Effects of colour-coded compartmentalised syringe trays on anaesthetic drug error detection under cognitive load.

BACKGROUND: Anaesthetic drug administration is complex, and typical clinical environments can entail significant cognitive load. Colour-coded anaesthetic drug trays have shown promising results for error identification and reducing cognitive load. METHODS: We used experimental psychology methods to test the potential benefits of colour-coded compartmentalised trays compared with conventional trays in a simulated visual search task. Effects of cognitive load were also explored through an accompanying working memory-based task. We hypothesised that colour-coded compartmentalised trays would improve drug-detection error, reduce search time, and reduce cognitive load. This comprised a cognitive load memory task presented alongside a visual search task to detect drug errors. RESULTS: All 53 participants completed 36 trials, which were counterbalanced across the two tray types and 18 different vignettes. There were 16 error-present and 20 error-absent trials, with 18 trials presented for each preloaded tray type. Syringe errors were detected more often in the colour-coded trays than in the conventional trays (91% vs 83%, respectively; P=0.006). In signal detection analysis, colour-coded trays resulted in more sensitivity to the error signal (2.28 vs 1.50, respectively; P<0.001). Confidence in response accuracy correlated more strongly with task performance for the colour-coded tray condition, indicating improved metacognitive sensitivity to task performance (r=0.696 vs r=0.447). CONCLUSIONS: Colour coding and compartmentalisation enhanced visual search efficacy of drug trays. This is further evidence that introducing standardised colour-coded trays into operating theatres and procedural suites would add an additional layer of safety for anaesthetic procedures.

Explaining normative-deliberative gaps is essential to dual-process theorizing.

We discuss significant challenges to assumptions of exclusivity and highlight methodological and conceptual pitfalls in inferring deliberative processes from reasoning responses. Causes of normative-deliberative gaps are considered (e.g., disputed or misunderstood normative standards, strategy preferences, task interpretations, cognitive ability, mindware and thinking dispositions) and a soft normativist approach is recommended for developing the dual-process 2.0 architecture.

Standardised colour-coded compartmentalised syringe trays improve anaesthetic medication visual search and mitigate cognitive load.

BACKGROUND: Anaesthetic procedures are complex and subject to human error. Interventions to alleviate medication errors include organised syringe storage trays, but no standardised methods for drug storage have yet been widely implemented. METHODS: We used experimental psychology methods to explore the potential benefits of colour-coded compartmentalised trays compared with conventional trays in a visual search task. We hypothesised that colour-coded compartmentalised trays would reduce search time and improve error detection for both behavioural and eye-movement responses. We recruited 40 volunteers to identify syringe errors presented in pre-loaded trays for 16 trials in total: 12 error present and four error absent, with eight trials presented for each tray type. RESULTS: Errors were detected faster when presented in the colour-coded compartmentalised trays than in conventional trays (11.1 s vs 13.0 s, respectively; P=0.026). This finding was replicated for correct responses for error-absent trays (13.3 s vs 17.4 s, respectively; P=0.001) and in the verification time of error-absent trays (13.1 s vs 17.2 s, respectively; P=0.001). On error trials, eye-tracking measures revealed more fixations on the drug error for colour-coded compartmentalised trays (5.3 vs 4.3, respectively; P<0.001), whilst more fixations on the drug lists for conventional trays (8.3 vs 7.1, respectively; P=0.010). On error-absent trials, participants spent longer fixating on the conventional trials (7.2 s vs 5.6 s, respectively; P=0.002). CONCLUSIONS: Colour-coded compartmentalisation enhanced visual search efficacy of pre-loaded trays. Reduced fixations and fixation times for the loaded tray were shown for colour-coded compartmentalised trays, indicating a reduction in cognitive load. Overall, colour-coded compartmentalised trays were associated with significant performance improvements when compared with conventional trays.

An International Validation of a Clinical Tool to Assess Carers' Quality of Life in Huntington's Disease.

