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Amyotrophic lateral sclerosis (ALS) is a severe neurodegenerative disease with ill-defined pathogenesis, calling for urgent developments of new therapeutic regimens. Herein, we applied PandaOmics, an AI-driven target discovery platform, to analyze the expression profiles of central nervous system (CNS) samples (237 cases; 91 controls) from public datasets, and direct iPSC-derived motor neurons (diMNs) (135 cases; 31 controls) from Answer ALS. Seventeen high-confidence and eleven novel therapeutic targets were identified and will be released onto ALS.AI (http://als.ai/). Among the proposed targets screened in the c9ALS Drosophila model, we verified 8 unreported genes (KCNB2, KCNS3, ADRA2B, NR3C1, P2RY14, PPP3CB, PTPRC, and RARA) whose suppression strongly rescues eye neurodegeneration. Dysregulated pathways identified from CNS and diMN data characterize different stages of disease development. Altogether, our study provides new insights into ALS pathophysiology and demonstrates how AI speeds up the target discovery process, and opens up new opportunities for therapeutic interventions.

A trust model IMPACTS (intention, measurability, performance, adaptivity, communication, transparency, and security) has been conceptualized to build human trust in autonomous systems. A system must exhibit the seven critical characteristics to gain and maintain its human partner’s trust towards an effective and collaborative team in achieving common goals. The IMPACTS model guided a design of an intelligent adaptive decision aid for dynamic target engagement processes in a human-autonomy interaction context. Positive feedback from subject matter experts who participated in a large-scale exercise controlling multiple unmanned assets indicated the decision aid’s effectiveness. It also demonstrated the IMPACTS model’s utility as a design principle for enabling trust between a human-autonomy team.

Background Video-laryngoscopy has proven valuable in management and training of difficult airways. We evaluate the Yann tube, a novel bi-directional articulable endotracheal tube and video stylet combination, together with video-laryngoscopy in a simulation setting to determine if it improves management and education of difficult airways. Methods We evaluated the Yann tube (with video-laryngoscopy) against direct and video-laryngoscopy alone across four simulated airway scenarios, and measured time and attempts to successful intubation, percentage-of-glottic-opening (POGO) score, and Cormack-Lehane grading. Afterward, we surveyed participant subjective experiences. Results There were 32 participants of varying experience. Pharyngeal obstruction was the only airway scenario where the Yann tube was significantly slower than video-laryngoscopy alone (37s vs 27s; p Conclusions Although the Yann tube did not significantly improve successful first pass intubation, it did not significantly take longer to perform, and improved airway visualization in certain difficult airway scenarios. The use of simulation also enhanced education and understanding of airway anatomy for novice intubators.

Background: Bandemia, defined as a band count >10%, is indicative of underlying infection and is increasingly being used for early detection of sepsis. While an absolute band level has been linked to worse outcomes, its trend has not been extensively studied as a prognostic marker. In this study, we assessed patients admitted to the ICU with sepsis or septic shock and evaluated the correlation between bandemia trends and clinical trajectory among these patients. Methods: This study was a retrospective chart review. Band counts, serum lactate levels, and SOFA scores at 0 and 72 h after admission to the ICU were collected. Patients were risk stratified into groups depending on their SOFA trends, and corresponding band trends and serum lactate levels were compared. Results: 134 patients were included for analysis. There was a statistically significant decrease in bandemia trends for patients with a reduction in SOFA scores [median (IQR)−4.5 (−11, 0); p < 0.0001], and a statistically significant increase in bandemia trends for patients with worsening SOFA scores [median (IQR) 4 (0, 8); p = 0.0007]. Conclusion: Early trends of serum band levels in patients with sepsis or septic shock may help to predict a clinical trajectory and overall prognosis. More investigation is warranted as to whether incorporating bandemia trends, when used in conjunction with other known markers such as lactate levels, may help to guide bedside clinical decisions such as risk stratification, tailored therapies, and ultimately improve outcomes.

Aging biology is a promising and burgeoning research area that can yield dual-purpose pathways and protein targets that may impact multiple diseases, while retarding or possibly even reversing age-associated processes. One widely used approach to classify a multiplicity of mechanisms driving the aging process is the hallmarks of aging. In addition to the classic nine hallmarks of aging, processes such as extracellular matrix stiffness, chronic inflammation and activation of retrotransposons are also often considered, given their strong association with aging. In this study, we used a variety of target identification and prioritization techniques offered by the AI-powered PandaOmics platform, to propose a list of promising novel aging-associated targets that may be used for drug discovery. We also propose a list of more classical targets that may be used for drug repurposing within each hallmark of aging. Most of the top targets generated by this comprehensive analysis play a role in inflammation and extracellular matrix stiffness, highlighting the relevance of these processes as therapeutic targets in aging and age-related diseases. Overall, our study reveals both high confidence and novel targets associated with multiple hallmarks of aging and demonstrates application of the PandaOmics platform to target discovery across multiple disease areas.

