Revisiting the maintenance of wakefulness test: from intra-/inter-scorer agreement to normative values in patients treated for obstructive sleep apnea

The Maintenance of Wakefulness Test is widely used to objectively assess sleepiness and make safety-related decisions, but its interpretation is subjective and normative values remain debated. Our work aimed to determine normative thresholds in non-subjectively sleepy patients with well-treated obstructive sleep apnea, and to assess intra- and inter-scorer variability. We included maintenance of wakefulness tests of 141 consecutive patients with treated obstructive sleep apnea (90% men, mean (SD) age 47.5 (9.2) years, mean (SD) pre-treatment apnea-hypopnea index of 43.8 (20.3) events/h). Sleep onset latencies were independently scored by two experts. Discordant scorings were reviewed to reach a consensus and half of the cohort was double-scored by each scorer. Intra- and inter-scorer variability was assessed using Cohen's kappa for 40, 33, and 19 min mean sleep latency thresholds. Consensual mean sleep latencies were compared between four groups according to subjective sleepiness (Epworth Sleepiness Scale score < versus ≥11) and residual apnea-hypopnea index (< versus ≥15 events/h). In well-treated non-sleepy patients (n = 76), the consensual mean (SD) sleep latency was 38.4 (4.2) min (lower normal limit [mean - 2SD] = 30 min), and 80% of them did not fall asleep. Intra-scorer agreement on mean sleep latency was high but inter-scorer was only fair (Cohen's kappa 0.54 for 33-min threshold, 0.27 for 19-min threshold), resulting in changes in latency category in 4%-12% of patients. A higher sleepiness score but not the residual apnea-hypopnea index was significantly associated with a lower mean sleep latency. Our findings suggest a higher than usually accepted normative threshold (30 min) in this context and emphasise the need for more reproducible scoring approaches.

Basal forebrain parvalbumin neurons modulate vigilant attention and rescue deficits produced by sleep deprivation

Attention is impaired in many neuropsychiatric disorders, as well as by sleep disruption, leading to decreased workplace productivity and increased risk of accidents. Thus, understanding the neural substrates is important. Here we test the hypothesis that basal forebrain neurons that contain the calcium-binding protein parvalbumin modulate vigilant attention in mice. Furthermore, we test whether increasing the activity of basal forebrain parvalbumin neurons can rescue the deleterious effects of sleep deprivation on vigilance. A lever release version of the rodent psychomotor vigilance test was used to assess vigilant attention. Brief and continuous low-power optogenetic excitation (1 s, 473 nm @ 5 mW) or inhibition (1 s, 530 nm @ 10 mW) of basal forebrain parvalbumin neurons was used to test the effect on attention, as measured by reaction time, under control conditions and following 8 hr of sleep deprivation by gentle handling. Optogenetic excitation of basal forebrain parvalbumin neurons that preceded the cue light signal by 0.5 s improved vigilant attention as indicated by quicker reaction times. By contrast, both sleep deprivation and optogenetic inhibition slowed reaction times. Importantly, basal forebrain parvalbumin excitation rescued the reaction time deficits in sleep-deprived mice. Control experiments using a progressive ratio operant task confirmed that optogenetic manipulation of basal forebrain parvalbumin neurons did not alter motivation. These findings reveal for the first time a role for basal forebrain parvalbumin neurons in attention, and show that increasing their activity can compensate for disruptive effects of sleep deprivation.

Detection of atypical attentional behaviors in young subjects

BACKGROUND

Vigilance ability refers to the accuracy and speed with which a person performs a cognitive-motor task, either voluntarily (endogenous mode) or following a warning stimulus (exogenous mode). In the context of a force production task, our study focuses on the impact of the states of vigilance by proposing an original approach that allows distinguishing between good (inlier) and poor (outlier) participants. We assume that the use of an external signal and duration of the temporal preparation (foreperiod) increase the speed and the precision of motor responses. Our objective is particularly challenging in the context of a limited dataset with a high level of noise.

NEW METHOD

Our original methodological approach consists of coupling the RANSAC (RANdom SAmple Consensus) algorithm with a statistical machine learning algorithm to handle noise.

COMPARISON WITH EXISTING METHODS

Our clustering approach, based on the coupling of RANSAC methodology with ensemble classifiers, overcomes the limitations of conventional supervised algorithms that are either not robust to outliers (such as K-Nearest Neighbors) and/or not adapted to few-shot learning (such as Support Vector Machines and Artificial Neural Networks).

RESULTS

The clustering results were validated in terms of reaction time distributions and force error distributions with respect to participant groups. We show that the use of an external signal and duration of the temporal preparation (foreperiod) increase the speed and the precision of motor responses.

CONCLUSION

Our study has allowed us to detect atypical attentional patterns and succeeds in separating the inliers from the outliers.

Edge-Based General Linear Models Capture Moment-to-Moment Fluctuations in Attention

Although we must prioritize the processing of task-relevant information to navigate life, our ability to do so fluctuates across time. Previous work has identified fMRI functional connectivity (FC) networks that predict an individual's ability to sustain attention and vary with attentional state from 1 min to the next. However, traditional dynamic FC approaches typically lack the temporal precision to capture moment-to-moment network fluctuations. Recently, researchers have "unfurled" traditional FC matrices in "edge cofluctuation time series" which measure timepoint-by-timepoint cofluctuations between regions. Here we apply event-based and parametric fMRI analyses to edge time series to capture moment-to-moment fluctuations in networks related to attention. In two independent fMRI datasets examining young adults of both sexes in which participants performed a sustained attention task, we identified a reliable set of edges that rapidly deflects in response to rare task events. Another set of edges varies with continuous fluctuations in attention and overlaps with a previously defined set of edges associated with individual differences in sustained attention. Demonstrating that edge-based analyses are not simply redundant with traditional regions-of-interest-based approaches, up to one-third of reliably deflected edges were not predicted from univariate activity patterns alone. These results reveal the large potential in combining traditional fMRI analyses with edge time series to identify rapid reconfigurations in networks across the brain.

The effect of sleep restriction, with or without high-intensity interval exercise, on behavioural alertness and mood state in young healthy males

Mood state and alertness are negatively affected by sleep loss, and can be positively influenced by exercise. However, the potential mitigating effects of exercise on sleep-loss-induced changes in mood state and alertness have not been studied comprehensively. Twenty-four healthy young males were matched into one of three, 5-night sleep interventions: normal sleep (NS; total sleep time (TST) per night = 449 ± 22 min), sleep restriction (SR; TST = 230 ± 5 min), or sleep restriction and exercise (SR + EX; TST = 235 ± 5 min, plus three sessions of high-intensity interval exercise (HIIE)). Mood state was assessed using the profile of mood states (POMS) and a daily well-being questionnaire. Alertness was assessed using psychomotor vigilance testing (PVT). Following the intervention, POMS total mood disturbance scores significantly increased for both the SR and SR + EX groups, and were greater than the NS group (SR vs NS; 31.0 ± 10.7 A.U., [4.4-57.7 A.U.], p = 0.020; SR + EX vs NS; 38.6 ± 14.9 A.U., [11.1-66.1 A.U.], p = 0.004). The PVT reaction times increased in the SR (p = 0.049) and SR + EX groups (p = 0.033) and the daily well-being questionnaire revealed increased levels of fatigue in both groups (SR; p = 0.041, SR + EX; p = 0.026) during the intervention. Despite previously demonstrated physiological benefits of performing three sessions of HIIE during five nights of sleep restriction, the detriments to mood, wellness, and alertness were not mitigated by exercise in this study. Whether alternatively timed exercise sessions or other exercise protocols could promote more positive outcomes on these factors during sleep restriction requires further research.

Vigilance to Spatialized Auditory Displays: Initial Assessment of Performance and Workload

OBJECTIVE

The present study was designed to evaluate human performance and workload associated with an auditory vigilance task that required spatial discrimination of auditory stimuli.

BACKGROUND

Spatial auditory displays have been increasingly developed and implemented into settings that require vigilance toward auditory spatial discrimination and localization (e.g., collision avoidance warnings). Research has yet to determine whether a vigilance decrement could impede performance in such applications.

METHOD

Participants completed a 40-minute auditory vigilance task in either a spatial discrimination condition or a temporal discrimination condition. In the spatial discrimination condition, participants differentiated sounds based on differences in spatial location. In the temporal discrimination condition, participants differentiated sounds based on differences in stimulus duration.

RESULTS

Correct detections and false alarms declined during the vigilance task, and each did so at a similar rate in both conditions. The overall level of correct detections did not differ significantly between conditions, but false alarms occurred more frequently within the spatial discrimination condition than in the temporal discrimination condition. NASA-TLX ratings and pupil diameter measurements indicated no differences in workload.

