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Electromagnetic fields
- What are electromagnetic fields?
- Static and low-frequency fields
- What are static and low-frequency electric and magnetic fields?
- Direct and alternating voltage
- Application/occurrence
- Effects of static and low-frequency fields
- Protection
- Reports & Evaluations
- Radiation protection relating to the expansion of the national grid
- Basics transfer of electrical power
- Effects
- Protection
- High-frequency fields
- What are high-frequency fields?
- Applications high-frequency fields
- Effects
- Protection
- Radiation protection in mobile communication
- What is mobile communication?
- Effects
- Protection
- Reports and evaluations
Optical radiation
- What is optical radiation?
- UV radiation
- What is UV radiation?
- Sun but safe!
- Sunbeds
- Effects of UV radiation
- Protection against UV radiation
- UV index
- Infrared radiation
- Laser
Ionising radiation
- What is ionising radiation?
- Radioactivity in the environment
- Where does radioactivity occur in the environment?
- What is the level of natural radiation exposure in Germany?
- Air, soil and water
- Radon
- Foodstuffs
- Building materials
- Relics
- Industrial residues (NORM)
- BfS laboratories
- Applications in medicine
- Diagnostics
- Radiotherapy
- Radiation protection in medicine: international activities
- Applications in daily life and in technology
- Radioactive radiation sources in Germany
- Register high-level radioactive radiation sources
- Type approval procedure
- Cabin luggage security checks
- Radioactive materials in watches
- Ionisation smoke detectors (ISM)
- Effects
- What are the effects of radiation?
- Effects of selected radioactive materials
- Consequences of a radiation accident
- Cancer and leukaemia
- Genetic radiation effects
- Individual radiosensitivity
- Epidemiology of radiation-induced diseases
- Ionising radiation: positive effects?
- Risk estimation and assessment
- Radiation protection
- Basic information
- Occupational radiation protection
- Nuclear accident management
- What is an emergency?
- What happens in an emergency?
- Federal and state tasks
- In the event of an emergency
- Protection of the population
- Radiation exposure
- Psychosocial consequences
- Decision support systems
- Measuring networks
- Exercises for emergency situations
- Defence against nuclear hazards
- Service offers
- Radon measurements
- Incorporation monitoring
- Biological dosimetry
- ProZES
Media centre
Media centre
- Multimedia
- Brochures
- Reports
- Online library
The BfS
The BfS
- About us
- Science and research
- Research concept
- Scientific collaborations
- EU research framework programme
- BfS research programme
- Third-party funded research
- Departmental research
- Selected research projects
- Selected research results
- Professional opinions
- Science Council
- Laws and regulations
- BfS Topics in the Bundestag
- Links
How is the radiation exposure of the population determined after a nuclear accident?
- In the case of a nuclear accident, the Federal Länder (federal states) establish emergency care centres in the affected areas after the passage of a radioactive cloud.
- People who have been in the area of the cloud can register and seek advice there.
- The emergency care centre staff can measure whether individuals have been radioactively contaminated.
- Depending on where an individual was during the period following the accident, the level of radioactivity in this area and consequently the exposure to the individual can be determined with the data from the radioactivity measuring network of the BfS.
In the case of a nuclear accident, the Federal Länder (federal states) establish emergency care centres in the affected areas after the passage of a radioactive cloud. People who have been in the area of the cloud can register and seek advice there.
Is the individual contaminated?
The emergency care centre staff can measure whether individuals have been radioactively contaminated, that is, whether they have got radioactive particles on their clothing or skin.
If necessary, contamination can be removed there. In most cases it is enough to remove and dispose of the clothing and to wash oneself thoroughly.
How much radiation exposure has been received?
In the emergency care centres or at a later date, the individuals can be asked where they were during the period following the accident. With the data from the radioactivity measuring network of the BfS, the level of radioactivity in this area and consequently the exposure to the individual can be determined.
If required, stool and urine samples can additionally be tested for radioactive substances to obtain more detailed information on the exposure.
Is there an increased risk of cancer?
By determining the radiation exposure, individuals who have an increased risk of developing cancer at a later time can be identified. Their health should be permanently monitored and if required, they should receive psychological counselling.
An increased risk of cancer can be statistically proven starting from a dose of 100 millisieverts.
Is prompt medical treatment necessary?
Estimating an individual's radiation exposure can help to distinguish if medical treatment is required for the exposure received or not. Many symptoms such as nausea and vomiting can also have other causes - for example stress.
As a rule, medical measures are only taken for apparent radiation symptoms such as burns and to improve the chance of survival in the case of very high radiation doses. A radiation exposure once suffered cannot be reversed. Medication for intensifying the elimination of incorporated radioactive substances has side effects so severe that it should only be given in justified individual cases in specialised hospitals.
In principle, the medical treatment of cases with radiation doses under 1,000 millisieverts is not appropriate. An increased risk of cancer is best met by regular check-ups for early detection.
State of 2018.01.19


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While engineers and designers feverishly worked overtime on the advancement of a four-passenger sports car they code-named the F-car, the Chevy public relations, marketing and advertising group prepared the world for the intro of a car they called the Panther.
All through the summer season of 1965 virtually every aspect of the car's design and advancement, from initial design sketches to clay models, was photographed and thoroughly recorded. Chevy used the assets to produce a 30 -minute film The Camaro for sale in Rumney NH , which was later on revealed on TELEVISION and in movie theaters. They likewise introduced females's clothes called the Camaro Collection and even a Camaro roadway race game.
Buy Classic Chevrolet Camaros
In November, Chevy sales executives and innovative individuals previewed prototype models at the GM Tech Center. Campbell-Ewald, Chevy's age-old ad agency, instantly began work on catalogs, direct mail and sales promo products, along with print, outside and TV/radio marketing. In April 1966, at the New York Auto Program Press Conference, Chevrolet sales executives admitted no name had been picked for the new automobile, but did announce that rates of 1967 Chevy Camaro for sale in Rumney NH design will remain in the Corvair-Chevy II range.
Throughout early 1966 Chevy agonized over a name for its Mustang-killer. GM's upper management fidgeted about the aggressive undertones of the Panther name. A comparable bout of cold feet would later trigger the Pontiac version, code named the Banshee, to be renamed Firebird. Over its brief lifetime, the F-car had been called by many names consisting of Wildcat, Chaparral, Commander and Nova. It's also rumored that Chevy thought about utilizing the letters "GM" in the name, and created G-Mini, which progressed into GeMini and finally Gemini. Nevertheless, GM's upper management banned the idea, fearing the automobile might be a failure.
Automotive legend has it that somebody at Chevrolet finally proposed the name Camaro and upper management rapidly agreed. Although the name has no genuine meaning, GM scientists supposedly discovered the word in a French dictionary as a slang term for "buddy" or "buddy." It's rumored that Ford Motor Company researchers likewise discovered other meanings, including "a shrimp-like animal" and an arcane term for "loose bowels."
Because a number or pre-launch products had actually currently been launched utilizing the Panther name, Chevy's a lot of pressing obstacle was to now rename their brand-new Mustang killer, the Camaro. Camaros are found in Rumney NH by looking for classic car dealers.
The price tag of $2,466 for a Camaro base coupe and $2,704 for a base convertible was fully competitive with Ford's rates of their 1967 Mustang models which was $2,461 for the conventional coupe, $2,692 for a basic fastback and $2,898 for a conventional convertible.Taking a page from Mustang's success in making added make money from choices and accessories, the Camaro could be purchased with nearly 80 factory alternatives and 40 dealership accessories.
Buyers could likewise alternative as much as a bigger 250-inch variation of the basic straight six engine, an option of 327-cubic-inch small-block V8s fed by either a two-barrel or a four-barrel carburetor and 2 versions of the 396-cubic-inch big-block V8. In order to keep the new Camaro from taking sales far from the Corvette, a corporate order forbade equipping it with engines larger than 400 cid. Transmission choices included a four-speed handbook, a two-speed "Powerglide" and in late 1967 the new three-speed "Turbo Hydra-Matic 350".


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Whiskey Hotline Hits the Road: Scotland Days 4-6
Posted: May 17, 2013
Categories: Spirits
Comments: 0
Tags: whiskey hotline, on the road
Been a while. Day 4 was a travel day, but we got some stuff done early. Drove the A95 to near Fogwatt and discovered the small drive that leads to Coleburn distillery. A distillery from 1897 until 1985, it was important for production experiments for DCL (now Diageo) but lost as so many others were to the economic downturn and sinking popularity of whisky in the 80's. It's now being renovated as a B&B/Restaurant/event space for live music by a Scottish musician called Mark Winchester. The grounds will make a beautiful resort, alas, no distilling will take place. Next we went to Aberlour, a pretty place set at the Aber (east coast Gaelic for "opening") of the river Lour, where it flows into the Spey. This reminded my just how good a'Bunahd (original) is. Drove all day after that to Ayr.
Day 5 morning was spent at AD Rattray Whisky Shop. Under the ownership of Tim Morrison (think Morrison Bowmore) and the direction of Nick White, this is a company that will be heard from in the US. The whiskies are excellent, the conversation with Tim even better. It's always great to have a chance to talk and ask questions to a person with such a deep history in the business. Particularly good were a 1991 Auchroisk, a 1997 Glen Grant, a 1992 Glentauchers, a 1991 Glen Garioch and a 1996 Bowmore. I hope to see all of these available soon in the US.
Then met with Stewart Laing and saw the new headquarters of Hunter Laing, his new venture with his sons Scott and Andrew. After a generation Stewart has parted ways with Douglas Laing and his brother Fred, moving Old Malt Cask, Douglas of Drumlanrig and adding First Editions with him. We wish both the best. Got to dig around in the first samples that will be entered into the new tasting room, as always found a nice Lochnagar, Inchgower and a Glenallechie 2005 that was quite mature for its age. Keep an eye on the blog for breaking news about new entries and possible special projects with these folks.
Day 6, I went to a chorale concert at the Royal Conservatiore of Scotland, i.e., I took a day off and hung out with good friends Steve and Kyoko Galloway and their kids. Had some great curry....


