Yes / Background The National Early Warning Score (NEWS) is being replaced with NEWS2 which adds 3 points for new confusion or delirium. We estimated the impact of adding delirium on the number of medium/high level alerts that are triggers to escalate care. Methods Analysis of emergency medical admissions in two acute hospitals (York Hospital (YH) and Northern Lincolnshire and Goole NHS Foundation Trust hospitals (NH)) in England. Twenty per cent were randomly assigned to have delirium. Results The number of emergency admissions (YH: 35584; NH: 35795), mortality (YH: 5.7%; NH: 5.5%), index NEWS (YH: 2.5; NH: 2.1) and numbers of NEWS recorded (YH: 879193; NH: 884072) were similar in each hospital. The mean number of patients with medium level alerts per day increased from 55.3 (NEWS) to 69.5 (NEWS2), a 25.7% increase in YH and 64.1 (NEWS) to 77.4 (NEWS2), a 20.7% increase in NH. The mean number of patients with high level alerts per day increased from 27.3 (NEWS) to 34.4 (NEWS2), a 26.0% increase in YH and 29.9 (NEWS) to 37.7 (NEWS2), a 26.1% increase in NH. Conclusions The addition of delirium in NEWS2 will have a substantial increase in medium and high level alerts in hospitalised emergency medical patients. Rigorous evaluation of NEWS2 is required before widespread implementation because the extent to which staff can cope with this increase without adverse consequences remains unknown.

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Failure to rescue (FTR) outcomes may be one consequence of the relationship be-tween healthcare provider behaviors and attitudes, organizational factors, and environ-mental factors that intersect to potentially threaten patient safety. Early warning systems (EWS) were designed as surveillance systems to reduce failure to rescue events and avoid morbidity and mortality. Challenges with EWS include lack of standardization, organiza-tional barriers, such as culture and supports, and human factor attributes such as intuition, expertise, and experience. The experience and perceptions of nurses using EWS technolo-gy as it relates to their clinical assessment, critical thinking, and decision-making skills has yet to be undertaken. This study adds to the body of EWS and FTR literature and the broader culture of safety literature in acute care environments. The purposes of this exploratory qualitative descriptive study was to explore the experiences of nurses using EWS in acute care practice settings and how they perceive it impacts on their critical thinking and clinical decision-making processes. The study identi-fied three informative findings: a) EWS has added value particularly with novice nurses or nurses new to practice settings, b) EWS provides benefits to nurses working in acute clinical environments that experience high volumes and high acuity of patients by alerting or reminding them about potential FTR situations, and c) Existing EWS may require mod-ification to improve adequacy, reduce redundancy, and reduce alarm fatigue. Based on the evidence reviewed, a qualitative study to increase our understanding of the experi-ence of nurses and their perception of the impact of EWS and related technology on their critical thinking and other nursing practice processes has the potential to contribute to a wider evaluation of EWS systems and to improve patient outcomes. / Thesis / Master of Science (MSc) / Before patients on general medical or surgical hospital units become so ill that they need to be transferred to an intensive care unit, they have abnormal vital signs and other physiological changes that can go unnoticed for 2448 hours. As these changes can be hard to detect and serious illness can begin very slowly at first, early warning systems have been developed to help health care professionals respond to patient’s conditions before they need to be in an intensive care unit. These early warning systems can be in the form of new technology and assist nurses with preventing a serious illness from becoming critical. It is not well research or understood how nurses experience such early warning systems technology and it is not well understood how nurses think this technology impacts their nursing practice. The overall aim of the study is to learn more about the experience and perception of nurses who use this technology, how they believe it informs their nursing practice and how it supports them in making clinical decisions about patient care.