CONCLUSION

Results indicated that tasks requiring auditory spatial discrimination can induce a vigilance decrement; and they may result in inferior vigilance performance, compared to tasks requiring discrimination of auditory duration.

APPLICATION

Vigilance decrements may impede performance and safety in settings that depend on sustained attention to spatial auditory displays. Display designers should also be aware that auditory displays that require users to discriminate differences in spatial location may result in poorer discrimination performance than non-spatial displays.

Increased Flow Limitation During Sleep Is Associated With Increased Psychomotor Vigilance Task Lapses in Individuals With Suspected OSA

BACKGROUND

Impaired daytime vigilance is an important consequence of OSA, but several studies have reported no association between objective measurements of vigilance and the apnea-hypopnea index (AHI). Notably, the AHI does not quantify the degree of flow limitation, that is, the extent to which ventilation fails to meet intended ventilation (ventilatory drive).

RESEARCH QUESTION

Is flow limitation during sleep associated with daytime vigilance in OSA?

STUDY DESIGN AND METHODS

Nine hundred ninety-eight participants with suspected OSA completed a 10-min psychomotor vigilance task (PVT) before same-night in-laboratory polysomnography. Flow limitation frequency (percent of flow-limited breaths) during sleep was quantified using airflow shapes (eg, fluttering and scooping) from nasal pressure airflow. Multivariable regression assessed the association between flow limitation frequency and the number of lapses (response times > 500 ms, primary outcome), adjusting for age, sex, BMI, total sleep time, depression, and smoking status.

RESULTS

Increased flow limitation frequency was associated with decreased vigilance: a 1-SD (35.3%) increase was associated with 2.1 additional PVT lapses (95% CI, 0.7-3.7; P = .003). This magnitude was similar to that for age, where a 1-SD increase (13.5 years) was associated with 1.9 additional lapses. Results were similar after adjusting for AHI, hypoxemia severity, and arousal severity. The AHI was not associated with PVT lapses (P = .20). In secondary exploratory analysis, flow limitation frequency was associated with mean response speed (P = .012), median response time (P = .029), fastest 10% response time (P = .041), slowest 10% response time (P = .018), and slowest 10% response speed (P = .005).

INTERPRETATION

Increased flow limitation during sleep was associated with decreased daytime vigilance in individuals with suspected OSA, independent of the AHI. Flow limitation may complement standard clinical metrics in identifying individuals whose vigilance impairment most likely is explained by OSA.

The Efficacy of a Multimodal Bedroom-Based 'Smart' Alarm System on Mitigating the Effects of Sleep Inertia

Previous work has demonstrated the modest impact of environmental interventions that manipulate lighting, sound, or temperature on sleep inertia symptoms. The current study sought to expand on previous work and measure the impact of a multimodal intervention that collectively manipulated light, sound, and ambient temperature on sleep inertia. Participants slept in the lab for four nights and were awoken each morning by either a traditional alarm clock or the multimodal intervention. Feelings of sleep inertia were measured each morning through Psychomotor Vigilance Test (PVT) assessments and ratings of sleepiness and mood at five time-points. While there was little overall impact of the intervention, the participant's chronotype and the length of the lighting exposure on intervention mornings both influenced sleep inertia symptoms. Moderate evening types who received a shorter lighting exposure (≤15 min) demonstrated more lapses relative to the control condition, whereas intermediate types exhibited a better response speed and fewer lapses. Conversely, moderate evening types who experienced a longer light exposure (>15 min) during the intervention exhibited fewer false alarms over time. The results suggest that the length of the environmental intervention may play a role in mitigating feelings of sleep inertia, particularly for groups who might exhibit stronger feelings of sleep inertia, including evening types.

In the heat of the moment: the effects of extreme temperatures on the cognitive functioning of firefighters

Exposure to high temperatures can have detrimental effects on cognitive processing and this is concerning for firefighters who routinely work in extreme temperatures. Whilst past research has studied the effects of heat on firefighter cognition, findings are mixed, and no work has measured the time course of cognitive recovery. This study compared working memory, vigilance, and cognitive flexibility of 37 firefighters before and after they engaged in a live-fire training exercise with temperatures exceeding 115 °C. To assess recovery, cognition was measured on exiting the fire, then 20- and 40-minutes post-fire. Results showed impaired vigilance and cognitive flexibility (increased errors, slower responses) immediately after the fire, but recovery at 20-minutes. These findings indicate that a live indoor fire negatively impacts cognitive processing, but this effect is relatively short-lived and return to baseline functioning is seen 20-minutes after exiting the fire. The findings could be used to inform re-entry and cooling decisions.

Recovery of Cognitive Performance Following Multi-Stressor Military Training

OBJECTIVE

This project aimed to assess the impact of an 8-day military training exercise on cognitive performance, and track its recovery in periods of reduced training load and partially restored sleep.

BACKGROUND

Military personnel often work in challenging multi-stressor environments, where sleep loss is inevitable. Sleep loss can impair multiple cognitive domains, which can have disastrous consequences in military contexts.

METHOD

A total of 57 male and female soldiers undergoing the Australian Army combat engineer Initial Employment Training course were recruited and tracked over a 16-day study period which included an 8-day field-based military training exercise. Cognitive performance was assessed via a computerised battery at seven time points across four sequential study periods; 1) baseline (PRE), 2) military field training exercise which included total sleep deprivation (EX-FIELD), 3) training exercise at simulated base with restricted sleep opportunities (EX-BASE), and 4) a 3-day recovery period (REC). Subjective load, fatigue, and sleep were evaluated continuously via questionnaire and actigraphy.

RESULTS

Psychomotor speed, reaction time, visual tracking and vigilance were impaired following the EX-FIELD period (p < 0.05). The majority of affected measures recovered 2 days following EX-FIELD, being no different in EX-BASE compared to PRE.

CONCLUSION

The sensitivity of the cognitive tests to sleep restriction, and recovery, indicates they can help assess operational readiness in military personnel. Future studies should explore other indicators of, and strategies to preserve, operational readiness in military personnel.

APPLICATION

This study highlights the impact of work-induced fatigue on cognitive performance, and would interest authorities seeking to preserve operational readiness.

Modality Changes in Vigilance Displays: Further Evidence of Supramodal Resource Depletion in Vigilance

OBJECTIVE

This study was designed to evaluate the effects of a modality change on vigilance performance to determine whether depletion of modality-specific resources contributes to the vigilance decrement.

BACKGROUND

Resource theory accounts for the vigilance decrement by arguing that the demands of vigilance deplete limited information processing resources. Research indicates that both supramodal and modality-specific resources are involved in vigilance, but it is unclear whether the vigilance decrement is due to depletion of supramodal resources, modality-specific resources, or both. If depletion of modality-specific resources contributes to the decrement, changing the modality of a vigilance display should improve vigilance performance after a decrement.

METHOD

Participants completed a 50-min vigilance task beginning in either the visual modality or the auditory modality. After 40-min, half of the participants experienced a sudden transition to the other modality; the remaining participants did not experience a modality change.

RESULTS

Performance declined over time and was generally superior in the auditory modality. Changing modality from visual to auditory increased correct detections, whereas changing from auditory to visual decreased correct detections. Both types of modality change were associated with an increase in false alarms, and neither had an effect on workload or stress.

CONCLUSION

Supramodal resource depletion, rather than modality-specific resource depletion, is the most likely explanation for the vigilance decrement that can be derived from resource theory.

APPLICATION

Modality changes are not likely to counteract the vigilance decrement and may actually increase false alarm errors. Countermeasure development should involve identification of depleted supramodal resources.

Effects of a simulated maritime shift schedule on vigilance, sleep, and sleepiness

Shift work is associated with circadian misalignment, which causes sleep loss, impairs performance, and increases the risk of accidents. Shorter, more frequently shifting watch schedules, widely used in industries such as maritime operation, defense, and mining, may mitigate these risks by reducing shift length and providing sleep opportunities for all workers across the biological night. However, the effects of frequently shifting work on sleep and performance still need to be clarified. The current study investigated the vigilance, sleepiness, and sleep patterns of fifteen participants who lived in a controlled and confined laboratory that mimicked a maritime environment for 14 d following a simulating frequent shift schedule. The results of psychomotor vigilance tasks (PVT) suggest that this shift schedule may lead to an accumulation of vigilance detrimental across watch days, with both reaction speed impairment and error growth. Furthermore, the circadian phase significantly affects PVT performance, with the afternoon shift section showing relatively better performance. Overall, more working hours per day resulted in poorer PVT performance. As the shift progressed, total sleep duration reduced slightly, and wake after sleep onset (WASO) increased. Sleep during the biological night was generally longer than sleep in the daytime. Less on-watch time was linked to longer overall sleep duration. Additionally, although the subjective sleepiness obtained by the Karolinska Sleepiness Scale (KSS) varied insignificantly across days, the KSS score was negatively correlated with PVT performance. This research can serve as a foundation for developing countermeasures to mitigate frequently shifting schedules' potentially detrimental effects and safety risks.

