Illuminating the Naturalistic Decision-Making Processes of Anesthesia Providers to Inform Medication Error-Reducing Interventions

Medication errors in anesthesia are prevalent and efforts to address medication errors bring with them new potential avenues of failure, especially when the work system and ‘work as done’ are not considered in the design of the intervention. I employed two methodologies in interviews of anesthesia providers to help further understand the context of anesthesia ‘work as done’ to inform the design of future medication error-reducing interventions. Results of the first interview methodology, the critical decision method, revealed a diverse array of challenging scenarios in which ‘work as done’ often deviates from ‘work as imagined.’ Results of the second interview methodology, vignette-based interviews, revealed how the decision-making processes of anesthesia providers may vary even when managing an identical case. These interviews provide context to the otherwise nebulous ‘variability’ of anesthesia provider ‘work as done.’ This context highlights the potential unforeseen dangers that may occur with the addition of future interventions and suggests avenues in which future interventions may fit better into the workflow of the anesthesia provider with design considerations. Future design efforts should focus on supporting the resilience of anesthesia providers: the information seeking and problem anticipation which are used to safely manage the uncertainty and complexity of their work. Future work should assess how ‘work as done’ may vary in different hospitals, and additionally focus on how ‘work as done’ influences the process of medication administration

Variability in Anesthesia and Its Implications for Improving Patient Safety

Improving patient safety in anesthesia has proven to be an arduous and challenging task. Despite the many strategies and interventions to improve patient safety that have been employed, patient harm in anesthesia remains a problem. The struggle to reduce patient harm in anesthesia is both attributable to and representative of the complexity of the anesthesia system. In navigating this complex system, anesthesia providers have different approaches to how they accomplish their work, which results in variability in anesthesia practice. This variability provides an immense challenge to designing and implementing efforts to improve patient safety, as rigid interventions are often met with intransigence due to their inability to mesh with variable practice. Just as anesthesia providers must be flexible to adapt to the complexities each case presents, human factors engineers are faced with the challenge of developing interventions that boast the same level of flexibility to fit within these work systems. In order to do so, we must first further our knowledge of the existing variability in anesthesia so it can be appropriately considered in future designs. It is only through proper consideration of the existing variability in anesthesia that we will be able to determine avenues for improving patient safety that are flexible to the entire scope of medication administration, and therefore are not susceptible to the same pitfalls that have inhibited the success of prior efforts. Thus, the overall objective of this dissertation was to provide a scope of the variability that exists in the practice of anesthesia such that it can be utilized by engineers to create interventions which are flexible to the entire scope of medication administration. Three studies were completed in this dissertation. The first study investigated the scope of variability and inconsistency in patient safety-related terminology in anesthesia through a structured literature review. The main finding of this study is that the term “medication error” had widely variant definitions which represent fundamentally different concepts. This inconsistency in terminology can lead to problems with synthesizing, interpreting, and overall sensemaking in relation to anesthesia medication safety. The second study investigated the scope of variability in the use and dosing of anesthesia medications through several statistical analyses of a large anesthesia dataset. The main finding of this study is that there was significant variability in the use and dosing of medications between five different hospitals within the same health system. By examining variability between hospitals in the same health system, we can identify potential avenues for interventions that improve patient safety and foresee potential difficulties with implementing these interventions. The third study investigated the feasibility of designing a standardized medication set that accounts for variability in anesthesia medication use through the development and use of a greedy algorithm. The main finding of this study is that, depending on the available size for a standardized medication set, a single standard set may be able to effectively cover a vast majority of cases at all institutions. Improving patient safety through standardization is possible despite the large amount of variability identified, though the design and implementation of such systems must be done with careful consideration of the existing variability. This dissertation informs anesthesia patient safety ideology and provides guidance towards how we can make lasting, widespread improvements to anesthesia patient safety

