Search

Purpose: Medical errors may be occasionally explained by inattentional blindness (IB), i.e., failing to notice an event/object that is in plain sight. We aimed to determine whether age/experience, restfulness/fatigue, and previous exposure to simulation education may affect IB in the anesthetic/surgical setting., Methods: In this multicentre/multinational study, a convenience sample of 280 anesthesiologists watched an attention-demanding video of a simulated trauma patient undergoing laparotomy and (independently/anonymously) recorded the abnormalities they noticed. The video contained four expected/common abnormalities (hypotension, tachycardia, hypoxia, hypothermia) and two prominently displayed unexpected/rare events (patient's head movement, leaky central venous line). We analyzed the participants' ability to notice the expected/unexpected events (primary outcome) and the proportion of expected/unexpected events according to age group and prior exposure to simulation education (secondary outcomes)., Results: Anesthesiologists across all ages noticed fewer unexpected/rare events than expected/common ones. Overall, younger anesthesiologists missed fewer common events than older participants did (P = 0.02). There was no consistent association between age and perception of unexpected/rare events (P = 0.28), although the youngest cohort (< 30 yr) outperformed the other age groups. Prior simulation education did not affect the proportion of misses for the unexpected/rare events but was associated with fewer misses for the expected/common events. Self-perceived restfulness did not impact perception of events., Conclusion: Anesthesiologists noticed fewer unexpected/rare clinical events than expected/common ones in an attention-demanding video of a simulated trauma patient, in keeping with IB. Prior simulation training was associated with an improved ability to notice anticipated/expected events, but did not reduce IB. Our findings may have implications for understanding medical mishaps, and efforts to improve situational awareness, especially in acute perioperative and critical care settings., (© 2024. Canadian Anesthesiologists' Society.)

Objective: An up-to-date and thorough literature review is needed to identify factors that influence driver situation awareness (SA) during control transitions in conditionally automated vehicles (AV). This review also aims to ascertain SA components required for takeovers, aiding in the design and evaluation of human-vehicle interfaces (HVIs) and the selection of SA assessment methodologies., Background: Conditionally AVs alleviate the need for continuous road monitoring by drivers yet necessitate their reengagement during control transitions. In these instances, driver SA is crucial for effective takeover decisions and subsequent actions. A comprehensive review of influential SA factors, SA components, and SA assessment methods will facilitate driving safety in conditionally AVs but is still lacking., Method: A systematic literature review was conducted. Thirty-four empirical research articles were screened out to meet the criteria for inclusion and exclusion., Results: A conceptual framework was developed, categorizing 23 influential SA factors into four clusters: task/system, situational, individual, and nondriving-related task factors. The analysis also encompasses an examination of pertinent SA components and corresponding HVI designs for specific takeover events, alongside an overview of SA assessment methods for conditionally AV takeovers., Conclusion: The development of a conceptual framework outlining influential SA factors, the examination of SA components and their suitable design of presentation, and the review of SA assessment methods collectively contribute to enhancing driving safety in conditionally AVs., Application: This review serves as a valuable resource, equipping researchers and practitioners with insights to guide their efforts in evaluating and enhancing driver SA during conditionally AV takeovers., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: The goal of this study was to assess how different real-time gaze sharing visualization techniques affect eye tracking metrics, workload, team situation awareness (TSA), and team performance., Background: Gaze sharing is a real-time visualization technique that allows teams to know where their team members are looking on a shared display. Gaze sharing visualization techniques are a promising means to improve collaborative performance on simple tasks; however, there needs to be validation of gaze sharing with more complex and dynamic tasks., Methods: This study evaluated the effect of gaze sharing on eye tracking metrics, workload, team SA, and team performance in a simulated unmanned aerial vehicle (UAV) command-and-control task. Thirty-five teams of two performed UAV tasks under three conditions: one with no gaze sharing and two with gaze sharing. Gaze sharing was presented using a fixation dot (i.e., a translucent colored dot) and a fixation trail (i.e., a trail of the most recent fixations)., Results: The results showed that the fixation trail significantly reduced saccadic activity, lowered workload, supported team SA at all levels, and improved performance compared to no gaze sharing; however, the fixation dot had the opposite effect on performance and SA. In fact, having no gaze sharing outperformed the fixation dot. Participants also preferred the fixation trail for its visibility and ability to track and monitor the history of their partner's gaze., Conclusion: The results showed that gaze sharing has the potential to support collaboration, but its effectiveness depends highly on the design and context of use., Application: The findings suggest that gaze sharing visualization techniques, like the fixation trail, have the potential to improve teamwork in complex UAV tasks and could have broader applicability in a variety of collaborative settings., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

The driver's takeover time is crucial to ensure a safe takeover transition in conditional automated driving. The study aimed to construct a prediction model of driver's takeover time based on individual characteristics, external environment, and situation awareness variables. A total of 18 takeover events were designed with scenarios, non-driving-related tasks, takeover request time, and traffic flow as variables. High-fidelity driving simulation experiments were carried out, through which the driver's takeover data was obtained. Fifteen basic factors and three dynamic factors were extracted from individual characteristics, external environment, and situation awareness. In this experiment, these 18 factors were selected as input variables, and XGBoost and Shapely were used as prediction methods. A takeover time prediction model (BM + SA model) was then constructed. Moreover, we analyzed the main effect of input variables on takeover time, and the interactive contribution made by the variables. And in this experiment, the 15 basic factors were selected as input variables, and the basic takeover time prediction model (BM model) was constructed. In addition, this study compared the performance of the two models and analyzed the contribution of input variables to takeover time. The results showed that the goodness of fit of the BM + SA model (Adjusted&#95;R 2 ) was 0.7746. The XGBoost model performs better than other models (support vector machine, random forest, CatBoost, and LightBoost models). The relative importance degree of situation awareness variables, individual characteristic variables, and external environment variables to takeover time gradually reduced. Takeover time increased with the scan and gaze durations and decreased with pupil area and self-reported situation awareness scores. There was also an interaction effect between the variables to affect takeover time. Overall, the performance of the BM + SA model was better than that of the BM model. This study can provide support for predicting driver's takeover time and analyzing the mechanism of influence on takeover time. This study can provide support for the development of real-time driver's takeover ability prediction systems and optimization of human-machine interaction design in automated vehicles, as well as for the management department to evaluate and improve the driver's takeover performance in a targeted manner., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objective: This study developed a fixation-related electroencephalography band power (FRBP) approach for situation awareness (SA) assessment in automated driving., Background: Maintaining good SA in Level 3 automated vehicles is crucial to drivers' takeover performance when the automated system fails. A multimodal fusion approach that enables the analysis of the visual behavioral and cognitive processes of SA can facilitate real-time assessment of SA in future driver state monitoring systems., Method: Thirty participants performed three simulated automated driving tasks. After each task, the Situation Awareness Global Assessment Technique (SAGAT) was deployed to capture their SA about key elements that could affect their takeover task performance. Participants eye movements and brain activities were recorded. Data on their brain activity after each eye fixation on the key elements were extracted and labeled according to the correctness of the SAGAT. Mixed-effects models were used to identify brain regions that were indicative of SA, and machine learning models for SA assessment were developed based on the identified brain regions., Results: Participants' alpha and theta oscillation at frontal and temporal areas are indicative of SA. In addition, the FRBP technique can be used to predict drivers' SA with an accuracy of 88% using a neural network model., Conclusion: The FRBP technique, which incorporates eye movements and brain activities, can provide more comprehensive evaluation of SA. Findings highlight the potential of utilizing FRBP to monitor drivers' SA in real-time., Application: The proposed framework can be expanded and applied to driver state monitoring systems to measure human SA in real-world driving.

Situation awareness (SA) is an important non-technical skill for nurses. Nurses interact directly with patients and review their clinical signs. If we improve nurses' SA, they will likely detect clinical changes and prevent patient harm. A clinical endeavor that can benefit from improved nurses' SA is the prevention of Healthcare-Acquired Urinary Tract Infection (HAUTI). Electronic Health Records contain comprehensive nursing assessment data that researchers can use to analyze trends and provide a context-based understanding of the infection risk factors. We conducted a study that involved extracting nursing assessment data and preparing it for supervised learning algorithms and predicting HAUTI. In this paper, we share the methods we used to prepare the data for supervised learning algorithms and present the challenges related to data missingness.