Driver Vigilance Decrement is More Severe During Automated Driving than Manual Driving

OBJECTIVE

The present study compared the performance, workload, and stress associated with driver vigilance in two types of vehicle: a traditional, manually operated vehicle, and a partially automated vehicle.

BACKGROUND

Drivers of partially automated vehicles must monitor for hazards that constitute automation failures and the need for human intervention, but recent research indicates that a driver's ability to do so declines as a function of time. That research lacked a comparison measure of driving without vehicle automation, so it is unknown to what degree these effects are specific symptoms of monitoring the roadway during an automated drive. Drivers in manual control of their vehicle must similarly monitor for hazards and may suffer similar vigilance decrements.

METHOD

Participants completed a simulated 40-minute drive while monitoring for hazards. Half of participants completed the drive with an automated driving system that maintained speed and lane position; the remaining half manually controlled the vehicle's speed and lane position.

RESULTS

Driver sensitivity to hazards decreased and tendency to make false alarms increased over time in the automated control condition, but not in the manual control condition. Drivers in both conditions detected fewer hazards as the drive progressed. Ratings of workload and task-induced stress were elevated similarly in both conditions.

CONCLUSION

Partially automated driving appears to uniquely impair driver vigilance by reducing the ability to discriminate between benign and dangerous events in the driving environment as the drive progresses.

APPLICATION

Applied interventions should target improvements in driver sensitivity to hazardous situations that signal potential automation failures.

Adopting Stimulus Detection Tasks for Cognitive Workload Assessment: Some Considerations

OBJECTIVE

This article tackles the issue of correct data interpretation when using stimulus detection tasks for determining the operator's workload.

BACKGROUND

Stimulus detection tasks are a relative simple and inexpensive means of measuring the operator's state. While stimulus detection tasks may be better geared to measure conditions of high workload, adopting this approach for the assessment of low workload may be more problematic.

METHOD

This mini-review details the use of common stimulus detection tasks and their contributions to the Human Factors practice. It also borrows from the conceptual framework of the inverted-U shape model to discuss the issue of data interpretation.

RESULTS

The evidence being discussed here highlights a clear limitation of stimulus detection task paradigms.

CONCLUSION

There is an inherent risk in using a unidimensional tool like stimulus detection tasks as the primary source of information for determining the operator's psychophysiological state.

APPLICATION

Two recommendations are put forward to Human Factors researchers and practitioners dealing with the interpretation conundrum of dealing with stimulus detection tasks.

Do extreme temperatures affect cognition? A short review of the impact of acute heat stress on cognitive performance of firefighters

Research shows that exposure to high environmental temperatures can affect task performance. Theoretical explanations outline that heat is a source of stress that competes for limited-capacity resources, therefore if a task is resource-intensive, and/or if heat stress is extreme, performance will suffer. One occupation in which individuals complete demanding tasks and make difficult decisions, often in temperatures exceeding 200°C, is firefighting. Yet very little is currently known about the impact of heat stress on the cognitive functioning of firefighters. This short review summarizes the limited research in this area, focusing on studies that measured cognition of firefighters following a realistic training exercise. The findings are mixed with evidence that heat stress improves, impairs, and has no impact on cognitive functioning. While there are differences in the firefighting activities utilized, and the temperatures that participants were exposed to, it is argued that the varied findings can be attributed to the tasks used to assess cognitive processing, and the cognitive functions being measured. In accordance with the wider field of research, it is concluded that complex functioning, such as sustained attention, vigilance, and working memory is negatively impacted by acute exposure to extreme heat. Greater understanding of factors affecting cognition would inform safety practices and more research is needed to understand how and when heat stress may influence cognition in firefighting scenarios.

Temperament Behaviours in Individually Tested Sheep Are Not Related to Behaviours Expressed in the Presence of Conspecifics

Individual behavioural testing in sheep is common; however, outcomes may be misleading as they are a highly gregarious species that is usually managed in groups. We investigated whether behaviour expressed by 3-4-month-old Merino lambs (n = 220) in social isolation was related to their behaviour towards the same stimuli when three other conspecifics were present, and if measures of temperament (vocalisations and locomotory behaviours) were repeatable across both social situations. Expression of all behaviours were reduced when conspecifics were present, and vocalisations were rarely performed in social groups, suggesting that this behaviour is a response to social isolation. Similarities across the two social situations, in ranked order of how individual lambs expressed each behaviour, indicate that vigilance and attentional orienting towards a human were repeatable (p < 0.001), as was vigilance in a startle test (p < 0.05). However, no clear relationship between behaviours expressed across the two social situations was found. The results of this study suggest that testing sheep individually should be conducted with caution where the outcome is applied to animals managed in groups. Vigilance shows promise as a measure of an underlying trait that is stable across social contexts.

Noise intensity modulates the responses of mantled howler monkeys to anthropophony

Anthropogenic noise is a major global pollutant but its effects on primates are poorly understood, limiting our ability to develop mitigation actions that favor their welfare and conservation. In this study, we used an experimental approach to determine the impact of variation in noise intensity on mantled howler monkeys (Alouatta palliata). We conducted the study at Los Tuxtlas (México), where we studied the physiological stress (proxied via fecal glucocorticoid metabolites, fGCM) and behavioral responses of 16 males. We played back chainsaw noise at two intensities (40 and 80 dB) and used days in which groups were not exposed to noise as matched controls. With increased noise intensity fGCM increased, vigilance and vocalizations were longer, and vigilance, vocalizations, and flight occurred quicker. Physiological and behavioral responses occurred even after low-intensity noise playbacks (i.e., 40 dB). Therefore, noise intensity is a significant factor explaining the responses of mantled howler monkeys to anthropogenic noise. These results imply that management actions aimed at eradicating anthropogenic noise are required for the conservation and welfare of mantled howler monkeys at Los Tuxtlas.

Resting-State fMRI Study of Vigilance Under Circadian and Homeostatic Modulation Based on Fractional Amplitude of Low-Frequency Fluctuation and Regional Homogeneity in Humans Under Normal Entrained Conditions

BACKGROUND

How brain neural activity changes at multiple time points throughout the day and the neural mechanisms underlying time-dependent modulation of vigilance are less clear.

PURPOSE

To explore the effect of circadian rhythms and homeostasis on brain neural activity and the potential neural basis of time-dependent modulation of vigilance.

STUDY TYPE

Prospective.

SUBJECTS

A total of 30 healthy participants (22-27 years old).

FIELD STRENGTH/SEQUENCE

A 3.0 T, T1-weighted imaging, echo-planar functional MRI (fMRI).

ASSESSMENT

Six resting-state fMRI (rs-fMRI) scanning sessions were performed at fixed times (9:00 h, 13:00 h, 17:00 h, 21:00 h, 1:00 h, and 5:00 h) to investigate fractional amplitude of low-frequency fluctuation (fALFF) and regional homogeneity (ReHo) diurnal variation. The fALFF/ReHo and the result of the psychomotor vigilance task were used to assess local neural activity and vigilance.

STATISTICAL TESTS

One-way repeated measures analysis of variance (ANOVA) was used to assess changes in vigilance (P < 0.05) and neural activity in the whole brain (P < 0.001 at the voxel level and P < 0.01 at the cluster level, Gaussian random field [GRF] corrected). Correlation analysis was used to examine the relationship between neural activity and vigilance at all-time points of the day.

RESULTS

The fALFF/ReHo in the thalamus and some perceptual cortices tended to increase from 9:00 h to 13:00 h and from 21:00 h to 5:00 h, whereas the key nodes of the default mode network (DMN) tended to decrease from 21:00 h to 5:00 h. The vigilance tended to decrease from 21:00 h to 5:00 h. The fALFF/ReHo in the thalamus and some perceptual cortices was negatively correlated with vigilance at all-time points of the day, whereas the fALFF/ReHo in the key nodes of the DMN was positively correlated with vigilance.

DATA CONCLUSION

Neural activities in the thalamus and some perceptual cortices show similar trends throughout the day, whereas the key nodes of the DMN show roughly opposite trends. Notably, diurnal variation of the neural activity in these brain regions may be an adaptive or compensatory response to changes in vigilance.

