Critical Errors Research Articles

First worldwide report on Hugo RAS™ surgical platform in right and left colectomy.

The diffusion of robotic surgery is rapidly and constantly growing in different surgical specialties. Recently, novel robotic platforms have entered into the market. To date, however, most of the reports on their clinical use have specifically focused on gynecological and urological surgery. In this study, we present the first three robotic-assisted colectomies performed with the new Hugo RAS system (Medtronic, Minneapolis, MN, USA). The surgical team had previous robotic experience and completed simulation training and an official 2-day cadaver laboratory session. Operating room setting and trocar layout were planned and two full cadaver procedures were carried out (right and left colectomy). Onsite dry-run sessions were performed before tackling clinical cases. Three patients underwent robotic-assisted colectomies: one left colectomy, two right colectomies with complete mesocolic excision (CME) and high vascular ligation (HVL) at our Institution. Preoperative diagnosis was colonic adenocarcinoma in all cases. A description of the operative room setup, robotic arm configuration and docking angles is provided. Mean docking time and console time were 8 and 259min, respectively. All the surgical steps were completed without critical surgical errors or high-priority alarms. Neither intraoperative complications nor conversions to open surgery were recorded. Postoperative courses were uneventful with a mean length of stay of 5days. Further clinical data and experience are required for procedural standardization and potential integration of the system into robotic general surgery and colorectal programs.

Contesting Commemoration: The 1876 Centennial, Independence Day, and the Reconstruction-Era South by Jack Noe

Reviewed by: Contesting Commemoration: The 1876 Centennial, Independence Day, and the Reconstruction-Era South by Jack Noe Krista Kinslow (bio) Contesting Commemoration: The 1876 Centennial, Independence Day, and the Reconstruction-Era South. Jack Noe. Baton Rouge: Louisiana State Univ. Press, 2021. ISBN 978-0-8071-7558-3. 244 pp., cloth, $45.00. In Contesting Commemoration: The 1876 Centennial, Independence Day, and the Reconstruction-Era South, Jack Noe adds to the small but growing body of literature on the 1876 World’s Fair. Just in the last few years, scholars (especially art historians) have broken new ground in exploring how the visual culture of the first world’s fair in the United States reflected the conflicted world of the post–Civil War era. Noe expands on this theme by looking at how Reconstruction politics were integral to understanding the Centennial Exhibition, as well as Fourth of July celebrations in the years after the war. He correctly observes that “the commemorative activity of the Reconstruction era was inseparably intertwined with its politics, and ostensibly unifying and celebratory commemorations of the nation’s founding served as arenas for reflecting the deep sectional, partisan, and racial divisions of an unreconciled nation” (13). While he claims that “this book zeroes in on this particular moment” of the 1876 Fair, the work misses opportunities to offer more groundbreaking interpretations (13). This volume is divided into six chapters, with the first two and the last looking at Fourth of July celebrations in the South. The early parts of the book examine how white Southerners rejected the Fourth of July during and after the Civil War, as such celebrations “were symbolic of nationalism and an identity that white southerners had rejected” (55). Meanwhile, African Americans embraced the holiday, as a way to “articulate their claim to the rights of citizenship” (48). [End Page 119] However, as Redemption became reality by 1876, white Southerners began to lose some of their ”antipathy” to Independence Day celebrations, although such festivities continued to be “politically charged” (171–72). The middle of the book explores various facets of the Centennial Exhibition, with a focus on how Southerners, white and Black, reacted to the event. White Southerners often discussed the fair with derision, but African Americans, in contrast, looked at the exhibition as a place to prove their belonging to the nation. This is where Noe misses significant opportunities, as the book really does not present much evidence of African Americans discussing the fair. His best example, on the planned monument to Richard Allen, was an initiative of the African Methodist Episcopal Church headquartered in Philadelphia. Noe is much stronger in showing the various ways white Southerners reacted to the fair, with some linking it to Radical Reconstruction and others seeing it as an opportunity to advance the economic interests of the region, the state, or the local area in which they lived. This is something he terms the “New Departure approach” to the Centennial (75). The controversies over who would represent each Southern state on the Centennial Planning Committee is well covered here, especially the details of the story in Texas. However, it appears the author has mistaken the Louisiana commissioner, John C. Lynch, with Mississippi’s Black representative, John R. Lynch, an understandable mistake, given that the newspaper source he cites made the same critical error (137). In suggesting that the Centennial was “designed to heal the wounds of the Civil War,” Noe perhaps takes its planners too much at their word, given that he also points out that works of art depicting the war abounded, in particular the controversial pro-Union painting Battle of Gettysburg (131). It is in this section that the book would have greatly benefited from some photographs or illustrations, as it is difficult for a reader to understand the analysis without seeing the visual image. The book’s organization breaks down as well. This is perhaps unsurprising, given that the Centennial Exhibition included local, state, and national components and that the book also tries to cover decades of Independence Day celebrations in the entire South, meaning that there is too much to analyze in one volume. It seems it would have been better to focus on one...

