Assessing the effectiveness of warnings and the phenomenological characteristics of false memories.

The phenomenology of false memories was investigated in three experiments in which participants heard two experimenters read lists of items that were related to critical nonpresented items. In Experiments 1, following a recognition memory test, participants rated the phenomenological characteristics of their memories immediately and after a 48-hour delay. False recognition was prevalent and on several dimensions participants rated their true memories as more vivid than their false memories. In Experiments 2 and 3, following the study phase, participants were warned about the phenomenological differences between true and false memories and were instructed to use this information to avoid reporting nonpresented items. This type of warning was ineffective at reducing false recall (Experiment 2) and false recognition (Experiment 3) relative to unwarned participants. Importantly, the inability of explicit warnings to impact illusory recollections demonstrates that the false memories cannot be attributed simply to a criterion shift.

The influence of age on the delivery, tolerance, and efficacy of thoracic irradiation in the combined modality treatment of limited stage small cell lung cancer.

PURPOSE: To assess the impact of age on the delivery, tolerance, and efficacy of thoracic irradiation (TI) for limited small cell lung cancer (L-SCLC). METHODS AND MATERIALS: This is a retrospective review of data from 608 patients 80 years or less with L-SCLC, who participated in two previously reported randomized trials (BR3 and BR.6) of the National Cancer Institute of Canada. All patients received the same chemotherapy, consisting of cyclophosphamide, doxorubicin, vincristine (CAV), and etoposide cisplatin (EP) delivered either in sequential or alternating sequence. In BR.3, TI was given after chemotherapy with randomization to 25 Gy in 10 fractions or 37.5 Gy in 15 fractions. In BR.6, TI (40 Gy in 15 fractions) was given concurrently with EP with randomization to either the early (with cycle 2, week 4) or late (with cycle 6, week 16) arm. RESULTS: A total of 665 patients entered these two trials. Of these, 608 patients were eligible for analysis, 300 in BR.3 and 308 in BR.6. Five hundred and twenty patients were under age 70 and 88 patients were 70 years or older. Baseline characteristics between the two groups were comparable. In BR3, 179 patients (60%) participated in radiotherapy randomization (61% young, 52% elderly), and 176 patients actually received TI. In BR.6, randomization occurred at study entry for all patients, and 282 (91.6%) patients received TI (92% young, 88% elderly). More patients of both age groups randomized to receive late TI did not receive TI (13% and 14%) than those randomized to the early TI arm (3%) of BR.6. We could identify no tendency to reduce field sizes to minimize toxicity in either age group at higher doses of TI. Once TI was started, there was no difference between the two age groups with regards to the proportion of patients who completed TI, although elderly patients were less likely to complete high dose TI. Of those who completed TI, there was no difference in the time to complete TI, mean dose delivered or in the incidence of acute and late TI-related toxicities. No statistical difference in response rate, local relapse rate, or overall survival was seen between young and older age groups. CONCLUSION: In summary, in the dose range examined, age does not appear to impact on the delivery, tolerance or efficacy of TI in the combined modality management of L-SCLC. Potentially curative combined modality treatment should not be withheld on the basis of age.

Source attributions and false memories: a test of the demand characteristics account.

When lists of related words are presented to subjects, they sometimes recall or recognize nonpresented words related to those lists (critical lures). In fact, subjects sometimes claim to remember which of two speakers said the critical lures. We examined whether this finding could be accounted for by demand characteristics. If subjects' willingness to make source attributions to critical lures reflects experimental demand, one would predict that subjects should be willing to change and should havelittle confidence in these attributions. Subjects made more attributions, were less likely to change their attributions, and were more confident in their attributions for critical lures than for unrelated distractors. Subjects had even more confidence in the attributions that they made for words that had actually been presented, and they were even less likely to change these attributions. These findings suggest that false memories are quite compelling but that they are also subtly different from true memories.

Ocular masquerade syndrome in lymphoid blast crisis of chronic myeloid leukemia.

