A multitasking assessment for aphasia: The Catalog Ordering Task

Multitasking assessments based on everyday scenarios are useful assessment tools that can reveal the consequences of language and cognitive impairments on functioning. Unfortunately, many existing multitasking assessments require a high degree of linguistic processing that may preclude their use with adults with aphasia. The purposes of this paper are to (1) describe the development of a multitasking assessment relevant to everyday activities, the Catalog Ordering Task (COT), specifically designed for aphasia, (2) investigate differences between the performances of adults without aphasia and adults with aphasia on the COT, and (3) explore the relationships between language and cognitive performances and the COT to facilitate clinical utility. Seventy-four participants, 40 adults with aphasia and 34 people without aphasia, completed the multitasking assessment in single and dual task conditions. The secondary task in the dual task condition was a tone detection task requiring a foot-pedal press. Participants with aphasia also completed additional language and cognitive assessments. We systematically developed the Catalog Ordering Test (COT) with considerations for semantics, syntax, and ecological validity. Criterion validity with acceptable levels of inter-rater and test-retest reliability were observed. Adults with aphasia performed with about half the accuracy and twice as slowly as people without aphasia. Adults with all severity levels of aphasia were able to complete the COT. Multitasking performance on the COT was related to impairment-level measures of language and cognition. The COT is a potentially clinically useful assessment of multitasking, specially designed for aphasia.

The effects of multitasking on metacognitive monitoring in primary and secondary school students

Influenced by the epidemic and the rapid popularization of smart devices, media multitasking has become increasingly common in people's lives and has attracted the attention of researchers, particularly among adolescents who are native to the digital era. However, previous studies have focused primarily on the relationship between multitasking and general cognitive functions, paying less attention to the connection between multitasking and metacognition, and there is a lack of research specifically addressing adolescents in this context. To address this gap, the current study conducted two experiments with upper primary and secondary school students to explore the relationship between multitasking and adolescents' metacognition under intrinsic and extrinsic cue conditions using metacognitive monitoring as an indicator. The results revealed that multitasking significantly reduced adolescents' metacognitive monitoring accuracy. However, the scores on the media multitasking questionnaire did not significantly correlate with metacognitive monitoring accuracy in the laboratory task. This finding suggested that multitasking, under both intrinsic and extrinsic cue conditions, impairs the accuracy of metacognitive monitoring for primary and secondary school students. However, daily media multitasking activities among these students were not significantly correlated with metacognitive monitoring accuracy.

Exploring the challenges of avoiding collisions with virtual pedestrians using a dual-task paradigm in individuals with chronic moderate to severe traumatic brain injury

BACKGROUND

Individuals with a moderate-to-severe traumatic brain injury (m/sTBI), despite experiencing good locomotor recovery six months post-injury, face challenges in adapting their locomotion to the environment. They also present with altered cognitive functions, which may impact dual-task walking abilities. Whether they present collision avoidance strategies with moving pedestrians that are altered under dual-task conditions, however, remains unclear. This study aimed to compare between individuals with m/sTBI and age-matched control individuals: (1), the locomotor and cognitive costs associated with the concurrent performance of circumventing approaching virtual pedestrians (VRPs) while attending to an auditory-based cognitive task and; (2) gaze behaviour associated with the VRP circumvention task in single and dual-task conditions.

METHODOLOGY

Twelve individuals with m/sTBI (age = 43.3 ± 9.5 yrs; >6 mo. post injury) and 12 healthy controls (CTLs) (age = 41.8 ± 8.3 yrs) were assessed while walking in a virtual subway station viewed in a head-mounted display. They performed a collision avoidance task with VRPs, as well as auditory-based cognitive tasks (pitch discrimination and auditory Stroop), both under single and dual-task conditions. Dual-task cost (DTC) for onset distance of trajectory deviation, minimum distance from the VRP, maximum lateral deviation, walking speed, gaze fixations and cognitive task accuracy were contrasted between groups using generalized estimating equations.

RESULTS

In contrast to CTLs who showed locomotor DTCs only, individuals with m/sTBI displayed both locomotor and cognitive DTCs. While both groups walked slower under dual-task conditions, only individuals with m/sTBI failed to modify their onset distance of trajectory deviation and maintained smaller minimum distances and smaller maximum lateral deviation compared to single-task walking. Both groups showed shorter gaze fixations on the approaching VRP under dual-task conditions, but this reduction was less pronounced in the individuals with m/sTBI. A reduction in cognitive task accuracy under dual-task conditions was found in the m/sTBI group only.

