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Regular physical activity is deemed beneficial to physical, cognitive, and emotional health. Walking may be an accessible means of meeting physical activity recommendations and improving cognition. However, exercise effects on cognition are often explored at shorter durations (30 min or less), with fewer studies exploring how cognition is impacted during longer bouts of exercise. 36 (7 women) civilians and active-duty soldiers completed a VO 2 max test and two one-hour walks, one at and one below the ventilatory threshold (VT), on separate days. They completed the Go/No-Go and Task-Switching Tasks before, every 15 min during, and immediately after exercise, while wearing a near-infrared spectroscopy (NIRS) system to monitor prefrontal cortex (PFC) activity. Response speed during the Go/No-Go task was improved at VT compared to sub-VT at the expense of task accuracy. FP cortex was deactivated during exercise in the Task-Switching Task, potentially due to the increased competition for resources between the frontal cortex and movement related areas. As a result, exercise at or below VT may improve or impair cognitive performance and activation in executive function-related areas depending on the task type and exercise intensity level., (Published by Elsevier Inc.)

In occupational domains such as sports, healthcare, driving, and military, both individuals and small groups are expected to perform challenging tasks under adverse conditions that induce transient cognitive states such as stress, workload, and uncertainty. Wearable and standoff 6DOF sensing technologies are advancing rapidly, including increasingly miniaturized yet robust inertial measurement units (IMUs) and portable marker-less infrared optical motion tracking. These sensing technologies may offer opportunities to track overt physical behavior and classify cognitive states relevant to human performance in diverse human-machine domains. We describe progress in research attempting to distinguish cognitive states by tracking movement behavior in both individuals and small groups, examining potential applications in sports, healthcare, driving, and the military. In the context of military training and operations, there are no generally accepted methods for classifying transient mental states such as uncertainty from movement-related data, despite its importance for shaping decision-making and behavior. To fill this gap, an example data set is presented including optical motion capture of rifle trajectories during a dynamic marksmanship task that elicits variable uncertainty; using machine learning, we demonstrate that features of weapon trajectories capturing the complexity of motion are valuable for classifying low versus high uncertainty states. We argue that leveraging metrics of human movement behavior reveals opportunities to complement relatively costly and less portable neurophysiological sensing technologies and enables domain-specific human-machine interfaces to support a wide range of cognitive functions.

Stress carries diverse implications for perceptual, cognitive, and affective functions. One population particularly susceptible to acute stress-induced cognitive changes are individuals with high-stress jobs (e.g., military personnel). These individuals are often tasked with maintaining peak cognitive performance, including memory, spatial navigation, and decision-making under threatening and uncertain conditions. Previous research has separately examined decision-making under conditions of stress or uncertainty (i.e., ambiguous discrimination between friends and foes). However, questions remain about how operationally relevant stress impacts memory encoding and recall, or spatial learning, as well as how uncertainty may impact decision-making during stress. To address this gap, we examined the influence of a military-relevant emotional stressor on a series of cognitive tasks including recognition memory task (RMT), spatial orienting task (SOT), and shoot/don't shoot decision making (DMT). To examine the effects of uncertainty and stress we varied the stimulus clarity in the DMT. We utilized threat of shock (TOS) as a high-stakes outcome for decision errors. TOS increased sympathetic arousal but did not affect subjective emotional or HPA responses. TOS influenced decision times and confidence ratings in the DMT, but not response sensitivity or response bias. DMT performance varied by stimulus clarity (uncertainty) but did not differ between stress conditions. TOS did not influence recognition memory or spatial orienting. In sum, high levels of stress and uncertainty characterize military operations, yet stress experienced in military contexts can be difficult to induce in laboratory settings. We discuss several avenues for future research, including methodological considerations to better assess the magnitude and specificity of emotional stress-induction techniques in Soldiers., Competing Interests: The authors have declared that no competing interests exist., (Copyright: This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.)

Introduction: Personnel performance under stress hinges on various factors, including individual traits, training, context, mental and physiological states, and task demands. This study explored the link between the traits of military personnel and their performance outcomes in five domains: move, shoot, communicate, navigate, and sustain., Methods: A total of 387 U.S. Army soldiers participated in this study, undergoing trait assessments covering physical, cognitive, social-emotional, demographic/lifestyle, and health domains. Performance was measured through lab and field events assessing a broad range of individual and team-level skills under conditions demanding resilience to acute cognitive and physical stress exposure. Analysis used feature selection and elastic net regression., Results: Analyses revealed complex associations between traits and performance, with physical, cognitive, health-related, social-emotional, and lifestyle traits playing roles in guiding and constraining performance. Measures of resilience, emotion regulation, grit, and mindfulness were identified as relevant predictors of several performance-related outcomes., Discussion: Results carry implications for the selection, training, and operational effectiveness of personnel in high-stakes occupations including military and first response. Further research is necessary to explore the mechanisms underlying these associations and inform targeted interventions to boost personnel effectiveness., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2024 Brunyé, Goring, Cantelon, Eddy, Elkin-Frankston, Elmore, Giles, Hancock, Masud, McIntyre, McKenzie, Mitchell, O’Donovan, Racicot and Ramsay.)

Stress occurs when conditions burden or exceed an individual's adaptive resources. Military personnel are often tasked with maintaining peak performance under such stressful conditions. Importantly, the effects of stress are nuanced and may vary as a function of individual traits and states. Recent interdisciplinary research has sought to model and identify such relationships. In two previously reported efforts, Soldiers first completed a comprehensive battery of trait assessments across four general domains thought to be predictive of performance: cognitive, health, physical, and social-emotional, and then completed the Decision-Making under Uncertainty and Stress (DeMUS) virtual reality task that probed spatial cognition, memory, and decision-making under stress and variable uncertainty. The present analysis explores whether cognitive, health, physical, and social-emotional trait assessments, as well as physiological state measures, predict or modulate DeMUS performance outcomes under stress. Multiple regression analyses examined the effect of each trait predictor and stress responsiveness on quantitative task performance outcomes. Results revealed that one measure of state stress reactivity, salivary cortisol, predicted lower recognition memory sensitivity. Further, trait measures of healthy eating, agility, flexibility, cognitive updating, and positive emotion predicted enhanced spatial orienting and decision-making performance and confidence. Together, the results suggest that select individual states and traits may predict cognition under stress. Future research should expand to ecologically relevant military stressors during training and operations.