EVIDENCE LEVEL

1.

TECHNICAL EFFICACY

1.

Versatile, vigilance, and gut microbiome support the priority of high-ranking hens

Dominance hierarchy exists in social animals and shows profound impacts on animals' survival, physical and mental health, and reproductive success. Aggressive interaction, as the main indicator used to calculate social hierarchy, however, is not found in some female animals. In this study, we aimed to figure out the establishment of social hierarchy in hens that almost perform aggressive behaviors and investigated the interactions of social hierarchy with production performance and gut microbiome. Forty 49-day-old Qingyuan hens were randomly divided into four groups. The social hierarchy of hens was calculated by the relative position around the feeder. The rank 1 (R1), R2, R3, R4, R5, R6, R7, R8, R9, and R10 birds were determined in ascending order. Then, R1 and R2 birds (four duplicates, n = 8) were named as the high-ranking hens (HR) group, while R9 and R10 individuals were named as the low-ranking hens (LR) group (four duplicates, n = 8). The heart index (p = 0.01), number of visits per day, daily feed intake, and occupation time per day were higher in the HR group than LR group, but the LR group had a higher feed intake per visit than the HR group. The alpha diversity was significantly lower in the HR group than the LR group (p = 0.05). The relative abundance of phylum Firmicutes was higher while that of phylum Deferribacterota was lower in the HR group than LR group (p < 0.05). At the genus level, the relative abundance of Succinatimonas, Eubacterium hallii group, and Anaerostipes were higher in HR group than in LR group. The relative abundance of Bacteroides, Mucispirillum, Subdoligranulum, and Barnesiellaceae unclassified was higher in the LR group than HR group (p < 0.05). In conclusion, the rank of hens could be calculated by the relative position around the feeder when they compete for food. The dominant hens have a versatile. Moreover, they are more vigilant and have priority when foraging. Low-ranking hens adopt strategies to get enough food to sustain themselves. Hens of high-rank possess beneficial bacteria that use favorable substances to maintain the balance of the gut environment.

Understanding, readiness, and response of healthcare professionals in combating falsified medical products in Eritrea: a population-based survey

Background

The circulation of falsified medical products is a global threat and is expected to be higher in low- and middle-income countries.

Objective

This study was conducted to assess the understanding, readiness, and response of Eritrea's healthcare professionals (HCPs), and identify potential areas of intervention to combat circulation of falsified medical products.

Design

This was a nationwide population-based cross-sectional survey, conducted in December 2021.

Methods

This study enrolled representative samples of HCPs working in public and private health facilities. Two-stage stratified cluster sampling was used to select study participants and data were collected through face-to-face interviews. Descriptive statistics, Mann-Whitney U test, Kruskal-Wallis test along with their post hoc tests, Jonckheere-Terpstra, and logistic regression analyses were performed as appropriate.

Results

The study enrolled 707 HCPs, and 96.6% were successfully surveyed. The majority of the participants (62.5%) encountered products with suspected quality defects and 63.8% claimed that they had reported the incident(s) at least once. About 85% reported that complaints should be submitted to the Eritrean Pharmacovigilance Centre and 74.0% indicated that it should be reported at the earliest time possible even if the reporter lacks details. The standard reporting form for suspected product quality issues was correctly recognized by 13.8%. Overall, the median knowledge and attitude scores were found to be 9 out of 17 (interquartile range, IQR: 4.0) and 30 out of 35 (IQR: 4.0), respectively. Not knowing how to report (55.6%) and what to report (34.9%), no/delayed feedback from the regulatory authority (30.0%), and unavailability of reporting forms (29.0%) were the frequently reported barriers to reporting. In addition, profession (p = 0.027), no/delayed feedback (adjusted odds ratio [AOR]: 4.70; 95% CI: 2.17-10.18; p < 0.001), and not knowing how to report (AOR: 0.12; 95% CI: 0.05-0.28; p < 0.001) were found to be determinants of reporting suspected product quality defects.

Conclusion

The readiness and response of Eritrea's HCPs in detecting and reporting falsified medical products seems promising, although a significant knowledge gap was observed.

Attempting to counteract vigilance decrement in older adults with brain stimulation

Introduction

Against the background of demographic change and the need for enhancement techniques for an aging society, we set out to repeat a study that utilized 40-Hz transcranial alternating current stimulation (tACS) to counteract the slowdown of reaction times in a vigilance experiment but with participants aged 65 years and older. On an oscillatory level, vigilance decrement is linked to rising occipital alpha power, which has been shown to be downregulated using gamma-tACS.

Method

We applied tACS on the visual cortex and compared reaction times, error rates, and alpha power of a group stimulated with 40 Hz to a sham and a 5-Hz-stimulated control group. All groups executed two 30-min-long blocks of a visual task and were stimulated according to group in the second block. We hypothesized that the expected increase in reaction times and alpha power would be reduced in the 40-Hz group compared to the control groups in the second block (INTERVENTION).

Results

Statistical analysis with linear mixed models showed that reaction times increased significantly over time in the first block (BASELINE) with approximately 3 ms/min for the SHAM and 2 ms/min for the 5-Hz and 40-Hz groups, with no difference between the groups. The increase was less pronounced in the INTERVENTION block (1 ms/min for SHAM and 5-Hz groups, 3 ms/min for the 40-Hz group). Differences among groups in the INTERVENTION block were not significant if the 5-Hz or the 40-Hz group was used as the base group for the linear mixed model. Statistical analysis with a generalized linear mixed model showed that alpha power was significantly higher after the experiment (1.37 μV2) compared to before (1 μV2). No influence of stimulation (40 Hz, 5 Hz, or sham) could be detected.

Discussion

Although the literature has shown that tACS offers potential for older adults, our results indicate that findings from general studies cannot simply be transferred to an old-aged group. We suggest adjusting stimulation parameters to the neurophysiological features expected in this group. Next to heterogeneity and cognitive fitness, the influence of motivation and medication should be considered.

Single sessions of transcranial direct current stimulation and transcranial random noise stimulation exert no effect on sleepiness in patients with narcolepsy and idiopathic hypersomnia

Background

Hypersomnia poses major challenges to treatment providers given the limitations of available treatment options. In this context, the application of non-invasive brain stimulation techniques such as transcranial electrical stimulation (tES) may open up new avenues to effective treatment. Preliminary evidence suggests both acute and longer-lasting positive effects of transcranial direct current stimulation (tDCS) on vigilance and sleepiness in hypersomniac patients. Based on these findings, the present study sought to investigate short-term effects of single sessions of tDCS and transcranial random noise stimulation (tRNS) on sleepiness in persons suffering from hypersomnia.

Methods

A sample of 29 patients suffering from narcolepsy or idiopathic hypersomnia (IH) was recruited from the Regensburg Sleep Disorder Center and underwent single sessions of tES (anodal tDCS, tRNS, sham) over the left and right dorsolateral prefrontal cortex on three consecutive days in a double-blind, sham-controlled, pseudorandomized crossover trial. The primary study endpoint was the mean reaction time measured by the Psychomotor Vigilance Task (PVT) before and directly after the daily tES sessions. Secondary endpoints were additional PVT outcome metrics as well as subjective outcome parameters (e.g., Karolinska Sleepiness Scale; KSS).

Results

There were no significant treatment effects neither on objective (i.e., PVT) nor on subjective indicators of sleepiness.

Conclusion

We could not demonstrate any clinically relevant effects of single sessions of tDCS or tRNS on objective or subjective measures of sleepiness in patients with hypersomnia. However, we cannot exclude that repeated sessions of tES may affect vigilance or sleepiness in hypersomniac patients.

Vigilance to Painful Laser Stimuli is Associated with Increased State Anxiety and Tense Arousal

Introduction

Pain is frequently accompanied by enhanced arousal and hypervigilance to painful sensations. Here, we describe our findings in an experimental vigilance task requiring healthy participants to indicate when randomly timed moderately painful stimuli occur in a long train of mildly painful stimuli.

Methods

During a continuous performance task with painful laser stimuli (CPTpain), 18 participants rated pain intensity, unpleasantness, and salience. We tested for a vigilance decrement over time using classical metrics including correct targets (hits), incorrectly identified non-targets (false alarms), hit reaction time, and false alarm reaction time. We measured state anxiety and tense arousal before and after the task.

