Identification of emergencies in the telephone queue and routing to a fast track (FAST): study protocol for a prospective, two-armed cohort study.

BACKGROUND: In Germany, the telephone patient service 116,117 for callers with non-life-threatening health issues is available 24/7. Based on structured initial assessment, urgency and placement of suitable medical care offer have been offered since 2020. The service has been in increasing demand for several years: Depending on time and residence, this can result in longer waiting times. METHODS: Prospective, two-armed cohort study with two intervention groups and one control group, alternating between blinding and unblinding for employees of 116,117 regarding prioritization status. Two interventions based on automated voice dialogues (1: Simple self-rating tool, 2: Automated brief query of emergency symptoms). In case of high level of urgency, callers are prioritized. Validation of urgency and need for care is carried out routinely based on structured initial assessment. DISCUSSION: By creating and providing a largely reproducible documentation of the implemented solutions for a waiting queue management, the developed approach would be available for comparable projects in the German health care system or in the European context. This potentially leads to a reduction in the use of resources in the development of comparable technical solutions based on automated voice dialogs. TRIAL REGISTRATION: DRKS00031235, registered on 10th November 2023, https://drks.de/search/de/trial/DRKS00031235 .

To follow or not to follow: Influence of valence and consensus on the sense of agency.

Advice from others influence our decisions. Irrespective of whether we follow them or not, we sometimes regret not having listened or blame the other for bad guidance. How does compliance with advice and outcome of the chosen action influence a person's sense of agency? We conducted two online experiments using explicit and implicit measures of the sense of agency. Participants played a digital thimblerig and received hints towards either of the cups. Correct choices came with financial benefits whereas incorrect choices came with losses. Benefits increased explicit agency ratings compared to losses, so did dissent choices compared to advice compliance. Conversely, temporal binding as implicit measure for sense of agency was not affected by advice compliance while being larger for losses compared to benefits. We propose that consensus and outcome valence directly affect reflective aspects of the sense of agency, whereas the influence on prospective aspects depends on situational characteristics.

Connecting action control and agency: Does action-effect binding affect temporal binding?

The sense of agency, i.e., the notion that we, as agents, are in control of our own actions and can affect our environment by acting, is an integral part of human volition. Recent work has attempted to ground agency in basic mechanisms of human action control. Along these lines, action-effect binding has been shown to affect explicit judgments of agency. Here, we investigate if such action-effect bindings are also related to temporal binding which is often used as an implicit measure of agency. In two experiments, we found evidence for the establishment of short-term action-effect bindings as well as temporal binding effects. However, the two phenomena were not associated with each other. This finding suggests that the relation of action control and agency is not a simple one, and it adds to the evidence in favor of a dissociation between subjective agency and perceptual biases such as temporal binding.

Eye did this! Sense of agency in eye movements.

This study investigates the sense of agency (SoA) for saccades with implicit and explicit agency measures. In two eye tracking experiments, participants moved their eyes towards on-screen stimuli that subsequently changed color. Participants then either reproduced the temporal interval between saccade and color-change (Experiment 1) or reported the time points of these events with an auditory Libet clock (Experiment 2) to measure temporal binding effects as implicit indices of SoA. Participants were either made to believe to exert control over the color change or not (agency manipulation). Explicit ratings indicated that the manipulation of causal beliefs and hence agency was successful. However, temporal binding was only evident for caused effects, and only when a sufficiently sensitive procedure was used (auditory Libet clock). This suggests a feebler connection between temporal binding and SoA than previously proposed. The results also provide evidence for a relatively fast acquisition of sense of agency for previously never experienced types of action-effect associations. This indicates that the underlying processes of action control may be rooted in more intricate and adaptable cognitive models than previously thought. Oculomotor SoA as addressed in the present study presumably represents an important cognitive foundation of gaze-based social interaction (social sense of agency) or gaze-based human-machine interaction scenarios. PUBLIC SIGNIFICANCE STATEMENT: In this study, sense of agency for eye movements in the non-social domain is investigated in detail, using both explicit and implicit measures. Therefore, it offers novel and specific insights into comprehending sense of agency concerning effects induced by eye movements, as well as broader insights into agency pertaining to entirely newly acquired types of action-effect associations. Oculomotor sense of agency presumably represents an important cognitive foundation of gaze-based social interaction (social agency) or gaze-based human-machine interaction scenarios. Due to peculiarities of the oculomotor domain such as the varying degree of volitional control, eye movements could provide new information regarding more general theories of sense of agency in future research.

