The Influence of Physician Information on Patients' Choice of Physician in mHealth Services Using China's Chunyu Doctor App: Eye-Tracking and Questionnaire Study.

BACKGROUND: Mobile health (mHealth) is becoming more popular as a way of sharing medical information. For the patient, it saves time, reduces the need for travel, reduces the cost of searching for information, and brings medical services "to your fingertips." However, it also brings information overload and makes the patient's choice of physician more difficult. OBJECTIVE: This study aimed to identify the types of physician information that play a key role in patients' choice of physician and to explore the mechanism by which this information contributes to this choice. METHODS: Based on the stimulus-organism-response (SOR) model and online trust theory, we proposed a research model to explain the influence of physician information on patients' choice of physician. The model was based on cognitive trust and affective trust and considered the moderating role of patient expertise. Study 1 was an eye-tracking experiment (n=42) to identify key factors affecting patients' choice of physician. Study 2 was a questionnaire study (n=272); Partial Least Squares Structural Equation Modeling was used to validate the research model. RESULTS: The results of Study 1 revealed that seven types of physician information played a key role in patients' choice of physician. The results of Study 2 revealed that (1) physicians' profile photo information affected patients' choice of physician by positively influencing affective trust (P<.001); (2) physicians' nonprofile photo information affected patients' choice of physician by positively influencing cognitive trust (P<.001); (3) patient-generated information affected patients' choice of physician by positively affecting cognitive trust (P<.001) and affective trust (P<.001), and patient expertise played a positive moderating role on both (P=.04 and P=.01, respectively); and (4) cognitive trust and affective trust both positively affected patients' choice of physician, with affective trust playing a more significant role (P<.001 and P<.001, respectively). CONCLUSIONS: Seven types of physician information were mainly used by patients when choosing physicians offering mHealth services; trust played an important role in this choice. In addition, the level of patient expertise was an important variable in moderating the influence of physician information and patients' trust. This paper supports the theoretical basis of information selection and processing by patients. These findings can help guide app developers in the construction of medical apps and in the management of physician information in order to facilitate patients' choice of physician.

Gaze entropy measures detect alcohol-induced driver impairment.

Driving under the influence of alcohol is an ongoing cause of road traffic accidents. The biphasic nature of alcohol effects on subjective experience appears to contribute to the prevalence of drink-driving, as people perceive the declining phase of the BAC curve as recovery from intoxication and are more willing to drive despite significant impairments in objectively measured functions. The present study investigates whether alcohol-induced changes in gaze behaviour can be detected during engagement in a simulated driving task. In a repeated-measures and placebo-controlled design, this study examines the biphasic influence of moderate alcohol intake (0.6 g/kg) on measures of gaze behaviour and simulated driving performance. Twenty-two healthy young adults completed three driving sessions (baseline, ascending and descending) under two conditions (placebo, alcohol) while their eye movements were simultaneously recorded. The results revealed that gaze behaviour as measured by gaze transition entropy (GTE) and stationary gaze entropy (SGE) and driving performance measured by the standard deviation of lateral position (SDLP) of the vehicle, were significantly affected by alcohol across the ascending and descending sessions. The alcohol-induced reduction in GTE with an increase in SGE is discussed as alcohol's impact on top-down modulation of gaze resulting in more dispersed and erratic pattern of visual scanning. The observed changes in gaze behaviour also mediated the influence of alcohol upon driving performance. These results have significant implications for the development of driver monitoring systems that can detect alcohol-induced impairment.

Abnormalities of saccadic eye movements in dementia due to Alzheimer's disease and mild cognitive impairment.

Background: There is increasing evidence that people in the early stages of Alzheimer's disease (AD) have subtle impairments in cognitive inhibition that can be detected by using relatively simple eye-tracking paradigms, but these subtle impairments are often missed by traditional cognitive assessments. People with mild cognitive impairment (MCI) are at an increased likelihood of dementia due to AD. No study has yet investigated and contrasted the MCI subtypes in relation to eye movement performance. Methods: In this work we explore whether eye-tracking impairments can distinguish between patients with the amnesic and the non-amnesic variants of MCI. Participants were 68 people with dementia due to AD, 42 had a diagnosis of aMCI, and 47 had a diagnosis of naMCI, and 92 age-matched cognitively healthy controls. Results: The findings revealed that eye-tracking can distinguish between the two forms of MCI. Conclusions: The work provides further support for eye-tracking as a useful diagnostic biomarker in the assessment of dementia.

