Mental Effort in Elite and Nonelite Rowers

Mental effort (intensity of attention) in elite sports has remained a debated topic and a challenging phenomenon to measure. Thus, a quasi-ecological laboratory study was conducted to investigate mental effort in elite rowers as compared with a group of nonelites. Findings suggest that eye-tracking measures-specifically, blink rates and pupil size-can serve as valid indicators of mental effort in physically demanding sport tasks. Furthermore, findings contradict the notion that elite athletes spend less cognitive effort than their lower-level peers. Specifically, elites displayed similar levels of self-reported effort and performance decrement with increasing mental load and significantly more mental effort overall as measured by pupil-size increase (relative to baseline) during rowing trials as compared with the nonelites in the sample. Future studies on eye tracking in sports may include investigations of mental effort in addition to selective attention during physically demanding tasks.

Use of the first-acquired language modulates pupil size in the processing of island constraint violations

Introduction

Traditional studies of the population called "heritage speakers" (HS) have treated this group as distinct from other bilingual populations, e.g., simultaneous or late bilinguals (LB), focusing on group differences in the competencies of the first-acquired language or "heritage language". While several explanations have been proposed for such differences (e.g., incomplete acquisition, attrition, differential processing mechanisms), few have taken into consideration the individual variation that must occur, due to the fluctuation of factors such as exposure and use that characterize all bilinguals. In addition, few studies have used implicit measures, e.g., psychophysiological methods (ERPs; Eye-tracking), that can circumvent confounding variables such as resorting to conscious metalinguistic knowledge.

Methodology

This study uses pupillometry, a method that has only recently been used in psycholinguistic studies of bilingualism, to investigate pupillary responses to three syntactic island constructions in two groups of Spanish/English bilinguals: heritage speakers and late bilinguals. Data were analyzed using generalized additive mixed effects models (GAMMs) and two models were created and compared to one another: one with group (LB/HS) and the other with groups collapsed and current and historical use of Spanish as continuous variables.

Results

Results show that group-based models generally yield conflicting results while models collapsing groups and having usage as a predictor yield consistent ones. In particular, current use predicts sensitivity to L1 ungrammaticality across both HS and LB populations. We conclude that individual variation, as measured by use, is a critical factor tha must be taken into account in the description of the language competencies and processing of heritage and late bilinguals alike.

Application of Pupillometry in Neurocritical Patients

Pupillary light reflex (PLR) assessment is a crucial examination for evaluating brainstem function, particularly in patients with acute brain injury and neurosurgical conditions. The PLR is controlled by neural pathways modulated by both the sympathetic and parasympathetic nervous systems. Altered PLR is a strong predictor of adverse outcomes after traumatic and ischemic brain injuries. However, the assessment of PLR needs to take many factors into account since it can be modulated by various medications, alcohol consumption, and neurodegenerative diseases. The development of devices capable of measuring pupil size and assessing PLR quantitatively has revolutionized the non-invasive neurological examination. Automated pupillometry, which is more accurate and precise, is widely used in diverse clinical situations. This review presents our current understanding of the anatomical and physiological basis of the PLR and the application of automated pupillometry in managing neurocritical patients. We also discuss new technologies that are being developed, such as smartphone-based pupillometry devices, which are particularly beneficial in low-resource settings.

Give me a break! Unavoidable fatigue effects in cognitive pupillometry

Pupillometry has a rich history in the study of perception and cognition. One perennial challenge is that the magnitude of the task-evoked pupil response diminishes over the course of an experiment, a phenomenon we refer to as a fatigue effect. Reducing fatigue effects may improve sensitivity to task effects and reduce the likelihood of confounds due to systematic physiological changes over time. In this paper, we investigated the degree to which fatigue effects could be ameliorated by experimenter intervention. In Experiment 1, we assigned participants to one of three groups-no breaks, kinetic breaks (playing with toys, but no social interaction), or chatting with a research assistant-and compared the pupil response across conditions. In Experiment 2, we additionally tested the effect of researcher observation. Only breaks including social interaction significantly reduced the fatigue of the pupil response across trials. However, in all conditions we found robust evidence for fatigue effects: that is, regardless of protocol, the task-evoked pupil response was substantially diminished (at least 60%) over the duration of the experiment. We account for the variance of fatigue effects in our pupillometry data using multiple common statistical modeling approaches (e.g., linear mixed-effects models of peak, mean, and baseline pupil diameters, as well as growth curve models of time-course data). We conclude that pupil attenuation is a predictable phenomenon that should be accommodated in our experimental designs and statistical models.

