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PubMedDate not supplied

Effects of information processing demands on slow negative shift latencies and N100 amplitude in selective and divided attention.

The influence of information processing demands on auditory event-related potentials (ERPs) in selective and divided attention was examined by varying the stimulation rate and target difficulty in a two-channel discrimination task. Subjects were required to detect targets in either one or both ears (channels) in a series of tones presented randomly to both ears. The amplitude of the N100 component (latency 80-140 msec) of the ERP to all stimuli in an attended channel was greater if attention was focused on that channel that if it was directed to the opposite channel. N100 amplitude was also reduced in divided attention compared to focused attention. In general, these effects were obtained only if the stimulation rate was high and/or targets were difficult to detect. However, these effects of attention modulated an underlying slow negative shift (SNS) rather than N100 directly. The onset and peak latencies of the SNS were strongly dependent on the processing demands of the task. The results show that the temporal relationship of the SNS to the N100 component is the principal factor responsible for variations in the effects of attention on the ERP with changes in information processing demands. The relationship between these ERP components and resource allocation theories of attention is discussed.

Adolescent↗

PubMed1988

Implications of ERP data for psychological theories of attention.

The contribution of the event-related potential (ERP) research to understanding human selective attention will be evaluated. A closely related issue, the starting point of the present treatment, involves the nature and extent of automaticity in information processing. The mismatch-negativity component of the ERP suggests that the basic, obligatory, processing of the physical features of auditory stimuli is unaffected by the direction of attention. These data also reveal a possible mechanism for attention switching to stimulus change occurring in the unattended input, observed by cognitive psychologists. The N1 wave of the ERP might in turn provide a data base for explaining similar attention switches to stimulus onsets after breaks in stimulation and to offsets of long-duration stimuli. With regard to selective attention, the processing negativity might make it possible to delineate the central principle of stimulus selection in attention, a goal probably inaccessible to non-physiological attention research. In the visual modality, cognitive psychologists have found that spatial attention is more fundamental and powerful in stimulus selection than any other form of visual selective attention. Consistently, ERP data show that the exogenous components in vision are enhanced by spatial selective attention but not when attended and unattended stimuli are not spatially separated. Also, ERP data (the P3 wave) give support to certain forms of resource-allocation theories of attention. In addition, with regard to the currently popular distinction between automatic versus controlled processing, these data strongly suggest that extended consistent-mapping training does not lead to a "genuine" automatization of a search process in the sense of independence of a limited-capacity system.

Attention↗

PubMed1992

Time effects on event-related brain potentials and vigilance performance.

A review of the literature showed that in vigilance or oddball tasks, changes over time in event-related potentials (ERPs) and performance measures often seem to be unrelated, but a number of studies had some shortcomings. In the present study a visual vigilance experiment was carried out, in which single-trial ERPs and performance data of 40 males were obtained. A relationship between time trends in behavioral and ERP measures was found: an early P3 amplitude and response latency (RT) showed an inversely varying relation over time. Analysis of covariance showed that the two linear trends tap the same aspect of processing: both trends became insignificant when adjusted for common variance. A negative correlation between mean values of P3 amplitude and RT rather than for change scores has been observed in previous studies, but has been ignored in the literature. However, correlations with RT have also been reported for other ERP deflections. Although there were several correlations between mean scores, most time-induced changes in ERP parameters appeared to be unrelated to worsening performance, for which several explanations are advanced. The ERP results do not support the hypothesis that a decrement in performance is caused by increasing difficulty discriminating targets from nontargets. A gradual decline in effort or resources allocated to the task might be an alternative explanation of performance deterioration. However, an effort-hypothesis cannot easily be tested. Effort is often invoked post hoc, and has previously been associated with many ERP components. The relationship between ERPs and the signal detection measures "sensitivity" d' and "response bias" beta is discussed.

Adolescent↗

PubMed1995

Concepts and applications of EEG analysis in aviation performance evaluation.

