Assessment of Physiological Responses During Field Science Task Performance: Feasibility and Future Needs.

OBJECTIVE: By understanding the physiological demands of different types of tasks that will be performed during extravehicular activity (EVA) on Mars, human performance safety risks can be mitigated. In addition, such understanding can assist in planning EVAs with an appropriate balance of human health and safety with scientific mission return. BACKGROUND: This paper describes the results of a study of technical feasibility performed within a Mars human research analog, with participants conducting scientifically relevant planetary science sample analysis and return tasks in two distinct field locations. METHODS: The authors collected heart rate, respiration rate, and heart rate variability (HRV) data, using commercial off-the-shelf hardware and software from study participants as they performed field science tasks within a concept of operations for a Mars science return human expedition mission. These data were remotely monitored, shared in real time, and later analyzed to identify different responses to different tasks in order to determine if there were any predictable or consistent patterns among participants. RESULTS: It was ultimately determined that, while differences exist between responses to tasks, they are highly subject to multiple sources of individual variability, dynamics of evolving field science tasks, and demands of a demanding physical environment. Further, distributional analyses of participants do not support parametric statistical analysis techniques. CONCLUSION: The authors conclude that the physiology of individual astronauts should be extensively studied and modeled to support individualized automated monitoring tools for each crew member that is sent to Mars. Application: Physiological monitoring for specialized populations will require significant individual-level analysis, baselining, and bootstrap statistical methods to enable appropriate human performance determinations.

Electronic intracavitary brachytherapy quality management based on risk analysis: The report of AAPM TG 182.

PURPOSE: The purpose of this study was to provide guidance on quality management for electronic brachytherapy. MATERIALS AND METHODS: The task group used the risk-assessment approach of Task Group 100 of the American Association of Physicists in Medicine. Because the quality management program for a device is intimately tied to the procedure in which it is used, the task group first designed quality interventions for intracavitary brachytherapy for both commercial electronic brachytherapy units in the setting of accelerated partial-breast irradiation. To demonstrate the methodology to extend an existing risk analysis for a different application, the task group modified the analysis for the case of post-hysterectomy, vaginal cuff irradiation for one of the devices. RESULTS: The analysis illustrated how the TG-100 methodology can lead to interventions to reduce risks and improve quality for each unit and procedure addressed. CONCLUSION: This report provides a model to guide facilities establishing a quality management program for electronic brachytherapy.

Considerations for developing chronic care system for traumatic brain injury based on comparisons of cancer survivorship and diabetes management care.

Experts in traumatic brain injury (TBI) rehabilitation recently proposed the framing of TBI as a chronic disease rather than a discrete event. Within the framework of the Chronic Care Model (CCM), a systematic comparison of three diseases - cancer survivorship, diabetes management and TBI chronic care - was conducted regarding chronic needs and the management of those needs. In addition, comparisons of these conditions require comparative evaluations of disease management characteristics and the survivor concept. The analysis found diabetes is more established within the CCM, where care is integrated across specialists and primary care providers. No single comparison provides a full analogue for understanding the chronic care health delivery system for TBI, indicating the need for a separate model to address needs and resources for TBI survivors. The findings from this research can provide practitioners with a context to develop a robust continued care health system for TBI. Practitioner Summary: We examine development of a chronic care system for traumatic brain injury. We conducted a systematic comparison of Chronic Care Model elements of decision and information support. Development of capabilities using a benchmark of diabetes care, with additional insights from cancer care, provides insights for implementing TBI chronic care systems.

Community health integration through pharmacy process and ergonomics redesign (CHIPPER).

As the expansion and utilisation of community pharmacy systems increases, so does the risk for an adverse drug event to occur. In attempts to mitigate this risk, many community pharmacies implement health information technology (IT); however, there are challenges in integrating the wider systems components necessary for a successful implementation with minimal unintended consequences. The purpose of this paper is to introduce a Community Health Integration through Pharmacy Process and Ergonomics Redesign (CHIPPER) framework, which explores the multiple angles of health IT integration to support medication delivery processes in community pharmacy systems. Specifically, CHIPPER identifies the information flows that occur between different parts of the system (initiation, upstream, midstream and downstream) with varying end-users and tasks related to medication delivery processes. In addition to the justification and presentation of the CHIPPER model, this paper reviews several broad applications for CHIPPER and presents two example studies that demonstrate the CHIPPER framework. Practitioner Summary: Most medication delivery in the US occurs through outpatient-based community pharmacy practice. Community pharmacies are challenged by inconsistent and incomplete information flow and technology integration between providers, pharmacy practitioners and patients. This paper presents a framework for improved healthcare systems engineering analysis of pharmacy practice, with case study examples.

Delays and user performance in human-computer-network interaction tasks.

OBJECTIVE: This article describes a series of studies conducted to examine factors affecting user perceptions, responses, and tolerance for network-based computer delays affecting distributed human-computer-network interaction (HCNI) tasks. BACKGROUND: HCNI tasks, even with increasing computing and network bandwidth capabilities, are still affected by human perceptions of delay and appropriate waiting times for information flow latencies. METHOD: Conducted were 6 laboratory studies with university participants in China (Preliminary Experiments 1 through 3) and the United States (Experiments 4 through 6) to examine users' perceptions of elapsed time, effect of perceived network task performance partners on delay tolerance, and expectations of appropriate delays based on task, situation, and network conditions. RESULTS: Results across the six experiments indicate that users' delay tolerance and estimated delay were affected by multiple task and expectation factors, including task complexity and importance, situation urgency and time availability, file size, and network bandwidth capacity. Results also suggest a range of user strategies for incorporating delay tolerance in task planning and performance. CONCLUSION: HCNI user experience is influenced by combinations of task requirements, constraints, and understandings of system performance; tolerance is a nonlinear function of time constraint ratios or decay. APPLICATION: Appropriate user interface tools providing delay feedback information can help modify user expectations and delay tolerance. These tools are especially valuable when delay conditions exceed a few seconds or when task constraints and system demands are high. Interface designs for HCNI tasks should consider assistant-style presentations of delay feedback, information freshness, and network characteristics. Assistants should also gather awareness of user time constraints.

