Pulling the lever in a hurry: the influence of impulsivity and sensitivity to reward on moral decision-making under time pressure.

BACKGROUND: Making timely moral decisions can save a life. However, literature on how moral decisions are made under time pressure reports conflicting results. Moreover, it is unclear whether and how moral choices under time pressure may be influenced by personality traits like impulsivity and sensitivity to reward and punishment. METHODS: To address these gaps, in this study we employed a moral dilemma task, manipulating decision time between participants: one group (N = 25) was subjected to time pressure (TP), with 8 s maximum time for response (including the reading time), the other (N = 28) was left free to take all the time to respond (noTP). We measured type of choice (utilitarian vs. non-utilitarian), decision times, self-reported unpleasantness and arousal during decision-making, and participants' impulsivity and BIS-BAS sensitivity. RESULTS: We found no group effect on the type of choice, suggesting that time pressure per se did not influence moral decisions. However, impulsivity affected the impact of time pressure, in that individuals with higher cognitive instability showed slower response times under no time constraint. In addition, higher sensitivity to reward predicted a higher proportion of utilitarian choices regardless of the time available for decision. CONCLUSIONS: Results are discussed within the dual-process theory of moral judgement, revealing that the impact of time pressure on moral decision-making might be more complex and multifaceted than expected, potentially interacting with a specific facet of attentional impulsivity.

Moral reasoning behind the veil of ignorance: An investigation into perspective-taking accessibility in the context of autonomous vehicles.

Perspective-taking (PT) accessibility has been recognized as an important factor in affecting moral reasoning, also playing a non-trivial role in moral investigation towards autonomous vehicles (AVs). A new proposal to deepen this effect leverages the principles of the veil of ignorance (VOI), as a moral reasoning device aimed to control self-interested decisions by limiting the access to specific perspectives and to potentially biased information. Throughout two studies, we deepen the role of VOI reasoning in the moral perception of AVs, disclosing personal and contingent information progressively throughout the experiment. With the use of the moral trilemma paradigm, two different VOI conditions were operationalized, inspired by the Original Position theory by John Rawls and the Equiprobability Model by John Harsanyi. Evidence suggests a significant role of VOI reasoning in affecting moral reasoning, which seems not independent from the order in which information is revealed. Coherently, a detrimental effect of self-involvement on utilitarian behaviours was detected. These results highlight the importance of considering PT accessibility and self-involvement when investigating moral attitudes towards AVs, since it can help the intelligibility of general concerns and hesitations towards this new technology.

Psychophysiological stress influences temporal accuracy.

Distortions of duration perception are often observed in response to highly arousing stimuli, but the exact mechanisms that evoke these variations are still under debate. Here, we investigate the effect of induced physiological arousal on time perception. Thirty-eight university students (22.89 ± 2.5; 28 females) were tested with spontaneous finger-tapping tasks and a time bisection task (with stimuli between 300 and 900 ms). Before the time bisection task, half of the participants (STRESS group) performed a stress-inducing task, i.e., the Paced Auditory Serial Addition Test (PASAT), whereas the other participants (CONTROL group) performed a control task, the Paced Auditory Number Reading Task (PANRAT). The PASAT induced a greater heart rate, but not electrodermal, increase, as well as a more unpleasant and arousing state compared to the PANRAT. Moreover, although the two groups presented a similar performance at the finger-tapping tasks, participants in the STRESS group showed better temporal performance at the time bisection task (i.e., lower constant error) than the controls. These results indicate that psychophysiological stress may alter the subsequent perception of time.

Efficacy of ICT-based interventions in improving psychological outcomes among older adults with MCI and dementia: A systematic review and meta-analysis.

