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Spontaneous and intentional pattern switching in a multisegmental bimanual coordination task.

Two experiments required right-handed subjects to trace circular trajectories while complying with either a symmetric or asymmetric pattern. In symmetric patterns, circles were traced in a mirror image either inward or outward. In asymmetric patterns, circles were traced in the same direction either clockwise or counterclockwise. Subjects were instructed to trace with spatial accuracy while maintaining a strict temporal relationship to a metronome that scaled movement rates from 1.25 to 3 Hz. The symmetric patterns were more stable than asymmetric patterns; the circularity of trajectories was greater for the dominant side; and there were spontaneous reversals in the direction of circling in the nondominant limb when performing asymmetric patterns. The second experiment examined the same subjects under the instruction of intentionally changing the pattern by reversing the left or right limb circling direction when cued to do so. The degree of interlimb interference was highly asymmetric and contingent on the direction of pattern change. Intentional direction reversals were more expedient and with less disruption to the contralateral limb when asymmetric to symmetric pattern changes were effected through a reversal in the direction of nondominant side. The results are interpreted with reference to evidence that the supplementary motor area mediates descending input to the upper limbs during disparate bimanual actions, but not during symmetric actions.

Adult↗

Stability of bimanual coordination in Parkinson's disease and cognitive modulation of intention.

The functional integrity of the bimanual neuro-motor system of Parkinson's disease (PD) subjects (stageII) compared to controls (2 x n = 16) was evaluated by measures of coordination stability of tapping in in-phase, anti-phase, and 90 degrees-phase. Recently, intentional influence was modeled as an additive attractor function on the intrinsic dynamics, resulting in predictions tested by Scholz and Kelso (1990). In this study, the intentional influence was modulated by attaching cognitive meaning to the rhythmical pattern, which was expected to enhance the stability of coordination and, if effective, might be profitable to PD patients. Half of the PD subjects significantly lacked stability. They were less stable than controls, lost coordination at lower frequencies, and needed more time to switch between phase patterns. The reduction of stability was reflected in the progression of the disease. Cognitive meaning reduced variability of the single-hands but not of relative phase, and no effect on switching time was found. The results suggest a weaker coupling strength between the limbs in PD patients lacking stability.

Attention↗

Survival following intentional massive overdose of 'Ecstasy'.

A case of intentional overdose with 18 'Ecstasy' tablets is described. 'Ecstasy' is a semi-synthetic hallucinogenic amphetamine and acute adverse reactions follow from the effects of sympathetic stimulation. To our knowledge this is the first reported case of massive intentional overdose reported in the literature.

Adult↗

The appropriateness of intention to treat decisions for invasive therapy in coronary artery disease in The Netherlands.

OBJECTIVE: To determine the appropriateness of intention to treat decisions concerning coronary artery bypass grafting (CABG) and percutaneous transluminal coronary angioplasty (PTCA) for patients with coronary artery disease in The Netherlands. DESIGN: Prospective study of intention to treat decisions using a computerised expert system. SETTING: "Presentation" sessions in 10 tertiary referral heart centres in 1992. PATIENTS: 3207 consecutive patients: 1618 CABG and 1589 PTCA candidates. MAIN OUTCOME MEASURE: Percentage of invasive treatment decisions rated appropriate, uncertain, or inappropriate by the expert system. RESULTS: PTCA decisions were common for patients with one-vessel disease and CABG decisions for patients with three-vessel and left main disease. PTCA decisions outnumbered CABG decisions in acute myocardial infarction. Of CABG decisions, 84% were rated appropriate, 12% uncertain, and 4% inappropriate. The proportions for PTCA decisions were 39% appropriate, 31% uncertain, and 29% inappropriate. Type C lesion was the main determinant of inappropriateness of PTCA decisions. If type C lesions were downgraded to type A/B lesions the rate of inappropriate PTCA decisions dropped to 6%. CONCLUSIONS: Clinicians in tertiary referral centres in The Netherlands favoured CABG if vessel disease was extensive or involved the left main artery, and PTCA for patients with less extensive disease and with acute myocardial infarction. Few CABG decisions were inappropriate. The main determinant of inappropriateness of PTCA decisions was its intended use in patients with type C lesions.

Aged↗

Effects of peripheral cooling on intention tremor in multiple sclerosis.

