Arrows don’t look at you: Qualitatively different attentional mechanisms triggered by gaze and arrows

Eye gaze conveys rich information concerning the states of mind of others, playing a critical role in social interactions, signaling internal states, and guiding others’ attention. On the basis of its social significance, some researchers have proposed that eye gaze may represent a unique attentional stimulus. However, contrary to this notion, the majority of the literature has shown indistinguishable attentional effects when eye gaze and arrows have been used as cues. Taking a different approach, in this study we aimed at finding qualitative attentional differences between gazes and arrows when they were used as targets instead of as cues. We used a spatial Stroop task, in which participants were required to identify the direction of eyes or arrows presented to the left or the right of a fixation point. The results showed that the two types of stimuli led to opposite spatial interference effects, with arrows producing faster reaction times when the stimulus direction was congruent with the stimulus position (a typical spatial Stroop effect), and eye gaze producing faster reaction times when it was incongruent (a Breversed^ spatial Stroop effect). This reversed Stroop is interpreted as an eye-contact effect, therefore revealing the unique nature of eyes as special social-attention stimuli

Assessing the Evidential Value of Mental Fatigue and Exercise Research

Open access funding provided by University of Lausanne. Cristian Mesquida is funded by Technological University Dublin (project ID PTUD2002), Darías Holgado is supported by a grant from “Ministerio de Universidades” of Spain and Next Generation Fonds from the European Union, and Rafael Román-Caballero is funded by a predoctoral fellowship from the Spanish Ministry of Education, Culture, and Sport (FPU17/02864).It has often been reported that mental exertion, presumably leading to mental fatigue, can negatively affect exercise performance; however, recent findings have questioned the strength of the effect. To further complicate this issue, an overlooked problem might be the presence of publication bias in studies using underpowered designs, which is known to inflate false positive report probability and effect size estimates. Altogether, the presence of bias is likely to reduce the evidential value of the published literature on this topic, although it is unknown to what extent. The purpose of the current work was to assess the evidential value of studies published to date on the effect of mental exertion on exercise performance by assessing the presence of publication bias and the observed statistical power achieved by these studies. A traditional meta-analysis revealed a Cohen's d(z) effect size of - 0.54, 95% CI [- 0.68, - 0.40], p 1000, and inconclusive evidence in favor of the effect, adjusted d(z) = 0.01, 95% CrI [- 0.46, 0.37], BF10 = 0.90. Furthermore, the median observed statistical power assuming the unadjusted meta-analytic effect size (i.e., - 0.54) as the true effect size was 39% (min = 19%, max = 96%), indicating that, on average, these studies only had a 39% chance of observing a significant result if the true effect was Cohen's d(z) = - 0.54. If the more optimistic adjusted effect size (- 0.36) was assumed as the true effect, the median statistical power was just 20%. We conclude that the current literature is a useful case study for illustrating the dangers of conducting underpowered studies to detect the effect size of interest.University of LausanneTechnological University Dublin ID PTUD2002“Ministerio de Universidades” of SpainNext Generation Fonds European UnionSpanish Ministry of Education, Culture, and Sport FPU17/0286

Please don't stop the music: A meta-analysis of the cognitive and academic benefits of instrumental musical training in childhood and adolescence

An extensive literature has investigated the impact of musical training on cognitive skills and academic achievement in children and adolescents. However, most of the studies have relied on cross-sectional designs, which makes it impossible to elucidate whether the observed differences are a consequence of the engagement in musical activities. Previous meta-analyses with longi- tudinal studies have also found inconsistent results, possibly due to their reliance on vague definitions of musical training. In addition, more evidence has appeared in recent years. The current meta-analysis investigates the impact of early programs that involve learning to play musical instruments on cognitive skills and academic achievement, as previous meta-analyses have not focused on this form of musical training. Following a systematic search, 34 indepen- dent samples of children and adolescents were included, with a total of 176 effect sizes and 5998 participants. All the studies had pre-post designs and, at least, one control group. Overall, we found a small but significant benefit (gΔ = 0.26) with short-term programs, regardless of whether they were randomized or not. In addition, a small advantage at baseline was observed in studies with self-selection (gpre = 0.28), indicating that participants who had the opportunity to select the activity consistently showed a slightly superior performance prior to the beginning of the inter- vention. Our findings support a nature and nurture approach to the relationship between instru- mental training and cognitive skills. Nevertheless, evidence from well-conducted studies is still scarce and more studies are necessary to reach firmer conclusions.Ministerio de Educación, Cultura y DeporteComunidad Autónoma de MadridMinisterio de Economía, Industria y CompetitividadUniversidad de Granada / CBU

