When tomorrow comes: A prospective risk assessment of a future artificial general intelligence-based uncrewed combat aerial vehicle system.

There are concerns that Artificial General Intelligence (AGI) could pose an existential threat to humanity; however, as AGI does not yet exist it is difficult to prospectively identify risks and develop requisite controls. We applied the Work Domain Analysis Broken Nodes (WDA-BN) and Event Analysis of Systemic Teamwork-Broken Links (EAST-BL) methods to identify potential risks in a future 'envisioned world' AGI-based uncrewed combat aerial vehicle system. The findings suggest five main categories of risk in this context: sub-optimal performance risks, goal alignment risks, super-intelligence risks, over-control risks, and enfeeblement risks. Two of these categories, goal alignment risks and super-intelligence risks, have not previously been encountered or dealt with in conventional safety management systems. Whereas most of the identified sub-optimal performance risks can be managed through existing defence design lifecycle processes, we propose that work is required to develop controls to manage the other risks identified. These include controls on AGI developers, controls within the AGI itself, and broader sociotechnical system controls.

Using systems thinking-based risk assessment methods to assess hazardous manual tasks: a comparison of Net-HARMS, EAST-BL, FRAM and STPA.

Formal risk assessment is a component of safety management relating to hazardous manual tasks (HMT). Systems thinking approaches are currently gaining interest for supporting safety management. Existing HMT risk assessment methods have been found to be limited in their ability to identify risks across the whole work system; however, systems thinking-based risk assessment (STBRA) methods were not designed for the HMT context and have not been tested in this area. The aim of this study was to compare the performance of four state-of-the-art STBRA methods: Net-HARMS, EAST-BL, FRAM and STPA to determine which would be most useful for identifying HMT risks. Each method was independently applied by one of four analysts to assess the risks associated with a hypothetical HMT system. The outcomes were assessed for alignment with a benchmark analysis. Using signal detection theory (SDT), overall STPA was found to be the best performing method having the highest hit rate, second lowest false alarm rate and highest Matthews Correlation Coefficient of the four methods.Practitioner summary: A comparison of four systems thinking risk assessment methods found that STPA had the highest level of agreement with the benchmark analysis and is the most suitable for practitioners to use to identify the risks associated with HMT systems.

Incident reporting in the outdoors: a systems-based analysis of injury, illness, and psychosocial incidents in led outdoor activities in Australia.

Incident reporting systems are a fundamental component of safety management, however, most systems used in practice are not aligned with contemporary accident causation models. This article presents an analysis of a National Incident Dataset (NID) for adverse incidents occurring in the Australian Led Outdoor Activity (LOA) sector. The aim was to investigate the adverse Injury, Illness, and Psychosocial incidents reported to the NID. In total, 1657 injuries, 532 illnesses, and 146 psychosocial incidents were analysed from 357,691 program participation days. The findings show that the rate of incidents per 1000 program participant days in LOAs was 4.6 for injury, 1.5 for illness, and 0.04 for psychosocial incidents, and incident severity was predominately minor. The analysis of systemic contributory factors demonstrates that incidents in LOA are systemic in nature, with multiple levels of the LOA system identified as contributing to adverse incidents. For example, contributory factors were identified across local government (facilities), schools (communication), parents (communication), LOA management (policies and procedures), people involved in the incidents (mental and physical condition), and the environment (terrain) and equipment (clothing). This study presents an assessment of the current state of safety in the Australian LOA sector and demonstrates the utility of applying systems ergonomics methods in practice. Practitioner summary: This article presents an analysis of 1657 injury, 532 illness, and 146 psychosocial incidents occurring in the Australian Led Outdoor Activity (LOA) sector, using a systems ergonomics method. The findings demonstrate the incident charactersitics and how decisions and actions from across the system contribute to adverse incidents in LOAs.

Evaluation of a systems ergonomics-based incident reporting system.

