The role of cue salience in prospective memory commission errors in nonperformed nonfocal tasks

Prospective memory (PM) refers to the ability to remember to execute an intention in the future without having a permanent reminder. These intentions can be performed when they are not relevant or become no-longer needed, the so-called "commission errors". The present study aims to understand the effect of cue salience on PM commission errors with unperformed intentions and on the ongoing task performance-associated costs. Through a between-subjects design, eighty-one participants were assigned to 3 conditions: the no-PM condition, which served as control, and the salient and nonsalient conditions, which were asked to perform a lexical decision task and an incomplete nonfocal prospective memory task (i.e. no PM cues were presented). Subsequently, participants were instructed to no longer execute the prospective intention. In the second phase, a lexical decision task occurred again, including irrelevant PM cues, which should not be answered as such. In the salient condition, cues were salient (i.e. presented in red or blue background). In contrast, in the nonsalient condition, PM cues appeared on a black background, as any other stimuli. In the no-PM control condition, participants only performed an LDT. A commission error occurred when the (irrelevant) intention was performed in this second phase. Results showed that more participants performed a commission error in the presence of salient cues, even when PM intentions became irrelevant. Additionally, when cues were not salient, participants took longer to answer the LDT, as reasoned by the spontaneous retrieval theory. These findings are discussed according to the dual-mechanism account.

Isolating the effects of visual imagery on prospective memory

Two experiments investigated the role of visual imagery in prospective memory (PM). In experiment 1, 140 participants completed a general knowledge quiz which included a PM task of writing a letter "X" next to any questions that referred to space. Participants either visualised themselves performing this task, verbalised an implementation intention about the task, did both, or did neither. Performance on the PM task was enhanced in both conditions involving visual imagery but not by implementation intentions alone. In experiment 2, 120 participants imagined themselves writing a letter "X" next to questions about space, or in a bizarre imagery condition imagined themselves drawing an alien next to those questions. Relative to the control condition, PM was significantly enhanced when participants imagined writing a letter "X" next to the target questions, but not by the bizarre imagery task. The findings indicate that the robust effects of imagery observed in retrospective memory also extend to PM.

Development of the Virtual Kitchen Protocol for Prospective Memory: a virtual reality-based measure of everyday prospective memory abilities

INTRODUCTION

Prospective memory is the ability to remember to accomplish a task at a specified point in the future. While this cognitive ability has a large impact on daily functioning, it is rarely assessed during neuropsychological evaluations. Furthermore, existing clinical prospective memory measures are few in number and have significant limitations, including applicability to everyday functioning and appropriate norming for older adulthood. There are also many gaps in the literature on prospective memory, such as how environmental factors affect performance across the lifespan.

METHOD

In the current study, we develop and establish a new virtual reality-based measure of prospective memory, the Virtual Kitchen Protocol for Prospective Memory. Young adults (ages 18-29; n = 56), healthy older adults (ages 60-90; n = 94), and clinical older adults (ages 62-90; n = 30) were compared on their performances on both the developed virtual reality prospective memory test and a parallel paper-and-pencil prospective memory test to investigate the impact of test environment across participant group.

RESULTS

The Virtual Kitchen Protocol for Prospective Memory was found to adequately differentiate between young adult, healthy older adult, and clinical older adult populations - suggesting baseline ability for prospective memory assessment in clinical settings with older adults and potential for future improvement of neuropsychological evaluations. Additionally, the developed virtual prospective memory task appeared to mimic environmental factors in everyday life but did not replicate the benefit previously measured in healthy older adults' prospective memory ability in naturalistic settings.

CONCLUSIONS

Overall, the current study built upon extant knowledge of prospective memory in both normal and abnormal aging, suggesting future directions in replicating familiar home environments. Findings provided additional evidence toward future validation of virtual reality assessment tools in clinical neuropsychological evaluations of cognitive abilities, such as prospective memory, with both healthy and clinical older adult populations.

Using EEG to investigate the influence of boredom on prospective memory in top-down and bottom-up processing mechanisms for intelligent interaction

We aimed to investigate the alpha (α) activity in operators experiencing boredom while performing prolonged monitoring and prospective memory tasks using different processing mechanisms. Fifty-four participants underwent electroencephalography (EEG) and were found to have poorer prospective memory performance under top-down conditions. Further, α power and synchronisation were higher during bottom-up than in top-down processes, revealing an inhibition effect of the former. Significant differences in brain regions and hemispheres were identified to distinguish different cognitive processes in both information-processing mechanisms. Thus, people are likely to cope with boredom differently in terms of top-down and bottom-up processes. Specifically, a higher attention level was reported during top-down processing, to mitigate the negative influences of boredom. Overall, this study provides EEG evidence which suggests that prospective memory can be enhanced in top-down processing during prolonged monitoring tasks by increasing the salience of cues.

Evidence accumulation modelling in the wild: understanding safety-critical decisions

Evidence accumulation models (EAMs) are a class of computational cognitive model used to understand the latent cognitive processes that underlie human decisions and response times (RTs). They have seen widespread application in cognitive psychology and neuroscience. However, historically, the application of these models was limited to simple decision tasks. Recently, researchers have applied these models to gain insight into the cognitive processes that underlie observed behaviour in applied domains, such as air-traffic control (ATC), driving, forensic and medical image discrimination, and maritime surveillance. Here, we discuss how this modelling approach helps researchers understand how the cognitive system adapts to task demands and interventions, such as task automation. We also discuss future directions and argue for wider adoption of cognitive modelling in Human Factors research.

Task interruptions from the perspective of work functions: The development of an observational tool applied to inpatient hospital care in France The Team'IT tool

BACKGROUND

In France, hospital units responsible for providing inpatient care have few opportunities to address the issue of task interruptions. In Australia, the Dual Perspectives Method (DMP) has been developed to assess interruptions. The method makes it possible to link teamwork and interruptions, by considering the work functions that constitute the system.

OBJECTIVE

To develop a tool that can characterize interruptions from the point of view of work functions that is tailored to French hospital units providing inpatient care. The aim was to adapt the items recorded using the DPM and their response categories, and to study the acceptability of observing interruptions for participating teams.

