Evaluating the Construct Validity of the Charité Alarm Fatigue Questionnaire using Confirmatory Factor Analysis.

Background: The Charité Alarm Fatigue Questionnaire (CAFQa) is a 9-item questionnaire that aims to standardize how alarm fatigue in nurses and physicians is measured. We previously hypothesized that it has 2 correlated scales, one on the psychosomatic effects of alarm fatigue and the other on staff's coping strategies in working with alarms. Objective: We aimed to validate the hypothesized structure of the CAFQa and thus underpin the instrument's construct validity. Methods: We conducted 2 independent studies with nurses and physicians from intensive care units in Germany (study 1: n=265; study 2: n=1212). Responses to the questionnaire were analyzed using confirmatory factor analysis with the unweighted least-squares algorithm based on polychoric covariances. Convergent validity was assessed by participants' estimation of their own alarm fatigue and exposure to false alarms as a percentage. Results: In both studies, the χ2 test reached statistical significance (study 1: χ226=44.9; P=.01; study 2: χ226=92.4; P<.001). Other fit indices suggested a good model fit (in both studies: root mean square error of approximation <0.05, standardized root mean squared residual <0.08, relative noncentrality index >0.95, Tucker-Lewis index >0.95, and comparative fit index >0.995). Participants' mean scores correlated moderately with self-reported alarm fatigue (study 1: r=0.45; study 2: r=0.53) and weakly with self-perceived exposure to false alarms (study 1: r=0.3; study 2: r=0.33). Conclusions: The questionnaire measures the construct of alarm fatigue as proposed in our previous study. Researchers and clinicians can rely on the CAFQa to measure the alarm fatigue of nurses and physicians.

A critical review of clinician-directed nudges.

As nudges-subtle changes to the way options are presented to guide choice-have gained popularity across policy domains in the past 15 years, healthcare systems and researchers have eagerly deployed these light-touch interventions to improve clinical decision-making. However, recent research has identified the limitations of nudges. Although nudges may modestly improve clinical decisions in some contexts, these interventions (particularly nudges implemented as electronic health record alerts) can also backfire and have unintended consequences. Further, emerging research on crowd-out effects suggests that healthcare nudges may direct attention and resources toward the clinical encounter and away from the main structural drivers of poor health outcomes. It is time to move beyond nudges and toward the development of multi-level, structurally focused interventions.

Sex differences in the acoustic structure of terrestrial alarm calls in vervet monkeys (Chlorocebus pygerythrus).

The alarm calls of vervet monkeys (Chlorocebus pygerythrus) have been the subject of considerable focus by researchers, owing primarily to the purported referential qualities of different alarm call types. With this focus on reference, acoustic variation among calls elicited by the same range of predators has typically been overlooked. Specifically, at least one type of alarm call-the terrestrial alarm-was described over 50 years ago as being acoustically distinct between males and females-a description that has largely eluded more systematic scrutiny. Here, we provide a quantitative acoustic analysis and comparison of terrestrial alarm calls produced by adult male and female vervet monkeys. We use a random forest model to determine which acoustic variables best distinguish between the calls of males and females, and use an unsupervised clustering technique to objectively determine whether alarms produced by each sex fall into discrete types. We found that the calls of males and females differed most in frequency-based parameters, with male alarms containing more energy at lower frequencies relative to females. Calls produced by males were also of longer duration, and consisted of longer individual call elements relative to female calls. While calls generally fell into clusters associated with either male or female alarms, we found that some fell into atypical clusters given the caller's sex, and that the clusters themselves showed evidence of intergradation. We discuss these results in terms of potential differences in the function of, and motivation for, calling by males and females. We emphasize the need for a more holistic approach to the classification of vocal signals that considers contextual, functional, and structural variation.

Alarm fatigue and sleep quality in medical staff-a Polish-Czech-Slovak study on workplace ergonomics.

