The floating duck syndrome: biased social learning leads to effort-reward imbalances.

An increasingly common phenomenon in modern work and school settings is individuals taking on too many tasks and spending effort without commensurate rewards. Such an imbalance of efforts and rewards leads to myriad negative consequences, such as burnout, anxiety and disease. Here, we develop a model to explain how such effort-reward imbalances can come about as a result of biased social learning dynamics. Our model is based on a phenomenon that on some US college campuses is called 'the floating duck syndrome'. This phrase refers to the social pressure on individuals to advertise their successes but hide the struggles and the effort put in to achieve them. We show that a bias against revealing the true effort results in social learning dynamics that lead others to underestimate the difficulty of the world. This in turn leads individuals to both invest too much total effort and spread this effort over too many activities, reducing the success rate from each activity and creating effort-reward imbalances. We also consider potential ways to counteract the floating duck effect: we find that solutions other than addressing the root cause, biased observation of effort, are unlikely to work.

A preliminary examination of the TOMM2 in a sample of Spanish speakers in the United States.

BACKGROUND: The Test of Memory Malingering (TOMM) is a widely used performance validity measure that is available in both English and Spanish. The Spanish version, however, has historically lacked normative data from samples that are representative of the U.S. Hispanic/Spanish speaking population. OBJECTIVE: The aim of the current study was to collect normative data on the update TOMM 2 for Hispanic individuals residing in the U.S. METHODS: Normative data on the TOMM 2 was collected across 9 sites from different regions of the U.S. The total sample consisted of n = 188 cognitively healthy adults aged 18 and over with no current or prior history of neurological or psychiatric disorder. Descriptive analyses were performed on total raw scores. RESULTS: Participants obtained a mean score of 48.15 (SD = 2.81) on trial 1 of the TOMM 2, 49.86 (SD = 0.487) on trial 2, and 49.84 (SD = 0.509) on the recognition trial. Scores are provided for traditional cutoff scores as well as some popular cutoffs reported in the literature. Item level analyses were conducted as well as evaluation of performance based on a variety of demographics. CONCLUSION: When compared to the English-speaking normative sample used for the original TOMM, this sample demonstrated better performance on the TOMM 2 indicating better cultural appropriateness of the items. This is the first study conducted that provides culturally appropriate descriptive norms for use with Spanish speakers living in the U.S.

The Discrepancy Between External and Internal Load/Intensity during Blood Flow Restriction Exercise: Understanding Blood Flow Restriction Pressure as Modulating Factor.

Physical exercise induces acute psychophysiological responses leading to chronic adaptations when the exercise stimulus is applied repeatedly, at sufficient time periods, and with appropriate magnitude. To maximize long-term training adaptations, it is crucial to control and manipulate the external load and the resulting psychophysiological strain. Therefore, scientists have developed a theoretical framework that distinguishes between the physical work performed during exercise (i.e., external load/intensity) and indicators of the body's psychophysiological response (i.e., internal load/intensity). However, the application of blood flow restriction (BFR) during exercise with low external loads/intensities (e.g., ≤ 30% of the one-repetition-maximum, ≤ 50% of maximum oxygen uptake) can induce physiological and perceptual responses, which are commonly associated with high external loads/intensities. This current opinion aimed to emphasize the mismatch between external and internal load/intensity when BFR is applied during exercise. In this regard, there is evidence that BFR can be used to manipulate both external load/intensity (by reducing total work when exercise is performed to exhaustion) and internal load/intensity (by leading to higher physiological and perceptual responses compared to exercise performed with the same external load/intensity without BFR). Furthermore, it is proposed to consider BFR as an additional exercise determinant, given that the amount of BFR pressure can determine not only the internal but also external load/intensity. Finally, terminological recommendations for the use of the proposed terms in the scientific context and for practitioners are given, which should be considered when designing, reporting, discussing, and presenting BFR studies, exercise, and/or training programs.

Life history strategy and romantic satisfaction in patients' behavior.

