Safety Learning Research Articles

Evaluation of Measure Dx, a Resource to Accelerate Diagnostic Safety Learning and Improvement.

Several strategies have been developed to detect diagnostic errors for organizational learning and improvement. However, few health care organizations (HCOs) have integrated these strategies into routine operations. To address this gap, the Agency for Healthcare Research and Quality released "Measure Dx: A Resource To Identify, Analyze, and Learn From Diagnostic Safety Events" in 2022. We conducted an evaluation of Measure Dx to measure feasibility of implementation and effects on short-term and intermediate outcomes related to diagnostic safety. Prospective observational study. Teams from 11 HCOs, primarily academic medical centers. Participants were asked to use Measure Dx over approximately 6months and attend monthly virtual learning collaborative sessions to share and discuss approaches to measuring diagnostic safety. Descriptive outcomes were gathered at the HCO level and included uptake of different case-finding strategies and the number of cases reviewed and confirmed to have diagnostic safety improvement opportunities. We collected information on organizational practices related to diagnostic safety at each HCO at baseline and at the conclusion of the project. The 11 HCOs completed all requirements for the evaluation. Each of the four diagnostic safety case finding strategies outlined in Measure Dx were used by at least three HCOs. Across the cohort, participants reviewed 703 cases using a standardized data collection instrument. Of those cases, 224 (31.8%) were identified as diagnostic safety events with improvement opportunities. Unexpectedly, self-ratings on the checklist assessment declined for several organizations. Use of Measure Dx can help accelerate implementation of systematic approaches to diagnostic error measurement and learning across a variety of HCOs, while potentially enabling HCOs to identify opportunities to improve diagnostic safety practices.

Nursing Students' Experiences and Perceived Learning Effectiveness of Patient Safety and Its Influencing Factors: An Integrative Literature Review.

To examine and synthesise the current literature to gain insights into nursing students' experiences, their perceived learning effectiveness of patient safety and its influencing factors. Integrative review. CINAHL, Medline, Scopus, and Embase databases from January 2011 to October 2023. Of the 5940 papers initially retrieved, 33 were included after title, abstract, and full-text screening. No papers were omitted through quality appraisal. Despite nursing students' generally positive attitude towards patient safety, their idealistic view did not translate into actual actions of upholding patient safety due to various factors. Moreover, their experiences and perceived effectiveness of learning patient safety were influenced by factors such as organisational safety culture and pedagogical contexts. Thematic analysis revealed four themes: 'perception, attitudes, and evaluation towards patient safety'; 'supportive organizational culture as impetus to promote patient safety'; 'perceived confidence, knowledge, and competence toward patient safety'; and 'educational contexts and pedagogies to promote learning of patient safety'. There is an inadequate focus on patient safety in clinical education compared to classroom education. Given that the clinical setting serves as an authentic learning environment of patient safety, nursing faculties play a crucial role in reforming existing nursing curricula to integrate patient safety education in both settings to ensure continuity of learning. Clinical nursing leaders should also proactively review and reform organisational culture and practices to enable nursing students' acquisition and internalisation of patient safety learning. This review highlighted the need for further collaboration between nursing faculties and healthcare institutions to advocate an environment conducive to nursing students' effective learning of patient safety. Reporting adheres to the Reporting items for systematic review and meta-analyses (PRISMA) 2020 guidelines. No patient or public contribution.

Perceived Leadership Support, Safety Citizenship, and Employee Safety Behavior in the Construction Industry: The Role of Safety Learning

The construction industry faces significant challenges in ensuring worker safety, encompassing both physical hazards and mental health concerns. Drawing on Social Exchange Theory (SET), this study explores the impact of perceived leadership support (PLS) on employee safety behavior (ESB) and safety citizenship behavior (SCB), focusing on the mediating role of SCB and the moderating effect of safety learning (SL). A quantitative approach was employed, collecting a sample size of 410 construction workers from various companies within the Turkish construction sector. Data were collected through electronic questionnaires and analyzed using Partial Least Squares Structural Equation Modeling (PLS-SEM). The results reveal that PLS positively influences both ESB and SCB. Additionally, SCB mediates the relationship between PLS and ESB, while SL moderates the effect of PLS on both SCB and ESB, further strengthening the positive relationships. This study highlights the critical role of leadership support and safety learning in promoting safer behaviors within the construction industry, suggesting that organizations should cultivate a proactive safety culture to enhance safety outcomes.

