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Centre for Ergonomics Occupational Safety and Health
                    (CErgOSH)




                   Our strengths
1Centre for Ergonomics, Occupational Safety and Health
          2School of Sport and Exercise Science

          3School of Psychology

          4 School of Aviation




OHSIG Conference presentation
27 Oct 2011


         *Massey  University Research Fund Summer Studentship 2010 and 2011
         Study also supported by the NZDF Defence Technology Agency
This video available at
http://youtu.be/Y4JoXT3or3M
   Symptoms of hypoxia are dependent on the level of hypoxia
    (i.e. the altitude), are deceptively insidious, initially very
    subtle and progressive:
    ◦ Visual: reduced colour perception, peripheral vision, acuity, and dimming
    ◦ General: euphoria, task fixation, personality changes, fuzziness, amnesia,
      mental confusion, loss of self criticism, poor judgement and decision
      making
    ◦ Neuromuscular: clumsiness, fine tremor, slurring of speech, slowing of
      movements, „hypoxic flap‟
    ◦ Times of useful consciousness
         Altitude                          Time of useful consciousness
         18,000 ft                         10-15 min
         25,000 ft                         2-3 min
         40,000 ft                         About 30 seconds
   Evidence for the effects of mild hypoxia is mixed
    ◦ Reduced complex reaction times, but well learned tasks
      unaffected at 5000 and 8000 ft (Denison et al 1966)
    ◦ Impaired novel task learning under mild hypoxia                    (Crow and
      Kelman, 1969, Farmer et al 1992)

    ◦ Simple tasks - logical reasoning and a vigilance -
      unaffected at 8000 ft (Morgan and Green 1972, Fiorica et al 1971)
    ◦ Slower judgement time at 7000 ft but accuracy unaffected
      (McCarthy et al 1995)

    ◦ No effects on visual function at 7000 ft            (Corban et al 1995)

    ◦ Impaired sleep quality at about 8000 ft             (Muhn et al 2009)
Our concern
    Mild hypoxia associated with exposure to aircraft cabin
       altitudes of 8000 ft may be an unrecognised factor
   contributing to impaired decision-making performance of
   aircrew in uncertain, novel, or emergency situations, and
     may be a factor that could have contributed, and may
            contribute in the future, to aircraft accidents


                    Hypothesis
Mild hypoxia (equivalent to cabin altitudes of about
    8000 ft) impairs complex cognitive (decision-
 making) task performance (especially when there
      are additional multiple stressors and task
                      demands)
Study design
                            Familiarisation session
                                 15 students

Hypoxicator delivers normoxic or hypoxic air equivalent to 8000 ft
             First exposure                   Second exposure
            (Hypoxia or Normoxia)             (Hypoxia or Normoxia)

                       Counterbalanced presentation

   Physiological measurements              Cognitive Tasks
                                          Psychomotor task
   • SaO2



   • HR                                   Complex decision     • Reasoning task
                                          making tasks         • Memory task
Normoxia                    Normoxia or mild hypoxia



                 0                 30                 60           90                 120        150
         Time
         (min)                          Rest period                     Rest period



                 Cognitive tasks                      Cognitive tasks                 Cognitive tasks


• SaO2


• HR
Physiological results


                                                      Heart Rate (bpm)

       100                                       90
           98             98     1%              85




                                      HR (bpm)
           96                                    80
SaO2 (%)




                                                 75
           94
                                                 70
           92
           90
                          91     1%              65
                                                 60
           88                                    55
           86                                    50




                      Normoxia             Mild Hypoxia
Simple joystick „steering‟ task
  ◦ Keep white disc inside yellow target with joystick
Braking task
  ◦ Press foot pedal when lights come on. Duration ~10
      minutes: 15 brake trials, 35-50 seconds apart

Measurements
 ◦ Time outside target
 ◦ Braking reaction time

Prediction based on previous research
  ◦ No significant effect of mild hypoxia
Results
  ◦ No significant effects
Belief bias
 People find logic tasks (syllogisms) difficult when believability of
  conclusion conflicts with logical validity of argument

                                Syllogism
                           All mammals can walk
                           Whales are mammals
                               Whales can walk
    Unbelievable conclusions incline people to think syllogisms are invalid
      Believable conclusions incline people to think syllogisms are valid
    Belief Bias makes judging the validity of Conflict (unbelievable)
      syllogisms hard and Nonconflict (believable) syllogisms easy
Dual process
 Reasoning while doing another mental task (i.e. the logic task)
  causes poorer performance on Conflict syllogisms but not
  Nonconflict syllogisms ..... because Conflict syllogisms require much
  more concentration and deliberation to judge correctly
Reasoning Task                           – Belief bias/Dual process task
   Method
    ◦  12 logical syllogisms for each block Example of a valid conflict syllogism
            6 conflict syllogisms,
            6 non-conflict syllogisms
            Half valid, half invalid
    ◦       Random presentation

     Measurements
    ◦  Accuracy
    ◦  Response Time

   Prediction
    ◦ Mild hypoxia will reduce performance on Conflict and Invalid (i.e.
      difficult) syllogisms but not Non-conflict and Valid (i.e. easy)
      syllogisms
   Results
    ◦ No change in Accuracy
    ◦ Conflict syllogisms judged more slowly in mild hypoxia at 30 & 90 min
    ◦ Invalid syllogisms judged more slowly in mild hypoxia at 30 min
1.       Reading Span measure of Working Memory (WM)
     ◦       Processing Component
             Judge the semantic and/or syntactic sense of sentence
                   He was a fanatical yellow of football, rugby, and cricket.