Results

We found a vigilance decrement across four 12.5-minute blocks of painful laser stimuli in hits [F3,51=2.91; p=0.043; time block 1>block 4 (t=2.77; p=0.035)]. Both self-report state anxiety (tpaired,17=3.34; p=0.0039) and tense arousal (tpaired,17=3.20; p=0.0053) increased after the task. We found a vigilance decrement during our laser pain vigilance task consistent with vigilance decrements found in other stimulus modalities. Furthermore, state anxiety positively correlated with tense arousal.

Discussion

CPTpain acutely increased tense arousal and state anxiety, consistent with previous results implicating the reciprocal interaction of state anxiety and acute painful sensations and the role of pain in augmenting tense arousal. These results may indicate a psychological process which predisposes the hypervigilant to developing greater acute pain, resulting in positive feedback, greater pain and anxiety.

ART in Europe, 2019: results generated from European registries by ESHRE†

STUDY QUESTION

What are the data and trends on ART and IUI cycle numbers and their outcomes, and on fertility preservation (FP) interventions, reported in 2019 as compared to previous years?

SUMMARY ANSWER

The 23rd ESHRE report highlights the rising ART treatment cycles and children born, alongside a decline in twin deliveries owing to decreasing multiple embryo transfers; fresh IVF or ICSI cycles exhibited higher delivery rates, whereas frozen embryo transfers (FET) showed higher pregnancy rates (PRs), and reported IUI cycles decreased while maintaining stable outcomes.

WHAT IS KNOWN ALREADY

ART aggregated data generated by national registries, clinics, or professional societies have been gathered and analyzed by the European IVF-Monitoring (EIM) Consortium since 1997 and reported in a total of 22 manuscripts published in Human Reproduction and Human Reproduction Open.

STUDY DESIGN, SIZE, DURATION

Data on medically assisted reproduction (MAR) from European countries are collected by EIM for ESHRE each year. The data on treatment cycles performed between 1 January and 31 December 2019 were provided by either national registries or registries based on initiatives of medical associations and scientific organizations or committed persons in one of the 44 countries that are members of the EIM Consortium.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Overall, 1487 clinics offering ART services in 40 countries reported, for the second time, a total of more than 1 million (1 077 813) treatment cycles, including 160 782 with IVF, 427 980 with ICSI, 335 744 with FET, 64 089 with preimplantation genetic testing (PGT), 82 373 with egg donation (ED), 546 with IVM of oocytes, and 6299 cycles with frozen oocyte replacement (FOR). A total of 1169 institutions reported data on IUI cycles using either husband/partner's semen (IUI-H; n = 147 711) or donor semen (IUI-D; n = 51 651) in 33 and 24 countries, respectively. Eighteen countries reported 24 139 interventions in pre- and post-pubertal patients for FP, including oocyte, ovarian tissue, semen, and testicular tissue banking.

MAIN RESULTS AND THE ROLE OF CHANCE

In 21 countries (21 in 2018) in which all ART clinics reported to the registry 476 760 treatment cycles were registered for a total population of approximately 300 million inhabitants, allowing the best estimate of a mean of 1581 cycles performed per million inhabitants (range: 437-3621). Among the reporting countries, for IVF the clinical PRs per aspiration slightly decreased while they remained similar per transfer compared to 2018 (21.8% and 34.6% versus 25.5% and 34.1%, respectively). In ICSI, the corresponding PRs showed similar trends compared to 2018 (20.2% and 33.5%, versus 22.5% and 32.1%) When freeze-all cycles were not considered for the calculations, the clinical PRs per aspiration were 28.5% (28.8% in 2018) and 26.2% (27.3% in 2018) for IVF and ICSI, respectively. After FET with embryos originating from own eggs, the PR per thawing was at 35.1% (versus 33.4% in 2018), and with embryos originating from donated eggs at 43.0% (41.8% in 2018). After ED, the PR per fresh embryo transfer was 50.5% (49.6% in 2018) and per FOR 44.8% (44.9% in 2018). In IVF and ICSI together, the trend toward the transfer of fewer embryos continues with the transfer of 1, 2, 3, and ≥4 embryos in 55.4%, 39.9%, 2.6%, and 0.2% of all treatments, respectively (corresponding to 50.7%, 45.1%, 3.9%, and 0.3% in 2018). This resulted in a reduced proportion of twin delivery rates (DRs) of 11.9% (12.4% in 2018) and a similar triplet DR of 0.3%. Treatments with FET in 2019 resulted in twin and triplet DR of 8.9% and 0.1%, respectively (versus 9.4% and 0.1% in 2018). After IUI, the DRs remained similar at 8.7% after IUI-H (8.8% in 2018) and at 12.1% after IUI-D (12.6% in 2018). Twin and triplet DRs after IUI-H were 8.7% and 0.4% (in 2018: 8.4% and 0.3%) and 6.2% and 0.2% after IUI-D (in 2018: 6.4% and 0.2%), respectively. Eighteen countries (16 in 2018) provided data on FP in a total number of 24 139 interventions (20 994 in 2018). Cryopreservation of ejaculated sperm (n = 11 592 versus n = 10 503 in 2018) and cryopreservation of oocytes (n = 10 784 versus n = 9123 in 2018) were most frequently reported.

LIMITATIONS, REASONS FOR CAUTION

Caution with the interpretation of results should remain as data collection systems and completeness of reporting vary among European countries. Some countries were unable to deliver data about the number of initiated cycles and/or deliveries.

WIDER IMPLICATIONS OF THE FINDINGS

The 23rd ESHRE data collection on ART, IUI, and FP interventions shows a continuous increase of reported treatment numbers and MAR-derived livebirths in Europe. Although it is the largest data collection on MAR in Europe, further efforts toward optimization of both the collection and the reporting, from the perspective of improving surveillance and vigilance in the field of reproductive medicine, are awaited.

STUDY FUNDING/COMPETING INTEREST(S)

The study has received no external funding and all costs are covered by ESHRE. There are no competing interests.

Vigilance has mainly a social function in a wild group of spider monkeys (Ateles geoffroyi)

Vigilance is a widespread behavior that allows individuals to socially acquire information and/or effectively detect potential risks posed by predators and conspecifics. In this study, we aimed to investigate how social factors (i.e., subgroup size, number of males and immatures in the subgroup, presence of fission and fusion events, subgroup activity), individual characteristics (i.e., sex, presence of dependent offspring) and possible vulnerability to predation (i.e., being in smaller subgroups or lower in the canopy) explain variation in vigilance behavior in a wild group of spider monkeys (Ateles geoffroyi). We collected vigilance data during focal samples of all adults, subadults and juveniles of the group (N = 38), and ran generalized linear mixed models with a Bayesian approach. We found that the proportion of time both sexes spent in vigilance increased with subgroup size and during fusion events. Individuals also spent more time in vigilance when the subgroup was resting or socializing compared to other activities. Moreover, the proportion of time spent in vigilance increased in subgroups with more immatures. An alternative model with similar fit suggested that the proportion of time spent in vigilance increased in females when subgroups included more adult and subadult males. Overall, these results suggest that our study group mainly directed vigilance toward conspecifics (i.e., social vigilance), probably as a result of the relatively low predation pressure experienced, and contribute to the understanding of the multiple social factors affecting vigilance in group-living primates.

Same place, different time, head up: Multiple antipredator responses to a recolonizing apex predator

Prey adjust their antipredator behavioral tactics to minimize the risk of an encounter with predators. Spatiotemporal responses of prey to predators have been reported, but the nature of antipredator response is not ubiquitous and it is the object of increasing interest, especially considering the recent recovery of large carnivores in Europe, and the potential for behavioral antipredator responses to elicit consequences at the ecosystem level. We have tested multiple antipredator responses by fallow deer Dama dama to wolf Canis lupus in a Mediterranean protected area recently recolonized by this apex predator. Through intensive camera trapping, we tested for temporal and spatial association between predator and prey, and we have also studied deer vigilance in forest habitats where focal observations are usually impossible. Wolf detection rates were spatially associated with those of fallow deer. Accordingly, no evidence was found for fallow deer avoiding sites with higher predator detection rates. Temporal activity patterns were significantly different between the 2 species, with the wolf being mainly nocturnal whereas fallow deer was active especially during daylight. A comparison with a preliminary study strongly suggests an increase in the diurnal activity of fallow deer along with the stabilization of wolf presence in the area. Both the rate and the duration of vigilance of female fallow deer increased with the local frequency of wolf activity. We suggest an antipredator response based on temporal-rather than spatial-avoidance, as well as increased vigilance.