CONCLUSION

Individuals with m/sTBI present altered locomotor and gaze behaviours, as well as altered cognitive performances, when executing a collision avoidance task involving moving pedestrians in dual-task conditions. Potential mechanisms explaining those alterations are discussed. Present findings highlight the compromised complex walking abilities in individuals with m/sTBI who otherwise present a good locomotor recovery.

Swimming with a head-mounted display: dual-task costs

Head-up displays (HUDs) have the potential to change work in operation environments by providing hands-free information to wearers. However, these benefits may be accompanied by trade-offs, primarily by increasing cognitive load due to dividing attention. Previous studies have attempted to understand the trade-offs of HUD usage; however, all of which were focused on land-based tasks. A gap in understanding exists when examining HUD use in aquatic environments as immersion introduces unique environmental and physiological factors that could affect multitasking. In this study, we investigated multitasking performance associated with swimming with a HUD. Eighteen participants completed three tasks: swimming only, a HUD-administered word recall task, and a dual-task combining both tasks. Results revealed significant dual-task interference in both tasks, though possibly less pronounced than in land-based tasks. These findings enhance not only help characterise dual-task performance, but also offer valuable insights for HUD design for aquatic settings.

Many-to-many mapping: A simulation study of how the number of traits and tasks affect the evolution of form and function

Many-to-many mapping of form-to-function posits that multiple morphological and physiological traits affect the performance of multiple tasks in an organism, and that redundancy and multitasking occur simultaneously to shape the evolution of an organism's phenotype. Many-to-many mapping is expected to be ubiquitous in nature, yet little is known about how it influences the evolution of organismal phenotype. The F-matrix is a powerful tool to study these issues because it describes how multiple traits affect multiple tasks. We undertook a simulation study using the F-matrix to test how the number of traits and the number of tasks affect trait integration and evolvability, as well as the relationships among tasks. We found that as the number of traits and/or tasks increases, the relationships between the tasks and the integration between the traits become weaker, and that the evolvability of the traits increases, all resulting in a system that is freer to evolve. We also found that as the number of traits increases, performance tradeoffs tend to become weaker, but only to a point. Our work shows that it is important to consider not only multiple traits, but also the multitude of tasks that those traits carry out when studying form-function relationships. We suggest that evolution of these relationships follows functional lines of least resistance, which are less defined in more complex systems, resulting in a mechanism for diversification.

Dual-tasking modulates movement speed but not value-based choices during walking

Value-based decision-making often occurs in multitasking scenarios relying on both cognitive and motor processes. Yet, laboratory experiments often isolate these processes, thereby neglecting potential interactions. This isolated approach reveals a dichotomy: the cognitive process by which reward influences decision-making is capacity-limited, whereas the influence of motor cost is free of such constraints. If true, dual-tasking should predominantly impair reward processing but not affect the impact of motor costs. To test this hypothesis, we designed a decision-making task in which participants made choices to walk toward targets for rewards while navigating past an obstacle. The motor cost to reach these rewards varied in real-time. Participants either solely performed the decision-making task, or additionally performed a secondary pitch-recall task. Results revealed that while both reward and motor costs influenced decision-making, the secondary task did not affect these factors. Instead, dual-tasking slowed down participants' walking, thereby reducing the overall reward rate. Hence, contrary to the prediction that the added cognitive demand would affect the weighing of reward or motor cost differentially, these processes seem to be maintained at the expense of slowing down the motor system. This slowdown may be indicative of interference at the locomotor level, thereby underpinning motor-cognitive interactions during decision-making.

The future of cardiovascular magnetic resonance: All-in-one vs. real-time (Part 1)

Cardiovascular magnetic resonance (CMR) protocols can be lengthy and complex, which has driven the research community to develop new technologies to make these protocols more efficient and patient-friendly. Two different approaches to improving CMR have been proposed, specifically "all-in-one" CMR, where several contrasts and/or motion states are acquired simultaneously, and "real-time" CMR, in which the examination is accelerated to avoid the need for breathholding and/or cardiac gating. The goal of this two-part manuscript is to describe these two different types of emerging rapid CMR. To this end, the vision of each is described, along with techniques which have been devised and tested along the pathway of clinical implementation. The pros and cons of the different methods are presented, and the remaining open needs of each are detailed. Part 1 will tackle the "all-in-one" approaches, and Part 2 the "real-time" approaches along with an overall summary of these emerging methods.

