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Automatic atrial anti-tachy pacing for the termination of spontaneous atrial tachyarrhythmias: clinical experience with a novel dual-chamber pacemaker.

UNLABELLED: Automatic atrial anti-tachy pacing (aATP) is a novel approach to treat paroxysmal/persistent atrial tachyarrhythmias in pacemaker patients. To evaluate the efficacy of aATP in terminating spontaneous atrial flutter/tachycardia episodes (AT), a dual-chamber stimulator with extensive diagnostic capabilities and programmable aATP therapies (AT500(TM), Medtronic Inc.) was implanted in 30 patients with conventional pacing indications. During a mean follow-up time of 5.5 (1-12) months, aATP was delivered for 10494 AT. According to automatic device analysis, 8289 AT were treated with success (success-rate 79.0%). On 468 AT stored with the corresponding atrial EGM, an additional manual analysis was performed. The success-rate based on automatic analysis of these AT episodes (73.1%) was comparable to that found for all treated AT (79.0%), but manual EGM analysis revealed that only 209 of the 468 treated AT episodes (44.7%) were actually terminated by aATP. The aATP success-rate in the slower (cycle length 360-270 ms) AT detection zone was significantly higher (73.8%, 62/84 eps) than in the overlapping, faster (cycle length 270-220 ms) AT zone (38.3%, 147/384 eps, P<0.01). CONCLUSIONS: According to manual analysis, 1. aATP was safe and had a success-rate of 44.7%, 2. aATP success-rate was higher for AT in the slower than in the faster detection zone and 3. automatic analysis overestimated the efficacy of aATP.

Adult↗

Automaticity in clinical psychology.

The authors provide an overview of the literature on the ability of response expectancies to elicit automatic responses in the form of self-fulfilling prophecies and link it to the broader psychological investigation of automatic processes. The authors review 3 areas of research in which response expectancies have been shown to affect experience, behavior, and physiology: placebo effects, the effects of false biofeedback on sexual arousal, and the alteration of perceptual and cognitive functions by hypnotic and nonhypnotic suggestion. Also reviewed are data suggesting that all behavior, including novel and intentional behavior, is initiated automatically. Following this review, the authors summarize some of the ways in which knowledge of response expectancy effects and other automatic processes that influence experience and behavior can enhance clinical practice.

Biofeedback, Psychology↗

Controlled information processing resources and the development of automatic detection responses in schizophrenia.

The relation between resource limitations and the type of processing (automatic vs. controlled) on a multiple-frame search task (MFST) was examined in 15 schizophrenic and 15 normal control subjects. After 320 trials of consistently mapped practice, the patients' detection accuracy was normalized, and the effect of processing load (letter array size) on their detection accuracy was eliminated, which suggests automatization. Changes in load effects with practice could not be used as an index of automatization in control subjects, because of their unexpected lack of load effects at the beginning of practice. In a dual-task (MFST during auditory shadowing) condition after MFST practice, patients' MFST accuracy deteriorated nonsignificantly, and patients' shadowing declined significantly. The findings suggest schizophrenics have reduced available processing resources, but research is needed to determine whether this is due to abnormal automatization.

Adult↗

Automatic aftereffects in two-choice reaction time: a mathematical representation of some concepts.

A mathematical model is developed to describe sequential effects in two-choice reaction time experiments with a short response-stimulus interval. Evidence is briefly discussed that in conditions with short response-stimulus intervals, automatic aftereffects dominate sequential effects, and the influence of subjective expectancy can be neglected. In these conditions the model premises three components of automatic aftereffects--facilitation, inhibition, and noise, with a common decay factor. Influence of response-stimulus interval and practice on sequential effects are examined and related to parameter changes in the proposed single-decay model. The decrease of automatic aftereffects with increasing response-stimulus interval is primarily ascribed to an increasing decay factor. The parameter representation of the model also clarifies the issue of the disappearance of automatic aftereffects with practice. It shows a gradual fading of inhibition in the initial stages of practice, together with a slower decrease of the facilitation effect. The single-decay model provides a satisfactory explanation for the processes involved in compatible two-choice reaction time with short response-stimulus interval.

Choice Behavior↗

Automatic and controlled attention processes in auditory target detection.

Shiffrin and Schneider proposed a general theory of attention that postulates the existence of automatic and controlled search processes. They concluded that automatic processes develop when the mapping between stimuli and responses is consistent and controlled processing occurs when the mapping is varied. The effects of consistent and varied mapping were examined in an auditory target detection task. Subjects listened for one or three target letters embedded in a stream of dichotic letter pairs. Subjects responded faster and made fewer errors under the consistent mapping (CM) condition than under the varied mapping (VM) condition, and the effect of memory set size decreased over practice in the CM condition but not the VM condition. The results are discussed in terms of automatic and controlled processes involved in recognition of target stimuli. A review of research on auditory target detection suggests that the development of automatic processes may account for some apparent discrepancies in the literature.

