Coping with life events through possible selves

This study examines the integration of life events into the possible selves repertoire and explores the potential relationship between event-related possible selves and coping. The sample consisted of 198 participants, with age ranging from 18 - 84. Participants were administered interviews consisting of demographic information, the Possible Selves Interview, the Social Readjustment Rating Scale, the Ways of Coping Checklist-Revised, the Satisfaction with Life Scale, and the General Well-Being Schedule. Results indicate that the Integration of stressful events into the possible selves repertoire positively impacted coping. This study paves the way for important prevention programs aimed at promoting an individual's well being.

Adaptive Brain-Computer Interface Systems For Communication in People with Severe Neuromuscular Disabilities

Brain-computer interfaces (BCI) have the potential to restore communication or control abilities in individuals with severe neuromuscular limitations, such as those with amyotrophic lateral sclerosis (ALS). The role of a BCI is to extract and decode relevant information that conveys a user's intent directly from brain electro-physiological signals and translate this information into executable commands to control external devices. However, the BCI decision-making process is error-prone due to noisy electro-physiological data, representing the classic problem of efficiently transmitting and receiving information via a noisy communication channel.

This research focuses on P300-based BCIs which rely predominantly on event-related potentials (ERP) that are elicited as a function of a user's uncertainty regarding stimulus events, in either an acoustic or a visual oddball recognition task. The P300-based BCI system enables users to communicate messages from a set of choices by selecting a target character or icon that conveys a desired intent or action. P300-based BCIs have been widely researched as a communication alternative, especially in individuals with ALS who represent a target BCI user population. For the P300-based BCI, repeated data measurements are required to enhance the low signal-to-noise ratio of the elicited ERPs embedded in electroencephalography (EEG) data, in order to improve the accuracy of the target character estimation process. As a result, BCIs have relatively slower speeds when compared to other commercial assistive communication devices, and this limits BCI adoption by their target user population. The goal of this research is to develop algorithms that take into account the physical limitations of the target BCI population to improve the efficiency of ERP-based spellers for real-world communication.

In this work, it is hypothesised that building adaptive capabilities into the BCI framework can potentially give the BCI system the flexibility to improve performance by adjusting system parameters in response to changing user inputs. The research in this work addresses three potential areas for improvement within the P300 speller framework: information optimisation, target character estimation and error correction. The visual interface and its operation control the method by which the ERPs are elicited through the presentation of stimulus events. The parameters of the stimulus presentation paradigm can be modified to modulate and enhance the elicited ERPs. A new stimulus presentation paradigm is developed in order to maximise the information content that is presented to the user by tuning stimulus paradigm parameters to positively affect performance. Internally, the BCI system determines the amount of data to collect and the method by which these data are processed to estimate the user's target character. Algorithms that exploit language information are developed to enhance the target character estimation process and to correct erroneous BCI selections. In addition, a new model-based method to predict BCI performance is developed, an approach which is independent of stimulus presentation paradigm and accounts for dynamic data collection. The studies presented in this work provide evidence that the proposed methods for incorporating adaptive strategies in the three areas have the potential to significantly improve BCI communication rates, and the proposed method for predicting BCI performance provides a reliable means to pre-assess BCI performance without extensive online testing.

Traitement des émotions évoquées par les expressions faciales, vocales et musicales à la suite d’un traumatisme craniocérébral