Quantitative studies of the human EEG during signal detection, flight simulation and actual flight performance tasks are reviewed here from the perspective of basic animal research on the neurophysiological and functional correlates of relevant rhythmic patterns. Evidence is examined which relates distinct EEG frequency changes to psychomotor behavior, signal processing and intrinsic attentional modulation during complex performance. Findings indicate that the EEG can provide a valid and objective index for mental effort but, in addition, may reveal task-related cognitive resource allocation, task mastery and task overload.

Adult↗

PubMed1995

A psychophysiological inquiry into the nature of the Sokolovian orienting response comparator model: skin conductance and EEG data.

The mechanisms which trigger the orienting response (OR) are still the subject of lively debate. Sokolov (1990) proposes the development of a multidimensional model of the physical parameters of stimulation. Recent OR research has shown that the skin conductance OR (SCOR) is related to task demands and controlled processing, although this is not so clear for central physiological indexes of orienting. Seventy-three subjects performed visual discriminations of stimuli within a warning-stimulus paradigm. The physical complexity of stimuli and their task relevance were manipulated within subjects, while the nonspecific effects of workload were controlled with a group factor. SCORs were measured concurrently with 1-s epochs of EEG alpha and theta power from Fz, Cz, Pz, and Oz. Neither index was reliably affected by the physical complexity of stimulation alone. However, both higher task relevance and higher workload significantly increased the magnitude of EEGORs and SCORs. Task averages of central and autonomic activity showed an overall pattern of covariation, but a second-by-second breakdown of EEG spectra suggests that the SCOR may be an aggregate of the activation of diverse brain mechanisms responsible for physiological orienting. The results are consistent with a model of orienting as a continuous dimension of resource allocation to anticipated and current task demands, rather than with the abrupt dichotomy between voluntary and involuntary orienting. Implications for the classical OR Sokolovian model are discussed.

Analysis of Variance↗

PubMed1995

Psychological and social aspects of burns.

Although the literature on the psychological consequences of burns is fairly extensive, the evidence gathered by the charity 'Changing Faces' over the last 2 years suggests that the resources allocated to psychological rehabilitation are still far from adequate. This article draws on the personal experience of one of the authors who was in a car fire 24 years ago, reviews some of the literature, briefly looks at the work done by Changing Faces and discusses some of the tasks of the 'burns team'. The authors are aware that generalizations about the consequences of burns are fraught with risk because every fire has its own causes and complications, but it is hoped that the themes expressed here do raise important general points.

Burns↗

PubMed1989

Modeling for policy decisions: potential and problems.

Because decision modeling involves the construction of an explicit, mathematically describable structure of the pertinent elements of a clinical problem, the relative effectiveness of alternative approaches to care can be identified; costly procedures become apparent; new technologies can be assessed in relation to the old in terms of effectiveness and costs; the marginal benefit to be achieved by duplicative or alternative practices can be determined. All of this can be accomplished in terms of patient outcome and without the bias and self-interest of which the profession has been accused. Furthermore, if a resource allocation or reimbursement decision made in the name of cost containment eliminates or limits access to effective diagnostic or therapeutic technologies, the impact of that decision on effective care can be explicitly and quantitatively expressed through decision modeling. When such analyses are based on patient outcome, they are difficult to ignore and provide a pivotal point for discussions and eventual compromise.

Decision Support Techniques↗

PubMed1995

Development and validation of simplified predictive index for major complications in contemporary percutaneous transluminal coronary angioplasty practice. The Registry Committee of the Society for Cardiac Angiography and Interventions.

