Consistency and Variation in Reasoning About Physical Assembly.

The ability to reason about how things were made is a pervasive aspect of how humans make sense of physical objects. Such reasoning is useful for a range of everyday tasks, from assembling a piece of furniture to making a sandwich and knitting a sweater. What enables people to reason in this way even about novel objects, and how do people draw upon prior experience with an object to continually refine their understanding of how to create it? To explore these questions, we developed a virtual task environment to investigate how people come up with step-by-step procedures for recreating block towers whose composition was not readily apparent, and analyzed how the procedures they used to build them changed across repeated attempts. Specifically, participants (N = 105) viewed 2D silhouettes of eight unique block towers in a virtual environment simulating rigid-body physics, and aimed to reconstruct each one in less than 60 s. We found that people built each tower more accurately and quickly across repeated attempts, and that this improvement reflected both group-level convergence upon a tiny fraction of all possible viable procedures, as well as error-dependent updating across successive attempts by the same individual. Taken together, our study presents a scalable approach to measuring consistency and variation in how people infer solutions to physical assembly problems.

Time Course of Creativity in Dance.

Time-motion studies revolutionized the design and efficiency of repetitive work last century. Would time-idea studies revolutionize the rules of intellectual/creative work this century? Collaborating with seven professional dancers, we set out to discover if there were any significant temporal patterns to be found in a timeline coded to show when dancers come up with ideas and when they modify or reject them. On each of 3 days, the dancers were given a choreographic problem (or task) to help them generate a novel, high quality contemporary dance phrase. They were videoed as they worked on this task for sessions of 15, 30, and 45 min. At the end of each 15 min interval during each session, we had them perform the phrase they were creating. They recorded and then coded the video of themselves dancing during these sessions by using a coding language we developed with them to identify when ideas are introduced, modified, and rejected. We found that most ideas are created early and that though these early ideas are aggressively pruned early on, many still make it into the final product. The two competing accounts of creativity in design research make predictions for the temporal structure of creativity. Our results support neither account, rather showing a more blended version of the two. The iterative design view, arguably the dominant view, is that good ideas are the product of generating many ideas, choosing one fairly early, committing to it, and iteratively improving it. The "fail fast fail often" view is that good ideas are the product of rapidly generating and discarding ideas and holding back from early commitment to any one in particular. The result of holding back commitment, typically, is not that an idea is taken up later and then incrementally improved at the last minute, as much as that later designs are not completely novel, instead incorporating the best parts of the entire sequence of ideas. In our study, we found no evidence that one account or the other was more predictive for the domain of contemporary dance. The behavior of the dancers that we studied revealed elements of both, calling into question how predictive these theories are.

A Randomized Controlled Trial on the Effect of a Double Check on the Detection of Medication Errors.

STUDY OBJECTIVE: The use of a double check by 2 nurses has been advocated as a key error-prevention strategy. This study aims to determine how often a double check is used for high-alert medications and whether it increases error detection. METHODS: Emergency department and ICU nurses worked in pairs to care for a simulated patient. Nurses were randomized into single- and double-check groups. Errors intentionally introduced into the simulation included weight-based dosage errors and wrong medication vial errors. The evaluator recorded whether a double check was used, whether errors were detected, and observational data about nurse behavior during the simulation. RESULTS: Forty-three pairs of nurses consented to enroll in the study. All nurses randomized to the double-check group used a double check. In the single-check group, 9% of nurses detected the weight-based dosage error compared with 33% of nurses in the double-check group (odds ratio 5.0; 95% confidence interval 0.90 to 27.74). Fifty-four percent of nurses in the single-check group detected the wrong vial error compared with 100% of nurses in the double-check group (odds ratio 19.9; 95% confidence interval 1.0 to 408.5). CONCLUSION: Our study demonstrates that nurses use double checks before administering high-alert medications. Use of a double check increases certain error detection rates in some circumstances, but not others. Both techniques missed many errors. In some cases, the second nurse actually dissuaded the first nurse from acting on the error.

Impact of wireless electronic medical record system on the quality of patient documentation by emergency field responders during a disaster mass-casualty exercise.

INTRODUCTION: The use of wireless, electronic, medical records and communications in the prehospital and disaster field is increasing. OBJECTIVE: This study examines the role of wireless, electronic, medical records and communications technologies on the quality of patient documentation by emergency field responders during a mass-casualty exercise. METHODS: A controlled, side-to-side comparison of the quality of the field responder patient documentation between responders utilizing National Institutes of Health-funded, wireless, electronic, field, medical record system prototype ("Wireless Internet Information System for medicAl Response to Disasters" or WIISARD) versus those utilizing conventional, paper-based methods during a mass-casualty field exercise. Medical data, including basic victim identification information, acuity status, triage information using Simple Triage and Rapid Treatment (START), decontamination status, and disposition, were collected for simulated patients from all paper and electronic logs used during the exercise. The data were compared for quality of documentation and record completeness comparing WIISARD-enabled field responders and those using conventional paper methods. Statistical analysis was performed with Fisher's Exact Testing of Proportions with differences and 95% confidence intervals reported. RESULTS: One hundred simulated disaster victim volunteers participated in the exercise, 50 assigned to WIISARD and 50 to the conventional pathway. Of those victims who completed the exercise and were transported to area hospitals, medical documentation of victim START components and triage acuity were significantly better for WIISARD compared to controls (overall acuity was documented for 100% vs 89.5%, respectively, difference = 10.5% [95%CI = 0.5-24.1%]). Similarly, tracking of decontamination status also was higher for the WIISARD group (decontamination status documented for 59.0% vs 0%, respectively, difference = 9.0% [95%CI = 40.9-72.0%]). Documentation of disposition and destination of victims was not different statistically (92.3% vs. 89.5%, respectively, difference = 2.8% [95%CI = -11.3-17.3%]). CONCLUSIONS: In a simulated, mass-casualty field exercise, documentation and tracking of victim status including acuity was significantly improved when using a wireless, field electronic medical record system compared to the use of conventional paper methods.

An ontology of geo-reasoning to support medical response to attacks with weapons of mass destruction.

We study how Metropolitan Medical Response System units conceptualize the physical space of a disaster and their organized response. Using a variety of ethnographic methods before, during, and after a disaster drill, we have developed an initial ontology for geospatial and context-aware technology. The conceptual map of first responders is far more complex than a geographical map. Zones and Areas are used to describe documented concepts critical to MMRS operations. Ad hoc locations also play a critical role, helping first responders communicate tactics in spatial terms. Such distinctions play an important role in the way our experts think about their activity. Successful geoaware alerting systems must incorporate these notions if they are to seamlessly fit into the work flow of first responders.

Image-dependent interaction of imagery and vision.

The influence of imagery on perception depends on the content of the mental image. Sixty-three students responded to the location of the 2 hands of a clock while visualizing the correct or an incorrect clock. Reaction time was shorter with valid cueing. Could this have resulted from visual acquisition strategies such as planning visual saccades or shifting covert attention? No. In this study, a crucial control condition made participants look at rather than visualize the cue. Acquisition strategies should have affected equally both types of cueing, but we observed that the effect of the visual cue was smaller and limited to a particular subcase in which one expects visual acquisition strategies. Thus, what matters is the similarity of the content of the mental image with the visual scene. In addition, an interaction involving the hand used for responding supports the notion that composite imagery is lateralized.