Equipment Setup Research Articles

Cost-Effective Formation of Ti/Ni/Ti/Au Ohmic Contacts to n-type SiC Using SiO2 Encapsulation Layer during Phosphorous Implant Activation

The purpose of this research is to develop a cost-effective formation of ohmic contacts to n-type SiC through ion implantation and activation. Although Nitrogen is commonly used as an n-type dopant, especially for in-situ doping during epitaxial growth, Phosphorus was chosen because of its higher solubility limit in SiC materials. Consequently, Phosphorus can achieve selective doping at much higher concentrations (above 1020 cm-3), which will be beneficial in regions such as source/drain and cathode where low contact resistance is needed. After ion implantation, the dopants must be thermally activated, and crystal damage must be recovered through annealing at high temperature between 1400~1700°C. During this stage, the material used as the cap layer will have a notable impact on the morphology and structure of the material. The proposed ohmic metal stacks and SiO2 encapsulation enable cost-effective formation of ohmic contacts to n-type SiC where complex fabrication equipment setup is unavailable.

Unlocking the Methodology of Escape Rooms: Considerations for Conducting Applied Escape Rooms in Research

Background Teams are the foundation of modern organizations. Many organizations are interested in interventions to bolster the effectiveness of their workforce. One viable intervention is an escape room. Escape rooms are engaging, team-based activities that require individuals to work together to complete multiple tasks in a limited amount of time. Purpose The purpose of this article is to provide ten considerations that are relevant to leveraging escape rooms as a means for data collection. Specifically, we offer guidance regarding pilot testing, equipment set-up, participant recruitment, briefing participants, progress monitoring, hints, room maintenance, data maintenance and analysis, and revising the room and study. Conclusion The considerations provided in this article can assist researchers when attempting to employ an escape room as a mechanism to collect data.

Ultrasound scanning techniques

BackgroundUltrasound is an essential tool for the hepatobiliary and pancreatic surgeon. MethodsThis review focuses on transabdominal, open intraoperative, and laparoscopic ultrasonography of the liver, biliary tract, and pancreas. The goal is to obtain optimal ultrasound images through an understanding of the equipment setup, transducer (probe) selection, terminology, and general scanning principles. Outlined is a structured, standardized approach necessary to obtain complete information when doing intraoperative ultrasound. When done by the surgeon, the goal of the examination typically is to answer a question or questions through a focused rather than a comprehensive diagnostic examination. Finally, presented are the details of techniques specific to scanning each of the major organs. ResultsA structured, standardized ultrasound scanning approach provides for optimal image acquisition. It allows one to develop standardized views of common structures resulting in "pattern recognition," making learning and interpreting images easier. A standardized approach ensures a complete ultrasound examination, and it minimizes the chance of missed findings. SummaryThe general principles for transabdominal, open intraoperative, and laparoscopic ultrasonography scanning are similar. One can gather considerable information using these modalities during a clinical examination, procedure, or operation. For success, it is critical to develop a standardized approach to scanning and use it every time. This facilitates familiarity when viewing images, making it easier for the novice to learn and gain experience. Using a systematic approach ensures that the experienced ultrasonographer obtains all the essential information needed at the time of surgery.

PERSPECTIVE SUBSYSTEMS FOR GUIDANCE ON THE MOVEMENT AREA OF THE AERODROME FOR SYSTEMS THAT MEET THE A-SMGCS CONCEPT FOR DOMESTIC AVIATION ENTERPRISES

Now native companies have not finished their transition from the SMGCS’s conception to the ASMGCSs conception at this moment. It’s caused by many factors, among them significant differences in the systems structure between native and foreign companies. While there are not significant difficulties in the native and foreign equipment set ups, and that means close successful transition to the A-SMGCS’s conception. Big domestic airports have necessary equipment set already. They have organized most necessary subsystems. It is necessary to determine some perspective ways to implement the user guidance subsystem, based on the experience of foreign colleagues, and also taking into account the peculiarities of the domestic set of equipment.

