scholarly journals Investigating the cognitive capacity constraints of an ICU care team using a systems engineering approach

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Jaeyoung Park ◽  
Xiang Zhong ◽  
Yue Dong ◽  
Amelia Barwise ◽  
Brian W. Pickering

Abstract Background ICU operational conditions may contribute to cognitive overload and negatively impact on clinical decision making. We aimed to develop a quantitative model to investigate the association between the operational conditions and the quantity of medication orders as a measurable indicator of the multidisciplinary care team’s cognitive capacity. Methods The temporal data of patients at one medical ICU (MICU) of Mayo Clinic in Rochester, MN between February 2016 to March 2018 was used. This dataset includes a total of 4822 unique patients admitted to the MICU and a total of 6240 MICU admissions. Guided by the Systems Engineering Initiative for Patient Safety model, quantifiable measures attainable from electronic medical records were identified and a conceptual framework of distributed cognition in ICU was developed. Univariate piecewise Poisson regression models were built to investigate the relationship between system-level workload indicators, including patient census and patient characteristics (severity of illness, new admission, and mortality risk) and the quantity of medication orders, as the output of the care team’s decision making. Results Comparing the coefficients of different line segments obtained from the regression models using a generalized F-test, we identified that, when the ICU was more than 50% occupied (patient census > 18), the number of medication orders per patient per hour was significantly reduced (average = 0.74; standard deviation (SD) = 0.56 vs. average = 0.65; SD = 0.48; p < 0.001). The reduction was more pronounced (average = 0.81; SD = 0.59 vs. average = 0.63; SD = 0.47; p < 0.001), and the breakpoint shifted to a lower patient census (16 patients) when at a higher presence of severely-ill patients requiring invasive mechanical ventilation during their stay, which might be encountered in an ICU treating patients with COVID-19. Conclusions Our model suggests that ICU operational factors, such as admission rates and patient severity of illness may impact the critical care team’s cognitive function and result in changes in the production of medication orders. The results of this analysis heighten the importance of increasing situational awareness of the care team to detect and react to changing circumstances in the ICU that may contribute to cognitive overload.

2014 ◽  
Vol 136 (7) ◽  
Author(s):  
Robert R. Parker ◽  
Edgar Galvan ◽  
Richard J. Malak

Prior research suggests that set-based design representations can be useful for facilitating collaboration among engineers in a design project. However, existing set-based methods are limited in terms of how the sets are constructed and in their representational capability. The focus of this article is on the problem of modeling the capabilities of a component technology in a way that can be communicated and used in support of system-level decision making. The context is the system definition phases of a systems engineering project, when engineers still are considering various technical concepts. The approach under investigation requires engineers familiar with the component- or subsystem-level technologies to generate a set-based model of their achievable technical attributes, called a technology characterization model (TCM). Systems engineers then use these models to explore system-level alternatives and choose the combination of technologies that are best suited to the design problem. Previously, this approach was shown to be theoretically sound from a decision making perspective under idealized circumstances. This article is an investigation into the practical effectiveness of different TCM representational methods under realistic conditions such as having limited data. A power plant systems engineering problem is used as an example, with TCMs generated for different technical concepts for the condenser component. Samples of valid condenser realizations are used as inputs to the TCM representation methods. Two TCM representation methods are compared based on their solution accuracy and computational effort required: a Kriging-based interpolation and a machine learning technique called support vector domain description (SVDD). The results from this example hold that the SVDD-based method provides the better combination of accuracy and efficiency.


2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
G. Shankaranarayanan ◽  
Bin Zhu

Purpose Data quality metadata (DQM) is a set of quality measurements associated with the data. Prior research in data quality has shown that DQM improves decision performance. The same research has also shown that DQM overloads the cognitive capacity of decision-makers. Visualization is a proven technique to reduce cognitive overload in decision-making. This paper aims to describe a prototype decision support system with a visual interface and examine its efficacy in reducing cognitive overload in the context of decision-making with DQM. Design/methodology/approach The authors describe the salient features of the prototype and following the design science paradigm, this paper evaluates its usefulness using an experimental setting. Findings The authors find that the interface not only reduced perceived mental demand but also improved decision performance despite added task complexity due to the presence of DQM. Research limitations/implications A drawback of this study is the sample size. With a sample size of 51, the power of the model to draw conclusions is weakened. Practical implications In today’s decision environments, decision-makers deal with extraordinary volumes of data the quality of which is unknown or not determinable with any certainty. The interface and its evaluation offer insights into the design of decision support systems that reduce the complexity of the data and facilitate the integration of DQM into the decision tasks. Originality/value To the best of my knowledge, this is the only research to build and evaluate a decision-support prototype for structured decision-making with DQM.


