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Electroencephalography (EEG) is a method for recording electrical activity, indicative of cortical brain activity from the scalp. EEG has been used to diagnose neurological diseases and to characterize impaired cognitive states. When the electrical activity of neurons are temporally synchronized, the likelihood to reach their threshold potential for the signal to propagate to the next neuron, increases. This phenomenon is typically analyzed as the spectral intensity increasing from the summation of these neurons firing. Non-linear analysis methods (e.g., entropy) have been explored to characterize neuronal firings, but only analyze temporal information and not the frequency spectrum. By examining temporal and spectral entropic relationships simultaneously, we can better characterize how neurons are isolated, (the signal’s inability to propagate to adjacent neurons), an indicator of impairment. A novel time-frequency entropic analysis method, referred to as Activation Complexity (AC), was designed to quantify these dynamics from key EEG frequency bands. The data was collected during a cognitive impairment study at NASA Langley Research Center, involving hypoxia induction in 49 human test subjects. AC demonstrated significant changes in EEG firing patterns characterize within explanatory (p < 0.05) and predictive models (10% increase in accuracy). The proposed work sets the methodological foundation for quantifying neuronal isolation and introduces new potential technique to understand human cognitive impairment for a range of neurological diseases and insults.

ObjectivesIn Europe, there is a distinction between two different healthcare organisation systems, the tax-based healthcare system (THS) and the social health insurance system (SHI). Our aim was to investigate whether the characteristics, treatment and mortality of older, critically ill patients in the intensive care unit (ICU) differed between THS and SHI.SettingICUs in 16 European countries.ParticipantsIn total, 7817 critically ill older (≥80 years) patients were included in this study, 4941 in THS and 2876 in the SHI systems.Primary and secondary outcomes measuresWe chose generalised estimation equations with robust standard errors to produce population average adjusted OR (aOR). We adjusted for patient-specific variables, health economic data, including gross domestic product (GDP) and human development index (HDI), and treatment strategies.ResultsIn SHI systems, there were higher rates of frail patients (Clinical Frailty Scale>4; 46% vs 41%; p<0.001), longer length of ICU stays (90±162 vs 72±134 hours; p<0.001) and increased levels of organ support. The ICU mortality (aOR 1.50, 95% CI 1.09 to 2.06; p=0.01) was consistently higher in the SHI; however, the 30-day mortality (aOR 0.89, 95% CI 0.66 to 1.21; p=0.47) was similar between THS and SHI. In a sensitivity analysis stratifying for the health economic data, the 30-day mortality was higher in SHI, in low GDP per capita (aOR 2.17, 95% CI 1.42 to 3.58) and low HDI (aOR 1.22, 95% CI 1.64 to 2.20) settings.ConclusionsThe 30-day mortality was similar in both systems. Patients in SHI were older, sicker and frailer at baseline, which could be interpreted as a sign for a more liberal admission policy in SHI. We believe that the observed trend towards ICU excess mortality in SHI results mainly from a more liberal admission policy and an increase in treatment limitations.Trial registration numbers NCT03134807 and NCT03370692.

The present study examined the effects of an electroencephalographic- (EEG-) based system for adaptive automation on tracking performance and workload. In addition, event-related potentials (ERPs) to a secondary task were derived to determine whether they would provide an additional degree of workload specificity. Participants were run in an adaptive automation condition, in which the system switched between manual and automatic task modes based on the value of each individual's own EEG engagement index; a yoked control condition; or another control group, in which task mode switches followed a random pattern. Adaptive automation improved performance and resulted in lower levels of workload. Further, the P300 component of the ERP paralleled the sensitivity to task demands of the performance and subjective measures across conditions. These results indicate that it is possible to improve performance with a psychophysiological adaptive automation system and that ERPs may provide an alternative means for distinguishing among levels of cognitive task demand in such systems. Actual or potential applications of this research include improved methods for assessing operator workload and performance.

