Human Factors Integration in Robotic Surgery

OBJECTIVE

Using the example of robotic-assisted surgery (RAS), we explore the methodological and practical challenges of technology integration in surgery, provide examples of evidence-based improvements, and discuss the importance of systems engineering and clinical human factors research and practice.

BACKGROUND

New operating room technologies offer potential benefits for patients and staff, yet also present challenges for physical, procedural, team, and organizational integration. Historically, RAS implementation has focused on establishing the technical skills of the surgeon on the console, and has not systematically addressed the new skills required for other team members, the use of the workspace, or the organizational changes.

RESULTS

Human factors studies of robotic surgery have demonstrated not just the effects of these hidden complexities on people, teams, processes, and proximal outcomes, but also have been able to analyze and explain in detail why they happen and offer methods to address them. We review studies on workload, communication, workflow, workspace, and coordination in robotic surgery, and then discuss the potential for improvement that these studies suggest within the wider healthcare system.

CONCLUSION

There is a growing need to understand and develop approaches to safety and quality improvement through human-systems integration at the frontline of care.Precis: The introduction of robotic surgery has exposed under-acknowledged complexities of introducing complex technology into operating rooms. We explore the methodological and practical challenges, provide examples of evidence-based improvements, and discuss the implications for systems engineering and clinical human factors research and practice.

Slack Is Needed to Solve the Shortage of Nurses

Healthcare systems are facing a shortage of nurses. This article identifies some of the major causes of this and the issues that need to be solved. We take a perspective derived from queuing theory: the patient-nurse relationship is characterized by a scarcity of time and resources, requiring comprehensive coordination at all levels. For coordination, we take an information-theoretic perspective. Using both perspectives, we analyze the nature of healthcare services and show that ensuring slack, meaning a less than exhaustive use of human resources, is a sine qua non to having a good, functioning healthcare system. We analyze what coordination efforts are needed to manage relatively simple office hours, wards, and home care. Next, we address the level of care where providers cannot themselves prevent the complexity of organization that possibly damages care tasks and job quality. A lack of job quality may result in nurses leaving the profession. Job quality, in this context, depends on the ability of nurses to coordinate their activities. This requires slack resources. The availability of slack that is efficient depends on a stable inflow and retention rate of nurses. The healthcare system as a whole should ensure that the required nurse workforce will be able to coordinate and execute their tasks. Above that, workforce policies need more stability.

A critical review of hot executive functioning in youth attention-deficit/hyperactivity disorder: Methodological limitations, conceptual considerations, and future directions

Hot executive functioning (EF) - EF under emotionally or motivationally salient conditions - is a putative etiology of attention-deficit/hyperactivity disorder (ADHD), disruptive behavior problems (DBPs), and their related impairments. Despite two decades of research, the present study is the first review of the construct in youth ADHD, with a particular focus on the role of task design, age, and DBPs, as well as relevant conceptual and methodological considerations. While certain hot EF tasks have been investigated extensively (e.g., choice impulsivity), substantial inconsistency in measurement of the broader construct remains, severely limiting conclusions. Future research should a) consider the extent to which various hot EF tasks relate to one another, a higher order factor, and other related constructs; b) further investigate task design, particularly the elicitation of emotion or motivation and its anticipated effect on EF; and c) incorporate multiple levels of analysis to validate similarities and differences among tasks with regard to the affective experiences and cognitive demands they elicit. With improved measurement and conceptual clarity, hot EF has potential to advance the literature on etiological pathways to ADHD, DBPs and associated impairments and, more broadly, may represent a useful tool for understanding the influence of emotion and motivation on cognition.

Applying Different Strategies of Task Constraint Manipulation in Small-Sided and Conditioned Games: How Do They Impact Physical and Tactical Demands?

This study aimed to investigate how different strategies of task constraint manipulation impact physical and tactical demands in small-sided and conditioned games (SSCG). Ten recreational U-17 soccer players participated in this study (16.89 ± 0.11 years). We used different strategies of task manipulation to design two 4 vs. 4 SSCG: Structural SSCG and Functional SSCG. In Structural SSCG, pitch format and goal sizes were manipulated, while in Functional SSCG, players were allowed to kick the ball twice and at least 5 passes to shoot at the opponent’s goal. Players participated in four Structural and Functional SSCG, of five minutes duration with a two-minute interval in between. Players’ physical performance and tactical behavior were assessed using the WIMU PROTM inertial device. Structural SSCG stimulated players to cover more distance in sprinting (p = 0.003) and high-speed running (p < 0.001). Regarding tactical behavior, Structural SSCG stimulated players to explore game space better (p < 0.001). Moreover, Functional SSCG stimulated players to be closer to the ball, decreasing the effective playing space (p = 0.008). We conclude that these strategies of task constraint manipulation impact physical and tactical demands of the game.

