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Jamestown Medical Clinic System.

Comprehensive health care can be provided in rural and poor areas despite a decreasing number of physicians in those areas. A single physician increased his productivity by 300% to 400% by combining already available resources: specially trained and supervised nurse-practitioners, problem-oriented charting, and multiphasic screening. With emphasis on the nurse-practitioner as the main "person of contact" for the patient, the physician is able to shift from 50% to 75% of his usual tasks to these specially trained personnel. Patients have come to regard the physician as a "consultant" to the nurse-practitioner.

Community Health Services

Aging and shifts of visual spatial attention.

Three experiments examined adult age differences in the efficiency of endogenous (voluntary) and exogenous (involuntary) attention shifts. Younger and older subjects performed a spatial cuing task in which abruptly onset peripheral cues (Experiment 1) or central, symbolic cues (Experiments 2 and 3) were presented before a target stimulus at intervals ranging from 50 to 250 ms. With peripheral cues, the magnitude of cuing effects was at least as great for older as for younger adults and followed a similar time course. Similar results were obtained with symbolic cues, although cuing effects for older adults varied with cue difficulty. The results suggest that cue encoding may decline with advancing age but that the efficiency of the shift process is preserved.

Adolescent

Cognitive task influence on relative hemispheric motor control: mouth asymmetry and lateral eye movements.

While strictly verbal cognitive tasks showed a strong left-hemisphere dominance, the presence of visualization and emotion in cognitive tasks resulted in increased involvement of the right hemisphere in motor control of speech as measured by mouth asymmetry. Spontaneous smiles showed right-hemisphere dominance. Lateral eye movements showed an unexpected shift to left gaze during speech which may suggest a dual task interference between speech and gaze motor control.

Adolescent

Information processing in the cerebral hemispheres: selective hemispheric activation and capacity limitations.

Several previous experiments have found that concurrently maintaining verbal information in memory influences visual laterality patterns (e.g., Hellige & Cox, 1976; Kinsbourne, 1975). The present article critically reviews existing experiments and reports five additional experiments designed to identify the mechanisms responsible for such effects. Experiment 1 demonstrates that laterality patterns are not influenced by a concurrent memory task that does not require verbal processing. (The verbal nature of the concurrent task was an important aspect of previous experiments.) Experiments 2 and 3 were designed to determined whether concurrent verbal memory primarily influences very early visuospatial processes or later processes such as those involved in visuospatial memory. In Experiment 2, observers indicated whether two simulteneously presented nonsense forms had the same shape. Observers held 0, 2, 4, or 6 words in memory during each shape judgment trial. Responses were faster when the forms were presented to the left visual field--right hemisphere (LVF-RH) than to the right visual field--left hemisphere (RVF-LH). This effect did not interact with memory set size. In Experiment 3, observers indicated whether either of two simultaneously presented forms was identical to a target form held in memory. Observers held 0, 2, or 6 words in memory on each trial. On same-as-target trials, responses were faster on LVF-RH trials than on RVF-LH trials in the no-word memory condition; this difference was reversed in the two-word and six-word conditions. The combined results of Experiments 2 and 3 suggest that concurrent verbal memory influences stages of processing beyond the initial registration of visuospatial information. Experiments 4 and 5 examined the influence of concurrent verbal memory on verbal laterality tasks. Observers indicated whether two simultaneously presented letters of different cases had the same name. In Experiment 4, different groups of observers held 0, 2, 4, or 6 words in memory on each letter-pair trial. In Experiment 5, memory set size was manipulated within subjects. On the same-pair trials of Experiment 4 and the first session of Experiment 5, responses in the no-memory condition were faster on RVF-LH trials than on LVF-RH trials; this difference was reversed in all of the work memory conditions. This shift is opposite to that found when the laterality task does not require verbal processing and further indicates that concurrent verbal memory influences processing stages beyond those that are common to the form-pair and letter-pair tasks. Neither directness-of-pathway nor attention-gradient laterality models can explain the entire pattern of results from the present experiments. Rather, the results suggest that the left hemisphere functions as a typical limited-capacity information processing system that can be influenced somewhat separately from the right hemisphere system.

Cerebral Cortex

Impaired extra-dimensional shift performance in medicated and unmedicated Parkinson's disease: evidence for a specific attentional dysfunction.