Impact of Prescribed Exercise on the Physical and Cognitive Health of Adults with Down Syndrome: The MinDSets Study

The duplication of chromosome 21, as evidenced in Down Syndrome (DS), has been linked to contraindications to health, such as chronotropic and respiratory incompetence, neuromuscular conditions, and impaired cognitive functioning. The purpose of this study was to examine the effects of eight weeks of prescribed exercise and/or cognitive training on the physical and cognitive health of adults with DS. Eighty-three participants (age 27.1 ± 8.0 years) across five continents participated. Physical fitness was assessed using a modified version of the six-minute walk test (6MWT), while cognitive and executive functions were assessed using the Corsi block test, the Sustained-Attention-To-Response Task (SART), and the Stroop task (STROOP). All were completed pre- and post-intervention. Participants were assigned to eight weeks of either exercise (EXE), 3 × 30 min of walking/jogging per week, cognitive training (COG) 6 × ~20 min per week, a combined group (COM), and a control group (CON) engaging in no intervention. 6MWT distance increased by 11.4% for EXE and 9.9% for COM (p < 0.05). For SART, there were positive significant interactions between the number of correct and incorrect responses from pre- to post-intervention when participants were asked to refrain from a response (NO-GO-trials) across all experimental groups (p < 0.05). There were positive significant interactions in the number of correct, incorrect, and timeout incompatible responses for STROOP in EXE, COG, and COM (p < 0.05). Walking generated a cognitive load attributed to heightened levels of vigilance and decision-making, suggesting that exercise should be adopted within the DS community to promote physical and cognitive well-being.

The WACDT, a modern vigilance task for network defense

Vigilance decrement refers to a psychophysiological decline in the capacity to sustain attention to monotonous tasks after prolonged periods. A plethora of experimental tasks exist for researchers to study vigilance decrement in classic domains such as driving and air traffic control and baggage security; however, the only cyber vigilance tasks reported in the research literature exist in the possession of the United States Air Force (USAF). Moreover, existent cyber vigilance tasks have not kept up with advances in real-world cyber security and consequently no longer accurately reflect the cognitive load associated with modern network defense. The Western Australian Cyber Defense Task (WACDT) was designed, engineered, and validated. Elements of network defense command-and-control consoles that influence the trajectory of vigilance can be adjusted within the WACDT. These elements included cognitive load, event rate, signal salience and workload transitions. Two forms of the WACDT were tested. In static trials, each element was adjusted to its maximum level of processing difficulty. In dynamic trials, these elements were set to increase from their minimum to their maximum values. Vigilance performance in static trials was shown to improve over time. In contrast, dynamic WACDT trials were characterized by vigilance performance declines. The WACDT provides the civilian human factors research community with an up-to-date and validated vigilance task for network defense accessible to civilian researchers.

Fear-Conditioning to Unpredictable Threats Reveals Sex and Strain Differences in Rat Fear-Potentiated Startle (FPS)

Fear-potentiated startle (FPS) has been widely used to study fear processing in humans and rodents. Human studies showed higher startle amplitudes and exaggerated fear reactivity to unpredictable vs. predictable threats in individuals suffering from post-traumatic stress disorder (PTSD). Although human FPS studies use both sexes, a surprisingly limited number of rodent FPS studies use females. Here we investigate the effects of signal-threat contingency, signal-threat order and threat predictability on FPS in both sexes. We use a classic fear-conditioning protocol (100% contingency of cue and shock pairings, with forward conditioning such that the cue co-terminates with the shock) and compare it to modified fear-conditioning protocols (70% contingency; backward conditioning; or cue and shock un-paired). Although there are no sex differences in the startle amplitudes when corrected for body weight, females consistently demonstrate higher shock reactivity during fear-conditioning. Both sexes and strains demonstrate comparable levels of cued, non-cued, and contextual fear in the classic FPS and FPS following fear-conditioning with 70% contingency or backward order (cue co-starts with shock). However, in the classic FPS, Sprague-Dawley females show reduced proportion between cued fear and cue-elicited vigilant state than males. Lastly, a prominent sex difference is uncovered following unpredictable fear-conditioning (cue and shock un-paired), with Wistar, but not Sprague-Dawley, females showing significantly higher startle overall during the FPS recall, regardless of trial type, and higher contextual fear than males. This striking sex difference in processing unpredictable threats in rodent FPS might help to understand the mechanisms underlying higher incidence of PTSD in women.

Sleep Architecture and Sleep EEG Alterations are Associated with Impaired Cognition Under Sleep Restriction

Purpose

Many studies have investigated the cognitive, emotional, and other impairments caused by sleep restriction. However, few studies have explored the relationship between cognitive performance and changes in sleep structure and electroencephalography (EEG) during sleep. The present study aimed to examine whether changes in sleep structure and EEG can account for cognitive impairment caused by sleep restriction.

Patients and Methods

Sixteen young adults spent five consecutive nights (adaptation 9h, baseline 8h, 1st restriction 6h, 2nd restriction 6h, and recovery 10h) in a sleep laboratory, with polysomnography recordings taken during sleep. Throughout waking periods in each condition, participants completed the psychomotor vigilance test (PVT), which measures vigilant attention, and the Go/No-Go task, which measures inhibition control.

Results

The results showed that sleep restriction significantly decreased the proportion of N1 and N2 sleep, increased the proportion of N3 sleep, and reduced the time spent awake after sleep onset (WASO) and sleep onset latency. Poorer performance on the PVT and Go/No Go task was associated with longer WASO, a larger proportion of N3 sleep, and a smaller proportion of N2 sleep. Additionally, the power spectral density of delta waves significantly increased after sleep restriction, and this increase predicted a decrease in vigilance and inhibition control the next day.

Conclusion

These findings suggest that sleep architecture and EEG signatures may partially explain cognitive impairment caused by sleep restriction.

Frightened of giants: fear responses to elephants approach that of predators

Animals are faced with a variety of dangers or threats, which are increasing in frequency with ongoing environmental change. While our understanding of fearfulness of such dangers is growing in the context of predation and parasitism risk, the extent to which non-trophic, interspecific dangers elicit fear in animals remains less appreciated. We provide an experimental test for fear responses of savannah ungulates to a dominant and aggressive megaherbivore, the African bush elephant (Loxodonta africana), and contrast responses to an apex predator known to elicit fear in this system. Using an automated behavioural response system, we contrast vigilance and run responses of ungulates to elephant, leopard (Panthera pardus), and control (red-chested cuckoo Cuculus solitarius) vocalizations. Overall, we find that ungulates responded to elephant calls, both in terms of an increase in run and vigilance responses relative to controls. The magnitude of most behavioural responses (four of six considered) to elephant vocalizations were not significantly different than responses to leopards. These results suggest that megaherbivores can elicit strong non-trophic fear responses by ungulates and call to broaden frameworks on fear to consider dominant species, such as megaherbivores, as key modifiers of fear-induced interactions.

Effect of homeostatic pressure on daytime vigilance performance: Evidence from behaviour and resting-state EEG

Vigilance is highly sensitive to the time-of-day effect and goes through the daytime trough during the period of the post-noon dip. A midday nap could maintain individuals' vigilance at an optimal level. Thus, homeostatic sleep pressure is one of the main reasons for the post-noon dip in daytime vigilance. The current study focussed on the role of homeostatic sleep pressure in the diurnal variation of vigilance performance with normal circadian rhythms and the corresponding neural basis. With 34 healthy adults, we recorded the resting-state electroencephalogram activities and the following vigilance performance measured by psychomotor vigilance test in the morning, the no-nap mid afternoon, and the nap mid afternoon. The circadian process was controlled by measuring vigilance and resting-state electroencephalogram activities at the same time point in the nap and no-nap conditions. Homeostatic sleep pressure accumulated from morning to mid afternoon induced the declined vigilance performance and a global increase in resting-state delta, theta, alpha, and beta1 bands power, and a local increase in beta2 band power in the central region. Furthermore, the more the spontaneous beta2 power increased, the less vigilance declined from morning to mid afternoon. The current findings suggest that homeostatic sleep pressure increased cortical excitability but decreased cortical communication efficiency from morning to mid afternoon. In addition, the activity of the high beta waves probably reflected the compensatory effort to counteract the negative impact of the low arousal state on the following vigilance task by performing more action preparation in the no-nap afternoon.

Medication errors in an oncology inpatient setting in India-Audit by clinical pharmacists

BACKGROUND

Good clinical practices and strict vigilance are needed, especially for patients receiving chemotherapy. Regular audits using a specially developed tool need to be conducted in the oncology wards to identify lapses in the use of chemotherapy drugs.

METHODOLOGY

Observational study was conducted in the adult and paediatric oncology inpatient settings in an Indian tertiary care hospital for a period of 2.5 years. It was an audit of case files of chemotherapy patients for their drug prescriptions, medication reconciliation records and adverse drug reports. Data was presented as frequencies and percentages.