INTRODUCTION: Incident reporting and learning systems are a fundamental component of safety management. The purpose of this study was to evaluate a novel incident reporting system specific to the Australian Led Outdoor Activity (LOA) sector. The Understanding and Preventing Led Outdoor Accidents Data System (UPLOADS), is a recently introduced systems thinking-based incident reporting and learning system that utilises contemporary safety theory and methods. METHOD: The implementation of UPLOADS was evaluated using the RE-AIM framework based on the following dimensions: Reach, Efficacy, Adoption, Implementation, and Maintenance. A pragmatic evaluation approach was used in which evaluation data were collected through the triangulation of multiple sources including different LOA stakeholders from both the individual organisational level (LOA providers) and LOA sector governance level (LOA industry representatives), incident data collected through the UPLOADS National Incident Dataset, and the online and physical presence of UPLOADS. RESULTS: The findings show that a key strength of UPLOADS is its effectiveness as incident reporting tool for improving safety in the LOA sector. However, a weakness of UPLOADS is that it is not being implemented appropriately by the LOA providers. CONCLUSION: Overall, the current findings suggest that UPLOADS incident reporting tool is perceived by SMEs as an effective tool for improving safety in LOA. However, further work is required for UPLOADS to have a greater impact on the LOA sector. Specifically, Implementation of the UPLOADS system requires improvement, as well as additional training and education may be required to upskill and empower LOA providers to improve reporting and enhance the value placed on safety by LOA stakeholders. The RE-AIM framework was an appropriate evaluation framework for understanding the effectiveness of UPLOADS as a LOA sector specific incident reporting and learning system. PRACTICAL APPLICATIONS: The current findings have practical implications for ergonomics researchers applying evaluation frameworks in the real world, and LOA providers for implementing safety interventions. Lastly, contemporary systems-based incident reporting and learning systems have the capability to enhance the safety practices of the LOA sector.

PIGG variant pathogenicity assessment reveals characteristic features within 19 families.

PURPOSE: Phosphatidylinositol Glycan Anchor Biosynthesis, class G (PIGG) is an ethanolamine phosphate transferase catalyzing the modification of glycosylphosphatidylinositol (GPI). GPI serves as an anchor on the cell membrane for surface proteins called GPI-anchored proteins (GPI-APs). Pathogenic variants in genes involved in the biosynthesis of GPI cause inherited GPI deficiency (IGD), which still needs to be further characterized. METHODS: We describe 22 individuals from 19 unrelated families with biallelic variants in PIGG. We analyzed GPI-AP surface levels on granulocytes and fibroblasts for three and two individuals, respectively. We demonstrated enzymatic activity defects for PIGG variants in vitro in a PIGG/PIGO double knockout system. RESULTS: Phenotypic analysis of reported individuals reveals shared PIGG deficiency-associated features. All tested GPI-APs were unchanged on granulocytes whereas CD73 level in fibroblasts was decreased. In addition to classic IGD symptoms such as hypotonia, intellectual disability/developmental delay (ID/DD), and seizures, individuals with PIGG variants of null or severely decreased activity showed cerebellar atrophy, various neurological manifestations, and mitochondrial dysfunction, a feature increasingly recognized in IGDs. Individuals with mildly decreased activity showed autism spectrum disorder. CONCLUSION: This in vitro system is a useful method to validate the pathogenicity of variants in PIGG and to study PIGG physiological functions.

Applying a systems thinking lens to injury causation in the outdoors: Evidence collected during 3 years of the Understanding and Preventing Led Outdoor Accidents Data System.

INTRODUCTION: This article presents a detailed systems analysis of injury incidents from 35 Australian led outdoor activity organisations between 2014 to 2017. METHOD: Injury incident reports were collected using a specific led outdoor activity incident reporting system known as UPLOADS (Understanding and Preventing Led Outdoor Accidents Data System). RESULTS: In total, 1367 people sustained injuries from across 20 different activities, with an injury rate of 1.9 injured people per 1000 participants over the three-year period. A total of 2234 contributory factors from multiple levels of the led outdoor activity system were identified from the incident reports, and 361 relationships were identified between contributory factors. DISCUSSION: This systems analysis of injury incidents demonstrates that it is not only factors within the immediate context of the incident (Participants, Environment, Equipment) but factors from across multiple systemic levels that contributes to injury incidents (Schools, Parents, Activity centre management). Prevention efforts should focus on addressing the whole network of contributing factors and not only the prominent factors at the lower system levels within the immediate context of the injury incident occurrences.