Groups of patients with Parkinson's disease, either medicated, or unmedicated and early in the course, together with age- and IQ-matched control subjects were tested in two paradigms measuring different aspects of selective attention. The first set of tests compared visual discrimination learning following intra- and extra-dimensional shifts, using a "total change" design in which each shift was made in the presence of novel exemplars of the compound stimuli used as discriminanda. The second test consisted of a visual search task in which the number of alternatives was varied. The results of the first experiment showed a selective deficit in both groups of Parkinsonian subjects in their ability to perform an extra-dimensional shift. In the visual search task, the patients were less accurate, but responded with equivalent choice reaction times to those of controls. The results are discussed in terms of the nature of the attentional dysfunction that occurs in Parkinson's disease.

Aged

Effect of a mental arithmetic task on dark focus of accommodation.

Three subjective techniques for measuring accommodation (polarized vernier optometer, laser optometer, and a hand optometer based on the vernier principle) were used to measure subjects' dark focus while they performed a short-term mental arithmetic task. Compared with the initial values measured without the arithmetic task, significant changes in dark focus occurred when the task was performed. The effects depended on the initial dark focus of the subjects: in far-dark-focus subjects, inward shifts were generally observed; in near-dark-focus subjects, the dark focus shifted in different directions when different measuring techniques were used. The individual changes in dark focus due to the mental task were reproducible when the mean dark focus of the group shifted inward and when the same technique for measuring accommodation was used. The results have implications for the interpretation of dark focus shifts that are found following prolonged visual work at close distances, e.g. at visual display terminals.

Accommodation, Ocular

Influence of three short-chain peptides (alpha-MSH, MSH/ACTH 4-10, MIF-I on) dimensional attention.

Male, albino rats were treated with alpha-MSH, MSH/ACTH 4-10, MIF-I or a diluent control solution and then tested on a visual discrimination problem. Immediately after acquistion of the visual task the animals were tested with a spatial extradimensional shift problem. The animals treated with the MSH/ACTH 4-10 and MIF-I acquired the discrimination nonsignificantly faster than animals treated with alpha-MSH or a placebo. A subproblem analysis of the EDS behavior indicated that the peptides significantly improved performance probably by affecting attention.

Adrenocorticotropic Hormone

Contingent negative variation (CNV) influenced by preceding slow potential shifts (pSPSs).

The study was undertaken to elaborate the influence of slow potential shifts preceding S1 on the CNV. Eighteen subjects participated in a forewarned reaction time task. The EEG was recorded from F3, F4, Cz, P3 and P4 referred to linked mastoids. Selected averages of EOG-corrected trials with negative, positive and no shifts greater than 8 microV - within 2 sec before S1 at the respective location - were compared. Results showed greater CNV after positive shifts compared to negative shifts (P less than 0.05) and no significant interaction with location. Slow potential shifts before S1 did not affect reaction time. Evidence of a baseline effect is discussed as a ceiling effect as well as an expression of an active regulatory mechanism responsible for a desired activation at S2. As slow potentials may also interact with task conditions, it is suggested first to control the baseline in order to obtain reliable CNV measures, and secondly to use baseline effects as a tool to get insight into brain regulatory mechanisms.

Adolescent

Patterns of task-related slow brain potentials in dyslexia.

Six dyslexic youths who met the Hughes and Denckla criteria of "dyslexia pure" and 10 normal control subjects were investigated with DC recordings of task-related cortical negativity using 10 leads over the right and left hemispheres. Potentials were recorded during the following tasks: reading, orthographic error detection, letter series, word assembly, word fluency, finding of antonyms, and viewing of Necker cubes. Both groups exhibited greater right hemisphere negativity during the Necker cube task. Whereas controls revealed greater left hemisphere negativity during linguistic tasks, the reverse was found with dyslexics. The right shift was pronounced with the reading, orthographic error detection, and antonym conditions. Differences between the two groups were also found for the pattern of cortical distribution. We conclude that dyslexia is associated with changes in the lateral distribution of cortical activity during certain types of language processing.

Adolescent

Spatial properties of rod-cone interactions in flicker and hue detection.

Rod-cone interactions in flicker and hue detection were compared to examine the hypothesis that they are mediated by mechanisms with different spatial properties. Flicker and hue thresholds for a 1 deg test stimulus (TS) were measured as a function of background luminance and diameter. Flicker thresholds were reduced from their dark-adapted value by an 11 deg diameter background, but not by a 1 deg background. These results, in agreement with previous work, demonstrate that light adaptation of rods surrounding the TS is necessary to eliminate their effect on cone flicker thresholds. In contrast, hue thresholds were reduced from their dark-adapted value to a comparable degree by 1 and 11 deg backgrounds, indicating that light adaptation of the rods stimulated by the TS is sufficient to abolish the rod-cone hue interaction. Our results support the contention that the rod-cone flicker and hue interactions are mediated by different mechanisms. We also demonstrated that changing the detection task while keeping stimulus parameters constant is sufficient to shift between these two types of rod-cone interactions.

