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PubMed1983

Right hemispheric specialization for mental imagery: a review of the evidence.

An implicit assumption in the literature on functional hemispheric asymmetry is that the right hemisphere plays a special role in mental imagery. Using a definition of mental imagery as quasi-perceptual experience, we draw distinctions among visual imagery, visual recognition memory, and visuospatial abilities. We then review the research literature to evaluate the hypothesis that mental imagery is a specialized function of the right cerebral hemisphere, and find that it receives little unambiguous support. Case reports of loss of imagery are no more frequent with right than with left unilateral brain damage. Systematic studies of brain-injured patients provide some support for the hypothesis, but are also consistent with the alternative hypothesis of bilateral representation of imagery. Commissurotomized patients report dreaming and being able to form visual images. Behavioral and psychophysiological studies of non-brain-injured patients either fail to provide evidence in favor of the hypothesis or can be interpreted as compatible with the alternate hypothesis of bilateral hemispheric involvement in imagery. We conclude that there is, presently, insufficient empirical basis for considering imagery a right hemispheric function. We then discuss implications of this conclusion for future research.

Brain Injuries↗
PubMed1985

The statistical interaction of cerebral specialization and integration in the interpretation of dynamic brain images.

Two constructs of brain function, namely cerebral specialization and integration, have been examined in the analysis of blood flow and metabolic function resulting from dynamic imaging procedures. The purpose of the current paper is to illustrate the interaction of these two constructs at the statistical level. Because of the statistical interaction, it is argued that the currently accepted statistical evidence for cerebral specialization is, in fact, partially a function of the degree of regional cerebral integration. Therefore, found asymmetries of flow or rate may be solely a function of cerebral integration. These points are discussed with respect to developing a better understanding of stimulus/brain/behavior relations.

Blood Glucose↗
PubMed1984

Structural specializations in cat of chronically demyelinated spinal cord axons as seen in freeze-fracture replicas.

Axons in chronically demyelinated spinal cord lesions, induced by ethidium bromide injection, display patches of intramembranous particles and indentations resembling nodal and paranodal axolemmal specializations respectively. Both occur in the marginal region of the lesions where the demyelinated axons are intimately associated with astrocytic and oligodendrocytic processes, and probably correspond to the aberrant node-like and paranodal junctional complexes seen in thin sections of this region. Demyelinated axons in the center of the lesion, which are not in contact with glial processes, do not display these membrane specializations.

Animals↗
PubMed1984

Regional specialization of the quail retina: ganglion cell density and oil droplet distribution.

The ganglion cell density of the quail's retina was studied in sections and whole mounts. Two regions of high ganglion cell density were found, corresponding to an afoveate area centralis and an area dorsalis. Oil droplets were found to be isotropically distributed throughout the retina. It is proposed that the significance of such retinal regional specialization, in comparison to similar studies in the pigeon and the chick, is that regional specialization in the avian retina is more closely related to feeding habits than to phylogenetic descendence.

Animals↗
PubMed1987

Membrane specializations and extracellular material associated with host astrocytes in peripheral neural transplants.

The work of Aguayo and colleagues [Aguayo, David and Bray (1981) J. Exp. Biol. 95, 231-240] demonstrates that grafts of peripheral neural tissue are able to induce regenerative elongation of cut axons in the adult central nervous system. Elucidation of the mechanism of this response requires an understanding of the cellular interactions induced by these types of transplant. In previous studies [Zhou, Lawrence, Morris and Raisman (1986) Neuroscience 17, 815-827; Zhou, Lindsay, Lawrence and Raisman (1986) Neuroscience 17, 803-813] we have transplanted decapsulated adult superior cervical sympathetic ganglia or nodose ganglia into either the septal nuclei or the choroid fissure of adult syngeneic rat hosts. We found that host astrocytes invade the transplants along Schwann cell fascicles and around blood vessels. This raises the questions of what form the migrating astrocytes take, what routes they follow, and what is their fate. In the present study we have taken advantage of the fact that at longer survivals astrocytes accumulate as "paravascular cuffs", and we show that they have several specialized ultrastructural features, such as plasmalemmal caveolae, desmosomes, hemidesmosomes and accumulations of extracellular material. The specific stimuli inducing (or enhancing) these astrocytic specializations and their significance in relation to the wider morphogenetic events induced by peripheral neural transplants remain to be elucidated. However, the observations are further evidence of the remarkable mobility and plasticity of central astrocytes in transplantation situations, and in particular emphasize the involvement of the cell surface and its relationship to extracellular matrix.