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In silico investigation of the effect of particle diameter on deposition uniformity in pulmonary drug delivery

Systemic drug delivery via the pulmonary route has a critical limitation because dose uniformity is strongly dependent upon patient inhalation technique. The most frequent and critical errors in inhalation technique are overly forceful inspiration and insufficient breath-holding. In this study, response surface methodology was used with an in silico whole lung particle deposition model for bolus administration to investigate whether varying the inhaled drug particle size could reduce the dependence of deposition upon flow rate and/or breath-holding duration. The range of particle aerodynamic diameters studied was 0.1–10 µm for flow rates between 500–2000 mL/s and breath-holding duration between 0–15 seconds. Comparison with published experimental data showed that this modeling approach can accurately predict the lung deposition. The simulation results indicated that the deposition of particles with aerodynamic diameter in the range of 0.1–1.5 µm should be minimally affected by flow rate over the 500–2000 mL/s range. There was found to be no particle size whose deposition was completely independent of breath-holding duration. The smallest particles, whose deposition is diffusion-driven, were found to be the least sensitive to breath-holding time, but this size is of limited practical use. On the other hand, the simulations indicated that particles with a 1.5 µm diameter would provide acceptable consistency in dose reaching the acini region when the breath-holding duration was greater than 10 seconds. It is hoped that this finding could provide a means of improving dose uniformity for systemic delivery via the pulmonary route by facilitating simplified patient instructions.

On the sample complexity of actor-critic method for reinforcement learning with function approximation

Reinforcement learning, mathematically described by Markov Decision Problems, may be approached either through dynamic programming or policy search. Actor-critic algorithms combine the merits of both approaches by alternating between steps to estimate the value function and policy gradient updates. Due to the fact that the updates exhibit correlated noise and biased gradient updates, only the asymptotic behavior of actor-critic is known by connecting its behavior to dynamical systems. This work puts forth a new variant of actor-critic that employs Monte Carlo rollouts during the policy search updates, which results in controllable bias that depends on the number of critic evaluations. As a result, we are able to provide for the first time the convergence rate of actor-critic algorithms when the policy search step employs policy gradient, agnostic to the choice of policy evaluation technique. In particular, we establish conditions under which the sample complexity is comparable to stochastic gradient method for non-convex problems or slower as a result of the critic estimation error, which is the main complexity bottleneck. These results hold in continuous state and action spaces with linear function approximation for the value function. We then specialize these conceptual results to the case where the critic is estimated by Temporal Difference, Gradient Temporal Difference, and Accelerated Gradient Temporal Difference. These learning rates are then corroborated on a navigation problem involving an obstacle and the pendulum problem which provide insight into the interplay between optimization and generalization in reinforcement learning.

Ensuring Fact-Based Metabolite Identification in Liquid Chromatography-Mass Spectrometry-Based Metabolomics.

Metabolite identification represents a major bottleneck in contemporary metabolomics research and a step where critical errors may occur and pass unnoticed. This is especially the case for studies employing liquid chromatography-mass spectrometry technology, where there is increased concern on the validity of the proposed identities. In the present perspective article, we describe the issue and categorize the errors into two types: identities that show poor biological plausibility and identities that do not comply with chromatographic data and thus to physicochemical properties (usually hydrophobicity/hydrophilicity) of the proposed molecule. We discuss the problem, present characteristic examples, and propose measures to improve the situation.