A Comprehensive Assessment of Co-occurring Birth Defects among Infants with Non-Syndromic Anophthalmia or Microphthalmia.

PURPOSE: Infants with anophthalmia or microphthalmia frequently have co-occurring birth defects. Nonetheless, there have been few investigations of birth defect patterns among these children. Such studies may identify novel multiple malformation syndromes, which could inform future research into the developmental processes that lead to anophthalmia/microphthalmia and assist physicians in determining whether further testing is appropriate. METHODS: This study includes cases with anophthalmia/microphthalmia identified by the Texas Birth Defects Registry from 1999 to 2014 without clinical or chromosomal diagnoses of recognized syndromes. We calculated adjusted observed-to-expected ratios for two - through five-way birth defect combinations involving anophthalmia/microphthalmia to estimate whether these combinations co-occur more often than would be expected if they were independent. We report combinations observed in ≥5 cases. RESULTS: We identified 653 eligible cases with anophthalmia/microphthalmia (514 [79%] with co-occurring birth defects), and 111 birth defect combinations, of which 44 were two-way combinations, 61 were three-way combinations, six were four-way combinations and none were five-way combinations. Combinations with the largest observed-to-expected ratios were those involving central nervous system (CNS) defects, head/neck defects, and orofacial clefts. We also observed multiple combinations involving cardiovascular and musculoskeletal defects. CONCLUSION: Consistent with previous reports, we observed that a large proportion of children diagnosed with anophthalmia/microphthalmia have co-occurring birth defects. While some of these defects may be part of a sequence involving anophthalmia/microphthalmia (e.g., CNS defects), other combinations could point to as yet undescribed susceptibility patterns (e.g., musculoskeletal defects). Data from population-based birth defect registries may be useful for accelerating the discovery of previously uncharacterized malformation syndromes.

Systems thinking-based risk assessment methods applied to sports performance: A comparison of STPA, EAST-BL, and Net-HARMS in the context of elite women's road cycling.

There is increasing interest in applying systems Human Factors and Ergonomics (HFE) methods in sport. Risk assessment (RA) methods can be used identify risks which may impact the performance of individual athletes, teams, and overall sports systems; however, they have not yet been tested in sport. This study sets out to apply and compare three systems thinking-based RA methods in the context of elite sports performance and report on the frequency and types of the risks identified. The Systems-Theoretic Process Analysis (STPA) method, the Event Analysis of Systemic Teamwork Broken Links (EAST-BL) method, and the Networked Hazard Analysis and Risk Management System (Net-HARMS) method were applied to elite women's road cycling to identify all the credible risks that could degrade optimal team performance. The findings demonstrate that all three methods appear to provide useful results in a context other than safety, and that multiple risks threatening the performance of the cycling team were identified. Whilst the frequency and types of risks differed across the methods applied, there are additional theoretical, methodological, and practical implications to be considered prior to the selection and use of systems thinking-based RA approaches. Recommendations and directions for future HFE and sports science research are discussed.

With Crisis Comes Opportunity: Redesigning Performance Departments of Elite Sports Clubs for Life After a Global Pandemic.

The suspension of major sporting competitions due to the global COVID-19 pandemic had a substantial negative impact on the sporting industry. As such, a successful and sustainable return to sport will require extensive modifications to the current operations of sporting organizations. In this article we argue that methods from the realm of sociotechnical systems (STS) theory are highly suited for this purpose. The aim of the study was to use such methods to develop a model of an Australian Football League (AFL) club's football department. The intention was to identify potential modifications to the club's operations to support a return to competition following the COVID-19 crisis. Subject Matter Experts from an AFL club participated in three online workshops to develop Work Domain Analysis and Social Organization and Cooperation Analysis models. The results demonstrated the inherent complexity of an AFL football department via numerous interacting values, functions and processes influencing the goals of the system. Conflicts within the system were captured via the modeling and included pursing goals that may not fully reflect the state of the system, a lack of formal assessment of core values, overlapping functions and objects, and an overemphasis on specialized roles. The current analysis has highlighted potential areas for modification in the football department, and sports performance departments in general.