Standardization of protocol design for user training in EEG-based Brain-Computer Interface

Brain-computer interfaces (BCIs) are systems that enable a person to interact with a machine using only neural activity. Such interaction can be non-intuitive for the user hence user trainings are developed to increase one's understanding, confidence and motivation, which would in parallel increase system performance. To clearly address the current issues in the BCI user training protocol design, here it is divided into introductory period and BCI interaction period. First, the introductory period (before BCI interaction) must be considered as equally important as the BCI interaction for user training. To support this claim, a review of papers show that BCI performance can depend on the methodologies presented in such introductory period. To standardize its design, the literature from human-computer interaction (HCI) is adjusted to the BCI context. Second, during the user-BCI interaction, the interface can take a large spectrum of forms (2D, 3D, size, color etc.) and modalities (visual, auditory or haptic etc.) without following any design standard or guidelines. Namely, studies that explore perceptual affordance on neural activity, show that motor neurons can be triggered from a simple observation of certain objects, and depending on objects' properties (size, location etc.) neural reactions can vary greatly. Surprisingly, the effects of perceptual affordance were not investigated in the BCI context. Both inconsistent introductions to BCI as well as variable interface designs make it difficult to reproduce experiments, predict their outcomes and compare results between them. To address these issues, a protocol design standardization for user training is proposed.

Crowdsourcing as a Tool for Urban Emergency Management: Lessons from the Literature and Typology

Recently, citizen involvement has been increasingly used in urban disaster prevention and management, taking advantage of new ubiquitous and collaborative technologies. This scenario has created a unique opportunity to leverage the work of crowds of volunteers. As a result, crowdsourcing approaches for disaster prevention and management have been proposed and evaluated. However, the articulation of citizens, tasks, and outcomes as a continuous flow of knowledge generation reveals a complex ecosystem that requires coordination efforts to manage interdependencies in crowd work. To tackle this challenging problem, this paper extends to the context of urban emergency management the results of a previous study that investigates how crowd work is managed in crowdsourcing platforms applied to urban planning. The goal is to understand how crowdsourcing techniques and quality control dimensions used in urban planning could be used to support urban emergency management, especially in the context of mining-related dam outages. Through a systematic literature review, our study makes a comparison between crowdsourcing tools designed for urban planning and urban emergency management and proposes a five-dimension typology of quality in crowdsourcing, which can be leveraged for optimizing urban planning and emergency management processes.

How Does the Adjustment of Training Task Difficulty Level Influence Tactical Behavior in Soccer?

Purpose: This study aimed to investigate if player tactical skill level and age category influence team performance and player exploratory behavior in tasks with different difficulty levels. Method: In total, 48 youth male soccer players participated in the study (U15, n = 24, mean age = 13.06 ± 1.53 years; U17, n = 24, mean age = 16.89 ± 0.11 years). Player tactical skills were evaluated through the System of Tactical Assessment in Soccer (FUT-SAT), allowing them to be organized into three groups according to tactical efficiency: Higher tactical skill level (Group 01), Intermediate tactical skill level (Group 02), and Lower tactical skill level (Group 03). Next, Group 01 and Group 03 of both categories performed six Small-Sided and Conditioned Games (SSCG) each, namely three High difficulty SSCGs and three Low difficulty SSCGs. Team performance and players' exploratory behavior were analyzed through the Offensive Sequences Characterization System and Lag Sequential Analysis, respectively. Results: We found that team performance and players' exploratory behavior were influenced both by the age and tactical skill level of the players, as well as by task difficulty level. Conclusion: Therefore, in an attempt to improve player performance, practitioners must carefully manipulate key task constraints to adapt training task difficulty levels to player age and tactical skill level.

