Personal relationships with an intelligent interactive telephone health behavior advisor system: a multimethod study using surveys and ethnographic interviews

The burgeoning of consumer health informatics and virtual health care can help people improve their health. However, little is known about individuals' reactions to such systems. We conducted an evaluation of the telephone-linked care (TLC) system, a computer-based telecommunications system, that functions as an at home monitor, educator, and counselor for patients with chronic health conditions. Our multimethod assessment of individuals' reactions to using TLC included both quantitative and qualitative methods. Ethnographic in-depth open-ended interviews indicated more subtle and surprising reactions to TLC than the overall positive responses from surveys: individuals formed personal relationships with this technology. This relationship formation suggests that TLC designers may have been successful in their attempts to emulate a conversation with a human being. Our study adds to evidence that technology can serve as a projective device for peoples' values and psychological issues. Both designers and users project values and goals onto computer-based technologies and take on different identities through it. Different groups of users, therefore, may see the same technology differently. People also form relationships with technologies, as they did with TLC. These findings, as well as implications for system design and health outcomes, need to be explored in additional studies.     

Use of the iso-inertial force mass relationship in the prediction of dynamic human performance

The purpose of this investigation was to develop a new test of muscle function, termed the isoinertial force-mass relationship, and to determine its relationship to dynamic physical performance in comparison to an isometric test. A group of 13 trained subjects performed an isometric, and a series of iso-inertial maximal upper body tests, in a bench press movement at loads of 30%, 60%, 100% (concentric) and 100%, 130% and 150% (eccentric) of maximum. Vertical forces exerted throughout the movement were recorded by a force plate. In addition, the subjects performed the following three performance tests: a maximal bench press, a seated shotput, and two drop bench-press throws from a height of 0.25 m, with loads of 10 kg and 30% of maximum. Correlation analysis demonstrated that in each instance the iso-inertial force mass tests were the best predictors of performance (r=0.78–0.88) with both contraction type and mass specific effects apparent. Maximal isometric force and rate of force development were significantly related to some performance variables (r=0.22–0.78). However, for all the performance movements assessed, the iso-inertial test modality recorded the highest relationship to performance. The difference in the relationship between performance and iso-inertial and isometric test modalities was particularly evident in the light load dynamic performance of the seated shotput (r=0.86 vsr=0.38, respectively). These results are explained in part by the neural and mechanical differences between iso-inertial and isometric muscle actions and their respective specificity to dynamic physical performance.     

The Distribution of Attention Across Auditory Input Channels: An Assessment Using the Human Evoked Potential

In order to determine the extent to which distraction disrupts performance when attention is divided, the distribution of attention across five auditory input channels was assessed using the N1 component of the human auditory evoked potential. In addition, the possibility that methylphenidate (Ritalin) affects the distribution of attention across input channels was tested. Sixteen subjects performed a tone discrimination task under conditions of focused attention and divided attention, both with and without the presence of stimuli interposed between the points to be attended. The subjects performed in two sessions during which they received either methylphenidate (10 mg) or a placebo in a double-blind design. The results showed that the interposed stimuli were receiving some attention resulting in a disruption of performance. Methylphenidate did not affect the distribution of attention as reflected in the N1 wave. The data are interpreted as showing that: 1) distraction plays a major role in producing performance deficits observed with divided attention; and 2) methylphenidate does not appreciably affect the distribution of attention across input channels.     

CONSISTENCY OF PERFORMANCE CHANGE AND AUTONOMIC RESPONSE AS A FUNCTION OF EXPRESSED ATTITUDE TOWARD A SPECIFIC STRESS SITUATION

A persistent problem in stress research has been that some individuals may show impairment, while others show improvement or no change in performance under stress. Attempts to relate this variance in performance to general anxiety or other personality variables have generally not been too successful. Based upon responses to a fear of shock item in an attitude questionnaire, Ss were classified as “high fear of shock” or “low fear of shock” types. Half of the Ss in each group were assigned a perceptual-motor task; the others were assigned a cognitive-interference task. After training, all Ss were informed that they would be required to maintain their training performance levels in a situation in which they would be shocked if performance declined. Performance and heart rate measures taken during training were compared with the same measures taken under the threat-of-shock conditions. Results indicate significant differences between groups in both performance and physiological activity with “high fear of shock”Ss exhibiting relatively greater performance impairment and increased heart rate.     

Model building on the basis of Dutch cervical cancer screening data

A mass screening programme for cervical cancer is in progress in three pilot regions in The Netherlands. All women living in these regions aged 35-53 are invited to undergo screening at three-year intervals. The MISCAN simulation model was developed for the analysis and optimization of screening programmes. In this paper the model-based approach to evaluation is first outlined and then illustrated by analysing data from the first two screening rounds in the pilot regions. This analysis resulted in a rather restricted range of data-compatible assumptions for the mean duration of preclinical disease (14-19 yr) and the frequency of spontaneous regression of preinvasive lesions (45-65%), as well as a rather wide sensitivity range for the Pap smear (50-90%). These preliminary findings are compared with those of a previous MISCAN analysis of cervical cancer screening in British Columbia. On the basis of an assumed 18-yr duration, 50% regression and 70% sensitivity, a number of screening policies relating to the same age ranges but with different intervals are compared. Both the analysis and the policy comparisons are preliminary, but the findings are nevertheless reasonable and consistent with those of previous studies. A more complete MISCAN-based analysis of the Dutch screening programme and subsequent optimization of screening policies will be possible when further results become available and a cost-effectiveness analysis procedure has been incorporated into the MISCAN programme.     

