Delirium in early-stage Alzheimer's disease : enhancing cognitive reserve as a possible preventive measure

Delirium is a disorder of acute onset with fluctuating symptoms and is characterized by inattention, disorganized thinking, and altered levels of consciousness. The risk for delirium is greatest in individuals with dementia, and the incidence of both is increasing worldwide because of the aging of our population. Although several clinical trials have tested interventions for delirium prevention in individuals without dementia, little is known about the mechanisms for the prevention of delirium in early-stage Alzheimer’s disease (AD). The purpose of this article is to explore ways of preventing delirium and slowing the rate of cognitive decline in early-stage AD by enhancing cognitive reserve. An agenda for future research on interventions to prevent delirium in individuals with early-stage AD is also presented.

The cost effectiveness of Naltrexone added to cognitive-behavioral therapy in the treatment of alcohol dependence

he purpose of this study was to evaluate the comparative cost of treating alcohol dependence with either cognitive behavioral therapy (CBT) alone or CBT combined with naltrexone (CBT+naltrexone). Two hundred ninety-eight outpatients dependent on alcohol who were consecutively treated for alcohol dependence participated in this study. One hundred seven (36%) patients received adjunctive pharmacotherapy (CBT+naltrexone). The Drug Abuse Treatment Cost Analysis Program was used to estimate treatment costs. Adjunctive pharmacotherapy (CBT+naltrexone) introduced an additional treatment cost and was 54% more expensive than CBT alone. When treatment abstinence rates (36.1% CBT; 62.6% CBT+naltrexone) were applied to cost effectiveness ratios, CBT+naltrexone demonstrated an advantage over CBT alone. There were no differences between groups on a preference-based health measure (SF-6D). In this treatment center, to achieve 100 abstainers over a 12-week program, 280 patients require CBT compared with 160 CBT+naltrexone. The dominant choice was CBT+naltrexone based on modest economic advantages and significant efficiencies in the numbers needed to treat.

Mechanisms of change in negative thinking and urinary monoamines in depressed patients during acute treatment with group cognitive behavior therapy and antidepressant medication

This naturalistic study investigated the mechanisms of change in measures of negative thinking and in 24-h urinary metabolites of noradrenaline (norepinephrine), dopamine and serotonin in a sample of 43 depressed hospital patients attending an eight-session group cognitive behavior therapy program. Most participants (91%) were taking antidepressant medication throughout the therapy period according to their treating Psychiatrists' prescriptions. The sample was divided into outcome categories (19 Responders and 24 Non-responders) on the basis of a clinically reliable change index [Jacobson, N.S., & Truax, P., 1991. Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59, 12–19.] applied to the Beck Depression Inventory scores at the end of the therapy. Results of repeated measures analysis of variance [ANOVA] analyses of variance indicated that all measures of negative thinking improved significantly during therapy, and significantly more so in the Responders as expected. The treatment had a significant impact on urinary adrenaline and metadrenaline excretion however, these changes occurred in both Responders and Non-responders. Acute treatment did not significantly influence the six other monoamine metabolites. In summary, changes in urinary monoamine levels during combined treatment for depression were not associated with self-reported changes in mood symptoms.

On the cognitive effectiveness of routing symbols in process modeling languages

Process models provide visual support for analyzing and improving complex organizational processes. In this paper, we discuss differences of process modeling languages using cognitive effectiveness considerations, to make statements about the ease of use and quality of user experience. Aspects of cognitive effectiveness are of importance for learning a modeling language, creating models, and understanding models. We identify the criteria representational clarity, perceptual discriminability, perceptual immediacy, visual expressiveness, and graphic parsimony to compare and assess the cognitive effectiveness of different modeling languages. We apply these criteria in an analysis of the routing elements of UML Activity Diagrams, YAWL, BPMN, and EPCs, to uncover their relative strengths and weaknesses from a quality of user experience perspective. We draw conclusions that are relevant to the usability of these languages in business process modeling projects.

Modeling the effects of strategic flexibility, organisational learning on e-business adoption and competitive advantage : an empirical investigation

The role of intangible firm capabilities as a source of competitive advantage has come into prominence in marketing strategy literature, due to the Resource Based View. This paper applies the Resource Based View and hypothesizes that strategic flexibility and organisation learning, conceptualised as capabilities, positively effect e-business adoption and competitive advantage. Partial Lease Squares analysis suggest that theoretical constructs function as hypothesised and explain a significant variation on e-business adoption and competitive advantage. Firms adopting e-business should develop capabilities such as strategic flexibility and organisation learning and that vendor firms may segment their potential clients based on these capabilities.

Design and evaluation of an MRI compatible axial compression device for 3D assessment of spinal deformity and flexibility

Magnetic Resonance Imaging (MRI) offers a valuable research tool for the assessment of 3D spinal deformity in AIS, however the horizontal patient position imposed by conventional scanners removes the axial compressive loading on the spine which is an important determinant of deformity shape and magnitude in standing scoliosis patients. The objective of this study was to design, construct and test an MRI compatible compression device for research into the effect of axial loading on spinal deformity using supine MRI scans. The compression device was designed and constructed, consisting of a vest worn by the patient, which was attached via straps to a pneumatically actuated footplate. An applied load of 0.5 x bodyweight was remotely controlled by a unit in the scanner operator’s console. The entire device was constructed using non-metallic components for MRI compatibility. The device was evaluated by performing unloaded and loaded supine MRI scans on a series of 10 AIS patients. The study concluded that an MRI compatible compression device had been successfully designed and constructed, providing a research tool for studies into the effect of axial loading on 3D spinal deformity in scoliosis. The 3D axially loaded MR imaging capability developed in this study will allow future research investigations of the effect of axial loading on spinal rotation, and for imaging the response of scoliotic spinal tissues to axial loading.