     ◦       Memory Component
             Recall last word of each of a set of 2-6 sentences
              Cricket in the previous sentence

2.       Event-based Prospective Memory (PM)
     ◦       PM = Remember to do something when a specific event occurs
     ◦       PM task = press F whenever you see the letter string “ean” in a sentence
                   Everyone knew his distinctive purple beanie and shoes.
     Method
    ◦  60 sentences, divided up into 15 blocks
    ◦  10 blocks contained a PM trial (a word with „ean‟ in it)
    ◦  At the end of each block, subject prompted to recall the last
       word of each of the sentences in the block

     Measurements
    ◦  Working Memory span – number of last words recalled correctly
    ◦  Sentence sense error rate
    ◦  Prospective Memory score – number of times an „ean‟ word was
       correctly spotted

       Prediction
    ◦     Working Memory span, Sentence sense error rate and
          Prospective Memory score will all be reduced by hypoxia
       Results
    ◦     Reduced WM span at 90 min
    ◦     No effect on Sentence Sense Error rate
    ◦     No effect on Prospective memory
    ◦
   Psychomotor task
    ◦ As predicted, no effect of mild hypoxia on psychomotor task

   Complex cognition tasks
    ◦ Reasoning
       Reasoning accuracy not noticeably affected by hypoxia
       Time to reason affected by hypoxia, particularly for „harder‟
        logical operations (i.e. conflict syllogisms and invalid
        syllogisms) that require concentration and deliberation

    ◦ Working Memory
       Working memory span reduced by hypoxia after 90 min
       Hypoxia had no effect on Sentence Sense Error Rate and
        Prospective memory
Conclusions
Tentative evidence that mild hypoxia (equivalent to
cabin altitudes of about 8000 ft) can affect aspects
of complex cognitive decision-making in novel and
                stressful situations
Limitations of this study
   Small sample size (n =15). We will be collecting data for at least 10
    more subjects to increase statistical power
   Students are not pilots
   Limited face validity of the complex cognitive reasoning and memory
    tests for aviation

                     Future study plans
   The effects of varying durations and levels of mild hypoxia in
     an increased sample size of pilots with more refined tests of
    complex cognitive performance (with higher face validity) and
                of risk judgement in a flight simulator

        The effects of combined exposure to mild hypoxia,
        dehydration, circadian dysrhythmia (jet-lag) and sleep
              deprivation (loss of and disturbed sleep)

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Pilot In-flight Complex Decision Making May be Impaired by Mild Hypoxia