METHOD

The items recorded in the DPM were translated and adapted taking into account the French definition of interruptions. This step identified 19 items that targeted the interrupted professional, and 16 that targeted the interrupting professional. The characteristics of interruptions were recorded in September 2019 among 23 volunteer teams in a region in western France. Two observers simultaneously observed the same professional. Observations lasted seven consecutive hours, and targeted all professional categories within the same team.

RESULTS

The characteristics of 1,929 interruptions were noted. The observation period was well-received by teams. The following terminology regarding the work functions of the interrupting professional was clarified: "coordination of institutional resources", in relation to "the establishment's support processes", "patient services", and "the patient's social life". We believe that our categorization of response modes is exhaustive.

CONCLUSIONS

We have developed an observational tool, Team'IT, which is tailored to inpatient hospital care in France. Its implementation is the first step in a system to support teams in managing interruptions, and will enable them to reflect on their working methods, and whether interruptions can be avoided. Our work is part of an approach that seeks to improve and enhance the safety of professional practices, by contributing to the longstanding, complex debate about the flow and effectiveness of patient care.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03786874 (December 26, 2018).

External Time Monitoring in Time-Based Prospective Memory: An Integrative Framework

We propose a new integrative framework of external time monitoring in prospective memory (PM) tasks and its relation with performance. Starting from existing empirical regularities and our theoretical analysis, the framework predicts that external monitoring in PM tasks comprises a first stage of loose monitoring to keep track of the passage of time, and a subsequent stage of finer-grained monitoring, based on interval reduction, to meet the PM deadline. Following our framework, we predicted and observed in three different datasets (N = 375): (1) a marked increase in external monitoring frequency in the final part of the period of the PM task, well captured by a proportional rate exponential growth function; (2) a positive association between individual compliance with this monitoring pattern and PM performance; (3) a positive relation between monitoring frequency in the time window immediately preceding the PM deadline and PM performance at the individual level; and (4) good individual compliance with an interval reduction pattern in external monitoring, especially in the time window closer to the PM deadline. These results support the proposed integrative framework, which has the potential to foster future research on external monitoring in PM and in other fields of cognitive science.

Alpha Oscillations in Parietal and Parietooccipital Explaining How Boredom Matters Prospective Memory

Intelligent interaction alters previous human–machine task allocation patterns. Human workers will suffer from boredom and inattention, posing a significant challenge for the human–machine interaction loop. This study aims to investigate the relationship between boredom and prospective memory, which is a memory form including the detecting, identifying, and executing functions. Thus, the attention and memory mechanisms are critical to complete prospective memory tasks when bored. This study recruited twenty-eight participants and used electroencephalography to measure the alpha power in brain regions. The results indicated that parietal oscillations had a mediation effect on prospective memory, which could be associated with the frequent unstable attention. In addition, this study found that parietooccipital oscillations linked boredom and prospective memory, and the default mode network (DMN) and visual processing during boredom could better explain this finding. The findings of this study suggested that attention management and influences of processing visual information were starting points to cope with boredom because they could help prepare for prospective memory and make optimal decisions accordingly.

Implementation intentions speed up young adults' responses to prospective memory targets in everyday life

Prospective memory (PM), which is the ability to remember to do something in the future, is vitally important for successful everyday functioning. Although young adults demonstrate high PM abilities in laboratory settings, their abilities to complete intended actions in naturalistic settings are surprisingly low. The present study tested the effectiveness of various encoding techniques in improving young adults' performance in everyday life. Ninety-two participants were asked to remember to take photographs of receipts for a duration of seven days. The task instructions were either given alone or followed by: (a) the if-then statement, (b) visualising the task, or (c) the combination of the if-then statement plus visualisation. The if-then statement alone significantly speeded up responses to the prospective memory targets, i.e., less time elapsed between getting a receipt and taking a photograph of it. With no effect of the if-then statement on the proportion of correct PM responses, the results may suggest that the if-then statement strengthened the PM cue-intention association but did not influence the PM cue saliency.

Distinct monitoring strategies underlie costs and performance in prospective memory

Prospective memory (PM) describes the ability to remember to perform goal-relevant actions at an appropriate time in the future amid concurrent demands. A key contributor to PM performance is thought to be the effortful monitoring of the environment for PM-related cues, a process whose existence is typically inferred from a behavioral interference measure of reaction times. This measure, referred to as "PM costs," is an informative but indirect proxy for monitoring, and it may not be sufficient to understand PM behaviors in all situations. In this study, we asked participants to perform a visual search task with arrows that varied in difficulty while concurrently performing a delayed-recognition PM task with pictures of faces and scenes. To gain a precise measurement of monitoring behavior, we used eye-tracking to record fixations to all task-relevant stimuli and related these fixation measures to both PM costs and PM accuracy. We found that PM costs reflected dissociable monitoring strategies: higher costs were associated with early and frequent monitoring while lower costs were associated with delayed and infrequent monitoring. Moreover, the link between fixations and PM costs varied with cognitive load, and the inclusion of fixation data yielded better predictions of PM accuracy than using PM costs alone. This study demonstrates the benefit of eye-tracking to disentangle the nature of PM costs and more precisely describe strategies involved in prospective remembering.

Integrated responding improves prospective memory accuracy

Prospective memory (PM) supports the planning and execution of future activities, and is particularly important in applied settings. We investigate a new response method that aims to improve PM accuracy by integrating the responses to an occasional PM task and a routine ongoing lexical-decision task. Instead of the most common three-choice method where the PM response replaces the ongoing response, participants were obligated to make explicit PM (present vs. absent) and ongoing (word vs. non-word) classifications on every trial through a four-choice response. Although replacement and obligatory responses were initially similar in PM accuracy, an advantage emerged with practice for the new obligatory method that was not simply due to slower responding associated with making four versus three choices. The nature of the errors differed between methods, with obligatory responding being characterised by fast PM errors and replacement by slower errors, suggesting avenues for further potential improvements in PM accuracy.