A 56-year-old woman presented with CML in lymphoid blast crisis. Complete remission with no suggestion of CML was achieved with chemotherapy. Twenty-six months later, an isolated ocular anterior chamber relapse of acute leukemia presenting as uveitis (ocular masquerade syndrome) was diagnosed and treated with radiotherapy. Ten months later, a second ocular relapse in the same location was diagnosed and treated with radiotherapy. Two months later, a systemic relapse into second chronic phase was diagnosed and is currently being treated with alpha interferon. Only one previous case of leukemic hypopyon in CML has been reported. This is also the first case of isolated ocular blast crisis relapse in CML to be described.

A test of Tiffany's cognitive model of drug urges and drug-use behavior.

Tiffany's (1990) cognitive model proposes that drug urges and drug use result from distinct (i.e., controlled versus automatic) cognitive processes. This study tested Tiffany's cognitive model utilizing innovative methods derived from the Multiple Resource Theory of cognitive psychology. Forty-two male and 42 female heavy drinking college students were assigned to 1 of 6 groups in two separate 1 (task) x 3 (treatment) factorial experiments in which half the subjects performed a math task while the other half performed a tracking task. Subjects received 1 of 3 treatments: Urge generation, "Drug" (Placebo) Consumption, or a Water control. The predictions were that urges would interfere with performance on the math task, and "drug" consumption would interfere with performance on the tracking task. The main dependent variables were measures of task performance. The results of this study do not clearly support the model; however, several suggestions for future tests of the cognitive model are discussed. Our findings highlight both the difficulty in testing the model, as well as opportunities for further integration of cognitive psychology and behavioral approaches to addictions.

Benign parotid adenomas: a review of the Princess Margaret Hospital experience.

BACKGROUND: The morbidity of treating benign parotid tumors is an important issue because the majority of patients are young. We therefore undertook this study to evaluate the outcome for these patients treated at the Princess Margaret Hospital. METHODS: A retrospective review was conducted on all patients registered with benign parotid tumors between 1970 and 1987. RESULTS: Seventy-six patients were included in this review; postoperative radiotherapy (XRT) was administered to 55 patients. Median follow-up time was 12.5 years. Postoperative XRT was particularly important for patients with recurrent disease. The risk of both temporary and permanent facial nerve paralyses increased with each operation. No patients in this study developed a malignancy. CONCLUSIONS: We recommend that all patients with benign parotid tumors be treated with a complete parotidectomy with preservation of the facial nerve. Consideration to postoperative XRT should be given to patients in whom there was tumor spillage, residual disease, or recurrences.

Effects of speech intelligibility level on concurrent visual task performance.

Four experiments were performed to determine if changes in the level of speech intelligibility in an auditory task have an impact on performance in concurrent visual tasks. The auditory task used in each experiment was a memory search task in which subjects memorized a set of words and then decided whether auditorily presented probe items were members of the memorized set. The visual tasks used were an unstable tracking task, a spatial decision-making task, a mathematical reasoning task, and a probability monitoring task. Results showed that performance on the unstable tracking and probability monitoring tasks was unaffected by the level of speech intelligibility on the auditory task, whereas accuracy in the spatial decision-making and mathematical processing tasks was significantly worse at low speech intelligibility levels. The findings are interpreted within the framework of multiple resource theory.

Selective disruption of hypermnesia for pictures and words.

In this study, we investigated the effects of various interpolated tasks on hypermnesia (improved recall across repeated tests) for pictures and words. In five experiments, subjects studied either pictures or words and then completed two free-recall tests, with varying activities interpolated between the tests. The tasks performed between tests were varied to test several hypotheses concerning the possible factor(s) responsible for disruption of the hypermnesic effect. In each experiment, hypermnesia was obtained in a control condition in which there was no interpolated task between tests. The remaining conditions showed that the effect of the interpolated tasks was related to the overlap of the cognitive processes involved in encoding the target items and performing the interpolated tasks. When pictures were used as the target items, no hypermnesia was obtained when subjects engaged in imaginal processing interpolated tasks, even when these tasks involved materials that were very distinct from the target items. When words were used as the target items, no hypermnesia was obtained when the interpolated tasks required verbal/linguistic processing, even when the items used in these tasks were auditorily presented. The results are discussed in terms of a strength-based model of associative memory.

