Load-dependent brain activation assessed by time-domain functional near-infrared spectroscopy during a working memory task with graded levels of difficulty

Acute hypoxia elicits prefrontal oxygenation asymmetry in young adults

Significance

Cerebrovascular reactivity can be evaluated by prefrontal cortex (PFC) hemodynamic responses and oxygenation changes secondary to hypoxia using near-infrared spectroscopy (NIRS). However, whether there are hemispheric differences in these NIRS-determined PFC hemodynamic responses and oxygenation changes remains unknown.

Aim

This study was performed to determine whether there are differences in the PFC hemodynamic responses and oxygenation changes secondary to hypoxia between the left and right frontal poles (FPL and FPR, respectively).

Approach

Fifteen young men participated in the study. During conduction of an isocapnic hypoxia protocol with a 10-min hypoxic phase at partial pressure of end-tidal oxygen (PET O 2 ) of 45 Torr, hemodynamic and oxygenation indices comprising oxygenated hemoglobin (oxy-Hb), deoxygenated Hb (deoxy-Hb), total Hb (total-Hb), and tissue oxygen saturation (StO 2 ) over FPL and FPR were measured by NIRS. The heart rate (HR) was evaluated by electrocardiography.

Results

In response to hypoxia, the HR increased, oxy-Hb decreased, deoxy-Hb increased, total-Hb increased above baseline, and StO 2 decreased. There was no difference in the change in total-Hb between FPL and FPR. However, there were greater changes in oxy-Hb, deoxy-Hb, and StO 2 over FPL than over FPR, indicating that PFC oxygenation asymmetry occurs in response to hypoxia. Moreover, the change in total-Hb over FPL was associated with the increase in HR.

Conclusions

NIRS-determined hemodynamic responses and oxygenation changes secondary to hypoxia might not simply reflect the direct effect of hypoxia on cerebral vessels. Although there is no hemispheric difference in the PFC hemodynamic responses to hypoxia as in total-Hb, PFC oxygenation asymmetry occurs in young adults.

Viewing and playing fantastical events does not affect children's cognitive flexibility and prefrontal activation

Media exposure, such as viewing fantastical content, can have negative, immediate, and long-term effects on children's executive function. A recent study showed that watching fantastical content on a tablet can impair children's inhibitory control and prefrontal activation during the performance of a task. However, the same effect was not observed when children played fantastical games on a tablet. We aimed to replicate and extend this research by examining whether the same effects are observed during a cognitive flexibility task. In this study, preschool children (N = 32, 15 girls, Mean age in months (SD) = 60.6 (10)) viewed or played fantastical content on a tablet and performed a Dimensional Change Card Sort (DCCS) task before or after the media exposure. We assessed children's behavioral performance and prefrontal activation, as measured by functional near-infrared spectroscopy (fNIRS), and found no behavioral or neural changes after exposure. Our analyses using the Bayes factor supported the null hypothesis that children's cognitive flexibility is unaffected by watching or playing fantastical content.

Effects of acute high-altitude exposure on working memory: A functional near-infrared spectroscopy study

INTRODUCTION

Inadequate oxygen availability may lead to impairment of neurocognitive functions. The aim of the present study was to investigate the effect of acute high-altitude exposure on the cerebral hemodynamic response and working memory.

METHODS

The same subjects performed working memory exercises with forward and backward digit span tasks both under normal oxygen conditions and in large simulated hypobaric hypoxia chambers, and a series of physiological parameters were evaluated. Functional near-infrared spectroscopy was used to measure cerebral blood flow changes in the dorsolateral prefrontal cortex (DLPFC) during the tasks.

RESULTS

Compared with normoxic conditions, under hypoxic conditions, the heart rate and blood pressure increased, blood oxygen saturation decreased significantly, and the forward task had similar accuracy and response time, while the backward task had lower accuracy and longer response time. Neuroimaging analysis showed increased activation in the DLPFC during the forward task and deactivation during the backward task under hypobaric hypoxia conditions.

CONCLUSION

Acute high-altitude exposure leads to physiological adaptations. The abnormal hemodynamic responses of the DLPFC to hypoxia at low pressure reveal the disruption of neurocognitive function by acute high-altitude exposure, which compromises complex cognitive functions, and provides a promising application for functional near infrared spectroscopy in the exploration of neural mechanisms in the brain during high-altitude exposure.

