Effects of task context on EEG correlates of mind-wandering.

This study was designed to examine how mind-wandering and its neural correlates vary across tasks with different attentional demands, motivated by the context regulation hypothesis of mind-wandering. Participants (n = 59 undergraduates) completed the sustained attention to response task (SART) and the Stroop selective attention task in counterbalanced order while EEG was recorded. The tasks included experience-sampling probes to identify self-reported episodes of mind-wandering, along with retrospective reports. Participants reported more mind-wandering during the SART than the Stroop and during whichever task was presented second during the session, compared with first. Replicating previous findings, EEG data (n = 37 usable participants) indicated increased alpha oscillations during episodes of mind-wandering, compared with on-task episodes, for both the SART and Stroop tasks. ERP data, focused on the P2 component reflecting perceptual processing, found that mind-wandering was associated with increased P2 amplitudes during the Stroop task, counter to predictions from the perceptual decoupling theory. Overall, the study found that self-report and neural correlates of mind-wandering are sensitive to task context. This line of research can further the understanding of how mechanisms of mind-wandering are adapted to varied tasks and situations.

Adversity and error-monitoring: Effects of emotional context.

This study tested whether self-reports of childhood adversity would predict altered error processing under emotional versus non-emotional task conditions. N = 99 undergraduates completed two selective attention tasks, a traditional color-word Stroop task and a modified task using emotional words, while EEG was recorded. Participants also completed self-report measures of adverse and positive childhood experiences, executive functioning, depression, current stress, and emotion regulation. Reports of adversity were robustly correlated with self-reported challenges in executive functioning, even when controlling for self-reported depression and stress, but adversity was not correlated with task performance. With regard to neural markers of error processing, adversity predicted an enhanced error-related negativity and blunted error-positivity, but only during the emotion-word blocks of the task. Moreover, error-related changes in alpha oscillations were predicted by adversity, in a pattern that suggested less error responsiveness in alpha patterns during the emotion block, compared to the color block, among participants with higher adversity. Overall, results indicate alterations in error monitoring associated with adversity, such that in an emotional context, initial error detection is enhanced and sustained error processing is blunted, even in the absence of overt performance changes.

Simultaneous EEG and pupillary evidence for post-error arousal during a speeded performance task.

Arousal evoked by detecting a performance error may provide a mechanism by which error detection leads to either adaptive or maladaptive changes in attention and performance. By pairing EEG data acquisition with simultaneous measurements of pupil diameter, which is thought to reflect norepinephrinergic arousal, this study tested whether transient changes in EEG oscillations in the alpha frequency range (8-12 Hz) following performance mistakes may reflect error-evoked arousal. In the inter-trial interval following performance mistakes (approximately 8% of trials), pupil diameter increased and EEG alpha power decreased, compared to the inter-trial interval following correct responses. Moreover when trials were binned based on pupil diameter on a within-subjects basis, trials with greater pupil diameter were associated with lower EEG alpha power during the inter-trial interval. This pattern of association suggests that error-related alpha suppression, like pupil dilation, reflects arousal in response to error commission. Errors were also followed by worse next-trial performance, implying that error-evoked arousal may not always be beneficial for adaptive control.

The wandering mind oscillates: EEG alpha power is enhanced during moments of mind-wandering.

What is your brain doing while your mind is wandering? This study used a within-subjects experience-sampling design to test whether episodes of mind-wandering during a demanding cognitive task are associated with increases in EEG alpha power. Alpha refers to cyclic oscillations in EEG activity at 8-12 Hz, and has been previously correlated with internally rather than externally directed cognition. Participants completed a speeded performance task with more than 800 trials while EEG was recorded. Intermittent experience-sampling probes asked participants to indicate whether their mind was wandering or on-task. Participants reported mind-wandering in response to approximately half of the probes. EEG alpha power was significantly higher preceding probes to which participants reported mind-wandering, compared with probes to which participants reported being on task. These findings imply that dynamic changes in alpha power may prove a valuable tool in studying momentary fluctuations in mind-wandering.

Rapid unexpected brain herniation in association with renal replacement therapy in acute brain injury: caution in the neurocritical care unit.

