Short-term retention of learning after rapid adaptation to native and non-native speecha).

Non-native, accented speech spoken by unfamiliar talkers can be challenging to recognize, but rapid improvements in perception are often observed after a short period of exposure. However, it is not clear whether these improvements are retained over multiple sessions. Stimulus variability facilitates learning for non-native speech, so it is possible it may also induce increased retention of learning for speech produced with an unfamiliar accent. In this paper, we conduct a retrospective analysis of a dataset well suited to examine learning of non-native English speech on both a within-session and across-session basis. During data collection, participants completed a protocol involving recognition of matrix sentences recorded by native and non-native talkers with different first languages. Listeners completed the protocol in a self-paced approach, including 15 blocks of 50 trials over 4-7 days, separated by an average of 1-2 days. Learning was strongest within the first day, and improvements were retained at subsequent test sessions. The pace of learning was faster for stimuli produced by native speakers of English as compared to non-native English speakers.

Vigilance to Spatialized Auditory Displays: Initial Assessment of Performance and Workload.

OBJECTIVE: The present study was designed to evaluate human performance and workload associated with an auditory vigilance task that required spatial discrimination of auditory stimuli. BACKGROUND: Spatial auditory displays have been increasingly developed and implemented into settings that require vigilance toward auditory spatial discrimination and localization (e.g., collision avoidance warnings). Research has yet to determine whether a vigilance decrement could impede performance in such applications. METHOD: Participants completed a 40-minute auditory vigilance task in either a spatial discrimination condition or a temporal discrimination condition. In the spatial discrimination condition, participants differentiated sounds based on differences in spatial location. In the temporal discrimination condition, participants differentiated sounds based on differences in stimulus duration. RESULTS: Correct detections and false alarms declined during the vigilance task, and each did so at a similar rate in both conditions. The overall level of correct detections did not differ significantly between conditions, but false alarms occurred more frequently within the spatial discrimination condition than in the temporal discrimination condition. NASA-TLX ratings and pupil diameter measurements indicated no differences in workload. CONCLUSION: Results indicated that tasks requiring auditory spatial discrimination can induce a vigilance decrement; and they may result in inferior vigilance performance, compared to tasks requiring discrimination of auditory duration. APPLICATION: Vigilance decrements may impede performance and safety in settings that depend on sustained attention to spatial auditory displays. Display designers should also be aware that auditory displays that require users to discriminate differences in spatial location may result in poorer discrimination performance than non-spatial displays.

ST Elevation MI with Normal Coronary Arteries: A MINOCA Case.

BACKGROUND: Myocardial infarction with nonobstructive coronary arteries (MINOCA) is a syndrome characterized by clinical evidence of myocardial infarction with normal or near-normal coronary arteries on angiography. CASE REPORT: A 35-year-old female patient presented with typical chest pain. EKG revealed sinus rhythm, 1 mm ST elevation in DI-aVL, prominent R waves in V1-V3 and ST-segment depression in DIII-aVF. She underwent emergent coronary angiography which revealed normal coronary arteries. Troponin levels peaked at 123 ng/mL. 2D Transthoracic echocardiogram showed an EF of 50 percent with lateral wall hypokinesis. A cardiac magnetic resonance imaging (CMR) showed myocardial scar tissue. Epicardial late gadolinium enhancement (LGE) was noted in the lateral left ventricular wall consistent with transmural myocardial infarction. DISCUSSION: MINOCA is not an uncommon presentation of acute MI (AMI). It is more frequent in younger women and nonwhites, is associated with fewer traditional risk factors, and usually presents with non-ST-segment elevation- myocardial infarction. Patients with MINOCA should undergo further testing to reveal the underlying etiology as treatment will vary depending on the cause. MINOCA is not a benign syndrome, with outcomes comparable to their AMI-CAD counterparts especially in younger patients.

The impacts of training on change deafness and build-up in a flicker task.

Performance on auditory change detection tasks can be improved by training. We examined the stimulus specificity of these training effects in behavior and ERPs. A flicker change detection task was employed in which spatialized auditory scenes were alternated until a "change" or "same" response was made. For half of the trials, scenes were identical. The other half contained changes in the spatial locations of objects from scene to scene. On Day 1, participants were either trained on this auditory change detection task (trained group), or trained on a non-auditory change detection task (control group). On Day 2, all participants were tested on the flicker task while EEG was recorded. The trained group showed greater change detection accuracy than the control group. They were less biased to respond "same" and showed full generalization of learning from trained to novel auditory objects. ERPs for "change" compared to "same" trials showed more negative going P1, N1, and P2 amplitudes, as well as a larger P3b amplitude. The P3b amplitude also differed between the trained and control group, with larger amplitudes for the trained group. Analysis of ERPs to scenes viewed prior to a decision revealed build-up of a difference between "change" and "same" trials in N1 and P2. Results demonstrate that training has an impact early in the "same" versus "change" decision-making process, and that the flicker paradigm combined with the ERP method can be used to study the build-up of change detection in auditory scenes.