Measurement of the low-energy antideuteron inelastic cross section

In this Letter, we report the first measurement of the inelastic cross section for antideuteron-nucleus interactions at low particle momenta, covering a range of 0.3 ≤ p < 4 GeV/c. The measurement is carried out using p-Pb collisions at a center-of-mass energy per nucleon–nucleon pair of $\sqrt{s_{\rm NN}}$ = 5.02 TeV, recorded with the ALICE detector at the CERN LHC and utilizing the detector material as an absorber for antideuterons and antiprotons. The extracted raw primary antiparticle-to-particle ratios are compared to the results from detailed ALICE simulations based on the geant4 toolkit for the propagation of (anti)particles through the detector material. The analysis of the raw primary (anti)proton spectra serves as a benchmark for this study, since their hadronic interaction cross sections are well constrained experimentally. The first measurement of the inelastic cross section for antideuteron-nucleus interactions averaged over the ALICE detector material with atomic mass numbers ⟨A⟩ = 17.4 and 31.8 is obtained. The measured inelastic cross section points to a possible excess with respect to the Glauber model parametrization used in geant4 in the lowest momentum interval of 0.3 ≤ p < 0.47 GeV/c up to a factor 2.1. This result is relevant for the understanding of antimatter propagation and the contributions to antinuclei production from cosmic ray interactions within the interstellar medium. In addition, the momentum range covered by this measurement is of particular importance to evaluate signal predictions for indirect dark-matter searches

J/ψ\psi elliptic and triangular flow in Pb-Pb collisions at sNN\sqrt{s_{\rm NN}} = 5.02 TeV

The inclusive J/ψ elliptic (v$_{2}$) and triangular (v$_{3}$) flow coefficients measured at forward rapidity (2.5 < y < 4) and the v$_{2}$ measured at midrapidity (|y| < 0.9) in Pb-Pb collisions at $\sqrt{s_{\mathrm{NN}}}$ = 5.02 TeV using the ALICE detector at the LHC are reported. The entire Pb-Pb data sample collected during Run 2 is employed, amounting to an integrated luminosity of 750 μb$^{−1}$ at forward rapidity and 93 μb$^{−1}$ at midrapidity. The results are obtained using the scalar product method and are reported as a function of transverse momentum p$_{T}$ and collision centrality. At midrapidity, the J/ψ v$_{2}$ is in agreement with the forward rapidity measurement. The centrality averaged results indicate a positive J/ψ v$_{3}$ with a significance of more than 5σ at forward rapidity in the p$_{T}$ range 2 < p$_{T}$< 5 GeV/c. The forward rapidity v$_{2}$, v$_{3}$, and v$_{3}$/v$_{2}$ results at low and intermediate p$_{T}$ (p$_{T}$ ≲ 8 GeV/c) exhibit a mass hierarchy when compared to pions and D mesons, while converging into a species-independent curve at higher p$_{T}$. At low and intermediate p$_{T}$, the results could be interpreted in terms of a later thermalization of charm quarks compared to light quarks, while at high p$_{T}$, path-length dependent effects seem to dominate. The J/ψ v$_{2}$ measurements are further compared to a microscopic transport model calculation. Using a simplified extension of the quark scaling approach involving both light and charm quark flow components, it is shown that the D-meson v$_{n}$ measurements can be described based on those for charged pions and J/ψ flow

Elliptic Flow of Electrons from Beauty-Hadron Decays in Pb-Pb Collisions at sNN\sqrt {s_{NN}} = 5.02 TeV

The elliptic flow of electrons from beauty hadron decays at midrapidity (|y|<0.8) is measured in Pb-Pb collisions at $\sqrt {s_{NN}}$ = 5.02 TeV with the ALICE detector at the LHC. The azimuthal distribution of the particles produced in the collisions can be parametrized with a Fourier expansion, in which the second harmonic coefficient represents the elliptic flow, $v_2$. The $v_2$ coefficient of electrons from beauty hadron decays is measured for the first time in the transverse momentum ($p_T$) range 1.3–6 GeV/c in the centrality class 30%–50%. The measurement of electrons from beauty-hadron decays exploits their larger mean proper decay length cτ ≈ 500 μm compared to that of charm hadrons and most of the other background sources. The $v_2$ of electrons from beauty hadron decays at midrapidity is found to be positive with a significance of 3.75 σ. The results provide insights into the degree of thermalization of beauty quarks in the medium. A model assuming full thermalization of beauty quarks is strongly disfavored by the measurement at high $p_T$, but is in agreement with the results at low $p_T$. Transport models including substantial interactions of beauty quarks with an expanding strongly interacting medium describe the measurement within uncertainties