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Oct. 8, 2009
TALLAHASSEE, Fla. – A pair of former Seminoles will get an opportunity to lace it up with the world's best players in the second year of the Women's Professional Soccer League, while a former Florida State assistant will look to defend the league title in 2010.
Former consensus All-American and 2007 MAC Herman Trophy winner Mami Yamaguchi was selected by the Atlanta Beat in the WPS International Expansion Draft back in late September.
"She's a player I've admired for quite awhile," said Atlanta Beat head coach Gareth O'Sullivan. "She's extremely intelligent, very creative, and very versatile. She played as an attacking midfielder at Florida State. This season at Umeå IK in Sweden, she has played a large part as a holding mid, and she has also played as an outside forward in a 4-3-3 for them."
At the WPS All-Star Game, Yamaguchi assisted on Madelaine Edlund's goal in the second minute and was robbed of her own goal on a strong save by Karina LeBlanc.
The WPS welcomes two new teams to the league in 2010, the Beat and the Philadelphia Independence. Each expansion team was allowed to draft the rights to five international players, providing them with the opportunity to begin a formal negotiation process with each selected player upon receiving permission from that player's current club. For the 2010 season, teams will ultimately be allowed to sign up to five international players per roster while holding the WPS-playing rights to a sixth international player. Yamaguchi was selected sixth overall in the expansion draft by the Beat.
Erika Sutton, who is currently serving as the volunteer assistant with the Seminole soccer team, was signed to a one-year contract by the Boston Breakers on Thursday, October 8. Sutton is no stranger to the Breakers as she signed a short-term contract with the club this past season and played one game with the team. She played 90 minutes for Boston in a July 19th match against FC Gold. Sutton's appearance with the Breakers made her the first Seminole to compete in the WPS.
"Erika Sutton is a young talented player who can play flank defender, flank midfielder or winger and has a wonderful balance of defending effort and attacking abilities," said Breakers head coach Tony DiCicco.
In two seasons with the Seminoles, Sutton finished with 14 points on five goals and four assists in 46 career games.
Pauliina Miettinen, a former volunteer assistant (2005) and assistant coach (2006) at Florida State, was introduced as the new head coach of FC Sky Blue on September 29. Miettinen, who has top-level coaching experience in both her native Finland and the United States, will assume the head coaching role for Sky Blue FC as the team embarks upon its mission of a successful title defense in 2010.
"I am excited to be involved with the Sky Blue FC family and the professional atmosphere of the team," Miettinen commented about her hiring. "After I visited New Jersey and the Sky Blue FC organization, there was no doubt in my mind that I wanted to be a part of this family. I am looking forward to coaching these dynamic athletes, and to working hard to prepare for the 2010 season and ensure the success of this team in the world's most competitive women's soccer league."
As a player, Miettinen capped nine times for the Finnish National Team as a goalkeeper before heading to Franklin Pierce College in Rindge, New Hampshire, where she converted to forward and was a three-year captain. She received All-America accolades on three occasions during her college career, compiling an NCAA record 309 points on 122 goals and 65 assists while leading the Ravens to three Division II National Championships. She also played seven seasons in the Finnish Premier League, where she helped HAK Helsinki to four national championships, four Finnish Cup championships and a UEFA Champions League semifinal.
Miettinen began her coaching career just over 10 years ago and she has coached at virtually every level of the game. In her first season as assistant coach at Franklin Pierce College in 1999, she helped her alma mater to its fourth national championship in five years. The Finnish native then joined the coaching staff at Barry University in Miami Shores, Florida, in 2001, where she assisted the soccer program to three consecutive NSCAA Top 11 finishes. She then became an assistant at perennial power Florida State University in 2005 and helped the Seminoles to the NCAA College Cup Semifinals.
Miettinen is the current head coach for PK-35 in Helsinki, Finland, which is currently tied for first place in the Finnish Premier League. Prior to taking over at PK-35, she spent two years at FC Kontu in Helsinki, advancing her club to the Finnish Premier League midway through her first season at the helm.
–WPS Sky Blue FC, Atlanta Beat and Boston Breakers contributed to this article.


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Project Cars for Wii U Delayed to 2015
Sorry Wii U fans, Project Cars has officially been delayed to 2015. The news was confirmed today in a tweet from Lee Kirton, PR Director for Bandai Namco Games UK.
Project Cars is a racing sim from Slightly Mad Studios. The game is coming to PC, PS4, Wii U, and Xbox One. While the Wii U version of the game has been pushed back to 2015, the other three versions of the title are still on track for a November release.
"We're committed to delivering an exceptional and unique experience for racing fans on Wii U and for this we kindly ask our devoted and passionate Nintendo for a little more time in order to ensure the game delivers on our vision of being the most authentic, beautiful, and technically-advanced racing game on any platform," said Slightly Mad Studios, in an article from Eurogamer.
If the above trailer is any indication of the final product, Project Cars will be worth the wait for Wii U owners.


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This is an Icon Plastics product – an Australian owned and operated company with over 40 years of experience in designing and manufacturing plastics products for Australia and around the world.
AdMerch only stock the best – Icon Plastics products are designed to last the test of time in a heavy duty environment, and are regarded as the best in their field.
Plastic containers and storage tubs have unlimited uses – shoes, kids toys, medicines, stationary, books, electronics, utensils, tools, cleaning products, medicines, appliances, craft supplies, clothing, office files, food products – anything you can think of can be stored securely and easily.
This stack and nest crate is also ideal for many industry applications, including:
- Security
- Legal
- General Food Processing
- Materials Handling
- Engineering
- Automotive
- Warehousing
- Distribution
- General Office
- Home Use
We deliver nationwide – so no matter where you're from – Melbourne, Sydney, Adelaide, Perth, Brisbane or anywhere else in Australia – we have a customised solution for your business or home.
Don't compromise – only choose the best and most reliable to get maximum value for money, and peace of mind.


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This is the first post in a series by Remodelaholic's Cassity Kmetzsch, who with her husband Justin added storage space to their well-loved and highly trafficked family room with help from HouseLogic.
When it comes to storage space, I think I can safely assume we all could use more. That's definitely the case for my family. Let me give you a taste of our problem. Warning: These pictures, which show our family room, may be all too familiar for comfort.
As you can see, stuff has found a precarious home on the family room piano:
The "Topple" game offers an apt name for this makeshift storage nook, which will soon become part of the new storage space.
All this clutter is a little embarrassing to admit, but, hey, life is messy.
Let me introduce you to our little family:
Image: Destinee Blau Photography
The four of us spend a lot of time in our family room. It's home to our home office, a crafting area, piano and accompanying music, board games, DVDs, music, electronic equipment, television, sofa, pillows, blankets, books, TOYS, toys, and oh, did I mention toys? Plus all the other random stuff that doesn't actually have a home.
The family room includes a large walk-in closet, where all these items used to be housed. But because of the super-hot summers here in Texas, we decided to turn it into a playhouse for our girls so they don't bake outside. We realize this may not be the ideal for some families, but we really wanted to keep our girls active at any time of year. While we're happy with our choice, it's created a major need for storage.
The solution
We decided to combine utility and aesthetics by creating a built-in shelf and cabinet unit along an entire wall of the family room (about 28 feet wide; 8 feet high), which will include a window seat with storage. I've always wanted a window seat! As HouseLogic points out, besides offering stylish seating, a window seat can add as much as 13 cubic feet of storage space.
In contemplating the wall space, we struck an unused square footage gold mine. That box on which the stair railing is mounted is a big box of nothing. Notice the hole I cut into the drywall to check.
And below is a view of the whole wall, including the box of nothing, where we'll erect the "Great Wall of Built-ins." This is going to be big!
Click on the image below to view an even larger version of the Great Wall. (Image will open in a new window.)
Here are our project goals:
- Reclaim this unused space.
- Add architectural interest.
- Incorporate some great design elements.
- Declutter our family room.
See how our storage space is taking shape.
What have you done to reclaim space and keep clutter at bay?


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In today's market, fluctuating component prices and inventory levels are a common occurrence. Just last year we saw semiconductor inventory reach an alarmingly high level, due to a surge in demand to facilitate an expected busy Christmas period.
Here at Trading Specialists we offer a full consignment selling option for your excess inventory. This is an ideal solution for when you have excess stock with a high residual value.
Full Consignment Benefits
We market your excess stock globally to 16,000 OEMs, CEMs and distributors in 40 different countries, 24 hours a day. This enables us to get you the maximum value for your excess stock.
We relocate your stock to our purpose-built ISO9001:2000 approved warehouse. We also cover the transport costs and provide insurance cover to give you complete piece of mind.
You will retain full title over the stock until it's sold, meaning that you can have access to any unsold parts, at any time. We provide you with 24/7 access to your stock via our secure web based Consignment Partner Login area.
You can even set your own price per part if you need to reach a target level of return. Or we can get one of our dedicated purchasing team members to asses current market values and attach a price for you.
If you would like more information or would like to speak to a member of our team, give us a call on 01904 436 444.


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How many circles do you think there are on this card? Let's count.
1) The card base is two Pool Party circles
2) The snowflakes on the background are tiny circles (Some are glittery! Always hard to see glitter in photos.)
3) The first house has a half circle window in the door
4) The second house has a wreath on the door
5) The third house has a round attic window
6) The ornament hanger is actually the round tag from my new favourite product--the Curvy Keepsake Box Thinlets Dies
The houses and wreath are from the Holiday Home Photopolymer Stamp Set. The houses were die cut with the Homemade Holiday Framelit Dies.
Come swim with us on The Paper Plunge! Use circles on a project and post it. Don't have a blog? You are welcome to share your project on my facebook page:Teachtostamp.
Go stamp something!