Binocular head-mounted chromatic pupillometry can detect structural and functional loss in glaucoma

Aim

The aim of this study is to evaluate the utility of binocular chromatic pupillometry in detecting impaired pupillary light response (PLR) in patients with primary open-angle glaucoma (POAG) and to assess the feasibility of using binocular chromatic pupillometer in opportunistic POAG diagnosis in community-based or telemedicine-based services.

Methods

In this prospective, cross-sectional study, 74 patients with POAG and 23 healthy controls were enrolled. All participants underwent comprehensive ophthalmologic examinations including optical coherence tomography (OCT) and standard automated perimetry (SAP). The PLR tests included sequential tests of full-field chromatic stimuli weighted by rods, intrinsically photosensitive retinal ganglion cells (ipRGCs), and cones (Experiment 1), as well as alternating chromatic light flash-induced relative afferent pupillary defect (RAPD) test (Experiment 2). In Experiment 1, the constricting amplitude, velocity, and time to maximum constriction/dilation were calculated in three cell type-weighted responses, and the post-illumination response of ipRGC-weighted response was evaluated. In Experiment 2, infrared pupillary asymmetry (IPA) amplitude and anisocoria duration induced by intermittent blue or red light flashes were calculated.

Results

In Experiment 1, the PLR of POAG patients was significantly reduced in all conditions, reflecting the defect in photoreception through rods, cones, and ipRGCs. The variable with the highest area under the receiver operating characteristic curve (AUC) was time to max dilation under ipRGC-weighted stimulus, followed by the constriction amplitude under cone-weighted stimulus and the constriction amplitude response to ipRGC-weighted stimuli. The impaired PLR features were associated with greater visual field loss, thinner retinal nerve fiber layer (RNFL) thickness, and cupping of the optic disk. In Experiment 2, IPA and anisocoria duration induced by intermittent blue or red light flashes were significantly greater in participants with POAG than in controls. IPA and anisocoria duration had good diagnostic value, correlating with the inter-eye asymmetry of visual field loss.

Conclusion

We demonstrate that binocular chromatic pupillometry could potentially serve as an objective clinical tool for opportunistic glaucoma diagnosis in community-based or telemedicine-based services. Binocular chromatic pupillometry allows an accurate, objective, and rapid assessment of retinal structural impairment and functional loss in glaucomatous eyes of different severity levels.

Pupil size reflects activation of subcortical ascending arousal system nuclei during rest

Neuromodulatory nuclei that are part of the ascending arousal system (AAS) play a crucial role in regulating cortical state and optimizing task performance. Pupil diameter, under constant luminance conditions, is increasingly used as an index of activity of these AAS nuclei. Indeed, task-based functional imaging studies in humans have begun to provide evidence of stimulus-driven pupil-AAS coupling. However, whether there is such a tight pupil-AAS coupling during rest is not clear. To address this question, we examined simultaneously acquired resting-state fMRI and pupil-size data from 74 participants, focusing on six AAS nuclei: the locus coeruleus, ventral tegmental area, substantia nigra, dorsal and median raphe nuclei, and cholinergic basal forebrain. Activation in all six AAS nuclei was optimally correlated with pupil size at 0-2 s lags, suggesting that spontaneous pupil changes were almost immediately followed by corresponding BOLD-signal changes in the AAS. These results suggest that spontaneous changes in pupil size that occur during states of rest can be used as a noninvasive general index of activity in AAS nuclei. Importantly, the nature of pupil-AAS coupling during rest appears to be vastly different from the relatively slow canonical hemodynamic response function that has been used to characterize task-related pupil-AAS coupling.