The future of CMR: All-in-one vs. real-time CMR (Part 2)

Cardiac Magnetic Resonance (CMR) protocols can be lengthy and complex, which has driven the research community to develop new technologies to make these protocols more efficient and patient-friendly. Two different approaches to improving CMR have been proposed, specifically "all-in-one" CMR, where several contrasts and/or motion states are acquired simultaneously, and "real-time" CMR, in which the examination is accelerated to avoid the need for breathholding and/or cardiac gating. The goal of this two-part manuscript is to describe these two different types of emerging rapid CMR protocols. To this end, the vision of all-in-one and real-time imaging are described, along with techniques which have been devised and tested along the pathway of clinical implementation. The pros and cons of the different methods are presented, and the remaining open needs of each are detailed. Part 1 tackles the "All-in-One" approaches, and Part 2 focuses on the "Real-Time" approaches along with an overall summary of these emerging methods.

Feasibility of Free-Breathing, Non-ECG-Gated, Black-Blood Cine Magnetic Resonance Images With Multitasking in Measuring Left Ventricular Function Indices

OBJECTIVE

To clinically validate the feasibility and accuracy of cine images acquired through the multitasking method, with no electrocardiogram gating and free-breathing, in measuring left ventricular (LV) function indices by comparing them with those acquired through the balanced steady-state free precession (bSSFP) method, with multiple breath-holds and electrocardiogram gating.

MATERIALS AND METHODS

Forty-three healthy volunteers (female:male, 30:13; mean age, 23.1 ± 2.3 years) and 36 patients requiring an assessment of LV function for various clinical indications (female:male, 22:14; 57.8 ± 11.3 years) were enrolled in this prospective study. Each participant underwent cardiac magnetic resonance imaging (MRI) using the multiple breath-hold bSSFP method and free-breathing multitasking method. LV function parameters were measured for both MRI methods. Image quality was assessed through subjective image quality scores (1 to 5) and calculation of the contrast-to-noise ratio (CNR) between the myocardium and blood pool. Differences between the two MRI methods were analyzed using the Bland-Altman plot, paired t-test, or Wilcoxon signed-rank test, as appropriate.

RESULTS

LV ejection fraction (LVEF) was not significantly different between the two MRI methods (P = 0.222 in healthy volunteers and P = 0.343 in patients). LV end-diastolic mass was slightly overestimated with multitasking in both healthy volunteers (multitasking vs. bSSFP, 60.5 ± 10.7 g vs. 58.0 ± 10.4 g, respectively; P < 0.001) and patients (69.4 ± 18.1 g vs. 66.8 ± 18.0 g, respectively; P = 0.003). Acceptable and comparable image quality was achieved for both MRI methods (multitasking vs. bSSFP, 4.5 ± 0.7 vs. 4.6 ± 0.6, respectively; P = 0.203). The CNR between the myocardium and blood pool showed no significant differences between the two MRI methods (18.89 ± 6.65 vs. 18.19 ± 5.83, respectively; P = 0.480).

CONCLUSION

Multitasking-derived cine images obtained without electrocardiogram gating and breath-holding achieved similar image quality and accurate quantification of LVEF in healthy volunteers and patients.

The effect of punishment and feedback on correcting erroneous behavior

INTRODUCTION

Understanding the consequences of non-punitive sanctions and feedback for nonintentional deviations (i.e., errors) is important to effective safety policy. This study aims to address a lack of research on the effects of punishment and feedback on correcting erroneous behavior in the context of multitasking.

METHOD

A Multi-Attribute Task Battery (MATB-II) was employed to simulate the demands of aviating, an important area of applied safety. Sixty participants were randomly assigned to one of four experimental groups (no intervention, punishment, feedback, punishment + feedback) and asked to perform the MATB-II. Punishment, feedback, and punishment + feedback decreased error and increased performance, with punishment alone having the greatest effect.

RESULTS

The results highlight the need for behavioral consequences or feedback to reduce erroneous behavior.

PRACTICAL APPLICATIONS

From an applied perspective, these results have implications for policy and training.