OBJECTIVES: This study was designed to determine the preprocedural risk factors for major complications (emergent coronary bypass surgery, myocardial infarction or death) of coronary angioplasty and to derive and validate a simplified index that predicts patients' a priori risk of complications. BACKGROUND: Previous studies of risk factors for complications after coronary angioplasty may not be generalizable to current, broad-based angioplasty practice. Furthermore, to our knowledge a clinically useful predictive index has not been derived and independently validated. METHODS: From data collected prospectively for the Registry of the Society for Cardiac Angiography and Interventions for 1992, multivariable logistic regression was used to determine which variables were independently associated with complications in 10,622 first angioplasty procedures. Stepwise regression and receiver operating characteristic curves then were used in this registry to develop a predictive index for complications that was validated using 5,250 first angioplasty procedures in the 1993 registry. RESULTS: Predictors of major complications were multivessel disease, unstable angina, recent myocardial infarction, type C lesion or left main angioplasty, shock, age, geographic region and absence of previous coronary bypass surgery. The derived predictive index consisted of the first six of these variables plus aortic valve disease and classified patients into four risk groups: low (1.3% complications), moderate (2.8%), high (12.7%) and very high (29.7%) risk. This index demonstrated consistent reliability and discriminatory ability when applied to the 1993 data. CONCLUSIONS: Predictors of major complications identified in selected populations also apply currently in broad-based practice. From these variables, a predictive index can stratify patients into risk groups before angioplasty, thus aiding in risk assessment, resource allocation and risk adjustment.

Angioplasty, Balloon, Coronary↗

PubMed1992

The status of psychosocial research in the rehabilitation of the cancer patient.

This article has tried to describe the current status of psychosocial research in the rehabilitation of the cancer patient. It attempted to weave together the author's perspective of how decisions early in the history of sponsored research programs, particularly by the National Cancer Institute, combined with a limited knowledge base led to limited growth of the Rehabilitation Program. Thus, the current status of psychosocial cancer rehabilitation can be reasonably attributed to the decision at the National Cancer Institute to encourage the development of cancer rehabilitation services, rather than to aggressively expand the knowledge base. Although, in retrospect, it is possible to criticize these decisions, in fact, they were legitimate choices among a wide range of options. It was also not possible in this article to discuss many topics in psychosocial cancer rehabilitation, particularly differences in psychosocial adjustment as a function of type of cancer. What the study attempted to do was to confront the impression that cancer rehabilitation, in general, and psychosocial cancer rehabilitation, in particular, are ancillary activities that can receive a secondary level of resource allocation and support. The point was made that determining if psychosocial rehabilitation is possible raises as many basic research questions as does understanding how chemotherapy works or how a malignancy develops. All three areas ask legitimate basic research questions on how the body works and how behavior changes. Today, 10 years after the start of the original Rehabilitation Program, psychosocial cancer rehabilitation is an established field of study and an integral part of most major oncology services. Now, as stated, what is needed is an expansion of its knowledge base. Some of the issues that are deserving of support include studies on cosmesis, to what extent voluntary processes can compensate loss in speech and swallowing functions, functional evaluation following alternative surgical procedures, what is the quality of life following long-term survival of cancer, what are the group dynamics following return of a cancer patient to a work site, and so on. Each of these research questions can be guided by the same model developed for cancer control research by Greenwald and Cullen. Other more general approaches include recognizing and promoting the preventative dimension of cancer rehabilitation and developing the art and practice of psychometric assessment of psychosocial aspects of cancer rehabilitation, just to name two such areas. The American Cancer Society also recently sponsored a meeting to review and set new directions for psychosocial rehabilitation research.(ABSTRACT TRUNCATED AT 400 WORDS)

Health Services Needs and Demand↗

PubMedDate not supplied

End of life care in Duchenne muscular dystrophy.

End of life care for patients with Duchenne muscular dystrophy (DMD) has become increasingly complex because of new technologies, changes in medical personnel over periods of time, emergence of home health care systems, and increasing patient and family autonomy in decision-making. In this review, we discuss the medical problems, particularly respiratory and cardiac failure, faced by DMD patients. Current concepts concerning the evaluation and options for treatment of these problems are presented as well as the ethical issues involved in the care of the DMD patient. These issues include the medical indications for treatment, patient preferences, quality-of-life issues, and contextual features related to legal, institutional, religious, geographic, cultural, social, and financial factors. We also present our experience at Loma Linda University Medical Center over the past 10 years in the development of a home mechanical ventilation program for DMD patients and an algorithm for the evaluation of these patients. Many patients with DMD do well on long-term ventilation, but some find that their quality of life is less than desirable and choose to discontinue this method of life-prolongation. Many of these new options are very expensive, making the decision to use them a difficult one. Ultimately, these are societal issues that require clear reflection on matters of resource allocation that should be performed by health care professionals, citizens, and health planners.

