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Radiation monotherapy as regional treatment for lymph node-positive Merkel cell carcinoma. Aerobic exercise training and improved neuropsychological function of older individuals. Moreover, findings of academic skill deficits may have implications for inferences regarding lateralized brain dysfunction in epilepsy patients. Imaging sensitivity was 83% based on correct identification of 10 of 12 positive lymph nodes (2 false negatives) and specificity was 95% based on correct identification of 20 of 21 disease-free lymph node basins (1 false positive). Aging and postural control: postural perturbations caused by changing the visual anchor. Intellectual Functioning Assessment of intellectual functioning following a stroke is important in order to establish a comparison point by which to judge impairments or strengths in other domains and for judging relative performance among domains of intellectual functioning. The introduction of neuropsychology into practice and research involving conditions without obvious neurological components follows older and eminently successful models of integrated care and treatment of the classical brain disorders. All groups showed an initial rapid change in gain that reflected reweighting of vision. In short, gross measures that collapse a wide swath of psychological and behavioral functioning are likely to obscure the profile of relative strengths and weaknesses that distinguishes one syndrome from others. We plan to analyze data from quality improvement efforts for joint arthroplasty patients with an eye toward optimizing our processes. In practice, protons differ from photons by having the property of increasing the dose very gradually with increasing depth and then rising to a peak at the end of its range (the Bragg peak); thus, it delivers less radiation in front of the tumor and no radiation behind the tumor target. A culturally appropriate measure of premorbid ability is recommended when a patient is first assessed to provide a context for interpreting specific neuropsychological tests. Although it takes a great deal of patience, resourcefulness, and perseverance, parents can look forward to modest rewards for the child and the family. Only two patients developed distant disease as the first site of disease beyond the primary site and both patients died from melanoma. Laboratory tests reveal a high osmolar gap, created by both the isopropyl alcohol and its metabolite acetone. Significant improvement was seen in mindfulness, perceived stress, empathic concern and perspective taking. In this case, it may be wise to choose an index or factor score as the most likely representation of underlying cognitive ability or choose another instrument that may allow the patient to demonstrate their reasoning skills without the need for verbal or motor output. An early marker to detect patients at high risk for developing these problematic forms of epilepsy has not been identified. Diagnostic performance of fluorine-18-fluorodeoxyglucose positron emission tomography in patients with Merkel cell carcinoma: a systematic review and meta-analysis. Neuropsychological profile of young adults with spina bifida with or without hydrocephalus. Ideally, a battery that allows for multiple assessments and emphases attention, memory, and naming skills. In 25% of cases, there is a prodromal stage in which there are symptoms of fatigue, sleep problems, decreased appetite, weight loss, asthenia, or anxiety. In general, neurocognitive impairments correlate with the duration and severity of the hypoxia [62, 65]. Furthermore, after training, brain activity in middle and inferior frontal gyrus was significantly increased [74]. Pseudobulbar palsy (dysarthria and swallowing difficulties), gait disturbances due to increased muscle tone, and parkinsonism are seen. The most common findings are summarized below, but an exhaustive review is beyond the scope of this chapter. Tests of constructional ability typically involve graphomotor tasks, such as copying of figures.