Today most people die gradually, from incremental illnesses, rather than from the heart attacks or fast-moving diseases that killed earlier generations. Given this new reality, the essays inFinal Actsexplore how we can make informed and caring end-of-life choices for ourselves and for those we loveùand what can happen without such planning. Contributors include patients, caretakers, physicians, journalists, lawyers, social workers, educators, hospital administrators, academics, psychologists, and a poet, and among them are ethicists, religious believers, and nonbelievers. Some write moving, personal accounts of \"good\" or 'bad\" deaths; others examine the ethical, social, and political implications of slow dying. Essays consider death from natural causes, suicide, and aid-in-dying (assisted suicide). Writing in a style free of technical jargon, the contributors discuss documents that should be prepared (health proxy, do-not-resuscitate order, living will, power of attorney); decision-making (over medical interventions, life support, hospice and palliative care, aid-in-dying, treatment location, speaking for those who can no longer express their will); and the roles played by religion, custom, family, friends, caretakers, money, the medical establishment, and the government. For those who yearn for some measure of control over death, the essayists inFinal Acts,from very different backgrounds and with different personal and professional experiences around death and dying, offer insight and hope.

PurposeThis paper is concerned with behavioural responses to reviewed ground rents in New Zealand. The focus is on how freehold growth information is interpreted when considering reviewed ground rents on ground leasehold value.Design/methodology/approachSemi-structured interviews were conducted with ground leaseholders to inform the design of a controlled experiment. The interviews revealed that (a) purchasers tended to directly compare freeholds to ground leaseholds and (b) used rudimentary valuation methods. In the experiment, 40 property investors were requested to estimate the ground leasehold value close to the ground rent review time. Thereafter, 20 of the investors reassessed their ground leasehold value estimate using a projection of the future ground rent and a statement as to freehold growth (treatment). The control group of the remaining 20 investors received the estimate of the future ground rent only.FindingsThe tendency for higher treatment group valuations indicated the growth information was too available. Comparing ground leaseholds directly to freeholds, rather than thinking about the cost implications, is attributed to a manifestation of the availability heuristic.Research limitations/implicationsThe study involves a typical ground lease arrangement (as verified by experts) in the New Zealand market where there are few protections for ground leaseholders. These findings justify prohibiting new ground leases where the ground rents are set by reference to freehold land value.Originality/valueThis paper extends behavioural theory (availability heuristic) to explaining human interaction with ground leaseholds.

PurposeTo document and analyse the decision to withhold or withdraw life-sustaining treatment (LST) in a population of very old patients admitted to the ICU.MethodsThis prospective study included intensive care patients aged ≥ 80 years in 309 ICUs from 21 European countries with 30-day mortality follow-up.ResultsLST limitation was identified in 1356/5021 (27.2%) of patients: 15% had a withholding decision and 12.2% a withdrawal decision (including those with a previous withholding decision). Patients with LST limitation were older, more frail, more severely ill and less frequently electively admitted. Patients with withdrawal of LST were more frequently male and had a longer ICU length of stay. The ICU and 30-day mortality were, respectively, 29.1 and 53.1% in the withholding group and 82.2% and 93.1% in the withdrawal group. LST was less frequently limited in eastern and southern European countries than in northern Europe. The patient-independent factors associated with LST limitation were: acute ICU admission (OR 5.77, 95% CI 4.32–7.7), Clinical Frailty Scale (CFS) score (OR 2.08, 95% CI 1.78–2.42), increased age (each 5 years of increase in age had a OR of 1.22 (95% CI 1.12–1.34) and SOFA score [OR of 1.07 (95% CI 1.05–1.09 per point)]. The frequency of LST limitation was higher in countries with high GDP and was lower in religious countries.ConclusionsThe most important patient variables associated with the instigation of LST limitation were acute admission, frailty, age, admission SOFA score and country.Trial registrationClinicalTrials.gov (ID: NTC03134807).