Fatigue and stress are critical variables that impair railway train drivers' safety performance, and individual differences may influence these effects. This study investigates how fatigue and stress affect high-speed train drivers' human error and the role of individual differences. We hypothesised that situation awareness (SA) mediates the effects of fatigue and stress on human error, and individual differences (age and work experience) moderate these effects. We surveyed 1,391 male drivers from eight Chinese railway bureaus and used PROCESS Macro for data analysis. The results revealed that fatigue and stress increased human error, directly and indirectly through SA. Age and work experience moderated the effect of fatigue and stress on SA, respectively. Older drivers had better SA under high fatigue, while more experienced drivers had better SA under high stress. These findings can inform more tailored safety management strategies to lower human error and enhance the safety of high-speed train operations.

Introduction: Managing obstetric shoulder dystocia requires swift action using correct maneuvers. However, knowledge of obstetric teams' performance during management of real-life shoulder dystocia is limited, and the impact of non-technical skills has not been adequately evaluated. We aimed to analyze videos of teams managing real-life shoulder dystocia to identify clinical challenges associated with correct management and particular non-technical skills correlated with high technical performance., Material and Methods: We included 17 videos depicting teams managing shoulder dystocia in two Danish delivery wards, where deliveries were initially handled by midwives, and consultants were available for complications. Delivery rooms contained two or three cameras activated by Bluetooth upon obstetrician entry. Videos were captured 5 min before and after activation. Two obstetricians assessed the videos; technical performances were scored as low (0-59), average (60-84), or high (85-100). Two other assessors evaluated non-technical skills using the Global Assessment of Team Performance checklist, scoring 6 (poor) to 30 (excellent). We used a spline regression model to explore associations between these two score sets. Inter-rater agreement was assessed using interclass correlation coefficients., Results: Interclass correlation coefficients were 0.71 (95% confidence interval 0.23-0.89) and 0.82 (95% confidence interval 0.52-0.94) for clinical and non-technical performances, respectively. Two teams had low technical performance scores; four teams achieved high scores. Teams adhered well to guidelines, demonstrating limited head traction, McRoberts maneuver, and internal rotation maneuvers. Several clinical skills posed challenges, notably recognizing shoulder impaction, applying suprapubic pressure, and discouraging women from pushing. Two non-technical skills were associated with high technical performance: effective patient communication, with teams calming the mother and guiding her collaboration during internal rotational maneuvers, and situation awareness, where teams promptly mobilized all essential personnel (senior midwife, consultant, pediatric team). Team communication, stress management, and task management skills were not associated with high technical performance., Conclusions: Videos capturing teams managing real-life shoulder dystocia are an effective tool to reveal challenges with certain technical and non-technical skills. Teams with high technical performance are associated with effective patient communication and situational awareness. Future training should include technical skills and non-technical skills, patient communication, and situation awareness., (© 2024 The Author(s). Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG).)

By conducting a mixed-design experiment using simplified accident handling tasks performed by two-person teams, this study examined the effects of automation function and condition (before, during, and after malfunction) on human performance. Five different and non-overlapping functions related to human information processing model were considered and their malfunctions were set in a first-failure way. The results showed that while the automation malfunction impaired task performance, the performance degradation for information analysis was more severe than response planning. Contrary to other functions, the situation awareness for response planning and response implementation tended to increase during malfunctioning and decrease after. In addition, decreased task performance reduced trust in automation, and malfunctions in earlier stages of information processing resulted in lower trust. Suggestions provided for the design and training related to automation emphasise the importance of high-level cognitive support and the benefit of involving automation error handling in training.

This paper examines the feasibility of incorporating visual cueing systems within vehicles to mitigate the risk of experiencing motion sickness. The objective is to enhance passenger awareness and the ability to anticipate the forces associated with car travel motion. Through a comprehensive literature review, the findings demonstrate that visual cues can mitigate motion sickness for particular in-vehicle configurations, whereas their influence on situational awareness is not clear yet. Each type of visual cue proved more effective when presented in the peripheral field of view rather than solely in the central vision. Promising applications can be found within interactive screens and ambient lighting, while the use of extended reality shows potential for future investigations. In addition, integrating such systems into highly automated vehicles shows potential to improve their overall user acceptance.

Objective: This study evaluated the causal relationships among situation awareness (SA), cohesion, and autonomic synchrony ( S E ) within teams. SA is often a team effort and should be more accurate in better-functioning teams., Background: Cohesive teams perform better overall, although the relationship appears reciprocal; the relationship to SA has not been considered previously. S E is a collective neurocognitive activity that has been connected to team coordination, communication, and performance in some circumstances., Method: In this experiment, 71 undergraduates, organized into 16 teams, played two matches of a first-person shooter computer game and completed self-report measures of cohesion and SA. S E was determined through time series analysis of electrodermal responses using the driver-empath framework., Results: Empaths and those who came from more synchronized teams reported less cohesion in the team. Granger causality regression showed reciprocal relations among SA, S E , and cohesion that were both positive and negative after controlling for match difficulty., Conclusion: The cohesion-SA relationship is similar to the reciprocal cohesion-performance relationship. S E plays an important and independent role in both the social and cognitive aspects of team behavior. It is possible, furthermore, that individuals who are more attuned to their co-workers reported a more accurate, and less obliging, social situation., Application: Results are applicable to situations requiring teamwork in a dynamic environment.

Aim: The aim of this study was to: (1) use cognitive task analysis to describe final year nursing students situation awareness in recognising, responding and escalating care of deteriorating patients in ward settings; and (2) make recommendations for training and practice., Design: A mixed methods cognitive task analysis with a convergent triangulation design., Method: Data collection involved observations of 33 final year nursing students in simulated deteriorating patient scenarios and retrospective cognitive interviews. A process tracing technique was applied to identify the cues to deterioration participants perceived; how cue perception altered as situational demands increased; the extent that participants made connections between perceived cues and reached a situational understanding; and the factors that influenced and constrained participants situation awareness. Qualitative and quantitative findings are woven together and presented using descriptive statistics, illustrative quotations and timeline extractions., Results: The median cue perception was 65.4% and 57.6% in the medical and surgical scenarios, respectively. Perception was negatively influenced by incomplete vital sign monitoring as situations escalated; limited physical assessments; passive scanning behaviours; poor task automaticity; and excessive cognitive demands. Incomplete perception, poor cue integration and underdeveloped mental models influenced situational understanding. Escalation calls did not always accurately reflect situations and a reporting mindset was evident. Clinical exposure to deteriorating patients was described as variable and opportunistic., Reporting Method: The study is reported in accordance with the Good Reporting of a Mixed Methods Study (GRAMMS) checklist., Patient or Public Contribution: Patients and public were not involved in this research., (© 2024 The Authors. Nursing Open published by John Wiley & Sons Ltd.)

Drivers must actively supervise automation as it can only function in limited conditions. A failure to supervise the system has negative consequences in terms of missed requests to take over control and may cause crashes or jeopardize safety. The objective of this study is to determine the effect of a novel, 3M (Mistakes, Mentoring, and Mastery) training program on drivers' behavior while using level 2 driving automation systems. To achieve this, 36 participants were assigned randomly to three different training programs (3M training, User manual, and Placebo) and drove through scenarios on a fixed-based driving simulator. The results showed that drivers in the 3M training group took back control more effectively when the driving automation system reached its limits compared to drivers who received User manual or Placebo training. Drivers in the 3M training Group also had higher situation awareness and improved trust in automation. The results indicate that an interactive approach to training with regards to vehicle automation can help drivers more safely interact with automation systems., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Healthcare today is the prerogative of teams rather than of individuals. In acute care domains such as anaesthesia, intensive care, and emergency medicine, the work is complex and fast-paced, and the team members are diverse and interdependent. Three decades of research into the behaviours of high-performing teams provides us with clear guidance on team training, demonstrating positive effects on patient safety and staff wellbeing. Here we consider team performance through the lens of situation awareness. Maintaining situation awareness is an absolute requirement for safe and effective patient management. Situation awareness is a dynamic process of perceiving cues in the environment, understanding what they mean, and predicting how the situation may evolve. In the context of acute clinical care, situation awareness can be improved if the whole team actively contributes to monitoring the environment, processing information, and planning next steps. In this narrative review, we explore the concept of situation awareness at the level of the team, the conditions required to maintain team situation awareness, and the relationship between team situation awareness, shared mental models, and team performance. Our ultimate goal is to help clinicians create the conditions required for high-functioning teams, and ultimately improve the safety of clinical care., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