Forgetting to Remember: The Impact of Post-traumatic Stress Disorder on Prospective and Retrospective Memory Performance

OBJECTIVE

We examined the impact of post-traumatic stress disorder (PTSD) on both prospective (PM) and retrospective (RM) memory performance among a cross-sectional veteran sample.

METHOD

Data from tests of PM/RM memory and PTSD, anxiety, depression and sleep disturbance symptoms were examined among a prospectively recruited sample of 26 veterans with confirmed PTSD (PTSD+) and 26 well-matched, combat-exposed controls who did not meet criteria for PTSD (PTSD-).

RESULTS

Small-to-moderate negative correlations emerged between PTSD symptom severity, visuospatial RM and some aspects of PM; general anxiety correlated more strongly with memory. The PTSD+ group demonstrated significantly worse, but still average visuospatial RM; differences in PM were nonsignificant between groups. Regression analyses implicated generalized anxiety, but not other psychiatric symptomology, as significant contributors to all memory performances.

CONCLUSIONS

Minimal memory differences were found between veterans with and without PTSD. PM/RM memory performance was better explained by generalized anxiety rather that PTSD-specific symptoms.

From retrospective to prospective memory research: a framework for investigating the deactivation of intentions

The definition of episodic memory has evolved into a multifaceted concept that gathered great attention in several research areas in psychology and neuroscience. Prospective memory (PM), or the ability to remember to perform delayed intentions at a later moment in the future, represents one side of this capacity for which that has been a growing interest. In this review, we examined a counterintuitive finding: PM intentions may persist and affect our behaviour despite successful goal attainment and task completion, which in daily life may be as serious as taking medication twice. This review aims to elucidate the existing knowledge and identify some unresolved questions concerning this specific memory failure. Therefore, this review provides an overview of the uprising research dedicated to both PM omission and commission errors, including an analysis of its definitions, of the current theoretical approaches of PM retrieval, and the main procedures used in this field to offer an integrative perspective on this topic. Finally, the last section is devoted to discussing future directions to test the predictions of our suggested theoretical explanations for PM deactivation. This might be an avenue for research that is likely to extend our understanding of episodic memory's usefulness in everyday life.

Evaluating process-based and crew- centred approaches to procedure design in aviation: workload and performance changes in go-around manoeuvres

In this article, we compare and evaluate two methods of procedure design using an aircraft go-around (GA) as a test scenario. We contrast the manufacturer specified, crew-centric procedure with a redesigned process-centred perspective. We test the claim that the process-centred design can take into account situational factors more effectively and generate less workload. We report a heuristic assessment of the new procedure against design guidelines and an evaluation in a full-flight simulator at the German Aerospace Centre (DLR) using qualified airline pilots to assess workload and performance. Both the manufacturer specified and new procedure were employed in three GA scenarios representative of increasing operational complexity. Results demonstrate an advantage for the new procedure design in the most complex scenario. The new, process-based procedure can reduce reported crew workload and improve response flexibility in more complex scenarios, improving rated performance. This study suggests that the process-based account in procedure design has advantages when compared to the flight crew-centric approach. These advantages include enhanced flexibility, robustness and improved crew performance during GA.

Prospective Memory Performance in Simulated Air Traffic Control : Robust to Interruptions but Impaired by Retention Interval

OBJECTIVE

To examine the effects of interruptions and retention interval on prospective memory for deferred tasks in simulated air traffic control.

BACKGROUND

In many safety-critical environments, operators need to remember to perform a deferred task, which requires prospective memory. Laboratory experiments suggest that extended prospective memory retention intervals, and interruptions in those retention intervals, could impair prospective memory performance.

METHOD

Participants managed a simulated air traffic control sector. Participants were sometimes instructed to perform a deferred handoff task, requiring them to deviate from a routine procedure. We manipulated whether an interruption occurred during the prospective memory retention interval or not, the length of the retention interval (37-117 s), and the temporal proximity of the interruption to deferred task encoding and execution. We also measured performance on ongoing tasks.

RESULTS

Increasing retention intervals (37-117 s) decreased the probability of remembering to perform the deferred task. Costs to ongoing conflict detection accuracy and routine handoff speed were observed when a prospective memory intention had to be maintained. Interruptions did not affect individuals' speed or accuracy on the deferred task.

CONCLUSION

Longer retention intervals increase risk of prospective memory error and of ongoing task performance being impaired by cognitive load; however, prospective memory can be robust to effects of interruptions when the task environment provides cuing and offloading.

APPLICATION

To support operators in performing complex and dynamic tasks, prospective memory demands should be reduced, and the retention interval of deferred tasks should be kept as short as possible.

Why We Fail to Rescue During Critical Events

Many factors come together probabilistically to affect clinician response to critical events in the operating room; no 2 critical events are alike. These factors involve 4 primary domains: (1) the event itself, (2) the individual anesthetist(s), (3) the operating room team, and (4) the resources available and environments in which the event occurs. Appreciating these factors, anticipating how they create vulnerabilities for error and poor response, and actively addressing those vulnerabilities (before events occur as well as during) will help clinicians manage critical event response more effectively and avoid errors.

Are subjective sleepiness and sleep quality related to prospective memory?

Event-based prospective memory (PM) involves carrying out intentions when specific events occur and is ubiquitous in everyday life. It consists of a prospective component (remembering that something must be done) and a retrospective component (remembering what must be done and when). Subjective sleep-related variables may be related to PM performance and an attention-demanding prospective component. In two studies, the relationship of subjective sleepiness and subjective sleep quality with both PM components was investigated with a laboratory PM task and separation of its components via Bayesian multinomial processing tree modeling. In Study 1, neither component of PM was related to naturally occurring subjective sleepiness or sleep quality. In Study 2, sleepiness was experimentally increased by placing some participants in a supine body posture. Testing participants in upright vs. supine posture affected neither PM component. However, body posture moderated the relationship between subjective sleep quality and the prospective component: In supine posture, subjective sleep quality tended to be more positively related to the prospective component. Overall, neither subjective sleepiness nor subjective sleep quality alone was related to PM.