According to evolutionary psychologists, an individual-consciously or not-who allocates resources for somatic effort focuses on homeostasis and the protection of themselves and others. During health crises, patients must choose between mobilizing their remaining resources to either recover or accepting the disease as inevitable. When patients choose to be proactive in terms of protecting their health, are conscientious, and compliant in the recovery process, a high level of patient activation is achieved. Therefore, we examined (N = 252) whether the patients' K fitness strategies are predictors for engagement in patient activation-type behavior. In addition, we tested the mediating effect of pain catastrophizing and the moderating effect of romantic satisfaction. We found that people with a medical diagnosis, who were in a romantic relationship, and had high-K fitness were much more likely to be activated patients. Moreover, pain catastrophizing mediated the relationship between high-K fitness strategy and patient activation, while romantic satisfaction moderated this relationship, amplifying its intensity. The findings highlight the importance of identifying patients' psychological resources (e.g., high-K strategy, romantic satisfaction, or pain perception) to keep them engaged in the health recovery process.

Influences of noise reduction on speech intelligibility, listening effort, and sound quality among adults with severe to profound hearing loss.

Introduction: Noise reduction (NR) algorithms have been integrated into modern digital hearing aids to reduce noise annoyance and enhance speech intelligibility. This study aimed to evaluate the influences of a novel hearing aid NR algorithm on individuals with severe-to-profound hearing loss. Methods: Twenty-five participants with severe-to-profound bilateral sensorineural hearing loss underwent three tests (speech intelligibility, listening effort, and subjective sound quality in noise) to investigate the influences of NR. All three tests were performed under three NR strength levels (Off, Moderate, and Strong) for both speech in noise program (SpiN) and speech in loud noise program (SpiLN), comprising six different hearing aid conditions. Results: NR activation significantly reduced listening effort. Subjective sound quality assessments also exhibited benefits of activated NR in terms of noise suppression, listening comfort, satisfaction, and speech clarity. Discussion: Individuals with severe-to-profound hearing loss still experienced advantages from NR technology in both listening effort measure and subjective sound quality assessments. Importantly, these benefits did not adversely affect speech intelligibility.

Attitudes of support people: a key element when implementing technologies for people with intellectual and visual disabilities.

AIM: The degree to which people with intellectual and visual disabilities can use technology relies on the level of support they receive. However, there is a lack of knowledge about the relationship between the constructs effort expectancy, attitudes, and behavioural intentions of support people (i.e. relatives and healthcare professionals) regarding the use of such technologies for people with intellectual and visual disabilities. The aim of this study was to gain insight into how these constructs are connected and to explore their relationship with support person's characteristics and the support need levels of people with intellectual and visual disabilities. METHODS: In total, 186 support people from a Dutch healthcare organisation focusing on people with intellectual and visual disabilities participated in an online questionnaire. We used a regression analysis to explore how the constructs, the characteristics, and the level of support needs were related. RESULTS: Both effort expectancy (ß = .35; t(185) = 5.04; p < .001) and attitude (ß = .75; t(185) = 15.55; p < .001) of support people were related to the intention to use technologies. The effect of effort expectancy (ß = .04; t(177) = .74; p = .462) on the intention to use technologies was mediated through attitude (ß = .74; t(177) = 13.28; p < .001). Younger support people scored higher on attitude than older support people. CONCLUSIONS: Support people's effort expectancy and attitude play a significant role in their intention to use technologies when supporting people with intellectual and visual disabilities, with attitude emerging as pivotal factor.

A better understanding of the relationship between effort expectancy, attitude, and the intention to use technologies in support people may facilitate the implementation of technologies.The intentions of support people to use technologies is not related to the level of support needs of people with intellectual and visual disabilities.Younger support people have a more positive attitude towards technology for people with support needs compared to older support people.A positive attitude has a strong and positive relationship to a higher behavioural intention. Therefore, when implementing technologies, healthcare organisations should pay special attention to the attitude of support people towards the use of technologies for people with support needs.

An audacious approach to conservation.

New digital and sensor technology provides a huge opportunity to revolutionise conservation, but we lack a plan for deploying the technologies effectively. I argue that environmental research should be concentrated at a small number of 'super-sites' and that the concentrated knowledge from super-sites should be used to develop holistic ecosystem models. These, in turn, should be morphed into digital twin ecosystems by live connecting them with automated environmental monitoring programmes. Data-driven simulations can then help select pathways to achieve locally determined conservation goals, and digital twins could revise and adapt those decisions in real-time. This technology-heavy vision for 'smart conservation' provides a map toward a future defined by more flexible, more responsive, and more efficient management of natural environments.

Full range leadership style and its effect on effectiveness, employee satisfaction, and extra effort: an empirical study.

