Opposed attentional hemi-bias on a visuoconstructive task in children with severe hyperactivity versus severe inattention.

Twenty six empirical investigations have now established that children and adults with DSM-defined Attention deficit/Hyperactivity disorder (ADHD) of the Hyperactive type (ADHD-H) or, more commonly, Combined Hyperactive/Inattentive types (ADHD-C) manifest a small but significant visual attentional bias to the right side (left subclinical neglect), consistently suggesting the existence of a subtle right hemisphere dysfunction or hemispheric imbalance in hyperactive people. Only one research team has investigated and compared the DSM-defined Inattentive subtype (ADHD-I) to the Hyperactive subtype (ADHD-H), confirming that line bisection is biased to the right in ADHD-H and discovering that it is biased to the left in ADHD-I. We aimed to test whether a similar crossed double dissociation would extend to Rey's Complex Figure Copy Task (RCF-CT), a simple visuospatial-constructive task. Clinical files of 205 juvenile clients from 6 to 16 years of age from a neuropsychological private clinic specialized in ADHD were analysed. Extreme scores on the Connors-3 Hyperactivity vs Inattention Parent Rating scales associated, respectively, with significant rightward and significant leftward emplacement of the drawing on the page on the RCF-CT. These results replicate previous findings and extend the "energetics" model of hemispheric specialization.

Outcome following cosmetic rostral nasal reconstruction after planectomy in 26 dogs.

OBJECTIVE: To report the outcome and owner satisfaction after planectomy for nasal planum neoplasia with cosmetic reconstruction with bilateral labial mucocutaneous rotation flaps in dogs. STUDY DESIGN: Multi-institutional, retrospective case series. ANIMALS: Twenty-six client-owned dogs. METHODS: Medical records were searched for dogs that had undergone the procedure. Signalment, diagnosis, surgery, complications, requirement for revision surgery, recurrence, and survival information were recorded. Owners were contacted by telephone about their dog's quality of life after the procedure and their satisfaction with their dog's outcome. RESULTS: Twenty-five dogs underwent radical planectomy, and 1 dog underwent resection of the nasal planum. Twenty-four dogs had a diagnosis of squamous cell carcinoma, 1 had a diagnosis of atypical adenocarcinoma, and 1 had a diagnosis of a mast cell tumor. Complications occurred in 19 (73%) dogs, with 9 dogs requiring revision surgery; 1 dog not surviving to discharge. Median survival time was 1542 days (range, 3-2010). Recurrence of the primary tumor was suspected in 2 (7.7%) dogs, both with narrow or incomplete excision. Among 11 owners interviewed, 10 were satisfied with their dog's appearance, and 8 reported they would consent to the procedure again. CONCLUSION: Dehiscence was common after this procedure, but local tumor control and survival times were excellent. Owner satisfaction was high, although preoperative client education is vital. CLINICAL SIGNIFICANCE: This technique should be considered as a viable option for dogs with nasal planum neoplasia given the high rate of recurrence with less aggressive treatment. Complications common following surgery, but do not persist long term and survival times were excellent.

Impact of AP@LZ in the daily life of three persons with Alzheimer's disease: long-term use and further exploration of its effectiveness.

AP@LZ is an electronic organiser that was designed to support the day-to-day activities of persons with Alzheimer's disease. To assess the potential of this technology, three participants (NI, JB, RD) were approached to take part in the study. They benefited from a structured cognitive intervention to learn how to operate AP@LZ; the intervention included the following learning stages: Acquisition, Application and Adaptation. Pre- and post-intervention measures were collected. NI, for whom a longitudinal study was conducted, still continued to use AP@LZ 24 months post-intervention. JB and RD also showed a gradual improvement in their performance throughout the intervention phase (sessions 1 to 19 for JB: performance increased from 50 to 100%; sessions 1 to 25 for RD: from 56 to 89%). The results of the use of AP@LZ in activities of daily living suggest that the application was beneficial for three persons with Alzheimer's disease whose profiles differed notably (age, cognitive and social profiles). Thus, results indicate that they were all able to learn how to operate AP@LZ's functions and to use them in their activities of daily living. Cognitive intervention appears to play an important role for the promotion of learning and adoption of such technology.

[Input data collection]. / Le recueil de données.

