Decision support-tools for early detection of infection in older people (aged> 65 years): a scoping review.

BACKGROUND: Infection is more frequent, and serious in people aged > 65 as they experience non-specific signs and symptoms delaying diagnosis and prompt treatment. Monitoring signs and symptoms using decision support tools (DST) is one approach that could help improve early detection ensuring timely treatment and effective care. OBJECTIVE: To identify and analyse decision support tools available to support detection of infection in older people (> 65 years). METHODS: A scoping review of the literature 2010-2021 following Arksey and O'Malley (2005) framework and PRISMA-ScR guidelines. A search of MEDLINE, Cochrane, EMBASE, PubMed, CINAHL, Scopus and PsycINFO using terms to identify decision support tools for detection of infection in people > 65 years was conducted, supplemented with manual searches. RESULTS: Seventeen papers, reporting varying stages of development of different DSTs were analysed. DSTs largely focussed on specific types of infection i.e. urine, respiratory, sepsis and were frequently hospital based (n = 9) for use by physicians. Four DSTs had been developed in nursing homes and one a care home, two of which explored detection of non- specific infection. CONCLUSIONS: DSTs provide an opportunity to ensure a consistent approach to early detection of infection supporting prompt action and treatment, thus avoiding emergency hospital admissions. A lack of consideration regarding their implementation in practice means that any attempt to create an optimal validated and tested DST for infection detection will be impeded. This absence may ultimately affect the ability of the workforce to provide more effective and timely care, particularly during the current covid-19 pandemic.

Effects of competing environmental variables and signage on route-choices in simulated everyday and emergency wayfinding situations.

This study examined the relative influence of environmental variables (corridor width and brightness) and signage (directional and exit signs), when presented in competition, on participants' route-choices in two situational variables (everyday vs. emergency), during indoor wayfinding in virtual environments. A virtual reality-based methodology was used. Thus, participants attempted to find a room (everyday situation) in a virtual hotel, followed by a fire-related emergency egress (emergency situation). Different behaviours were observed. In the everyday situation, for no-signs condition, participants choose mostly the wider and brighter corridors, suggesting a heavy reliance on the environmental affordances. Conversely, for signs condition, participants mostly complied with signage, suggesting a greater reliance on the signs rather than on the environmental cues. During emergency, without signage, reliance on environmental affordances seems to be affected by the intersection type. In the sign condition, the reliance on environmental affordances that started strong decreases along the egress route.

It's not what you say but how you say it: Examining the influence of perceived voice assistant gender and pitch on trust and reliance.

Voice assistants (VA) are virtual agents used to aid information seeking. Cues contained in speech, such as perceived gender and vocal pitch, may influence attitudes towards, and interactions with these agents. Given expansion of telehealth efforts and the potential for VA to advise patients on health-related topics outside of formal healthcare settings, the influence of VA vocal characteristics is examined in the context of medication instructions. Participants rated trust and reliance on VA after viewing medication labels and hearing recommendations from male and female agents with varying pitch. Results suggest agents perceived as female were rated as more trustworthy, while vocal pitch did not significantly influence trust. However, a trend of lower reliance with increasing pitch was observed. Additionally, participants relied significantly more on VA advice than medication labels when making decisions. Post-hoc analyses revealed trust and reliance primarily varied between participants. Pitch and gender explained only a small portion of within-participant variance. We found suggestive evidence for social categorizations distilled from vocal cues influencing interactions with agents delivering health-critical information. Future work should explore additional samples, vocal cues, and participant-level sources of variation.

Email phishing and signal detection: How persuasion principles and personality influence response patterns and accuracy.

Phishing is a social engineering tactic where a malicious actor impersonates a trustworthy third party with the intention of tricking the user into divulging sensitive information. Previous social engineering research in a real-world setting has shown an interaction between the personality of the target and the persuasion principle used. This study investigated whether this interaction is present in the realm of email phishing. Additionally, a signal detection theory framework was used to evaluate how the various persuasion principles influence accuracy, sensitivity (d'), and response criterion placement. A personality inventory and an email identification task (phishing or legitimate) were used. These data support previous findings that high extroversion is predictive of increased susceptibility to phishing attacks. The various persuasions principles elicited diverse response criterions and sensitivities, though all investigated persuasion principles resulted in a liberal decision criterion, except one. These findings are interpreted and discussed.

New and improved: the role of text augmentation and the application of response interpretation standards (coding schemes) in a final iteration of birth defects warnings development.