The Philips Visual Patient Avatar, a user-centered visualization technology, offers an alternative approach to patient monitoring. Computer-based simulation studies indicate that it increases diagnostic accuracy and confidence, while reducing perceived workload. About three months after the technology's integration into clinical practice, we conducted an assessment among anesthesia providers to determine their views on its strengths, limitations, and overall perceptions. This single-center qualitative study at the University Hospital of Zurich examined anesthesia providers' perceptions of the Philips Visual Patient Avatar after its implementation. The study included an online survey to identify medical personnel's opinions on the technology's strengths and areas for improvement, which were analyzed using thematic analysis. A total of 63 of the 377 invited anesthesia providers (16.7%) responded to the survey. Overall, 163 comments were collected. The most prevalent positive themes were good presentation of specific parameters (16/163; 9.8%) and quick overview/rapid identification of problems (15/163; 9.2%). The most common perceived area for improvement was the ability to adjust the visualization thresholds of Visual Patient Avatar, which represent the physiological upper and lower vital-sign limits (33/163; 20.3%). The study showed that users consider Philips Visual Patient Avatar a valuable asset in anesthesia, allowing for easier identification of underlying problems. However, the study also revealed a user desire for the ability to freely adjust the thresholds of the Visual Patient Avatar by the handling caregivers, which were fixed to the departmental standard during the study.

Aim: To examine the components of visual attention that maintain situational awareness during simulation training in undergraduate nursing students with different instruction levels., Background: Eye-tracking can provide deep insight into the nurses' attention during simulated practice. Knowing which gaze patterns promote situational awareness can significantly improve nurse instruction., Design: A comparative observational study investigated the role of visual attention on the performance quality, psychophysiological parameters (vital signs, anxiety and stress) and socioemotional competencies (cognitive workload, motivation and self-efficacy) of nursing students with various experience levels., Methods: Thirty nursing students divided into two groups according to their academic level: first cycle (n=14) and second-cycle (n=16) faced a clinical simulation scenario to resolve a cardiorespiratory arrest event. Eye tracking-based analysis required the selection of six areas of interest. The monitorization of vital signs included measuring blood pressure, heart rate, respiratory rate and oxygen saturation before and after the simulation practice. Participants completed the socioemotional questionnaire (NASA-TLX). They answered the state subscale of the State-Trait Anxiety Inventory (STAI), the Visual Analogue Scale (VAS) of stress, the Situational Motivation Scale (SIMS) and the Baessler and Schwarzer General Self-Efficacy Scale., Results: The first-cycle group displayed higher vital sign scores than the second cycle, apart from the post-simulation respiratory rate. All physiological parameters increased in mean value after the clinical simulation, except oxygen saturation. Anxiety was the only parameter in the socioemotional domain to present a statistically significant difference between the groups. First-year nursing students showed greater anxiety, stress, mental workload, identified regulation and intrinsic motivation, while second-year students showed higher levels of amotivation, external regulation and perceived self-efficacy. Eye-tracking data (revisits, gaze and duration of fixations) exhibited statistically significant differences depending on the area of interest in both groups (p =. 05). The performance outcomes showed a negative and moderate association with gaze the total number of gazes in the second-cycle group (rho = -0.640, p = 0.010)., Conclusion: Eye-tracking-based analysis can help to predict performance quality while maintaining situational awareness during nursing instruction., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Situational Awareness (SA) assessment is of paramount importance in various domains, with particular significance in the military for safe aviation decision-making. It involves encompassing perception, comprehension, and projection levels in human beings. Accurate evaluation of SA statuses across these three levels is crucial for mitigating human false-positive and false-negative rates in monitoring complex scenarios in the aviation context. This study proposes a comprehensive comparative analysis by involving two types of physiological records: electroencephalogram (EEG) signals and brain electrical activity mapping (BEAM) images. These two modalities are leveraged to automate precise SA evaluation using both conventional machine learning and advanced deep learning techniques. Benchmarking experiments reveal that the BEAM-based deep learning models attain state-of-the-art performance scores of 0.955 for both SA perception and comprehension levels, respectively. Conversely, the EEG signals-based manual feature extraction, selection, and classification approach achieved a superior accuracy of 0.929 for the projection level of SA. These findings collectively highlight the potential of deploying diverse physiological records as valuable computational tools for enhancing SA evaluation throughout aviation decision-making safety., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Lack of situation awareness (SA) is the primary cause of human errors when operating forklifts, so determining the SA level of the forklift operator is crucial to the safety of forklift operations. An EEG recognition approach of forklift operator SA in actual settings was presented in order to address the issues with invasiveness, subjectivity, and intermittency of existing measuring methods. In this paper, we conducted a field experiment that mimicked a typical forklift operation scenario to verify the differences in EEG states of forklift operators with different SA levels and investigate the correlation of multi-band combination features of each brain region of forklift operators with SA. Based on the sensitive EEG combination indexes, Support Vector Mechanism was used to construct a forklift operator SA recognition model. The results revealed that there were differences between forklift operators with high and low SA in the θ , α , and β frequency bands in zones F, C, P, and O; combined EEG indicators θ / β , ( α  +  θ )/( α  +  β ), and θ /( α  +  β ) in zones F, P, and C were significantly correlated with SA; the recognition accuracy of the model reached 88.64% in the case of combined EEG indicators of zones C & F & P as input. It could provide a reference for SA measurement, contributing to the improvement of SA., Competing Interests: XL was employed by the COSCO SHIPPING Heavy Industry Co., Ltd. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Li, Kang, Chen, Liu, Jiao and Luo.)

Background: Viscoelastic hemostatic assays, such as rotational thromboelastometry (ROTEM) or thromboelastography, enable prompt diagnosis and accelerate targeted treatment. However, the complex interpretation of the results remains challenging. Visual Clot-a situation awareness-based visualization technology-was developed to assist clinicians in interpreting viscoelastic tests., Objective: Following a previous high-fidelity simulation study, we analyzed users' perceptions of the technology, to identify its strengths and limitations from clinicians' perspectives., Methods: This is a mixed qualitative-quantitative study consisting of interviews and a survey. After solving coagulation scenarios using Visual Clot in high-fidelity simulations, we interviewed anesthesia personnel about the perceived advantages and disadvantages of the new tool. We used a template approach to identify dominant themes in interview responses. From these themes, we defined 5 statements, which were then rated on Likert scales in a questionnaire., Results: We interviewed 77 participants and 23 completed the survey. We identified 9 frequently mentioned topics by analyzing the interview responses. The most common themes were "positive design features," "intuitive and easy to learn," and "lack of a quantitative component." In the survey, 21 respondents agreed that Visual Clot is easy to learn and 16 respondents stated that a combination of Visual Clot and ROTEM would help them manage complex hemostatic situations., Conclusions: A group of anesthesia care providers found Visual Clot well-designed, intuitive, and easy to learn. Participants highlighted its usefulness in emergencies, especially for clinicians inexperienced in coagulation management. However, the lack of quantitative information is an area for improvement., (©Greta Gasciauskaite, Clara Castellucci, Amos Malorgio, Alexandra D Budowski, Giovanna Schweiger, Michaela Kolbe, Daniel Fries, Bastian Grande, Christoph B Nöthiger, Donat R Spahn, Tadzio R Roche, David W Tscholl, Samira Akbas. Originally published in JMIR Human Factors (https://humanfactors.jmir.org), 11.01.2024.)