Adolescent↗

PubMed1994

Replicating the chronic disease score (CDS) from automated pharmacy data.

Michael Von Korff and colleagues at the Center for Health Studies, Group Health Cooperative (GHC) of Puget Sound created a measure of chronic disease status (CDS) using automated outpatient pharmacy data. They reported the measure appeared to provide a stable and valid measure of health status. The availability of such a measure could become a new tool for a variety of applications, including screening, resource allocation, and quality assurance. The measure was replicated for its reliability and construct and predictive validity in the KPNW membership using automated pharmacy data. Reliability and validity were tested using correlation and regression techniques. The CDS showed test-retest reliability over time. It showed construct validity with the RAND-36 instrument and the BSI-8 depression screener. It showed predictive validity with health care visits and hospitalizations. The results were similar to those at GHC. The findings indicated that the CDS can serve, with certain precautions, as a readily accessible low cost measure of health status.

Chronic Disease↗

PubMed1994

Effects of clozapine, fluphenazine, and placebo on reaction time measures of attention and sensory dominance in schizophrenia.

Two reaction time (RT) paradigms were used to study clozapine's effects on sustained and selective attention compared to fluphenazine and placebo in 25 chronic schizophrenic patients. Sensory dominance was studied via simple and choice RTs to lights and tones, and on double-stimulus trials in which the two stimuli were presented simultaneously. Although 8 of the 25 patients could not perform the RT tasks when taking placebo, there were no effects of clozapine on simple or choice RT compared to placebo or fluphenazine. Subjects on all 3 treatments showed visual dominance: faster RT to lights than to tones on choice and double-stimulus trials. However, clozapine reduced this by means of a selective increase in RT to lights. Clozapine reduced failures to respond to the tone on double-stimulus trials. This was shown to be due to reductions in hallucinations. Clozapine does not generally improve attention, but it may increase the ability of schizophrenic persons to process nondominant or unattended stimuli possibly by increasing the efficiency of resource allocation. This may be partially mediated by a reduction in hallucinations.

Adult↗

PubMed2005

Towards a general theory of driver behaviour.

Taylor [Taylor, D.H., 1964. Drivers' galvanic skin response and the risk of accident. Ergonomics 7, 439-451] argued that drivers attempt to maintain a constant level of anxiety when driving which Wilde [Wilde, G.J.S., 1982. The theory of risk homeostasis: implications for safety and health. Risk Anal. 2, 209-225] interpreted to be coupled to subjective estimates of the probability of collision. This theoretical paper argues that what drivers attempt to maintain is a level of task difficulty. Naatanen and Summala [Naatanen, R., Summala, H., 1976. Road User Behaviour and Traffic Accidents. North Holland/Elsevier, Amsterdam, New York] similarly rejected the concept of statistical risk as a determinant of driver behaviour, but in so doing fell back on the learning process to generate a largely automatised selection of appropriate safety margins. However it is argued here that driver behaviour cannot be acquired and executed principally in such S-R terms. The concept of task difficulty is elaborated within the framework of the task-capability interface (TCI) model, which describes the dynamic interaction between the determinants of task demand and driver capability. It is this interaction which produces different levels of task difficulty. Implications of the model are discussed regarding variation in performance, resource allocation, hierarchical decision-making and the interdependence of demand and capability. Task difficulty homeostasis is proposed as a key sub-goal in driving and speed choice is argued to be the primary solution to the problem of keeping task difficulty within selected boundaries. The relationship between task difficulty and mental workload and calibration is clarified. Evidence is cited in support of the TCI model, which clearly distinguishes task difficulty from estimates of statistical risk. However, contrary to expectation, ratings of perceived risk depart from ratings of statistical risk but track difficulty ratings almost perfectly. It now appears that feelings of risk may inform driver decision making, as Taylor originally suggested, but not in terms of risk of collision, but rather in terms of task difficulty. Finally risk homeostasis is presented as a special case of task difficulty homeostasis.

