Robotically-induced auditory-verbal hallucinations: combining self-monitoring and strong perceptual priors.

BACKGROUND: Inducing hallucinations under controlled experimental conditions in non-hallucinating individuals represents a novel research avenue oriented toward understanding complex hallucinatory phenomena, avoiding confounds observed in patients. Auditory-verbal hallucinations (AVH) are one of the most common and distressing psychotic symptoms, whose etiology remains largely unknown. Two prominent accounts portray AVH either as a deficit in auditory-verbal self-monitoring, or as a result of overly strong perceptual priors. METHODS: In order to test both theoretical models and evaluate their potential integration, we developed a robotic procedure able to induce self-monitoring perturbations (consisting of sensorimotor conflicts between poking movements and corresponding tactile feedback) and a perceptual prior associated with otherness sensations (i.e. feeling the presence of a non-existing another person). RESULTS: Here, in two independent studies, we show that this robotic procedure led to AVH-like phenomena in healthy individuals, quantified as an increase in false alarm rate in a voice detection task. Robotically-induced AVH-like sensations were further associated with delusional ideation and to both AVH accounts. Specifically, a condition with stronger sensorimotor conflicts induced more AVH-like sensations (self-monitoring), while, in the otherness-related experimental condition, there were more AVH-like sensations when participants were detecting other-voice stimuli, compared to detecting self-voice stimuli (strong-priors). CONCLUSIONS: By demonstrating an experimental procedure able to induce AVH-like sensations in non-hallucinating individuals, we shed new light on AVH phenomenology, thereby integrating self-monitoring and strong-priors accounts.

Reducing the time to activation of the emergency call system in operating theatres: effect of installing vertical red line indicators.

BACKGROUND: The 7th National Audit Project of the Royal College of Anaesthetists (NAP7) recommended that an emergency call system be immediately accessible in all anaesthesia locations. It is essential that all theatre team members can rapidly call for help to reduce the risk of patient harm. However, the ability of staff to activate this system in a timely manner can be affected by cluttered or unfamiliar environments and cognitive overload. One proposed strategy to enable rapid identification and activation of emergency call systems is to install a red vertical painted stripe on the wall from the ceiling to the activation button. We investigated the effect of introducing this vertical red line on activation times in operating theatres in the UK and Australia. METHODS: Operating theatre team members, including anaesthetists, surgeons, anaesthetic nurses, surgical and theatre nurses, operating theatre practitioners, and technicians, were approached without prior warning and asked to simulate activation of an emergency call. Vertical red lines were installed, and data collection repeated in the same operating theatres 4-12 months later. RESULTS: After installation of vertical red lines, the proportion of activations taking >10 s decreased from 31.9% (30/94) to 13.6% (17/125, P=0.001), and >20 s decreased from 19.1% (18/94) to 4.8% (6/125, P<0.001). The longest duration pre-installation was 120 s, and post-installation 35 s. CONCLUSIONS: This simple, safe, and inexpensive design intervention should be considered as a design standard in all operating theatres to minimise delays in calling for help.

False-positive alarms in patients with implantable loop recorder followed by remote monitoring: A systematic review.

Remote Monitoring (RM) has been shown to provide useful information about arrhythmic events in patients with implantable loop recorders (ILRs), however there is few and conflicting data about the false positive (FP) alarms burden and characteristics among ILR recipients. The aim of the present systematic review was to evaluate incidence and characteristics of FP alarms among ILR patients followed by RM. We developed a systematic research in Embase, MEDLINE and PubMed databases and selected all papers focused on false positive ILR transmissions published from June 1, 2013 to June 1, 2023. Case reports, meeting summaries, posters and simple reviews were excluded. Twelve reports were finally selected, including five prospective and seven retrospective studies. Information about population characteristics, device type and setting, overall transmissions and FP alarms and any adopted strategies to reduce them were extracted from an overall population of 3.305 patients. FP alarms were 59.7% of the overall remote transmissions and were found in 1/5 of the analyzed population. FP alarms for atrial fibrillation were the most common cause of false transmissions and were mainly due to premature atrial and ventricular complexes. No clinical predictors of FP alarms were identified, except for nonparasternal ILR implantation site. Since the overload work due to FP alarms might reduce the benefit of remote monitoring of ILR patients, the device optimization is an important step until an help from machine-learning algorithms is available.