Speech recognition in noise task among children and young-adults: a pupillometry study

Introduction

Children experience unique challenges when listening to speech in noisy environments. The present study used pupillometry, an established method for quantifying listening and cognitive effort, to detect temporal changes in pupil dilation during a speech-recognition-in-noise task among school-aged children and young adults.

Methods

Thirty school-aged children and 31 young adults listened to sentences amidst four-talker babble noise in two signal-to-noise ratios (SNR) conditions: high accuracy condition (+10 dB and  + 6 dB, for children and adults, respectively) and low accuracy condition (+5 dB and + 2 dB, for children and adults, respectively). They were asked to repeat the sentences while pupil size was measured continuously during the task.

Results

During the auditory processing phase, both groups displayed pupil dilation; however, adults exhibited greater dilation than children, particularly in the low accuracy condition. In the second phase (retention), only children demonstrated increased pupil dilation, whereas adults consistently exhibited a decrease in pupil size. Additionally, the children's group showed increased pupil dilation during the response phase.

Discussion

Although adults and school-aged children produce similar behavioural scores, group differences in dilation patterns point that their underlying auditory processing differs. A second peak of pupil dilation among the children suggests that their cognitive effort during speech recognition in noise lasts longer than in adults, continuing past the first auditory processing peak dilation. These findings support effortful listening among children and highlight the need to identify and alleviate listening difficulties in school-aged children, to provide proper intervention strategies.

Effects of Stimulus Luminance, Stimulus Color and Intra-Stimulus Color Contrast on Visual Field Mapping in Neurologically Impaired Adults Using Flicker Pupil Perimetry

Purpose

We improve pupillary responses and diagnostic performance of flicker pupil perimetry through alterations in global and local color contrast and luminance contrast in adult patients suffering from visual field defects due to cerebral visual impairment (CVI).

Methods

Two experiments were conducted on patients with CVI (Experiment 1: 19 subjects, age M and SD 57.9 ± 14.0; Experiment 2: 16 subjects, age M and SD 57.3 ± 14.7) suffering from absolute homonymous visual field (VF) defects. We altered global color contrast (stimuli consisted of white, yellow, cyan and yellow-equiluminant-to-cyan colored wedges) in Experiment 1, and we manipulated luminance and local color contrast with bright and dark yellow and multicolor wedges in a 2-by-2 design in Experiment 2. Stimuli consecutively flickered across 44 stimulus locations within the inner 60 degrees of the VF and were offset to a contrasting (opponency colored) dark background. Pupil perimetry results were compared to standard automated perimetry (SAP) to assess diagnostic accuracy.

Results

A bright stimulus with global color contrast using yellow (p= 0.009) or white (p= 0.006) evoked strongest pupillary responses as opposed to stimuli containing local color contrast and lower brightness. Diagnostic accuracy, however, was similar across global color contrast conditions in Experiment 1 (p= 0.27) and decreased when local color contrast and less luminance contrast was introduced in Experiment 2 (p= 0.02). The bright yellow condition resulted in highest performance (AUC M = 0.85 ± 0.10, Mdn = 0.85).

Conclusion

Pupillary responses and pupil perimetry's diagnostic accuracy both benefit from high luminance contrast and global but not local color contrast.

Reproducibility of the pupillary light reflex over short intervals in psychiatric patients and community volunteers