Measuring visual attention to faces with cleft deformity.

BACKGROUND: Limited data are available regarding observers' visual attention to faces with congenital difference. We implemented eye tracking technology to examine this issue, as it pertains particularly to faces with cleft deformity. METHOD: Four hundred three observers assessed 273 clinical images, while their eye movements were unobtrusively tracked using an infrared sensor. Forty-one facial images of the repaired cleft lip, 137 images of other facial conditions, and 95 images of matched controls were assessed. Twenty facial regions of interest ("lookzones") were considered for all images observed. A separate cohort of 720 raters evaluated the images for attractiveness. Observer and image demographic information was collected. Visual fixation counts and durations were computed across all 20 lookzones for all images. The effect of a variety of variables on lookzone fixation was analyzed using factorial ANOVA testing. RESULTS: Cleft-repaired faces were rated as less attractive and drew observers' attention preferentially to the affected upper lip lookzone (p<.001). Images rated as less attractive garnered greater visual attention in the cleft-affected lookzones (p<.001). The eye tracking methodology demonstrated exquisite sensitivity to laterality of cleft deformity (p<.001). Individuals reporting a personal or a family history of facial deformity fixated more on the perioral region of cleft-repaired faces than did naïve observers (p<.001). CONCLUSION: These findings highlight the utility of eye tracking measures for understanding critical variables that influence the visual processing of faces with cleft deformity. The data may provide analytical tools for assessing surgical outcome and direct priority setting during surgeons' conversations with patients.

Smartphone telemedical emergency department consults for screening of nonacute dizziness.

OBJECTIVES/HYPOTHESIS: Each year, the United States spends over $4 billion on emergency department visits for evaluation of dizziness. Benign paroxysmal positional vertigo (BPPV) is a common cause of dizziness that can easily be diagnosed by observing characteristic eye movements during the Dix-Hallpike test (DHT). The DHT is easily performed; however, interpretation requires more advanced training. This may be part of the reason it is not commonly performed in emergency departments, and instead, patients undergo costly imaging tests. We evaluated whether smartphone-based video recordings of DHT could be assessed telemedically for screening of nonacute dizziness. STUDY DESIGN: Feasibility study. METHODS: Dizzy patients underwent objective vestibular testing, but also had videos of their eye movements recorded via a smartphone during the DHT. The videos were remotely reviewed by two neuro-otologists for BPPV screening and were compared to objective and in-person exam findings. RESULTS: Overall, 30 dizzy patients were evaluated with seven cases of BPPV. The sensitivity for diagnosing BPPV via a smartphone-recording of eye movements of the DHT was 92.86%, with a specificity of 100% and a negative predictive value of 97.87%. CONCLUSIONS: Our initial proof-of-concept study shows that remote screening of BPPV is possible with high specificity. Because the DHT is easily taught, having a remote otolaryngologist interpret the resulting eye movements may increase usage of the test and may lead to cost savings. LEVEL OF EVIDENCE: 4 Laryngoscope, 129:466-469, 2019.

The processing of the Dutch masculine generic zijn 'his' across stereotype contexts: An eye-tracking study.

Language users often infer a person's gender when it is not explicitly mentioned. This information is included in the mental model of the described situation, giving rise to expectations regarding the continuation of the discourse. Such gender inferences can be based on two types of information: gender stereotypes (e.g., nurses are female) and masculine generics, which are grammatically masculine word forms that are used to refer to all genders in certain contexts (e.g., To each his own). In this eye-tracking experiment (N = 82), which is the first to systematically investigate the online processing of masculine generic pronouns, we tested whether the frequently used Dutch masculine generic zijn 'his' leads to a male bias. In addition, we tested the effect of context by introducing male, female, and neutral stereotypes. We found no evidence for the hypothesis that the generically-intended masculine pronoun zijn 'his' results in a male bias. However, we found an effect of stereotype context. After introducing a female stereotype, reading about a man led to an increase in processing time. However, the reverse did not hold, which parallels the finding in social psychology that men are penalized more for gender-nonconforming behavior. This suggests that language processing is not only affected by the strength of stereotype contexts; the associated disapproval of violating these gender stereotypes affects language processing, too.

