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PubMed1999

Level of automation effects on performance, situation awareness and workload in a dynamic control task.

Various levels of automation (LOA) designating the degree of human operator and computer control were explored within the context of a dynamic control task as a means of improving overall human/machine performance. Automated systems have traditionally been explored as binary function allocations; either the human or the machine is assigned to a given task. More recently, intermediary levels of automation have been discussed as a means of maintaining operator involvement in system performance, leading to improvements in situation awareness and reductions in out-of-the-loop performance problems. A LOA taxonomy applicable to a wide range of psychomotor and cognitive tasks is presented here. The taxonomy comprises various schemes of generic control system function allocations. The functions allocated to a human operator and/or computer included monitoring displays, generating processing options, selecting an 'optimal' option and implementing that option. The impact of the LOA taxonomy was assessed within a dynamic and complex cognitive control task by measuring its effect on human/system performance, situation awareness and workload. Thirty subjects performed simulation trials involving various levels of automation. Several automation failures occurred and out-of-the-loop performance decrements were assessed. Results suggest that, in terms of performance, human operators benefit most from automation of the implementation portion of the task, but only under normal operating conditions; in contrast, removal of the operator from task implementation is detrimental to performance recovery if the automated system fails. Joint human/system option generation significantly degraded performance in comparison to human or automated option generation alone. Lower operator workload and higher situation awareness were observed under automation of the decision making portion of the task (i.e. selection of options), although human/system performance was only slightly improved. The implications of these findings for the design of automated systems are discussed.

Adult↗
PubMed1991

Bereavement and heightened existential awareness.

"Ask not for whom the bells toll; they toll for thee." John Donne's admonition, though written 350 years ago, endures with astonishing freshness; it speaks to something self-evident, to a truth that is well known to many who have experienced bereavement--that the death of a significant other has the potential to hurl the survivor into a confrontation with his/her own death. A confrontation with death--should we seek it? There is evidence in the clinical literature that in terminally ill patients such a confrontation may lead to pronounced positive psychological changes. Research (Yalom 1980) has documented that terminally ill patients may undergo a series of positive personal changes; they communicate more openly with family and close friends, they experience fewer fears, they rearrange their life priorities, they are less preoccupied with the trivialities of life, they live life more immediately rather than postpone experience and pleasure into the future. Does spousal bereavement in our culture confront individuals with their own personal death? Does it cause some widow/widowers to regard their existence in a different manner? If so, might it be possible that those bereaved individuals who examine their life deeply may have a different course of bereavement than those who do not look within? Might it even be possible that bereavement, for some individuals, results in psychological shifts analogous to the positive changes reported by terminally ill patients? These are the basic questions of our research inquiry. We designed a project which would allow us to determine, in a nonclinical sample of bereaved spouses, differences in the degree of existential awareness and the consequences of such awareness on the course of bereavement. We also attempted to determine which subjects were more likely to develop heightened existential awareness. The participants studied were part of an intervention project on bereavement in which we studied a sample of widows and widowers in the first few months of bereavement and then offered them an opportunity to participate in an eight-meeting support group. Reports of the clinical issues emerging in our short-term bereavement groups and of the efficacy of these groups were published elsewhere (Yalom and Vinogradov 1988; Lieberman and Yalom 1991).

Awareness↗
PubMed2003

Reliability of the self-awareness of deficits interview for adults with traumatic brain injury.

PRIMARY OBJECTIVE: This paper investigates the test-re-test reliability of the Self-Awareness of Deficits Interview (SADI) for assessing level of self-awareness in clients with traumatic brain injury (TBI). RESEARCH DESIGN: Twenty rehabilitation clients with TBI were interviewed using the SADI and re-test interviews were conducted 2-4 weeks later. METHODS AND PROCEDURES: Two checklists were used to collect collateral information on the client from significant others and rehabilitation staff. This information was used to assist in assigning SADI scores. MAIN OUTCOMES AND RESULTS: High test-re-test reliability was demonstrated for both total (ICC = 0.94) and sub-section scores (ICC = 0.85, 0.86 and 0.86). The results, combined with previous research indicating the high inter-rater reliability of the SADI, suggest the SADI is a reliable means of evaluating level of self-awareness. Further research is required to investigate other psychometric properties of the SADI and the two checklists.

