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Biomedical subjects

R Parasuraman

Publications and source records attributed to R Parasuraman.

At least 19 recordsLinked to original sources
PubMed2006

Renal disease burden following liver transplantation.

UNLABELLED: Significant chronic kidney disease (CKD) occurs following orthotopic liver transplant (OLT). Since CKD is associated with increased cardiovascular events, mortality, and hepatic allograft dysfunction, early recognition of CKD and implementation of changes may improve the long-term outcome. The purpose of this study was to determine the burden of renal disease following OLT. PATIENTS AND METHODS: We retrospectively reviewed our OLT recipients from 1997 until 2004. We calculated glomerular filtration rates (GFR) using the Modification of Diet in Renal Disease study (MDRD) method. The GFRs were further subdivided into pre-MELD and post-MELD eras. RESULTS: During the study period, we performed 407 OLTs. We censored data from living donor liver transplants (n = 14), combined liver-kidney transplants (n = 12), and from patients whom we did not have complete data for 6 months after transplant (n = 40). Mean MELD score at the time of transplant was 18 +/- 7 (mean +/- standard deviation). The mean GFR at 6 months following OLT was 63.7 +/- 30.2 mL/min per 1.73 m(2). Only 14% (n = 47) of our patients had normal renal function at 6 months, while 78% (n = 266) of our patients had mild to moderate risk for renal failure. Eight percent (n = 28) had stage 4 or 5 CKD. There were no differences between the pre-MELD and post-MELD GFRs. CONCLUSIONS: The burden of renal disease is significant in our patient population at 6 months posttransplantation. It may be important to introduce CKD management as early as 6 months after transplant to impact the outcomes of OLT recipients.

Adult↗
PubMed2005

Comparison of long-term actual renal allograft survival in mycophenolate mofetil and azathioprine-based triple drug immunosuppression protocols.

INTRODUCTION: The use of mycophenolate mofetil (MMF) in renal transplantation results in a 50% lower incidence of acute rejection compared to azathioprine (AZA). However, the graft survival reports are conflicting: the European trial and US database analysis suggest better survival with MMF, an observation that was not seen in the US and tricontinental studies. METHODS: We retrospectively reviewed our single-center experience (60% African-Americans) comparing the serum creatinine (SCr) values and 3-year actual graft survival with MMF versus AZA-based immunosuppression. Group I included patients transplanted between January 1990 and December 1992 on cyclosporine (CSA), AZA, and steroids; group II subjects, from January 1996 to December 1998 on CSA, MMF, and steroids. We analyzed SCr and all causes of graft losses at 3, 6, 12, 18, 24, and 36 months posttransplantation. RESULTS: The patient demographics were similar in both groups as was the mean SCr values at different times. The time-group interaction for SCr, the Kruskal-Wallis test for SCr for different categories (<1.5, 1.5 to 2.0, 2.0 to 2.5, and >2.5 mg/dL) and the all-cause graft loss between the two groups were not significantly different. CONCLUSION: Our results failed to show better long-term actual graft survival despite the 6-year interval between the two groups. These findings agree with the results of the United States and the tricontinental studies. A lower incidence of acute rejection early after transplantation observed with MMF may not always translate into a long-term benefit, possibly due to the influence of nonimmunological factors, such as hypertension, calcineurin inhibitor toxicity, more frequent cytomegalovirus infections, and increased attempts to withdraw steroids using MMF-based protocols.

Adrenal Cortex Hormones↗
PubMed2002

Disseminated microsporidiosis in a renal transplant recipient.

Disseminated microsporidiosis is diagnosed uncommonly in patients not infected with human immunodeficiency virus (HIV). We present a case of disseminated microsporidiosis in a renal transplant recipient who was seronegative for HIV. Chromotrope-based stains were positive for microsporidia in urine, stools, sputum, and conjunctival scrapings. Electron microscopy, immunofluorescence, polymerase chain reaction, and cultures of renal tissue identified the organism as Encephalitozoon cuniculi. The patient was treated with oral albendazole and topical fumagillin with clinical improvement. In addition, she underwent a transplant nephrectomy and immunosuppressive therapy was withdrawn. Follow-up samples were negative for microsporidia. However, the patient developed central nervous system manifestations and died. An autopsy brain tissue specimen demonstrated E. cuniculi by immunofluorescent staining. Disseminated microsporidiosis must be considered in the differential diagnosis of multiorgan involvement in renal allograft recipients.

Animals↗
PubMed2001

Dynamics of the spatial scale of visual attention revealed by brain event-related potentials.