The quality and safety of nursing care depends notably on the collection of data. In Quebec, there is a tool which aims to improve the organisation of care in accident and emergency departments. Nurses are on the frontline in the initial assessment of the patient. Unfortunately, their recognition is not on a par with their responsibility.

Brain lesions and IQ: recovery versus decline depends on age of onset.

A growing literature suggests that early lesions are associated with poorer IQ outcome. Those studies covered a restricted age range in pediatric populations only and did not control for important moderator variables. The present investigation studied IQ change in brain-lesioned children and adults (age 0 to 84 years). Altogether, 725 cases with a documented unilateral focal lesion were gathered from hospital charts and from published cases in the literature, including 240 with repeated IQ testing. Multiple regression analyses isolated the contribution of age at lesion onset to IQ change. Important mediator variables included were lesion side, site, volume, etiology, and so on. An early lesion was significantly associated with poorer postlesion IQ in time and with decline of IQ in time. Later onset lesions were associated with better postlesion IQ and recovery in time. The so-called Kennard principle is refuted, with regard to IQ.

Natural regeneration on seismic lines influences movement behaviour of wolves and grizzly bears.

Across the boreal forest of Canada, habitat disturbance is the ultimate cause of caribou (Rangifer tarandus caribou) declines. Habitat restoration is a focus of caribou recovery efforts, with a goal to finding ways to reduce predator use of disturbances, and caribou-predator encounters. One of the most pervasive disturbances within caribou ranges in Alberta, Canada are seismic lines cleared for energy exploration. Seismic lines facilitate predator movement, and although vegetation on some seismic lines is regenerating, it remains unknown whether vegetation regrowth is sufficient to alter predator response. We used Light Detection and Ranging (LiDAR) data, and GPS locations, to understand how vegetation and other attributes of seismic lines influence movements of two predators, wolves (Canis lupus) and grizzly bears (Ursus arctos). During winter, wolves moved towards seismic lines regardless of vegetation height, while during spring wolves moved towards seismic lines with higher vegetation. During summer, wolves moved towards seismic lines with lower vegetation and also moved faster near seismic lines with vegetation <0.7 m. Seismic lines with lower vegetation height were preferred by grizzly bears during spring and summer, but there was no relationship between vegetation height and grizzly bear movement rates. These results suggest that wolves use seismic lines for travel during summer, but during winter wolf movements relative to seismic lines could be influenced by factors additional to movement efficiency; potentially enhanced access to areas frequented by ungulate prey. Grizzly bears may be using seismic lines for movement, but could also be using seismic lines as a source of vegetative food or ungulate prey. To reduce wolf movement rate, restoration could focus on seismic lines with vegetation <1 m in height. However our results revealed that seismic lines continue to influence wolf movement behaviour decades after they were built, and even at later stages of regeneration. Therefore it remains unknown at what stage of natural regeneration, if any, wolves cease to respond to seismic lines. To reduce wolf response to seismic lines, active restoration tactics like blocking seismic lines and tree planting, along with management of alternate prey, could be evaluated.

Portacaval shunt in a calf: clinical, pathologic, and ultrasonographic findings.

A calf with a previous history of lameness was presented for weakness and anorexia. Increased liver enzymes and difficulty in assessing the portal system by ultrasonography were compatible with liver disease. Doppler ultrasonography revealed an extrahepatic portacaval shunt. This is the first ultrasonographic description of extrahepatic portacaval shunt in a ruminant.

Auditory hypergnosia as an example of psychic tonus in the temporal lobes: multiple case analyses.

In 2006, Braun proposed a new model of hemispheric specialization of energy management by the brain, which he termed the "psychic tonus" model of hemispheric specialization. The term "psychic tonus" is deliberately general. It invites further investigation designed to incorporate various behavioral and cognitive modalities. At present, any cognitive operation or behavior likely to require energy expenditure, such as cardiovascular or metabolic, is considered to be at one extreme while any cognitive operation or behavior likely to reduce energy expenditure is considered to be at the other extreme. The model states that the left hemisphere of the brain is specialized to increase psychic tonus and the right to decrease it. The model predicts that the tonus of auditory representation ought to also manifest these hemispheric specializations in the temporal lobes. Specifically, it was predicted that pathological positive auditory tonus (auditory hallucination) ought to be associated more frequently with right temporal lobe lesions. Our analysis of a large number of previously published cases of patients with unilateral lesions supports the prediction.