Background: Alarms are crucial in informing Healthcare Workers (HCWs) about critical patient needs, but unmanaged frequency and noise of alarms can de-sensitize medical staff and compromise patient safety. Alarm fatigue is identified as the major cause of the clinical alarm management problem. It occurs when the medical staff is overwhelmed by the number of clinical alarms. Methods: The survey was conducted online using Google's form-making tools from June to July 2023. There were three parts to the survey used in the study: a socio-demographic metric, the Alarm Fatigue Assessment Questionnaire (AFAQ), and The Pittsburgh Sleep Quality Index (PSQI). A significance level of 0.05 was used in the analysis. Results: The survey included 756 medical professionals from three European countries (Slovakia, the Czech Republic and Poland). The participants in the study were 42 years old on average, and they had 12 years of work experience. 603 out of 756 survey participants had poor sleep quality, 147 had good sleep quality, and 6 did not provide an answer. This study analyzed the alarm fatigue levels of respondents in every country. In the Czech Republic, Poland and Slovakia, a statistically significant association (p = 0.039, p = 0.001, p < 0.001) was found between alarm fatigue and sleep quality in medical staff. Conclusion: Based on our study, alarm fatigue and sleep quality of HCWs are correlated. Therefore, alarm fatigue and sleep hygiene should be monitored.

Development of a Novel Prediction Tool for Response to First-Line Treatments of Monosymptomatic Nocturnal Enuresis: A Randomized, Controlled, International, Multicenter Study (DRYCHILD).

PURPOSE: Nocturnal urine volume and bladder reservoir function are key pathogenic factors behind monosymptomatic nocturnal enuresis (MNE). We investigated the predictive value of these together with other demographic and clinical variables for response to first-line treatments in children with MNE. MATERIALS AND METHODS: A randomized, controlled, international, multicenter study was conducted in 324 treatment-naïve children (6-14 years old) with primary MNE. The children were randomized to treatment with or without prior consideration of voiding diaries. In the group where treatment choice was based on voiding diaries, children with nocturnal polyuria and normal maximum voided volume (MVV) received desmopressin (dDAVP) treatment, and children with reduced MVV and no nocturnal polyuria received an enuresis alarm. In the other group, treatment with dDAVP or alarm was randomly allocated. RESULTS: A total of 281 children (72% males) were qualified for statistical analysis. The change of responding to treatment was 21% higher in children where treatment was individualized compared to children where treatment was randomly selected (risk ratio = 1.21 [1.02-1.45], P = .032). In children with reduced MVV and no nocturnal polyuria (35% of all children), individualized treatment was associated with a 46% improvement in response compared to random treatment selection (risk ratio = 1.46 [1.14-1.87], P = .003). Furthermore, we developed a clinically relevant prediction model for response to dDAVP treatment (receiver operating characteristic curve 0.85). CONCLUSIONS: The present study demonstrates that treatment selection based on voiding diaries improves response to first-line treatment, particularly in specific subtypes. Information from voiding diaries together with clinical and demographic information provides the basis for predicting response. CLINICAL TRIAL REGISTRATION NO.: NCT03389412.

Continuous prediction and clinical alarm management of late-onset sepsis in preterm infants using vital signs from a patient monitor.

BACKGROUND AND OBJECTIVE: Continuous prediction of late-onset sepsis (LOS) could be helpful for improving clinical outcomes in neonatal intensive care units (NICU). This study aimed to develop an artificial intelligence (AI) model for assisting the bedside clinicians in successfully identifying infants at risk for LOS using non-invasive vital signs monitoring. METHODS: In a retrospective study from the NICU of the Máxima Medical Center in Veldhoven, the Netherlands, a total of 492 preterm infants less than 32 weeks gestation were included between July 2016 and December 2018. Data on heart rate (HR), respiratory rate (RR), and oxygen saturation (SpO2) at 1 Hz were extracted from the patient monitor. We developed multiple AI models using 102 extracted features or raw time series to provide hourly LOS risk prediction. Shapley values were used to explain the model. For the best performing model, the effect of different vital signs and also the input type of signals on model performance was tested. To further assess the performance of applying the best performing model in a real-world clinical setting, we performed a simulation using four different alarm policies on continuous real-time predictions starting from three days after birth. RESULTS: A total of 51 LOS patients and 68 controls were finally included according to the patient inclusion and exclusion criteria. When tested by seven-fold cross-validations, the mean (standard deviation) area under the receiver operating characteristic curve (AUC) six hours before CRASH was 0.875 (0.072) for the best performing model, compared to the other six models with AUC ranging from 0.782 (0.089) to 0.846 (0.083). The best performing model performed only slightly worse than the model learning from raw physiological waveforms (0.886 [0.068]), successfully detecting 96.1 % of LOS patients before CRASH. When setting the expected alarm window to 24 h and using a multi-threshold alarm policy, the sensitivity metric was 71.6 %, while the positive predictive value was 9.9 %, resulting in an average of 1.15 alarms per day per patient. CONCLUSIONS: The proposed AI model, which learns from routinely collected vital signs, has the potential to assist clinicians in the early detection of LOS. Combined with interpretability and clinical alarm management, this model could be better translated into medical practice for future clinical implementation.

