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Sources of situation awareness errors in aviation.

BACKGROUND: Situation Awareness (SA) is a crucial factor in effective decision-making, especially in the dynamic flight environment. Consequently, an understanding of the types of SA errors that occur in this environment is beneficial. METHODS: This study uses reports from the Aviation Safety Reporting System (ASRS) database (accessed by the term "situational awareness") to investigate the types of SA errors that occur in aviation. The errors were classified into one of three major categories: Level 1 (failure to correctly perceive the information), Level 2 (failure to comprehend the situation), or Level 3 (failure to project the situation into the future). RESULTS: Of the errors identified, 76.3% were Level 1 SA errors, 20.3% were Level 2, and 3.4% were Level 3. Level 1 SA errors occurred when relevant data were not available, when data were hard to discriminate or detect, when a failure to monitor or observe data occurred, when presented information was misperceived, or when memory loss occurred. Level 2 SA errors involved a lack of or an incomplete mental model, the use of an incorrect mental model, over-reliance on default values, and miscellaneous other factors. Level 3 errors involved either an overprojection of current trends or miscellaneous other factors. CONCLUSIONS: These results give an indication of the types and frequency of SA errors that occur in aviation, with failure to monitor or observe available information forming the largest single category. Many other causal factors are also indicated, however, including vigilance, automation problems, and poor mental models.

Accidents, Aviation↗

The use of diode array spectroradiometers for dosimetry in phototherapy.

An evaluation of two diode array radiometers, an UV spectroradiometer, Type SC-MP-A, from 4D Controls (Redruth, UK) and an USB2000-UV-VIS spectrometer from Ocean Optics (Duiven, NL), was carried out at the Photobiology Unit, University of Dundee. Three parameters of the instruments' performance were investigated, having been identified as the most likely sources of error in phototherapy dosimetry: (1) calibration, (2) stray light rejection, (3) angular response. An assessment was then made of the reliability of this type of instrument for dosimetry in clinical practice by measurement of a selection of phototherapy sources, in direct comparison with calibrated radiometers. Both instruments were found to have significant stray light levels (SC: 13% and USB: 39%). The use of stray light compensation and a high output calibration source improves accuracy to within acceptable limits. Angular responses were satisfactory: f2 values (+/- 60 degrees) of 5.9% and 7.8% for SC and USB, respectively. The SC spectroradiometer is supplied as a calibrated instrument. Using the supplied calibration resulted in errors in measuring phototherapy sources of up to 44% in UVA. Alternative calibration reduced the error in measuring UVA and UVB sources to within 12%. The USB spectrometer was found to have insufficient responsivity in both UVB and UVA to provide reproducible measurements of most phototherapy sources.

Equipment Failure Analysis↗

The delayed diagnosis of breast cancer: medicolegal implications and risk prevention for surgeons.

The delayed diagnosis of breast cancer is a leading source of error in clinical practice, and an important cause of medical malpractice claims for surgeons and other clinicians. If clinical situations frequently leading to the delayed diagnosis of breast cancer could be predicted, misdiagnosis could be avoided more easily. Therefore, a policy of risk prevention should focus on understanding which group of patients fall into a high-risk profile for diagnostic errors, and why physicians commonly commit errors when evaluating these specific patients. Drawing on multiple sources of medical malpractice information, a profile of high-risk for misdiagnosis was created and analyzed. We have identified a "Triad of Error" for misdiagnosed breast cancer, involving (1) young patients, with (2) self-discovered breast masses, and (3) negative mammograms. The "Triad of Error" accounts for the majority of cases of misdiagnosed breast cancer. An understanding by surgeons and other clinicians of the clinical, biological, and technical basis for the "Triad of Error", and how these factors interact to produce misdiagnoses, should lead to more rapid diagnosis of breast cancer, and fewer medical liability claims. The surgeon plays a central role in preventing the delayed diagnosis of breast cancer by interrupting this cycle of diagnostic error, through the use of tissue sampling techniques that rapidly establish a definitive diagnosis of breast abnormalities.

Journal Article↗

A multisolution method of phase determination by combined maximization of entropy and likelihood. VI. The use of error-correcting codes as a source of phase permutation and their application to the phase problem in powder, electron and macromolecular crystallography.