Examining post-error performance in a complex multitasking environment

Previous work on indices of error-monitoring strongly supports that errors are distracting and can deplete attentional resources. In this study, we use an ecologically valid multitasking paradigm to test post-error behavior. It was predicted that after failing an initial task, a subject re-presented with that task in conflict with another competing simultaneous task, would more likely miss their response opportunity for the competing task and stay 'tunneled' on the initially errored task. Additionally, we predicted that an error's effect on attention would dissipate after several seconds, making error cascades less likely when subsequent conflict tasks are delayed. A multi-attribute task battery was used to present tasks and collect measures of both post-error and post-correct performance. Results supported both predictions: post-error accuracy on the competing task was lower compared to post-correct accuracy, and error-proportions were higher at shorter delays, dissipating over time. An exploratory analysis also demonstrated that following errors (as opposed to post-correct trials), participants clicked more on the task panel of the initial error regardless of delay; this continued task-engagement provides preliminary support for errors leading to a cognitive tunneling effect.

Examining the Long-term Spillover Effects of a Pay-for-Performance Program in a Healthcare System That Lacks Referral Arrangements

BACKGROUND

Several studies have examined the intended effects of pay-for-performance (P4P) programs, yet little is known about the unintended spillover effects of such programs on intermediate clinical outcomes. This study examines the long-term spillover effects of a P4P program for diabetes care.

METHODS

This study uses a nationwide population-based natural experimental design with a 3-year follow-up period under Taiwan's universal coverage healthcare system. The intervention group consisted of 7688 patients who enrolled in the P4P program for diabetes care in 2017 and continuously participated in the program for three years. The comparison group was selected by propensity score matching (PSM) from patients seen by the same group of physicians. Each patient had four records: one pertaining to one year before the index date of the P4P program and the other three pertaining to follow-ups spanning over the next three years. Generalized estimating equations (GEEs) with difference-in-differences (DID) estimations were used to consider the correlation between repeated observations for the same patients and patients within the same matched pairs.

RESULTS

Patients enrolled in the P4P program showed improvements in incentivized intermediate clinical outcomes that persisted over three years, including proper control of glycated hemoglobin (HbA1c) and low-density lipoprotein cholesterol (LDL-C). We found a slight positive spillover effect of the P4P program on the control of non-incentivized triglyceride [TG]). However, we found no such effects on the non-incentivized high-density lipoprotein cholesterol (HDL-C) control.

CONCLUSION

The P4P program has achieved its primary goal of improving the incentivized intermediate clinical outcomes. The commonality in production among a set of activities is crucial for generating the spillover effects of an incentive program.

Biological stress responses to multitasking and work interruptions: A randomized controlled trial

In the course of digitalization, new stressors are emerging. In modern working and living environments, two ubiquitous, technology-mediated stressors are multitasking demands and work interruptions. However, biological stress response patterns to multitasking and work interruptions have been sparsely investigated so far. We thus aimed to comprehensively assess biological stress response patterns to both stressors and, additionally, test whether responses differ between digital and partially non-digital settings. A controlled experimental set-up was established and humans' biological markers of the Sympathetic Nervous System (SNS), the hypothalamic-pituitary adrenal (HPA) axis, and the immune system were assessed. N = 186 healthy participants (mean age: 23.2 ± 4.3 years, 74.7% female, body mass-index: 22.3 ± 3.1 kg/m2) took part in this pre-registered study. Each participant was randomly assigned to one of 6 experimental conditions (1 digital single-task, 3 dual-tasks [2 parallel tasks and 1 interruption], 1 multitasking, and 1 passive, control condition). Each one of the dual-tasking as well as the multitasking conditions included a non-digital sub-task, i.e., performing a task in presence of an examiner. All other conditions involved digital tasks only. Salivary alpha-amylase (sAA) levels as a marker for SNS reactivity significantly changed in work interruptions, parallel dual-tasking, and multitasking conditions. No changes were found for control conditions. Furthermore, no significant changes over time and no differences between the conditions were identified for three biological markers: cortisol as marker for HPA axis activity as well as for two immune system markers (secretory Immunoglobulin-A, C-reactive protein). A time course similar to sAA was found for perceived stress: with increases during task execution and decreases afterwards in multitasking and parallel dual-tasking. Yet, it did not change for the work interruption, passive control, and single-tasking condition. Overall, our findings show that dual- and multitasking are perceived as stressful and are associated with an activation of the SNS, but not with responses of HPA axis or immune system. This was consistent for digital as well as partially digital task demands. Our findings will also inform future research into the differential stress effects of digital and non-digital tasks to advance our understanding of biological stress response-patterns to multitasking and work interruptions. Therefore, our findings are highly relevant for understanding the long-term biological health effects of stress in modern (digitalized) environments.