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2016 Books Panels
Black Earth
: The Holocaust as History and Warning
(Tim Duggan 2015)
By Tim Snyder
In this epic history of extermination and survival, Timothy Snyder presents a new explanation of the great atrocity of the twentieth century, and reveals the risks that we face in the twenty-first. Based on new sources from eastern Europe and forgotten testimonies from Jewish survivors, Black Earth recounts the mass murder of the Jews as an event that is still close to us, more comprehensible than we would like to think, and thus all the more terrifying.
By overlooking the lessons of the Holocaust in the 21st century, Snyder concludes, we have misunderstood modernity and endangered the future. The early twenty-first century is coming to resemble the early twentieth, as growing preoccupations with food and water accompany ideological challenges to global order. Our world is closer to Hitler's than we like to admit, and saving it requires us to see the Holocaust as it was — and ourselves as we are. Groundbreaking, authoritative, and utterly absorbing, Black Earth reveals a Holocaust that is not only history but warning.


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Empire In Change
Power Intrigue Betrayal
The Vargos Empire is in crisis. The beloved Emperor Vargos III has died without naming an heir. Morgan Glaive City, the capital of the Vargos Empire, has become a hot bed of underhanded dealings, schemes, plots, and quiet violence that could erupt into civil war at any time as various factions via for power. During this uncertain time, many personal vendettas will be resolved; while some will face decisions that will have a profound impact on the empire. The players find themselves being drawn into the intrigue and find that their decisions will affect the future of an entire empire.
Will you choose a faction, push the empire to collapse, or try and seize power for yourself?


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"Manchester by the Sea" is an intriguing study of grief and trauma. At the same time, it is also a fascinating dance between cinematic storytelling and an understated character study. Director Kenneth Lonergan finds the perfect mix to pull his audience in and keep them engaged for the whole length of the film. The story follows Lee Chandler, who is drawn back to his old home in Manchester (New England, not Great Britain), after his brother died. We follow him as he takes charge of the situation, trying to handle the immediate challenges of any tragic death. In the process, he finds out that his brother named him guardian for his son, expecting him to move back to Manchester, which is a hard step for Lee for several reasons.
The centrepiece of this film is Casey Affleck's performance as Lee. There is no other way to put this, he feels like a completely real person. I don't usually come out of movies thinking "oh, that was clearly an actor", that's what suspension of disbelief is there for. But compared to this performance, some of Affleck's colleagues look like grade school theatre. He avoids great gestures whenever he can, thus forcing you to look closer and be drawn into the character even further.
And that deep investment is what makes Lonergan's use of flashbacks even more powerful. Whereas the main story of the film is extremely low-key when it comes to cinematic devices, the flashbacks engage in wilful control of knowledge, inserted precisely where they will have the largest impact. And what an impact they have.
Special mention should also be made of Lucas Hedges, who plays Lee's nephew Patrick, and Michelle Williams as Lee's ex-wife. Our experience is centred on Lee, but both Patrick and Michelle play an integral part in his grieving process, as he does in theirs.
And the words "grieving process" are central to this movie. This film doesn't play to your expectations, and it isn't over when it ends. The characters feel so real, because I felt like they continued to exist and struggle after I left the cinema. I also felt like there was more to their past I wasn't told. It is really quite amazing.