Adolescent↗
PubMed1998

Awareness and treatment of cardiovascular disease risk factors among middle-aged Swedish men and women.

OBJECTIVE: To study awareness and treatment of risk factors for cardiovascular disease in a primary care district where a screening program for hypercholesterolaemia involving one third of the population had been conducted 7 years earlier. DESIGN: A semi-structured telephone survey on four risk factors; blood pressure, serum cholesterol, blood sugar, and smoking habits. SETTING: The study was performed in a defined area in Blekinge county in Sweden. SUBJECTS: A random sample of the general population aged 40-49 years, in total 356 people. MAIN OUTCOME MEASURES: Awareness of individual risk factors, for cardiovascular diseases, on-going medication, and lifestyle changes in order to lower individual risks. RESULTS: A total of 95% had had their blood pressure measured at least once, compared with 69% for serum cholesterol. Twenty-two per cent had at some time been told that they had high blood pressure, and, of these, almost half (44%) received pharmacological treatment. Among the 62 subjects who were informed about hyperlipidaemia only 5% were taking a lipid-reducing drug. Among present smokers, 38% had had at least one quitting episode during the previous 2 years with a median duration of 60 days. CONCLUSION: In a general population there is a difference between blood pressure and cholesterol check-up and medicalization. Screening activities seem to raise the awareness of cardiovascular risk factors in a population, but when evaluating the tendency to change lifestyle the contagious effects of screening activities might be taken into account. Finding quick-relapsing former smokers among current non-smokers may be of importance when planning smoking cessation activities.

Adult↗
PubMed2006

The phonological awareness abilities of children with cerebral palsy who do not speak.

To investigate the importance of the connection between being able to speak and the emergence of phonological awareness abilities, the performance of children with cerebral palsy (five speakers and six non-speakers) was assessed at syllable, onset-rime, and phoneme levels. The children were matched with control groups of children for non-verbal intelligence. No group differences were found for the identification of syllables, reading non-words, or judging spoken rhyme. The children with cerebral palsy who could speak, however, performed better than the children with cerebral palsy who could not speak and the control group of children without disabilities, judging written words for rhyme. The children with cerebral palsy who could not speak performed poorly in comparison to those who could speak (but not the control group of children) when segmenting syllables and on the phoneme manipulation task. The findings suggest that non-speaking children with cerebral palsy have phonological awareness performance that varies according to the mental processing demands of the task. The ability to speak facilitates performance when phonological awareness tasks (written rhyme judgment, syllable segmentation, and phoneme manipulation) require the use of an articulatory loop.

Awareness↗
PubMed2006

Patient compliance in brain injury rehabilitation in relation to awareness and cognitive and physical improvement.

UNLABELLED: The purpose of the present study was to investigate the relationship between patients' compliance and awareness and outcome of brain injury rehabilitation. Subjects were 98 patients who underwent a holistic neuropsychological outpatient rehabilitation programme. Patients had suffered a traumatic brain injury (n = 26), a cerebrovascular accident (n = 58), or another neurological insult (n = 14). MEASURES: Two staff members, a neuropsychologist and a physiotherapist, retrospectively and separately rated patients' awareness and their compliance. Outcome was measured with the d2 test of concentration, measures of oxygen uptake, strength endurance, running speed, and patients' and relatives' ratings of patients' cognitive, physical, and overall problems on the European Brain Injury Questionnaire (EBIQ). The discrepancy between patients' and relatives' ratings on the EBIQ was incorporated as a second measure of patients' awareness. RESULTS: The neuropsychologist's compliance ratings were significantly related to measures of insight, improvement of d2 performance accuracy and stability, improvement of oxygen uptake, and reduction of cognitive and overall problems as reported by the patients, while the physiotherapist's compliance ratings were related to measures of insight, improvement of d2 performance speed, improvement of oxygen uptake and strength endurance, and all three EBIQ patient scales. DISCUSSION: The results suggest a differential relationship between situation-specific compliance and outcome.

Activities of Daily Living↗
PubMed2006

Awareness and knowing: implications for rehabilitation.

