James Agutter

Visual correlation for situational awareness

We present a novel visual correlation paradigm for situational awareness (SA) and suggest its usage in a diverse set of applications that require a high level of SA. Our approach is based on a concise and scalable representation, which leads to a flexible visualization tool that is both clear and intuitive to use. Situational awareness is the continuous extraction of environmental information, its integration with previous knowledge to form a coherent mental picture, and the use of that picture in anticipating future events. In this paper we build on our previous work on visualization for network intrusion detection and show how that approach can be generalized to encompass a much broader class of SA systems. We first propose a generalization that is based on what we term, the w/sup 3/ premise, namely that each event must have at least the what, when and where attributes. We also present a second generalization, which increases flexibility and facilitates complex visual correlations. Finally, we demonstrate the generality of our approaches by applying our visualization paradigm in a collection of diverse SA areas.

Development and Evaluation of a Graphical Anesthesia Drug Display

Background Usable real-time displays of intravenous anesthetic concentrations and effects could significantly enhance intraoperative clinical decision-making. Pharmacokinetic models are available to estimate past, present, and future drug effect-site concentrations, and pharmacodynamic models are available to predict the drugs associated physiologic effects. Methods An interdisciplinary research team (bioengineering, architecture, anesthesiology, computer engineering, and cognitive psychology) developed a graphic display that presents the real-time effect-site concentrations, normalized to the drugs’ EC95, of intravenous drugs. Graphical metaphors were created to show the drugs’ pharmacodynamics. To evaluate the effect of the display on the management of total intravenous anesthesia, 15 anesthesiologists participated in a computer-based simulation study. The participants cared for patients during two experimental conditions: with and without the drug display. Results With the drug display, clinicians administered more bolus doses of remifentanil during anesthesia maintenance. There was a significantly lower variation in the predicted effect-site concentrations for remifentanil and propofol, and effect-site concentrations were maintained closer to the drugs’ EC95. There was no significant difference in the simulated patient heart rate and blood pressure with respect to experimental condition. The perceived performance for the participants was increased with the drug display, whereas mental demand, effort, and frustration level were reduced. In a postsimulation questionnaire, participants rated the display to be a useful addition to anesthesia monitoring. Conclusions The drug display altered simulated clinical practice. These results, which will inform the next iteration of designs and evaluations, suggest promise for this approach to drug data visualization.

Effects of Integrated Graphical Displays on Situation Awareness in Anaesthesiology

Abstract: Anaesthetic information displays have been shown to influence anaesthesiologists’ situation awareness. In study 1 an object display was compared with the traditional display currently used. Twelve anaesthesiologists (residents and faculty members) participated in a simulator evaluation of the displays. Reaction times for detection of critical events and situation awareness were measured. The object display improved situation awareness for one of four test scenarios. Low-level situation awareness was higher with the traditional display, and medium-level situation awareness was higher with the new display. In study 2, an integrated 3D display was compared to the traditional display. Twelve students participated in the evaluation. The new 3D display helped the observers to see changes more rapidly. In one scenario, situation awareness was higher with the new display than with the traditional display. In summary, during 63% of the simulated scenarios, reliable differences were found in favour of the new displays. Thus, by introducing integrated graphical displays in the operating room, anaesthesiologists’ performance may be improved.

The Employment of an Iterative Design Process to Develop a Pulmonary Graphical Display

OBJECTIVE Data representations on todays medical monitors need to be improved to advance clinical awareness and prevent data vigilance errors. Simply building graphical displays does not ensure an improvement in clinical performance because displays have to be consistent with the users clinical processes and mental models. In this report, the development of an original pulmonary graphical display for anesthesia is used as an example to show an iterative design process with built-in usability testing. DESIGN The process reported here is rapid, inexpensive, and requires a minimal number of subjects per development cycle. Three paper-based tests evaluated the anatomic, variable mapping, and graphical diagnostic meaning of the pulmonary display. MEASUREMENTS A confusion matrix compared the designers intended answer with the subjects chosen answer. Considering deviations off the diagonal of the confusion matrix as design weaknesses, the pulmonary display was modified and retested. The iterative cycle continued until the anatomic and variable mapping cumulative test scores for a chosen design scored above 90% and the graphical diagnostic meaning test scored above 75%. RESULTS The iterative development test resulted in five design iterations. The final graphical pulmonary display improved the overall intuitiveness by 18%. The display was tested in three categories: anatomic features, variable mapping, and diagnostic accuracy. The anatomic intuitiveness increased by 25%, variable mapping intuitiveness increased by 34%, and diagnostic accuracy decreased slightly by 4%. CONCLUSION With this rapid iterative development process, an intuitive graphical display can be developed inexpensively prior to formal testing in an experimental setting.

Design Activity Framework for Visualization Design

An important aspect in visualization design is the connection between what a designer does and the decisions the designer makes. Existing design process models, however, do not explicitly link back to models for visualization design decisions. We bridge this gap by introducing the design activity framework, a process model that explicitly connects to the nested model, a well-known visualization design decision model. The framework includes four overlapping activities that characterize the design process, with each activity explicating outcomes related to the nested model. Additionally, we describe and characterize a list of exemplar methods and how they overlap among these activities. The design activity framework is the result of reflective discussions from a collaboration on a visualization redesign project, the details of which we describe to ground the framework in a real-world design process. Lastly, from this redesign project we provide several research outcomes in the domain of cybersecurity, including an extended data abstraction and rich opportunities for future visualization research.