Objective: The effects of three prototypical designs of energy consumption displays on energy-specific situation awareness were examined., Background: Energy efficiency is crucial for the sustainability of technical systems. However, without accurate situation awareness of energy dynamics (energy dynamics awareness, EDA) it can be challenging for humans to optimize the use of energy resources of electric vehicles (EVs) through their behavior., Method: We examined three prototypical energy display designs that varied by their informational value to support EDA. Furthermore, we investigated the differential effects on EDA measured by (1) a newly constructed scale (experienced EDA), (2) estimating energy consumption, and (3) identifying efficient trips in an online experiment. Participants ( N = 82) watched standardized driving scenes (videos) of EV trips presenting the energy displays., Results: We found a strong effect of display type on experienced EDA, with the trace display being the most supportive. The EDA scale showed excellent internal consistency. The consumption estimation and efficient trip identification indicators were not affected by the display type., Conclusion: The study indicates that experienced EDA is immediately affected by displays with higher information value, but performance might need more time and training. More research is needed to investigate the cognitive processes related to EDA and to examine how distinct display elements enhance EDA., Application: Results from this research can be used as guidance for the design of energy displays, especially in EVs. The EDA scale can be used as an evaluation measure in the human-centered design process of energy displays.

We examined the impact of sharing periscope imagery and analysis tools in eighteen five-member teams (Sonar, Periscope, 2xTrack Motion Analysts, Track Manager) who undertook simulated submarine patrol tasks. Compared to a baseline condition, sharing imagery to team members increased perceived individual workload, with no improvement to team performance (tactical picture accuracy). When both imagery and analysis tools were shared, perceived workload increased and tactical picture compilation was more accurate. Despite this improved tactical picture for the imagery and analysis tools condition, there was no advantage to mission completion (rendezvous/close contact detection) or situation awareness. In contrast to the increased subjective workload, individuals in teams provided with shared imagery (with or without tools) had a lower physiological response (heart rate, electrodermal) to task demands compared to the baseline condition. Sharing imagery and analysis tools likely benefited tactical picture compilation by enabling dynamic task redistribution and multiple streams of concurrent data analysis., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Purpose: The purpose of this study was to explore the relationship between situation awareness (SA) and the physical environment in patient rooms through building a conceptual model., Background: Nurses work in very complicated and dynamic environments where having high levels of SA could be critical for their performance. Studies have also shown that nurses' awareness of the physical environment and patient room is a part of their awareness of dynamic situations in which nurses' spatial awareness may play a role in SA. Despite literature outlining the importance of SA, there is a lack of studies exploring the relationship between the two., Method: A literature review was conducted for the study from nursing and psychology databases. Thirty-three articles, books, and dissertations from a scoping review were included for in-depth review., Results: An in-depth review of the harvested literature indicated that there is in fact a relationship between these two phenomena. Founded on Endsley's model of SA, the literature review in this study offers a conceptual model that articulates a plausible causal pathway between the physical environment and SA., Conclusions: There are a lot of studies focusing on SA and various aspects of it related to nursing, but almost none mention the physical environment and its impact on SA. The current inquiry suggests that spatial awareness plays a prominent role in SA., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Expert performers in time constrained sports use a range of information sources to facilitate anticipatory and decision-making processes. However, research has often focused on responders such as batters, goalkeepers, defenders, and returners of serve, and failed to capture the complex interaction between opponents, where responders can also manipulate probabilities in their favour. This investigation aimed to explore the interaction between top order batters and fast or medium paced bowlers in cricket and the information they use to inform their anticipatory and decision-making skills in Twenty20 competition. Eleven professional cricketers were interviewed (8 batters and 3 bowlers) using semi-structured questions and scenarios from Twenty20 matches. An inductive and deductive thematic analysis was conducted using the overarching themes of Situation Awareness (SA) and Option Awareness (OA). Within SA, the sub-themes identified related to information sources used by bowlers and batters (i.e., stable contextual information, dynamic contextual information, kinematic information). Within OA, the sub-themes identified highlighted how cricketers use these information sources to understand the options available and the likelihood of success associated with each option (e.g., risk and reward, personal strengths). A sub-theme of 'responder manipulation' was also identified within OA to provide insight into how batters and bowlers interact in a cat-and-mouse like manner to generate options that manipulate one another throughout the competition. A schematic has been developed based on the study findings to illustrate the complex interaction between the anticipation and decision-making processes of professional top order batters and fast or medium paced bowlers in Twenty20 cricket., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

A firefighter's situation awareness (SA) is considered crucial to making effective tactical decisions and actions at the scene. Despite the importance of the firefighter's SA, there have been limited research efforts to understand what cues and information firefighters use to assess ongoing situations and predict future conditions. In addition to fire events, contemporary firefighters respond to an increasing volume of non-fire incidents. Thus, this study aims to identify firefighters' SA during three fire incidents (single house fire, vehicle fire, and passenger aircraft fire) and three non-fire incidents (medical emergency, hazardous materials, and urban search and rescue). A goal-directed task analysis was conducted via focus group discussions with eight career firefighters. Findings indicate that firefighters build their SA by processing various cues from hazards (e.g., fire, ignition source), humans (e.g., occupants, bystanders, drivers, passengers), spatial elements (e.g., building structure, location of hazards), and surrounding conditions (e.g., traffic, weather). Our findings provide insights into SA measurement, SA-oriented work processes, training for SA, and designing technologies to support firefighters' SA during all-hazard responses., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

This study aimed to investigate the effect of a looming visual cue on situation awareness and perceived urgency in response to a takeover request (TOR), and to explore the underlying mechanisms of this effect through three experiments. In Experiment 1, the optimal size and speed of a red disk were determined, which were effective in capturing looming motion and conveying the urgency of the situation. The results indicated that both looming speed and size ratio had significant effects on situation awareness and perceived urgency. In Experiment 2, the effects of looming stimuli were compared with dimming stimuli, and the results showed that the looming visual cue was more effective in promoting perceived urgency and situation awareness. The results also indicated that the looming visual cue attracted more visual attention than the dimming visual cue, in line with previous studies. Experiment 3 utilized a driving simulator to test the effectiveness of the looming visual cue in promoting fast and appropriate responses to TORs in complex driving scenarios. The results showed that the looming visual cue was more effective in promoting perceived urgency and enhancing situation awareness, especially in highly complex driving situations. Overall, the findings suggest that the looming visual cue is a powerful tool for promoting fast and appropriate responses to TORs and enhancing situation awareness, particularly in complex driving scenarios. These results have important implications for designing effective TOR systems and improving driver safety on the road., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors.)

Objective: This study used the looking-at-nothing phenomenon to explore situation awareness (SA) and the effects of working memory (WM) load in driving situations., Background: While driving, people develop a mental representation of the environment. Since errors in retrieving information from this representation can have fatal consequences, it is essential for road safety to investigate this process. During retrieval, people tend to fixate spatial positions of visually encoded information, even if it is no longer available at that location. Previous research has shown that this "looking-at-nothing" behavior can be used to trace retrieval processes., Method: In a video-based laboratory experiment with 2 (WM) x 3 (SA level) within-subjects design, participants ( N = 33) viewed a reduced screen and evaluated auditory statements relating to different SA levels on previously seen dynamic traffic scenarios while eye movements were recorded., Results: When retrieving information, subjects more frequently fixated emptied spatial locations associated with the information relevant for the probed SA level. The retrieval of anticipations (SA level 3) in contrast to the other SA level information resulted in more frequent gaze transitions that corresponded to the spatial dynamics of future driving behavior., Conclusion: The results support the idea that people build a visual-spatial mental image of a driving situation. Different gaze patterns when retrieving level-specific information indicate divergent retrieval processes., Application: Potential applications include developing new methodologies to assess the mental representation and SA of drivers objectively., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Problem: Increasing numbers of crashes involving pedelecs, and particularly older pedelec users, induce a need to enhance cycling safety. We evaluated a prototype cyclist warning system (CWS) that aims to increase situation awareness (SA) by alerting to safety critical events (SCE) with trimodal (auditory, visual, tactile)., Method: To investigate the effects of CWS usage, we conducted a 2x2 mixed design bicycle simulator study with factors (1) CWS usage (within: rides WITH vs. WITHOUT CWS) and (2) age group (between: younger vs. older cyclists) on braking reaction time, gaze behavior, mental workload, and perceived safety. In sum, N = 64 participants (n = 32 younger, 18-40 years; n = 32 older, ≥ 55 years) took part in the study and experienced two balanced blocks of short rides including SCE of particular relevance for cycling safety., Results: CWS usage resulted in earlier braking reactions to all investigated SCE and partly earlier fixation on the critical interaction partners (CIP) indicating increased cyclists' SA. Consistently to behavioral measures, participants' assessments regarding perceived safety further supported the safety improvements derived from CWS independently of age group. Moreover, CWS usage did not add to mental workload ratings. Age effects were selectively found for gaze data showing that across all SCE, older adults fixated longer and more frequently on street alignment, and less frequently on other road users., Discussion: Taken together, the CWS evaluation showed promising results indicating the potential of the tested CWS to increase SA and enhance cyclists' safety both on a behavioral level and regarding subjective assessments. Further research should address the systems' safety potential under real-world conditions and for situations of higher complexity., Practical Applications: Understanding the potential impact of road safety measures such as CWS is important to contribute effectively to reducing SCE., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023. Published by Elsevier Ltd.)