Extended Fitts' model of pointing time in eye-gaze input system - Incorporating effects of target shape and movement direction into modeling.

This study attempted to investigate the effects of the target shape and the movement direction on the pointing time using an eye-gaze input system and extend Fitts' model so that these factors are incorporated into the model and the predictive power of Fitts' model is enhanced. The target shape, the target size, the movement distance, and the direction of target presentation were set as within-subject experimental variables. The target shape included: a circle, and rectangles with an aspect ratio of 1:1, 1:2, 1:3, and 1:4. The movement direction included eight directions: upper, lower, left, right, upper left, upper right, lower left, and lower right. On the basis of the data for identifying the effects of the target shape and the movement direction on the pointing time, an attempt was made to develop a generalized and extended Fitts' model that took into account the movement direction and the target shape. As a result, the generalized and extended model was found to fit better to the experimental data, and be more effective for predicting the pointing time for a variety of human-computer interaction (HCI) task using an eye-gaze input system.

Building an ACT-R Reader for Eye-Tracking Corpus Data.

Cognitive architectures have often been applied to data from individual experiments. In this paper, I develop an ACT-R reader that can model a much larger set of data, eye-tracking corpus data. It is shown that the resulting model has a good fit to the data for the considered low-level processes. Unlike previous related works (most prominently, Engelmann, Vasishth, Engbert & Kliegl, ), the model achieves the fit by estimating free parameters of ACT-R using Bayesian estimation and Markov-Chain Monte Carlo (MCMC) techniques, rather than by relying on the mix of manual selection + default values. The method used in the paper is generalizable beyond this particular model and data set and could be used on other ACT-R models.

Noise-robust fixation detection in eye movement data: Identification by two-means clustering (I2MC).

Eye-tracking research in infants and older children has gained a lot of momentum over the last decades. Although eye-tracking research in these participant groups has become easier with the advance of the remote eye-tracker, this often comes at the cost of poorer data quality than in research with well-trained adults (Hessels, Andersson, Hooge, Nyström, & Kemner Infancy, 20, 601-633, 2015; Wass, Forssman, & Leppänen Infancy, 19, 427-460, 2014). Current fixation detection algorithms are not built for data from infants and young children. As a result, some researchers have even turned to hand correction of fixation detections (Saez de Urabain, Johnson, & Smith Behavior Research Methods, 47, 53-72, 2015). Here we introduce a fixation detection algorithm-identification by two-means clustering (I2MC)-built specifically for data across a wide range of noise levels and when periods of data loss may occur. We evaluated the I2MC algorithm against seven state-of-the-art event detection algorithms, and report that the I2MC algorithm's output is the most robust to high noise and data loss levels. The algorithm is automatic, works offline, and is suitable for eye-tracking data recorded with remote or tower-mounted eye-trackers using static stimuli. In addition to application of the I2MC algorithm in eye-tracking research with infants, school children, and certain patient groups, the I2MC algorithm also may be useful when the noise and data loss levels are markedly different between trials, participants, or time points (e.g., longitudinal research).

Eye-tracking measurements and their link to a normative model of monitoring behaviour.

Increasing automation necessitates operators monitoring appropriately (OMA) and raises the question of how to identify them in future selections. A normative model was developed providing criteria for the identification of OMA. According to this model, the monitoring process comprises distinct monitoring phases (orientation, anticipation, detection and recheck) in which attention should be focused on relevant areas. The current study tests the normative model on the basis of eye tracking. The eye-tracking data revealed increased concentration on relevant areas during the orientation and anticipation phase in comparison to the other phases. For the assessment of monitoring behaviour in the context of personnel selection, this implies that the anticipation and orientation phases should be considered separately as they appear to be more important in the context of monitoring than the other phases. PRACTITIONER SUMMARY: A normative model was developed for the assessment of monitoring behaviour. Using the eye-tracking method, this model was tested with applicants for an Air Traffic Controller training programme. The results are relevant for the future selection of human operators, who will have to monitor highly automated systems.

Gaze pattern variations among men when assessing female attractiveness.