Two-dimensional C-arm robotic navigation system (i-Navi) in spine surgery: a pilot study.

Pedicle screws placement is very common procedure in spinal surgery. Robotic assisted surgery has been widely used in this operation. We assessed the accuracy of thoracolumbar spine trans-pedicle screws (TPS) implantation utilizing a noval robotic navigation system (i-Navi robotic navigation system) by planning with two-dimensional (2-D) C-arm. This study was approved by the Institutional Review Board of the Cathay General Hospital on June 21, 2018 (IRB number: CGH-P 106,092), and written informed consents were obtained from all the patients. There are 18 patients were enrolled in the study. All the patients received the posterior fusion with TPS insertion under the assistant of our robotic navigation system. There are 18 patients were included into our study, there are 2 patients were quitted from the study due to the equipment setup was not complete. Other 16 patients completed the entire procedure successfully. There is total 88 pedicle screws were inserted through i-Navi robotic navigation system. There are 79 of 88 screws were graded A, and 9 screws were graded B; no screws were graded C or D. No vascular or nerve injuries were noted after the operations. We present our i-Navi robotic navigation system, by planning with 2-D C-arm imaging and pre-operative CT scans. According to the results of study, we think it can provide a reliable and easy tool to perform the TPS in thoracic lumbar spine surgery.

On-flow enzymatic inhibitor screening: The emerging success of liquid chromatography-based assays

Enzymes are targets commonly explored in screening assays aiming to discover new leads in the drug development process. Among the diverse assay models to identify new enzymatic inhibitors, on-flow assays based on liquid chromatography (LC) can be highlighted. In these approaches, the ligand-enzyme interaction can be examined by monitoring the catalytic activity or the affinity/retention. Most applications use the biological target immobilized in solid supports resulting in the acquisition of an immobilized enzymatic reactor (IMER). Coupling IMERs to LC or mass spectrometry (MS) systems allows monitoring enzyme activity online and studying binding events between target and ligands. On-flow screening assays present many advantages for the hit-to-lead process, such as the possibility of system automation, reusability, and high stability. This review covers articles from the last decade that combine the use of varied immobilization methods on different solid supports and several equipment setups in on-flow systems, emphasizing the performance and capacity of recognizing and identifying biologically active compounds in various matrices.

A Data-Driven Approach to Running Gait Assessment Using Inertial Measurement Units

Background: Running is an extremely common exercise, both recreationally and competitively. Combined with clinical assessment, technology-driven biomechanical gait analysis can be used to examine markers of performance and injury risk in runners. Indications: The indication is to provide clinicians and sports science researchers a framework for using inertial measurement units (IMU) for data-driven, quantitative gait assessments. Technique Description: This video details practical application of IMU use in biomechanical gait assessments. Details on participant and equipment setup, in-session protocols, and selection of gait variables are included. Results: Following collection of demographic and anthropometric outcomes, IMUs should be placed on rigid segments of the lower extremity, sacrum, and trunk. In our model, we place IMUs on the foot, shank, thigh, sacrum, and lower thoracic spine. Following static anatomical calibration, running gait biomechanics are evaluated at multiple speeds using IMUs, 2-dimensional high-speed video cameras, and an instrumented treadmill. The high-speed video and IMU data are analyzed together at various parts of the gait cycle, including foot strike, mid-stance, toe-off, and flight. Many kinematic and kinetic variables (ie, unilateral discrete joint angles, joint excursions, joint moments, spatiotemporal outcomes, etc) can be selected for analysis, ideally via a collaboration between the sports science, athletic, and sports medicine teams. A collaborative approach should also be used to determine how this information will be used to alter training programs or influence injury risk in the running athlete. Discussion/Conclusion: This report details how to use a data-driven approach to evaluate running gait biomechanics using IMU technology. This framework for gait analysis is most applicable, and effective, when the team of researchers works in conjunction with coaches, sport scientists, and athletes. Utilizing this framework, training can be adapted based on the objective and clinical assessment to reduce injury risk and improve performance in the gait assessment.