The pupillary light reflex (PLR) is a method for measuring dynamic responses within the autonomic nervous system, and would have potential value as a point of care test in a psychiatry clinic if reproducible results could be obtained in a short period of time. We collected PLR from adult community volunteers and depressed outpatients with the purpose of demonstrating (1) that valid data could be obtained >90% of the time from both the community volunteers and the patients, and (2) that reproducible results could be obtained with repeated measurement over short periods of time. Valid data were captured for 90.3% of 76 participants, allowing for two attempts of the PLR per participant. Success rates were similar for depressed patients and community volunteers. Eighteen of these 76 participants provided repeated paired measurements after 5 and 10 minutes of dark adaptation, producing high correlations for maximal constriction velocity (MCV) between assay 1 and 2 (Pearson's r=0.71, p<0.001), but there was a significant 8% increase in velocity for MCV between assay 1 and 2 (∆=0.34+0.59 mm/sec, p<0.05). In contrast, PLR measurements were stable when tested in a separate cohort of 21 additional participants at 10 and 15 minutes of dark adaptation with a MCV Pearson's correlation of r=0.84, p<0.001, with a non-significant 1% difference between the two time points. These findings indicate an acceptable rate of collecting valid and reproducible PLR data when contrasting 2 measurements of PLR after 10 or 15 minutes of dark adaptation in depressed and suicidal patients. This article is protected by copyright. All rights reserved.

Combat Sports as a Model for Measuring the Effects of Repeated Head Impacts on Autonomic Brain Function: A Brief Report of Pilot Data

Automated pupil light reflex (PLR) is a valid indicator of dysfunctional autonomic brain function following traumatic brain injury. PLR's use in identifying disturbed autonomic brain function following repeated head impacts without outwardly visible symptoms has not yet been examined. As a combat sport featuring repeated 'sub-concussive' head impacts, mixed martial arts (MMA) sparring may provide a model to understand such changes. The aim of this pilot study was to explore which, if any, PLR variables are affected by MMA sparring. A cohort of n = 7 MMA athletes (age = 24 ± 3 years; mass = 76.5 ± 9 kg; stature = 176.4 ± 8.5 cm) took part in their regular sparring sessions (eight rounds × 3 min: 1 min recovery). PLR of both eyes was measured immediately pre- and post-sparring using a Neuroptic NPi-200. Bayesian paired samples t-tests (BF₁₀ ≥ 3) revealed decreased maximum pupil size (BF₁₀ = 3), decreased minimum pupil size (BF₁₀ = 4) and reduced PLR latency (BF₁₀ = 3) post-sparring. Anisocoria was present prior to sparring and increased post-sparring, with both eyes having different minimum and maximum pupil sizes (BF₁₀ = 3-4) and constriction velocities post-sparring (BF₁₀ = 3). These pilot data suggest repeated head impacts may cause disturbances to autonomic brain function in the absence of outwardly visible symptoms. These results provide direction for cohort-controlled studies to formally investigate the potential changes observed.

Time Scales and Moments of Listening Effort Revealed in Pupillometry

This article offers a collection of observations that highlight the value of time course data in pupillometry and points out ways in which these observations create deeper understanding of listening effort. The main message is that listening effort should be considered on a moment-to-moment basis rather than as a singular amount. A review of various studies and the reanalysis of data reveal distinct signatures of effort before a stimulus, during a stimulus, in the moments after a stimulus, and changes over whole experimental testing sessions. Collectively these observations motivate questions that extend beyond the "amount" of effort, toward understanding how long the effort lasts, and how precisely someone can allocate effort at specific points in time or reduce effort at other times. Apparent disagreements between studies are reconsidered as informative lessons about stimulus selection and the nature of pupil dilation as a reflection of decision making rather than the difficulty of sensory encoding.

Top-down control of the left visual field bias in cued visual spatial attention

A left visual field (LVF) bias in perceptual judgments, response speed, and discrimination accuracy has been reported in humans. Cognitive factors, such as visual spatial attention, are known to modulate or even eliminate this bias. We investigated this problem by recording pupillometry together with functional magnetic resonance imaging (fMRI) in a cued visual spatial attention task. We observed that (i) the pupil was significantly more dilated following attend-right than attend-left cues, (ii) the task performance (e.g. reaction time [RT]) did not differ between attend-left and attend-right trials, and (iii) the difference in cue-related pupil dilation between attend-left and attend-right trials was inversely related to the corresponding difference in RT. Neuroscientically, correlating the difference in cue-related pupil dilation with the corresponding cue-related fMRI difference yielded activations primarily in the right hemisphere, including the right intraparietal sulcus and the right ventrolateral prefrontal cortex. These results suggest that (i) there is an asymmetry in visual spatial attention control, with the rightward attention control being more effortful than the leftward attention control, (ii) this asymmetry underlies the reduction or the elimination of the LVF bias, and (iii) the components of the attentional control networks in the right hemisphere are likely part of the neural substrate of the observed asymmetry in attentional control.