Background In 2014, the Accreditation Council for Graduate Medical Education (ACGME) formally mandated trainee (resident and fellow) participation in health care quality improvement (QI) projects as one of the Clinical Learning Environment Review (CLER) Pathways to Excellence. Subsequent national reviews showed large variations in how QI education is conducted, as well as a significant mismatch between educational and organizational goals. Objective We developed a web-based platform to engage trainees in QI that better aligned with best practice methodology and matched identified institutional priorities. Methods A needs assessment survey was distributed to trainees to understand the obstacles to compliance with ACGME QI requirements. Based on the results, a web-based clearinghouse, called the QI Platform, was developed and launched in July 2016, and utilization was analyzed in February 2019. Results A total of 196 of 440 needs assessment surveys (45%) were completed. Themes extracted from surveys to identify barriers in QI participation included difficulties designing projects, lack of mentorship or expert support, and difficulty engaging an interprofessional team. Over 2.5 years, 151 projects were registered on the platform. Of these, 17 (11%) were collaborative entries. At the time of analysis, 166 of 437 trainees (38%) were listed as participants in active QI projects. A total of 22 projects were archived as complete, and 68 incomplete projects were reassigned to the “Ideas” section as works in progress after lead trainee graduation. Conclusions An institutional QI Platform clearinghouse for GME QI projects was feasible to develop and maintain, and it appeared acceptable to most GME programs and trainees for recording and tracking QI projects, and linking these to hospital QI priorities.

Adverse event (AE) reporting is a key component of patient safety and physicians are known to underreport. The authors hypothesized that integrating AE reporting into a mobile application used in daily physician workflow would increase physician reporting of AEs. After integrating AE reporting into a free-text mobile application used for daily workflow, the change in AE reporting by physicians was analyzed using Mann-Whitney U tests. AE reporting by physicians increased more than 37-fold (21 to 806; U = 7.5, P < .0001). AE reporting by physicians as a proportion of all AE reports received increased 120-fold (from 0.1% to 12% of all reports, U = 10, P < .0001). Integrating AE reporting into a free-text mobile application used in daily physician workflow markedly increased their reporting of AEs. This approach shifted time burden from physicians to quality officers. Implementation should be coupled with physician education about identifying AEs and content to include in reports.

An experiment was conducted to investigate the effects of automation and role allocation on performance in a simulated picture compilation task with fourteen two-person student teams. In the absence of automation support, the system integrated sensor information. In the presence of automation support, the system both integrated sensor information and identified contacts. Roles were assigned either based on warfare domain or geographical sectors. Results showed that human-automation system performance was similar in two automation conditions, but participants were slower in classifying tracks and overall classified fewer tracks when the automation was present. We conclude that working with automation may lead to degraded team performance due to complacency and additional task complexity.

A study was conducted to examine the operational use of multi-sensor data fusion for military airborne intelligence, surveillance and reconnaissance. Participants performed a simulated picture compilation task wherein they had to identify all ships and planes in their area of operation using various sensors. One group performed the task using only native sensor data. The second group had imperfect data fusion to help them resolve the kinematic information, but they still had to identify each contact. The results indicated that data fusion automation improved the identification of ships and planes over the native sensor group. However, over time, map clutter continually increased for the group with fusion automation, surpassing the clutter for the native sensor group. The results suggest that while multi-sensor data fusion has benefits for picture compilation, dealing with plot clutter from false and spurious tracks is a key concern. Interface suggestions are provided to mitigate the effects.

We conducted two experiments to examine the effect of providing automation support and communicating the limitations of the automation on team performance in a simulated navy environment. Two-person teams engaged with a picture compilation task with or without automation support. In the first experiment, there was no explicit explanations provided regarding the automation’s limitations. In the second experiment, limitations of the automation were communicated to the participants verbally. A comparison of two experiments revealed that participants classified fewer contacts when the automation support was present. Moreover, communicating the limitations of automation resulted in even fewer classifications than when no information was provided. Possible reasons for these results include confusion created by the additional information and reprioritization. These results highlight the complexity of delivering automation transparency to operators in safety-critical environments. We conclude that automation transparency should be carefully designed and delivered to avoid negative impacts on performance.

