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Pitigoi IC, Coe BC, Calancie OG, Brien DC, Yep R, Riek HC, Kirkpatrick RH, Noyes BK, White BJ, Blohm G, Munoz DP. Attentional modulation of eye blinking is altered by sex, age, and task structure. eNeuro 2024; 11:ENEURO.0296-23.2024. [PMID: 38331578 PMCID: PMC10915461 DOI: 10.1523/eneuro.0296-23.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 01/15/2024] [Accepted: 02/05/2024] [Indexed: 02/10/2024] Open
Abstract
Spontaneous eye blinking is gaining popularity as a proxy for higher cognitive functions, as it is readily modulated by both environmental demands and internal processes. Prior studies were impoverished in sample size, sex representation and age distribution, making it difficult to establish a complete picture of the behavior. Here we present eye-tracking data from a large cohort of normative participants (n=604, 393 F, aged 5-93 years) performing two tasks: one with structured, discrete trials (interleaved pro/anti-saccade task; IPAST) and one with a less structured, continuous organization in which participants watch movies (free-viewing; FV). Sex- and age-based analyses revealed that females had higher blink rates between the ages of 22 and 58 years in the IPAST, and 22 and 34 years in FV. We derived a continuous measure of blink probability to reveal behavioral changes driven by stimulus appearance in both paradigms. In the IPAST, blinks were suppressed near stimulus appearance, particularly on correct anti-saccade trials, which we attribute to the stronger inhibitory control required for anti-saccades compared to pro-saccades. In FV, blink suppression occurred immediately after scene changes, and the effect was sustained on scenes where gaze clustered among participants (indicating engagement of attention). Females were more likely than males to blink during appearance of novel stimuli in both tasks, but only within the age bin of 18-44 years. The consistency of blink patterns in each paradigm endorses blinking as a sensitive index for changes in visual processing and attention, while sex and age differences drive interindividual variability.Significance Statement Eye-tracking is becoming useful as a non-invasive tool for detecting preclinical markers of neurological and psychiatric disease. Blinks are understudied despite being an important supplement to saccade and pupil eye-tracking metrics. The present study is a crucial step in developing a healthy baseline for blink behavior to compare to clinical groups. While many prior blink studies suffered from small sample sizes with relatively low age- and sex-diversity (review by Jongkees & Colzato, 2016), our large cohort of healthy participants has permitted a more detailed analysis of sex and age effects in blink behavior. Furthermore, our analysis techniques are robust to temporal changes in blink probability, greatly clarifying the relationship between blinking, visual processing, and inhibitory control mechanisms on visual tasks.
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Affiliation(s)
- Isabell C Pitigoi
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada K7L 3N6
| | - Brian C Coe
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada K7L 3N6
| | - Olivia G Calancie
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada K7L 3N6
| | - Donald C Brien
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada K7L 3N6
| | - Rachel Yep
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada K7L 3N6
| | - Heidi C Riek
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada K7L 3N6
| | - Ryan H Kirkpatrick
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada K7L 3N6
| | - Blake K Noyes
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada K7L 3N6
| | - Brian J White
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada K7L 3N6
| | - Gunnar Blohm
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada K7L 3N6
| | - Douglas P Munoz
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada K7L 3N6
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2
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Perquin MN, van Vugt MK, Hedge C, Bompas A. Temporal Structure in Sensorimotor Variability: A Stable Trait, But What For? COMPUTATIONAL BRAIN & BEHAVIOR 2023; 6:1-38. [PMID: 36618326 PMCID: PMC9810256 DOI: 10.1007/s42113-022-00162-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/22/2022] [Indexed: 01/05/2023]
Abstract
Human performance shows substantial endogenous variability over time, and this variability is a robust marker of individual differences. Of growing interest to psychologists is the realisation that variability is not fully random, but often exhibits temporal dependencies. However, their measurement and interpretation come with several controversies. Furthermore, their potential benefit for studying individual differences in healthy and clinical populations remains unclear. Here, we gather new and archival datasets featuring 11 sensorimotor and cognitive tasks across 526 participants, to examine individual differences in temporal structures. We first investigate intra-individual repeatability of the most common measures of temporal structures - to test their potential for capturing stable individual differences. Secondly, we examine inter-individual differences in these measures using: (1) task performance assessed from the same data, (2) meta-cognitive ratings of on-taskness from thought probes occasionally presented throughout the task, and (3) self-assessed attention-deficit related traits. Across all datasets, autocorrelation at lag 1 and Power Spectra Density slope showed high intra-individual repeatability across sessions and correlated with task performance. The Detrended Fluctuation Analysis slope showed the same pattern, but less reliably. The long-term component (d) of the ARFIMA(1,d,1) model showed poor repeatability and no correlation to performance. Overall, these measures failed to show external validity when correlated with either mean subjective attentional state or self-assessed traits between participants. Thus, some measures of serial dependencies may be stable individual traits, but their usefulness in capturing individual differences in other constructs typically associated with variability in performance seems limited. We conclude with comprehensive recommendations for researchers. Supplementary Information The online version contains supplementary material available at 10.1007/s42113-022-00162-1.