Fewer emergency department alarms is associated with reduced use of medications for acute agitation.

BACKGROUND AND OBJECTIVES: Patient monitoring systems provide critical information but often produce loud, frequent alarms that worsen patient agitation and stress. This may increase the use of physical and chemical restraints with implications for patient morbidity and autonomy. This study analyzes how augmenting alarm thresholds affects the proportion of alarm-free time and the frequency of medications administered to treat acute agitation. METHODS: Our emergency department's patient monitoring system was modified on June 28, 2022 to increase the tachycardia alarm threshold from 130 to 150 and to remove alarm sounds for several arrhythmias, including bigeminy and premature ventricular beats. A pre-post study was performed lasting 55 days before and 55 days after this intervention. The primary outcome was change in number of daily patient alarms. The secondary outcomes were alarm-free time per day and median number of antipsychotic and benzodiazepine medications administered per day. The safety outcome was the median number of patients transferred daily to the resuscitation area. We used quantile regression to compare outcomes between the pre- and post-intervention period and linear regression to correlate alarm-free time with the number of sedating medications administered. RESULTS: Between the pre- and post-intervention period, the median number of alarms per day decreased from 1332 to 845 (-37%). This was primarily driven by reduced low-priority arrhythmia alarms from 262 to 21 (-92%), while the median daily census was unchanged (33 vs 32). Median hours per day free from alarms increased from 1.0 to 2.4 (difference 1.4, 95% CI 0.8-2.1). The median number of sedating medications administered per day decreased from 14 to 10 (difference - 4, 95% CI -1 to -7) while the number of escalations in level of care to our resuscitation care area did not change significantly. Multivariable linear regression showed a 60-min increase of alarm-free time per day was associated with 0.8 (95% CI 0.1-1.4) fewer administrations of sedating medication while an additional patient on the behavioral health census was associated with 0.5 (95% CI 0.0-1.1) more administrations of sedating medication. CONCLUSION: A reasonable change in alarm parameter settings may increase the time patients and healthcare workers spend in the emergency department without alarm noise, which in this study was associated with fewer doses of sedating medications administered.

Evaluation of a scoring system for vein suitability in platelet apheresis donors.

INTRODUCTION: Donor vein assessment for the selection of good quality veins is crucial for a successful apheresis procedure. This study intends to find out the effectiveness of a vein assessment scoring tool (VST) used and found to be effective in selecting whole blood donors to reduce the difficulty in identifying good quality veins for the plateletpheresis procedure. MATERIALS AND METHODS: This was a prospective observational study on platelet apheresis donors with the application of a VST consisting of three vein descriptor parameters (vein visibility, vein palpability, and vein size) with 5 Likert-type responses constituting a score of 0-12 for each arm. Two vein assessors independently evaluated the vein in both arms and marked their responses blinded from each other as well from the principal investigator. The scores were then calculated and analyzed at the end of the study for their association with phlebotomy and procedural outcomes. RESULTS: A total of 190 donors were recruited. The mean scores for the arms with successful and failed phlebotomy were 9.1 and 9.4 (SD 2.3), respectively. The intra-class correlation Alpha Cronbach value was 0.834 and 0.837 for total scoring in the left arm and right arm, respectively, between the two assessors. Scores neither showed a correlation with other outcomes like low flow alarms, hematoma formation, number of phlebotomy attempts, and procedure completion. CONCLUSION: The study showed that the vein score tool did not truly predict the phlebotomy outcome in apheresis donors, though there was a good degree of inter-assessor reliability.