A room of errors simulation to improve pharmacy operators' knowledge of cytotoxic drug production.

We used an educational healthcare simulation tool called room of errors (ROE) to raise pharmacy operators' awareness of potential errors in a chemotherapy production process and assessed its impact on their knowledge and satisfaction. Twenty-five errors (compiled from internal procedures, literature and our hospital's reported incidents) were categorised as static (n = 7, visible by the participant anytime) and dynamic (n = 18, made by a pseudooperator in front of the participant). Our simulated cytotoxic production unit (CPU) hosted the 1 h-simulation. Two pharmacists (supervisor/pseudo-operator) welcomed the trainee for a 10-min briefing. During the 20-min simulation, participants watched the pseudo-operator's gestures in a simulated chemotherapy production process. Participants called out each error observed (recorded by the supervisor). A 20-min debriefing followed. ROE's impact on knowledge was measured through participants' answers to a before-and after 18-item questionnaire about CPU's procedures and certainty about answers on a scale (0%-100%). Participants evaluated the training using a satisfaction questionnaire (Likert scale, 1-6). The 14 participants detected 70.4% ± 11.4% of errors. Least-detected errors were "using non-disinfected vials" (42.9%) and "touching syringe plunger" (0%). Critical errors (expired leftovers or glucose instead of sodium chloride) were detected at 57.1%. Knowledge improved from 60.3% to 94.1% (p < 0.001) and certainty from 75.3% to 98.8% (p < 0.001). Participants appreciated this non-judgmental, informative, and original training (satisfaction 95.7%). Some pointed out difficulties settling into the game quickly and visualising static and dynamic errors simultaneously. This ROE simulation improved operators' knowledge and certainty. Longer-term testing should be done to measure knowledge retention over time.

Event-Triggered Single-Network ADP for Zero-Sum Game of Unknown Nonlinear Systems with Constrained Input

In this paper, an event-triggered adaptive dynamic programming (ADP) method is proposed to deal with the H∞ problem with unknown dynamic and constrained input. Firstly, the H∞-constrained problem is regarded as the two-player zero-sum game with the nonquadratic value function. Secondly, we develop the event-triggered Hamilton–Jacobi–Isaacs(HJI) equation, and an event-triggered ADP method is proposed to solve the HJI equation, which is equivalent to solving the Nash saddle point of the zero-sum game. An event-based single-critic neural network (NN) is applied to obtain the optimal value function, which reduces the communication resource and computational cost of algorithm implementation. For the event-triggered control, a triggering condition with the level of disturbance attenuation is developed to limit the number of sampling states, and the condition avoids Zeno behavior by proving the existence of events with minimum triggering interval. It is proved theoretically that the closed-loop system is asymptotically stable, and the critic NN weight error is uniformly ultimately boundedness (UUB). The learning performance of the proposed algorithm is verified by two examples.

Determination of the representative volume element model critical size for carbon fiber reinforced polymer composites

The critical size is a prerequisite to accurately evaluate mechanical properties by utilizing the representative volume element (RVE) model. This study proposes a method to determine the RVE model critical size based on statistical theory. First of all, the distribution types followed by the calculated results of models are tested by hypothesis test methods. Afterwards, the least sample for a given confidence level is determined by using the t-test. Lastly, the RVE model critical size is determined by analyzing the dispersion of statistics. The results show that the mechanical properties of different models for the same size follow a normal distribution. The least sample exists where the error of mechanical properties is stable. By quantifying the dispersion of mechanical properties, the RVE model critical size is determined at low significance level and low critical error, hence the error of results for an arbitrary model with this size can be quantified.