Distracted to a fault: Attention, actions, and time perception.

In the last years, it has become general consensus that actions change our time perception. Performing an action to elicit a specific event seems to lead to a systematic underestimation of the interval between action and effect, a phenomenon termed temporal (or previously intentional) binding. Temporal binding has been closely associated with sense of agency, our perceived control over our actions and our environment, and because of its robust behavioral effects has indeed been widely utilized as an implicit correlate of sense of agency. The most robust and clear temporal binding effects are typically found via Libet clock paradigms. In the present study, we investigate a crucial methodological confound in these paradigms that provides an alternative explanation for temporal binding effects: a redirection of attentional resources in two-event sequences (as in classical operant conditions) versus singular events (as in classical baseline conditions). Our results indicate that binding effects in Libet clock paradigms may be based to a large degree on such attentional processes, irrespective of intention or action-effect sequences. Thus, these findings challenge many of the previously drawn conclusions and interpretations with regard to actions and time perception.

Intentional binding: Merely a procedural confound?

Sense of agency (SoA) is the feeling of having control over one's actions and their outcomes. Previous research claimed that SoA is reflected in "intentional binding" effects, that is, the subjective compression of time between a voluntary action and an intended outcome. Conventional paradigms, however, typically lack an isolated manipulation of different degrees of agency (or intentionality), as the presence or absence of actions (along with subsequent perceptual changes) represents a potential confound variable. Using a newly developed paradigm, we were able to replicate typical "intentional binding" results in an initial experiment in which such a confound was deliberately included. We then eliminated this confound in a follow-up experiment by keeping the presence of actions and perceptual changes constant between conditions with and without agency while only manipulating subjective SoA. Here, explicit ratings showed that participants indeed felt responsible for effects in the Agency condition but not in the Baseline condition (demonstrating the successful manipulation of SoA), while we no longer found any differences in "intentional binding" effects between conditions. This indicates that previously reported relations between intentional binding and SoA could be merely based on procedural confounds. In particular, temporal compression effects usually interpreted in terms of "intentional binding" may rather result from more basic temporal grouping mechanisms for any (perceptual and/or motor) events that are perceived as meaningfully belonging together (e.g., as parts of a trial episode). (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Social Action Effects: Representing Predicted Partner Responses in Social Interactions.

The sociomotor framework outlines a possible role of social action effects on human action control, suggesting that anticipated partner reactions are a major cue to represent, select, and initiate own body movements. Here, we review studies that elucidate the actual content of social action representations and that explore factors that can distinguish action control processes involving social and inanimate action effects. Specifically, we address two hypotheses on how the social context can influence effect-based action control: first, by providing unique social features such as body-related, anatomical codes, and second, by orienting attention towards any relevant feature dimensions of the action effects. The reviewed empirical work presents a surprisingly mixed picture: while there is indirect evidence for both accounts, previous studies that directly addressed the anatomical account showed no signs of the involvement of genuinely social features in sociomotor action control. Furthermore, several studies show evidence against the differentiation of social and non-social action effect processing, portraying sociomotor action representations as remarkably non-social. A focus on enhancing the social experience in future studies should, therefore, complement the current database to establish whether such settings give rise to the hypothesized influence of social context.

Response modalities and the cognitive architecture underlying action control: Intra-modal trumps cross-modal action coordination.