2020 ◽  
Vol 43 ◽  
Author(s):  
Valerie F. Reyna ◽  
David A. Broniatowski

Abstract Gilead et al. offer a thoughtful and much-needed treatment of abstraction. However, it fails to build on an extensive literature on abstraction, representational diversity, neurocognition, and psychopathology that provides important constraints and alternative evidence-based conceptions. We draw on conceptions in software engineering, socio-technical systems engineering, and a neurocognitive theory with abstract representations of gist at its core, fuzzy-trace theory.


Objective: While the use of intraoperative laser angiography (SPY) is increasing in mastectomy patients, its impact in the operating room to change the type of reconstruction performed has not been well described. The purpose of this study is to investigate whether SPY angiography influences post-mastectomy reconstruction decisions and outcomes. Methods and materials: A retrospective analysis of mastectomy patients with reconstruction at a single institution was performed from 2015-2017.All patients underwent intraoperative SPY after mastectomy but prior to reconstruction. SPY results were defined as ‘good’, ‘questionable’, ‘bad’, or ‘had skin excised’. Complications within 60 days of surgery were compared between those whose SPY results did not change the type of reconstruction done versus those who did. Preoperative and intraoperative variables were entered into multivariable logistic regression models if significant at the univariate level. A p-value <0.05 was considered significant. Results: 267 mastectomies were identified, 42 underwent a change in the type of planned reconstruction due to intraoperative SPY results. Of the 42 breasts that underwent a change in reconstruction, 6 had a ‘good’ SPY result, 10 ‘questionable’, 25 ‘bad’, and 2 ‘had areas excised’ (p<0.01). After multivariable analysis, predictors of skin necrosis included patients with ‘questionable’ SPY results (p<0.01, OR: 8.1, 95%CI: 2.06 – 32.2) and smokers (p<0.01, OR:5.7, 95%CI: 1.5 – 21.2). Predictors of any complication included a change in reconstruction (p<0.05, OR:4.5, 95%CI: 1.4-14.9) and ‘questionable’ SPY result (p<0.01, OR: 4.4, 95%CI: 1.6-14.9). Conclusion: SPY angiography results strongly influence intraoperative surgical decisions regarding the type of reconstruction performed. Patients most at risk for flap necrosis and complication post-mastectomy are those with questionable SPY results.


Aerospace ◽  
2021 ◽  
Vol 8 (3) ◽  
pp. 61
Author(s):  
Dominik Eisenhut ◽  
Nicolas Moebs ◽  
Evert Windels ◽  
Dominique Bergmann ◽  
Ingmar Geiß ◽  
...  

Recently, the new Green Deal policy initiative was presented by the European Union. The EU aims to achieve a sustainable future and be the first climate-neutral continent by 2050. It targets all of the continent’s industries, meaning aviation must contribute to these changes as well. By employing a systems engineering approach, this high-level task can be split into different levels to get from the vision to the relevant system or product itself. Part of this iterative process involves the aircraft requirements, which make the goals more achievable on the system level and allow validation of whether the designed systems fulfill these requirements. Within this work, the top-level aircraft requirements (TLARs) for a hybrid-electric regional aircraft for up to 50 passengers are presented. Apart from performance requirements, other requirements, like environmental ones, are also included. To check whether these requirements are fulfilled, different reference missions were defined which challenge various extremes within the requirements. Furthermore, figures of merit are established, providing a way of validating and comparing different aircraft designs. The modular structure of these aircraft designs ensures the possibility of evaluating different architectures and adapting these figures if necessary. Moreover, different criteria can be accounted for, or their calculation methods or weighting can be changed.


2021 ◽  
Vol 10 (2) ◽  
pp. 50
Author(s):  
Naomi Biegel ◽  
Karel Neels ◽  
Layla Van den Berg

Grandparents constitute an important source of childcare to many parents. Focusing on the Belgian context, this paper improves our understanding of childcare decision-making by investigating how formal childcare availability and availability of grandparents affect childcare arrangements. By means of multinomial regression models we simultaneously model uptake of formal and informal childcare by parents. Combining linked microdata from the Belgian censuses with contextual data on childcare at the level of municipalities, we consider formal childcare availability at a local level, while including a wide array of characteristics which may affect grandparental availability. Results indicate that increasing formal care crowds-out informal care as the sole care arrangement, whereas combined use of formal and informal care becomes more prevalent. Characteristics indicating a lack of grandmaternal availability increase uptake of formal care and inhibit to a lesser extent the uptake of combined formal and informal care. While increasing formal care substitutes informal care use, the lack of availability of informal care by grandparents may be problematic, particularly for those families most prone to use informal care.