Adaptation, Ocular

Structural comparison of apomyoglobin and metaquomyoglobin: pH titration of histidines by NMR spectroscopy.

Proton NMR spectroscopy was applied to myoglobin in the ferric, water-liganded form (metMbH2O) and the apo form (apoMb) to probe the structure and stability of the latter. Proteins from sperm whale and horse skeletal muscles were studied to simplify the spectral assignment task. Nuclear Overhauser effects and the response of chemical shifts to variations of pH were used as indicators of residual native holoprotein structure in the apoprotein. The investigation was focused in the histidine side chains and their environment. In metMbH2O, the resonances of all imidazole rings not interacting with the heme were assigned by applying standard two-dimensional methods. These assignments were found to differ from those reported elsewhere [Carver, J. A., & Bradbury, J. H. (1984) Biochemistry 23, 4890-4905] except for His-12, -113, and -116. Only one histidine (His-36) has a pK(a) higher than 7, two (His-48 and His-113) have a pK(a) lower than 5.5, and two (His-24 and His-82) appear not to titrate between pH 5.5 and pH 10. In the apoproteins, the signals of His-113 and His-116, as well as those of His-24, -36, -48, and -119 previously assigned in the horse globin [Cocco, M. J.. & Lecomte, J. T. J. (1990) Biochemistry 29, 11067-11072], could be followed between pH 5 and pH 10. A comparison to the holoprotein data indicated that heme removal has limited effect on the pK(a) and the surroundings of these residues. Five additional histidines which occur in the two helices and connecting loops forming the heme binding site were identified in the horse apoprotein. Four of these were found to have pK(a) values lower than that expected of an exposed residue. The NOE and titration data were proposed to reflect the fact that several holoprotein structural elements, in particular outside the heme binding site, are maintained in the apoprotein. In the heme binding region of the apoprotein structure, the low pK(a)'s suggest local environments which are resistant to protonation.

Amino Acid Sequence

Persistence and problem-solving skills in young male alcoholics.

This study compares the level of persistence between 31 inpatient alcoholic males and 31 abstinent or light social drinking males matched on age, education, socioeconomic status and estimated premorbid IQ. An unsolvable anagram and diagram were selected as measures of persistence. Results indicated that alcoholics persisted for significantly shorter periods of time on both measures than their matched controls. However, there were no significant group differences on two measures from the Wisconsin Card Sorting Test (set shifting and set maintenance). Persistence measures from the unsolvable tasks were not significantly correlated with the set maintenance score of the Wisconsin Card Sorting Test. Possible explanations are considered for these findings of persistence deficits without problem-solving impairments among young alcoholics.

Adult

The effects of stimulus complexity and sensory modality on reaction time in normal and retarded readers.

Intra- and crossmodal performance of normal and retarded readers was compared in a reaction-time task. Both reading groups showed slower crossmodal than intramodal shifting. This effect occurred equally for both reading groups. Differences between the two groups occurred, however, when a complex visual stimulus was present. The complex stimulus resulted in the retarded readers showing slower reaction times to other stimuli in that setting. This effect occurred for stimuli both within and across modalities. The results suggested that the demands of stimulus complexity within the visual modality rather than the demands of crossmodal shifting were related to reading ability.

Achievement

Immediate colour constancy.

Colour constancy is traditionally interpreted as the stable appearance of the colour of a surface despite changes in the spectral composition of the illumination. When colour constancy has been assessed quantitatively, however, by observers making matches between surfaces illuminated by different sources, its completeness has been found to be poor. An alternative operational approach to colour constancy may be taken which concentrates instead on detecting the underlying chromatic relationship between the parts of a surface under changes in the illuminant. Experimentally the observer's task was to determine whether a change in the appearance of a surface was due to a change in its reflecting properties or to a change in the incident light. Observers viewed computer simulations of a row of three Mondrian patterns of Munsell chips. The centre pattern was a reference pattern illuminated by a simulated, spatially uniform daylight; one of the outer patterns was identical but illuminated by a different daylight; and the other outer pattern was equivalent but not obtainable from the centre pattern by such a change in illuminant. Different patterns and different shifts in daylight were generated in each experimental trial. The task of the observer was to identify which of the outer patterns was the result of an illuminant change. Observers made reliable discriminations of the patterns with displays of durations from several seconds to less than 200 ms, and, for one observer, with displays of 1 ms. By these measures, human observers appear capable of colour constancy that is extremely rapid, and probably preattentive in origin.

