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.

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.

Re-conceptualising IS function's support performance : a preliminary model

While IS function has gained widespread attention for over two decades, there is little consensus among information systems (IS) researchers and practitioners on how best to evaluate IS function's support performance. This paper reports on preliminary findings of a larger research effort proceeds from a central interest in the importance of evaluating IS function's support in organisations. This study is the first that attempts to re-conceptualise and conceive evaluate IS function's support as a multi- dimensional formative construct. We argue that a holistic measure for evaluating evaluate IS function's support should consist of dimensions that together assess the variety of the support functions and the quality of the support services provided to end-users. Thus, the proposed model consists of two halves, "Variety" and "Quality" within which resides seven dimensions. The Variety half includes five dimensions: Training; Documentation; Data- related Support, Software-related Support; and Hardware-related Support. The Quality half includes two dimensions: IS Support Staff and Support Services Performance. The proposed model is derived using a directed content analysis of 83 studies; from top IS outlets, employing the characteristics of the analytic theory and consistent with formative construct development procedures.

Exercise, appetite, and energy balance: The interactions between energy expenditure and intake, and the implications for weight management

This book disseminates current information pertaining to the modulatory effects of foods and other food substances on behavior and neurological pathways and, importantly, vice versa. This ranges from the neuroendocrine control of eating to the effects of life-threatening disease on eating behavior. The importance of this contribution to the scientific literature lies in the fact that food and eating are an essential component of cultural heritage but the effects of perturbations in the food/cognitive axis can be profound. The complex interrelationship between neuropsychological processing, diet, and behavioral outcome is explored within the context of the most contemporary psychobiological research in the area. This comprehensive psychobiology- and pathology-themed text examines the broad spectrum of diet, behavioral, and neuropsychological interactions from normative function to occurrences of severe and enduring psychopathological processes

Wellness in older adults

Understanding perception of wellness in older adults is a question to be understood against the backdrop of concerns about whether global ageing and the ‘bulge’ of ageing baby boomers will increase health care cost beyond what modern economies can deal with. Older adults who age in a healthy way and who take responsibility for their own health offer a positive alternative and change the perception that older adults are a burden on their society’s health system. The concept of successful ageing introduced by Rowe and Kahn (1987; 1997) suggested that older adults age successfully if they avoid disease and disability, maintain high cognitive and physical functioning and remain actively engaged with life. This concept, however, did not reflect older adults’ own perceptions of what constitutes successful ageing or how perceptions of wellness or health-related quality of life influenced the older adult’s understanding of his or her own health and ageing. A research project was designed to examine older adults’ perceptions of wellness in order to gain an understanding of the factors that influence perception of their own wellness. Specifically, the research wanted to explore two aspects: whether belonging to a unique organisation, in this instance a Returned Services Club, influenced perceptions of wellness; and whether there are significant gender differences for the perception of wellness. A mixed method project with two consecutive studies was designed to answer these questions: a quantitative survey of members of a Returned Services Club and of the surrounding community in Queensland, Australia, and a qualitative study conducting focus groups to explore findings of the survey. The results of the survey were used to determine the composition of the focus groups. The participants for the first study, (N=257), community living adults 65 years and older, were chosen from the membership role of a Returned Services Club or recruited by personal approach from the community surrounding the Services Club. Participants completed a survey that consisted of a perception of wellness instrument, a health-related quality of life instrument, and questions on morbidities, modifiable life style factors and demographics. Data analysis found that a number of individual factors influenced perception of wellness and health-related quality of life. Positive influences were independent mobility, exercise and gambling at non-hazardous levels, and negative influences were hearing loss, memory problems, chronic disease and being single. Membership of the Services Club did not contribute to perception of wellness beyond being a member of a social group. While there may have been an expectation that members of an organisation that is traditionally associated with high alcohol use and problematic gambling may have lower perceptions of wellness, this study suggested that the negative influences may have been counteracted by the positive effects of social interaction, thus having neither negative nor positive influences on perception of wellness. There were significant differences in perception of wellness and in health-related quality of life for women and men. The most significant difference was for women aged 85-90 who had significantly lower scores for perception of wellness than men or than any other age group. This result was the impetus for conducting focus groups with adults aged 85-90 years of age. Focus groups were conducted with 24 women and four men aged 85-90 to explore the survey findings for this age group. Results from the focus groups indicated that for older adults perception of wellness was a multidimensional construct of more complexity than indicated by the survey instrument. Elite older women (women over 85 years of age) related their perception of wellness to their ability to do what they wanted to do, and what they wanted to do significantly more than anything else, was to stay connected to family, friends and the community to which they belonged. From the focus group results it appeared that elite older women identified with the three elements of successful ageing – low incidence of disability and disease, high physical and cognitive functioning, and active engagement with life – but not in a flat structure. It appears that for elite older women good physical and mental health function to enable social connectedness. It is the elements of health that impact on the ability to do what they wanted to do that were identified as key factors: independent mobility, hearing and memory - factors that impact on the ability to interact socially. These elements were only identified when they impacted on the person’s ability to do what they wanted to do, for example mobility problems that were managed were not considered a problem. The study also revealed that older women use selection, optimisation and compensation to meet their goal of staying socially connected. The shopping centre was a key factor in this goal and older women used shopping centres to stay connected to the community and for exercise as well as shopping. Personal and public safety and other environmental concerns were viewed in the same context of enabling or disabling social connectedness. This suggested that for elite older women the model of successful ageing was hierarchical rather than flat, with social connectedness at the top, supported by cognitive functioning and good physical and mental health. In conclusion, this research revealed that perception of wellness in older adults is a complex, multidimensional construct. For older adults good health is related to social connectedness and is not a goal in itself. Health professionals and the community at large have a responsibility to take into account the ability of the older adult to stay socially connected to their community and to enable this, if the goal is to keep older adults healthy for as long as possible. Maintaining or improving perception of wellness in older adults will require a broad biopsychosocial approach that utilises findings such as older adults’ use of shopping centres for non-shopping purposes, concerns about personal and environmental safety and supporting older adults to maintain or improve their social connectedness to their communities.

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.

A cybernetic approach to land management issues

This work is a digital version of a dissertation that was first submitted in partial fulfillment of the Degree of Doctor of Philosophy at the Queensland University of Technology (QUT) in March 1994. The work was concerned with problems of self-organisation and organisation ranging from local to global levels of hierarchy. It considers organisations as living entities from local to global things that a living entity – more particularly, an individual, a body corporate or a body politic - must know and do to maintain an existence – that is to remain viable – or to be sustainable. The term ‘land management’ as used in 1994 was later subsumed into a more general concept of ‘natural resource management’ and then merged with ideas about sustainable socioeconomic and sustainable ecological development. The cybernetic approach contains many cognitive elements of human observation, language and learning that combine into production processes. The approach tends to highlight instances where systems (or organisations) can fail because they have very little chance of succeeding. Thus there are logical necessities as well as technical possibilities in designing, constructing, operating and maintaining production systems that function reliably over extended periods. Chapter numbers and titles to the original thesis are as follows: 1. Land management as a problem of coping with complexity 2. Background theory in systems theory and cybernetic principles 3. Operationalisation of cybernetic principles in Beer’s Viable System Model 4. Issues in the design of viable cadastral surveying and mapping organisation 5. An analysis of the tendency for fragmentation in surveying and mapping organisation 6. Perambulating the boundaries of Sydney – a problem of social control under poor standards of literacy 7. Cybernetic principles in the process of legislation 8. Closer settlement policy and viability in agricultural production 9. Rate of return in leasing Crown lands