Micro- and macroergonomic changes in mental workload and medication safety following the implementation of new health IT

Health information technology (IT) is a promising way to achieve safer medication management in the delivery of healthcare. However, human factors/ergonomics dictates that in order to make the complex, cognitive work of healthcare delivery safer, health IT must properly support human cognition. This means, for example, that new health IT must reduce, not increase, workload during safety-critical tasks. The present study was the first to quantitatively assess the short- and long-term impact of bar coded medication administration (BCMA) IT on nurses' mental workload as well as on perceived medication safety. One-hundred seventy registered nurses across 3 dissimilar clinical units at an academic, freestanding pediatric hospital in the Midwest US participated in surveys administered before, 3 months after, and 12 months after the hospital implemented BCMA. Nurses rated their external mental workload (interruptions, divided attention, being rushed) and internal mental workload (concentration, mental effort) during medication administration tasks as well as the likelihood of each of three medication safety events: medication administration errors, medication errors on the clinical unit, and clinical unit-level adverse drug events. Clinical unit differences were assessed. Findings generally confirmed the hypothesis that external but not internal mental workload was associated with the perceived likelihood of a medication safety event. Comparisons of mental workload from pre- to post-BCMA revealed statistically significant changes in the critical care unit only. Medication safety appeared to improve over the long term in the hematology/oncology unit only. In the critical care and medical/surgical units, medication safety exhibited short-term improvements that were eliminated over time. Changes in mental workload and medication safety, two classically microergonomic constructs, were deeply embedded in macroergonomic phenomena. These included the fit between the BCMA system and the nature of nursing work, the process of BCMA implementation, and BCMA interactions with concurrent changes occurring in the hospital. Findings raise questions about achieving sustainable performance improvement with health IT as well as the balance between micro- and macroergonomic approaches to studying technology change.Relevance to industryDesigners must consider how technology changes cognitive work, including mental workload. Hospitals and other implementers of technology must ensure that new technology fits its users, their tasks, and the context of use, which may entail tailoring implementation, for example, to specific clinical units. Evaluators must look over time to assess both changes in cognitive work and implementation issues. Healthcare practitioners must also recognize that new technology means a complex transformation to an already complex sociotechnical system, which calls for a macroergonomic approach to design and analysis.     

A General Role for Early Onset Cues and Intra-Event Learning; Comment on McDonald and Siegel (2004).

Research on classical conditioning with drug unconditional stimuli has had a profound effect on the understanding of general conditioning processes. The experiment reported by R. V. McDonald and S. Siegel (see record 2004-10475-001) demonstrates that cues coincident with the onset of an event can become associated with the rest of the event. This sort of learning is probably ubiquitous and has been proposed as a mechanism behind the development of panic disorder, in which interoceptive cues coincident with the start of a panic attack can be associated with the rest of the attack and can eventually come to elicit full-blown panic on their own. Evidence that extinction exposure to early onset cues can reduce their power is especially important. Drug conditioning research continues to provide a powerful testing ground for important general principles of learning. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

广钢转炉分厂2号方坯连铸机拉速问题的探讨

通过分析钢水在结晶器内凝固的不均匀性及对钢水结晶的热量平衡计算，讨论连铸中间包钢水温度、结晶器冷却水流量及进出水温差对拉坯速度的影响。     

Salt-water up-coning during extraction of fresh water from a tropical island

Rainwater can collect in a lens-shaped region within the rock of a tropical island, and may be separated from the underlying salt water by a sharp interface. This paper presents a nonlinear theory for determining the shape of this interface. The island is assumed to be saturated with rain, and provision is made for the outflow of rain-water through the sides of the island. The effect of a bore well on the shape of the interface is investigated, and the problem is solved using a spectral method. An integral-equation method is also presented for the case when the island has infinite width.     

Behavioral depression during cocaine withdrawal is associated with decreased spontaneous activity of ventral tegmental area dopamine neurons.