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Affiliation(s)
- Marlou Nadine Perquin
- Biopsychology & Cognitive Neuroscience, Faculty of Psychology and Sports Science, Bielefeld University, Bielefeld, Germany
- Cognitive Neuroscience, Faculty of Biology, Bielefeld University, Bielefeld, Germany
- CUBRIC, School of Psychology, Cardiff University, Cardiff, UK
| | - Marieke K. van Vugt
- Bernoulli Institute for Mathematics, Computer Science and Artificial Intelligence, University of Groningen, Groningen, Netherlands
| | - Craig Hedge
- School of Psychology, College of Health & Life Sciences, Aston University, Aston, UK
| | - Aline Bompas
- CUBRIC, School of Psychology, Cardiff University, Cardiff, UK
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3
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Ortega J, Plaska CR, Gomes BA, Ellmore TM. Spontaneous Eye Blink Rate During the Working Memory Delay Period Predicts Task Accuracy. Front Psychol 2022; 13:788231. [PMID: 35242077 PMCID: PMC8886217 DOI: 10.3389/fpsyg.2022.788231] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 01/11/2022] [Indexed: 11/17/2022] Open
Abstract
Spontaneous eye blink rate (sEBR) has been linked to attention and memory, specifically working memory (WM). sEBR is also related to striatal dopamine (DA) activity with schizophrenia and Parkinson’s disease showing increases and decreases, respectively, in sEBR. A weakness of past studies of sEBR and WM is that correlations have been reported using blink rates taken at baseline either before or after performance of the tasks used to assess WM. The goal of the present study was to understand how fluctuations in sEBR during different phases of a visual WM task predict task accuracy. In two experiments, with recordings of sEBR collected inside and outside of a magnetic resonance imaging bore, we observed sEBR to be positively correlated with WM task accuracy during the WM delay period. We also found task-related modulation of sEBR, including higher sEBR during the delay period compared to rest, and lower sEBR during task phases (e.g., stimulus encoding) that place demands on visual attention. These results provide further evidence that sEBR could be an important predictor of WM task performance with the changes during the delay period suggesting a role in WM maintenance. The relationship of sEBR to DA activity and WM maintenance is discussed.
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Affiliation(s)
- Jefferson Ortega
- Department of Psychology, The City College of the City University of New York, New York, NY, United States
| | - Chelsea Reichert Plaska
- Department of Psychology, The City College of the City University of New York, New York, NY, United States.,Behavioral and Cognitive Neuroscience Program, The Graduate Center of the City University of New York, New York, NY, United States
| | - Bernard A Gomes
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Timothy M Ellmore
- Department of Psychology, The City College of the City University of New York, New York, NY, United States.,Behavioral and Cognitive Neuroscience Program, The Graduate Center of the City University of New York, New York, NY, United States
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4
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Schröder R, Reuter M, Faßbender K, Plieger T, Poulsen J, Lui SSY, Chan RCK, Ettinger U. The role of the SLC6A3 3' UTR VNTR in nicotine effects on cognitive, affective, and motor function. Psychopharmacology (Berl) 2022; 239:489-507. [PMID: 34854936 PMCID: PMC8638222 DOI: 10.1007/s00213-021-06028-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 11/11/2021] [Indexed: 01/21/2023]
Abstract
RATIONALE Nicotine has been widely studied for its pro-dopaminergic effects. However, at the behavioural level, past investigations have yielded heterogeneous results concerning effects on cognitive, affective, and motor outcomes, possibly linked to individual differences at the level of genetics. A candidate polymorphism is the 40-base-pair variable number of tandem repeats polymorphism (rs28363170) in the SLC6A3 gene coding for the dopamine transporter (DAT). The polymorphism has been associated with striatal DAT availability (9R-carriers > 10R-homozygotes), and 9R-carriers have been shown to react more strongly to dopamine agonistic pharmacological challenges than 10R-homozygotes. OBJECTIVES In this preregistered study, we hypothesized that 9R-carriers would be more responsive to nicotine due to genotype-related differences in DAT availability and resulting dopamine activity. METHODS N=194 non-smokers were grouped according to their genotype (9R-carriers, 10R-homozygotes) and received either 2-mg nicotine or placebo gum in a between-subject design. Spontaneous blink rate (SBR) was obtained as an indirect measure of striatal dopamine activity and smooth pursuit, stop signal, simple choice and affective processing tasks were carried out in randomized order. RESULTS Reaction times were decreased under nicotine compared to placebo in the simple choice and stop signal tasks, but nicotine and genotype had no effects on any of the other task outcomes. Conditional process analyses testing the mediating effect of SBR on performance and how this is affected by genotype yielded no significant results. CONCLUSIONS Overall, we could not confirm our main hypothesis. Individual differences in nicotine response could not be explained by rs28363170 genotype.