Analysis of ST segment alarms in children admitted to the paediatric and cardiac intensive care units and cardiac progressive care unit: a single-centre retrospective study.

ST segment monitoring in the adult population allows for the early detection of myocardial ischaemia. In children admitted to the paediatric intensive care unit (PICU), cardiac intensive care unit (CICU), and cardiac progressive care unit (CPCU), it is unclear if continuous ST segment alarm monitoring is necessary in all patients. All patients admitted to the PICU, CICU, and CPCU during the study period were included. Children with any ST segment alarms were compared with those without an alarm during their stay. The electrocardiogram confirmed true ST segment alarms were compared with all other ST segment alarms. Demographic and clinical data were extracted from the medical record. Medical interventions and procedures occurring around ST segment alarms were recorded for multivariable analysis assessing for the association of true ST segment. Logistic regression was used to evaluate the associations with ST segment alarms during hospital stays. ST segment alarms occurred in 36% of hospital stays, and only 3.4% were considered true. True alarms were significantly more common among patients with a cardiac-related diagnosis, located in both cardiac units, and having received an intervention with any vasoactive medication. In the multivariable logistic regression, patients 11 years or older, hypotension, supraventricular tachycardia, and initiation/escalation of any vasoactive were independently associated with a true ST segment alarm. True ST segment alarms were infrequent, occurring in 1.2% of stays during the study period. Alarm monitoring may be beneficial in those with an underlying cardiac diagnosis.

Exploring Clinical Practices of Critical Alarm Settings in Intensive Care Units: A Retrospective Study of 60,000 Patient Stays from the MIMIC-IV Database.

In Intensive Care Unit (ICU), the settings of the critical alarms should be sensitive and patient-specific to detect signs of deteriorating health without ringing continuously, but alarm thresholds are not always calibrated to operate this way. An assessment of the connection between critical alarm threshold settings and the patient-specific variables in ICU would deepen our understanding of the issue. The aim of this retrospective descriptive and exploratory study was to assess this relationship using a large cohort of ICU patient stays. A retrospective study was conducted on some 70,000 ICU stays taken from the MIMIC-IV database. Critical alarm threshold values and threshold modification frequencies were examined. The link between these alarm threshold settings and 30 patient variables was then explored by computing the Shapley values of a Random Tree Forest model, fitted with patient variables and alarm settings. The study included 57,667 ICU patient stays. Alarm threshold values and alarm threshold modification frequencies exhibited the same trend: they were influenced by the vital sign monitored, but almost never by the patient's overall health status. This exploratory study also placed patients' vital signs as the most important variables, far ahead of medication. In conclusion, alarm settings were rigid and mechanical and were rarely adapted to the evolution of the patient. The management of alarms in ICU appears to be imperfect, and a different approach could result in better patient care and improved quality of life at work for staff.

The introduction of a sound reduction bundle in the intensive care unit and its impact on sound levels and patients.

BACKGROUND: ICU outcomes are continuing to improve. However, this has not been matched by similar improvements of the ICU bedspace environment, which can detrimentally impact on patient outcomes. Excessive sound and noise, especially, has been linked with adverse and potentially preventable patient outcomes and staff errors. There are many sources of sound in the ICU, with alarms from bedside equipment frequently listed as a main source. The number of alarms is increasing in parallel with the introduction of new and more sophisticated technologies to monitor and support patients. However, most alarms are not accurate or critical and are commonly ignored by staff. OBJECTIVE: The objective of this study was to evaluate the impact of a sound reduction bundle on sound levels, number of alarms, and patients' experience and perceived quality of sleep in the ICU. METHODS: This was a pre-post, quasi-experimental study investigating the impact of three study interventions implemented sequentially (staff education, visual warnings when sound levels exceeded the preset levels, and monitor alarm reconfigurations). Effects of staff education were evaluated using pre-education and post-education questionnaires, and the impact on patients was evaluated via self-report questionnaires. A sound-level monitor was used to evaluate changes in sound levels between interventions. Alarm audits were completed before and after alarm reconfiguration. RESULTS: Staff knowledge improved; however, sound levels did not change across interventions. The number of monthly monitor alarms reduced from 600,452 to 115,927. No significant differences were found in patients' subjective rating of their experience and sleep. CONCLUSION: The interventions did not lead to a sound-level reduction; however, there was a large reduction in ICU monitor alarms without any alarm-related adverse events. As the sources of sound are diverse, multidimensional interventions, including staff education, alarm management solutions, and environmental redesign, are likely to be required to achieve a relevant, lasting, and significant sound reduction.

