1. Designing for Attention With Sound: Challenges and Extensions to Ecological Interface Design Marcus O. Watson and Penelope M. Sanderson HUMAN FACTORS, Vol. 49, No. 2, April 2007, pp. 331 – 346

2. Background Ecological Interface Design (EID) is a framework that is based on the skills, rules, knowledge taxonomy of cognitive control. Ecological Interface Design (EID) is a framework that is based on the skills, rules, knowledge taxonomy of cognitive control. EID examples focus almost exclusively on visual displays. In the anesthesia work environment, however, auditory displays may provide better individual and team awareness of patient state. EID examples focus almost exclusively on visual displays. In the anesthesia work environment, however, auditory displays may provide better individual and team awareness of patient state.

3. Process for the design of auditory displays using EID

5. Method Using a work domain analysis of physiological monitoring in anesthesia, we identify information to display. Using a work domain analysis of physiological monitoring in anesthesia, we identify information to display. Using the skills, rules, and knowledge distinction we identify cognitive control needed. Using the skills, rules, and knowledge distinction we identify cognitive control needed. Using semantic mapping we map physiological variables and constraints to auditory dimensions. Using semantic mapping we map physiological variables and constraints to auditory dimensions.

6. Ecological Interface Design and the Auditory Modality Three principles underlie EID Three principles underlie EID 1. interface content should support knowledge-based behavior 1. interface content should support knowledge-based behavior 2. interface content should support rule- based behavior 2. interface content should support rule- based behavior 3. the interface should support skill-based behavior 3. the interface should support skill-based behavior

7. When played through speakers, auditory displays can be heard regardless of a listener ’ s posture. When played through speakers, auditory displays can be heard regardless of a listener ’ s posture. Auditory displays will be heard by anyone nearby, regardless of intent. Auditory displays will be heard by anyone nearby, regardless of intent. Auditory displays occur in time and cannot be reviewed at will by reorienting one ’ s sense organs. Auditory displays occur in time and cannot be reviewed at will by reorienting one ’ s sense organs.

8. PROBLEM IDENTIFICATION-Field Studies Field studies suggest that anesthesiologists may benefit from receiving patient information continuously but unobtrusively. Field studies suggest that anesthesiologists may benefit from receiving patient information continuously but unobtrusively. Auditory interfaces that provide critical information continuously by making displays ubiquitous and obligatory without extra workload could be useful supplements to visual displays. Auditory interfaces that provide critical information continuously by making displays ubiquitous and obligatory without extra workload could be useful supplements to visual displays.

9. Incident Report Data Incident report data suggest that an integrated and continuous display of patient vital signs may speed detection of events. Incident report data suggest that an integrated and continuous display of patient vital signs may speed detection of events. A display of respiratory vital signs in a continuous format compatible with pulse oximetry could therefore help the anesthesiologist achieve an overview of the most important aspects of a patient ’ s physiological state. A display of respiratory vital signs in a continuous format compatible with pulse oximetry could therefore help the anesthesiologist achieve an overview of the most important aspects of a patient ’ s physiological state.

10. NEEDS ANALYSIS-Work Domain Analysis WDA produces a representation of the purposes, first principles, functions, processes, and configuration of any work domain WDA produces a representation of the purposes, first principles, functions, processes, and configuration of any work domain A human agent is responsible for handling disturbances and maintaining desired operation. A human agent is responsible for handling disturbances and maintaining desired operation.

11. Sensed and Derived Values Researchers using EID usually seek to display information about functional purpose and abstract functions so that humans can monitor the stability of such high-level properties. Researchers using EID usually seek to display information about functional purpose and abstract functions so that humans can monitor the stability of such high-level properties.

12. Temporal Relations Understanding temporal relations is important when mapping the dynamic properties of a process into the temporal properties of auditory displays. Understanding temporal relations is important when mapping the dynamic properties of a process into the temporal properties of auditory displays.

13. Recipients of Information Patient monitoring is at times a vigilance task, and vigilance is sustained better – and with a lower level of subjective stress and workload – with auditory rather than visual displays. Patient monitoring is at times a vigilance task, and vigilance is sustained better – and with a lower level of subjective stress and workload – with auditory rather than visual displays.