INTRODUCTION: We aim to raise awareness for the potential for rapid brain edema and herniation in acutely brain-injured patients undergoing renal replacement therapy (RRT), including one case undergoing continuous veno-venous hemofiltration. Dialysis disequilibrium syndrome (DDS) may have been a possible cause for the brain edema. METHODS: We retrospectively reviewed four consecutive neurocritically ill patients in acute renal failure undergoing RRT between 2011 and 2013. Imaging, blood pressure, and laboratory data pre-, during, and post-RRT are presented in graphical form. We performed an extensive literature review. RESULTS: All patients suffered rapidly progressive herniation and death from global brain edema closely related in time to RRT, without other identifiable causes even after detailed review by three neurointensivists. Common clinical symptoms included sudden onset fixed and dilated pupils with apnea, consistent with brain stem compression. Herniation was not reversed by high-dose osmotherapy, and all patients died. Our detailed literature review provides plausible mechanisms for DDS as the most likely cause for our patients' brain edema. CONCLUSIONS: Even today, sudden brain edema and herniation may occur in association with RRT in neurocritically ill patients. We call for the establishment of RRT guidelines in patients with acute neurological injuries.

Does early adversity predict executive functioning difficulties among undergraduates? Dissociations among self-report, performance, and EEG measures.

OBJECTIVE: The present research aimed to determine whether self-reports of early adversity predicted individual differences in self-reported and laboratory-measured executive functioning in college-aged samples. METHOD: Two studies with young adult samples (n = 231 and n = 61) measured endorsement of adverse childhood experiences (ACEs), self-reported executive functioning difficulties on the Behavior Rating Inventory of Executive Function (BRIEF), and self-report measures of depression and emotion regulation. The second sample also completed laboratory performance tasks of working memory, inhibitory control, and selective attention while electroencephalogram (EEG) was recorded. RESULTS: In both samples, greater self-reported ACEs predicted greater reports of executive functioning difficulties on the BRIEF (rs = 0.378 and 0.322), relationships of medium effect size that remained significant when controlling for depression and emotion regulation variables. In the second sample, despite robust EEG/event-related potential (ERP) task findings in the group as a whole, neither lab task performance nor EEG/ERP measures were reliably correlated with individual differences in ACEs. CONCLUSIONS: We consider multiple alternative explanations for why early adversity predicted self-reported executive functioning difficulties but not lab task performance or neural measures in the same sample. These findings may reflect a propensity for negative self-evaluation among those with early adverse experiences, leading to inflated estimates of their own executive function problems. Alternatively, the findings may indicate that the lab tasks are insufficient in tapping aspects of executive functions that are relevant outside the lab context. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Stress regulation and cognitive control: evidence relating cortisol reactivity and neural responses to errors.

In this study, we tested the relationship between error-related signals of cognitive control and cortisol reactivity, investigating the hypothesis of common systems for cognitive and emotional self-regulation. Eighty-three participants completed a Stroop task while electroencephalography (EEG) was recorded. Three error-related indices were derived from the EEG: the error-related negativity (ERN), error positivity (Pe), and error-related alpha suppression (ERAS). Pre- and posttask salivary samples were assayed for cortisol, and cortisol change scores were correlated with the EEG variables. Better error-correct differentiation in the ERN predicted less cortisol increase during the task, whereas greater ERAS predicted greater cortisol increase during the task; the Pe was not correlated with cortisol changes. We concluded that an enhanced ERN, part of an adaptive cognitive control system, predicts successful stress regulation. In contrast, an enhanced ERAS response may reflect error-related arousal that is not adaptive. The results support the concept of overlapping systems for cognitive and emotional self-regulation.

Self-fulfilling prophecies through withdrawal of care: do they exist in traumatic brain injury, too?

OBJECTIVE: We examined factors associated with withdrawal of care (WOC) in moderate-severe traumatic brain injury (msTBI) patients, and how WOC may affect short-term mortality and receipt of neurosurgery. Variability in msTBI-related outcome prognostication by clinicians from different specialties was also assessed. METHODS: Rates of WOC, factors associated with WOC, and the relation between WOC and in-hospital case-fatality rate (CFR) and neurosurgery were determined in 232 prospectively enrolled msTBI patients in the ongoing OPTIMISM Study at a level-1 trauma center. In a concomitant web-based survey with clinical vignettes, outcome prognostication comfort, treatment aggressiveness, and WOC recommendations were examined among 106 respondents from neurology, neurocritical care, neurosurgery, trauma and anesthesia/critical care. RESULTS: The average age of the study sample was 53 years, with a median Glasgow Coma Scale of 6. The in-hospital CFR was 36 and 68 % of patients had WOC. Factors independently associated with WOC were advanced age, pupillary reactivity, lower intensive care unit-length-of-stay, pre- and in-hospital cardiac arrest, herniation, intracranial pressure crisis, and pre-existing endocrine disease. Inclusion of WOC in our multivariable regression model predicting in-hospital CFRs negated all other variables. Survey results suggested that in younger patients, some clinicians prognosticated overly pessimistically based upon data available at the time of presentation. CONCLUSION: In our msTBI cohort, WOC was the most important predictor of in-hospital mortality. We identified several important independent predictors of WOC. Large within-center variability in msTBI outcome prognostication with varying levels of possible clinical nihilism exists, which may form the basis of self-fulfilling prophecies.