Sustained attention (SA) is an important cognitive ability that plays a crucial role in successful cognitive control. Resting vagally-mediated heart rate variability (vmHRV) has emerged as an informative index of parasympathetic nervous system activity and a sensitive correlate of individual differences in cognitive control. However, it is unclear how resting vmHRV is associated with individual differences in sustained attention. The primary aim of the current study was to assess if resting vmHRV was associated with individual differences in performance on a neuropsychological assessment of sustained attention. We further aimed to characterize the relationship between resting vmHRV and dispositional factors related to sustained attention, specifically attentional errors in daily life, self-regulation, mindfulness and media-multitasking. Based on previous work, we hypothesized higher resting vmHRV would be associated with better sustained attention across task-based and self-report measures. We did not find resting vmHRV to be significantly associated with performance measures on a task-based assessment of sustained attention. Further, resting vmHRV was not significantly associated with attention errors, self-regulation, mindfulness, or media-multitasking. This work stands to expand the current understanding between parasympathetic functioning, cognition, and behavior, investigating the unexplored domain of sustained attention and related dispositional factors., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Objective: This study explores the feasibility of using machine learning to predict accurate versus inaccurate diagnoses made by pathologists based on their spatiotemporal viewing behavior when evaluating digital breast biopsy images., Materials and Methods: The study gathered data from 140 pathologists of varying experience levels who each reviewed a set of 14 digital whole slide images of breast biopsy tissue. Pathologists' viewing behavior, including zooming and panning actions, was recorded during image evaluation. A total of 30 features were extracted from the viewing behavior data, and 4 machine learning algorithms were used to build classifiers for predicting diagnostic accuracy., Results: The Random Forest classifier demonstrated the best overall performance, achieving a test accuracy of 0.81 and area under the receiver-operator characteristic curve of 0.86. Features related to attention distribution and focus on critical regions of interest were found to be important predictors of diagnostic accuracy. Further including case-level and pathologist-level information incrementally improved classifier performance., Discussion: Results suggest that pathologists' viewing behavior during digital image evaluation can be leveraged to predict diagnostic accuracy, affording automated feedback and decision support systems based on viewing behavior to aid in training and, ultimately, clinical practice. They also carry implications for basic research examining the interplay between perception, thought, and action in diagnostic decision-making., Conclusion: The classifiers developed herein have potential applications in training and clinical settings to provide timely feedback and support to pathologists during diagnostic decision-making. Further research could explore the generalizability of these findings to other medical domains and varied levels of expertise., (© The Author(s) 2023. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Cranial electrotherapy stimulation (CES) delivers low-intensity electrical currents to the brain to treat anxiety, depression, and pain. Though CES is considered safe and cost-effective, little is known about side effects emerging across different contexts. Our objective was to investigate how varying physical and cognitive demands impact the frequency and intensity of CES vestibular sensations in a sample of healthy young adults. We used a 2 (stimulation: sham, active) × 2 (physical demand: static sway, dynamic sit-to-stand) × 2 (cognitive demand: single-task remain silent, dual-task count backward) repeated measures design. Vestibular sensations were measured with surveys and wearable sensors capturing balance changes. Active stimulation did not influence reported vestibular sensations. Instead, high physical demand predicted more sensation reports. High cognitive demand, but not active stimulation, predicted postural sway unsteadiness. Significant effects of active stimulation on balance were observed only during the dynamic sit-to-stand transitions. In summary, CES induces vestibular sensations only for a specific outcome under certain circumstances. Our findings imply that consumers can safely maximize the benefits of CES while ensuring they are taking steps to minimize any potential side effects by considering their context and circumstances.

Background and Objectives: We examined the effects of ultra-brief training in mindfulness and cognitive reappraisal on affective response and performance under stress. We hypothesized that one or both types of training would decrease affective responding and improve performance, and that these effects might be moderated by acute stress induction., Design: We manipulated training (mindfulness, cognitive reappraisal, control) between subjects and level of stress (low, high) within subjects in a 3 × 2 mixed factorial design. Method: Participants ( N  = 112, ages 18-35) completed two sessions on different days. In each session, they received mindfulness or cognitive reappraisal training or listened to a control script prior to a low- or high-stress simulated hostage situation. We measured motor performance efficiency (proportion of shots that hit hostile and hostage targets), affective responding (self-reported anxiety, salivary cortisol and alpha amylase, and autonomic physiology), and physical activity., Results: Compared to control instructions, ultra-brief training in cognitive reappraisal or mindfulness reduced subjective anxiety and increased performance efficiency. There were few effects of training on other measures., Conclusion: Ultra-brief training in cognitive reappraisal or mindfulness prior to a stressful task may be both helpful and harmful; effects are preliminary and subject to boundary conditions.

Introduction: Personnel engaged in high-stakes occupations, such as military personnel, law enforcement, and emergency first responders, must sustain performance through a range of environmental stressors. To maximize the effectiveness of military personnel, an a priori understanding of traits can help predict their physical and cognitive performance under stress and adversity. This work developed and assessed a suite of measures that have the potential to predict performance during operational scenarios. These measures were designed to characterize four specific trait-based domains: cognitive, health, physical, and social-emotional., Materials and Methods: One hundred and ninety-one active duty U.S. Army soldiers completed interleaved questionnaire-based, seated task-based, and physical task-based measures over a period of 3-5 days. Redundancy analysis, dimensionality reduction, and network analyses revealed several patterns of interest., Results: First, unique variable analysis revealed a minimally redundant battery of instruments. Second, principal component analysis showed that metrics tended to cluster together in three to five components within each domain. Finally, analyses of cross-domain associations using network analysis illustrated that cognitive, health, physical, and social-emotional domains showed strong construct solidarity., Conclusions: The present battery of metrics presents a fieldable toolkit that may be used to predict operational performance that can be clustered into separate components or used independently. It will aid predictive algorithm development aimed to identify critical predictors of individual military personnel and small-unit performance outcomes., (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2023. This work is written by (a) US Government employee(s) and is in the public domain in the US.)

An accurate histopathologic diagnosis on surgical biopsy material is necessary for the clinical management of patients and has important implications for research, clinical trial design/enrollment, and public health education. This study used a mixed methods approach to isolate sources of diagnostic error while residents and attending pathologists interpreted digitized breast biopsy slides. Ninety participants, including pathology residents and attending physicians at major United States medical centers reviewed a set of 14 digitized whole-slide images of breast biopsies. Each case had a consensus-defined diagnosis and critical region of interest (cROI) representing the most significant pathology on the slide. Participants were asked to view unmarked digitized slides, draw their participant region of interest (pROI), describe its features, and render a diagnosis. Participants' review behavior was tracked using case viewer software and an eye-tracking device. Diagnostic accuracy was calculated in comparison to the consensus diagnosis. We measured the frequency of errors emerging during 4 interpretive phases: (1) detecting the cROI, (2) recognizing its relevance, (3) using the correct terminology to describe findings in the pROI, and (4) making a diagnostic decision. According to eye-tracking data, trainees and attending pathologists were very likely (∼94% of the time) to find the cROI when inspecting a slide. However, trainees were less likely to consider the cROI relevant to their diagnosis. Pathology trainees (41% of cases) were more likely to use incorrect terminology to describe pROI features than attending pathologists (21% of cases). Failure to accurately describe features was the only factor strongly associated with an incorrect diagnosis. Identifying where errors emerge in the interpretive and/or descriptive process and working on building organ-specific feature recognition and verbal fluency in describing those features are critical steps for achieving competency in diagnostic decision making., (Copyright © 2023. Published by Elsevier Inc.)

Adaptive gain theory proposes that the dynamic shifts between exploration and exploitation control states are modulated by the locus coeruleus-norepinephrine system and reflected in tonic and phasic pupil diameter. This study tested predictions of this theory in the context of a societally important visual search task: the review and interpretation of digital whole slide images of breast biopsies by physicians (pathologists). As these medical images are searched, pathologists encounter difficult visual features and intermittently zoom in to examine features of interest. We propose that tonic and phasic pupil diameter changes during image review may correspond to perceived difficulty and dynamic shifts between exploration and exploitation control states. To examine this possibility, we monitored visual search behavior and tonic and phasic pupil diameter while pathologists (N = 89) interpreted 14 digital images of breast biopsy tissue (1,246 total images reviewed). After viewing the images, pathologists provided a diagnosis and rated the level of difficulty of the image. Analyses of tonic pupil diameter examined whether pupil dilation was associated with pathologists' difficulty ratings, diagnostic accuracy, and experience level. To examine phasic pupil diameter, we parsed continuous visual search data into discrete zoom-in and zoom-out events, including shifts from low to high magnification (e.g., 1× to 10×) and the reverse. Analyses examined whether zoom-in and zoom-out events were associated with phasic pupil diameter change. Results demonstrated that tonic pupil diameter was associated with image difficulty ratings and zoom level, and phasic pupil diameter showed constriction upon zoom-in events, and dilation immediately preceding a zoom-out event. Results are interpreted in the context of adaptive gain theory, information gain theory, and the monitoring and assessment of physicians' diagnostic interpretive processes., Competing Interests: The authors have declared that no competing interests exist., (Copyright: This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.)