Feasibility and acceptability of a new web-based cognitive training platform for cognitively healthy older adults: the breakfast task

BACKGROUND

Developing efficient cognitive training for the older population is a major public health goal due to its potential cognitive benefits. A promising training target is executive control, critical for multitasking in everyday life. The aim of this pilot study was to establish the feasibility and acceptability of the Breakfast Task training in older adults, a new web-based cognitive training platform that simulates real-life multitasking demands.

METHODS

A community-based sample of 24 cognitively healthy participants aged between 60 and 75 (M = 69.12, SD = 3.83) underwent 5-session cognitive training protocol, delivered online. Each session lasted 45 min and occurred twice a week at participant's homes. Performance was recorded, and participants completed questionnaires at baseline and after the intervention.

RESULTS

Feasibility metrics showed overall high recruitment (82.7%), adherence and retention rates (100%). Acceptability was considered good based on participant's quantitative and qualitative responses. On average, participants rated the game as interesting, enjoyable and did not report difficulties in accessing the game online without supervision or in understanding the instructions. Participants showed a learning curve across sessions, suggesting improvement in the game outcomes and potential benefits from the emphasis change training approach. The study identified relevant areas that need improvements and adjustments, such as technical issues, session's structure, and dose.

CONCLUSIONS

The findings provide preliminary support for the feasibility and acceptability of the web-based Breakfast Task training platform in cognitively healthy older adults. Results suggest the value of further research to investigate the Breakfast Task training features and dose-response relationship, as well as its potential efficacy in older adults via larger randomized controlled trials.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT04195230 (Registered 11 December 2019).

Spillover effects of financial incentives for providers onto non-targeted patients: daycase surgery in English hospitals

BACKGROUND

Incentives for healthcare providers may also affect non-targeted patients. These spillover effects have important implications for the full impact and evaluation of incentive schemes. However, there are few studies on the extent of such spillovers in health care. We investigated whether incentives to perform surgical procedures as daycases affected whether other elective procedures in the same specialties were also treated as daycases.

DATA

8,505,754 patients treated for 92 non-targeted procedures in 127 hospital trusts in England between April and March 2016.

METHODS

Interrupted time series analysis of the probability of being treated as a daycase for non-targeted patients treated in six specialties where targeted patients were also treated and three specialties where they were not.

RESULTS

The daycase rate initially increased (1.04 percentage points, SE: 0.30) for patients undergoing a non-targeted procedure in incentivised specialties but then reduced over time. Conversely, the daycase rate gradually decreased over time for patients treated in a non-incentivised specialty.

DISCUSSION

Spillovers from financial incentives have variable effects over different activities and over time. Policymakers and researchers should consider the possibility of spillovers in the design and evaluation of incentive schemes.

"It is a different type of policing than in the bush": Police officers' perceptions of the differences in enforcement of the phone use while driving legislation in rural and urban areas

Mobile phone use while driving continues to be a significant road safety concern, despite the severe legal countermeasures to reduce this behaviour. Phone use while driving-related crashes have been demonstrated to be an issue in rural areas, yet research into the impact of legal sanctions on phone use while driving has primarily focussed on urban areas. Therefore, this study aimed to investigate differences in enforcement of phone use while driving between rural and urban environments as reported by police officers. In addition, to provide necessary context, this study aimed to explore how the police officers perceive differences in drivers' engagement in phone use while driving between rural and urban environments. To address these aims, a total of 26 police officers from Queensland, Australia (18 with both rural and urban experience, 6 with only rural experience and 2 with only urban experience) completed an interview. A total of seven themes were developed from the data. Several differences between rural and urban environments were identified concerning different types of phone offending behaviour, as well as different resources, management and infrastructure that can impact police enforcement. For example, it was suggested that drivers in rural areas have less reasons to use their phone while driving. Nevertheless, when this behaviour does occur, it is more challenging to enforce this law in rural compared to urban environments. The results not only provide important contextual information for phone use while driving research, but also suggest that enforcement strategies for this behaviour may need to be recontextualised to incorporate the more nuanced aspects of rural policing.