Social deviance activates the brain's error-monitoring system.

Social psychologists have long noted the tendency for human behavior to conform to social group norms. This study examined whether feedback indicating that participants had deviated from group norms would elicit a neural signal previously shown to be elicited by errors and monetary losses. While electroencephalograms were recorded, participants (N = 30) rated the attractiveness of 120 faces and received feedback giving the purported average rating made by a group of peers. The feedback was manipulated so that group ratings either were the same as a participant's rating or deviated by 1, 2, or 3 points. Feedback indicating deviance from the group norm elicited a feedback-related negativity, a brainwave signal known to be elicited by objective performance errors and losses. The results imply that the brain treats deviance from social norms as an error.

Effects of post-response arousal on cognitive control: Adaptive or maladaptive?

This study investigated whether detection of a performance mistake is followed by adaptive or detrimental effects on subsequent attention and performance. Using a Stroop task with spatial cueing, along with simultaneous EEG and pupillary measurements, we examined evidence bearing on two alternative hypotheses: maladaptive arousal and adaptive control. Error detection, indexed by the error-related negativity ERP component, was followed by pupil dilation and suppression of EEG oscillations in the alpha band, two indices of arousal that were associated with one another on a trial-by-trial basis. On the trials following errors, there was neural evidence of enhanced spatial cueing, manifested in greater hemispheric activation contralateral to the cued visual field. However, this post-error enhancement was not followed by changes in Stroop or spatial cueing effects in performance, nor by increased attentional cueing effects in ERP responses to targets. Rather, performance tended to be slower and less accurate following errors compared to correct trials, and higher post-response arousal, indexed by larger pupils, predicted next-trial slowing and decreased P2 amplitude to targets. Results favor the maladaptive arousal account of post-error cognitive control and offer only limited support for adaptive control.

Find the silver lining or ignore the cloud? Cognitive reappraisal versus visual attention training.

This study contrasted the efficacy of two strategies for emotion regulation, cognitive reappraisal (CR) and attentional control (AC), while using eye-tracking to examine gaze fixation patterns associated with each strategy. Participants (n = 98 undergraduates) viewed emotionally negative and neutral slides before and after one of three training conditions: CR training (verbal instructions to reframe interpretations of negative images), AC training (gaze-contingent feedback emphasizing fixation away from negative portions of images), or a no-training control condition. CR training led to the most beneficial consequences for self-reported emotion ratings; AC training improved emotion ratings more than the no-training control but not as much as CR. AC training led to significantly reduced time fixating gaze on negative content, whereas CR did not alter gaze fixations compared with the no-training control. Moreover, among the AC group, participants who looked away from negative content to a greater extent reported more beneficial change in emotional self-report, whereas that same pattern was not evident in the CR or no-training group. The findings add to evidence that CR training is more effective than distraction-related strategies and that CR does not necessitate gaze changes to be effective. Together, the findings contribute to furthering knowledge about distinct cognitive mechanisms involved in different strategies of emotion regulation. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Total Thyroidectomy as an Ambulatory Procedure in Community Practice.

OBJECTIVE: Increasingly, total thyroidectomy is offered as an ambulatory procedure. Most of the relevant outcomes research derives from academic centers, but most thyroid surgeries are performed in the community. The goal of this study is to evaluate the safety of total thyroidectomy performed as an ambulatory procedure in a community otolaryngology practice. STUDY DESIGN: Retrospective review and national database analysis. SETTING: A single community otolaryngology practice. METHODS: Adult patients undergoing total thyroidectomy by a single otolaryngologist between 2013 and 2019 were divided into 2 cohorts: planned ambulatory and planned admission. Charts were reviewed for demographics and surgical outcomes in the 2 groups. The Healthcare Cost and Utilization Project databases for New York and Florida between 2015 and 2016 were also analyzed to compare outcomes of thyroidectomy as an ambulatory surgery between different practice settings. RESULTS: A total of 99 total thyroidectomies were performed during the study time period; 66 of 99 (67%) were planned as ambulatory procedures and 33 of 99 (33%) were planned admissions. Five of the 66 (8%) planned outpatient surgeries required admission. Complications of vocal fold dysfunction, symptomatic hypocalcemia, and seroma formation were more commonly seen in the inpatient cohort. Only 2 ambulatory patients required admission after discharge. Nationally, odds of complication were higher for ambulatory total thyroidectomy at nonteaching practice sites, which is not duplicated in our study. CONCLUSIONS: Ambulatory total thyroidectomy can be undertaken safely in the community in carefully selected cases.