Regional Brain Glucose Hypometabolism in Young Women with Polycystic Ovary Syndrome: Possible Link to Mild Insulin Resistance.

OBJECTIVE: To investigate whether cerebral metabolic rate of glucose (CMRglu) is altered in normal weight young women with polycystic ovary syndrome (PCOS) who exhibit mild insulin resistance. MATERIALS AND METHODS: Seven women with PCOS were compared to eleven healthy female controls of similar age, education and body mass index. Regional brain glucose uptake was quantified using FDG with dynamic positron emission tomography and magnetic resonance imaging, and its potential relationship with insulin resistance assessed using the updated homeostasis model assessment (HOMA2-IR). A battery of cognitive tests was administered to evaluate working memory, attention and executive function. RESULTS: The PCOS group had 10% higher fasting glucose and 40% higher HOMA2-IR (p ≤ 0.035) compared to the Controls. The PCOS group had 9-14% lower CMRglu in specific regions of the frontal, parietal and temporal cortices (p ≤ 0.018). A significant negative relation was found between the CMRglu and HOMA2-IR mainly in the frontal, parietal and temporal cortices as well as in the hippocampus and the amygdala (p ≤ 0.05). Globally, cognitive performance was normal in both groups but scores on the PASAT test of working memory tended to be low in the PCOS group. CONCLUSIONS: The PCOS group exhibited a pattern of low regional CMRglu that correlated inversely with HOMA2-IR in several brain regions and which resembled the pattern seen in aging and early Alzheimer's disease. These results suggest that a direct association between mild insulin resistance and brain glucose hypometabolism independent of overweight or obesity can exist in young adults in their 20s. Further investigation of the influence of insulin resistance on brain glucose metabolism and cognition in younger and middle-aged adults is warranted.

Speech rate as a sticky switch: a multiple lesion case analysis of mutism and hyperlalia.

Though it has long been known on the basis of clinical associations and serendipitous observation that speech rate is related to mood and psychomotor baseline, it is less known that speech rate is also related to libido and to immune function. We make the case for a bipolar phenomenon of "psychic tonus," encompassing all these dimensions. The elated, agitated, libidinal, immunofacilitated, and talkative pole is an "approach" disposition primarily activated by the normal left hemisphere-especially, though not exclusively, its frontal lobe. The dejected, lethargic, delibidinized, immunosuppressed, and mute pole is an "avoidance" disposition primarily activated by the normal right hemisphere-especially, though not exclusively, its frontal lobe. In support of this proposed model, we present new evidence, via meta-analysis of previously published single lesion case reports, of a highly significant association between right hemisphere lesions and non-aphasic hyperlalia, and between left hemisphere lesions and non-aphasic mutism.

Opposed left and right brain hemisphere contributions to sexual drive: a multiple lesion case analysis.

Brain topographical studies of normal men have have shown that sexual excitation is asymmetric in the brain hemispheres. Group studies of patients with unilateral epileptic foci and other studies of patients with unilateral brain lesions have come to the same conclusion. The present study reviewed previously published single case reports of patients with frank hypo or hypersexuality subsequent to a unilateral brain lesion. Hyposexual patients tended to have left hemisphere lesions (primarily of the temporal lobe), and hypersexual patients tended to have right hemisphere lesions (primarily of the temporal lobe) (p < 0.05). We interpret this double dissociation as part of a more general phenomenon of psychic tone similarly dissociated with regard to hemispheric control, including mood, psychomotor baseline, speech rate, and even immunity. The behavioral significance of this psychic tone is to modulate approach versus avoidance behavior.

The GoodNEWS (Genes, Nutrition, Exercise, Wellness, and Spiritual Growth) Trial: a community-based participatory research (CBPR) trial with African-American church congregations for reducing cardiovascular disease risk factors--recruitment, measurement, and randomization.