Animals↗
PubMed1992

The endoplasmic reticulum of Purkinje neuron body and dendrites: molecular identity and specializations for Ca2+ transport.

Immunofluorescence and immunogold labeling, together with sucrose gradient separation and Western blot analysis of microsomal subfractions, were employed in parallel to probe the endoplasmic reticulum in the cell body and dendrites of rat cerebellar Purkinje neurons. Two markers, previously investigated in non-nerve cells, the membrane protein p91 (calnexin) and the lumenal protein BiP, were found to be highly expressed and widely distributed to the various endoplasmic reticulum sections of Purkinje neurons, from the cell body to dendrites and dendritic spines. An antibody (denominated anti-rough-surfaced endoplasmic reticulum), which recognized two membrane proteins, p14 and p40, revealed a similar immunogold labeling pattern. However, centrifugation results consistent with a widespread distribution were obtained for p14 only, while p40 was concentrated in the rough microsome-enriched subfractions. The areas enriched in the inositol 1,4,5-triphosphate receptor and thus presumably specialized in Ca2+ transport (stacks of multiple smooth-surfaced cisternae; the dendritic spine apparatus) also exhibited labeling for BiP and p91, and were positive for the anti-rough-surfaced endoplasmic reticulum antibody (presumably via the p14 antigen). Additional antibodies, that yielded inadequate immunocytochemical signals, were employed only by Western blotting of the microsomal subfractions, while the ryanodine receptor was studied by specific binding. The latter receptor and the Ca2+ ATPase, known in other species to be concentrated in Purkinje neurons, exhibited bimodal distributions with a peak in the light and another in the heavy subfractions. A similar distribution was also observed with another lumenal protein, protein disulfide isomerase. Taken as a whole, the results that we have obtained suggest the existence in the endoplasmic reticulum of Purkinje neurons of two levels of organization; the first identified by widespread, probably general markers (BiP, p91, possibly p14 and others), the second by specialization markers, such as the inositol 1,4,5-triphosphate receptor and, possibly, p40, which appear restricted to areas where specific functions appear to be localized.

Animals↗
PubMed1995

Intra-arterial 90Y brachytherapy: preliminary dosimetric study using a specially modified angioplasty balloon.