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Pearl the differential diagnosis for chronic tubulointerstitial nephritis is very broad. Extremely serious side effects such as delusions, paranoia, and frank psychosis are rare but can be seen with overdosage and abuse of the medication. This increased response time is thought to result from inhibitory processes acting upon the distracting stimulus during the prime trial, to prevent further processing. Raw scores greater than 3 suggest that further evaluation of depression is needed [55]. Carbon Monoxide Poisoning Carbon monoxide is a colorless, odorless gas produced as a by-product of combustion. Recent growing evidence indicates that subtle, organic abnormalities can be detected along the brain-gut axis, including the intestinal tract, the central nervous and the neural-hormonal system connecting them. The communication evaluation included 18 participants, due to poor patient follow-up. Some of the strongest evidence that there is no such association comes from large ecological studies showing the rise in incidence of autism has occurred in countries where the vaccines in question were not used, or that there is no difference in the incidence of autism in vaccinated and unvaccinated children, or that the rate has continued to increase after discontinuation of the vaccine. Some of the histologic abnormalities that are considered in tumor grading include the degree of pleomorphism (change in the structure of a neural cell), nuclear atypia (abnormalities within the nuclei of brain cells), endothelial proliferation (blood vessels with multiple endothelial layers and disorganized vessel walls), mitotic rates, and focal or superpalisading necrosis (a palisading pattern of necrosis in the tissue around the abnormal cancer cells). Very often, an intricate blending of the follicles with papillae is seen, resulting in a complex tubulopapillary pattern. Thus, it is necessary to put, for example, biomedical researchers and social researchers in dialogue. Students appreciated efforts to incorporate wellness into the curriculum but felt that it took time away from other efforts. I have never met anyone as generous with their time and teaching as Steve-he has trained a generation of clinicians from across the Harvard system in respiratory physiology. Because the mechanisms of postural control and their decline in older adults who fall are not fully understood, it remains a challenge to translate this modern view into effective rehabilitative programs for those with balance problems. The authors report that their intervention is being compared to a control group at another residency program, with baseline assessment of the Maslach Burnout Inventory, Connor-Davidson Resilience Scale, and Professional Quality of Life Scale; however, post intervention data are not presented. In 2003, the Hydrocephalus Association began collecting survey data from patients and their caregivers. Molecular studies of faecal samples have highlighted that only 7 to 9 of the 55 known divisions or phyla of the domain Bacteria are detected in faecal or mucosal samples from the human gut. Faculty-Focused Perioperative Ultrasound Training Program: A Single-Center Experience. To date, middle age appears relatively spared of cognitive sequelae of T2D; no difficulties are reported in any neuropsychological domain [5, 60]. The same extent of improvement was reported when physiotherapy was organized either as intermittent or continuous therapy [132]. The relation between endogenous testosterone and cognitive functioning in older women warrants further investigation so that the gender by age by sex hormone interactions can be further studied. Pearl Tumor lysis syndrome creates life-threatening metabolic derangements that require careful monitoring, specific pharmacological therapy, and possibly dialysis. Cardiac dysautonomia predicts long-term survival in hereditary transthyretin amyloidosis after liver transplantation. Probiotic foods or nutritional supplements are sometimes disparaged as `unregulated. Two successful candidates have just been selected to participate in this fellowship program. Diabetes impairs hippocampal function through glucocorticoidmediated effects on new and mature neurons. In addition, exposure typically occurs to multiple substances or mixtures of solvents, and there is not a known biological marker, such as blood levels, to document exposure. The authors also explored the role of the medical home in developing and supporting broader institutional efforts to promote resident wellness.

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The increase in nurses, scrub technicians, and anesthesiologists has enabled us to expand procedures to all locations on our Main Boston campus. This study highlights the importance of having protected and integrated time for any curriculum in order for it to be successful. It is generally best for parents to begin by focusing on a relatively simple behavior which is easy for the child to perform and for the parents to observe and quantify. Plasma lactate levels alone are not reliable markers of mitochondrial disease, and when performed with a tourniquet can result in a label of "lactic acidosis" inappropriately and subject a child to unnecessary invasive testing. The role of postoperative radiation and chemoradiation in merkel cell carcinoma: a systematic review of the literature. The effects of probiotics may be revealed through changes in either microbial populations or their metabolic activity. Indirectly, this study also suggests that brain injury related to depression may be compensated for by psychological strategies or social relationships. There was a higher proportion of the left hemisphere tumors that were in the temporal lobe (50% versus 25% of tumors in the right hemisphere), and the left hemisphere group reaction times may have been slower because of greater difficulty reconstructing memory. Therefore recent studies have been performed for tests that can be applied in the clinic settings by personnel other than psychologists. This randomized controlled trial aimed to understand the potential impact of passage meditation training on perceived stress reduction for health professionals. Older adults show a similar increase in processing time as compared to younger adults. It is also important for parents to consider factors which might prevent the child from successfully accomplishing the task. Mild cognitive impairment refers to a state in which cognitive deficits are milder than in dementia and not sufficiently severe to disrupt daily living. Probiotic ecosystems Whilst it is a worthwhile enterprise to search for and characterize novel probiotic species and strains, it is also worth remembering that the human gut microbiota is an ecosystem, and, like most ecosystems, it is better viewed as a whole and not simply as a sum of its parts. Subcortical hyperintensities impact cognitive function among a select subset of healthy elderly. In addition to measures of single-word reading and spelling, it is useful to assess reading comprehension, fluency of reading and writing, and writing composition. Impetus: Given the growing prevalence and impact of physician burnout in the modern health care system, targeted interventions designed to reduce burnout and promote wellbeing are necessary in medical training and practice. They specifically examined how directing attention to specifying item information should improve retrieval accuracy. Object recognition with severe spatial deficits in Williams syndrome: sparing and breakdown. Newly identified human commensals associated with healthy intestines may comprise probiotics of the future. Our clinical research ranges from database analysis, use of ultrasound for cardiac and lung assessment, and three-dimensional printing of patient-specific thoracic aortic aneurysm for preplanning for various arterial branching re-anastomosis. Additionally, the indicator subscales may have not been sensitive enough to detect small changes in outcomes that might occur with such small increases in sleep. By the policy of the local government, Wuhan Union Hospital was deployed as key medical center to treat severe patients. Contribution: While burnout was not shown to decrease with the debriefing sessions in this study, findings were limited by sample size. Sensory training may add to our theoretical understanding of postural control and its relationship to sensory information as well as inform the design of clinical interventions. Cardiac Magnetic Resonance Structure and function Cardiovascular magnetic resonance assessment of structure and function in patients with suspected or known cardiac amyloidosis follows well-standardized protocols (Table 2). Cells downstream will respond to the excitation of seizures as if learning occurred.