Influence of vascular parameters on the effectiveness of intra-aortic balloon pumping: A model study

The intra-aortic balloon pump has been widely used as a temporary heart-assist device. In this investigation, a nonlinear mathematical model of the arterial system and intra-aortic balloon pump was studied analytically. Thus, the influences of a number of vascular parameters on the effectiveness of intra-aortic balloon pumping (IABP) were determined. The effects of changes in vascular parameters of the model on a number of performance indexes were investigated. These performance indexes (aortic mean diastolic pressure, aortic end diastolic pressure, cardiac output, coronary flow and phase differences between the fundamental Fourier components of aortic root pressure and flow) were used as the criterion for an evaluation of the effectiveness of the assist pump. The following vascular parameters were perturbed by four steps (±10%, ±20%) from the values in the standard model: heart rate, peripheral resistance, left ventricular pressure, aortic elastance, aortic radius, arterial wall thickness, and aortic length. This model was evaluated for a wide range of balloon-pump phase-control settings (assisted case) and for the unassisted case (when the pump is disabled). It is concluded that changes in heart rate, peripheral resistance and left ventricular pressure cause the most significant changes in pump performance. Dr. Ohley is with the Datascope Corporation Dr. Kao is with the Technicare Corporation     

THE EFFECTS OF CHANGES IN AROUSAL LEVEL ON CRITICAL FLICKER FUSION FREQUENCY AND FIGURAL REVERSAL TASKS

The present study was designed to investigate the relationship between intra-and inter-individual differences in arousal level and performance on both critical flicker fusion frequency and figural reversal tasks. Forty male undergraduate Ss were used. Electrical skin conductance was used as the indicant of arousal level. For the intra-individual comparisons white noise was used to increase the Ss’arousal levels. Significant inverted U-shaped relationships were found between both flicker fusion thresholds and rates of figural reversal and skin conductance between individuals. A significant curvilinear relationship was found between rates of figural reversal and level of conductance within individuals. No significant curvilinear relationship was found between flicker fusion thresholds and level of conductance within individuals.     

无症状性脑梗死患者的心理功能测评

随着高敏度的脑成像技术如ＣＴ、ＭＲＩ在临床的广泛应用 ,发现了许多临床上无明显症状、体征或症状、体征与既往卒中史不相关的梗死灶 ,称之为无症状性脑梗死 (ａｓｙｍｐｔｏｍａｔｉｃｉｎｆａｒｃｔ)或静止性脑梗死(ｓｉｌｅｎｔｃｅｒｅｂｒａｌｉｎｆａｒｃｔｉｏｎ ,ＳＣＩ)。虽然这些病人经传统的神经系统检查未发现明显的异常 ,但有学者认为他们存在明显的认知功能障碍、精细运动障碍及情感障碍等。本文对 38例ＳＣＩ及 30例对照组进行了认知功能、记忆、精细运动、感知觉及情感等方面的评价 ,有利于ＳＣＩ以及血管性痴呆的早期防…     

Long-term ST database: A reference for the development and evaluation of automated ischaemia detectors and for the study of the dynamics of myocardial ischaemia

The long-term ST database is the result of a multinational research effort. The goal was to develop a challenging and realistic research resource for development and evaluation of automated systems to detect transient ST segment changes in electrocardiograms and for supporting basic research into the mechanisms and dynamics of transient myocardial ischaemia. Twenty-four hour ambulatory ECG records were selected from routine clinical practice settings in the USA and Europe, between 1994 and 2000, on the basic of occurrence of ischaemic and non-ischaemic ST segment changes. Human expert annotators used newly developed annotation protocols and a specially developed interactive graphic editor tool (Semia) that supported paperless editing of annotations and facilitated international co-operation via the Internet. The database contains 86 two- and three-channel 24h annotated ambulatory records from 80 patients and is stored on DVD-ROMs. The database annotation files contain ST segment annotations of transient ischaemic (1155) and heart-rate related ST episodes and annotations of non-ischaemic ST segment events related to postural changes and conduction abnormalities. The database is intended to complement the European Society of Cardiology ST-T database and the MIT-BIH and AHA arrhythmia databases. It provides a comprehensive representation of ‘real-world’ data, with numerous examples of transient ischaemic and non-ischaemic ST segment changes, arrhythmias, conduction abnormalities, axis shifts, noise and artifacts.     

The effect of erroneous responses on response monitoring in patients with major depressive disorder: a study with event-related potentials

Perceived failure is reported to have detrimental effects on subsequent performance in patients with major depressive disorder. We investigated the error-related negativity (ERN)/error negativity (Ne), an electrophysiological correlate of response monitoring, using a 64-channel EEG. Sixteen patients with DSM-IV major depressive disorder and 16 matched controls participated in an Eriksen flanker task with continuous performance feedback that signaled monetary reward. Compared to controls, patients with major depressive disorder showed a less negative ERN/Ne in error trials following error trials. This result might reflect impaired response monitoring processes in major depressive disorder resulting from an underactivity in a central reward pathway and/or a deficit in strategic reasoning.