Lentigo maligna of the head and neck. Results of treatment by radiotherapy.

BACKGROUND AND DESIGN: Although surgical excision is considered the treatment of choice for lentigo maligna, some elderly patients presenting with large lesions in the head and neck region may not be suitable candidates for surgical management. Radiotherapy has been used for this tumor at the Princess Margaret Hospital, Toronto, Ontario, for over the past 20 years with encouraging results. Fifty-four patients treated between 1968 and 1988 were identified, and their records were reviewed to determine treatment outcome. RESULTS: Younger patients with smaller lesions were treated with surgical excision (n = 18) and achieved an actuarial tumor control rate of 94% at 3 years. Older patients with larger lesions located in the head and neck area were treated by radiotherapy (n = 36), with an actuarial tumor control rate of 86% at 5 years. Three of the four patients not achieving tumor control by radiation were successfully treated with surgical excision, and two of them proved to have malignant melanomas (both Clark's level II) when examined histologically. One patient with residual pigmentation 4 months after treatment was unavailable for follow-up. No patients developed metastatic melanoma. The late cosmetic appearance was acceptable in the majority of irradiated patients, with 11% showing poor cosmesis due to progressive skin pallor, atrophy, and telangiectasia in the treated area. CONCLUSION: Conventional fractionated radiation therapy with superficial x-rays is a simple and effective method of management for lentigo maligna of the head and neck region. It is an excellent alternative treatment to surgical excision, with low morbidity and acceptable long-term cosmetic results.

The role of radiation oncology in small cell lung cancer.

Small cell lung cancer comprises a histologic subgroup of bronchogenic carcinomas distinguished particularly by a responsiveness to cytotoxic agents, and equally by a strong tendency to disseminate, both to mediastinal and distant sites. At one time considered suitable only for short-term palliation by radiation therapy, this disease is now managed by both systemic and regional approaches, typically with close integration of radiotherapy and chemotherapy. Thoracic irradiation produces modest improvements in both survival and local control in small cell lung cancer, when the clinical extent is limited to the chest. The optimal parameters of dose, treatment volume, fractionation, and temporal integration with chemotherapy are not yet defined. When the disease is more extensive radiotherapy plays a useful palliative role. New biological insights are being brought to the clinic, and have stimulated new therapeutic initiatives in the treatment of this disease. Modified radiotherapy fractionation schemes and sophisticated integration of chemotherapy and radiation therapy have resulted in further advances. In addition to improved response rates and median survivals, combined modality approaches suggest, in addition, the possibility of cured subset in cases of disease confined to the chest. The adverse effects of thoracic irradiation are manageable and the more serious can be prevented with careful attention to volume and technique. Radiotherapy offers relief of many symptoms and cost-effective palliation of metastatic lesions in most body sites. Considered as a significant problem in oncology, and apart from efforts at primary prevention, major progress in this disease is most likely to result from research focussed on the limited disease subset, which, unfortunately, consists of no more than half the incident cases. These patients have a median survival of 12-18 months, and are sufficiently numerous that it is possible to detect meaningful treatment progress in clinical trials of a reasonable size. Nevertheless, the marked advances of two decades ago, when chemotherapy first came into widespread use, are not seen today. Progress is now more likely to be seen in modest improvements in survival or tumor control rates when control and experimental regimens are compared statistically in large trials or in meta-analyses. While the evidence supports the use of thoracic radiotherapy the ideal drug combination is unknown, and there is a real need for new agents of substantially greater activity than those available today. While more rational combinations of agents may be possible, it seems likely that the limits of tolerance are being reached.(ABSTRACT TRUNCATED AT 400 WORDS)

Is preoperative or postoperative radiation therapy indicated in non-small cell cancer of the lung?

