Workload: Measurement and Management

Poster: The workload research project has as its task to survey the available literature on: (1) workload measurement techniques; and (2) the effects of workload on operator performance. The first set of findings provides practitioners with a collection of simple-to-use workload measurement techniques along with characterizations of the kinds of tasks each technique has been shown reliably address. This allows design practitioners to select and use the most appropriate techniques for the task(s) at hand. The second set of findings provides practitioners with the guidance they need to design for appropriate kinds and amounts of workload across all tasks for which the operator is responsible. This guidance helps practitioners design systems and procedures that ensure appropriate levels of engagement across all tasks, and avoid designs and procedures that result in operator boredom, complacency, loss of awareness, undue levels of stress, or skill atrophy that can result from workload that distracts operators from the tasks they perform and monitor, workload levels that are too low, too high, or too consistent or predictable. Only those articles that were peer reviewed, long standing and generally accepted in the field, and applicable to a relevant range of conditions in a select domain of interest, in analogous "extreme" environments to those in space were included. In addition, all articles were reviewed and evaluated on uni-dimensional and multi-dimensional considerations. Casner & Gore also examined the notion of thresholds and the conditions that may benefit mostly from the various methodological approaches. Other considerations included whether the tools would be suitable for guiding a requirement-related and design-related question. An initial review of over 225 articles was conducted and entered into an EndNote database. The reference list included a range of conditions in the domain of interest (subjective/objective measures), the seminal works in workload, as well as summary work

A Task Analytic Process to Define Future Concepts in Aviation

A necessary step when developing next generation systems is to understand the tasks that operators will perform. One NextGen concept under evaluation termed Single Pilot Operations (SPO) is designed to improve the efficiency of airline operations. One SPO concept includes a Pilot on Board (PoB), a Ground Station Operator (GSO), and automation. A number of procedural changes are likely to result when such changes in roles and responsibilities are undertaken. Automation is expected to relieve the PoB and GSO of some tasks (e.g. radio frequency changes, loading expected arrival information). A major difference in the SPO environment is the shift to communication-cued crosschecks (verbal / automated) rather than movement-cued crosschecks that occur in a shared cockpit. The current article highlights a task analytic process of the roles and responsibilities between a PoB, an approach-phase GSO, and automation

Extending Validated Human Performance Models to Explore NextGen Concepts

To meet the expected increases in air traffic demands, NASA and FAA are researching and developing Next Generation Air Transportation System (NextGen) concepts. NextGen will require substantial increases in the data available to pilots on the flight deck (e.g., weather,wake, traffic trajectory predictions, etc.) to support more precise and closely coordinated operations (e.g., self-separation, RNAV/RNP, and closely spaced parallel operations, CSPOs). These NextGen procedures and operations, along with the pilot's roles and responsibilities, must be designed with consideration of the pilot's capabilities and limitations. Failure to do so will leave the pilots, and thus the entire aviation system, vulnerable to error. A validated Man-machine Integration and design Analysis System (MIDAS) v5 model was extended to evaluate anticipated changes to flight deck and controller roles and responsibilities in NextGen approach and Land operations. Compared to conditions when the controllers are responsible for separation on decent to land phase of flight, the output from these model predictions suggest that the flight deck response time to detect the lead aircraft blunder will decrease, pilot scans to the navigation display will increase, and workload will increase

Evaluating Nextgen Closely Spaced Parallel Operations Concepts with Validated Human Performance Models: Flight Deck Guidelines

The objectives of the current research were to develop valid human performance models (HPMs) of approach and land operations; use these models to evaluate the impact of NextGen Closely Spaced Parallel Operations (CSPO) on pilot performance; and draw conclusions regarding flight deck display design and pilot-ATC roles and responsibilities for NextGen CSPO concepts. This document presents guidelines and implications for flight deck display designs and candidate roles and responsibilities. A companion document (Gore, Hooey, Mahlstedt, & Foyle, 2013) provides complete scenario descriptions and results including predictions of pilot workload, visual attention and time to detect off-nominal events

A Validated Set of MIDAS V5 Task Network Model Scenarios to Evaluate Nextgen Closely Spaced Parallel Operations Concepts

