The eyes speak when the mouth cannot: Using eye movements to interpret omissions in primary progressive aphasia.

Though it may seem simple, object naming is a complex multistage process that can be impaired by lesions at various sites of the language network. Individuals with neurodegenerative disorders of language, known as primary progressive aphasias (PPA), have difficulty with naming objects, and instead frequently say "I don't know" or fail to give a vocal response at all, known as an omission. Whereas other types of naming errors (paraphasias) give clues as to which aspects of the language network have been compromised, the mechanisms underlying omissions remain largely unknown. In this study, we used a novel eye tracking approach to probe the cognitive mechanisms of omissions in the logopenic and semantic variants of PPA (PPA-L and PPA-S). For each participant, we identified pictures of common objects (e.g., animals, tools) that they could name aloud correctly, as well as pictures that elicited an omission. In a separate word-to-picture matching task, those pictures appeared as targets embedded among an array with 15 foils. Participants were given a verbal cue and tasked with pointing to the target, while eye movements were monitored. On trials with correctly-named targets, controls and both PPA groups ceased visual search soon after foveating the target. On omission trials, however, the PPA-S group failed to stop searching, and went on to view many foils "post-target". As further indication of impaired word knowledge, gaze of the PPA-S group was subject to excessive "taxonomic capture", such that they spent less time viewing the target and more time viewing related foils on omission trials. In contrast, viewing behavior of the PPA-L group was similar to controls on both correctly-named and omission trials. These results indicate that the mechanisms of omission in PPA differ by variant. In PPA-S, anterior temporal lobe degeneration causes taxonomic blurring, such that words from the same category can no longer be reliably distinguished. In PPA-L, word knowledge remains relatively intact, and omissions instead appear to be caused by downstream factors (e.g., lexical access, phonological encoding). These findings demonstrate that when words fail, eye movements can be particularly informative.

Taxonomic Interference Associated with Phonemic Paraphasias in Agrammatic Primary Progressive Aphasia.

Phonemic paraphasias are thought to reflect phonological (post-semantic) deficits in language production. Here we present evidence that phonemic paraphasias in non-semantic primary progressive aphasia (PPA) may be associated with taxonomic interference. Agrammatic and logopenic PPA patients and control participants performed a word-to-picture visual search task where they matched a stimulus noun to 1 of 16 object pictures as their eye movements were recorded. Participants were subsequently asked to name the same items. We measured taxonomic interference (ratio of time spent viewing related vs. unrelated foils) during the search task for each item. Target items that elicited a phonemic paraphasia during object naming elicited increased taxonomic interference during the search task in agrammatic but not logopenic PPA patients. These results could reflect either very subtle sub-clinical semantic distortions of word representations or partial degradation of specific phonological word forms in agrammatic PPA during both word-to-picture matching (input stage) and picture naming (output stage). The mechanism for phonemic paraphasias in logopenic patients seems to be different and to be operative at the pre-articulatory stage of phonological retrieval. Glucose metabolic imaging suggests that degeneration in the left posterior frontal lobe and left temporo-parietal junction, respectively, might underlie these different patterns of phonemic paraphasia.

School violence: prevalence and intervention strategies for at-risk adolescents.

This study investigated the effects of social-cognitive group intervention on violence avoidance beliefs among at-risk adolescents. Fifty high school students were randomly assigned to an experimental or a control group. The experimental group participated in ten, 2-hour weekly sessions of a social-cognitive intervention. Both groups were administered a questionnaire before, immediately following, and 3 months after the intervention. Findings showed that the social-cognitive intervention did not result in significant differences between the groups on violence avoidance beliefs at posttest or follow-up. In addition, drug/alcohol users and nonusers, fighters and nonfighters, and students threatened at school and those not threatened were compared. Students who used drugs/alcohol and fought in school had significantly lower scores (i.e., a greater belief in using violence as a coping technique) than did students who did not engage in those behaviors.

Nephrologists' and internal medicine physicians' expectations of renal dietitians and general clinical dietitians.