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Affiliation(s)
| | - Martin Reuter
- Department of Psychology, University of Bonn, Bonn, Germany
| | - Kaja Faßbender
- Department of Psychology, University of Bonn, Bonn, Germany
| | - Thomas Plieger
- Department of Psychology, University of Bonn, Bonn, Germany
| | - Jessie Poulsen
- Nicotine Science Center, Fertin Pharma A/S, Vejle, Denmark
| | - Simon S Y Lui
- Department of Psychiatry, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Raymond C K Chan
- Neuropsychology and Applied Cognitive Neuroscience (NACN) Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Ulrich Ettinger
- Department of Psychology, University of Bonn, Bonn, Germany.
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5
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Ferencová N, Višňovcová Z, Bona Olexová L, Tonhajzerová I. Eye pupil – a window into central autonomic regulation via emotional/cognitive processing. Physiol Res 2021. [DOI: 10.33549//physiolres.934749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
If the eyes are windows into the soul, then the pupils represent at least the gateway to the brain and can provide a unique insight into the human mind from several aspects. The changes in the pupil size primarily mediated by different lighting conditions are controlled by the autonomic nervous system regulated predominantly at the subcortical level. Specifically, parasympathetically-linked pupillary constriction is under the Edinger-Westphal nucleus control and sympathetically-mediated pupillary dilation is regulated from the posterior hypothalamic nuclei. However, the changes in the pupil size can be observed at resting state even under constant lighting, these pupillary changes are mediated by global arousal level as well as by various cognitive factors. In this context, autonomic pathways modulating changes in the pupil size in response to the different light levels can be influenced by multiple central descending inputs driving pupillary changes under steady lighting conditions. Moreover, as the pupillary response is involved in emotional (task-evoked pupillary dilation as an index of emotional arousal) and cognitive (task-evoked pupillary dilation as an index of cognitive workload) stimulation, it can be used to detect the impact of mutual subcortical and cortical structures (i.e. overlapping brain structures included in autonomic, emotional and cognitive regulation) on the pupillary innervation system. Thus, complex understanding of the baseline pupil size´ and pupillary dynamics´ mechanisms may provide an important insight into the central nervous system functioning pointing to the pupillometry as a promising tool in the clinical application.
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Affiliation(s)
| | | | | | - I Tonhajzerová
- Department of Physiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic.