Attention↗

Memory as a function of attention, level of processing, and automatization.

The relationships between long-term memory (LTM) modification, attentional allocation, and type of processing are examined. Automatic/controlled processing theory (Schneider & Shiffrin, 1977) predicts that the nature and amount of controlled processing determines LTM storage and that stimuli can be automatically processed with no lasting LTM effect. Subjects performed the following: (a) an intentional learning, (b) a semantic categorization, (c) a graphic categorization, (d) a distracting digit-search while intentionally learning words, and (e) a distracting digit-search while ignoring words. Frequency judgments were more accurate in the semantic and intentional conditions than the graphic condition. Frequency judgments in the digit-search conditions were near chance. Experiment 2 extensively trained subjects to develop automatic categorization. Automatic categorization produced no frequency learning and little recognition. These results also disconfirm the Hasher and Zacks (1979) "automatic encoding" proposal regarding the nature of processing.

Adult↗

How semantic is automatic semantic priming?

Priming for semantically related concepts was investigated using a lexical decision task designed to reveal automatic semantic priming. Two experiments provided further evidence that priming in a single presentation lexical decision task (McNamara & Altarriba, 1988) derives from automatic processes. Mediated priming, but no inhibition or backward priming was found in this type of lexical decision task. Experiments 3 and 4 demonstrated that automatic priming was found only for associated word pairs, as determined by word association norms, and not for word pairs that are semantically related but not associated. It is argued that automatic priming in the lexical decision task occurs at a lexical level not at a semantic level.

Adult↗

Can automatic picture processing influence word judgments?

Two experiments were undertaken in order to evaluate the influence of automatic semantic processing of pictures on word judgments. In both studies, picture-word analogs of the Stroop task were employed. In Experiment 1, subjects were required to make a semantic category judgment about the word; in Experiment 2, they were simply to respond yes or no to whether the word was DOG. Taken together, the results of these experiments indicated that (a) perceptual factors such as lateral masking influence responding in these types of tasks and their contributions must be partialed out from the effects of semantic factors, (b) picture processing can facilitate word processing but only in a restricted set of circumstances, and (c) background pictures incompatible with the correct response can interfere with word judgments. The facilitation observed was attributed to the effects automatic picture processing has on an initial input process, while the interference appears to arise at a response selection and execution stage. Further, the results suggest that the semantic nature of automatic picture processing is at least somewhat different from that of automatic word processing.

Adult↗

The selective effects of alcohol on automatic and effortful memory processes.

Automatic and effortful memory processes were evaluated in a 2-session, within-subjects design involving an alcohol challenge and a no-alcohol condition. Free recall of a 90-word list measured effortful processing. Estimation of word frequency from the same list measured automatic processing. Acute intoxication was hypothesized to diminish effortful but not automatic memory processes. Healthy, male volunteers (n = 36) completed the 2 conditions 1 week apart. Presentation frequency influenced both free recall and frequency estimation, with both measures increasing as presentation frequency increased. Free recall was significantly lower in the alcohol than in the no-alcohol condition, but frequency estimation was not differentially affected. The data showed that an alcohol challenge dissociated automatic and effortful memory processes in volunteers. The authors discuss potential neurobiological substrates that may account for alcohol's selective disruption of effortful, verbal, episodic memory processing.

Adult↗

Gender differences in automatic in-group bias: why do women like women more than men like men?

Four experiments confirmed that women's automatic in-group bias is remarkably stronger than men's and investigated explanations for this sex difference, derived from potential sources of implicit attitudes (L. A. Rudman, 2004). In Experiment 1, only women (not men) showed cognitive balance among in-group bias, identity, and self-esteem (A. G. Greenwald et al., 2002), revealing that men lack a mechanism that bolsters automatic own group preference. Experiments 2 and 3 found pro-female bias to the extent that participants automatically favored their mothers over their fathers or associated male gender with violence, suggesting that maternal bonding and male intimidation influence gender attitudes. Experiment 4 showed that for sexually experienced men, the more positive their attitude was toward sex, the more they implicitly favored women. In concert, the findings help to explain sex differences in automatic in-group bias and underscore the uniqueness of gender for intergroup relations theorists.

Attitude↗

Automatic and effortful processing in depression.