OBJECTIVE: To document and compare nephrologists' and internal medicine physicians' expectations of renal dietitians and general clinical dietitians. DESIGN: Subjects completed a mailed survey. Respondents provided demographic information and used a 5-point Likert scale to note whether each of 14 job functions was appropriate for general clinical dietitians, renal dietitians, or both. SUBJECTS: Five hundred forty-one physicians registered with the Ohio State Medical Board (OSMB) were surveyed. Within this group were 283 nephrologists (the population of nephrologists registered with the OSMB) and 258 internal medicine physicians (selected randomly by the OSMB). A total of 133 physicians (25%) returned the survey; 119 surveys were usable: 70 from nephrologists and 49 from internists. STATISTICAL ANALYSES PERFORMED: A composite variable was created by coding and summing physicians' responses regarding dietitian job functions. This variable was averaged for both physician categories. A t test was conducted to compare composite variable results between the two physician groups. RESULTS: At least 50% of nephrologists and internists agreed that both types of dietitians should conduct nutrition assessments, determine patients' energy needs, evaluate medication-nutrient interactions, recommend diet and tube-feeding orders, instruct patients about physician-ordered diets, and teach nutrition concepts to hospital interns. Few physicians agreed that either type of dietitian should order diets, tube feedings, or diet instructions. APPLICATIONS/CONCLUSIONS: Clinical dietitians can educate physicians about dietitians roles informally in their institutions and formally by supporting programs like The American Dietetic Association Physician Nutrition Education Program. In addition, dietetics educators can hone their students' communication and problem-solving skills to promote positive physician-dietitian interaction.

Comparative evaluation of body composition in medically stable elderly.

OBJECTIVE: Accurate assessment is needed to identify the nutritional status of elderly persons. Anthropometric data were collected to describe body composition of the sample, including blacks and whites aged 55 to 89 years, and to explore the usefulness of several methods of body composition measurement. DESIGN: Baseline measurements were made as part of a longitudinal study. Body composition variables, particularly lean and lean-to-height measures, were used. SUBJECTS/SETTING: One hundred twenty-nine free-living medically stable elderly at senior community centers were self-selected into the study. STATISTICAL ANALYSIS: Descriptive statistics were generated for all variable by gender, race, and age (< 65, 65 to 74, and > or = 75 years). Actual height was correlated with estimated height using published equations. Analysis of variance revealed the effect of gender, race, or age on outcome variables. RESULTS: White women, black women, and white men made up 54%, 23%, and 23% of the sample, respectively. Most gender differences were expected. Black women had greater weight, body mass index, arm muscle circumference, and ratio of lean to height but lower percent lean body mass than white women. Subjects over 75 years old were shorter, lighter, and had lower ratio of lean to height. Gender and age had the greatest effect on ratio of lean to height. CONCLUSIONS/APPLICATIONS: A lean-to-height index appears to be a useful tool for tracking the status of lean mass in the elderly. Knee height may be especially useful because it, unlike stature, does not decrease with age. Furthermore, some published equations for estimating stature from knee height need adjustment, specifically for elderly black women.

A university-community model for the integration of nutrition research, practice, and education.

A model to integrate nutrition research, practice, and education was conceptualized and implemented to enhance student learning opportunities. The model encourages partnerships between educators and practitioners by providing a mechanism for faculty researchers to work with community practitioners to identify applied research and education projects in which students can participate in the design, implementation, analysis, and reporting. Learning experiences are discussed in relation to the knowledge and performance requirements for entry-level dietitians as mandated by The American Dietetic Association. Faculty and community practitioner relationships to support student learning and goal attainment are described. The research, practice, and education model has particular application to other universities struggling to balance limited resources with increasing expectations for community-university partnerships, and expectations for excellent teaching and scholarship. Resources needed (ie, staff, support services, and physical facilities) to develop and implement the model are discussed. Finally, acquisition options such as shared resources and in-kind contributions are suggested.

Effectiveness of a nutrition education and physical fitness training program in lowering lipid levels in the black elderly.

A multidisciplinary nutrition education and fitness training program was tested for its effectiveness in lowering lipid profiles of elderly clients through dietary modification and exercise. The program served 31 free-living, predominantly female, black elderly aged 56-88 years. Dietary, anthropometric, biochemical, and fitness assessments were performed before and after the 10-week, biweekly program. Significant decreases (p < 0.05) were seen in waist circumference, total cholesterol (TC), low-density lipoproteins (LDL-C), and TC/HDL-C ratio. These findings suggest a 10-week, biweekly program can be effective in producing both significant, as well as favorable changes, in atherogenic lipids in elderly black subjects.

Lack of significant changes in nutrition-related parameters with tumor necrosis factor treatment of cancer.