Structural correlates of commission errors in prospective memory

Prospective memory refers to remembering to perform an intended future action, such as remembering to take medication with breakfast. Historically, the field has focused on failures to initially remember a prospective memory task (omission errors), but interestingly, individuals will occasionally repeat a prospective memory action after it has been completed (e.g., double dosing). These failures in prospective memory deactivation/forgetting are termed commission errors. The current registered study investigated structural neuroimaging correlates of a laboratory measure of commission errors in 47 healthy older adults. Extant theories differed in their predicted outcomes: commission error risk was predicted to be highest in individuals with smaller medial temporal lobe volume (output monitoring theory), larger lateral prefrontal cortex volume (residual activation theory), or a combination of larger medial temporal lobe volume and smaller lateral prefrontal cortex volume (dual mechanisms theory). In registered analyses, we found that a higher number of commission errors was associated with larger medial temporal lobe/hippocampal grey matter volume (supporting dual mechanisms theory), but not with grey or white matter volume in the lateral parietal lobe, frontal pole, or a composite of ventrolateral/dorsolateral prefrontal cortex (not supporting dual mechanisms theory). In post hoc analyses, smaller volume in the lateral orbitofrontal cortex was associated with a higher number of commission errors, possibly indicating that the dual mechanisms theory of PFC control was conceptually correct, but that a different PFC subregion than anticipated exerts control over commission errors. Collectively, the registered and post hoc analysis findings showed a functional dissociation across MTL/PFC regions that was more consistent with the dual mechanisms theory than the alternative theories.

Interruptions experienced by nurses during pediatric medication administration in China: An observational study

PURPOSE

The objectives of this study were to describe (a) the frequency of interruptions experienced by a pediatric nurse per hour, (b) the sources of interruptions experienced by a pediatric nurse, and (c) the interruption outcomes during pediatric medication administration.

DESIGN AND METHODS

This design of this study was a cross-sectional observational study. A convenience sample of pediatric nurses was used in this study. The interruption observation sheet was used to collect data about the frequency, sources, and outcomes of interruptions.

RESULTS

There was a total of 43 nurses were observed in more than 180 medication administration rounds. An interruption rate of 94.51% occurred during pediatric medication administration. The frequency of interruptions was three or more times (51.04%). The most common source of interruption was attributed to the working environment (32.37%). The second most frequent reason for interruption came from personnel, such as caregivers (24.48%), followed by physicians (10.79%), and other nursing staff (9.54%). The third most common source of interruption was communication issues, including patient interviews, patient reports, and case discussion (8.71%). Six errors (2.49%) were reported out of 241 interruptions as a result of interruptions. In specific, causes of errors during pediatric medication administration were due to wrong medication dose.

PRACTICE IMPLICATIONS

This study provides important information on interruptions experienced by pediatric nurses during medication administration in Chinese hospital settings and found that interruptions frequently occur in pediatric units.

Implementation of pain best practices as part of the spinal cord injury knowledge mobilization network

Context/objective: The spinal cord injury (SCI) knowledge mobilization network (KMN) is a community of practice formed in 2011 as part of a national best practice implementation (BPI) effort to improve SCI care. This study objective was to determine whether completion and documentation of pain practices could be improved in a neurorehabilitation setting using the KMN implementation approach. Design: Single site, pre-post intervention study. Setting: Neurorehabilitation hospital. Participants: Twenty sequential consenting inpatients with SCI, with retrospective comparative analysis of 50 sequential SCI admissions pre-KMN. Interventions: A local Site Implementation Team (SIT) was formed to develop an implementation plan, including acceptable timeframes for completion and documentation of four specific pain best practices: (1) pain assessment on admission, (2) development of an Inter-Professional Pain Treatment Plan (IPTP), (3) pain monitoring throughout admission, and (4) a pain discharge plan. Outcomes: Provider adherences to pain best practices were the primary outcomes. The secondary outcome was patient satisfaction. Results: Provider adherence for most outcomes exceeded 70% completion within acceptable timeframes, with improvements found for all outcomes as compared to the retrospective cohort. Notably, pain education as part of the IPTP improved from 12% completion to 74%, documenting pain onset from 4.5% to 80% and pain discharge plan from 40% to 74%. Overall, participants were satisfied with their pain management. Conclusions: Pain best practices were more consistently documented after the KMN implementation. Pain practices in all four areas have now been expanded to all inpatient diagnoses using the same forms and framework created in the implementation process.

Time-of-day effects on prospective memory

Cognitive performance fluctuates during the course of a day. Different cognitive functions show optimal performance at different times of the day, known as the 'time-of-day effect'. While this effect has been observed for a number of cognitive domains including declarative memory, it is presently unclear whether performance fluctuations are also seen in prospective memory, i.e. memory for intentions to be realized in the future. The present study examined time-of-day effects in four different prospective memory tasks with varying degrees of complexity, taking into account circadian preference (i.e. morningness-eveningness/chronotype) and attentional resources (in one of the tasks). In a pilot study (n = 48) and a main experiment (n = 39), prospective memory was compared between morning groups (˜09:00) and evening groups (˜21:00) of young adults. We found time-of-day effects, with better performance in the evening than in the morning, in a simple one-item prospective memory task (Red Pencil Task, p = .02), a classical event-based prospective memory task including the detection of cue syllables in a lexical decision ongoing task (Syllable Detection Task, p < .048), and a rather naturalistic complex planning task for breakfast preparation (Dresden Breakfast Task, including time-based prospective memory (p = .026) and event-based prospective memory (p = .054)). These time-of-day effects were neither modulated by circadian preference nor by attentional resources. Another simple one-item prospective memory task was not affected by time of day (Color Task, p = .14). Ongoing task performance in the Syllable Detection Task and the Dresden Breakfast Task, overall, did not differ significantly between morning and evening groups. These findings provide tentative evidence for time-of-day effects in prospective memory of young adults, with better performance in the evening hours.