The purpose of this study is to determine if there is a positive relationship between full-range leadership and employees' effort, efficiency, and satisfaction. A questionnaire was administered to 577 executives from Colombian companies, and the data was analyzed using a partial least squares structural equation modeling (PLS-SEM) approach. The results show that both transformational and transactional leadership have a direct and significant impact on extra effort, effectiveness, and satisfaction, with transformational leadership having the greatest impact on these factors. Conversely, passive-avoidant leadership has negative effects on these three constructs. This study validates the effectiveness of the MLQ 5X in a South American country, a geographical region where such studies are in their early stages. Finally, the whole range of leadership styles-transformational, transactional, and passive-avoidant-is looked at. These styles are seen as second-order constructs that challenge latent multidimensional models as they emerge.

The relationship between effort-reward imbalance and quality of working life among medical caregivers: mediating effects of job burnout.

Background: To determine the relationship between effort-reward imbalance (ERI) and quality of working life (QWL) among medical caregivers and the mediating role of job burnout. Methods: This was a cross-sectional survey. A total of 787 medical caregivers at seven hospitals from Sichuan and Chongqing, China, between May to September 2023 were included in this observational study. The General Information Questionnaire, Effort-Reward Imbalance Questionnaire (ERI), Maslach Burnout Inventory-General Survey (MBI-GS), and Quality of Working Life Scale (QWL7-32) were used for data collection. SPSS 26.0 and PROCESSv3.3 were used for all data analyses, including descriptive statistics. Results: A total of 820 questionnaires were distributed, of which only 787 were valid (return rate; 95.98%). The QWL score of medical caregivers was 126.94 ± 16.69. However, QWL scores were significantly different depending on age, number of children, family support status, department, years of experience, night shift status, number of night shifts per month, number of hours worked per day, monthly income, and occurrence of errors or adverse events (p < 0.05). Furthermore, job burnout and ERI were negatively correlated with QWL (p < 0.01). Job burnout mediated (95% CI = -0.365, -0.260) the relationship between ERI and QWL, accounting for 58.65% of the total effect. Conclusion: Medical caregivers have a medium level of QWL. Job burnout partially mediates the relationship between ERI and QWL. Medical caregiver managers can improve QWL by directly intervening in occupational stress and indirectly intervening in job burnout.

Correlation analysis of occupational stress and metabolic syndrome among employees of a power grid enterprise in China.

BACKGROUND: Being in a state of high occupational stress may disrupt the metabolic balance of the body, thus increasing the risk of metabolic diseases. However, the evidence about the relationship between occupational stress and metabolic syndrome was limited. OBJECTIVES: To explore the association between occupational stress and metabolic syndrome (MetS) in employees of a power grid enterprise. METHODS: A total of 1091 employees were recruited from a power grid enterprise in China. Excluding those who failed to complete the questionnaire and those who had incomplete health check-ups, 945 subjects were included in the study. Assessment of occupational stress was used by job demand-control (JDC) and effort-reward imbalance (ERI) questionnaires, respectively. The information on body mass index (BMI), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were collected. The levels of high-density lipoprotein cholesterol (HDL-C), triglycerides (TG), and fasting blood glucose (FBG) in the fasting venous blood samples were measured. Logistic regression analysis and multiple linear regression methods were used to analyze the correlation between JDC and ERI models of occupational stress, metabolic syndrome, and its components, respectively. RESULTS: The prevalence of MetS was 8.4% and 9.9% in JDC and ERI model high occupational stress employees, respectively. ERI model occupational stress and smoking are significantly associated with the risk of MetS. ERI ratio was significantly associated with lower HDL-C levels. Gender, age, marital status, smoking, high-temperature and high-altitude work were significantly associated with metabolic component levels. CONCLUSION: Our study revealed a high detection rate of occupational stress in both JDC and ERI models among employees of a power grid enterprise. ERI model occupational stress, demanding more attention, was associated with the risk of MetS as well as its components such as HDL-C.

Factors influencing the use of big data within healthcare services: a systematic review.