Pupil Dilation During Encoding, But Not Type of Auditory Stimulation, Predicts Recognition Success in Face Memory

We encounter and process information from multiple sensory modalities in our daily lives, and research suggests that learning can be more efficient when contexts are multisensory. In this study, we were interested in whether face identity recognition memory might be improved in multisensory learning conditions, and to explore associated changes in pupil dilation during encoding and recognition. In two studies participants completed old/new face recognition tasks wherein visual face stimuli were presented in the context of sounds. Faces were learnt alongside no sound, low arousal sounds (Experiment 1), high arousal non-face relevant, or high arousal face relevant (Experiment 2) sounds. We predicted that the presence of sounds during encoding would improve later recognition accuracy, however, the results did not support this with no effect of sound condition on memory. Pupil dilation, however, was found to predict later successful recognition both at encoding and during recognition. While these results do not provide support to the notion that face learning is improved under multisensory conditions relative to unisensory conditions, they do suggest that pupillometry may be a useful tool to further explore face identity learning and recognition.

No alterations in potential indirect markers of locus coeruleus-norepinephrine function in insomnia disorder

The norepinephrine locus coeruleus system (LC NE) represents a promising treatment target in patients with insomnia disorder (ID) due to its well understood links to arousal and sleep regulation. However, consistent markers of LC NE activity are lacking. This study measured three potential indirect markers of LC NE activity - REM sleep, P3 amplitude during an auditory oddball paradigm (as a marker of phasic LC activation), and baseline pupil diameter (as a marker of tonic LC activation). The parameters were then combined in a statistical model and tested to compare LC NE activity between 20 subjects with insomnia disorder (13 female; age 44.2 ± 15.1 year) and 20 healthy, good sleeping controls (GSC; 11 female; age 45.4 ± 11.6 year). No group differences regarding the primary outcome parameters were detected. Specifically, insomnia disorder did not display the hypothesised changes in markers of LC NE function. While increased LC NE function remains an interesting speculative pathway for hyperarousal in insomnia disorder, the investigated markers do not appear closely related to each other and fail to discriminate between insomnia disorder and good sleeping controls in these samples.

Novel Objective Measures of Hypersomnolence

Purpose of review

To provide a brief overview of current objective measures of hypersomnolence, discuss proposed measure modifications, and review emerging measures.

Recent findings

There is potential to optimize current tools using novel metrics. High-density and quantitative EEG-based measures may provide discriminative informative. Cognitive testing may quantify cognitive dysfunction common to hypersomnia disorders, particularly in attention, and objectively measure pathologic sleep inertia. Structural and functional neuroimaging studies in narcolepsy type 1 have shown considerable variability but so far implicate both hypothalamic and extra-hypothalamic regions; fewer studies of other CDH have been performed. There is recent renewed interest in pupillometry as a measure of alertness in the evaluation of hypersomnolence.

Summary

No single test captures the full spectrum of disorders and use of multiple measures will likely improve diagnostic precision. Research is needed to identify novel measures and disease-specific biomarkers, and to define combinations of measures optimal for CDH diagnosis.

Pathologist pupil dilation reflects experience level and difficulty in diagnosing medical images