Family carers of individuals living with Huntington's disease (HD) manage a distinct and unique series of difficulties arising from the complex nature of HD. This paper presents the validation of the definitive measure of quality of life (QoL) for this group. The Huntington's Disease Quality of Life Battery for Carers (HDQoL-C) was expanded (n = 47) and then administered to an international sample of 1716 partners and family carers from 13 countries. In terms of the psychometric properties of the tool, exploratory analysis of half of the sample demonstrated good internal consistency and reliability. Some items on the full version did not meet psychometric thresholds and a short version (HDQoL-Cs) (n = 23) was developed based on more stringent criteria. This was achieved using standard psychometric item reduction techniques to both increase reliability and reduce the burden of carers completing the scale. Confirmatory factor analysis of the model structure showed a good fit for all factors and indicated that the HDQoL-C and HDQoL-Cs are psychometrically robust measures of QoL. We found that carers who lived with and looked after their spouse/partner had reduced sense of coping, hope for the future, and overall QoL. Carers with children who were at risk carried the gene or were symptomatic also had poorer QoL outcomes. Findings indicated the HDQoL-C and HDQoL-Cs are valid in multiple languages and across varied cultures as measures of self-reported QoL in family carers of individual's living with HD. These psychometrically validated tools can aid and guide the implementation of therapeutic interventions to improve life quality in this population and research into international and cross-cultural carer experiences. The HDQoL-Cs is recommended as the definitive international measure of HD carer QoL.

Using Eye Tracking to Explore Facebook Use and Associations with Facebook Addiction, Mental Well-being, and Personality.

Social networking sites (SNSs) have become ubiquitous in our everyday lives, and for all its communicative benefits, excessive SNS use has been associated with a range of negative health implications. In the present study, the authors use eye-tracking methodology to explore the relationship between individual differences in personality, mental well-being, SNS usage, and the focus of Facebook users' visual attention. Participants (n = 69, mean age = 23.09, SD = 7.54) completed questionnaire measures for personality and to examine changes in depression, anxiety, stress, and self-esteem. They then engaged in a Facebook session while their eye movements and fixations were recorded. These fixations were coded as being directed to social and update areas of interest (AOI) of the Facebook interface. An exploratory analysis of personality factors revealed a negative correlation between openness to experience and inspection times for the updates AOI and an unexpected negative relationship between extraversion and inspection times for social AOI. There were correlations between changes in depression score and inspection of updated AOI, with reduced depression scores associated with increased inspection of updates. Finally, self-reported duration of participants' typical Facebook sessions did not correlate with eye-tracking measures but were associated with increased Facebook addiction scores and greater increases in depression scores. These initial findings indicate that there are differences in the outcomes of interacting with Facebook which can vary based on Facebook addiction, personality variables, and the Facebook features that individuals interact with.

Event-related potentials support a dual process account of the Embedded Chinese Character Task.

Tests of the principles of dual process theory are typically conducted in the reasoning and judgement/decision-making literature. The present study explores dual process explanations with a new paradigm - the Embedded Chinese Character Task (ECCT). The beauty of this task is that it allows the contrast of automatic and deliberate processes without the potential for conflict. We used event-related potentials (ERPs) and behavioral measures to investigate the time course of automatic (Type 1) and deliberative (Type 2) processes on the ECCT. Thus we explored whether there were differences in processing speed in neural activation. The ECCT requires the extraction of one Chinese character from another, which requires either an automatic strategy reliant on knowledge of Chinese character formation and meaning (based on the radical), or a deliberative strategy using the shape of the components of the character (based on the stroke). Participants judged whether character elements were included or excluded in test characters. Faster response time were observed when judging 'inclusion relations' on automatic problems supporting the proposal that they required a Type 1 process. In line with the behavioral results, the hypothesized faster automatic process showed the rapid differentiation of N2 and P3b components between inclusion and exclusion responses, while no difference was shown for deliberative problems. Thus, neural differences in processing were shown between automatic and deliberate problems, and automatic processing was faster than deliberate processing.

Performance Under Stress: An Eye-Tracking Investigation of the Iowa Gambling Task (IGT).

Stress pervades everyday life and impedes risky decision making. The following experiment is the first to examine effects of stress on risky decision making in the Iowa Gambling Task (IGT), while measuring inspection time and conscious awareness of deck contingencies. This was original as it allowed a fine grained rigorous analysis of the way that stress impedes awareness of, and attention to maladaptive financial choices. The extended Cognitive Reflection Task (CRT) further afforded examination of the impact of impaired reflective thinking on risky decision making. Stressed participants were slower to avoid the disadvantageous decks and performed worse overall. They inspected disadvantageous decks for longer than the control condition and were slower in developing awareness of their poor deck quality compared to the control condition. Conversely, in the control condition greater inspection times for advantageous decks were observed earlier in the task, and better awareness of the deck contingencies was shown as early as the second block of trials than the stress condition. Path analysis suggested that stress reduced IGT performance by impeding reflective thinking and conscious awareness. Explicit cognitive processes, moreover, were important during the preliminary phase of IGT performance-a finding that has significant implications for the use of the IGT as a clinical diagnostic tool. It was concluded that stress impedes reflective thinking, attentional disengagement from poorer decks, and the development of conscious knowledge about choice quality that interferes with performance on the IGT. These data demonstrate that stress impairs risky decision making performance, by impeding attention to, and awareness of task characteristics in risky decision making.