Tools for developing a quality management program: human factors and systems engineering tools.

During the past 10 years, there has been growing acceptance and encouragement of partnerships between medical teams and engineers. Using human factors and systems engineering descriptions of process flows and operational sequences, the author's research laboratory has helped highlight opportunities for reducing adverse events and improving performance in health care and other high-consequence environments. This research emphasized studying human behavior that enhances system performance and a range of factors affecting adverse events, rather than a sole emphasis on human error causation. Developing a balanced evaluation requires novel approaches to causal analyses of adverse events and, more importantly, methods of recovery from adverse conditions. Recent work by the author's laboratory in collaboration with the Regenstrief Center for Healthcare Engineering has started to address possible improvements in taxonomies describing health care tasks. One major finding includes enhanced understanding of events and how event dynamics influence provider tasks and constraints. Another element of this research examines team coordination tasks that strongly affect patient care and quality management, but may be undervalued as "indirect patient care" activities.

Knowledge sharing and expertise coordination of event response in organizations.

This paper provides an overview of opportunities and challenges for expert coordination, knowledge sharing, and task performance using advanced information and communication technologies. Evolving in part from [Hendrick, H., 1991. Ergonomics in organizational design and management. Ergonomics 34(6), 743-756] discussion of macroergonomics, this paper describes the author's framework for systems engineering analysis of information flow and performance at team and organizational units of analysis. Work in the author's research lab has focused on several aspects of information technology use and team interactions to support shared understandings, task demands, and effective responses in responses to events. Multiple empirical studies are summarized describing evaluations of technology use, task cycles and expert knowledge coordination in several settings, including aerospace, healthcare, and project management.

Augmenting team cognition in human-automation teams performing in complex operational environments.

There is a growing reliance on automation (e.g., intelligent agents, semi-autonomous robotic systems) to effectively execute increasingly cognitively complex tasks. Successful team performance for such tasks has become even more dependent on team cognition, addressing both human-human and human-automation teams. Team cognition can be viewed as the binding mechanism that produces coordinated behavior within experienced teams, emerging from the interplay between each team member's individual cognition and team process behaviors (e.g., coordination, communication). In order to better understand team cognition in human-automation teams, team performance models need to address issues surrounding the effect of human-agent and human-robot interaction on critical team processes such as coordination and communication. Toward this end, we present a preliminary theoretical framework illustrating how the design and implementation of automation technology may influence team cognition and team coordination in complex operational environments. Integrating constructs from organizational and cognitive science, our proposed framework outlines how information exchange and updating between humans and automation technology may affect lower-level (e.g., working memory) and higher-level (e.g., sense making) cognitive processes as well as teams' higher-order "metacognitive" processes (e.g., performance monitoring). Issues surrounding human-automation interaction are discussed and implications are presented within the context of designing automation technology to improve task performance in human-automation teams.

Multi-team dynamics and distributed expertise in imission operations.

The evolution of space exploration has brought an increased awareness of the social and socio-technical issues associated with team performance and task coordination, both for the onboard astronauts and in mission control. Spaceflight operations create a unique environment in which to address classic group dynamics topics including communication, group process, knowledge development and sharing, and time-critical task performance. Mission operations in the early years of the 21st century have developed into a set of complex, multi-team task settings incorporating multiple mission control teams and flight crews interacting in novel ways. These more complex operational settings help highlight the emergence of a new paradigm of distributed supervisory coordination, and the need to consider multiple dimensions of expertise being supported and exchanged among team members. The creation of new mission profiles with very long-duration time scales (months, rather than days) for the International Space Station, as well as planned exploration missions to the Moon and Mars, emphasize fundamental distinctions from the 40 yr from Mercury to the Space Shuttle. Issues in distributed expertise and information flow in mission control settings from two related perspectives are described. A general conceptual view of knowledge sharing and task synchronization is presented within the context of the mission control environment. This conceptual presentation is supplemented by analysis of quasi-experimental data collected from actual flight controllers at NASA-Johnson Space Center, Houston, TX.

Analysis and modeling of information flow and distributed expertise in space-related operations.

Evolving space operations requirements and mission planning for long-duration expeditions require detailed examinations and evaluations of information flow dynamics, knowledge-sharing processes, and information technology use in distributed expert networks. This paper describes the work conducted with flight controllers in the Mission Control Center (MCC) of NASA's Johnson Space Center. This MCC work describes the behavior of experts in a distributed supervisory coordination framework, which extends supervisory control/command and control models of human task performance. Findings from this work are helping to develop analysis techniques, information architectures, and system simulation capabilities for knowledge sharing in an expert community. These findings are being applied to improve knowledge-sharing processes applied to a research program in advanced life support for long-duration space flight. Additional simulation work is being developed to create interoperating modules of information flow and novice/expert behavior patterns.