Cognitive Control As a Double-Edged Sword

Cognitive control, the ability to limit attention to goal-relevant information, aids performance on a wide range of laboratory tasks. However, there are many day-to-day functions which require little to no control and others which even benefit from reduced control. We review behavioral and neuroimaging evidence demonstrating that reduced control can enhance the performance of both older and, under some circumstances, younger adults. Using healthy aging as a model, we demonstrate that decreased cognitive control benefits performance on tasks ranging from acquiring and using environmental information to generating creative solutions to problems. Cognitive control is thus a double-edged sword - aiding performance on some tasks when fully engaged, and many others when less engaged.

Do older professional musicians have cognitive advantages?

The current study investigates whether long-term music training and practice are associated with enhancement of general cognitive abilities in late middle-aged to older adults. Professional musicians and non-musicians who were matched on age, education, vocabulary, and general health were compared on a near-transfer task involving auditory processing and on far-transfer tasks that measured spatial span and aspects of cognitive control. Musicians outperformed non-musicians on the near-transfer task, on most but not all of the far-transfer tasks, and on a composite measure of cognitive control. The results suggest that sustained music training or involvement is associated with improved aspects of cognitive functioning in older adults.

Timing is everything: Age differences in the cognitive control network are modulated by time of day

Behavioral evidence suggests that the attention-based ability to regulate distraction varies across the day in synchrony with a circadian arousal rhythm that changes across the life span. Using functional magnetic resonance imaging (fMRI), we assessed whether neural activity in an attention control network also varies across the day and with behavioral markers. We tested older adults in the morning or afternoon and younger adults tested in the afternoon using a 1-back task with superimposed distractors, followed by an implicit test for the distractors. Behavioral results replicated earlier findings with older adults tested in the morning better able to ignore distraction than those tested in the afternoon. Imaging results showed that time of testing modulates task-related fMRI signals in older adults and that age differences were reduced when older adults are tested at peak times of day. In particular, older adults tested in the morning activated similar cognitive control regions to those activated by young adults (rostral prefrontal and superior parietal cortex), whereas older adults tested in the afternoon were reliably different; furthermore, the degree to which participants were able to activate the control regions listed above correlated with the ability to suppress distracting information.

Magnetic resonance imaging of simple and infected hydatid cysts of the brain

Hydatid cyst of the brain is more common in children than adults. The cyst is always solitary unless the primary site is the brain. Cerebral hydatid cyst (CHCy) is most frequently supratentorial involving the territory of the middle cerebral artery, especially the parietal lobe. This study included 16 patients who were treated for CHCy. They were 11 male patients (68.75%), and 5 female patients (31.25%), ranging in age from 6 to 40 years with an average age of 14.7 years. Most of the patients were children-12 patients (75%), between 6 to 16 years of age. All patients were from rural areas. Headache, vomiting and seizures were the predominant symptoms. Papilloedema was present in 12 patients (75%). CT and MRI were performed in all patients. The cysts were all located in the cerebral hemispheres, except one in the posterior fossa, (Rt. cerebellar hemisphere). One lobe alone was affected in 7 patients (43.8%), two lobes in 6 patients (37.5%) and 3 lobes in two patients (12.5%). Round, or oval well defined cystic lesions isointense to the CSF in T1 and T2WI, with hypointense walls in T2WI and no surrounding perifocal edema or evidence of contrast enhancement were seen in 12 patients (75%) and were classified as simple or non-complicated CHCy. Cystic lesions with surrounding, T2 hyperintense area of perifocal edema, complete and incomplete (segment) rim of contrast enhancement were seen in 4 patients (25%), and were labeled as complicated or infected cysts (cysts with superadded pyogenic infection). All patients were treated surgically, hydatid birth (delivery of unruptured cyst) was achieved in 10 patients, cyst rupture occurred in 6 patients (37.5%), with subsequent recurrence (3 patients with recurrent multiple cysts and 3 patients with recurrent solitary cysts). All the recurrent cysts were surrounded by perifocal edema and showed ring enhancement. MRI has proved to be an excellent means of studying CHCy. It will be more widely used for diagnosis and surgical planning. It provided information about the exact cyst localization, cyst contents and presence or absence of superadded cyst infection.