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Tuesday, June 28, 2016
Anterior thalamic syndrome
Sunday, June 5, 2016
Koziol adjusted neuropsych exam
Koziol: views of basl ganglia an cognitive control
Cerebrocerebellar circuitry
Koziol Knowledge and anticipation
Phylogeny of brain systems
Child development and attentional networks (from Koziol)
Digit Span PET san sctivation
Leonard Koziol Assumptions of brain organization
Sunday, January 3, 2016
Wernicke area
Tuesday, September 11, 2012
A systematic review of amnestic and non-amnestic mild cognitive impairment induc
Tannenbaum C, Paquette A, Hilmer S, Holroyd-Leduc J, Carnahan R; Drugs & Aging 29 (8), 639-58 (Aug 2012)A systematic review of amnestic and non-amnestic mild cognitive impairment induced by anticholinergic, antihistamine, GABAergic and opioid drugsCarnahan R; Drugs & Aging 29 (8), 639-58 (Aug 2012
Background: Mild cognitive deficits are experienced by 18% of community-dwelling older adults, many of whom do not progress to dementia. The effect of commonly used medication on subtle impairments in cognitive function may be under-recognized. Objective: The aim of the review was to examine the evidence attributing amnestic or non-amnestic cognitive impairment to the use of medication with anticholinergic, antihistamine, GABAergic or opioid effects. Methods: MEDLINE and EMBASE were searched for randomized, double-blind, placebo-controlled trials of adults without underlying central nervous system disorders who underwent detailed neuropsychological testing prior to and after oral administration of drugs affecting cholinergic, histaminergic, GABAergic or opioid receptor pathways. Seventy-eight studies were identified, reporting 162 trials testing medication from the four targeted drug classes. Two investigators independently appraised study quality and extracted relevant data on the occurrence of amnestic, non-amnestic or combined cognitive deficits induced by each drug class. Only trials using validated neuropsychological tests were included. Quality of the evidence for each drug class was assessed based on consistency of results across trials and the presence of a dose-response gradient. Results: In studies of short-, intermediate- and long-acting benzodiazepine drugs (n = 68 trials), these drugs consistently induced both amnestic and non-amnestic cognitive impairments, with evidence of a dose-response relationship. H(1)-antihistamine agents (n = 12) and tricyclic antidepressants (n = 15) induced non-amnestic deficits in attention and information processing. Non-benzodiazepine derivatives (n = 29) also produced combined deficits, but less consistently than benzodiazepine drugs. The evidence was inconclusive for the type of cognitive impairment induced by different bladder relaxant antimuscarinics (n = 9) as well as for narcotic agents (n = 5) and antipsychotics (n = 5). Among healthy volunteers>60 years of age, low doses of commonly used medications such as lorazepam 0.5 mg, oxybutynin immediate release 5 mg and oxycodone 10 mg produced combined deficits. Conclusion: Non-amnestic mild cognitive deficits are consistently induced by first-generation antihistamines and tricyclic antidepressants, while benzodiazepines provoke combined amnestic and non-amnestic impairments. Risk-benefit considerations should be discussed with patients in order to enable an informed choice about drug discontinuation or substitution to potentially reverse cognitive adverse effects.
Tuesday, July 3, 2012
Sunday, February 19, 2012
evolutionary: brain size homo sapiens not largest
1. Boskops 1900 cc brains
2. Fossils found in Shkul caves in Qafzeh, Israel; in Wadjak in Indonesia; Fish Hock of S Africa all were larger than humans' 1300 cc but not as large as the Boskops.
Tuesday, February 7, 2012
Counting-backward test for executive function in idiopathic normal pressure hydr
Kanno S, Saito M, Hayashi A, Uchiyama M, Hiraoka K, Nishio Y, Hisanaga K, Mori E; Acta Neurologica Scandinavica (Jan 2012)
OBJECTIVES: The aim of this study was to develop and validate a bedside test for executive function in patients with idiopathic normal pressure hydrocephalus (INPH). MATERIALS AND METHODS: Twenty consecutive patients with INPH and 20 patients with Alzheimer's disease (AD) were enrolled in this study. We developed the counting-backward test for evaluating executive function in patients with INPH. Two indices that are considered to be reflective of the attention deficits and response suppression underlying executive dysfunction in INPH were calculated: the first-error score and the reverse-effect index. Performance on both the counting-backward test and standard neuropsychological tests for executive function was assessed in INPH and AD patients. RESULTS: The first-error score, reverse-effect index and the scores from the standard neuropsychological tests for executive function were significantly lower for individuals in the INPH group than in the AD group. The two indices for the counting-backward test in the INPH group were strongly correlated with the total scores for Frontal Assessment Battery and Phonemic Verbal Fluency. The first-error score was also significantly correlated with the error rate of the Stroop colour-word test and the score of the go/no-go test. In addition, we found that the first-error score highly distinguished patients with INPH from those with AD using these tests. CONCLUSION: The counting-backward test is useful for evaluating executive dysfunction in INPH and for differentiating between INPH and AD patients. In particular, the first-error score may reflect deficits in the response suppression related to executive dysfunction in INPH.
Sunday, September 5, 2010
Bedside testing of frontal lobes
Published tests:
EXIT- Executive Interview
bedside tests
fluency -- give F, A, S test and in alternate form give D only. Measure not only number of words produced, but also rule violations (giving responses with a different letter, and proper nouns) and repetitions. Subjects who do worse on category fluency have more likelihood of temporal involvement, and those with letter fluency only are more likely to have frontal involvement. Nonverbal analogue to letter fluency is design fluency. Show a box with five dots and ask them to create in one minute that have four lines that connect the dots. Several variations are used, one is d-kefs.
Mental flexibility-- on Trails B, Stuss et al. enhance the test by counting errors on Part B, which correlates best with DLPFC right sided injury. On DKEFS Trails, subjects alternate with letters and numbers. Older patients maybe asked to shift between numbers and days of the week, with a record of time to complete task and how many sequencing errors are made. Patients who cannot read may get Color Trails instead, connecting colored circles alternating between pink and yellow circles. Alternate form of Trails: Patients get one minute to create, from an array of dots (alternating half filled dots, half unfilled), as many designs as possible with four straight lines connecting dots. In first form, they are asked only to use unfilled dots, in the second, to alternate between filled and unfilled dots. Design and rule violations (ie failure to shift) are recorded.
Abstract reasoning: a) similarities between word pairs (dog/lion, table/chair. anger / joy) and b) proverbs- eg. " An old ox plows a straight row" and "Shallow brooks are noise" and " A beard well lathered is half shaved." Give credit for abstract and accurate answers.
Response inhibition: a) Stroop-- tabulate correct responses in 60 seconds, and the number of inhibition errors. b) Salient responses : Tell patient to to point to his chin while examiner touches nose, or tell patient to point to the ceiling while extending his hand c) Opposite-- when I tap once, you tap twice, and vice versa.
Working memory-- backwards digit span, spelling "world" backwards, serial sevens, saying days of week backwards, months in reverse order.
primitive reflexes-- snout, suck and grasp and glabellar
Complex motor programs
1) fist palm edge task-- perform 10 times, record the number of trials to learn the task, the number of perseverations, and the fluency of the movements.
2) Graphomotor sequences-- alternate m and n (cursive) elicit perseveration, micrographia.
3) Rhythm test-- ask patient to imitate finger taps in complex patterns.
Behavior-- observe and record, use a modified Manchester Behavior Questionnaire to survery based on both information and report. NPI and NPI-Q (short version) can be used (link to certification test: http://www.alz.washington.edu/cgi-bin/broker64)%20.%20May use the Dysexecutive Questionnaire (DEX) http://journals.lww.com/jonmd/Abstract/2008/01000/The_Dysexecutive_Questionnaire_Advanced__Item_and.13.aspx, Frontal Behavior Inventory (FBI) http://www.chumneurologie.org/conferences/FBI/FBI.pdf , and Frontal Systems Behavior Scale (FrSBE)
Saturday, September 4, 2010
New Executive Brain VII Summary
Ventral tegmental lesions causing pseudofrontal syndrome
update see Miller Nat Rev Neurosci 2000
DA depletion in midbrain caused frontal disconnection.
"Kevin" had retrograde without anterograde amnesia
Analogy- (partial) to schizophhrenia that also affects mesolimbic (temporal) and mesocortical (frontal) projections. EG argues schizophrenia represents a top down organizing defect ie. a type of auditory agnosia. Behav Brain Sci 1991.
New Executive Brain VI: Syndromes Orbitofrontal (OF) Pseudopsychopathy
Social interactions: ACC reins in amygdala. In monkeys, ACC is more important than OF in socially appropriate behaviors (Ito et al.).
EG argues, about moral reasoning and the frontal lobes, that understanding temporal relationships is key to understanding causation, and appreciation of consequences of behavior is necessary for moral reasoning. Inferential reasoning of the if.then kind, is at basis both of language and of moral reasoning. Counterfactuals, that is, if I had done this x then y would have happened, are impaired after OF damage.
New Executive Brain 3: Frontal lobe tests
The New Executive Brain V? Emotional brain, basal ganglia etc
Frontal lobes modify attenuate the amygdala (the "pre" prefrontal lobe actor); this done through orbitofrontal cortex. The amygdala also show evidence of valence mirroring that of evolutionarily later frontal lobe, ie left positive valence, right negative. Suppressing negative emotions is left DLPFC on left amygdala, fear engendering stimuli affect right amygdala, and lesion of right amygdala reduces the ability to experience fear. Anxiety may be associated with a large or hyperactive right amygdala. Emotionally charged crimes may be related to large right amygdala. Removal of right amygdala may attenuate ability to appreciate emotion of fear in others' faces.
In gambling experiment, both prefrontal and amygdalaoid lesions interfered with decision making, but only amygdaloid lesion was associated with a change in skin response. Distant threats in a virtual reality environment were mediated by DFPFC, but immediate threats were mediated by amygdala.
Author argues novelty/familiarization dichotomy can tie up loose ends of verbal/nonverbal debate.
Parkinson patients avoid choices leading to bad outcomes (risk aversion) more than selecting ones leading to a good outcome. (Frank et al., Science 2004).
The New Executive Brain 3: Tests of Frontal Function
Courtney et al. (Cereb Cortex 1996) showed faces on a grid then another set of faces with "what" question and "where" question, which respectively, activated ventral and dorsal visual stream representations within the frontal lobes (inferior and superior).
"How does an organism decide what information is important enough to be kept online" is a question that has been ignored in almost all neuropsychological paradigms. Goldberg divides decision making into veridical and ambiguous. Veridical is "I spend 300 of 1000 dollars, how much is left?" Ambiguous or adaptive is "Shall I wear gray, blue, or white?" What is the answer? Gertrude Stein asked "What is the question?" Disambiguation may requires prioritizing (remember Buridano's donkey from Luria's books). Individual must be able to disambiguate in multiple ways and switch set ( "White is for spring, but white is not allowed at school so I will wear gray"). Veridical decisions find the truth, adaptive ones find what is best for the organism.
In Cognitive Bias Test, individual is given a card and asked to pick the one "they like the most." Then they were asked to find the choice "most similar to the target" then the one "most different from the target." Frontal lobe is required only for the first condition, the only one requiring disambiguation. Frontal lesions did not affect the second and third conditions. In Alz disease, the disambiguating test declined much faster. Verdejo found same in individuals with substance abuse (altered adaptive but not veridical decision making).
Males made choices on CBT in a context dependent way, that is when the targets changed, so did their choices. Females made context independent choices, that is their choices were stable regardless of target. This is first account of gender differences in adaptive decision making. Males with damaged right frontal lobe performed in an extremely context dependent manner, and males with damaged left frontal lobes performed in an extremely context independent manner. In females, damage to either frontal lobe caused context dependent choices. The Wisconsin Card Sorting Test failed to differentiate laterality of the lesion.
The effects of posterior lesions were less robust than those of frontal lesions, but were nonetheless dimorphic. In males, posterior temporal lesions followed frontal lesions: left sided lesions made males more context independent, and right sided lesions made males more context dependent. In females, posterior lesions were opposite frontal lesions: on either side, they made decision making more context independent.
Goldberg argues that in male laterality is more articulated, but in the female, front-back differences are more articulated.
In functional imaging experiments, when asked to process verbal information, males coactivated front and back in same hemisphere, whereas females coactivated homologous regions across hemispheres. Males have greater functional differentiation of the hemispheres, whereas females have greater functional integration of hemispheres-- note they also have bigger callosa. However, males have larger longitudinal fasciculi within hemispheres (see book for citations).
An overwhelming number favored similarity over novel among humans on the CBT (unlike other primates who picked the novel object). However, that is only true among righthanders. Among lefthanders, many picked the choice that differed from the target, not the one similar to it. J Cogn Neurosci 1994. EG suspects that the 9:1 balance in favor of right handers represents evolutionary needs for stability versus innovation. Functional roles of left handers may be reversed on CBT (Ibid.).
The New Executive Brain 2: Novelty, subroutines, and hemispheres
2. Other right - left approaches (analytic/holistic, sequential/simultaneous processing) are difficult to operationalize and are rejected.
3. Bates E argued that in children, left hemisphere brain damage is inconsequential, but in right hemisphere patients it is devastating (in Bronan SH ed, Changing Nervous System: neurobehavioral consequences of early brain disorders, Oxford University Press, 1999).
4. History of civilisation is right to left shift; translating Vygotsky cultural historical psychology in neuroanatomical terms would reach similar conclusion
5. In neuropsych tests, averaging across six categories of WCST, the five trials of CVLT, and 30 trials of Benton Lines is not accurate anatomically. Should rescore old tests with that in mind.
6. Agnosias: leitmotif is left hemisphere is top down process, unable to recognize unique exemplars of generic categories "associative agnosias." Right hemisphere lesion cannot recognize exemplars as their own selves or as different exemplars of same category ("apperceptive agnosias"). see Goldberg JCEN 1990.
7. Animals may have paw prefence but its closer to 50-50 unlike humans.
8. Frontal function: divide into perseverative (difficulty with cognitive flexibility) unable to transition from one activity to another; and field dependent behavior (echopraxia/echolalia). Traditionally these are known as 2 aspects of executive control, ability to guide behavior by internal representations and ability to shift cognitive sets with exigencies. These may be referred to as "stability" and "plasticity" as well. Author postulates that D1 receptors maintain low level maintenance of current cognitive regime, and D2 receptors respond only to high levels of dopamine and cause destabilizing rapid updating of the cognitive regime, favoring the right hemisphere. On Executive Control Battery, perseveration was twice as common following left hemisphere injury. Echopraxia was twice as severe after right hemisphere injury. However, these differences were present only in men.
4. Authors Goldberg and Costa postulated the right hemisphere is important to cognitive novelty and the left to cognitive subroutines (Brain Lang 1981: 144-173). Information is processed from novel to familiar. . The left hemisphere information is stored in better articulated neural networks and easier to access. The right hemisphere is modified at a slower rate than the let hemisphere. It deals with novelty better due to it contains averaged default representation containing shared poorly differentiated features of many prior situations. The evidence that supports include Bever and Chiarello (Science 1974) who showed untrained musicians process with their right hemispheres, trained ones with their left hemispheres. He discusses obscure / familiar faces as being processed with right and left, (Henson et al, Science 2000). Alex Martin et al. (Hippocampus, 1997) used PET to show that with presentation of meaningful words, nonsense words, real objects and nonsense objects, the right mesiotemporal lobes were activated with first, novel presentation, decreasing with the second exposure. The left hemisphere activation was constant. Learning a complex motor skill activated first the right MFG, then late in training left posterior parietal cortex, left dorsal premotor cortex,and right anterior cerebellar cortex (Shadmehr and Holcomb, Science 1997).
More studies: learning grammar A and B: initial activation occurred in right ventral striatum, left premotor and anterior cingulum, replaced gradually by activation of right DLF and right posterior parietal (Berns et al. 1997 Science). Raichle (cereb Cortex 1994) found on a task of finding appropriate verbs for nouns, in naive condition activated ACC, left prefrontal, left temporal, and right cerebellum, but after practice only left medial occipital was activated. A task with longer processing has right hemisphere to a greater degree.
5. Constructs that are analagous to the novelty/familiarity distinction: Exploration/exploitation ( eg. gambling task, novel learning of task and exploiting task to make money) involved right frontopolar regions and left DLF regions respectively (Daw et al. Nature 2006 and Heekeren et al. Nature 2004). Another distinction is critic and actor; critic learns to predict future awards and actor uses the rewards to guide behavior. The "critic" in an fMRI study is the bilateral putamen and right ventral striatum, and the actor is the left anterior caudate. This resonates with an older idea that the OF lobes appraise value to person and prefrontal cortex navigates the external world.
6. Pathologic augmentation of orientating reaction (PTSD) has ep activity mostly in right hemisphere (Metzger, 2005 in Vasterling and Brewin).
The New Executive Brain by Elkhonon Goldberg I
Goldberg is a protege of Alexander Luria's, but emigrated from the USSR in the early 1970s, establishing a career in New York, academic, eventually private practice. He opens with a reference to The Creation of Adam, a painting in the Cistine Chapel that Goldberg presents as representing an allegory of the frontal lobes.
1. The left inferior prefrontal cortex becomes active when presented with statements with semantic violations (:"trains are sour"). Hagoort et al., Science 2004. fMRI study. Language and executive functions arose together. Language builds models, executive functions manipulates them and conducts operations on them.
2. Goal formation is action centered about "I need" not "It is." Therefore, formation of goals relates to the emergence of the mental representation of the self, in turn related to the development of the frontal lobes.
3. The dorsomedial thalamus nucelus is the highest point of integration in the thalamus and has many connections with the frontal lobes. It also maintains connections with the hippocampus (memory), the cingulum (emotion and uncertainty), amygdala (relations among individuals in species) and hypothalamus (in charge of homeostatic functions).
4. Goldberg speaks of the "fallacies" of modularity (the high tech revival of 18th century phrenology"). For example, the planum temporale is critical for phonologic processing, but is not narrowly dedicated. Rather, it is critical for auditory analysis in a categorical sense (is the sound a dog barking, a cat meowing , etc.). It activates both when phonological discriminations are made and when environmental sounds are matched with their sources. Fusiform gyrus is associated with facial recognition. Goldberg differentiates between a prior, preordained modularity and a posteriori, resultant modularity. A priori means the area is hard wired for the task. A gradiential view of neocortical organization means that certain tightly integrated neuronal groupings emerge over time, due to cognitive history of individual. This means is has less uniformity, more individual differences and will change over time. The left hemisphere, which has more dedication to "subroutines" has more modularity and the right hemisphere has less. Goldberg published his gradiential theory of modularity in 1989 in JCEN and republished as a book chapter in 1990 (Contemporary Neuropsychology and the Legacy of Luria, 1990). "Modularity is best applied to an evolutionary old structure, the thalamus." Goldberg discusses the "dynamic topology" of cortex and the evolving role of the thalamus in its new inferior position in the hierarchy, which is a reason its function has been elusive.
5. Jordan Grafman et al. showed in an fMRI study that when a cognitive task is characterized by a hierarchy of goals, the regions around the frontal lobes are activated when subjects have to keep in mind the main goal while performing subordinate goals (Nature, 1999). This was supported by D'espositio et al.who showed that increasingly abstract goals activate increasingly anterior portions of the frontal lobes. Anterior prefrontal cortex has a high number of dendritic spines per cell and high spine density, making it ideal for a variety of inputs.
6. E Koechlin et al (Science 2003) introduced the notion of a "hierarchical cascade of executive processes." The control operates in Brodman areas 6 (premotor), 44/45 (inferior frontal) and 46 (middle prefrontal) at level of stimuli, perceptual context, and temporal episode, respectively. Goldberg analogizes to perseveration of elements , features and activities, respectively.
Tuesday, August 10, 2010
cognitive effects of androgen deprivation
Cognitive effects of androgen deprivation therapy in an older cohort of men with prostate cancer; Mohile SG, Lacy M, Rodin M, Bylow K, Dale W, Meager MR, Stadler WM; Critical Reviews in Oncology/Hematology 75 (2), 152-9 (Aug 2010)
OBJECTIVE: To determine the baseline prevalence of cognitive impairment in older men treated with ADT and to assess changes in cognitive performance over time. METHODS AND RESULTS: Thirty-two patients (median age of 71 years, range 51-87) were administrated an extensive neuropsychological testing battery prior to ADT initiation, with 21 (65%) completing post-treatment evaluations 6 months later. At baseline, 45% scored>1.5 standard deviations below the mean on>or = 2 neuropsychological measures. Using standardized inferential statistics, no change in cognition was documented following treatment. The Reliable Change Index revealed that, on a case-by-case basis, 38% demonstrated a decline in measures of executive functioning and 48% showed improvement on measures of visuospatial abilities. Within exploratory analyses, patients who scored below expectation at baseline displayed no change in cognition, while patients with average or better scores at baseline displayed improvements in visuospatial planning and timed tests of phonemic fluency. CONCLUSIONS: We found a high prevalence of lower than expected cognitive performance among a sample of patients just starting ADT for prostate cancer. Assessment of baseline cognitive function should be taken into account for future research and to inform clinical management.neurodoc
Tuesday, July 27, 2010
Detestable or marvelous: Neuroanatomical correlates of character judgments
1. Neuropsychologia. 2010 May;48(6):1789-801. Epub 2010 Mar 6.
Department of Neurology, Division of Behavioral Neurology and Cognitive Neuroscience, University of Iowa College of Medicine, IA, USA. firstname.lastname@example.com
As we learn new information about the social and moral behaviors of other people, we form and update character judgments of them, and this can profoundly influence how we regard and act towards others. In the study reported here, we capitalized on two interesting neurological patient populations where this process of complex "moral updating" may go awry: patients with bilateral damage to ventromedial prefrontal cortex (vmPFC) and patients with bilateral damage to hippocampus (HC). We predicted that vmPFC patients, who have impaired emotion processing, would exhibit reduced moral updating, and we also investigated how moral updating might be affected by severe declarative memory impairment in HC patients. The vmPFC, HC, and brain-damaged comparison (BDC) participants made moral judgments about unfamiliar persons before and after exposure to social scenarios depicting the persons engaged in morally good, bad, or neutral behaviors. In line with our prediction, the vmPFC group showed the least amount of change in moral judgments, and interestingly, the HC group showed the most amount of change. These results suggest that the vmPFC and hippocampus play critical but complementary roles in updating moral character judgments about others: the vmPFC may attribute emotional salience to moral information, whereas the hippocampus may provide necessary contextual information from which to make appropriate character judgments. 2010 Elsevier Ltd. All rights reserved.
PMCID: PMC2862792 [Available on 2011/5/1]
Damage to right ventromedial prefronal area abolishes judgment of harmful intent
Neuron. 2010 Mar 25;65(6):845-51.
Moral judgments, whether delivered in ordinary experience or in the courtroom, depend on our ability to infer intentions. We forgive unintentional or accidental harms and condemn failed attempts to harm. Prior work demonstrates that patients with damage to the ventromedial prefrontal cortex (VMPC) deliver abnormal judgments in response to moral dilemmas and that these patients are especially impaired in triggering emotional responses to inferred or abstract events (e.g., intentions), as opposed to real or actual outcomes. We therefore predicted that VMPC patients would deliver abnormal moral judgments of harmful intentions in the absence of harmful outcomes, as in failed attempts to harm. This prediction was confirmed in the current study: VMPC patients judged attempted harms, including attempted murder, as more morally permissible relative to controls. These results highlight the critical role of the VMPC in processing harmful intent for moral judgment. (c) 2010 Elsevier Inc. All rights reserved.