Induction radiotherapy has no routine indication in the treatment of non-small cell cancer of the lung. No survival benefit has ever been shown in a properly conducted trial. Rarely it might be used prior to attempted complete resection of a tumour in close association with a vital organ, in the hopes of minimising damage to that organ. In combination with chemotherapy, irradiation may eventually find a role within an effective induction regimen, particularly in IIIA disease. Post-operative irradiation will reduce local-regional relapse rates in completely resected disease, but there is no demonstrable survival benefit. In incompletely resected disease, usually more advanced initially, there may be a similar effect, of smaller magnitude. However such patients are usually at greater risk from systemic relapse. The availability of radiotherapy should not encourage surgeons to use anything less than meticulous and consistent selection procedures; patients who are technically unresectable should be submitted for experimental protocols, or standard treatment with exclusive radiotherapy.

[Small cell lung carcinoma: role of thoracic irradiation and its timing in relation to chemotherapy]. / Carcinome bronchique à petites cellules: le rôle de l'irradiation thoracique et sa place chronologique par rapport à la chimiothérapie.

Combined modality therapy is of great importance in the management of small cell lung cancer. Randomized studies of the design chemotherapy with or without thoracic irradiation are required to demonstrate the impact of radiotherapy on rates of survival, local control and adverse effects. The method of meta-analysis allows one to analyse in a single study a set of different clinical trials of the same design. The first purpose of this paper is to briefly present the method, and the results of a meta-analysis on the role of thoracic irradiation combined with chemotherapy in the treatment of this disease. Thoracic irradiation added to chemotherapy results in a major decrease in local relapse (from 65% to 40% at 2 years), a modest increase in overall survival (from 16 to 22% at 2 years), and a small increase in lethal toxicity (from 1 to 2%). The second purpose is to discuss timing of thoracic irradiation with respect to the administration of chemotherapy using the results of a recently published trial. This Canadian study is based on the hypothesis that chemo resistant cells may develop as a result of spontaneous mutations during therapy. Limited disease patients all received the same chemotherapy (alternating 3-week cycles of CAV [cyclophosphamide, doxorubicin, vincristine] over EP [etoposide, cisplatinum] for a total of six cycles), after having been randomized to receive thoracic irradiation given either early (at 3 weeks following the beginning of treatment) or late (at 15 weeks). Of the 308 patients for analysis 155 were randomized to the "early radiotherapy" arm, and 157 to the "late radiotherapy". Prognostic factors were equally distributed between the two arms. The radiotherapy regiment consisted of a dose of 40 Gy in 15 fractions to a target volume including the primary tumor and mediastinum, and prophylactic brain irradiation (25 Gy in ten fractions in 2 weeks) to patients without progression of disease. The overall survival rate was better in the "early radiotherapy" arm, with a median survival of 21 months and on overall survival rate of 20% at 5 years, compared to a median of 16 months and a 5 years survival of 11% in the "late radiotherapy" arm. The survival curves are significantly different by the log rank (P = 0.008) and Wilcoxon (P = 0.005) tests, in favour of "early radiotherapy". After allowing for prognostic factors (sex, ECOG performance status) by the Cox model, the "early" arm retains a statistically significant advantage (P = 0.006).(ABSTRACT TRUNCATED AT 400 WORDS)

Initial recall, reminiscence, and hypermnesia: comment on Madigan and O'Hara (1992).

S. Madigan and R. O'Hara (1992) analyzed data from repeated free-recall experiments and concluded that the rate of item recovery across tests was related to the level of recall performance on an initial free-recall test. We report a reanalysis of these data along with Monte Carlo simulations that indicate the measures used by Madigan and O'Hara may have inflated the magnitude of the relation between initial recall and item recovery. The results are discussed in terms of their implications for future research investigating reminiscence and hypermnesia.

Patterns of failure following loco-regional radiotherapy in the treatment of limited stage small cell lung cancer.