The use of error-correcting codes as a source of efficient designs of phase permutation schemes is described. Three codes are used, all taken from the Bricogne BUSTER program [Bricogne (1993). Acta Cryst. D49, 37-60]: the Hamming [7, 4, 3], the Nordström-Robinson (16, 256, 6) and the Golay [24, 12, 8] or its punctured [23, 12, 7] form. These are used in a maximum-entropy-likelihood phasing environment to carry out phase permutation of basis-set reflections instead of the usual quadrant permutation or magic integer approaches. The use of codes in this way inevitably introduces some errors in the phase choices, but for most structures this is not significant especially when the gain in sampling efficiency is considered. For example, the Golay [24, 14, 8] allows the permutation of 24 centric phases in such a way that only 4096 phase sets are produced instead of 2(24) = 16777216, and one of these sets has, at most, only four wrong phases. The method is successfully applied to three powder diffraction data sets of increasing complexity, and with increasing degrees of overlap {Mg(3)BN(3), Sigma-2 ([Si(64)O(128)].4C(10)H(17)N) and the NU-3 zeolite}, a sparse electron diffraction data set for buckminsterfullerene, C(60), and the small protein molecule crambin at 3 Å resolution where 42 reflections are phased with a Uweighted mean phase error of 58.5 degrees.

Journal Article↗

Standardized initial head position in cervical range-of-motion assessment: reliability and error analysis.

OBJECTIVE: To assess the clinical reliability and precision of the OSI CA-6000 Spinal Motion Analyzer for measurement of range of motion in cervical spines of pain-free subjects by using a novel procedure designed to minimize variability and quantitatively evaluate sources of errors. METHODS: Twenty asymptomatic volunteer subjects were evaluated twice by each of two trained examiners in one session. Subject position was carefully standardized. Rotation, lateral bending, and flexion-extension were evaluated in repeated movements (cycles) from extreme to extreme. ANALYSIS: Descriptive statistics and reliability coefficients (interclass correlation coefficients [ICCs]) were calculated for all full- and half-cycle motions. Possible sources of systematic errors were evaluated, and random errors were estimated. RESULTS: ICCs indicate that the instrument performs very reliably for rotation and lateral bending (0.93-0.97) and acceptably for flexion-extension (0.75-0.93) measurements. Differences in instrument placement, subject posture, or both in different trials correlate neither with differences in measured values nor with variances. Within-trial errors did not correlate with ranges of motion. Standardizing head position resulted in increases in reliability of from 3% to 15% for axial rotation and lateral bending but actually decreased the ICCs for flexion-extension (up to 14%) compared with data collected under a less-stringent protocol. Errors in clinical use are estimated at 4.5 degrees. CONCLUSIONS: By using our modifications to the accessories and standardization of subject position, the CA-6000 is a highly precise and reliable instrument for measuring active cervical motion about the 3 Cartesian axes. Individuals can repeat the same patterns of motion in sequential trials on the same day with very little variation. Ease of repetitious measurement without examiner intervention contributes to the instrument's ability to obtain highly reliable data. Changes in instrument placement or subject body posture between trials do not give rise to systematic errors. Design of the instrument for flexion-extension could be improved.

Adult↗

Response and nonresponse bias in oral health surveys.

Oral health surveys are undertaken to provide estimates of the dental health and behaviors of populations or population subgroups. However, the integrity of the data from sample surveys may be compromised by one or more sources of sampling and nonsampling error. An important source of nonsampling error is the failure to collect data from some of the individuals comprising the sample. Consequently, the response to a sample survey, and the direction and magnitude of bias induced by nonresponse, need to be taken into account when using estimates derived from sample surveys. Although the response rate to a survey is usually used as an indicator of the quality of the data it provides, nonresponse error is a function of nonresponse and the extent of differences in the characteristics of responders and nonresponders. Nonresponse may be managed in two ways. The first is to reduce nonresponse to a minimum using response-enhancement strategies. The second is the post-survey adjustment of data using weighting or imputation techniques to produce estimates that correct for nonresponse. This paper discusses issues concerning response and nonresponse bias in oral health surveys and provides guidelines on the management and reporting of nonresponse. It describes response-enhancement strategies to reduce noncontacts and refusals, sources of data to facilitate the comparison of responders and nonresponders, methods of assessing the degree of bias induced by nonresponse, techniques for producing adjusted survey estimates, and the assumptions on which these procedures and processes are based.

Bias↗

Exposure-measurement error is frequently ignored when interpreting epidemiologic study results.

INTRODUCTION: One important source of error in study results is error in measuring exposures. When interpreting study results, one should consider the impact that exposure-measurement error (EME) might have had on study results. METHODS: To assess how often this consideration is made and the form it takes, journal articles were randomly sampled from original articles appearing in the American Journal of Epidemiology and Epidemiology in 2001, and the International Journal of Epidemiology between December 2000 and October 2001. RESULTS: Twenty-two (39%) of the 57 articles surveyed mentioned nothing about EME. Of the 35 articles that mentioned something about EME, 16 articles described qualitatively the effect EME could have had on study results. Only one study quantified the impact of EME on study results; the investigators used a sensitivity analysis. Few authors discussed the measurement error in their study in any detail. CONCLUSIONS: Overall, the potential impact of EME on error in epidemiologic study results appears to be ignored frequently in practice.