Hippocampal damage abolishes stress response
The hippocampus (HC) is necessary for learning and memory, but it also plays a role in other behaviors such as those related to stress and anxiety. In support of the latter idea, we show here that bilateral HC damage abolishes the cortisol response to psychosocial stress. We collected salivary cortisol, heart rate, and affective responses to the Trier Social Stress Test (TSST) from 7 participants with bilateral HC lesions, 12 participants with damage outside the HC, and 28 healthy normal comparison participants matched to the HC participants on age and sex. HC participants showed elevated pre-stress cortisol, but no cortisol response to the TSST. Heart rate and affective responses in the HC group were similar to those of the comparison groups. Participants with brain damage outside the HC showed stress responses that were comparable to those of the healthy comparison group. These findings support the idea that the functions of the human HC extend beyond learning and memory, and suggest that the HC is necessary for producing the cortisol response to psychosocial stress.
PMCID: PMC2692817 [Available on 2010/6/1]
Localization of Benton Facial Recognition Test and J. Lo.
Two of the most successful and widely used tests developed by Arthur Benton and colleagues are the Facial Recognition Test (FRT) and Judgment of Line Orientation Test (JLO), which probe visuoperceptual and visuospatial functions typically associated with right hemisphere structures, especially parietal, occipitoparietal, and occipitotemporal structures. Taking advantage of a large database of focal lesion patients (the Iowa Neurological Patient Registry), we used a new lesion-deficit mapping technique to investigate the neuroanatomical correlates of FRT and JLO performance. For the FRT, there were 201 patients with relevant data; of these, 38 were impaired on the FRT, and failure was most strongly associated with lesions in the right posterior-inferior parietal and right ventral occipitotemporal (fusiform gyrus) areas. For the JLO, there were 181 patients with relevant data; of these, 23 were impaired on the JLO, and failure was most strongly associated with lesions in the right posterior parietal region. These findings put new empirical teeth in the localizing value of the FRT and JLO tests, and they extend and sharpen previous work that had pointed to right posterior structures as being important for FRT and JLO performance
PMCID: PMC2853018 Free PMC Article
PMID: 19051129 [PubMed - indexed for MEDLINE]
Focality of clock drawing test determined by error type
The Clock Drawing Test (CDT) is widely used in clinical neuropsychological practice. The CDT has been used traditionally as a "parietal lobe" test (e.g., Kaplan, 1988), but most empirical work has focused on its sensitivity and specificity for detecting and differentiating subtypes of dementia. There are surprisingly few studies of its neuroanatomical correlates. The authors investigated the neuroanatomical correlates of the CDT, using 133 patients whose lesions provided effective coverage of most of both hemispheric convexities and underlying white matter. On the CDT, 30 subjects were impaired and 87 were unimpaired (16 were "borderline"). Impairments on the CDT were associated with damage to right parietal cortices (supramarginal gyrus) and left inferior frontal-parietal opercular cortices. Visuospatial errors were predominant in patients with right hemisphere damage, whereas time setting errors were predominant in patients with left hemisphere lesions. These findings provide new empirical evidence regarding the neuroanatomical correlates of the CDT, and together with previous work, support the use of this quick and easily administered test not only as a screening measure but also as a good index of focal brain dysfunction. PsycINFO Database Record (c) 2008 APA, all rights reserved.
PMCID: PMC2834527 Free PMC Article
Sunday, July 25, 2010
Neurology of lying-- localizaion
Langleben et al. Neuroimage 2002-- guilty knowledge test (GKT) and fMRI showed activation in SFG and ACC.
Ganis et al. Cereb Cortex 2003. right anterior prefrontal cortex was involved in well rehearsed more elaborate lies, whereas a network involving anterior prefrontal cortex involved in spontaneous lies.
Kozel et al J Neuropsychiatry and Clin Neurosci 2005- OF cortex and ACC involved in deceptio
Abe et al. (Brain 2009) noted PD patients are "honest" and have trouble lying, and that left DLPFC is dominant for inhibiting replies, esp truth telling, ie feigning ignorance.
Karim et al. Cereb Cortex-- TMS of left cortex FACILITATES lying perhaps by relieving moral conflict.
Sellal JNNP 1993- reflex epilepsy, patient had seizures when he lied. Had meningioma in right anterior clinoid. Tumor pressed on amygdala.
Hakun et al Neurocase 2008-- fMRI as lie detector-ventrolateral frontal activated even when lying was not demanded explicitly
Seth et al. Neuroimage 2006- MEEG can be used for trial by trial detection of lies.
Modell et al. J Neuropsychiatry and Clin Neurosci 1992-- pathological lying associated with decreased tracer uptake in right thalamus.
Yang et al. Br J Psych 2007. Increased white matter among pathological liars especially OF, IFG, MFG.
Fenelon et al. BMJ 1991 and other cits.-- Munchhausen's s- associated with bilateral frontotemporal atrophy, hyperperfusion of right thalamus, cerebral palsy, high signal in PVWM bihemispheric.
Grezes et al J Neurosci 2004. detecting deception activates amygdala and rostral ACC.
Harada et al. Neurosci Research 2009- moral and lie judgments activate VMPFC, lateral OF, left temporal, left temp-par junction, and right cerebellum.
Etcoff et al. Nature 2000- loss of language due to left MCA stroke was associated with increased ability to detect deception.
Stuss et al. Brain 2001- bilateral esp right OF lesions impaired ability to detect deception.
Autistics have trouble lying.
Saturday, July 24, 2010
Go, no go task, parcellated and localized within the VLPFC and pre SMA
Author divides go/no go tasks into components including working memory, stimulus-driven attention ( reorienting of attention), error monitoring, top down control processes, and response inhibition. The literature suggests the VLPFC is key to response inhibition (see Buxbaum et al, Hum Brain Mapping 2005). However, DLPFC and pre-SMA also are recruited for this task and for stop-signal and for antisaccade tasks.
Transcranial magnetic stimulation of right VLPFC disrupts response inhibition, but stimulation of left IFG, DLPFC, dorsal premotor cortex, and right angular gyrus does not. Subregions of the VLPFC play different roles. The subregions are posterior IFG, inferior frontal junction, and IFG/insula.
pIFG usually activates with go/no go stimuli. IFJ, located at border of inferior frontal sulcus and precentral sulcus, is associated with processing infrequent stimuli. Thus pIFG is the "core region" for go/no go response inhibition. The same area is involved in reorienting attention (see Corbetta M, Neuron 2008). The reorienting attention network involves pIFG, IFJ, IFG/insula, and temporal parietal junction. This is segregated from a dorsal network involving the frontal eye fields (FEF), and intraparietal sulcus that employs a top down mechanism . pIFG may activate with both networks and provide the communication between the two.
IFJ is involved in stimulus driven attention and is more involved in processing infrequent stimuli, such as infrequent go or infrequent no go on go/no go tasks. By contrast pIFG is only activated on infrequent no go.
IFG insula is activated, but is tough to differentiate from insula and IFG insula is also activated in many other tasks. Its function is not specific and it may be more related to task awareness.
Pre SMA on right is also core to response inhibition. This is true on both lesion studies and TMR studies. Pre SMA is robustly activated during go/no go whether the task is simple or complex or whether the test is oral or manual. Pre SMA is thought to be important to conflict resolution of task. The anteriror cingulate gyrus (ACC) activates for error processing. DLPFC activation may be related to top down processes and working memory.
Hemispheric asymmetry with right sided dominance is noted in most studies especially for pIFG. However the left pre SMA and VLPFC may be important. "Balance" may be disrupted with left sided lesions that can thus cause deficits on task also.
Coin rotation test validation
Sunday, June 13, 2010
Hyperfamiliarity for faces (HFF) in epilepsy- left temporal localization?
Author reviews literature and attributes the first case to Kraepelin (1886).
Case one-- 46 yo policeman had a GTCS preceded by an aura of anxiety, deja vu and sulfuric smell. One month later the patient developed HFF (everyone seemed familiar), memory problems, distractibility and hyperemotionality for sadness. FRT performance was low average but patient was impaired on Rey O delayed recall.
Case 2- 62 yo rh attorney developed CPS at age 31 with sense of doom, palpitations and nightmares. Seizures involved HFF,
table has 2 more new cases and 5 old cases
Pertinent facts about HFF- specifically absent are delusions, hyperfamiliarity for nonface objects, or auditory hallucinations. Lesions involved left hemisphere (5 cases), bilateral (2 cases) or unknown (2 cases).
Authors cite that the hippocampus is important for recollection and the perirhinal cortex for feeling of familiarity. Deja vu and deja vecu occur more often with right hemisphere lesions establishing "right sided dominance for familiarity." The normal electrical response for familiarity is suppression v. activation for novelty stimulus. Authors speculate the left (impaired) side is unable to recognize faces (nvelty signallig) whereas the right (unipaired) side is in overdrive and falsely signal familiarity. Patients quickly accept their familiarity is false, due to intact right hemisphere structures otherwise. Contrtast to reduplication syndromes (Capgras) with right hemispheric and bifrontal abnormality.
Tuesday, June 8, 2010
Emotional perception deficits in ALS
Cognitive deficits occur in up to half of ALS patients, particularly bulbar ALS, including early bulbar ALS patients who are not demented.
13 subjects with bulbar ALS from teh Hershey ALS Center were given 2 tasks: the emotional faces task, in which they were required to point or say the word denoting the emotional facial expression (happy, sad, angry, afraid, disgusted). Second, they were asked to respond to tape recording of emotionally intoned sentenced and identify the emotion conveyed.
The ALS group did worse on the MMSE and GDS, control tasks for dementia and depression. They also did worse on the facial task, especially for faces connoting sad, disgusted and surprised faces. They did normally on the prosody task, but by emotion did worse on the surprised prosody recognition task.
Sunday, June 6, 2010
Scales ADHD
Thursday, June 3, 2010
Psychosis and EEG abnormalities as manifestations of Hashimoto' sencephalopathy
Authors claim there are two forms: a vasculitis type with strokelike manifestations and seizures, and a diffuse progressive type with dementia and psychiatric manifestations. Authors present a 38 year old woman (type 2) with a history of RA, and depression, and a history of hypothyroidism (not mandatory for HE), with acute psychosis with auditory hallucinations and bizarre behavior, a CSF pleocytosis (37 WBC, normal protein) normal memory, EEG showing slowing. Behavioral exam abnormal calculations, constructional praxis, and attention. CSF showed 12 cells. MRi showed punctuate lesions in left frontal gyrus. Treatment with methylprednisoline 1000 mg per day for three days followed by prednisone 50 mg per day for one month resulted in resolution of all symptoms and EEG,
Authors discuss that half of patients have MRI abnormalities that can mimic tumor, granuloma, infection, stroke, degeneration, or leukodystrophy. Several patients had other autoimmune abnormalities including RF, or p ANCA. Etiology of condition is not known.
Isolated inability to write cursively after transient ischemic attack (TIA)
78 year old right handed truck driver whose TIA was bilateral upper extremity weakness that resolved the same day. Post TIA he could write block letters but not cursively. On neurologic/behavioral examination, he complained of being unable to remember what he had read. He was diagnosed with obstructive sleep apnea. Elemental neurological examination was normal. Behavioral examination showed a normal MMSE (29/30, minus one for recall) with perseverations noted on an alternating programs test and Luria loops. The patient had trouble with cursive copying and writing. MRI could not be done (pacemaker); Spect showed bilateral hypoperfusion of the parietal and occipital lobes. Literature review of lesions suggests implied lesion of left superior parietal area (Alexander et al, Arch neurol 1992), parieto occipital white matter bilaterally (Baxter and Warrington, JNNP 1986). Hanley JR, and Peters , S(Cortex, 1996) showed the opposite , in a patient who had a left hemisphere lesion, with impaired spelling of lower case letters in block and had excellent cursive writing. Ohno et al. (Neurology, 2000) had a patient with pure apractic agraphia due to a thalamic lesion which blocked motor programming, and who could not write kana, kanji, Roman alphabet or Arabic numerals. Otsuki et al. (JNNP, 1999) reported a patient with apractic agraphia due to a hemorrhage in the left superior parietal lobe. Authors believe cursive and block writing are represented differentially.
Finger agnosia in Alzheimer's disease
Authors compared patients with Alzheimer's disease seen at Memory disorders clinic at University of Florida, comparing 38 AD patients and 10 normal age matched controls. Subjects with Alzheimer's disease had trouble naming fingers, especially their index finger (correct answers allowed were index finger, forefinger, and "dog" finger." All normal controls named all three fingers tested (including thumb, index finger, and pinky). AD patients 37 % could not name index finger, 5% could not name their thumb, 13 % could not name their pinky. None could name index finger and not name thumb or pinky.
Stratified by severity, with mild AD patients (mean MMSE of 23), moderate (mean MMSE of 19) and severe (mean MMSE of 11), 14 % of mild patients cold not name their index finger, 45 % of moderates could not, and 54 % of severe patients could not.
Friday, May 7, 2010
Ventromedial prefrontal cortex modulates fatigue after penetrating TBI
97 PBI patients and 37 controls from Vietnam Head Injury Study were enrolled. Fatigue was assessed via questionnaires (Krupp Fatigue Scale). CT scan localization of lesions was made to nonfrontal, ventromedial prefrontal, and dorsolateral /lateral prefrontal. All 3 areas were associated with fatigue, but only VM was associated with increasing fatigue with larger lesion volume. Authors note this may allow linkage of fatigue to other ventromedial functions such as effort and reward participation.
Note one of references was a John Deluca functional MRI paper showing role for same area in MS related fatigue J Neurol Sci 2008; 270:28-39.
Cognitive effects of pregabalin in healthy volunteers
32 healthy volunteers were randomized to pregabalin (300 bid) or placebo for twelve weeks and underwent cognitive tests before and after. Subjects on pregabalin showed worse performance on 3 of 6 target cognitive measures, including digit symbol test, Stroop, and Controlled Oral Word Association Test. They were paralleled by changes on the Portland Neurotoxicity Scale.
Sunday, May 2, 2010
Parcelling frontal functions
Chapter summarized authors' (esp Wager's) meta-analyses of functional imaging studies. These involve working memory, task switching, response inhibition, and emotion. cites Stuss and Alexander, 2007. See chapter.
Sunday, January 31, 2010
Luria-- Semantic fragments for repetition and recall
These stories have layers of meaning and complexity
1. Tolstoy's The Hen and the Golden Eggs- A man had a hen which laid golden eggs. He wanted to get more of the eggs at once, and so he killed the hen. But inside he found nothing; it was just a hen like any other.
2. Tolstoy's The jackdaw and the Pigeons. A jackdaw heard that some pigeons had plenty of food. She painted herself white and flew into the pigeons house. The pigeons thought she was a pigeon, and took her in. However, she forgot herself and cried like a jackdaw. The pigeons then realized she was a jackdaw and sent her away. She went back to her family, but they did not recognize her, and would not have her either.
3. Tolstoy's The Ant and the Pigeon. An ant went down to the stream to drink. A wave swamped him and he began to drown. A pigeon flew past him and threw him a twig. He climbed on the twig and was saved.
The next day, a hunter set a net and caught the pigeon. When he took it from the net, however, the ant crawled up stealthily and bit the hunter on his hand. The hunter cried out and the pigeon flew away.
4. The Lion and the mouse. A lion was asleep and a mouse ran over his body. The lion awoke and caught the mouse. The mouse begged him to let her go. The lion laughed and let her go. The next day, a hunter caught the lion and tied him with a rope to a tree. The mouse came through stealthily, gnawed through the rope, and set the lion free.
5. The Lion and the Fox. The Lion grew old and could no longer hunt animals. So the lion had to learn how to live by cunning. He lay in his den and pretended to be ill. The animals came up to him and he ate them. One day a fox came but would not go into his den. The lion asked her "Why don't you come in?" The fox replied, " I can see tracks coming into your den but none coming out."
6. The Stupid Dog. A dog was walking over a bridge at night and saw the reflection of the moon in the water. The dog decided it was cheese and jumped into the water. But of course, she found nothing and only got wet.
Results patients who had trouble recalling individual words sometimes had no trouble with semantic fragments, and normals had no trouble with 2 successive fragments. Amnesics would present the semantic content of one part of the story but forget the second part (retroactive inhibition).
Luria-- sentence repetition-- aphasia or amnesia??
AR Luria. The Neuropsychology of Memory VH WInston and Sons, Washington , D.C. 1976 p. 103
Patients with vascular lesions could repeat one sentence, had trouble with the second one. Patient either reverts to first sentence or contaminates elements, displaying "recency effect" but also simplifying the structure of the sentence while maintaining its elements. However, patients with temporal lesions showed no "freezing or inert repetition" as in frontal lesions.
Sentence recall-- Luria
Although list learning requires multiple presentations, normals can easily recall one and then a second 7 or 8 word sentence (simplified if aphasic) and then repeat both sentences in order.
first sentence: "Apple trees grew in the garden behind the high fence" or "The hunter killed a wolf on the edge of the forest. " Second sentence : " In Tashkent there was an earthquake and many houses were destroyed" or "In Tushino there was an air display and parachute jumps."
Simpler versions "The boy is cold" or "the girl is asleep" or "the boy hit the dog" or "the girl drinks tea"
Results: Amnesics could repeat the sentences immediately, or after empty or filled pauses, with some trouble if the pause was filled with rapid speech. However, when given a second sentence, they either lost the first or mixed up the elements.
Disturbance of seriality due to left temporal lesions
Luria in Neuropsychology of memory states that left temporal lesions cause a disturbance of retroactive inhibition in which the last word of the list inhibits recall of predecessors on the list, especially with longer lists. The effect only occurs with lists presented and reproduced verbally. Luria gives original credit to Lashley
Lashley KS. Functional determination of cerebral localization. Arch Neurol Psych 38: 1937.
Learned motor responses.
Subject is asked to raise his left hand to one tap, and his right hand to 2 taps, or to raise his hand to one tap and to refrain from raising his hand to 2 taps.
More complicated version: patient is asked to respond to a fist with a finger, or to a finger with a fist. Or, he is asked to responnd to two taps with one tap, and to one tap with 2 taps.
More complicated yet. the subject is asked to respond to a weak tap with a powerful hand movement, and to a powerful tap with a weak hand movement. Or, to respond to a short acoustic stimulus with a slow movement, and a long stimulus with a prolonged movement. (cf Marushevskii M, Disturbance of the simplest forms of voluntary action in local lesions of the frontal lobes. in Luria AR, Khomskaya ED (eds), The frontal lobes and the regulation of psychological processes. Moscow, MGU Press, 1966.
Luria's adaptation: He would give one task, and when mastered give a second, then without repeating instructions, go back to the first, and then the second task. Normals had little trouble either learning the task or switching. Neither empty or filled paused had much effect, (except occipital lesions for visual tasks and temporal lesions for auditory tasks). Massive tumors had problems with task.
Patients with thalamic lesions could learn the task, but not do it verbally. These patients learned the task, were not affected by interference, but could not talk about it.
Unadze illusion fixed set test
From Luria's book Neuropsychology of Memory
Unadze DN. Experimental psychological investigations. Moscow. Nauka. 1966.
A subject is given 2 balls of different sizes to squeeze (one per hand) 10-15 times for several seconds per squeeze. He compares their sizes and reports his finding. Then, without visual inspection he is given 2 balls of equal size and asked to compare the sizes. The result is that the hand that held the larger ball now reports it is holding a smaller ball, and is maintained even after 12-18 trials.
Luria's variation was to test normal, mildly and severely impaired subjects on the test. He found that in severely amnesic subjects only, and only with interference, the fixed set effect was achieved but rapidly forgotten, underlying the importance in interference on somatic memory. Pauses less than 2 minutes had little effect on retention, as with other types of learning.
Saturday, January 30, 2010
Gerstmann's syndrome reader
Kombos T, Picht t, Suess O. Electrical Excitability of the Angular Gyrus. Journal of Clinical Neurophysiology 25(6) December 2008 .
Comment. This is the first report of direct electrical stimulation of AG in humans. Stimulation resulted in responses in contralateral upper extremity in 3/5 patients. No lower extremity stimulation was found.
Anema HA.a, Kessels RPCcd, de Haan EHFe, Kappelle L, Leijten F, van Zandvoort Martine , Dijkerman,H. Differences in finger localisation performance of patients with finger agnosia
19(14) September 2008 .
Comment : 3 patients with AG lesions were able to point with their finger effectively
to a tactile stimulus (body schema intact) but unable to do so with a drawing of hand or to name the finger.
Other body parts did not have this dissociation between body schema and body image.
Tamura I, Kikuchi S, Otsuki M, Tashiro K. The writing of arabic numerals, kanji, and kana in brain-damaged patients. 14(6), 6 May 2003, pp 861-865.
Comment. 4 patients with Gerstmann's syndrome and 4 with Wernicke's aphasia were compared. All patients could copy letters, and were righthanded. Subjects were presented with coins, and then asked to write the respective number value in kana , Kanji and Arabic numerals. For GS patients, kanji writing was better than Arabic, that was better than kana writing. For WA aphasia patients, Arabic numeral writing was better than kana and kanji. Discussion: "In the case of GS, there was a problem in the concept of number. In the case of WA, the concept of number was relatively well preserved." GS subjects made substitution errors in Arabic number writing. Authors postulate a deficiency processing recall of somesthetic graphemes linked to the concept of number.
Wingard E, Barrett A, Crucian G, Doty, L, Heilman, KM. The Gerstmann syndrome in Alzheimer's disease. Journal of Neurology, Neurosurgery & Psychiatry 72(3) March 2002 .
Comment : among 38 patients with Alzheimer's disease, the four constituent components of Gerstmann's syndrome did not cluster together, leading the authors to speculate that their association is fortuitous due to contiguous networks, and that the four features of Gerstmann's syndrome do not share a common network.
Baciul M, Koenig O, Vernier M, Bedoin N, Rubin C, Segebarth C. Categorical and coordinate spatial relations: fMRI evidence for hemispheric specialization. Neuroreport 10(6) April 1999.
Comment: 16 healthy males were examined on a coordinate and a category task using fMRI paradigm. The category task was whether a dot was above or below a horizontal line. The coordinate task was whether the distance between the dot and the line was within a reference distance. The coordinate task related to right AG activation which decreased over time. The category task depended upon Left AG activation which did not decrease over time and in fact increased over time. Results subserve the hypothesis that the left hemisphere subserves the development of new spatial categorization.
Thursday, January 7, 2010
Cognition and Fragile X syndrome
Fragile X problems persist into adulthood (even though it is considered a pediatric disease). Two separate conditions exist. Patients with the premutation (55-200 repeats of the FMR1 gene) have RNA toxicity but not full blown cognitive abnormalities. RNA toxicity can include primary ovarian insufficiency, fragile X associated tremor ataxia syndrome (FXTAS), fibromyalgia, hypothyroidism, and psychiatric issues such as anxiety and depression. Boys in this range can experience shyness, social anxiety disorders, ADHD and autism spectrum disorders. This is due to excess FMR1 gene.
Patients with the full mutation (greater than 200 repeats) have LACK of FMR1 and Fragile X syndrome (opposite of above in which there is excess RNA present). They present with severe cognitive abnormalities. In boys this manifests as autism, in girls as severe learning disabilities. They also have connective tissue disorders, agression, and psychiatric problems as above. Males with FXS usually have IQ below 70 (severe) but 15 % are "high functioning" with IQ above. High functioning is due to mosaicism within cells or within methylation and the degree of impairment is related to the amount of FMRP present. Among girls, 40 % have a normal IQ, 35 % are borderline, and 25 % have an IQ below 70. The activation percentage (pct of normal X that is active) correlates with disease and that and amount of FMRP available also affects functioning of offspring.
FXS is the most common cause of intellectual impairment and of autism spectrum disease. The full mutation occurs in 1:2500 in population, and the premutation occurs in 1:250 girls and 1:800 boys in the general population. Genetics: FXS patients always have their mother as a carrier. Fathers often pass the premutation on, to their daughters and it does not expand to a full mutation. Mothers with premutation often have expansion to full mutation in their offspring, especially if the number of repeats is greater than 100.
See also posts on FXS and FXTAS on www.neurologyminutiae.blogspot.com