The purpose of this systematic review and meta-analysis was to investigate empirical evidence about the effectiveness of Information and Communication Technology-based interventions (ICTs) on different psychological outcomes in adults aged over 60 years with Mild Cognitive Impairment (MCI) or dementia. We conducted a systematic search on Pubmed, Web of Science, Scopus, and PsycInfo with publication year between January 2010 up to April 2021. Any pre-post quantitative intervention study with at least one of the following domains examined: quality of life (QoL), psychological well-being, social interaction, engagement, mood, anxiety, stress, loneliness, self-efficacy, or self-esteem was included. The risk of bias and quality of evidence were assessed using tools based on the Cochrane Handbook for Systematic Review of Interventions criteria. Forty-eight studies with a total of 1488 participants met the selection criteria. Because of the high heterogeneity, we ran nine different random effects meta-analyses divided by outcome and type of cognitive decline which indicated that these treatments were ineffective overall, with some exceptions. Only anxiety (small effect size =-0.375 [-0.609; -0.140]) and behavioral symptoms (BS) (medium effect size =-0.585 [-1.019; -0.152]) in people with dementia (PwD) were found to change significantly. Moreover, effect sizes for QoL in dementia and for mood in people with MCI became significant when moderated by type of ICT, living situation, and experimental setting. In particular, Virtual Reality (VR) appeared to be more effective than other devices for both PwD and MCI, and nursing homes were found to be the best setting for administering these treatments. The trim and fill method found no evidence of publication bias in any of the 9 analyses. However, quality of evidence within (RoB 2, RoB 2 Crossover, ROBINS) and across (GRADE assessment) studies was low, thus these findings should be interpreted with caution. In general, ICT-based intervention can be considered a promising approach for improving anxiety and BS in PwD, and for improving QoL in PwD and mood in people with MCI, specifically when VR is used, when participants live in nursing homes, and when interventions are carried out in nursing homes.1.

Emotion regulation strategies differentially modulate neural activity across affective prediction stages: An HD-EEG investigation.

Emotion regulation (ER) strategies can influence how affective predictions are constructed by the brain (generation stage) to prearrange action (implementation stage) and update internal models according to incoming stimuli (updating stage). However, neurocomputational mechanisms by which this is achieved are unclear. We investigated through high-density EEG if different ER strategies (expressive suppression vs. cognitive reappraisal) predicted event-related potentials (ERPs) and brain source activity across affective prediction stages, as a function of contextual uncertainty. An S1-S2 paradigm with emotional faces and pictures as S1s and S2s was presented to 36 undergraduates. Contextual uncertainty was manipulated across three blocks with 100, 75, or 50% S1-S2 affective congruency. The effects of ER strategies, as assessed through the Emotion Regulation Questionnaire, on ERP and brain source activity were tested for each prediction stage through linear mixed-effects models. No ER strategy affected prediction generation. During implementation, in the 75% block, a higher tendency to suppress emotions predicted higher activity in the left supplementary motor area at 1,500-2,000 ms post-stimulus, and smaller amplitude of the Contingent Negative Variation at 2,000-2,500 ms. During updating, in the 75% block, a higher tendency to cognitively reappraise emotions predicted larger P2, Late Positive Potential, and right orbitofrontal cortex activity. These results suggest that both ER strategies interact with the levels of contextual uncertainty by differently modulating ERPs and source activity, and that different strategies are deployed in a moderately predictive context, supporting the efficient updating of affective predictive models only in the context in which model updating occurs.

Unbalanced functional connectivity at rest affects the ERP correlates of affective prediction in high intolerance of uncertainty individuals: A high density EEG investigation.

In a recent study we outlined the link between Intolerance of Uncertainty (IU) and the neural correlates of affective predictions, as constructed by the brain (generation stage) to prepare to relevant stimuli (implementation stage), and update predictive models according to incoming stimuli (updating stage). In this study we further explored whether the brain's functional organization at rest can modulate neural activity elicited within an emotional S1-S2 paradigm as a function of IU and uncertainty of S1-S2 contingencies. We computed resting state functional connectivity (RS-FC) from a 3-min resting period recorded with high density EEG, and we tested whether RS graph theory nodal measures (i.e., strength, clustering coefficient, betweenness centrality) predicted in-task ERP modulation as a function of IU. We found that RS-FC differently predicted in-task ERPs within the generation and updating stages. Higher IU levels were associated to altered RS-FC patterns within both domain-specific (i.e., right superior temporal sulcus) and domain-general regions (i.e., right orbitofrontal cortex), predictive of a reduced modulation of in-task ERPs in the generation and updating stages. This is presumably ascribable to an unbalancing between synchronization and integration within these regions, which may disrupt the exchange of information between top-down and bottom-up pathways. This altered RS-FC pattern may in turn result in the construction of less efficient affective predictions and a reduced ability to deal with contextual uncertainty in individuals high in IU.

Moral judgment, decision times and emotional salience of a new developed set of sacrificial manual driving dilemmas.