Analysis and detection of cognitive load and frustration in drivers' speech

Non-driving related cognitive load and variations of emotional state may impact a driver’s capability to control a vehicle and introduces driving errors. Availability of reliable cognitive load and emotion detection in drivers would benefit the design of active safety systems and other intelligent in-vehicle interfaces. In this study, speech produced by 68 subjects while driving in urban areas is analyzed. A particular focus is on speech production differences in two secondary cognitive tasks, interactions with a co-driver and calls to automated spoken dialog systems (SDS), and two emotional states during the SDS interactions - neutral/negative. A number of speech parameters are found to vary across the cognitive/emotion classes. Suitability of selected cepstral- and production-based features for automatic cognitive task/emotion classification is investigated. A fusion of GMM/SVM classifiers yields an accuracy of 94.3% in cognitive task and 81.3% in emotion classification.

Design and evaluation of an MRI compatible axial compression device for 3D assessment of spinal deformity and flexibility in adolescent idiopathic scoliosis

Magnetic Resonance Imaging (MRI) offers a valuable research tool for the assessment of 3D spinal deformity in AIS, however the horizontal patient position imposed by conventional scanners removes the axial compressive loading on the spine. The objective of this study was to design, construct and test an MRI compatible compression device for research into the effect of axial loading on spinal deformity using supine MRI scans. The device was evaluated by performing unloaded and loaded supine MRI scans on a series of 10 AIS patients. The patient group had a mean initial (unloaded) major Cobb angle of 43±7º, which increased to 50±9º on application of the compressive load. The 7° increase in mean Cobb angle is consistent with that reported by a previous study comparing standing versus supine posture in scoliosis patients (Torell et al, 1985. Spine 10:425-7).

Multitasking, cognitive coordination and cognitive shifts during web searching

As Web searching becomes more prolific for information access worldwide, we need to better understand users’ Web searching behaviour and develop better models of their interaction with Web search systems. Web search modelling is a significant and important area of Web research. Searching on the Web is an integral element of information behaviour and human–computer interaction. Web searching includes multitasking processes, the allocation of cognitive resources among several tasks, and shifts in cognitive, problem and knowledge states. In addition to multitasking, cognitive coordination and cognitive shifts are also important, but are under-explored aspects of Web searching. During the Web searching process, beyond physical actions, users experience various cognitive activities. Interactive Web searching involves many users’ cognitive shifts at different information behaviour levels. Cognitive coordination allows users to trade off the dependences among multiple information tasks and the resources available. Much research has been conducted into Web searching. However, few studies have modelled the nature of and relationship between multitasking, cognitive coordination and cognitive shifts in the Web search context. Modelling how Web users interact with Web search systems is vital for the development of more effective Web IR systems. This study aims to model the relationship between multitasking, cognitive coordination and cognitive shifts during Web searching. A preliminary theoretical model is presented based on previous studies. The research is designed to validate the preliminary model. Forty-two study participants were involved in the empirical study. A combination of data collection instruments, including pre- and post-questionnaires, think-aloud protocols, search logs, observations and interviews were employed to obtain users’ comprehensive data during Web search interactions. Based on the grounded theory approach, qualitative analysis methods including content analysis and verbal protocol analysis were used to analyse the data. The findings were inferred through an analysis of questionnaires, a transcription of think-aloud protocols, the Web search logs, and notes on observations and interviews. Five key findings emerged. (1) Multitasking during Web searching was demonstrated as a two-dimensional behaviour. The first dimension was represented as multiple information problems searching by task switching. Users’ Web searching behaviour was a process of multiple tasks switching, that is, from searching on one information problem to searching another. The second dimension of multitasking behaviour was represented as an information problem searching within multiple Web search sessions. Users usually conducted Web searching on a complex information problem by submitting multiple queries, using several Web search systems and opening multiple windows/tabs. (2) Cognitive shifts were the brain’s internal response to external stimuli. Cognitive shifts were found as an essential element of searching interactions and users’ Web searching behaviour. The study revealed two kinds of cognitive shifts. The first kind, the holistic shift, included users’ perception on the information problem and overall information evaluation before and after Web searching. The second kind, the state shift, reflected users’ changes in focus between the different cognitive states during the course of Web searching. Cognitive states included users’ focus on the states of topic, strategy, evaluation, view and overview. (3) Three levels of cognitive coordination behaviour were identified: the information task coordination level, the coordination mechanism level, and the strategy coordination level. The three levels of cognitive coordination behaviour interplayed to support multiple information tasks switching. (4) An important relationship existed between multitasking, cognitive coordination and cognitive shifts during Web searching. Cognitive coordination as a management mechanism bound together other cognitive processes, including multitasking and cognitive shifts, in order to move through users’ Web searching process. (5) Web search interaction was shown to be a multitasking process which included information problems ordering, task switching and task and mental coordinating; also, at a deeper level, cognitive shifts took place. Cognitive coordination was the hinge behaviour linking multitasking and cognitive shifts. Without cognitive coordination, neither multitasking Web searching behaviour nor the complicated mental process of cognitive shifting could occur. The preliminary model was revisited with these empirical findings. A revised theoretical model (MCC Model) was built to illustrate the relationship between multitasking, cognitive coordination and cognitive shifts during Web searching. Implications and limitations of the study are also discussed, along with future research work.