Purpose: Digital whole slide imaging allows pathologists to view slides on a computer screen instead of under a microscope. Digital viewing allows for real-time monitoring of pathologists' search behavior and neurophysiological responses during the diagnostic process. One particular neurophysiological measure, pupil diameter, could provide a basis for evaluating clinical competence during training or developing tools that support the diagnostic process. Prior research shows that pupil diameter is sensitive to cognitive load and arousal, and it switches between exploration and exploitation of a visual image. Different categories of lesions in pathology pose different levels of challenge, as indicated by diagnostic disagreement among pathologists. If pupil diameter is sensitive to the perceived difficulty in diagnosing biopsies, eye-tracking could potentially be used to identify biopsies that may benefit from a second opinion. Approach: We measured case onset baseline-corrected (phasic) and uncorrected (tonic) pupil diameter in 90 pathologists who each viewed and diagnosed 14 digital breast biopsy cases that cover the diagnostic spectrum from benign to invasive breast cancer. Pupil data were extracted from the beginning of viewing and interpreting of each individual case. After removing 122 trials ( < 10 % ) with poor eye-tracking quality, 1138 trials remained. We used multiple linear regression with robust standard error estimates to account for dependent observations within pathologists. Results: We found a positive association between the magnitude of phasic dilation and subject-centered difficulty ratings and between the magnitude of tonic dilation and untransformed difficulty ratings. When controlling for case diagnostic category, only the tonic-difficulty relationship persisted. Conclusions: Results suggest that tonic pupil dilation may indicate overall arousal differences between pathologists as they interpret biopsy cases and could signal a need for additional training, experience, or automated decision aids. Phasic dilation is sensitive to characteristics of biopsies that tend to elicit higher difficulty ratings and could indicate a need for a second opinion.

Investigating the Reliability of Pupillometry as a Measure of Individualized Listening Effort

Recordings of the pupillary response have been used in numerous studies to assess listening effort during a speech-in-noise task. Most studies focused on averaged responses across listeners, whereas less is known about pupil dilation as an indicator of the individuals’ listening effort. The present study investigated the reliability of several pupil features as potential indicators of individual listening effort and the impact of different normalization procedures on the reliability. The pupil diameters of 31 normal-hearing listeners were recorded during multiple visits while performing a speech-in-noise task. The signal-to-noise ratios (SNRs) of the stimuli ranged from −12 dB to +4 dB. All listeners were measured twice at separate visits, and 11 were re-tested at a third visit. To examine the reliability of the pupil responses across visits, the intraclass correlation coefficient was applied to the peak and mean pupil dilation and to the temporal features of the pupil response, extracted using growth curve analysis. The reliability of the pupillary response was assessed in relation to SNR and different normalization procedures over multiple visits. The most reliable pupil features were the traditional mean and peak pupil dilation. The highest reliability results were obtained when the data were baseline-corrected and normalized to the individual pupil response range across all visits. Moreover, the present study results showed only a minor impact of the SNR and the number of visits on the reliability of the pupil response. Overall, the results may provide an important basis for developing a standardized test for pupillometry in the clinic.

EEG and pupillometric signatures of working memory overload

Understanding the physiological correlates of cognitive overload has implications for gauging the limits of human cognition, developing novel methods to define cognitive overload, and mitigating the negative outcomes associated with overload. Most previous psychophysiological studies manipulated verbal working memory load in a narrow range (an average load of 5 items). It is unclear, however, how the nervous system responds to a working memory load exceeding typical capacity limits. The objective of the current study was to characterize the central and autonomic nervous system changes associated with memory overload, by means of combined recording of electroencephalogram (EEG) and pupillometry. Eighty-six participants were presented with a digit span task involving the serial auditory presentation of items. Each trial consisted of sequences of either 5, 9, or 13 digits, each separated by 2 s. Both theta activity and pupil size, after the initial rise, expressed a pattern of a short plateau and a decrease with reaching the state of memory overload, indicating that pupil size and theta possibly have similar neural mechanisms. Based on the described above triphasic pattern of pupil size temporal dynamics, we concluded that cognitive overload causes physiological systems to reset, and release effort. Although memory capacity limits were exceeded and effort was released (as indicated by pupil dilation), alpha continued to decrease with increasing memory load. These results suggest that associating alpha with the focus of attention and distractor suppression is not warranted.

