Fatigue and vigilance in medical experts detecting breast cancer.

An abundance of laboratory-based experiments has described a vigilance decrement of reducing accuracy to detect targets with time on task, but there are few real-world studies, none of which have previously controlled the environment to control for bias. We describe accuracy in clinical practice for 360 experts who examined >1 million women's mammograms for signs of cancer, whilst controlling for potential biases. The vigilance decrement pattern was not observed. Instead, test accuracy improved over time, through a reduction in false alarms and an increase in speed, with no significant change in sensitivity. The multiple-decision model explains why experts miss targets in low prevalence settings through a change in decision threshold and search quit threshold and propose it should be adapted to explain these observed patterns of accuracy with time on task. What is typically thought of as standard and robust research findings in controlled laboratory settings may not directly apply to real-world environments and instead large, controlled studies in relevant environments are needed.

The message matters: changes to binary Computer Aided Detection recommendations affect cancer detection in low prevalence search.

Computer Aided Detection (CAD) has been used to help readers find cancers in mammograms. Although these automated systems have been shown to help cancer detection when accurate, the presence of CAD also leads to an over-reliance effect where miss errors and false alarms increase when the CAD system fails. Previous research investigated CAD systems which overlayed salient exogenous cues onto the image to highlight suspicious areas. These salient cues capture attention which may exacerbate the over-reliance effect. Furthermore, overlaying CAD cues directly on the mammogram occludes sections of breast tissue which may disrupt global statistics useful for cancer detection. In this study we investigated whether an over-reliance effect occurred with a binary CAD system, which instead of overlaying a CAD cue onto the mammogram, reported a message alongside the mammogram indicating the possible presence of a cancer. We manipulated the certainty of the message and whether it was presented only to indicate the presence of a cancer, or whether a message was displayed on every mammogram to state whether a cancer was present or absent. The results showed that although an over-reliance effect still occurred with binary CAD systems miss errors were reduced when the CAD message was more definitive and only presented to alert readers of a possible cancer.

Framing the fallibility of Computer-Aided Detection aids cancer detection.

Computer-Aided Detection (CAD) has been proposed to help operators search for cancers in mammograms. Previous studies have found that although accurate CAD leads to an improvement in cancer detection, inaccurate CAD leads to an increase in both missed cancers and false alarms. This is known as the over-reliance effect. We investigated whether providing framing statements of CAD fallibility could keep the benefits of CAD while reducing over-reliance. In Experiment 1, participants were told about the benefits or costs of CAD, prior to the experiment. Experiment 2 was similar, except that participants were given a stronger warning and instruction set in relation to the costs of CAD. The results showed that although there was no effect of framing in Experiment 1, a stronger message in Experiment 2 led to a reduction in the over-reliance effect. A similar result was found in Experiment 3 where the target had a lower prevalence. The results show that although the presence of CAD can result in over-reliance on the technology, these effects can be mitigated by framing and instruction sets in relation to CAD fallibility.

The optimal use of computer aided detection to find low prevalence cancers.

People miss a high proportion of targets that only appear rarely. This low prevalence (LP) effect has implications for applied search tasks such as the clinical reading of mammograms. Computer aided detection (CAD) has been used to help radiologists search mammograms by highlighting areas likely to contain a cancer. Previous research has found a benefit in search when CAD cues were correct but a cost to search when CAD cues were incorrect. The current research investigated whether there is an optimal way to present CAD to ensure low error rates when CAD is both correct and incorrect. Experiment 1 compared an automatic condition, where CAD appeared simultaneously with the display to an interactive condition, where participants could choose to use CAD. Experiment 2 compared the automatic condition to a confirm condition, where participants searched the display first before being shown the CAD cues. The results showed that miss errors were reduced overall in the confirm condition, with no cost to false alarms. Furthermore, having CAD be interactive, resulted in a low uptake where it was only used in 34% of trials. The results showed that the presentation mode of CAD can affect decision-making in LP search.

Telephone conversations affect the executive but not the alerting or orienting network.