Strategic attention and decision control support prospective memory in a complex dual-task environment

Human performance in complex multiple-task environments depends critically on the interplay between cognitive control and cognitive capacity. In this paper we propose a tractable computational model of how cognitive control and capacity influence the speed and accuracy of decisions made in the event-based prospective memory (PM) paradigm, and in doing so test a new quantitative formulation that measures two distinct components of cognitive capacity (gain and focus) that apply generally to choices among two or more options. Consistent with prior work, individuals used proactive control (increased ongoing task thresholds under PM load) and reactive control (inhibited ongoing task accumulation rates to PM items) to support PM performance. Individuals used cognitive gain to increase the amount of resources allocated to the ongoing task under time pressure and PM load. However, when demands exceeded the capacity limit, resources were reallocated (shared) between ongoing task and PM processes. Extending previous work, individuals used cognitive focus to control the quality of processing for the ongoing and PM tasks based on the particular demand and payoff structure of the environment (e.g., higher focus for higher priority tasks; lower focus under high time pressure and with PM load). Our model provides the first detailed quantitative understanding of cognitive gain and focus as they apply to evidence accumulation models, which - along with cognitive control mechanisms - support decision-making in complex multiple-task environments.

Rapid eye movement sleep mediates age-related decline in prospective memory consolidation

STUDY OBJECTIVES

Prospective memory, or remembering to execute future intentions, accounts for half of everyday forgetting in older adults. Sleep intervals benefit prospective memory consolidation in young adults, but it is unknown whether age-related changes in slow wave activity, sleep spindles, and/or rapid eye movement (REM) sleep mediate hypothesized effects of aging on prospective memory consolidation.

METHODS

After an adaptation night, 76 adults aged 18-84 completed two experimental nights of in-laboratory polysomnography recording. In the evening, participants encoded and practiced a prospective memory task and were tested the next morning. On a counterbalanced night, they encoded and practiced a control task, and were tested the following morning.

RESULTS

Increasing age predicted worse prospective memory consolidation (r = -.34), even when controlling for encoding, speed, and control-task performance (all ps < .05). Frontal delta power, slow oscillations, and spindle density were not related to prospective memory consolidation. REM sleep duration, however, explained significant variance in prospective memory consolidation when controlling for age (∆R2 = .10). Bootstrapping mediation showed that less REM sleep significantly mediated the aging effect on prospective memory consolidation [b = -.0016, SE = 0.0009 (95% confidence interval [CI] = -0.0042 to -0.0004)]. REM sleep continued to mediate 24.29% of the total effect of age on prospective memory after controlling for numerous demographic, cognitive, mental health, and sleep variables.

CONCLUSION

Age-related variance in REM sleep is informative to how prospective memory consolidation changes with increasing age. Future work should consider how both REM sleep and slow wave activity contribute, perhaps in a sequential or dynamic manner, to preserving cognitive functioning with increasing age.

When a child dies of heatstroke after a parent or caretaker unknowingly leaves the child in a car: How does it happen and is it a crime?

It is commonly reported that in the course of a drive, a parent or caretaker loses awareness of the presence of a child in the back seat of the car. Upon arriving at the destination, the driver exits the car and unknowingly leaves the child in the car. This incomprehensible lapse of memory exposes forgotten children to hazards, including death from heatstroke. More than 400 children in the past 20 years have suffered from heatstroke after being unknowingly forgotten in cars. How can loving and attentive parents, with no evidence of substance abuse or an organic brain disorder, have a catastrophic lapse of memory that places a child's welfare in jeopardy? This article addresses this question at multiple levels of analysis. First, it is concluded that the loss of awareness of a child in a car is a failure of a type of memory referred to as prospective memory (PM), that is, failure to remember to execute a plan in the future. Second, factors that increase the likelihood that PM will fail are identified. Third, research on the neurobiology of PM and PM-related memory failures are reviewed, including a discussion of how competition between brain structures contributes to a failure of PM. Finally, the issue of whether a failure of PM that results in harm to a child qualifies as a criminal offence is discussed. Overall, this neuropsychological perspective on how catastrophic memory errors occur should be of value to the scientific community, the public and law-enforcement agencies.

Redefining the pattern of age-prospective memory-paradox: new insights on age effects in lab-based, naturalistic, and self-assigned tasks

Prospective memory (PM) involves remembering intended actions in the future, such as posting a letter when seeing a post box (event-based PM) or making a phone call at 2:00 pm (time-based PM). Studies on aging and PM have often reported negative age effects in the laboratory, but positive age effects in naturalistic tasks outside the laboratory (the so-called age–PM-paradox). The present study re-examined this pattern of the paradox by studying, for the first time, age differences in time- and event-based PM in lab-based, experimenter-generated naturalistic and self-assigned real-life PM tasks within the same sample of young and older adults. Results showed that differential age effects in and outside the laboratory were qualified by the type of PM cue. While age-related deficits were obtained for laboratory event-based tasks, no age effect was obtained for naturalistic event-based PM. Age benefits in the field were only observed for naturalistic time-based tasks, but not for participants’ own self-assigned time-based tasks. These findings indicate that the age benefits for naturalistic PM tasks may have been overestimated due to the dominant use of experimenter-generated naturalistic time-based PM tasks in previous studies. Therefore, the precise pattern of the age–PM-paradox may need redefining as mostly consisting of negative age effects in lab-based PM tasks and mostly the absence of negative age effects (rather than age benefits) in naturalistic and self-assigned tasks outside the laboratory.

Thought probes during prospective memory encoding: Evidence for perfunctory processes

For nearly 50 years, psychologists have studied prospective memory, or the ability to execute delayed intentions. Yet, there remains a gap in understanding as to whether initial encoding of the intention must be elaborative and strategic, or whether some components of successful encoding can occur in a perfunctory, transient manner. In eight studies (N = 680), we instructed participants to remember to press the Q key if they saw words representing fruits (cue) during an ongoing lexical decision task. They then typed what they were thinking and responded whether they encoded fruits as a general category, as specific exemplars, or hardly thought about it at all. Consistent with the perfunctory view, participants often reported mind wandering (42.9%) and hardly thinking about the prospective memory task (22.5%). Even though participants were given a general category cue, many participants generated specific category exemplars (34.5%). Bayesian analyses of encoding durations indicated that specific exemplars came to mind in a perfunctory manner rather than via strategic, elaborative mechanisms. Few participants correctly guessed the research hypotheses and changing from fruit category cues to initial-letter cues eliminated reports of specific exemplar generation, thereby arguing against demand characteristics in the thought probe procedure. In a final experiment, encoding duration was unrelated to prospective memory performance; however, specific-exemplar encoders outperformed general-category encoders with no ongoing task monitoring costs. Our findings reveal substantial variability in intention encoding, and demonstrate that some components of prospective memory encoding can be done "in passing."