OBJECTIVE: To investigate the effect of peripheral sustained cooling on intention tremor in patients with multiple sclerosis (MS). MS induced upper limb intention tremor affects many functional activities and is extremely difficult to treat.Materials/ METHODS: Deep (18 degrees C) and moderate (25 degrees C) cooling interventions were applied for 15 minutes to 23 and 11 tremor arms of patients with MS, respectively. Deep and moderate cooling reduced skin temperature at the elbow by 13.5 degrees C and 7 degrees C, respectively. Evaluations of physiological variables, the finger tapping test, and a wrist step tracking task were performed before and up to 30 minutes after cooling. RESULTS: The heart rate and the central body temperature remained unchanged throughout. Both cooling interventions reduced overall tremor amplitude and frequency proportional to cooling intensity. Tremor reduction persisted during the 30 minute post cooling evaluation period. Nerve conduction velocity was decreased after deep cooling, but this does not fully explain the reduction in tremor amplitude or the effects of moderate cooling. Cooling did not substantially hamper voluntary movement control required for accurate performance of the step tracking task. However, changes in the mechanical properties of muscles may have contributed to the tremor amplitude reduction. CONCLUSIONS: Cooling induced tremor reduction is probably caused by a combination of decreased nerve conduction velocity, changed muscle properties, and reduced muscle spindle activity. Tremor reduction is thought to relate to decreased long loop stretch reflexes, because muscle spindle discharge is temperature dependent. These findings are clinically important because applying peripheral cooling might enable patients to perform functional activities more efficiently.

Activities of Daily Living↗

Intention tremor--a method of measurement.

A method of measuring and analysing intention tremor using a linear accelerometer is described. Reasons are given for measuring this particular parameter of the tremor, for using this specific energy conversion device, and for employing the particular form of analysis. A comparison of the numerical values obtained for the amount of tremor activity, compared with a corresponding clinical grading, is made for 30 patients with intention tremor due to a variety of pathological causes. It is shown that the method gives clear correlation with the clinical assessments, although certain discrepancies are noted, and their importance discussed.

Acceleration↗

Intentional maps in posterior parietal cortex.

The posterior parietal cortex (PPC), historically believed to be a sensory structure, is now viewed as an area important for sensory-motor integration. Among its functions is the forming of intentions, that is, high-level cognitive plans for movement. There is a map of intentions within the PPC, with different subregions dedicated to the planning of eye movements, reaching movements, and grasping movements. These areas appear to be specialized for the multisensory integration and coordinate transformations required to convert sensory input to motor output. In several subregions of the PPC, these operations are facilitated by the use of a common distributed space representation that is independent of both sensory input and motor output. Attention and learning effects are also evident in the PPC. However, these effects may be general to cortex and operate in the PPC in the context of sensory-motor transformations.

Animals↗

Gap effect in reflexive and intentional prosaccades.

The analysis of saccadic eye movements has assumed an important role as a pathophysiological approach in neuropsychiatric diseases. However, before abnormal cognitive saccade behavior can be fully understood, some basic psychophysiological aspects have to be further investigated. Previous studies have demonstrated a shortening of saccade latency when the fixation stimulus was removed prior to the appearance of a peripheral visual target. This gap effect is smaller for antisaccades (AS; away from the target) than for reflexive saccades (RS; towards the target). Apart from the generation of an intentional eye movement, AS rely on different processes including reflex inhibition and spatial reversal of the saccade direction. We wondered whether intentional prosaccades (IpS) that do not rely on these additional processes also show a reduced gap effect. Therefore, we compared the gap effect in a saccade paradigm for RS and IpS in healthy subjects. We found a smaller gap effect in IpS than in RS and suggest that this reduction reflects endogenous strategic processes. Our findings further imply that reflex inhibition is not the unique cause for the smaller gap effect in AS than in RS and suggest that an endogenous component may be involved. We hypothesize that frontal control on the superior colliculus fixation cell activity may continue even after the fixation stimulus has disappeared, thus inhibiting a fixation offset and reducing the gap effect.

Aged↗

Microelectrode recording for the somatotopic placement of stereotactic thalamic lesions in the treatment of parkinsonian and cerebellar intention tremor.

Patients with parkinsonian tremor and rigidity and cerebellar intention tremor can be effectively treated with thalamic lesions provided that an accurate neurophysiologic method is employed to compensate for individual spatial variability of subcortical structures. The method described employs a technique of microelectrode recording in which the homuncular organization in ventralis posterior is explored and gives information as to the ideal laterality of lateral thalamic nuclear mass lesions for the treatment of tremor. This procedure has been used in 11 patients, 9 with Parkinson's disease and 2 with cerebellar intention tremor with good results and no complications to date.

Cerebellar Diseases↗

Present state of intentional hemodilution.