Predictive Power of the "Trigger Tool" for the detection of adverse events in general surgery: a multicenter observational validation study

Background In spite of the global implementation of standardized surgical safety checklists and evidence-based practices, general surgery remains associated with a high residual risk of preventable perioperative complications and adverse events. This study was designed to validate the hypothesis that a new “Trigger Tool” represents a sensitive predictor of adverse events in general surgery. Methods An observational multicenter validation study was performed among 31 hospitals in Spain. The previously described “Trigger Tool” based on 40 specific triggers was applied to validate the predictive power of predicting adverse events in the perioperative care of surgical patients. A prediction model was used by means of a binary logistic regression analysis. Results The prevalence of adverse events among a total of 1,132 surgical cases included in this study was 31.53%. The “Trigger Tool” had a sensitivity and specificity of 86.27% and 79.55% respectively for predicting these adverse events. A total of 12 selected triggers of overall 40 triggers were identified for optimizing the predictive power of the “Trigger Tool”. Conclusions The “Trigger Tool” has a high predictive capacity for predicting adverse events in surgical procedures. We recommend a revision of the original 40 triggers to 12 selected triggers to optimize the predictive power of this tool, which will have to be validated in future studies

Role of age and comorbidities in mortality of patients with infective endocarditis

[Purpose]: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. [Methods]: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups:<65 years,65 to 80 years,and ≥ 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk. [Results]: A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 ≥ 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients ≥80 years who underwent surgery were significantly lower compared with other age groups (14.3%,65 years; 20.5%,65-79 years; 31.3%,≥80 years). In-hospital mortality was lower in the <65-year group (20.3%,<65 years;30.1%,65-79 years;34.7%,≥80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%,≥80 years; p = 0.003).Independent predictors of mortality were age ≥ 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32–3.34), CCI ≥ 3 (HR:1.62; 95% CI:1.39–1.88),and non-performed surgery (HR:1.64;95% CI:11.16–1.58).When the three age groups were compared,the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality. [Conclusion]: There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group

Los potenciales beneficios cognitivos de la práctica musical desde la infancia hasta el envejecimiento saludable