Assessment of Intraoperative Nerve Monitoring Parameters Associated With Facial Nerve Outcome in Parotidectomy for Benign Disease.

Importance: Prior studies suggest that the use of facial nerve monitoring decreases the rate of immediate postoperative facial nerve weakness in parotid surgery, but published data are lacking on normative values for these parameters or cutoff values to prognosticate facial nerve outcomes. Objective: To identify intraoperative facial nerve monitoring parameters associated with postoperative weakness and to evaluate cutoff values for these parameters under which normal nerve function is more likely. Design, Setting, and Participants: This retrospective case series of 222 adult patients undergoing parotid surgery for benign disease performed with intraoperative nerve monitoring was conducted at an academic medical institution from September 13, 2004, to October 30, 2014. The data analysis was conducted from May 2018 to January 2019. Main Outcomes and Measures: The main outcome measure was facial nerve weakness. Receiver operating characteristic curves were generated to define optimal cut point to maximize the sensitivity and specificity of the stimulation threshold, mechanical events, and spasm events associated with facial nerve weakness. Results: Of 222 participants, 121 were women and 101 were men, with a mean (SD) age of 51 (16) years. The rate of temporary facial nerve paresis of any nerve branch was 45%, and the rate of permanent paralysis was 1.3%. The mean predissection threshold was 0.22 milliamperes (mA) (range, 0.1-0.6 mA) and the mean postdissection threshold was 0.24 mA (range, 0.08-1.0 mA). The average number of mechanical events was 9 (range, 0-66), and mean number of spontaneous spasm events was 1 (range, 0-12). Both the postdissection threshold (area under the curve [AUC], 0.69; 95% CI, 0.62-0.77) and the number of mechanical events (AUC, 0.58; 95% CI, 0.50-0.66) were associated with early postoperative facial nerve outcome. The number of spasm events was not associated with facial nerve outcome. The optimal cutoff value for the threshold was 0.25 mA, and the optimal cutoff for number of mechanical events was 8. If a threshold of greater than 0.25 mA was paired with more than 8 mechanical events, there was a 77% chance of postoperative nerve weakness. Conversely, if a threshold was 0.25 mA or less and there were 8 mechanical events or less, there was 69% chance of normal postoperative nerve function. No parameters were associated with permanent facial nerve injury. Conclusions and Relevance: Postdissection threshold and the number of mechanical events are associated with immediate postoperative facial nerve function. Accurate prediction of facial nerve function may provide anticipatory guidance to patients and may provide surgeons with intraoperative feedback allowing adjustment in operative techniques and perioperative management.

Sports Organizations as Complex Systems: Using Cognitive Work Analysis to Identify the Factors Influencing Performance in an Elite Netball Organization.

There is increasing interest in the adoption of a complex systems thinking approach when attempting to understand and optimize sports performance. Despite this, few studies have attempted to model elite sports organizations. The aim of this study was to use methods from the Cognitive Work Analysis (CWA) framework to develop a model of an elite netball organization and identify wider organizational functions and constraints influencing performance. Two phases of CWA were used: (i) Work Domain Analysis (WDA); and, (ii) Social Organization and Co-operation Analysis (SOCA). A WDA model of the elite netball organization was developed via subject matter expert (SME) workshops, and a SOCA was undertaken to identify the different functions, roles, and responsibilities of key actors within the organization. The findings identify various factors that influence performance. Functions that appear to provide a competitive edge are discussed, including a strong club ethos, a shared responsibility for performance, and a focus on player and staff health and well-being. Factors that potentially have a negative impact on performance include organizational priorities not related to playing netball, and additional coach and athlete roles beyond coaching, training, and playing. The implications for understanding and optimizing elite sports organizations are discussed.

Influence of exercise duration on cardiorespiratory responses, energy cost and tissue oxygenation within a 6 hour treadmill run.