PURPOSE: Irradiation has been shown to be effective in preventing restenosis after dilatation in human peripheral arteries. We have developed a dedicated system for coronary intraarterial irradiation using a 90Y pure beta-emitting source inside a specially modified angioplasty balloon. This paper presents a preliminary dosimetric evaluation of this system. METHODS AND MATERIALS: Specially fabricated titanium-covered and activated yttrium wires (outer diameter 0.32 mm) were used for these studies. Dosimetry was performed using small thermoluminescent dosimeters (TLDs) placed on the surface of the 2-cm long angioplasty balloons, inflated with contrast medium to a diameter of 2.5, 3, 3.5, and 4 mm. Radioactive 90Y wires were left in the inner balloon catheter and the surface dose rate was measured and extrapolated to 72 h after activation to allow a comparison between the values obtained. After observing the poor centering of the source within the standard angioplasty balloon, a new centering balloon was developed. A conventional balloon was subdivided into four evenly spaced interconnecting chambers, thus assuring adequate centering of the inner catheter. Thermoluminescent dosimetric measurements were performed with a 3.5 mm centering balloon to evaluate the homogeneity of the surface doses compared to those measured with the conventional balloon. RESULTS: Thermoluminescent dosimetric measurements using the standard balloons filled with contrast medium were plotted semilogarithmically as a function of distance from the balloon surface. The logarithms of the measured doses fit a straight line as a function of depth. The doses at 1 mm and 3 mm are approximately 50 and 10% of the surface dose, respectively. Due to the poor centering of the source in the conventional balloons, the dispersion and standard deviations (SDs) of the measured surface doses increased proportionally to the balloon diameter (SDs are 1.89, 5.52, 5.79, and 6.46 Gy for 2.5, 3, 3.5, and 4 mm balloon diameters, respectively). For the 3.5 mm centering and conventional balloons the respective mean, minimum, and maximum surface doses were 8.41 Gy (min. 7.26; max. 9.46) and 7.89 Gy (min. 2.18; max. 16.06) and their standard deviations were 0.66 and 5.79 Gy, respectively. CONCLUSIONS: Conventional angioplasty balloons cannot ensure a homogeneous dose delivery to an arterial wall with an intralumenal 90Y beta source. Preliminary dosimetric results using a modified centering balloon show that it permits improved surface dose distribution (axial and circumferential homogeneity), making it suitable for clinical applications.

Angioplasty, Balloon, Coronary↗
PubMed1979

Treatment of epilepsy: with special reference to developing countries.

1. Epilepsy, a common chronic neurological disorder, constitutes an important medical problem especially as in the developing countries there is a great dearth and shortage of health personnel, especially trained ones, in clinical neurosciences. The prevalence of epilepsy in developing countries is probably higher than in the Caucasians although accurate epidemiological data are lacking. 2. Epilepsy is discussed with special regard to the need for accurate diagnosis, and the difficulties encountered in developing countries. 3. Pharmacotherapy should be as simple as possible and suggestions are made on the essential drugs useful in the control of epilepsy with special reference to developing countries and in the context of economics and ready availability. Grand mal and focal epilepsies could be controlled by phenobarbitone, with phenytoin, sulthiame and carbamazepine kept as reserves or adjuncts. Minor (generalised) epilepsies could be controlled by ethosuximide, with clonazepam and sodium valproate (sodium dipropylacetate) as reserve drugs and adjuncts. For status epilepticus, diazepam is effective and readily available, with clonazepam and phenytoin as alternatives. 4. The problems in the management of epilepsy in the developing countries include lack of facilities and personnel to ensure accurate diagnosis and treatment, inadequate supply or non-availability of drugs, high defaulting rate of patients, the adverse and often pernicious social stigmatisation of the epileptic. 5. Possible solutions to some of these problems include integration of management (in simple terms) of convulsive disorders into the basic health system of delivery of health care in developing countries, aggressive pursuit of health education of the public by governmental and non-governmental agencies, active, intensive and sustained promotion of training of health personnel in clinical neurosciences and research aimed at producing long-acting anticonvulsants.

Africa↗
PubMed1986

Evaluation of a special low birth weight formula, with and without the use of medium chain triacylglycerols.

A special low birth weight formula containing 1.8 g/100 ml of medium chain triacylglycerols (Nenatal) was compared with 'modified' Nenatal (medium chain triacylglycerols (MCT) replaced by long chain triacylglycerols (LCT)) and standard modified baby milk (Cow and Gate Premium). 22 infants of birth weight less than 1500 g and gestational age less than 33 weeks were studied for three weeks when enteral feeds were well tolerated. Nenatal was given to all infants for the first and third weeks, during the middle week 11 infants received Premium and 11 infants received modified Nenatal. On Nenatal there was a significant elevation of serum beta-hydroxybutyrate and small amounts of medium chain fatty acids were detected in the serum. Glucose and long chain triacylglycerol levels were similar on all feeds. Incremental weight gain and energetic efficiency of weight gain was significantly greater on Nenatal than on Premium, but there was no difference in this respect between Nenatal and modified Nenatal. We conclude that the use of a special low birth weight formula is associated with increased weight gain, but this is not dependent on the presence of MCT in the feed. Therefore although feeds containing MCT are well tolerated, there seems little advantage in including MCT in the formulation of low birth weight feeds.