RESULTS

1.3% medication errors and 0.23% adverse drug reactions were reported during the study period. Majority were transcription (38%) and drug reconstitution errors (29%) and were either in the near-miss or no-harm category.

CONCLUSION

Medication errors were found in the oncology wards, but due to the vigilance of clinical pharmacists, none of the patients were harmed as a consequence of these errors.

Sleep with Open Eyes in Two Species of Deer, the Indian Sambar (Rusa unicolor) and Sika Deer (Cervus nippon)

The relationship between postures, sleep stages and eye state was established in two species of deer, the Indian sambar (Rusa unicolor) and sika deer (Cervus nippon), based on video recording. In both species, the state of rest or behavioral sleep was recorded in the sternal position, holding the head above the ground, and in the lateral position, with the head resting on the croup or on the ground. Rest accounted for at least 80% of the time in these positions. Based on behavior criteria a substantial portion of rest represented slow-wave sleep. Episodes of rapid eye movements (REM sleep) were recorded in the lateral position. They did not exceed 2 min. When the deer were in the sternal posture, they kept their eyes open most of the time: in average 96% of the time in sambars and 82% in sika deer. Episodes of the open eye in this posture lasted up to 8.4 min in sambars and up to 3.3 min in sika deer. In the lateral position, such episodes were 4 and 1.5 times shorter. Sleeping with open eyes in ungulates may be an important mechanism of maintaining vigilance.

Mapping between cognitive theories and psycho-physiological models of attention system performance

Declines in the capacity to sustain attention to repetitive, monotonous tasks is a phenomenon known as vigilance decrement (Endsley M, Kiris E. The out-of-the-loop performance problem and level of control in automation. 1995. Hum Factors. 37:32-64). This review compares cognitive theories with psycho-physiological models of vigilance decrement, and a gap is identified in mapping between the 2. That is, theories of vigilance decrement refer to "cognitive" resources; by contrast, psychophysiological models of the cerebral systems associated with attention explain performance functions according to neurochemical resources. A map does not currently exist in the literature that bridges the gap between cognitive theories of vigilance decrement and psychophysiological models of the human attention system. The link between "cognitive resource" theories of vigilance decrement and the psychophysiological models of attention performance is a gap in the literature that this review fills. This comprehensive review provides an expanded psychophysiological understanding of vigilance decrement that could help inform the management of declines in sustained attention capacity in operational settings. In addition, elucidating the link between cognitive theories of vigilance decrement and psychophysiological models of the human attention system might be used to treat and better understand pathologies such as attention-deficit hyperactivity disorder.

The ANTI-Vea-UGR Platform: A Free Online Resource to Measure Attentional Networks (Alertness, Orienting, and Executive Control) Functioning and Executive/Arousal Vigilance

The Attentional Networks Test for Interactions and Vigilance-executive and arousal components (ANTI-Vea) is a computerized task of 32 min duration in the standard format. The task simultaneously assesses the main effects and interactions of the three attentional networks (i.e., phasic alertness, orienting, and executive control) and two dissociated components of vigilance with reasonable reliability (executive and arousal vigilance). We present this free and publicly accessible resource (ANTI-Vea-UGR; https://anti-vea.ugr.es/) developed to easily run, collect, and analyze data with the ANTI-Vea (or its subtasks measuring some attentional and/or vigilance components embedded in the ANTI-Vea). Available in six different languages, the platform allows for the adaptation of stimulus timing and procedure to facilitate data collection from different populations (e.g., clinical patients, children). Collected data can be freely downloaded and easily analyzed with the provided scripts and tools, including a Shiny app. We discuss previous evidence supporting that attention and vigilance components can be assessed in typical lab conditions as well as online and outside the laboratory. We hope this tutorial will help researchers interested in measuring attention and vigilance with a tool useful to collect data from large sample sizes and easy to use in applied contexts.

Vigilance behaviour during the calving season in female Tibetan antelopes (Pantholopshodgsonii)

Tibetan antelopes (Pantholopshodgsonii) migrate great distances to specific delivery and calving areas. In the current study, we investigated calving site selection and vigilance behaviour during delivery and nursing in migratory female Tibetan antelopes at Zonag Lake. According to observations and analysis, the females were distributed south of Zonag Lake, where vegetation was abundant. We determined their dates of migration (crossing the Qinghai-Tibet Highway observation site), showing a shift of one month during the period from June in 2008 to May 2021. Results also showed that 81.4% of females expressed high vigilance behaviour during calving and nursing compared to those without calves (7.1%). From delivery until calf standing, females were highly vigilant and spent considerable time scanning, with 96% of females showing vigilance behaviour. Females with calves (average 9.94 ± 0.62 s) spent more time on vigilance behaviour than females without calves (average 6.25 ± 1.38 s). Females with newborns spent the greatest amount of time being vigilant (average 51.63 ± 4.24 s). These results not only identify basic Tibetan antelope calving behaviour, but also provide scientific analysis and evidence for further ethological research on female Tibetan antelopes.

An Evaluation of Sleepiness, Performance, and Workload Among Operators During a Real-Time Reactive Telerobotic Lunar Mission Simulation

OBJECTIVE

We assessed operator performance during a real-time reactive telerobotic lunar mission simulation to understand how daytime versus nighttime operations might affect sleepiness, performance, and workload.

BACKGROUND

Control center operations present factors that can influence sleepiness, neurobehavioral performance, and workload. Each spaceflight mission poses unique challenges that make it difficult to predict how long operators can safely and accurately conduct operations. We aimed to evaluate the performance impact of time-on-task and time-of-day using a simulated telerobotic lunar rover to better inform staffing and scheduling needs for the upcoming Volatiles Investigating Polar Exploration Rover (VIPER) mission.

METHODS

We studied seven trained operators in a simulated mission control environment. Operators completed two five-hour simulations in a randomized order, beginning at noon and midnight. Performance was evaluated every 25 minutes using the Karolinska Sleepiness Scale, Psychomotor Vigilance Task, and NASA Task Load Index.

RESULTS

Participants rated themselves as sleepier (5.06 ± 2.28) on the midnight compared to the noon simulation (3.12 ± 1.44; p < .001). Reaction time worsened over time during the midnight simulation but did not vary between simulations. Workload was rated higher during the noon (37.93 ± 20.09) compared to the midnight simulation (32.09 ± 21.74; p = .007).

CONCLUSION

Our findings suggest that work shifts during future operations should be limited in duration to minimize sleepiness. Our findings also suggest that working during the day, when distractions are present, increases perceived workload. Further research is needed to understand how working consecutive shifts and taking breaks within a shift influence performance.

How the time-of-day affects the EEG signatures of vigilance fluctuation

Previous research suggested the homeostatic effect on the top-down control system as a major factor for daytime vigilance decrement, yet how it alters the cognitive processes of vigilance remains unclear. Using EEG, the current study measured the vigilance of 28 participants under three states: the morning, the midafternoon after napping and no-nap. The drift-diffusion model was applied to decompose vigilant reaction time into decision and non-decision components. From morning to midafternoon, vigilance declined during sustained wakefulness, but remained stable after midday napping. Increased sleep pressure negatively affected decision time and drift rate, but did not significantly alter the non-decision process. Frontocentral N2 amplitude decreased from morning to no-nap afternoon, associated with slowing decision time. In contrast, parietal P3 had no diurnal alterations during sustained wakefulness, but enhanced after napping. Pre-stimulus parietooccipital alpha power enhanced under high sleep pressure relative to low, accompanied by more lapses in no-nap vs. post-napping conditions. The homeostasis effect is a major contributor to daily vigilance fluctuation, specifically targeting top-down control processes during the pre-stimulus and decision-making stages. Under the influence of sleep homeostasis, the speed of decision-making declines with degradation in target monitoring from morning to afternoon, leading to post-noon vigilance decrement.

Accidental Intraarterial Placement of a Venous Cannula: When In Doubt Take It Out!-A Case Report

An artery may be entered on the dorsum of the hand with the mistaken belief that it is a vein. Intraarterial injection of drugs is one of the dreadful consequences of accidental intraarterial cannulation. In this case of a 3-month-old infant, we emphasize the fact that careful observation can prevent unintentional intraarterial drug injection via an 'assumed intravenous' cannula and prevent the associated morbidity. When there is a suspicion of an intraarterial placement of venous cannula, it is of paramount significance to confirm before the injection of medications. Aberrant arterial anatomy should be kept in mind, particularly in children on the dorsum of the hand, where placement of an intravenous cannula is usually considered safe.