The growing interest in the subject of moral judgment in driver and autonomous vehicle behavior highlights the importance of investigating the suitability of sacrificial dilemmas as experimental tools in the context of traffic psychology. To this aim a set of validated sacrificial trolley problems and a new set of trolley-like driving dilemmas were compared through an online survey experiment, providing normative values for rates of participants' choices; decision times; evaluation of emotional valence and arousal experienced during the decision process; and ratings of the moral acceptability. Results showed that while both sets of dilemmas led to a more frequent selection of utilitarian outcomes, the driving-type dilemmas seemed to enhance faster decisions mainly based on the utilitarian moral code. No further differences were observed between the two sets, confirming the reliability of the moral dilemma tool in the investigation of moral driving behaviors. We suggest that as moral judgments and behaviors become more lifelike, the individual's moral inclination emerge more automatically and effectively. This new driving-type dilemma set may help researchers who work in traffic psychology and moral decision-making to approach the complex task of developing realistic moral scenarios more easily in the context of autonomous and nonautonomous transportation.

The role of repetitive transcranial magnetic stimulation (rTMS) in the treatment of behavioral addictions: Two case reports and review of the literature.

BACKGROUND: Several behaviors, besides consumption of psychoactive substances, produce short-term reward that may lead to persistent aberrant behavior despite adverse consequences. Growing evidence suggests that these behaviors warrant consideration as nonsubstance or "behavioral" addictions, such as pathological gambling, internet gaming disorder and internet addiction. CASE PRESENTATION: Here, we report two cases of behavioral addictions (BA), compulsive sexual behavior disorder for online porn use and internet gaming disorder. A 57-years-old male referred a loss of control over his online pornography use, started 15 years before, while a 21-years-old male university student reported an excessive online gaming activity undermining his academic productivity and social life. Both patients underwent a high-frequency repetitive transcranial magnetic stimulation (rTMS) protocol over the left dorsolateral prefrontal cortex (l-DLPFC) in a multidisciplinary therapeutic setting. A decrease of addictive symptoms and an improvement of executive control were observed in both cases. DISCUSSION: Starting from these clinical observations, we provide a systematic review of the literature suggesting that BAs share similar neurobiological mechanisms to those underlying substance use disorders (SUD). Moreover, we discuss whether neurocircuit-based interventions, such as rTMS, might represent a potential effective treatment for BAs.

Dealing with uncertainty: A high-density EEG investigation on how intolerance of uncertainty affects emotional predictions.

Intolerance of uncertainty (IU) can influence emotional predictions, constructed by the brain (generation stage) to prearrange action (implementation stage), and update internal models according to incoming stimuli (updating stage). However, neurocomputational mechanisms by which IU affects emotional predictions are unclear. This high-density EEG study investigated if IU predicted event-related potentials (ERPs) and brain sources activity developing along the stages of emotional predictions, as a function of contextual uncertainty. Thirty-six undergraduates underwent a S1-S2 paradigm, with emotional faces and pictures as S1s and S2s, respectively. Contextual uncertainty was manipulated across three blocks, each with 100%, 75%, or 50% S1-S2 emotional congruency. ERPs, brain sources and their relationship with IU scores were analyzed for each stage. IU did not affect prediction generation. During prediction implementation, higher IU predicted larger Contingent Negative Variation in the 75% block, and lower left anterior cingulate cortex and supplementary motor area activations. During prediction updating, as IU increased P2 to positive S2s decreased, along with P2 and Late Positive Potential in the 75% block, and right orbito-frontal cortex activity to emotional S2s. IU was therefore associated with altered uncertainty assessment and heightened attention deployment during implementation, and to uncertainty avoidance, reduced attention to safety cues and disrupted access to emotion regulation strategies during prediction updating.

A Retrospective Comparative Study in Patients With Cocaine Use Disorder Comorbid With Attention Deficit Hyperactivity Disorder Undergoing an rTMS Protocol Treatment.

Background: Adult attention-deficit/hyperactivity disorder (ADHD) is associated with high comorbidity with other psychiatric diseases, including cocaine use disorder (CocUD). Given the common fronto-striatal dysfunction, ADHD patients often use cocaine as self-medication for ameliorating symptoms by increasing striatal dopamine release. Yet, comorbidity with ADHD is related to poor treatment outcomes. CocUD has been treated with transcranial magnetic stimulation (TMS), but no studies investigated the outcomes in patients comorbid with ADHD. Methods: Twenty-two ADHD/CocUD and 208 CocUD-only participants received a high-frequency (15 Hz) rTMS treatment stimulating the left-DLPFC. We investigated whether both groups of patients shared similar demographic and clinical characteristics at baseline. Then, we monitored the effect of treatment testing for potential differences between groups. Results: At baseline demographic, toxicology and clinical features were not different between the two groups except for global severity index (GSI from SCL-90): patients of ADHD/CocUD group reported higher general symptomatology compared to the CocUD-only group. Concerning the effect of treatment, both groups significantly improved over time regarding cocaine use, craving, and other negative affect symptoms. No differences were observed between groups. Conclusions: To our knowledge, this is the first study comparing the demographic characterization and rTMS clinical improvements of patients with a dual diagnosis of ADHD and CocUD against CocUD-only patients. Cocaine use and common self-reported withdrawal/abstinence symptoms appear to benefit from rTMS treatment with no differences between groups. Future studies are needed to further investigate these preliminary results.