The Closely Spaced Parallel Operations (CSPO) scenario is a complex, human performance model scenario that tested alternate operator roles and responsibilities to a series of off-nominal operations on approach and landing (see Gore, Hooey, Mahlstedt, Foyle, 2013). The model links together the procedures, equipment, crewstation, and external environment to produce predictions of operator performance in response to Next Generation system designs, like those expected in the National Airspaces NextGen concepts. The task analysis that is contained in the present report comes from the task analysis window in the MIDAS software. These tasks link definitions and states for equipment components, environmental features as well as operational contexts. The current task analysis culminated in 3300 tasks that included over 1000 Subject Matter Expert (SME)-vetted, re-usable procedural sets for three critical phases of flight; the Descent, Approach, and Land procedural sets (see Gore et al., 2011 for a description of the development of the tasks included in the model; Gore, Hooey, Mahlstedt, Foyle, 2013 for a description of the model, and its results; Hooey, Gore, Mahlstedt, Foyle, 2013 for a description of the guidelines that were generated from the models results; Gore, Hooey, Foyle, 2012 for a description of the models implementation and its settings). The rollout, after landing checks, taxi to gate and arrive at gate illustrated in Figure 1 were not used in the approach and divert scenarios exercised. The other networks in Figure 1 set up appropriate context settings for the flight deck.The current report presents the models task decomposition from the tophighest level and decomposes it to finer-grained levels. The first task that is completed by the model is to set all of the initial settings for the scenario runs included in the model (network 75 in Figure 1). This initialization process also resets the CAD graphic files contained with MIDAS, as well as the embedded operator models that comprise MIDAS. Following the initial settings, the model progresses to begin the first tasks required of the two flight deck operators, the Captain (CA) and the First Officer (FO). The task sets will initialize operator specific settings prior to loading all of the alerts, probes, and other events that occur in the scenario. As a note, the CA and FO were terms used in developing this model but the CA can also be thought of as the Pilot Flying (PF), while the FO can be considered the Pilot-Not-Flying (PNF)or Pilot Monitoring (PM). As such, the document refers to the operators as PFCA and PNFFO respectively

Modeling and Evaluating Pilot Performance in NextGen: Review of and Recommendations Regarding Pilot Modeling Efforts, Architectures, and Validation Studies

NextGen operations are associated with a variety of changes to the national airspace system (NAS) including changes to the allocation of roles and responsibilities among operators and automation, the use of new technologies and automation, additional information presented on the flight deck, and the entire concept of operations (ConOps). In the transition to NextGen airspace, aviation and air operations designers need to consider the implications of design or system changes on human performance and the potential for error. To ensure continued safety of the NAS, it will be necessary for researchers to evaluate design concepts and potential NextGen scenarios well before implementation. One approach for such evaluations is through human performance modeling. Human performance models (HPMs) provide effective tools for predicting and evaluating operator performance in systems. HPMs offer significant advantages over empirical, human-in-the-loop testing in that (1) they allow detailed analyses of systems that have not yet been built, (2) they offer great flexibility for extensive data collection, (3) they do not require experimental participants, and thus can offer cost and time savings. HPMs differ in their ability to predict performance and safety with NextGen procedures, equipment and ConOps. Models also vary in terms of how they approach human performance (e.g., some focus on cognitive processing, others focus on discrete tasks performed by a human, while others consider perceptual processes), and in terms of their associated validation efforts. The objectives of this research effort were to support the Federal Aviation Administration (FAA) in identifying HPMs that are appropriate for predicting pilot performance in NextGen operations, to provide guidance on how to evaluate the quality of different models, and to identify gaps in pilot performance modeling research, that could guide future research opportunities. This research effort is intended to help the FAA evaluate pilot modeling efforts and select the appropriate tools for future modeling efforts to predict pilot performance in NextGen operations

Design and baseline characteristics of the finerenone in reducing cardiovascular mortality and morbidity in diabetic kidney disease trial

Background: Among people with diabetes, those with kidney disease have exceptionally high rates of cardiovascular (CV) morbidity and mortality and progression of their underlying kidney disease. Finerenone is a novel, nonsteroidal, selective mineralocorticoid receptor antagonist that has shown to reduce albuminuria in type 2 diabetes (T2D) patients with chronic kidney disease (CKD) while revealing only a low risk of hyperkalemia. However, the effect of finerenone on CV and renal outcomes has not yet been investigated in long-term trials. Patients and Methods: The Finerenone in Reducing CV Mortality and Morbidity in Diabetic Kidney Disease (FIGARO-DKD) trial aims to assess the efficacy and safety of finerenone compared to placebo at reducing clinically important CV and renal outcomes in T2D patients with CKD. FIGARO-DKD is a randomized, double-blind, placebo-controlled, parallel-group, event-driven trial running in 47 countries with an expected duration of approximately 6 years. FIGARO-DKD randomized 7,437 patients with an estimated glomerular filtration rate >= 25 mL/min/1.73 m(2) and albuminuria (urinary albumin-to-creatinine ratio >= 30 to <= 5,000 mg/g). The study has at least 90% power to detect a 20% reduction in the risk of the primary outcome (overall two-sided significance level alpha = 0.05), the composite of time to first occurrence of CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure. Conclusions: FIGARO-DKD will determine whether an optimally treated cohort of T2D patients with CKD at high risk of CV and renal events will experience cardiorenal benefits with the addition of finerenone to their treatment regimen. Trial Registration: EudraCT number: 2015-000950-39; ClinicalTrials.gov identifier: NCT02545049