A sero-epidemiological survey for Bunyaviridae and certain other arboviruses in Pakistan

Complement fixation test reactions to the following viruses were studied in 372 samples (157 rodents, 172 domestic animals, 43 persons) from Pakistan: Bunyaviridae, Phlebovirus: Phlebotomus fever Sicilian (PFS), Phlebotomus fever Naples (PFN), Karimabad (KAR), Salehabad (SAL); Nairovirus: Crimean-Congo haemorrhagic fever (CCHF), Hazara (HAZ), Dera Ghazi Khan (DGK), Dhori (DHO); Uukuvirus: Manawa (MWA); "possible members": Bakau (BAK), Bhanja (BHA). Reoviridae, Orbivirus: Wad Medani (WM). Unclassified: Wanowrie (WAN). Four of these viruses are Phlebotomus-borne (PFS, PFN, KAR, SAL). The other nine ar tick-borne. Antibodies against each virus were detected in sera from rodents. Antibodies against PFS, PFN, KAR, CCHF, DGK, BHA, WM and WAN viruses were detected in sera from domestic animals. Antibodies against PFS, CCHF, DGK, DHO, MWA, BHA, and BHA and WAN viruses were detected in human sera. The presence in Pakistan of KAR, DHO, BHA, and WAN viruses is documented for the first time. Over-all prevalence rates were highest for BHA (12.1%) and WM (10.7%) viruses, followed by DGK, CCHF, PFN and PFS (4.0 to 5.4%) and DHO, KAR, WAN, SAL, MWA, BAK and HAZ (0.3 to 2.1%). Epidemiological factors relating to virus circulation and human disease are discussed.

Conceptual processing of distractors by older but not younger adults

Evidence from perceptually based implicit memory tasks demonstrates greater priming from distracting information among older compared with younger adults. We examined whether older adults also show greater conceptually based implicit priming from distracting information. We measured priming using a general-knowledge test that was preceded by an incidental-encoding task (a color-naming Stroop task in one experiment and a 1-back task involving pictures with irrelevant words superimposed in a second experiment). Younger adults showed no priming from the distracting information in either experiment, whereas older adults showed reliable priming in both experiments. Thus, unlike young adults, older adults process irrelevant information conceptually and then can use that information to boost their performance on a subsequent task.

Age differences in memory for meaningful and arbitrary associations: A memory retrieval account

Older adults typically show poor associative memory performance relative to younger adults. This age-related effect, however, is mediated by the meaningfulness of the materials used, such that age differences are minimized with the use of information that is consistent with prior knowledge. While this effect has been interpreted as facilitative learning through schematic support, the role of memory retrieval on this effect has yet to be explored. Using an associative memory paradigm that varied the extent of controlled retrieval for previously studied meaningful or arbitrary associations, older and younger adults in the present study retrieved realistic and unrealistic grocery item prices in a speeded, or in a slow, more control-based retrieval condition. There were no age differences in memory for realistic (meaningful) prices in either condition; however, younger adults showed better memory than older adults for unrealistic prices in the controlled retrieval condition only. These results suggest that age differences in memory for arbitrary associations can, at least partly, be accounted for by age reductions in strategic, controlled retrieval. (PsycINFO Database Record

The STAR score: a method for auditing clinical records

INTRODUCTION

Adequate medical note keeping is critical in delivering high quality healthcare. However, there are few robust tools available for the auditing of notes. The aim of this paper was to describe the design, validation and implementation of a novel scoring tool to objectively assess surgical notes.

METHODS

An initial 'path finding' study was performed to evaluate the quality of note keeping using the CRABEL scoring tool. The findings prompted the development of the Surgical Tool for Auditing Records (STAR) as an alternative. STAR was validated using inter-rater reliability analysis. An audit cycle of surgical notes using STAR was performed. The results were analysed and a structured form for the completion of surgical notes was introduced to see if the quality improved in the next audit cycle using STAR. An education exercise was conducted and all participants said the exercise would change their practice, with 25% implementing major changes.