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Here we present a brief synopsis of this literature and offer some unique insights into the points of interest. However, there has been suggestion that the presence of psychiatric symptoms along with cognitive deficits may increase the likelihood of developing permanent deficits. Contribution: this cross-sectional study showed that the grading scale was more strongly correlated with student wellbeing than any other aspects of the curriculum structure. Problems have also consistently been seen on tasks requiring focus and shifting of attention [20, 21] and less so on sustaining attention tasks [22]. If the first (or any) generation following derivation retained viable bacteria, then one would expect that gnotobiotic techniques would be unsuccessful. Spontaneous dissection of extracranial and intracranial posterior circulation arteries. As subjects became more proficient, the length of time between task assignment and task execution was systematically increased. Interestingly, findings indicate that the stress reduction and mental health benefits were greater for participants who identified as only moderately or less spiritual relative to those who identified as highly spiritual. Merkel cell carcinoma of the head and neck: pathogenesis, current and emerging treatment options. Neurologic and neuropsychological morbidity following major surgery: comparison of coronary artery bypass and peripheral vascular surgery. In this chapter, we will shortly discuss recent evidence supporting the hypothesis that the gut microbiota can influence host metabolism using various mechanisms and that changes in microbiota composition trigger modifications of metabolic behaviour. The presence of other disturbances such as tics, anxiety, aggression, or depression may influence the choice of pharmacologic agent. The direct cognitive consequences of medically well-studied endocrine disorders, such as diabetes, tend to be relatively subtle and thus less likely to be identified in these patients. The article also provides links to various programs as well as faculty contact information. To be in the presence of such patients is akin to standing in front of a dam bursting with words and thoughts. Rehabilitation Outcomes Following Anoxia Outcome following severe anoxia is variable, however, the majority of patients have poor outcome [3]. Their neuropsychological symptoms vary, from the sudden, often dramatic, loss of significant abilities due to stroke or the progressive cognitive withering of vascular dementia to the subtle dampening of cognitive acuity that occurs with primary breathing disorders or the intermittent diminution of function accompanying many migraine headaches. We propose an interdisciplinary approach to the study of cognitive aging to ameliorate the present insufficiency in understanding. In the last 50 years, with the growing understanding of neurological disorders, neuropsychologists and medical specialists in clinics, at bedside, and in laboratories together have contributed to important clinical and scientific advances in the understanding of the common pathological conditions of the brain: stroke, trauma, epilepsy, certain movement disorders, tumor, toxic conditions (mostly alcohol-related), and degenerative brain diseases. Attentional capacity is commonly assessed using span tests, such as Digit Span and Spatial Span from the Wechsler batteries [49]. It is difficult to establish the prevalence of the different dementias partly not only because of this overlap but also because different diagnostic criteria are often used [7, 8]. However, when depression is based on self-report and varies broadly along a continuum, no additive effect is found on cognitive performance, although a primary effect of diabetes on cerebral atrophy and reduced psychomotor functioning is detectable, consistent with the literature [91]. Group 1 received training once per week lasting ninety minutes over the course of six weeks. The total Global Severity Score is calculated by combining the total tic and impairment scores. Greater provider burnout was associated with lower perceived care quality, reduced patient satisfaction, reduced quality indicators and reduced perceptions of safety. This brief, involuntary muscular twitching 27 Mitochondrial Disorders 495 is then often followed by generalized seizures, ataxia, weakness, and dementia [42]. Future studies could evaluate alternate delivery methods to impact of increased physician access to food and drink. Brock has proposed a temporal binding deficit which postulates that many features of autism, such as superiority in processing of detail (local processing) and disadvantage in global processing necessitating integration of information either over space (visuo-spatial perception) or context (integration of words into meaningful sentences), can be explained by a failure of temporal integration, or binding, between cortical areas [157]. Gender, and advancing age of subjects tested, exerted significantly different effects on severity of cognitive declines during headaches.

