Phenomenology and neural correlates of implicit and emergent motor awareness in patients with anosognosia for hemiplegia

Anosognosia for hemiplegia (AH) is characterized by a lack of awareness of motor disorders and appears associated with fronto-temporal-parietal damage. Neuropsychological evidence indicates that behavioral indices of residual forms of motor awareness may co-exist with explicit denial of impairment. Here we explore whether the attempt by AH patients to perform an action may disclose residual forms of motor awareness and whether such forms are underpinned by different neural structures. Twelve hemiplegic patients affected by AH were tested in tasks assessing: (i) implicit awareness (IA), indexed by discrepancies between verbal reports and actual motor behavior; (ii) emergent awareness (EA), indexed by increased verbal awareness induced by the attempt to perform actions. IA and EA were found in five and three patients, respectively. Lesion analysis indicates that while the lack of IA is associated with damage to subcortical white matter anterior to the basal ganglia, lack of EA is linked to damage to cortical regions including insulo-frontal, temporal and parietal structures. Our results indicate that deficits in explicit and implicit awareness are associated with lesions involving different cortico-subcortical structures. Moreover, the results show that the attempt to perform an action may ameliorate body awareness deficits and have implications for rehabilitation.     

A promoting early presentation intervention increases breast cancer awareness in older women after 2 years: a randomised controlled trial

Background:

We have developed the Promoting Early Presentation (PEP) Intervention to equip older women with the knowledge, skills, confidence and motivation to present promptly with breast symptoms, and thereby improve survival from breast cancer. The PEP Intervention consists of a 10-min interaction between a radiographer and an older woman, supported by a booklet. Our previous report showed that at 1 year, the PEP intervention increased the proportion who were breast cancer aware compared with usual care.

Methods:

We randomised 867 women aged 67–70 years attending for their final routine appointment on the National Health Service Breast Screening Programme to receive the PEP Intervention, a booklet alone or usual care. The primary outcome was breast cancer awareness measured using a validated questionnaire asking about knowledge of breast cancer symptoms, knowledge that the risk of breast cancer increases with age and breast checking behaviour.

Results:

At 2 years, the PEP Intervention increased the proportion who were breast cancer aware compared with usual care (21 vs 6% odds ratio 8.1, 95% confidence interval 2.7–25.0).

Conclusions:

The uniquely large and sustained effect of the PEP Intervention on breast cancer awareness increases the likelihood that a woman will present promptly should she develop breast cancer symptoms up to many years later.     

培养创新意识的分子生物学教学策略研究与实践

针对研究生分子生物学教学中存在的弊端,从教学内容和考核方式等方面进行了改革。实践表明,在培养学生的创新意识方面收到了良好的效果。     

Clinical and neurocognitive correlates of insight in patients with bipolar I disorder in remission

Objective: The relationship between insight and neurocognition in bipolar disorder has not been clearly established. Method: A neuropsychological battery assessing attention, mental control, perceptual‐motor skills, executive functions, verbal fluency and abstraction, and visuo‐spatial attention was administered to 50 bipolar remitted patients and 50 healthy controls. Insight was assessed with the Scale to Assess Unawareness of Mental Disorder. Results: Patients presented significantly worse neurocognitive performance. Insight was impaired in 60% of patients, and age, educational level, manic symptoms, age of disease onset, number of admissions, and performance on several neurocognitive tests correlated significantly with insight. A regression model revealed that age and Trail Making Test part B (TMT‐B) performance accounted for 32% of the variance in overall illness awareness, while performance on the TMT‐B alone accounted for 28% of the variance. Conclusion: Impaired insight and neurocognitive dysfunction seem to be present in euthymic bipolar patients. Insight in bipolar disorder may be partially dependent on intact neurocognition.     

Clarifying the Associations Between Language and Social Development in Autism: A Study of Non-native Phoneme Recognition

Autism spectrum disorders (ASDs) are characterized by correlated deficiencies in social and language development. This study explored a fundamental aspect of auditory information processing (AIP) that is dependent on social experience and critical to early language development: the ability to compartmentalize close-sounding speech sounds into singular phonemes. We examined this ability by assessing whether close-sounding non-native language phonemes were more likely to be perceived as disparate sounds by school-aged children with high-functioning ASD (n = 27), than by unaffected control subjects (n = 35). No significant group differences were observed. Although earlier in autistic development there may exist qualitative deficits in this specific aspect of AIP, they are not an enduring characteristic of verbal school-aged children with ASD.     

