Computer-based Assessment Tool Research Articles

P18. Development And Comparative Evaluation Of Computer-based Assessment Tools for Manual and Robotic Microsurgery

P18. Development And Comparative Evaluation Of Computer-based Assessment Tools for Manual and Robotic Microsurgery

Predicting the incidence of mild cognitive impairment with a computer-based cognitive assessment tool in community-dwelling older adults: The Otassha study.

This study examined the ability of a computer-based cognitive assessment tool (CompBased-CAT) to predict mild cognitive impairment (MCI) in community-dwelling older adults. A two-year longitudinal study was conducted using data from 2016 to 2018 from the Otassha study cohort of community-dwelling older adults. MCI was defined as a Mini-Mental Status Examination (MMSE) score of <27. The CompBased-CAT was used at baseline, with each subtest score converted into a Z-score. Subsequently, the total Z-scores were calculated. Participants were divided into robust and MCI groups, and all variables were compared using the t-test or χ2 test. Receiver operating characteristic (ROC) curves and logistic regression analyses were conducted, with MCI and total Z-scores as dependent and independent variables, respectively. Among the 455 participants (median age, 72 years; range, 65-89 years; 282 women and 173 men), 32 developed MCI after two years. The participants in the MCI group were significantly older. They had lower maximal gait speed, baseline MMSE scores, subtest Z-scores, and total Z-scores than those in the robust group. The area under the ROC curve was 0.79 (95% confidence interval: 0.70-0.87; P <0.01). The sensitivity was 0.76, and the specificity was 0.75. The logistic regression analysis showed an odds ratio of 1.34 (95% confidence interval: 1.18-1.52; P <0.01). This study showed that CompBased-CAT can detect MCI, which is an early stage of dementia. Thus, CompBased-CAT can be used in future community health checkups and events for older adults.

Development of an Offline Computer-Based Assessment Tool in Statistics and Probability Utilizing MS PowerPoint and MS Excel

This capstone project aimed to develop an offline computer-based assessment (CBA) tool that uses a computer instead of a traditional paper test in evaluating student learning. This addresses the difficulties faced by teachers in administering quarterly assessments. Incorporating technology into student assessment can increase student interest because of the immediate feedback generated automatically and can help teachers improve their work performance. This capstone project employed a developmental approach and utilized a modified ADDIE (Analysis, Design, and Development) model to design the tool using Microsoft PowerPoint and Excel. Ten experts in mathematics, ICT, and assessment validated the face and content validity of the developed CBA tool. Based on the panel’s evaluation, the developed offline CBA tool in Statistics and Probability has passed all the assigned criteria, such as functionality, usability, efficiency, technicality, and accessibility. Overall, the developed CBA tool is suitable for use to address assessment-related issues.

Digital measurement of hands-on performance? Ecological validation of a computer-based assessment of automotive repair skills

We investigated the ecological validity of performance measures from a computer-based assessment tool that utilises scripted video vignettes. The intended purpose of this tool is to assess the maintenance and repair skills of automotive technician apprentices, complementing traditional hands-on assessment formats from the German journeymen’s exams. We hypothesise that the ability to correctly judge repair actions shown in videos is a good predictor of the ability to perform corresponding actions in hands-on scenarios. Apprentices in the third year of vocational training carried out repairs on real cars or car systems, while experts rated their performance. After this, they worked on our computer-based tests, which utilise videos of very similar repairs. The correlation between video judgement and hands-on performance was lower than expected for most repair actions as well as for overall scores, indicating insufficient ecological validity of the test score interpretations. However, the findings are promising for developing future tests, as the results for some repair actions indicate it is generally possible to develop ecologically valid video-based items focusing on hands-on skills. We discuss the results in the light of a validation framework that combines validity evidence from different sources for the same assessment tool. Finally, we hope our findings contribute to a broader discussion about the psychometric quality of exams.