Le traitement des émotions joue un rôle essentiel dans les relations interpersonnelles. Des déficits dans la reconnaissance des émotions évoquées par les expressions faciales et vocales ont été démontrés à la suite d’un traumatisme craniocérébral (TCC). Toutefois, la majorité des études n’ont pas différencié les participants selon le niveau de gravité du TCC et n’ont pas évalué certains préalables essentiels au traitement émotionnel, tels que la capacité à percevoir les caractéristiques faciales et vocales, et par le fait même, la capacité à y porter attention. Aucune étude ne s’est intéressée au traitement des émotions évoquées par les expressions musicales, alors que la musique est utilisée comme méthode d’intervention afin de répondre à des besoins de prise en charge comportementale, cognitive ou affective chez des personnes présentant des atteintes neurologiques. Ainsi, on ignore si les effets positifs de l’intervention musicale sont basés sur la préservation de la reconnaissance de certaines catégories d’émotions évoquées par les expressions musicales à la suite d’un TCC. La première étude de cette thèse a évalué la reconnaissance des émotions de base (joie, tristesse, peur) évoquées par les expressions faciales, vocales et musicales chez quarante et un adultes (10 TCC modéré-sévère, 9 TCC léger complexe, 11 TCC léger simple et 11 témoins), à partir de tâches expérimentales et de tâches perceptuelles contrôles. Les résultats suggèrent un déficit de la reconnaissance de la peur évoquée par les expressions faciales à la suite d’un TCC modéré-sévère et d’un TCC léger complexe, comparativement aux personnes avec un TCC léger simple et sans TCC. Le déficit n’est pas expliqué par un trouble perceptuel sous-jacent. Les résultats montrent de plus une préservation de la reconnaissance des émotions évoquées par les expressions vocales et musicales à la suite d’un TCC, indépendamment du niveau de gravité. Enfin, malgré une dissociation observée entre les performances aux tâches de reconnaissance des émotions évoquées par les modalités visuelle et auditive, aucune corrélation n’a été trouvée entre les expressions vocales et musicales. La deuxième étude a mesuré les ondes cérébrales précoces (N1, N170) et plus tardives (N2) de vingt-cinq adultes (10 TCC léger simple, 1 TCC léger complexe, 3 TCC modéré-sévère et 11 témoins), pendant la présentation d’expressions faciales évoquant la peur, la neutralité et la joie. Les résultats suggèrent des altérations dans le traitement attentionnel précoce à la suite d’un TCC, qui amenuisent le traitement ultérieur de la peur évoquée par les expressions faciales. En somme, les conclusions de cette thèse affinent notre compréhension du traitement des émotions évoquées par les expressions faciales, vocales et musicales à la suite d’un TCC selon le niveau de gravité. Les résultats permettent également de mieux saisir les origines des déficits du traitement des émotions évoquées par les expressions faciales à la suite d’un TCC, lesquels semblent secondaires à des altérations attentionnelles précoces. Cette thèse pourrait contribuer au développement éventuel d’interventions axées sur les émotions à la suite d’un TCC.

Expert players accurately detect an opponent's movement intentions through sound alone

Sounds offer a rich source of information about events taking place in our physical and social environment. However, outside the domains of speech and music, little is known about whether humans can recognize and act upon the intentions of another agent’s actions detected through auditory information alone. In this study we assessed whether intention can be inferred from the sound an action makes, and in turn, whether this information can be used to prospectively guide movement. In two experiments experienced and novice basketball players had to virtually intercept an attacker by listening to audio recordings of that player’s movements. In the first experiment participants had to move a slider, while in the second one their body, to block the perceived passage of the attacker as they would in a real basketball game. Combinations of deceptive and non-deceptive movements were used to see if novice and/or experienced listeners could perceive the attacker’s intentions through sound alone. We showed that basketball players were able to more accurately predict final running direction compared to non-players, particularly in the second experiment when the interceptive action was more basketball specific. We suggest that athletes present better action anticipation by being able to pick up and use the relevant kinematic features of deceptive movement from event-related sounds alone. This result suggests that action intention can be perceived through the sound a movement makes and that the ability to determine another person’s action intention from the information conveyed through sound is honed through practice.