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6
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Ferencová N, Višňovcová Z, Bona Olexová L, Tonhajzerová I. Eye pupil - a window into central autonomic regulation via emotional/cognitive processing. Physiol Res 2021; 70:S669-S682. [PMID: 35199551 DOI: 10.33549/physiolres.934749] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
If the eyes are windows into the soul, then the pupils represent at least the gateway to the brain and can provide a unique insight into the human mind from several aspects. The changes in the pupil size primarily mediated by different lighting conditions are controlled by the autonomic nervous system regulated predominantly at the subcortical level. Specifically, parasympathetically-linked pupillary constriction is under the Edinger-Westphal nucleus control and sympathetically-mediated pupillary dilation is regulated from the posterior hypothalamic nuclei. However, the changes in the pupil size can be observed at resting state even under constant lighting, these pupillary changes are mediated by global arousal level as well as by various cognitive factors. In this context, autonomic pathways modulating changes in the pupil size in response to the different light levels can be influenced by multiple central descending inputs driving pupillary changes under steady lighting conditions. Moreover, as the pupillary response is involved in emotional (task-evoked pupillary dilation as an index of emotional arousal) and cognitive (task-evoked pupillary dilation as an index of cognitive workload) stimulation, it can be used to detect the impact of mutual subcortical and cortical structures (i.e. overlapping brain structures included in autonomic, emotional and cognitive regulation) on the pupillary innervation system. Thus, complex understanding of the baseline pupil size´ and pupillary dynamics´ mechanisms may provide an important insight into the central nervous system functioning pointing to the pupillometry as a promising tool in the clinical application.
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Affiliation(s)
- N Ferencová
- Department of Physiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic.
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7
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Fluid intelligence and the locus coeruleus-norepinephrine system. Proc Natl Acad Sci U S A 2021; 118:2110630118. [PMID: 34764223 DOI: 10.1073/pnas.2110630118] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2021] [Indexed: 11/18/2022] Open
Abstract
The last decade has seen significant progress identifying genetic and brain differences related to intelligence. However, there remain considerable gaps in our understanding of how cognitive mechanisms that underpin intelligence map onto various brain functions. In this article, we argue that the locus coeruleus-norepinephrine system is essential for understanding the biological basis of intelligence. We review evidence suggesting that the locus coeruleus-norepinephrine system plays a central role at all levels of brain function, from metabolic processes to the organization of large-scale brain networks. We connect this evidence with our executive attention view of working-memory capacity and fluid intelligence and present analyses on baseline pupil size, an indicator of locus coeruleus activity. Using a latent variable approach, our analyses showed that a common executive attention factor predicted baseline pupil size. Additionally, the executive attention function of disengagement--not maintenance--uniquely predicted baseline pupil size. These findings suggest that the ability to control attention may be important for understanding how cognitive mechanisms of fluid intelligence map onto the locus coeruleus-norepinephrine system. We discuss how further research is needed to better understand the relationships between fluid intelligence, the locus coeruleus-norepinephrine system, and functionally organized brain networks.
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8
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Eye tracking to assess concussions: an intra-rater reliability study with healthy youth and adult athletes of selected contact and collision team sports. Exp Brain Res 2021; 239:3289-3302. [PMID: 34467416 DOI: 10.1007/s00221-021-06205-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 08/21/2021] [Indexed: 10/20/2022]
Abstract
Eye movements that are dependent on cognition hold promise in assessing sports-related concussions but research on reliability of eye tracking measurements in athletic cohorts is very limited. This observational test-retest study aimed to establish whether eye tracking technology is a reliable tool for assessing sports-related concussions in youth and adult athletes partaking in contact and collision team sports. Forty-three youth (15.4 ± 2.2 years) and 27 adult (22.2 ± 2.9 years) Rugby Union and soccer players completed the study. Eye movements were recorded using SMIRED250mobile while participants completed a test battery twice, with a 1-week interval that included self-paced saccade (SPS), fixation stability, memory-guided sequence (MGS), smooth pursuit (SP), and antisaccades (AS) tasks. Intra-class correlation coefficient (ICC), measurement error (SEM) and smallest real difference (SRD) were calculated for 47 variables. Seventeen variables achieved an ICC > 0.50. In the adults, saccade count in SPS had good reliability (ICC = 0.86, SRD = 146.6 saccades). In the youth, the average blink duration in MGS had excellent reliability (ICC = 0.99, SRD = 59.4 ms); directional errors in AS tasks and gain of diagonal SP had good reliability (ICC = 0.78 and 0.77, SRD = 25.3 and 395.1%, respectively). Four metrics were found in this study to be reliable candidates for further biomarker validity research in contact and collision sport cohorts. Many variables failed to present a sufficient level of robustness for a practical diagnostic tool; possibly, because athletic cohorts have higher homogeneity, along with latent adverse effects of undetected concussions and repetitive head impacts. Since reliability of a measure can influence type II error, effect sizes, and confidence intervals, it is strongly advocated to conduct dedicated reliability evaluations prior to any validity studies.