The COVID-19 pandemic has forced the health care industry to develop dynamic protocols to maximize provider safety as aerosolizing procedures, specifically intubation, increase the risk of contracting SARS-CoV-2. The authors sought to create a quality improvement framework to ensure safe practices for intubating providers, and describe a multidisciplinary model developed at an academic tertiary care facility centered on rapid-cycle improvements and real-time gap analysis to track adherence to COVID-19 intubation safety protocols. The model included an Intubation Safety Checklist, a standardized documentation template for intubations, obtaining real-time feedback, and weekly multidisciplinary team meetings to review data and implement improvements. This study captured 68 intubations in suspected COVID-19 patients and demonstrated high personal protective equipment compliance at the institution, but also identified areas for process improvement. Overall, the authors posit that an interdisciplinary workgroup and the integration of standardized processes can be used to enhance intubation safety among providers during the COVID-19 pandemic.

Background: Health care workers treating Coronavirus disease 2019 (COVID-19) patients face significant stressors such as caring for critically ill and dying patients, physically demanding care requiring new degrees of personal protective equipment use, risk of contracting the disease, and putting loved ones at risk. This study investigates the stress impact from COVID-19 exposure and how nurses and medical providers (eg, physicians, nurse practitioners, physician assistants) experience these challenges differently. Methods: An electronic, self-administered questionnaire was sent to all hospital staff over 6 weeks surveying exposure to COVID-19 patients and degree of stress caused by this exposure. Responses from medical providers and nurses were analyzed for significant contributors to stress levels, as well as comparing responses from medical providers versus nurses. Results: Stress levels from increased risk of disease contraction while on the job, fear of transmitting it to family or friends, and the resulting social stigma were highest in medical staff during the COVID-19 pandemic. Compared with medical providers, nurses had nearly 4 times the odds of considering job resignation due to COVID-19. However, most health care workers (77.4% of medical providers and 52.9% of nurses) strongly agreed or agreed with the statements indicating high levels of altruism in their desire to treat COVID-19 patients. Conclusion: The significant stress burden placed on nurses likely contributes to increased thoughts of job resignation. However, health care providers displayed high levels of altruism during this time of extreme crisis, despite their personal risks of caring for COVID-19 patients.

Physicians routinely rely on nontechnical skills—including leadership ability, managerial skills and financial considerations—when delivering patient care. Efficient practice management is a commonplace expectation of attending anesthesiologists, but there is no uniform residency training to foster the expertise required to succeed in this endeavor. The purpose of this study is to evaluate a novel practice management course for anesthesiology residents. METHODS: Senior anesthesiology residents (Clinical Anesthesia-3) at The George Washington University were eligible to participate in a 1-month Ambulatory Anesthesiology–Practice Management Rotation focusing on the acquisition of nontechnical skills and knowledge applicable to becoming an effective clinical leader. The rotation included 1-week service as operating room manager, completion of an online module, assigned readings with follow-up discussions, and completion of a billing and reimbursement exercise. The interventions, in aggregate, were measured with a preknowledge and a postknowledge test. RESULTS: Twelve residents out of 14 (86%) completed the preknowledge and postknowledge tests. Residents scored significantly higher on the postcourse exam (61.49%, SD 18.65%) than the pretest (42.7%, SD 12.7%) (P < .004). CONCLUSION: A curriculum designed to develop the practice management skills required of a physician anesthesiologist is feasible and effective at improving knowledge within a 1-month, senior resident rotation.

Introduction The COVID-19 pandemic has resulted in an increased use of Powered Air Purifying Respirators (PAPRs), by health care providers to mitigate the risk of viral transmission, especially for aerosol-generating procedures. In this study, we evaluate communication devices that could be used concurrently with PAPRs to promote improved communication. Methods We tested two devices, a Bluetooth earpiece and a throat microphone that operated over mobile networks, against a control scenario in a simulated operating room environment with participants donning PAPRs. Participants read a short paragraph to each other, transcribed short phrases, and evaluated the scenarios according to speech intelligibility, ease of use, and comfort. Results There were 30 participants of varying PAPR experience. The Bluetooth headset had the most accurate transcriptions, followed by control, and lastly the neckpiece (94.7%vs 88.4%vs 76%, p Conclusion Communication devices have the potential to bridge but also worsen communications barriers between providers donning PAPRs.

