Measuring Correlates of Mental Workload During Simulated Driving Using cEEGrid Electrodes: A Test-Retest Reliability Analysis.

The EEG reflects mental processes, especially modulations in the alpha and theta frequency bands are associated with attention and the allocation of mental resources. EEG has also been used to study mental processes while driving, both in real environments and in virtual reality. However, conventional EEG methods are of limited use outside of controlled laboratory settings. While modern EEG technologies offer hardly any restrictions for the user, they often still have limitations in measurement reliability. We recently showed that low-density EEG methods using film-based round the ear electrodes (cEEGrids) are well-suited to map mental processes while driving a car in a driving simulator. In the present follow-up study, we explored aspects of ecological and internal validity of the cEEGrid measurements. We analyzed longitudinal data of 127 adults, who drove the same driving course in a virtual environment twice at intervals of 12-15 months while the EEG was recorded. Modulations in the alpha and theta frequency bands as well as within behavioral parameters (driving speed and steering wheel angular velocity) which were highly consistent over the two measurement time points were found to reflect the complexity of the driving task. At the intraindividual level, small to moderate (albeit significant) correlations were observed in about 2/3 of the participants, while other participants showed significant deviations between the two measurements. Thus, the test-retest reliability at the intra-individual level was rather low and challenges the value of the application for diagnostic purposes. However, across all participants the reliability and ecological validity of cEEGrid electrodes were satisfactory in the context of driving-related parameters.

Management of arterial hypertension: Transfer from clinical guidelines into daily practice - Results of a survey in German practitioners offices.

INTRODUCTION: The principal objective of clinical guidelines is to improve the quality of medical care. However, standardized evaluation of the adoption into daily practice is missing. The aim of our study was to investigate the implementation of guideline recommendations on the management of arterial hypertension (AH) in German general practitioner's (GPs) offices. METHODS: A questionnaire focusing on the implementation of the German guidelines for the management of AH was developed and prospectively rolled out in 3.200 GPs and field-based specialists in internal medicine in Germany. Data were interpreted in an explorative way. RESULTS: Data from 689 German physicians that participated in the survey were analyzed. Effectiveness of lifestyle changes in the management of AH was rated as very high or high in 36.6%. When lifestyle changes only will not normalize blood pressure (BP), medical treatment will be initiated after 2-6 months by majority of physicians. Decision for mono- or combination therapy was driven by BP and patient's risk profile. Choice for a specific antihypertensive substance was based on the recommendations of scientific guidelines in the majority of GPs. CONCLUSIONS: Medication treatment algorithms recommended in 2015 by German guidelines are well accepted by GPs. Lifestyle changes are voted by only slightly more than one-third as a reasonable tool for the management of AH in the setting of the medical office. This might reflect a lack of certified medical education regarding this topic. Our study was not designed to register the time from publication of guidelines to practical implementation.

Evaluating Mental Load During Realistic Driving Simulations by Means of Round the Ear Electrodes.

Film based round the ear electrodes (cEEGrids) provide both, the accessibility of unobtrusive mobile EEG as well as a rapid EEG application in stationary settings when extended measurements are not possible. In a large-scale evaluation of driving abilities of older adults (N > 350) in a realistic driving simulation, we evaluated to what extent mental demands can be measured using cEEGrids in a completely unrestricted environment. For a first frequency-based analysis, the driving scenario was subdivided into different street segments with respect to their task loads (low, medium, high) that was a priori rated by an expert. Theta activity increased with task load but no change in Alpha power was found. Effects gained clarity after removing pink noise effects, that were potentially high in this data set due to motion artifacts. Theta fraction increased with task load and Alpha fraction decreased. We mapped this effect to specific street segments by applying a track-frequency analysis. Whilst participants drove with constant speed and without high steering wheel activity, Alpha was high and theta low. The reverse was the case in sections that required either high activity or increased attentional allocation to the driving context. When calculating mental demands for different street segments based on EEG, this measure is highly significant correlated with the experts' rating of task load. Deviances can be explained by specific features within the segments. Thus, modulations in spectral power of the EEG were validly reflected in the cEEGrids data. All findings were in line with the prominent literature in the field. The results clearly demonstrate the usability of this low-density EEG method for application in real-world settings where an increase in ecological validity might outweigh the loss of certain aspects of internal validity.