Forgiveness as morally serious response to errors in healthcare: A narrative review

Retribution is often seen as a morally serious response to errors and undesirable behaviors, typically expressed through blame, punishment, and exclusion. These actions are meant to uphold professional standards, deter future wrongdoing, and restore moral balance. However, I argue that while retribution addresses certain ethical concerns, it is incomplete and can be counterproductive, particularly for patient safety and organizational learning. Systems that focus primarily on individual blame risk fostering underreporting, entrenching learning disabilities, and exacerbating harm. In this paper I propose that forgiveness — the foregoing of vindictive resentment toward a wrongdoer — offers a morally serious alternative. It facilitates accountability, restoration, and healing without trivializing the ethical weight of the harm done. By encouraging forward-looking accountability, forgiveness allows the wrongdoer to acknowledge their mistakes, make amends, and help improve practice. This not only respects the humanity of everyone involved, and addresses emotional and relational consequences, but also recognizes the systemic factors that contribute to errors. I outline concrete steps for integrating forgiveness into healthcare’s post-incident processes, balancing accountability with the need for healing and systemic change.

“A lifelong journey:” a phenomenological exploration of faculty perceptions about coach training at an academic medical center

BackgroundCoaching in academic medicine may help learners develop lifelong learning skills. Studies typically evaluate the impact on coachees and program outcomes. Limited information is available about educating faculty to integrate the role of coaching. We explored a faculty coach training program at an academic medical center in the southern region of the United States.MethodsTwenty faculty members in the college of medicine completed the 34-h training program meeting alternate weeks from May to November 2021. We collected data from reflections during training, a post-training survey, and three post-training focus group discussions making this a qualitatively driven mixed methods research. We used a transcendental phenomenological approach for the qualitative analysis entailing deriving essential meaning of the participants’ training experiences and perceptions about coaching.ResultsWe identified 3 themes (1) perceptions, skills, and understanding of coaching, (2) perceived additional benefits from coach training, and (3) effective instructional practices to teach coaching. Under the first theme, participants expressed improved understanding about the process of coaching in academic medicine, noted the importance of listening to the whole person without judgment, questioning with curiosity, vulnerability, self-awareness, and reflection for building trust. Perceived additional benefits included personal development and illuminating discoveries. Sub-themes for effective instructional practices were learning community encompassing mindfulness, psychological safety, social cohesion, experiential and interactive learning, and suggestions. Faculty experienced internal transformation while learning coaching and felt they had the capacity to influence personal and professional development of learners and colleagues. The concepts reflection, awareness, growth, and relationship were threaded throughout the three themes.ConclusionsThe training evoked self-awareness and opportunities for personal growth. The newly trained coaches expressed the beginning of an internal transformation to embody being a coach and demonstrated willingness to influence personal and professional development of learners and colleagues. Effective instructional practices to teach coaching included mindfulness practice, psychological safety, social cohesion, and experiential and interactive learning. Based on these findings, it may be summarized that in the process of training to be a coach, the faculty not only recognized the benefits of coaching for learners but also realized individual personal benefits.

