There is limited clinical research on the effectiveness of alarm management strategies and nursing behaviors related to alarms in clinical settings. As many as 76% of physiological monitor alarms are overlooked as clinically insignificant by nursing staff. Excessive alarms may impact patient outcomes and cause cognitive overload for nurses that can result in medical errors and missed patient resuscitations. The purpose of this systematic review was to rate alarm management studies on level of evidence for interventions, nursing responses to alarms, and impact on alarm fatigue behavior. The nursing role effectiveness model guided this project. Twenty-seven studies were reviewed to analyze outcome effectiveness by addressing structure, process, and outcomes related to how the roles of the nurse affect nurse-sensitive patient outcomes. The Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) and the Cochrane guidelines guided study selection and analysis. A second reviewer collaborated on the search strategy and provided an independent review of the identified literature. The effectiveness of alarm management was difficult to determine because most studies were descriptive, cohort, or nonrandomized trials. Review findings did not support a relationship between the amount of alarms and increased alarm fatigue behaviors. Findings indicated that nurses' attitudes and alarm fatigue behaviors are present globally and have not significantly altered since reduction strategies were implemented. The findings may impact social change by decreasing nurses' stress levels related to cognitive workloads, improving patient outcomes, and supporting increased levels of nurses' workforce satisfaction.

Detta examensarbete är ett projekt inom metodiken tjänstedesign som utforskar ekosystemet av aktörer i kedjan av trygghetslarm för äldre i Malmö Kommun. Syftet med detta examensarbete var att utforma förslag till tjänstekoncept som uppfyller de behov som användaren av trygghetslarmet upplever. Detta med hänsyn till alla involverade aktörer inom ekosystemet i kedjan av trygghetslarm för äldre. Dessa skulle utformas genom att identifiera de främsta problemområdena, samt relaterade primära behov, som uppstår i relationerna mellan de olika involverade aktörerna i den nuvarande tjänsten. Denna kvalitativa forskningsmetod har främst använts för att, utifrån insikter insamlade genom kundinteraktioner, designa om och utveckla en användarcentrerad tjänst. Parallellt har den tillika använts för att skapa en hållbar och konkurrenskraftig tjänst gentemot tjänsteleverantören. Denna metod utgår från en iterativ process där varje iteration består av fyra steg: kundinteraktioner, kundinsikter, idégenerering och triggermaterial. De kundinteraktioner som genomfördes genererade insikter som analyserades och användes för att generera konceptidéer som iterativt utvecklades under fyra iterationer till två slutkoncept.  Utifrån de identifierade problemområdena, med relaterade primära behov, identifierades två behovsgrupper; Ensamanvändare och Primäranvändare. Med hänsyn till de primära behoven för behovsgruppen Ensamanvändare utformades ett tjänstekoncept som benämndes Äldreguiden. För behovsgruppen Primäranvändare utformades riktlinjer för utveckling av det befintliga systemet som benämndes Design guidelines för Information. Slutsatsen av examensarbetet är att det framtagna förslaget för tjänstekoncept samt de utformade riktlinjerna ses ha potential att tillmötesgå de analyserade primära behov som de två identifierade behovsgrupperna upplevde. / This Master’s degree project is a project in the methodology of Service Design that explores the ecosystem of actors within the chain of security alarms for the elderly in Malmö Municipality. The purpose of this degree project was to draft proposals for service concepts that meet the needs of the security alarm user. This takes into account all involved actors in the ecosystem in the chain of security alarms for the elderly. These proposals would be designed by identifying the main problem areas, as well as related primary needs arising in the relationships between the various involved actors in the current service. This qualitative research method has been used primarily to design and develop a user-centered service based on insights collected through customer interactions. In parallel, it has also been used to create a sustainable and competitive service towards the service provider. This method is based on an iterative process where each iteration consists of four steps: customer interactions, customer insights, idea generation and triggers. The customer interactions conducted generated insights that were analyzed and used to generate concept ideas that were developed iteratively during four iterations into two final concepts. Based on the identified problem areas, with related primary needs, two needs groups were identified; Ensamanvändaren and Primäranvändaren. Considering the primary needs of the need group Ensamanvändaren, a service concept was developed, called Äldreguiden. For the Primäranvändaren need group, guidelines were developed for the development of the existing system, called Design guidelines för Information. The conclusion of the thesis is that the draft proposal for service concepts as well as the guidelines developed are seen as having the potential to meet the primary needs identified for the two analyzed needs groups.