Structural behaviour of Q355 and Q460 press-braked rectangular hollow section stub columns

As inspired by the concept of modular integrated construction, component-assembly-structure, it leads to a great opportunity to reassess the basic structural elements made by an uncommon manufacturing process. Rectangular hollow sections (RHS) can be fabricated by tip-to-tip welding two press-braked channels together to form an integrated cross-section. This unique technique gains more flexibilities and economic efficiencies regarding the setup of production equipment as compared to the mainstream manufacturing process. In this paper, a comprehensive investigation into press-braked RHSs comprising material tests, residual stress measurements, stub column tests, and numerical studies is presented. A total of 40 tensile coupons, 108 sectioned residual stress strips, 10 stub columns, and 290 numerical models were combined to investigate various characteristics of press-braked RHSs. Of the results observed, the strength enhancement of corner materials due to the cold-working can be conservatively captured by the predictive model from AISI S100-16. A simplified predictive residual stress pattern is proposed to represent residual stress distributions of press-braked RHSs. The applicability of Eurocode 3, ANSI/AISC 360-16, and the direct strength method (DSM) for the design of press-braked RHS stub columns under compression was evaluated based on the experimental and numerical results. And modified design approaches were also proposed and shown to have a more accurate, consistent, and safe prediction of compressive resistance for press-braked RHSs.

Development of a simulation technical competence curriculum for medical simulation fellows

Background and needsMedical educators with simulation fellowship training have a unique skill set. Simulation fellowship graduates have the ability to handle basic and common troubleshooting issues with simulation software, hardware, and equipment setup. Outside of formal training programs such as this, simulation skills are inconsistently taught and organically learned. This is important to address because there are high expectations of medical educators who complete simulation fellowships. To fill the gap, we offer one way of teaching and assessing simulation technical skills within a fellowship curriculum and reflect on lessons learned throughout the process. This report describes the instructional designs, implementation, and program evaluation of an educational intervention: a simulation technology curriculum for simulation fellows.Curriculum designThe current iteration of the simulation technical skill curriculum was introduced in 2018 and took approximately 8 months to develop under the guidance of expert simulation technology specialists, simulation fellowship-trained faculty, and simulation center administrators. Kern’s six steps to curriculum development was used as the guiding conceptual framework. The curriculum was categorized into four domains, which emerged from the outcome of a qualitative needs assessment. Instructional sessions occurred on 5 days spanning a 2-week block. The final session concluded with summative testing.Program evaluationFellows were administered summative objective structured exams at three stations. The performance was rated by instructors using station-specific checklists. Scores approached 100% accuracy/completion for all stations.ConclusionsThe development of an evidence-based educational intervention, a simulation technical skill curriculum, was highly regarded by participants and demonstrated effective training of the simulation fellows. This curriculum serves as a template for other simulationists to implement formal training in simulation technical skills.

Gas Condensate Wells: Challenges of Sampling, Testing and Production Optimization