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Blockade of the mineralocorticoid receptor in healthy men: effects on experimentally induced panic symptoms, stress, hormones, and cognition. Relationship of pass/fail grading and curriculum structure with wellbeing among preclinical medical students: A multi-institutional study. The latter is of interest, given its demonstrated ability to modulate the systemic immune response in humans. For cognitive deficits, treatment seems most effective when a combination of compensatory and restorative approaches is used. Most parents are ambivalent about starting their child on medication, so it is best to give them ample time to consider the decision carefully. In a pinch one may use a substance readily the trigeminal nerve has both motor and sensory components. Stereotypies are a kind of perseveration wherein patients repeatedly engage in the same behaviors, to no apparent purpose (Section 4. Motor development in 7- to 12-year olds shows difficulty in spatially mediated motor tasks [59]. An inhibitory mechanism may serve to limit entrance into working memory only to information that is along the "goal path" of comprehension. We run three to four endoscopy suites per day, providing care for outpatients and inpatients and caring for 450plus patients each month. Culture remained for a few decades the only way to access the dominant fecal microbiota and explore its functional contribution. Typical examination of depression in research and clinical settings often includes instruments that yield a single summary score though depressive symptoms are known to range from somatic, affective, cognitive, and motivational components. The gene fusion is not found in other thyroid neoplasms except some cases of "follicular variant of papillary carcinoma. The interaction between the stroma and tumor can result in unusual histologic patterns reminiscent of fibroadenoma, phyllodes tumor, or fibrocystic disease of the breast. Patients with T1D also are at a slightly increased risk for hypertension, found in 3. Prevalence and clinical significance of computerized tomography verified idiopathic calcinosis of the basal ganglia. Preexisting cognitive impairment in women before cardiac surgery and its relationship with C-reactive protein concentrations. Thinking on your feet: a neuropsychological review of peripheral vascular disease. Each fellow completes a research project, is encouraged to obtain a Masters in Biomedical Informatics, and completes the Program in Clinical Effectiveness at Harvard School of Public Health. Carbon monoxide results in approximately 40,000 emergency department visits [129] and 800 deaths per year in the United States [130]. Acute symptoms, including dizziness, headache, or feelings of intoxication, can occur, but most of the research has focused on the effects of chronic exposure. Below we summarize studies which explore perceptual postural control mechanisms in elderly individuals with and without a 522 E. This study examines the effect on health care performance of stress-management training designed to enhance coping skills. This circuit is the neuroanatomical basis for organizing behavioral responses to solve complex problems, such as learning new information, systematically searching memory, or activating remote memories. It is funded by the Norwegian Medical Association and is located at a psychiatric facility, Modum Bad. However, more recent research suggests that cognitive impairment in old age may be related to a breakdown in myelin integrity [17]. This discrepancy between vocabulary and morphology was observed despite the fact that English is a relatively uninflected language.