Background: The emergence of big data holds the promise of aiding healthcare providers by identifying patterns and converting vast quantities of data into actionable insights facilitating the provision of precision medicine and decision-making. Objective: This study aimed to investigate the factors influencing use of big data within healthcare services to facilitate their use. Method: A systematic review was conducted in February 2024, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Database searches for articles published between 01 January 2020 and 18 February 2024 and included PubMed, Scopus, ProQuest and Cochrane Library. The Authority, Accuracy, Coverage, Objectivity, Date, Significance ( AACODS) checklist was used to evaluate the quality of the included articles. Subsequently, a thematic analysis was conducted on the findings of the review, using the Boyatzis approach. Results: A final selection of 46 studies were included in this systematic review. A significant proportion of these studies demonstrated acceptable quality, and the level of bias was deemed satisfactory. Thematic analysis identified seven major themes that influenced the use of big data in healthcare services. These themes were grouped into four primary categories: performance expectancy, effort expectancy, social influence, and facilitating conditions. Factors associated with "effort expectancy" were the most highly cited in the included studies (67%), while those related to "social influence" received the fewest citations (15%). Conclusion: This study underscored the critical role of "effort expectancy" factors, particularly those under the theme of "data complexity and management," in the process of using big data in healthcare services. Implications: Results of this study provide groundwork for future research to explore facilitators and barriers to using big data in health care, particularly in relation to data complexity and the efficient and effective management of big data, with significant implications for healthcare administrators and policymakers.

Teacher support and its impact on ESL student engagement in blended learning: The mediating effects of L2 grit and intended effort.

BACKGROUND: In the shifting paradigm of English as a Foreign Language (EFL) instruction, blended learning has become increasingly prevalent, necessitating understanding factors that drive student engagement. The research delves into the intricate interaction between teacher support and student engagement, postulating that L2 grit and intended effort function as mediators within this dynamic. METHODS: We employed a cross-sectional design involving a sample of 712 EFL students engaged in blended learning courses. Through quantitative analysis, we measured the constructs of teacher support, L2 grit, intended effort, and student engagement with validated scales. Structural Equation Modeling (SEM) was applied to investigate the relationships between these variables and to test the hypothesized mediation effects. RESULTS: The results demonstrated that teacher support correlated with higher levels of student engagement. L2 grit and intended effort were identified as significant mediators in this relationship. L2 grit acted as a bridge between teacher support and student engagement, reflecting the essential role of perseverance and passion for long-term language learning objectives. Intended effort further mediated this relationship, indicating that supportive teacher behaviors foster greater student effort, enhancing overall engagement. The study also revealed a chain mediation effect, suggesting that teacher support sequentially enhances L2 grit, which in turn increases intended effort, cumulatively leading to improved student engagement. CONCLUSION: The findings offer evidence of the central role of teacher support in bolstering student engagement through the development of L2 grit and the enhancement of intended effort. This paper underlines the necessity of a supportive learning environment in blended EFL settings and presents a novel sequential mediation framework that can guide educators, curriculum designers, and policymakers in creating more effective learning experiences.

Transcranial direct current stimulation enhances effort maintenance in ADHD.

BACKGROUND: Youth with attention-deficit/hyperactivity disorder (ADHD) exhibit increased effort aversion, likely due to deficits in anticipatory dopamine firing. Previous research has shown that transcranial direct current stimulation (tDCS) targeting the right prefrontal cortex can enhance activity in dopaminergic meso-striatal regions. However, the extent to which this specific tDCS configuration effectively modulates effort behavior in anticipation of rewards in ADHD remains uncertain. HYPOTHESIS: We expected an increase of effort maintenance and invigoration during and following our tDCS set-up compared to sham in subjects with ADHD. METHODS: Twenty-four children and adolescents with ADHD (mean age: 11.6 years; 95 % CI [10.7, 12.4]) received 2 mA and sham tDCS for 20 min each. The anode was positioned over the ventromedial prefrontal cortex (PFC), while the cathode was placed over the right dorsolateral PFC, generating an electrical field with maximal strength in the right PFC. During and after the tDCS sessions, participants performed a button-pressing task aimed at earning delayed monetary rewards. Primary outcomes were effort maintenance (frequency of button presses) and invigoration (slopes of button presses), measuring motor task performance. RESULTS: We observed a significant increase in effort maintenance both during (b = 2.66; p < 0.001) and after tDCS (b = 2.04; p= .007) compared to sham. No significant difference was found for invigoration during stimulation, while after bonferroni correction (p = 0.025) a non-significant decrease was found after tDCS compared to sham (b = -5.18; p = 0.041). CONCLUSION: tDCS targeting the ventromedial PFC (anodal) and right dorsolateral PFC (cathodal) increases effort maintenance in children and adolescents with ADHD.

Effortful retrieval of semantic memories induces forgetting of related negative and neutral episodic memories.