The main problem of fluid sampling during well testing of reservoirs with near-critical fluids (gas condensate and volatile oil) is due to the fact that even a small pressure drawdown usually leads to the formation of a two-phase mixture in the bottom hole area, and it is almost impossible to take representative samples with downhole samplers or a formation tester. Sampling via test-separator and the current non-separation methods are also imperfect. An alternative method—MIKS (Multiphase IsoKinetic Sampling)—of gas condensate well testing was proposed, which is based on emulsifying a multiphase flow to particles of about 1–10 μm. Thereby MIKS would eliminate the problem of particle slippage in a homogeneous flow and enables high-quality sampling directly from the flowmeter line. The initial formation fluid is characterized by the maximum value of the condensate-gas ratio (CGR). Therefore, first, the well effluent would be adjusted to the mode with the maximum CGR using a choke manifold and a multiphase flow meter. Then the flow mixture is transferred to a by-pass line with an emulsifier to achieve an isokinetic flow. Thereafter, pressure samples can be taken into pressurized sampling bottles, in which thermodynamic conditions are preset according to the flow line. The efficiency of sampling and recombining procedures allows for conducting a study of reservoir samples in the field laboratory directly on the rig and obtaining a complete PVT report even before the completion of drilling and abandonment of the well. An additional economic effect is achieved by reducing the costs of transporting and samples storage. Well test equipment setup becomes much more compact and less weight; the costs of drilling time are reduced, which is viably important for well testing on the Arctic conditions. Another major problem in the development of gas condensate reservoirs is avoiding the condensate banking around producing wells. Optimization of condensate production can be achieved by maintaining the well operation mode at maximum CGR level by means of multiphase flowmeters. The formed condensate bank can be destroyed by a combination of methods—hydraulic fracturing, followed by cycling process—purging the formation with dried gas and/or injection of methanol into the formation. Methanol can be obtained from synthesis gas as a by-product in the utilization of associated gas also at the field. The specified set of measures will allow to revive the GC wells that are losing productivity, as well as to extend the period of high productivity of new wells.

Preparation of Rat Sciatic Nerve for Ex Vivo Neurophysiology.

Ex vivo preparations enable the study of many neurophysiological processes in isolation from the rest of the body while preserving local tissue structure. This work describes the preparation of rat sciatic nerves for ex vivo neurophysiology, including buffer preparation, animal procedures, equipment setup and neurophysiological recording. This work provides an overview of the different types of experiments possible with this method. The outlined method aims to provide 6 h of stimulation and recording on extracted peripheral nerve tissue in tightly controlled conditions for optimal consistency in results. Results obtained using this method are A-fibre compound action potentials (CAP) with peak-to-peak amplitudes in the millivolt range over the entire duration of the experiment. CAP amplitudes and shapes are consistent and reliable, making them useful to test and compare new electrodes to existing models, or the effects of interventions on the tissue, such as the use of chemicals, surgical alterations, or neuromodulatory stimulation techniques. Both conventional commercially available cuff electrodes with platinum-iridium contacts and custom-made conductive elastomer electrodes were tested and gave similar results in terms of nerve stimulus strength-duration response.

Ray-Tracing Based Reconstruction Of PIV Measurements In The Outlet Zone Of Gaseous Flow In Packed Beds

The flow characteristics of packed beds are essential for the optimization of heat and mass transfer in countless industrial processes. In this study a method is introduced to allow optical measurement techniques in a transparent bulk reactor, so that optical distortions are corrected by a ray tracing based reconstruction. The velocity of the gas flow is measured by a classical particle image velocimetry measurement approach, where the optically distorted raw particle images, obtained through the transparent spheres, are corrected by a ray tracing step before a common cross-correlation evaluation of the velocity fields. Special calibration procedures, linking the exact geometrical set-up of the measurement equipment with respect to the packed bed reactor to the numerical model used for distortion correction, are necessary for this approach, which is validated in this study at the outlet flow field of the bed. The main principles like the experimental setup, calibration and correction method are presented and discussed, as well as the precision of the initial flow field obtained in the experimental symmetric reactor. Results of flow fields at the surface of a 17layer transparent packed bed for particle Reynolds numbers in the range of 200 to 500 show the impact and advantages of the additional ray tracing step. A validation of the ray tracing based correction method is shown by comparing the flow of the freeboard, obtained from undistorted particle images, to the flow field behind transparent spheres, which initially cause strong optical distortions in the raw particle images. The continuously evolving velocity profiles, through regions of originally strong optical distortion, show the applicability of the method even for the reconstruction of vortical structures in the interstices of spherical packings.

Exploiting Multiple EEG Data Domains with Adversarial Learning.