A-179 Improving specimen labeling errors in the pediatric emergency department at a tertiary care hospital

Abstract Background Specimen labeling errors, such as unlabeled, mislabeled, or sample-requisition mismatches, pose risks to patient care. Correcting these errors, particularly for pediatric patients, is crucial to avoid unnecessary stress to the family and time spent on follow-up. In 2018, the BCCH Emergency Department (ED) reported the highest labeling error rates among all departments at our tertiary care hospital, accounting for approximately 30% of all errors. Methods To address this issue, a quality improvement project following the Model for Improvement framework was initiated in 2019 at the ED. An interdisciplinary team approach was adopted initially, and a positive patient identification system (PPID) was implemented later in February 2022. Patient Safety Learning System (PSLS) data from January 2019 to November 2023 were analyzed to evaluate the impact of these interventions. Results 1763 (22.6%) of the 7802 PSLS events recorded during this period were sample labeling errors. Ward collections accounted for the majority of labeling errors compared to laboratory collections (20.3% vs 2.4%). In the ED, most of the labeling errors occurred with unspecified samples (25%), swabs (24%), urine (23%), and blood culture (19%). The interdisciplinary team intervention initially reduced labeling errors, but its impact was inconsistent. However, the implementation of PPID in 2022 led to a significant and consistent decrease in labeling errors in the ED (4.51 errors/month vs 1.14 errors/month; p = 0.01) (Figure. 1). Conclusions While the implementation of PPID has notably improved labeling errors in the ED, complete elimination remains challenging. In addition, more specific PSLS filing categories are needed to capture sources of labeling error from unspecified samples. Continued efforts are necessary to achieve the goal of zero labeling errors.

Handholding reduces the recovery of threat memories and magnifies prefrontal hemodynamic responses

Human touch is a powerful means of social and affective regulation, promoting safety behaviors. Yet, despite its importance across human contexts, it remains unknown how touch can promote the learning of new safety memories and what neural processes underlie such effects. The current study used measures of peripheral physiology and brain activity to examine the effects of interpersonal touch during safety learning (extinction) on the recovery of previously learned threat. We observed that handholding during extinction significantly reduced threat recovery, which was reflected in enhanced prefrontal hemodynamic responses. This effect was absent when learners were instructed to hold a rubber ball, independent of the presence of their partners. Our findings indicate that social touch contributes to safety learning, potentially influencing threat memories via prefrontal circuitry.

Developmental Differences in a Hippocampal–Cingulate Pathway Involved in Learned Safety Following Interpersonal Trauma Exposure

Nearly 65% of youth experience trauma, and up to one-third of youth with trauma exposure face profound mental health sequelae. There remains a need to elucidate factors that contribute to psychopathology following trauma exposure, and to optimize interventions for youth who do not benefit sufficiently from existing treatments. Here, we probe safety signal learning (SSL), which is a mechanism of fear reduction that leverages learned safety to inhibit fear in the presence of threat-associated stimuli and has been shown to attenuate fear via a hippocampal-cingulate--specifically, a dorsal anterior cingulate cortex (dACC)--pathway. The present study used behavioral and task-based functional magnetic resonance imaging data to examine age-related associations between interpersonal trauma exposure and the behavioral and neural correlates (ie, activation and functional connectivity) of SSL in a group of 102 youth (aged 9-19 years; 46 female, 56 male) with (n= 52) and without (n= 50) interpersonal trauma exposure. Primary analyses examined anterior hippocampal activation and anterior hippocampus-dACC functional connectivity. Exploratory analyses examined centromedial (CMA) and laterobasal (LBA) amygdala activation and anterior hippocampal, CMA, and LBA functional connectivity with additional anterior cingulate subregions (ie, subgenual anterior cingulate cortex [sgACC] and rostral anterior cingulate cortex [rosACC]). Both youth with and without interpersonal trauma exposure successfully learned conditioned safety, which was determined by using self-report of contingency awareness. Youth with interpersonal trauma exposure (relative to youth in the comparison group) exhibited age-specific patterns of lower hippocampal activation (F2,96= 3.75, pFDR= .049, ηp2= 0.072), and, in exploratory analyses, showed heightened centromedial amygdala activation (F1,96= 5.37, pFDR= .046, ηp2= 0.053) and an age-related decrease in hippocampal-sgACC functional connectivity during SSL (F1,94= 10.68, pFDR= .015, ηp2= 0.102). We also show that hippocampal-sgACC functional connectivity mediated the association between interpersonal trauma exposure and post-traumatic stress disorder symptoms in an age-specific manner in the overall sample. Together, these findings suggest that although age- and trauma-specific differences in the neural correlates of SSL may relate to the development of psychopathology, youth with interpersonal trauma exposure demonstrate successful learning of conditioned safety over time. We worked to ensure that the study questionnaires were prepared in an inclusive way. We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. While citing references scientificall`y relevant for this work, we also actively worked to promote sex and gender balance in our reference list. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list. We actively worked to promote sex and gender balance in our author group. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. One or more of the authors of this paper received support from a program designed to increase minority representation in science.