Behavioural marker systems (observational frameworks geared towards the assessment of non-technical skills by way of behavioural markers) exist across a variety of high-risk occupations, however, no identifiable system currently exists developed from rotary operative data. In this study, discussion groups ( n  = 9) were undertaken with subject matter experts ( n  = 20)-including pilots and technical crew operating across search and rescue and offshore transport environments-with the objective of identifying role-specific behavioural markers. Systems were reviewed on an iterative basis by the academic team and received final reviews by additional subject matter experts ( n  = 6). Two behavioural marker systems were constructed: HeliNOTS (O) for offshore transport pilots and HeliNOTS (SAR) for search and rescue crews; each with domain-specific behavioural markers. Both represent a significant step towards a nuanced approach to training and assessment of helicopter flight crews' non-technical skills and are the first publicly available systems tailored to these distinct mission types. Practitioner summary: There is no publicly available behavioural marker system based on data from rotary operatives. Across this study, two prototype systems were developed: HeliNOTS (SAR) for helicopter search and rescue, and HeliNOTS (O) for helicopter offshore transport. Both HeliNOTS systems represent a nuanced approach towards rotary CRM training and assessment.

Surgical flow disruptions are unexpected deviations from the natural progression which can potentially compromise the safety of the operation. Separation of the surgeon from the patient and team members is the main contributor for flow disruptions (FDs) in robot-assisted surgery (RAS). FDs have been categorised as communication, coordination, surgeon task considerations, training, equipment/ technology, external factors, instrument changes, and environmental factors. There may be an association between FDs and task error rate. Intervention to counter FDs include training, operating room adjustments, checklists, teamwork, communication improvement, ergonomics, technology, guidelines, workflow optimisation, and team briefing. Future studies should focus on identifying the significant disruptive FDs and the impact of interventions on surgical flow during RAS., (© 2023. The Author(s).)

This study investigated differences in eye movement indicators among forklift operators with different situation awareness (SA) and the relationship between eye movement indicators and the SA of forklift operators to verify the effectiveness of eye movement tracking in assessing SA and the factors affecting operators' SA for improving forklift operation safety. An eye movement tracking system was used to collect eye movement data from 15 forklift operators while they performed a series of forklift tasks. The SA global assessment technique (SAGAT) was used to determine the SA score of each operator. The results indicated that the fixation duration percentage (FDP), fixation count percentage (FCP) and average fixation duration (AFD) all had a positive relationship with SA in the work-related area of interest (AOI). These findings support eye movement tracking as an effective technique to quantitatively evaluate forklift operators' SA and provide insights into how forklift operators' SA could be improved.

The Philips Visual Patient Avatar represents an alternative method of patient monitoring that, according to computer-based simulation studies, enhances diagnostic accuracy and confidence and reduces workload. After its clinical integration, we assessed pediatric anesthesia providers' perspectives on this technology. This is a single-center qualitative study, conducted at the University Hospital Zurich using in-depth individual interviews. We aimed to identify the advantages and limitations of the Visual Patient Avatar in pediatric anesthesia and to assess children's and parents' reactions from caregivers' perspectives. Thematic analysis was used to identify the dominant themes. Fourteen members of the institution's pediatric anesthesia team were interviewed. The most prevalent themes were children's positive reactions towards the Visual Patient Avatar (92.9%) and enhanced speed in problem identification (71.4%). Additionally, 50% of participants reported finding the Visual Patient Avatar useful for diverting children's attention during anesthesia induction, and 50% suggested that its vital sign thresholds should be adaptable for different age groups. The study revealed that the Visual Patient Avatar was recognized as a tool in pediatric anesthesia, enabling prompt identification of underlying issues and receiving positive feedback from both children and parents. The most commonly voiced wish for improvement in the study was the ability to customize the Visual Patient Avatar's thresholds for different age groups.

Patient monitoring is crucial in critical care medicine. Perceiving and interpreting multiple vital signs requires a high workload that can lead to decreased situation awareness and consequently inattentional blindness, defined as impaired perception of unexpectedly changing data. To facilitate information transfer, we developed and validated the Visual-Patient avatar. Generated by numerical data, the animation displays the status of vital signs and patient installations according to a user-centered design to improve situation awareness. As a surrogate parameter for information transfer in patient monitoring, we recorded visual attention using eye-tracking data. In this computer-based study, we compared the correlation of visually perceived and correctly interpreted vital signs between a Visual-Patient-avatar ICU and conventional patient monitoring. A total of 50 recruited study participants (25 nurses, 25 physicians) from five European study centers completed five randomized scenarios in both modalities. Using a stationary eye tracker as the primary endpoint, we recorded how long different areas of interest of the two monitoring modalities were viewed. In addition, we tested for a possible association between the length of time an area of interest was viewed and the correctness of the corresponding question. With the conventional monitor, participants looked at the installation site the longest (median 2.13-2.51 s). With the Visual-Patient-avatar ICU, gaze distribution was balanced; no area of interest was viewed for particularly long. For both modalities, the longer an area was viewed, the more likely the associated question was answered incorrectly (OR 0.97, 95% CI 0.95-0.99, p = 0.008). The Visual-Patient-avatar ICU facilitates and improves information transfer through its visualizations, especially with written information. The longer an area of interest was viewed, the more likely the associated question was answered incorrectly.

Visual Patient Avatar ICU is an innovative approach to patient monitoring, enhancing the user's situation awareness in intensive care settings. It dynamically displays the patient's current vital signs using changes in color, shape, and animation. The technology can also indicate patient-inserted devices, such as arterial lines, central lines, and urinary catheters, along with their insertion locations. We conducted an international, multi-center study using a sequential qualitative-quantitative design to evaluate users' perception of Visual Patient Avatar ICU among physicians and nurses. Twenty-five nurses and twenty-five physicians from the ICU participated in the structured interviews. Forty of them completed the online survey. Overall, ICU professionals expressed a positive outlook on Visual Patient Avatar ICU. They described Visual Patient Avatar ICU as a simple and intuitive tool that improved information retention and facilitated problem identification. However, a subset of participants expressed concerns about potential information overload and a sense of incompleteness due to missing exact numerical values. These findings provide valuable insights into user perceptions of Visual Patient Avatar ICU and encourage further technology development before clinical implementation.

Bainbridge's Ironies of Automation was a prescient description of automation related challenges for human performance that have characterised much of the 40 years since its publication. Today a new wave of automation based on artificial intelligence (AI) is being introduced across a wide variety of domains and applications. Not only are Bainbridge's original warnings still pertinent for AI, but AI's very nature and focus on cognitive tasks has introduced many new challenges for people who interact with it. Five ironies of AI are presented including difficulties with understanding AI and forming adaptations, opaqueness in AI limitations and biases that can drive human decision biases, and difficulties in understanding the AI reliability, despite the fact that AI remains insufficiently intelligent for many of its intended applications. Future directions are provided to create more human-centered AI applications that can address these challenges.

Objective: Examine the extent to which increasing information integration across displays in a simulated submarine command and control room can reduce operator workload, improve operator situation awareness, and improve team performance., Background: In control rooms, the volume and number of sources of information are increasing, with the potential to overwhelm operator cognitive capacity. It is proposed that by distributing information to maximize relevance to each operator role (increasing information integration), it is possible to not only reduce operator workload but also improve situation awareness and team performance., Method: Sixteen teams of six novice participants were trained to work together to combine data from multiple sensor displays to build a tactical picture of surrounding contacts at sea. The extent that data from one display were available to operators at other displays was manipulated (information integration) between teams. Team performance was assessed as the accuracy of the generated tactical picture., Results: Teams built a more accurate tactical picture, and individual team members had better situation awareness and lower workload, when provided with high compared with low information integration., Conclusion: A human-centered design approach to integrating information in command and control settings can result in lower workload, and enhanced situation awareness and team performance., Application: The design of modern command and control rooms, in which operators must fuse increasing volumes of complex data from displays, may benefit from higher information integration based on a human-centered design philosophy, and a fundamental understanding of the cognitive work that is carried out by operators.

