Curtis Craig

Using Cognitive Task Analysis to Identify Critical Decisions in the Laparoscopic Environment

Objective: The aim of this study was to identify the critical decisions surgeons need to make regarding laparoscopic surgery, the information these decisions are based on, the strategies employed by surgeons to reach their objectives, and the difficulties experienced by novices. Background: Laparoscopic training focuses on the development of technical skills. However, successful surgical outcomes are also dependent on appropriate decisions made during surgery, which are influenced by critical cues and the use of appropriate strategies. Novices might not be as adept at cue detection and strategy use. Method: Participants were eight attending surgeons. The authors employed task-analytic techniques to identify critical decisions inherent in laparoscopy and the cues, strategies, and novice traps associated with these decisions. Results: The authors used decision requirements tables to organize the data into the key decisions made during the preoperative, operative, and postoperative phases as well as the cues, strategies, and novice traps associated with these decisions. Key decisions identified for the preoperative phase included but were not limited to the decision of performing a laparoscopic versus open surgery, necessity to review the literature, practicing the procedure, and trocar placement. Some key decisions identified for the operative phase included converting to open surgery, performing angiograms, cutting tissue or organs, and reevaluation of the approach. Only one key decision was identified for the postoperative phrase: whether the surgeon’s technique needs to be evaluated and revised. Conclusion: The laparoscopic environment requires complex decision making, and novices are prone to errors in their decisions. Application: The information elicited in this study is applicable to laparoscopic training.

Attentional network deficits in children with autism spectrum disorder.

Abstract Statement of purpose: Individuals with autism spectrum disorder (ASD) often demonstrate deficient attentional ability, but the specific nature of the deficit is unclear. The Attention Networks model provides a useful approach to deconstruct this attentional deficit into its component parts. Method: Fifty-two neurotypical (NT) children and 14 children with ASD performed the child version of the Attention Network Test (ANT). The latter requires participants to indicate the direction of a centre target stimulus, which is presented above/below fixation and sometimes flanked by either congruent or incongruent distractor stimuli. Results: Relative to NT children, those with ASD were: (1) slower to react to spatially cued trials and (2) more error prone on executive (conflict) attention trials. Conclusions: Young children with ASD have intact alerting attention, but less-efficient orienting and executive attention.

Mental stress experienced by first-year residents and expert surgeons with robotic and laparoscopic surgery interfaces

Prior research has indicated that novices experienced a beneficial stress profile in the robotic surgery (da Vinci) training environment when compared to the laparoscopic surgery training environment. The objective of this study was to assess whether this finding generalizes to expert surgeons. Towards that end, first-year residents’ and attending surgeons’ performances and subjective stress experiences were assessed in a surgical training task that was performed with the da Vinci and laparoscopic surgery interfaces. This study indicated that both groups exhibited superior performance and lower stress with the da Vinci surgical system than the laparoscopic system. The results provide further support for the sensitivity of the Dundee Stress State Questionnaire in identifying different stress responses experienced by trainees and experts in the minimally invasive surgery environment.

Sideways Camera Rotations of 90° and 135° Result in Poorer Performance of Laparoscopic Tasks for Novices

Objective: The aim of this study was to determine the impact of sideways visuomotor rotations between 0° and 180° on novice performance in a laparoscopic simulator. Background: The laparoscopic surgical environment often involves visuomotor rotations because the laparoscope may be placed to the surgeon’s side. Basic research by Cunningham indicated that visuomotor rotations between 90° and 135° result in peak performance decrements. Research by Ames and colleagues failed to replicate Cunningham’s results in the laparoscopic environment, possibly due to (a) confounds from carryover effects or (b) use of an alternative laparoscopic training task rather than the straight-line pointing task used by Cunningham. Two experiments were conducted to determine if Cunningham’s results generalize to the laparoscopic environment when controlling for carryover effects for a three-dimensional “straight-line” pointing task (Experiment 1) and a laparoscopic training task (Experiment 2). Method: In Experiments 1 and 2, participants were assigned to one of five visuomotor rotations: 0°, 45°, 90°, 135°, or 180°. Utilizing a laparoscopic simulator, participants performed either a three-dimensional pointing task (Experiment 1) or a peg transfer task (Experiment 2). Results: In both experiments, visuomotor rotations of 90° or 135° resulted in the poorest performance. Conclusion: When controlling for carryover effects, Cunningham’s results generalize to novices’ performance of a pointing and a peg transfer task in the laparoscopic environment. Applications: The results indicate that 90° and 135° sideways laparoscope placements may result in worse performance for novices in the laparoscopic environment, indicating potentially longer learning curves for these conditions in the laparoscopic as well as other teleoperation environments.