Electroencephalography (EEG) is shown to be a valuable data source for evaluating subjects' mental states. However, the interpretation of multi-modal EEG signals is challenging, as they suffer from poor signal-to-noise-ratio, are highly subject-dependent, and are bound to the equipment and experimental setup used, (i.e. domain). This leads to machine learning models often suffer from poor generalization ability, where they perform significantly worse on real-world data than on the exploited training data. Recent research heavily focuses on cross-subject and cross-session transfer learning frameworks to reduce domain calibration efforts for EEG signals. We argue that multi-source learning via learning domain-invariant representations from multiple data-sources is a viable alternative, as the available data from different EEG data-source domains (e.g., subjects, sessions, experimental setups) grow massively. We propose an adversarial inference approach to learn data-source invariant representations in this context, enabling multi-source learning for EEG-based brain- computer interfaces. We unify EEG recordings from different source domains (i.e., emotion recognition datasets SEED, SEED-IV, DEAP, DREAMER), and demonstrate the feasibility of our invariant representation learning approach in suppressing data- source-relevant information leakage by 35% while still achieving stable EEG-based emotion classification performance.

P-67915014-268 - Does intra-operative navigation improve accuracy of implant position in secondary reconstruction of large orbital defects?

<h3>Background and Purpose</h3> Literature supporting use of intra-operative navigation (ION) in orbital reconstruction is abundant. However, evidence on the role of ION in improving orbital implant position is sparse. Our objective was to determine if ION influenced implant position accuracy in secondary orbital reconstruction. <h3>Methods</h3> This was designed as a prospective observational study comparing two groups of patients requiring secondary orbital reconstruction; the test group received intra-operative guidance with ION, while the control did not. The groups were matched for age and defect size. Primary outcome variables included assessment of deviations between the ideal implant position and achieved implant position in six degrees of freedom; horizontal, vertical and transverse (linear), pitch, roll and yaw (angular). Secondary outcome variables included assessment of procedural time. Descriptive and inferential statistics were used to compare means and variance. <h3>Results</h3> A total of 24 patients were recruited into the study with a mean age of 27.79 years. Results demonstrated that implant position accuracy was significantly superior in the transverse plane (medio-lateral) for the test group (p=0.03). The total duration of the procedure was longer by 8minutes (p=0.047), while surgery time was 15minutes shorter when using ION (p<0.001). This was due to the additional equipment setup time for the test group (mean 23mins, p<0.001). <h3>Conclusion</h3> The study demonstrated that ION may be a useful intra-operative guide to improve implant position in infero-medial orbital defects requiring reconstruction. ION also reduced the time required for intra-orbital dissection and positioning of the implant.

Paediatric Cardiac Anaesthesia at the Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria: The Hurdles, Struggles, and Successes

Background: Open-heart surgery started at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC) Ile-Ife, Nigeria, 5 years ago through partnership with foreign partners. This paper reviewed the difficulties facing the development of paediatric cardiac anaesthesia, the pattern, and the outcome of cases managed.&#x0D; Methods: A review of the infrastructure, equipment, manpower and operational setup for open-heart surgery at OAUTHC was done. A retrospective study of all patients that were operated on from April 2016 to March 2021 was performed. Extracted data were analysed with Statistical Packages for the Social Scientists using descriptive statistics.&#x0D; Results: A total of 102 patients had open-heart surgeries during the period under review by the various teams in a shared facility of the hospital's main theatre. Challenges with manpower, infrastructure, and supplies were major limitations to service delivery. Most of the patients (75.5%) were aged &lt; 5 years. The commonest procedures performed were ventricular septal defect closure (31.4%), total correction of tetralogy of Fallot (26.5%), and atrial septal defect closure (9.8%). Fast-tracked anaesthesia was used always except where it was contraindicated. Most (76.7%) of the cases were extubated within 24 hours after surgery; the mean (SD) duration of ventilation in the ICU was 0.99 (1.2) days and the average length of ICU stay was 3 days. The overall mortality rate was 20.6%.&#x0D; Conclusion: Numerous challenges confront the provision of sustainable paediatric cardiac anaesthesia services in resource-constrained settings like ours. Much can be achieved with appropriate investment in material and manpower, and partnership with experienced teams.&#x0D; Authors&#x0D; A T Adenekan 1, A M Owojuyigbe 1, O I Aaron 1, O O Ojo 2

