Low attentional engagement makes attention network activity susceptible to emotional interference

The aim of this study was to investigate whether emotion-attention interaction depends on attentional engagement. To investigate emotional modulation of attention network activation, we used a functional MRI paradigm consisting of a visuospatial attention task with either frequent (high-engagement) or infrequent (low-engagement) targets and intermittent emotional or neutral distractors. The attention task recruited a bilateral frontoparietal network with no emotional interference on network activation when the attentional engagement was high. In contrast, when the attentional engagement was low, the unpleasant stimuli interfered with the activation of the frontoparietal attention network, especially in the right hemisphere. This study provides novel evidence for low attentional engagement making attention control network activation susceptible to emotional interference. © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins.Fil: Exposito, Veronica. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Tampere; FinlandiaFil: Pickard, Natasha. California State University; Estados UnidosFil: Solbakk, Anne-Kristin. University of Oslo; NoruegaFil: Ogawa, Keith H.. Saint Mary's College Of California; Estados UnidosFil: Knight, Robert T.. California State University; Estados UnidosFil: Hartikainen, Kaisa M.. Universidad de Tampere; Finlandi

Performance of emergency surgical front of neck airway access by head and neck surgeons, general surgeons, or anaesthetists:an in situ simulation study

BACKGROUND The “Can’t Intubate Can’t Oxygenate” (CICO) emergency requires urgent front of neck airway access to prevent death. In cases reported to the 4th National Audit Project, the most successful front of neck airway (FONA) was a surgical technique, almost all of which were performed by surgeons. Subsequently, UK guidelines adopted surgical cricothyroidotomy as the preferred emergency surgical FONA technique. Despite regular skills-based training, anaesthetists may still be unwilling to perform an emergency surgical FONA. AIM To compare consultant anaesthetists, head and neck surgeons and general surgeons in a high-fidelity simulated emergency. We hypothesised that head and neck surgeons would successfully execute emergency surgical FONA faster than anaesthetists and general surgeons. METHODS We recruited 15 consultants from each specialty (total 45). All agreed to participate in an in-situ hi-fidelity simulation of an ‘anaesthetic emergency’. Participants were not told in advance that this would be a CICO scenario. RESULTS There was no significant difference in total time to successful ventilation between the three groups (median 86 vs. 98 vs. 126.5 seconds, p=0.078). However, anaesthetists completed the emergency surgical FONA procedure significantly faster than general surgeons (median 50 vs. 86 seconds, p=0.018). Despite this strong performance, qualitative data suggested some anaesthetists still believed ‘surgeons’ best placed to perform emergency surgical FONA in a genuine CICO situation. CONCLUSION Anaesthetists regularly trained in emergency emergency surgical FONA function at levels comparable to head and neck surgeons and should feel empowered to lead this procedure in the event of a CICO emergency

Prefrontal Cortex Lesions Impair Object-Spatial Integration

How and where object and spatial information are perceptually integrated in the brain is a central question in visual cognition. Single-unit physiology, scalp EEG, and fMRI research suggests that the prefrontal cortex (PFC) is a critical locus for object-spatial integration. To test the causal participation of the PFC in an object-spatial integration network, we studied ten patients with unilateral PFC damage performing a lateralized object-spatial integration task. Consistent with single-unit and neuroimaging studies, we found that PFC lesions result in a significant behavioral impairment in object-spatial integration. Furthermore, by manipulating inter-hemispheric transfer of object-spatial information, we found that masking of visual transfer impairs performance in the contralesional visual field in the PFC patients. Our results provide the first evidence that the PFC plays a key, causal role in an object-spatial integration network. Patient performance is also discussed within the context of compensation by the non-lesioned PFC

Object-Spatial Behavioral Results.

<p>(<b>A</b>) Patients showed an overall impairment in object-spatial integration resulting in decreased stimulus sensitivity (d’) across all trials and conditions. (<b>B</b>) Similarly, patients showed an overall response impairment resulting in increased reaction times across all trials and conditions. Error bars indicate SEM. (*), significant difference with p = 0.0032; (**), significant difference with p<0.0005.</p

Patient Demographics.

<p>Note: BA, Brodmann area; HB, hypertensive bleed.</p

Effects of Early Mask on Patient Performance.

<p>(<b>A</b>) Box plot comparing control (left) and patient (right) hemispheric cost during the mask condition (contralesional minus ipsilesional). Nine out of the ten participants show this hemispheric cost whereas control subjects show no real bias. (<b>B</b>) We confirmed group differences by way of resampling statistics (see <b><a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0034937#s4" target="_blank">Methods</a></b>), which confirm that the hemispheric behavioral asymmetry is greater in patients compared to controls (z = 1.66, p = 0.049). (*), significant difference with p = 0.050.</p

Behavioral Paradigm.

<p>(<b>A</b>) In all three conditions (early mask, delayed mask, and no mask) subjects were presented with an unidentifiable, non-verbalizable, black and white object and a gray location cue (see Materials and <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0034937#s4" target="_blank">Methods</a> for details). (<b>B</b>) Schematic of the main hypothesis. In the early mask condition, the mask adds noise during the processing of the visual object and spatial cue by the non-lesioned hemisphere, reducing the fidelity of the transcallosal transfer of visual information (disconnected green/red line over visual cortex). In the delayed mask condition, however, task-relevant visual information crosses the corpus callosum before the mask appears, allowing the non-lesioned hemisphere to assist in object-spatial recognition (intact green line over visual cortex). Blue shading illustrates the location of the subjects’ lesions.</p

Patient MRIs.

<p>Lesion reconstructions are show for individual patients [n = 10], and we include a group average overlay (bottom). MRI reconstructions were obtained using MRIcro <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0034937#pone.0034937-Rorden1" target="_blank">[32]</a>. For the group average, patients with right hemisphere lesions [P01 and P07] were transcribed to the left hemisphere for display purposes. The color bar indicates the percent of patients with a lesion in a specific region. The area of greatest lesion overlap across the patients occurs in Brodmann areas 9 and 46, centered in the middle frontal gyrus.</p

Summary of Reaction Times.

<p>Note: SEM, standard error of the mean; Hemispheric differences: *<i>P</i><0.0005.</p