Applying Socio-Technical Models to Alarm Management: Tailoring Bed Exit Alerts in Medical-Surgical Units.

Integration of smartphone technology with the patient call-bell system provides the opportunity to enhance patient safety by supporting nurses' ability to communicate and prioritize care delivery directly. However, challenges are associated with achieving a balance between alarm support and alarm fatigue, including distracting nurses from patient care or desensitizing the nurse to other alarms and calls [1]. Our hospitals have quantitative and anecdotal reports of seriously high volumes of wireless alerts on the nurses' smartphones. Nurses have complained that the phones are generating too much noise to consume or timely prioritize. Preliminary alarm inventory revealed the Bed Exit wireless alert as a leading contributor of signal volume across many units and hospitals. The lack of standard policies and workflow improvement processes has increased nuisance alarms, making these Health Information Technologies less useful and safe. Using system data, workflow observations, and nursing interviews, Singh and Sittig's HIT Safety framework [2] was applied to identify and prioritize sociotechnical factors and interventions that impact the end-to-end Bed Exit alarm workflow. This study reviews the application of sociotechnical models and frameworks to reduce wireless calls without introducing risk and impacting patient care.

A Positioning Alarm System for Explosive Impact Debris Protective Suit Based on an Accelerometer Array.

Protection suits are vital for firefighters' safety. Traditional protection suits physically protect firemen from burns, but cannot locate the position of bodily injuries caused by impact debris. Herein, we present a wearable impact debris positioning system for firefighter protection suits based on an accelerometer array. Wearable piezoelectric accelerometers are distributed regularly on the suit to detect the vibration on different body parts, which is conducive to determining the position of injured body parts. In addition, the injured parts can be displayed on a dummy body model on the upper computer with a higher localization accuracy of 4 cm. The positioning alarm system has a rapid response time of 0.11 ms, attributed to the smart signal processing method. This work provides a reliable and smart method for locating and assessing the position of bodily injuries caused by impact debris, which is significant because it enables fire commanders to rescue injured firefighters in time.

Synergism of (E)-ß-farnesene and Its Analogue to Insecticides against the Green Peach Aphid Myzus persicae.

With high aphid-repellent activity but low stability, (E)-ß-farnesene (EßF), the major component of the aphid alarm pheromone, can be used as a synergist to insecticides. Some EßF analogues possess both good aphid-repellent activity and stability, but the synergistic effect and related mechanism are still unclear. Therefore, this study investigated the synergistic effect and underlying mechanism of the EßF and its analogue against the aphid Myzus persicae. The results indicated that EßF and the analogue showed significantly synergistic effects to different insecticides, with synergism ratios from 1.524 to 3.446. Mechanistic studies revealed that EßF and the analogue exhibited effective repellent activity, significantly upregulated target OBP genes by 161 to 731%, increased aphid mobility, and thereby enhanced contact with insecticides. This research suggests that the EßF analogue represents a novel synergist for insecticides, with the potential for further application in aphid control owing to its enhanced bioactivity and the possibility of reducing insecticide doses.

The Dynamic Change in the Reliability Function Level in a Selected Fire Alarm System during a Fire.