The experiences of older adults with cognitive impairment in using falls prevention alarms in hospital: A qualitative descriptive study.

INTRODUCTION: Bed and chair sensor alarms are commonly used for falls prevention in hospitals, despite questionable efficacy. Research analysing older adults' experiences of alarms is scarce, and adults with cognitive impairment are consistently excluded. AIM: The aim of this study was to explore how older adults with cognitive impairment perceive and experience falls prevention alarms in hospital. METHOD: A qualitative descriptive design investigated older adults' experiences of alarms in a Geriatric Evaluation and Management ward in Melbourne. Patients were included if they had been provided an alarm. Semi-structured interviews were the primary method of data collection with two observation sessions and medical record analyses completed to enable triangulation of findings. Data were subjected to thematic analysis, and the Person-Environment-Occupation framework was chosen to add insight into the complexities of older adults' experiences of alarms. FINDINGS: All 11 participants had a level of cognitive impairment with delirium, confusion, or impulsiveness recorded in their medical file. Two overarching themes were identified: communication and collaboration with staff and rationalisation of alarm use. Participants' perceived staff were focussed on falls prevention but experienced a lack of communication about the purpose of alarms. Participants wanted an individualised approach to alarms. Some were comforted with the thought of alarms alerting staff, making them feel well cared for and believed alarms were a useful 'back-up'. Others found alarms uncomfortable, frustrating, and restricting. Application of the Person-Environment-Occupation framework provided insight into how enabling and restrictive factors can impact whether the alarm is experienced positively or negatively. Seven unwitnessed falls occurred during the participants' admissions. Thirty-four per cent of alarm triggers observed were considered false alerts. CONCLUSION: Older adults commonly reported negative experiences using bed/chair sensor alarms. Occupational therapists have the training to collaborate with people with cognitive impairment and assess the usefulness of alarms in reducing falls, based on how they interact with the older adult's unique person, environment, and occupation domains.

Is snoozing losing? Why intermittent morning alarms are used and how they affect sleep, cognition, cortisol, and mood.

Pressing the snooze button is a common way to start the day, but little is known about this behaviour. Through two studies we determined predictors and effects of snoozing. In Study 1 (n = 1732) respondents described their waking habits, confirming that snoozing is widespread, especially in younger individuals and later chronotypes. Morning drowsiness and shorter sleep were also more common for those who snooze. Study 2 was a within-subjects laboratory study (with polysomnography) on habitual snoozers (n = 31), showing that 30 min of snoozing improved or did not affect performance on cognitive tests directly upon rising compared to an abrupt awakening. Bayes factors indicate varying strengths of this evidence. Snoozing resulted in about 6 min of lost sleep, while preventing awakenings from slow-wave sleep (N3). There were no clear effects of snoozing on the cortisol awakening response, morning sleepiness, mood, or overnight sleep architecture. A brief snooze period may thus help alleviate sleep inertia, without substantially disturbing sleep, for late chronotypes and those with morning drowsiness.

Improving detectability of auditory interfaces for medical alarms through temporal variation in amplitude envelope.