It has been known for well over a century that brain-damaged patients are often unaware of the very deficits that impair performance in everyday life. Pathologies of awareness have been described for many neurological, psychiatric and neuropsychological deficits and the construct of "awareness" or "insight" understandably now receives attention from many researchers within the clinical and cognitive neurosciences. This paper does not attempt to explain the nature of consciousness or its impairment but rather considers four aspects of consciousness/awareness that health care professionals interested in understanding, measuring and improving deficits of awareness should consider.

Awareness↗
PubMedDate not supplied

Effects of phonemic awareness instruction on the encoding skills of children with severe speech impairment.

PURPOSE: To examine the effects of phoneme-grapheme correspondence and phonemic awareness instruction on the encoding abilities of three pre-reading children with severe speech impairment (SSI). METHOD: Using a single subject multiple baseline design across behaviours and participants, children received phoneme-grapheme awareness instruction followed by instruction in segmenting, manipulating, and encoding consonant-vowel-consonant (CVC) pseudowords. RESULTS: Generalization occurred to encoding of novel CVC pseudo- and real words for two of the three participants. CONCLUSIONS: Results suggest that phoneme-grapheme correspondence and phonemic awareness instruction is effective in developing encoding skills in children with SSI. Findings are consistent with those for other at-risk children.

Articulation Disorders↗
PubMed2006

Awareness and control of hypertension among the elderly in a university hospital.

Because medically useful information could also be gathered through hospital-based studies, the aim of this study was to assess the prevalence, awareness, treatment, and control of HT among the elderly at a university hospital in Turkey. A total of 3,038 elderly were enrolled. Overall, 75.1% of the patients had HT. Among the hypertensive elderly, 88.9% were aware that they had HT, and only 20.9% had BPs that were under control. The low prevalence of control, even among individuals aware of their HT, suggests that the education of health care providers at all stages of professional training is especially important.

Aged↗
PubMed2003

Increasing disability awareness of future spinal cord injury physicians.

OBJECTIVE: This prospective study was designed to evaluate a disability awareness training program for medical students. METHODS: First- and second-year medical school students participated in an interactive disability awareness program consisting of 6 sessions spaced across 1 year. The Modified Issues in Disability Scale (MIDS), administered at program commencement and completion, was used to measure attitudes toward people with a disability. The paired t test was used to compare pre- and posttest data on the MIDS. In addition, gain scores on content-based tests were used to measure learning for each session. Participants also completed evaluation forms for each session. RESULTS: Two hundred and six students completed the MIDS forms at program commencement and completion. Analysis revealed a significant average increase (P = 0.033) in positive attitudes toward people with disabilities between the pre- and posttest data. Content learning also was evidenced by an average 34% gain from pretest to posttest. The participant evaluation summary for the sessions averaged 3.95 on a Likert-type scale of 5, which was characterized as "very good." Subjective evaluations were extremely favorable, as evidenced by requests for more information and exposure. CONCLUSION: This project illustrates the effectiveness of disability awareness training among medical school students during the early period of their training.

Attitude of Health Personnel↗
PubMed2005

Raising awareness of on-line cancer information: helping providers empower patients.

While the digital divide remains a special problem in health care, providers' reluctance to refer patients to the Internet is an equally important problem. The Bridging the Digital Divide Project: Your Access to Cancer Information was designed with two target audiences in mind-consumers and health care providers. A total of 256 providers from varied health care settings enrolled in workshops over a 10-month period (2001-2002). Results suggest differences in awareness and use of on-line cancer information among providers and confirm that many providers need to become more comfortable with referring patients to on-line information. At completion of the workshops, all participants reported an increased awareness of cancer information websites, increased confidence in making judgments about the reliability and appropriateness of the sites, an increased willingness to discuss Internet information sources with patients and their family members, and an increased awareness of and intention to use the CIS. Providers from the community hospital were more likely than other groups to report that what they had learned about the Internet was helpful and that their comfort level using the Internet had increased. Partnerships between providers and the CIS may help to further increase this comfort level, ultimately benefiting cancer patients.

Attitude of Health Personnel↗
PubMed2006

Communities' awareness, perception and participation in the Community-Based Medical Education of the University of Maiduguri.