14. Identifying Required Cognitive Control we noticed a mismatch between the kind of cognitive control (SKR) available to the anesthesiologists, given the monitoring equipment and the kind of cognitive control they sometimes preferred. we noticed a mismatch between the kind of cognitive control (SKR) available to the anesthesiologists, given the monitoring equipment and the kind of cognitive control they sometimes preferred. We hypothesized that a change in display modality might change the way cognitive control is exercised. We hypothesized that a change in display modality might change the way cognitive control is exercised.

15. The AIMS study data suggested that variable-tone pulse oximetry – a ubiquitous, obligatory display – helped anesthesiologists detect events early and with a low level of cognitive control. The AIMS study data suggested that variable-tone pulse oximetry – a ubiquitous, obligatory display – helped anesthesiologists detect events early and with a low level of cognitive control. Auditory alarms often recapture attention, and responding to them is faster than to visual alarms Auditory alarms often recapture attention, and responding to them is faster than to visual alarms

16. DESIGN SYNTHESIS-Establishing a Modality Johannsen (2004) has suggested that designers should develop auditory displays principally to minimize human error at the skill-based level. Johannsen (2004) has suggested that designers should develop auditory displays principally to minimize human error at the skill-based level. Auditory displays can support people ’ s peripheral awareness of system state while they perform other tasks. Auditory displays can support people ’ s peripheral awareness of system state while they perform other tasks.

17. Semantic Mapping Semantic mapping is the process by which the functional structure and constraints in a work domain are mapped to perceptual forms in a way that supports cognitive control at the desired levels. Semantic mapping is the process by which the functional structure and constraints in a work domain are mapped to perceptual forms in a way that supports cognitive control at the desired levels.

18. We describe how we arrived at a workable sonification of respiratory vital signs (Step 7, Figure 1): We describe how we arrived at a workable sonification of respiratory vital signs (Step 7, Figure 1): 1. Kinds of auditory displays. 1. Kinds of auditory displays. 2. Candidate sound dimension mappings. 2. Candidate sound dimension mappings. 3. Number of auditory streams 3. Number of auditory streams 4. Promoting skill-based behavior 4. Promoting skill-based behavior 5. Choosing the carrier tone. 5. Choosing the carrier tone. 6. Piggybacking information on the carrier tone. 6. Piggybacking information on the carrier tone.

21. Attentional Mapping Table 3 lists attentional mapping issues and trade-offs across different possible respiratory sonifications. Table 3 lists attentional mapping issues and trade-offs across different possible respiratory sonifications.

23. Individual attention. A sonification imposes obligatory and transitory stimuli on an individual (whether delivered via earpiece or speakers), so auditory displays must be designed to control attention properly over time. A sonification imposes obligatory and transitory stimuli on an individual (whether delivered via earpiece or speakers), so auditory displays must be designed to control attention properly over time. Attentional mapping “ gives designers requirements for how an auditory display should control attention alongside other interface elements, based in a knowledge of auditory attention ” Attentional mapping “ gives designers requirements for how an auditory display should control attention alongside other interface elements, based in a knowledge of auditory attention ”

24. Team attention. An auditory display must be tolerated by everyone who has to hear it. An auditory display must be tolerated by everyone who has to hear it. An auditory display must be meaningful for staff who must hear it, helping staff detect abnormal patient states while still performing their normal tasks. An auditory display must be meaningful for staff who must hear it, helping staff detect abnormal patient states while still performing their normal tasks.

25. If not all staff need to hear a display, then it can be delivered just to those who need to hear it (Patterson et al.,1999) via earpieces and wireless. If not all staff need to hear a display, then it can be delivered just to those who need to hear it (Patterson et al.,1999) via earpieces and wireless. Auditory displays should avoid the speech range so that normal verbal communications are preserved. Auditory displays should avoid the speech range so that normal verbal communications are preserved.

26. Evaluation Results Novices and anesthesiologists perform concurrent tasks better when supported by respiratory sonification than by visual display. Novices and anesthesiologists perform concurrent tasks better when supported by respiratory sonification than by visual display. Participants respond faster to questions about sonified patient status and check visual monitors less often when sonification is available. Participants respond faster to questions about sonified patient status and check visual monitors less often when sonification is available.

27. Conclusion EID principles do not address when information should be displayed and to whom. EID principles do not address when information should be displayed and to whom. An attentional mapping stage helps to specify answers to these questions so that a workable auditory display for anesthesia monitoring is achieved. An attentional mapping stage helps to specify answers to these questions so that a workable auditory display for anesthesia monitoring is achieved.