Previous work has shown that talking on a mobile phone leads to an impairment of visual attention. Gunnell et al. (2020) investigated the locus of these dual-task impairments and found that although phone conversations led to cognitive delays in response times, other mechanisms underlying particular selective attention tasks were unaffected. Here, we investigated which attentional networks, if any, were impaired by having a phone conversation. We used the attentional network task (ANT) to evaluate performance of the alerting, orienting, and executive attentional networks, both in conditions where people were engaged in a conversation and where they were silent. Two experiments showed that there was a robust delay in response across all three networks. However, at the individual network level, holding a conversation did not influence the size of the alerting or orienting effects but it did reduce the size of the conflict effect within the executive network. The findings suggest that holding a conversation can reduce the overall speed of responding and, via its influence on the executive network, can reduce the amount of information that can be processed from the environment. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Double reading reduces miss errors in low prevalence search.

Low prevalence studies show that people miss a large proportion of targets if they appear rarely. This finding has implications for real-world tasks, such as mammography, where it is important to detect infrequently appearing cancers. We examined whether having people search in pairs in a "double reading" procedure reduces miss errors in low prevalence search compared with when participants search the displays alone. In Experiment 1 pairs of participants searched for a mass in a laboratory mammogram task. Participants either searched the same display together (in the same room) or searched the displays independently (in separate rooms). Experiment 2 further manipulated the reading order so that paired participants either read the mammograms in the same or different orders. The results showed that, although there was no effect of reading order, double reading led to a substantial reduction in miss errors compared with single reading conditions. Furthermore, the reason for the double reading improvement differed across reading environments: When participants read the displays in a shared environment (i.e., in the same room) the improvement occurred due to an increase in sensitivity; however, when participants read the display in different rooms the improvement occurred due to a change in response bias. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Having a phone conversation delays but does not disrupt cognitive mechanisms.

Previous research has shown that talking on a mobile phone leads to impairments in a number of cognitive tasks. However, it is not yet known whether the act of conversation disrupts the underlying cognitive mechanisms (the Cognitive Disruption hypothesis) or leads to a delay in response due to a limit on central cognitive resources (the Cognitive Delay hypothesis). We investigated this here using two cognitive search tasks that investigate spatial learning and time-based selection: Contextual Cueing and Visual Marking. In Contextual Cueing, responses to repeated displays are faster than those to novel displays. In Visual Marking, participants prioritize attention to new information and deprioritize old, unimportant information (the Preview Benefit). Experiments 1 to 3 investigated whether Contextual Cueing occurred while people were engaged in a phone conversation, whereas Experiments 4 to 6 investigated whether a Preview Benefit occurred, again while people were engaged in conversation. The results showed that having a conversation did not interfere with the mechanisms underlying spatial learning or time-based selection. However, in all experiments there was a significant increase in response times. The results are consistent with a Cognitive Delay account explaining the dual-task cost of having a phone conversation on concurrent cognitive tasks. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

The hazards of perception: evaluating a change blindness demonstration within a real-world driver education course.

Overconfidence in one's driving ability can lead to risky decision-making and may therefore increase the accident risk. When educating people about the risks of their driving behavior, it is all too easy for individuals to assume that the message is not meant for them and so can be ignored. In this study we developed and assessed the effect of a road safety demonstration based around the phenomenon of change blindness within a real-world Driver Awareness Course. We collected quantitative and qualitative data to evaluate the effectiveness of the demonstration in both a police-led environment (Experiment 1) and a laboratory environment (Experiment 2). We also compared the change blindness intervention to two control tasks. The results showed that participants' self-reported ability to spot important visual changes was reduced after the change blindness demonstration in both experiments, but was not reduced after participation in the control tasks of Experiment 2. Furthermore, participants described the change blindness demonstrations positively and would recommend that they were shown more widely.

Telephone conversation impairs sustained visual attention via a central bottleneck.