PURPOSE: The physiological mechanisms for alterations in oxygen utilization ([Formula: see text]) and the energy cost of running (Cr ) during prolonged running are not completely understood, and could be linked with alterations in muscle and cerebral tissue oxygenation. METHODS: Eight trained ultramarathon runners (three women; mean ± SD; age 37 ± 7 yr; maximum [Formula: see text] 60 ± 15 mL min-1 kg-1) completed a 6 hr treadmill run (6TR), which consisted of four modules, including periods of moderate (3 min at 10 km h-1, 10-CR) and heavy exercise intensities (6 min at 70% of maximum [Formula: see text], HILL), separated by three, 100 min periods of self-paced running (SP). We measured [Formula: see text], minute ventilation ([Formula: see text]), ventilatory efficiency ([Formula: see text]), respiratory exchange ratio (RER), Cr , muscle and cerebral tissue saturation index (TSI) during the modules, and heart rate (HR) and perceived exertion (RPE) during the modules and SP. RESULTS: Participants ran 58.3 ± 10.5 km during 6TR. Speed decreased and HR and RPE increased during SP. Across the modules, HR and [Formula: see text] increased (10-CR), and RER decreased (10-CR and HILL). There were no significant changes in [Formula: see text], [Formula: see text], Cr , TSI and RPE across the modules. CONCLUSIONS: In the context of positive pacing (decreasing speed), increased cardiac drift and perceived exertion over the 6TR, we observed increased RER and increased HR at moderate and heavy exercise intensity, increased [Formula: see text] at moderate intensity, and no effect of exercise duration on ventilatory efficiency, energy cost of running and tissue oxygenation.

Use of Coronary Computed Tomographic Angiography to Guide Management of Patients With Coronary Disease.

BACKGROUND: In a prospective, multicenter, randomized controlled trial, 4,146 patients were randomized to receive standard care or standard care plus coronary computed tomography angiography (CCTA). OBJECTIVES: The purpose of this study was to explore the consequences of CCTA-assisted diagnosis on invasive coronary angiography, preventive treatments, and clinical outcomes. METHODS: In post hoc analyses, we assessed changes in invasive coronary angiography, preventive treatments, and clinical outcomes using national electronic health records. RESULTS: Despite similar overall rates (409 vs. 401; p = 0.451), invasive angiography was less likely to demonstrate normal coronary arteries (20 vs. 56; hazard ratios [HRs]: 0.39 [95% confidence interval (CI): 0.23 to 0.68]; p < 0.001) but more likely to show obstructive coronary artery disease (283 vs. 230; HR: 1.29 [95% CI: 1.08 to 1.55]; p = 0.005) in those allocated to CCTA. More preventive therapies (283 vs. 74; HR: 4.03 [95% CI: 3.12 to 5.20]; p < 0.001) were initiated after CCTA, with each drug commencing at a median of 48 to 52 days after clinic attendance. From the median time for preventive therapy initiation (50 days), fatal and nonfatal myocardial infarction was halved in patients allocated to CCTA compared with those assigned to standard care (17 vs. 34; HR: 0.50 [95% CI: 0.28 to 0.88]; p = 0.020). Cumulative 6-month costs were slightly higher with CCTA: difference $462 (95% CI: $303 to $621). CONCLUSIONS: In patients with suspected angina due to coronary heart disease, CCTA leads to more appropriate use of invasive angiography and alterations in preventive therapies that were associated with a halving of fatal and non-fatal myocardial infarction. (Scottish COmputed Tomography of the HEART Trial [SCOT-HEART]; NCT01149590).

A Systematic Evaluation of Field-Based Screening Methods for the Assessment of Anterior Cruciate Ligament (ACL) Injury Risk.

