A situated method for modelling and analysing the efficiency of cognitive activity during the radiology reporting workflow using eye-tracking

The success of modern medical imaging systems has created a data overload problem, where an ever-increasing number of examinations, generate more images per study, which all need to be evaluated by radiologists or other reporting practitioners. This operational bottleneck hasthe potentialto create fatigue and burnout due to the high mental workload that is required to keep up with the demand. The focus of this problem centres around the cognitive complexity of the radiology reporting workflow, and the associated workstation interactions involved in diagnostic report generation. There has been a significant body of work evaluating the behaviour of radiologists using controlled laboratory-based techniques, but these non-naturalistic studies fail to address the highly context dependant nature of the radiology reporting workflow. For example, the early eye-tracking work of Charmody et al; the psychometric studies by Krupinksi et al; and also the workstation interaction evaluations of Moise et al; whilst highly principled, can be all be questioned on the grounds of ecological validity and authenticity. This thesis asserts that the only way to truly understand and resolve the radiology data overload problem, is by developing a situated method for observing the reporting workflow that can evaluate the behaviours of the reporting clinicians in relation to their authentic reporting context. To this end, this study has set out to develop a new approach for observing and analysing the cognitive activities of the reporters relative to the demands of their genuine working environment, and supported through the application of a Critical Realist’s perspective to naturalistic workplace observations. This goal was achieved through the development of four key project deliverables: • An in-depth exploratory study of the radiology overload problem based on an extensive literature review and situated observations of authentic reporting workflows. • A descriptive hierarchical activity modelof the reporting workflow that can be understood by both clinicians, application designers and researchers. • A generalised methodology and research protocolfor conducting situated observations of the radiology reporting workflow, using an analysis based on the process tracing of sequencesof Object Related Actions, captured with eye-tracking and multimodal recordings. • A set of case studies demonstrating the applicability of the research protocol involving 5 Radiology Consultants, 2 Radiology Registrars and one Reporting Radiographer at a single NHS Hospital within the UK. The final workflow evaluation of the case studies demonstrated that activities such as error correction, and the collection of supporting radiological information from previous studies is complex, time consuming and cognitively demanding. These types of activities are characterised by long, low utility actions that correspond to what Kahneman refers to as “Thinking Slow”. Also, the participants appeared to be self-optimising their workflow via a sparse use of complex functionality and system tools. From these observations, the author recommends that any intervention that can reduce the number and the duration of the object related actions used to produce radiology reports, will reduce cognitive load, increase overall efficiency, and go some way to alleviate the data overload problem. 4 This study establishes a new set of situated techniques that are able to capture and quantify the complex dynamicactivities that make up the radiology reporting workflow. Itis hoped that the ability to distil usefuland impactful insightsfrom the user’s workstation behaviours can be used as the basis for further development in the area of workflow analysis and redesign, which will ultimately improve the working lives of Radiologists and other Reporting Clinicians. Lastly, the generic nature of these techniques make them amenable for use within any type of complex sociotechnical human factors study related to the cognitive efficiency of the user

Effects of midlatitude westerlies on the paleoproductivity at the Agulhas Bank slope during the penultimate glacial cycle: Evidence from coccolith Sr/Ca ratios

Modern primary productivity on the Agulhas Bank, off South Africa, has been proposed to be linked to the midlatitude westerlies. A paleoproductivity record from this area may therefore resolve temporal changes in the westerly dynamics. Accordingly, we produced a coccolith Sr/Ca-based paleoproductivity record from core MD96-2080 (Agulhas Bank slope) during the penultimate glacial-interglacial cycle. Deriving the productivity signal from Sr/Ca requires a correction for a temperature effect, here constrained using Mg/Ca sea surface temperatures from the foraminifer Globigerina bulloides from core MD96-2080. Phases of depressed productivity coincided with periods of stratification in the same core, indicated by high relative abundances of the coccolithophore Florisphaera profunda and with low relative abundances of the upwelling indicator G. bulloides in the nearby Cape Basin. These observations collectively suggest that productivity was regulated by upwelling throughout this region. We infer that, as in the present, periods of low productivity result from a more northerly position of the westerlies, potentially accompanied by subtropical front displacements, and blockage of upwelling promoting easterlies. Productivity minima also coincide with periods of increased ice-rafted detritus (IRD) deposition on the Agulhas Plateau, which also indicates extreme northward positions of the westerlies. The influence of the westerlies appears to be obliquity conditioned, as productivity minima (and IRD maxima) occur during low-obliquity intervals. The dynamic connection between productivity and the westerlies is supported by coeval salinity changes in the South Indian Gyre that likewise respond sensitively to a poleward contraction of the westerlies

Functional impact of global rare copy number variation in autism spectrum disorders.

International audienceThe autism spectrum disorders (ASDs) are a group of conditions characterized by impairments in reciprocal social interaction and communication, and the presence of restricted and repetitive behaviours. Individuals with an ASD vary greatly in cognitive development, which can range from above average to intellectual disability. Although ASDs are known to be highly heritable ( approximately 90%), the underlying genetic determinants are still largely unknown. Here we analysed the genome-wide characteristics of rare (<1% frequency) copy number variation in ASD using dense genotyping arrays. When comparing 996 ASD individuals of European ancestry to 1,287 matched controls, cases were found to carry a higher global burden of rare, genic copy number variants (CNVs) (1.19 fold, P = 0.012), especially so for loci previously implicated in either ASD and/or intellectual disability (1.69 fold, P = 3.4 x 10(-4)). Among the CNVs there were numerous de novo and inherited events, sometimes in combination in a given family, implicating many novel ASD genes such as SHANK2, SYNGAP1, DLGAP2 and the X-linked DDX53-PTCHD1 locus. We also discovered an enrichment of CNVs disrupting functional gene sets involved in cellular proliferation, projection and motility, and GTPase/Ras signalling. Our results reveal many new genetic and functional targets in ASD that may lead to final connected pathways