Vigilance Decrement During On-Road Partially Automated Driving Across Four Systems

OBJECTIVE

This study uses a detection task to measure changes in driver vigilance when operating four different partially automated systems.

BACKGROUND

Research show temporal declines in detection task performance during manual and fully automated driving, but the accuracy of using this approach for measuring changes in driver vigilance during on-road partially automated driving is yet unproven.

METHOD

Participants drove four different vehicles (Tesla Model 3, Cadillac CT6, Volvo XC90, and Nissan Rogue) equipped with level-2 systems in manual and partially automated modes. Response times to a detection task were recorded over eight consecutive time periods.

RESULTS

Bayesian analysis revealed a main effect of time period and an interaction between mode and time period. A main effect of vehicle and a time period x vehicle interaction were also found.

CONCLUSION

Results indicated that the reduction in detection task performance over time was worse during partially automated driving. Vehicle-specific analysis also revealed that detection task performance changed across vehicles, with slowest response time found for the Volvo.

APPLICATION

The greater decline in detection performance found in automated mode suggests that operating level-2 systems incurred in a greater vigilance decrement, a phenomenon that is of interest for Human Factors practitioners and regulators. We also argue that the observed vehicle-related differences are attributable to the unique design of their in-vehicle interfaces.

Ratio Indexes Based on Spectral Electroencephalographic Brainwaves for Assessment of Mental Involvement: A Systematic Review

BACKGROUND

This review systematically examined the scientific literature about electroencephalogram-derived ratio indexes used to assess human mental involvement, in order to deduce what they are, how they are defined and used, and what their best fields of application are. (2) Methods: The review was carried out according to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. (3) Results: From the search query, 82 documents resulted. The majority (82%) were classified as related to mental strain, while 12% were classified as related to sensory and emotion aspects, and 6% to movement. The electroencephalographic electrode montage used was low-density in 13%, high-density in 6% and very-low-density in 81% of documents. The most used electrode positions for computation of involvement indexes were in the frontal and prefrontal cortex. Overall, 37 different formulations of involvement indexes were found. None of them could be directly related to a specific field of application. (4) Conclusions: Standardization in the definition of these indexes is missing, both in the considered frequency bands and in the exploited electrodes. Future research may focus on the development of indexes with a unique definition to monitor and characterize mental involvement.

Dual orexin/hypocretin receptor antagonism attenuates NMDA receptor hypofunction-induced attentional impairments in a rat model of schizophrenia

Schizophrenia is a neuropsychiatric condition that is associated with impaired attentional processing and performance. Failure to support increasing attentional load may result, in part, from inhibitory failure in attention-relevant cortical regions, and available antipsychotics often fail to address this issue. Orexin/hypocretin receptors are found throughout the brain and are expressed on neurons relevant to both attention and schizophrenia, highlighting them as a potential target to treat schizophrenia-associated attentional dysfunction. In the present experiment, rats (N = 14) trained in a visual sustained attention task that required discrimination of trials which presented a visual signal from trials during which no signal was presented. Once trained, rats were then co-administered the psychotomimetic N-methyl-D-aspartate (NMDA) receptor antagonist dizocilpine (MK-801: 0 or 0.1mg/kg, intraperitoneal injections) and the dual orexin receptor antagonist filorexant (MK-6096: 0, 0.1, or 1mM, intracerebroventricular infusions) prior to task performance across six sessions. Dizocilpine impaired overall accuracy during signal trials, slowed reaction times for correctly-responded trials, and increased the number of omitted trials throughout the task. Dizocilpine-induced increases in signal trial deficits, correct response latencies, and errors of omission were reduced following infusions of the 0.1mM, but not 1mM, dose of filorexant. As such, orexin receptor blockade may improve attentional deficits in a state of NMDA receptor hypofunction.

Multiple Sentinels in a Cooperative Breeder Synchronize Rather Than Coordinate Gazing

Sentinels can detect predators and rivals early by monitoring their surroundings from vantage points. Multiple sentinels in a group may reduce the perceived predation risk by diluting the risk and increasing collective detection, especially if sentinels monitor different areas at the same time. We investigated sentinel behavior in groups of the Florida scrub jay (Aphelocoma caerulescens). Sentinels in this species turn their heads frequently to monitor different areas for threats. As predicted, we found that sentinels turned their heads less frequently in the presence of other sentinels. Multiple sentinels, however, tended to gaze in the same direction at the same time more often than predicted by chance alone. Gaze synchronization reduces the efficiency of collective detection by reducing visual coverage at any one time at the group level. Despite the benefits of the presence of other sentinels, our results highlight the limits to collective detection when multiple individuals are vigilant at the same time.

EuMAR: a roadmap towards a prospective, cycle-by-cycle registry of medically assisted reproduction in Europe

More than 20 years ago, the survey of activities in medically assisted reproduction (MAR) was initiated in Europe and resulted in cross-sectional annual reports, as issued by the European IVF Monitoring (EIM) consortium of ESHRE. Over time, these reports mirror the continuous development of the technologies and contribute to increased transparency and surveillance of reproductive care. Meanwhile, progressive changes of existing treatment modalities and the introduction of new technologies resulted in the need of a cumulative approach in the assessment of treatment outcomes, which warrants a prospective cycle-by-cycle data registry on MAR activities, including fertility preservation. This change in the paradigm of data collection in Europe towards the construction of cumulative outcome results is expected to generate additional insights into cross-institutional but also cross-border movements of patients and reproductive material. This is essential to improve vigilance and surveillance. The European monitoring of Medically Assisted Reproduction (EuMAR) project, co-funded by the European Union, will establish a registry for the transnational collection of prospective cycle-by-cycle MAR and fertility preservation data on the basis of an individual reproductive care code (IRCC). The rationale for the project and the objectives are presented here.

A review of cyber vigilance tasks for network defense

The capacity to sustain attention to virtual threat landscapes has led cyber security to emerge as a new and novel domain for vigilance research. However, unlike classic domains, such as driving and air traffic control and baggage security, very few vigilance tasks exist for the cyber security domain. Four essential challenges that must be overcome in the development of a modern, validated cyber vigilance task are extracted from this review of existent platforms that can be found in the literature. Firstly, it can be difficult for researchers to access confidential cyber security systems and personnel. Secondly, network defense is vastly more complex and difficult to emulate than classic vigilance domains such as driving. Thirdly, there exists no single, common software console in cyber security that a cyber vigilance task could be based on. Finally, the rapid pace of technological evolution in network defense correspondingly means that cyber vigilance tasks can become obsolete just as quickly. Understanding these challenges is imperative in advancing human factors research in cyber security.

CCS categories

Human-centered computing~Human computer interaction (HCI)~HCI design and evaluation methods.

Assessment of Vigilance Level during Work: Fitting a Hidden Markov Model to Heart Rate Variability

This study aimed to enhance the real-time performance and accuracy of vigilance assessment by developing a hidden Markov model (HMM). Electrocardiogram (ECG) signals were collected and processed to remove noise and baseline drift. A group of 20 volunteers participated in the study. Their heart rate variability (HRV) was measured to train parameters of the modified hidden Markov model for a vigilance assessment. The data were collected to train the model using the Baum-Welch algorithm and to obtain the state transition probability matrix A^ and the observation probability matrix B^. Finally, the data of three volunteers with different transition patterns of mental state were selected randomly and the Viterbi algorithm was used to find the optimal state, which was compared with the actual state. The constructed vigilance assessment model had a high accuracy rate, and the accuracy rate of data prediction for these three volunteers exceeded 80%. Our approach can be used in wearable products to improve their vigilance level assessment functionality or in other fields that have key positions with high concentration requirements and monotonous repetitive work.

Red deer Cervus elaphus blink more in larger groups

Most animals need to spend time being vigilant for predators, at the expense of other activities such as foraging. Group-living animals can benefit from the shared vigilance effort of other group members, with individuals reducing personal vigilance effort as group size increases. Behaviors like active scanning or head lifting are usually used to quantify vigilance but may not be accurate measures of this. We suggest that measuring an animal's blinking rate gives a meaningful measure of vigilance: increased blinking implies reduced vigilance, as the animal cannot detect predators when its eyes are closed. We describe an observational study of a captive population of red deer, where we measured the blinking rates of individual deer from groups of differing sizes (where mean group size ranged between 1 and 42.7 individuals). We demonstrate that as group size increases in red deer, individuals increase their blink rate, confirming the prediction that vigilance should decrease. Blinking is a simple non-invasive measure and offers a useful metric for assessing the welfare of animals experiencing an increase in perceived predation risk or other stressors.