The temporal dynamics of the spatial scaling of attention during visual search were examined by recording event-related potentials (ERPs). A total of 16 young participants performed a search task in which the search array was preceded by valid cues that varied in size and hence in precision of target localization. The effects of cue size on short-latency (P1 and N1) ERP components, and the time course of these effects with variation in cue-target stimulus onset asynchrony (SOA), were examined. Reaction time (RT) to discriminate a target was prolonged as cue size increased. The amplitudes of the posterior P1 and N1 components of the ERP evoked by the search array were affected in opposite ways by the size of the precue: P1 amplitude increased whereas N1 amplitude decreased as cue size increased, particularly following the shortest SOA. The results show that when top-down information about the region to be searched is less precise (larger cues), RT is slowed and the neural generators of P1 become more active, reflecting the additional computations required in changing the spatial scale of attention to the appropriate element size to facilitate target discrimination. In contrast, the decrease in N1 amplitude with cue size may reflect a broadening of the spatial gradient of attention. The results provide electrophysiological evidence that changes in the spatial scale of attention modulate neural activity in early visual cortical areas and activate at least two temporally overlapping component processes during visual search.

Adult↗
PubMed2001

The role of the air traffic controller in future air traffic management: an empirical study of active control versus passive monitoring.

Proposals for air traffic management such as Free Flight call for a transfer of responsibility for separation between aircraft from air traffic controllers (ATCos) to pilots. Under many proposals, the role of the ATCo will change from one of active control to passive monitoring. The present study directly compared these types of control with respect to ATCo mental workload, conflict detection, and memory. Eighteen ATCos participated in an air traffic control simulation of Free Flight procedures under moderate and high traffic load. Dependent variables included accuracy and timeliness in detecting potential conflicts, accepting and handing off aircraft, mental workload (as assessed by a secondary task, heart rate variability, and subjective ratings), and memory for aircraft location. High traffic density and passive control both degraded conflict detection performance. Actual or potential applications of this research include the recommendation that designs for future air traffic management keep authority for separation of aircraft with the controller.

Adult↗
PubMed2000

Genetics and visual attention: selective deficits in healthy adult carriers of the epsilon 4 allele of the apolipoprotein E gene.

The epsilon4 allele of the apolipoprotein E (APOE) gene is associated with altered brain physiology in healthy adults before old age, but concomitant deficits in cognition on standardized tests of cognitive function have not been consistently demonstrated. We hypothesized that sensitive and specific assessment of basic attentional functions that underlie complex cognition would reveal evidence of impairment in otherwise asymptomatic individuals. We found that as early as middle age, nondemented carriers of the varepsilon4 allele of the APOE gene showed deficits when visual attention was spatially directed by cues in tasks of visual discrimination and visual search, in comparison to those without the epsilon4 allele (epsilon2 and epsilon3 carriers). Two component attentional operations were selectively affected: (i) shifting spatial attention following invalid location cues, and (ii) adjusting the spatial scale of attention during visual search. These changes occurred only in the presence of the epsilon4 allele and without decline in other aspects of attention (vigilance), memory, or general cognition. The results show that specific components of visual attention are affected by APOE genotype and that the course of cognitive aging is subject to selective alteration by a genetic trait.

Apolipoprotein E4↗
PubMed2000

Complementary neural mechanisms for tracking items in human working memory.

Recognition of a specific visual target among equally familiar distracters requires neural mechanisms for tracking items in working memory. Event-related functional magnetic resonance imaging revealed evidence for two such mechanisms: (i) Enhanced neural responses, primarily in the frontal cortex, were associated with the target and were maintained across repetitions of the target. (ii) Reduced responses, primarily in the extrastriate visual cortex, were associated with stimulus repetition, regardless of whether the stimulus was a target or a distracter. These complementary neural mechanisms track the status of familiar items in working memory, allowing for the efficient recognition of a currently relevant object and rejection of irrelevant distracters.

Cerebral Cortex↗
PubMed2000

Alzheimer disease constricts the dynamic range of spatial attention in visual search.

A cued visual search task was used to examine the dynamic range over which spatial attention affects target identification during visual search. Precues varied in validity (valid, invalid, or neutral) and in precision (cue size) of target localization. Participants were "young-old" (65-74 years) and "old-old" (75-85 years) elderly adults and individuals in the mild stage of dementia of the Alzheimer type (DAT). For all participants, search was speeded as the precision with which a precue surrounding the location of a subsequently appearing target increased (precue size decreased). The cue size effect was evident in both feature and conjunction search, but was greatly reduced in both old-old and DAT groups compared to the young-old. However, whereas all non-demented adults showed a progressive modulation of search efficiency over the entire range of cue sizes, the dynamic range of spatial attention was restricted to the most precise cue in the DAT group. The restriction in the dynamic range of spatial attention may represent an underlying component of the impairment in perceptual and memory functioning found in early-stage DAT.