Pilot data from eye-tracking research suggest that each male participant has his own gaze pattern, usefully regarded as an individual difference, when viewing female targets whom they are rating for attractiveness. Gaze patterns appear to be consistent within a given male participant across a variety of target models, and these individual differences may override characteristics of the model in determining fixation points, body region focus, and other eye-tracker variables. The goal of the present study was to elucidate these variations of gaze pattern by assessing the extent to which systematic "types" of gaze patterns exist among a group of male participants. Latent class analysis was used to place 60 men into groups based on their gaze pattern. A two-cluster solution produced the most interpretable analysis, and groups formed by this clustering were significantly different from each other on variables of interest. Cross validation of this solution across three additional female models resulted in some support for generalization, though exceptions were noted.

Developing and evaluating a target-background similarity metric for camouflage detection.

BACKGROUND: Measurement of camouflage performance is of fundamental importance for military stealth applications. The goal of camouflage assessment algorithms is to automatically assess the effect of camouflage in agreement with human detection responses. In a previous study, we found that the Universal Image Quality Index (UIQI) correlated well with the psychophysical measures, and it could be a potentially camouflage assessment tool. METHODOLOGY: In this study, we want to quantify the camouflage similarity index and psychophysical results. We compare several image quality indexes for computational evaluation of camouflage effectiveness, and present the results of an extensive human visual experiment conducted to evaluate the performance of several camouflage assessment algorithms and analyze the strengths and weaknesses of these algorithms. SIGNIFICANCE: The experimental data demonstrates the effectiveness of the approach, and the correlation coefficient result of the UIQI was higher than those of other methods. This approach was highly correlated with the human target-searching results. It also showed that this method is an objective and effective camouflage performance evaluation method because it considers the human visual system and image structure, which makes it consistent with the subjective evaluation results.

Disentangling working memory processes during spatial span assessment: a modeling analysis of preferred eye movement strategies.

The neurocognitive processes involved during classic spatial working memory (SWM) assessment were investigated by examining naturally preferred eye movement strategies. Cognitively healthy adult volunteers were tested in a computerized version of the Corsi Block-Tapping Task--a spatial span task requiring the short term maintenance of a series of locations presented in a specific order--coupled with eye tracking. Modeling analysis was developed to characterize eye-tracking patterns across all task phases, including encoding, retention, and recall. Results revealed a natural preference for local gaze maintenance during both encoding and retention, with fewer than 40% fixated targets. These findings contrasted with the stimulus retracing pattern expected during recall as a result of task demands, with 80% fixated targets. Along with participants' self-reported strategies of mentally "making shapes," these results suggest the involvement of covert attention shifts and higher order cognitive Gestalt processes during spatial span tasks, challenging instrument validity as a single measure of SWM storage capacity.

Inserting spaces before and after words affects word processing differently in Chinese: Evidence from eye movements.

Unlike in English, there are no spaces between printed words in Chinese. In this study, we explored how inserting a space before or after a word affects the processing of that word in Chinese reading. Native Chinese readers' eye movements were monitored as they read sentences with different presentation conditions. The results show that inserting a space after a word facilitates its processing, but inserting a space before a word does not show this effect and inhibits the processing of that word in some cases. Our results are consistent with the prediction of a word segmentation and recognition model in Chinese Li et al., 2009, Cognit. Psychol., 58, 525. Additionally, we found that a space guides the initial landing position on the word: the initial landing position was further away from the space that inserted into the text, whether it was before or after a word.

Gaze properties of women judging the attractiveness of masculine and feminine male faces.

Most studies of female facial masculinity preference have relied upon self-reported preference, with participants selecting or rating the attractiveness of faces that differ in masculinity. However, researchers have not established a consensus as to whether women's general preference is for male faces that are masculine or feminine, and several studies have indicated that women prefer neither. We investigated women's preferences for male facial masculinity using standard two-alternative forced choice (2AFC) preference trials, paired with eye tracking measures, to determine whether conscious and non-conscious measures of preference yield similar results. We found that women expressed a preference for, gazed longer at, and fixated more frequently on feminized male faces. We also found effects of relationship status, relationship context (whether faced are judged for attractiveness as a long- or short-term partner), and hormonal contraceptive use. These results support previous findings that women express a preference for feminized over masculinized male faces, demonstrate that non-conscious measures of preference for this trait echo consciously expressed preferences, and suggest that certain aspects of the preference decision-making process may be better captured by eye tracking than by 2AFC preference trials.

