Hypercalcaemia of malignancy: a case of vitamin-D-mediated hypercalcaemia in lymphoma.

Hypercalcaemia of malignancy (HCM) is a paraneoplastic syndrome that often portends a poor prognosis. We present an extremely rare (<1%) case of HCM due to extrarenal calcitriol (1,25-(OH)2D) production in a patient with splenic marginal zone lymphoma. A man in his 80s presented with a 3-week history of fatigue, unsteadiness and abdominal pain, and new findings of anaemia, kidney injury and hypercalcaemia. Laboratory evaluation, bone marrow biopsy and positron emission tomography/computed tomography (PET/CT) confirmed the diagnosis of splenic marginal zone lymphoma which produced calcitriol (1,25-(OH)2D3), causing the patient's hypercalcaemia.

Workload transition rate matters: Evidence from growth curve modeling.

This research examined three specific gaps in the workload transition literature: (1) the impact of workload transition rate, (2) the applicability of current theoretical explanations, and (3) the variability of performance overall and over time. Sixty Naval flight students multitasked in an unmanned aerial vehicle control testbed and workload transitioned at three rates: slow, medium, or fast. Response time and accuracy were analyzed via growth curve modeling. Slow transitions had the largest decline in performance over time. Medium transitions had some of the slowest, but most accurate and consistent performance. Fast transitions had some of the fastest, but least accurate performance. However, all performance trends significantly varied, suggesting multiple theoretical explanations may apply and performance may also depend on the individual. Design guidance on how to maximize performance goals with transition rate is provided, but future research needs to study the theoretical explanations and impact of individual differences further.

Near-Perfect Automation: Investigating Performance, Trust, and Visual Attention Allocation.

OBJECTIVE: Assess performance, trust, and visual attention during the monitoring of a near-perfect automated system. BACKGROUND: Research rarely attempts to assess performance, trust, and visual attention in near-perfect automated systems even though they will be relied on in high-stakes environments. METHODS: Seventy-three participants completed a 40-min supervisory control task where they monitored three search feeds. All search feeds were 100% reliable with the exception of two automation failures: one miss and one false alarm. Eye-tracking and subjective trust data were collected. RESULTS: Thirty-four percent of participants correctly identified the automation miss, and 67% correctly identified the automation false alarm. Subjective trust increased when participants did not detect the automation failures and decreased when they did. Participants who detected the false alarm had a more complex scan pattern in the 2 min centered around the automation failure compared with those who did not. Additionally, those who detected the failures had longer dwell times in and transitioned to the center sensor feed significantly more often. CONCLUSION: Not only does this work highlight the limitations of the human when monitoring near-perfect automated systems, it begins to quantify the subjective experience and attentional cost of the human. It further emphasizes the need to (1) reevaluate the role of the operator in future high-stakes environments and (2) understand the human on an individual level and actively design for the given individual when working with near-perfect automated systems. APPLICATION: Multiple operator-level measures should be collected in real-time in order to monitor an operator's state and leverage real-time, individualized assistance.

Scan-based eye tracking measures are predictive of workload transition performance.

Given there is no unifying theory or design guidance for workload transitions, this work investigated how visual attention allocation patterns could inform both topics, by understanding if scan-based eye tracking metrics could predict workload transition performance trends in a context-relevant domain. The eye movements of sixty Naval flight students were tracked as workload transitioned at a slow, medium, and fast pace in an unmanned aerial vehicle testbed. Four scan-based metrics were significant predictors across the different growth curve models of response time and accuracy. Stationary gaze entropy (a measure of how dispersed visual attention transitions are across tasks) was predictive across all three transition rates. The other three predictive scan-based metrics captured different aspects of visual attention, including its spread, directness, and duration. The findings specify several missing details in both theory and design guidance, which is unprecedented, and serves as a basis of future workload transition research.

Transitions Between Low and High Levels of Mental Workload can Improve Multitasking Performance.

OCCUPATIONAL APPLICATIONS Complex and dynamic environments including military operations, healthcare, aviation, and driving require operators to transition seamlessly between levels of mental workload. However, little is known about how the rate of an increase in workload impacts multitasking performance, especially in the context of real-world tasks. We evaluated both gradual and sudden workload increases in the dynamic multitasking environment of an Unmanned Aerial Vehicle (UAV) command and control testbed and compared them to constant workload. Workload transitions were found to improve response time and accuracy compared to when workload was held constant at low or high. These results suggest that workload transitions may allow operators to better regulate mental resources. These findings can also inform the design of operations and technology to assist operators' management of cognitive resources, which include negating the adverse effects of vigilance decrements during low workload periods and data overload during high workload periods.

TECHNICAL ABSTRACT Background High workload and workload transitions can affect performance; however, it is not clear how the rate of transition from low to high workload influences performance in a multitasking setting. Purpose We investigated the effect of workload transition rate on performance in a multitasking environment that is akin to the expectations of operators in complex, data-rich work domains. Method An Unmanned Aerial Vehicle (UAV) command and control testbed was used to vary workload between low, high, gradually transitioning from low to high, and suddenly transitioning from low to high. Performance measures consisted of the response time and accuracy of one primary task and three secondary tasks. Analyses compared: (a) performance differences between gradual and sudden increases in workload; (b) performance during the low workload phases of the workload transitions; and (c) performance during the high workload phases of the workload transitions. Results Overall, there were limited performance differences between gradual and sudden workload transitions. However, both types of transitions led to better performance than constant workload, lending some support for the effort regulation explanation which suggests that participants actively evaluated the amount of mental resources necessary to successfully complete a task after a workload transition. Conclusions Gradual and sudden workload transitions benefit primary and secondary task performance, suggesting that the applicability of existing theoretical explanations depend on the context. For example, varying task demands can be a means to assist operators in the appropriate regulation of mental resources in domains with interdependent tasks. These findings can inform occupation and technology design to support task management.

A Retrospective Analysis of Pain Burden in Hospitalized Young Adult Cancer Patients Compared with Their Older Adult Counterpart.

CONTEXT: Research shows an increased symptom burden in young adult (YA) cancer patients compared with their older adult counterpart. OBJECTIVES: The purpose of this study was to identify differences in clinical characteristics and related outcomes between YA and older adult cancer patients admitted for cancer-related pain. MATERIALS AND METHODS: We retrospectively identified 190 hospitalized patients in a single academic center with admissions for cancer-related pain. Patients were grouped into either "young adult" (18-39) or "older adult" (>40) cohorts. We compared differences in patient characteristics and pain regimens. RESULTS: Median oral morphine equivalent per 24 hours was higher in the YA group (194 mg vs. 70 mg, p = 0.010). Younger patients received patient-controlled analgesia (PCA) more frequently (p = 0.023). The number of palliative care consults and adjuvants prescribed did not differ between groups (p > 0.05), although YAs more frequently had an inpatient pain anesthesia consult (p = 0.047). CONCLUSION: Findings show increased opioid requirements and PCA use in YAs being treated for malignancy compared with their older adult counterpart.