Exploring the Experience of Novelty When Viewing Creative Adverts: An ERP Study.

The electrophysiological correlates of experiencing novelty in creative advertising were studied in 28 healthy subjects using event-related potentials. Participants viewed images that were difficult to interpret until a description was presented providing either a creative description (CD) featuring an unexpected description of the image based on the original advertisement, or a normal description (ND), which was a literal description of the image (and served as a baseline condition). Participants evaluated the level of creativity of the description. The results showed that the N2 amplitude was higher for CDs than for NDs across middle and right scalp regions between 240 and 270 ms, most likely reflecting conflict detection. Moreover, CDs demonstrated greater N400 than NDs in a time window between 380 and 500 ms, it is argued that this reflects semantic integration. The present study investigates the electrophysiological correlates of experiencing novelty in advertising with ecologically valid stimuli. This substantially extends the findings of earlier laboratory studies with more artificial stimuli.

The Monty Hall problem revisited: Autonomic arousal in an inverted version of the game.

The asymmetry of autonomic arousal for potential losses and gains was assessed by the galvanic skin response (GSR) of participants playing classic and inverted versions of the Monty Hall problem (MHP). In both versions, the prize remained the same (a pen valued at £10 for the right answer), but in the modified version, prizes were received prior to choosing the door. Both experimental groups showed increased levels of GSR while completing the task, demonstrating increased autonomic arousal during the game. However, a robust difference in GSR was detected between classic and inverted versions of the MHP, thus demonstrating the differing autonomic arousal involved in deciding between the alternatives presented by the game. Participants experienced a stronger autonomic response when they could lose the prize than when they could win the prize. This experiment presents the first demonstration of this effect on the MHP. The stronger autonomic arousal for the inverted task may indicate a stronger emotional reaction and/or greater attentional focus than for the standard version of the task. These data demonstrate that potential losses increase arousal in more complex tasks than is typically shown.

Slower is not always better: Response-time evidence clarifies the limited role of miserly information processing in the Cognitive Reflection Test.

We report a study examining the role of 'cognitive miserliness' as a determinant of poor performance on the standard three-item Cognitive Reflection Test (CRT). The cognitive miserliness hypothesis proposes that people often respond incorrectly on CRT items because of an unwillingness to go beyond default, heuristic processing and invest time and effort in analytic, reflective processing. Our analysis (N = 391) focused on people's response times to CRT items to determine whether predicted associations are evident between miserly thinking and the generation of incorrect, intuitive answers. Evidence indicated only a weak correlation between CRT response times and accuracy. Item-level analyses also failed to demonstrate predicted response-time differences between correct analytic and incorrect intuitive answers for two of the three CRT items. We question whether participants who give incorrect intuitive answers on the CRT can legitimately be termed cognitive misers and whether the three CRT items measure the same general construct.

Do graduate entry nursing student's experience 'Imposter Phenomenon'?: An issue for debate.

The recruitment of Graduates into the nursing profession is seen as advantageous in the academic literature. Conversely educated nurses are often portrayed in the media as "too posh to wash". We would argue these conflicting discourses have a negative effect on graduate entry nurse education. Graduate nursing students may be particularly susceptible to "Imposter Phenomenon" a concept that describes an "internal experience of intellectual phoniness" exhibited by individuals who appear successful to others, but internally feel incompetent. We would like to encourage debate through the presentation of a small set of pilot data that established that 70% of the participants had frequent to intense experiences of Imposter Phenomenon. Students experienced feelings of failure despite consistent high achievement. Our findings and the prevalent negative rhetoric surrounding highly educated student nurses raise concerns regarding the impact of the anti-intellectualism on the Graduate entry student's perception of self. Others may argue that this could simply be a 'natural' or expected level of anxiety in a time of transition that has no lasting impact. We debate this issue in relation to the existing literature to encourage critical dialogue.

The vulnerability of rules in complex work environments: dynamism and uncertainty pose problems for cognition.