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9
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Abstract
Forster and Lavie (Journal of Experimental Psychology: Learning, Memory, and Cognition, 40[1], 251-260, 2014; Psychological Science, 27[2], 203-212, 2016) found that task-irrelevant distraction correlated positively with a measure of mind-wandering and a report of attention-deficit/hyperactivity disorder (ADHD) symptomology. Based primarily on these results, Forster and Lavie claimed to establish an attention-distractibility trait. Here, I tested whether these associations could be distinguished from associations with working memory capacity and task-relevant distraction (measured with an antisaccade task). With data collected from 226 subjects (ns differ among analyses), the results from the current study suggest that the measures of task-irrelevant distraction and working memory capacity were not (or only very weakly) associated with measures of mind wandering (measured both with a stand-alone questionnaire and in-task thought probes) and ADHD symptomology. Task-relevant interference (i.e., antisaccade accuracy) was associated with mind-wandering reports from in-task thought probes (presented in a separate task), but not the stand-alone mind wandering questionnaire or ADHD symptomology. Additionally, the measure of irrelevant-distraction exhibited low internal consistency suggesting that (as measured) it may not be a suitable individual difference measure. [Preregistration, data, analysis scripts and output are available via the Open Science Framework: https://osf.io/bhs24/ ].
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10
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Mitre-Hernandez H, Covarrubias Carrillo R, Lara-Alvarez C. Pupillary Responses for Cognitive Load Measurement to Classify Difficulty Levels in an Educational Video Game: Empirical Study. JMIR Serious Games 2021; 9:e21620. [PMID: 33427677 PMCID: PMC7834946 DOI: 10.2196/21620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 09/25/2020] [Accepted: 11/05/2020] [Indexed: 01/25/2023] Open
Abstract
Background A learning task recurrently perceived as easy (or hard) may cause poor learning results. Gamer data such as errors, attempts, or time to finish a challenge are widely used to estimate the perceived difficulty level. In other contexts, pupillometry is widely used to measure cognitive load (mental effort); hence, this may describe the perceived task difficulty. Objective This study aims to assess the use of task-evoked pupillary responses to measure the cognitive load measure for describing the difficulty levels in a video game. In addition, it proposes an image filter to better estimate baseline pupil size and to reduce the screen luminescence effect. Methods We conducted an experiment that compares the baseline estimated from our filter against that estimated from common approaches. Then, a classifier with different pupil features was used to classify the difficulty of a data set containing information from students playing a video game for practicing math fractions. Results We observed that the proposed filter better estimates a baseline. Mauchly’s test of sphericity indicated that the assumption of sphericity had been violated (χ214=0.05; P=.001); therefore, a Greenhouse-Geisser correction was used (ε=0.47). There was a significant difference in mean pupil diameter change (MPDC) estimated from different baseline images with the scramble filter (F5,78=30.965; P<.001). Moreover, according to the Wilcoxon signed rank test, pupillary response features that better describe the difficulty level were MPDC (z=−2.15; P=.03) and peak dilation (z=−3.58; P<.001). A random forest classifier for easy and hard levels of difficulty showed an accuracy of 75% when the gamer data were used, but the accuracy increased to 87.5% when pupillary measurements were included. Conclusions The screen luminescence effect on pupil size is reduced with a scrambled filter on the background video game image. Finally, pupillary response data can improve classifier accuracy for the perceived difficulty of levels in educational video games.
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Affiliation(s)
| | | | - Carlos Lara-Alvarez
- Center for Research in Mathematics, Zacatecas, Mexico.,Center for Research and Advanced Studies of the National Polytechnic Institute, Tamaulipas, Ciudad Victoria, Mexico
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11
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Abstract
The relation between working memory capacity (WMC) and baseline pupil diameter was examined. Participants (N = 341) performed several WMC tasks and baseline pupil diameter was measured in a dark room with a black background screen. The results indicated a weak and non-significant correlation between WMC and baseline pupil diameter consistent with some prior research. A meta-analysis of available studies (k = 26; N = 4356) similarly indicated a weak and non-significant correlation between WMC and baseline pupil diameter. Moderator analyses indicated that the primary moderator responsible for heterogeneity across studies was where the study was conducted. Studies from one laboratory tend to demonstrate a significant positive correlation, whereas other laboratories have yet to demonstrate the correlation. Broadly, the results suggest that the correlation between WMC and baseline pupil diameter is weak and not particularly robust.