Since 1904 bedwetting alarms have been developed and scientifically described for the treatment of nocturnal enuresis, also known as bedwetting. Currently, several bedwetting alarms of various designs are available on the overseas market. These can be imported to South Africa at great cost. As affordable alarms were not readily available in South Africa, there was a need to develop and evaluate a new unit. In order to improve the efficacy of this new device, it was accompanied by detailed user guidelines and instructions. The use of this alarm was tested and the observations of thirteen bedwetting children recorded. Additionally, a programme was developed to counsel enuretic children with accompanying problems, and to assist the parents in dealing with their child's bedwetting problem. The observations and findings will be useful in practice and future research. / Psychology of Education / M. Ed. (Educational Psychology - Specialisation in Guidance and Counselling)

International Telemetering Conference Proceedings / October 25-28, 1999 / Riviera Hotel and Convention Center, Las Vegas, Nevada / Recent years have seen a sharp rise in the size of satellite constellations. The monitoring and analysis tools in use today, however, were developed for smaller constellations and are ill-equipped to handle the increased volume of telemetry data. A new technology that can accommodate vast quantities of data is 3-D visualization. Data is abstracted to show the degree to which it deviates from normal, allowing an analyst to absorb the status of thousands of parameters in a single glance. Trend alarms notify the user of dangerous trends before data exceeds normal limits. Used appropriately, 3-D visualization can extend the life of a satellite by ten to twenty percent.

Background: Alarm interpretation and management are fundamental to managing critically ill patients. 1 There is little research as to the decision process nurses use to prioritize alarms or manage specific monitor parameters. Objective: The purpose of this study is to gain insight into the intricacy of the intensive care unit (ICU) nurses'critical decision process, using a human performance framework, when responding to monitor alarms. Method: Design: Descriptive design using semi-structured interview. Open-ended questions were developed based on the critical decision method (CDM) to explore ICU nurses' critical decision making process related to monitor alarms. Sixteen ICU nurses at a community hospital were interviewed to elicit perceptions and thought processes related to monitor alarms. Results: Responses to monitor alarms were affected by nursing experience, tones of the alarm, nurses' knowledge of the patient's condition as well as immediate visualization of patient to judge the urgency of an alarm. Both advanced beginner and expert nurses had similar initial response to monitor alarms; however, expert nurses added depth to their immediate assessment process by using previous experiences, intuition, and clinical expertise. Advanced beginner nurses frequently look to expert nurses for advice, guidance, and examples of clinical expertise. The majority of nurses had little or no formal training on the cardiac monitors used by that facility and all felt it would be beneficial in monitor alarm management. Conclusion: Understanding the decision-making process used by nurses can guide the development of policies and learning experiences that are crucial clinical support for alarm management.

Post-fire reconstruction often includes the analysis of smoke alarms. The determination of whether or not an alarm has sounded during a fire event is of great interest. Until recently, analysis of smoke alarms involved in fires has been limited to electrical diagnostics, which, at best, determined whether or not a smoke alarm was capable of alarm during the fire event. It has subsequently been proposed that evaluation of the soot deposition around a smoke alarm horn can be used to conclude whether a smoke alarm has sounded during a fire event. In order to evaluate the effectiveness of using enhanced soot deposition patterns as an indication of smoke alarms sounding within a fire event, four test series were undertaken. First, a population of smoke alarms representative of the available market variety of horn configurations was selected. This population was subjected four test series. Test Series 1 consisted of UL/EN style experiments with fuel sources that included flaming polyurethane, smoldering polyurethane, flaming wood crib, and flaming turpentine pool. In Test Series 2, alarms were exposed to "nuisance" products from frying bacon, frying tortillas, burnt toast, frying breading, and airborne dust. Test Series 3 exposed the alarms to the following fire sources: smoldering cable, flaming cable, flaming boxes with paper, and flaming boxes with plastic cups. Test Series 4 included new, used, and pre-exposed smoke alarms that were exposed to two larger scale fires: a smoldering transitioning to flaming cabinet/wall assembly fire and a flaming couch section. The results from all four series were used to generate a hueristic for use in evaluating alarms from fire events. These criteria were blindly tested against the population of alarms to develop a correlation between the criteria and the previously tested smoke alarms. The results support the evaluation of soot deposition on smoke alarms exposed to a fire event as a viable method to determine whether or not an alarm sounded, without false positive or negative identifications.