  • 1.
  • 2. Centre for Ergonomics Occupational Safety and Health (CErgOSH) Our strengths
  • 3.
  • 4. 1Centre for Ergonomics, Occupational Safety and Health 2School of Sport and Exercise Science 3School of Psychology 4 School of Aviation OHSIG Conference presentation 27 Oct 2011 *Massey University Research Fund Summer Studentship 2010 and 2011 Study also supported by the NZDF Defence Technology Agency
  • 5. This video available at http://youtu.be/Y4JoXT3or3M
  • 6. Symptoms of hypoxia are dependent on the level of hypoxia (i.e. the altitude), are deceptively insidious, initially very subtle and progressive: ◦ Visual: reduced colour perception, peripheral vision, acuity, and dimming ◦ General: euphoria, task fixation, personality changes, fuzziness, amnesia, mental confusion, loss of self criticism, poor judgement and decision making ◦ Neuromuscular: clumsiness, fine tremor, slurring of speech, slowing of movements, „hypoxic flap‟ ◦ Times of useful consciousness Altitude Time of useful consciousness 18,000 ft 10-15 min 25,000 ft 2-3 min 40,000 ft About 30 seconds
  • 7. Evidence for the effects of mild hypoxia is mixed ◦ Reduced complex reaction times, but well learned tasks unaffected at 5000 and 8000 ft (Denison et al 1966) ◦ Impaired novel task learning under mild hypoxia (Crow and Kelman, 1969, Farmer et al 1992) ◦ Simple tasks - logical reasoning and a vigilance - unaffected at 8000 ft (Morgan and Green 1972, Fiorica et al 1971) ◦ Slower judgement time at 7000 ft but accuracy unaffected (McCarthy et al 1995) ◦ No effects on visual function at 7000 ft (Corban et al 1995) ◦ Impaired sleep quality at about 8000 ft (Muhn et al 2009)
  • 8. Our concern Mild hypoxia associated with exposure to aircraft cabin altitudes of 8000 ft may be an unrecognised factor contributing to impaired decision-making performance of aircrew in uncertain, novel, or emergency situations, and may be a factor that could have contributed, and may contribute in the future, to aircraft accidents Hypothesis Mild hypoxia (equivalent to cabin altitudes of about 8000 ft) impairs complex cognitive (decision- making) task performance (especially when there are additional multiple stressors and task demands)
  • 9. Study design Familiarisation session 15 students Hypoxicator delivers normoxic or hypoxic air equivalent to 8000 ft First exposure Second exposure (Hypoxia or Normoxia) (Hypoxia or Normoxia) Counterbalanced presentation Physiological measurements Cognitive Tasks Psychomotor task • SaO2 • HR Complex decision • Reasoning task making tasks • Memory task
  • 10. Normoxia Normoxia or mild hypoxia 0 30 60 90 120 150 Time (min) Rest period Rest period Cognitive tasks Cognitive tasks Cognitive tasks • SaO2 • HR
  • 11.
  • 12. Physiological results Heart Rate (bpm) 100 90 98 98 1% 85 HR (bpm) 96 80 SaO2 (%) 75 94 70 92 90 91 1% 65 60 88 55 86 50 Normoxia Mild Hypoxia
  • 13. Simple joystick „steering‟ task ◦ Keep white disc inside yellow target with joystick Braking task ◦ Press foot pedal when lights come on. Duration ~10 minutes: 15 brake trials, 35-50 seconds apart Measurements ◦ Time outside target ◦ Braking reaction time Prediction based on previous research ◦ No significant effect of mild hypoxia Results ◦ No significant effects
  • 14. Belief bias  People find logic tasks (syllogisms) difficult when believability of conclusion conflicts with logical validity of argument Syllogism All mammals can walk Whales are mammals Whales can walk Unbelievable conclusions incline people to think syllogisms are invalid Believable conclusions incline people to think syllogisms are valid Belief Bias makes judging the validity of Conflict (unbelievable) syllogisms hard and Nonconflict (believable) syllogisms easy Dual process  Reasoning while doing another mental task (i.e. the logic task) causes poorer performance on Conflict syllogisms but not Nonconflict syllogisms ..... because Conflict syllogisms require much more concentration and deliberation to judge correctly
  • 15. Reasoning Task – Belief bias/Dual process task  Method ◦ 12 logical syllogisms for each block Example of a valid conflict syllogism  6 conflict syllogisms,  6 non-conflict syllogisms  Half valid, half invalid ◦ Random presentation  Measurements ◦ Accuracy ◦ Response Time  Prediction ◦ Mild hypoxia will reduce performance on Conflict and Invalid (i.e. difficult) syllogisms but not Non-conflict and Valid (i.e. easy) syllogisms  Results ◦ No change in Accuracy ◦ Conflict syllogisms judged more slowly in mild hypoxia at 30 & 90 min ◦ Invalid syllogisms judged more slowly in mild hypoxia at 30 min
  • 16. 1. Reading Span measure of Working Memory (WM) ◦ Processing Component  Judge the semantic and/or syntactic sense of sentence He was a fanatical yellow of football, rugby, and cricket. ◦ Memory Component  Recall last word of each of a set of 2-6 sentences  Cricket in the previous sentence 2. Event-based Prospective Memory (PM) ◦ PM = Remember to do something when a specific event occurs ◦ PM task = press F whenever you see the letter string “ean” in a sentence Everyone knew his distinctive purple beanie and shoes.
  • 17. Method ◦ 60 sentences, divided up into 15 blocks ◦ 10 blocks contained a PM trial (a word with „ean‟ in it) ◦ At the end of each block, subject prompted to recall the last word of each of the sentences in the block  Measurements ◦ Working Memory span – number of last words recalled correctly ◦ Sentence sense error rate ◦ Prospective Memory score – number of times an „ean‟ word was correctly spotted  Prediction ◦ Working Memory span, Sentence sense error rate and Prospective Memory score will all be reduced by hypoxia  Results ◦ Reduced WM span at 90 min ◦ No effect on Sentence Sense Error rate ◦ No effect on Prospective memory ◦
  • 18. Psychomotor task ◦ As predicted, no effect of mild hypoxia on psychomotor task  Complex cognition tasks ◦ Reasoning  Reasoning accuracy not noticeably affected by hypoxia  Time to reason affected by hypoxia, particularly for „harder‟ logical operations (i.e. conflict syllogisms and invalid syllogisms) that require concentration and deliberation ◦ Working Memory  Working memory span reduced by hypoxia after 90 min  Hypoxia had no effect on Sentence Sense Error Rate and Prospective memory
  • 19. Conclusions Tentative evidence that mild hypoxia (equivalent to cabin altitudes of about 8000 ft) can affect aspects of complex cognitive decision-making in novel and stressful situations
  • 20. Limitations of this study  Small sample size (n =15). We will be collecting data for at least 10 more subjects to increase statistical power  Students are not pilots  Limited face validity of the complex cognitive reasoning and memory tests for aviation Future study plans  The effects of varying durations and levels of mild hypoxia in an increased sample size of pilots with more refined tests of complex cognitive performance (with higher face validity) and of risk judgement in a flight simulator  The effects of combined exposure to mild hypoxia, dehydration, circadian dysrhythmia (jet-lag) and sleep deprivation (loss of and disturbed sleep)