Purpose : Digital whole slide imaging allows pathologists to view slides on a computer screen instead of under a microscope. Digital viewing allows for real-time monitoring of pathologists' search behavior and neurophysiological responses during the diagnostic process. One particular neurophysiological measure, pupil diameter, could provide a basis for evaluating clinical competence during training or developing tools that support the diagnostic process. Prior research shows that pupil diameter is sensitive to cognitive load and arousal, and it switches between exploration and exploitation of a visual image. Different categories of lesions in pathology pose different levels of challenge, as indicated by diagnostic disagreement among pathologists. If pupil diameter is sensitive to the perceived difficulty in diagnosing biopsies, eye-tracking could potentially be used to identify biopsies that may benefit from a second opinion. Approach : We measured case onset baseline-corrected (phasic) and uncorrected (tonic) pupil diameter in 90 pathologists who each viewed and diagnosed 14 digital breast biopsy cases that cover the diagnostic spectrum from benign to invasive breast cancer. Pupil data were extracted from the beginning of viewing and interpreting of each individual case. After removing 122 trials ( < 10 % ) with poor eye-tracking quality, 1138 trials remained. We used multiple linear regression with robust standard error estimates to account for dependent observations within pathologists. Results : We found a positive association between the magnitude of phasic dilation and subject-centered difficulty ratings and between the magnitude of tonic dilation and untransformed difficulty ratings. When controlling for case diagnostic category, only the tonic-difficulty relationship persisted. Conclusions : Results suggest that tonic pupil dilation may indicate overall arousal differences between pathologists as they interpret biopsy cases and could signal a need for additional training, experience, or automated decision aids. Phasic dilation is sensitive to characteristics of biopsies that tend to elicit higher difficulty ratings and could indicate a need for a second opinion., (© 2023 Society of Photo-Optical Instrumentation Engineers (SPIE).)

The ability to regulate the intake of unhealthy foods is critical in modern, calorie dense food environments. Frontal areas of the brain, such as the dorsolateral prefrontal cortex (DLPFC), are thought to play a central role in cognitive control and emotional regulation. Therefore, increasing activity in the DLPFC may enhance these functions which could improve the ability to reappraise and resist consuming highly palatable but unhealthy foods. One technique for modifying brain activity is transcranial direct current stimulation (tDCS), a non-invasive technique for modulating neuronal excitability that can influence performance on a range of cognitive tasks. We tested whether anodal tDCS targeting the right DLPFC would influence how people perceived highly palatable foods. In the present study, 98 participants were randomly assigned to receive a single session of active tDCS (2.0 mA) or sham stimulation. While receiving active or sham stimulation, participants viewed images of highly palatable foods and reported how pleasant it would be to eat each food (liking) and how strong their urge was to eat each food (wanting). We found that participants who received active versus sham tDCS stimulation perceived food as less pleasant, but there was no difference in how strong their urge was to eat the foods. Our findings suggest that modulating excitability in the DLPFC influences "liking" but not "wanting" of highly palatable foods. Non-invasive brain stimulation might be a useful technique for influencing the hedonic experience of eating but more work is needed to understand when and how it influences food cravings., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors.)

Background: Metacognition is a cognitive process that involves self-awareness of thinking, understanding, and performance. This study assesses pathologists' metacognition by examining the association between their diagnostic accuracy and self-reported confidence levels while interpreting skin and breast biopsies., Design: We studied 187 pathologists from the Melanoma Pathology Study (M-Path) and 115 pathologists from the Breast Pathology Study (B-Path). We measured pathologists' metacognitive ability by examining the area under the curve (AUC), the area under each pathologist's receiver operating characteristic (ROC) curve summarizing the association between confidence and diagnostic accuracy. We investigated possible relationships between this AUC measure, referred to as metacognitive sensitivity, and pathologist attributes. We also assessed whether higher metacognitive sensitivity affected the association between diagnostic accuracy and a secondary diagnostic action such as requesting a second opinion., Results: We found no significant associations between pathologist clinical attributes and metacognitive AUC. However, we found that pathologists with higher AUC showed a stronger trend to request secondary diagnostic action for inaccurate diagnoses and not for accurate diagnoses compared with pathologists with lower AUC., Limitations: Pathologists reported confidence in specific diagnostic terms, rather than the broader classes into which the diagnostic terms were later grouped to determine accuracy. In addition, while there is no gold standard for the correct diagnosis to determine the accuracy of pathologists' interpretations, our studies achieved a high-quality reference diagnosis by using the consensus diagnosis of 3 experienced pathologists., Conclusions: Metacognition can affect clinical decisions. If pathologists have self-awareness that their diagnosis may be inaccurate, they can request additional tests or second opinions, providing the opportunity to correct inaccurate diagnoses., Highlights: Metacognitive sensitivity varied across pathologists, with most showing higher sensitivity than expected by chance.None of the demographic or clinical characteristics we examined was significantly associated with metacognitive sensitivity.Pathologists with higher metacognitive sensitivity were more likely to request additional tests or second opinions for their inaccurate diagnoses.

Introduction: The ability to perform optimally under pressure is critical across many occupations, including the military, first responders, and competitive sport. Despite recognition that such performance depends on a range of cognitive factors, how common these factors are across performance domains remains unclear. The current study sought to integrate existing knowledge in the performance field in the form of a transdisciplinary expert consensus on the cognitive mechanisms that underlie performance under pressure., Methods: International experts were recruited from four performance domains [(i) Defense; (ii) Competitive Sport; (iii) Civilian High-stakes; and (iv) Performance Neuroscience]. Experts rated constructs from the Research Domain Criteria (RDoC) framework (and several expert-suggested constructs) across successive rounds, until all constructs reached consensus for inclusion or were eliminated. Finally, included constructs were ranked for their relative importance., Results: Sixty-eight experts completed the first Delphi round, with 94% of experts retained by the end of the Delphi process. The following 10 constructs reached consensus across all four panels (in order of overall ranking): (1) Attention; (2) Cognitive Control-Performance Monitoring; (3) Arousal and Regulatory Systems-Arousal; (4) Cognitive Control-Goal Selection, Updating, Representation, and Maintenance; (5) Cognitive Control-Response Selection and Inhibition/Suppression; (6) Working memory-Flexible Updating; (7) Working memory-Active Maintenance; (8) Perception and Understanding of Self-Self-knowledge; (9) Working memory-Interference Control, and (10) Expert-suggested-Shifting., Discussion: Our results identify a set of transdisciplinary neuroscience-informed constructs, validated through expert consensus. This expert consensus is critical to standardizing cognitive assessment and informing mechanism-targeted interventions in the broader field of human performance optimization., Competing Interests: VM was employed by Mindflex Group Ltd. JG is a stockholder in MAP Biotech Pty Ltd. SC has received speakers fees Janssen-Cilag Australia, Lundbeck Otsuka Australia, Servier Australia; Investigator Initiated research funding Janssen-Cilag Australia; Lundbeck Otsuka Australia; Advisory Boards Lundbeck Otsuka Australia. AT has received research funding from BHP, Rio Tinto, and Shell. SD is a Member of the Board of Advisors Eisai Australia Pty Ltd. MY has received payments in relation to court-, expert witness-, and/or expert review-reports. JD was employed by Florida Maxima Corporation. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Albertella, Kirkham, Adler, Crampton, Drummond, Fogarty, Gross, Zaichkowsky, Andersen, Bartone, Boga, Bond, Brunyé, Campbell, Ciobanu, Clark, Crane, Dietrich, Doty, Driskell, Fahsing, Fiore, Flin, Funke, Gatt, Hancock, Harper, Heathcote, Heaton, Helsen, Hussey, Jackson, Khemlani, Killgore, Kleitman, Lane, Loft, MacMahon, Marcora, McKenna, Meijen, Moulton, Moyle, Nalivaiko, O’Connor, O’Conor, Patton, Piccolo, Ruiz, Schücker, Smith, Smith, Sobrino, Stetz, Stewart, Taylor, Tucker, van Stralen, Vickers, Visser, Walker, Wiggins, Williams, Wong, Aidman and Yücel.)

