Transfer of learned cognitive control settings within and between tasks.

Cognitive control is modulated based on learned associations between conflict probability and stimulus features such as color. We investigated whether such learning-guided control transfers to novel stimuli and/or a novel task. In Experiments 1 and 2, participants experienced an item-specific proportion congruence (ISPC) manipulation in a Stroop (Experiment 1) or Flanker (Experiment 2) task with mostly congruent (MC) and mostly incongruent (MI) colors in training blocks. During a transfer block, participants performed the same task and encountered novel transfer stimuli paired with MC or MI colors. Evidencing within-task transfer, in both experiments, responses were faster to incongruent transfer stimuli comprising an MI color compared with an MC color. In Experiment 3, we investigated between-task transfer from Stroop to Flanker. After training with an ISPC manipulation in the Stroop task, a Flanker task was completed with the same colors but without an ISPC manipulation (i.e., 50% congruent). Responses were faster to incongruent transfer stimuli paired with the previously-MI colors compared with the previously-MC colors. Additionally, transfer was evident in the first half of the Flanker task but not the second half. The evidence for within-task transfer, in combination with the novel evidence for between-task transfer, suggests learned control settings are flexibly retrieved and executed when predictive cues signaling these control settings are encountered in novel stimuli or a novel task. Theoretical implications are discussed alongside potential neural mechanisms mediating transfer of learning-guided control.

A Retrospective Observational Case Series of Low-Flow Venovenous Extracorporeal Carbon Dioxide Removal Use in Patients with Respiratory Failure.

We aimed to describe the use of venovenous extracorporeal carbon dioxide removal (ECCO2R) in patients with hypercapnic respiratory failure. We performed a retrospective case note review of patients admitted to our tertiary regional intensive care unit and commenced on ECCO2R from August 2013 to February 2015. Fourteen patients received ECCO2R. Demographic data, physiologic data (including pH and partial pressure of carbon dioxide in arterial blood [PaCO2]) when starting ECCO2R (t = 0), at 4 hourly intervals for the first 24 hours, then at 24 hour intervals until cessation of ECCO2R, and overall outcome were recorded. Patients are reported separately depending on whether the indication for ECCO2R was an exacerbation of chronic obstructive pulmonary disease (COPD; n = 5), or acute respiratory distress syndrome (ARDS) and persisting hypercapnoea (n = 9). Patients were managed with ECCO2R (Hemolung, ALung Inc, Pittsburgh, PA). Median duration of ECCO2R was 5 days. Four complications related to ECCO2R were reported, none resulting in serious adverse outcomes. Ten patients were discharged from intensive care unit (ICU) alive. A statistically significant improvement in pH (p = 0.012) was demonstrated. Our observational series of ECCO2R shows that this technique can be safely used to achieve therapeutic goals in patients requiring lung protection, and in COPD, in line with current publications in this area.

Atrio-oesophageal fistula after transcatheter radiofrequency ablation.

A 68-year-old woman presented 3 weeks following unsuccessful transcatheter radiofrequency ablation (TcRFA) for treatment of her chronic atrial fibrillation. Neurological signs manifested on day 2 of admission with generalised tonic-clonic seizures and reduced Glasgow Coma Score. She was treated for presumed central nervous system (CNS) infection, intubated and transferred to the intensive care unit. CT of the head showed bilateral oedema secondary to acute embolic stroke. Blood cultures grew Streptococcus viridans, and lumbar puncture findings were consistent with CNS infection. Echocardiography showed only a septostomy puncture from the atrial fibrillation ablation procedure. Thoracic CT demonstrated air in the left atrium, consistent with the diagnosis of atrio-oesophageal fistula, a rarely reported iatrogenic complication of TcRFA. MRI of the head showed significant neurological injury with innumerable embolic infarcts. After discussion with her family regarding the significant neurological insult, and with no signs of any clinical improvement, the patient died on day 8 of admission.