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A Felician Sister publicly professes perpetual vows of poverty, chastity, and obedience following a formation period of temporary profession.
During a special Eucharistic liturgy, friends, family, and members of the Felician community gather with the Sister to witness and celebrate her profession of perpetual vows. This public ceremony of perpetual profession—where a woman publicly professes her religious vows for life—is the culmination of a 9- to 12-year period of initial formation. Perpetual profession is a sacred commitment to dedicate the rest of her life in service to God and Church as a Felician Sister.
Perpetual profession of vows is not an end in itself, but rather just the beginning of our lives as Felician Sisters. The call to religious life is one of continuous conversion of heart, mind, and spirit based on an open and loving response to the Will of God. Ongoing spiritual, apostolic, and personal formation continues throughout the course of our lives as consecrated women religious.


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Experience anew the miracle of Christmas--and one special baby
A young girl, a decidedly unplanned pregnancy, and one miraculous little baby--it's an amazing story, one that sometimes gets buried under the tinsel of Christmas. That is, until something causes us to pause and reconsider the true magic of the holiday season. "A Baby Changes Everything "celebrates that baby in the manger in a fresh new way. Lyrics to Faith Hill's song "A Baby Changes Everything" are joined by reflective stanzas on the wonder of God's love and the Christmas season, how a baby can change our lives in an instant, and how one Baby changed the world forever. Along with the accompanying audio CD, "A Baby Changes Everything" makes for a beautiful expression of all that is wonderful about Christmas.