BACKGROUND: Auditory interfaces play a vital role in many applications, informing users about both urgent and routine information critical to safety. Unfortunately, problems related to high alarm rates, low reliability, and sound annoyance create barriers to optimising the quality of patient care in perioperative medicine and critical care. Here, we explore how to reduce annoyance and improve detection by manipulating a sound's temporal envelope or the way its energy changes over time. METHODS: In the first experiment, participants were asked to detect a series of percussive and flat tones presented at six signal-to-noise ratios while performing a concurrent speech comprehension task. In the second experiment, different participants were asked to evaluate the relative annoyance of these same sounds. RESULTS: Relative to industry-standard flat tones, percussive tones were significantly less annoying and more detectable. Although more detectable, percussive tones did not impair concurrent speech comprehension. CONCLUSIONS: Temporal variation in amplitude envelope represents a promising path towards improving auditory interfaces for patient monitoring. By using temporally variable sounds, auditory interfaces can be more effective in alerting users. This is important for safety-critical areas, such as medical alarms, where annoyance often limits efficacy. As this manipulation can preserve the pitch and rhythm of tone sequences, it is compatible with users' pre-existing knowledge of current alarms.

Incremental advances will improve medical device alarm sounds.

The March issue contains a laboratory study of auditory perception, which is an unusual topic for this journal. A perspective is provided on how the study relates to recent research on clinical auditory alarms and displays. Techniques used in the study are explored and explained, such as enrolment of non-clinician volunteer participants, use of coordinate response measure phrase stimuli, presentation of sound loudness levels using the decibel scale, and analysis using signal detection theory. Such efforts to improve the safety, efficacy, and tolerability of modern medical device alarms are critical for improved patient safety.

Auditory roughness: a delicate balance.

Auditory roughness in medical alarm sounds is an important design attribute, and has been shown to impact user performance and perception. While roughness can assist in decreased signal-to-noise ratios (perceived loudness) and communicate urgency, it might also impact patient recovery. Therefore, considerations of neuroscience correlates, music theory, and patient impact are critical aspects to investigate in order to optimise alarm design.

Rehabilitation professionals' perspectives and experiences with the use of technologies for violence prevention: a qualitative study.

BACKGROUND: There is growing public policy and research interest in the development and use of various technologies for managing violence in healthcare settings to protect the health and well-being of patients and workers. However, little research exists on the impact of technologies on violence prevention, and in particular in the context of rehabilitation settings. Our study addresses this gap by exploring the perceptions and experiences of rehabilitation professionals regarding how technologies are used (or not) for violence prevention, and their perceptions regarding their efficacy and impact. METHODS: This was a descriptive qualitative study with 10 diverse professionals (e.g., physical therapy, occupational therapy, recreation therapy, nursing) who worked across inpatient and outpatient settings in one rehabilitation hospital. Data collection consisted of semi-structured interviews with all participants. A conventional approach to content analysis was used to identify key themes. RESULTS: We found that participants used three types of technologies for violence prevention: an electronic patient flagging system, fixed and portable emergency alarms, and cameras. All of these were perceived by participants as being largely ineffective for violence prevention due to poor design features, malfunction, limited resources, and incompatibility with the culture of care. Our analysis further suggests that professionals' perception that these technologies would not prevent violence may be linked to their focus on individual patients, with a corresponding lack of attention to structural factors, including the culture of care and the organizational and physical environment. CONCLUSIONS: Our findings suggest an urgent need for greater consideration of structural factors in efforts to develop effective interventions for violence prevention in rehabilitation settings, including the design and implementation of new technologies.

An Open-Source, Interoperable Architecture for Generating Real-Time Surgical Team Cognitive Alerts from Heart-Rate Variability Monitoring.

