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.

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).

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.

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).

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.

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.

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.

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.

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.

"Don't lose hope early": Hemorrhagic diffuse axonal injury on head computed tomography is not associated with poor outcome in moderate to severe traumatic brain injury patients.

BACKGROUND: Diffuse axonal injury (DAI) on magnetic resonance imaging has been associated with poor functional outcome after moderate-severe traumatic brain injury (msTBI). Yet, DAI assessment with highly sensitive magnetic resonance imaging techniques is unfeasible in the acute trauma setting, and computed tomography (CT) remains the key diagnostic modality despite its lower sensitivity. We sought to determine whether CT-defined hemorrhagic DAI (hDAI) is associated with discharge and favorable 3- and 12-month functional outcome (Glasgow Coma Scale score ≥4) after msTBI. METHODS: We analyzed 361 msTBI patients from the single-center longitudinal Outcome Prognostication in Traumatic Brain Injury study collected over 6 years (November 2009 to November 2015) with prospective outcome assessments at 3 months and 12 months. Patients with microhemorrhages on CT were designated "CT-hDAI-positive" and those without as "CT-hDAI-negative." For secondary analyses "CT-hDAI-positive" was stratified into two phenotypes according to presence ("associated") versus absence ("predominant") of concomitant large acute traumatic lesions to determine whether presence versus absence of additional focal mass lesions portends a different prognosis. RESULTS: Seventy (19%) patients were CT-hDAI-positive (n = 36 predominant; n = 34 associated hDAI). In univariate analyses, CT-hDAI-positive status was associated with discharge survival (p = 0.004) and favorable outcome at 3 months (p = 0.003) and 12 months (p = 0.005). After multivariable adjustment, CT-hDAI positivity was no longer associated with discharge survival and functional outcome (all ps > 0.05). Stratified by hDAI phenotype, predominant hDAI patients had worse trauma severity, longer intensive care unit stays, and more systemic medical complications. Predominant hDAI, but not associated hDAI, was an independent predictor of discharge survival (adjusted odds ratio, 24.7; 95% confidence interval [CI], 3.2-192.6; p = 0.002) and favorable 12-month outcome (adjusted odds ratio, 4.7; 95% CI, 1.5-15.2; p = 0.01). Sensitivity analyses using Cox regression confirmed this finding for 1-year survival (adjusted hazard ratio, 5.6; 95% CI, 1.3-23; p = 0.048). CONCLUSION: The CT-defined hDAI was not an independent predictor of unfavorable short- and long-term outcomes and should not be used for acute prognostication in msTBI patients. Predominant hDAI patients had good clinical outcomes when supported to intensive care unit discharge and beyond. LEVEL OF EVIDENCE: Prognostic study, level III.

Intertrial interval duration affects error monitoring.

The purpose of this study was to investigate the effect of varying intertrial interval (ITI) durations on neural signals of error monitoring, given the importance of the ITI as a time window for engaging in self-evaluation and cognitive control. In a between-subjects design, 35 participants were assigned to one of three ITI durations (short: 768 ms; medium: 1,280 ms; long: 1,792 ms) in a standard Stroop task while EEG was recorded. Participants in the short-ITI group demonstrated lower performance accuracy, a reduced error-related negativity (even when correcting for frequency of errors), lower error-related alpha suppression during the ITI, and increased post-error slowing. Results indicate that fast-paced trial timing can be disruptive to self-monitoring, perhaps due to capacity limitations or bottlenecks in processing.

Reconstructive Techniques for the Saddle Nose Deformity in Granulomatosis With Polyangiitis: A Systematic Review.

Importance: Repairing the saddle nose deformity in the setting of granulomatosis with polyangiitis disease is a rare but challenging situation for any surgeon. Given that the available data in the literature is based on case reports and small case series, there is little evidence available to help delineate which reconstructive techniques are optimal. Objective: To examine which techniques were most successful in reconstructive rhinoplasty for a saddle nose deformity secondary to granulomatosis with polyangiitis. Evidence Review: PubMed, MEDLINE, Cochrane Collaboration Databases, and Web of Science were searched using the terms Wegener's granulomatosis or granulomatosis with polyangiitis cross-referenced with saddle nose deformity or acquired nasal deformity. These databases were supplemented with 2 cases from Boston Medical Center. Databases were queried from inception of article collection through December 14, 2015, to identify publications reporting the repair of a saddle nose deformity and granulomatosis with polyangiitis. Findings: A total of 10 studies met inclusion criteria yielding a cohort of 44 patients. The overall success rate for rhinoplasty, both primary and secondary, was 84.1% (37 of 44 patients), with a complication rate of 20%. The use of a single L-shaped graft fared better than individually placed grafts. An increased risk of graft failure was noted as the number of overall grafts increased and if nonautologous tissue was used. Conclusions and Relevance: Rhinoplasty for saddle nose deformity is a safe and effective procedure in the setting of granulomatosis with polyangiitis. In the face of this disease, reconstruction should focus on placing a robust, L-shaped strut graft with autologous tissue over individual grafts. Additionally, the use of split-calvarial bone appears to have a slightly lower complication rate over costal cartilage.

Mindfulness-of-breathing exercise modulates EEG alpha activity during cognitive performance.

The present study investigated whether engaging in a mindful breathing exercise would affect EEG oscillatory activity associated with self-monitoring processes, based on the notion that mindfulness enhances attentional awareness. Participants were assigned to either an audio exercise in mindful breathing or an audio control condition, and then completed a Stroop task while EEG was recorded. The primary EEG measure of interest was error-related alpha suppression (ERAS), an index of self-monitoring in which alpha power is reduced, suggesting mental engagement, following errors compared to correct responses. Participants in the mindful-breathing condition showed increased alpha power during the listening exercise and enhanced ERAS during the subsequent Stroop task. These results indicate enhanced error-monitoring among those in the mindful-breathing group.