Social and Non-social Mechanisms of Inequity Aversion in Non-human Animals

Research over the last decades has shown that humans and other animals reveal behavioral and emotional responses to unequal reward distributions between themselves and other conspecifics. However, cross-species findings about the mechanisms underlying such inequity aversion are heterogeneous, and there is an ongoing discussion if inequity aversion represents a truly social phenomenon or if it is driven by non-social aspects of the task. There is not even general consensus whether inequity aversion exists in non-human animals at all. In this review article, we discuss variables that were found to affect inequity averse behavior in animals and examine mechanistic and evolutionary theories of inequity aversion. We review a range of moderator variables and focus especially on the comparison of social vs. non-social explanations of inequity aversion. Particular emphasis is placed on the importance of considering the experimental design when interpreting behavior in inequity aversion tasks: the tasks used to probe inequity aversion are often based on impunity-game-like designs in which animals are faced with unfair reward distributions, and they can choose to accept the unfair offer, or reject it, leaving them with no reward. We compare inequity-averse behavior in such impunity-game-like designs with behavior in less common choice-based designs in which animals actively choose between fair and unfair rewards distributions. This review concludes with a discussion of the different mechanistic explanations of inequity aversion, especially in light of the particular features of the different task designs, and we give suggestions on experimental requirements to understand the “true nature” of inequity aversion.

The Expanded Evidence-Centered Design (e-ECD) for Learning and Assessment Systems: A Framework for Incorporating Learning Goals and Processes Within Assessment Design

Evidence-centered design (ECD) is a framework for the design and development of assessments that ensures consideration and collection of validity evidence from the onset of the test design. Blending learning and assessment requires integrating aspects of learning at the same level of rigor as aspects of testing. In this paper, we describe an expansion to the ECD framework (termed e-ECD) such that it includes the specifications of the relevant aspects of learning at each of the three core models in the ECD, as well as making room for specifying the relationship between learning and assessment within the system. The framework proposed here does not assume a specific learning theory or particular learning goals, rather it allows for their inclusion within an assessment framework, such that they can be articulated by researchers or assessment developers that wish to focus on learning.

Upper Extremity Muscular Strength in Push-Pull Tasks: Model Approach Towards Task Design

BACKGROUND

Pushing and pulling in workplaces are common actions. Repetitive forceful exertions in long-duration works lead to increased risk of musculoskeletal disorders and injuries.

AIM

To investigate the upper extremity strength in generic push-pull modes while using hand tools and forecasting the limits of the workers while frequent or continuous operation.

SETTINGS AND DESIGN

The study was conducted among men workers in Ahmedabad city, India, and the design was cross-sectional study.

MATERIALS AND METHODS

In all, 100 men were recruited (Group 1: 18-39 years and Group 2: 40-60 years). Upper extremity muscular strength (isometric mode) testing of the preferred hand during push-pull type of manual hand-tool operations was carried out for 60 s. Forecasting of strength to generate predictions for future events (120 s) based on known past events (measured 60 s) was carried out using Holt-Winters time-series model.

STATISTICAL ANALYSIS

Descriptive statistics was used for analysis. For prediction model evaluation, WEKA 3.8.2 was used.

RESULTS

Anthropometric parameters of both groups were similar, having no effect on generated strength. Largely, pull strength was recorded to be higher than push strength, wherein Group 2 men generated slightly higher strength. Seated strength was also higher than standing exertion. Forecasting reveals steady strength values for Group 1 men, whereas steep decline among Group 2 men with increasing duration of trial.

CONCLUSION

The strength data generated would aid in work schedule design. Strength forecasting model would assist in developing engineering guidelines in the design of tools at workplace.

The Role of Psychometrics in Individual Differences Research in Cognition: A Case Study of the AX-CPT

Investigating individual differences in cognition requires addressing questions not often thought about in standard experimental designs, especially regarding the psychometric properties of the task. Using the AX-CPT cognitive control task as a case study example, we address four concerns that one may encounter when researching the topic of individual differences in cognition. First, we demonstrate the importance of variability in task scores, which in turn directly impacts reliability, particularly when comparing correlations in different populations. Second, we demonstrate the importance of variability and reliability for evaluating potential failures to replicate predicted correlations, even within the same population. Third, we demonstrate how researchers can turn to evaluating psychometric properties as a way of evaluating the feasibility of utilizing the task in new settings (e.g., online administration). Lastly, we show how the examination of psychometric properties can help researchers make informed decisions when designing a study, such as determining the appropriate number of trials for a task.

