Intuitive System Training

NPS NRP Project PosterIntuitive System TrainingNaval Education & Training Command (NETC)This research is supported by funding from the Naval Postgraduate School, Naval Research Program (PE 0605853N/2098). https://nps.edu/nrpChief of Naval Operations (CNO)Approved for public release. Distribution is unlimited.

Adopting online lecturing for improved learning: A case study from teacher education

This paper presents the results of a study that examined the integration of video lectures into a pre-service teacher unit of study. The aim of the research was to ascertain how students used the pre-recorded videos to complement their learning. The focus was on the pedagogy, and explored three factors: convenience, self-regulation of learning and design to aid learning. A mixed method approach to the data collection was used. Data sources included reflective journals, surveys and semi-structured interviews. An analysis of the data indicates that the pre-service teachers viewed the use of pre-recorded lectures positively and that they were a useful resource for self-study. The use of a webcam was also viewed positively as a design feature of the lectures. Overall, the responses to the innovation were positive

Intuitive System Training

NPS NRP Executive SummaryIntuitive System TrainingNaval Education & Training Command (NETC)This research is supported by funding from the Naval Postgraduate School, Naval Research Program (PE 0605853N/2098). https://nps.edu/nrpChief of Naval Operations (CNO)Approved for public release. Distribution is unlimited.

Use of a 3-item short-form version of the Barthel Index for use in stroke: systematic review and external validation

Background and Purpose—There may be a potential to reduce the number of items assessed in the Barthel Index (BI), and shortened versions of the BI have been described. We sought to collate all existing short-form BI (SF-BI) and perform a comparative validation using clinical trial data. Methods—We performed a systematic review across multidisciplinary electronic databases to find all published SF-BI. Our validation used the VISTA (Virtual International Stroke Trials Archive) resource. We describe concurrent validity (agreement of each SF-BI with BI), convergent and divergent validity (agreement of each SF-BI with other outcome measures available in the data set), predictive validity (association of prognostic factors with SF-BI outcomes), and content validity (item correlation and exploratory factor analyses). Results—From 3546 titles, we found 8 articles describing 6 differing SF-BI. Using acute trial data (n=8852), internal reliability suggested redundancy in BI (Cronbach α, 0.96). Each SF-BI demonstrated a strong correlation with BI, modified Rankin Scale, National Institutes of Health Stroke Scale (all ρ≥0.83; P<0.001). Using rehabilitation trial data (n=332), SF-BI demonstrated modest correlation with quality of life measures Stroke Impact Scale and 5 domain EuroQOL (ρ≥0.50, P<0.001). Prespecified prognostic factors were associated with SF-BI outcomes (all P<0.001). Our factor analysis described a 3 factor structure, and item reduction suggested an optimal 3-item SF-BI comprising bladder control, transfer, and mobility items in keeping with 1 of the 3-item SF-BI previously described in the literature. Conclusions—There is redundancy in the original BI; we have demonstrated internal and external validity of a 3-item SF-BI that should be simple to use

A review of the safety climate literature as it relates to naval aviation.

The purpose of this literature review is to provide the background to an evaluation of the utility of the Command Safety Assessment Survey (CSAS) as a valid predictor of future mishaps. The end goal is to be able to use the survey to identify at risk U.S. Naval squadrons prior to the occurrence of mishaps. Safety climate describes employees' perceptions, attitudes, and beliefs about risk and safety (Mearns & Flin, 1999). Safety climate is most commonly evaluated using questionnaires. Although assessments of safety climate are not widespread in civil aviation, the United States Navy has been using the CSAS since 2000 to measure the safety climate of aviation squadrons. This review argues that a comprehensive assessment of the construct (the extent to which the questionnaire measures what it is intended to measure) and discriminate validity (correlate the data from the questionnaire with a criterion variable, such as accidents) of the CSAS should be carried out. This assessment is necessary to ensure that squadron Commanding Officers, and senior leadership, are being provided with valid and reliable information on squadron safety climate.Approved for public release; distribution is unlimited

Acute stroke: we have the treatments and we have the evidence – we need to use them