A Novel Computer-Based Assessment Tool for Evaluating Early Literacy Skills in Italian Preschoolers

ABSTRACT The present contribution aims at presenting an assessment tool (i.e., the TALK-assessment) built to evaluate the language development and school readiness of Italian preschoolers before they enter primary school, and its predictive validity for the children’s reading and writing skills at the end of the first year of primary school. The early literacy competences of 98 preschoolers were assessed and the statistical proprieties (item difficulty level and Discrimination Index, and the factorial structure using Confirmatory Factor Analysis) of each subtest of the assessment were presented (Study 1). Results showed that the subtests of the tool have good psychometric properties, with the only exception of the morpho-syntactic comprehension task, and are adequate for use with preschoolers in the school context. Study 2 investigated the early literacy skills of a group of 62 preschoolers and their reading and writing abilities at the end of primary school 1st grade. The scores obtained in the phonological awareness task of the final version of the assessment in preschool significantly predicted children’s reading scores 12 months later, at primary school. The scores obtained in the lexical comprehension and morpho-syntactic production (i.e., sentence repetition) tasks of the final version of the assessment in preschool significantly predicted children’s writing scores 12 months later, at primary school. The assessment has specific characteristics that make it a valuable candidate for adoption in educational settings, both to identify fragile areas in time to modify the children’s developmental paths to literacy and to prevent future language and literacy difficulties at primary school.

Online Assessment and Game-Based Development of Inductive Reasoning.

The aims of the study were (1) to develop a domain-general computer-based assessment tool for inductive reasoning and to empirically test the theoretical models of Klauer and Christou and Papageorgiou; and (2) to develop an online game to foster inductive reasoning through mathematical content and to investigate its effectiveness. The sample was drawn from fifth-grade students for the assessment (N = 267) along with the intervention study (N = 122). The online figurative test consisted of 54 items: nine items were developed for each of the six inductive reasoning processes. The digital game-based training program included 120 learning tasks embedded in mathematical content with differential feedback and instructional support. The test had good psychometric properties regarding reliabilities, means, and standard deviations. Confirmatory factor analyses revealed that the six processes of inductive reasoning and the three latent factors of Similarity, Dissimilarity, and Integration could be empirically confirmed. The training program was effective in general (corrected effect size = .38); however, the process of cross-classification was not developed significantly. Findings could contribute to a more detailed understanding of the structure and the modifiability of inductive reasoning processes and could reveal further insights into the nature of fluid intelligence.

Development and validity of the Computer-Based Cognitive Assessment Tool for intervention in community-dwelling older individuals.

AimThe Mini‐Mental State Examination is a widely used cognitive assessment tool. However, it has several limitations, including the learning effect and interrater reliability. Therefore, we developed a Computer‐Based Cognitive Assessment Tool (CompBased‐CAT), which runs on a tablet or personal computer. In this study, we examined the validity and discrimination ability of the CompBased‐CAT.MethodsParticipants were recruited from the Otasha‐Kenshin study carried out in 2016. We included 773 community‐dwelling older individuals in Japan (332 men, 441 women, aged 65–97 years). CompBased‐CAT scores were converted to z‐scores, and the correlation with Mini‐Mental State Examination scores was examined using Pearson's correlation coefficient. Furthermore, the ability to discern cognitive impairment was examined using the receiver operating characteristic curve.ResultsThe Pearson's correlation coefficient for the Mini‐Mental State Examination scores and each task component of the CompBased‐CAT ranged from 0.24 to 0.41 (P < 0.001), and the correlation coefficient of the total z‐scores was 0.51 (P < 0.001). The sensitivity, specificity and area under the receiver operating characteristic curve of the discriminating ability of the CompBased‐CATool for cognitive impairment were 0.81, 0.77 and 0.85, respectively.ConclusionsThe CompBased‐CAT certainly possesses validity, discriminating ability and utility as a new cognitive assessment tool in community‐dwelling older individuals. Geriatr Gerontol Int 2020; ••: ••–••.