Importance: Medical second opinions are common, although little is known about the best processes for obtaining them. This study assesses whether knowledge of a prior physician's diagnosis influences consulting physicians' diagnoses., Objective: To measure the extent to which dermatopathologists' diagnoses are influenced by prior diagnostic information from another dermatopathologist., Design, Setting, and Participants: Dermatopathologists were randomly assigned to interpret 1 slide set of 18 melanocytic skin biopsy specimens in 2 phases (5 slide sets totaling 90 cases). Phase 1 interpretations were conducted without prior diagnostic information. After a washout period of 12 or more months, dermatopathologists' phase 2 interpretations were conducted with their identical slide set; for a random subset of cases in phase 2, participants were shown prior diagnoses by other dermatopathologists that were either more or less severe than their own phase 1 diagnosis of the case. Using the Melanocytic Pathology Assessment Tool and Hierarchy for Diagnosis tool, cases ranged from class I (benign) to class V (≥pT1b invasive melanoma). Data collection took place from August 2018 to March 2021, and data analysis was performed from March to December 2021., Intervention: Prior diagnoses were actual diagnoses from board-certified and/or fellowship-trained dermatopathologists. A prior diagnosis was always in a more severe or less severe diagnostic class than the participant's phase 1 interpretation; more or less severe was determined by the randomization scheme. In the control condition of no prior diagnostic information, the participants were told that a prior diagnosis was not available., Main Outcomes and Measures: When exposure was to a prior diagnosis in a higher diagnostic class, the primary study outcome was whether a participant's diagnosis in phase 2 was in a higher diagnostic class than the participant's diagnosis in phase 1. When exposure was to a prior diagnosis in a lower diagnostic class, the primary study outcome was whether a participant's diagnosis in phase 2 was in a lower diagnostic class than the participant's diagnosis in phase 1. The effect of prior diagnostic information was measured using the relative risk (RR) of each outcome relative to the control condition of no prior diagnostic information, adjusted for the diagnostic class of the phase 1 diagnosis. Prior to data collection, it was hypothesized that participants would be swayed in the direction of prior diagnostic information., Results: A total of 149 dermatopathologists (median [range] age, 47 years [34-76] years; 101 [68%] were male) provided 5322 interpretations of study cases. Participants were more likely to increase the severity of their diagnosis when the prior diagnosis was of greater severity compared with when no prior diagnosis was provided (RR, 1.52; 95% CI, 1.34-1.73); likewise, participants gave less severe diagnoses when prior diagnoses were of lesser severity (RR, 1.38; 95% CI, 1.19-1.59). Trends were similar among dermatopathologists who had previously stated they were "not at all influenced" by prior diagnoses. Prior diagnoses also swayed dermatopathologists away from correct diagnoses., Conclusions and Relevance: In this randomized controlled trial, despite the preference of most dermatopathologists to receive prior diagnoses when providing second opinions, this information swayed them away from a correct diagnosis to an incorrect diagnosis.

Although pathologists have their own viewing habits while diagnosing, viewing behaviors leading to the most accurate diagnoses are under-investigated. Digital whole slide imaging has enabled investigators to analyze pathologists' visual interpretation of histopathological features using mouse and viewport tracking techniques. In this study, we provide definitions for basic viewing behavior variables and investigate the association of pathologists' characteristics and viewing behaviors, and how they relate to diagnostic accuracy when interpreting whole slide images. We use recordings of 32 pathologists' actions while interpreting a set of 36 digital whole slide skin biopsy images (5 sets of 36 cases; 180 cases total). These viewport tracking data include the coordinates of a viewport scene on pathologists' screens, the magnification level at which that viewport was viewed, as well as a timestamp. We define a set of variables to quantify pathologists' viewing behaviors such as zooming, panning, and interacting with a consensus reference panel's selected region of interest (ROI). We examine the association of these viewing behaviors with pathologists' demographics, clinical characteristics, and diagnostic accuracy using cross-classified multilevel models. Viewing behaviors differ based on clinical experience of the pathologists. Pathologists with a higher caseload of melanocytic skin biopsy cases and pathologists with board certification and/or fellowship training in dermatopathology have lower average zoom and lower variance of zoom levels. Viewing behaviors associated with higher diagnostic accuracy include higher average and variance of zoom levels, a lower magnification percentage (a measure of consecutive zooming behavior), higher total interpretation time, and higher amount of time spent viewing ROIs. Scanning behavior, which refers to panning with a fixed zoom level, has marginally significant positive association with accuracy. Pathologists' training, clinical experience, and their exposure to a range of cases are associated with their viewing behaviors, which may contribute to their diagnostic accuracy. Research in computational pathology integrating digital imaging and clinical informatics opens up new avenues for leveraging viewing behaviors in medical education and training, potentially improving patient care and the effectiveness of clinical workflow., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2022 The Authors.)

One growing area of multitasking research involves a focus on performing cognitive and motor tasks in tandem. In these situations, increasing either cognitive or motor demands has implications for performance in both tasks, an effect which is thought to be due to competing neural resources. Separate research suggests that non-invasive brain stimulation may offer a means to mitigate performance decrements experienced during multitasking. In the present study, we investigated the degree to which a commercially available non-invasive brain stimulation device (Halo Sport) alters balance performance in the presence of different types of cognitive demands. Specifically, we tested if performing a secondary cognitive task impacts postural sway in healthy young adults and if we could mitigate this impact using transcranial direct current stimulation (tDCS) applied over the primary motor cortex. Furthermore, we included conditions of unstable and stable surfaces and found that lower surface stability increased postural sway. In addition, we found that cognitive load impacted postural sway but in the opposite pattern we had anticipated, with higher sway found in the single-task control condition compared to executive function conditions. Finally, we found a small but significant effect of tDCS on balance with decreased sway for active (compared to sham) tDCS.

Diagnoses of medical images can invite strikingly diverse strategies for image navigation and visual search. In computed tomography screening for lung nodules, distinct strategies, termed scanning and drilling, relate to both radiologists' clinical experience and accuracy in lesion detection. Here, we examined associations between search patterns and accuracy for pathologists (N = 92) interpreting a diverse set of breast biopsy images. While changes in depth in volumetric images reveal new structures through movement in the z-plane, in digital pathology changes in depth are associated with increased magnification. Thus, "drilling" in radiology may be more appropriately termed "zooming" in pathology. We monitored eye-movements and navigation through digital pathology slides to derive metrics of how quickly the pathologists moved through XY (scanning) and Z (zooming) space. Prior research on eye-movements in depth has categorized clinicians as either "scanners" or "drillers." In contrast, we found that there was no reliable association between a clinician's tendency to scan or zoom while examining digital pathology slides. Thus, in the current work we treated scanning and zooming as continuous predictors rather than categorizing as either a "scanner" or "zoomer." In contrast to prior work in volumetric chest images, we found significant associations between accuracy and scanning rate but not zooming rate. These findings suggest fundamental differences in the relative value of information types and review behaviors across two image formats. Our data suggest that pathologists gather critical information by scanning on a given plane of depth, whereas radiologists drill through depth to interrogate critical features.