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Independent and combined effects of improved water, sanitation, and hygiene, and improved complementary feeding, on child stunting and anaemia in rural Zimbabwe: a cluster-randomised trial.

BACKGROUND: Child stunting reduces survival and impairs neurodevelopment. We tested the independent and combined effects of improved water, sanitation, and hygiene (WASH), and improved infant and young child feeding (IYCF) on stunting and anaemia in in Zimbabwe. METHODS: We did a cluster-randomised, community-based, 2 × 2 factorial trial in two rural districts in Zimbabwe. Clusters were defined as the catchment area of between one and four village health workers employed by the Zimbabwe Ministry of Health and Child Care. Women were eligible for inclusion if they permanently lived in clusters and were confirmed pregnant. Clusters were randomly assigned (1:1:1:1) to standard of care (52 clusters), IYCF (20 g of a small-quantity lipid-based nutrient supplement per day from age 6 to 18 months plus complementary feeding counselling; 53 clusters), WASH (construction of a ventilated improved pit latrine, provision of two handwashing stations, liquid soap, chlorine, and play space plus hygiene counselling; 53 clusters), or IYCF plus WASH (53 clusters). A constrained randomisation technique was used to achieve balance across the groups for 14 variables related to geography, demography, water access, and community-level sanitation coverage. Masking of participants and fieldworkers was not possible. The primary outcomes were infant length-for-age Z score and haemoglobin concentrations at 18 months of age among children born to mothers who were HIV negative during pregnancy. These outcomes were analysed in the intention-to-treat population. We estimated the effects of the interventions by comparing the two IYCF groups with the two non-IYCF groups and the two WASH groups with the two non-WASH groups, except for outcomes that had an important statistical interaction between the interventions. This trial is registered with ClinicalTrials.gov, number NCT01824940. FINDINGS: Between Nov 22, 2012, and March 27, 2015, 5280 pregnant women were enrolled from 211 clusters. 3686 children born to HIV-negative mothers were assessed at age 18 months (884 in the standard of care group from 52 clusters, 893 in the IYCF group from 53 clusters, 918 in the WASH group from 53 clusters, and 991 in the IYCF plus WASH group from 51 clusters). In the IYCF intervention groups, the mean length-for-age Z score was 0·16 (95% CI 0·08-0·23) higher and the mean haemoglobin concentration was 2·03 g/L (1·28-2·79) higher than those in the non-IYCF intervention groups. The IYCF intervention reduced the number of stunted children from 620 (35%) of 1792 to 514 (27%) of 1879, and the number of children with anaemia from 245 (13·9%) of 1759 to 193 (10·5%) of 1845. The WASH intervention had no effect on either primary outcome. Neither intervention reduced the prevalence of diarrhoea at 12 or 18 months. No trial-related serious adverse events, and only three trial-related adverse events, were reported. INTERPRETATION: Household-level elementary WASH interventions implemented in rural areas in low-income countries are unlikely to reduce stunting or anaemia and might not reduce diarrhoea. Implementation of these WASH interventions in combination with IYCF interventions is unlikely to reduce stunting or anaemia more than implementation of IYCF alone. FUNDING: Bill & Melinda Gates Foundation, UK Department for International Development, Wellcome Trust, Swiss Development Cooperation, UNICEF, and US National Institutes of Health.The SHINE trial is funded by the Bill & Melinda Gates Foundation (OPP1021542 and OPP113707); UK Department for International Development; Wellcome Trust, UK (093768/Z/10/Z, 108065/Z/15/Z and 203905/Z/16/Z); Swiss Agency for Development and Cooperation; US National Institutes of Health (2R01HD060338-06); and UNICEF (PCA-2017-0002)