This article discusses fundamental issues associated with the functional reliability of selected fire alarm systems (FASs) in operation during building fires. FASs operate under diverse external or internal natural environmental conditions, and the operational process of FAS should take into account the impacts of physical phenomena that occur during fires. Their operation is associated with the constant provision of reliability. FAS designers should also consider the system's reliability when developing fire control matrices, tables, algorithms, or scenarios. All functions arising from an FAS control matrix should be implemented with a permissible reliability level, RDPN(t), prior to, as well as during, a fire. This should be assigned to the controls saved in the fire alarm control unit (FCP). This article presents the process by which high temperatures generated during a fire impact the reliability of FAS functioning. It was developed considering selected critical paths for a specific scenario and the control matrix for an FAS. Such assumptions make it possible to determine the impact of various temperatures generated during a fire on the reliability of an FAS. To this end, the authors reviewed that the waveform of the R(t) function changes for a given FAS over time, Δt, and then determined the fitness paths. The critical paths are located within the fire detection and suppression activation process, using FAS or fixed extinguishing devices (FEDs), and the paths were modeled with acceptable and unacceptable technical states. The last section of this article defines a model and graph for the operational process of a selected FAS, the analysis of which enables conclusions to be drawn that can be employed in the design and implementation stages.

Design of AI-Enhanced and Hardware-Supported Multimodal E-Skin for Environmental Object Recognition and Wireless Toxic Gas Alarm.

Post-earthquake rescue missions are full of challenges due to the unstable structure of ruins and successive aftershocks. Most of the current rescue robots lack the ability to interact with environments, leading to low rescue efficiency. The multimodal electronic skin (e-skin) proposed not only reproduces the pressure, temperature, and humidity sensing capabilities of natural skin but also develops sensing functions beyond it-perceiving object proximity and NO2 gas. Its multilayer stacked structure based on Ecoflex and organohydrogel endows the e-skin with mechanical properties similar to natural skin. Rescue robots integrated with multimodal e-skin and artificial intelligence (AI) algorithms show strong environmental perception capabilities and can accurately distinguish objects and identify human limbs through grasping, laying the foundation for automated post-earthquake rescue. Besides, the combination of e-skin and NO2 wireless alarm circuits allows robots to sense toxic gases in the environment in real time, thereby adopting appropriate measures to protect trapped people from the toxic environment. Multimodal e-skin powered by AI algorithms and hardware circuits exhibits powerful environmental perception and information processing capabilities, which, as an interface for interaction with the physical world, dramatically expands intelligent robots' application scenarios.

Heart and shoal: Social cues and oxytocin receptors impact stress recovery in the zebrafish.

In many species, social interactions decrease behavioral, hormonal, and neural responses to environmental stressors. While "social buffering" and its mechanisms have received considerable attention in mammals, we know less about the phenomenon in fish. The nonapeptide oxytocin regulates social behavior across vertebrates and plays an important role in social buffering in mammals. We investigated social buffering in the zebrafish by evaluating how the social environment and oxytocin receptors impact recovery from an acute stressor. Male and female fish were briefly exposed to alarm substance and recovered either in isolation or within view of a stimulus shoal. Alarm substance did not increase social approach, but social stimuli improved behavioral stress recovery. Oxytocin receptor antagonism decreased social approach during stress recovery and impaired stress recovery exclusively in individuals with access to visual social stimuli. Our findings contribute to the growing body of evidence that social stimuli buffer stress responses in fish and suggest that oxytocin receptors may play a role in socially-buffered stress recovery across taxa.

Isochrony as ancestral condition to call and song in a primate.