Wearable technologies for measuring digital and chemical physiology are pervading the consumer market and hold potential to reliably classify states of relevance to human performance including stress, sleep deprivation, and physical exertion. The ability to efficiently and accurately classify physiological states based on wearable devices is improving. However, the inherent variability of human behavior within and across individuals makes it challenging to predict how identified states influence human performance outcomes of relevance to military operations and other high-stakes domains. We describe a computational modeling approach to address this challenge, seeking to translate user states obtained from a variety of sources including wearable devices into relevant and actionable insights across the cognitive and physical domains. Three status predictors were considered: stress level, sleep status, and extent of physical exertion; these independent variables were used to predict three human performance outcomes: reaction time, executive function, and perceptuo-motor control. The approach provides a complete, conditional probabilistic model of the performance variables given the status predictors. Construction of the model leverages diverse raw data sources to estimate marginal probability density functions for each of six independent and dependent variables of interest using parametric modeling and maximum likelihood estimation. The joint distributions among variables were optimized using an adaptive LASSO approach based on the strength and directionality of conditional relationships (effect sizes) derived from meta-analyses of extant research. The model optimization process converged on solutions that maintain the integrity of the original marginal distributions and the directionality and robustness of conditional relationships. The modeling framework described provides a flexible and extensible solution for human performance prediction, affording efficient expansion with additional independent and dependent variables of interest, ingestion of new raw data, and extension to two- and three-way interactions among independent variables. Continuing work includes model expansion to multiple independent and dependent variables, real-time model stimulation by wearable devices, individualized and small-group prediction, and laboratory and field validation., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Brunyé, Yau, Okano, Elliott, Olenich, Giles, Navarro, Elkin-Frankston, Young and Miller.)

This paper studies why pathologists can misdiagnose diagnostically challenging breast biopsy cases, using a data set of 240 whole slide images (WSIs). Three experienced pathologists agreed on a consensus reference ground-truth diagnosis for each slide and also a consensus region of interest (ROI) from which the diagnosis could best be made. A study group of 87 other pathologists then diagnosed test sets (60 slides each) and marked their own regions of interest. Diagnoses and ROIs were categorized such that if on a given slide, their ROI differed from the consensus ROI and their diagnosis was incorrect, that ROI was called a distractor . We used the HATNet transformer-based deep learning classifier to evaluate the visual similarities and differences between the true (consensus) ROIs and the distractors. Results showed high accuracy for both the similarity and difference networks, showcasing the challenging nature of feature classification with breast biopsy images. This study is important in the potential use of its results for teaching pathologists how to diagnose breast biopsy slides.

Cranial electrotherapy stimulation (CES) is a neuromodulation tool used for treating several clinical disorders, including insomnia, anxiety, and depression. More recently, a limited number of studies have examined CES for altering affect, physiology, and behavior in healthy, non-clinical samples. The physiological, neurochemical, and metabolic mechanisms underlying CES effects are currently unknown. Computational modeling suggests that electrical current administered with CES at the earlobes can reach cortical and subcortical regions at very low intensities associated with subthreshold neuromodulatory effects, and studies using electroencephalography (EEG) and functional magnetic resonance imaging (fMRI) show some effects on alpha band EEG activity, and modulation of the default mode network during CES administration. One theory suggests that CES modulates brain stem (e.g., medulla), limbic (e.g., thalamus, amygdala), and cortical (e.g., prefrontal cortex) regions and increases relative parasympathetic to sympathetic drive in the autonomic nervous system. There is no direct evidence supporting this theory, but one of its assumptions is that CES may induce its effects by stimulating afferent projections of the vagus nerve, which provides parasympathetic signals to the cardiorespiratory and digestive systems. In our critical review of studies using CES in clinical and non-clinical populations, we found severe methodological concerns, including potential conflicts of interest, risk of methodological and analytic biases, issues with sham credibility, lack of blinding, and a severe heterogeneity of CES parameters selected and employed across scientists, laboratories, institutions, and studies. These limitations make it difficult to derive consistent or compelling insights from the extant literature, tempering enthusiasm for CES and its potential to alter nervous system activity or behavior in meaningful or reliable ways. The lack of compelling evidence also motivates well-designed and relatively high-powered experiments to assess how CES might modulate the physiological, affective, and cognitive responses to stress. Establishing reliable empirical links between CES administration and human performance is critical for supporting its prospective use during occupational training, operations, or recovery, ensuring reliability and robustness of effects, characterizing if, when, and in whom such effects might arise, and ensuring that any benefits of CES outweigh the risks of adverse events., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Brunyé, Patterson, Wooten and Hussey.)

Objective: The aim of this study was to evaluate whether the effects of transcranial direct current stimulation (tDCS) on cognitive performance are influenced by the state-dependency of targeted cortical regions., Methods: In a mixed within- and between-participants design, we targeted either the right parietal or left dorsolateral prefrontal cortex and measured effects on visual search versus inhibitory control (respectively). Critically, during active and sham stimulation, participants were exposed to an unrelated or task-congruent prime., Results: Analyses examined whether priming induced state-dependent changes in behavior on a subsequent visual search or inhibitory control task. Results demonstrated consistent support for the null hypothesis, with neither tDCS nor priming influencing behavioral outcomes., Conclusions: This outcome does not provide direct support for state-dependency or activity-selectivity models of tDCS effects on cognitive outcomes. We discuss the possibility that behavioral patterns supporting these mechanistic models may only be found when the priming and outcome tasks share critical neurocognitive features. Overall, we found no evidence that offline (pretask) tDCS targeting the right parietal or left dorsolateral prefrontal induces reliable changes in visual search or inhibitory control behavior, and this pattern is not modulated by state-dependency induced by priming task-related activity.

Expert radiologists can quickly extract a basic "gist" understanding of a medical image following less than a second exposure, leading to above-chance diagnostic classification of images. Most of this work has focused on radiology tasks (such as screening mammography), and it is currently unclear whether this pattern of results and the nature of visual expertise underlying this ability are applicable to pathology, another medical imaging domain demanding visual diagnostic interpretation. To further characterize the detection, localization, and diagnosis of medical images, this study examined eye movements and diagnostic decision-making when pathologists were briefly exposed to digital whole slide images of melanocytic skin biopsies. Twelve resident (N = 5), fellow (N = 5), and attending pathologists (N = 2) with experience interpreting dermatopathology briefly viewed 48 cases presented for 500 ms each, and we tracked their eye movements towards histological abnormalities, their ability to classify images as containing or not containing invasive melanoma, and their ability to localize critical image regions. Results demonstrated rapid shifts of the eyes towards critical abnormalities during image viewing, high diagnostic sensitivity and specificity, and a surprisingly accurate ability to localize critical diagnostic image regions. Furthermore, when pathologists fixated critical regions with their eyes, they were subsequently much more likely to successfully localize that region on an outline of the image. Results are discussed relative to models of medical image interpretation and innovative methods for monitoring and assessing expertise development during medical education and training., Competing Interests: Declaration of Interests Statement: The authors have no conflicts of interest to declare.

Digital whole slide images are Food and Drug Administration approved for clinical diagnostic use in pathology; however, integration is nascent. Trainees from 9 pathology training programs completed an online survey to ascertain attitudes toward and experiences with whole slide images for pathological interpretations. Respondents (n = 76) reported attending 63 unique medical schools (45 United States, 18 international). While 63% reported medical school exposure to whole slide images, most reported ≤ 5 hours. Those who began training more recently were more likely to report at least some exposure to digital whole slide image training in medical school compared to those who began training earlier: 75% of respondents beginning training in 2017 or 2018 reported exposure to whole slide images compared to 54% for trainees beginning earlier. Trainees exposed to whole slide images in medical school were more likely to agree they were comfortable using whole slide images for interpretation compared to those not exposed (29% vs 12%; P = .06). Most trainees agreed that accurate diagnoses can be made using whole slide images for primary diagnosis (92%; 95% CI: 86-98) and that whole slide images are useful for obtaining second opinions (93%; 95% CI: 88-99). Trainees reporting whole slide image experience during training, compared to those with no experience, were more likely to agree they would use whole slide images in 5 years for primary diagnosis (64% vs 50%; P = .3) and second opinions (86% vs 76%; P = .4). In conclusion, although exposure to whole slide images in medical school has increased, overall exposure is limited. Positive attitudes toward future whole slide image diagnostic use were associated with exposure to this technology during medical training. Curricular integration may promote adoption., Competing Interests: Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Dr. Elmore serves as Editor in Chief of Adult Primary Care topics at UpToDate., (© The Author(s) 2020.)