RESULTS

Statistical analysis of STAR showed that it is reliable (Cronbach's α = 0.959). On completing the audit cycle, there was an overall increase in the STAR score from 83.344% to 97.675% (p < 0.001) with significant improvements in the documentation of the initial clerking from 59.0% to 96.5% (p < 0.001) and subsequent entries from 78.4% to 96.1% (p < 0.001).

CONCLUSIONS

The authors believe in the value of STAR as an effective, reliable and reproducible tool. Coupled with the application of structured forms to note keeping, it can significantly improve the quality of surgical documentation and can be implemented universally.

Neural Correlates of Enhanced Memory for Meaningful Associations with Age

Evidence suggests that age differences in associative memory are attenuated for associations that are consistent with prior knowledge. Such knowledge structures have traditionally been associated with the default network (DN), which also shows reduced modulation with age. In the present study, we investigated whether DN activity and connectivity patterns could account for this age-related effect. Younger and older adults underwent functional magnetic resonance imaging as they learned realistic and unrealistic prices of common grocery items. Both groups showed greater activity in the DN during the encoding of realistic, relative to unrealistic, prices. Moreover, DN activity at encoding and retrieval and its connectivity with an attention control network at encoding were associated with enhanced memory for realistic prices. Finally, older adults showed overactivation of control regions during retrieval of realistic prices relative to younger adults. Our findings suggest that DN activity and connectivity patterns (traditionally viewed as indicators of cognitive failure with age), and additional recruitment of control regions, might underlie older adults' enhanced memory for meaningful associations.

Cultural differences in visual attention: Implications for distraction processing

We investigated differences between participants of East Asian and Western descent in attention to and implicit memory for irrelevant words which participants were instructed to ignore while completing a target task (a Stroop Task in Experiment 1 and a 1-back task on pictures in Experiment 2). Implicit memory was measured using two conceptual priming tasks (category generation in Experiment 1 and general knowledge in Experiment 2). Participants of East Asian descent showed reliable implicit memory for previous distractors relative to those of Western descent with no evidence of differences on target task performance. We also found differences in a Corsi Block spatial memory task in both studies, with superior performance by the East Asian group. Our findings suggest that cultural differences in attention extend to task-irrelevant background information, and demonstrate for the first time that such information can boost performance when it becomes relevant on a subsequent task.

Necrotizing enterocolitis and hypothyroidism in a newborn infant: treatment with intravenous L-thyroxine

Gastrointestinal complications of hypothyroidism are well documented and include constipation, obstipation, and abdominal distention, as well as ileus, pseudo-obstruction, tumor-like mass of the intestine, and megacolon. We report herein on a 2-week-old, full-term female infant, who had both necrotizing enterocolitis (NEC) and congenital hypothyroidism. We further describe the response to therapy with intravenous L-thyroxine. To our knowledge, the patient's course is the first report of intravenous L-thyroxine in the management of congenital hypothyroidism when oral replacement is not an option. The possible causal relationship between NEC and hypothyroidism is discussed.

Task-linked Diurnal Brain Network Reorganization in Older Adults: A Graph Theoretical Approach

Testing older adults in the morning generally improves behavioral performance relative to afternoon testing. Morning testing is also associated with brain activity similar to that of young adults. Here, we used graph theory to explore how time of day (TOD) affects the organization of brain networks in older adults across rest and task states. We used nodes from the automated anatomical labeling atlas to construct participant-specific correlation matrices of fMRI data obtained during 1-back tasks with interference and rest. We computed pairwise group differences for key graph metrics, including small-worldness and modularity. We found that older adults tested in the morning and young adults did not differ on any graph metric. Both of these groups differed from older adults tested in the afternoon during the tasks—but not rest. Specifically, the latter group had lower modularity and small-worldness (indices of more efficient network organization). Across all groups, higher modularity and small-worldness strongly correlated with reduced distractibility on an implicit priming task. Increasingly, TOD is seen as important for interpreting and reproducing neuroimaging results. Our study emphasizes how TOD affects brain network organization and executive control in older adults.