BACKGROUND: Community-based medical education (CBME) is no longer a new innovation in medical education since the establishment of The Network: Towards Unity for Health (The Network: TUFH) 25 years ago. The CBME of the University of Maiduguri medical college is 14 years old and has never been assessed in terms of the population it serves. The study was conducted to determine the level of awareness, perception, and participation of the communities in CBME. METHODS: A cross-sectional survey was carried out in 11 village units of three Local Government Areas (LGAs) using a 14-item structured questionnaire administered to adults in randomly selected households. The questionnaire was based on guide questions used for focus group discussions held earlier with community leaders. RESULTS: Awareness of students' visits among respondents was 73.7%. Knowledge of the frequency of presence of the students in the communities was 72.2%. "To examine and treat" (33.6%) and "to ask questions" (16.6%) were the most prominent reasons given for the visits. The majority of respondents perceived the visits as beneficial (72.2%). More frequent visits were requested by 54.4% of the respondents. The communities were willing to be more accessible and felt that the LGAs should provide more logistic support to the program. DISCUSSION: This study revealed that communities were aware of students' visits and knew reasons for the visits, thought visits were beneficial, and were willing to provide more support for these visits.

Adult↗
PubMed2006

Changes in depression awareness and attitudes in Australia: the impact of beyondblue: the national depression initiative.

OBJECTIVE: To assess changes in depression awareness and attitudes in Australia and the effect that beyondblue: the national depression initiative has had on these. METHOD: Data from national surveys of mental health literacy in 1995 and 2003-2004 were analysed to see if states and territories that funded beyondblue (the high-exposure states) had greater changes than those that did not (the low-exposure states). In both surveys, participants were shown a depression vignette and asked whether they themselves or family or friends had ever had a similar problem, whether they thought the person would be discriminated against, and questions about the likelihood of long-term positive and negative outcomes for the person. Participants were also assessed for symptoms of psychological distress in the past month. RESULTS: There was an increase in the percentage of people who said that they or their family or friends had a problem like the person in the vignette. This increase was greater in the high-exposure states. However, there was no change in reports of current psychological distress, suggesting that there is greater depression awareness or openness rather than a real increase in symptoms. People in the high-exposure states also showed an increase in the belief that discrimination would occur. There was little change in beliefs about long-term outcomes, apart from people in high-exposure states believing that a depressed person would be more understanding of other people's feelings. CONCLUSIONS: The data are consistent with beyondblue having had an effect on awareness of depression and of discrimination against depressed people.

Adolescent↗
PubMed2002

Bridge to services: drug injectors' awareness and utilization of drug user treatment and social service referrals, medical care, and HIV testing provided by needle exchange programs.

Using qualitative interviews conducted in 1999, we examine awareness and use of drug user treatment and social service referrals, medical care, and HIV testing provided by needle exchange programs (NEPs) among injectors who use NEPs (N=26) and injectors who get their syringes from other sources (N=20). A four-category typology of NEP service knowledge and use emerges from these interviews: "Active involvement--use of services; "Stepping stone"--no use of services but knowledge that specific services are available; "Vague awareness"--nonspecific knowledge of service availability: and "Unaware:--no awareness of the service provision function of NEPs. We describe patterns of distribution of respondents among these categories and suggest policy implications.

Adult↗
PubMed1995

Proprioception and stability: foot position awareness as a function of age and footwear.

We examined the hypothesis that awareness of foot position in terms of the slope of the weight-bearing surface declines with age. We further postulated that the decline would be due to a change in plantar tactile sensibility, and that footwear would further impair position judgments. We compared 15 men aged over 65 years (mean age 73) with 36 men aged under 40 (mean age 30) in terms of estimates of amplitude and direction of surface slopes. We employed a ratio scale of 0-10 representing actual slopes of 0 degrees-25 degrees in increments of 2.5 degrees. In order to examine whether subjects overestimated high angles they were told that the scale ranged from 0 to 15. We found significant differences between the two groups in terms of estimates and the effect of footwear. Psychophysical functions for estimate of slope were 0.95 for the young when barefoot and 0.71 when shod compared with 0.80 and 0.81 respectively for the older men. We conclude that sensitivity to foot position declines with age, mainly owing to loss of plantar tactile sensitivity. Footwear impairs foot position awareness in both young and old. Loss of foot position awareness may contribute to the frequency of falls in later life.

Adult↗
PubMed2001

The auditory evoked response as an awareness monitor during anaesthesia.