Recent research has shown that holding telephone conversations disrupts one's driving ability. We asked whether this effect could be attributed to a visual attention impairment. In Experiment 1, participants conversed on a telephone or listened to a narrative while engaged in multiple object tracking (MOT), a task requiring sustained visual attention. We found that MOT was disrupted in the telephone conversation condition, relative to single-task MOT performance, but that listening to a narrative had no effect. In Experiment 2, we asked which component of conversation might be interfering with MOT performance. We replicated the conversation and single-task conditions of Experiment 1 and added two conditions in which participants heard a sequence of words over a telephone. In the shadowing condition, participants simply repeated each word in the sequence. In the generation condition, participants were asked to generate a new word based on each word in the sequence. Word generation interfered with MOT performance, but shadowing did not. The data indicate that telephone conversation disrupts attention at a central stage, the act of generating verbal stimuli, rather than at a peripheral stage, such as listening or speaking.

Why do we miss rare targets? Exploring the boundaries of the low prevalence effect.

Observers tend to miss a disproportionate number of targets in visual search tasks with rare targets. This 'prevalence effect' may have practical significance since many screening tasks (e.g., airport security, medical screening) are low prevalence searches. It may also shed light on the rules used to terminate search when a target is not found. Here, we use perceptually simple stimuli to explore the sources of this effect. Experiment 1 shows a prevalence effect in inefficient spatial configuration search. Experiment 2 demonstrates this effect occurs even in a highly efficient feature search. However, the two prevalence effects differ. In spatial configuration search, misses seem to result from ending the search prematurely, while in feature search, they seem due to response errors. In Experiment 3, a minimum delay before response eliminated the prevalence effect for feature but not spatial configuration search. In Experiment 4, a target was present on each trial in either two (2AFC) or four (4AFC) orientations. With only two response alternatives, low prevalence produced elevated errors. Providing four response alternatives eliminated this effect. Low target prevalence puts searchers under pressure that tends to increase miss errors. We conclude that the specific source of those errors depends on the nature of the search.

It is not good to talk: conversation has a fixed interference cost on attention regardless of difficulty.

It is well-documented that telephone conversations lead to impaired driving performance. Kunar et al. (Psychon Bull Rev 15:1135-1140, 2008) showed that this deficit was, in part, due to a dual-task cost of conversation on sustained visual attention. Using a multiple object tracking (MOT) task they found that the act of conversing on a hands-free telephone resulted in slower response times and increased errors compared to when participants performed the MOT task alone. The current study investigates whether the dual-task impairment of conversation on sustained attention is affected by conversation difficulty or task difficulty, and whether there was a dual-task deficit on attention when participants overheard half a conversation. Experiment 1 manipulated conversation difficulty by asking participants to discuss either easy questions or difficult questions. The results showed that there was no difference in the dual-task cost depending on conversation difficulty. Experiment 2 showed a similar dual-task deficit of attention in both an easy and a difficult visual search task. Experiments 3 and 4 showed that in contrast to work using a dot tracking and choice reaction time task (Emberson et al., Psychol Sci 21:1383-1388, 2010), there was little deficit on MOT performance of hearing half a conversation, provided people heard the conversations in their native language. The results are discussed in terms of a resource-depleted account of attentional resources showing a fixed conversational-interference cost on attention.

Does contextual cuing guide the deployment of attention?

Contextual cuing experiments show that when displays are repeated, reaction times to find a target decrease over time even when observers are not aware of the repetition. It has been thought that the context of the display guides attention to the target. The authors tested this hypothesis by comparing the effects of guidance in a standard search task with the effects of contextual cuing. First, in standard search, an improvement in guidance causes search slopes (derived from Reaction Time x Set Size functions) to decrease. In contrast, the authors found that search slopes in contextual cuing did not become more efficient over time (Experiment 1). Second, when guidance was optimal (e.g., in easy feature search), they still found a small but reliable contextual cuing effect (Experiments 2a and 2b), suggesting that other factors, such as response selection, contribute to the effect. Experiment 3 supported this hypothesis by showing that the contextual cuing effect disappeared when the authors added interference to the response selection process. Overall, the data suggest that the relationship between guidance and contextual cuing is weak and that response selection can account for part of the effect.