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Transient cerebral hypoperfusion may become persistent if counterregulatory mechanisms become impaired. A huge advance both clinically and scientifically would be to develop an early marker with prognostic value to detect patients at high risk for developing multiple foci or generalizing seizures, as these are generally poor prognostic markers in terms of seizure outcome. Contribution: the information detailed in this paper can be useful for programs initiating orientations for each of the transitions and for guiding thematic content for longitudinal curriculum planning. Although direct comparison to prior classes was not possible, the changes in wellbeing were not improved compared to a pre-intervention cohort. This study used a more difficult task than the studies cited above, in which people with autism were asked to view photographs of faces and choose a label that described the emotion (simple or complex) expressed in the picture (the previous studies asked participants to either identify pictures as familiar or unfamiliar or whether a face showed emotion or was neutral). Further, neuropsychological impairments are common in patients with pulmonary disorders in which continuous or intermittent hypoxia or hypoxemia occur without ischemia. However, there was no effect of laterality of hemisphere on the hit rates (accuracy) of recognition. Impetus: Mindfulness-based initiatives have demonstrated self-care benefits among hospice and palliative care clinicians. Standard treatment is limited to symptom management, including antiepileptic medications. Promoting a Restrictive Intraoperative Transfusion Strategy: the Influence of a Transfusion Guideline and a Novel Software Tool. Both are caused by release of neurotransmitters initiated by discharges arising from the upper brain stem and trigeminal system. Therefore, those patients with digestive symptoms were more likely to suffer liver injury although the mean alanine aminotransferase and aspartate aminotransferase were in the normal range (Table 3). Despite the general conclusions described above, a review of the literature on endocrine conditions and cognition reveals considerable discrepancies and inconsistencies. Quality of parental relationships among persons with a lifetime history of posttraumatic stress disorder. The Levy Laboratory conducts research using in vivo approaches in rats and mice on mechanisms underlying triggers of migraine headache. Regional cerebral blood flow in fibromyalgia: single-photon-emission computed tomography evidence of reduction in the pontine tegmentum and thalami. This program has helped highlight the potential pitfalls associated with unnecessary use of opioids in the hospital environment. Quantitative differences in intestinal Faecalibacterium prausnitzii in obese Indian children. Ultrasonographically assessed carotid morphology and the risk of coronary heart disease. Those who wish to participate in the cognitive neuroscience of these fields through grant-funded research will find these chapters very valuable. In addition to many different genera and species of probiotics, different strains of the same species also are used. Dominated by specific genera, these compositions have been named the Bacteroides-, Prevotella- and Ruminococcus- enterotypes. Training involved three distinct phases: overt verbalization, overt self-guidance, and covert internalized self-monitoring. The relationship between professional burnout and quality and safety in health-care: a meta-analysis. In contrast, there is a notable lack of research examining the neural mechanisms underlying developmental dysgraphia. Whatmough Introduction Dementia is a condition of persistent decline in multiple mental domains essential to normal daily living. The cells are arranged in small follicles, trabeculae, solid sheets, or sometimes papillae. Confusion may last from days to weeks, and physical, cognitive, and emotional impairments can persist for months or be permanent [3]. The Role of Neuropsychology in Epilepsy Neuropsychology plays a limited role in epilepsy diagnosis. The exact mechanism of action for probiotic action is not defined but gut bacterial population replacement and metabolic changes induced by probiotics have been proposed. All residents participated in the monthly Balint sessions; however, study enrollment was voluntary and only 17 of 36 residents completed baseline and 12-month questionnaires.

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In addition, many children are dependent on technology and need the support of medical or assistive devices to compensate for impaired body functions. These treatable conditions are, however, rare and represent less than 5% of dementias [12]. Attention Impairments in attention, concentration, distractibility, and reduced processing speed are among the most commonly reported cognitive impairments. Nevertheless, youth with later disease onset still show small but broad neurocognitive sequelae that mirror the effects reported in overall pediatric samples, including spared memory and learning skills [36]. The Division of Vascular Anesthesia continues to provide services for patients undergoing open and endovascular vascular surgery. By four months of age, the gut microbial concentrations of infants who had been born via Caesarian are under-represented in Escherichia coli and Bacteroides spp. Effects of Tumors on Cognitive Function the theory of how brain tumors cause functional damage has traditionally been based on the observation that brain tumors are associated with less functional damage than other more rapidly acquired brain injuries such as head injuries and stroke. In contrast to this wealth of observational data, interventional trials have shown inconsistent effects of lowering Hcy on the rate of cognitive decline. So far significant differences have not been shown between follicular adenoma and follicular carcinoma in Three major, apparently nonoverlapping, molecular pathways are implicated in follicular neoplasms. Yet, the prevalent theories of cognitive aging primarily focus on deficits in executive processing, associated with frontal functioning. O Introduction besity is defined as a massive expansion of the adipose tissue and is typically associated with a wide cluster of metabolic alterations, including glucose homeostasis disorders. However, a report of increased mortality in the probiotic-consuming group of a randomized, clinical trial in subjects with acute pancreatitis highlights the importance of care when designing and launching studies with compromised individuals. Alternatively, both depression and cognitive changes could be symptoms of vascular changes in the brain. Remarkably, the incidence of thyroid cancer has steadily increased in most countries over the past two decades, predominantly attributable to an increase in papillary carcinomas. Statistically significant changes were seen in self-regulation and self-compassion; a positive but non-significant trend was seen in empathy and perceived stress scores. The general finding is that of early brain overgrowth followed by slowed or no growth. Neuropsychological problems after paediatric stroke: two year follow-up of Swiss children. A question then arises as to what constitutes underachievement: how low must performance be for it to be considered problematic A weakness of this proposed identification method is that the use of a specific cut point. We refer to this effect as inverse gain reweighting, meaning, that as stimulus amplitude goes up, the response to that stimulus goes down. Prevalence, recognition, and implications of mental impairment among hemodialysis patients. Rarely occurs in patients who had native nephrectomy therefore suggesting that it is the native kidneys, rather than the allograft, that is the cause. Secondary changes such as hemorrhage, hemosiderin deposition, sclerosis, edema, necrosis, and cystic change are not uncommon. The dominant mucosa associated microbiota is also subjectspecific and remarkably conserved for a given individual from the ileal to the sigmoid-rectal mucosa. Serum cholesterol changes after midlife and late-life cognition: twenty-oneyear-follow-up study. Mild traumatic brain injury: causality considerations from a neuroimaging and neuropathology perspective. Perseveration is a pragmatic problem at least in the sense that it results in a failure to adhere to conversational expectations regarding informativeness. These treatments include semantic feature analysis, semantic cueing, and phonological cuing.