Blood gas analysis plays a central role in modern medicine. Advances in technology have expanded the range of available parameters and increased the complexity of their interpretation. By applying user-centered design principles, it is possible to reduce the cognitive load associated with interpreting blood gas analysis. In this international, multicenter study, we explored anesthesiologists' perspectives on Visual Blood, a novel visualization technique for presenting blood gas analysis results. We conducted interviews with participants following two computer-based simulation studies, the first utilizing virtual reality (VR) (50 participants) and the second without VR (70 participants). Employing the template approach, we identified key themes in the interview responses and formulated six statements, which were rated using Likert scales from 1 (strongly disagree) to 5 (strongly agree) in an online questionnaire. The most frequently mentioned theme was the positive usability features of Visual Blood. The online survey revealed that participants found Visual Blood to be an intuitive method for interpreting blood gas analysis (median 4, interquartile range (IQR) 4-4, p < 0.001). Participants noted that minimal training was required to effectively learn how to interpret Visual Blood (median 4, IQR 4-4, p < 0.001). However, adjustments are necessary to reduce visual overload (median 4, IQR 2-4, p < 0.001). Overall, Visual Blood received a favorable response. The strengths and weaknesses derived from these data will help optimize future versions of Visual Blood to improve the presentation of blood gas analysis results.

Objective: To investigate the impact of interface display modalities and human-in-the-loop presence on the awareness, workload, performance, and user strategies of humans interacting with teleoperated robotic systems while conducting inspection tasks onboard spacecraft., Background: Due to recent advancements in robotic technology, free-flying teleoperated robot inspectors are a viable alternative to extravehicular activity inspection operations. Teleoperation depends on the user's situation awareness; consequently, a key to successful operations is practical bi-directional communication between human and robot agents., Method: Participants ( n = 19) performed telerobotic inspection of a virtual spacecraft during two degrees of temporal communication, a Synchronous Inspection task and an Asynchronous Inspection task. Participants executed the two tasks while using three distinct visual displays (2D, 3D, AR) and accompanying control systems., Results: Anomaly detection performance was better during Synchronous Inspection than the Asynchronous Inspection of previously captured imagery. Users' detection accuracy reduced when given interactive exocentric 3D viewpoints to accompany the egocentric robot view. The results provide evidence that 3D projections, either demonstrated on a 2D interface or augmented reality hologram, do not affect the mean clearance violation time (local guidance performance), even though the subjects perceived a benefit., Conclusion: In the current implementation, the addition of augmented reality to a classical egocentric robot view for exterior inspection of spacecraft is unnecessary, as its margin of performance enhancement is limited in comparison., Application: Results are presented to inform future human-robot interfaces to support crew autonomy for deep space missions.

Objective: The goal of this systematic literature review is to investigate the relationship between indirect physiological measurements and direct measures of situation awareness (SA)., Background: Across different environments and tasks, assessments of SA are often performed using techniques designed specifically to directly measure SA, such as SAGAT, SPAM, and/or SART. However, research suggests that indirect physiological sensing methods may also be capable of predicting SA. Currently, it is unclear which particular physiological approaches are sensitive to changes in SA., Method: Seven databases were searched using the PRISMA reporting guidelines. Eligibility criteria included human-subject experiments that used at least one direct SA assessment technique, as well as at least one physiological measurement. Information extracted from each article was the physiological metric(s), the direct SA measurement(s), the correlation between these two metrics, and the experimental task(s). All studies underwent a quality assessment., Results: Twenty-five articles were included in this review. Eye tracking techniques were the most commonly used physiological measures, and correlations between conscious aspects of eye movement measures and direct SA scores were observed. Evidence for cardiovascular predictors of SA were mixed. EEG studies were too few to form strong conclusions, but were consistently positive., Conclusion: Further investigation is needed to methodically collect more relevant data and comprehensively model the relationships between a wider range of physiological measurements and direct assessments of SA., Application: This review will guide researchers and practitioners in methods to indirectly assess SA with sensors and highlight opportunities for future research on wearables and SA.

Vehicle automation promises to reduce the demands of the driving task, making driving less fatiguing, more convenient, and safer. Nevertheless, Level 3 automated vehicles rely on a human driver to be ready to resume control, requiring the driver to reconstruct situation awareness (SA) and resume the driving task. Understanding the interaction between non-driving-related task (NDRT) use, SA, and takeover capacity is important because an effective takeover is entirely dependent on, and scaffolds from, effectively reconstructed SA. While a number of studies have looked at the behavioural impact of being 'in- or on-the-loop', fewer consider the cognitive impact, particularly the consequences for SA. The present study exposed participants to an extended simulated automated drive involving two critical takeover scenarios (early- and late-drive). We compared automated vehicle (AV) operators who were required to passively monitor the vehicle to those engaging with self-selected NDRTs. Monitoring operators demonstrated lower total- and schema-specific SA count scores following a fatiguing drive compared to those engaging with self-selected NDRTs. NDRT engagement resulted in no significant difference in SA count scores early- and late-drive. Assessment of differences in the type and sensory modality of NDRTs indicated operators make fundamentally different selections about the NDRTs they engage with in an automated driving environment compared to a manual environment. The present study provides further evidence linking SA and AV operator behaviour and underscores the need to understand the role of SA in takeover capacity. Our findings suggest that although SA declines over time regardless of driving task requirements (Monitoring versus NDRT engagement), NDRT use may facilitate better SA construction, with implications for the regulation of NDRT use in AVs as the technology progresses., Competing Interests: Declaration of Competing Interest This research was supported by an Australian Government Research Training Program (RTP) Scholarship. The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Medical technology innovation has improved patient monitoring in perioperative and intensive care medicine and continuous improvement in the technology is now a central focus in this field. Because data density increases with the number of parameters captured by patient-monitoring devices, its interpretation has become more challenging. Therefore, it is necessary to support clinicians in managing information overload while improving their awareness and understanding about the patient's health status. Patient monitoring has almost exclusively operated on the single-sensor-single-indicator principle-a technology-centered way of presenting data in which specific parameters are measured and displayed individually as separate numbers and waves. An alternative is user-centered medical visualization technology, which integrates multiple pieces of information (e.g., vital signs), derived from multiple sensors into a single indicator-an avatar-based visualization-that is a meaningful representation of the real-world situation. Data are presented as changing shapes, colors, and animation frequencies, which can be perceived, integrated, and interpreted much more efficiently than other formats (e.g., numbers). The beneficial effects of these technologies have been confirmed in computer-based simulation studies; visualization technologies improved clinicians' situation awareness by helping them effectively perceive and verbalize the underlying medical issue, while improving diagnostic confidence and reducing workload. This review presents an overview of the scientific results and the evidence for the validity of these technologies., (© 2023. The Author(s).)

Objectives: Research examining decision-making in sports has predominantly used experimental approaches that fail to provide a holistic understanding of the various factors that impact the decision-making process. The current study aimed to explore the decision-making processes of Senior (expert) and Academy (near-expert) Gaelic Football players using a focus group approach., Methods: Four focus groups were conducted; two with Senior players ( n = 5; n = 6) and two with U17 Academy players ( n = 5; n = 6). In each focus group, short video clips of Senior Gaelic football games were played, and the action was paused at key moments. The group then discussed the options available to the player in possession, the decision they would make in that situation, and importantly, what factors influenced the final decision. Thematic analysis was used to identify themes that emerged from the focus groups., Results and Discussion: Four primary themes emerged that affected the decision-making process. Three themes were related to information sources, namely, pre-match context (coach tactics and instructions, match importance, and opposition status), current match context (score and time remaining), and visual information (player positioning and field space, and visual search strategy), and the fourth theme related to individual differences (self-efficacy, risk propensity, perceived pressure, physical characteristics, action capabilities, fatigue) that moderated the decision-making process. Compared to the near-expert Academy players, the expert Senior players displayed a more sophisticated understanding of the various sources of information and were able to integrate them in a more complex manner to make projections regarding future scenarios. For both groups, the decision-making process was moderated by individual differences. A schematic has been developed based on the study findings in an attempt to illustrate the hypothesized decision-making process., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 McLoughlin, Broadbent, Kinrade, Coughlan and Bishop.)