Animal songs differ from calls in function and structure, and have comparative and translational value, showing similarities to human music. Rhythm in music is often distributed in quantized classes of intervals known as rhythmic categories. These classes have been found in the songs of a few nonhuman species but never in their calls. Are rhythmic categories song-specific, as in human music, or can they transcend the song-call boundary? We analyze the vocal displays of one of the few mammals producing both songs and call sequences: Indri indri. We test whether rhythmic categories (a) are conserved across songs produced in different contexts, (b) exist in call sequences, and (c) differ between songs and call sequences. We show that rhythmic categories occur across vocal displays. Vocalization type and function modulate deployment of categories. We find isochrony (1:1 ratio, like the rhythm of a ticking clock) in all song types, but only advertisement songs show three rhythmic categories (1:1, 1:2, 2:1 ratios). Like songs, some call types are also isochronous. Isochrony is the backbone of most indri vocalizations, unlike human speech, where it is rare. In indri, isochrony underlies both songs and hierarchy-less call sequences and might be ancestral to both.

Integrated pulmonary index during procedural sedation and analgesia: A cluster-randomized trial.

AIM: To evaluate the effectiveness of utilizing the integrated pulmonary index for capnography implementation during sedation administered by nurses. DESIGN: Cluster-randomized trial. METHODS: Participants were enrolled from the interventional radiology department at an academic hospital in Canada. Nurses were randomized to either enable or disable the Integrated Pulmonary Index feature of the capnography monitor. Procedures were observed by a research assistant to collect information about alarm performance characteristics. The primary outcome was the number of seconds in an alert condition state without an intervention being applied. RESULTS: The number of seconds in an alarm state without intervention was higher in the group that enabled the integrated pulmonary index compared to the group that disabled this feature, but this difference did not reach statistical significance. Likewise, the difference between groups for the total alarm duration, total number of alarms and the total number of appropriate alarms was not statistically significant. The number of inappropriate alarms was higher in the group that enabled the Integrated Pulmonary Index, but this estimate was highly imprecise. There was no difference in the odds of an adverse event (measured by the Tracking and Reporting Outcomes of Procedural Sedation tool) occurring between groups. Desaturation events were uncommon and brief in both groups but the area under the SpO2 90% desaturation curve scores were lower for the group that enabled the integrated pulmonary index. CONCLUSION: Enabling the integrated pulmonary index during nurse-administered procedural sedation did not reduce nurses' response times to alarms. Therefore, integrating multiple physiological parameters related to respiratory assessment into a single index did not lower the threshold for intervention by nurses. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: The time it takes to respond to capnography monitor alarms will not be reduced if the integrated pulmonary Iindex feature of capnography monitors is enabled during nurse-administered procedural sedation. IMPACT: Results do not support the routine enabling of the integrated pulmonary index when nurses use capnography to monitor patients during procedural sedation as a strategy to reduce the time it takes to initiate responses to alarms. REPORTING METHOD: CONSORT. PATIENT OR PUBLIC CONTRIBUTION: There was no patient or public contribution. TRIAL REGISTRATION: This study was prospectively registered at ClinicalTrials.gov (ID: NCT05068700).

Risk Perception: Chemical Stimuli in Predator Detection and Feeding Behaviour of the Invasive Round Goby Neogobius melanostomus.

The round goby Neogobius melanostomus is a notoriously invasive fish originating from the Ponto-Caspian region that in recent decades has successfully spread across the globe. One of its primary impacts is direct predation; in addition, when entering new ecosystems, the round goby is likely to become a food resource for many higher native predators. However, little is known either about the indirect effects of predators on the round goby as prey or its feeding behaviour and activity. The non-consumptive effect of the presence of higher native predators presumably plays an important role in mitigating the impact of non-native round gobies as mesopredators on benthic invertebrate communities, especially when both higher- and mesopredators occupy the same habitat. We tested the food consumption probability and gut evacuation rates in round gobies in response to chemical signals from a higher predator, the European eel Anguilla anguilla. Gobies were placed individually in experimental arenas equipped with shelters and exposed to water from a tank in which (a) the higher predator had actively preyed on a heterospecific prey, earthworms Lumbricus sp. (the heterospecific treatment; HS); (b) the higher predator had fed on round gobies (the conspecific treatment; CS); or (c) the water was provided as a control treatment (C). To ensure exposure to the chemical stimuli, this study incorporated the application of skin extracts containing damaged-released alarm cues from the CS treatment; distilled water was used for the remaining treatments. No significant differences were observed in either the food consumption probability or gut evacuation rate in the tested treatments. Despite the lack of reaction to the chemical stimuli, round gobies did exhibit high evacuation rates (R = 0.2323 ± 0.011 h-1; mean ± SE) in which complete gut clearance occurred within 16 h regardless of the applied treatment. This rapid food processing suggests high efficiency and great pressure on resources regardless of the presence or not of a higher predator. These findings hint at the boldness of round gobies, which did not exhibit any pronounced threat sensitivity. This would seem to suggest great efficiency in food processing and a potential competitive advantage over local native species when colonising new ecosystems, irrespective of the presence of native predators. Our study did not detect any non-consumptive effect attributable to the higher predator, given that the feeding activity of the invasive round goby was not altered.