Bias↗

Nonresponse error in injury-risk surveys.

BACKGROUND: Nonresponse is a potentially serious source of error in epidemiologic surveys concerned with injury control and risk. This study presents the findings of a records-matching approach to investigating the degree to which survey nonresponse may bias indicators of violence-related and unintentional injuries in a random-digit-dialed (RDD) telephone survey. METHODS: Data from a statewide RDD survey of 4155 individuals aged 16 years and older conducted in Illinois in 2003 were merged with ZIP code-level data from the 2000 Census. Using hierarchical linear models, ZIP code-level indicators were used to predict survey response propensity at the individual level. Additional models used the same ZIP code measures to predict a set of injury-risk indicators. RESULTS: Several ZIP code measures were found to be predictive of both response propensity and the likelihood of reporting partner violence. For example, people residing in high-income areas were less likely to participate in the survey and less likely to report forced sex by partner, processes that suggest an over-estimation of this form of violence. In contrast, estimates of partner isolation may be under-estimated, as those residing in geographic areas with smaller-sized housing were less likely to participate in the survey but more likely to report partner isolation. No ZIP code-level correlates of survey response propensity, however, were found also to be associated with driving-under-the-influence (DUI) indicators. CONCLUSIONS: There is evidence of a linkage between survey response propensity and one variety of injury prevention measure (partner violence) but not another (DUI). The approach described in this paper provides an effective and inexpensive tool for evaluating nonresponse error in surveys of injury prevention and other health-related conditions.

Accidents↗

A review of common errors in the indirect measurement of blood pressure. Sphygmomanometry.

There are three sources of error in the indirect measurement of blood pressure: (1) observer bias, (2) faulty equipment, and (3) failure to standardize the techniques of measurement. This article examines each area extensively, discusses the cumulative effect of these errors on the accuracy of indirect blood pressure measurement, and reviews the recommendations for proper indirect measurement of blood pressure.

Blood Pressure Determination↗

Precision error in dual-photon absorptiometry related to source age.

An average, variable precision error of up to 6% related to source age was observed for dual-photon absorptiometry of the spine in a longitudinal study of bone mineral content involving 393 women. Application of a software correction for source decay compensated for only a portion of this error. The authors conclude that measurement of bone-loss rates using serial dual-photon bone mineral measurements must be interpreted with caution.

Adult↗

A comparison of traditional protractor versus Oxford Cobbometer radiographic measurement: intraobserver measurement variability for Cobb angles.

STUDY DESIGN: A comparison between measurement of radiographs using a traditional protractor method and the Oxford Cobbometer, which has the potential to reduce error. OBJECTIVE: To assess measurement variability of Cobb angles using the Oxford Cobbometer and to compare it to that of measurements made using the traditional protractor method. SUMMARY OF BACKGROUND DATA: Studies of the Cobb method have multiple sources of error and subsequent intraobserver variability. Estimates of intraobserver variability are from 2.8 degrees to 10 degrees. METHOD: Fifty-three scoliosis curves were measured by 3 examiners. Two measurement sets were performed using the traditional protractor method and two measurement sets performed using the Oxford Cobbometer. RESULTS: For the protractor method, intraobserver variability was 9.01 degrees (95% confidence interval 7.32-10.88). For the Cobbometer method, the value was 5.77 degrees (95% confidence interval 3.25-7.63). The difference between error for construction and Cobbometer methods was significant (P < 0.001). CONCLUSIONS: This study demonstrates a lower intraobserver variability for the Oxford Cobbometer compared to the traditional construction method. The Oxford Cobbometer, besides being quick and easy to use, does not require the drawing of lines on films or the use of wide diameter radiographic markers and hence removes some sources of intrinsic error incurred during the traditional method of measuring Cobb angles.

Adolescent↗

Sources of propionate in inborn errors of propionate metabolism.