We investigated the relationship between the latency of the Nb wave of the auditory evoked response (AER) and periods of awareness during propofol anaesthesia. In the anaesthetic room before cardiac surgery the AER was recorded continuously in 14 patients. Awareness was measured by the ability of the patient to respond to command using the isolated forearm technique (IFT). The Nb latencies were shorter when the patients were able to respond than at loss of response (P<0.001). In six patients who repeated this transition from response to loss of response, there was a high and significant correlation between Nb latencies. None of the patients had any recollection of events after the initial induction of anaesthesia as measured by explicit and implicit memory tests. These results suggest that the Nb latency of the AER may represent an indication of awareness in individual patients, but wide inter-patient variability limits its practical usefulness. In addition, because no evidence of memory was demonstrated, even when patients were known to be awake, the relationship between AER and memory processing remains unclear.

Aged↗
PubMed2003

Detection of awareness in surgical patients with EEG-based indices--bispectral index and patient state index.

BACKGROUND: Patient state index (PSI) and bispectral index (BIS) are values derived from the EEG, which can measure the hypnotic component of anaesthesia. We measured the ability of PSI and BIS to distinguish consciousness from unconsciousness during induction and emergence from anaesthesia and a period of awareness in surgical patients. METHODS: Forty unpremedicated patients were randomized to receive: (1) sevoflurane/remifentanil (< or =0.1 microg kg(-1) min(-1)), (2) sevoflurane/remifentanil (> or = 0.2 microg kg(-1) min(-1)), (3) propofol/remifentanil (< or =0.1 microg kg(-1) min(-1)), (4) propofol/remifentanil (> or = 0.2 microg kg(-1) min(-1)). Every 30 s after the start of the remifentanil, patients were asked to squeeze the investigator's hand. Sevoflurane or propofol were given until loss of consciousness (LOC1). Tunstall's isolated forearm technique was used during neuromuscular block with succinylcholine. After tracheal intubation, propofol or sevoflurane were stopped until return of consciousness (ROC1). Propofol or sevoflurane were re-started to induce LOC2. After surgery, drugs were discontinued and recovery (ROC2) was observed. PSI and BIS at LOC (LOC1 and LOC2) were compared with those at ROC (ROC1 and ROC2) (t-test). Prediction probability (P(k)) was calculated from values at the last command before and at LOC and ROC. Values are mean (SD). RESULTS: At non-responsiveness, BIS (66 (17)) and PSI (55 (23)) were significantly less than at responsiveness (BIS, 79 (14); PSI, 77 (18); P<0.05). The wide variation with both BIS and PSI measurements of the 80 'awareness' values led to an erroneous classification as unconscious in some cases (BIS, six patients; PSI, nine patients). P(k) was 0.68 (0.03) (BIS) and 0.69 (0.03) (PSI). CONCLUSIONS: Despite significant differences between mean values at responsiveness and non-responsiveness for BIS and PSI, neither measure may be sufficient to detect awareness in an individual patient, reflected by a P(k) less than below 70%.

Adult↗
PubMed1991

Temporal dissociation of motor responses and subjective awareness. A study in normal subjects.

The aim of the present study was to examine the timing of different responses given simultaneously to a single event, the sudden displacement of a visual object occurring at the onset of the grasping movement directed at that object. The subjects were requested to correct their movement in order to reach accurately for the object and to signal the time at which they became aware of its displacement by a simple vocal utterance (Tah!). The onset of the motor adjustment was measured using kinematic landmarks obtained from the hand trajectory. Movements executed during trials where the object was displaced had an earlier peak in acceleration (107 ms) than movements executed during control trials (120 ms). By contrast, the vocal signal occurred 420 ms following object displacement, that was more than 300 ms after the onset of the motor correction. Control experiments were performed in order to verify the influence of possible interferences between the two tasks. Motor corrections performed without vocal utterance had the same timing as when the vocal signal was produced. Vocal signals produced in response to object's displacements but in the absence of reaching movements had the same latency as when movements were performed. We conclude from these results that the two responses were generated independently of each other. Assuming that the vocal responses in this experiment did signal the subject's awareness, the observed delay between motor corrections and these responses suggests that neural activity must be processed during a significant and quantifiable amount of time before it can give rise to conscious experience. This dissociation between motor responses and awareness in normal subjects is discussed in the light of clinical cases where overt behaviour and conscious experience are dissociated by cerebral lesions.

Awareness↗