Effect of intravenous haloperidol on the duration of delirium and coma in critically ill patients (Hope-ICU):A randomised, double-blind, placebo-controlled trial

Background: Delirium is frequently diagnosed in critically ill patients and is associated with poor clinical outcomes. Haloperidol is the most commonly used drug for delirium despite little evidence of its effectiveness. The aim of this study was to establish whether early treatment with haloperidol would decrease the time that survivors of critical illness spent in delirium or coma. Methods: We did this double-blind, placebo-controlled randomised trial in a general adult intensive care unit (ICU). Critically ill patients (≥18 years) needing mechanical ventilation within 72 h of admission were enrolled. Patients were randomised (by an independent nurse, in 1:1 ratio, with permuted block size of four and six, using a centralised, secure web-based randomisation service) to receive haloperidol 2·5 mg or 0·9% saline placebo intravenously every 8 h, irrespective of coma or delirium status. Study drug was discontinued on ICU discharge, once delirium-free and coma-free for 2 consecutive days, or after a maximum of 14 days of treatment, whichever came first. Delirium was assessed using the confusion assessment method for the ICU (CAM-ICU). The primary outcome was delirium-free and coma-free days, defined as the number of days in the first 14 days after randomisation during which the patient was alive without delirium and not in coma from any cause. Patients who died within the 14 day study period were recorded as having 0 days free of delirium and coma. ICU clinical and research staff and patients were masked to treatment throughout the study. Analyses were by intention to treat. This trial is registered with the International Standard Randomised Controlled Trial Registry, number ISRCTN83567338. Findings: 142 patients were randomised, 141 were included in the final analysis (71 haloperidol, 70 placebo). Patients in the haloperidol group spent about the same number of days alive, without delirium, and without coma as did patients in the placebo group (median 5 days [IQR 0-10] vs 6 days [0-11] days; p=0·53). The most common adverse events were oversedation (11 patients in the haloperidol group vs six in the placebo group) and QTc prolongation (seven patients in the haloperidol group vs six in the placebo group). No patient had a serious adverse event related to the study drug. Interpretation: These results do not support the hypothesis that haloperidol modifies duration of delirium in critically ill patients. Although haloperidol can be used safely in this population of patients, pending the results of trials in progress, the use of intravenous haloperidol should be reserved for short-term management of acute agitation. Funding: National Institute for Health Research. © 2013 Elsevier Ltd.

Social Influences of Error Monitoring

Adolescence is characterized by dramatic hormonal, physical, and psychological changes, and is a period of risk for affective and anxiety disorders. Pubertal development during adolescence plays a major role in the emergence of these disorders, particularly among girls. Thus, it is critical to identify early biomarkers of risk. One potential biomarker, the error-related negativity (ERN), is an event-related potential following an erroneous response. Individuals with an anxiety disorder demonstrate a greater ERN than healthy comparisons, an association which is stronger in adolescence, suggesting that pubertal development may play a role in the ERN as a predictor of anxiety. One form of anxiety often observed in adolescence, particularly among girls, is social anxiety, which is defined as anxiety elicited by social-evaluative contexts. In adults, enhancements of the ERN in social-evaluative contexts is positively related to social anxiety symptoms, suggesting that the ERN in social contexts may serve as a biomarker for social anxiety. This dissertation examined the ERN in and its relation with puberty and social anxiety among 76 adolescent girls. Adolescent girls completed a flanker task in two different

Low spatial frequency filtering modulates early brain processing of affective complex pictures

Recent research on affective processing has suggested that low spatial frequency information of fearful faces provide rapid emotional cues to the amygdala, whereas high spatial frequencies convey fine-grained information to the fusiform gyrus, regardless of emotional expression. In the present experiment, we examined the effects of low (LSF, <15 cycles/image width) and high spatial frequency filtering (HSF, >25 cycles/image width) on brain processing of complex pictures depicting pleasant, unpleasant, and neutral scenes. Event-related potentials (ERP), percentage of recognized stimuli and response times were recorded in 19 healthy volunteers. Behavioral results indicated faster reaction times in response to unpleasant LSF than to unpleasant HSF pictures. Unpleasant LSF pictures and pleasant unfiltered pictures also elicited significant enhancements of P1 amplitudes at occipital electrodes as compared to neutral LSF and unfiltered pictures, respectively; whereas no significant effects of affective modulation were found for HSF pictures. Moreover, mean ERP amplitudes in the time between 200 and 500ms post-stimulus were significantly greater for affective (pleasant and unpleasant) than for neutral unfiltered pictures; whereas no significant affective modulation was found for HSF or LSF pictures at those latencies. The fact that affective LSF pictures elicited an enhancement of brain responses at early, but not at later latencies, suggests the existence of a rapid and preattentive neural mechanism for the processing of motivationally relevant stimuli, which could be driven by LSF cues. Our findings confirm thus previous results showing differences on brain processing of affective LSF and HSF faces, and extend these results to more complex and social affective pictures.