BACKGROUND: Several birth defects warning symbols identified as most successful in an earlier study (Mayhorn and Goldsworthy, 2007) were further modified and then evaluated within a nationally distributed field trial (n = 2773). The purpose for the current research was to determine whether symbol warning components could be improved further, whether the addition of text enhanced comprehension uniformly across symbols, and whether results varied by the application of different interpretation standards (coding schemes). METHOD: A total of 11 warning labels were examined: four new symbols plus the existing baseline symbol, each in versions with and without text, plus a text-only condition. Participant interpretation accuracy and preferences were assessed during face-to-face interview sessions. RESULTS: For symbol-only conditions, several candidate symbols outperformed the existing symbol, one substantially so. The effect of adding text to symbols varied significantly by symbol. Symbol plus text and text-only conditions performed equivalently, generally exceeded symbol-only conditions, and often surpassed the American National Standards Institute benchmark of 85% accurate interpretation. CONCLUSIONS: The research effort has identified a teratogen symbol and warning that outperforms the one currently in use. The effort has also identified important pragmatic and conceptual issues that should inform future work to improve medication labeling and other hazard communication.

Who's the real expert here? Pedigree's unique bias on trust between human and automated advisers.

OBJECTIVE: We assessed the effects of source type bias (human or automation) on adviser trust in a dual adviser decision-making task. BACKGROUND: Source type and reliability's effects on adviser trust have been studied in a dual-adviser context, but the influence of pedigree (perceived expertise) across source types lacked robust investigation. As situations with two decision-aids of uneven pedigree can easily arise, it is critical to understand how operators are biased towards a decision-aid of a certain source type and pedigree. METHOD: A decision-making task similar to the paradigm of Convoy Leader (Lyons and Stokes, 2012) was given to participants, where a military convoy route had to be selected in the presence of IEDs and insurgent activity. We measured behavioral reliance and trust attitudes. Pedigree was manipulated via controlled adviser descriptions, in a manner consistent with past investigations (Madhavan and Wiegmann, 2007a). RESULTS: We found a trust bias towards the human adviser, reversed only when there is a far greater pedigree in the automated adviser. Trust attitudes were also strongly indicative of reliance behaviors. CONCLUSION: Pedigree is a strong influencer of trust in a decision-aid and biased towards human advisers. Trust is highly predictive of reliance decisions. APPLICATION: System designers must take care with how "expert" automation is portrayed, particularly if it is used in conjunction with other human advisers (e.g.: conflicting advice from air-traffic control and an onboard system).

Beyond abuse and exposure: framing the impact of prescription-medication sharing.

OBJECTIVES: We sought to document the frequency, circumstances, and consequences of prescription medication-sharing behaviors and to use a medication-sharing impact framework to organize the resulting data regarding medication-loaning and -borrowing practices. METHODS: One-on-one interviews were conducted in 2006, and participants indicated (1) prescription medicine taken in the past year, (2) whether they had previously loaned or borrowed prescription medicine, (3) scenarios in which they would consider loaning or borrowing prescription medicine, and (4) the types of prescription medicines they had loaned or borrowed. RESULTS: Of the 700 participants, 22.9% reported having loaned their medications to someone else and 26.9% reported having borrowed someone else's prescription. An even greater proportion of participants reported situations in which medication sharing was acceptable to them. CONCLUSIONS: Sharing prescription medication places individuals at risk for diverse consequences, and further research regarding medication loaning and borrowing behaviors and their associated consequences is merited.

Exploring students' prospective memory inside and outside the lab.

This study compared activity-based intentions with event- and time-based intentions. Forty-five participants completed a laboratory session that tested activity-, event-, and time-based prospective memory. Participants were then asked to keep a record of their planned academic and work-related activities for 1 week. Results revealed a main effect of context such that participants were better at performing intentions in the naturalistic setting than in the laboratory. A strong trend of intention type showed that event-based tasks were more likely to be performed than activity- and time-based tasks. An interaction of context and intention type suggested that participants were significantly better at performing time-based tasks in the naturalistic setting than in the lab. Nearly half of the participants reported using simple memory aids such as alarm clocks, parent or friend reminders, or other external cues. Strikingly, very few reported using electronic devices to aid their memory for future intentions.

Comparing older and younger adults in an event-based prospective memory paradigm containing an output monitoring component.