Multi-lab study on the pure-gas permeation of commercial polysulfone (PSf) membranes: Measurement standards and best practices

Gas-separation membranes are a critical industrial component for a low-carbon and energy-efficient future. As a result, many researchers have been testing membrane materials over the past several decades. Unfortunately, almost all membrane-based testing systems are home-built, and there are no widely accepted material standards or testing protocols in the literature, making it challenging to accurately compare experimental results. In this multi-lab study, ten independent laboratories collected high-pressure pure-gas permeation data for H2, O2, CH4, and N2 in commercial polysulfone (PSf) films. Equipment information, testing procedures, and permeation data from all labs were collected to provide (1) accepted H2, O2, CH4, and N2 permeability values at 35 °C in PSf as a reference standard, (2) statistical analysis of lab-to-lab uncertainties in evaluating permeability, and (3) a list of best practices for sample preparation, equipment set-up, and permeation testing using constant-volume variable-pressure apparatuses. Results summarized in this work provide a reference standard and recommended testing protocols for pure-gas testing of membrane materials.

Erodibility of Nanocomposite-Improved Unsaturated Soil Using Genetic Programming, Artificial Neural Networks, and Evolutionary Polynomial Regression Techniques

Genetic programming (GP) of four levels of complexity, including artificial neural networks of the hyper-tanh activation function (ANN-Hyper-Tanh), artificial neural networks of the sigmoid activation function (ANN-Sigmoid), evolutionary polynomial regression (optimized with genetic algorithm) (EPR), and intelligent techniques have been used to predict the erodibility of lateritic soil collected from an erosion site and treated with hybrid cement. Southeastern Nigeria and specifically Abia State is being destroyed by gully erosion, the solution of which demands continuous laboratory examinations to determine the parameters needed to design sustainable solutions. Furthermore, complicated equipment setups are required to achieve reliable results. To overcome constant laboratory works and equipment needs, intelligent prediction becomes necessary. This present research work adopted four different metaheuristic techniques to predict the erodibility of the soil; classified as A-7-6, weak, unsaturated, highly plastic, high swelling and high clay content treated with HC utilized in the proportions of 0.1–12% at the rate of 0.1%. The results of the geotechnics aspect of the work shows that the HC, which is a cementitious composite formulated from blending nanotextured quarry fines (NQF) and hydrated lime activated nanotextured rice husk ash (HANRHA), improves the erodibility of the treated soil substantially and consistently. The outcome of the prediction models shows that EPR with SSE of 1.6% and R2 of 0.996 outclassed the other techniques, though all four techniques showed their robustness and ability to predict the target (Er) with high performance accuracy.

The Impact of Total Automaton on the Clinical Laboratory Workforce: A Case Study.

BackgroundThere has been a significant concern that total automation can decrease the need for laboratory personnel at all levels. The objective of this study was to investigate the impact of total laboratory automation on the clinical laboratory workforce.MethodsA one-year data including the demographical features of laboratory workforce and technical productivity of laboratory tests were provided by two medical laboratory departments of similar profile and different equipment setup; one adopting a total automation system and the other utilizing discrete analysis system. The technical productivities of the two laboratories were compared and statistically tested.ResultsA similar technical productivity per single laboratory worker was noted in the hematology section in each of the two sites with no significant difference (average odd radio = 0.9, p = 0.79). However, with total automation, the number of tests performed per single worker has increased to an average of 1.4 and 3.7 times with total automation in the clinical chemistry and serology sections, respectively (p ≤ 0.001).ConclusionTotal laboratory automation improves the productivity of the laboratory, leading to a decreased laboratory workforce. The laboratory workload has increased steadily therefore, the existing laboratory workforce, in the absence of automation, could not have been able to maintain the current volume of service. Adoption of automation reduces repetitive manual labor, thereby allowing the redefinition of the job roles of the laboratory workforce. TLA is ideal for laboratories that suffer from workforce shortages or managing high volume testing with less staff.