Preoperative intentional hemodilution is induced by isovolemic exchange of whole blood with colloid solutions in order to gain autologous blood while maintaining normovolemia. The basic mechanism that compensates for the fall of oxygen capacity of the diluted blood is the rise in cardiac output, and organ blood flow, factors that result from the improved fluidity of blood at lower hematocrits. Normal tissues maintain adequate oxygenation during hemodilution through the enhanced redistribution of blood. In ischemic tissues this effect is enhanced, and causes an increase in the oxygenation of ischemic tissues. Limited preoperative and intraoperative hemodilution are alternatives to donor blood transfusion in patients undergoing elective surgery. In shock patients the hemodilution achieved with red cell free primary volume substitutes is an effective treatment for shock-induced microcirculatory disorders; furthermore, intentional hemodilution is the most effectual hemorheological therapy for the treatment of ischemic disease.

Animals↗

National trends in hospitalization of youth with intentional self-inflicted injuries.

OBJECTIVE: The authors examined national trends from 1990 to 2000 in the utilization of community hospital inpatient services by young people (5-20 years of age) with intentional self-inflicted injuries. METHOD: Discharge abstracts from a nationally representative sample of community hospitals were analyzed, with a focus on youth discharges (N=10,831) with a diagnosis of intentional self-inflicted injury (ICD-9-CM: E950-E959). Census data were used to derive national population-based rates of self-inflicted injuries requiring inpatient treatment. Overall population-based trends in hospitalizations for self-inflicted injury were calculated and stratified by gender and age. Among youths hospitalized with a self-inflicted injury, trends were also calculated for length of stay, inpatient costs, method of injury, and associated mental disorder diagnoses. RESULTS: The annual hospitalization rate of youths with self-inflicted injuries declined from 49.1 per 100,000 in 1990 to 44.9 per 100,000 in 2000, and the mean length of inpatient stay significantly declined from 3.6 days to 2.7 days. Among the hospitalized patients, there were increases in the rate of cutting (4.3% to 13.2%) and ingestion of acetaminophen (22.1% to 26.9%), antidepressants (10.0% to 14.0%), and opiates (2.3% to 3.3%) as a cause of injury, whereas there were decreases in the ingestion of salicylates (14.9% to 10.2%) and barbiturates (1.5% to 0.7%). There were significant increases in the proportion of subjects with primary mental disorder discharge diagnoses of depressive disorder (29.2% to 46.0%), bipolar disorder (1.3% to 8.2%), and substance use disorder (5.4% to 10.7%) and significant decreases in the rate of adjustment disorders (22.2% to 11.4%) and nonmental disorders (31.9% to 13.6%). After excluding cutting, which may be more closely related to self-mutilation than suicidal self-injury, the annual hospitalization rate of youths with self-inflicted injuries declined from 47.2 per 100,000 in 1990 to 39.4 per 100,000 in 2000. CONCLUSIONS: Over the decade of study, young people admitted to community hospitals with self-inflicted injuries tended to have more severe psychiatric diagnoses and to be treated during shorter inpatient stays. These trends suggest that the role of youth inpatient care has narrowed, becoming focused on those with severe psychiatric disorders.

Adolescent↗

Alteration of intention and self-initiated action associated with bilateral anterior cingulotomy.

Neuropsychological manifestations of bilateral anterior cingulate cortex lesions were studied in patients treated with cingulotomy for chronic intractable pain. Cingulotomy patients more than 1 year postsurgery were contrasted with nonsurgical chronic pain patients. Patients were assessed on a neuropsychological battery, including measures of response intention, initiation, generation, and persistence. Cingulotomy patients were intact across most cognitive domains, but they showed deficits of focused and sustained attention as well as mild executive dysfunction. Self-initiated responding--including spontaneous verbal utterances and unstructured design fluency--was most impaired. Results indicate that the greatest impact of cingulotomy lesions is on response intention and self-initiated behavior, with reduced behavioral spontaneity.

Adult↗

Intention to practice primary care by pediatric residents: nature or nurture?

Factors associated with the intention to practice primary care were examined in a survey of a national sample of PL-2 residents (n = 98). Socioemotional orientation (nature), faculty and peer encouragement (nurture), and clinical experiences during residency (nurture) were independently associated with a primary care career choice. For residents who changed career intentions to primary care from a nonprimary care preference, gender, encouragement by faculty and peers, and outpatient experiences during residency were associated with the change. Encouragement by both faculty and peers had the strongest influence on primary care career choice for all residents.

Emotions↗

Comprehending speaker intent in rebuttal analogy use: the role of irony mapping, absurdity comparison and argumentative convention.