There is currently a growing interest in ways to enhance and preserve our cognitive skills through changes in lifestyle. Extensive scientific evidence links several behavioral and environmental factors, such as smoking, alcohol and drug abuse, a sedentary lifestyle, and inadequate nutrition, to an increased risk of cognitive impairment, dementia, and accelerated aging. On the other side, education, physical exercise, and cognitively stimulating occupations and leisure activities have all been associated with neurocognitive benefits and the prevention of the pervasive consequences of neural aging. Among them, a wealth of studies has associated musical training, and particularly learning to play an instrument, with differences in auditory and sensorimotor skills, as well as in multiple non-musical cognitive capacities: intelligence, visuospatial abilities, processing speed, executive control, attention and vigilance, episodic and working memory, and language. In addition, anatomical and functional changes have been documented in several brain networks, some of them related to higher-order cognitive processing or non-musical skills. A priori, the characteristics of playing a musical instrument make it a promising candidate for producing a transfer effect. It involves multiple sensory and motor systems, and requires a wide variety of higher-level cognitive processes. Moreover, a regular and motivated practice of progressive difficulty is necessary to master the technique of an instrument. The wide range of observed differences between musicians and nonmusicians suggests that musical practice might produce near and far transfer. However, some voices have argued against the causal role of musical training and hypothesized that the advantages are the consequence of the lack of control of cross-sectional studies. Skeptic authors rather propose that high-functioning children, with higher musical aptitude, higher socioeconomic status, and high openness to experience are more likely to be interested in music. Therefore, the idea that learning to play a musical instrument is the cause of a broad cognitive enhancement is still controversial. The research program in the present thesis dissertation aimed to contribute with answers to the debate. First, in a comprehensive meta-analysis of intervention studies (i.e., with a pre-posttest assessment), we showed that the available evidence of randomized controlled trials with children and adolescents supports a small benefit of musical training (d = 0.26). Interestingly, a small advantage at baseline was observed in studies with self-selection (d = 0.28), indicating that participants who had the opportunity to select the activity consistently showed a slightly superior performance prior to the beginning of the intervention. However, baseline performance did not fully explain the differences between children/adolescents with and without musical training, which rules out the effect being a methodological artifact (e.g., regression toward the mean). In addition, some moderators of the effect were observed: (a) the larger the baseline difference, the smaller the observed effect of musical training; (b) participants with lower socioeconomic status showed greater improvements compared to those with middle-high socioeconomic status; (c) the earlier the age of commencement, the larger the effect. Second, we conducted a meta-analysis regardless of the age of the participants to examine the impact of learning to play an instrument on music-related skills. The available intervention studies also suggested near transfer, but they are still scarce to reach firm conclusions. One explanation for the potential broad benefits of musical training might be its impact on attention and executive functions, as they are necessary functions for many cognitive tasks and daily activities. Indeed, in a well-controlled crosssectional study with a preregistered design, we found superior vigilance and psychomotor speed for musicians than non-musicians. Importantly, our extensive control of confounders led to smaller effects in contrast to the previous literature. These results are consistent with a nature and nurture hypothesis, in which expert musicians might have preexisting advantages (cognitive, personality, and/or musical aptitudes) that would promote the acquisition of musical skills and motivation to practice, while at the same time, this long-term engagement would also result in multiple neural and cognitive changes. Finally, we meta-analyzed the literature on musical training in healthy aging. We included both cross-sectional and experimental studies as they are complementary: experimental methodology involves randomization and thus allows the establishment of causal relationships, while correlational designs analyze samples with longer musical training. We observed benefits in both types of designs, although the experimental evidence is less abundant. Taken all together, it seems that musical training might have a protective effect in some functions and, mostly, an enhancing effect throughout life. Thus, musicians would present a superior cognitive performance at all stages of life. I proposed here several non-exclusive mechanisms to explain cognitive benefits of musical training. Given the high demands that musical practice places on multiple cognitive functions (e.g., memory), learning to play an instrument could specifically enhance cognitive abilities through neuroplasticity as a consequence of the increased use of those abilities. However, it might promote the use of more efficient strategies (e.g., improved rehearsal mechanism and semantic organization). As it is a multisensory activity, it might lead to multimodal representations of reallife events (e.g., spatial or visual representation of auditory words), enriching them with complementary inputs. Also, the characteristics of musical training might build a greater propensity for effort (i.e., learned industriousness), making effortful tasks less aversive and more engaging. Finally, the enhancements on domain-general cognitive functions, especially attention and executive control, might spread their benefits on other cognitive tasks, such as preventing the interference of irrelevant events in working memory. Overall, the contribution of musical training to cognitive skills seems to be rather small and probably makes very little difference in daily life, so it might be not one of the first-choice interventions if the only purpose is cognitive enhancement. However, learning to play an instrument is an enriching activity in itself and can become an important source of pleasure in the player's life. In addition to the social and emotional benefits of playing, practicing this activity for long periods (several decades) could also have significant implications for the development of basic cognitive skills, especially in samples with lower cognitive performance, low socioeconomic status or suffering from neurological conditions.El interés por las formas de mejorar y preservar nuestras capacidades cognitivas a través de los estilos de vida ha crecido en los últimos años. Una abundante evidencia científica vincula ciertos factores ambientales y ciertos hábitos, como el tabaquismo, el abuso de alcohol y drogas, el sedentarismo y una nutrición inadecuada, con un mayor riesgo de deterioro cognitivo, una mayor prevalencia de demencias y un envejecimiento acelerado. En el lado contrario, la educación, el ejercicio físico, y las profesiones y actividades de ocio mentalmente estimulantes se han asociado a beneficios neurocognitivos y a la prevención de las consecuencias del envejecimiento cerebral. Una de esas actividades ha sido la práctica musical, y en particular aprender a tocar un instrumento, la cual se ha relacionado con diferencias en las habilidades auditivas y sensoriomotoras, así como en múltiples habilidades cognitivas que no son específicas de la música: la inteligencia, las habilidades visuoespaciales, la