Pushing the Bounds of Bounded Optimality and Rationality

All forms of cognition, whether natural or artificial, are subject to constraints of their computing architecture. This assumption forms the tenet of virtually all general theories of cognition, including those deriving from bounded optimality and bounded rationality. In this letter, we highlight an unresolved puzzle related to this premise: what are these constraints, and why are cognitive architectures subject to cognitive constraints in the first place? First, we lay out some pieces along the puzzle edge, such as computational tradeoffs inherent to neural architectures that give rise to rational bounds of cognition. We then outline critical next steps for characterizing cognitive bounds, proposing that some of these bounds can be subject to modification by cognition and, as such, are part of what is being optimized when cognitive agents decide how to allocate cognitive resources. We conclude that these emerging views may contribute to a more holistic perspective on the nature of cognitive bounds, as well as their alteration subject to cognition.

EchoEFNet: Multi-task deep learning network for automatic calculation of left ventricular ejection fraction in 2D echocardiography

Left ventricular ejection fraction (LVEF) is essential for evaluating left ventricular systolic function. However, its clinical calculation requires the physician to interactively segment the left ventricle and obtain the mitral annulus and apical landmarks. This process is poorly reproducible and error prone. In this study, we propose a multi-task deep learning network EchoEFNet. The network use ResNet50 with dilated convolution as the backbone to extract high-dimensional features while maintaining spatial features. The branching network used our designed multi-scale feature fusion decoder to segment the left ventricle and detect landmarks simultaneously. The LVEF was then calculated automatically and accurately using the biplane Simpson's method. The model was tested for performance on the public dataset CAMUS and private dataset CMUEcho. The experimental results showed that the geometrical metrics and percentage of correct keypoints of EchoEFNet outperformed other deep learning methods. The correlation between the predicted LVEF and true values on the CAMUS and CMUEcho datasets was 0.854 and 0.916, respectively.

Cognitive load decreases the sense of agency during continuous action

The sense of agency that normally accompanies voluntary actions depends on a combination of sensory predictions and other inferences. For example, when people manipulate moving objects and rate their degree of control, control ratings are influenced by proximal correlations between motor commands and visual feedback as well as the overall success or failure of the action. The relative importance of sensory predictions vs. post hoc feedback may depend on the availability and perceived reliability of those cues, which is context dependent. The present study investigated how increasing cognitive load during a visuomotor tracking task influences the sense of agency, and whether cognitive load influences the extent to which control ratings depend on sensory predictions vs. post hoc feedback. In Experiments 1 and 2, participants performed a dual task that involved tracking a moving target using a joystick while rehearsing 3, 5, or 7 digits. Control ratings decreased as memory set size increased, even though set size had no significant effect on objective tracking error. Experiment 3 replicated this finding while also manipulating the favorability of feedback presented after each trial. Control ratings were correlated with post hoc feedback, but there was no significant interaction between feedback and cognitive load. These results suggest that sensorimotor predictions, performance feedback, and availability of working memory resources can all influence sense of agency. The hypothesis that people rely more on post hoc feedback to rate control when they are distracted was not supported.

Is distraction on the road associated with maladaptive mobile phone use? A systematic review