Efficacy of transabdominal sonoelastography in the diagnosis of caesarean section scar endometrioma: A pilot study

Transabdominal sonoelastography (TASE) is a new imaging technique that maps the elastic properties of soft tissue. We evaluated 34, consecutive women with suspected scar endometrioma using standard B-mode ultrasound and elastography. Twenty-three women (23/34) underwent surgical excision and had the diagnosis confirmed by histopathology. All endometriomas (23 patients) in B-mode imaging appeared as hypoechoic masses along the line of a previous caesarean section incision and the outer borders were difficult to define precisely. By TASE, the endometrioma presented a typical blue-green-red appearance and the outer borders were clearly defined. (red and green area corresponds with the central hypoechoic soft areas). Strain ratios varied from 0.02 to 0.75. Real-time TASE is a simple, useful technique in confirming a clinical diagnosis of endometrioma in a caesarean section scar. Compared with B-mode ultrasound, it provides additional, preoperative information about the extent of the lesion that may be helpful to the surgeon.

Renal hemodynamic changes in children with liver cirrhosis

To assess the sensitivity of duplex Doppler ultrasonography in detecting early impairment of renal function in childhood cirrhosis, intrarenal arterial pulsatility index (PI) and resistive index (RI) were measured in 10 ascitic and 11 non-ascitic children with liver cirrhosis and normal creatinine clearance and 10 age- and sex-matched controls. PI and RI were higher in ascitic than non-ascitic children [PI 1.54+/-0.4 vs. 1.1+/-0.2 (mean +/- SD), P=0. 006; RI 0.76+/-0.07 vs. 0.68+/-0.07, P=0.03). Non-ascitic patients had higher PI and RI than controls (P=0.002 and 0.0001, respectively). PI was inversely correlated with creatinine clearance (r=-0.54, P=0.01). A significant positive relationship was observed between both PI and RI and Child score (r=0.47, P=0.009; r=0.45, P=0. 01, respectively). However, no significant correlation was observed between PI and RI and portal hypertension. We conclude that renal vascular resistance indexes evaluated by duplex Doppler ultrasonography are increased in the non-ascitic phase of cirrhosis. Development of ascites is associated with a further increase in these indexes. The resistance indexes are best correlated with severity of hepatocellular dysfunction, assessed by Child score, but not with portal hypertension. Hence, monitoring these indexes, especially PI, is a non-invasive means of studying early renal hemodynamic alteration in childhood cirrhosis.

Predictions transform memories: How expected versus unexpected events are integrated or separated in memory

Our brains constantly generate predictions about the environment based on prior knowledge. Many of the events we experience are consistent with these predictions, while others might be inconsistent with prior knowledge and thus violate our predictions. To guide future behavior, the memory system must be able to strengthen, transform, or add to existing knowledge based on the accuracy of our predictions. We synthesize recent evidence suggesting that when an event is consistent with our predictions, it leads to neural integration between related memories, which is associated with enhanced associative memory, as well as memory biases. Prediction errors, in turn, can promote both neural integration and separation, and lead to multiple mnemonic outcomes. We review these findings and how they interact with factors such as memory reactivation, prediction error strength, and task goals, to offer insight into what determines memory for events that violate our predictions. In doing so, this review brings together recent neural and behavioral research to advance our understanding of how predictions shape memory, and why.

Conservative management of staghorn stones

INTRODUCTION

Since the seminal works by Singh and Blandy in the 1970s, the management of staghorn stones has almost exclusively involved surgical intervention. In contrast, a more recent study found that conservative management was not as unsafe as previously believed. The present review sought to examine the available literature to understand the implications of a conservative strategy.