Body Weight↗
PubMed1995

The shape of 2f1-f2 suppression tuning curves reflects basilar membrane specializations in the mustached bat, Pteronotus parnellii.

Iso-suppression tuning curves (STCs) of the 2f1-f2 distortion product (dp) were measured over a primary frequency range of 20 to 93 kHz in mustached bats, Pteronotus parnellii parnellii. Primary levels were chosen to produce dp levels between 0 and 7 dB SPL. At frequencies outside the ranges of 60-72 kHz and 90-93 kHz the shapes of the STCs were symmetrical or asymmetrical with a steep high frequency slope. In the vicinity of 61 kHz where a strong stimulus frequency otoacoustic emission (SFOAE) is present, the asymmetry of the STCs was inverted with a very steep low frequency slope (max. -89 dB/kHz) and a shallow high frequency slope. The inverted STCs resemble neuronal tuning curves of the same species with best frequencies at about 61 kHz. Close to 61 kHz the STCs were sharply tuned with Q10dB values up to 177. The STC-thresholds were about 20 dB above the neuronal thresholds. Thickenings of the basilar membrane located just basal to the cochlear place of the SFOAE frequency are probably involved in creating the asymmetric STCs. Cochlear resonance at the SFOAE frequency and an increased longitudinal coupling within the thickened basilar membrane region are thought to contribute to the specialized STC shape. In the range of 90-93 kHz, the STCs are also sharply tuned with inverted asymmetry which is probably not due to an harmonic effect of the specialized cochlear mechanics in the 60 kHz region but may be caused by an independent mechanism.

Acoustic Stimulation↗
PubMedDate not supplied

An unusual membrane specialization of mammalian cells in vitro.

An unusual membrane specialization, termed "particle rows," was revealed by freeze-fracture electron microscopy in cultured mammalian cells including dissociated central nervous system tissue and peripheral connective tissue. The specialization consisted of rows of particles slightly elevated on the P fracture face, with a regular periodicity of 35 nm between the rows and a uniform length of the rows of 100 nm. It was usually associated with caveolae (pits) and sometimes accompanied gap junctions, or tight and gap junctional complexes within the same membrane. The particle rows are probably expressed by more than one cell type, all in immature form.

Animals↗
PubMed1987

The competition of autistic stereotyped behavior with usual and specially assessed reinforcers.

This study was conducted to empirically assess a reinforcement theory of stereotyped behavior. Six students with autism were first presented with tasks, and no contingent reinforcers were provided for correct responding. Then, contingent reinforcers that were typically used with the students (usual reinforcers) were presented in a multiple baseline across subjects design. Three of the students evidenced decreases in stereotypy and increases in responding in the presence of usual reinforcers. The other three students required external suppression of stereotypy before increases in responding were shown. For these students, usual reinforcers and specially assessed reinforcers were then compared. The specially assessed reinforcers resulted in decreases in stereotypy and increases in responding and subjective measures of responsiveness. The results were discussed in terms of supporting a competing reinforcement hypothesis, such that powerful external reinforcers will successfully compete with and suppress reinforcers provided by stereotypy.

Adolescent↗
PubMed1996

Extrapyramidal symptoms during long-term treatment with antipsychotics: special focus on clozapine and D1 and D2 dopamine antagonists.