<p> One of the important objectives of a Radar Warning Receiver (RWR) aboard a tactical aircraft is to evaluate the level of threat posed by hostile radars in an extremely complex Electronic Warfare (EW) environment in reliable, robust and timely manner. For the RWR objective to be achieved, it passively collects electromagnetic signals emitted from potentially hostile radars. One class of such radar systems is the Multi-Function Radar (MFR) which presents a serious threat from the stand point of a RWR. MFRs perform multiple functions simultaneously employing complex hierarchical signal architecture. The purpose of this paper is to uncover the evolution of the operational mode (radar function) from the view point of a target carrying the RWR when provided with noisy observations and some prior knowledge about how the observed radar functions. The RWR estimates the radar's threat which is directly dependant on its current mode of operation. This paper presents a grid filter approach to estimate operational mode probabilities accurately with the aid of pre-trained Observable Operator Models (OOMs) and Hidden Markov Models (HMMs). Subsequently, the current mode of operation of a radar is estimated in the maximum a posteriori (MAP) sense. Practicality of this novel approach is tested for an EW scenario in this paper by means of a hypothetical MFR example. Finally, we conclude that the OOM-based grid filter tracks the mode of operation of a MFR more accurately than the corresponding HMM-based grid filter. </p> / Thesis / Master of Applied Science (MASc)

The I-81 Corridor in Virginia traverses the western part of the state, connecting Bristol in the south to Winchester in the north. A study carried out at the Virginia Tech Center for Transportation Research identified traffic safety, work zone safety and traffic control, trucking issues, and intercity traveler information needs as important issues that deserve attention on the I-81 Corridor in Virginia. Analysis of work zone accident statistics showed a need for real-time systems to enhance work zone safety. Real-time advanced warning and traffic control systems provide a means of dynamic information dissemination and advanced warning, thereby enhancing work zone safety and facilitating traffic control. The focus of this research was on the development of functional and system requirements for a real-time advanced warning and traffic control system for work zones. This task was based on the examination of work zone accidents and their causes. The functional requirements include advanced warning, surveillance, advisory, and control functions. Each of these functions consists of several sub-functions. The needs with respect to each of these functions have also been identified. System requirements such as real-time operation, credibility, portability, ease of installation, and adaptability were also identified. Evaluation criteria and potential Measures Of Effectiveness (MOEs) for the evaluation of the system were also identified. Additionally, issues related to the evaluation of the system, such as time duration for evaluation and data collection techniques were identified and examined. / Master of Science

An average of 42,000 fatalities occur on the United States of America's roads each year as a result of motor-vehicle crashes (National Highway Traffic Safety Administration, 2003). The dangers with respect to curves exist, from late notification of direction and speed, varying methods for determining advisory speeds, as well as driver unfamiliarity and/or over confidence. A curve-warning device, a device that notifies the driver of an upcoming curve and, possibly, conveys its vehicle-specific advisory speed and even direction, has the potential to drastically reduce the dangers of curve navigation. This study was performed as a proof of concept with regard to appropriate modalities and respective stimuli for a curve warning application. For this study, objective and subjective measurements were collected in a simulator environment to compare conditions comprised of multiple stimuli from the auditory (icon, tone, and speech), visual (Heads Down Display and Heads Up Display), and haptic (throttle push-back) modalities. The results of the study show that the speech stimulus was the most appropriate of the auditory stimuli for both objective and subjective measurements. Objectively, the HDD and HUD were comparable with respect to performance, although the participants tended to favor the HDD in their subjective ratings. The throttle push-back did little to positively impact the performance measurements, and based on participant comments and ratings, it is not recommended for a curve-warning application. Of the stimulus conditions (combinations of two and three modalities), the Speech and HDD condition provided performance gains and subjective acceptability above the rest of the conditions. / Master of Science