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12
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Khairat S, Coleman C, Ottmar P, Jayachander DI, Bice T, Carson SS. Association of Electronic Health Record Use With Physician Fatigue and Efficiency. JAMA Netw Open 2020; 3:e207385. [PMID: 32515799 PMCID: PMC7284310 DOI: 10.1001/jamanetworkopen.2020.7385] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE The use of electronic health records (EHRs) is directly associated with physician burnout. An underlying factor associated with burnout may be EHR-related fatigue owing to insufficient user-centered interface design and suboptimal usability. OBJECTIVE To examine the association between EHR use and fatigue, as measured by pupillometry, and efficiency, as measured by mouse clicks, time, and number of EHR screens, among intensive care unit (ICU) physicians completing a simulation activity in a prominent EHR. DESIGN, SETTING, AND PARTICIPANTS A cross-sectional, simulation-based EHR usability assessment of a leading EHR system was conducted from March 20 to April 5, 2018, among 25 ICU physicians and physician trainees at a southeastern US academic medical center. Participants completed 4 simulation patient cases in the EHR that involved information retrieval and task execution while wearing eye-tracking glasses. Fatigue was quantified through continuous eye pupil data; EHR efficiency was characterized through task completion time, mouse clicks, and EHR screen visits. Data were analyzed from June 1, 2018, to August 31, 2019. MAIN OUTCOMES AND MEASURES Primary outcomes were physician fatigue, measured by pupillometry (with lower scores indicating greater fatigue), and EHR efficiency, measured by task completion times, number of mouse clicks, and number of screens visited during EHR simulation. RESULTS The 25 ICU physicians (13 women; mean [SD] age, 32.1 [6.1] years) who completed a simulation exercise involving 4 patient cases (mean [SD] completion time, 34:43 [11:41] minutes) recorded a total of 14 hours and 27 minutes of EHR activity. All physician participants experienced physiological fatigue at least once during the exercise, and 20 of 25 participants (80%) experienced physiological fatigue within the first 22 minutes of EHR use. Physicians who experienced EHR-related fatigue in 1 patient case were less efficient in the subsequent patient case, as demonstrated by longer task completion times (r = -0.521; P = .007), higher numbers of mouse clicks (r = -0.562; P = .003), and more EHR screen visits (r = -0.486; P = .01). CONCLUSIONS AND RELEVANCE This study reports high rates of fatigue among ICU physicians during short periods of EHR simulation, which were negatively associated with EHR efficiency and included a carryover association across patient cases. More research is needed to investigate the underlying causes of EHR-associated fatigue, to support user-centered EHR design, and to inform safe EHR use policies and guidelines.
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Affiliation(s)
- Saif Khairat
- Carolina Health Informatics Program, University of North Carolina at Chapel Hill
- School of Nursing, University of North Carolina at Chapel Hill
| | - Cameron Coleman
- Department of Preventive Medicine, University of North Carolina at Chapel Hill
| | - Paige Ottmar
- Gilling’s School of Public Health, University of North Carolina at Chapel Hill
| | | | - Thomas Bice
- Pulmonary Diseases and Critical Care Medicine, University of North Carolina at Chapel Hill
| | - Shannon S. Carson
- Pulmonary Diseases and Critical Care Medicine, University of North Carolina at Chapel Hill
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13
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Perquin MN, Bompas A. Reliability and correlates of intraindividual variability in the oculomotor system. J Eye Mov Res 2019; 12:10.16910/jemr.12.6.11. [PMID: 33828751 PMCID: PMC7962678 DOI: 10.16910/jemr.12.6.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Even if all external circumstances are kept equal, the oculomotor system shows intraindividual variability over time, affecting measures such as microsaccade rate, blink rate, pupil size, and gaze position. Recently, some of these measures have been associated with ADHD on a between-subject level. However, it remains unclear to what extent these measures constitute stable individual traits. In the current study, we investigate the intraindividual reliability of these oculomotor features. Combining results over three experiments (> 100 healthy participants), we find that most measures show good intra-individual reliability over different time points (repeatability) as well as over different conditions (generalisation). However, we find evidence against any correlation with self-assessed ADHD tendencies, mind wandering, and impulsivity. As such, the oculomotor system shows reliable intra-individual reliability, but its benefit for investigating self-assessed individual differences in healthy subjects remains unclear. With our results, we highlight the importance of reliability and statistical power when studying between-subject differences.
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