Stress-induced overeating behaviors explained from a (transitory) relief-learning perspective

People use various behaviors to cope with stressful events. These behaviors are mostly adaptive, as they allow a successful release of stress without impacting other aspects of life: How nice is it to have a break with a few spoons of that favorite ice cream during a hectic working day? However, when excessive consumption of high-sugar/salt ultra-processed food becomes the gateway to find relief from stress, eating loses this adaptive function and may escalate to binge eating, lead to obesity, and other medical conditions linked to overweight.Several etiological models attempt to explain stress-induced eating and excessive overeating behaviors characterizing these clinical conditions. The popular Emotional Eating Theory proposes that stress-related (over-)eating, a major predictor of obesity and diagnosed binge eating disorders, develops based on negative reinforcement learning since food consumption regulates the negative affective state associated with stressful circumstances. Differently, the prominent Incentive Sensitization Theory explains overeating, binge eating disorders (including bulimia), and obesity in terms of excessive amplification of reward ‘wanting’, which is thought to emerge from overexposure to obesogenic (food)cues. The several studies oriented by these theories have paved the way to better understand stress-related (over-)eating and its clinical excesses. However, a deep mechanistic understanding of how and why stress-induced (over-)eating can escalate till clinical forms of overeating remain elusive. A well-funded connection of the mechanisms proposed by the Emotional Eating Theory and the Incentive Sensitization Theory might address this etiological open question. To avoid erroneous arguments, it is however essential to first address the internal theoretical and methodological shortcomings of each theory and connected studies. These shortcomings stem from conceptual fallacies and poorly implemented designs, which might partially explain the ‘high variability and low replicability’ problem of empirical findings. Next, the formulation of a new integrative model could provide fresh insight into the deep learning and biological mechanisms of this escalation. A successful formalization of this model could then create the much-needed impact in clinical and preventive research since excessive overeating is a behavior hard to change once established.In this opinion paper, I propose to apply recent insights we gathered on the role of relief from the field of safety learning to stress (over-)eating. I will present a new relief-based model that, as a starting point, has the potential to connect the Emotional Eating Theory with the Incentive Sensitization Theory, setting the base for more integrative science.

Developing Indigenous Cultural Safety in Law: Clinical Legal Education as a Method for Getting it Done

The imperative of law schools to embed Indigenous cultural safety in legal education is well established. This paper argues that clinical legal education can make an important pedagogical contribution to the development of Indigenous cultural safety within the study of law. Drawing on a case study of a legal clinic in Logan, Queensland, this paper details clinic teaching and learning activities, and highlights the role of yarning as a process for engaging cultural humility and understanding. A review of pedagogical theories is provided to demonstrate that multiple theoretical approaches support the clinical method as an effective vehicle for delivering transformative learning on issues such as institutional racial bias within law, the legal profession, and broader society. Clinic evaluation reveals strong cultural safety learning outcomes. This paper concludes with some observations about the clinic’s strengths and limitations, including the benefits of devolving autonomy for clinic design to Indigenous clinical supervisors, issues of scalability and funding for community stakeholders.

Organizational resilience and primary care nurses' work conditions and well-being: a multilevel empirical study in China.