Objective: Performance and mental workload were observed for the administration of a rest break or exogenous vibrotactile signals in auditory and visual monitoring tasks. Background: Sustained attention is mentally demanding. Techniques are required to improve observer performance in vigilance tasks. Method: Participants ( N = 150) monitored an auditory or a visual display for changes in signal duration in a 40-min watch. During the watch, participants were administered a rest break or exogenous vibrotactile signals. Results: Detection accuracy was significantly greater in the auditory than in the visual modality. A short rest break restored detection accuracy in both sensory modalities following deterioration in performance. Participants experienced significantly lower mental workload when monitoring auditory than visual signals, and a rest break significantly reduced mental workload in both sensory modalities. Exogenous vibrotactile signals had no beneficial effects on performance, or mental workload. Conclusion: A rest break can restore performance in auditory and visual vigilance tasks. Although sensory differences in vigilance tasks have been studied, this study is the initial effort to investigate the effects of a rest break countermeasure in both auditory and visual vigilance tasks, and it is also the initial effort to explore the effects of the intervention of a rest break on the perceived mental workload of auditory and visual vigilance tasks. Further research is warranted to determine exact characteristics of effective exogenous vibrotactile signals in vigilance tasks. Application: Potential applications of this research include procedures for decreasing the temporal decline in observer performance and the high mental workload imposed by vigilance tasks.

Background: Opioid use is high in renal transplant patients, both before and after surgery, in part due to the chronic pain associated with end-stage renal disease. Recent studies have shown patients with high opioid consumption post-transplant have higher incidences of graft loss and mortality. Despite this, opioids remain the mainstay of postoperative analgesia. Aims and Objectives: We wanted to see if known analgesic adjuncts, namely regional anesthesia via a continuous transversus abdominis plane (TAP) catheter block or systemic intravenous lidocaine, could reduce the postoperative opioid requirement in this patient group. Materials and Methods: We conducted a retrospective analysis of renal transplant patients over a 2-year period, comparing patients who had an opioid patient-controlled analgesia pump as their main treatment modality, against patients who had either a TAP block or systemic lidocaine as an adjunct. As a primary outcome measure, we calculated their oral morphine equivalents for the 72 hours post-transplant. We excluded patients who had surgical complications, or were on chronic opioid therapy for other conditions. Results: We identified 86 patients over this study period. We found that regional anesthesia was associated with a 34.4% reduction (P < 0.01) and systemic lidocaine with a 36.5% reduction (P = 0.134) in cumulative opioid consumption without adversely affecting the quality of pain control. No significant complications were noted. Conclusion: Both regional anesthesia and systemic lidocaine are viable opioid sparing adjuncts for postoperative acute pain in this patient population.

Strategies to combat auditory overload were studied. Normal-hearing males were tested in a sound isolated room in a mock-up of a military land vehicle. Two tasks were presented concurrently, in quiet and vehicle noise. For Task 1 dichotic phrases were delivered over a communications headset. Participants encoded only those beginning with a preassigned call sign (Baron or Charlie). For Task 2, they agreed or disagreed with simple equations presented either over loudspeakers, as text on the laptop monitor, in both the audio and the visual modalities, or not at all. Accuracy was significantly better by 20% on Task 2 when the equations were presented visually or audiovisually. Scores were at least 78% correct for dichotic phrases presented over the headset, with a right ear advantage of 7%, given the 5 dB speech-to-noise ratio. The left ear disadvantage was particularly apparent in noise, where the interaural difference was 12%. Relatively lower scores in the left ear, in noise, were observed for phrases beginning with Charlie. These findings underscore the benefit of delivering higher priority communications to the dominant ear, the importance of selecting speech sounds that are resilient to noise masking, and the advantage of using text in cases of degraded audio.

Blue force tracking (BFT) is a military technology that provides positional awareness of friendly forces on a digital map through global positioning system (GPS) technology. For dismounted soldiers, having readily available information on the location of friendly forces can be critical for mission success. However, GPS can report positions that are spatially inaccurate. The present study required 36 military participants to lead a team through a simulated mission in a virtual environment. The mission required the participant to find and support friendly forces engaged in a firefight with enemy forces. Participants had a digital map, an unreliable BFT device, or a perfectly reliable BFT device. The results indicated that participants using BFT engaged enemy forces more quickly, used their BFT to gain a wider scope of their environment, and had lower workload. For most measures, there were no significant differences between reliable and unreliable BFT, suggesting that even an unreliable BFT can provide benefits to soldier performance.