Many complex work environments rely heavily on cognitive operators using rules. Operators sometimes fail to implement rules, with catastrophic human, social and economic costs. Rule-based error is widely reported, yet the mechanisms of rule vulnerability have received less attention. This paper examines rule vulnerability in the complex setting of airline transport operations. We examined 'the stable approach criteria rule', which acts as a system defence during the approach to land. The study experimentally tested whether system state complexity influenced rule failure. The results showed increased uncertainty and dynamism led to increased likelihood of rule failure. There was also an interaction effect, indicating complexity from different sources can combine to further constrain rule-based response. We discuss the results in relation to recent aircraft accidents and suggest that 'rule-based error' could be progressed to embrace rule vulnerability, fragility and failure. This better reflects the influence that system behaviour and cognitive variety have on rule-based response. Practitioner Summary: In this study, we examined mechanisms of rule vulnerability in the complex setting of airline transport operations. The results suggest work scenarios featuring high uncertainty and dynamism constrain rule-based response, leading to rules becoming vulnerable, fragile or failing completely. This has significant implications for rule-intensive, safety critical work environments.

The intersection between Descriptivism and Meliorism in reasoning research: further proposals in support of 'soft normativism'.

The rationality paradox centers on the observation that people are highly intelligent, yet show evidence of errors and biases in their thinking when measured against normative standards. Elqayam and Evans' (2011) reject normative standards in the psychological study of thinking, reasoning and deciding in favor of a 'value-free' descriptive approach to studying high-level cognition. In reviewing Elqayam and Evans' (2011) position, we defend an alternative to descriptivism in the form of 'soft normativism,' which allows for normative evaluations alongside the pursuit of descriptive research goals. We propose that normative theories have considerable value provided that researchers: (1) are alert to the philosophical quagmire of strong relativism; (2) are mindful of the biases that can arise from utilizing normative benchmarks; and (3) engage in a focused analysis of the processing approach adopted by individual reasoners. We address the controversial 'is-ought' inference in this context and appeal to a 'bridging solution' to this contested inference that is based on the concept of 'informal reflective equilibrium.' Furthermore, we draw on Elqayam and Evans' (2011) recognition of a role for normative benchmarks in research programs that are devised to enhance reasoning performance and we argue that such Meliorist research programs have a valuable reciprocal relationship with descriptivist accounts of reasoning. In sum, we believe that descriptions of reasoning processes are fundamentally enriched by evaluations of reasoning quality, and argue that if such standards are discarded altogether then our explanations and descriptions of reasoning processes are severely undermined.

The neural correlates of belief-bias inhibition: the impact of logic training.

Functional Magnetic Resonance Imaging (fMRI) was used to investigate the brain activity associated with response change in a belief bias paradigm before and after logic training. Participants completed two sets of belief biased reasoning tasks. In the first set they were instructed to respond based on their empirical beliefs, and in the second - following logic training - they were instructed to respond logically. The comparison between conflict problems in the second scan versus in the first scan revealed differing activation for the left inferior frontal gyrus, left middle frontal gyrus, cerebellum, and precuneus. The scan was time locked to the presentation of the minor premise, and thus demonstrated effects of belief-logic conflict on neural activation earlier in the time course than has previously been shown in fMRI. These data, moreover, indicated that logical training results in changes in brain activity associated with cognitive control processing.

Further evidence of reliability and validity of the Huntington's disease quality of life battery for carers: Italian and French translations.

BACKGROUND: Existing research suggests that family caregivers of persons with Huntington's disease (HD) face a distinct series of problems, linked to the complex nature of the disease. Aubeeluck and Buchanan (Clin Genet, 71(5):434-445, 2007) developed and validated a disease-specific measure used to explore caregivers quality of life and assess the efficacy of therapeutic interventions. This current study builds on this research through the validation of French and Italian translations of the Huntington's disease quality of life battery for carers (HDQoL-C). METHOD: A total of 301 family carers completed the HDQoL-C. Participants were recruited through the "Euro-HDB" study which is measuring the burden in HD across Europe and the USA. RESULTS: Factor analysis demonstrated good internal consistency, reliability and congruent validity. Carers who cared for patients with less clinically severe symptoms reported significantly better QoL than carers of patients with more clinically severe symptoms. DISCUSSION: Findings indicate the HDQoL-C is multi-lingual, multi-cultural and easily applicable in other languages.

Cognitive control in belief-laden reasoning during conclusion processing: an ERP study.