Effects of efficient fronto-temporal circuitry on lexical ambiguity resolution: converging evidence from cross-age comparisons in eye-tracking and ERP data

Eye-tracking was used to examine how younger and older adults use syntactic and semantic information to disambiguate noun/verb (NV) homographs (e.g., park). We find that young adults exhibit inflated first fixations to NV-homographs when only syntactic cues are available for disambiguation (i.e., in syntactic prose). This effect is eliminated with the addition of disambiguating semantic information. Older adults (60+) as a group fail to show the first fixation effect in syntactic prose; they instead reread NV homographs longer. This pattern mirrors that in prior event-related potential work (Lee & Federmeier, 2009, 2011), which reported a sustained frontal negativity to NV-homographs in syntactic prose for young adults, which was eliminated by semantic constraints. The frontal negativity was not observed in older adults as a group, although older adults with high verbal fluency showed the young-like pattern. Analyses of individual differences in eye-tracking patterns revealed a similar effect of verbal fluency in both young and older adults: high verbal fluency groups of both ages show larger first fixation effects, while low verbal fluency groups show larger downstream costs (rereading and/or refixating NV homographs). Jointly, the eye-tracking and ERP data suggest that effortful meaning selection recruits frontal brain areas important for suppressing contextually inappropriate meanings, which also slows eye movements. Efficacy of fronto-temporal circuitry, as captured by verbal fluency, predicts the success of engaging these mechanisms in both young and older adults. Failure to recruit these processes requires compensatory rereading or leads to comprehension failures (Lee & Federmeier, in press).

Traitement des émotions évoquées par les expressions faciales, vocales et musicales à la suite d’un traumatisme craniocérébral

Le traitement des émotions joue un rôle essentiel dans les relations interpersonnelles. Des déficits dans la reconnaissance des émotions évoquées par les expressions faciales et vocales ont été démontrés à la suite d’un traumatisme craniocérébral (TCC). Toutefois, la majorité des études n’ont pas différencié les participants selon le niveau de gravité du TCC et n’ont pas évalué certains préalables essentiels au traitement émotionnel, tels que la capacité à percevoir les caractéristiques faciales et vocales, et par le fait même, la capacité à y porter attention. Aucune étude ne s’est intéressée au traitement des émotions évoquées par les expressions musicales, alors que la musique est utilisée comme méthode d’intervention afin de répondre à des besoins de prise en charge comportementale, cognitive ou affective chez des personnes présentant des atteintes neurologiques. Ainsi, on ignore si les effets positifs de l’intervention musicale sont basés sur la préservation de la reconnaissance de certaines catégories d’émotions évoquées par les expressions musicales à la suite d’un TCC. La première étude de cette thèse a évalué la reconnaissance des émotions de base (joie, tristesse, peur) évoquées par les expressions faciales, vocales et musicales chez quarante et un adultes (10 TCC modéré-sévère, 9 TCC léger complexe, 11 TCC léger simple et 11 témoins), à partir de tâches expérimentales et de tâches perceptuelles contrôles. Les résultats suggèrent un déficit de la reconnaissance de la peur évoquée par les expressions faciales à la suite d’un TCC modéré-sévère et d’un TCC léger complexe, comparativement aux personnes avec un TCC léger simple et sans TCC. Le déficit n’est pas expliqué par un trouble perceptuel sous-jacent. Les résultats montrent de plus une préservation de la reconnaissance des émotions évoquées par les expressions vocales et musicales à la suite d’un TCC, indépendamment du niveau de gravité. Enfin, malgré une dissociation observée entre les performances aux tâches de reconnaissance des émotions évoquées par les modalités visuelle et auditive, aucune corrélation n’a été trouvée entre les expressions vocales et musicales. La deuxième étude a mesuré les ondes cérébrales précoces (N1, N170) et plus tardives (N2) de vingt-cinq adultes (10 TCC léger simple, 1 TCC léger complexe, 3 TCC modéré-sévère et 11 témoins), pendant la présentation d’expressions faciales évoquant la peur, la neutralité et la joie. Les résultats suggèrent des altérations dans le traitement attentionnel précoce à la suite d’un TCC, qui amenuisent le traitement ultérieur de la peur évoquée par les expressions faciales. En somme, les conclusions de cette thèse affinent notre compréhension du traitement des émotions évoquées par les expressions faciales, vocales et musicales à la suite d’un TCC selon le niveau de gravité. Les résultats permettent également de mieux saisir les origines des déficits du traitement des émotions évoquées par les expressions faciales à la suite d’un TCC, lesquels semblent secondaires à des altérations attentionnelles précoces. Cette thèse pourrait contribuer au développement éventuel d’interventions axées sur les émotions à la suite d’un TCC.