Despite huge global burden, stroke disease has traditionally received little attention in the general medical press. We review a series of four acute stroke research articles published in a themed issue of the Lancet. Claiborne-Johnston and coworkers presented a scoring system to stratify risk of stroke following transient ischaemic attack. Chalela and colleagues demonstrated that magnetic resonance imaging is superior to computed tomography in detecting acute ischaemic stroke and that fears of missing intracranial haemorrhage are unfounded. The SITS-MOST (Safe Implementation of Thrombolysis in Stroke – Monitoring Study) group reported positive experience of translating acute stroke thrombolysis trials into routine clinical practice in Europe, and the PROSIT (Project on Stroke Services in Italy) group studied acute effects of admission to a dedicated stroke unit. The message from all of these reports is that evidence-based, successful management of acute stroke is possible, and that investment in health infrastructure and changing mind sets of health practitioners to improve stroke care will deliver benefits

Bayesian modeling of pilot belief and visual misperception in helicopter overland navigation

This paper aims to provide a framework to model human belief and misperception in helicopter overland navigation. Helicopter overland navigation is known to be a challenging cognitive task, and understanding the cognitive processes associated with it is non-trivial. Twelve military personnel participated in the study and statistical analysis showed that their gaze parameters can be predicted by their level of expertise. Some pilots showed common visual misperception during the navigation task, which can be explained by the following errors: 1) confusion between inference and evidence, 2) incorrect mutually exclusive assumptions on the data, and 3) biased sampling. Simulation results on two cases observed in the experiments are given. Quantitative differences in dynamic perceptions between a Bayesian agent and misperceiving humans are presented with the suggested modeling framework

Validating and comparing stroke prognosis scales

Objective: To compare the prognostic accuracy of various acute stroke prognostic scales using a large, independent, clinical trials dataset. Methods: We directly compared 8 stroke prognostic scales, chosen based on focused literature review (Acute Stroke Registry and Analysis of Lausanne [ASTRAL]; iSCORE; iSCORE-revised; preadmission comorbidities, level of consciousness, age, and neurologic deficit [PLAN]; stroke subtype, Oxfordshire Community Stroke Project, age, and prestroke modified Rankin Scale [mRS] [SOAR]; modified SOAR; Stroke Prognosis Instrument 2 [SPI2]; and Totaled Health Risks in Vascular Events [THRIVE]) using individual patient-level data from a clinical trials archive (Virtual International Stroke Trials Archive [VISTA]). We calculated area under receiver operating characteristic curves (AUROC) for each scale against 90-day outcomes of mRS (dichotomized atmRS.2), Barthel Index (.85), and mortality. We performed 2 complementary analyses: the first limited to patients with complete data for all components of all scales (simultaneous) and the second using as many patients as possible for each individual scale (separate). We compared AUROCs and performed sensitivity analyses substituting extreme outcome values for missing data. Results: In total, 10,777 patients contributed to the analyses. Our simultaneous analyses suggested that ASTRAL had greatest prognostic accuracy for mRS, AUROC 0.78 (95% confidence interval [CI] 0.75–0.82), and SPI2 had poorest AUROC, 0.61 (95%CI 0.57–0.66). Our separate analyses confirmed these results: ASTRAL AUROC 0.79 (95% CI 0.78–0.80 and SPI2 AUROC 0.60 (95% CI 0.59–0.61). On formal comparative testing, there was a significant difference in modified Rankin Scale AUROC between ASTRAL and all other scales. Sensitivity analysis identified no evidence of systematic bias from missing data. Conclusions: Our comparative analyses confirm differences in the prognostic accuracy of stroke scales. However, even the best performing scale had prognostic accuracy that may not be sufficient as a basis for clinical decision-making

Lacunar infarcts, depression and anxiety symptoms one year after stroke

Background: Mood disorders are frequent after stroke and are associated with poorer quality of life. Previous studies have reported conflicting results as to stroke subtype in the incidence of poststroke mood disorders. We explored the relationship between subcortical ischemic stroke subtype (lacunar) and presence of such symptoms at 1 year after stroke. Methods: Anonymized data were accessed from the Virtual International Stroke Trials Archive. Stroke subtypes were classified according to the Trial of Org 10172 in Acute Stroke Treatment classification. Depression and anxiety symptoms were assessed using Hospital Anxiety and Depression Scale. We investigated independent predictors of depression and anxiety symptoms using a logistic regression model. Results: Data were available for 2160 patients. Almost one fifth of the patients developed both anxiety and depression at 1-year follow-up. After adjusting for confounders, the lacunar subtype was least associated with both anxiety (odds ratio [OR] = .61; 95% confidence interval [CI] = .46-.80) and depression symptoms (OR = .71; CI = .55-.93) versus other stroke subtypes. Conclusions: Lacunar strokes have a weaker association with presence of anxiety and depression symptoms compared with other subtypes