Advances in sensing and positioning technology, fueled by wide deployment of wireless networks, have made many devices location-aware. These emerging technologies have enabled a new class of applications, known as Location-Based Services (LBS), offering both new business opportunities and a wide array of new quality of life enhancing services. One example of such services is spatial alarms, an enabling technology for location-based advertisement, location-based alerts or reminders and a host of other applications. On the other hand, the ability to locate mobile users accurately also opens door for new threats - the intrusion of location privacy. The time series of location data can be linked to personal identity, which leads to unauthorized information exposure about the individual's medical conditions, alternative lifestyles, unpopular political views or location-based spam and stalking. Thus, there are two important challenges for location-based service provisioning. How do we scale LBSs in the presence of client mobility and location dependent constraints for the multitude of new, upcoming location-based applications under a common framework? How do we provide anonymous location- based services with acceptable performance and quantifiable privacy protection in the next generation of mobile networks, systems and applications? This dissertation delivers technical solutions to address these important challenges. First, we introduce spatial alarms as the basic primitive to represent a class of locationbased services that require location-based trigger capability. Similar to time-based alarms, spatial alarms serve as spatial event reminders that enable us to express different location-based information needs supported by a variety of applications ranging from location-based advertisements, location-based personal assistants, to friend locator services like Google Latitude. We develop a generalized framework and a suite of optimization techniques for server-centric scalable processing of spatial alarms. Our architecture and algorithm development provide significant performance enhancement in terms of system scalability compared to naive spatial alarm processing techniques, while maintaining high accuracy for spatial alarm processing on the server side and reduced communication costs and energy consumption on the client side. Concretely, we develop safe period optimizations for alarm processing and introduce spatial alarm grouping techniques to further reduce the unnecessary safe period computation costs. In addition, we introduce a distributed alarm processing architecture that advocates the partitioning of the alarm processing load among the server and the relevant mobile clients to reduce the server load and minimize the client-to-server communication cost through intelligent distribution and parallelization. We also explore a variety of optimization opportunities such as incorporating non-spatial constraints into the location-based information monitoring problem and utilizing efficient indexing methods such as bitmap indexing to further enhance the performance and scalability of spatial alarm processing in the presence of mobility hotspots and skewed spatial alarm distributions. Second, we develop the PrivacyGrid framework for privacy-enhanced location service provisioning, focusing on providing customizable and personalized location privacy solutions while scaling the mobile systems and services to a large number of mobile users and a large number of service requests. The PrivacyGrid approach has three unique characteristics. First, we develop a three-tier architecture for scaling anonymous information delivery in a mobile environment while preserving customizable location privacy. Second, we develop a suite of fast, dynamic location cloaking algorithms. It is known that incorporation of privacy protection measures may lead to an inherent conflict between the level of privacy and the quality of services (QoS) provided by the location-based services. Our location cloaking algorithms can scale to higher levels of location anonymity while achieving a good balance between location privacy and QoS. Last but not the least; we develop two types of location anonymization models under the PrivacyGrid architecture, one provides the random way point mobility model based location cloaking solution, and the other provides a road network-based location privacy model powered by both location k-anonymity and segment s-anonymity. A set of graph-based location cloaking algorithms are developed, under the MobiCloak approach, to provide desired levels of privacy protection for users traveling on a road network through scalable processing of anonymous location services. This dissertation, to the best of our knowledge, is the first one that presents a systematic approach to the design and development of the spatial alarm processing framework and various optimization techniques. The concept of spatial alarms and the scaling techniques developed in this dissertation can serve as building blocks for many existing and emerging location-based and presence based information and computing services and applications. The second unique contribution made in this dissertation is its development of the PrivacyGrid architecture for scaling anonymous location based services under the random waypoint mobility model and its extension of the PrivacyGrid architecture through introducing the MobiCloak road-network based location cloaking algorithms with reciprocity support for spatially constrained network mobility model. Another unique feature of the PrivacyGrid and MobiCloak development is its ability to protect location privacy of mobile users while maintaining the end-to-end QoS for location-based service provisioning in the presence of dynamic and personalized privacy constraints.