Validation of Soave–Redlich–Kwong equation of state coupled with a classical mixing rule for sound speed of non-ideal gas mixture of oxygen-hydrogen as liquid rocket propellants

Numerical simulations of inlet jets flow of propellants in the main combustion chamber equipped in a liquid rocket engine have been conducted by compressible CFD technics employing a van der Waals-type equation of state (EOS) and chemical reaction models. Various simulations have been already conducted both for combustion and non-combustion state in the chamber; however, the accuracy of EOS for the mixture of propellant employing a classical mixing rule (CMR), particularly for the sound speed, has not been understood well. Therefore, we have validated the applicability of Soave–Redlich–Kwong (SRK) EOS as one of the van der Waals-type EOSs coupled with the CMR for the sound speed using molecular dynamics (MD) simulations against an imaginary model of oxygen-hydrogen mixture system. We found that SRK EOS coupled with a well-employed CMR can reproduce the sound speed in the MD simulations within a relative error of several percent and that the CMR hardly increases the deviation of the SRK EOS in the single component. The present results suggest that the SRK EOS with the CMR cannot be the main factor to cause critical errors in the CFD based on RANS, which will give reliability to current CFD simulations for internal flows in a combustion chamber of a liquid rocket engine.

Automating log analysis for industrial equipment maintenance using elastic stack

Contemporary technological equipment generates a substantial amount of data that can provide insights into system performance and help predict failures and critical errors. However, manual analysis of this data is time-consuming, and hence there is a need for automated tools to collect, process, and store log files. In this context, the study aims to develop an information system that can streamline log file analysis using ELK software solutions from the IT industry. The article explores the structure and components of ELK software and develops a software solution's structural diagram and architecture for practical use. Based on the conducted research, a software solution was implemented, and log data provided by the NASA Ames Research Center was analyzed and visualized through graphs and histograms. The study's novelty lies in using the ELK software stack for log file analysis of technological equipment, which is a widely used solution in the IT industry. The proposed system aims to reduce log file analysis time and help make informed decisions about system performance and maintenance.

О ПЕРВИЧНЫХ ТЕХНИЧЕСКИХ УСТРОЙСТВАХ И ТРЕБОВАНИЯХ К КЛЮЧАМ БЕЗОПАСНОСТИ КВАНТОВЫХ СИСТЕМ

Purpose of the article: development of new methods, algorithms and models to detect unauthorized actions of an intruder/s in relation to broadcast data represented in the form of one-photon pure states of light particles, which will allow: to strengthen the secrecy of basic security keys, improve procedures for data exchange and processing by legitimate users of the telecommunications system, expand the functionality of existing technological solutions in their classic representation. Research method: system analysis, information security assessment method. The result: risks of critical system errors for procedures of basic states measurement results matching and supposed potential possibilities of attacker to realize vulnerabilities through active phase of attacks with explicit critical outcome are presented. It is established that translation of mixed single-photon states and imposition on receiving hardware is explicitly uncontrolled, unaccountable and not contained in any algorithm of quantum protocols, which, according to the authors, is the most critical vulnerability of modern cryptographic systems based on quantum mechanics. A way to solve problems of “silent” scanning and to counteract hidden active attacks on quantum channel and particle states is proposed. The essence of the solution consists in non-orthogonality of states of a random basis vector and duplication of a main communication channel containing an information path on pulse signals broadcasting, where a known number of synchro-sentences in a backup line allows to trace an attacker. Fundamental is the knowledge of the primary-natural errors occurring at each of the stages of the formation of the main security key.

Refinement of the Process Capability Index Сalculation

The variability of product performance is the reason for the introduction of special methods to ensure product quality, particularly statistical methods. These include introducing statistical process control (SPC) in production and calculating the process capability index to determine the manufacturing ability to meet the product’s quality requirements. To a large extent, the ability of a process to meet the requirements was determined by the location of the process or the mathematical expectation of the controlled quality characteristic value. Process setup center variability within the boundaries of the Shewhart control chart of the average values was supposed to be the natural state for a statistically controlled process. However, the calculation of the process capability index did not consider the possibility of a shift in the actual value of the process setup center for a controlled characteristic from its mathematical expectation. It was proposed to adjust the process capability index for the setup center’s possible deviation. It demonstrated the possibility of critical errors in determining the ability of a production process to meet requirements without considering the process setup center. The effectiveness of the proposed solutions was also demonstrated by the example of determining the ability of the welding wire manufacturing process to meet the requirements for metal yield strength of the welded joint of metal bridge span constructions.