A simulation-based evaluation of a graphic cardiovascular display.

INTRODUCTION:A graphic presentation of complex information can facilitate early detection and management of adverse events. Prior work found that graphical presentation of selected cardiovascular variables led to earlier detection of a simulated ischemic event. Based on these findings, a second evaluation explored the utility of a graphical cardiovascular display (GCD) in a variety of simulated adverse cardiopulmonary events for two different display configurations. In this evaluation, we revised the GCD to present hemodynamic variables with or without a pulmonary artery catheter. Our hypotheses were that the revised GCD would improve detection of adverse cardiopulmonary events and add no additional perceived workload. METHODS:Sixteen anesthesiologists and anesthesia residents were enrolled in a simulation-based evaluation of the GCD. Participants were randomly split into two groups balanced for expertise and asked to manage six simulated adverse cardiopulmonary events. The GCD was present in half of the simulations, balanced across scenarios and groups. Participants’ verbalizations and actions during each scenario were recorded and transcribed. Transcripts of treatment interventions were subsequently rated by two blinded expert anesthesiologists. Perceived workload, time to detection, and proper treatment of the adverse event were compared between groups. RESULTS:Experts ranked anesthesiologists using the GCD as being more effective overall and individually in three of six scenarios. Use of the GCD was demonstrated to influence the time to detection and the time to treatment of some critical events. There were no workload differences between display groups. DISCUSSION:Treatment intervention by participants using the GCD was rated superior by two blinded experts. The presence of the GCD resulted in a modest improvement in the time to detect myocardial ischemia and increased pulmonary capillary wedge pressure. The GCD may be a useful adjunct to monitor patients during adverse cardiopulmonary events.

Development and evaluation of a just-in-time support system.

Objective: To lay the foundation for a framework of just-in-time support (JITS) for novices dealing with urgent, unfamiliar tasks, and to evaluate a JITS system. Background: More than 350,000 people die annually of cardiac arrest in the United States. In response, automated defibrillators are advocated that, unfortunately, do not provide important respiratory support. This paper presents elements of a framework for a JITS system that instructs a lay responder to follow a treatment protocol for integrating respiratory support with the use of an automatic external defibrillator. Method: We simulated a medical emergency using a high-fidelity patient simulator and asked participants to care for the patient. Results: When using a paper-based NASA treatment protocol, participants made more errors and took longer to stabilize the injured person than when using the JITS system. Conclusion: These findings demonstrate the benefit of a JITS system to instruct novices in unfamiliar tasks. Application: The JITS system has the potential to improve the treatment outcome of victims of cardiac arrest. The JITS framework can be applied to many situations in which novices deal with urgent tasks without expertise available.

Graphical user interface simplifies infusion pump programming and enhances the ability to detect pump-related faults

BACKGROUND:Drug administration errors are frequent and are often associated with the misuse of IV infusion pumps. One source of these errors may be the infusion pump’s user interface. METHODS:We used failure modes-and-effects analyses to identify programming errors and to guide the design of a new syringe pump user interface. We designed the new user interface to clearly show the pump’s operating state simultaneously in more than 1 monitoring location. We evaluated anesthesia residents in laboratory and simulated environments on programming accuracy and error detection between the new user interface and the user interface of a commercially available infusion pump. RESULTS:With the new user interface, we observed the number of programming errors reduced by 81%, the number of keystrokes per task reduced from 9.2 ± 5.0 to 7.5 ± 5.5 (mean ± SD), the time required per task reduced from 18.1 ± 14.1 seconds to 10.9 ± 9.5 seconds and significantly less perceived workload. Residents detected 38 of 70 (54%) of the events with the new user interface and 37 of 70 (53%) with the existing user interface, despite no experience with the new user interface and extensive experience with the existing interface. CONCLUSIONS:The number of programming errors and workload were reduced partly because it took less time and fewer keystrokes to program the pump when using the new user interface. Despite minimal training, residents quickly identified preexisting infusion pump problems with the new user interface. Intuitive and easy-to-program infusion pump interfaces may reduce drug administration errors and infusion pump-related adverse events.

Graphic data display for cardiovascular system

Our multi-disciplinary group has developed a visual representation for cardiovascular physiological variables. This enhances a clinician’s ability to detect and rapidly respond to critical events. The integrated and intuitive display communicates a patient’s cardiovascular state so that it is easily and quickly understood without prior training. The display is designed to show patterns of functional relationships that aid in the detection, diagnosis, and treatment of a critical event.

Development and Evaluation of Just-in-Time Training to Provide Cardio-Pulmonary Resusciation

More than 350,000 people die annually of cardiac arrest. In response to this epidemic, automated defibrillators are advocated, but they do not provide important respiratory support. However, adding respiratory support makes the system more complex and difficult to use. To solve this problem we developed a graphical computer based “just-in-time” training that instructs a responder to follow a standard treatment protocol. We simulated a medical emergency in a patient simulator and asked novice volunteers to care for the patient. When using a paper-based version of the treatment protocol (based on a NASA protocol), subjects took significant longer to remove an obstruction from the airway and stabilize the injured person than when using an animated graphic treatment protocol. These findings validate the potential of graphically based just-in-time training to instruct novices in tasks they have not performed before.