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As designers and cognitive scientists begin to explore human experience as a relation between people and products, there is a need for constructs that index relational properties (i.e., properties of a product that are dependent on properties of an actor). One such construct that has recently become popular with designers is affordance. Affordances, such as pass-through-able, depend on properties of both an object (e.g., width of an opening) and properties of an actor (e.g., girth or shoulder width). In this article, three relational constructs are suggested to reflect important properties of the coupling between humans and products: affording, specifying, and satisfying. Affording refers to constraints on the action coupling between actor and product. Specifying refers to constraints on the perceptual or informational coupling. Finally, satisfying refers to constraints on value (e.g., attractiveness or desirability). The case is made that each of these three constructs are critical to determining the quality of the experience of an agent with a product (e.g., the capacity for satisfying interactions).

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Monitoring radio messages while driving is an omnipresent dual-task combination in police work, but it is also one that is considered unsafe for regular drivers. Whereas regular drivers are expected to fully prioritize the driving task, police officers typically do not have the option to stop their car to attend important incoming messages, nor can they afford an uninformed arrival at the scene. A novel method for the visualization of observational data shows that police work is highly fragmented, and suggests that frequent reports on work overload are related to dual- task involvement in this fragmented workflow. Therefore, a series of experimental studies have been conducted to understand the mechanics that underlie and result from task prioritization in a dynamic complex socio-technical system, such as the police context. Methodological implications are presented for the interpretation of tradeoffs between task performance and mental effort as function of task prioritization. Furthermore, practical implications are presented for the development of information technology in police vehicles. Finally, recommendations for future research include the validation of an integrated model on coping strategies, task prioritization, and dual-task switching.

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This article addresses the need of including acoustical perspectives in the debate on alarm fatigue within the healthcare domain. We show how conceptualisations and proposed solutions to alarm fatigue are unequally distributed across what could be called the ‘alarm chain’: a generic model of the core structural elements and dynamic relations that constitute any alarm scenario. A focal point in the alarm chain – the ‘alarm mediation cleft’ – seems to divide the alarm fatigue literature from the segment of the alarm literature that deals with auditory alarm design. The current healthcare discourse on alarm fatigue is centred around the ‘premediated alarm phase’, which has the consequence of an unfortunate dichotomous approach
to the functionality of sound. We address some shortcomings of this approach and outline some methodological implications and potentials of searching for signs of alarm fatigue in the ‘post-mediated alarm phase’.

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Physiologic monitors are plagued with alarms that create a cacophony of sounds and visual alerts causing “alarm fatigue” which creates an unsafe patient environment because a life-threatening event may be missed in this milieu of sensory overload. Using a state-of-the-art technology acquisition infrastructure, all monitor data including 7 ECG leads, all pressure, SpO2, and respiration waveforms as well as user settings and alarms were stored on 461 adults treated in intensive care units. Using a well-defined alarm annotation protocol, nurse scientists with 95% inter-rater reliability annotated 12,671 arrhythmia alarms.
The excessive number of physiologic monitor alarms is a complex interplay of inappropriate user settings, patient conditions, and algorithm deficiencies. Device solutions should focus on use of all available ECG leads to identify non-artifact leads and leads with adequate QRS amplitude. Devices should provide prompts to aide in more appropriate tailoring of alarm settings to individual patients. Atrial fibrillation alarms should be limited to new onset and termination of the arrhythmia and delays for ST-segment and other parameter alarms should be configurable. Because computer devices are more reliable than humans, an opportunity exists to improve physiologic monitoring and reduce alarm fatigue.

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In health care, the design, development and commercialization of innovative products is often found frustrating due to the slow inefficient and difficult nature of its systems. One part of this problem is the fact that health systems are highly regulated complex systems that include various stakeholders and unique challenges. Nevertheless, designers and other innovators are often unaware of these unique features of health systems. It is important that designers and managers are able to understand the system, anticipate challenges and account for them in their work.
We therefore aim to establish and evaluate an overarching conceptual model, which can delineate both the systems of health care innovation process and the relevant stakeholders in these systems. This paper reviews the application and potential benefits of one of the promising models called Multilevel Design Model (MDM) by employing an expert-participatory testing on multiple cases in documented clinical reports (n=8). The evaluation of the MDM model followed by further adaptations and changes to the model itself, as well as to the accompanying user guidelines. With some adjustments, the MDM was able to visualize and explain the systems of the health care innovation process in a systematic and shared manner usable for health product designers, innovators and health organizations. We propose the adjusted MDM model for further use in the design and development of health care innovations.

Intensive care units (ICUs) are complex work environments where false alarms occur more frequently than on non-critical care units. The Joint Commission National Patient Safety Goal .06.01.01 targeted improving the safety of clinical alarm systems and required health care facilities to establish alarm systems safety as a hospital priority by July 2014. An important initial step toward this requirement is identifying ICU nurses’ perceptions and common clinical practices toward clinical alarms, where little information is available.

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