Maladaptive Mobile Phone Use (MMPU) (also known as Smartphone Addiction, Nomophobia, Fear of Missing Out, or Problematic Mobile Phone Use) is a growing mental health problem. However, the health and safety consequences of MMPU remain unexplored in many real-life contexts. A potential setting where MMPU may have some negative repercussions is on the road. It is well established that road users (e.g., drivers, motorcyclists, pedestrians, and cyclists) increasingly injure themselves or others due to distractions such as phone use while on the road. Emerging research suggests that MMPU is a possible determinant of this risky behaviour. Therefore, it is essential to investigate the relationship between MMPU and mobile phone use behaviour on the road, as it could help guide and improve interventions aimed at increasing road safety. This systematic review investigated the relationship between maladaptive mobile phone use and mobile phone use behaviour on the road in terms of attitudes and risk perception, intention, phone use engagement, performance changes, and safety outcomes. A total of 44 studies were identified with 47 unique samples of road users, of which 68.1% (32/47) were comprised of drivers, 19.1% (9/47) were pedestrians, 8.5% (4/47) were unspecified road users, and there was one group of motorcyclists and cyclists. Our findings confirmed that MMPU is related to risky behaviour on the roads. In the 29 studies considering observed or self-reported behaviour, 90.9% (30/33) found that road users who scored higher in MMPU are more likely to use their phones on the road as cyclists, drivers, motorcyclists, and pedestrians. Of the nine studies that analysed performance changes, 55.6% (5/9) showed evidence that MMPU changes the performance of road users engaging in mobile phone use, meaning that there is evidence suggesting that MMPU determines the level of impairment. Of the nine studies that analysed the safety-related-outcomes, 66.7% (6/9) found that the higher the MMPU score, the more likely road users are to experience safety-critical traffic events. This review contributes to the literature by showing a pathway between the negative health consequences of MMPU and road trauma. We also identified that the quality of the studies was generally low due to study design and blinding aspects. This field of research also lacks standard practices as researchers avoid using established and well-validated questionnaires, often creating new ones to measure MMPU. This hinders the generalisability of the findings and raises questions about the construct validity and external validity of MMPU. The usefulness of future research would be enhanced by a consistent methodological approach using the same scales based on standard behavioural definitions. The cross-disciplinary nature of MMPU effects means that transport and road safety professionals need to work with healthcare professionals and technology organisations to understand and address MMPU as a contributing factor to road crashes.

EEG microstate changes according to mental fatigue induced by aircraft piloting simulation: An exploratory study

BACKGROUND

A continuous flight task load can induce fatigue and lead to changes in electroencephalography (EEG). EEG microstates can reflect the activities of large-scale neural networks during mental fatigue. This exploratory experiment explored the effects of mental fatigue induced by continuous simulated flight multitasking on EEG microstate indices.

METHODS

Twenty-four participants performed continuous 2-hour aircraft piloting simulation while EEG were recorded. The Stanford sleepiness scale (SSS) and critical flicker fusion frequency (CFF) were measured before and after the task. Microstate analysis was applied to EEG. Four microstate classes (A-D) were identified during the pre-task, post-task, beginning, and end phases. The effects of mental fatigue were analyzed.

RESULTS

Compared with the pre-task, the post-task had a higher global explained variance (GEV) and time parameters of class C but lower occurrence and coverage of class D. The end had a higher GEV but lower duration and coverage of class D than at the beginning. After 2 h of multitasking, the transition probability between A and D, and between B and D decreased but between A and C increased. Subjective fatigue scores were negatively correlated with occurrence and coverage of class D. Task performance was negatively correlated with duration and coverage of class C but positively correlated with duration and occurrence of class B.

CONCLUSION

Time parameters and transition probability of EEG microstates can detect mental fatigue induced by continuous aircraft piloting simulation. The global brain network activation of mental fatigue can be detected by EEG microstates that can evaluate flight fatigue.

The effects of dual-task interference on visual search and verbal memory

The operational costs of multitasking are more pressing given the increase in wearable technologies (head-up displays; HUDs) that facilitate multitasking. Often multitasking comes with performance costs, where the addition of more tasks impairs the performance of the tasks. The current study explored the extent to which multitasking interference can be characterised in simulated environments, as opposed to risky and harsh environments in real operational contexts. Forty-eight participants completed several trials where they performed a visual search task while navigating a simulated environment. There were three conditions: a standalone memory task, a standalone search task, and both tasks simultaneously. Results revealed significant dual-task interference when comparing the dual-task to each of the single-tasks. Results were corroborated by subjective workload and stress metrics. The results could prove useful for designing systems for individuals who routinely multitask in operational environments. Specifically, by furthering the understanding of their performance capabilities and trade-offs due to multitasking.Practitioner summary: Due to the demands of multitasking in operational environments, quantifying the degree of information lost on each task individually will aid in the understanding of the deficits of multitasking performance. This study shows that deficits in multi-tasking (via a HUD) can be understood in simulated environments to a similar degree as real-world tasks.