Rebuttal analogies (e.g., "Politicians arguing over the renaming of an airport is like watering your petunias when your house is on fire") are commonly used as responses in verbal conflicts. The following study investigated the role that irony mapping, absurdity comparison, and argumentative convention play in interpreters' derivations of speaker's intentions in using rebuttal analogies. In general, these intentions are to demonstrate the unsoundness of the opposed proposition ("argument") and its advocate ("social attack"), (Whaley & Holloway, 1996). Three rebuttal analogy types were rated on argumentativeness and social attack in verbal conflict and nonverbal conflict scenarios. The results of six experiments on 120 participants found that analogies with ironic bases (e.g., "Doubling the defense budget in order to intimidate North Korea is like using a chainsaw to file your nails") were perceived as more of a social attack and as more argumentative than analogies with absurd (e.g., "... using ketchup to wax your car") and nonironic (e.g., "... using a nailfile to file your nails") bases. No difference was found between the two scenario types. Norming data confirmed equivalence of absurdity of ironic and absurd bases, and greater irony of ironic over absurd bases. The results thus implicate hearers' use of the ironic structure between bases and targets in the interpretation of rebuttal analogies rather than mere absurdity comparison or argumentative convention.

Adult↗

Skilled Hong Kong immigrants' intention to repatriate.

"An emphasis on skills in Australian immigration policy in the past decade has led to the increase of highly skilled Hong Kong immigrants. However, Australia has not been able to retain all of them.... This paper reports the results of an in-depth study on intention to repatriate and work in Hong Kong, conducted in Australia with 111 professional and managerial Hong Kong immigrants. Correlational and loglinear analyses on prediction of such an intention are presented. Research findings on the career-family dilemma experienced by a number of immigrants are likewise discussed."

Asia↗

Parenteral drug products containing aluminum as an ingredient or a contaminant: response to Food and Drug Administration notice of intent and request for information. ASCN/A.S.P.E.N. Working Group on Standards for Aluminum Content of Parenteral Nutrition Solutions.

Aluminum remains a significant contaminant of total parenteral nutrition (TPN) solutions and may be elevated in bone, urine, and plasma of infants receiving TPN. Aluminum accumulation in tissues of uremic patients and adult TPN patients has been associated with low-turnover bone disease. Furthermore, aluminum has also been linked with encephalopathy and anemia in uremic patients and with hepatic cholestasis in experimental animals. Because of the toxic effects of aluminum, the Food and Drug Administration (FDA) recently published a notice of intent to set an upper limit of 25 micrograms/L for aluminum in large-volume parenterals and to require manufacturers of small-volume parenterals, such as calcium and phosphate salts, to measure aluminum content and note this content on the package label. The ASCN/A.S.P.E.N. Working Group on Standards for Aluminum Content of Parenteral Nutrition Solutions supports these intentions and further urges the FDA to require that cumulative aluminum intake in terms of safe, unsafe, and toxic quantities of aluminum per kilogram be made known to physicians and pharmacists preparing the TPN solutions, to ensure that manufacturers use appropriate control procedures in aluminum measurements, and to employ a standard unit of aluminum measurement.

Adult↗

Impact of direct mail intervention on knowledge, attitudes, and behavioral intentions regarding use of emergency medical services for symptoms of acute myocardial infarction.

This study evaluated a direct mail intervention called the "Call Fast, Call 911" campaign designed to increase use of emergency medical services for symptoms of acute myocardial infarction. The campaign was targeted at individuals over the age of 50. Persons over 50 years of age (N = 130,000) in King County, Washington, were randomly assigned to intervention or control groups. Individuals in the intervention groups received six direct mail pieces over a 1-year period encouraging them to call 911 quickly in response to chest pain. A postintervention telephone survey of a random sample of households (N = 434) assessed the impact of the campaign on knowledge, attitudes, and behavioral intentions regarding use of emergency medical services for symptoms of acute myocardial infarction. The results showed no significant differences between intervention and control groups in terms of knowledge of AMI. However, there were significant differences in beliefs and behavioral intentions to call 911 in a cardiac emergency.

Aged↗

Breastfeeding attitudes, intention, and initiation in low-income women: the effect of the best start program.

This study compared breastfeeding attitudes, intention, and initiation among low-income women exposed or not exposed to the Best Start program. A between- (experimental vs control group) and within-factor (pretest vs posttest) repeated measures design was employed. A nonprobability sample of 54 subjects was randomly assigned to a control group (n = 28) or an experimental group (n = 26). Using the Breastfeeding Attrition Prediction Tool, statistically significant group by time interaction effects were found for negative breastfeeding sentiment, positive breastfeeding sentiment, and breastfeeding control scales. Compared to the control group, the experimental group had significantly increased positive breastfeeding sentiment (P <.01), decreased negative breastfeeding sentiment (P <.01), and increased breastfeeding control (P <.01) from pretest to posttest. Following exposure to the Best Start program, subjects in the experimental group showed statistically significantly higher breastfeeding intention and initiation than did those in the control group. Practical implications are discussed.

Adult↗