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Eight years ago, the presidents of four locals affiliated with the Washington Education Association (WEA) met at a diner in the Yakima Valley. Their agenda included an item that would dominate their business meetings for years to come: negotiating with the school district as a single unit while bargaining separate contracts.
The strategy was untried, but something was needed to counter the efforts of Yakima School District officials who were blocking contract settlements with unjustified delays, scare tactics, and a "divide and conquer" approach.
As a first step, the local presidents each agreed to attend the other groups' bargaining sessions, says Janet Beck, a WEA MidState UniServ director and staff negotiator.
"They have since ended up supporting each other to the point where one or more groups might settle for less compensation, for example, in order for another group to get closer to earning a living wage," she adds.
Two more Yakima locals joined the solidarity group—bringing the tally to five education support professional (ESP) locals and one teachers' unit. For most matters, they are six separate unions with different names and agendas. But when they're at the bargaining table, they stand 1,500 strong as Yakima Educators United (YEU).
The unified strategy of sharing contract information, attending each other's bargaining sessions, and supporting one another in the media and at school board meetings has paid off.
Last spring, contracts were ratified for the Yakima Educational Office Professionals (YEOP) and Yakima Education Association (YEA), which represents teachers.
"It is important to support each other's proposals since all of our employee groups are needed to have an education system that functions properly," says Steve McKenna, YEA president. "Through our unified strategy, we learn to see our employee groups through each other's eyes."
Last December, after a total of 16 long months of negotiations, contracts were ratified with the Yakima Association of Building Services (YABS), Yakima Maintenance Association (YMA), Yakima Professional Technical Association (YPTA), and Yakima Association of Paraeducators (YAP).
"We'd still be fighting if it weren't for YEU," says Buffy Phillips, president-elect of YAP. "We started YEU to support each other and share what was going on with each other's unions. From networking, we all knew [the district] had the funds to negotiate. "
The district's fund balance for 2012 was more than $25 million, according to district records.
"They had the funds in reserve," says Beck, the Midstate Uniserv director. "They just didn't want to bargain."
The six new contracts include gains in wages, insurance contributions by the district, and improvements regarding family leave and other issues.
"The most satisfying aspect of YEU," Beck explains, "is to see them stand together as a union of unions and know they will continue to organize together."
YEU's unity is particularly exemplified by the group's support of paraeducators. According to YEU, 70 percent of local paraeducators qualify for food stamps, and those who provide insurance for family members earn less than $1,000 a month.
"The other bargaining units took less so paraeducators could get more," Beck says. "Showing particular support toward paraeducators was their statement of solidarity."
The need to unite behind paraeducators was brought to light when members discovered that substitute custodians in the district earned several dollars more per hour than full-time paraeducators.
In 2011, it was agreed that paraeducator and custodian associations would work with district officials on a job study comparing the two groups. Results showed the work of paraeducators and custodians to be of equal value.
"People think we work in the front office making photocopies," says Phillips, who was on the job study committee. "That's a misperception. Paraeducators help to instruct students in math and reading—right alongside teachers."
In most U.S. school districts, paraeducators must have a high school degree. According to federal government requirements, those working in Title I schools must hold a two-year or higher degree, have a minimum of two years of college, or pass a rigorous state or local assessment exam. In Yakima, paraeducators are required to have a two-year college degree, 72 credit hours, or pass a state-issued test.
"We help students with social skills, problem-solving skills, and work hard to boost their self-esteem," says Phillips.
Under the 2009-2011 contracts, new paraeducators in Yakima earned $11.89 an hour while custodians made around $16 an hour. With the new contract, the lowest pay level for paraeducators will be $12.86 an hour—an 8 percent gain to the bottom step on the salary scale. At the top of the scale, paraeducators now earn $18,500, representing a 2.5 percent increase. Paraeducators also received a lump sum payment of 1 percent of base compensation.
McKenna says teachers were adamant about speaking out at board meetings and community events on behalf of ESPs.
"Teachers recognize that ESP members are invaluable partners in our educational system," he says. "We are all in the same struggle for decent working conditions, fair compensation, and adequate resources to do our jobs properly."


