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Background: We sought to investigate the differential impact of EVAR (endovascular aneurysm repair) vis-á-vis OSR (open surgical repair) on ruptured AAA (abdominal aortic aneurysm) mortality by sex and geographically. Methods: We performed a retrospective study of administrative data on EVAR from state statistical agencies, vascular registries, and academic publications, as well as ruptured AAA mortality rates from the World Health Organization for 14 14 states across Australasia, East Asia, Europe, and North America. Results: Between 2011-2016, the proportion of treatment of ruptured AAAs by EVAR increased from 26.1 to 43.8 percent among females, and from 25.7 to 41.2 percent among males, and age-adjusted ruptured AAA mortality rates fell from 12.62 to 9.50 per million among females, and from 34.14 to 26.54 per million among males. The association of EVAR with reduced mortality was more than three times larger (2.2 vis-á-vis 0.6 percent of prevalence per 10 percentage point increase in EVAR) among females than males. The association of EVAR with reduced mortality was substantially larger (1.7 vis-á-vis 1.1 percent of prevalence per 10 percentage point increase in EVAR) among East Asian states than European+ states. Conclusions: The increasing adoption of EVAR coincided with a decrease in ruptured AAA mortality. The relationship between EVAR and mortality was more pronounced among females than males, and in East Asian than European+ states. Sex and ethnic heterogeneity should be further investigated.

People can use different internal strategies to manage their daily tasks, but systematic research on these strategies and their significance for actual performance is still quite sparse. Here we examined self-reported internal strategy use with a 10-block version of the videogame EPELI (Executive Performance in Everyday LIving) in a group of 202 neurotypical adults of 18-50 years of age. In the game, participants perform lists of everyday tasks from memory while navigating in a virtual apartment. Open-ended strategy reports were collected after each EPELI task block, and for comparison also after an EPELI Instruction Recall task and a Word List Learning task assessing episodic memory. On average, 45% of the participants reported using some strategy in EPELI, the most common types being grouping (e.g., performing the tasks room by room), utilising a familiar action schema, and condensing information (e.g., memorising only keywords). Our pre-registered hypothesis on the beneficial effect of self-initiated strategy use gained support, as strategy users showed better performance on EPELI as compared with no strategy users. One of the strategies, grouping, was identified as a clearly effective strategy type. Block-by-block transitions suggested gradual stabilisation of strategy use over the 10 EPELI blocks. The proneness to use strategies showed a weak but reliable association between EPELI and Word List Learning. Overall, the present results highlight the importance of internal strategy use for understanding individual differences in memory performance, as well as the potential benefit for internal strategy employment when faced with everyday memory tasks.

A recently developed virtual reality task, EPELI (Executive Performance in Everyday LIving), quantifies goal-directed behavior in naturalistic conditions. Participants navigate a virtual apartment, performing household chores given by a virtual character. EPELI aims to tap attention, executive function, and prospective memory. To ensure its applicability to further research and clinical work and to study its relationship to relevant background factors, we examined several key properties of EPELI in 77 typically developing 9–13-year-old children. These included EPELI’s internal consistency, age and gender differences, sensitivity to gaming experience, head-mounted display (HMD) type, and verbal recall ability, as well as its relationships with parent-rated everyday executive problems. Of the eight EPELI measures, the following six showed acceptable internal consistency: task and navigation efficacy, number of correctly performed tasks and overall actions, time monitoring, and controller movement. Some measures were associated with age, gender, or verbal encoding ability. Moreover, EPELI performance was associated with parent-rated everyday executive problems. There were no significant associations of gaming background, task familiarity, or HMD type with the EPELI measures. These results attest to the reliability and ecological validity of this new virtual reality tool for the assessment of attention, executive functions, and prospective memory in children.

Working memory (WM) training, typically entailing repetitive practice with one or two tasks, has mostly yielded only limited task-specific transfer effects. We developed and tested a new WM training approach where the task paradigm, stimulus type, and predictability of the stimulus sequence were constantly altered during the 4-week training period. We expected that this varied training protocol would generate more extensive transfer by facilitating the use of more general strategies that could be applied to a range of WM tasks. Pre-post transfer effects following varied training (VT group, n = 60) were compared against traditional training (TT group, training a single adaptive WM task, n = 63), and active controls (AC, n = 65). As expected, TT evidenced strong task-specific near transfer as compared to AC. In turn, VT exhibited task-specific near transfer only on one of the measures, and only as compared to the TT group. Critically, no evidence for task-general near transfer or far transfer effects was observed. In sum, the present form of VT failed to demonstrate broader transfer. Nevertheless, as VT has met with success in other cognitive domains, future studies should probe if and how it would be possible to design WM training protocols that promote structural learning where common features of specific tasks would be identified and utilised when selecting strategies for novel memory tasks.