Forgetting to remember? Prospective memory within the context of pain

BACKGROUND

Pain interferes with cognitive functioning in several ways. Among other symptoms, pain patients often report difficulties with remembering future intentions. It remains unclear, however, whether it is the pain per se that impairs prospective remembering or other factors that often characterize people with pain (e.g. poor sleep quality). In this experiment, we investigated whether prospective memory is impaired within the context of pain, and whether this impairment is enhanced when the threat value of pain is increased.

METHODS

Healthy participants engaged in an ongoing word categorization task, during which they received either experimental pain stimuli (with or without threatening instructions designed to increase the threat value of pain), or no pain stimuli (no somatic stimuli and no threatening instructions). Crucially, participants were also instructed to perform a prospective memory intention on future moments that would be signalled by specific retrieval cues.

RESULTS

Threatening instructions did not differentiate the pain groups in terms of pain threat value; therefore, we only focus on the difference between pain and no pain. Pain and no-pain groups performed the prospective memory intention with similar frequency, indicating that prospective memory is not necessarily impaired when the intended action has to be performed in a painful context.

CONCLUSIONS

Findings are discussed in the framework of the multiprocess theory of prospective memory, which differentiates between the spontaneous and the strategic retrieval of intentions. Methodological considerations and suggestions for future research are discussed.

SIGNIFICANCE

This laboratory study combines established methods from two research fields to investigate the effects of a painful context on memory for future intentions. Painful context did not impair performance of a prospective memory intention that is assumed to be retrieved by means of spontaneous processing.

Implementation Intention and Reminder Effects on Behavior Change in a Mobile Health System: A Predictive Cognitive Model

BACKGROUND

Implementation intentions are mental representations of simple plans to translate goal intentions into behavior under specific conditions. Studies show implementation intentions can produce moderate to large improvements in behavioral goal achievement. Human associative memory mechanisms have been implicated in the processes by which implementation intentions produce effects. On the basis of the adaptive control of thought-rational (ACT-R) theory of cognition, we hypothesized that the strength of implementation intention effect could be manipulated in predictable ways using reminders delivered by a mobile health (mHealth) app.

OBJECTIVE

The aim of this experiment was to manipulate the effects of implementation intentions on daily behavioral goal success in ways predicted by the ACT-R theory concerning mHealth reminder scheduling.

METHODS

An incomplete factorial design was used in this mHealth study. All participants were asked to choose a healthy behavior goal associated with eat slowly, walking, or eating more vegetables and were asked to set implementation intentions. N=64 adult participants were in the study for 28 days. Participants were stratified by self-efficacy and assigned to one of two reminder conditions: reminders-presented versus reminders-absent. Self-efficacy and reminder conditions were crossed. Nested within the reminders-presented condition was a crossing of frequency of reminders sent (high, low) by distribution of reminders sent (distributed, massed). Participants in the low frequency condition got 7 reminders over 28 days; those in the high frequency condition were sent 14. Participants in the distributed conditions were sent reminders at uniform intervals. Participants in the massed distribution conditions were sent reminders in clusters.

RESULTS

There was a significant overall effect of reminders on achieving a daily behavioral goal (coefficient=2.018, standard error [SE]=0.572, odds ratio [OR]=7.52, 95% CI 0.9037-3.2594, P<.001). As predicted by ACT-R, using default theoretical parameters, there was an interaction of reminder frequency by distribution on daily goal success (coefficient=0.7994, SE=0.2215, OR=2.2242, 95% CI 0.3656-1.2341, P<.001). The total number of times a reminder was acknowledged as received by a participant had a marginal effect on daily goal success (coefficient=0.0694, SE=0.0410, OR=1.0717, 95% CI -0.01116 to 0.1505, P=.09), and the time since acknowledging receipt of a reminder was highly significant (coefficient=-0.0490, SE=0.0104, OR=0.9522, 95% CI -0.0700 to -0.2852], P<.001). A dual system ACT-R mathematical model was fit to individuals' daily goal successes and reminder acknowledgments: a goal-striving system dependent on declarative memory plus a habit-forming system that acquires automatic procedures for performance of behavioral goals.

CONCLUSIONS

Computational cognitive theory such as ACT-R can be used to make precise quantitative predictions concerning daily health behavior goal success in response to implementation intentions and the dosing schedules of reminders.

Prospective Memory Performance in Persons With Schizophrenia and Bipolar Disorder and Healthy Persons

PURPOSE

There is a paucity of studies comparing prospective memory (PM) impairment between persons with schizophrenia and bipolar disorder. The aim of this study was to directly compare PM performances of these two groups and healthy controls.

DESIGN AND METHODS

A total of 44 persons with schizophrenia and 76 with bipolar disorder, and 44 healthy controls formed the study sample.

FINDINGS

Patients were found to be impaired in PM relative to controls and the two patient groups showed similar level of PM performance after controlling confounding sociodemographic and clinical variables.

PRACTICE IMPLICATIONS

The findings add to the evidence concerning the neurocognitive similarity between cohorts of schizophrenia and bipolar disorder with respect to PM. Rehabilitative effort in PM remedies for both patient groups is warranted.

The Dynamic Interplay Between Bottom-Up and Top-Down Processes Supporting Prospective Remembering

Like many dual process theories in the psychological sciences, existing models of prospective memory (i.e., remembering to execute future intentions) emphasize the role of singular top-down or bottom-up processes that act in isolation. We argue that top-down and bottom-up processes are interconnected and dynamically interact to support prospective memory. We elaborate on this dynamic multiprocess framework by focusing on recent behavioral, neuroimaging, and eye-tracking research that demonstrated the dynamic nature of monitoring (top-down) and spontaneous retrieval (bottom-up) processes in relation to contextual factors, metacognition, and individual differences. We conclude that identifying how dual processes interact with environmental and individual difference factors is crucial for advancing understanding of cognition and behavior.