Amino acids are widely regarded as the most important sources of propionate in disorders of propionate metabolism. Propionate production was measured in the fasting state by continuous infusion of sodium [1-13C]propionate in three children with methylmalonic acidemia (MMA) and three with propionic acidemia (PA). The contribution of isoleucine, valine, threonine, and methionine catabolism to total propionate production was estimated by extrapolation from the hydroxylation of phenylalanine determined by a continuous-infusion [2H5]phenylalanine technique. The contribution of gut bacterial propionate production was determined by measuring total propionate production before and after treatment with oral metronidazole (10 to 20 mg/kg/d for 1 week). Amino acid catabolism accounted for a mean of 51.7% (range, 24.5% to 66.4%) of total propionate production. The mean decrease in propionate production after metronidazole was 22.2% +/- 8.5 (P less than .02); this percentage is likely to represent the minimum propionate production attributable to gut bacteria. Approximately 30% of total propionate production was unaccounted for, and is likely to arise primarily from odd-chain fatty acid catabolism in the fasting state. These results indicate that sources of propionate other than from protein catabolism are important in disorders of propionate metabolism, and explain the generally disappointing response to dietary protein restriction.

Amino Acids↗

Study: CPOE facilitates 22 types of medication errors.

Fragmentation of data and human/machine interface are two key sources of potential errors. Make sure your system accounts for the total flow of products, services, and people. Avoid complacency; newer systems mean newer potential sources of errors.

Humans↗

Co-registration of x-ray and MR fields of view in a hybrid XMR system.

PURPOSE: To validate one possible function of a real-time x-ray/MR (XMR) interface in a hybrid XMR system using x-ray images as "scouts" to prescribe the MR slices. MATERIALS AND METHODS: The registration process consists of two steps: 1) calibration, in which the system's geometric parameters are found from fiducial-based registration; and 2) application, in which the x-ray image of a target structure and the estimated geometric parameters are used to prescribe an MR slice to observe the target structure. Errors from the noise in the location of the fiducial markers, and MR gradient nonlinearity were studied. Computer simulations were used to provide guidelines for fiducial marker placement and tolerable error estimation. A least-squares-based correction method was developed to reduce errors from gradient nonlinearity. RESULTS: In simulations with both sources of errors and the correction for gradient nonlinearity, the use of 16 fiducial markers yielded a mean error of about 0.4 mm over a 7200 cm(3) volume. Phantom scans showed that the prescribed target slice hit most of the target line, and that the length visualized was improved with the least-squares correction. CONCLUSION: The use of 16 fiducial markers to co-register XMR FOVs can offer satisfactory accuracy in both simulations and experiments.

Algorithms↗

[Critical study on the operative treatment of scaphoidpseudarthrosis (author's transl)].

At first causes for the emergence of os naviculare non-union and therapeutical principles are discussed. The Matti-Russe operative procedure, after a thorough evaluation of all available possibilities, seems to be the method most preferable. Seemingly bad results most of the time occur due to technical errors and mistakes in selection of the transplant. Furthermore sources of error in placing the skin incision, in extirpation of the pseudarthrosis gap, in preparation of the graft bed and in styloidectomy are explained in detail. Recommendations for the post-operative management are presented.

Adolescent↗

Pulmonary circulation evaluation before cavopulmonary connections: the cavopulmonary bypass.

The outcome of Fontan-type procedures is dependent on several risk factors, among which pulmonary vascular resistances (PVRs) are an important component. Preoperative calculation of PVR entails several potential sources of error, particularly in patients with pulmonary atresia or multiple sources of pulmonary blood flow. In an attempt to develop a reliable test that accurately assesses the hemodynamic patterns of the pulmonary vascular bed before a Fontan procedure, a simulation of Fontan-type circulation was achieved in 13 patients by a partial cardiopulmonary bypass between the main pulmonary artery and both venae cavae (cavopulmonary bypass). During cavopulmonary bypass, pressures and resistances were recorded. Immediately after cavopulmonary bypass, the circulation was converted to standard cardiopulmonary bypass and the cavopulmonary connection was carried out. Preoperative pulmonary vascular resistance indexes were assessed roughly by the arteriovenous oxygen difference in systemic and pulmonary beds. There was no correlation between preoperative and perioperative calculations of pulmonary vascular resistance indexes (r = 0.24; p = not significant). Hemodynamic data available for all patients then were correlated to the early postoperative outcome assessed by a subjective four-point scale. A positive, significant correlation was found with intraoperative PVR (r = 0.90; p < 0.001), indexed PVR (r = 0.90; p < 0.001), and the pulmonary to systemic vascular resistance ratio (r = 0.98; p < 0.0001). Two of 13 patients had a 4-mm fenestration in the atrial baffle. No mortality or morbidity was related to the procedure. The absolute values of PVR and pulmonary vascular resistance indexes were strikingly higher than generally admitted for this type of procedure.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

Estimating human long bone cross-sectional geometric properties: a comparison of noninvasive methods.

