmetry of loading was explored. Findings show that cord leads to a more symmetric loading but is prone to fraying and subsequent breaking below the specified strength. Straps have higher strength and wear resistance properties but lead to slightly less symmetric loading outcomes. In general, the C-RED retains some asymmetric loading regardless of winching material; however the marginally higher bilateral asymmetry of the strap is offset by the gains in strength and wear resistance.

Universal intravenous access cleaning device fails to sterilize stopcocks.

BACKGROUND: Contamination of a central venous catheter may occur through use of conventional open-lumen stopcock devices (COLDs), or disinfectable, needleless, closed connectors (DNCCs). We investigated the effectiveness of a new universal IV access cleaning device (Site-Scrub) compared with 70% isopropyl alcohol prep pads for sanitizing COLDs or DNCCs inoculated with common catheter-associated pathogens. METHODS: Site-Scrub was compared with 70% alcohol prep pads for sanitizing contaminated female Luer lock COLD or DNCC filled with sterile saline or propofol and 2 common bacterial central venous catheter contaminants (Staphylococcus epidermidis or Pseudomonas aeruginosa). Devices were contaminated using a glove touch (COLD and DNCC) or syringe tip (COLD). The primary end point of the study was colony-forming units (CFU) after 24 hours. RESULTS: The use of glove touch contamination, the contaminants, S epidermidis and P aeruginosa, produced CFU in saline-filled COLDs treated with the Site-Scrub, but not in those treated with alcohol pads (P < 0.001). Similar results were observed with propofol-filled COLDs (P < 0.001). For DNCCs filled with saline or propofol, both alcohol and Site-Scrub effectively reduced CFU growth compared with contaminated controls (P < 0.001). When COLDs were contaminated by treated syringe tips, there was no significant evidence of reduction in CFU growth by using either alcohol pads or Site-Scrub compared with contaminated controls. CONCLUSIONS: These data suggest that when the inner surface of the COLD is contaminated, both alcohol pads and Site-Scrub were not significantly effective in decontaminating the COLD. When the COLD rim is contaminated, however, alcohol pads outperform Site-Scrub. DNCCs were uniformly decontaminated with either treatment. Future work should focus on better access systems because current COLDs are difficult to decontaminate.

Bilateral symmetry of ground reaction force with a motor-controlled resistance exercise system using a mechanical advantage barbell for spaceflight.

The reduced gravity experienced during spaceflight leads to muscle and bone atrophy, and resistance exercise has proven to be an effective countermeasure. Thus, a compact computer-controlled electric-motor resistance exercise system is being developed for NASA. In order to save power, space, and weight, the torque specifications of the motor were reduced by half because of a unique barbell design that employs a two-to-one mechanical advantage. Since the force-generating motor is on one side of the barbell, there is the potential for asymmetric barbell loading. Therefore, the purpose of this preliminary study is to compare the unilateral ground reaction forces (GRF) of the new barbell of the motor and ground sides. Multiple repetitions of fixed tempo deadlift exercise were performed with motor-controlled resistance using the new barbell. Unilateral GRF data was measured with a force plate under each foot, and the readings from each force plate are compared to each other. Results indicate the mechanical advantage barbell exercises have bilaterally asymmetric GRF compared to a theoretical 50-50 split, and the astronauts would need to alternate the left-right orientation to compensate for the asymmetry.

Comparison of isoinertial to simulated inertial force from a controlled resistance exercise device for spaceflight - biomed 2011.

Spaceflight leads to muscle and bone atrophy, and isoinertial (free-weight) exercises provide a sufficient stimulus to elicit increases in both muscle strength and bone mineral density in earth-based studies. Therefore, a computer controlled resistance exercise device is being developed for NASA that is able to simulate the inertial loading experienced when lifting a mass on earth. The ground reaction force with the device is compared to the ground reaction force measured during isoinertial dead-lifts over a full spectrum of resistance levels. Results indicate promise of adequately simulating the inertial effects experienced during terrestrial exercise by compensating for the difference by calibrating the control signal with the addition of (-7.27 + 0.03*desired resistance level) percent to the base desired resistance level.

Thermal damage of the humidified ventilator circuit in the operating room: an analysis of plausible causes.

Fire in the operating room is a rare but potentially devastating event. In this case report, we describe 2 separate fires of a Westmed heated humidification circuit. We conducted a detailed analysis of potential causes of the fires, including a simulation and series of experiments. Our conclusions were (1) a combination of factors led to the fires; and (2) substantial changes in the design could decrease, but may not completely eliminate, the risk of operating room fire.