The shifting emphasis in higher education toward STEM disciplines and vocational training may diminish opportunity for students to develop self-awareness as an integral dimension of critical thinking. In addition, contemporary texts on critical thinking accord little emphasis to the role of self-awareness, placing it, at best, on a par with inductive and deductive reasoning. By contrast, this article seeks to illustrate the central role self-awareness plays in reading texts with depth and precision. Based on our observation of common student reading errors made in both history and psychology classrooms, we have developed a simple, easily applied, and effective method called “three-level understanding” that we use to correct these errors by training students to read and think with critical awareness. This article explains this principle of three-level understanding and demonstrates its application through use of “circle diagrams.” In addition, we demonstrate that this same method can be used to facilitate effective and in-depth classroom discussion. We argue that the cultivation of self-awareness through the teaching of three-level understanding not only benefits students academically, but also provides them with tools needed to relate effectively with themselves, others, and the larger, complicated, 21st-century world.

The major airlines in the United States have not had a loss of life accident involving a jet airliner since 2001. The number of fatal accidents involving turbo-prop aircraft in the U.S. has drastically decreased over the same period with only two accidents in the last decade. Most of the credit for this exceptional safety record is given to increased automation in aviation and improved training by the aviation industry. These excellent U.S. safety records, while impressive, do not take into consideration accidents which happen outside of the United States and the causal factors identified during accident investigations. While automation is a technology that supports safety, it has also been identified as inducing human error, a factor which is increasingly cited as contributing to aviation accidents. With this in mind, it is incumbent upon designers of aircraft systems and human factors engineers to continue to identify human/machine interface issues in existing, novel, and yet-to-be developed technology that air crew interact with during flight. This poster presentation will describe the interaction which can occur when operators of complex systems become disengaged from safety critical monitoring while experiencing mental states of inattention, complacency, boredom. Previous research (Pope and Bogart 1992), and a description of experimental applications of psychophysiological measures of operators and real-time adaptive automation (AA, Pope, Bogart, and Bartolome 1995) will be presented. The psychophysiological and subjective results of an open-loop, pre-scripted system in which the level of automation of the NASA Multi-Attribute Task Battery is modulated will be reported. The implications of the results of this investigation for closed-loop adaptive automation research, specifically the use of dynamic function allocation in AA, will be discussed. The design of a psychophysiologically modulated automation system to maintain effective operator state will be described. The implications of these results for critical system characteristics (e.g., operator state indices, methods for invoking changes among system states, individual differences among users, etc.) that have previously been studied or which require further examination will be explained. Extension of this fundamental research to adaptive automation in realworld flight deck designs will be presented and discussed.

The major airlines in the United States have not had a loss of life accident involving a jet airliner since 2001. The number of fatal accidents involving turbo-prop aircraft in the US has drastically decreased over the same period with only two accidents in the last decade. Most of the credit for this exceptional safety record is given to increased automation in aviation and improved training by the aviation industry. These excellent US safety records while impressive do not permit ignoring accidents which happen outside of the United States and the causal factors identified during accident investigations. While automation is a technology which supports safety, it has also been identified as inducing human error, a factor which is increasingly cited as contributing to aviation accidents. With this in mind it is incumbent upon designers of aircraft systems and human factors engineers to continue to identify human/machine interface issues in existing, novel, and yet-to-be developed technology that air crew interact with during flight. This presentation will describe the dangerous interaction which can occur when operators of complex systems become disengaged from safety critical monitoring, including mental states of inattention, complacency, boredom. Evidence from previous research and a description of experimental applications of psychophysiological measures of operators and real-time adaptive automation will be presented. Specifically, the empirical results of an investigation of a contemporary Psychophysiologically Adaptive System (PAS) in which the level of automation of the NASA Multi-Attribute Task Battery is modulated by engagement indices derived from the users' electroencephalogram will be discussed. Future theoretical and methodological directions for this type of closed-loop research will be discussed. Specifically, the capacity for this type of PAS to maintain effective operator state and to enable validation of candidate physiological indices will be described. Consideration will also be given to critical system characteristics (e.g., engagement indices, methods for invoking changes among system states, individual differences among users, etc.) that have been studied or require further examination. Extension of this fundamental research to adaptive automation in real-world flight deck designs will be presented and discussed.