Effects of macular xanthophyll supplementation on brain-derived neurotrophic factor, pro-inflammatory cytokines, and cognitive performance

PurposeOxidative and inflammatory processes play a major role in stress-induced neural atrophy. There is a wide body of literature linking oxidative and inflammatory stress with reductions in neurotrophic factors, stress resilience, and cognitive function. Based on their antioxidant and anti-inflammatory capacity, we investigated the effect of the dietary carotenoids lutein and zeaxanthin, along with the zeaxanthin isomer meso-zeaxanthin (collectively the “macular xanthophylls” [MXans]) on systemic brain-derived neurotrophic factor (BDNF) and anti-oxidant capacity (AOC), and the pro-inflammatory cytokines TNF-α, IL-6, and IL-1β. To investigate higher-order effects, we assessed cognitive performance. Methods59 young (18–25 yrs.), healthy subjects participated in a 6-month, double-blind, placebo-controlled trial to evaluate the effects of MXan supplementation on the aforementioned serum parameters and cognitive performance. Subjects were randomly assigned to one of three groups: placebo, 13 mg, or 27 mg/day total MXans; all measures were taken at baseline and 6 months. Blood was obtained via fasting blood draw, and MXan concentration in the retina (termed macular pigment optical density [MPOD]) was measured via customized heterochromatic flicker photometry. Serum BDNF and cytokines were assessed via ELISA. Serum antioxidant capacity (AOC) and serum MXan concentrations were quantified via colorimetric microplate assay, and high-performance liquid chromatography, respectively. Cognitive performance was measured via a computer-based assessment tool (CNS Vital Signs). ResultsBDNF, MPOD, serum MXans, and AOC all increased significantly versus placebo in both treatment groups over the 6-month study period (p < .05 for all). IL-1β decreased significantly versus placebo in both treatment groups (p = .0036 and p = .006, respectively). For cognitive measures, scores for composite memory, verbal memory, sustained attention, psychomotor speed, and processing speed all improved significantly in treatment groups (p < .05 for all) and remained unchanged in the placebo group. Several measures were found to be significantly associated in terms of relational changes over the course of the study. Notably, change in BDNF was related to change in IL-1β (r = −0.47; p < .001) and MPOD (r = 0.44; p = .0086). Additionally, changes in serum MXans were strongly related to AOC (r = 0.79 & 0.61 for lutein and zeaxanthin isomers respectively; p < .001). For cognitive scores, change in BDNF was correlated to change in composite memory (r = 0.32; p = .014) and verbal memory (r = 0.35; p = .007), whereas change in MPOD was correlated with change in both psychomotor speed (r = 0.38; p = .003), and processing speed (r = 0.35; p = .007). Change in serum lutein was found to be significantly correlated to change in verbal memory (r = 0.41; p < .001), composite memory (r = 0.31; p = .009), and sustained attention (r = 0.28; p = .036). Change in serum zeaxanthin isomers was significantly correlated with change in verbal memory (r = 0.33; p = .017). Lastly, change in AOC was significantly associated with verbal memory (r = 0.34; p = .021), composite memory (r = 0.29; p = .03), and sustained attention (r = 0.35; p = .016). No significant relational changes in any cognitive parameter were found for the placebo group. ConclusionsSix months of daily supplementation with at least 13 mg of MXans significantly reduces serum IL-1β, significantly increases serum MXans, BDNF, MPOD, and AOC, and improves several parameters of cognitive performance. Findings suggest that increased systemic antioxidant/anti-inflammatory capacity (and not necessarily deposition of the carotenoids in neural tissues), may explain many of the effects determined in this study. The significant relationship between change in BDNF and IL-1β over the course of the study suggests that regular consumption of MXans interrupts the inflammatory cascade that can lead to reduction of BDNF. Changes in MPOD and BDNF appear to account for enhancement in cognitive parameters that involve speed of processing and complex processing, respectively.ISRCTN Clinical Trial Registration: ISRCTN16156382.

Protocol for a prospective cohort study of assessing postoperative cognitive changes after total hip and knee arthroplasty in the Greater Toronto area

IntroductionCognitive changes after anaesthesia and surgery, such as delirium and postoperative cognitive dysfunction (POCD), are common and lead to poor outcomes and increased healthcare costs. While several interventions for delirium...