velocidad de procesamiento, el control ejecutivo, la atención, la capacidad de vigilancia, la memoria episódica, la memoria de trabajo y el lenguaje. También se han documentado cambios anatómicos y funcionales en varias redes cerebrales, algunas de ellas involucradas en procesos cognitivos de orden superior o capacidades no musicales. Tocar un instrumento musical es una actividad con unas características que, a priori, la convierten en una candidata prometedora para producir efectos de transferencia. Tocar un instrumento implica múltiples sistemas sensoriales y motores, y requiere una gran variedad de procesos cognitivos de nivel superior. Además, dominar la técnica de un instrumento conlleva una práctica regular y motivada con una dificultad progresiva. La amplia gama de aspectos cognitivos que se ven mejorados en las personas con formación musical sugiere que la práctica musical podría producir una transferencia cercana y lejana. Sin embargo, algunas voces han argumentado en contra del papel causal de la formación musical y plantean que todas las ventajas son consecuencia de la falta de control de los estudios transversales. Esas voces escépticas han propuesto que ciertas variables predisponen a que las personas se interesan y se impliquen en la práctica musical: un mayor rendimiento cognitivo previo al comienzo de la formación musical, mayores capacidades musicales, un mayor estatus socioeconómico y una mayor apertura a la experiencia como rasgo de personalidad. Por lo tanto, aún existe controversia en torno a la idea de que aprender a tocar un instrumento musical cause beneficios cognitivos. El conjunto de estudios que conforman esta tesis pretende aportar respuestas a este debate. En primer lugar, en un metaanálisis exhaustivo de los estudios de intervención (es decir, aquellos con un diseño pre-postest), encontramos que la evidencia disponible de los ensayos controlados aleatorizados con niños y adolescentes respaldan la existencia de un beneficio cognitivo pequeño de la práctica musical (d = 0,26). También observamos una pequeña ventaja al inicio del estudio en los estudios sin aleatorización (d = 0,28), lo que confirma que las personas que seleccionaron la práctica musical en base a sus propias motivaciones tenían un rendimiento superior antes del comienzo de la intervención. Sin embargo, el rendimiento inicial de los participantes no explicaba totalmente las diferencias entre los niños/adolescentes con y sin formación musical, lo que descarta que el efecto sea un artefacto metodológico (por ejemplo, la regresión a la media). Además, el efecto de la práctica musical estaba moderado por algunas variables: (a) el beneficio de la práctica musical disminuía cuanto mayor era la diferencia entre los dos grupos al principio del estudio (antes de la intervención); (b) los participantes con un estatus socioeconómico más bajo mostraban mayores mejoras en comparación con aquellos con un estatus socioeconómico medio-alto; y (c) cuanto más temprana era la edad de inicio, mayor era el efecto. En segundo lugar, realizamos un metaanálisis en todas las edades sobre el impacto de aprender a tocar un instrumento en las capacidades auditivas relacionadas con la música. Los estudios de intervención disponibles sugirieron una transferencia cercana, pero su número era escaso para conducir a conclusiones firmes. Una explicación de los amplios beneficios de la práctica musical podría ser a través de los beneficios que produciría en la atención y las funciones ejecutivas, ya que son funciones esenciales en muchas tareas cognitivas y actividades cotidianas. De esta forma, en un estudio transversal con un diseño prerregistrado y en el que controlamos una lista extensa de variables de confusión, un grupo de músicos adultos mostraron ventajas en la capacidad de vigilancia y la velocidad psicomotora en comparación a un grupo de personas sin formación musical. Destaca que los efectos observados tras el exhaustivo control de variables de confusión fueron menores que los encontrados en múltiples estudios transversales anteriores. Estos resultados son coherentes con una explicación de las diferencias cognitivas basada tanto en factores innatos como en la experiencia, es decir, las ventajas encontradas en los músicos expertos pueden ser consecuencia de factores anteriores a la práctica musical (ventajas cognitivas previas, rasgos de personalidad y/o aptitudes musicales anteriores a la formación musical) que promoverían la adquisición de las habilidades musicales y la motivación para practicar, mientras que la práctica musical a lo largo del tiempo también daría lugar, por su parte, a múltiples cambios neuronales y cognitivos. Por último, se realizó un metaanálisis de los estudios en el envejecimiento saludable. Incluimos tanto estudios transversales como experimentales, ya que son dos metodologías complementarias: los diseños experimentales implican la aleatorización de los participantes y, por tanto, permiten establecer relaciones causales, mientras que los diseños correlacionales analizan muestras con un entrenamiento musical más prolongado. Nuestro metaanálisis mostró beneficios en ambos tipos de diseño, aunque la evidencia experimental fue menos abundante. En conjunto, parece que la práctica musical podría tener un efecto protector en algunas funciones cognitivas, pero sobre todo tendría un efecto potenciador a lo largo de la vida. Por tanto, las ventajas en el rendimiento cognitivo de los músicos estarían presentes en todas las etapas de la vida. Propongo la existencia de varios mecanismos no excluyentes para explicar los beneficios cognitivos del entrenamiento musical. Dadas las demandas elevadas de la práctica musical sobre múltiples funciones cognitivas (por ejemplo, la memoria), aprender a tocar un instrumento podría mejorar específicamente las capacidades mentales a través de la neuroplasticidad desencadena por un mayor uso de esas capacidades. Sin embargo, podría promover el uso de estrategias más eficientes (por ejemplo, mejoras en el mecanismo de ensayo y la organización semántica). También, al tratarse de una actividad multisensorial, podría dar lugar a representaciones multimodales de los acontecimientos de la vida real (por ejemplo, representando espacial o visualmente las palabras auditivas), enriqueciéndolas con una información complementaria. Además, las características del entrenamiento musical podrían convertir a quienes la practican en personas con una mayor propensión al esfuerzo (es decir, con una mayor laboriosidad aprendida), por lo que las tareas que requieren esfuerzo podrían ser menos aversivas y más atractivas. Por último, las mejoras en funciones cognitivas generales, especialmente la atención y el control ejecutivo, podrían extender sus beneficios a otras tareas cognitivas, como la prevención de la interferencia de eventos irrelevantes en la memoria de trabajo. En general, la contribución del entrenamiento musical a las habilidades cognitivas parece ser bastante pequeña y probablemente marque una diferencia reducida en la vida diaria, por lo que podría no ser una de las intervenciones de primera elección si el único propósito es la mejora cognitiva. Sin embargo, aprender a tocar un instrumento es una actividad enriquecedora en sí misma y puede convertirse una fuente importante de placer en la vida de quien lo toca. Lo interesante es que, además de los beneficios sociales y emocionales de tocar, podría tener además implicaciones significativas en el desarrollo de habilidades cognitivas básicas tras largos periodos de práctica (de varias décadas) y en muestras con un menor rendimiento cognitivo, un bajo nivel socioeconómico o que sufren alguna afección neurológica.Tesis Univ. Granada.Spanish Ministry of Education, Culture and Sport to RRC (FPU17/02864)Grant from the Autonomous Community of Madrid to MAV (2016-T1/SOC-1395)The Spanish Ministry of Economy, Industry, and Competitiveness to JL (PSI2017-84926-P)MAV (PSI2017-85159-P)Universidad de Granada / CBU