Load-Dependent Prefrontal Cortex Activation Assessed by Continuous-Wave Near-Infrared Spectroscopy during Two Executive Tasks with Three Cognitive Loads in Young Adults

The present study examined the evolution of the behavioral performance, subjectively perceived difficulty, and hemodynamic activity of the prefrontal cortex as a function of cognitive load during two different cognitive tasks tapping executive functions. Additionally, it investigated the relationships between these behavioral, subjective, and neuroimaging data. Nineteen right-handed young adults (18–22 years) were scanned using continuous-wave functional near-infrared spectroscopy during the performance of n-back and random number generation tasks in three cognitive load conditions. Four emitter and four receptor optodes were fixed bilaterally over the ventrolateral and dorsolateral prefrontal cortices to record the hemodynamic changes. A self-reported scale measured the perceived difficulty. The findings of this study showed that an increasing cognitive load deteriorated the behavioral performance and increased the perceived difficulty. The hemodynamic activity increased parametrically for the three cognitive loads of the random number generation task and in a two-back and three-back compared to a one-back condition. In addition, the hemodynamic activity was specifically greater in the ventrolateral prefrontal cortex than in the dorsolateral prefrontal cortex for both cognitive tasks (random number generation and n-back tasks). Finally, the results highlighted some links between cerebral oxygenation and the behavioral performance, but not the subjectively perceived difficulty. Our results suggest that cognitive load affects the executive performance and perceived difficulty and that fNIRS can be used to specify the prefrontal cortex’s implications for executive tasks involving inhibition and working memory updating.

The Potential Role of fNIRS in Evaluating Levels of Consciousness

Over the last few decades, neuroimaging techniques have transformed our understanding of the brain and the effect of neurological conditions on brain function. More recently, light-based modalities such as functional near-infrared spectroscopy have gained popularity as tools to study brain function at the bedside. A recent application is to assess residual awareness in patients with disorders of consciousness, as some patients retain awareness albeit lacking all behavioural response to commands. Functional near-infrared spectroscopy can play a vital role in identifying these patients by assessing command-driven brain activity. The goal of this review is to summarise the studies reported on this topic, to discuss the technical and ethical challenges of working with patients with disorders of consciousness, and to outline promising future directions in this field.

Depth-selective data analysis for time-domain fNIRS: moments vs. time windows

Time-domain measurements facilitate the elimination of the influence of extracerebral, systemic effects, a key problem in functional near-infrared spectroscopy (fNIRS) of the adult human brain. The analysis of measured time-of-flight distributions of photons often relies on moments or time windows. However, a systematic and quantitative characterization of the performance of these measurands is still lacking. Based on perturbation simulations for small localized absorption changes, we compared spatial sensitivity profiles and depth selectivity for moments (integral, mean time of flight and variance), photon counts in time windows and their ratios for different time windows. The influence of the instrument response function (IRF) was investigated for all measurands and for various source-detector separations. Variance exhibits the highest depth selectivity among the moments. Ratios of photon counts in different late time windows can achieve even higher selectivity. An advantage of moments is their robustness against the shape of the IRF and instrumental drifts.

Multiscale Entropy as a New Feature for EEG and fNIRS Analysis

The present study aims to apply multiscale entropy (MSE) to analyse brain activity in terms of brain complexity levels and to use simultaneous electroencephalogram and functional near-infrared spectroscopy (EEG/fNIRS) recordings for brain functional analysis. A memory task was selected to demonstrate the potential of this multimodality approach since memory is a highly complex neurocognitive process, and the mechanisms governing selective retention of memories are not fully understood by other approaches. In this study, 15 healthy participants with normal colour vision participated in the visual memory task, which involved the making the executive decision of remembering or forgetting the visual stimuli based on his/her own will. In a continuous stimulus set, 250 indoor/outdoor scenes were presented at random, between periods of fixation on a black background. The participants were instructed to make a binary choice indicating whether they wished to remember or forget the image; both stimulus and response times were stored for analysis. The participants then performed a scene recognition test to confirm whether or not they remembered the images. The results revealed that the participants intentionally memorising a visual scene demonstrate significantly greater brain complexity levels in the prefrontal and frontal lobe than when purposefully forgetting a scene; p < 0.05 (two-tailed). This suggests that simultaneous EEG and fNIRS can be used for brain functional analysis, and MSE might be the potential indicator for this multimodality approach.