Performing two actions at the same time usually hampers performance. Previous studies have demonstrated a strong impact of the particular effector systems on performance in multiple action control situations. However, an open question is whether performance is generally better or worse in situations in which two actions within the same effector system are coordinated (intra-modal actions: e.g., two pedal or two manual actions) compared to situations requiring two different effector systems (cross-modal actions: e.g., a manual combined with a vocal action). Performance differences can be predicated, among others, in the light of encapsulation accounts. Encapsulation of modules on the output side of processing would suggest that actions in two different modules can be triggered simultaneously without significant interference between the actions. Thus, cross-modal actions should lead to better performance compared to intra-modal actions. We investigated this issue in two basic experiments, in which participants responded to a single stimulus (thereby maximizing control over input and central processing stages) with one or two either intra-modal or cross-modal responses (manual-manual vs. manual-oculomotor/manual-vocal in Experiment 1/2, respectively). The results represent clear evidence for a performance advantage of intra-modal over cross-modal action control across both effector system combinations and independent of the particular spatial compatibility relation between responses. The results suggest performance benefits by taking advantage of integrated, holistic representations of intra-modal action compounds.

To prevent means to know: Explicit but no implicit agency for prevention behavior.

Human agents draw on a variety of explicit and implicit cues to construct a sense of agency for their actions and the effects of these actions on the outside world. Associative mechanisms binding actions to their immediate effects support the evolution of agency for operant actions. However, human agents often also act to prevent a certain event from occurring. Such prevention behavior poses a critical challenge for the sense of agency, as successful prevention inherently revolves around the absence of a perceivable effect. By assessing the psychological microstructure of singular operant and prevention actions we show that this comes with profound consequences: agency for prevention actions is only evident in explicit measures but not in corresponding implicit proxies. These findings attest to an altered action representation in prevention behavior and they support recent proposals to model related processes such as avoidance learning in terms of propositional rather than associative terms.

Anticipation in sociomotor actions: Similar effects for in- and outgroup interactions.

In social interactions, own actions often trigger a particular response from another person. The sociomotor framework proposes that this consistent behavior of others can become incorporated into own action control. In line with this idea, recent studies have shown that own motor actions are facilitated if they are predictably being imitated rather than counterimitated by a social interaction partner. In the present study, we investigated whether this finding is influenced by the relationship between the interacting persons. To that end, we manipulated whether a participant was being imitated and counterimitated by an ingroup or by an outgroup member. In two experiments, we found a beneficial influence of being imitated irrespective of group membership. The results suggest that, while people incorporated their partner's behavior into own action control, this was not further qualified by group membership as a higher-order social variable. This finding points to a universal account of action control for actions with social action effects and actions with inanimate action effects alike.

When actions go awry: Monitoring partner errors and machine malfunctions.

Human actions often aim at triggering certain responses from social interaction partners, but these responses do not always come as expected. Here we show that unexpected partner errors trigger sustained monitoring and that this monitoring exceeds the level that is observed if participants are faced with a machine malfunction rather than an error of an interaction partner (Experiment 1). Critically, this pattern of results emerged even though both types of errors were signaled by physically identical events in an oddball task, ruling out alternative explanations in terms of differential bottom-up factors. Unexpected delays in the action-effect sequence, however, did not trigger increased monitoring for social as compared to nonsocial situations (Experiment 2). These results indicate that mechanisms of performance monitoring might be recruited especially when facing the variability that is inherent in social interactions. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Something from nothing: Agency for deliberate nonactions.

Several law systems punish nonactions such as failures to render assistance, although it is unknown if people spontaneously experience a sense of authorship for the consequences of their not acting. Here we provide evidence that events caused by deliberate choices not to act can indeed give rise to a vivid sense of agency. In three experiments, participants reported a sense of agency for events following nonactions and, crucially, temporal binding between nonactions and subsequent consequences suggested a sense of agency for nonactions even at an implicit level. These findings indicate that a sense of agency is not confined to overt body movements. At the same time, agency was more pronounced when the same event resulted from an action rather than being the consequence of a nonaction, highlighting the importance of ascribing different degrees of responsibility for the consequences of acting and not acting.