Adult↗
PubMed2000

Acetylcholine affects the spatial scale of attention: evidence from Alzheimer's disease.

Location precues were used to manipulate the spatial scale of attention in visual search for a target in an array of letters in patients with dementia of the Alzheimer type (DAT) and in age-matched older controls. Cue size varied in the amount of spatial precision conferred. Scopolamine, a muscarinic antagonist, decreased overall arousal and broadened spatial attention after a precise precue (small and valid) to target location for DAT patients but not for controls, suggesting a selective effect for attentional impairment induced by cholinergic blockade. In contrast, physostigmine, a cholinesterase inhibitor, did not alter the distribution of spatial attention relative to no-drug baseline testing for patients. Results support a differential role for cholinergic mechanisms in the modulation of the spatial scale of visual attention.

Acetylcholine↗
PubMed2000

Designing automation for human use: empirical studies and quantitative models.

An emerging knowledge base of human performance research can provide guidelines for designing automation that can be used effectively by human operators of complex systems. Which functions should be automated and to what extent in a given system? A model for types and levels of automation that provides a framework and an objective basis for making such choices is described. The human performance consequences of particular types and levels of automation constitute primary evaluative criteria for automation design when using the model. Four human performance areas are considered--mental workload, situation awareness, complacency and skill degradation. Secondary evaluative criteria include such factors as automation reliability, the risks of decision/action consequences and the ease of systems integration. In addition to this qualitative approach, quantitative models can inform design. Several computational and formal models of human interaction with automation that have been proposed by various researchers are reviewed. An important future research need is the integration of qualitative and quantitative approaches. Application of these models provides an objective basis for designing automation for effective human use.

Automation↗
PubMed2000

A model for types and levels of human interaction with automation.

Technical developments in computer hardware and software now make it possible to introduce automation into virtually all aspects of human-machine systems. Given these technical capabilities, which system functions should be automated and to what extent? We outline a model for types and levels of automation that provides a framework and an objective basis for making such choices. Appropriate selection is important because automation does not merely supplant but changes human activity and can impose new coordination demands on the human operator. We propose that automation can be applied to four broad classes of functions: 1) information acquisition; 2) information analysis; 3) decision and action selection; and 4) action implementation. Within each of these types, automation can be applied across a continuum of levels from low to high, i.e., from fully manual to fully automatic. A particular system can involve automation of all four types at different levels. The human performance consequences of particular types and levels of automation constitute primary evaluative criteria for automation design using our model. Secondary evaluative criteria include automation reliability and the costs of decision/action consequences, among others. Examples of recommended types and levels of automation are provided to illustrate the application of the model to automation design.

Automation↗
PubMed2000

Fuzzy signal detection theory: basic postulates and formulas for analyzing human and machine performance.

Signal detection theory (SDT) assumes a division of objective truths or "states of the world" into the nonoverlapping categories of signal and noise. The definition of a signal in many real settings, however, varies with context and over time. In the terminology of fuzzy logic, a real-world signal has a value that falls in a range between unequivocal presence and unequivocal absence. The definition of a response can also be nonbinary. Accordingly the methods of fuzzy logic can be combined with SDT, yielding fuzzy SDT. We describe the basic postulates of fuzzy SDT and provide formulas for fuzzy analysis of detection performance, based on four steps: (a) selection of mapping functions for signal and response; (b) use of mixed-implication functions to assign degrees of membership in hits, false alarms, misses, and correct rejections; (c) computation of fuzzy hit, false alarm, miss, and correct rejection rates; and (d) computation of fuzzy sensitivity and bias measures. Fuzzy SDT can considerably extend the range and utility of SDT by handling the contextual and temporal variability of most real-world signals. Actual or potential applications of fuzzy SDT include evaluation of the performance of human, machine, and human-machine detectors in real systems.

Fuzzy Logic↗
PubMed2000

Human versus automation in responding to failures: an expected-value analysis.

A simple analytical criterion is provided for deciding whether a human or automation is best for a failure detection task. The method is based on expected-value decision theory in much the same way as is signal detection. It requires specification of the probabilities of misses (false negatives) and false alarms (false positives) for both human and automation being considered, as well as factors independent of the choice--namely, costs and benefits of incorrect and correct decisions as well as the prior probability of failure. The method can also serve as a basis for comparing different modes of automation. Some limiting cases of application are discussed, as are some decision criteria other than expected value. Actual or potential applications include the design and evaluation of any system in which either humans or automation are being considered.

Automation↗
PubMed1999

Age-related reduction in 3-D visual motion priming.