Sleep Architecture and Sleep-Related Breathing Disorders of Seafarers on Board Merchant Ships: A Polysomnographic Pilot Field Study on the High Seas

As seafarers are assumed to have an increased risk profile for sleep-related breathing disorders, this cross-sectional observational study measured (a) the feasibility and quality of polysomnography (PSG) on board merchant ships, (b) sleep macro- and microarchitecture, (c) sleep-related breathing disorders, such as obstructive sleep apnea (OSA), using the apnea-hypopnea index (AHI), and (d) subjective and objective sleepiness using the Epworth Sleepiness Scale (ESS) and pupillometry. Measurements were carried out on two container ships and a bulk carrier. A total of 19 out of 73 male seafarers participated. The PSG's signal qualities and impedances were comparable to those in a sleep laboratory without unusual artifacts. Compared to the normal population, seafarers had a lower total sleep time, a shift of deep sleep phases in favor of light sleep phases as well as an increased arousal index. Additionally, 73.7% of the seafarers were diagnosed with at least mild OSA (AHI ≥ 5) and 15.8% with severe OSA (AHI ≥ 30). In general, seafarers slept in the supine position with a remarkable frequency of breathing cessations. A total of 61.1% of the seafarers had increased subjective daytime sleepiness (ESS > 5). Pupillometry results for objective sleepiness revealed a mean relative pupillary unrest index (rPUI) of 1.2 (SD 0.7) in both occupational groups. In addition, significantly poorer objective sleep quality was found among the watchkeepers. A need for action with regard to poor sleep quality and daytime sleepiness of seafarers on board is indicated. A slightly increased prevalence of OSA among seafarers is likely.

Reproducibility of Mesopic and Photopic Pupil Sizes in Myopic Children Using a Dedicated Pupillometer with Human-Assisted or Automated Reading

This study aimed to investigate the reproducibility of pupil size measurements over time and between reading methods when comparing human-assisted reading to automated reading. Pupillary data were analyzed on a subset of myopic children enrolled in a multicenter randomized clinical trial on myopia control with low-dose atropine. Pupil size measurements were obtained prior to randomization at two time points (screening and baseline visits) using a dedicated pupillometer under mesopic and photopic conditions. A customized algorithm was built to perform automated readings, allowing comparisons between human-assisted and automated readings. Reproducibility analyses followed the principles of Bland and Altman and included the calculation of the mean difference between measurements and limits of agreement (LOA). We included 43 children. Mean (standard deviation) age was 9.8 (1.7) years and 25 (58%) children were girls. Using human-assisted readings, reproducibility over time showed mesopic mean difference of 0.02 mm with LOA from -0.87 mm to 0.91 mm, whereas photopic mean difference was -0.01 mm with LOA from -0.25 mm to 0.23 mm. Reproducibility between human-assisted and automated readings was also higher under photopic conditions, with mean difference of 0.03 mm and LOA from -0.03 mm to 0.10 mm at screening and mean difference of 0.03 mm and LOA from -0.06 mm to 0.12 mm at baseline. Using a dedicated pupillometer, we found that examinations performed under photopic conditions demonstrated higher reproducibility over time and between reading methods. We speculate whether mesopic measurements are sufficiently reproducible to be monitored over time. Furthermore, photopic measurements may be of greater relevance when evaluating the side effects of atropine treatment, such as photophobia.

Evaluation of Nociception during Pediatric Surgery: A Topical Review

The association between intraoperative nociception and increased patient's morbidity is well established. However, hemodynamic parameters, such as heart rate and blood pressure, may result in an inadequate monitor of nociception during surgery. Over the last two decades, different devices have been marketed to "reliably" detect intraoperative nociception. Since the direct measure of nociception is impractical during surgery, these monitors measures nociception surrogates such as sympathetic and parasympathetic nervous systems responses (heart rate variability, pupillometry, skin conductance), electroencephalographic changes, and muscular reflex arc. Each monitor carries its own advantages and disadvantages. The manuscript aims to give an overview of the most up-to-date information available in the literature on current nociceptor monitors available in clinical practice, with particular focus on their applications in pediatrics.