Objective: Evaluate and model the advantage of a situation awareness (SA) supported by an augmented reality (AR) display for the ground-based joint terminal attack Controller (JTAC), in judging and describing the spatial relations between objects in a hostile zone., Background: The accurate world-referenced description of relative locations of surface objects, when viewed from an oblique slant angle (aircraft, observation post) is hindered by (1) the compression of the visual scene, amplified at a lower slang angle, (2) the need for mental rotation, when viewed from a non-northerly orientation., Approach: Participants viewed a virtual reality (VR)-simulated four-object scene from either of two slant angles, at each of four compass orientations, either unaided, or aided by an AR head-mounted display (AR-HMD), depicting the scene from a top-down (avoiding compression) and north-up (avoiding mental rotation) perspective. They described the geographical layout of four objects within the display., Results: Compared with the control condition, that condition supported by the north-up SA display shortened the description time, particularly on non-northerly orientations (9 s, 30% benefit), and improved the accuracy of description, particularly for the more compressed scene (lower slant angle), as fit by a simple computational model., Conclusion: The SA display provides large, significant benefits to this critical phase of ground-air communications in managing an attack-as predicted by the task analysis of the JTAC., Application: Results impact the design of the AR-HMD to support combat ground-air communications and illustrate the magnitude by which basic cognitive principles "scale up" to realistically simulated real-world tasks such as search and rescue.

Effective team behavior in high-performance environments such as in sport and the military requires individual team members to efficiently perceive the unfolding task events, predict the actions and action intents of the other team members, and plan and execute their own actions to simultaneously accomplish individual and collective goals. To enhance team performance through effective cooperation, it is crucial to measure the situation awareness and dynamics of each team member and how they collectively impact the team's functioning. Further, to be practically useful for real-life settings, such measures must be easily obtainable from existing sensors. This paper presents several methodologies that can be used on positional and movement acceleration data of team members to quantify and/or predict team performance, assess situation awareness, and to help identify task-relevant information to support individual decision-making. Given the limited reporting of these methods within military cohorts, these methodologies are described using examples from team sports and teams training in virtual environments, with discussion as to how they can be applied to real-world military teams., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

An event-related potential (ERP)-based brain-computer interface (BCI) can be used to monitor a user's cognitive state during a surveillance task in a situational awareness context. The present study explores the use of an ERP-BCI for detecting new planes in an air traffic controller (ATC). Two experiments were conducted to evaluate the impact of different visual factors on target detection. Experiment 1 validated the type of stimulus used and the effect of not knowing its appearance location in an ERP-BCI scenario. Experiment 2 evaluated the effect of the size of the target stimulus appearance area and the stimulus salience in an ATC scenario. The main results demonstrate that the size of the plane appearance area had a negative impact on the detection performance and on the amplitude of the P300 component. Future studies should address this issue to improve the performance of an ATC in stimulus detection using an ERP-BCI.

Cognitive competency is an essential complement to the existing ship pilot screening system that should be focused on. Situation awareness (SA), as the cognitive foundation of unsafe behaviors, is susceptible to influencing piloting performance. To address this issue, this paper develops an identification model based on random forest- convolutional neural network (RF-CNN) method for detecting at-risk cognitive competency (i.e., low SA level) using wearable EEG signal acquisition technology. In the poor visibility scene, the pilots' SA levels were correlated with EEG frequency metrics in frontal (F) and central (C) regions, including α/β ( p  = 0.071 < 0.1 in F and p  = 0.042 < 0.05 in C), θ/(α + θ) ( p  = 0.048 < 0.05 in F and p  = 0.026 < 0.05 in C) and (α + θ)/β ( p  = 0.046 < 0.05 in F and p  = 0.012 < 0.05 in C), and then a total of 12 correlation features were obtained based on a 5 s sliding time window. Using the RF algorithm developed by principal component analysis (PCA) for further feature combination, these salient combinations are used as input sets to obtain the CNN algorithm with optimal parameters for identification. The comparative results of the proposed RF-CNN (accuracy is 84.8%) against individual RF (accuracy is 78.1%) and CNN (accuracy is 81.6%) methods demonstrate that the RF-CNN with feature optimization provides the best identification of at-risk cognitive competency (accuracy increases 6.7%). Overall, the results of this paper provide key technical support for the development of an adaptive evaluation system of pilots' cognitive competency based on intelligent technology, and lay the foundation and framework for monitoring the cognitive process and competency of ship piloting operation in China., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Jiang, Chen, Ren and Zhu.)

Background: Situation awareness (SA) is a key factor in accountability and ensuring patient safety in health care. SA is an essential element to research on human factors in healthcare. It is essential to identify valid instruments for measuring this concept and assessing how it is affected by interventions and educational methods., Methods: This systematic review aimed to assess the measurement properties of situation awareness instruments in health care providers' (HCP S ) using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology. Four databases (Medline (through PubMed), Embase, Scopus, and Web of Science) were systematically searched. A manual search was also conducted on Google Scholar and the reference list of the included primary studies to supplement the electronic search. Studies aiming to determine the measurement properties of SA instruments or non-technical skills in HCP S were included. The overall results for each measurement property were reported as sufficient, insufficient, inconsistent, or indeterminate, and the quality of evidence was reported as high, moderate, low, or very low., Results: A total of 25 studies and 15 instruments were included in the study. More than one measurement property was reported in some of the studies, and none of the studies presented all measurement properties. The most common measurement properties were content validity (12/25) and internal consistency (12/25). Cross-cultural validity and responsiveness were not investigated in any study. Evidence quality for the measurement properties was not high in any of the 15 instruments., Conclusions: None of the instruments can be recommended as the most suitable instrument, and all instruments were classified as promising instruments in need of further psychometric assessment. This systematic review proves the dire need for the development and psychometric evaluation of instruments to measure SA in HCPs in clinical settings., Systematic Review Registration: PROSPERO CRD42020147349., (© 2023. The Author(s).)

Background: Performance levels in football are ever more important and no longer are just physical, technical, and tactical skills, the ones that make an athlete stand out. Cognitive variables, such as stress-coping, become more important and seem to be explaining differences in performance, for example, through reaching an optimal level of arousal. In addition, it is suggested that stress-coping skills also affect situation awareness (SA), important for decision-making in the complex and dynamic situations in football. Objective: This study was conducted to examine how stress-coping skills, such as stress mindset, affect performance and SA in the context of a football match. Methods: Twenty elite female football players participated in the study. The final sample size consisted of 15 players for the Stress Mindset Measure (SMM) analysis and 8 players for the multilevel model analyses. Two types of intervention were used to manipulate stress mindset and control over heart rate variability (HRV); a serious game called "Stressjam," and a reflection tool called "Brainjam." Questionnaires for stress mindset and SA and video analysis for performance were used. A total of three matches were assessed. Results: The "Stressjam" intervention resulted in significant differences in stress mindset throughout the intervention [ F (1,5) = 7.357, P  = 0.008]. Subsequently, multilevel analysis showed a positive, strong, and significant correlation between stress mindset, manipulated through "Stressjam" and SA [ r (14) = 0.69, P  = 0.014]. A correlation of practical interest, given the confidence intervals, was found between stress mindset, manipulated through "Stressjam," and performance. Conclusion: Cognitive variables, such as stress-coping, correlate significantly with SA in football. A correlation of practical interest was found between stress-coping and performance. Further research is needed to study the relationship between stress-coping and performance in football.