Objective: To quantify goal-directed behavior and ADHD symptoms in naturalistic conditions, we developed a virtual reality task, EPELI (Executive Performance in Everyday LIving), and tested its predictive, discriminant and concurrent validity. Method: We collected EPELI data, conventional neuropsychological task data, and parent-ratings of executive problems and symptoms in 38 ADHD children and 38 typically developing controls. Results:EPELI showed predictive validity as the ADHD group exhibited higher percentage of irrelevant actions reflecting lower attentional-executive efficacy and more controller movements and total game actions, both indicative of hyperactivity-impulsivity. Further, the five combined EPELI measures showed excellent discriminant validity (area under curve 88 %), while the correlations of the EPELI efficacy measure with parent-rated executive problems (r =.57) and ADHD symptoms (r =.55) pointed to its concurrent validity. Conclusion: We provide a proof-of-concept validation for a new virtual reality tool for ecologically valid assessment of ADHD symptoms.

Cognitive task performance is a dynamic process that evolves over time, starting from the first encounters with a task. An important aspect of these task dynamics is the employment of strategies to support successful performance and task acquisition. Focusing on episodic memory performance, we: (1) tested two hypotheses on the effects of novelty and task difficulty on strategy use, (2) replicated our previous results regarding strategy use in a novel memory task, and (3) evaluated whether repeated open-ended strategy queries affect task performance and/or strategy use. The present pre-registered online study comprised 161 adult participants who were recruited through the Prolific crowdsourcing platform. We employed two separate 5-block list learning tasks, one with 10 pseudowords and the other with 18 common nouns, and collected recall performance and strategy reports for each block. Using Bayesian linear mixed effects models, the present findings (1) provide some support for the hypothesis that task-initial strategy development is not triggered only by task novelty, but can appear also in a familiar, moderately demanding task; (2) replicate earlier findings from an adaptive working memory task indicating strategy use from the beginning of a task, associations between strategy use and objective task performance, and only modest agreement between open-ended versus list-based strategy reports; and (3) indicate that repeated open-ended strategy reports do not affect objective recall. We conclude that strategy use is an important aspect of memory performance right from the start of a task, and it undergoes development at the initial stages depending on task characteristics. In a larger perspective, the present results concur with the views of skill learning and adaptivity in cognitive task performance.

Increasing evidence indicates that the coronavirus disease 2019 (COVID-19) pandemic is associated with adverse psychological effects, including heightened levels of anxiety. This study examined whether COVID-19-related anxiety levels during the early stage of the pandemic predicted demanding working memory (WM) updating performance. Altogether, 201 healthy adults (age range, 18-50) mostly from North America and the British Isles were recruited to this study via the crowdsourcing site . The results showed that higher levels of COVID-19-related anxiety during the first weeks of the pandemic outbreak were associated with poorer WM performance as measured by the n-back paradigm. Critically, the unique role of COVID-19-related anxiety on WM could not be explained by demographic factors, or other psychological factors such as state and trait anxiety or fluid intelligence. Moreover, across three assessment points spanning 5-6 weeks, COVID-19-related anxiety levels tended to decrease over time. This pattern of results may reflect an initial psychological "shock wave" of the pandemic, the cognitive effects of which may linger for some time, albeit the initial anxiety associated with the pandemic would change with habituation and increasing information. Our results contribute to the understanding of cognitive-affective reactions to a major disaster.

