Utilizing Data and Alarm Champions to Enhance Alarm Management: A Pediatric Quality Improvement Initiative.

BACKGROUND: Nuisance and false alarms distract clinicians from urgent alerts, raising patient safety risks. LOCAL PROBLEM: High alarm rates in a pediatric progressive care unit resulted in experiencing 180-250 alarms per day or 1 alarm every 3 to 4 minutes per clinician. METHODS: Through Plan-Do-Study-Act cycles, environmental, policy, and technology changes were implemented to decrease the average alarms/day/bed and percentage of time in alarm. INTERVENTIONS: Alarm settings tailored to patient needs using features embedded within the patient monitoring system were implemented and monitored with the assistance of alarm champions. RESULTS: The average number of alarms/day/bed decreased from 177.69 to 96.94 over the course of 10 years, a 45.45% reduction. The percentage of time in alarm decreased from 7.52% to 2.83%, a 62.37% reduction. CONCLUSIONS: Arming clinicians with technology to analyze real-time clinical data made alarms meaningful and actionable, decreasing false alarms without compromising patient safety.

Comparison of particle image velocimetry and the underlying agents dynamics in collectively moving self propelled particles.

Collective migration of cells is a fundamental behavior in biology. For the quantitative understanding of collective cell migration, live-cell imaging techniques have been used using e.g., phase contrast or fluorescence images. Particle tracking velocimetry (PTV) is a common recipe to quantify cell motility with those image data. However, the precise tracking of cells is not always feasible. Particle image velocimetry (PIV) is an alternative to PTV, corresponding to Eulerian picture of fluid dynamics, which derives the average velocity vector of an aggregate of cells. However, the accuracy of PIV in capturing the underlying cell motility and what values of the parameters should be chosen is not necessarily well characterized, especially for cells that do not adhere to a viscous flow. Here, we investigate the accuracy of PIV by generating images of simulated cells by the Vicsek model using trajectory data of agents at different noise levels. It was found, using an alignment score, that the direction of the PIV vectors coincides with the direction of nearby agents with appropriate choices of PIV parameters. PIV is found to accurately measure the underlying motion of individual agents for a wide range of noise level, and its condition is addressed.

Modes of information flow in collective cohesion.

Pairwise interactions are fundamental drivers of collective behavior-responsible for group cohesion. The abiding question is how each individual influences the collective. However, time-delayed mutual information and transfer entropy, commonly used to quantify mutual influence in aggregated individuals, can result in misleading interpretations. Here, we show that these information measures have substantial pitfalls in measuring information flow between agents from their trajectories. We decompose the information measures into three distinct modes of information flow to expose the role of individual and group memory in collective behavior. It is found that decomposed information modes between a single pair of agents reveal the nature of mutual influence involving many-body nonadditive interactions without conditioning on additional agents. The pairwise decomposed modes of information flow facilitate an improved diagnosis of mutual influence in collectives.

Transfer entropy dependent on distance among agents in quantifying leader-follower relationships.

Synchronized movement of (both unicellular and multicellular) systems can be observed almost everywhere. Understanding of how organisms are regulated to synchronized behavior is one of the challenging issues in the field of collective motion. It is hypothesized that one or a few agents in a group regulate(s) the dynamics of the whole collective, known as leader(s). The identification of the leader (influential) agent(s) is very crucial. This article reviews different mathematical models that represent different types of leadership. We focus on the improvement of the leader-follower classification problem. It was found using a simulation model that the use of interaction domain information significantly improves the leader-follower classification ability using both linear schemes and information-theoretic schemes for quantifying influence. This article also reviews different schemes that can be used to identify the interaction domain using the motion data of agents.

An information-theoretic approach to infer the underlying interaction domain among elements from finite length trajectories in a noisy environment.

Transfer entropy in information theory was recently demonstrated [Basak et al., Phys. Rev. E 102, 012404 (2020)] to enable us to elucidate the interaction domain among interacting elements solely from an ensemble of trajectories. Therefore, only pairs of elements whose distances are shorter than some distance variable, termed cutoff distance, are taken into account in the computation of transfer entropies. The prediction performance in capturing the underlying interaction domain is subject to the noise level exerted on the elements and the sufficiency of statistics of the interaction events. In this paper, the dependence of the prediction performance is scrutinized systematically on noise level and the length of trajectories by using a modified Vicsek model. The larger the noise level and the shorter the time length of trajectories, the more the derivative of average transfer entropy fluctuates, which makes the identification of the interaction domain in terms of the position of global minimum of the derivative of average transfer entropy difficult. A measure to quantify the degree of strong convexity at the coarse-grained level is proposed. It is shown that the convexity score scheme can identify the interaction distance fairly well even while the position of the global minimum of the derivative of average transfer entropy does not. We also derive an analytical model to explain the relationship between the interaction domain and the change in transfer entropy that supports our cutoff distance technique to elucidate the underlying interaction domain from trajectories.