Cancer and its therapies frequently produce anorexia and cachexia. In this study, the acute (3 days) and chronic (4 wks) nutrition-related effects of cancer therapy with recombinant human tumor necrosis factor (rHuTNF) were investigated and described. Nutritional status, as measured by body weight and body composition (body fat and lean-to-fat ratio) with use of bioelectrical impedance, did not appear to deteriorate. None of the serum lipids changed significantly, but triglycerides did rise modestly over four weeks of therapy. Glucose and the peptide hormones (insulin, C-peptide, glucagon, and pancreatic polypeptide) thought to affect appetite did not change with rHuTNF therapy. Therefore, although TNF is thought to contribute to wasting in animal models, it had no negative effect on nutritional status in our small sample. The lack of adverse effect noted in this study is possibly due to the low dose level of rHuTNF or to adaptation.

Violence and illegal drug use among adolescents: evidence from the U.S. National Adolescent Student Health Survey.

The relationships between violence, drug use, and victimization were examined in a representative sample of American adolescents. The commonly used illegal drugs (marijuana, amyl/butyl nitrites, psychedelics, amphetamines, and cocaine) and alcohol were considered. Drug users, compared to nonusers, fought more, took more risks which predisposed them to assault, and were assaulted more both at school and outside school supervision. Adolescents who were victims at school were also more likely to be victimized outside of school supervision. This study clearly demonstrates that the aggressor may also be the victim, and that illegal drug/alcohol use is related to victimization.

The effect of exercise training on body weight and peptide hormone patterns in normal weight college-age men.

Resting and peak glucose, insulin, glucagon, gastric inhibitory polypeptide (GIP) and pancreatic polypeptide (PP) levels were evaluated pretraining, 3 weeks and 10 weeks posttraining in seven college age males. The exercise consisted of thrice weekly session of jogging at 70% VO2max for 20 minutes plus warmup and cool down. Following the 10 weeks, VO2max increased significantly. Body weight remained constant and body fat decreased significantly. Fasting and peak blood glucose levels were normal at the beginning of the study yet improved with training. As expected, fasting and peak insulin levels decreased significantly with training. Although GIP did not change significantly with training, an uncoupling of GIP and insulin peak responses was observed. Glucagon levels were essentially unchanged. Fasting and peak PP levels increased slightly as training occurred. These hormone responses suggest that perhaps body weight and/or changes in body fat stores and fuel use might influence peptide hormone responses with training.

Sources of drug information among adolescent students.

A sample of 1023 eighth and tenth grade students in small to medium-sized central Texas school districts was assessed to determine the amount of information they receive from ten sources about six categories of drugs. The amount of information males reported receiving about each drug category was significantly greater than what females reported, and the amount of information that eighth graders reported receiving about each drug category was significantly greater than what tenth graders reported. Television was the primary source of drug information for all categories of drugs except inhalants, for which friends and television were equally important sources. Parents and printed media (magazines or newspapers) were of secondary importance, followed by friends and teachers. Adolescents were less likely to receive drug-related information from experience, siblings, church, doctors, and police. The reliance on the mass media for drug information in smaller school districts is a pattern which has been previously observed in larger urban districts. This consistency suggests that mass media approaches to drug education are likely to be as effective in rural areas and smaller towns as they are among urban adolescents. Implications for television programming are discussed.

Peer influence and drug use among adolescents in rural areas.

A sample of 1,004 eighth and tenth grade students in twenty-three small Central/East Texas communities was assessed to determine 1) their perception of the number of their friends who use drugs, 2) the amount of information they received about drugs from their friends, and 3) the connection between those perceptions and drug use. A multiple regression model which included grade, gender, the degree to which friends are perceived to use drugs and the amount of information about drugs received from friends explained 39 percent of the variance in the degree to which rural adolescents were involved in drug use. An item specific analysis of the subcomponents of these composite variables explained 44 percent of the variance in the degree to which rural adolescents were involved in drug use. This same four-factor model accurately classified over 81 percent of non-drug-users and 67 percent of users using discriminant analysis. Students who perceived a higher degree of drug use among their friends and who received more information about drugs from their friends used drugs more frequently. Lower marijuana use in these rural areas as compared to the nation, both as a peer perception and as a fact, may protect these students to a degree from broader patterns of drug use. The findings of this study support the theory that peer pressure is related to drug abuse, even in rural areas.

The response of serum growth hormone and prolactin to training in weight-maintaining healthy males.