Navigating an unfamiliar city almost certainly brings out uncertainty about getting from place to place. This uncertainty, in turn, triggers information gathering. While navigational uncertainty is common, little is known about what type of information people seek when they are uncertain. The primary choices for information types with environments include landmarks (distal or local), landmark configurations (relation between two or more landmarks), and a distinct geometry, at least for some environments. Uncertainty could lead individuals to more likely seek one of these information types. Extant research informs both predictions about and empirical work exploring this question. This review covers relevant cognitive literature and then suggests empirical approaches to better understand information-seeking actions triggered by uncertainty. Notably, we propose that examining continuous navigation data can provide important insights into information seeking. Benefits of continuous data will be elaborated through one paradigm, spatial reorientation, which intentionally induces uncertainty through disorientation and cue conflict. While this and other methods have been used previously, data have primarily reflected only the final choice. Continuous behavior during a task can better reveal the cognition-action loop contributing to spatial learning and decision making.

Purpose: Physicians' eye movements provide insights into relative reliance on different visual features during medical image review and diagnosis. Current theories posit that increasing expertise is associated with relatively holistic viewing strategies activated early in the image viewing experience. This study examined whether early image viewing behavior is associated with experience level and diagnostic accuracy when pathologists and trainees interpreted breast biopsies. Approach: Ninety-two residents in training and experienced pathologists at nine major U.S. medical centers interpreted digitized whole slide images of breast biopsy cases while eye movements were monitored. The breadth of visual attention and frequency and duration of eye fixations on critical image regions were recorded. We dissociated eye movements occurring early during initial viewing (prior to first zoom) versus later viewing, examining seven viewing behaviors of interest. Results: Residents and faculty pathologists were similarly likely to detect critical image regions during early image viewing, but faculty members showed more and longer duration eye fixations in these regions. Among pathology residents, year of residency predicted increasingly higher odds of fixating on critical image regions during early viewing. No viewing behavior was significantly associated with diagnostic accuracy. Conclusions: Results suggest early detection and recognition of critical image features by experienced pathologists, with relatively directed and efficient search behavior. The results also suggest that the immediate distribution of eye movements over medical images warrants further exploration as a potential metric for the objective monitoring and evaluation of progress during medical training., (© 2020 Society of Photo-Optical Instrumentation Engineers (SPIE).)

Emotional states are thought to influence athletic performance. Emotions characterized by high arousal enhance exercise performance. Extant research has focused on the valence and arousal dimensions of emotions, but not whether the motivational dimension (the extent to which the emotion engenders approach or avoidance behaviors) influences exercise performance. Two studies aimed to determine whether films and music chosen to induce approach- (i.e., anger), avoidance- (i.e., fear), and neutral-oriented emotions would successfully induce their intended emotional states (Study 1) and whether anger and fear emotion inductions would influence 2-mile time trial performance (Study 2). In Study 1, the films and music successfully induced their intended emotions. In Study 2, run time and perceived level of exertion did not differ between emotions across all participants or among faster running participants per a median split. However, among slower running participants, the anger induction increased the 2-mile running speed relative to the neutral induction. These findings suggest that emotions eliciting approach-related motivational states may improve exercise performance, particularly in slower runners., (Copyright © 2020 Giles, Horner, Anderson, Elliott and Brunyé.)

Finding one's way to a destination is a common, everyday task that often relies on spatial information provided by humans and/or automatic devices. However, the information can be inaccurate. How we decide which route to take will depend on our thoughts about the available route information, including who or what provided it, and how these sources may be associated with differential accuracy and fallibility. In three experiments (previously reported in Brunyé et al. (Q J Exper Psychol 68(3):585-607, 2015)), we found that when route directions conflicted with the perceived environment, people trusted the landmark information other humans provided, but relied on the turn direction information from an automatic device. But what guides these behavioral results? Here we present a systematic linguistic analysis of retrospective reports that sheds some light on how information about the direction source affects cognitive focus. A focus on direction sources in the instruction triggered a cognitive focus on the direction source throughout. Participants who systematically switched strategies focused more on features of the scenario than those who did not. Non-switching strategies were associated with a higher focus on the participants' own reasoning processes, in particular when relying on turn information. These results highlight how cognitive focus is guided by scenario factors and individual preferences, triggering inferences that influence decisions.

Research on the feasibility of using transcranial direct current stimulation to modulate the function of the anterior cingulate cortex is limited in part due to its anatomical depth. However, high-definition transcranial direct current stimulation may be better able to reach the anterior cingulate cortex and modulate its function and behavioral outputs. The purpose of this study was to assess the feasibility of using high-definition transcranial direct current stimulation, as compared to traditional bipolar transcranial direct current stimulation, to modulate behavioral measures of anterior cingulate cortex function. In a mixed design, 36 participants received either high-definition transcranial direct current stimulation or bipolar transcranial direct current stimulation, and experienced anodal, cathodal, and sham stimulation over the course of three visits. Two behavioral tasks were used to assess anterior cingulate cortex function before and after stimulation: the multi-source interference task and an emotional facial expression interference task. High-definition transcranial direct current stimulation and bipolar transcranial direct current stimulation groups did not differ in their performance (as measured via response times and error rates) on either task. High-definition transcranial direct current stimulation and bipolar transcranial direct current stimulation were similarly ineffective in modulating behavior related to the anterior cingulate cortex. Future research should explore other transcranial direct current stimulation montages including extracephalic montages (e.g. shoulder, neck) for targeted stimulation of the anterior cingulate cortex.

Action-compatibility effects (ACEs) arise due to incongruity between perceptuo-motor traces stored in memory and the perceptuo-motor demands of a retrieval task. Recent research has suggested that ACEs arising during spatial memory retrieval are additionally modulated by individual differences in how experienced participants are with a college campus environment. However, the extent and nature of experience with a real-world environment is difficult to assess and control, and characteristics of the retrieval task itself might modulate ACEs during spatial memory retrieval. The present study provides a more controlled and in-depth examination of how individual differences and task-based factors interact to shape ACEs when participants retrieve spatial memories. In two experiments, participants with varied video game experience learned a virtual environment and then used the computer mouse to verify spatial relationships from different perspectives. Mouse trajectories demonstrated ACEs, differing by retrieval perspective and video game experience. Videogame experts demonstrated the ACE based on learned spatial relationships during egocentric retrieval only, whereas videogame novices showed the ACE based on semantic processing of directional terms only. Specifically, gaming experts invoke perspective-specific perceptuo-motor associations to retrieve spatial knowledge, whereas non-experts are influenced by semantically based associations specific to the retrieval task. Results are discussed in the context of action-compatibility effects, the intentional weighting hypothesis, and the flexible encoding and retrieval of spatial information.