With the ubiquity of broadband, wireless and mobile networking and the diversity of user-driven social networks and social channels, we are entering an information age where people and vehicles are connected at all times, and information and influence are diffused continuously through not only traditional authoritative media such as news papers, TV and radio broadcasting, but also user-driven new channels for disseminating information and diffusing influence. Social network users and mobile travelers can influence and be influenced by the social and spatial connectivity that they share through an impressive array of social and spatial channels, ranging from friendship, activity, professional or social groups to spatial, location-aware, and mobility aware events. In this dissertation research, we argue that spatial alarms and activity-based social networks are two fundamentally new types of information and influence diffusion channels. Such new channels have the potential of enriching our professional experiences and our personal life quality in many unprecedented ways. For instance, spatial alarms enable people to share their experiences or disseminate certain points of interest by leaving location-dependent greetings, tips or graffiti and location dependent tour guide to their friends, colleagues and family members. Through social networks, people can influence their friends and colleagues by the activities they have engaged, such as reviews and blogs on certain events or products. More interestingly, the power of such spatial and social diffusion of information and influence can go far beyond our physical reach. People can utilize user-generated social and spatial channels as effective means to disseminate information and propagate influence to a much wider and possibly unknown range of audiences and recipients at any time and in any location. A fundamental challenge in embracing such new and exciting ways of information diffusion is to develop effective and scalable models and algorithms as enabling technology and building blocks. This dissertation research is dedicated towards this ultimate objective with three novel and unique contributions. First, we develop an activity driven and self-configurable social influence model and a suite of computational algorithms to compute and rank social network nodes in terms of activity-based influence diffusion over social network topologies. By activity driven we mean that the real impact of social influence and the speed of such influence propagation should be computed based on the type, the amount and the time window of the activities performed by a social network node in addition to its social connectivity (social network topology). By self-configurable we mean that the diffusion efficiency and effectiveness are dynamically adapted based on the settings and tunings of multiple spatial and social parameters such as diffusion context, diffusion location, diffusion rate, diffusion energy (heat), diffusion coverage and diffusion incentives (e.g., reward points), to name a few. We evaluate our approach through datasets collected from Facebook, Epinions, and DBLP datasets. Our experimental results show that our activity based social influence model outperforms existing topology-based social influence model in terms of effectiveness and quality with respect to influence ranking and influence coverage computation. Second, we further enhance our activity based social influence model along two dimensions. At first, we use a probabilistic diffusion model to capture the intrinsic properties of social influence such that nodes in a social network may have the choice of whether to participate in a social influence propagation process. We examine threshold based approach and independent probabilistic cascade based approach to determine whether a node is active or inactive in each round of influence diffusion. Secondly, we introduce incentives using multi-scale reward points, which are popularly used in many business settings. We then examine the effectiveness of reward points based incentives in stimulating the diffusion of social influences. We show that given a set of incentives, some active nodes may become more active whereas some inactive nodes may become active. Such dynamics changes the composition of the top-k influential nodes computed by activity-based social influence model. We make several interesting observations: First, popular users who are high degree nodes and have many friends are not necessarily influential in terms of spawning new activities or spreading ideas and information. Second, most influential users are more active in terms of their participation in the social activities and interactions with their friends in the social network. Third, multi-scale reward points based incentives can be effective to both inactive nodes and active nodes. Third, we introduce spatial alarms as the basic building blocks for location-dependent information sharing and influence diffusion. People can share and disseminate their location based experiences and points of interest to their friends and colleagues in the form of spatial alarms. Spatial alarms are triggered and delivered to the intended subscribers only when the subscribers move into the designated geographical vicinity of the spatial alarms, enabling delivering and sharing of relevant information and experience at the right location and the right time with the right subscribers. We studied how to use locality filters and subscriber filers to enhance the spatial alarm processing using traditional spatial indexing techniques. In addition, we develop a fast spatial alarm indexing structure and algorithms, called Mondrian Tree, and demonstrate that the Mondrian tree enabled spatial alarm system can significantly outperform existing spatial indexing based solutions such as R-tree, $k$-d tree, Quadtree. This dissertation consists of six chapters. The first chapter introduces the research hypothesis. We describe our activity-based social influence model in Chapter 2. Chapter 3 presents the probabilistic social influence model powered with rewards incentives. We introduce spatial alarms and the basic system architecture for spatial alarm processing in Chapter 4. We describe the design of our Mondrian tree index of spatial alarms and alarm free regions in Chapter 5. In Chapter 6 we conclude the dissertation with a summary of the unique research contributions and a list of open issues closely relevant to the research problems and solution approaches presented in this dissertation.

The most recognized risk associated with the HeartMate II is thrombosis. In the presence of developing clot, the HeartMate II Display Monitor and System Controller senses a decrease in pump flow and is accompanied by audible and visual alarms when flow rates drop below a certain threshold; however, when flow is completely inhibited, the Display Monitor and System Controller both fail to indicate that flow has reduced to zero and does not produce any corresponding alarms. To test the efficacy of the HeartMate II alarms, the Donavan Mock was used to simulate the hemodynamics of a typical heart failure patient. The hemodynamics were then improved by the addition of the HeartMate II LVAS. Partially occluding the inflow and outflow of the HeartMate II did display changes in flow and presented with alarms when appropriate; however, complete occlusions of the device failed to produce any alarms or accurate changes in flow.

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