Viscoelastic point-of-care haemostatic resuscitation methods, such as ROTEM or TEG, are crucial in deciding on time-efficient personalised coagulation interventions. International transfusion guidelines emphasise increased patient safety and reduced treatment costs. We analysed care providers' perceptions of ROTEM to identify perceived strengths and areas for improvement. We conducted a single-centre, mixed qualitative-quantitative study consisting of interviews followed by an online survey. Using a template approach, we first identified themes in the responses given by care providers about ROTEM. Later, the participants rated six statements based on the identified themes on five-point Likert scales in an online questionnaire. Seventy-seven participants were interviewed, and 52 completed the online survey. By analysing user perceptions, we identified ten themes. The most common positive theme was "high accuracy". The most common negative theme was "need for training". In the online survey, 94% of participants agreed that monitoring the real-time ROTEM temograms helps to initiate targeted treatment more quickly and 81% agreed that recurrent ROTEM training would be beneficial. Anaesthesia care providers found ROTEM to be accurate and quickly available to support decision-making in dynamic and complex haemostatic situations. However, clinicians identified that interpreting ROTEM is a complex and cognitively demanding task that requires significant training needs., Competing Interests: D.W.T. and C.B.N. are designated inventors of Philips Visual-Patient-avatar, for which the University of Zurich and Koninklijke Philips N.V. hold various patents, design protections, and trademarks. There are cooperation and licensing agreements with Philips Medizin Systeme B&ouml;blingen GmbH, B&ouml;blingen, Germany; Koninklijke Philips N.V., Amsterdam, The Netherlands; Philips Research/Philips Electronics Nederland BV, Eindhoven, The Netherlands; Philips USA, Cambridge, MA, USA. Under these agreements, D.W.T. receives research funding and D.W.T. and C.B.N. receive travel support, lecturing honoraria, and may receive royalties in the event of successful commercialization. D.W.T., C.B.N., and D.R.S. are designated inventors of Visual Clot technology, for which the University of Zurich holds various patents and trademarks. D.W.T., C.B.N., and D.R.S. may receive royalties in the event of successful commercialization. D.W.T. receives honoraria/travel support for consulting or lecturing from: Instrumentation Laboratory, Bedford, MA, USA, Swiss Foundation for Anaesthesia Research, Zurich, Switzerland, International Symposium on Intensive Care on Emergency Medicine, Brussels, Belgium. C.B.N. receives honoraria/travel support for consulting or lecturing from: Instrumentation Laboratory, Bedford, MA, USA. D.R.S. academic department is receiving grant support from the Swiss National Science Foundation, Berne, Switzerland, the Swiss Society of Anaesthesiology and Perioperative Medicine (SSAPM), Berne, Switzerland, the Swiss Foundation for Anaesthesia Research, Zurich, Switzerland, Vifor SA, Villars-sur-Gl&acirc;ne, Switzerland and Vifor (International) AG, St. Gallen, Switzerland. D.R.S. is co-chair of the A.B.C-Trauma Faculty, sponsored by unrestricted educational grants from Novo Nordisk Health Care AG, Zurich, Switzerland, CSL Behring GmbH, Marburg, Germany, LFB Biom&eacute;dicaments, Courtaboeuf Cedex, France and Octapharma AG, Lachen, Switzerland. D.R.S. received honoraria/travel support for consulting or lecturing from: Danube University of Krems, Austria, US Department of Defense, Washington, USA, European Society of Anaesthesiology and Intensive Care, Brussels, BE, Korean Society for Patient Blood Management, Seoul, Korea, Korean Society of Anaesthesiologists, Seoul, Korea, Network for the Advancement of Patient Blood Management, Haemostasis and Thrombosis, Paris, France, Alexion Pharmaceuticals Inc., Boston, MA, Bayer AG, Z&uuml;rich, Switzerland, B. Braun Melsungen AG, Melsungen, Germany, CSL Behring GmbH, Hattersheim am Main, Germany and Berne, Switzerland, Celgene International II S&agrave;rl, Couvet, Switzerland, Daiichi Sankyo AG, Thalwil, Switzerland, Haemonetics, Braintree, MA, USA, Instrumentation Laboratory (Werfen), Bedford, MA, USA, LFB Biom&eacute;dicaments, Courtaboeuf Cedex, France, Merck Sharp & Dohme, Kenilworth, New Jersey, USA, Novo Nordisk Health Care AG, Zurich, Switzerland, PAION Deutschland GmbH, Aachen, Germany, Pharmacosmos A/S, Holbaek, Denmark, Pfizer AG, Z&uuml;rich, Switzerland, Pierre Fabre Pharma, Alschwil, Switzerland, Portola Schweiz GmbH, Aarau, Switzerland, Roche Diagnostics International Ltd., Reinach, Switzerland, Sarstedt AG & Co., Sevelen, Switzerland and N&uuml;mbrecht, Germany, Shire Switzerland GmbH, Zug, Switzerland, Tem International GmbH, Munich, Germany, Vifor Pharma, Munich, Germany, Neuilly sur Seine, France and Villars-sur-Gl&acirc;ne, Switzerland, Vifor (International) AG, St. Gallen, Switzerland, Zuellig Pharma Holdings, Singapore, Singapore. KZ academic department received support from B. Braun Melsungen, CSL Behring, Fresenius Kabi, and Vifor Pharma for the implementation of Frankfurt&lsquo;s Patient Blood Management program. KZ has received honoraria for participation in advisory board meetings for Haemonetics and Vifor and received speaker fees from CSL Behring, Masimo, Pharmacosmos, Boston Scientific, Salus, iSEP, Edwards and GE Healthcare. He is the Principal Investigator of the EU-Horizon 2020 project ENVISION (Intelligent plug-and-play digital tool for real-time surveillance of COVID-19 patients and smart decision-making in Intensive Care Units) and Horizon Europe 2021 project COVend (Biomarker and AI-supported FX06 therapy to prevent progression from mild and moderate to severe stages of COVID-19). FJR received speaker fees from CSL Behring, Helios Germany, university hospital W&uuml;rzburg and Keller Medical GmbH. FJR received financial support by HemoSonics LLC, pharma-consult Petersohn, LifeSystems and Boehringer Ingelheim. FP received honoraria from Pharmacosmos for scientific lectures. The other authors do not have any conflict of interest.

Interpreting blood gas analysis results can be challenging for the clinician, especially in stressful situations under time pressure. To foster fast and correct interpretation of blood gas results, we developed Visual Blood. This computer-based, multicentre, noninferiority study compared Visual Blood and conventional arterial blood gas (ABG) printouts. We presented six scenarios to anaesthesiologists, once with Visual Blood and once with the conventional ABG printout. The primary outcome was ABG parameter perception. The secondary outcomes included correct clinical diagnoses, perceived diagnostic confidence, and perceived workload. To analyse the results, we used mixed models and matched odds ratios. Analysing 300 within-subject cases, we showed noninferiority of Visual Blood compared to ABG printouts concerning the rate of correctly perceived ABG parameters (rate ratio, 0.96; 95% CI, 0.92-1.00; p = 0.06). Additionally, the study revealed two times higher odds of making the correct clinical diagnosis using Visual Blood (OR, 2.16; 95% CI, 1.42-3.29; p < 0.001) than using ABG printouts. There was no or, respectively, weak evidence for a difference in diagnostic confidence (OR, 0.84; 95% CI, 0.58-1.21; p = 0.34) and perceived workload (Coefficient, 2.44; 95% CI, -0.09-4.98; p = 0.06). This study showed that participants did not perceive the ABG parameters better, but using Visual Blood resulted in more correct clinical diagnoses than using conventional ABG printouts. This suggests that Visual Blood allows for a higher level of situation awareness beyond individual parameters' perception. However, the study also highlighted the limitations of today's virtual reality headsets and Visual Blood.

(1) Background: This study examines the differences in emotions induced by accidents and incidents as emotional stimuli and the effects on pilot situation awareness (SA) after induction. (2) Method: Forty-five jet pilots were randomly divided into three groups after which their emotions were induced using the pictures of accident, incident, and neutral stimulus, respectively. (3) Results: The conditions of accidents and incidents both induced changes in the pilots' happiness and sadness and the changes in the emotion were regulated by the emotional intelligence of pilots in the high SA group. The emotion induction, which caused a direct change in pilot's happiness and fear, resulted in conditions that indirectly affected level 1 of SA in pilots. (4) Conclusions: The research elucidates the difference between accident and incident in inducing pilot emotions, and reminds us that SA level exerts the regulating effects on the same emotional induction conditions.