Parsing, Generation and Grammar

Humans use their grammatical knowledge in more than one way. On one hand, they use it to understand what others say. On the other hand, they use it to say what they want to convey to others (or to themselves). In either case, they need to assemble the structure of sentences in a systematic fashion, in accordance with the grammar of their language. Despite the fact that the structures that comprehenders and speakers assemble are systematic in an identical fashion (i.e., obey the same grammatical constraints), the two ‘modes’ of assembling sentence structures might or might not be performed by the same cognitive mechanisms. Currently, the field of psycholinguistics implicitly adopts the position that they are supported by different cognitive mechanisms, as evident from the fact that most psycholinguistic models seek to explain either comprehension or production phenomena. The potential existence of two independent cognitive systems underlying linguistic performance doubles the problem of linking the theory of linguistic knowledge and the theory of linguistic performance, making the integration of linguistics and psycholinguistic harder. This thesis thus aims to unify the structure building system in comprehension, i.e., parser, and the structure building system in production, i.e., generator, into one, so that the linking theory between knowledge and performance can also be unified into one. I will discuss and unify both existing and new data pertaining to how structures are assembled in understanding and speaking, and attempt to show that the unification between parsing and generation is at least a plausible research enterprise. In Chapter 1, I will discuss the previous and current views on how parsing and generation are related to each other. I will outline the challenges for the current view that the parser and the generator are the same cognitive mechanism. This single system view is discussed and evaluated in the rest of the chapters. In Chapter 2, I will present new experimental evidence suggesting that the grain size of the pre-compiled structural units (henceforth simply structural units) is rather small, contrary to some models of sentence production. In particular, I will show that the internal structure of the verb phrase in a ditransitive sentence (e.g., The chef is donating the book to the monk) is not specified at the onset of speech, but is specified before the first internal argument (the book) needs to be uttered. I will also show that this timing of structural processes with respect to the verb phrase structure is earlier than the lexical processes of verb internal arguments. These two results in concert show that the size of structure building units in sentence production is rather small, contrary to some models of sentence production, yet structural processes still precede lexical processes. I argue that this view of generation resembles the widely accepted model of parsing that utilizes both top-down and bottom-up structure building procedures. In Chapter 3, I will present new experimental evidence suggesting that the structural representation strongly constrains the subsequent lexical processes. In particular, I will show that conceptually similar lexical items interfere with each other only when they share the same syntactic category in sentence production. The mechanism that I call syntactic gating, will be proposed, and this mechanism characterizes how the structural and lexical processes interact in generation. I will present two Event Related Potential (ERP) experiments that show that the lexical retrieval in (predictive) comprehension is also constrained by syntactic categories. I will argue that the syntactic gating mechanism is operative both in parsing and generation, and that the interaction between structural and lexical processes in both parsing and generation can be characterized in the same fashion. In Chapter 4, I will present a series of experiments examining the timing at which verbs’ lexical representations are planned in sentence production. It will be shown that verbs are planned before the articulation of their internal arguments, regardless of the target language (Japanese or English) and regardless of the sentence type (active object-initial sentence in Japanese, passive sentences in English, and unaccusative sentences in English). I will discuss how this result sheds light on the notion of incrementality in generation. In Chapter 5, I will synthesize the experimental findings presented in this thesis and in previous research to address the challenges to the single system view I outlined in Chapter 1. I will then conclude by presenting a preliminary single system model that can potentially capture both the key sentence comprehension and sentence production data without assuming distinct mechanisms for each.