Reading ability and phonological awareness in Japanese children with dyslexia

In alphabetic languages, the deficit of the phonological awareness is considered as the core deficit in developmental dyslexia. However, the role of phonological awareness in the acquisition of reading Japanese kana, the transparent, mora-based phonogram, has not been understood completely. We examine the abilities of Japanese dyslexic children on different types of Japanese phonological tasks, and discussed which tasks significantly account for each aspect of reading ability. METHODS: Fifteen dyslexic children (9.53+/-1.52 years old), and 15 children with normal reading ability (9.17+/-0.90 years old) participated in this study. They performed three types of phonological awareness tasks. The mora counting task and the mora reversal task of words require phonological awareness at the mora level. The letter rhyming task, which resembles the task in English language, requires phonological awareness at the phoneme level. We evaluated the reading ability by the reading speed, the reading errors, and the number of pauses while reading sentences aloud. RESULTS: The task performances of the dyslexic group on all three phonological awareness tasks were significantly lower than those of the control group. Stepwise multiple regression analysis revealed that the mora counting task and the rhyming letter task most significantly explained the reading speed and number of reading pauses. The mora reversal task of words, together with the antegraded digit span, significantly explained the reading errors. CONCLUSIONS: Japanese dyslexics showed deficits of phonological awareness both at the mora and the phoneme levels. Phonological awareness must be crucial for acquiring the ability of decoding phonograms, including Japanese kana.     

Awareness in children: another two cases

Intraoperative awareness is an anesthesia complication and occurs when a patient becomes conscious during a procedure performed under general anesthesia and subsequently has recall of these events. Awareness is well described phenomenon in adults, with an incidence of 0.1–0.2 % for low-risk surgical procedures. Recent studies have shown that awareness in children is more common than in adults. However, causes and the long-term psychological impact of awareness in children are unknown. We report on two cases of intraoperative awareness in children in an attempt to throw further light on this complex problem.     

护士肌肉骨骼损伤职业影响因素的调查分析

目的了解护士职业性肌肉骨骼损伤（OMSI）及其自我防护意识的状况,探讨职业因素对护士OMSI的影响。方法采用便利整群抽样法,应用护士OMSI症状自评量表和护士OMSI自我防护意识调查表对816名护士实施问卷调查。结果护士OMSI的年总发生率为56．62％,其中2个部位以上损伤者占47．55％;不同科室护士的OMSI年发生率及其自我防护行为得分存在统计学差异（均P〈0．01）。影响护士的OMSI年发生率的因素有工作时弯腰次数、每日搬运患者次数、科室、轮值夜班频率等（P〈0．05,P〈0．01）。结论手术室和外科护士易发生OMSI;护士OMSI的保护因子是自我防护意识、工作满意度和工作环境,其危险因子为轮值夜班频繁、工作时弯腰次数、搬抬患者次数、科室、工作时持续坐姿时间。管理者应采取措施预防或应对护士OMSI的发生。     

Visual recalibration of auditory spatial perception: two separate neural circuits for perceptual learning

A remarkable example of rapid perceptual learning is the visual recalibration of auditory spatial perception, which can result in either a bias (ventriloquism after-effect) or an improvement (multisensory enhancement) in auditory localization. Here, we examine the possibility that these after-effects might depend on two distinct neural pathways (geniculostriate vs. collicular–extrastriate). To this end, patients with a lesion of the striate cortex (hemianopic patients) or temporoparietal cortex (neglect patients) were asked to localize weak sounds, before and after a brief exposure to repetitive auditory–visual stimulation which was given either in the normal or in the affected field. Adaptation comprised spatially disparate (Experiment 1) or spatially coincident (Experiment 2) auditory–visual stimuli. After exposure to spatially disparate stimuli in the normal field, all patients exhibited the usual shifts toward the visual attractor, at each sound location. In contrast, when the same kind of adaptation was given in the affected field, a consistent shift was still evident in neglect patients but not in patients with hemianopia. After adaptation to spatially coincident stimuli, and regardless of the adaptation hemifield, all patients exhibited a significant improvement in auditory localization, which was largest for sounds presented at the adapted location. The findings suggest the presence of two distinct recalibration mechanisms. Adapting to spatially conflicting stimuli invokes a corrective mechanism implemented within the geniculostriate circuit, which tries to reduce the registered discrepancy. Adapting to spatially aligned inputs invokes a mechanism implemented along a collicular–extrastriate circuit, which tries to reduce the localization error.     

Pavlovian conditioning of an approach bias in low-dependent smokers

Rationale In the present study, it was investigated whether smokers can acquire a behavioural approach bias through Pavlovian conditioning. Objectives More specifically, it was tested whether pairing neutral stimuli with either smoking availability or unavailability would lead to both differential urge responding to these stimuli and a corresponding shift in approach bias. Materials and methods Thirty-nine low-dependent smokers performed a stimulus–response compatibility (SRC) task with which one can determine an approach bias. Next, participants received a conditioning session in which one cue (either a blue or yellow background screen colour) was paired with the opportunity to smoke (CS+) and another cue was paired with the absence of the opportunity to smoke (CS−). After conditioning, all participants again performed the SRC task. Results Evidence for the conditioning of an approach bias but not smoking urges was found. This effect, although, was only apparent when smokers had been prompted to determine the contingency between the cues and smoking outcome. Conclusions It is concluded that one can differentially condition an approach bias in low-dependent smokers.