Investigating the Optimal Baseline Positioning to Maximize Cognitive Experimental Outcome

In emotional and cognitive research, the baseline is commonly used for standardization purposes in order to have a reference for the identification of the activation. Since no previous studies have investigated which moment of the experiment could be considered optimal for baseline evaluation, we designed an experimental protocol to analyze which time interval could be considered more effective in highlighting differences between the baseline state and the cognitive effort exhibited during tasks (specifically, reaction and working memory tasks). Several indexes were extracted from EEG signals during the visualization of the considered baseline stimuli and the execution of tasks. From our results, as regards to the considered Global Field Power (GFP) indexes (Attention and Memorization indexes), the last baseline stimulus seems to be the best one to highlight the difference in cognitive workload between the individual baseline condition and the two cognitive tasks. Instead, in terms of Engagement index (EI), the difference between Reaction Task (RT) and the individual baseline condition seems to be best highlighted by the relaxing video right after performed tasks. In conclusion, the best baseline position to maximize the differences in cognitive workload may vary among the considered indexes because of confounding effects and individual differences, but further analyses are required to validate this result.

Working Memory, Cognitive Load andCardiorespiratory Fitness: Testing the CRUNCHModel with Near-Infrared Spectroscopy

The present study aimed to examine the effects of chronological age and cardiorespiratory fitness (CRF) on cognitive performance and prefrontal cortex activity, and to test the compensation-related utilization of neural circuits hypothesis (CRUNCH). A total of 19 young adults (18–22 years) and 37 older ones (60–77 years) with a high or low CRF level were recruited to perform a working memory updating task under three different cognitive load conditions. Prefrontal cortex hemodynamic responses were continuously recorded using functional near-infrared spectroscopy, and behavioral performances and perceived difficulty were measured. Results showed that chronological age had deleterious effects on both cognitive performance and prefrontal cortex activation under a higher cognitive load. In older adults, however, higher levels of CRF were related to increased bilateral prefrontal cortex activation patterns that allowed them to sustain better cognitive performances, especially under the highest cognitive load. These results are discussed in the light of the neurocognitive CRUNCH model.

Oxyhemoglobin changes in the prefrontal cortex in response to cognitive tasks: a systematic review

PURPOSE OF THE STUDY

the aim of this study was to synthesize PFC fNIRS outcomes on the effects of cognitive tasks compared to resting/baseline tasks in healthy adults from studies utilizing a pre/post design.

MATERIAL AND METHODS

original research studies were searched from seven databases (MEDLINE, EMBASE, CENTRAL, CINAHL, SCOPUS, PEDro and PubMed). Subsequently, two independent reviewers screened the titles and abstracts followed by full-text reviews to assess the studies' eligibility.

RESULTS

eleven studies met the inclusion criteria and had data abstracted and quality assessed. Methodology varied considerably and yet cognitive tasks resulted in the ΔO₂Hb increasing in 8 of the 11 and ΔHHb decreasing in 8 of 8 studies that reported this outcome. The cognitive tasks from 10 of the 11 studies were classified as "Working Memory" and "Verbal Fluency Tasks".

CONCLUSIONS

although, the data comparison was challenging provided the heterogeneity in methodology, the results across studies were similar.

Functional Near-Infrared Spectroscopy Recordings of Visuospatial Working Memory Processes. Part II: A Replication Study in Children on Sensitivity and Mental-Ability-Induced Differences in Functional Activation

In a previous study in young adults, we showed that hemodynamic changes as measured by functional near-infrared spectroscopy (fNIRS) were sensitive for identifying visuospatial working memory (WM)-related functional brain activation in the prefrontal cortex. This functional activation, however, could not be verified for participants with far-above-average mental ability, suggesting different cognitive processes adopted by this group. The present study was designed to confirm these findings in 11- to 13-year-old children by applying the same study design, experimental task, fNIRS setup, and statistical approach. We successfully replicated the earlier findings on sensitivity of fNIRS with regard to visuospatial WM-specific task demands in our children sample. Likewise, mental-ability-induced differences in functional activation were even more pronounced in the children compared with in the young adults. By testing a children sample, we were able to not only replicate our previous findings based on adult participants but also generalize the validity of these findings to children. This latter aspect seems to be of particular significance considering the relatively large number of fNIRS studies on WM performance in children.