Resilience is crucial for a health system to better prevent and respond to public health threats and provide high-quality services. Despite the growing interest in the concept of resilience in health care, however, there is little empirical evidence of the impact of organizational resilience, especially in primary care settings. As the largest professional group in primary care, primary care nurses are taking more and more responsibilities during their daily practice, which influences both their work conditions and well-being. This study aims to examine the association between organizational resilience and primary care nurses' working conditions and well-being. Using a convenience sampling approach, we recruited 175 primary care nurses from 38 community health centres (CHCs) in four cities in China. Organizational resilience was operationalized as comprising two domains: adaptive capacity and planning capacity, and measured using a 16-item scale. The primary care nurses' working condition indicators comprised variables of psychological safety, organizational commitment, professional commitment, and self-directed learning; well-being indicators included depression and burn-out. Hierarchical linear regression models were built for analysis. We found that the sampled CHCs have a relatively high level of organizational resilience. The organizational resilience was positively associated with the four indicators of working conditions: psychological safety (β = 0.04, P < 0.01), organizational commitment (β = 0.38, P < 0.01), professional commitment (β = 0.39, P < 0.01), and self-directed learning (β = 0.28, P < 0.01). However, organizational resilience was not significantly associated with the two well-being indicators. Furthermore, we found that the adaptive capacity has stronger association compared with planning capacity. Therefore, primary care manager should build resilient organizations, especially the adaptive capacity, in order to enhance primary care nurses' psychological safety, commitment and learning behaviours. Further studies should also be conducted to understand the link between organizational resilience and primary care nurses' well-being.

Multimodal assessment of the role of intolerance of uncertainty in fear acquisition and extinction

Personality traits linked to internalizing disorders influence the way we develop fears, but also how we regain a sense of safety. In the present study, we investigated the effect of intolerance of uncertainty (IU) on defensive responses using a differential fear conditioning protocol with an extinction phase. The conditioned stimulus was associated with an aversive sound (90 dB) in 75 % of the presentations during acquisition. A final sample of 176 participants completed the experiment. We measured self-reports of associative (expectancy of the unconditioned stimulus in acquisition) and evaluative learning (arousal and valence), and both physiological (skin conductance response) and electrocortical responses (steady-state visually evoked potentials, ssVEPs; late positive potentials, LPP) to the conditioned stimuli. Our results show that IU's impact is limited, with no effect in both acquisition and extinction. These findings emphasize the necessity of large samples in research on inter-individual differences and contribute to our understanding of how IU may or may not be involved in fear and safety learning processes considering multiple aspects of fear responding.

SafeSteps: a persuasive child pedestrian safety learning mobile application

SafeSteps: a persuasive child pedestrian safety learning mobile application

The PIM.3 process improvement process—Part of the iNTACS certified process expert training

AbstractThis paper documents the results of the PIM.3 (Process Improvement Management) working group in INTACS (International Assessor Certification Schema) supported by the VDA‐QMC (Verband der Deutschen Automobilindustrie/German Automotive Association–Quality Management Center). INTACS promotes Automotive SPICE, which is an international standard that allows process capability assessment of projects, which implement systems that integrate mechanics, electronics, and software including optionally cybersecurity, functional safety, and machine learning. The paper outlines that for the first time since more than 20 years, the INTACS and VDA‐QMC included a process like PIM.3 Process Improvement Management in the scope for the assessor training. Before that, the assessments focused on the management, engineering, and support processes of series projects, while the improvement management has not been trained or assessed.

Safety learning culture with Port State Control in China: a qualitative analysis

ABSTRACT This exploratory study analyzes the mechanisms and barriers through which the Port State Control (PSC) regimes can promote or undermine a safety learning culture. PSC Officers (PSCOs), ideally positioned to collect ship data, have the potential to significantly enhance safety learning at national and global levels. The study, which involved semi-structured interviews with eleven seafarers and twenty PSCOs from China, underscores the inherent potential of PSC regimes to enhance safety and promote ship safety. This might be achieved through the establishment of mutually beneficial relationships with crew members, companies, and other maritime stakeholders, including regulators at national and international levels. However, the quality and diversity of ship feedback depend on seafarers’ willingness or reluctance to contribute. The paper concludes with actionable recommendations, including promoting trustful interactions during inspections, enhancing non-technical skills for PSCOs and in-depth safety assessments.