The power of human gaze on infant learning.

Social learning enables infants to acquire information, especially through communication. However, it is unknown whether humans are the prime source of information for infant learning. Here we report that humans have a powerful influence on infants' object learning compared with nonhuman agents (robots). Twelve-month-old infants were shown videos in which a human or a robot gazed at an object. The results demonstrated that the infants followed the gaze direction of both agents, but only human gaze facilitated their object learning: Infants showed enhanced processing of, and preferences for, the target object gazed at by the human but not by the robot. Importantly, an extended fixation on a target object without the orientation of human gaze did not produce these effects. Together, these findings show the importance of humanness in the gazer, suggesting that infants may be predisposed to treat humans as privileged sources of information for learning.

Selective attention of patients with anorexia nervosa while looking at pictures of their own body and the bodies of others: an exploratory study.

OBJECTIVE: Attention and assessment biases are part of body image disturbances shown by patients with anorexia nervosa (AN). The aim of this article was to study these biases by using eye movement analyses. METHODS: As stimuli, the study used 24 standardized pictures showing young women and a standardized picture of the respective study participant. With an eye movement tracer, we were able to determine what body areas that the study participants look at. The study participants were also asked to rate the attractiveness of the stimuli. Data from 35 patients with AN and 32 healthy controls were included. RESULTS: Patients with AN judge their own body areas as being less attractive than the controls on a rating scale from 1 to 5 (e.g., breasts: mean [standard deviation] = 0.9 [1.0] versus 2.2 [0.8], p < .001). They were also more critical in their assessment of the bodies of others (e.g., attractiveness of people with ideal weight: 2.1 [0.9] versus 2.8 [0.5], p < .001). They spent less time looking at their own breasts (1.8 [0.9] versus 2.2 [1.0] seconds, p = .09) but significantly more time at their thighs (1.1 [0.6] versus 0.8 [0.4] seconds, p = .05). CONCLUSIONS: The results confirm the assumption of cognitive biases. The differences, however, are often small and vary greatly.

Learning to ignore distracters.

Eye tracking has indicated that older and young adults process distracters similarly when reading single sentences. The present study extended this approach by presenting short paragraphs, sentence by sentence. Eye tracking measures included reading times per word, and the duration of the first fixation and total fixations to the distracters and target words. Comprehension was tested following each paragraph, and recognition of distracters and target words was assessed. The results indicated that young adults were able to learn to ignore the distracters as they read through the paragraphs, whereas older adults were less successful at learning to ignore the distracters.

The effect of lexical frequency on spoken word recognition in young and older listeners.

When identifying spoken words, older listeners may have difficulty resolving lexical competition or may place a greater weight on factors like lexical frequency. To obtain information about age differences in the time course of spoken word recognition, young and older adults' eye movements were monitored as they followed spoken instructions to click on objects displayed on a computer screen. Older listeners were more likely than younger listeners to fixate high-frequency displayed phonological competitors. However, degradation of auditory quality in younger listeners does not reproduce this result. These data are most consistent with an increased role for lexical frequency with age.

Evaluation of traditional, orthogonal, and radial tree diagrams by an eye tracking study.

Node-link diagrams are an effective and popular visualization approach for depicting hierarchical structures and for showing parent-child relationships. In this paper, we present the results of an eye tracking experiment investigating traditional, orthogonal, and radial node-link tree layouts as a piece of empirical basis for choosing between those layouts. Eye tracking was used to identify visual exploration behaviors of participants that were asked to solve a typical hierarchy exploration task by inspecting a static tree diagram: finding the least common ancestor of a given set of marked leaf nodes. To uncover exploration strategies, we examined fixation points, duration, and saccades of participants' gaze trajectories. For the non-radial diagrams, we additionally investigated the effect of diagram orientation by switching the position of the root node to each of the four main orientations. We also recorded and analyzed correctness of answers as well as completion times in addition to the eye movement data. We found out that traditional and orthogonal tree layouts significantly outperform radial tree layouts for the given task. Furthermore, by applying trajectory analysis techniques we uncovered that participants cross-checked their task solution more often in the radial than in the non-radial layouts.