Retrieval-induced forgetting (RIF) experiments show that the act of retrieving some recently encoded items from a given conceptual category leads to greater forgetting of competing items from that same category. However, RIF studies using emotional stimuli have produced mixed results, perhaps due to the reinstatement of arousal or negative affect during retrieval practice. To induce forgetting of negative episodic memories more indirectly, we examined if retrieving neutral semantic memories leads to RIF of related negative memories. In two experiments, participants studied eight categorized lists comprised of an equal number of negative and neutral words (Experiment 1) or neutral words preceded by neutral or negative images (Experiment 2). To avoid re-exposing individuals to negative material during retrieval practice, participants then performed a semantic memory retrieval task in which they generated (i.e., completed word-stems for) new neutral words from half of the studied categories. We found that semantic retrieval, or word generation, induced forgetting of recently studied words irrespective of their emotional valence or original emotional context. Additionally, across both experiments, less successful word generation was associated with stronger RIF effects. In Experiment 2, the magnitude of RIF was also correlated with higher subjective ratings of retrieval effort during word generation. Together, these results suggest that even when retrieving neutral semantic memories, effortful retrieval may enhance inhibitory processes that lead to forgetting of both neutral and negative episodic memories.

Effect of Fatigue on Word Production in Aphasia.

Speech production in aphasia is often described as "effortful", though the consequences of consistent, high degrees of cognitive effort have not been explored. Using recent work on mental effort as a theoretical framework, the present study examined how effort-related fatigue produces decrements in performance in picture naming among participants with post-stroke aphasia. We analyzed three data sets from prior studies where participants completed a large picture naming test. Decreasing naming accuracy across trials was statistically significant in two of the three samples. There were also significant effects of practice (better performance on a second test administration), word frequency (better performance for more frequent words), and word length (better performance for shorter words). These results are the first concrete demonstration of fatigue affecting performance on a language task in post-stroke aphasia. They open a new avenue for research on mental effort/fatigue with potential implications for aphasia assessment, treatment, and management.

Predicting future medical needs and mortality risk in geriatric long-term care patients : Development and validation of the Nascher score and revised Nascher score.

BACKGROUND: Choosing the right intensity of medical care is a huge challenge particularly in long-term geriatric care. The Nascher score was developed to assess future medical care needs. The aim of this study was to determine whether the Nascher score and a revised version can predict future medical needs. METHODS: In this retrospective cohort study, 396 residents in long-term care hospitals, who were admitted over a period of two years and followed up to two and a half yeare, were analysed. Outcome parameters were: (1) number of medication changes, (2) number of ward doctor documentations and (3) number of acute illnesses treated with antibiotics, and mortality risk. Based on the first results, an alternative scoring of the Nascher score with 12 instead of 26 items was developed, called the revised Nascher score. RESULTS: The Nascher score significantly correlated with the number of medication changes, the number of ward doctor documentations, and the number of acute ilnesses treated with antibiotics with Spearman correlation coefficients of 0.30, 0.26, and 0.15, respectively. The revised Nascher score showed a higher correlation with correlation coefficients of 0.36, 0.26, and 0.21, respectively. Residents with a Nascher score in the highest quartile had a significantly higher mortality risk than residents in the lowest quartile (hazard ratio, HR 2.97, 95% confidence interval, CI 1.80-4.34). The corresponding values for the revised Nascher score were HR 3.03, 95% CI 2.03-4.54 in the highest and HR 1.80, 95% CI 1.24-2.60 in the middle quartiles. CONCLUSION: The Nascher score and even more so the revised Nascher score are well suited to predicting the various parameters of future medical needs and mortality risk.

Context effects in cognitive effort evaluation.

When given a choice, people will avoid cognitively effortful courses of action because the experience of effort is evaluated as aversive and costly. At the same time, a body of work spanning psychology, economics, and neuroscience suggests that goods, actions, and experiences are often evaluated in the context in which they are encountered, rather in absolute terms. To probe the extent to which the evaluation of cognitive effort is also context-dependent, we had participants learn associations between unique stimuli and subjective demand levels across low-demand and high-demand contexts. We probed demand preferences and subjective evaluation using a forced-choice paradigm as well by examining effort ratings, taken both on-line (during learning) and off-line (after choice). When choosing between two stimuli objectively identical in terms of demand, participants showed a clear preference for the stimulus learned in the low- versus high-demand context and rated this stimulus as more subjectively effortful than the low-demand context in on-line but not off-line ratings, suggesting an assimilation effect. Finally, we observed that the extent to which individual participants who exhibited stronger assimilation effects in off-line demand ratings were more likely to manifest an assimilation effect in demand preferences. Broadly, our findings suggest that effort evaluations occur in a context-dependent manner and are specifically assimilated to the broader context in which they occur.