Two experiments with younger and older adults were conducted to investigate the output-monitoring component of event-based prospective memory. In the standard form of the task, participants must remember to press a key when a certain class of items is encountered. To evaluate output monitoring, event-based cues were repeated and participants were asked to press a different key if they could remember that an earlier response was made to a particular cue. Younger adults forgot fewer of their successful responses, but displayed a distinct bias to claim that they had responded earlier when actually they had forgotten to respond. By contrast, older adults displayed this bias much less frequently. Elaborated responding to cues had the effect of improving the performance of younger, but not older adults. The results are discussed in terms of natural repetitions and omission errors that might be made in everyday prospective memory tasks.

Special issue on warnings: advances in delivery, application, and methods.

This special issue of Applied Ergonomics concerns the topic of warnings, safety communications designed to decrease harm to people and property. The field has evolved over time, and with it there has been advancement in knowledge and application. The current special issue contains 14 articles that reflect three distinguishable areas within the warnings literature where such changes are taking place in the laboratories and workplaces of our international colleagues: (1) multimodality of warning delivery, (2) emerging application areas, and (3) new methodology. This special issue brings together a set of studies investigating various factors that might impact safety behavior in diverse settings and domains where warnings are likely to be encountered. It is our hope that the special issue will motivate to development and exploration of new ideas regarding warning design and their use in a variety of applications that improve safety.

Age differences and transfer on control solution testing with blood glucometers.

The elderly are at an increased risk for being diagnosed with diabetes. While previous studies have examined technique errors when a patient used his or her current blood glucometer or a single novel glucometer, no study has measured errors as a patient transferred to using a second, novel experimental glucometer. Results support findings that older adults perform more slowly and less accurately than younger adults when transferring between pieces of equipment. Implications for future blood glucometer design and training are discussed.

Training users to counteract phishing.

Phishing is an increasingly more prevalent form of online, social engineered scams that escalate costs and risks to society year to year. This study demonstrates an association between anti-phishing training techniques used in previous research and individual differences which could affect phishing susceptibility. Results indicated that anti-phishing training in both a simple comic and more complex video game form is helpful in decreasing phishing susceptibility as measured by Miss rates for all individuals including college aged and computer savvy participants. Based on the results of the present study, implications for future efforts to combat phishing are discussed.

Prescription medication sharing among adolescents: prevalence, risks, and outcomes.

We interviewed 594 adolescents throughout the United States. One in five reported sharing prescription medication. Of these, less than half received instructions, many delayed professional care, few informed providers, and a third reported experiencing side effects. Efforts to reduce medication sharing prevalence and risks among adolescents may be justified.

Interpretation of pharmaceutical warnings among adolescents.

PURPOSE: Warnings are an important component of pharmaceutical risk mitigation efforts, yet very little research attention has been directed toward adolescent interpretation of such warnings. This study examined adolescents' interpretations of and preferences for warning symbols and statements related to pharmaceuticals with teratogenic properties. METHODS: A total of 200 adolescents interpreted one of four warning symbols and four warning statements. Responses were coded using an established three-tier coding system. Symbol preferences were elicited. Interpretation accuracy and symbol preferences were analyzed by symbol and statement. RESULTS: The symbol in use on medication labels at the time of the study elicited nearly goal levels of interpretation accuracy; however it exceeded allowable levels of critical confusion. An alternative symbol elicited more fully correct responses than the existing symbol and was preferred to the existing symbol by a margin of 2 to 1. Yet another symbol was most preferred despite eliciting fewer correct interpretations. The impact of warning statements on overall warning interpretation varied by statement and statement-symbol combinations. At least one statement appeared to lessen the overall message of caution, and few adolescents expressed an awareness of risk if one "may become pregnant" until explicitly informed of this risk. CONCLUSIONS: Comprehension of medical warning symbols and statements among adolescents is an important public health issue. Those involved in adolescent health education and research have considerable theoretical and practical tools for approaching the development and evaluation of such warning messages. Understanding how warnings are interpreted can lead to more effective communication efforts and reduce risk.

Refining teratogen warning symbols for diverse populations.