The Validity of Functional Near-Infrared Spectroscopy Recordings of Visuospatial Working Memory Processes in Humans

Functional near infrared spectroscopy (fNIRS) is increasingly used for investigating cognitive processes. To provide converging evidence for the validity of fNIRS recordings in cognitive neuroscience, we investigated functional activation in the frontal cortex in 43 participants during the processing of a visuospatial working memory (WM) task and a sensory duration discrimination (DD) task functionally unrelated to WM. To distinguish WM-related processes from a general effect of increased task demand, we applied an adaptive approach, which ensured that subjective task demand was virtually identical for all individuals and across both tasks. Our specified region of interest covered Brodmann Area 8 of the left hemisphere, known for its important role in the execution of WM processes. Functional activation, as indicated by an increase of oxygenated and a decrease of deoxygenated hemoglobin, was shown for the WM task, but not in the DD task. The overall pattern of results indicated that hemodynamic responses recorded by fNIRS are sensitive to specific visuospatial WM capacity-related processes and do not reflect a general effect of increased task demand. In addition, the finding that no such functional activation could be shown for participants with far above-average mental ability suggested different cognitive processes adopted by this latter group.

In vivo real time non invasive monitoring of brain penetration of chemicals with near-infrared spectroscopy: Concomitant PK/PD analysis

BACKGROUND

Near-infrared spectroscopy (NIRS) is a non-invasive technique that monitors changes in oxygenation of haemoglobin. The absorption spectra of near-infrared light differ for the oxygenation-deoxygenation states of haemoglobin (oxygenate (HbO2) and deoxygenate (Hb), respectively) so that these two states can be directly monitored.

COMPARISON WITH EXISTING METHOD(S)

Different methodologies report different basal values of HbO2 and Hb absolute concentrations in brain. Here, we attempt to calculate basal HbO2 levels in rat CNS via evaluation of the influence of exogenous oxygen or exogenous carbon dioxide on the NIRS parameters measured in vivo.

NEW METHOD

Furthermore the possibility that changes of haemoglobin oxygenation in rat brain as measured by NIRS might be a useful index of brain penetration of chemical entities has been investigated. Different compounds from different chemical classes were selected on the basis of parallel ex vivo and in vivo pharmacokinetic (PK/PD) studies of brain penetration and overall pharmacokinetic profile.

RESULTS

It appeared that NIRS might contribute to assess brain penetration of chemical entities, i.e. significant changes in NIRS signals could be related to brain exposure, conversely the lack of significant changes in relevant NIRS parameters could be indicative of low brain exposure.

CONCLUSIONS

This work is proposing a further innovation on NIRS preclinical applications i.e. a "chemical" NIRS [chNIRS] approach for determining penetration of drugs in animal brain. Therefore, chNIRS could became a non invasive methodology for studies on neurobiological processes and psychiatric diseases in preclinical but also a translational strategy from preclinical to clinical investigations.

Towards a ternary NIRS-BCI: single-trial classification of verbal fluency task, Stroop task and unconstrained rest

OBJECTIVE

The majority of near-infrared spectroscopy (NIRS) brain-computer interface (BCI) studies have investigated binary classification problems. Limited work has considered differentiation of more than two mental states, or multi-class differentiation of higher-level cognitive tasks using measurements outside of the anterior prefrontal cortex. Improvements in accuracies are needed to deliver effective communication with a multi-class NIRS system. We investigated the feasibility of a ternary NIRS-BCI that supports mental states corresponding to verbal fluency task (VFT) performance, Stroop task performance, and unconstrained rest using prefrontal and parietal measurements.

APPROACH

Prefrontal and parietal NIRS signals were acquired from 11 able-bodied adults during rest and performance of the VFT or Stroop task. Classification was performed offline using bagging with a linear discriminant base classifier trained on a 10 dimensional feature set.

MAIN RESULTS

VFT, Stroop task and rest were classified at an average accuracy of 71.7% ± 7.9%. The ternary classification system provided a statistically significant improvement in information transfer rate relative to a binary system controlled by either mental task (0.87 ± 0.35 bits/min versus 0.73 ± 0.24 bits/min).