Inferring domain of interactions among particles from ensemble of trajectories.

An information-theoretic scheme is proposed to estimate the underlying domain of interactions and the timescale of the interactions for many-particle systems. The crux is the application of transfer entropy which measures the amount of information transferred from one variable to another, and the introduction of a "cutoff distance variable" which specifies the distance within which pairs of particles are taken into account in the estimation of transfer entropy. The Vicsek model often studied as a metaphor of collectively moving animals is employed with introducing asymmetric interactions and an interaction timescale. Based on ensemble data of trajectories of the model system, it is shown that using the interaction domain significantly improves the performance of classification of leaders and followers compared to the approach without utilizing knowledge of the domain. Given an interaction timescale estimated from an ensemble of trajectories, the first derivative of transfer entropy averaged over the ensemble with respect to the cutoff distance is presented to serve as an indicator to infer the interaction domain. It is shown that transfer entropy is superior for inferring the interaction radius compared to cross correlation, hence resulting in a higher performance for inferring the leader-follower relationship. The effects of noise size exerted from environment and the ratio of the numbers of leader and follower on the classification performance are also discussed.

Erratum: Inferring domain of interactions among particles from ensemble of trajectories [Phys. Rev. E 102, 012404 (2020)].

This corrects the article DOI: 10.1103/PhysRevE.102.012404.

Using periodic orbits to compute chaotic transport rates between resonance zones.

Transport properties of chaotic systems are computable from data extracted from periodic orbits. Given a sufficient number of periodic orbits, the escape rate can be computed using the spectral determinant, a function that incorporates the eigenvalues and periods of periodic orbits. The escape rate computed from periodic orbits converges to the true value as more and more periodic orbits are included. Escape from a given region of phase space can be computed by considering only periodic orbits that lie within the region. An accurate symbolic dynamics along with a corresponding partitioning of phase space is useful for systematically obtaining all periodic orbits up to a given period, to ensure that no important periodic orbits are missing in the computation. Homotopic lobe dynamics (HLD) is an automated technique for computing accurate partitions and symbolic dynamics for maps using the topological forcing of intersections of stable and unstable manifolds of a few periodic anchor orbits. In this study, we apply the HLD technique to compute symbolic dynamics and periodic orbits, which are then used to find escape rates from different regions of phase space for the Hénon map. We focus on computing escape rates in parameter ranges spanning hyperbolic plateaus, which are parameter intervals where the dynamics is hyperbolic and the symbolic dynamics does not change. After the periodic orbits are computed for a single parameter value within a hyperbolic plateau, periodic orbit continuation is used to compute periodic orbits over an interval that spans the hyperbolic plateau. The escape rates computed from a few thousand periodic orbits agree with escape rates computed from Monte Carlo simulations requiring hundreds of billions of orbits.

Using heteroclinic orbits to quantify topological entropy in fluid flows.

Topological approaches to mixing are important tools to understand chaotic fluid flows, ranging from oceanic transport to the design of micro-mixers. Typically, topological entropy, the exponential growth rate of material lines, is used to quantify topological mixing. Computing topological entropy from the direct stretching rate is computationally expensive and sheds little light on the source of the mixing. Earlier approaches emphasized that topological entropy could be viewed as generated by the braiding of virtual, or "ghost," rods stirring the fluid in a periodic manner. Here, we demonstrate that topological entropy can also be viewed as generated by the braiding of ghost rods following heteroclinic orbits instead. We use the machinery of homotopic lobe dynamics, which extracts symbolic dynamics from finite-length pieces of stable and unstable manifolds attached to fixed points of the fluid flow. As an example, we focus on the topological entropy of a bounded, chaotic, two-dimensional, double-vortex cavity flow. Over a certain parameter range, the topological entropy is primarily due to the braiding of a period-three orbit. However, this orbit does not explain the topological entropy for parameter values where it does not exist, nor does it explain the excess of topological entropy for the entire range of its existence. We show that braiding by heteroclinic orbits provides an accurate computation of topological entropy when the period-three orbit does not exist, and that it provides an explanation for some of the excess topological entropy when the period-three orbit does exist. Furthermore, the computation of symbolic dynamics using heteroclinic orbits has been automated and can be used to compute topological entropy for a general 2D fluid flow.