Let’s go beyond “the effect of”: reappraising the impact of ordinary activities on cognition [Annotation]

University of Granad

Let’s go beyond “the effect of”: reappraising the impact of ordinary activities on cognition [Annotation]

University of Granad

Spatial interference triggered by gaze and arrows. The role of target background on spatial interference

Recent evidence with a spatial interference paradigm has shown that arrows and eye gaze yield opposite congruency effects, arrow target eliciting faster responses when their direction is congruent with their position (standard congruency effect), and gaze producing faster reaction times for incongruent conditions (reversed congruency effect). But in ecological contexts eye gaze tend to be more perceptually complex (i.e., embedded in the whole face) than simple arrows. The present study aimed to replicate this dissociation using whole faces and a comparable non-social target, formed by arrows embedded in a colored geometric background. Whereas the reversed congruency effect with gaze was replicated, the standard spatial interference with arrows was surprisingly absent. A similar outcome appeared when the contrast between the arrows and the task-irrelevant background increased. The results confirm the robustness of the reversed congruency effect with eyes, regardless of whether they are presented alone or within a face. In addition, and importantly, the unexpected absence of the spatial conflict with complex arrow targets seems to be a consequence of higher figure-ground segregation demands, which extend the processing of the task-relevant spatial dimension and, in turn, cause the decay of the location code. This pattern of results, and the provided interpretation, can explain previous unexplained findings in the spatial interference literature