Color Perception

Characteristic distribution of alpha 2 wave in electroencephalograms of schizophrenic patients during discriminative tasks: support for the hypofrontality hypothesis of schizophrenia.

In a preliminary study, we noticed that alpha 2 activity in the frontal regions was suppressed less in schizophrenic patients than in other patients during the discriminative tasks. This was confirmed with 37 schizophrenic and 16 nonschizophrenic patients under the treatment of neuroleptics, 15 nonmedicated schizophrenic patients and 32 normal controls. The EEGs in eye-closed resting and during the auditory and visual discriminative tasks were recorded. Alpha 2 power values of the frontal, central, parietal, occipital and temporal regions in every subject group were processed by cluster analysis. During the discriminative tasks, the frontal regions were the most isolated cluster in schizophrenic patients and, in the normal and medicated nonschizophrenic groups, the frontal regions were incorporated in a different cluster. The same result was obtained by different statistical analyses of F-alpha 2 power ratio. The relative abundance of alpha 2 power value shifts from the occipital to the frontal regions during the discriminative tasks in schizophrenic patients. The weakened suppression of alpha 2 waves in the frontal regions by the discriminative tasks in schizophrenic patients supports the hypofrontal hypothesis of schizophrenia.

Adolescent

Event-related covariances during a bimanual visuomotor task. II. Preparation and feedback.

Event-related covariance (ERC) patterns were computed from pre-stimulus and feedback intervals of a bimanual, visuomotor judgment task performed by 7 right-handed men. Late contingent negative variation (CNV) ERC patterns that preceded subsequently accurate right- or left-hand responses differed from patterns that preceded subsequently inaccurate responses. Recordings from electrodes placed at left frontal, midline antero-central, and appropriately contralateral central and parietal sites were prominent in ERC patterns of subsequently accurate performances. This suggests that a distributed cortical 'preparatory network,' composed of distinct cognitive, integrative motor, somesthetic, and motor components, is essential for accurate visuomotor performance. ERC patterns related to feedback about accurate and inaccurate responses were similar to each other in the interval immediately after feedback onset, but began to differ in an interval spanning an early P300 peak. The difference became even greater in an interval spanning a late P300 peak. For both early and late P300 peaks, ERC patterns following feedback about inaccurate performance involved more frontal sites than did those following feedback about accurate performance. Together with the stimulus- and response-locked results presented in part I, results of this study on the preparatory and feedback periods suggest that ERCs show salient features of the rapidly shifting, functional cortical networks that are responsible for simple cognitive tasks. ERCs thus provide a new perspective on information processing in the human brain in relation to behavior--a perspective that supplements conventional EEG and ERP procedures.

Adult

Shifts in hemispheric advantage during familiarization with complex visual patterns.

Twenty females unfamiliar with kanji were given a recognition task involving tachistoscopic presentation of kanji to the right and left visual fields. Repeated exposure to these novel stimuli resulted in significantly increased competence at the task. To analyze different approaches to the task, subjects were divided into an initial left visual field advantage and an initial right visual field advantage group. Over the course of the experiment subjects in the initial left visual field advantage group shifted from a left to a right visual field advantage, showing both a linear trend and a quadratic trend, while the initial right visual field advantage group showed only a quadratic trend. The results are consistent with observations in other novel stimuli situations which have demonstrated a shift in hemispheric advantage from right to left with increased competence and which have demonstrated individual differences in the pattern of shifting hemispheric advantage.

Adult

An interleaved tracking procedure to monitor unstable psychometric functions.

In some experimental situations, the psychometric function underlying performance may not be stable, but instead may shift along the stimulus axis in response to changes in attention, learning, or task difficulty. When this occurs, the measured threshold may be influenced and the slope of the measured function will be inaccurately shallow. With commonly used experimental procedures, it is difficult to know whether a shallow psychometric function slope is a true reflection of the sensory process, or is a result of "averaging" a highly variable underlying function. Here, a new method is described of estimating psychometric function slope from the variability in two interleaved adaptive tracks, consulted on alternate trials, that is resistant to the effects of shifting performance levels. Further, a mechanism is described for assessing the likelihood that a threshold was, in fact, stable over the course of its measurement. Computer simulations are reported as well as verification of the method in measurements of human performance on a psychophysical task. Several conditions of externally imposed variability were simulated to establish the ability of these procedures to identify unstable functions and produce accurate slope estimates. The procedures worked well for thresholds shifting by as little as 4 dB if the variation did not occur too rapidly. The procedure and associated analyses are recommended as a relatively "free" means of calculating slope and quantifying threshold reliability with little extra experimental effort.

Attention