Belief bias is the tendency to accept conclusions that are compatible with existing beliefs more frequently than those that contradict beliefs. It is one of the most replicated behavioral findings in the reasoning literature. Recently, neuroimaging studies using functional magnetic resonance imaging (fMRI) and event-related potentials (ERPs) have provided a new perspective and have demonstrated neural correlates of belief bias that have been viewed as supportive of dual-process theories of belief bias. However, fMRI studies have tended to focus on conclusion processing, while ERPs studies have been concerned with the processing of premises. In the present research, the electrophysiological correlates of cognitive control were studied among 12 subjects using high-density ERPs. The analysis was focused on the conclusion presentation phase and was limited to normatively sanctioned responses to valid-believable and valid-unbelievable problems. Results showed that when participants gave normatively sanctioned responses to problems where belief and logic conflicted, a more positive ERP deflection was elicited than for normatively sanctioned responses to nonconflict problems. This was observed from -400 to -200 ms prior to the correct response being given. The positive component is argued to be analogous to the late positive component (LPC) involved in cognitive control processes. This is consistent with the inhibition of empirically anomalous information when conclusions are unbelievable. These data are important in elucidating the neural correlates of belief bias by providing evidence for electrophysiological correlates of conflict resolution during conclusion processing. Moreover, they are supportive of dual-process theories of belief bias that propose conflict detection and resolution processes as central to the explanation of belief bias.

'All the burden on all the carers': exploring quality of life with family caregivers of Huntington's disease patients.

BACKGROUND: Existing research suggests that family caregivers of persons with Huntington's disease face a unique series of problems, linked to the complex nature of the disease. There is little research that explicitly investigates the impact of HD on the quality of life (QoL) of the family caregiver. The purpose of this study was to explore the quality of life issues for family carers of Huntington's disease patients in a focus group setting. METHODS: Participants were recruited via a Huntington's Disease Association (HDA) family conference day. Six semi-directed focus groups (n = 47) explored disease-specific aspects of QoL that were deemed important to family carers of this carer group. Data were analysed using Interpretative Phenomenological Analysis (IPA). RESULTS: Analysis of the focus group data identified four superordinate themes: 'Levels of Support', 'Dissatisfaction with Caregiving Role', 'Practical Aspects of Caring' and 'Feelings and Emotional Well-being'. CONCLUSIONS: These data provide evidence that QoL is compromised in many ways for HD family carers. The carers in this study often negated their own needs as their caregiving role overwhelmed them and 'took over' their lives.

Negations in syllogistic reasoning: evidence for a heuristic-analytic conflict.

An experiment utilizing response time measures was conducted to test dominant processing strategies in syllogistic reasoning with the expanded quantifier set proposed by Roberts (2005). Through adding negations to existing quantifiers it is possible to change problem surface features without altering logical validity. Biases based on surface features such as atmosphere, matching, and the probability heuristics model (PHM; Chater & Oaksford, 1999; Wetherick & Gilhooly, 1995) would not be expected to show variance in response latencies, but participant responses should be highly sensitive to changes in the surface features of the quantifiers. In contrast, according to analytic accounts such as mental models theory and mental logic (e.g., Johnson-Laird & Byrne, 1991; Rips, 1994) participants should exhibit increased response times for negated premises, but not be overly impacted upon by the surface features of the conclusion. Data indicated that the dominant response strategy was based on a matching heuristic, but also provided evidence of a resource-demanding analytic procedure for dealing with double negatives. The authors propose that dual-process theories offer a stronger account of these data whereby participants employ competing heuristic and analytic strategies and fall back on a heuristic response when analytic processing fails.

Figural effects in a syllogistic evaluation paradigm: an inspection-time analysis.

Robust biases have been found in syllogistic reasoning that relate to the figure of premises and to the directionality of terms in given conclusions. Mental models theorists (e.g., Johnson-Laird & Byrne, 1991) have explained figural bias by assuming that reasoners can more readily form integrated models of premises when their middle terms are contiguous than when they are not. Biases associated with the direction of conclusion terms have been interpreted as reflecting a natural mode of reading off conclusions from models according to a "first-in, first-out principle." We report an experiment investigating the impact of systematic figural and conclusion-direction manipulations on the processing effort directed at syllogistic components, as indexed through a novel inspection-time method. The study yielded reliable support for mental-models predictions concerning the nature and locus of figural and directionality effects in syllogistic reasoning. We argue that other accounts of syllogistic reasoning seem less able to accommodate the full breadth of inspection-time findings observed.