Clinical alarm and decision support systems that lack clinical context may create non-actionable nuisance alarms that are not clinically relevant and can cause distractions during the most difficult moments of a surgery. We present a novel, interoperable, real-time system for adding contextual awareness to clinical systems by monitoring the heart-rate variability (HRV) of clinical team members. We designed an architecture for real-time capture, analysis, and presentation of HRV data from multiple clinicians and implemented this architecture as an application and device interfaces on the open-source OpenICE interoperability platform. In this work, we extend OpenICE with new capabilities to support the needs of the context-aware OR including a modularized data pipeline for simultaneously processing real-time electrocardiographic (ECG) waveforms from multiple clinicians to create estimates of their individual cognitive load. The system is built with standardized interfaces that allow for free interchange of software and hardware components including sensor devices, ECG filtering and beat detection algorithms, HRV metric calculations, and individual and team alerts based on changes in metrics. By integrating contextual cues and team member state into a unified process model, we believe future clinical applications will be able to emulate some of these behaviors to provide context-aware information to improve the safety and quality of surgical interventions.

The effect of educational interventions in managing nurses' alarm fatigue: An integrative review.

BACKGROUND: Alarm fatigue is becoming more widely acknowledged as a serious safety concern in modern clinical practice. Nurses are not always proficient in the alarms' functions and capabilities, and they do not undertake training regularly. Educating nurses on alarms maintains their knowledge and abilities in complex clinical settings. Some education has been undertaken to improve clinical alarm response, but the evidence for evaluating the effectiveness of nurse education interventions is limited. OBJECTIVE: To evaluate the effects of educational interventions for reducing alarm fatigue in nurses, including the reduction of excessive, false and non-actionable alarms, which are major factors causing alarm fatigue in nurses. DATA SOURCES: PUBMED, EMBASE, CINAHL, SCOPUS and OVID databases were systematically searched from 2016 to 2021. DESIGN: Integrative Review. REVIEW METHODS: An integrative review of literature was performed using the PRISMA checklist. Critical appraisal was done using Joanna Briggs Institute level of evidence. RESULTS: Thirteen studies met the inclusion criteria. The results of most studies showed that educational intervention was beneficial for reducing the total number of alarms and false alarms. Furthermore, nurses' perceptions and knowledge improved, but the reduction in nurses' alarm fatigue is uncertain. A positive effect in alarm management practices was identified after the educational intervention. CONCLUSION: Educational intervention may be the way to manage nurses' alarm fatigue. The use of medical devices in hospitals is increasing exponentially, and for this reason, alarms are inevitable. The introduction of effective and continuous education and training programs for nurses concerning clinical alarm management as well as raising nurses' awareness of the occurrence of alarm fatigue is vital.

Multisensory alarm to benefit alarm identification and decrease workload: a feasibility study.

The poor design of conventional auditory medical alarms has contributed to alarm desensitization, and eventually, alarm fatigue in medical personnel. This study tested a novel multisensory alarm system which aims to help medical personnel better interpret and respond to alarm annunciation during periods of high cognitive load such as those found within intensive care units. We tested a multisensory alarm that combined auditory and vibrotactile cues to convey alarm type, alarm priority, and patient identity. Testing was done in three phases: control (conventional auditory), Half (limited multisensory alarm), and Full (complete multisensory alarm). Participants (N = 19, undergraduates) identified alarm type, priority, and patient identity (patient 1 or 2) using conventional and multisensory alarms, while simultaneously completing a cognitively demanding task. Performance was based on reaction time (RT) and identification accuracy of alarm type and priority. Participants also reported their perceived workload. RT was significantly faster for the Control phase (p < 0.05). Participant performance in identifying alarm type, priority, and patient did not differ significantly between the three phase conditions (p = 0.87, 0.37, and 0.14 respectively). The Half multisensory phase produced the lowest mental demand, temporal demand, and overall perceived workload score. These data suggest that implementation of a multisensory alarm with alarm and patient information may decrease perceived workload without significant changes in alarm identification performance. Additionally, a ceiling effect may exist for multisensory stimuli, with only part of an alarm benefitting from multisensory integration.

Perceptually Discriminating the Highest Priority Alarms Reduces Response Time: A Retrospective Pre-Post Study at Four Hospitals.