Resting levels of serum growth hormone (GH) and prolactin (PRL) were measured pretraining, 3 weeks and 10 weeks posttraining in seven college age males. The exercise consisted of thrice weekly sessions at 70% VO2max for 20 minutes plus warmup and cool down. Body weight remained constant during the ten week training period. However, body fat decreased significantly. Resting daytime levels of GH decreased significantly with training while resting PRL levels were unchanged. The hormone responses suggest attenuation of resting GH levels with training and may relate to changes in body fat.

Serum and red cell folate concentrations in outpatients receiving lithium carbonate.

We measured serum and RBC folate levels in 17 outpatients taking lithium for the prophylaxis of recurrent major affective disorder. In contrast to a previous report, we found no evidence for low folate concentrations or for any significant correlation between folate levels and affective morbidity.

A comparison of taste acuity for salt in renal patients vs. normal subjects.

In this pilot study, 30 patients with renal disease receiving renal replacement therapy (10 each in the following groups: continuous ambulatory peritoneal dialysis [CAPD] patients, hemodialysis [HD] patients, and renal transplant recipients) and 10 control subjects were given salt solutions of varying concentrations (0 to 600 mmol/L) and asked to rate them subjectively according to their perceived taste intensity. The mean age in each of the four groups ranged from 31.9 to 34.1 years. No significant differences were found in the ratings of perceived salt intensity among patients and control subjects. On the basis of 3-day food records plus recall of seasonings used, mean intake of sodium was estimated to be higher in CAPD patients and control subjects than in HD and transplant patients (p less than 0.02). Patients on CAPD stated a preference for salty items, whereas control subjects preferred the less salty items despite similar estimated sodium intakes. It thus appears that the ability to perceive various salt tastes may not be impaired in patients on renal replacement therapy. In addition, inappropriate salt intake commonly seen in those patients may be due to increased salt appetite, specifically in those patients managed by CAPD.

Motivational techniques of dietitians counseling individuals with type II diabetes.

A survey was conducted to ascertain to what extent dietitians use techniques cited in the literature considered to affect adherence by patients with non-insulin dependent (Type II) diabetes. A survey instrument listing techniques related to changing behavior, the counseling process, and content of teaching was developed and mailed to 500 members of the ADA Diabetes Care and Education Practice Group. Responses were received from 39% of the sample. For a majority of techniques, data analysis showed statistical association between frequency of use, perceived importance, and adequacy of practitioner training. Dietitians regularly used only 40% of the cited techniques related to changing behavior and the counseling process, but they said most of the items were important. Only half of the items related to the content of teaching were rated as important, and dietitians felt prepared to use only 70% of them. Most dietitians did not teach concepts related to glucose utilization, energy metabolism, and the metabolic role of insulin in diabetes. Those findings suggest that dietitians do not regularly use many techniques considered effective in obtaining dietary adherence of patients with diabetes. Since other studies show compliance is directly influenced by skills of the provider, dietitians could improve cost-effective health care by developing further professional expertise in the area of counseling patients with diabetes.

Weight change and peptide hormone responses in patients receiving interferon.

The purpose of this pilot study was to describe body weight status and peptide hormone responses in patients receiving interferon (IFN) therapy for renal cell carcinoma. Eighteen patients were on therapy for approximately two to three months. Mean weight loss of the patients was 2.2 +/- 0.9 kg (mean +/- SEM) or 4.9 +/- 0.9% of prestudy weight. Of the 18 patients, 6 were further evaluated for peptide hormone responses to meal stimulation before and after treatment (mean: 1.5 months). These subjects had a mean weight loss of 4.3 +/- 1.6 kg or 7.0 +/- 3.5% of prestudy weight. Blood was drawn from subjects before and six times after they had consumed a defined formula liquid meal to provoke enteroinsular peptide release. It was discovered that one-half of this group (n = 3; Group A) had some glucose intolerance following IFN therapy, despite increased response of insulin, gastric inhibitory polypeptide (GIP), and pancreatic polypeptide (PP) to meal stimulation. Further, patients in Group A had a weight loss of -11.7 +/- 2.7% of prestudy weight, whereas the other three patients (Group B) experienced a mean loss of -2.3 +/- 1.2% (p less than 0.04). The three subjects characterized by the smaller loss of prestudy weight (Group B) had decreased glucose response to meal stimulation, despite decreased responses of insulin and GIP. Response of PP was slightly increased with treatment in group B, but the increase was not as large as that in Group A. These data may suggest that extreme weight loss and altered peptide hormone response occur in a subset of cancer patients receiving interferon therapy.