This study is concerned with slowly varying, long‐duration brain event‐related potential (ERP) components, referred to as Slow Wave activity. Slow Wave activity can be observed in the epoch following P3b, suggesting that it reflects further processing invoked by increased task demands, beyond the processing that underlies P3b. The present experiment was designed to distinguish Slow Wave activity related to specific types of task demands which arise during difficult perceptual (pattern recognition) and conceptual (arithmetic) mental operations. Three late ERP components that respond differentially in amplitude to manipulation of perceptual and conceptual difficulty were identified: 1) A P3b, with a topography focused about Pz, evidently related to the subjective categorization of easy and difficult conceptual operations, that increased when the subjective low‐probability operation was performed; 2) A longer latency, centroparietal positive Slow Wave that increased directly with perceptual difficulty but was not affected by conceptual difficulty; 3) A very long latency negative Slow Wave, broadly distributed over centroposterior scalp, that increased directly with conceptual difficulty while its onset was delayed when perceptual difficulty increased.
The main findings of this study bear upon differences in the functional roles of P3b and a shorter latency, more centrally distributed endogenous positive component denoted as P3e. At the present writing, we have observed P3e only in conjunction with P3b. As in the case of P3b, P3e is fully endogenous in that it can be‐ elicited by omission of a stimulus if stimulus omission conveys relevant information to the subject. It was found that P3e and P3b relate differently to information delivery. Information delivery was manipulated by varying event probabilities and the discriminability of the events. The well known properties of P3b, namely that its amplitude is large when elicited by low probability (high information content) events and is reduced by perceptual difficulty (information loss‐equivocation), were replicated in the current study. In contrast to P3b, variation of event probability had no effect upon P3e amplitude, but increased perceptual difficulty markedly reduced P3e amplitude. In addition, two CNV‐type negativities were observed in the epochs prior to presentation of the informative signal event: 1) A negativity that was maximal over central scalp related to the subject's prediction that a rare or frequent event would be presented; 2) A negativity that was maximal over occipital scalp related to a stimulus that informed the subject whether the subsequent discrimination of the signal would be easy or difficult. Finally, there was a serendipitous Hading of an apparently new short duration component, tentatively labeled Px, which is elicited by presentation of the signal that informs the subject whether the subsequent discrimination will be easy or difficult.
We examined decision-making in the real-world environment of trauma patient resuscitation and anesthesia in a Level One Trauma Center. The present paper focuses on the risk factors in the trauma treatment environment that can lead to errors or misjudgments, and strategies that may be helpful in reducing these risks. Video and audio recordings were made of a number of trauma cases involving tracheal intubation, including both emergency intubations performed during resuscitation and “elective” intubations prior to surgery. Post-treatment questionnaires completed by anesthesia personnel suggested that their perceived misjudgments were primarily procedural errors caused by lack of preparation for low probability events, inadequate monitoring of available indices, or carelessness. However, video analyses of a subset of the cases by a non-participant anesthesiologist, in conjunction with examination of patient management records, not only confirmed the occurrence of such errors but also identified instances of knowledge-based errors, which caused subsequent cascades of adverse events. Video analysis also documented the shortcuts that are characteristic of emergency intubations. The post-treatment questionnaires also suggested an association between team interactions and anesthesiologist performance. To follow up on this, we transcribed and categorized verbal communications for several minutes before, during, and after intubation in a subset of cases. This analysis indicated that during emergency intubations not only was more information communicated than during elective intubations, but that there were increases specifically in the incidence of directives, comments conveying plans or strategies, and comments both seeking and offering needed information. The discussion presents a number of strategies that emerged from the present analyses for reducing the risk factors involved in trauma treatment decision-making.
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