BACKGROUND: The current research reports on efforts to refine the design of recently developed teratogen warning symbols and to examine their interpretation by different populations such as those with low health literacy, adolescents, and individuals who are not fluent in English. METHODS: Alternative symbols identified as most successful in an earlier study were further refined through the use of multiple focus groups and expert review. Six symbols emerged as potential candidates to replace the current symbol. A nationally distributed field trial (n = 700) examined these six alternate teratogen warnings in addition to the symbol presently in use. RESULTS: Five of the alternate warning symbols exceeded the level of correct interpretation elicited by the current symbol. No symbol exceeded the ANSI limit of 5% critical confusion. Two symbols consistently elicited the most accurate responses in terms of message interpretation, target audience, intended action, and perceived consequences of ignoring the warning. CONCLUSIONS: This effort produced at least two viable alternative symbols that appear to be more effective than the current symbol at communicating both the instruction to not take while pregnant and the consequence that exposure could cause birth defects. Several results varied by participant characteristics. Understanding how members of diverse subpopulations might interact with these warnings should be informative to healthcare professionals.

Perceptions of driver distraction by cellular phone users and nonusers.

The present study examined the perceptions of cellular phone users and nonusers on issues relating to vehicle control and driver distraction. Participants were asked if they own a cellular phone; if so, how much they use it; and their beliefs regarding cellular phone use while driving, including actions involving the use of cellular phones which could potentially cause vehicular accidents and the need for laws. A total of 330 individuals participated; 72% owned a cellular phone. The results indicate that nonusers of cellular phones believed more strongly than users that cellular phone use while driving negatively affects driving performance and that talking on the cellular phone could potentially cause an accident, and they also had a greater preference for new laws limiting such acts. Cellular phone users, more than nonusers, preferred no laws limiting cellular phone use and believed more strongly that other people driving while using a cellular phone were more dangerous than themselves doing the same. Implications of these results are discussed. Actual or potential applications of this research include interventions that limit driver distractibility.

Decisions, decisions: analysis of age, cohort, and time of testing on framing of risky decision options.

Decision making in uncertain environments is a daily challenge faced by adults of all ages. Framing decision options as either gains or losses is a common method of altering decision-making behavior. In the experiment reported here, benchmark decision-making data collected in the 1970s by Tversky and Kahneman (1981, 1988) were compared with data collected from current samples of young and older adults to determine whether behavior was consistent across time. Although differences did emerge between the benchmark and the present samples, the effect of framing on decision behavior was relatively stable. The present findings suggest that adults of all ages are susceptible to framing effects. Results also indicated that apparent age differences might be better explained by an analysis of cohort and time-of-testing effects. Actual or potential applications of this research include an understanding of how framing might influence the decision-making behavior of people of all ages in a number of applied contexts, such as product warning interactions and medical decision scenarios.

Hazards in the home: using older adults' perceptions to inform warning design.

Older adults' perceptions of hazards associated with home product usage and beliefs about product warnings were assessed. Focus group interview data were coded along the dimensions of (a) product type; (b) hazard type; (c) hazard knowledge; (d) hazard avoidance; (e) product warning presence; and (f) product warning necessity. A survey supplemented the focus group results by gathering measures of usage patterns and usability difficulties associated with various types of household products. Older adults reported routine use of products they considered to be hazardous and identified an array of home safety concerns. Furthermore, personal experience was an important source of older adults' hazard knowledge and they described a number of hazard avoidance strategies. These data provide insight into older adults' home safety behaviour and suggest a number of approaches to improving hazard communication and warning design.

Champagne, beer, or coffee? A corpus of gender-related and neutral words.

A list of gender-related and gender-neutral words for use in testing gender stereotyping and memory was created and evaluated. Words were rated by samples of undergraduates at universities located in the northeast, southeast, and south-central United States. A substantial list of masculine, feminine, and gender-neutral words was identified. These lists allow researchers to construct large lists of gender-associated words while being able to control for extraneous variables, such as word frequency and word length. In addition, the high reliability across the samples suggests that gender ratings are a fairly stable phenomenon. Applications for this list are discussed. The word lists presented in Tables 1-3 and the raw data analyzed in this article may be downloaded from www.psychonomic.org/archive/.

Investigating the encoding and retrieval of intentions with event-related potentials.

Strong evidence exists in the literature that remembering to complete intentions involves executive processing subserved by the frontal lobes. Event-related potentials were measured during the encoding of actions with the intention to perform versus more neutral material about which there was no such intentionality. Event-related potentials were also measured in a two-alternative discrimination task requiring identification of the to-be-performed actions and to-be-memorized actions. The results suggest that formation and retrieval of intentions differs from encoding and retrieval of similar material committed to memory. Additionally, the results suggest that right frontal areas may play an important role in the formation of prospective actions and that intentions are kept active in memory by processing mediated by the left frontal pole.