Distraction by task-irrelevant stimuli: the effects of endogenous spatial attention and visual working memory load

Salient stimuli, like sudden changes in the environment or emotional stimuli, generate a priority signal that captures attention even if they are task-irrelevant. However, to achieve goal-driven behavior, we need to ignore them and to avoid being distracted. It is generally agreed that top-down factors can help us to filter out distractors. A fundamental question is how and at which stage of processing the rejection of distractors is achieved. Two circumstances under which the allocation of attention to distractors is supposed to be prevented are represented by the case in which distractors occur at an unattended location (as determined by the deployment of endogenous spatial attention) and when the amount of visual working memory resources is reduced by an ongoing task. The present thesis is focused on the impact of these factors on three sources of distraction, namely auditory and visual onsets (Experiments 1 and 2, respectively) and pleasant scenes (Experiment 3). In the first two studies we recorded neural correlates of distractor processing (i.e., Event-Related Potentials), whereas in the last study we used interference effects on behavior (i.e., a slowing down of response times on a simultaneous task) to index distraction. Endogenous spatial attention reduced distraction by auditory stimuli and eliminated distraction by visual onsets. Differently, visual working memory load only affected the processing of visual onsets. Emotional interference persisted even when scenes occurred always at unattended locations and when visual working memory was loaded. Altogether, these findings indicate that the ability to detect the location of salient task-irrelevant sounds and identify the affective significance of natural scenes is preserved even when the amount of visual working memory resources is reduced by an ongoing task and when endogenous attention is elsewhere directed. However, these results also indicate that the processing of auditory and visual distractors is not entirely automatic.

Oscillatory mechanisms of conscious perception and attention

Although the prominent role of neural oscillations in perception and cognition has been continuously investigated, some critical questions remain unanswered. My PhD thesis was aimed at addressing some of them. First, can we dissociate oscillatory underpinnings of perceptual accuracy and subjective awareness? Current work would strongly suggest that this dissociation can be drawn. While the fluctuations in alpha-amplitude decide perceptual bias and metacognitive abilities, the speed of alpha activity (i.e., alpha-frequency) dictates sensory sampling, shaping perceptual accuracy. Second, how are these oscillatory mechanisms integrated during attention? The obtained results indicate that a top-down visuospatial mechanism modulates neural assemblies in visual areas via oscillatory re-alignment and coherence in the alpha/beta range within the fronto-parietal brain network. These perceptual predictions are reflected in the retinotopically distributed posterior alpha-amplitude, while perceptual accuracy is explained by the higher alpha-frequency at the to-be-attended location. Finally, sensory input, elaborated via fast gamma oscillations, is linked to specific phases of this slower activity via oscillatory nesting, enabling integration of the feedback-modulated oscillatory activity with sensory information. Third, how can we relate this oscillatory activity to other neural markers of behaviour (i.e., event-related potentials)? The obtained results favour the oscillatory model of ERP genesis, where alpha-frequency shapes the latency of early evoked-potentials, namely P1, with both neural indices being related to perceptual accuracy. On the other hand, alpha-amplitude dictates the amplitude of later P3 evoked-response, whereas both indices shape subjective awareness. Crucially, by combining different methodological approaches, including neurostimulation (TMS) and neuroimaging (EEG), current work identified these oscillatory-behavior links as causal and not just as co-occurring events. Current work aimed at ameliorating the use of the TMS-EEG approach by explaining inter-individual differences in the stimulation outcomes, which could be proven crucial in the way we design entrainment experiments and interpret the results in both research and clinical settings.