Romantic love affects emotional processing of love-unrelated stimuli: An EEG/ERP study using a love induction task.

The aim of the present study was to investigate (a) the neural correlates of a love induction task (LIT) including listening to love-related songs and thinking about the romantic relationship, and (b) the effects of romantic love on the emotional processing of love-unrelated stimuli during a passive viewing task. The EEG was recorded in two groups of university students: people in love (Love Group, LG, N = 22, 19 F) and people not in love (Control Group, CG, N = 20, 15 F). The LIT induced higher pleasantness and arousal in the LG than in the CG, as well as higher alpha activity in occipital-right electrodes, suggesting active mental imagery and internal focused attention. During the picture viewing task, the LG displayed larger N1 amplitudes than the CG in response to unpleasant pictures, and lower amplitudes of the late positive potential to both pleasant and unpleasant pictures at frontal sites. Overall, these results suggest an early attentional modulation of the neural responses to unpleasant, mood-incongruent cues, followed by an implicit emotional down-regulation of arousing stimuli, which might have important implications for everyday attitudes and behaviors.

What's next? Neural correlates of emotional predictions: A high-density EEG investigation.

Emotions were recently reconsidered as predictions, constructed by the brain (generation stage) to prearrange action (implementation stage), and update internal models according to incoming stimuli (updating stage). However, it is unclear how emotional predictions are shaped by stimuli predictability. This study investigated the role of stimuli predictability on emotional predictions through high-density EEG. Twenty-six undergraduates underwent a S1-S2 paradigm, with emotional faces as S1s and emotional pictures as S2s. Stimuli predictability was manipulated across three blocks, in which S1 valence was predictive of S2 in the 100%, 75%, or 50% of trials. ERPs and brain sources were analyzed for each stage. During prediction generation, a larger N170/superior temporal sulcus activity emerged to fearful faces in blocks with full (100%) and medium (75%) predictive ratios. During implementation, the random block (50%) elicited a valence-independent pre-allocation of resources, reflected by a larger CNV and activation of a wide left network. In the updating stage, emotional pictures always elicited a larger LPP, while a larger P2 to neutral stimuli and a higher activity of the orbitofrontal cortex signaled early valence-dependent and late block-dependent prediction errors. These findings provide the first evidence of how stimuli predictability shape each neurocomputational stage of emotional predictions construction.

Moral Decision-Making, Stress, and Social Cognition in Frontline Workers vs. Population Groups During the COVID-19 Pandemic: An Explorative Study.

On March 9, 2020, Italy has gone into "lockdown" because of COVID-19 pandemic, with a national quarantine. All non-essential working activities and schools of all levels have been temporarily closed: consequently, the entire population have been forced to dramatically change their daily habits. The pandemic raised important psychological, moral, social, and economic issues. Our research focused on the moral decision-making of people during an emergency. This paper reports two studies. The aim of Study 1 was to evaluate moral decision-making, level of perceived stress, ability of mentalizing and empathy in university students and Italian workers. 224 front-line workers (FLW), 413 second-line workers (SLW), and 663 university students (US), during Italian Phase 1 of lockdown, completed an online questionnaire. The results of Study 1 showed that participants in the FLW group are more likely to choose utilitarian solutions and judge as morally acceptable actions finalized to saving lives of more people if this requires sacrificing a low number of individuals. At the same time, decision-making was experienced as less unpleasant and less arousing with respect to the other two groups, demonstrating a greater ability to keep emotional control under pressure. In Study 2, we compared the same variables used in Study 1, selecting two professional categories from the FLW group engaged in emergency during COVID-19, namely healthcare providers (n = 82) and public safety personnel (n = 117). Our results showed that healthcare providers were more stressed and emotionally involved than public safety personnel, with higher empathic concern and arousal in moral decision-making. We suggest it is essential providing immediate psychological support and monitoring physical and emotional well-being for workers in the front-line during emergencies like the COVID-19 pandemic, in order to prevent experiences of moral distress or mental health problems.