Physical effort modulates perceptual awareness judgment independent of level of processing.

Recent studies have emphasized the association between action and perceptual awareness, suggesting that action-related information can contribute to perceptual awareness. Given that the Level of Processing (LoP) hypothesis proposes that the emergence of awareness depends on the level of stimulus processing, the current study examines whether action impacts perceptual awareness across different processing levels. In Experiment 1, participants identified target stimuli's color (low-level task) or category (high-level task) via mouse clicks, followed by visual awareness ratings. Experiment 2 replicated the tasks using hand-grip dynamometers. Results from Experiment 1 support the LoP theory, showing a more gradual emergence of awareness for low-level features and a more dichotomous emergence for high-level features. In Experiment 2, higher reported visual awareness ratings were observed at greater physical effort, regardless of task type. These results suggest that action-related information influences reported awareness of stimuli in the same way at low- and high-level stimulus processing.

Midurethral sling infectious complications: A systematic review.

BACKGROUND: The French Health Authority (Haute Autorité de santé) and French scientific societies (Collège national des gynécologues et obstétriciens français) recommend the use of midurethral slings as the surgical treatment of choice for stress incontinence due to urethral hypermobility and failure of hygienic diet and pelvic rehabilitation. Within a year of implantation, almost 90% of patients no longer experience stress urinary incontinence. Despite their recognized efficacy, retropubic and/or trans-obturator midurethral sling can expose patients to potentially severe infectious complications. METHODS: A comprehensive literature review using Pubmed, Medline, Embase and Cochrane: "stress urinary incontinence", and/or the following keywords "complications", "infections", "abscess", "prosthetic exposures", "fistula", "erosion", "cellulitis", "fasciitis" in association with the keywords "midurethral slings", "suburethral sling", "tension free vaginal tape" and "trans-obturator tape. In the 330 articles, 61 really dealt with infectious complications following the implantation of synthetic midurethral slings in women. RESULTS: Preoperative urinalysis and intraoperative antibiotic prophylaxis were rarely reported (n=1 and n=11, respectively). We recorded thirty-six cases of abscess, twenty-one cases of cellulitis, sixteen cases of fistula and forty-one cases of prosthetic exposure. In 95.5% of cases, patients were treated with broad-spectrum antibiotics. Total explantation of the prosthesis was performed in 56% of patients at the initial management, with two-stage explantation performed in 23% of cases, partial explantation was carried out in 12% of cases, and the prosthesis was left in place in 9% of cases. No deaths were recorded. CONCLUSION: To limit the risk of urinary tract infections and potential prosthetic infections, a prophylactic approach should be adopted by performing a preoperative urinalysis and administering intraoperative antibiotic prophylaxis should be discussed. In the event of prosthetic and/or surgical site infection, broad-spectrum probabilistic antibiotic therapy should be initiated as early as possible until targeted antibiotic therapy. Total explantation of the prosthesis appears to be the most appropriate surgical strategy.

Markers of too little effort or too much alertness during neuropsychological assessment: Demonstration with perioperative changes.

OBJECTIVE: Cognitive assessment is based on performance in different tests. However, this performance might be hindered by lack of effective effort on the one hand, and by too much stress on the other hand. Despite their known impact, there are currently no effective tools for measuring cognitive effort or stress effect during cognitive assessment. We developed real-time electrophysiological markers for cognitive effort and for stress effect, which could be used during cognitive assessment. METHODS: We assessed these markers during the use of the Montreal Cognitive Assessment (MoCA) before and after cardiac surgery, which is known to involve cognitive decline in up to 30%-50% of elderly patients. RESULTS: The major findings of the study, for the largest group of patients, with preoperative MoCA in the intermediate range, were that the decline is significantly associated (1) with higher preoperative cognitive effort and (2) with higher postoperative stress effect during the test. CONCLUSIONS: These findings, as well as preliminary additional ones, suggest a potential importance for monitoring cognitive effort and stress effect during assessment in general, and specifically during perioperative assessment. SIGNIFICANCE: Easy-to-use markers could improve the efficacy of cognitive assessment and direct treatment generally, and specifically for perioperative decline.