Students learn more effectively through repeated retrieval of study materials relative to repeated exposure to the materials, a phenomenon known as the testing effect or retrieval practice. This pattern has been demonstrated repeatedly with verbal materials, and more recently with visuospatial materials. The extent to which retrieval practice produces spatial memories that successfully transfer to more diverse task demands remains unknown. Transferring spatial memory to novel task demands can involve challenging orientation and perspective transformations, possibly limiting the benefits of retrieval practice for application to realistic spatial tasks. In 4 experiments, participants learned a map of a large-scale urban environment, engaging in either study practice (repeated exposure) or retrieval practice (exposure and testing). Across experiments we varied the retrieval demands of the final memory test, increasing the breadth of transfer from study to test (from near to far transfer). Final memory tests included reconstructing a map from memory (Experiment 1), judgments of relative direction from an allocentric perspective (Experiment 2), judgments of relative direction from an egocentric perspective (Experiment 3), and navigating between target landmarks within the learned environment (Experiment 4). Results demonstrated that retrieval practice enhances near to medium transfer of memory for the map itself, including accessing spatial memory from varied orientations. However, it does not assist in medium to far transfer of spatial knowledge to pointing or navigation tasks performed from an alternate perspective. Results are considered in the context of domain-specific theories of spatial memory and navigation, and domain-general theories of learning strategies and transfer. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Applied ergonomics research examines not only the fit, form and function of military uniforms, but also their ability to effectively camouflage personnel as they perform job-related tasks. Many of these job-related tasks involve moving through environments, but existing literature examining camouflage effectiveness often assumes that movement effectively "breaks" even the best camouflage patterns, rendering them of limited utility for reducing the visual signature of a moving target. However, recent research demonstrates that animals equipped with adaptive camouflage change their patterning in predictable ways during movement and this adaptation decreases detectability, suggesting that uniform patterning may still hold value for reducing conspicuity during movement. The present experiment examined whether three visual pattern characteristics, local contrast, orientation, and spatial frequency, would influence the detectability of a moving human target. Participants attempted to detect and localize a simulated human target moving across a background scene, and a factorial design varied target movement speed, and the local contrast, spatial frequency, and orientation of its camouflage patterning. Results showed that target detectability was strongly influenced by target movement rate, pattern local contrast, and pattern spatial frequency, and these effects persisted even under conditions of very fast movement. Importantly, we found that the effect of local contrast was most robust under conditions of movement, suggesting its importance for reducing detectability of moving personnel. We conclude that movement is not always sufficient to break the concealment offered by a pattern with low contrast and a spatial frequency match with its background. Results are discussed in the context of visual processing theories and the application of these findings to the design and development of static and adaptive camouflage patterns for military personnel., (Published by Elsevier Ltd.)

Four experiments examined perceptuo-motor associations involved in spatial knowledge encoding and retrieval. Participants learned spatial information by studying a map or by navigating through a real environment and then verified spatial descriptions based on either egocentric or cardinal directional terms. Participants moved the computer mouse to a YES or NO button to verify each statement. We tracked mouse cursor trajectories to examine perceptuo-motor associations in spatial knowledge. An encoding hypothesis predicts that perceptuo-motor associations depend on the involvement of perceptions and actions during encoding, regardless of how spatial knowledge would be used. The retrieval hypothesis predicts that perceptuo-motor associations change as a function of retrieval demands, regardless of how they are learned. The results supported the retrieval hypothesis. Participants showed action compatibility effects with egocentric retrieval, regardless of how spatial information was learned. With well-developed spatial knowledge, a reliable compatibility effect emerged during egocentric retrieval, but no or limited compatibility effects emerged with cardinal retrieval. With less-developed knowledge, the compatibility effects evident during cardinal retrieval suggest a process of egocentric recoding. Other factors of environment learning, such as location proximity and orientation changes, also impacted the compatibility effect, as revealed in the temporal dynamics of mouse movements. Taken together, the results demonstrate that retrieval demands differentially rely upon perceptuo-motor associations in long-term spatial knowledge. This effect is also modulated by environment experience, proximity of learned locations, and experienced orientations.

Basic and applied research are increasingly adopting transcranial electrical stimulation (tES) for modulating perceptual, cognitive, affective, and motor processes. Industry and defense applications of tES hold potential for accelerating training and knowledge acquisition and sustaining work-related performance in the face of fatigue, workload, and stress. This mini-review article describes the promises and perils of tES, and reviews research testing its influence on two broad applied areas: sustaining and dividing attention, and operating in virtual environments. Also included is a discussion of challenges related to viable mechanistic explanations for tES effectiveness, attempts at replication and consideration of null results, and the potential importance of individual differences in predicting tES influences on human performance. Finally, future research directions are proposed to address these challenges and help develop a fuller understanding of tES viability for enhancing real-world performance.

Background: To assess reproducibility and accuracy of overall Nottingham grade and component scores using digital whole slide images (WSIs) compared to glass slides., Methods: Two hundred and eight pathologists were randomized to independently interpret 1 of 4 breast biopsy sets using either glass slides or digital WSI. Each set included 5 or 6 invasive carcinomas (22 total invasive cases). Participants interpreted the same biopsy set approximately 9 months later following a second randomization to WSI or glass slides. Nottingham grade, including component scores, was assessed on each interpretation, providing 2045 independent interpretations of grade. Overall grade and component scores were compared between pathologists (interobserver agreement) and for interpretations by the same pathologist (intraobserver agreement). Grade assessments were compared when the format (WSI vs. glass slides) changed or was the same for the two interpretations., Results: Nottingham grade intraobserver agreement was highest using glass slides for both interpretations (73%, 95% confidence interval [CI]: 68%, 78%) and slightly lower but not statistically different using digital WSI for both interpretations (68%, 95% CI: 61%, 75%; P = 0.22). The agreement was lowest when the format changed between interpretations (63%, 95% CI: 59%, 68%). Interobserver agreement was significantly higher ( P < 0.001) using glass slides versus digital WSI (68%, 95% CI: 66%, 70% versus 60%, 95% CI: 57%, 62%, respectively). Nuclear pleomorphism scores had the lowest inter- and intra-observer agreement. Mitotic scores were higher on glass slides in inter- and intra-observer comparisons., Conclusions: Pathologists' intraobserver agreement (reproducibility) is similar for Nottingham grade using glass slides or WSI. However, slightly lower agreement between pathologists suggests that verification of grade using digital WSI may be more challenging., Competing Interests: The data in this manuscript were presented in part at the 106th annual meeting of the United States and Canadian Academy of Pathology, March 4-10, 2017, San Antonio, TX, USA. (Platform presentation, Abstract 2032).

Introduction: As specialized medical professionals such as radiologists, pathologists, and cardiologists gain education and experience, their diagnostic efficiency and accuracy change, and they show altered eye movement patterns during medical image interpretation. Existing research in this area is limited to interpretation of static medical images, such as digitized whole slide biopsies, making it difficult to understand how expertise development might manifest during dynamic image interpretation, such as with angiograms or volumetric scans., Methods: A two-group (novice, expert) comparative pilot study examined the feasibility and utility of tracking and interpreting eye movement patterns while cardiologists viewed video-based coronary angiograms. A non-invasive eye tracking system recorded cardiologists' (n = 8) visual behaviour while they viewed and diagnosed a series of eight angiogram videos. Analyses assessed frame-by-frame video navigation behaviour, eye fixation behaviour, and resulting diagnostic decision making., Results: Relative to novices, expert cardiologists demonstrated shorter and less variable video review times, fewer eye fixations and saccadic eye movements, and less time spent paused on individual video frames. Novices showed repeated eye fixations on critical image frames and regions, though these were not predictive of accurate diagnostic decisions., Discussion: These preliminary results demonstrate interpretive decision errors among novices, suggesting they identify and process critical diagnostic features, but sometimes fail to accurately interpret those features. Results also showcase the feasibility of tracking and understanding eye movements during video-based coronary angiogram interpretation and suggest that eye tracking may be valuable for informing assessments of competency progression during medical education and training.

Inspecting digital imaging for primary diagnosis introduces perceptual and cognitive demands for physicians tasked with interpreting visual medical information and arriving at appropriate diagnoses and treatment decisions. The process of medical interpretation and diagnosis involves a complex interplay between visual perception and multiple cognitive processes, including memory retrieval, problem-solving, and decision-making. Eye-tracking technologies are becoming increasingly available in the consumer and research markets and provide novel opportunities to learn more about the interpretive process, including differences between novices and experts, how heuristics and biases shape visual perception and decision-making, and the mechanisms underlying misinterpretation and misdiagnosis. The present review provides an overview of eye-tracking technology, the perceptual and cognitive processes involved in medical interpretation, how eye tracking has been employed to understand medical interpretation and promote medical education and training, and some of the promises and challenges for future applications of this technology.