Concept mapping as an approach for expert-guided model building: The example of health literacy.

Concept mapping served as the starting point for the aim of capturing the comprehensive structure of the construct of 'health literacy.' Ideas about health literacy were generated by 99 experts and resulted in 105 statements that were subsequently organized by 27 experts in an unstructured card sorting. Multidimensional scaling was applied to the sorting data and a two and three-dimensional solution was computed. The three dimensional solution was used in subsequent cluster analysis and resulted in a concept map of nine "clusters": (1) self-regulation, (2) self-perception, (3) proactive approach to health, (4) basic literacy and numeracy skills, (5) information appraisal, (6) information search, (7) health care system knowledge and acting, (8) communication and cooperation, and (9) beneficial personality traits. Subsequently, this concept map served as a starting point for developing a "qualitative" structural model of health literacy and a questionnaire for the measurement of health literacy. On the basis of questionnaire data, a "quantitative" structural model was created by first applying exploratory factor analyses (EFA) and then cross-validating the model with confirmatory factor analyses (CFA). Concept mapping proved to be a highly valuable tool for the process of model building up to translational research in the "real world".

Neurodevelopmental disruption in early-onset temporal lobe epilepsy: evidence from a voxel-based morphometry study.

Childhood onset of epilepsy has long been associated with an adverse impact on brain development and cognition. In this study it is proposed that earlier (vs later) onset of temporal lobe epilepsy (TLE) has a negative developmental impact on distant brain structures. One hundred ten patients with TLE were assigned to early (≤14 years, N=58) and late (>15 years, N=52) age at onset of epilepsy groups. Voxel-based morphometry revealed onset-dependent abnormalities (in terms of a gray matter excess in the early-onset group), which were found mainly in frontal regions. An excess of gray matter is not a usual finding in TLE. However, within a neurodevelopmental framework, retained gray matter is discussed as reflecting neurodevelopmental disruption. The findings indicate the importance of quantitative MRI for the detection of subtle secondary abnormalities in focal TLE and once more underline the importance of early seizure management in children with intractable TLE.

Assessing competence: the European Survey on Aging Protocol (ESAP).

OBJECTIVES: The main goal of this research project was to translate and adapt the European Survey on Ageing Protocol (ESAP) to 7 European countries/cultures. This article presents preliminary results from the ESAP, the basic assessment instrument of EXCELSA (European Longitudinal Study of Aging). METHODS: 672 individuals aged 30-85, selected through quota sampling (by age, gender, education and living conditions), participated in this study, with 96 subjects from each of the 7 European countries. The basic research protocol for assessing competence and its determinants was designed to be administered in a 90-min in-home face-to-face interview. It contains a series of questions, instruments, scales and physical tests assessing social relationships and caregiving, mental abilities, well-being, personality, mastery and perceived control, self-reported health, lifestyles, anthropometry, biobehavioral measures and sociodemographic variables. RESULTS: 84% of ESAP measures are age-dependent and 75% of them discriminate between education levels. Minor differences were found due to gender, and between people living in rural and urban areas. Exploratory factor analysis yielded 10 factors accounting for 67.85% of total variance, one of which was identified as cognitive and physical 'competence'. This factorial structure was tested across countries through concordance coefficients. Finally, using structural equation modeling, our data were fitted into a model of competence. When the sample was split into younger groups (aged 30-49 years) and older ones (50 and more years), the same model was appropriate for our data. DISCUSSION: The results are discussed in accordance with other findings on psychosocial, biophysical and sociodemographic components of competence, and also in accordance with theories on competence and successful aging.

Societal trends, mobility behaviour and sustainable transport in Europe and North America: the European Union network STELLA.

This contribution introduces the work of the European Union network Sustainable Transport in Europe and Links and Liaisons to America (STELLA) in the first section and examines especially social and behavioural aspects of sustainable transport from a transatlantic perspective in the second section. One of the most significant societal trends, the ageing of societies, is surveyed and its implications for mobility behaviour are shown. The sustainability of this behaviour is considered along with constraints and drivers of this behaviour in Europe and North America. The contribution takes up relevant policy issues and concludes with a discussion of a transatlantic research agenda on social and behavioural aspects of sustainable transport especially concerning the elderly.