PURPOSE: The probability of treatment resistant cells developing in a tumor, such as small cell lung cancer (SCLC) which has a rapid cell cycle time, is a function of the number of tumor cells present and of time. Theoretically, the development of resistance to chemotherapy and radiotherapy should be minimized by using all treatment modalities early in the treatment program. METHODS AND MATERIALS: The importance of the timing of loco-regional radiotherapy was assessed in a multi-institution randomized study. Three hundred and eight patients with limited small cell lung cancer (LSCLC) were given three cycles of cyclophosphamide, doxorubicin and vincristine alternating with three cycles of etoposide and cisplatin. In addition, patients were randomized to receive locoregional radiotherapy: 40 Gy in 15 fractions in 3 weeks with treatment planning techniques to limit the spinal cord dose to be < or = 35 Gy either with the first cycle (early) or with the sixth cycle of chemotherapy (late). Responding patients received prophylactic brain irradiation (25 Gy in 10 fractions in 2 weeks) after completion of locoregional radiotherapy and chemotherapy. RESULTS: 96% of the 155 eligible patients allocated to the "early" arm and 87% of the 153 allocated to the "late" arm received locoregional radiotherapy; 26 patients did not receive locoregional radiotherapy. The mean field sizes were similar in both arms. The mean radiation doses were significantly less in the "early" arm (p = 0.0319 Wilcoxon rank sum test). Any differences in the frequency of toxicities were minor. All patients have been followed for at least 2 years and the median follow up is 4 years. 64% had a complete response in the "early" arm compared with 56% in the "late" arm (p = 0.137). Survival was measured from the start of chemotherapy. There was a significant improvement in survival in the "early" arm; median survival was 21.2 months compared with 16.0 months in the "late" arm (p = .008 log rank test). Survival at 2, 3, and 4 years was 40%, 32%, and 25%, respectively, for the "early" arm and 33%, 22%, and 15% for the "late" arm. There were 232 (75%) recurrences among those patients whose disease recurred. The proportion who had local recurrence within the radiation field was 41% and 39% for "early" and "late" treatment arms respectively. The proportion of brain metastases in the "late" arm (28%) was significantly higher than in the "early" arm (18%) p = .0425 Fishers' exact test. CONCLUSION: We conclude that early administration of locoregional radiotherapy in a combined modality treatment is superior to late consolidative locoregional radiotherapy in limited small cell lung cancer.

Recognition performance level and the magnitude of the misinformation effect in eyewitness memory.

The issue of whether misleading postevent information affects performance on the modified recognition test introduced by McCloskey and Zaragoza (1985) was examined in a meta-analysis. Results indicated that a misinformation effect can be obtained with the modified test. The meta-analysis also revealed that recognition hit rates are higher in studies that yield a misinformation effect than in studies in which the misinformation effect is not significant. The data from the meta-analysis were also used to assess whether the misinformation effect is related to the length of the retention interval. Results showed that a misinformation effect is more likely to be obtained with long retention intervals, although in the available data there is a confound between the length of the retention interval and the recognition level obtained.

[The role of radiotherapy in bronchopulmonary cancer]. / Le rôle de la radiothérapie dans le cancer bronchopulmonaire.

Pulmonary cancer is a major problem as much in terms of public health as for treatment. Radiotherapy plays an important therapeutic role. For a long time it has been used to treat inoperable tumours and for palliation, none the less in certain clinical situations it can be used as an alternative cure: in that case it's most often integrated with surgery and-or chemotherapy. Modern techniques of localization and of planning treatment have been briefly reviewed. In small cell cancer the survival is improved, as well as local control by thoracic irradiation. Current research has produced new knowledge in radiobiology which is opening up new therapeutic possibilities in the treatment of this disease. Various schemas for fractionating the radiotherapy and its sophisticated integration with chemotherapy have enable notable progress. Non-small cell bronchial cancer presents a particular challenge on account of its relative insensitivity to chemotherapy. Treatment is based on surgery and radiotherapy. Radiotherapy is a useful alternative to surgery for those patients who are inoperable on account of poor respiratory function. For cancer which has advanced locally new strategies of induction by associating radiotherapy and chemotherapy prior to surgery are under evaluation. Numerous cases of advanced disease are typically treated with radiotherapy alone. New schemas for hyperfractioning are giving rise to promising results and are clearly beneficial in combination with other therapeutic approaches. The side effects of thoracic irradiation can be controlled; the most serious can be prevented by careful attention to the volume treated and to the technique of irradiation. Radiotherapy offers an effective alternative and has a good cost effective relationship for the palliative treatment of metastatic lesions. The optimal use of these local and systemic therapies would enable an improvement in the evolution of the disease in these patients with pulmonary cancer.