Measuring reliability and validity of “Stressometer®”: A computer-based mass screening and assessment tool for evaluation of stress level and sources of stressors

Introduction:It is essential to develop tools that can identify stress manifestation, source of stressors, and suffering in an effort to bridge the treatment gap and enhance behavioral health in the developing world. To that aim, the Stressometer® (SOM) was developed as a comprehensive scale of stress and behavioral health for use around the world.Materials and Methods:A validation study of the Stressometer® (SOM) was undertaken with a sample in India that included a nonclinical group and a group of patients at a clinic in New Delhi. For validation purposes, participants were also administered three currently validated scales, including Perceived Stress Scale, Stress Overload Scale (SOS), and Depression Anxiety Stress Scale (DASS).Results:The Stressometer® (SOM) was found to be reliable and had high correlations with established scales.Conclusion:Stressometer® (SOM) is a valid and reliable, computer based mass screening tool for evaluation of stress level and sources of stress. Overall, Stressometer® (SOM) creates a robust measurement of stress and behavioral health that is likely culturally neutral and thus has universal applicability. A scale such as this one is ideal for use in the developing world to help bridge the treatment gap created and enhance behavioral health, especially in those suffering.

Számítógépes kockázatelemzés és büntetõeljárás

A szerzők áttekintést nyújtanak az Egyesült Államok büntetőeljárása során alkalmazott számítógépes kockázatelemzési eszközökről és az ilyen algoritmusok alkalmazásának lehetőségeiről a magyar büntetőeljárási rendszerben.

Development of EirV3: A Computer-Based Tool for Patient-Reported Outcome Measures in Cancer.

Immediate transfer of patient-reported outcome measures (PROMs) for use in medical consultations is facilitated by electronic assessments. We aimed to describe the rationale and development of Eir version 3 (EirV3), a computer-based symptom assessment tool for cancer, with emphasis on content and user-friendliness. EirV3's specifications and content were developed through multiprofessional, stepwise, and iterative processes (from 2013 to 2016), with literature reviews on traditional and electronic assessment and classification methods, formative iterative usability tests with end-users, and assessment of patient preferences for paper versus electronic assessments. EirV3 has the following two modules: Eir-Patient for PROMs registration on tablets and Eir-Doctor for presentation of PROMs in a user-friendly interface on computers. Eir-Patient starts with 19 common cancer symptoms followed by specific, in-depth questions for endorsed symptoms. The pain section includes a body map for pain location and intensity, whereas physical functioning, nutritional intake, and well-being are standard questions for all. Data are wirelessly transferred to Eir-Doctor. Symptoms with intensity scores ≥ 3 (on a 0 to 10 scale) are marked in red, with brighter colors corresponding to higher intensity, and supplemented with graphs displaying symptom development over time. Usability results showed that patients and health care providers found EirV3 to be intuitive, easy to use, and relevant. When comparing PROM assessments on paper versus tablets (n = 114), 19% of patients preferred paper, 41% preferred tablets, and 40% had no preference. Median intraclass correlation coefficient between paper and tablets (0.815) was excellent. Iterative test rounds followed by continuous improvements led to a user-friendly, applicable symptom assessment tool, EirV3, developed for and by end-users. EirV3 is undergoing international testing of clinical and cross-cultural adaptability.

Computerized Dual-Task Testing of Gait and Visuospatial Cognitive Functions; Test-Retest Reliability and Validity.