Ground reaction force comparison of controlled resistance methods to isoinertial loading of the squat exercise - biomed 2010.

The ground reaction force during the concentric (raising) portion of the squat exercise was compared to that of isoinertial loading (free weights) for three pneumatically controlled resistance methods: constant resistance, cam force profile, and proportional force control based on velocity. Constant force control showed lower ground reaction forces than isoinertial loading throughout the range of motion (ROM). The cam force profile exhibited slightly greater ground reaction forces than isoinertial loading at 10 and 40% ROM with fifty-percent greater loading at 70% ROM. The proportional force control consistently elicited greater ground reaction force than isoinertial loading, which progressively ranged from twenty to forty percent increase over isoinertial loading except for being approximately equal at 85% ROM. Based on these preliminary results, the proportional control shows the most promise for providing loading that is comparable in magnitude to isoinertial loading. This technology could optimize resistance exercise for sport-specific training or as a countermeasure to atrophy during spaceflight.

Ground reaction force comparison of bilateral symmetry with pneumatic resistance squat device and free weights - biomed 2009.

UNLABELLED: The unloading of spaceflight leads to bone and muscle atrophy, and a pneumatic resistance squat exercise countermeasure has the potential to provide optimized controllable resistance in a lightweight and compact configuration. However each end of the barbell in the proposed device is connected to a separate resistance cylinder which could lead to bilaterally asymmetric loading. Therefore, the purpose of the study is to compare the unilateral ground reaction forces (GRF) of the new squat device compared to free weights. METHODS: Four previously trained men (mean +/- SD; age = 20+/-2 years, body mass = 99+/-18 kg) performed three sets of three repetitions of maximal exertion squat exercises with pneumatically controlled constant resistance and free weights each with a resistance level set to half of the body weight of each subject. Unilateral GRF data for each lifting modality at the negative to positive transition of the squat exercise was measured with a force plate under each foot. RESULTS: The pneumatic resistance GRF (N; mean +/- SD) was 749+/-114 on the left leg and 786+/-123 on the right leg and the free weight GRF was 786+/-114 left and 861+/-111 right resulting in a 5% difference between left and right GRF with pneumatics and 9% difference with free weights. The correlation coefficient between left and right GRF was 0.92 with pneumatics and 0.80 with free weights. CONCLUSION: Because the pneumatic device elicited more bilaterally symmetric GRF than traditional free weights, the separate resistance cylinders are an acceptable design configuration.

Validity and reliability of a controlled pneumatic resistance exercise device.

During the concentric portion of the free-weight squat exercise, accelerating the mass from rest results in a fluctuation in ground reaction force. It is characterized by an initial period of force greater than the load while accelerating from rest followed by a period of force lower than the external load during negative acceleration. During the deceleration phase, less force is exerted and muscles are loaded sub-optimally. Thus, using a reduced inertia form of resistance such as pneumatics has the capability to minimize these inertial effects as well as control the force in real time to maximize the force exerted over the exercise cycle. To improve the system response of a preliminary design, a squat device was designed with a reduced mass barbell and two smaller pneumatic cylinders. The resistance was controlled by regulating cylinder pressure such that it is capable of adjusting force within a repetition to maximize force exerted during the lift. The resistance force production of the machine was statically validated with the input voltage and output force R2 =0.9997 for at four increments of the range of motion, and the intraclass correlation coefficient (ICC) between trials at the different heights equaled 0.999. The slew rate at three forces was 749.3 N/s +/- 252.3. Dynamic human subject testing showed the desired input force correlated with average and peak ground reaction force with R2 = 0.9981 and R2 = 0.9315, respectively. The ICC between desired force and average and peak ground reaction force was 0.963. Thus, the system is able to deliver constant levels of static and dynamic force with validity and reliability. Future work will be required to develop the control strategy required for real-time control, and performance testing is required to determine its efficacy.

Interactive variable resistance exercise system concept and preliminary results.

In order to maximize loading during resistance exercise, muscles should be heavily taxed throughout the entire range of motion for that exercise. Traditional constant resistance squats only tax the lower-extremity muscles to their limits at the "sticking region" or a critical joint configuration of the exercise cycle. Therefore, a Smith machine was modified for pneumatic resistance with appropriate computer control so that it is capable of adjusting force within a repetition of the squat exercise. The control program was designed to increase the loading after accelerating to a specified lifting velocity which indicates increased strength capacity from being past the sticking region. Human subject testing showed the percent increase from initial to final resistance level normalized by body and barbell weight was an average of 14% (+/-5%) for men and 29% (+/-14%) for women with both separately showing a significant increase in resistance level (p>0.00005 each). The men had significantly higher initial (p=0.007) and final (p=0.04) normalized resistance levels than the women. This investigation indicates that interactive variable resistance exercise is capable of significantly increasing the loading after a desired instantaneous velocity is reached; however, further performance testing is required to determine its efficacy.