The effect of different distractions on remembering delayed intentions

In safety-critical domains, frequently intentions need to be delayed until an ongoing task is completed. Research using the delay-execute paradigm showed that interruptions during the delay cause forgetting. However, staff members often handle an initial distraction not by interrupting the ongoing task but by acknowledging the distraction or multitasking. In Experiments 1a and 1b, we observed that, compared to a no distraction condition, multitasking significantly decreased remembering of intentions and interrupting decreased remembering even further. In Experiment 2, interruptions with context change reduced remembering of intentions compared to uninterrupted delays, and at the same time, interruptions without context change improved memory performance compared to uninterrupted delays. However, improved memory performance resulted in decreased interrupting task performance. Theoretically, the results support the contextual cueing mechanism of delay-execute tasks. Considering safety-critical domains, multitasking, interruptions and context changes can contribute to forgetting of tasks.

Reminders make people adhere better to a self-help sleep intervention

The experiment presented in this paper investigated the effects of different kinds of reminders on adherence to automated parts of a cognitive behavioural therapy for insomnia (CBT-I) delivered via a mobile device. Previous studies report that computerized health interventions can be effective. However, treatment adherence is still an issue. Reminders are a simple technique that could improve adherence. A minimal intervention prototype in the realm of sleep treatment was developed to test the effects of reminders on adherence. Two prominent ways to determine the reminder-time are: a) ask users when they want to be reminded, and b) let an algorithm decide when to remind users. The prototype consisted of a sleep diary, a relaxation exercise and reminders. A within subject design was used in which the effect of reminders and two underlying principles were tested by 45 participants that all received the following three different conditions (in random order): a) event-based reminders b) time-based reminders c) no reminders. Both types of reminders improved adherence compared to no reminders. No differences were found between the two types of reminders. Opportunity and self-empowerment could partly mediate adherence to filling out the sleep diary, but not to the number of relaxation exercises conducted. Although the study focussed on CBT-I, we expect that designers of other computerized health interventions benefit from the tested opportunity and self-empowerment principles for reminders to improve adherence, as well.

Traditions of research into interruptions in healthcare: A conceptual review

BACKGROUND

Researchers from diverse theoretical backgrounds have studied workplace interruptions in healthcare, leading to a complex and conflicting body of literature. Understanding pre-existing viewpoints may advance the field more effectively than attempts to remove bias from investigations.

OBJECTIVE

To identify research traditions that have motivated and guided interruptions research, and to note research questions posed, gaps in approach, and possible avenues for future research.

METHODS

A critical review was conducted of research on interruptions in healthcare. Two researchers identified core research communities based on the community's motivations, philosophical outlook, and methods. Among the characteristics used to categorise papers into research communities were the predominant motivation for studying interruptions, the research questions posed, and key contributions to the body of knowledge on interruptions in healthcare. In cases where a paper approached an equal number of characteristics from two traditions, it was placed in a blended research community.

RESULTS

A total of 141 papers were identified and categorised; all papers identified were published from 1994 onwards. Four principal research communities emerged: epidemiology, quality improvement, cognitive systems engineering (CSE), and applied cognitive psychology. Blends and areas of mutual influence between the research communities were identified that combine the benefits of individual traditions, but there was a notable lack of blends incorporating quality improvement initiatives. The question most commonly posed by researchers across multiple communities was: what is the impact of interruptions? Impact was measured as a function of task time or risk in the epidemiology tradition, situation awareness in the CSE tradition, or resumption lag (time to resume an interrupted task) in the applied cognitive psychology tradition. No single question about interruptions in healthcare was shared by all four of the core communities.

CONCLUSIONS

Much research on workplace interruptions in healthcare can be described in terms of fundamental values of four distinct research traditions and the communities that bring the values and methods: of those research traditions to their investigations. Blends between communities indicate that mutual influence has occurred as interruptions research has progressed. It is clear from this review that there is no single or privileged perspective to study interruptions. Instead, these findings suggest that researchers investigating interruptions in healthcare would benefit from being more aware of different perspectives from their own, especially when they consider workplace interventions to reduce interruptions.

ERPs and their brain sources in perceptual and conceptual prospective memory tasks: Commonalities and differences between the two tasks

The present study examined whether Event-Related Potential (ERP) components and their neural generators are common to perceptual and conceptual prospective memory (PM) tasks or specific to the form of PM cue involved. We used Independent Component Analysis (ICA) to study the contributions of brain source activities to scalp ERPs across the different phases of two event-based PM-tasks: (1) holding intentions during a delay (monitoring) (2) detecting the correct context to perform the delayed intention (cue detection) and (3) carrying out the action (realisation of delayed intentions). Results showed that monitoring for both perceptual and conceptual PM-tasks was characterised by an enhanced early occipital negativity (N200). In addition the conceptual PM-task showed a long-lasting effect of monitoring significant around 700ms. Perceptual PM-task cues elicited an N300 enhancement associated with cue detection, whereas a midline N400-like response was evoked by conceptual PM-task cues. The Prospective Positivity associated with realisation of delayed intentions was observed in both conceptual and perceptual tasks. A common frontal-midline brain source contributed to the Prospective Positivity in both tasks and a strong contribution from parieto-frontal brain sources was observed only for the perceptually cued PM-task. These findings support the idea that: (1) The enhanced N200 can be understood as a neural correlate of a 'retrieval mode' for perceptual and conceptual PM-tasks, and additional strategic monitoring is implemented according the nature of the PM task; (2) ERPs associated with cue detection are specific to the nature of the PM cues; (3) Prospective Positivity reflects a general PM process, but the specific brain sources contributing to it depend upon the nature of the PM task.

From good intentions to healthy habits: towards integrated computational models of goal striving and habit formation

Computational models were developed in the ACT-R neurocognitive architecture to address some aspects of the dynamics of behavior change. The simulations aim to address the day-to-day goal achievement data available from mobile health systems. The models refine current psychological theories of self-efficacy, intended effort, and habit formation, and provide an account for the mechanisms by which goal personalization, implementation intentions, and remindings work.