Task relevance determines binding of effect features in action planning.

Action planning can be construed as the temporary binding of features of perceptual action effects. While previous research demonstrated binding for task-relevant, body-related effect features, the role of task-irrelevant or environment-related effect features in action planning is less clear. Here, we studied whether task-relevance or body-relatedness determines feature binding in action planning. Participants planned an action A, but before executing it initiated an intermediate action B. Each action relied on a body-related effect feature (index vs. middle finger movement) and an environment-related effect feature (cursor movement towards vs. away from a reference object). In Experiments 1 and 2, both effects were task-relevant. Performance in action B suffered from partial feature overlap with action A compared to full feature repetition or alternation, which is in line with binding of both features while planning action A. Importantly, this cost disappeared when all features were available but only body-related features were task-relevant (Experiment 3). When only the environment-related effect of action A was known in advance, action B benefitted when it aimed at the same (vs. a different) environment-related effect (Experiment 4). Consequently, the present results support the idea that task relevance determines whether binding of body-related and environment-related effect features takes place while the pre-activation of environment-related features without binding them primes feature-overlapping actions.

Action-effect anticipation and temporal adaptation in social interactions.

Interacting agents may anticipate their partner's upcoming response and include it in their action plan. In turn, observing an overt response can trigger agents to adapt. But although anticipation and adaptation are known to shape action control, their interplay in social interactions remains largely unexplored. In 4 experiments, we asked how both of these mechanisms could contribute to one striking phenomenon: Agents initiate actions faster when they know their partner will produce a compatible rather than an incompatible response. In Experiment 1, we manipulated the compatibility between agents' actions and partners' responses and investigated the interplay between adaptation and anticipation within the same dyadic interaction. In Experiments 2-4, we isolated the contribution of each mechanism by having agents interact with virtual partners whose responses could be experimentally controlled. We found that adaptation and anticipation exert parallel but independent effects on action execution: Participants initiated their actions more quickly when the upcoming partner response was compatible and, independently, when their partner had responded more quickly on the preceding trial. These findings elucidate models of action control in social interactions. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Sociomotor actions: Anticipated partner responses are primarily represented in terms of spatial, not anatomical features.

The sociomotor framework proposes that people can represent their actions in terms of the behavior these actions evoke in others, so that anticipating the behavior of others triggers own actions. In social interactions, such as imitation, it thus highlights the acting model rather than the responding person. In line with this idea, motor actions are facilitated if they are foreseeably imitated rather than counterimitated by a social partner. In the present study, we investigate how exactly another's behavior is represented in such sociomotor actions. The effect of being imitated can be explained by two distinct forms of compatibility between model and imitator actions: correspondence of anatomical features (imitative compatibility) and correspondence of spatial features (spatial compatibility). Both types of features often go hand in hand, though research on motor priming shows that spatial and anatomical features of other's actions are represented independently. We therefore investigated to which degree the benefit of anticipated imitation is caused by spatial or imitative compatibility. Across 5 experiments, we found that only spatial compatibility of the imitator's behavior influenced the model's actions, while imitative compatibility had no influence. Actors thus seem to represent actions of their social partners mainly in terms of nonsocial, spatial features. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Revisiting intersubjective action-effect binding: No evidence for social moderators.

Effect-based accounts of human action control have recently highlighted the possibility of representing one's own actions in terms of anticipated changes in the behavior of social interaction partners. In contrast to action effects that pertain to the agent's body or the agent's physical environment, social action effects have been proposed to come with peculiarities inherent to their social nature. Here, we revisit the currently most prominent demonstration of such a peculiarity: the role of eye contact for action-effect learning in social contexts (Sato & Itakura, 2013, Cognition, 127, 383-390). In contrast to the previous demonstration of action-effect learning, a conceptual and a direct replication both yielded evidence for the absence of action-effect learning in the proposed design, irrespective of eye contact. Bayesian statistics supported this claim by demonstrating evidence in favor of the null hypothesis of no effect. These results suggest a limited generalizability of the original findings-for example, due to limitations that are inherent in the proposed study design or due to cultural differences.