Use of the facelift incision for excision of non-tuberculous mycobacterial lymphadenitis in children.

OBJECTIVES: To present cases of pediatric periparotid nontuberculous mycobacterial lymphadenitis excised through a facelift incision in order to review the advantages of this approach to parotidectomy. We also aim to discuss scenarios in which to forgo the facelift incision in favor of a traditional modified Blair incision. METHODS: Retrospective series of seven consecutive patients who underwent parotidectomy for nontuberculous mycobacterial lymphadenitis between 2013 and 2018. RESULTS: The series included three uses of the facelift incision and four uses of the modified Blair incision, which was specifically selected for cases of bulky lymphadenopathy anterior to the masseter muscle. All cases of Modified Blair incision involved circumferential dissection of the marginal mandibular branch of the facial nerve. The facelift incision permitted complete removal of disease in cases located posterior to the masseter as well as neck dissection as inferiorly as level III. Post-operatively, temporary marginal mandibular nerve weakness was seen in all cases of Modified Blair incision. Scar widening was most notable in patients who required skin excision or dermal curettage. CONCLUSION: The facelift incision offers a more hidden scar. This may serve as an alternative approach to parotid surgery in young children with nontuberculous mycobacterial lymphadenitis, except in cases of bulky disease anterior to the masseter muscle for which optimal exposure of the marginal mandibular nerve via a modified Blair incision is warranted.

Error-monitoring ability predicts daily stress regulation.

This study examined whether individual differences in error-related self-regulation predict emotion regulation in daily life, as suggested by a common-systems view of cognitive and emotional self-regulation. Participants (N= 47) completed a Stroop task, from which error-related brain potentials and behavioral measures of error correction were computed. Participants subsequently reported on daily stressors and anxiety over a 2-week period. As predicted by the common-systems view, a physiological marker of error monitoring and a behavioral measure of error correction predicted emotion regulation in daily life. Specifically, participants higher in cognitive control, as assessed neurally and behaviorally, were less reactive to stress in daily life. The results support the notion that cognitive control and emotion regulation depend on common or interacting systems.

Error detection and posterror behavior in depressed undergraduates.

This study examined the influence of depression on error-monitoring and behavioral compensation after errors, two important aspects of cognitive control. Undergraduates differing in self-reported depression levels completed a modified Stroop task while error-related scalp potentials were recorded. Behaviorally, participants with higher depression scores were disproportionately slower and less accurate after errors in a task condition that included negative emotional words. Physiological results indicated that the amplitudes of the error-related negativity (ERN) and error positivity (Pe), two indices of error detection, were not correlated with depression score. ERN amplitudes predicted behavioral slowdown after errors, but only among more depressed participants in the negative-word condition. Together, the results imply that depression is associated not with an error detection deficit, but rather with alterations in subsequent performance changes, once errors have been identified.

Trouble crossing the bridge: altered interhemispheric communication of emotional images in anxiety.

Worry is thought to involve a strategy of cognitive avoidance, in which internal verbalization acts to suppress threatening emotional imagery. This study tested the hypothesis that worry-prone individuals would exhibit patterns of between-hemisphere communication that reflect cognitive avoidance. Specifically, the hypothesis predicted slower transfer of threatening images from the left to the right hemisphere among worriers. Event-related potential (ERP) measures of interhemispheric transfer time supported this prediction. Left-to-right hemisphere transfer times for angry faces were relatively slower for individuals scoring high in self-reported worry compared with those scoring low, whereas transfer of happy and neutral faces did not differ between groups. These results suggest that altered interhemispheric communication may constitute one mechanism of cognitive avoidance in worry.

Is attention enhanced following performance errors? Testing the adaptive control hypothesis.

The present study tested whether people adaptively sharpen attentional focus following performance mistakes, as predicted by current theories of cognitive control. Participants completed a reverse Stroop task in which target stimuli were preceded by an informative spatial cue. Cue validity and Stroop interference effects on performance were robust, but neither effect was altered by commission of an error on the prior trial, as predicted by the adaptive control model. Likewise, a prior error did not enhance cue-evoked spatial asymmetries in EEG, nor did it enhance validity effects on neural responses evoked by targets. Instead, errors were followed by poorer overall performance and generalized arousal, as measured by generally suppressed EEG alpha power in postresponse and cue-to-target intervals following errors compared to correct responses. Results support an alternative theory that post-error changes in neural activity and performance reflect arousal, orienting, or cognitive bottlenecking rather than adaptive control of attention.