Cross-sectional properties (areas, second moments of area) have been used extensively for reconstructing the mechanical loading history of long bone shafts. In the absence of a fortuitous break or available computed tomography (CT) facilities, the endosteal and/or periosteal boundaries of a bone may be approximated using alternative noninvasive methods. The present study tests whether cross-sectional geometric properties of human lower limb bones can be adequately estimated using two such techniques: the ellipse model method (EMM), which uses biplanar radiography alone, and the latex cast method (LCM), which involves molding of the subperiosteal contour in combination with biplanar radiography to estimate the contour of the medullary canal. Results of both methods are compared with "true" cross-sectional properties calculated by direct sectioning. The study sample includes matched femora and tibiae of 50 Pecos Pueblo Amerindians. Bone areas and second moments of area were calculated for the midshaft femur and tibia and proximal femoral diaphysis in each individual. Percent differences between methods were derived to evaluate directional (systematic) and absolute (random) error. Multiple regression was also used to investigate the sources of error associated with each method. The results indicate that while the LCM shows generally good correspondence to the true cross-sectional properties, the EMM generally overestimates true parameters. Regression equations are provided to correct this overestimation, and, when applied to another sample, are shown to significantly improve estimates for the femoral midshaft, although corrections are less successful for the other section locations. Our results suggest that the LCM is an adequate substitute for estimating cross-sectional properties when direct sectioning and CT are not feasible. The EMM is a reasonable alternative, although the bias inherent in the method should be corrected if possible, especially when the results of the study are to be compared with data collected using different methods.

Adult↗

A simple correction for B1 field errors in magnetization transfer ratio measurements.

B1 errors are a problem in magnetization transfer ratio (MTR) measurements because the MTR value is dependent on the amplitude of the magnetization transfer (MT) pulse. B1 errors can arise from radiofrequency (RF) nonuniformity (caused by the RF coil, or skin effect and dielectric resonance in the subject's head) and also from inaccurate setting of the transmitter output when compensating for varying amounts of loading of the RF coil. B1 errors, and hence MTR errors, may be up to 5-10%, a large source of error in quantitative MR measurements. Radiofrequency nonuniformity may cause MTR histograms to be broadened. The dependence of MTR on B1 was modeled using binary spin bath theory, with a continuous wave (CW) approximation. For B1 reductions of up to 20%, normalized plots for different brain tissue types could be approximated by a single line, indicating that a systematic correction could be applied to MTR measurements with a known B1 error, regardless of tissue type. On a 1.5-T scanner with a birdcage coil, MTR was measured in 18 tissue types in five controls. The MT pulse amplitude was reduced in steps from its nominal value by up to 20%. Averaging data over all controls and tissue types resulted in a line fitting mtr(normalized)=0.812b(1normalized)+0.193, where mtr(normalized) is the normalized value of MTR (relative to its value at the nominal B1) and b(1normalized) is the normalized value of B1 (relative to its nominal value). For a 20% reduction in MT pulse amplitude (i.e., b(1normalized)=0.80), the mean MTR value for the 18 tissue types was 7.0 percent units (pu) below the correct value. After correction using the single equation above for all tissue types, all MTR values were within 1.5 pu of their correct value [root mean square (rms) error=0.7 pu]. Magnetization transfer ratio values tended to be slightly overcorrected because the simple linear correction scheme is only an approximation to the true MTR dependence on B1. A B1 field mapping technique was implemented, based on the double angle method (DAM), with fast spin-echo (FSE) readout, and TR=15 s; this took a total of 6 min of imaging time. This was used to quantify B(1) errors and correct MTR maps and histograms. However, the cerebrospinal fluid (CSF) T1 is very long (approximately 4.2 s); thus, to achieve complete longitudinal relaxation (a requirement of the DAM B1 mapping method), an increase in TR and, hence, acquisition time would be required. In general, however, we are not interested in calculating the B1 in the CSF, although it is important that the B1 is determined in partial volume voxels around the CSF. Using our birdcage head coil, whole-brain B1 histograms were found to have full-width half maximums (FWHMs) ranging from just 6.8% to 11.5% of the nominal B1 value. The FSE DAM B1 field mapping technique was shown to be robust, although a longer TR time may be desirable to ensure complete elimination of CSF partial volume errors. The procedure can be applied on any scanner where the Euro-MT sequence is available, or alternatively, where the amplitude of B1 or of the MT pulse can be manually reduced in order to perform this type of "calibration" experiment for the particular MTR sequence used. The MTR is known to be highly dependent on the parameters of the sequence used, in particular, the MT pulse shape, flip angle, duration, and offset frequency, and the repetition time TR' between successive MT pulses. Therefore, correction schemes will differ for different MTR sequences, and new data sets would be required to calculate these different correction schemes.

Algorithms↗