Low prevalence search for cancers in mammograms: Evidence using laboratory experiments and computer aided detection.

People miss a large proportion of targets when they only appear rarely. This Low Prevalence (LP) Effect could lead to serious consequences if it occurred in the real-world task of searching for cancers in mammograms. Using a novel mammogram search task, we asked participants to search for a prespecified cancer (Experiments 1-2) or a range of masses (Experiments 3-5) under high or low prevalence conditions. Experiment 1 showed that an LP Effect occurred using these stimuli. Experiment 2 tested an overreliance hypothesis and showed that the use of Computer Aided Detection (CAD) led to fewer missed cancers with a valid CAD prompt yet, a large proportion of cancers were missed when CAD was incorrect. Experiment 3-5 showed that false alarms also increased when searching for a range of masses and that CAD reduced miss errors when it correctly cued the target but increased miss errors and false alarms when it did not. Furthermore, when a mass fell outside the CAD prompt it was more likely to be misidentified. No LP Effect was observed with the addition of CAD when people were asked to search for a range of targets. Theories and implications for mammogram search are discussed. (PsycINFO Database Record

The influence of attention on value integration.

People often have to make decisions based on many pieces of information. Previous work has found that people are able to integrate values presented in a rapid serial visual presentation (RSVP) stream to make informed judgements on the overall stream value (Tsetsos et al. Proceedings of the National Academy of Sciences of the United States of America, 109(24), 9659-9664, 2012). It is also well known that attentional mechanisms influence how people process information. However, it is unknown how attentional factors impact value judgements of integrated material. The current study is the first of its kind to investigate whether value judgements are influenced by attentional processes when assimilating information. Experiments 1-3 examined whether the attentional salience of an item within an RSVP stream affected judgements of overall stream value. The results showed that the presence of an irrelevant high or low value salient item biased people to judge the stream as having a higher or lower overall mean value, respectively. Experiments 4-7 directly tested Tsetsos et al.'s (Proceedings of the National Academy of Sciences of the United States of America, 109(24), 9659-9664, 2012) theory examining whether extreme values in an RSVP stream become over-weighted, thereby capturing attention more than other values in the stream. The results showed that the presence of both a high (Experiments 4, 6 and 7) and a low (Experiment 5) value outlier captures attention leading to less accurate report of subsequent items in the stream. Taken together, the results showed that valuations can be influenced by attentional processes, and can lead to less accurate subjective judgements.

The downside of choice: Having a choice benefits enjoyment, but at a cost to efficiency and time in visual search.

The efficiency of how people search for an item in visual search has, traditionally, been thought to depend on bottom-up or top-down guidance cues. However, recent research has shown that the rate at which people visually search through a display is also affected by cognitive strategies. In this study, we investigated the role of choice in visual search, by asking whether giving people a choice alters both preference for a cognitively neutral task and search behavior. Two visual search conditions were examined: one in which participants were given a choice of visual search task (the choice condition), and one in which participants did not have a choice (the no-choice condition). The results showed that the participants in the choice condition rated the task as both more enjoyable and likeable than did the participants in the no-choice condition. However, despite their preferences, actual search performance was slower and less efficient in the choice condition than in the no-choice condition (Exp. 1). Experiment 2 showed that the difference in search performance between the choice and no-choice conditions disappeared when central executive processes became occupied with a task-switching task. These data concur with a choice-impaired hypothesis of search, in which having a choice leads to more motivated, active search involving executive processes.

Visual search for transparency and opacity: attentional guidance by cue combination?