Risk indicators are metrics that are widely used in risk management to indicate how risky an activity is. Among different types of risk indicators, early warning systems are designed to help decision makers predict and be prepared for catastrophic events. Especially, in complex systems where outcomes are often difficult to predict, early warnings can help decision makers manage possible risks and take a proactive approach. Early prediction of catastrophic events and outcomes are at the heart of risk management, and help decision makers take appropriate actions in order to mitigate possible effects of such events. For example, physicians would like to prevent any adverse events for their patients and like to use all pieces of information that help accurate early diagnosis and interventions. In this research, first we study risk assessment for occupational injuries using accident severity grade as an early warning indicator. We develop a new severity scoring system which considers multiple injury severity factors, and can be used as a part of a novel three-dimensional risk assessment matrix which includes an incident's severity, frequency, and preventability. Then we study the predictability of health outcome based on early risk indicators. A systems model of patient health outcomes and hospital length of stay is presented based on initial health risk and physician assessment of risk. The model elaborates on the interdependent effects of hospital service and a physician's subjective risk assessment on length of stay and mortality. Finally, we extend our research to study the predictive power of early warning systems and prognostic risk indicators in predicting different outcomes in health such as mortality, disease diagnosis, adverse outcomes, care intensity, and survival. This study provides a theoretical framework on why risk indicators can or cannot predict healthcare outcomes, and how better predictors can be designed. Overall, these three essays shed light on complexities of risk assessments, especially in health domain, and in the contexts where individuals continuously observe and react to the risk indicators. Furthermore, our multi-method research approach provides new insights into improving the design and use of the risk measures. / Ph. D.

Abstract The aim of the studie was to investigate if the Pediatric Early Warning Score system, PEWS, is an useful instrument on a children's inpatient ward, regarding the detecting of deterioration in children's vital signs. For this, a quantitative descriptive design with qualitative elements was used. Method: Study specific questionnaires were distributed to 86 persons (helpnurses, nurses and doctors). Of these, 36 answered and sent back the surveys. Results: Of 36 responses 25 felt experienced a faster detection of deterioration of vital signs in the child. Many felt that they had faster response from the physician on call by providing an assessment figure of the child's condition. Conclusion: Most of the persons experienced that the use of the assessment intrument PEWS detected a deterioration of the child´s vital signs earlier than before using the instrument. Staff experienced greater security in their work when they had a tool to help and they also experienced an earlier response from physicians. / SAMMANFATTNING   Syftet med studien var att undersöka om bedömningsinstrumentet Pediatric Early Warning Score, PEWS, är till användning och vägledning på barnavdelning med avseende att upptäcka försämring av barns vitalparametrar. För detta användes en beskrivande kvantitativ design med kvalitativa inslag. Metod: Ett studiespecifikt enkätformulär gick ut till 86 personer (undersköterskor, sjuksköterskor och läkare på två pediatriska vårdavdelningar). Av dessa besvarades 36 enkäter. Resultat: Av 36 svarande ansåg 25 att man snabbare upptäckte försämring av vitalparametrarna hos barnet. Många ansåg att de fick snabbare gensvar från jourläkare genom att uppge en bedömningssiffra över barnets hälsotillstånd. Slutsats: Med hjälp av bedömningsinstrumentet PEWS upplevde personalen att en upptäckt av försämring av barnets vitalparametrar gjordes tidigare, samt att gensvar från jourläkare erhölls snabbare. Personalen upplevde en ökad trygghet i sitt arbete då man hade ett arbetsredskap till hjälp.

The purpose of the present study was to examine effects of driver, vehicle, and environment characteristics on Collision Warning System (CWS) design. One hypothesis was made that the capability of collision avoidance would not be same among a driver, vehicle, and environment group with different characteristics. Accident analysis and quantitative analysis was used to examine this hypothesis in terms of ‘risk’ and ‘safety margin’ respectively. Rear-end collision had a stronger focus in the present study. As a result of accident analysis, heavy truck showed a higher susceptibility of the fatal rear-end accidents than car and light truck. Also, dry road surface compared to wet or snow, dark condition compared to daylight condition, straight road compared to curved road, level road compared to grade, crest or sag, roadway having more than 5 travel lanes compared to roadway having 2, 3 or 4 travel lanes showed a higher susceptibility of the fatal rear-end accidents. Relative rear-end accidents involvement proportion compared to the other types of collision was used as a measure of susceptibility. As a result of quantitative analysis, a significant difference in terms of Required Minimum Warning Distance (RMWD) was made among a different vehicle type and braking system group. However, relatively small difference was made among a different age, gender group in terms of RMWD. Based on the result, breaking performance of vehicle should be regarded as an input variable in the design of CWS, specifically warning timing criteria, was concluded.