In 3 experiments, younger and older adults judged the perceived motion of three-dimensional (3-D) figures that rotated in depth either unambiguously or ambiguously. Both groups were found to be equivalent in judging the direction of single rotations of the simulated 3-D objects (Experiment 1). In Experiments 2 and 3, a single unambiguous rotation (prime) was followed 0-3200 ms later by an ambiguous rotation (target). Motion priming was indicated by the disambiguation of the second rotation by the first rotation. 3-D motion priming was initially found to be similar in young and old, but it rapidly reduced in the older participants compared to the younger ones. Using a nonluminance depth cue--occlusion--to induce 3-D motion, diminished contrast sensitivity in the elderly was ruled out as a cause of the reduced priming. The results show that 3-D motion priming exhibits robust age-related decline. An age-related decrease in temporal persistence may account for the reduction in 3-D motion priming in older adults.

Adult↗
PubMed1999

Selective review of key perioperative renal-electrolyte disturbances in chronic renal failure patients.

The medical care of chronic renal failure patients is often complicated by the comorbid conditions of hypertension and coronary artery disease in the perioperative period. The limitations on solute and water excretion imposed by renal dysfunction increase the susceptibility of this population to both salt deficit and surfeit, as well as hyponatremia and hypernatremia perioperatively. Accurate assessment and successful treatment of these complications in renal failure patients require understanding of the concept of electrolyte-free water, proper utilization of diuretics, and calculated prescription of fluid therapy. The presence of hyperkalemia in the adapted renal failure patient generally indicates a severe reduction in glomerular filtration, such that nonrenal hypokalemic treatments are imperative. IV calcium-based therapy and infusion of insulin with glucose represent the mainstays of immediate therapy, and sodium bicarbonate therapy should be given only when severe acidemia is present. Perioperative aggravation of preexistent hypertension is common. Rebound hypertension attributable to injudicious adjustment of the medical regimen should be diligently searched for first, before any new therapies are recommended. Relief of pain or anxiety may be all that is necessary. Briefly acting calcium channel blocker therapy should not be employed in these cases, and smooth IV control by a variety of agents is preferable, the choice of the agent contingent on the clinical scenario.

Antihypertensive Agents↗
PubMed1999

Scale of attentional focus in visual search.

The effects of the spatial scale of attention on feature and conjunction search were examined in two experiments. Adult participants in three age groups--young, young-old, and old-old--were given precues of varying validity and precision in indicating the location of a target letter subsequently presented in a visual array. Systematic decreases in the size of a valid precue (toward the size of the target) progressively facilitated both feature and conjunction search, with a greater benefit accruing to conjunction search. Age-related slowing in conjunction search was mitigated by precise (small and valid) precues, presumably because they reduced the need for participants in the young-old group to focus and to shift attention. Nevertheless, this benefit was reduced in the old-old group. The effects of valid location precue size varied with cue-target stimulus onset asynchrony (SOA) in a manner that interacted with search difficulty: Effects of cue size developed more rapidly in feature search but more slowly in conjunction search. Finally, when precues were invalid for target location, search was faster with larger sized precues. Thus, in both easy feature search and hard conjunction search, the scale of visuospatial attention modulates the speed of visual search. Furthermore, when the SOA is sufficiently long for cue effects to develop, the ability to dynamically adjust the scale of visuospatial attention appears to decline in advanced age. These results go beyond current models in suggesting that visuospatial attention possesses two dynamic properties--shifting in space and varying in scale--that are deployed independently, depending on task demands.

Adolescent↗
PubMed1997

Automation-induced monitoring inefficiency: role of display location.

Operators can be poor monitors of automation if they are engaged concurrently in other tasks. However, in previous studies of this phenomenon the automated task was always presented in the periphery, away from the primary manual tasks that were centrally displayed. In this study we examined whether centrally locating an automated task would boost monitoring performance during a flight-simulation task consisting of system monitoring, tracking and fuel resource management sub-tasks. Twelve nonpilot subjects were required to perform the tracking and fuel management tasks manually while watching the automated system monitoring task for occasional failures. The automation reliability was constant at 87.5% for six subjects and variable (alternating between 87.5% and 56.25%) for the other six subjects. Each subject completed four 30 min sessions over a period of 2 days. In each automation reliability condition the automation routine was disabled for the last 20 min of the fourth session in order to simulate catastrophic automation failure (0 % reliability). Monitoring for automation failure was inefficient when automation reliability was constant but not when it varied over time, replicating previous results. Furthermore, there was no evidence of resource or speed accuracy trade-off between tasks. Thus, automation-induced failures of monitoring cannot be prevented by centrally locating the automated task.

Adolescent↗