Hypermnesia in free recall and cued recall.

In three experiments, categorized lists and both free recall and cued recall tests were used to examine hypermnesia. In Experiment 1, materials were drawn from obvious and nonobvious categories in an attempt to vary the amount of relational processing at encoding. The study materials in Experiment 2 consisted of a long word list that comprised several exemplars from each of a number of common categories. In Experiment 3, a single exemplar was drawn from each of 45 categories. In each experiment, similar magnitudes of hypermnesia were obtained on free and cued recall tests. Examination of the specific items recalled across tests indicated that similar processes underlie the hypermnesic effect for both test conditions. Implications of the results for extant accounts of the hypermnesic effect are discussed. It is concluded that the dynamics of retrieval processes change in a systematic fashion across repeated tests and the retention interval following study and that an adequate account of the nature of these changes in retrieval dynamics is essential to our understanding of hypermnesia and related phenomena.

Role of environmental context in eyewitness memory.

We investigated whether varying the environmental context will affect the magnitude of retroactive interference produced by misleading postevent information in an eyewitness memory paradigm. Previous eyewitness memory studies have typically presented the original and misleading information in the same environmental context. In this experiment, the physical contexts in which the original information and the misleading information were presented were varied, a procedure that is more analogous to what usually occurs in real world situations. We tested 288 subjects, half using the original and misleading information in the same encoding context and half using a different context for presenting the two types of information. Memory for the original event was assessed using either the standard recognition test procedure or the modified test developed by McCloskey and Zaragoza (1985). Measures of both recognition accuracy and response latency showed no difference in performance attributable to varying the environmental context. The present data replicate the findings of previous single-context experiments that showed the two recognition test procedures to produce different patterns of results. Thus, environmental context seems to play little role in determining the magnitude of the misleading postevent information effect.

Late neurological complications after prophylactic cranial irradiation in patients with small-cell lung cancer: the Toronto experience.

We retrospectively analyzed the charts of 58 long-term survivors of small-cell lung cancer (SCLC) (greater than 2 years) for neurological complications and their impact on the well-being of these patients. We also attempted to have patients complete a questionnaire regarding any possible neurological problems. This was done in 14 patients. Metastasis to the CNS occurred significantly less often in patients who received prophylactic cranial irradiation (PCI) in a dose of 20 Gy in five equal fractions (two of 48), compared with patients who did not receive it (four of 10) (P less than .006). Delayed neurological complications occurred in nine of 48 (19%) patients who received PCI. However, in only two patients did PCI appear to be responsible for progressive dementia. In the other seven patients (one with weakness in the arms and legs, one with transient left hemiparesis, two with hearing loss, and three with various visual disturbances), chemotherapeutic agents (mainly cisplatin and vincristine) and underlying diseases probably contributed significantly to the occurrence of these complications. In addition, these neurological disturbances were transient or ran a stable course and did not adversely affect the daily life of these patients. In comparison, amongst the 10 patients who did not receive PCI one had progressive dementia and another had hemiparesis secondary to probable brain embolism. We conclude that the use of PCI in these doses was effective in reducing the frequency of CNS metastases and had an adverse effect on the daily life and well-being only in a minority of the patients. Until results of controlled randomized studies show otherwise, PCI should continue to be used as a part of the combined modality treatment of completely responding patients with limited SCLC.