A Novel Multitasking Ant Colony Optimization Method for Detecting Multiorder SNP Interactions

MOTIVATION

Linear or nonlinear interactions of multiple single-nucleotide polymorphisms (SNPs) play an important role in understanding the genetic basis of complex human diseases. However, combinatorial analytics in high-dimensional space makes it extremely challenging to detect multiorder SNP interactions. Most classic approaches can only perform one task (for detecting k-order SNP interactions) in each run. Since prior knowledge of a complex disease is usually not available, it is difficult to determine the value of k for detecting k-order SNP interactions.

METHODS

A novel multitasking ant colony optimization algorithm (named MTACO-DMSI) is proposed to detect multiorder SNP interactions, and it is divided into two stages: searching and testing. In the searching stage, multiple multiorder SNP interaction detection tasks (from 2nd-order to kth-order) are executed in parallel, and two subpopulations that separately adopt the Bayesian network-based K2-score and Jensen-Shannon divergence (JS-score) as evaluation criteria are generated for each task to improve the global search capability and the discrimination ability for various disease models. In the testing stage, the G test statistical test is adopted to further verify the authenticity of candidate solutions to reduce the error rate.

RESULT

Three multiorder simulated disease models with different interaction effects and three real age-related macular degeneration (AMD), rheumatoid arthritis (RA) and type 1 diabetes (T1D) datasets were used to investigate the performance of the proposed MTACO-DMSI. The experimental results show that the MTACO-DMSI has a faster search speed and higher discriminatory power for diverse simulation disease models than traditional single-task algorithms. The results on real AMD data and RA and T1D datasets indicate that MTACO-DMSI has the ability to detect multiorder SNP interactions at a genome-wide scale. Availability and implementation: https://github.com/shouhengtuo/MTACO-DMSI/.

Mining context-aware resource profiles in the presence of multitasking

Healthcare organisations are becoming increasingly aware of the need to improve their care processes and to manage their scarce resources efficiently to secure high-quality care standards. As these processes are knowledge-intensive and heavily depend on human resources, a comprehensive understanding of the complex relationship between processes and resources is indispensable for efficient resource management. Organisational mining, a subfield of Process Mining, reveals insights into how (human) resources organise their work based on analysing process execution data recorded in Health Information Systems (HIS). This can be used to, e.g., discover resource profiles which are groups of resources performing similar activity instances, providing an extensive overview of resource behaviour within healthcare organisations. Healthcare managers can employ these insights to allocate their resources efficiently, e.g., by improving the scheduling and staffing of nurses. Existing resource profiling algorithms are limited in their ability to apprehend the complex relationship between processes and resources because they do not take into account the context in which activities were executed, particularly in the context of multitasking. Therefore, this paper introduces ResProMin-MT to discover context-aware resource profiles in the presence of multitasking. In contrast to the state-of-the-art, ResProMin-MT is capable of taking into account more complex contextual activity dimensions, such as activity durations and the degree of multitasking by resources. We demonstrate the feasibility of our method within a real-life healthcare context, validated by medical domain experts.

Does What Happens in the ED Stay in the ED? The Effects of Emergency Department Physician Workload on Post-ED Care Use

PROBLEM DEFINITION

Emergency department (ED) crowding has been a pressing concern in healthcare systems in the U.S. and other developed countries. As such, many researchers have studied its effects on outcomes within the ED. In contrast, we study the effects of ED crowding on system performance outside the ED-specifically, on post-ED care utilization. Further, we explore the mediating effects of care intensity in the ED on post-ED care use.

METHODOLOGY/RESULTS

We utilize a dataset assembled from more than four years of microdata from a large U.S. hospital and exhaustive billing data in an integrated health system. By using count models and instrumental variable analyses to answer the proposed research questions, we find that there is an increasing concave relationship between ED physician workload and post-ED care use. When ED workload increases from its 5th percentile to the median, the number of post-discharge care events (i.e., medical services) for patients who are discharged home from the ED increases by 5% and it is stable afterwards. Further, we identify physician test-ordering behavior as a mechanism for this effect: when the physician is busier, she responds by ordering more tests for less severe patients. We document that this "extra" testing generates "extra" post-ED care utilization for these patients.

MANAGERIAL IMPLICATIONS

This paper contributes new insights on how physician and patient behaviors under ED crowding impact a previously unstudied system performance measure: post-ED care utilization. Our findings suggest that prior studies estimating the cost of ED crowding underestimate the true effect, as they do not consider the "extra" post-ED care utilization.