Persistent Spinal Pain Syndrome: A Proposal for Failed Back Surgery Syndrome and ICD-11.

OBJECTIVE: For many medical professionals dealing with patients with persistent pain following spine surgery, the term Failed back surgery syndrome (FBSS) as a diagnostic label is inadequate, misleading, and potentially troublesome. It misrepresents causation. Alternative terms have been suggested, but none has replaced FBSS. The International Association for the Study of Pain (IASP) published a revised classification of chronic pain, as part of the new International Classification of Diseases (ICD-11), which has been accepted by the World Health Organization (WHO). This includes the term Chronic pain after spinal surgery (CPSS), which is suggested as a replacement for FBSS. METHODS: This article provides arguments and rationale for a replacement definition. In order to propose a broadly applicable yet more precise and clinically informative term, an international group of experts was established. RESULTS: 14 candidate replacement terms were considered and ranked. The application of agreed criteria reduced this to a shortlist of four. A preferred option-Persistent spinal pain syndrome-was selected by a structured workshop and Delphi process. We provide rationale for using Persistent spinal pain syndrome and a schema for its incorporation into ICD-11. We propose the adoption of this term would strengthen the new ICD-11 classification. CONCLUSIONS: This project is important to those in the fields of pain management, spine surgery, and neuromodulation, as well as patients labeled with FBSS. Through a shift in perspective, it could facilitate the application of the new ICD-11 classification and allow clearer discussion among medical professionals, industry, funding organizations, academia, and the legal profession.

Patent Foramen Ovale Closure Indications: A Clinical Update.

Patent foramen ovale (PFO) is a commonly identified congenital cardiac defect, present in 25-30 percent of adults. Though usually clinically silent, PFOs can result in paradoxical embolization, resulting in platypnea-orthodeoxia syndrome (POS), migraines, myocardial infarctions, or cerebrovascular accidents. Patients with incidentally noted PFOs should be managed conservatively, but in patients with cryptogenic stroke and amenable anatomy, closure with a percutaneous closure device is recommended.

Cardiac Sarcoidosis Presenting as Ventricular Tachycardia.

Cardiac sarcoidosis is a rare clinical diagnosis, but can be identified in autopsy in up to a quarter of patients with sarcoidosis. Bradycardia, heart block, and syncope are often the presenting arrhythmias associated with sarcoidosis, but ventricular tachycardia can also occur. We present a patient presenting in ventricular tachycardia, later found to have multi-organ system involvement of sarcoidosis. The patient required pacemaker, implantable cardioverter-defibrillator, and immunosuppression for management of cardiac sarcoidosis. Patients with cardiac sarcoidosis are at elevated risk for arrhythmias, and patients with ventricular tachycardia and reduced ejection fraction should be evaluated for implantable cardioverter-defibrillator. In conclusion, sarcoid cardiomyopathy can present as ventricular tachycardia, and requires evaluation and management targeted at prevention of sudden cardiac death.

Pre-stimulus brain state predicts auditory pattern identification accuracy.

Recent studies show that pre-stimulus band-specific power and phase in the electroencephalogram (EEG) can predict accuracy on tasks involving the detection of near-threshold stimuli. However, results in the auditory modality have been mixed, and few works have examined pre-stimulus features when more complex decisions are made (e.g. identifying supra-threshold sounds). Further, most auditory studies have used background sounds known to induce oscillatory EEG states, leaving it unclear whether phase predicts accuracy without such background sounds. To address this gap in knowledge, the present study examined pre-stimulus EEG as it relates to accuracy in a tone pattern identification task. On each trial, participants heard a triad of 40-ms sinusoidal tones (separated by 40-ms intervals), one of which was at a different frequency than the other two. Participants' task was to indicate the tone pattern (low-low-high, low-high-low, etc.). No background sounds were employed. Using a phase opposition measure based on inter-trial phase consistencies, pre-stimulus 7-10 Hz phase was found to differ between correct and incorrect trials ∼200 to 100 ms prior to tone-pattern onset. After sorting trials into bins based on phase, accuracy was found to be lowest at around π-+ relative to individuals' most accurate phase bin. No significant effects were found for pre-stimulus power. In the context of the literature, findings suggest an important relationship between the complexity of task demands and pre-stimulus activity within the auditory domain. Results also raise interesting questions about the role of induced oscillatory states or rhythmic processing modes in obtaining pre-stimulus effects of phase in auditory tasks.