Automatic processes require few attentional resources, but effortful processes use attentional capacity. Research on cognitive processing by depressed individuals is reviewed and the following is concluded: (a) Depression interferes with effortful processing. The degree of interference is determined by the degree of effortfulness of the task, the severity of depression, and the valence of the stimulus material to be processed. (b) Depression interferes only minimally with automatic processes. Hypothetical causal mechanisms for interference in effortful processes by depression, whether interference in effortful processing is unique to depression or characteristic of psychopathology in general, and whether negative automatic thoughts are associated with current depression or depression proneness are also addressed. The effortful-automatic perspective has implications for understanding depressive clinical features, treating depression, and conducting future research.

Attention↗

An 'automatic pilot' for the hand in human posterior parietal cortex: toward reinterpreting optic ataxia.

We designed a protocol distinguishing between automatic and intentional motor reactions to changes in target location triggered at movement onset. In response to target jumps, but not to a similar change cued by a color switch, normal subjects often could not avoid automatically correcting fast aiming movements. This suggests that an 'automatic pilot' relying on spatial vision drives fast corrective arm movements that can escape intentional control. In a patient with a bilateral posterior parietal cortex (PPC) lesion, motor corrections could only be slow and deliberate. We propose that 'on-line' control is the most specific function of the PPC and that optic ataxia could result from a disruption of automatic hand guidance.

Adult↗

A comparison of manual and automatic processing in general dental practice.

Although automatic processing is becoming more widely available in general dental practice, there is little objective information regarding the quality of this type of processing. Thus a postal study was undertaken to compare manual and automatic processing using a questionnaire together with a standardised, pre-exposed test radiograph for routine processing. Analysis of variance showed significant differences between the manually processed, automatically processed and control test films, in respect of D Min (P < 0.001), test strip (P < 0.001), and step density values (P < 0.01) but not for D Max (P > 0.1). The manually processed test films generally had significantly less density than the automatically processed test films or control test films.

Analysis of Variance↗

In-field validation of automatic blood pressure measuring devices.

The method for rapid evaluation of automatic blood pressure (BP) measurement devices (READ) is based on numerous BP measurements at rest and during a standardised postural challenge in a small number of subjects with a wide range of BPs. The present study proposes additional parameters of the READ for in-field validation of automatic BP measurement devices. BP measurements were done in supine position for 10 min followed by head-up tilt for 30 min and again supine for 10 min. BPs were determined simultaneously by automatic (AU) and mercury sphygmomanometric (MS) measurements on the same arm. The BP differences DeltaBP:AU-MS were calculated. Three units of the Colin BP-8800 and the Datex-Engstrom Cardiocaptrade mark II were evaluated. Based on DeltaBP(AU-MS), the grade of accuracy, aberration patterns and correlates of accuracy were assessed for each unit. Per unit, an average of 121 measurements were done, every BP category being met in >/=20 MS measurements. In general, the AU systolic BP values were higher than MS systolic BP values (mean systolic DeltaBP = 1.26 +/- 17.1 mm Hg) and AU diastolic BP values were lower than MS diastolic BP values (mean diastolic DeltaBP = -12.31 +/- 7.8 mm Hg). All units classified into category D of the British Hypertension Society grading system and exhibited inconsistent aberration patterns, making design of correction formulas impractical. Inaccuracy of the instruments was independent on mode of measurement, posture, magnitude of the BP and heart rate, early or late measurements from beginning of the head-up tilt test, and prolonged use of the unit. The READ permitted to identify rapidly the degree of accuracy of automatic BP measuring devices. Identification of the aberration pattern of an instrument could be the basis for calculating equations for correction of the measured BP. Further studies will show which parameters of the READ may expose specific defects of the instruments. Journal of Human Hypertension (2000) 14, 37-42.

Adult↗

Accuracy of the OMRON M4 automatic blood pressure measuring device.