METHODS

A systematic search of the literature was carried out using MEDLINE®, Embase™ and the Cochrane Central Register of Controlled Trials. All papers looking at management of staghorn calculi were reviewed and studies with a conservative management arm were identified. Outcomes of interest were recurrent or severe urinary tract infections, progressive renal deterioration, dialysis requirements, morbidity and disease specific mortality. Owing to the lack of relevant data, a descriptive review was carried out.

RESULTS

Our literature search yielded 10 suitable studies involving a total of 304 patients with staghorn stones managed conservatively. Progressive renal deterioration occurred in 0-100% of cases (mean 27.5%) with a higher rate among bilateral staghorn sufferers (44% vs 9%). Dialysis was required in 9% of patients (20% bilateral, 6% unilateral). The mean rate of severe infection was 8.7% and recurrent urinary tract infections occurred in as high as 50% of cases (80% bilateral, 41% unilateral). Disease specific mortality ranged from 0% to 67% (mean 20.5%).

CONCLUSIONS

It appears that conservative management of staghorn calculi is not as unsafe as previously thought and selection of patients with unilateral asymptomatic stones with minimal infection should be considered.

Do young adults show conceptual knowledge of previous distractors?

Using implicit tests, older adults have been found to retain conceptual knowledge of previously seen task-irrelevant information. While younger adults typically do not show the same effect, evidence from one study [Gopie, N., Craik, F. I. M., & Hasher, L. (2011). A double dissociation of implicit and explicit memory in younger and older adults. Psychological Science, 22, 634-640. doi: 10.1177/0956797611403321 ] suggests otherwise. In that study, young adults showed greater explicit than implicit memory for previous distractors on a word fragment completion task. This was interpreted as evidence for maintaining access to previous conceptual knowledge of the distractors. Here, we report two failures to replicate that original finding, followed by a third study designed to test directly whether young adults use conceptual-level information that was previously irrelevant. Our findings agree with others that young adults show weak to no evidence of conceptual knowledge of previously irrelevant information.

Plasma endothelin-1 concentrations in children with cirrhosis and their relationship to renal function and the severity of portal hypertension

BACKGROUND

Plasma endothelin-1 (ET-1) is a potent vasoconstrictor peptide involved in the pathogenesis of several disorders. Endothelin-1 concentrations are increased in adult patients with cirrhosis. However, little is known about ET-1 concentrations in children with cirrhosis.

METHODS

Radioimmune assay was used to measure plasma ET-1 concentrations in 19 children with cirrhosis (8 patients with ascites, and 11 without ascites), and 11 age- and sex-matched healthy children. The plasma ET-1 concentrations were correlated with the mean blood pressure, creatinine clearance, and severity of portal hypertension, as measured by portal flow volume and portal flow velocity.

RESULTS

Patients with cirrhosis and ascites had increased plasma ET-1 concentrations compared with patients who did not have ascites (6.8 pg/mL +/- 0.62 pg/mL vs. 4.6 pg/mL +/- 0.35 pg/mL; mean +/- SEM; < 0.01) and controls (3.6 pg/mL +/- 0.27 pg/mL; mean +/- SEM; < 0.0005). Plasma ET-1 concentrations were higher in patients with cirrhosis who did not have ascites compared with controls ( < 0.005). No significant differences were observed between concentrations of the patients with cholestasis and those without cholestasis (5.4 pg/mL +/- 0.52 pg/mL vs. 5.2 +/- 0.32 pg/mL; mean +/- SEM; = 0.1). Plasma ET-1 concentrations correlated positively with the mean blood pressure ( = 0.58; < 0.05) and negatively with renal function, as measured by creatinine clearance ( = -0.7; <0.005). However, no correlation was detected between ET-1 concentrations and portal flow volume ( = -0.02; = 0.4) or portal flow velocity ( = -0.16; = 0.4).

CONCLUSIONS

Plasma ET-1 concentrations are increased in children with cirrhosis, with or without ascites, compared with controls. Patients with cirrhosis and ascites have increased ET-1 concentrations compared with those without ascites. The degree of increase does not relate to the severity of portal hypertension. This increase tends to maintain systemic blood pressure but is associated with a decrease in renal function.