SIGNIFICANCE

These results suggest that effective communication can be achieved with a ternary NIRS-BCI that supports VFT, Stroop task and rest via measurements from the frontal and parietal cortices. Further development of such a system is warranted. Accurate ternary classification can enhance communication rates offered by NIRS-BCIs, improving the practicality of this technology.

Effects of Increasing Neuromuscular Electrical Stimulation Current Intensity on Cortical Sensorimotor Network Activation: A Time Domain fNIRS Study

Neuroimaging studies have shown neuromuscular electrical stimulation (NMES)-evoked movements activate regions of the cortical sensorimotor network, including the primary sensorimotor cortex (SMC), premotor cortex (PMC), supplementary motor area (SMA), and secondary somatosensory area (S2), as well as regions of the prefrontal cortex (PFC) known to be involved in pain processing. The aim of this study, on nine healthy subjects, was to compare the cortical network activation profile and pain ratings during NMES of the right forearm wrist extensor muscles at increasing current intensities up to and slightly over the individual maximal tolerated intensity (MTI), and with reference to voluntary (VOL) wrist extension movements. By exploiting the capability of the multi-channel time domain functional near-infrared spectroscopy technique to relate depth information to the photon time-of-flight, the cortical and superficial oxygenated (O₂Hb) and deoxygenated (HHb) hemoglobin concentrations were estimated. The O₂Hb and HHb maps obtained using the General Linear Model (NIRS-SPM) analysis method, showed that the VOL and NMES-evoked movements significantly increased activation (i.e., increase in O₂Hb and corresponding decrease in HHb) in the cortical layer of the contralateral sensorimotor network (SMC, PMC/SMA, and S2). However, the level and area of contralateral sensorimotor network (including PFC) activation was significantly greater for NMES than VOL. Furthermore, there was greater bilateral sensorimotor network activation with the high NMES current intensities which corresponded with increased pain ratings. In conclusion, our findings suggest that greater bilateral sensorimotor network activation profile with high NMES current intensities could be in part attributable to increased attentional/pain processing and to increased bilateral sensorimotor integration in these cortical regions.

Single-trial classification of near-infrared spectroscopy signals arising from multiple cortical regions

Near-infrared spectroscopy (NIRS) brain-computer interface (BCI) studies have primarily made use of measurements taken from a single cortical area. In particular, the anterior prefrontal cortex has been the key area used for detecting higher-level cognitive task performance. However, mental task execution typically requires coordination between several, spatially-distributed brain regions. We investigated the value of expanding the area of interrogation to include NIRS measurements from both the prefrontal and parietal cortices to decode mental states. Hemodynamic activity was monitored at 46 locations over the prefrontal and parietal cortices using a continuous-wave near-infrared spectrometer while 11 able-bodied adults rested or performed either the verbal fluency task (VFT) or Stroop task. Offline classification was performed for the three possible binary problems using 25 iterations of bagging with a linear discriminant base classifier. Classifiers were trained on a 10 dimensional feature set. When all 46 measurement locations were considered for classification, average accuracies of 80.4±7.0%, 82.4±7.6%, and 82.8±5.9% in differentiating VFT vs rest, Stroop vs rest and VFT vs Stroop, respectively, were obtained. Relative to using measurements from the anterior PFC alone, an overall average improvement of 11.3% was achieved. Utilizing NIRS measurements from the prefrontal and parietal cortices can be of value in classifying mental states involving working memory and attention. NIRS-BCI accuracies may be improved by incorporating measurements from several, distinct cortical regions, rather than a single area alone. Further development of an NIRS-BCI supporting combinations of VFT, Stroop task and rest states is also warranted.