Peak lifting velocities of men and women for the reduced inertia squat exercise using force control.

The purpose of the research was to determine peak velocities for the reduced inertia squat exercise at various resistance levels based on an isometric strength assessment for both men and women. On a Smith machine modified for pneumatic resistance, 12 males and 12 females previously trained college-age participants performed a maximal isometric strength assessment with knee angles of 90 degrees , 110 degrees , 130 degrees , 150 degrees and 170 degrees (180 degrees = full extension) followed by dynamic maximal effort squats with resistance maintained at 40, 50, 60, 70, and 80% of their lowest maximum isometric strength. No interaction existed between the men and women during isometric strength tests with the men stronger in every joint position (P < 0.05). The lowest isometric strength occurred at 90 degrees without variation. There was an interaction between men and women for peak lifting velocity during the dynamic lifts (P = 0.021) with the men producing higher velocities at all levels of resistance (P < 0.05). The difference in peak velocity between the sexes was greatest at the lowest resistance level and that difference was less significant at the higher resistance levels. The relationship between resistance force and peak lifting velocity is applicable to increasing the efficiency of the squat by maximizing force output per repetition by varying the resistance as the lifter approaches peak velocity similar to isokinetics with preloading and active instead of reactive resistance.

Reducing the incidence of surgical fires: supplying nasal cannulae with sub-100% O2 gas mixtures from anesthesia machines.

In June 2003, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) recommended: "As a general policy, use air or FiO2 at < or =30% for open delivery (consistent with patient needs)" to prevent surgical fires. One way to interpret JCAHO's recommendation is that 100% O2 should not be indiscriminately used, and anesthesia providers should have the ability, consistent with patient needs and their clinical judgment, to deliver sub-100% O2 with nasal cannulae. An auxiliary O2 flowmeter has a barbed outlet connector that offers a convenient means to connect a cannula to an anesthesia machine and is routinely used for open delivery of 100% O2. The auxiliary O2 flowmeter provides only 100% O2 and thus does not allow titration of the O2 concentration to patient needs and may increase the risk of surgical fires. This report clarifies the JCAHO recommendation and describes different means of addressing it that are based primarily on using the anesthesia machine to blend a sub-100% O2 gas mixture and delivering it via a nasal cannula. The options presented depend on the model and manufacturer of the anesthesia machine and allow delivery via nasal cannula of O2 concentrations that range from 21% to 100%.

Pneumatic strength assessment device: design and isometric measurement.

In order to load a muscle optimally during resistance exercise, it should be heavily taxed throughout the entire range of motion for that exercise. However, traditional constant resistance squats only tax the lower-extremity muscles to their limits at the "sticking region" or a critical joint configuration of the exercise cycle. Therefore, a linear motion (Smith) exercise machine was modified with pneumatics and appropriate computer control so that it could be capable of adjusting force to control velocity within a repetition of the squat exercise or other exercise performed with the device. Prior to application of this device in a dynamic squat setting, the maximum voluntary isometric force (MVIF) produced over a spectrum of knee angles is needed. This would reveal the sticking region and overall variation in strength capacity. Five incremental knee angles (90, 110, 130, 150, and 170 degrees, where 180 degrees defined full extension) were examined. After obtaining university-approved informed consent, 12 men and 12 women participated in the study. The knee angle was set, and the pneumatic cylinder was pressurized such that the subject could move the barbell slightly but no more than two-centimeters. The peak pressure exerted over a five-second maximum effort interval was recorded at each knee angle in random order and then repeated. The average of both efforts was then utilized for further analysis. The sticking region occurred consistently at a 90 degrees knee angle, however, the maximum force produced varied between 110 degrees and 170 degrees with the greatest frequency at 150 degrees for both men and women. The percent difference between the maximum and minimum MVIF was 46% for men and 57% for women.

Carcinoid heart disease: a case report and literature review.

We report a patient who presented for elective exploratory laparotomy, and resection of a pelvic mass, which was thought to be ovarian carcinoma. Intraoperative transesophageal echocardiography demonstrated right-sided valvular heart lesions, which suggested the diagnosis of carcinoid syndrome before a pathologic confirmation was obtained. This article discusses the classical presentation and anesthetic management of patients with carcinoid syndrome and emphasizes the importance of proper preoperative diagnosis and careful planning if the incidence and severity of the symptoms that this condition can provoke are to be reduced.