Habituation of the stress response multiplex to repeated cold pressor exposure

Humans show remarkable habituation to aversive events as reflected by changes of both subjective report and objective measures of stress. Although much experimental human research focuses on the effects of stress, relatively little is known about the cascade of physiological and neural responses that contribute to stress habituation. The cold pressor test (CPT) is a common method for inducing acute stress in human participants in the laboratory; however, there are gaps in our understanding of the global state changes resulting from this stress-induction technique and how these responses change over multiple exposures. Here, we measure the stress response to repeated CPT exposures using an extensive suite of physiologic measures and state-of-the-art analysis techniques. In two separate sessions on different days, participants underwent five 90 s CPT exposures of both feet and five warm water control exposures, while electrocardiography (ECG), impedance cardiography, continuous blood pressure, pupillometry, scalp electroencephalography (EEG), salivary cortisol and self-reported pain assessments were recorded. A diverse array of adaptive responses are reported that vary in their temporal dynamics within each exposure as well as habituation across repeated exposures. During cold-water exposure there was a cascade of changes across several cardiovascular measures (elevated heart rate (HR), cardiac output (CO) and Mean Arterial Pressure (MAP) and reduced left ventricular ejection time (LVET), stroke volume (SV) and high-frequency heart rate variability (HF)). Increased pupil dilation was observed, as was increased power in low-frequency bands (delta and theta) across frontal EEG electrode sites. Several cardiovascular measures also habituated over repeated cold-water exposures (HR, MAP, CO, SV, LVET) as did pupil dilation and alpha frequency activity across the scalp. Anticipation of cold water induced stress effects in the time-period immediately prior to exposure, indexed by increased pupil size and cortical disinhibition in the alpha and beta frequency bands across central scalp sites. These results provide comprehensive insight into the evolution of a diverse array of stress responses to an acute noxious stressor, and how these responses adaptively contribute to stress habituation.

Brightness Perception in World-Centered Coordinates Assessed by Pupillometry

Subjective brightness perception reportedly differs among the peripheral visual fields owing to lower- and higher-order cognition. However, there is still a lack of information associated with subjective brightness perception in the world-centered coordinates, not in the visual fields. In this study, we aimed to investigate the anisotropy of subjective brightness perception in the world-centered coordinates based on pupillary responses to the stimuli in five locations by manipulating the world-centered coordinates through active (requiring head movement) and passive scenes (without head movement) in a virtual reality environment. Specifically, this study aimed to elucidate if there is an ecological advantage in the five different locations in the world-centered coordinates. The pupillary responses to glare and halo stimuli indicated that the brightness perception differed among the five locations in the world-centered coordinates. Furthermore, we found that the pupillary response to stimuli at the top location might be influenced by ecological factors (such as from the bright sky and the sun's existence). Thus, we have contributed to the understanding of the extraretinal information influence on subjective brightness perception in the world-centered coordinates, demonstrating that the pupillary response is independent of head movement.

Salient omissions-pupil dilation in response to unexpected omissions of sound and touch

Introduction

Recent theories describe perception as an inferential process based on internal predictive models adjusted by means of prediction violations (prediction error). To study and demonstrate predictive processing in the brain the use of unexpected stimulus omissions has been suggested as a promising approach as the evoked brain responses are uncontaminated by responses to stimuli. Here, we aimed to investigate the pupil's response to unexpected stimulus omissions in order to better understand surprise and orienting of attention resulting from prediction violation. So far only few studies have used omission in pupillometry research and results have been inconsistent.

Methods

This study adapted an EEG paradigm that has been shown to elicit omission responses in auditory and somatosensory modalities. Healthy adults pressed a button at their own pace, which resulted in the presentation of sounds or tactile stimuli in either 88%, 50% or 0% (motor-control) of cases. Pupil size was recorded continuously and averaged to analyze the pupil dilation response associated with each condition.

Results

Results revealed that omission responses were observed in both modalities in the 88%-condition compared to motor-control. Similar pupil omission responses were observed between modalities, suggesting modality-unspecific activation of the underlying brain circuits.

Discussion

In combination with previous omission studies using EEG, the findings demonstrate predictive models in brain processing and point to the involvement of subcortical structures in the omission response. Our pupillometry approach is especially suitable to study sensory prediction in vulnerable populations within the psychiatric field.