The common occurrence of age decline in mobility and cognition does cause a decrease in the level of physical activity and an increased falls risk. Consequently, dual -task (DT) assessment that simultaneously addresses both mobility skills and cognitive functions are important because, continued difficulties and fall injuries will have a sizable impact in this population. The first objective of the present study was to assess test-retest reliability of a computerized DT treadmill walking protocol and concurrent outcome measures of gait and visuospatial executive function in a group of healthy older adults. Secondly, discriminative validity was evaluated by examining the effect of DT conditions (single task vs. dual-task) on; (a) spatiotemporal gait measures (average and coefficient of variation) and (b) visuomotor and visuospatial executive performance measures. Twenty-five community-dwelling individuals median age 65 (range 61–67) were recruited from a Fitness Facility. Participants performed a computerized visuomotor tracking task and a visuospatial executive game task in standing and while treadmill walking. Testing was conducted on two occasions, 1 week apart. Moderate to high test-retest reliability (ICC values of 0.65–0.88) were observed for spatiotemporal gait variables. No significant differences between the group means were observed between test periods in any gait variable. Moderate test-retest reliability (ICC values of 0.6–0.65) was observed for measures of visuomotor and visuospatial executive performance during treadmill walking. Significant DT effects were observed for both spatiotemporal gait variables and visuospatial executive performance measures. This study demonstrates the reliability and reproducibility of the computer-based assessment tool for dual task treadmill walking. The high to moderate ICC values and the lack of systematic errors in the measures indicate that this tool has the ability to repeatedly record reliable data from community-dwelling older adults. The present computerized dual-task protocols broaden the types of standardized visuomotor and visuospatial executive activities for use with DT treadmill walking that has previously been reported.

Pre- and postoperative neurocognitive deficits in brain tumor patients assessed by a computer based screening test

Neurocognitive assessment becomes increasingly important in neuro-oncology. The presence and degree of neurocognitive deficits in patients with brain tumors appear to be important not only as outcome measures but also in treatment planning and as possible prognostic markers for tumor-progression. Common screening methods for neurocognitive deficits are often insufficient in uncovering subtle changes or harbor the risk of being observer-dependent and time-consuming. We present data of brain tumor patients screened by a computer-based neurocognitive assessment tool before and after surgery. 196 patients with tumor resections were tested at our institution using the NeuroCog Fx® software 2days before and 3–4months after surgery. Additionally to the test results, patient-related information, such as age, sex, handedness, level of education, pre- and postoperative neurological status, KPS, location and histopathological diagnosis were recorded. These prospectively collected results were correlated in the here presented retrospective study. The majority of patients with malignant gliomas, metastases and meningiomas showed significant deficits in various neurocognitive domains, most of them improved or did not decline in their postoperative neurocognitive performances. Interestingly, there was no significant correlation of neurocognitive deficits and brain tumor location. In future, standardized neuropsychological assessment should become an essential part of the management and care of patients with brain tumors to provide a more personalized and tailored treatment. Further studies will improve the understanding of the influence of various treatment modalities on neuro-cognition.

Redesign and Validation of Sisom, an Interactive Assessment and Communication Tool for Children With Cancer.

BackgroundChildren with cancer undergo intensive and long treatment periods that expose them and their families to a number of difficult physical, mental, and social challenges. Empowering children by actively involving them in their care can help them to cope with these challenges. It can, however, be difficult for children to be involved and talk about their illness experiences in a “traditional” conversation with health care professionals, especially for younger children. Sisom (Norwegian acronym “Si det som det er” or “Tell it how it is”) is an interactive computer-based assessment and communication tool to give children (aged 6-12 years) with cancer a “voice” in their care. Because of technological advances and widespread use of mobile devices Sisom had to be redesigned to better meet the needs of children of today.ObjectiveTo redesign Sisom for use on mobile devices and to validate and adapt it for use in a Swedish population of children with cancer.MethodsA user-experience design was used. Content adaptation included forward-backward translation by Swedish and Norwegian translators. Healthy children (n=5), children with experiences of cancer treatment (n=5) and their parents (n=5), and pediatric nurses (n=2) were then involved in culturally adapting Sisom to the Swedish context. The iterative low- and high-fidelity evaluation was supported by a think aloud method, semistructured interviews, and drawings to capture children’s views of Sisom. The redesign and evaluation continued until no further changes or improvements were identified by the participants or the researchers.ResultsChildren, parents, and pediatric nurses offered many suggestions for improvements to the original version in terms of content, aesthetics, and usability of Sisom. The most significant change that emerged through user input was a modification that entailed not using problem-focused statements in the assessment items. The parents and pediatric nurses considered the revised assessment items to be general and less diagnosis specific. The evaluation of aesthetics resulted in brighter colors and more positive and exciting details in the animations. The evaluation of usability included improvements of the verbal instructions on how to navigate in Sisom 2, and also that the answers to assessment items in Sisom 2 should be saved to provide the children with the option to pause and to continue answering the remaining assessment items at a later stage.ConclusionsOverall, this paper describes the process of using user-experience design with children in order to redesign and validate an interactive assessment and communication tool and how the outcomes of this process resulted in a new version, Sisom 2. All participants confirmed the usability and qualities of using the final version. Future research should be directed toward the implementation of Sisom 2 in clinical practice and to evaluate outcomes from individual and organizational levels.