Spontaneous Distractor Reactivation With Age: Evidence for Bound Target-Distractor Representations in Memory

Reduced attentional control with age is associated with the processing and maintenance of task-irrelevant information in memory. Yet the nature of these memory representations remains unclear. We present evidence that, relative to younger adults (n = 48), older adults (n = 48) both (a) store simultaneously presented target and irrelevant information as rich, bound memory representations and (b) spontaneously reactivate irrelevant information when presented with previously associated targets. In a three-stage implicit reactivation paradigm, re-presenting a target picture that was previously paired with a distractor word spontaneously reactivated the previously associated word, making it become more accessible than an unreactivated distractor word in a subsequent implicit memory task. The accessibility of reactivated words, indexed by priming, was also greater than the degree of distractor priming shown by older adults in a control condition (n = 48). Thus, reduced attentional control influences the processing and representation of incoming information.

Electrophysiological signature of suppression of competitors during interference resolution

The electrophysiological evidence for suppression to date primarily draws upon traditional retrieval-induced forgetting and Think/No-Think paradigms, which involve strategic and intentional restriction of thought. Here event-related potential (ERP) signatures of suppression were examined using a novel task, which unlike traditional paradigms, does not include an initial priming step or intentional thought restraint. Participants were instructed to verbally generate semantically related responses to cue words (e.g., "PIZZA"), and unrelated responses to others. According to an inhibitory account of interference resolution, semantic competition from automatically activated target words must be resolved in order to generate an unrelated response, whereas no resolution is required for generating related responses. In a subsequent phase, accessibility for target words (e.g., "PEPPERONI") that required suppression, words that did not require suppression, as well as new control words was measured using a lexical decision task. We observed a sustained late positivity for unrelated responses in the generation task, and early negative amplitudes of suppressed items in the lexical decision task. These findings are consistent with inhibitory mechanisms operating at retrieval to suppress competitors and show that such processes operate on automatically activated items that are not presented in the context of an experiment, representative of retrieval situations that occur in everyday life.

How Older Adults Remember the World Depends On How They See It

Age-related changes in visual exploration and memory have typically been studied separately. However, recent evidence suggests that mnemonic processes both affect, and are affected by, eye movements (EMs). Thus, by relating older adults' memory deficits to age-specific visual exploration patterns, we can improve upon models of cognitive aging.

A rare case of primary epithelioid angiosarcoma of the ureter

Angiosarcoma is an extremely rare vascular malignancy with a 1-year survival rate of 50%, regardless of tumour origin. Distant metastases are common and occur in the lungs, bone, lymph nodes and soft tissues. The majority of patients with angiosarcoma present with localised disease, although 25-45% have distant metastases at presentation. There are few reported cases of angiosarcomas of the bladder and we report the second case in the literature of primary angiosarcoma of the ureter. We suggest that, in atypical manifestations of suspected urothelial malignancy, the multidisciplinary team considers the possibility of rarer, aggressive tumours early. This may influence clinical decision making towards offering radical treatments earlier, before it is too late to do so owing to aggressive oncological behaviour.

Cultural differences in distraction processing: influence of context at retrieval

Cultural differences in information processing affect perceptual judgment, attention, and memory. We investigated whether cultural differences in processing patterns, specifically East Asian participants' tendency to encode holistically, compared to Western tendencies to process analytically, affect performance on an implicit memory test. First, participants completed a 1-back task on pictures with superimposed distracting words. After a delay filled with a computerised Corsi block task, they performed a word fragment task in which some fragments could be completed with the distracting words from the 1-back task. Critically, fragments were presented with the same pictures as previously seen (matched condition), with no pictures (control condition), or with pictures from other trials on the 1-back task (mismatched condition). Non-Asian Canadian participants showed virtually no priming for distraction, independent of the reinstatement of encoding context. East Asian Canadian participants showed superior priming for fragments that had been paired with their original pictures. They did not show evidence of a detriment for the mismatched, relative to control, condition.