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Neuropsychological research on encephalomyopathy has generally consisted of chart reviews and case studies. Vascular dementia: clinical assessment, neuropsychological features, and treatment. Cognitive impairment is associated with subcortical magnetic resonance imaging grey matter T2 hypointensity in multiple sclerosis. Asterixis is defined as a flapping tremor caused by the disturbance in the oscillatory networks in the brain. Postural sway with earth-fixed and body referenced finger contact in young and older adults. Neuropsychology traditionally focuses on the clinical symptoms of cognitive disruption caused by epilepsy, but the neuroplastic mechanisms underlying the disorder are important in showing why the cognitive effects of epilepsy are so varied. Achikam OrenGrinberg, have been extremely active in the field of education in critical care echocardiography and ultrasound. On a personal note, I have had the honor and pleasure of having Steve as my mentor and a fellow researcher in pulmonary physiology, and in particular in studies of the appropriate use of mechanical ventilation in patients with acute respiratory distress syndrome. A number of studies have introduced manipulations to enhance the encoding of item-specific information for the target words so as to reduce false recognition (and recall) in older adults. Major focus on treatment of hyperuricemia with prophylactic allopurinol and in those patients with very high uric acid levels the use of rasburicase to degrade uric acid. Cognitive and motor development during childhood in boys with Klinefelter syndrome. Effects of a 14-day healthy longevity lifestyle program on cognition and brain function. Impetus: this qualitative study sought to understand the impact of a mindful communication program on patient-centered care and physician wellbeing. Verbal Fluency Verbal fluency is a measure of how quickly and efficiently a person can access stored knowledge about words. Despite some transfer of learning to highly similar job contexts, learning continues to be highly task-specific. The assumption of this discussion is that damage to certain brain regions confers risk for depression. Estrogen and/or androgen replacement therapy and cognitive functioning in surgically menopausal women. Pearl Unlike patients with hyponatremia due to low solute intake, primary polydipsia patients have a very high urine output (up to 15 L in 24 hours) when they have access to water. Other neuro-opthalmological abnormalities may include blepharospasm and reduced blinking frequency, all of which may interfere with higher level spatial cognition. They found reduced gray matter volume in the left parietal region that corresponded to areas of reduced activation in participants with dyslexia relative to nondyslexic participants. Neuropsychologists can assess many aspects of fine motor functioning through observation, informal testing, or formal testing. Contribution: A model of resident participation and learning was developed, which identified components necessary for the creation of positive learning environments. Abnormality in limbic structures (hippocampus, amygdala, subiculum, entorhinal cortex, anterior cingulate gyrus, mammillary body, septum) was present in a majority of autism cases examined [9, 10, 16, 17]. Carotid and lower extremity arterial disease in elderly adults with isolated systolic hypertension. Contribution: this study demonstrated that 66% of pediatric residents in a tertiary hospital in Argentina experience burnout. Neuropsychological test performance in mildly hypoxemic patients with chronic obstructive pulmonary disease. Rapid transition to the operating room is a major predictor of outcome for these patients, so this transition is particularly gratifying for our teams and speaks to our commitment to providing exemplary care for our patients. This is a crucial finding since working memory is a basic cognitive mechanism that underlies successful performance on many other cognitive tasks. Indeed the overwhelming majority of sudden cardiac deaths (estimated at about 325,000 per year) are thought to be from ventricular fibrillation.