Accidents, Traffic↗

PubMed2005

Estimating crashes involving heavy vehicles in Western Australia, 1999-2000: a capture-recapture method.

A two-sample exploratory study of police and hospital records was undertaken to estimate the number of fatalities and serious injuries for heavy vehicle drivers involved in a crash in Western Australia. The capture-recapture method was used to assess differences and similarities in characteristics of heavy vehicle drivers from both sources. Each heavy vehicle driver involved in a crash from the police report was matched against the heavy vehicle driver's hospitalisation record from the Hospital Morbidity Data System, with surname, initials, date of birth, gender, date of crash, road user type and vehicle type as matching fields. The estimated number of fatalities and serious injuries to heavy vehicle drivers from 1st July 1999 to 31st December 2000 was 5 and 59, respectively, which was 25 and 31% higher based on the capture-recapture methodology than the aggregated (non-overlapping) total officially reported to the police and hospitals. No significant age difference (p>0.05) was found for drivers involved in a heavy vehicle crash between the two sources (37 years versus 40 year of age). However, female heavy vehicle drivers were over-represented in the hospital records (11%) compared to the police records (1%). The capture-recapture approach is useful for evaluating the completeness of data sources and identifying biases within datasets. The underestimation of heavy vehicle drivers seriously injured and killed has important implications for heavy vehicle safety management and resource allocation in Western Australia.

Accidents, Traffic↗

PubMed2004

Meeting recommendations for multiple healthy lifestyle factors. Prevalence, clustering, and predictors among adolescent, adult, and senior health plan members.

BACKGROUND: Whereas much is known about single lifestyle-related health risk factor prevalence and covariates, more research is needed to elucidate the interactions among multiple healthy lifestyle factors and variables that may predict adherence to these factors. Such data may guide both clinical and health policy decision making and person-centered approaches to population health improvement. METHODS: We document the prevalence and cluster patterns of multiple healthy lifestyle factors among a random sample of adolescents (n =616), adults (n =585), and seniors (n =685) from a large Midwestern health plan. Modifiable, lifestyle-related health factors assessed included physical activity, nonsmoking, high-quality diet, and healthy weight for all subjects; adults and seniors were also asked about their alcohol consumption. Second, we sought to identify characteristics associated with the likelihood of meeting recommendations for healthy lifestyle factors. The healthy lifestyle factors sum score was categorized into three levels, that is, 0 to 2, 3, or 4 to 5 healthy lifestyle factors (4 for adolescents), and we used ordinal logistic regression to estimate the odds of meeting each of these criteria from several demographic characteristics and disease states. RESULTS: Overall, only 14.5% of adolescent, adult, and senior health plan members meet recommended guidelines for four common healthy lifestyle factors. Only 10.8% of adults and 12.8% of seniors met all five behavior-related factors. For adolescents, only being nondepressed was associated with an increased likelihood to be in adherence to multiple healthy lifestyle factors (odds ratio [OR]=2.15; p <0.05). For adults, being in the 50- to 64-year-old cohort (OR=1.46, p<0.05), having a college degree (OR=1.65; p <0.05), and having no chronic disease (OR=1.92; p <0.05) were all associated with an increased likelihood to be in adherence to multiple healthy lifestyle factors. For seniors, having a college degree (OR=1.61; p <0.05), was the only variable associated with an increased likelihood to be in adherence to multiple healthy lifestyle factors. CONCLUSIONS: A small proportion of health plan members meet multiple recommended healthy lifestyle guidelines at once. This analysis identifies population subgroups of specific interest and importance based on adherence to multiple healthy lifestyle factors, and predictors for increased likelihood to be in adherence to multiple healthy lifestyle factors. It presents a potentially useful summary measure based on person-centered measures of healthy lifestyle factors. Clinicians may derive meaningful information from analyses that address adherence to multiple healthy lifestyle factors. Health systems administrators may use this information to influence health policy and resource allocation decisions. Further studies are needed to assess the usefulness of this comprehensive lifestyle-related health measure as a metric of progress toward public health goals, or as a clinical metric that conveys information on future health status and directs interventions at the individual level.