Comparing the effect of daytime sleep and wakefulness on mnemonic discrimination.

Sleep is considered the optimal state to consolidate hippocampal-dependent memories. A particular memory process is mnemonic discrimination. Mnemonic discrimination refers to the ability to differentiate between novel and previously encountered information. Previous studies have found that mnemonic discrimination is impaired by sleep deprivation, whereas nocturnal sleep seems to protect memory representations when compared to a similar period of wakefulness. In this study we tested whether a daytime nap can facilitate mnemonic discrimination as assessed by the Mnemonic Similarity Task. Thirty-eight participants performed incidental learning of 256 images of unique everyday items at about 12:00 PM. Fifteen minutes later, in a recognition test, they were presented with 192 images: 64 targets (Old), 64 foils (New) and 64 lures (Similar to targets). For each image they had to decide whether it was already presented, never presented, or similar to an image presented during the encoding session. Then participants were split into a Nap group (N=19), who had a 90-min nap opportunity in the lab, and a Wake group (N=19), who stayed in the lab playing a low-arousing game. At 3:00 PM all participants performed a delayed recognition test, similar to the immediate test but with different images. Similar memory discrimination was observed in both the Nap and Wake group. The lack of a beneficial effect of sleep could be due to the differences between diurnal and nocturnal sleep and/or the potential role of videogames in facilitating memory discrimination during wakefulness.

Sleep quality and quantity in Italian University students: an actigraphic study.

According to international recommendations, young adults should sleep at least 7 h per night and experience good sleep quality to avoid physical and mental health problems. University students are particularly exposed to the risk of sleep issues due to their tendency to go to bed late at night and other social and environmental factors. Here, we aimed to objectively characterize the weekly sleep habits using actigraphy (in terms of quantity, quality, and timing) in 82 Italian university students (mean age = 23.89, SD = 2.51 yrs, 44 women). Exploratory analyses were performed using linear mixed-effect regression to account for several factors (e.g., gender, circadian preferences, depressive symptomatology). We showed that participants spent in bed (TIB) about 7 h and 31 min during weekdays and 7 h and 46 min during the weekend, with 76.83% of the sample showing a TIB longer than 7 h. Women students spent more time in bed than men (~25 min) and went to bed earlier (~29 min). One-third of the sample showed a sleep efficiency <85%, whereas 70.73% of the sample showed a wake after sleep onset >40 min, with no differences between men and women. Depressive symptoms, alcohol and coffee consumption affected sleep onset latency, whereas circadian preference was strongly associated with bed and waketime. Moreover, most of the students did not take daytime naps to catch-up with sleep loss. Overall, our sample spent adequate time in bed, but they experienced a moderate low sleep quality, mainly due to high wake after sleep onset.

Electrophysiological correlates of attentional monitoring during a complex driving simulation task.

Starting from the evidence that complex tasks (e.g., driving) require lots of cognitive resources, this research aims at assessing the change of attentional electrophysiological correlates during an oddball task performed while driving a simulator. Twenty-four participants drove along six courses on a moped simulator, preceded by a baseline condition (i.e., watching a video clip of one driving course). Throughout the task, an auditory passive multi-feature oddball with both traffic-related and unrelated stimuli was presented, and the EEG activity was recorded along with driving performance indexes. The main results point out that, as participants learn to drive safely, more attentional resources are available to process the deviant oddball stimuli, as shown by the increase in the amplitude of mismatch negativity (deviant pure tones) and P3a (traffic-related sounds) in the second block of driving. We interpreted these effects as dependent on stimuli complexity and salience.

A genetic profile of oxytocin receptor improves moral acceptability of outcome-maximizing harm in male insurance brokers.

In recent years, conflicting findings have been reported in the scientific literature about the influence of dopaminergic, serotonergic and oxytocinergic gene variants on moral behavior. Here, we utilized a moral judgment paradigm to test the potential effects on moral choices of three polymorphisms of the Oxytocin receptor (OXTR): rs53576, rs2268498 and rs1042770. We analyzed the influence of each single polymorphism and of genetic profiles obtained by different combinations of their genotypes in a sample of male insurance brokers (n = 129), as compared to control males (n = 109). Insurance brokers resulted significantly more oriented to maximize outcomes than control males, thus they expressed more than controls the utilitarian attitude phenotype. When analyzed individually, none of the selected variants influenced the responses to moral dilemmas. In contrast, a composite genetic profile that potentially increases OXTR activity was associated with higher moral acceptability in brokers. We hypothesize that this genetic profile promotes outcome-maximizing behavior in brokers by focusing their attention on what represents a greater good, that is, saving the highest number of people, even though at the cost of sacrificing one individual. Our data suggest that investigations in a sample that most expresses the phenotype of interest, combined with the analysis of composite genetic profiles rather than individual variants, represent a promising strategy to find out weak genetic influences on complex phenotypes, such as moral behavior.