First measurement of quarkonium polarization in nuclear collisions at the LHC

International audienceThe polarization of inclusive J/ψ and ϒ(1S) produced in Pb–Pb collisions at sNN=5.02 TeV at the LHC is measured with the ALICE detector. The study is carried out by reconstructing the quarkonium through its decay to muon pairs in the rapidity region 2.5<y<4 and measuring the polar and azimuthal angular distributions of the muons. The polarization parameters λθ , λϕ and λθϕ are measured in the helicity and Collins-Soper reference frames, in the transverse momentum interval 2<pT<10 GeV/ c and pT<15 GeV/ c for the J/ψ and ϒ(1S) , respectively. The polarization parameters for the J/ψ are found to be compatible with zero, within a maximum of about two standard deviations at low pT , for both reference frames and over the whole pT range. The values are compared with the corresponding results obtained for pp collisions at s=7 and 8 TeV in a similar kinematic region by the ALICE and LHCb experiments. Although with much larger uncertainties, the polarization parameters for ϒ(1S) production in Pb–Pb collisions are also consistent with zero

A new laboratory to study hadron-hadron interactions

One of the big challenges for nuclear physics today is to understand, starting from first principles, the effective interaction between hadrons with different quark content. First successes have been achieved utilizing techniques to solve the dynamics of quarks and gluons on discrete space-time lattices. Experimentally, the dynamics of the strong interaction have been studied by scattering hadrons off each other. Such scattering experiments are difficult or impossible for unstable hadrons and hence, high quality measurements exist only for hadrons containing up and down quarks. In this work, we demonstrate that measuring correlations in the momentum space between hadron pairs produced in ultrarelativistic proton-proton collisions at the CERN LHC provides a precise method to obtain the missing information on the interaction dynamics between any pair of unstable hadrons. Specifically, we discuss the case of the interaction of baryons containing strange quarks (hyperons). We demonstrate for the first time how, using precision measurements of p-$\Omega^{-}$ correlations, the effect of the strong interaction for this hadron-hadron pair can be studied and compared with predictions from lattice calculations

Elliptic and triangular flow of (anti)deuterons in Pb-Pb collisions at sNN\sqrt{s_{\mathrm{NN}}} = 5.02 TeV

International audienceThe measurements of the (anti)deuteron elliptic flow (v2) and the first measurements of triangular flow (v3) in Pb-Pb collisions at a center-of-mass energy per nucleon-nucleon collision sNN = 5.02 TeV are presented. A mass ordering at low transverse momentum (pT) is observed when comparing these measurements with those of other identified hadrons, as expected from relativistic hydrodynamics. The measured (anti)deuteron v2 lies between the predictions from the simple coalescence and blast-wave models, which provide a good description of the data only for more peripheral and for more central collisions, respectively. The mass number scaling, which is violated for v2, is approximately valid for the (anti)deuterons v3. The measured v2 and v3 are also compared with the predictions from a coalescence approach with phase-space distributions of nucleons generated by iebe-vishnu with ampt initial conditions coupled with urqmd, and from a dynamical model based on relativistic hydrodynamics coupled to the hadronic afterburner smash. The model predictions are consistent with the data within the uncertainties in midcentral collisions, while a deviation is observed in the most central collisions

Measurement of isolated photon-hadron correlations in sNN\sqrt{s_{\rm{NN}}} = 5.02 TeV pppp and pp-Pb collisions

This paper presents isolated photon-hadron correlations using pp and p-Pb data collected by the ALICE detector at the LHC. For photons with |η| < 0.67 and 12 < $p_{\rm T}$ < 40 GeV/c, the associated yield of charged particles in the range |η| < 0.80 and 0.5 < $p_{\rm T}$ <10 GeV/c is presented. These momenta are much lower than previous measurements at the LHC. No significant difference between pp and p-Pb is observed, with Pythia 8.2 describing both data sets within uncertainties. This measurement constrains nuclear effects on the parton fragmentation in p-Pb collisions, and provides a benchmark for future studies of Pb-Pb collisions