Development, feasibility, and validity of a computer-based utility assessment tool for measuring asthma-specific health utilities in Malaysia using the standard gamble method

Objectives: To develop and test the feasibility and validity of a computer-based utility assessment tool that used standard gamble (SG) method for measuring asthma-specific health utilities. Methods: A computer-based SG (CBSG) tool was developed using Microsoft® PowerPoint 2007 to value asthma-specific health states in Malaysia. Eight hypothetical health states were considered, including two anchor states (healthy and dead), three chronic (C) states and three temporary (T) states (each numbered 1 through 3, with increasing severity) in addition to the subject's current health state. Twenty adult asthma patients completed the CBSG tool in addition to paper-based Asthma Control Test, three health status measures (EQ-5D, EQ-VAS, and Mini Asthma Quality of Life Questionnaire (MiniAQLQ)), and VAS utility assessment tool. Patients and interviewers rated the difficulty of the VAS and CBSG tools. Correlations between current health state values derived from the various measures were determined. Results: The SG and the VAS received similar difficulty ratings. 17 patients completed the CBSG tool within 30 minutes. The mean utilities determined by the CBSG tool for the T1-T3 asthma health states met the expected logical order of 1>2>3, but those for the C1-C3 states did not. Correlation between current health state values derived from the CBSG tool and other measurement tools was poor. Conclusion: The CBSG tool developed for measuring utilities of asthma health states showed acceptable feasibility and overall validity.

Non-criteria anti-phospholipid antibodies and cognitive impairment in SLE.

The pathogenesis of cognitive impairment (CI) in patients with systemic lupus erythematosus (SLE) is unknown. Anti-phospholipid antibodies (APL) have been implicated. The APL which have been evaluated have variably included anti-cardiolipin (ACL) antibodies, lupus anticoagulant (LAC), and antibodies to beta-2 glycoprotein I (β2GPI). Few studies have examined other APL (so-called non-criteria APL). We evaluated the association of CI with a broad spectrum of non-criteria APL. Subjects meeting SLE classification criteria were recruited from three different patient populations. Cognitive function was assessed with the Automated Neuropsychologic Assessment Metrics (ANAM), a validated computer-based assessment tool. The total throughput score (TTS = number of correct responses/time) was used as the primary outcome measure. The following APL of all three isotypes were assessed by ELISA using standardized techniques: anti-β2GPI, anti-phosphatidyl ethanolamine (aPE), anti-phosphatidyl choline (aPC), anti-phosphatidyl inositol (aPI), anti-phosphatidyl serine (aPS), anti-phosphatidyl glycerol (aPG), anti-phosphatidic acid (aPA). Fifty-seven (57) patients were evaluated. Of the 57, 12 had definite CI (>1.5 SD below the mean of an age-, sex-, and race-matched RA population). The two groups were significantly different with regard to age, ethnicity, and family income. There was no significant difference between groups with regard to the presence of any non-criteria APL. When titers of specific non-criteria APL were compared with TTS, no significant correlations were found. Using multiple linear regression and adjusting for relevant covariates including age, ethnicity, and family income, neither the presence nor the titer of any non-criteria APL significantly influenced TTS. In this cross-sectional study, non-criteria APL were not associated with CI.

Primary care physicians' perspectives on computer-based health risk assessment tools for chronic diseases: a mixed methods study.