In schizophrenic patients in maintenance treatment, clozapine, compared to classic neuroleptics, induces relatively few extrapyramidal syndromes (EPS), especially less akathisia and tremor and usually no dystonia or rigidity. In patients with dyskinetic movements (acute or tardive) induced by other neuroleptics, clozapine may reduce or even remove dyskinesia or permit it to disappear. It cannot, however, be excluded that clozapine can induce dyskinesia in extremely rare cases, but it seems more likely that this is due to previous treatment with classic neuroleptics. The earlier clozapine is started, the less chance of development of dyskinesia. The low level of EPS with clozapine may be linked to the special receptor-binding profile of this drug: during treatment with therapeutic doses of clozapine, the level of D2 receptor blockade is too low (40% to 50% occupancy by positron emission tomography) to induce EPS, and the D1 receptor blockade (also 40% to 50% occupancy) has a lower EPS potential than D2 blockade. This binding profile may at the same time contribute to the special antipsychotic properties of clozapine. Other receptor affinities may contribute to the beneficial effect of clozapine in EPS and schizophrenia.

Antipsychotic Agents↗
PubMed1992

The follow-up care of babies discharged from special care baby units in England and Wales between 1988 and 1989.

This survey of District Health Authorities in England and Wales forms part of a wider study into the needs of babies discharged from special care baby units in South Glamorgan Health Authority. The aim of the survey was to find out what types of care were offered to babies who had been in a Special Care Baby Unit (SCBU) and their families following the babies' discharge from hospital. This in turn raised interesting issues concerning the community care of these babies and their families which are discussed in this article.

Community Health Nursing↗
PubMedDate not supplied

Meeting the nation's health objectives: special project grants.

The purpose of this article is to encourage and motivate the nursing community to become active partners with the US Public Health Service in meeting the health objectives for the nation by the year 2000. The three major public health goals to be achieved during the 1990s are identified. The Special Project Grant Program in the Division of Nursing, Bureau of Health Professions, Health Resources and Services Administration, United States Public Health Service, is described as an opportune resource for nurses to use in their search for funds to demonstrate the ability and capacity of nursing to promote health and prevent disease in this nation's high-risk and underserved populations. Several descriptions of highly successful grants, funded by the Division of Nursing's Special Project Grant Program, are featured as motivating examples of creative and original endeavors by nursing to assist in meeting this nation's health objectives during the 1990s.

Forecasting↗
PubMed2004

Patterns of beta-blocker utilization in patients with chronic heart failure: experience from a specialized outpatient heart failure clinic.

BACKGROUND: Beta-blockers have been shown incontrovertibly to improve morbidity and survival in patients with heart failure. However, there is limited information regarding their use in clinical practice settings, and reasonable utilization targets for quality improvement initiatives have not been established. METHOD: We identified 500 consecutive patients with chronic heart failure seen at a specialized outpatient heart failure clinic from March 2001 to May 2001, and retrospectively extracted clinical and drug information from an electronic medical record. RESULTS: In this cross-sectional analysis, the rate of beta-blocker utilization was 69%. Seventy-five percent of patients had at least tried a beta-blocker. Among those with beta-blockers initiated, 16% experienced side effects that led to drug discontinuation (9.1%) or down-titration (6.9%) that was similar across all NYHA classes. A lower utilization rate of beta-blockers was observed in patients of advanced age and those with diabetes mellitus, concomitant antiarrhythmic therapy, and preserved left ventricular ejection fraction (P <.05). Respiratory disease remained the most common reason for withholding beta-blocker therapy, especially with severe obstructive (rather than restrictive) physiology. CONCLUSION: It appears that about 70% of patients with chronic heart failure can be successfully treated with a beta-blocker in a specialized heart failure outpatient setting where physicians are committed to beta-blocker use in heart failure. It is possible that subgroups with lower utilization rates can be targeted for quality improvement initiatives.

Adrenergic beta-Antagonists↗
PubMed2005

Diagnostic accuracy and reproducibility in the interpretation of Ottawa ankle and foot rules by specialized emergency nurses.