Evaluation of a Natural Language Processing Approach to Identify Diagnostic Errors and Analysis of Safety Learning System Case Review Data: Retrospective Cohort Study.

Diagnostic errors are an underappreciated cause of preventable mortality in hospitals and pose a risk for severe patient harm and increase hospital length of stay. This study aims to explore the potential of machine learning and natural language processing techniques in improving diagnostic safety surveillance. We conducted a rigorous evaluation of the feasibility and potential to use electronic health records clinical notes and existing case review data. Safety Learning System case review data from 1 large health system composed of 10 hospitals in the mid-Atlantic region of the United States from February 2016 to September 2021 were analyzed. The case review outcome included opportunities for improvement including diagnostic opportunities for improvement. To supplement case review data, electronic health record clinical notes were extracted and analyzed. A simple logistic regression model along with 3 forms of logistic regression models (ie, Least Absolute Shrinkage and Selection Operator, Ridge, and Elastic Net) with regularization functions was trained on this data to compare classification performances in classifying patients who experienced diagnostic errors during hospitalization. Further, statistical tests were conducted to find significant differences between female and male patients who experienced diagnostic errors. In total, 126 (7.4%) patients (of 1704) had been identified by case reviewers as having experienced at least 1 diagnostic error. Patients who had experienced diagnostic error were grouped by sex: 59 (7.1%) of the 830 women and 67 (7.7%) of the 874 men. Among the patients who experienced a diagnostic error, female patients were older (median 72, IQR 66-80 vs median 67, IQR 57-76; P=.02), had higher rates of being admitted through general or internal medicine (69.5% vs 47.8%; P=.01), lower rates of cardiovascular-related admitted diagnosis (11.9% vs 28.4%; P=.02), and lower rates of being admitted through neurology department (2.3% vs 13.4%; P=.04). The Ridge model achieved the highest area under the receiver operating characteristic curve (0.885), specificity (0.797), positive predictive value (PPV; 0.24), and F1-score (0.369) in classifying patients who were at higher risk of diagnostic errors among hospitalized patients. Our findings demonstrate that natural language processing can be a potential solution to more effectively identifying and selecting potential diagnostic error cases for review and therefore reducing the case review burden.

Pavlovian safety learning: An integrative theoretical review.

Safety learning involves associating stimuli with the absence of threats, enabling the inhibition of fear and anxiety. Despite growing interest in psychology, psychiatry, and neuroscience, safety learning lacks a formal consensus definition, leading to inconsistent methodologies and varied results. Conceptualized as a form of inhibitory learning (conditioned inhibition), safety learning can be understood through formal learning theories, such as the Rescorla-Wagner and Pearce-Hall models. This review aims to establish a principled conceptualization of 'Pavlovian safety learning', identifying cognitive mechanisms that generate safety and the boundary conditions that constrain it. Based on these observations, we define Pavlovian safety learning as an active associative process, where surprising threat-omission (safety prediction error) acts as a salient reinforcing event. Instead of producing merely neutral or nonaversive states, safety learning endows stimuli with active positive associations to 'safety'. The resulting stimulus-safety memories counteract the influence of fear memories, promoting fear regulation, positive affect, and relief. We critically analyze traditional criteria of conditioned inhibition for their relevance to safety and propose areas for future innovation. A principled concept of Pavlovian safety learning may reduce methodological inconsistencies, stimulate translational research, and facilitate a comprehensive understanding of an indispensable psychological construct.