INTRODUCTION: Although cardiovascular diseases (CVD) are the leading cause of death among Americans, significant disparities persist in CVD prevalence, morbidity, and mortality based on race and ethnicity. However, few studies have examined risk factor reduction among the poor and ethnic minorities. METHODS: Community-based participatory research (CBPR) study using a cluster randomized design--African-American church congregations are the units of randomization and individuals within the congregations are the units of analysis. Outcome variables include dietary change (Diet History Questionnaire), level of physical activity (7-Day Physical Activity Recall), lipoprotein levels, blood pressure, fasting glucose, and hemoglobin A1c. RESULTS: Eighteen (18) church congregations were randomized to either a health maintenance intervention or a control condition. Complete data were obtained on 392 African-American individuals, 18 to 70 years of age, predominantly employed women with more than a high school diploma. Treatment and intervention groups were similar at baseline on saturated fat intake, metabolic equivalent of tasks (METS) per day, and other risk factors for CVD. CONCLUSIONS: The GoodNEWS trial successfully recruited and evaluated CVD-related risk among African-American participants using a CBPR approach. Several logistical challenges resulted in extending the recruitment, preliminary training, and measurement periods. The challenges were overcome with the assistance of a local community consultant and a professional event planner. Our experience supports the need for incorporating non-traditional community-based staff into the design and operational plan of CBPR trials.

Gamma Knife surgery for hypothalamic hamartomas causing refractory epilepsy: preliminary results from a prospective observational study.

OBJECT: Hypothalamic hamartomas (HHs) are congenital lesions typically presenting with medically refractory epilepsy. Open or endoscopic surgical procedures to remove or disconnect the hamartoma have been reported to be effective but are associated with significant morbidity. The authors of studies on Gamma Knife surgery for HHs have reported an encouraging rate of epilepsy resolution with minimal side effects. At the Centre Hospitalier Universitaire de Sherbrooke, the authors have undertaken a prospective observational study of the outcomes of patients who underwent radiosurgery for HHs. METHODS: Patients were included in the study if they had an HH, refractory epilepsy, and no other suspected seizure focus. After radiosurgery, seizure status was assessed every 3 months and reported using the Engel Classification. Quality of life evaluation was performed annually using a standardized questionnaire, and neuropsychological evaluation was performed after 2 years. RESULTS: Nine patients were included in the study. They ranged in age from 12 to 57 years. Epilepsy began in infancy in all cases and was refractory to standard antiepileptic drugs. The patients received an average of 2 antiepileptic drugs before undergoing radiosurgery. Using the Régis Classification, 6 patients had smaller hamartomas (Grade I-III) and underwent treatment of the entire lesion, using a margin dose of 14-20 Gy. Treatment volume ranged from 0.3 to 1.0 ml. Three patients had larger lesions (Grade IV-VI) for which a radiosurgical disconnection was attempted, targeting the area of attachment to the hypothalamus. For those patients, the margin dose was 15 or 16 Gy, with treatment volume ranging from 0.8 to 1.8 ml. In all patients, the radiation dose received by the optic pathways was kept below 10 Gy. Disconnection led to no improvement in epilepsy (Engel Class IV). Four patients in whom the entire lesion was treated are now seizure free (Engel Class I), with another having only rare seizures (Engel Class II). Quality of life and verbal memory were improved in those patients with more than 3 years of follow-up. No adverse event occurred after radiosurgery. CONCLUSIONS: Radiosurgery safely and effectively controlled the epileptic disorder in patients with HHs when the entire lesion could be targeted. Radiosurgical disconnection is ineffective and cannot be recommended.

Brain modules of hallucination: an analysis of multiple patients with brain lesions.

We systematically reviewed the localization of focal brain lesions that cause isolated hallucination in a single sensory modality. Case reports of post-lesion nonparoxysmal hallucination in 1 (and only 1) of 3 sensory modalities (i.e., visual, auditory, somatic) were reviewed, and the content of the qualitative descriptions was analyzed for each modality. The lesion is practically always located in the brain pathway of the sensory modality of the hallucination. There seem to exist localized sensory brain circuits that in healthy people diminish the intensity of internal sensory representation. After a lesion, hallucinosis seems to be caused also by compensatory overactivation of tissue in the nearby brain sensory pathway. This type of hallucination may indeed be termed a "release" form, whereby patients are aware of the hallucinatory nature of their experience, but not usually of "dream centres" as proposed by Lhermitte. Instead, we propose that it is dreaming that should be considered a special case of neural "release."