Confidence tracks sensory- and decision-related ERP dynamics during auditory detection.

Recent research has focused on measuring neural correlates of metacognitive judgments in decision and post-decision processes during memory retrieval and categorization. However, many tasks (e.g., stimulus detection) may require monitoring of earlier sensory processing. Here, participants indicated which of two intervals contained an 80-ms pure tone embedded in white noise. One frequency (e.g., 1000 Hz) was presented on ∼80% of all trials (i.e., 'primary' trials). Another frequency (e.g., 2500 Hz) was presented on ∼20% of trials (i.e., 'probe' trials). The event-related potential (ERP) was used to investigate the processing stages related to confidence. Tone-locked N1, P2, and P3 amplitudes were larger for trials rated with high than low confidence. Interestingly, a P3-like late positivity for the tone-absent interval showed high amplitude for low confidence. No 'primary' vs. 'probe' differences were found. However, confidence rating differences between primary and probe trials were correlated with N1 and tone-present P3 amplitude differences. We suggest that metacognitive judgments can track both sensory- and decision-related processes (indexed by the N1 and P3, respectively). The particular processes on which confidence judgments are based likely depend upon the task an individual is faced with and the information at hand (e.g., presence or absence of a signal).

Sustained frontal midline theta enhancements during effortful listening track working memory demands.

Recent studies demonstrate that frontal midline theta power (4-8 Hz) enhancements in the electroencephalogram (EEG) relate to effortful listening. It has been proposed that these enhancements reflect working memory demands. Here, the need to retain auditory information in working memory was manipulated in a 2-interval 2-alternative forced-choice delayed pitch discrimination task ("Which interval contained the higher pitch?"). On each trial, two square wave stimuli differing in pitch at an individual's ∼70.7% correct threshold were separated by a 3-second ISI. In a 'Roving' condition, the lowest pitch stimulus was randomly selected on each trial (uniform distribution from 840 to 1160 Hz). In a 'Fixed' condition, the lowest pitch was always 979 Hz. Critically, the 'Fixed' condition allowed one to know the correct response immediately following the first stimulus (e.g., if the first stimulus is 979 Hz, the second must be higher). In contrast, the 'Roving' condition required retention of the first tone for comparison to the second. Frontal midline theta enhancements during the ISI were only observed for the 'Roving' condition. Alpha (8-13 Hz) enhancements were apparent during the ISI, but did not differ significantly between conditions. Since conditions were matched for accuracy at threshold, results suggest that frontal midline theta enhancements will not always accompany difficult listening. Mixed results in the literature regarding frontal midline theta enhancements may be related to differences between tasks in regards to working memory demands. Alpha enhancements may reflect task general effortful listening processes.

The Neurostimulation Appropriateness Consensus Committee (NACC): Recommendations on Bleeding and Coagulation Management in Neurostimulation Devices.

INTRODUCTION: The Neurostimulation Appropriateness Consensus Committee (NACC) was formed by the International Neuromodulation Society (INS) in 2012 to evaluate the evidence to reduce the risk of complications and improve the efficacy of neurostimulation. The first series of papers, published in 2014, focused on the general principles of appropriate practice in the surgical implantation of neurostimulation devices. The NACC was reconvened in 2014 to address specific patient care issues, including bleeding and coagulation. METHODS: The INS strives to improve patient care in an evidence-based fashion. The NACC members were appointed or recruited by the INS leadership for diverse expertise, including international clinical expertise in many areas of neurostimulation, evidence evaluation, and publication. The group developed best practices based on peer-reviewed evidence and, in the absence of specific evidence, on expert opinion. Recommendations were based on international evidence in accordance with guideline creation. CONCLUSIONS: The NACC has recommended specific measures to reduce the risk of bleeding and neurological injury secondary to impairment of coagulation in the setting of implantable neurostimulation devices in the spine, brain, and periphery.

The Neurostimulation Appropriateness Consensus Committee (NACC) Recommendations for Infection Prevention and Management.