Software for collecting statistical data of the quality of web resources peformance

In Ukraine, as in most countries of the world, the information society is being formed as an integrated environment, the process of its formation is conditioned by the technological, economic and social development of the country. The article presents an effective mechanism and means of tracking statistical data of the operation of web resources, the impact of the operation quality of web resources on the number of visits and the security of web applications. Have been studied the functional capabilities that such systems should provide, and its potential to ensure a constant improvement in the quality of services provided to clients. Web resources, namely websites, databases or internal applications of enterprises have become an integral part of the modern information environment and one of the main drivers of economic and trade development. Without them, the rapid exchange of data and the automation of the work of various industries, the existence of production and modern infrastructure are impossible. Because of this, the quality of service offered by web applications and their security is a key aspect of the functioning of industrial sectors and infrastructure facilities that cannot function correctly without the appropriate software. The main goals of creating systems for collecting statistical data on the quality of web resource performance are the economic development and industry security improvement, the quality improvement of user services by optimizing and modernizing the flaws discovered during software support stage, and the elimination of critical errors and vulnerabilities in software.

FMEA Based Fuzzy Topsis for Assessment of Quality Problems in Telescopic Platform Production

In order to increase process and product quality fast and least costly, it is very useful to focus on the process that causes the important quality problems. In this study, quality problems and related processes in a company that produces on-vehicle equipment in the automotive industry are examined. The purpose of this study is to provide a quality improvement perspective to reduce process and product defects. Fault Mode and Effects Analysis (FMEA) is applied to detect faults, determine their causes and prioritize them. Prioritization of critical quality errors is revealed using traditional FMEA and FMEA-based fuzzy Technique for Order Preference by Similarity to Ideal Solution (TOPSIS). The FMEA-based fuzzy TOPSIS method has been proposed because of its ability to handle uncertainty arising from the subjective judgments of decision makers. The results are compared and the preventions are suggested to avoid from the most important process that causes the quality problem.

Time-differenced double difference method for measurement of Navigation with Indian Constellation (NavIC) receiver differential phase bias

The pseudo-range (PR) and carrier phase (CP) observations of Global Navigation Satellite System (GNSS)/Navigation with Indian Constellation (NavIC) receivers are influenced due to various errors like ionosphere delay, troposphere delay, receiver and satellite clock error, multipath, integer ambiguity, receiver hardware noise etc. However, the real-time positioning and navigation applications are in quest of high-quality carrier phase measurements with zero bias. The GNSS/NavIC receiver hardware noise is one of the critical error sources that degrade the quality of carrier phase measurements. And it can be measured by computing the differential phase bias or carrier phase bias employing the double-difference method. This research article proposes a novel approach called Time Differenced Double Difference Carrier Phase (TDDDCP) for estimating differential phase bias or carrier phase bias of NavIC receiver. Moreover, the proposed TDDDCP technique has the advantage over the Double Difference Carrier Phase (DDCP) because it requires data from only one satellite with two zero base length receivers for which the differential phase bias is to be measured. The experimental results show that the differential phase bias value differs for different satellites, ranging from −0.3904 m to 0.3168 m. The bias-free carrier phase observations based on position coordinates (X, Y, Z) found improved precision of standard deviation of 0.4176 m, 0.645 m, and 0.328 m, respectively.

Clinical recommendations for dry powder inhaler use in the management of COPD in primary care