Mechanistic modeling of alarm signaling in seed-harvester ants.

Ant colonies demonstrate a finely tuned alarm response to potential threats, offering a uniquely manageable empirical setting for exploring adaptive information diffusion within groups. To effectively address potential dangers, a social group must swiftly communicate the threat throughout the collective while conserving energy in the event that the threat is unfounded. Through a combination of modeling, simulation, and empirical observations of alarm spread and damping patterns, we identified the behavioral rules governing this adaptive response. Experimental trials involving alarmed ant workers (Pogonomyrmex californicus) released into a tranquil group of nestmates revealed a consistent pattern of rapid alarm propagation followed by a comparatively extended decay period [1]. The experiments in [1] showed that individual ants exhibiting alarm behavior increased their movement speed, with variations in response to alarm stimuli, particularly during the peak of the reaction. We used the data in [1] to investigate whether these observed characteristics alone could account for the swift mobility increase and gradual decay of alarm excitement. Our self-propelled particle model incorporated a switch-like mechanism for ants' response to alarm signals and individual variations in the intensity of speed increased after encountering these signals. This study aligned with the established hypothesis that individual ants possess cognitive abilities to process and disseminate information, contributing to collective cognition within the colony (see [2] and the references therein). The elements examined in this research support this hypothesis by reproducing statistical features of the empirical speed distribution across various parameter values.

Locus coeruleus noradrenaline depletion and its differential impact on CO2-induced panic and hyperventilation in male and female mice.

CO2 exposure has been used to investigate the panicogenic response in patients with panic disorder. These patients are more sensitive to CO2, and more likely to experience the "false suffocation alarm" which triggers panic attacks. Imbalances in locus coeruleus noradrenergic (LC-NA) neurotransmission are responsible for psychiatric disorders, including panic disorder. These neurons are sensitive to changes in CO2/pH. Therefore, we investigated if LC-NA neurons are differentially activated after severe hypercapnia in mice. Further, we evaluated the participation of LC-NA neurons in ventilatory and panic-like escape responses induced by 20% CO2 in male and female wild type mice and two mouse models of altered LC-NA synthesis. Hypercapnia activates the LC-NA neurons, with males presenting a heightened level of activation. Mutant males lacking or with reduced LC-NA synthesis showed hypoventilation, while animals lacking LC noradrenaline present an increased metabolic rate compared to wild type in normocapnia. When exposed to CO2, males lacking LC noradrenaline showed a lower respiratory frequency compared to control animals. On the other hand, females lacking LC noradrenaline presented a higher tidal volume. Nevertheless, no change in ventilation was observed in either sex. CO2 evoked an active escape response. Mice lacking LC noradrenaline had a blunted jumping response and an increased freezing duration compared to the other groups. They also presented fewer racing episodes compared to wild type animals, but not different from mice with reduced LC noradrenaline. These findings suggest that LC-NA has an important role in ventilatory and panic-like escape responses elicited by CO2 exposure in mice.

Meaning and prediction of 'excess mortality': a comparison of Covid-19 and pre-Covid-19 mortality data in 31 Eurostat countries from 1965 to 2021.