Reminders Through Association

People often fail to follow through on good intentions. While limited self-control is frequently the culprit, another cause is simply forgetting to enact intentions when opportunities arise. We introduce a novel, potent approach to facilitating follow-through: the reminders-through-association approach. This approach involves associating intentions (e.g., to mail a letter on your desk tomorrow) with distinctive cues that will capture attention when you have opportunities to act on those intentions (e.g., Valentine's Day flowers that arrived late yesterday, which are sitting on your desk). We showed that cue-based reminders are more potent when the cues they employ are distinctive relative to (a) other regularly encountered stimuli and (b) other stimuli encountered concurrently. Further, they can be more effective than written or electronic reminder messages, and they are undervalued and underused. The reminders-through-association approach, developed by integrating and expanding on past research on self-control, reminders, and prospective memory, can be a powerful tool for policymakers and individuals.

When the phone rings - factors influencing its impact on the experience of patients and healthcare workers during primary care consultation: a qualitative study

Background

In the primary health care setting, patients interact directly with their healthcare workers (HCW), which include their primary physicians, nurses and pharmacists. Studies have shown that such interactions, when interrupted by phone calls received by either party, can lead to adverse outcomes and negative experiences. There is insufficient data however on the factors affecting the reaction and responses of both patients and HCWs when phone calls occur amidst their interaction. Understanding these factors will allow for the introduction of targeted measures to mitigate the negative impact of such interruptions and improve patient-HCW relationships. This study therefore aims to understand the impact of unplanned phone calls during primary health care consultations on patient–HCW interactions and the factors affecting the patient and the HCW responses.

Method

This study used focus group discussions (FGD) to gather qualitative data from patients and HCWs who had visited or worked in a major public primary healthcare institution in Singapore. The FGDs were audio-recorded, transcribed, audited and analyzed using standard content analysis to identify emergent themes.

Results

15 patients and 16 HCWs participated in 5 FGDs. The key themes that emerged from these FGDs were patients’ and HCWs’ attitudes toward professionalism and respect, task and thought interruption, call characteristics, the impact on patient safety and stakeholders’ experiences. Phone calls during consultations answered by either party often resulted in the answering party feeling apologetic and would usually keep the phone conversations short as a sign of respect to the other party. Both stakeholders valued the consultation time and similarly reported negative experiences if the phone-call interruptions became prolonged. Calls from the desk phone answered by HCWs were perceived by most patients to be relevant to healthcare services, with the assumption that HCWs exercised professionalism and would not attend to personal calls during their clinical duties.HCWs expressed their concerns and distress about potential medical errors due to phone-calls interrupting their clinical tasks and thinking processes. However, they acknowledged that these same phone-calls were important to allow clarifications of instructions and improved the safety of other patients.

Conclusion

Phone interruptions affected patient and HCW interaction during consultations and factors leading to their adverse reactions need to be recognized and addressed.

Applying Psychological Science to Examine Prospective Memory in Simulated Air Traffic Control

Failures to remember to perform deferred task actions in work settings such as air traffic control can have serious consequences. Most research examining the cognitive mechanisms underlying prospective memory has used simple, static tasks, which may make it difficult to generalize results to work settings. I describe a body of research that has applied theory and methods from the basic prospective-memory and attention-capture literatures to simulations of air traffic control. These theories and methods can be used to anticipate many findings, such as the finding that prospective-memory demands incur performance costs in ongoing air traffic control tasks, and that prospective-memory error and costs to ongoing air traffic control tasks can be reduced by the use of spatial context or prospective-memory aids. Research in laboratory settings that simulates work contexts such as air traffic control can both establish the utility of psychological theory and produce application-relevant information.

Allowing brief delays in responding improves event-based prospective memory for young adults living with HIV disease

Event-based prospective memory (PM) tasks require individuals to remember to perform an action when they encounter a specific cue in the environment, and they have clear relevance for daily functioning for individuals with HIV. In many everyday tasks, not only must the individual maintain the intent to perform the PM task, but the PM task response also competes with the alternative and more habitual task response. The current study examined whether event-based PM can be improved by slowing down the pace of the task environment. Fifty-seven young adults living with HIV performed an ongoing lexical decision task while simultaneously performing a PM task of monitoring for a specific word (which was focal to the ongoing task of making lexical decisions) or syllable contained in a word (which was nonfocal). Participants were instructed to refrain from making task responses until after a tone was presented, which occurred at varying onsets (0-1600 ms) after each stimulus appeared. Improvements in focal and nonfocal PM accuracy were observed with response delays of 600 ms. Furthermore, the difference in PM accuracy between the low-demand focal PM task and the resource-demanding nonfocal PM task was reduced by half across increasingly longer delays, falling from 31% at 0-ms delay to only 14% at 1600-ms delay. The degree of ongoing task response slowing for the PM conditions, relative to a control condition that did not have a PM task and made lexical decisions only, also decreased with increased delay. Overall, the evidence indicates that delaying the task responses of younger HIV-infected adults increased the probability that the PM relevant features of task stimuli were adequately assessed prior to the ongoing task response, and by implication that younger HIV infected adults can more adequately achieve PM goals when the pace of the task environment is slowed down.

Investigating the cost to ongoing tasks not associated with prospective memory task requirements

The purpose of the current study was to investigate the relationship between prospective memory (PM) and consciousness by examining cost to ongoing activities, with cost assumed to reflect a direction of conscious resources away from the ongoing task in service of the PM task. Ongoing task blocks in which the PM task was relevant or irrelevant were alternated to achieve three aims: determine if cost would persist in irrelevant blocks when relevant and irrelevant blocks were clearly demarcated and irrelevant stimuli were incompatible with the PM task; investigate if costs would be greatest at the start of irrelevant blocks; and determine whether costs would occur when the irrelevant block preceded any relevant blocks. Costs were found in irrelevant blocks and greater cost at the start of the irrelevant blocks suggest the cost may be due in part to participants making decisions about the engagement of conscious resources at transition points.