Sensitivity of fNIRS to cognitive state and load

Functional near-infrared spectroscopy (fNIRS) is an emerging low-cost noninvasive neuroimaging technique that measures cortical bloodflow. While fNIRS has gained interest as a potential alternative to fMRI for use with clinical and pediatric populations, it remains unclear whether fNIRS has the necessary sensitivity to serve as a replacement for fMRI. The present study set out to examine whether fNIRS has the sensitivity to detect linear changes in activation and functional connectivity in response to cognitive load, and functional connectivity changes when transitioning from a task-free resting state to a task. Sixteen young adult subjects were scanned with a continuous-wave fNIRS system during a 10-min resting-state scan followed by a letter n-back task with three load conditions. Five optical probes were placed over frontal and parietal cortices, covering bilateral dorsolateral PFC (dlPFC), bilateral ventrolateral PFC (vlPFC), frontopolar cortex (FP), and bilateral parietal cortex. Activation was found to scale linearly with working memory load in bilateral prefrontal cortex. Functional connectivity increased with increasing n-back loads for fronto-parietal, interhemispheric dlPFC, and local connections. Functional connectivity differed between the resting state scan and the n-back scan, with fronto-parietal connectivity greater during the n-back, and interhemispheric vlPFC connectivity greater during rest. These results demonstrate that fNIRS is sensitive to both cognitive load and state, suggesting that fNIRS is well-suited to explore the full complement of neuroimaging research questions and will serve as a viable alternative to fMRI.

Phantoms for diffuse optical imaging based on totally absorbing objects, part 2: experimental implementation

We present the experimental implementation and validation of a phantom for diffuse optical imaging based on totally absorbing objects for which, in the previous paper [J. Biomed. Opt.18(6), 066014, (2013)], we have provided the basic theory. Totally absorbing objects have been manufactured as black polyvinyl chloride (PVC) cylinders and the phantom is a water dilution of intralipid-20% as the diffusive medium and India ink as the absorber, filled into a black scattering cell made of PVC. By means of time-domain measurements and of Monte Carlo simulations, we have shown the reliability, the accuracy, and the robustness of such a phantom in mimicking typical absorbing perturbations of diffuse optical imaging. In particular, we show that such a phantom can be used to generate any absorption perturbation by changing the volume and position of the totally absorbing inclusion.

Non-contact in vivo diffuse optical imaging using a time-gated scanning system

We report on the design and first in vivo tests of a novel non-contact scanning imaging system for time-domain near-infrared spectroscopy. Our system is based on a null source-detector separation approach and utilizes polarization-selective detection and a fast-gated single-photon avalanche diode to record late photons only. The in-vivo tests included the recording of hemodynamics during arm occlusion and two brain activation tasks. Localized and non-localized changes in oxy- and deoxyhemoglobin concentration were detected for motor and cognitive tasks, respectively. The tests demonstrate the feasibility of non-contact imaging of absorption changes in deeper tissues.

Phantoms for diffuse optical imaging based on totally absorbing objects, part 1: Basic concepts

The design of inhomogeneous phantoms for diffuse optical imaging purposes using totally absorbing objects embedded in a diffusive medium is proposed and validated. From time-resolved and continuous-wave Monte Carlo simulations, it is shown that a given or desired perturbation strength caused by a realistic absorbing inhomogeneity of a certain absorption and volume can be approximately mimicked by a small totally absorbing object of a so-called equivalent black volume (equivalence relation). This concept can be useful in two ways. First, it can be exploited to design realistic inhomogeneous phantoms with different perturbation strengths simply using a set of black objects with different volumes. Further, it permits one to grade physiological or pathological changes on a reproducible scale of perturbation strengths given as equivalent black volumes, thus facilitating the performance assessment of clinical instruments. A set of plots and interpolating functions to derive the equivalent black volume corresponding to a given absorption change is provided. The application of the equivalent black volume concept for grading different optical perturbations is demonstrated for some examples.

Method for the discrimination of superficial and deep absorption variations by time domain fNIRS

A method for the discrimination of superficial and deep absorption variations by time domain functional near infrared spectroscopy is presented. The method exploits the estimate of the photon time-dependent pathlength in different domains of the sampled medium and makes use of an approach based on time-gating of the photon distribution of time-of-flights. Validation of the method is performed in the two-layer geometry to focus on muscle and head applications. Numerical simulations varied the thickness of the upper layer, the interfiber distance, the shape of the instrument response function and the photon counts. Preliminary results from in vivo data are also shown.

GLM analysis of time resolved NIRS data of motor activation during different motor tasks

The hemodynamic response to motor activation was investigated by time-resolved NIRS in healthy subjects and patients with unilateral impairment in motor ability. Healthy subjects performed a simple and a complex finger movement task, patients a handgrip task. A General Linear Model approach (GLM) was applied during NIRS data processing. In general, compared to the integral (continuous wave signal), higher significance of activation was found for the variance signal that selectively represents changes in the deep compartment. A discussion of GLM results with respect to task complexity and difficulty is provided.