Mediating Effect of Transformative Learning Process on the Psychological Safety and Transformative Learning Outcome among Information Technology Firms in Beijing, China

This paper investigates the mediating effect of transformative learning processes on the relationship between psychological safety and transformative learning outcomes among information technology firms in Beijing, China. With the rapid evolution of the technology industry, fostering a conducive learning environment becomes essential for employee development and organizational success. Drawing on a sample of information technology firms in Beijing, this study explores how psychological safety influences transformative learning outcomes, and whether transformative learning processes mediate this relationship. The research employs a structured questionnaire survey to collect data from employees, focusing on variables related to psychological safety, transformative learning processes, and transformative learning outcomes. Preliminary findings indicate a significant positive association between psychological safety and transformative learning outcomes. Moreover, transformative learning processes, including social support, attitude toward uncertainty, and criticality, demonstrate a mediating effect on this relationship. Specifically, employees who perceive higher levels of psychological safety are more likely to engage in transformative learning processes, leading to enhanced transformative learning outcomes. These results underscore the importance of promoting psychological safety and facilitating transformative learning processes within information technology firms. By fostering a supportive and inclusive work environment, organizations can empower employees to embrace change, cultivate innovative thinking, and ultimately drive organizational success in the dynamic technology landscape of Beijing, China.

Modular control architecture for safe marine navigation: Reinforcement learning with predictive safety filters

Many autonomous systems are safety-critical, making it essential to have a closed-loop control system that satisfies constraints arising from underlying physical limitations and safety aspects in a robust manner. However, this is often challenging to achieve for real-world systems. For example, autonomous ships at sea have nonlinear and uncertain dynamics and are subject to numerous time-varying environmental disturbances such as waves, currents, and wind. There is increasing interest in using machine learning-based approaches to adapt these systems to more complex scenarios, but there are few standard frameworks that guarantee the safety and stability of such systems. Recently, predictive safety filters (PSF) have emerged as a promising method to ensure constraint satisfaction in learning-based control, bypassing the need for explicit constraint handling in the learning algorithms themselves. The safety filter approach leads to a modular separation of the problem, allowing the use of arbitrary control policies in a task-agnostic way. The filter takes in a potentially unsafe control action from the main controller and solves an optimization problem to compute a minimal perturbation of the proposed action that adheres to both physical and safety constraints. In this work, we combine reinforcement learning (RL) with predictive safety filtering in the context of marine navigation and control. The RL agent is trained on path-following and safety adherence across a wide range of randomly generated environments, while the predictive safety filter continuously monitors the agents' proposed control actions and modifies them if necessary. The combined PSF/RL scheme is implemented on a simulated model of Cybership II, a miniature replica of a typical supply ship. Safety performance and learning rate are evaluated and compared with those of a standard, non-PSF, RL agent. It is demonstrated that the predictive safety filter is able to keep the vessel safe, while not prohibiting the learning rate and performance of the RL agent.

A multilevel examination of an inhibitory retrieval approach to exposure: Differentiating the unique and combined effects of multiple-context and multiple-stimulus cues

Background and objectivesA proposed strategy for attenuating the return of fear is conducting exposure therapy in multiple contexts (e.g., different locations), which is believed to enhance the generalizability of safety learning. Although conducting exposure in multiple contexts can be differentiated from conducting exposure with multiple stimuli, the two strategies are often conflated. Furthermore, researchers have not yet determined whether one of these strategies, or a combination thereof, is most effective in attenuating fear renewal. MethodsAccordingly, the present treatment-analogue study examined the unique and combined effects of multiple-context and multiple-stimulus imagery-based exposure manipulations on threat expectancy, behavioral approach/anxiety, and attentional bias for threat over Zoom. Community adults (N = 134) who met diagnostic criteria for snake phobia were randomized to exposure to a single snake in multiple environmental contexts (MC), exposure to multiple snakes in a single environmental context (MS), or exposure to multiple snakes in multiple environmental contexts (MS/MC). ResultsResults revealed significant reductions in threat expectancy and behavioral anxiety, but not attentional bias for threat in all three groups. However, behavioral approach declined over the course of exposure in the MS/MC condition but remained stable in the MC and MS conditions. There were no significant group differences in behavioral approach/anxiety or attentional bias at a one-week follow-up. However, participants in the MC condition reported lower threat expectancy at a one-week follow-up than the other groups and this group difference was partially mediated by lower mean distress during exposure. ConclusionsImplications of these findings for the inhibitory retrieval theory are discussed.