Adolescent↗

PubMed2005

The polyp detection rate of colonoscopy: a national study of Medicare beneficiaries.

National-level data on the proportion of colonoscopies in routine practice that result in polyp detection are limited. Our goal was to determine the diagnostic yield of colonoscopy among population subgroups. We reviewed Medicare claims data for all fee-for-service beneficiaries 65 years or older who underwent colonoscopy in 1999. With the use of diagnosis and procedure codes, the proportion of procedures with polyps was estimated. Three different criteria for polyp detection were used. Approximately 1.8 million colonoscopy procedures were identified. Depending on the specific criteria used, 23.9% to 35.7% of examinations noted polyps. The detection rate was highest in younger patients, men, and whites. The apparent yield of colonoscopy in terms of polyp detection is at least 24%. These data may be informative in predicting resource allocation for therapeutic procedures associated with colonoscopy. Future studies should determine the use and yield of serial colonoscopies for polyp surveillance.

Age Factors↗

PubMed2005

A population-based assessment of major trauma in a large Canadian region.

BACKGROUND: The cause of major trauma has not been well defined using population-based methodologies. METHODS: We performed a population-based surveillance of major traumatic injuries in adult residents of the Calgary Health Region over a period of 3 years. RESULTS: A total of 1,475 victims of major trauma were identified (69.5 per 100,000/y). Males were at significantly higher risk as compared with females (104.5 vs. 35.2 per 100,000; relative risk = 3.0, 95% confidence interval = 2.64-3.35), as were urban as compared with rural residents (70.7 vs. 49.0 per 100,000; relative risk = 1.4; 95% confidence interval = 1.11-1.91). A strikingly high incidence rate of major trauma was observed among those aged 85 years or more at 242.3 per 100,000 per year; elderly men were at 16.8-fold (95% confidence interval = 11.04-24.79) higher risk than young females. The majority were unintentional (53.9 per 100,000/y). Suicide, assault, and homicide occurred at annualized rates of 8.5, 4.8, and 1.6 per 100,000, respectively. Motor vehicle-related injuries (39%), falls or jumps (33%), and being struck by an object or animal (10%) were responsible for the majority of traumas. Firearm injuries were relatively uncommon (2.0 per 100,000/y). The annual mortality rate was 20.0 per 100,000. CONCLUSIONS: This study provides rigorous, population-based data on the cause of severe injury in the Calgary Health Region. It is hoped that ongoing work in this area will be useful in the development of effective injury prevention and health resource allocation strategies.

Adolescent↗

PubMed2006

Early predictors of prolonged mechanical ventilation in major torso trauma patients who require resuscitation.

BACKGROUND: The study purpose was to identify early predictors of prolonged mechanical ventilation in major torso trauma patients. METHODS: This was a retrospective review of torso trauma patients who met specific criteria for shock resuscitation and required 48 hours of mechanical ventilation. Independent variables evaluated included patient demographics, injury characteristics, and initial 24-hour resuscitation parameters. Univariate and multivariate logistic regression analyses were performed using a significance level of P <.05. RESULTS: Over 59 months, 224 patients met study criteria. Age was 34 years (range 25 to 69), 68% were male, 78% sustained blunt trauma, and injury severity score was 27 (range 18 to 38). Thirty-three percent required prolonged mechanical ventilation. In the analysis, predictors of prolonged mechanical ventilation included total fluid resuscitation, facial trauma, age, positive end-expiratory pressure > or =10 mm Hg on admission, arterial partial pressure of oxygen divided by the fraction of inspired oxygen ratio less than 300 at 24 hours, and chest abbreviated injury scale score. CONCLUSIONS: The need for prolonged mechanical ventilation can be accurately predicted and these predictors may assist clinicians in resource allocation and patient management decisions.

Adult↗