Despite widespread use of the automatic blood pressure (BP) measuring device OMRON M4, there is little formal validation on its accuracy. A study was conducted to assess the accuracy of the OMRON M4 compared with the true indirect BP measured by mercury sphygmomanometer (MS). A rapid method for the evaluation of automatic blood pressure measurement devices (READ) was applied for this study. The READ is based on numerous BP measurements at rest and during a standardised postural challenge in a small number of subjects who exhibit a wide range of BPs. Blood pressure measurements were done in supine position for 10 min followed by head-up tilt for 30 min and again supine for 10 min. The automatic device (AU) and the MS were connected to one arm-cuff by means of a T connector. A stethoscope with dual sets of ear-pieces was used for duplicate MS measurements (MS1 and MS2). The MS1, MS2 and AU measurements were taken simultaneously in a blinded manner. Three units of the automatic instrument were evaluated. An average of 111 measurements per unit were performed, every BP category being present in >/=15 MS measurements. The differences between MS1 and MS2 measurements (DeltaBP: MS1-MS2) were utilized to assess the consistency of true indirect BP and the differences between AU and MS measurements (DeltaBP:AU-MS2) were utilized to assess the accuracy of the AU. The following characteristics of the OMRON M4 were assessed: (1) grade of accuracy, (2) aberration pattern, (3) consistency of the aberration-pattern, and (4) correlation between levels of BP and DeltaBP: AU-MS. For MS paired readings, 92-100% of systolic and 99-100% of diastolic readings fell within 5 mm Hg difference range, that is consistent with a British Hypertension Society grade A of both. For AU compared to MS2, 29-64% of systolic and 73-94% of diastolic readings fell within 5 mm Hg and 49-86% of systolic and 86-99% of diastolic readings fell within 10 mm Hg and the devices qualified C, D and C, respectively. All devices exhibited irregular and inconsistent aberration patterns, making the design of correction formulas impractical. In conclusion, the OMRON M4 device did not meet the requirements of the British Hypertension Society and, therefore, cannot be recommended for clinical use.

Adult↗

Effects of calibration and automatic greyscale adjustment on detectability of simulated bone lesions using a storage phosphor system.

OBJECTIVES: To analyse the interaction of calibration, automatic greyscale adjustment and X-ray exposure on the evaluation of simulated bone lesions with the Digora (Orion Corporation Soredex, Helsinki, Finland) storage phosphor system. METHODS: Exposures were made under five conditions based on the exposure time for Ektaspeed Plus film: A-calibration exposure 100%, exposure 100%; B-calibration exposure 100%, exposure 50%; C-calibration exposure 100%, exposure 10%; D-calibration exposure 50%, exposure 50%; E-calibration exposure 10%, exposure 10%. Series of images of artificial bone lesions were created each representing one of the five conditions, with or without automatic greyscale adjustment and including one of two lesion sizes. The series were evaluated by seven expert radiologists. Results were analysed by means of MANOVA statistics. RESULTS: The large lesions were evaluated significantly better than the small lesions (P < 0.011). The two 10% exposure conditions were evaluated significantly worse than the other three (P < 0.029) which had comparable results. Automatic greyscale adjustment had no significant effect (P > 0.253). CONCLUSIONS: The Digora should be calibrated for the highest exposure to be used to optimize the wide latitude. Automatic greyscale adjustment is not useful for the detection of simulated bone lesions.

Bone Diseases↗

Cognitive behaviour therapy approach to disputing automatic thoughts: a two-stage model.

Research shows that clients with automatic thoughts (dysfunctional thinking) often do not think of alternative explanations in relation to negative events. Furthermore, these automatic thoughts are characterized by a broad global, self-evaluative and ambiguous nature that could make disputing (or changing the ways they think) the most difficult part of the therapeutic process. This paper proposes a two-stage practise-based disputing model, guided by research, that aims to 'bring' an automatic thought to a specific, objective, quantifiable and concrete level at which not only is the particular aspect(s) of the automatic thought that causes emotional disturbances finely focused, but the disputing is also likely to be effective and manageable. Furthermore, it will also generate alternative explanations that are helpful in reducing emotional disturbances and in facilitating problem solving approach. In this paper, the authors use a case example to discuss the rationale that underpins the conceptualization of the model and to illustrate the process in which the strategies of the model are effectively used.

Cognitive Behavioral Therapy↗

Depression, automatic thoughts, alexithymia, and assertiveness in patients with tension-type headache.

OBJECTIVE: The role of psychological factors related to headache has long been a focus of investigation. The aim of this study was to evaluate depression, automatic thoughts, alexithymia, and assertiveness in persons with tension-type headache and to compare the results with those from healthy controls. METHODS: One hundred five subjects with tension-type headache (according to the criteria of the International Headache Society classification) and 70 controls were studied. The Beck Depression Inventory, Automatic Thoughts Scale, Toronto Alexithymia Scale, and Rathus Assertiveness Schedule were administered to both groups. Sociodemographic variables and headache features were evaluated via a semistructured scale. RESULTS: Compared with healthy controls, the subjects with headache had significantly higher scores on measures of depression, automatic thoughts, and alexithymia and lower scores on assertiveness. Subjects with chronic tension-type headache had higher depression and automatic thoughts scores than those with episodic tension-type headache. CONCLUSIONS: These findings suggested that persons with tension-type headache have high depression scores and also may have difficulty with expression of their emotions. Headache frequency appears to influence the likelihood of coexisting depression.

Adult↗