Author(s):  
Cheng-Ju Hsieh ◽  
Mario Fifić ◽  
Cheng-Ta Yang

Abstract It has widely been accepted that aggregating group-level decisions is superior to individual decisions. As compared to individuals, groups tend to show a decision advantage in their response accuracy. However, there has been a lack of research exploring whether group decisions are more efficient than individual decisions with a faster information-processing speed. To investigate the relationship between accuracy and response time (RT) in group decision-making, we applied systems’ factorial technology, developed by Townsend and Nozawa (Journal of Mathematical Psychology 39, 321–359, 1995) and regarded as a theory-driven methodology, to study the information-processing properties. More specifically, we measured the workload capacity CAND(t), which only considers the correct responses, and the assessment function of capacity AAND(t), which considers the speed-accuracy trade-off, to make a strong inference about the system-level processing efficiency. A two-interval, forced-choice oddball detection task, where participants had to detect which interval contains an odd target, was conducted in Experiment 1. Then, in Experiment 2, a yes/no Gabor detection task was adopted, where participants had to detect the presence of a Gabor patch. Our results replicated previous findings using the accuracy-based measure: Group detection sensitivity was better than the detection sensitivity of the best individual, especially when the two individuals had similar detection sensitivities. On the other hand, both workload capacity measures, CAND(t) and AAND(t), showed evidence of supercapacity processing, thus suggesting a collective benefit. The ordered relationship between accuracy-based and RT-based collective benefit was limited to the AAND(t) of the correct and fast responses, which may help uncover the processing mechanism behind collective benefits. Our results suggested that AAND(t), which combines both accuracy and RT into inferences, can be regarded as a novel and diagnostic tool for studying the group decision-making process.


2021 ◽  
Vol 1 ◽  
pp. 3369-3378
Author(s):  
Stephan Husung ◽  
Christian Weber ◽  
Atif Mahboob ◽  
Sven Kleiner

AbstractModel-Based Systems Engineering (MBSE) is an efficient approach to support product development in order to meet today's challenges. The MBSE approach includes methods and, above all, modelling approaches of the technical system with the aim of continuous use in development. The objective of this paper is to use the potential of the MBSE models and to show the added value of such models on the system level when used as a single source. With this objective, this paper presents a three-step approach to systematically identify and apply meaningful modelling approaches within MBSE, based on the needs during the development process. Furthermore, an FMEA example is included in this paper to elaborate the use of MBSE in the system failure analysis.


2021 ◽  
Vol 16 (3) ◽  
pp. 225-227
Author(s):  
Stan Lipovetsky

The work describes a series of techniques designed to obtain regression models resistant to multicollinearity and having some other features needed for meaningful results. These models include enhanced ridge-regressions with several regularization parameters, regressions by data segments and by levels of the dependent variable, latent class models, unitary response, models, orthogonal and equidistant regressions, minimization in Lp-metric, and other criteria and models. All the approaches have been practically implemented in various projects and found useful for decision making in economics, management, marketing research, and other fields requiring data modeling and analysis.


Author(s):  
Salar Safarkhani ◽  
Ilias Bilionis ◽  
Jitesh H. Panchal

Systems engineering processes coordinate the efforts of many individuals to design a complex system. However, the goals of the involved individuals do not necessarily align with the system-level goals. Everyone, including managers, systems engineers, subsystem engineers, component designers, and contractors, is self-interested. It is not currently understood how this discrepancy between organizational and personal goals affects the outcome of complex systems engineering processes. To answer this question, we need a systems engineering theory that accounts for human behavior. Such a theory can be ideally expressed as a dynamic hierarchical network game of incomplete information. The nodes of this network represent individual agents and the edges the transfer of information and incentives. All agents decide independently on how much effort they should devote to a delegated task by maximizing their expected utility; the expectation is over their beliefs about the actions of all other individuals and the moves of nature. An essential component of such a model is the quality function, defined as the map between an agent’s effort and the quality of their job outcome. In the economics literature, the quality function is assumed to be a linear function of effort with additive Gaussian noise. This simplistic assumption ignores two critical factors relevant to systems engineering: (1) the complexity of the design task, and (2) the problem-solving skills of the agent. Systems engineers establish their beliefs about these two factors through years of job experience. In this paper, we encode these beliefs in clear mathematical statements about the form of the quality function. Our approach proceeds in two steps: (1) we construct a generative stochastic model of the delegated task, and (2) we develop a reduced order representation suitable for use in a more extensive game-theoretic model of a systems engineering process. Focusing on the early design stages of a systems engineering process, we model the design task as a function maximization problem and, thus, we associate the systems engineer’s beliefs about the complexity of the task with their beliefs about the complexity of the function being maximized. Furthermore, we associate an agent’s problem solving-skills with the strategy they use to solve the underlying function maximization problem. We identify two agent types: “naïve” (follows a random search strategy) and “skillful” (follows a Bayesian global optimization strategy). Through an extensive simulation study, we show that the assumption of the linear quality function is only valid for small effort levels. In general, the quality function is an increasing, concave function with derivative and curvature that depend on the problem complexity and agent’s skills.


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