Improving emergency airway cart efficiency in compliance with Joint Commission standards

Background and objectiveEmergency Airway Carts (EAC) are essential for pediatric otolaryngologists to provide rapid bedside care for emergent airway scenarios. At many institutions, EAC bronchoscopy equipment is individually peal-packaged due to Joint Commission (JC) standards, creating significant inefficiency in equipment assembly during time sensitive clinical settings. The objective of this quality improvement initiative was to improve the efficiency of use of our emergency airway cart equipment. MethodsIndividually peel-packaged bronchoscope equipment was replaced with JC compliant sets. Otolaryngology trainees (N = 8) and pediatric otolaryngology attending physicians (N = 11) were tested in a simulated airway emergency scenario, requiring bronchoscope assembly. Complete bronchoscope assembly and time to tracheal visualization (TTV) was measured for each participant, which started with initial clinical scenario presentation and ended with successful visualization of the trachea using the rigid bronchoscope. ResultsPre-airway cart interventions, 68.4% of participants built a complete bronchoscope with no missing pieces, which improved to 100% with the new cart organization. Post-EAC interventions, all 19 participants reduced TTV significantly by a mean of 177.7 s (p < 0.001). Trainees reduced TTV by a mean of 251.2 s (46.2%, p < 0.0001) and attendings by 124.2 s (31.5%, p < 0.0022). All participants found the new airway cart sets easier to use and improved equipment setup efficiency. ConclusionsCompiling bronchoscope equipment into sterile sets allowed for improved TTV and bronchoscope quality for trainees and attending physicians while maintaining JC standards. Simulation improved confidence among both trainees and attending surgeons in providing optimal patient care in airway emergencies.

Understanding the Cognitive Demands, Skills, and Assessment Approaches for Endotracheal Intubation: Cognitive Task Analysis.

BackgroundProper airway management is an essential skill for hospital personnel and rescue services to learn, as it is a priority for the care of patients who are critically ill. It is essential that providers be properly trained and competent in performing endotracheal intubation (ETI), a widely used technique for airway management. Several metrics have been created to measure competence in the ETI procedure. However, there is still a need to improve ETI training and evaluation, including a focus on collaborative research across medical specialties, to establish greater competence-based training and assessments. Training and evaluating ETI should also incorporate modern, evidence-based procedural training methodologies.ObjectiveThis study aims to use the cognitive task analysis (CTA) framework to identify the cognitive demands and skills needed to proficiently perform a task, elucidate differences between novice and expert performance, and provide an understanding of the workload associated with a task. The CTA framework was applied to ETI to capture a broad view of task and training requirements from the perspective of multiple medical specialties.MethodsA CTA interview was developed based on previous research into the tasks and evaluation methods of ETI. A total of 6 experts from across multiple medical specialties were interviewed to capture the cognitive skills required to complete this task. Interviews were coded for main themes, subthemes in each category, and differences among specialties. These findings were compiled into a skills tree to identify the training needs and cognitive requirements of each task.ResultsThe CTA revealed that consistency in equipment setup and planning, through talk or think-aloud methods, is critical to successfully mastering ETI. These factors allow the providers to avoid errors due to patient characteristics and environmental factors. Variation among specialties derived primarily from the environment in which ETI is performed, subsequent treatment plans, and available resources. Anesthesiology typically represented the most ideal cases with a large potential for training, whereas paramedics faced the greatest number of constraints based on the environment and available equipment.ConclusionsAlthough the skills tree cannot perfectly capture the complexity and detail of all potential cases, it provided insight into the nuanced skills and training techniques used to prepare novices for the variability they may find in practice. Importantly, the CTA identified ways in which challenges faced by novices may be overcome and how this training can be applied to future cases. By making these implicit skills and points of variation explicit, they can be better translated into teachable details. These findings are consistent with previous studies looking at developing improved assessment metrics for ETI and expanding upon their work by delving into methods of feedback and strategies to assist novices.