Health risk assessment tools compute an individual's risk of developing a disease. Routine use of such tools by primary care physicians (PCPs) is potentially useful in chronic disease prevention. We sought physicians' awareness and perceptions of the usefulness, usability and feasibility of performing assessments with computer-based risk assessment tools in primary care settings. Focus groups and usability testing with a computer-based risk assessment tool were conducted with PCPs from both university-affiliated and community-based practices. Analysis was derived from grounded theory methodology. PCPs (n = 30) were aware of several risk assessment tools although only select tools were used routinely. The decision to use a tool depended on how use impacted practice workflow and whether the tool had credibility. Participants felt that embedding tools in the electronic medical records (EMRs) system might allow for health information from the medical record to auto-populate into the tool. User comprehension of risk could also be improved with computer-based interfaces that present risk in different formats. In this study, PCPs chose to use certain tools more regularly because of usability and credibility. Despite there being differences in the particular tools a clinical practice used, there was general appreciation for the usefulness of tools for different clinical situations. Participants characterised particular features of an ideal tool, feeling strongly that embedding risk assessment tools in the EMR would maximise accessibility and use of the tool for chronic disease management. However, appropriate practice workflow integration and features that facilitate patient understanding at point-of-care are also essential.

Improvement of the Cognitive Perceptual Assessment for Driving (CPAD) based on Usability Test

Objective: The aim of this study was to perform a usability test for CPAD (Cognitive Perceptual Assessment for Driving) and improve it based on the test results. Background: The cognitive perceptual assessment for driving is a computer-based assessment tool to assess the driving capacity of people with brain-damages. It may be a good tool for evaluating the brain-damaged drivers safe driving capabilities and screening cognitive and perceptual deficits related to driving. We performed a usability test to improve the CPAD based on the result. Method: Both the software consisting of 8 sub-tests (depth perception, sustained attention, divided attention, stroop test, field dependency, digit span, trail making A, trail making B) and the hardware including the input and output devices (joystick, mouse, keyboard, touch screen) were evaluated through user interviews. Also we identified the problems and issues in using them by observing the participants performing the CPAD tasks. Results: Based on the results, the task instructions were visually and auditorily improved and more practice examples were added to help the users understand the instructions better and increase the input accuracy, a response time window was added and the joystick and touch screen were simplified, which made it easier for the user to perform the CAPD tasks. Conclusion: User discomforts were minimized by improving the task environment, unless it had affected the evaluation criteria. Application: We plan to distribute the improved version of the CPAD to the regional rehabilitation hospitals, and the driving support centers for people with disabilities throughout the country, so it could be used as an evaluation tool for disabled drivers cognitive and perceptual functions.

Real-time effects of normobaric, transient near-anoxia on performance.

Recent physiological incidents involving pilots of high performance fighter aircraft have raised the question of whether inadvertent, short bursts of significantly reduced oxygen could negatively impact real-time performance. This study evaluated normobaric, real-time performance in the setting of transient near-anoxia to inform future countermeasure development. The study was performed on 12 healthy subjects without significant medical history. Following collection of baseline data, real-time performance changes were evaluated during sequentially increasing periods of near-anoxic gas exposure (F(I)0(2) = 1%) using a computer-based performance assessment tool. Both room air and 100% oxygen were used as the prebreathe/recovery gases. Statistical analysis was performed on the results. Under normobaric conditions, subjects inspiring up to five near-anoxic breaths showed no significant performance decrement in either accuracy or effective actions per minute. Mean accuracy up to five near-anoxic breaths was 0.67 (SD = 0.01) as compared to a baseline mean of 0.68 (SD = 0.02). Hyperoxia had a protective effect on subject physiological response to near anoxia. These normobaric findings offer an assessment of real-time performance changes in the setting of transient, near-anoxic gas exposure. Overall, the results help inform the design of increasingly complex aircraft oxygen delivery systems in terms of how tightly such systems must match the sea-level gas equivalent with increasing altitude. This is particularly relevant as such systems are being called upon to ensure safe aircrew operations across an expanding operational flight envelope.