Sleep quality improves during treatment with repetitive transcranial magnetic stimulation (rTMS) in patients with cocaine use disorder: a retrospective observational study.

BACKGROUND: Sleep disturbance is a prominent and common complaint in people with cocaine use disorder (CUD), either during intake or withdrawal. Repetitive transcranial magnetic stimulation (rTMS) has shown promise as a treatment for CUD. Thus, we evaluated the relationship between self-perceived sleep quality and cocaine use pattern variables in outpatients with CUD undergoing an rTMS protocol targeted at the left dorsolateral prefrontal cortex. METHODS: This is a retrospective observational study including 87 patients diagnosed with CUD according to the DSM-5 criteria. Scores in Pittsburgh Sleep Quality Index (PSQI), Cocaine Craving Questionnaire (CCQ), Beck Depression Inventory-II (BDI-II), Self-rating Anxiety Scale (SAS), and Symptoms checklist 90-Revised (outcome used: Global Severity Index, GSI) were recorded at baseline, and after 5, 30, 60, and 90 days of rTMS treatment. Cocaine use was assessed by self-report and regular urine screens. RESULTS: Sleep disturbances (PSQI scores > 5) were common in patients at baseline (mean ± SD; PSQI score baseline: 9.24 ± 3.89; PSQI > 5 in 88.5% of patients). PSQI scores significantly improved after rTMS treatment (PSQI score Day 90: 6.12 ± 3.32). Significant and consistent improvements were also seen in craving and in negative-affect symptoms compared to baseline. Considering the lack of a control group, in order to help the conceptualization of the outcomes, we compared the results to a wait-list group (n = 10). No significant improvements were observed in the wait-list group in any of the outcome measures. CONCLUSIONS: The present findings support the therapeutic role of rTMS interventions for reducing cocaine use and accompanying symptoms such as sleep disturbance and negative-affect symptoms. TRIAL REGISTRATION: ClinicalTrials.gov.NCT03733821.

Long-Term Outcome of Repetitive Transcranial Magnetic Stimulation in a Large Cohort of Patients With Cocaine-Use Disorder: An Observational Study.

Background: Cocaine is a psychostimulant drug used as performance enhancer throughout history. The prolonged use of cocaine is associated with addiction and a broad range of cognitive deficits. Currently, there are no medications proven to be effective for cocaine-use disorder (CocUD). Previous preliminary clinical work suggests some benefit from repetitive transcranial magnetic stimulation (rTMS) stimulating the prefrontal cortex (PFC), involved in inhibitory cognitive control, decision-making and attention. All published studies to date have been limited by small sample sizes and short follow-up times. Methods: This is a retrospective observational study of 284 outpatients (of whom 268 were men) meeting DSM-5 criteria for CocUD. At treatment entry, most were using cocaine every day or several times per week. All patients underwent 3 months of rTMS and were followed for up to 2 years, 8 months. Self-report, reports by family or significant others and regular urine screens were used to assess drug use. Results: Median time to the first lapse (resumption of cocaine use) since the beginning of treatment was 91 days. For most patients, TMS was re-administered weekly, then monthly, throughout follow-up. The decrease in frequency of rTMS sessions was not accompanied by an increase in lapses to cocaine use. Mean frequency of cocaine use was <1·0 day/month (median 0), while serious rTMS-related adverse events were infrequent, consistent with published reports from smaller studies. Conclusions: This is the first follow-up study to show that rTMS treatment is accompanied by long-lasting reductions in cocaine use in a large cohort.

Sensors Capabilities, Performance, and Use of Consumer Sleep Technology.

Sleep is crucial for the proper functioning of bodily systems and for cognitive and emotional processing. Evidence indicates that sleep is vital for health, well-being, mood, and performance. Consumer sleep technologies (CSTs), such as multisensory wearable devices, have brought attention to sleep and there is growing interest in using CSTs in research and clinical applications. This article reviews how CSTs can process information about sleep, physiology, and environment. The growing number of sensors in wearable devices and the meaning of the data collected are reviewed. CSTs have the potential to provide opportunities to measure sleep and sleep-related physiology on a large scale.