Determining 'excess mortality' makes it possible to compare the burden of disasters between countries and over time, and thus also to evaluate the success of mitigation measures. However, the debate on coronavirus disease 2019 (Covid-19) has exposed that calculations of excess mortalities vary considerably depending on the method and its specification. Moreover, it is often unclear what exactly is meant by 'excess mortality'. We define excess mortality as the excess over the number of deaths that would have been expected counter-factually, that is without the catastrophic event in question. Based on this definition, we use a very parsimonious calculation method, namely the linear extrapolation of death figures from previous years to determine the excess mortality during the Covid-19 pandemic. But unlike most other literature on this topic, we first evaluated and optimized the specification of our method using a larger historical data set in order to identify and minimize estimation errors and biases. The result shows that excess mortality rates in the literature are often inflated. Moreover, they would have exhibited considerable excess mortalities in the period before Covid-19, if this value had already been of public interest at that time. Three conclusions can be drawn from this study and its findings: (i) All calculation methods for current figures should first be evaluated against past figures. (ii) To avoid alarm fatigue, thresholds should be introduced which would differentiate between 'usual fluctuations' and 'remarkable excess'. (iii) Statistical offices could provide more realistic estimates.

Alarm Management in Intensive Care: Qualitative Triangulation Study.

BACKGROUND: The high number of unnecessary alarms in intensive care settings leads to alarm fatigue among staff and threatens patient safety. To develop and implement effective and sustainable solutions for alarm management in intensive care units (ICUs), an understanding of staff interactions with the patient monitoring system and alarm management practices is essential. OBJECTIVE: This study investigated the interaction of nurses and physicians with the patient monitoring system, their perceptions of alarm management, and smart alarm management solutions. METHODS: This explorative qualitative study with an ethnographic, multimethods approach was conducted in an ICU of a German university hospital. Using triangulation in data collection, 102 hours of field observations, 12 semistructured interviews with ICU staff members, and the results of a participatory task were analyzed. The data analysis followed an inductive, grounded theory approach. RESULTS: Nurses and physicians reported interacting with the continuous vital sign monitoring system for most of their work time and tasks. There were no established standards for alarm management; instead, nurses and physicians stated that alarms were addressed through ad hoc reactions, a practice they viewed as problematic. Staff members' perceptions of intelligent alarm management varied, but they highlighted the importance of understandable and traceable suggestions to increase trust and cognitive ease. CONCLUSIONS: Staff members' interactions with the omnipresent patient monitoring system and its alarms are essential parts of ICU workflows and clinical decision-making. Alarm management standards and workflows have been shown to be deficient. Our observations, as well as staff feedback, suggest that changes are warranted. Solutions for alarm management should be designed and implemented with users, workflows, and real-world data at the core.

Bimodal alarm signals modulate responses to monomodal alarm signals in Camponotus modoc carpenter ants.

Distressed western carpenter ants, Camponotus modoc, produce alarm pheromone and substrate-borne vibrations. The alarm pheromone attracts nestmates but the effects of vibratory signals, or of bimodal pheromonal and vibratory signals, are not known. Worker ants of two Camponotus congeners reportedly stand still ("freeze") or run fast in response to engineered drumming vibrations inputted on plastic, but many responses to ant-produced vibratory signals on wood have not yet been investigated. Generally, orientating toward signalers under vertebrate predator attack seems maladaptive and not beneficial to ant colonies. We tested the hypotheses (1) that vibratory alarm signals cause freezing, rapid running but not attraction of nestmates, and (2) that bimodal alarm signals modulate responses to monomodal alarm signals, thereby possibly reducing predation risk. Laser Doppler vibrometry recordings revealed that the ants' vibratory signals readily propagate through ant nest lamellae, and thus quickly inform nest mates of perceived threats. With a speaker modified to record and deliver vibratory signals, we obtained drumming signals of distressed ants on a Douglas fir veneer, and bioassayed signal effects on ants in an arena with a suspended veneer floor. In response playback of vibratory signals, ants ran rapidly, or froze, but did not approach the vibratory signals. Exposed to alarm pheromone, ants frequently visited the pheromone source. However, concurrently exposed to both alarm pheromone and vibratory signals, ants visited the pheromone source less often but spent more time "frozen." The ants' modulated responses to bimodal signals seem adaptive but the reproductive fitness benefits are still to be quantified.