Disarming the gunslinger effect: Reaction beats intention for cooperative actions.

According to the famous physicist Niels Bohr, gunfights at high noon in Western movies not only captivate the cinema audience but also provide an accurate illustration of a psychophysical law. He suggested that willed actions come with slower movement execution than reactions, and therefore that a film's hero is able to get the upper hand even though the villain normally draws first. A corresponding "gunslinger effect" has been substantiated by empirical studies. Because these studies used a markedly competitive setting, however, it is currently unclear whether the gunslinger effect indeed reflects structural differences between willed actions and reactive movements, or whether it is a by-product of the competitive setting. To obtain bullet-proof evidence for a true reactive advantage, we investigated willed and reactive movements during a cooperative interaction of two participants. A pronounced reactive advantage emerged, indicating that two independent systems indeed control willed and reactive movements.

Sociomotor action control.

Our actions affect the behavior of other people in predictable ways. In the present article, we describe a theoretical framework for action control in social contexts that we call sociomotor action control. This framework addresses how human agents plan and initiate movements that trigger responses from other people, and we propose that humans represent and control such actions literally in terms of the body movements they consistently evoke from observers. We review evidence for this approach and discuss commonalities and differences to related fields such as joint action, intention understanding, imitation, and interpersonal power. The sociomotor framework highlights a range of open questions pertaining to how representations of other persons' actions are linked to one's own motor activity, how specifically they contribute to action initiation, and how they affect the way we perceive the actions of others.

My mistake? Enhanced error processing for commanded compared to passively observed actions.

We often ask other people to carry out actions for us in order to reach our goals. However, these commanded actions may sometimes go awry, and goal attainment is hindered by errors of the following person. Here, we investigated how the commanding person processes these errors of their follower. Because such errors indicate that the original goal of the command is not met, error processing for these actions should be enhanced compared to passively observing another person's actions. Participants thus either commanded another agent to perform one of four key press responses or they passively observed the agent responding. The agent could respond correctly or commit an error in either case. We compared error processing of commanded and passively observed actions using observation-related post-error slowing (oPES) as a behavioral marker and observed-error-related negativity (oNE /oERN) and observed-error positivity (oPE ) as electrophysiological markers. Whereas error processing, as measured via the oERN, was similarly pronounced for commanded and observed actions, commanded actions gave rise to stronger oPES and a stronger oPE . These results suggest that enhanced monitoring is an automatic by-product of commanding another person's actions.

Do we see it or not? Sensory attenuation in the visual domain.

Sensory consequences of an agent's actions are perceived less intensely than sensory stimuli that are not caused (and thus not predicted) by the observer. This effect of sensory attenuation has been discussed as a key principle of perception, potentially mediating various crucial functions such as agency and the discrimination of self-caused sensory stimulation from stimuli caused by external factors. Precise models describe the theoretical underpinnings of this phenomenon across a variety of modalities, especially the auditory, tactile, and visual domain. Despite these strong claims, empirical evidence for sensory attenuation in the visual domain is surprisingly sparse and ambiguous. In the present article, the authors therefore aim to clarify the role of sensory attenuation for learned visual action effects. To this end, the authors present a comprehensive replication effort including 3 separate, high-powered experiments on sensory attenuation in the visual domain with 1 direct and 2 preregistered, conceptual replication attempts of an influential study on this topic (Cardoso-Leite et al., 2010). Signal detection analyses were targeted to distinguish between true visual sensitivity and response bias. Contrary to previous assumptions and despite high statistical power, however, the authors found no evidence for sensory attenuation of learned visual action effects. Bayesian analyses further supported the null hypothesis of no effect, thus constraining theories that promote sensory attenuation as an immediate and necessary consequence of voluntary actions. (PsycINFO Database Record