Effetto di distrattori acustici rispetto a distrattori visivi in un compito di memoria visiva: analisi del segnale EEG

Studi recenti hanno evidenziato cambiamenti nei ritmi alpha (8-12 Hz) e theta (4-8 Hz) in vari processi modulatori top-down e di controllo cognitivo come la memoria di lavoro (WM, working memory) e la soppressione di distrattori. I compiti di WM richiedono attenzione interna sostenuta per dare priorità alle informazioni rilevanti a discapito di quelle interferenti che distraggono dall’obiettivo. I meccanismi di attenzione in tali compiti sono associati ad aumento di potenza alpha, che riflette la funzione inibitoria di tale ritmo, in regioni che elaborano informazioni distraenti, e ad aumento di potenza theta, soprattutto in regioni frontali, che riflette funzioni di controllo cognitivo per raggiungere l’obiettivo pur in presenza di interferenze. Questo lavoro è volto ad indagare gli effetti di distrattori acustici rispetto a distrattori visivi in un compito di visual WM. A tale scopo sono stati acquisiti ed elaborati i segnali EEG di 12 soggetti volontari mentre eseguivano un compito di visual WM, in cui la fase di retention (mantenimento in memoria delle informazioni codificate) veniva interrotta con la presentazione di distrattori di due modalità sensoriali differenti (visiva e acustica), per valutare le variazioni dell’attività cerebrale in termini di ritmi alpha e theta e le regioni coinvolte. Si è osservato un aumento maggiore di potenza alpha (principalmente posteriore) in presenza del distrattore acustico rispetto al visivo sia nella fase pre-distrattore che nella fase distrattore, statisticamente significativo nella fase distrattore. Si è osservato un aumento maggiore di potenza theta (principalmente frontale) in presenza del distrattore acustico rispetto al visivo in tutte le fasi del task, statisticamente significativo nella fase iniziale di retention e nella fase del distrattore. I risultati potrebbero indicare una maggiore necessità di controllo cognitivo e di protezione da stimoli interferenti in caso di distrattore acustico rispetto al visivo.

Event-free survival at 24 months is a robust end point for disease-related outcome in diffuse large B-cell lymphoma treated with immunochemotherapy.

PURPOSE: Studies of diffuse large B-cell lymphoma (DLBCL) are typically evaluated by using a time-to-event approach with relapse, re-treatment, and death commonly used as the events. We evaluated the timing and type of events in newly diagnosed DLBCL and compared patient outcome with reference population data. PATIENTS AND METHODS: Patients with newly diagnosed DLBCL treated with immunochemotherapy were prospectively enrolled onto the University of Iowa/Mayo Clinic Specialized Program of Research Excellence Molecular Epidemiology Resource (MER) and the North Central Cancer Treatment Group NCCTG-N0489 clinical trial from 2002 to 2009. Patient outcomes were evaluated at diagnosis and in the subsets of patients achieving event-free status at 12 months (EFS12) and 24 months (EFS24) from diagnosis. Overall survival was compared with age- and sex-matched population data. Results were replicated in an external validation cohort from the Groupe d'Etude des Lymphomes de l'Adulte (GELA) Lymphome Non Hodgkinien 2003 (LNH2003) program and a registry based in Lyon, France. RESULTS: In all, 767 patients with newly diagnosed DLBCL who had a median age of 63 years were enrolled onto the MER and NCCTG studies. At a median follow-up of 60 months (range, 8 to 116 months), 299 patients had an event and 210 patients had died. Patients achieving EFS24 had an overall survival equivalent to that of the age- and sex-matched general population (standardized mortality ratio [SMR], 1.18; P = .25). This result was confirmed in 820 patients from the GELA study and registry in Lyon (SMR, 1.09; P = .71). Simulation studies showed that EFS24 has comparable power to continuous EFS when evaluating clinical trials in DLBCL. CONCLUSION: Patients with DLBCL who achieve EFS24 have a subsequent overall survival equivalent to that of the age- and sex-matched general population. EFS24 will be useful in patient counseling and should be considered as an end point for future studies of newly diagnosed DLBCL.