BACKGROUND: Laboratory-based measures provide an accurate method to identify risk factors for anterior cruciate ligament (ACL) injury; however, these methods are generally prohibitive to the wider community. Screening methods that can be completed in a field or clinical setting may be more applicable for wider community use. Examination of field-based screening methods for ACL injury risk can aid in identifying the most applicable method(s) for use in these settings. OBJECTIVE: The objective of this systematic review was to evaluate and compare field-based screening methods for ACL injury risk to determine their efficacy of use in wider community settings. DATA SOURCES: An electronic database search was conducted on the SPORTDiscus™, MEDLINE, AMED and CINAHL databases (January 1990-July 2015) using a combination of relevant keywords. A secondary search of the same databases, using relevant keywords from identified screening methods, was also undertaken. STUDY SELECTION: Studies identified as potentially relevant were independently examined by two reviewers for inclusion. Where consensus could not be reached, a third reviewer was consulted. Original research articles that examined screening methods for ACL injury risk that could be undertaken outside of a laboratory setting were included for review. STUDY APPRAISAL AND SYNTHESIS METHODS: Two reviewers independently assessed the quality of included studies. Included studies were categorized according to the screening method they examined. A description of each screening method, and data pertaining to the ability to prospectively identify ACL injuries, validity and reliability, recommendations for identifying 'at-risk' athletes, equipment and training required to complete screening, time taken to screen athletes, and applicability of the screening method across sports and athletes were extracted from relevant studies. RESULTS: Of 1077 citations from the initial search, a total of 25 articles were identified as potentially relevant, with 12 meeting all inclusion/exclusion criteria. From the secondary search, eight further studies met all criteria, resulting in 20 studies being included for review. Five ACL-screening methods-the Landing Error Scoring System (LESS), Clinic-Based Algorithm, Observational Screening of Dynamic Knee Valgus (OSDKV), 2D-Cam Method, and Tuck Jump Assessment-were identified. There was limited evidence supporting the use of field-based screening methods in predicting ACL injuries across a range of populations. Differences relating to the equipment and time required to complete screening methods were identified. LIMITATIONS: Only screening methods for ACL injury risk were included for review. Field-based screening methods developed for lower-limb injury risk in general may also incorporate, and be useful in, screening for ACL injury risk. CONCLUSIONS: Limited studies were available relating to the OSDKV and 2D-Cam Method. The LESS showed predictive validity in identifying ACL injuries, however only in a youth athlete population. The LESS also appears practical for community-wide use due to the minimal equipment and set-up/analysis time required. The Clinic-Based Algorithm may have predictive value for ACL injury risk as it identifies athletes who exhibit high frontal plane knee loads during a landing task, but requires extensive additional equipment and time, which may limit its application to wider community settings.

Role of multidetector computed tomography in the diagnosis and management of patients attending the rapid access chest pain clinic, The Scottish computed tomography of the heart (SCOT-HEART) trial: study protocol for randomized controlled trial.

BACKGROUND: Rapid access chest pain clinics have facilitated the early diagnosis and treatment of patients with coronary heart disease and angina. Despite this important service provision, coronary heart disease continues to be under-diagnosed and many patients are left untreated and at risk. Recent advances in imaging technology have now led to the widespread use of noninvasive computed tomography, which can be used to measure coronary artery calcium scores and perform coronary angiography in one examination. However, this technology has not been robustly evaluated in its application to the clinic. METHODS/DESIGN: The SCOT-HEART study is an open parallel group prospective multicentre randomized controlled trial of 4,138 patients attending the rapid access chest pain clinic for evaluation of suspected cardiac chest pain. Following clinical consultation, participants will be approached and randomized 1:1 to receive standard care or standard care plus ≥64-multidetector computed tomography coronary angiography and coronary calcium score. Randomization will be conducted using a web-based system to ensure allocation concealment and will incorporate minimization. The primary endpoint of the study will be the proportion of patients diagnosed with angina pectoris secondary to coronary heart disease at 6 weeks. Secondary endpoints will include the assessment of subsequent symptoms, diagnosis, investigation and treatment. In addition, long-term health outcomes, safety endpoints, such as radiation dose, and health economic endpoints will be assessed. Assuming a clinic rate of 27.0% for the diagnosis of angina pectoris due to coronary heart disease, we will need to recruit 2,069 patients per group to detect an absolute increase of 4.0% in the rate of diagnosis at 80% power and a two-sided P value of 0.05. The SCOT-HEART study is currently recruiting participants and expects to report in 2014. DISCUSSION: This is the first study to look at the implementation of computed tomography in the patient care pathway that is outcome focused. This study will have major implications for the management of patients with cardiovascular disease. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01149590.