Impact of task design on task performance and injury risk: case study of a simulated drilling task

Existing evidence is limited regarding the influence of task design on performance and ergonomic risk, or the association between these two outcomes. In a controlled experiment, we constructed a mock fuselage to simulate a drilling task common in aircraft manufacturing, and examined the effect of three levels of workstation adjustability on performance as measured by productivity (e.g. fuselage completion time) and quality (e.g. fuselage defective holes), and ergonomic risk as quantified using two common methods (rapid upper limb assessment and the strain index). The primary finding was that both productivity and quality significantly improved with increased adjustability, yet this occurred only when that adjustability succeeded in reducing ergonomic risk. Supporting the inverse association between ergonomic risk and performance, the condition with highest adjustability created the lowest ergonomic risk and the best performance while there was not a substantial difference in ergonomic risk between the other two conditions, in which performance was also comparable. Practitioner Summary: Findings of this study supported a causal relationship between task design and both ergonomic risk and performance, and that ergonomic risk and performance are inversely associated. While future work is needed under more realistic conditions and a broader population, these results may be useful for task (re)design and to help cost-justify some ergonomic interventions.

Self-selected duty cycle times for grip force, wrist flexion postures and three grip types

Performance and health issues are common in industry. On-the-job productivity gains related to good design, which could help justify ergonomics intervention, are often not considered. More quantitative data are needed to model the discomfort/productivity relationship for upper limb activity in simulated repetitive assembly type work. Eighteen participants completed an experiment, simulating a repetitive upper limb task with force, posture and grip type recorded as independent variables. Duty cycle time and discomfort were recorded as dependent variables. Participants performed 18 experiment combinations (block designed around force); each treatment lasted 35 min, including breaks. Analysis indicated a significant two-way interaction between posture and grip type. Results from this experiment were used to model the effect of these variables on operator discomfort and performance.

An application of item response theory to fMRI data: prospects and pitfalls

When using functional brain imaging to study neuropsychiatric patients an important challenge is determining whether the imaging task assesses individual differences with equal precision in healthy control and impaired patient groups. Classical test theory (CTT) requires separate reliability studies of patients and controls to determine equivalent measurement precision with additional studies to determine measurement precision for different levels of disease severity. Unlike CTT, item response theory (IRT) provides estimates of measurement error for different levels of ability, without the need for separate studies, and can determine if different tests are equivalently difficult when investigating differential deficits between groups. To determine the potential value of IRT in functional brain imaging, IRT was applied to behavioral data obtained during a multi-center functional MRI (fMRI) study of working memory (WM). Average item difficulty was approximately one standard deviation below the ability scale mean, supporting the task's sensitivity to individual differences within the ability range of patients with WM impairment, but not within the range of most controls. The correlation of IRT estimated ability with fMRI activation during the task recognition period supported the linkage of the latent IRT scale to brain activation data. IRT can meaningfully contribute to the design of fMRI tasks.

adults: the impact of task design and implications for understanding neurodevelopment

The neural systems underlying reward-related behaviors across development have recently generated a great amount of interest. Yet, the neurodevelopmental literature on reward processing is marked by inconsistencies due to the heterogeneity of the reward paradigms used, the complexity of the behaviors being studied, and the developing brain itself as a moving target. The present review will examine task design as one source of variability across findings by compiling this literature along three dimensions: (1) task structures, (2) cognitive processes, and (3) neural systems. We start with the presentation of a heuristic neural systems model, the Triadic Model, as a way to provide a theoretical framework for the neuroscience research on motivated behaviors. We then discuss the principles guiding reward task development. Finally, we review the extant developmental neuroimaging literature on reward-related processing, organized by reward task type. We hope that this approach will help to clarify the literature on the functional neurodevelopment of reward-related neural systems, and to identify the role of the experimental parameters that significantly influence these findings.

Development of orthogonal task designs in fMRI studies of higher cognition: the NIMH experience

This paper chronicles one researcher's journey at the National Institute of Mental Health, exploring ways to understand the neural systems responsible for the cognitive sub-processes of working memory tasks. Both the opportunities and the pitfalls with applying the idea of cognitive subtraction to neuroimaging data were well-known from studies using positron emission tomography. We took advantage of the improved temporal resolution of fMRI with a delayed-recognition task and identified the time-courses of the different stages of the task (encoding, memory delay, and recognition test) as predictor variables in a multiple regression analysis. Because these signals were temporally independent, individual components of tasks could be contrasted with one another, rather than entire tasks, reducing the problem of violations of pure insertion in cognitive subtraction. This approach enabled us to draw more detailed conclusions about the neural systems of higher cognition and the organization of prefrontal cortex than had been possible before fMRI. Further enhancements and innovations over the last 20 years by a multitude of researchers across the field have greatly expanded this knowledge, but this approach called "orthogonal task design" has remained a fundamental component of many of these modern studies.