Automated target recognition (ATR) technologies are designed to help operators detect and identify potential threats. However, ATRs can generate a high number of false alarms (FA), resulting in low operator trust and potential automation disuse. In this study, we examined whether lowering the level of automation (LOA) of ATR could reduce FAs and support automation compliance and reliance. Participants performed a visual search for a target with or without the help of ATR. The ATR operated at three LOAs and two levels of reliability. The results suggested that the lowest LOA resulted in greater automation compliance and reliance. Operators also performed better in one measure of diagnostic accuracy under the low automation condition. The findings suggest that operating ATR at lower LOAs provide an effective method for improving ATR use and for detecting potential threats.

Supervisory control of uninhabited aerial vehicles requires vigilance, also termed sustained attention. This pilot study investigated the efficacy of short duration vibrotactile signals presented o...

Ecological interface design (EID) is an approach to designing user interfaces that is based on the objective of providing functional system relationships to users in ways that reduce perceptual loa...

There has been a great deal of human factors research on unmanned air and ground vehicles, but there is very little research examining the unique human factors problems associated with unmanned und...

There is little guidance for designers on how to map information requirements to tactile displays. In this paper, we propose new directions for carrying out the mapping of tactile displays based on semantic mapping techniques used in auditory and visual displays. We discuss these techniques in relation to the design of a multimodal ground control station (GCS) for unmanned aerial vehicles to improve the visually-dominated GCS interface. We hope that this approach will encourage the design of better, safer, and more intuitive UAV GCS interfaces to reduce the frequency of mishaps related to human error.

The Independent LifeStyle Assistant (I.L.S.A.) is an agent-based monitoring and support system to help elderly people live longer in their homes by reducing caregiver burden. I.L.S.A. is a multiagent system that incorporates a unified sensing model, situation assessments, response planning, real-time responses, and machine learning. This paper describes the six-month study of the system we fielded in elders' homes and the major lessons we learned during development.

The present study examined age differences in trust and reliance of an automated decision aid. In Experiment 1, older and younger participants performed a simple mathematical task concurrent with a simulated medication management task. The decision aid was designed to facilitate medication management, but with varying reliability. Trust, self-confidence and usage of the aid were measured. The results indicated that older adults had greater trust in the aid and were less confident in their performance, but they did not calibrate trust differently than younger adults. In Experiment 2, a variant of the same task was used to investigate whether older adults are subject to over-reliance on the automation. Differences in omission and commission errors were examined. The results indicated that older adults were more reliant on the decision aid and committed more automation-related errors. A signal detection analyses indicated that older adults were less sensitive to automation failures. Results are discussed with respect to the perceptual and cognitive factors that influence age differences in the use of fallible automation.

The effects of divided attention were examined in younger adults (M = 23 years) and older adults (M = 64 years) who searched for traffic signs in digitized images of traffic scenes. Sign search was executed under single-task and dual-task conditions in scenes containing either small or large amounts of visual clutter. For both age groups, clutter and the secondary task had additive effects on search accuracy, speed, and oculomotor involvement. Compared with the younger adults, older adults were less accurate, especially with high-clutter scenes, were slower to decide that a target sign was not present, and exhibited a marginally greater divided-attention effect on reaction times. They exhibited longer fixations in the divided-attention condition, in which they also showed a disproportionate reduction in recognition memory for the content of the secondary task. Actual or potential applications of this research include methods for evaluating the distraction of conversations and safety implications of conversation on visual search behavior.

Younger and older participants were trained in a triple conjunction visual search task to examine age differences in the development of proficient performance. For the first 8 days, participants searched for a target defined by its contrast polarity, shape, and orientation. On Days 9 through 16, the target identity was switched to one defined by opposing feature values. On Day 17, the target was returned to the original feature values. Results indicated that, after training, younger adults reduced their display size effects more than elderly adults. Disruption occurred after the first but not after the second transfer. However, each time the target was switched, there were no age differences in disruption. Eye movement data suggest that older adults use a similar feature selection strategy as younger adults but may be more susceptible to distraction. The results are discussed in terms of current models of attention and search.

Two experiments examined the disruption of feature-based selection in triple-conjunction search at multiple target transfers. In Experiment 1, after 10 training sessions, a new target possessing previous distractor features was introduced. This produced disruption in RT and fixation number, but no disruption in feature-based selection. Specifically, there was a tendency to fixate objects sharing the target's contrast polarity and shape and this did not change even upon transfer to the new target. In Experiment 2, 30 training sessions were provided with three target transfers. At the first transfer, the results replicated Experiment 1. Subsequent transfers did not produce disruption on any measure. These findings are discussed in terms of strength theory, Guided Search, rule-based approaches to perceptual learning, and the area activation model.