A series of seven experiments explored search for opaque targets among transparent distractors or vice versa. Static stimuli produced very inefficient search. With moving items, search for an opaque target among transparent distractors was quite efficient while search for transparent targets was less efficient (Experiment 1). Transparent and opaque items differed from each other on the basis of motion cues, luminance cues, and figural cues (e.g., junction type). Motion cues were not sufficient to support efficient search (Experiments 2-5). Violations of the luminance rules of transparency disrupt search (Experiments 3 and 4). Experiment 5 shows that search becomes inefficient if X-junctions are removed. Experiments 6 and 7 show that efficient search survives if X-junctions are occluded. It appears that guidance of attention to an opaque target is guidance based on "cue combination" (M. S. Landy, L. T. Maloney, E. B. Johnston, & M. Young, 1995). Several cues must be present to produce a difference between opaque and transparent surfaces that is adequate to guide attention.

Visual change with moving displays: more evidence for color feature map inhibition during preview search.

Preview search with moving stimuli was investigated. The stimuli moved in multiple directions, and preview items could change either their color or their shape before onset of the new (search) displays. In Experiments 1 and 2, the authors found that (a) a preview benefit occurred even when more than 5 moving items had to be ignored, and (b) color change, but not shape change, disrupted preview search in moving stimuli. In contrast, shape change, but not color change, disrupted preview search in static stimuli (Experiments 3 and 4). Results suggest that preview search with moving displays is influenced by inhibition of a color map, whereas preview search with static displays is influenced by inhibition of locations of old distractors.

When a reappearance is old news: visual marking survives occlusion.

Performance in a visual search task becomes more efficient if half of the distractors are presented before the rest of the stimuli. This "preview benefit" may partly be due to inhibition of the old (previewed) items. The preview effect is abolished, however, if the old items offset briefly before reappearing (D. G. Watson & G. W. Humphreys, 1997). The authors examined whether this offset effect still occurred if the old items undergo occlusion. Results show that a preview benefit was found when the old items were occluded but not otherwise, consistent with the idea of top-down attentional inhibition being applied to the old items. The preview benefit is attenuated, however, by movement of the irrelevant stimuli in the displays.

The affective consequences of visual attention in preview search.

Comparisons of emotional evaluations of abstract stimuli just seen in a two-object visual search task show that prior distractors are devalued, as compared with prior targets or novel items, perhaps as a consequence of persistent attentional inhibition (Raymond, Fenske, & Tavassoli, 2003). To further explore such attention-emotion effects, we measured search response time in a preview search task and emotional evaluations of colorful, complex images just seen therein. On preview trials, the distractors appeared 1,000 msec before the remaining items. On no-preview trials, all the items were presented simultaneously. A single distractor was then rated for its emotional tone. Previewed distractors were consistently devalued, as compared with nonpreviewed distractors, despite longer exposure and being associated with an easier task. This effect was observed only in the participants demonstrating improved search efficiency with preview, but not in others, indicating that the attentional mechanisms underlying the preview benefit have persistent affective consequences in visual search.

When are abrupt onsets found efficiently in complex visual search? Evidence from multielement asynchronous dynamic search.

Previous work has found that search principles derived from simple visual search tasks do not necessarily apply to more complex search tasks. Using a Multielement Asynchronous Dynamic (MAD) visual search task, in which high numbers of stimuli could either be moving, stationary, and/or changing in luminance, Kunar and Watson (M. A Kunar & D. G. Watson, 2011, Visual search in a Multi-element Asynchronous Dynamic (MAD) world, Journal of Experimental Psychology: Human Perception and Performance, Vol 37, pp. 1017-1031) found that, unlike previous work, participants missed a higher number of targets with search for moving items worse than for static items and that there was no benefit for finding targets that showed a luminance onset. In the present research, we investigated why luminance onsets do not capture attention and whether luminance onsets can ever capture attention in MAD search. Experiment 1 investigated whether blinking stimuli, which abruptly offset for 100 ms before reonsetting--conditions known to produce attentional capture in simpler visual search tasks--captured attention in MAD search, and Experiments 2-5 investigated whether giving participants advance knowledge and preexposure to the blinking cues produced efficient search for blinking targets. Experiments 6-9 investigated whether unique luminance onsets, unique motion, or unique stationary items captured attention. The results found that luminance onsets captured attention in MAD search only when they were unique, consistent with a top-down unique feature hypothesis.