Over 1400 patients using dry powder inhalers (DPIs) to deliver COPD maintenance therapies were recruited across Europe and Australia. Their peak inspiratory flow (PIF) was measured, inhaler technique was observed, and adherence to treatment assessed. From relating the findings with patient health status, and thereby identifying critical errors, key clinical recommendations for primary care clinicians were determined, namely – measure PIF before prescribing a DPI to ensure inhalation manoeuvre ability is well-matched with the device. Some patients could benefit from inhalation training whereas others should have their DPI changed for one better suited to their inspiratory ability or alternatively be prescribed an active device (such as a soft mist inhaler or pressurized metered dose inhaler). Observing the inhalation technique was valuable however this misses suboptimal PIF (approaching one fourth of patients with a satisfactory observed manoeuvre had a suboptimal PIF for their DPI). Assess adherence as deliberate non-adherence can point to a mismatch between a patient and their inhaler (deliberate non-adherence was significantly associated with PIFs below the minimum for the DPI). In-person observation of inhalation technique was found to be inferior to video rating based on device-specific checklists. Where video assessments are not possible, observation training for healthcare professionals would therefore be valuable particularly to improve the ability to identify the critical errors associated with health status namely ‘teeth and lips sealed around mouthpiece’, ‘breathe in’ and ‘breathing out calmly after inhalation’. However, it is recommended that observation alone should not replace PIF measurement in the DPI selection process.Trial registration:https://clinicaltrials.gov/ct2/show/NCT04532853.

Identifying Accessibility Improvement Opportunities for Global Environmental Communication Websites

Digital environmental information presented with low web accessibility reduces participation in environmental advocacy and information seeking behaviors for many people with disabilities, creating a consequential digital divide. We use WEB AIM computer automated analysis of web accessibility to assess the general accessibility of online environmental communication messages. Results show 95.3% of the popular websites in our sample had indicators of potentially critical accessibility errors. Our findings highlight the importance of addressing digital environmental information accessibility shortcomings so that educational, informational and persuasive environmental messages can increase environmental literacy of vulnerable populations and help to bridge the digital divide.

Retention of military combat lifesaving skills during six months following classroom-style and individualized-style initial training

ABSTRACT The current study was performed to obtain insight into the retention of combat lifesaving (CLS) skills after initial training and to compare a more individualized-style training with a more classroom-style training. We measured performance at 0 month, 2 months, and 6 months after initial training in 40 CLSers (17 individualized, 23 classroom). Each test consisted of two 20-minute scenarios with a medical mannequin to simulate combat injuries. An instructor scored the actions, which were divided into critical and non-critical by medical experts. We also measured the speed of performing the protocol and perceived mental effort and anxiety. There were no differences between the groups in critical actions. The full sample made on average almost six critical errors per scenario at 6 months. However, on non-critical actions, the individualized group scored better at 0 month. The individualized group also performed the protocol faster at each test. The classroom group reported an increase in mental effort and anxiety at subsequent tests, while the individualized group did not. Based on the high number of critical errors at 6 months, and on the drop-off in performance at 2 months, we advise that extra refresher training is organized within 2 months after initial training to improve retention further down the line.

Association between Inhalation Instruction Method in Community Pharmacies and Inhaler Device Handling Error in Patients with Obstructive Lung Disease: An Evaluation of the Impact of Practical Demonstration by Pharmacists.

Inhaler devices play an important role in the management of obstructive lung diseases including asthma, chronic obstructive pulmonary disease (COPD), and asthma-COPD overlap. Some of these patients show suboptimal inhaler techniques; however, time for inhaler instruction by pharmacists is limited in daily clinical practice. Therefore, sufficient education regarding inhaler device handling should be provided within a limited time frame. The current study aimed to investigate the instruction methods provided by community pharmacists and their influence on inhaler device handling techniques in outpatient clinical care settings. We retrospectively collected the data of outpatients with obstructive lung diseases who were referred to our hospital and who underwent inhalation technique assessments conducted by community pharmacists. The prevalence of handling errors, clinical characteristics of patients, and instruction methods were analyzed. In total, 138 patients (170 devices) were included in this study. Approximately 70.0% of patients received verbal explanations combined with leaflets about inhaler instructions. In a device-based analysis, 63 (37.1%) of 170 devices had at least one technical error and 18 (10.6%) of the devices had critical errors. Patients without critical errors received practical demonstration instructions from pharmacists combined with leaflets and verbal explanations more frequently than those with critical errors (22.8 vs. 0%, p < 0.01). This study revealed that patients with obstructive lung diseases commonly present with inhaler device handling errors and critical errors were observed with non-negligible frequency in daily practice in Japan. Combined instruction with leaflet, verbal explanation, and pharmacist demonstration may be effective in improving proper inhaler treatment.