OBJECTIVES: The ED is often confronted with long waiting periods. Because of the progressive shortage in general practitioners, further growth is expected in the number of patients visiting the ED without consulting a general practitioner first. These patients mainly present with minor injuries suitable for a standardized diagnostic protocol. The question was raised whether these injuries can be treated by trained ED nurses (specialized emergency nurses [SENs]). The aim of this study was to evaluate the diagnostic accuracy and reproducibility of SENs in assessing ankle sprains by applying the Ottawa Ankle Rules (OAR) and Ottawa Foot Rules (OFR). METHODS: In a prospective study, all ankle sprains presented in the ED from April to July 2004 were assessed by both a SEN and a junior doctor (house officer [HO]) randomized for first observer. Before the study, SENs were trained in applying OAR and OFR. In all patients, radiography was performed (gold standard). The diagnostic accuracy for the application of OAR and OFR was calculated for both groups and was compared using z statistics. Furthermore, from the paired results, reproducibility was calculated using kappa statistics. RESULTS: In total, 106 injuries were assessed in pairs, of which 14 were ultimately found to concern acute fractures (prevalence, 13%). The sensitivity for the SEN group was 0.93 (95% confidence interval [CI], 0.64-1.00) compared with 0.93 (95% CI, 0.64-1.00) for the HO group (no significance [ns]). The specificity of the nurses was 0.49 (95% CI, 0.38-0.60) compared with 0.39 (95% CI, 0.29-0.50) for the doctors (ns). The positive predictive value for the SEN group was 0.22 (95% CI, 0.13-0.35) compared with 0.19 (95% CI, 0.11-0.31) for the HO group (ns). The negative predictive value for the nurses was 0.98 (95% CI, 0.87-1.00) compared with 0.97 (95% CI, 0.84-1.00) for the doctors (ns). The interobserver agreement for the OAR and OFR subsets was kappa = 0.38 for the lateral malleolus; kappa = 0.30, medial malleolus; kappa = 0.50, navicular; kappa = 0.45, metatarsal V base; and kappa = 0.43, weight-bearing. The overall interobserver agreement for the OAR was kappa = 0.41 and kappa = 0.77 for the OFR. CONCLUSION: Specialized emergency nurses are able to assess ankle and foot injuries in an accurate manner with regard to the detection of acute fractures after a short, inexpensive course.

Adolescent↗
PubMedDate not supplied

Insurance coverage and financial burden for families of children with special health care needs.

OBJECTIVE: To examine the role of insurance coverage in protecting families of children with special health care needs (CSHCN) from the financial burden associated with care. METHODS: Data from the 2001 National Survey of Children with Special Health Care Needs were analyzed. We built 2 multivariate regression models by using "work loss/cut back" and "experiencing financial problems" as the dependent variables, and insurance status as the primary independent variable of interest while adjusting for income, race/ethnicity, functional limitation/severity, and other sociodemographic predictors. RESULTS: Approximately 29.9% of CSHCN live in families where their condition led parents to report cutting back on work or stopping work completely. Families of 20.9% of CSHCN reported experiencing financial difficulties due to the child's condition. Insurance coverage significantly reduced the likelihood of financial problems for families at every income level. The proportion of families experiencing financial problems was reduced from 35.7% to 23.0% for the poor and 44.9% to 24.5% for low-income families with continuous insurance coverage (P < .01 for both comparisons). Similarly, the proportion of parents having to cut back or stop work was reduced from 42.8% to 35.9% for the poor (P < .05) and 43.5% to 33.9% for low-income families (P < .01). CONCLUSIONS: Continuous health insurance coverage provides protection from financial burden and hardship for families of CSHCN in all income groups. This evidence is supportive of policies designed to promote universal coverage for CSHCN. However, many poor and low-income families continue to experience work loss and financial problems despite insurance coverage. Hence, health insurance should not be viewed as a solution in itself, but instead as one element of a comprehensive strategy to provide financial safety for families with CSHCN.

Adolescent↗