Withdrawal from an escalating-dose, bingelike regimen of cocaine administration in rats produced significantly depressed levels of locomotor activity during the nocturnal portion of the day-night cycle. This effect was observed during the first 48 hrs of testing. Extracellular single-unit recordings of ventral tegmental area (VTA) dopamine (DA) neurons revealed no differences between saline- and cocaine-treated rats with respect to basal firing rates. However, significantly fewer spontaneously active VTA DA neurons were encountered in rats withdrawn from binge cocaine. As with the nocturnal hypoactivity, this effect was observed only during the first 48 hrs of withdrawal. These findings suggest that short-term DA neuron dysfunction during cocaine withdrawal temporally corresponds to behavioral disruptions that are similar to those described in human addicts. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Drug Onset Cues, Conditioned Withdrawal, and Drug Relapse: Comment on McDonald and Siegel (2004).

Previous research has shown that under certain conditions environmental cues associated with morphine administration induce drug-opposite conditioned effects that mimic symptoms of opiate withdrawal. R. V. McDonald and S. Siegel (see record 2004-10475-001) extend these observations by demonstrating that acute exposure to a low dose of morphine induces symptoms of opiate withdrawal in rats previously exposed to a high dose of morphine. They hypothesized that early drug onset cues, repeatedly paired with later, larger drug effects, mediate the paradoxical effect of the low drug dose on behavior. They also hypothesized that conditioned withdrawal symptoms induced by the early drug onset cues may mediate the "priming" effect of drugs on relapse and craving. The authors of this comment discuss the degree to which the literature supports this hypothesis. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Disentangling the Sources of Opioid Withdrawal Responses: Comment on McDonald and Siegel (2004).

R. V. McDonald and S. Siegel (see record 2004-10475-001) present new evidence for the idea that opioid drug-opposite responses can become conditioned to cues of initial drug onset and that they could, therefore, play a role in the development of tolerance of some drug effects and a role in the elicitation of withdrawal-like symptoms in cases in which addicted individuals are exposed to small doses of the drug they normally consume. In this comment, some puzzling features of the data are discussed, and alternative explanations are suggested. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

φ140mm套管拔套侧钻工艺技术在濮城油田的应用

濮城油田开发后期,因事故导致损坏的井数不断增多,不仅损失了相当一部分储量,而且严重威胁着油田的发展。针对这一问题,应用拔套侧钻工艺技术对有潜能的事故井进行侧钻更新,投产后取得了良好的效果,成为油田增储上产和挖潜剩余油的重要手段,同时也为解决困扰油田发展的难题找到了好的方法。     

Mind, brain, and self in psychoanalysis: Therapeutic implications of the mind-body relation.

Theoretical and empirical findings regarding the mind-body relation and its integration within a concept of the self-as-person lead to certain therapeutic implications and applications. The mind-set of the analyst or psychotherapist regarding the integration of mind-body can have important reverberations, which can dictate decisions for therapeutic intervention and management. Implications for conceptualizing technical modifications in analytic therapy are suggested. Conceptualization of mind and brain operating as an integrated and functional unity contribute to better understanding aspects of mental functioning that remain beyond the reach of conscious awareness and direct therapeutic processing. Particular attention is paid to the issue of combining medications clinically with psychotherapy and psychoanalysis. Future integration of psychoanalysis with advancing trends in therapeutic intervention and with rapidly expanding neurobiological understanding of mental actions as related to brain activity may require a deepening awareness of complexities of the mind-body relation and a more analytically meaningful resolution of the problem. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Smoking Withdrawal Dynamics: III. Correlates of Withdrawal Heterogeneity.

Five parameters of postcessation smoking withdrawal variability derived from clinical data (T. M. Piasecki, D. E. Jorenby, S. S. Smith, M. C. Fiore, & T. B. Baker, 2003a, 2003b) were predicted from baseline measures and pharmacotherapy assignment. Smokers who were more dependent, older, and high in negative affect reported more severe withdrawal. Women, heavier smokers, and those with a history of depression reported more variable symptoms. Smokers treated with nicotine patch, bupropion, or both reported less severe withdrawal than did those given placebo, but medication did not affect the slope of symptoms over time, day-to-day variability of symptoms, or the size of acute changes in symptoms associated with lapses to smoking. Prior research has shown that these symptom facets predict later relapse: thus, current pharmacotherapies may aid cessation by diminishing withdrawal severity, but they do not affect all clinically important aspects of withdrawal. (PsycINFO Database Record (c) 2010 APA, all rights reserved)