Cognitive mechanisms underlying the limited transfer effects of working memory (WM) training remain poorly understood. We tested in detail the Strategy Mediation hypothesis, according to which WM training generates task-specific strategies that facilitate performance on the trained task and its untrained variants. This large-scale pre-registered randomized controlled trial (n = 258) used a 4-week adaptive WM training with a single digit n-back task. Strategy use was probed with open-ended strategy reports. We employed a Strategy training group (n = 73) receiving external strategy instruction, a Traditional training group (n = 118) practicing without strategy instruction, and Passive controls (n = 67). Both training groups showed emerging transfer to untrained n-back task variants already at intermediate test after 3 training sessions, extending to all untrained n-back task variants at posttest after 12 training sessions. The Strategy training group outperformed the Traditional training group only at the beginning of training, indicating short-lived strategy manipulation effects. Importantly, in the Traditional training group, strategy evolvement modulated the gains in the trained and untrained n -back tasks, supporting the Strategy Mediation hypothesis. Our results concur with the view of WM training as cognitive skill learning.

Working memory (WM) training with the N-Back task has been argued to improve cognitive capacity and general cognitive abilities (the Capacity Hypothesis of training), although several studies have shown little or no evidence for such improvements beyond tasks that are very similar to the trained task. Laine et al. demonstrated that instructing young adult participants to use a specific visualisation strategy for N-back training resulted in clear, generalised benefits from only 30 min of training (Strategy Mediation Hypothesis of training). Here, we report a systematic replication and extension of the Laine et al. study, by administering 60 younger and 60 older participants a set of WM tasks before and after a 30-min N-back training session. Half the participants were instructed to use a visualisation strategy, the others received no instruction. The pre-post test battery encompassed a criterion task (digit N-back), two untrained tasks N-back tasks (letters and colours), and three structurally different WM tasks. The instructed visualisation strategy significantly boosted at least some measures of N-back performance in participants of both age groups, although the strategy generally appeared more difficult to implement and less beneficial for older adults. However, the strategy did not improve performance on structurally different WM tasks. We also found significant associations between N-back performance and the type and level of detail of self-generated strategies in the uninstructed participants, as well as age group differences in reported strategy types. WM performance appeared to partly reflect the application of strategies, and Strategy Mediation should be considered to understand the mechanisms of WM training. Claims of efficient training should demonstrate useful improvement beyond task-specific strategies.

The original version of this article unfortunately contained the following mistakes. 1. In the Results section under the paragraph Disease Severity, the sentence “The PIs ranged between -0.47 and 0.57 MMSE points” should read -0.49 and 0.59 MMSE points. 2. In Figs. 3, 5, and 7, the labels “favour bilinguals” and “favours monolinguals” should be inverted. Therefore, it should be “favours monolinguals” and “favours bilinguals”. Please see below for the correct figures. © 2020, The Author(s).

Some studies have linked bilingualism with a later onset of dementia, Alzheimer’s disease (AD), and mild cognitive impairment (MCI). Not all studies have observed such relationships, however. Differences in study outcomes may be due to methodological limitations and the presence of confounding factors within studies such as immigration status and level of education. We conducted the first systematic review with meta-analysis combining cross-sectional studies to explore if bilingualism might delay symptom onset and diagnosis of dementia, AD, and MCI. Primary outcomes included the age of symptom onset, the age at diagnosis of MCI or dementia, and the risk of developing MCI or dementia. A secondary outcome included the degree of disease severity at dementia diagnosis. There was no difference in the age of MCI diagnosis between monolinguals and bilinguals [mean difference: 3.2; 95% confidence intervals (CI): −3.4, 9.7]. Bilinguals vs. monolinguals reported experiencing AD symptoms 4.7 years (95% CI: 3.3, 6.1) later. Bilinguals vs. monolinguals were diagnosed with dementia 3.3 years (95% CI: 1.7, 4.9) later. Here, 95% prediction intervals showed a large dispersion of effect sizes (−1.9 to 8.5). We investigated this dispersion with a subgroup meta-analysis comparing studies that had recruited participants with dementia to studies that had recruited participants with AD on the age of dementia and AD diagnosis between mono- and bilinguals. Results showed that bilinguals vs. monolinguals were 1.9 years (95% CI: −0.9, 4.7) and 4.2 (95% CI: 2.0, 6.4) older than monolinguals at the time of dementia and AD diagnosis, respectively. The mean difference between the two subgroups was not significant. There was no significant risk reduction (odds ratio: 0.89; 95% CI: 0.68–1.16) in developing dementia among bilinguals vs. monolinguals. Also, there was no significant difference (Hedges’ g = 0.05; 95% CI: −0.13, 0.24) in disease severity at dementia diagnosis between bilinguals and mono