The effects of visual clutter, luminance, and aging on traffic sign conspicuity were examined in two experiments. Experiment 1a evaluated clutter using subjective judgments from 28 older and younger observers. Participants categorized daytime and nighttime traffic scenes into high or low clutter. Using these categorized scenes, in Experiment 1b a new sample of 28 younger and older participants visually searched for traffic signs. Reaction time and eye movement data were analyzed. Results suggested that aging and clutter affect con-spicuity. Moreover, older adults had poorer performance on target-absent trials. No luminance effect or any age by clutter interactions were obtained. Expertise gained through many years of driving may dampen clutter effects experienced by older adults. The nonlinear relationship between fixation frequency and fixation duration is discussed in relation to similar findings in experimental visual search. Results suggest that age differences found in processing simple visual stimuli may not generalize to more naturalistic scenes.

In this paper we introduce MIFresh, a grocery store system consisting of a large display and individual kiosks that aims to increase the demand of local produce. In cities like Detroit, where poverty and health are major concerns, increasing consumption of local produce can help create local jobs, sustain the environment, and improve health. We used rapid contextual design to analyze Detroit's existing food system and, based on our findings, iteratively design a solution. MIFresh uses proven techniques such as coupons and rewards points programs and delivers education and awareness about the importance of consuming local produce. User testing results among the target population are promising.

Five experiments were carried out to examine whether top-down processes can aid search, even when targets and distractors are variably mapped. Experiments 1a and 1b determined that effortless VM search can be obtained in Contrast Polarity X Orientation and Color X Orientation conjunction search when one feature dimension remains consistently mapped across blocks. Experiment 2 showed that efficient VM search is possible when both dimensions are variably mapped. In Experiment 3, efficient VM search was found when target-distractor reversals occurred on a trial-wise basis. Experiments 4 and 5 found that VM search deteriorates when target identity is not known prior to display onset. These studies demonstrate the role of top-down mechanisms in the development of efficient VM search and present several challenges to strength-theoretic views on the mechanisms underlying automaticity.

Ten younger and ten older adults were provided with 16 sessions of conjunction search under consistent mapping, where target and distractors remain constant in identity. The target and one distractor were reversed after every fourth session. After the first four training sessions, on target-present trials, display size slopes were near zero for both age groups. However, on target-absent trials, older adults continued to show significantly larger display size effects than younger adults. There were no systematic age differences in either the probability of fixating objects that possess the target's features or in the amount of disruption at any reversal. Thus, although older adults exhibited more conservative criteria in visual search, they developed proficient and flexible search skill to the same degree as their younger counterparts. These data have implications for models of visual attention, skill acquisition, and cognitive aging.

Latency and eye movement measures were used to examine the effects of aging, clutter, and luminance on visual search for traffic signs embedded in digitized images of driving scenes. Initially 14 older and 14 younger observers classified daytime and nighttime traffic scenes as containing low or high amounts of clutter. Next, an independent sample of 14 younger and 14 older participants searched for traffic signs contained within these scenes. Errors were more common among the elderly. Search efficiency declined with increased clutter and with aging. However, relative to the young, older adults did not suffer disproportionately as a result of increased clutter. The methods developed might be profitably employed to assess sign conspicuity and sign acquisition during driving.

Military signal operators listen, transcribe, and respond to audio traffic over multiple audio channels, in high-level noise from vehicles and weapons. The messages typically overlap in time and may be difficult to disentangle. Two studies were carried out to determine the benefit of supplemental texting. Normal-hearing participants were tested in a mock up of a military command post. Brief messages were played simultaneously over a communications headset (dichotic) and a loudspeaker array, either in quiet or in a background of vehicle noise. The at-ear speech-to-noise ratio was 5 dB. Only those messages beginning with a pre-assigned call sign were encoded. Mean scores of 84% or better were observed for messages presented over the headset, although there was a clear right ear advantage in noise. Messages coming over the loudspeakers were more difficult to understand but a visual cue directing attention to the source of an incoming targeted message resulted in a significant improvement of 7%. Replacing audio messages over the loudspeakers in noise with visual or audiovisual presentations resulted in an improvement from 71% to 96% that did not negatively affect headset performance. The data suggest that texting is a viable option for communication in cases of degraded audio.