A relationship between temperature and aggression in NFL football penalties

Background Increased ambient temperature has been implicated in increased physical aggression, which has important practical consequences. The present study investigates this established relationship between aggressive behavior and ambient temperature in the highly aggressive context of professional football in the National Football League (NFL). Methods Using a publicly available dataset, authors conducted multiple hierarchical regression analyses on game-level data (2326 games). Results The analysis revealed that temperature positively predicted aggressive penalties in football, and that this relationship was significant for teams playing at home but not for visiting teams. Conclusion These results indicate that even in the aggressive context of football, warmer weather contributes to increased violence. Further, the presence of the heat-aggression relationship for the home team suggests that the characteristics of interacting groups may influence whether heat would have an adverse effect on the outcome of those interactions.

The Importance of Water is in Question Aquatic Nature Images Do Not Have Significantly Higher Restorativeness Ratings than Green Nature Images

Previous research has indicated that aquatic features in nature may have additional restorative potential. The present study assessed the perceived restorativeness for nature images that contained only aquatic features (no greenery) and compared them to images that contained only greenery (no water) and only urban environments (no water or greenery) instead of using images that had various proportions of water and greenery, as conducted in previous research. There were no significant differences in ratings on the short-version of Perceived Restorativeness Scale’s (PRS) for aquatic-only compared to green-only images, but both had superior ratings on the short PRS compared to urban images. Thus, our findings indicated that aquatic-only images may not increase restorative potential compared to green-only images, at least not as assessed by the short PRS. Future research needs to assess the restorative effect induced by aquatic-only and green-only nature scenery on cognitive performance.

Oxygenation of the prefrontal cortex during sequential planning in the Tower of London

To investigate the utility of neural theories for human planning, this study used near-infrared spectroscopy to investigate prefrontal (PFC) oxygenation for a well-established planning task: The Tower of London (TOL). Changes in prefrontal oxygenated hemoglobin from baseline were measured during task performance. Performing the Tower of London led to a significant increase in oxygenation in the left caudal region of the PFC in difficult trials moves relative to easier trials. The different degree of prefrontal oxygenation agrees with previous research and provides further evidence for a capacity utilization framework for measuring neurocognitive demand. Higher activity in the left rostral frontopolar region predicted better performance in the Tower of London, which agrees with a proposed rostral-caudal control hierarchy for the prefrontal cortex. Observed results support the feasibility of near-infrared spectroscopy to assess activity during tasks requiring planning ability and provide support for two neurocognitive models, capacity utilization and rostro-caudal control hierarchy.

A positive relationship between nature appreciation, emotional functioning, and perception of work value

Previous research has noted potential emotional benefits of being in nature. This study examined whether nature appreciation is also positively related to perception of work-value. Frequency of nature appreciation and a number of variables related to emotion, well-being, and perceived work value were analyzed using hierarchical regression techniques with a publicly available data set, consisting of a large sample of middle-aged and older adults. Nature appreciation was significantly associated with certain emotional outcomes including increased positive affect, well-being, as well as reduced perceived stress. Nature was also associated with increased epinephrine, implying a complex relationship between nature and emotion regulation. Nature offers numerous benefits for individuals across the spectrum of psychological functioning. The findings are relevant for psychologists in promoting the well being of workers.

Camera Placement in Simulated Laparoscopic Surgery Influences Performance

Laparoscopic surgery requires surgeons to view rotated visual feedback of the surgical field. However, systematic assessments of the effects of visuomotor rotations on performance have been controversial. Forty novice undergraduates performed a pointing task in a laparoscopic trainer box while experiencing one of five different visuomotor rotations: 0°, 45°, 90°, 135°, and 180°. Performance was measured using root mean squared error (RMSE). When initially exposed to the visuomotor rotations, participants’ performance was superior in the 0° condition when compared to the 45°, 90°, and 135° conditions. The pattern of results observed in the present study were consistent with basic research by Cunningham (1989) that showed the most severe performance decrements for rotations between 90° and 135°. With prolonged exposure to the visuomotor rotations, participants adapted to the distortions. The results of the present study are relevant to the design of laparoscopic training currilicula.

Minimizing the impact of interruptions in a pediatric retail pharmacy

Researchers identified two needs of the in-hospital pediatric retail pharmacy. First was the reduction of the risk and frequency of errors. Second was the need to improve the efficiency of primary pharmacy tasks. Interruptions were identified as the primary issue. The team performed an extensive literature review and conducted interviews and observations to assess the pharmacy work system, work flow, and the impact of interruptions. A human factors analysis was done to accurately represent the pharmacy work system from data collection, and derive recommendations to improve efficiency and accuracy. Some of the recommendations were rapidly implemented into the pharmacy work system, including increased staffing during periods of high work demand, changes to counter spacing, and design changes to bags intended to contain refrigerated components. The research team conducted follow-up observations and collected survey data from pharmacy staff to determine the impact of the implemented interventions and identify key improvements.