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41 Adaptive Implementation of Cognitive Control in School-Aged Children with ADHD: A Diffusion-Model Analysis
- Tyler A Warner, Cynthia L Huang-Pollock
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 648-649
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Objective:
Because cognitive resources are limited, models of cognitive control predict that additional control is engaged only if it improves task performance. Increased response caution, which occurs when individuals increase the threshold of information needed before making a decision, is one example of cognitive control adaptation. While previous studies have measured increased response caution via increased reaction time, the diffusion model can be used to derive a boundary separation parameter that directly indexes response caution and eliminates capturing alternative influences on reaction time. This study aims to determine if school-aged children, either with or without ADHD, show adaptive changes in response caution during a set-shifting task. These groups have demonstrated mixed results when analyzing reaction time, so this study utilizes diffusion modeling to measure response caution more directly. The set-shifting task presents switches in a random order such that they cannot be predicted; therefore, increasing response caution is only adaptive following errors, called post-error slowing (PES), but not following switch trials. It is predicted that children will show increased response caution only when adaptive. If child with ADHD adapt their response caution fundamentally differently, then there will be individual differences in change in boundary separation.
Participants and Methods:Children ages 8-12 with (n=193) and without (n=70) ADHD completed the Navon set-shifting task. Participants saw one of four global shapes made up of local shapes and were asked to identify one or the other based upon the background color. Of the 144 trials, 70 presented a switch between global and local. Trials were presented in the same randomized order for all participants, self-paced, and followed by feedback on correctness. The diffusion model parameters boundary separation (a), drift rate (v), and nondecision time (Ter) were estimated by condition, including a) post-error versus after correct and b) post-switch versus post-same. For PES analyses, only participants with a sufficient number of errors for modeling were included (ADHD n=113, control n=19).
Results:Participants were slower on trials immediately following errors (F(1, 130)=119.76, p<.001, n2=.48) and switches (F(1, 261)=154.93, p<.001, n2=.37). In PES, slowing was attributable to increased boundary separation, F(1, 130)=16.11, p<.001, n2=.11, as well as slower drift rate and longer nondecision time (both p<.01, n2 >.05). However, as predicted, post-switch slowing was only attributable slower drift rate and longer nondecision time (both p<.001, n2 >.10), not increased boundary separation, F(1, 261)=0.77, p=.38, n2<.01. Overall, children with ADHD had slower drift rates (F(1, 261)=4.63, p<.001, n2=.10) and narrower boundary separation (F(1, 261)=10.56, p=.001, n2=.04). However, there were no ADHD x trial-type interactions for PES or post-switch (both p>.33, n2<.01).
Conclusions:School-aged children demonstrated increased response caution following errors, but not following switches. This demonstrates an adaptive use of cognitive control. The diffusion model was crucial in determining this, as reaction time slowed following switches for reasons unrelated to cognitive control. Additionally, although children with ADHD demonstrated slower drift rates and narrower boundary separation overall, they showed no differences when adapting response caution.
Nucleated red blood cells as a biomarker for mortality in neonates following cardiac surgery
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- Kurt D. Piggott, Syeda Maqsood, Cynthia L. Warner, Timothy Pettitt, Shengping Yang, Jason Turner, Amira Soliman, Casey Norlin, LaTasha Lewis, Ajay Bhatia
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- Journal:
- Cardiology in the Young / Volume 32 / Issue 7 / July 2022
- Published online by Cambridge University Press:
- 31 August 2021, pp. 1048-1052
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Introduction:
Nucleated red blood cells (NRBCs) are immature red cells that under normal conditions are not present in the peripheral circulation. Several studies have suggested an association between elevated NRBC and poor outcome in critically ill adults and neonates. We sought to determine if elevations in NRBC value following cardiac surgery and following clinical events during the hospital stay can be used as a biomarker to monitor for mortality risk in neonates post-cardiac surgery.
Materials and methods:We constructed a retrospective study of 264 neonates who underwent cardiac surgery at Children’s Hospital, New Orleans between 2011 and 2020. Variables included mortality and NRBC value were recorded following cardiac surgery and following peri-operative clinical events. The study was approved by LSU Health IRB. Sensitivity, specificity, receiver operating characteristic (ROC) curves with area under the curve (AUC) and logistic regression analysis were performed.
Results:Thirty-six patients (13.6%) died, of which 32 had an NRBC value ≥10/100 white blood cell (WBC) during hospitalisation. Multi-variable analysis found extracorporeal membrane oxygenation use (OR 10, 95% CI 2.9–33, p=<0.001), NRBC ≥10/100 WBC (OR 16.1, CI 4.1–62.5, p ≤ 0.001) and peak NRBC in the 14-day period post-cardiac surgery (continuous variable, OR 1.05, 95% CI 1.0–1.09, p = 0.03), to be independently associated with mortality. Using a cut-off NRBC value of 10/100 WBC, there was an 88.9% sensitivity and a 90.8% specificity, with ROC curve showing an AUC of 0.9 and 0.914 for peak NRBC value in 14 days post-surgery and entire hospitalisation, respectively.
Conclusions:NRBC ≥10/100 WBC post-cardiac surgery is strongly associated with mortality. Additionally, NRBC trend appears to show promise as an accurate biomarker for mortality.