INTRODUCTION: The use of neurostimulation for pain has been an established therapy for many decades and is a major tool in the arsenal to treat neuropathic pain syndromes. Level I evidence has recently been presented to substantiate the therapy, but this is balanced against the risk of complications of an interventional technique. METHODS: The Neurostimulation Appropriateness Consensus Committee (NACC) of the International Neuromodulation Society convened an international panel of well published and diverse physicians to examine the best practices for infection mitigation and management in patients undergoing neurostimulation. The NACC recommendations are based on evidence scoring and peer-reviewed literature. Where evidence is lacking the panel added expert opinion to establish recommendations. RESULTS: The NACC has made recommendations to improve care by reducing infection and managing this complication when it occurs. These evidence-based recommendations should be considered best practices in the clinical implantation of neurostimulation devices. CONCLUSION: Adhering to established standards can improve patient care and reduce the morbidity and mortality of infectious complications in patients receiving neurostimulation.

The Polyanalgesic Consensus Conference (PACC): Recommendations for Intrathecal Drug Delivery: Guidance for Improving Safety and Mitigating Risks.

INTRODUCTION: Intrathecal therapy is an important part of the pain treatment algorithm for chronic disease states. The use of this option is a viable treatment strategy, but it is inherent for pain physicians to understand risk assessment and mitigation. In this manuscript, we explore evidence and mitigating strategies to improve safety with intrathecal therapy. METHODS: A robust literature search was performed covering January 2011 to October 9, 2016, in PubMed, Embase, MEDLINE, Biomed Central, Google Scholar, Current Contents Connect, and International Pharmaceutical Abstracts. The information was cross-referenced and compiled for evidence, analysis, and consensus review, with the intent to offer weighted recommendations and consensus statements on safety for targeted intrathecal therapy delivery. RESULTS: The Polyanalgesic Consensus Conference has made several best practice recommendations to improve care and reduce morbidity and mortality associated with intrathecal therapy through all phases of management. The United States Prevention Service Task Force evidence level and consensus strength assessments are offered for each recommendation. CONCLUSION: Intrathecal therapy is a viable and relatively safe option for the treatment of cancer- and noncancer-related pain. Continued research and expert opinion are required to improve our current pharmacokinetic and pharmacodynamic model of intrathecal drug delivery, as this will undoubtedly improve safety and efficacy.

The Neurostimulation Appropriateness Consensus Committee (NACC) Safety Guidelines for the Reduction of Severe Neurological Injury.

INTRODUCTION: Neurostimulation involves the implantation of devices to stimulate the brain, spinal cord, or peripheral or cranial nerves for the purpose of modulating the neural activity of the targeted structures to achieve specific therapeutic effects. Surgical placement of neurostimulation devices is associated with risks of neurologic injury, as well as possible sequelae from the local or systemic effects of the intervention. The goal of the Neurostimulation Appropriateness Consensus Committee (NACC) is to improve the safety of neurostimulation. METHODS: The International Neuromodulation Society (INS) is dedicated to improving neurostimulation efficacy and patient safety. Over the past two decades the INS has established a process to use best evidence to improve care. This article updates work published by the NACC in 2014. NACC authors were chosen based on nomination to the INS executive board and were selected based on publications, academic acumen, international impact, and diversity. In areas in which evidence was lacking, the NACC used expert opinion to reach consensus. RESULTS: The INS has developed recommendations that when properly utilized should improve patient safety and reduce the risk of injury and associated complications with implantable devices. CONCLUSIONS: On behalf of INS, the NACC has published recommendations intended to reduce the risk of neurological injuries and complications while implanting stimulators.

Trigemino-Cervical Neuropathic Pain Relieved by Serially Repeated Peripheral Nerve Field Stimulation Without Tolerance: Case Report.

BACKGROUND: With its relative simplicity and safety, peripheral nerve field stimulation (PNFS; PENS) is contributing to the re-emergence of peripheral nerve stimulation as an effective therapy for neuropathic pain (NPP). CASE PRESENTATION: A 70-year-old woman had developed severe, medically refractory NPP unilaterally in the scalp and face 20 years earlier, following a maxillofacial surgical procedure. PNFS gave substantial relief of the pain and allodynia and was repeated successfully on a further 25 occasions over the subsequent five years. Tolerance did not develop. CONCLUSION: Serially repeated PNFS can provide sustained relief of NPP over long periods, without tolerance, where a permanent implant may be inappropriate, unavailable, or declined.