The present experiment examined whether physiological arousal induced by acute bouts of aerobic exercise would influence attention and memory for scenes depicting or not depicting weapons. In a repeated-measures design, participants exercised at either low or high exertion levels. During exercise, they were presented with images, some of which depicted weapons; immediately following exercise, they completed a recognition test for portions of central and peripheral scene regions. Two primary results emerged. First, in the low exertion condition, we replicated extant research showing inferior peripheral scene memory when images contained, versus did not contain, weapons. Second, the high exertion condition increased central scene memory relative to low exertion, and this effect was specific to images containing weapons. Thus, we provide evidence for accentuated weapon focus effects during states of exercise-induced physiological arousal. These results contribute new applied and theoretical understandings regarding the interactions between physiological state, breadth of attention, and memory.

Retrieval practice involves repeatedly testing a student during the learning experience, reliably conferring learning advantages relative to repeated study. Transcranial direct current stimulation (tDCS) of the left dorsolateral prefrontal cortex (dlPFC) has also been shown to confer learning advantages for verbal memory, though research is equivocal. The present study examined the effects of retrieval versus study practice with or without left dlPFC tDCS on verbal episodic memory. Participants (N = 150) experienced either retrieval practice or study practice, and active anodal, active cathodal, or sham tDCS while encoding word lists, and then returned two days later for a final recall test. Three primary patterns emerged: first, during encoding, tDCS did not influence recall rates in the retrieval practice group. Second, during final recall, participants in the retrieval practice groups recalled more than those in the study practice groups. Finally, during final recall, anodal tDCS decreased recall relative to sham and cathodal stimulation, suggesting that it interfered with developing highly detailed memories that could be relied upon for subsequent recollection. Data support existing research demonstrating the effectiveness of retrieval practice as a learning strategy, but also suggest that anodal dlPFC stimulation can induce long-term negative impacts on verbal episodic memory retrieval., (Published by Elsevier Inc.)

Target visual salience and biological motion independently influence the accuracy and latency of observer detection. However, it is currently unknown how these target parameters might interact in modulating the detectability of camouflaged human targets. In two experiments, observers performed a visual target detection task. In a pilot experiment, observers detected a static human target with parametrically varied visual salience, superimposed on a complex background scene. As expected, results demonstrated varied target detectability as a function of salience, with observers showing higher hit rates and faster response times as a function of increased salience. In the Main Experiment, observers detected simulated human targets walking across a complex scene at five different speeds and three different levels of visual salience (as validated in the pilot experiment). We found strong effects of both movement rate and visual salience, and the two parameters interacted. Specifically, increasing the rate of biological motion increased detectability for even the least salient camouflage patterns. In other words, biological motion can "break" even the least conspicuous camouflage pattern. In contrast, a very salient pattern was highly detectable under static and moving conditions. Results are considered in relation to theories of camouflage detectability, and trade-offs between camouflage development efforts versus advanced training in military maneuvering., (Copyright © 2018. Published by Elsevier Ltd.)

Acute exercise consistently benefits both emotion and cognition, particularly cognitive control. We evaluated acute endurance exercise influences on emotion, domain-general cognitive control and the cognitive control of emotion, specifically cognitive reappraisal. Thirty-six endurance runners, defined as running at least 30 miles per week with one weekly run of at least 9 miles (21 female, age 18-30 years) participated. In a repeated measures design, participants walked at 57% age-adjusted maximum heart rate (HR max ; range 51%-63%) and ran at 70% HR max (range 64%-76%) for 90 min on two separate days. Participants completed measures of emotional state and the Stroop test of domain-general cognitive control before, every 30 min during and 30 min after exercise. Participants also completed a cognitive reappraisal task (CRT) after exercise. Functional near-infrared spectroscopy (fNIRS) tracked changes in oxygenated and deoxygenated hemoglobin (O 2 Hb and dHb) levels in the prefrontal cortex (PFC). Results suggest that even at relatively moderate intensities, endurance athletes benefit emotionally from running both during and after exercise and task-related PFC oxygenation reductions do not appear to hinder prefrontal-dependent cognitive control.

Planning routes from maps involves perceiving the symbolic environment, identifying alternate routes and applying explicit strategies and implicit heuristics to select an option. Two implicit heuristics have received considerable attention, the southern route preference and initial segment strategy. This study tested a prediction from decision-making theory that increasing cognitive load during route planning will increase reliance on these heuristics. In two experiments, participants planned routes while under conditions of minimal (0-back) or high (2-back) working memory load. In Experiment 1, we examined how memory load impacts the southern route heuristic. In Experiment 2, we examined how memory load impacts the initial segment heuristic. Results replicated earlier results demonstrating a southern route preference (Experiment 1) and initial segment strategy (Experiment 2) and further demonstrated that evidence for heuristic reliance is more likely under conditions of concurrent working memory load. Furthermore, the extent to which participants maintained efficient route selection latencies in the 2-back condition predicted the magnitude of this effect. Together, results demonstrate that working memory load increases the application of heuristics during spatial decision making, particularly when participants attempt to maintain quick decisions while managing concurrent task demands.

Following a baseline demographic survey, 87 pathologists interpreted 240 digital whole slide images of breast biopsy specimens representing a range of diagnostic categories from benign to atypia, ductal carcinoma in situ, and invasive cancer. A web-based viewer recorded pathologists' behaviors while interpreting a subset of 60 randomly selected and randomly ordered slides. To characterize diagnostic search patterns, we used the viewport location, time stamp, and zoom level data to calculate four variables: average zoom level, maximum zoom level, zoom level variance, and scanning percentage. Two distinct search strategies were confirmed: scanning is characterized by panning at a constant zoom level, while drilling involves zooming in and out at various locations. Statistical analysis was applied to examine the associations of different visual interpretive strategies with pathologist characteristics, diagnostic accuracy, and efficiency. We found that females scanned more than males, and age was positively correlated with scanning percentage, while the facility size was negatively correlated. Throughout 60 cases, the scanning percentage and total interpretation time per slide decreased, and these two variables were positively correlated. The scanning percentage was not predictive of diagnostic accuracy. Increasing average zoom level, maximum zoom level, and zoom variance were correlated with over-interpretation.

Transcranial electrical stimulation (tES) uses low intensity current to alter neuronal activity in superficial cortical regions, and has gained popularity as a tool for modulating several aspects of perception and cognition. This mini-review article provides an overview of tES and its potential for modulating spatial processes underlying successful navigation, including spatial attention, spatial perception, mental rotation and visualization. Also considered are recent advances in empirical research and computational modeling elucidating several stable cortical-subcortical networks with dynamic involvement in spatial processing and navigation. Leveraging these advances may prove valuable for using tES, particularly transcranial direct and alternating current stimulation (tDCS/tACS), to indirectly target subcortical brain regions by altering neuronal activity in distant yet functionally connected cortical areas. We propose future research directions to leverage these advances in human neuroscience.

Habitual exercise is associated with enhanced domain-general cognitive control, such as inhibitory control, selective attention, and working memory, all of which rely on the frontal cortex. However, whether regular exercise is associated with more specific aspects of cognitive control, such as the cognitive control of emotion, remains relatively unexplored. The present study employed a correlational design to determine whether level of habitual exercise was related to performance on the Stroop test measuring selective attention and response inhibition, the cognitive reappraisal task measuring cognitive reappraisal success, and associated changes in prefrontal cortex (PFC) oxygenation using functional near-infrared spectroscopy. 74 individuals (24 men, 50 women, age 18-32 years) participated. Higher habitual physical activity was associated with lower Stroop interference (indicating greater inhibitory control) and enhanced cognitive reappraisal success. Higher habitual exercise was also associated with lower oxygenated hemoglobin (O 2 Hb) in the PFC in response to emotional information. However, NIRS data indicated that exercise was not associated with cognitive control-associated O 2 Hb in the PFC. Behaviorally, the findings support and extend the previous findings that habitual exercise relates to more successful cognitive control of neutral information and cognitive reappraisal of emotional information. Future research should explore whether habitual exercise exerts causal benefits to cognitive control and PFC oxygenation, as well as isolate specific cognitive control processes sensitive to change through habitual exercise.