OBJECTIVE: Reduce nurse response time for emergency and high-priority alarms by increasing discriminability between emergency and all other alarms and suppressing redundant and likely false high-priority alarms in a secondary alarm notification system (SANS). BACKGROUND: Emergency alarms are the most urgent, requiring immediate action to address a dangerous situation. They are clinician-triggered and have higher positive predictive value (PPV). High-priority alarms are automatically triggered and have lower PPV. METHOD: We performed a retrospective pre-post study, analyzing data 15 months before and 25 months after a SANS redesign was implemented in four hospitals. For emergency alarms, we incorporated digitized human speech to distinguish them from automatically triggered alarms, leaving their onset and escalation pathways unchanged. For automatically triggered alarms, we suppressed some by delaying initial onset and escalation by 20 s. We used linear mixed models to assess the change in response time, Fisher's exact test for the proportion of response times longer than 120 s, and control charts for process stability. RESULTS: Response time for emergency alarms decreased at all hospitals (main, from 26.91 s to 22.32 s, p < .001; cardiac, from 127.10 s to 52.43 s, p < .001; cancer, from 18.03 s to 15.39 s, p < .001). Improvements were sustained. Automatically triggered alarms decreased 25.0%. Response time for the three automatically triggered cardiac alarms increased at the four hospitals. CONCLUSION: Auditory sound disambiguation was associated with a sustained reduced nurse response time for emergency alarms, but suppressing some high-priority automatically triggered alarms was not. APPLICATION: Distinguishing and escalating urgent, actionable alarms with higher PPV improves response time.

Novel interventions significantly reduce falls with fractures: A meta-analysis and systematic review.

INTRODUCTION: Worldwide, falls lead to possible complications such as prolonged hospitalization, prolonged bed rest, pressure injuries, fractures and mortality. AIMS: The study aimed to evaluate the effectiveness of novel fall prevention strategies that utilized technology in preventing falls. METHODS: The meta-analysis and systematic review was guided by the Cochrane guidelines for systematic reviews of interventions. The authors searched databases for specified keywords. RESULTS: A total of 22 studies were included. Interventions included multi-modal fall prevention interventions, camera surveillance, motion sensors and bed/chair exit alarms. Video monitoring was equivocal in reducing fall rates. Exit alarms statistically significantly reduce falls between groups but not within groups. The interventions were not statistically significant in reducing falls with minor injuries but they were statistically significant in reducing falls with serious injuries including fractures. CONCLUSION: A comprehensive fall prevention care plan, rather than one specific intervention, is necessary to prevent falls effectively.

A First-Out Alarm Detection Method via Association Rule Mining and Correlation Analysis.

Alarm systems are commonly deployed in complex industries to monitor the operation status of the production process in real time. Actual alarm systems generally have alarm overloading problems. One of the major factors leading to excessive alarms is the presence of many correlated or redundant alarms. Analyzing alarm correlations will not only be beneficial to the detection of and reduction in redundant alarm configurations, but also help to track the propagation of abnormalities among alarm variables. As a special problem in correlated alarm detection, the research on first-out alarm detection is very scarce. A first-out alarm is known as the first alarm that occurs in a series of alarms. Detection of first-out alarms aims at identifying the first alarm occurrence from a large number of alarms, thus ignoring the subsequent correlated alarms to effectively reduce the number of alarms and prevent alarm overloading. Accordingly, this paper proposes a new first-out alarm detection method based on association rule mining and correlation analysis. The contributions lie in the following aspects: (1) An association rule mining approach is presented to extract alarm association rules from historical sequences based on the FP-Growth algorithm and J-Measure; (2) a first-out alarm determination strategy is proposed to determine the first-out alarms and subsequent alarms through correlation analysis in the form of a hypothesis test on conditional probability; and (3) first-out rule screening criteria are proposed to judge whether the rules are redundant or not and then consolidated results of first-out rules are obtained. The effectiveness of the proposed method is tested based on the alarm data generated by a public simulation platform.