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What is Browlift?
The brow lift, also known as a forehead lift, is a plastic surgery procedure which can restore a more youthful and refreshed appearance by elevating the eyebrows to a higher position. The procedure can improve the appearance of forehead creases and furrows, frown lines, drooping eyebrows, and hooding over the eyes caused by a low brow position. Today, the brow lift is often performed as an endoscopic procedure which is less invasive and involves decreased scarring.
Our Philosophy:
Good candidates for the brow lift include healthy men and women with brows set in a low position and an associated "heavy lid look". Patients with high hair lines may not be good candidates for the endoscopic technique as the procedure involves a slight increase in forehead height post-operatively. Instead, these patients may be good candidates for an open brow lift technique which actually lowers the hair line post-operatively.
Dr. Moynihan performs the brow lift in an outpatient surgical center using sedation or general anesthesia. The procedure takes about an hour to complete. For the endoscopic brow lift, three 1.5cm incisions are made behind the hair line, resulting in small, well-concealed scars. Once the incisions are made, the brows are released and elevated to a higher position.
Recovery after a brow lift takes about one week. Swelling and bruising are common and will begin to fade within about a week. Discomfort is usually minimal, but medication can be prescribed if necessary to help control any discomfort that patients do experience. Most patients can return to work and other light activities within one week, though more strenuous activities will need to be postponed for at least two weeks.
Additional Browlift FAQs
What is a brow lift?
The brow lift, also known as a forehead lift, is a plastic surgery procedure which elevates the eyebrows, minimizing the appearance of forehead furrows and creases, frown lines, drooping eyebrows, and hooding over the eyes caused by a low brow position. The result is a more refreshed and youthful-looking appearance. Brow lifts today are commonly performed with the use of an endoscope which involves less scarring.
Who is a good candidate for a brow lift?
Healthy men and women whose brows are set in a low position with an associated "heavy lid look" may be good candidates for the brow lift. Patients with high hair lines may not be appropriate candidates for an endoscopic brow lift and may, instead, be candidates for an open brow lift technique which lowers the hair line post-operatively.
What happens during the brow lift consultation?
During the consultation, your forehead will be examined, your medical history taken, and your goals discussed. All details of the procedure, such as the anesthesia, the recovery, the risks, the costs, and so on, will be explained.
Where is brow lift surgery performed?
Dr. Moynihan performs brow lifts in an outpatient surgical center.
What is the anesthesia used for the brow lift procedure?
Sedation or general anesthesia may be used for the brow lift.
How are brow lifts performed?
For an endoscopic brow lift, three 1.5cm incisions are made behind the hairline. Working through the incisions, the brows are released and then elevated to a higher position. The open brow lift involves a more extensive incision.
How long is the surgical time for the brow lift?
The brow lift takes about an hour to complete.
Where are the incisions made for brow lifts?
The endoscopic brow lift involves three 1.5cm incisions which are located behind the hair line. The open brow lift involves one longer incision also located behind the hairline.
Will I have scars after undergoing a brow lift?
While the brow lift will leave scars, they tend to be well-concealed behind the hairline. The scars resulting from an endoscopic are also very small.
How much pain occurs with brow lifts?
Discomfort after a brow lift is usually minimal and can be managed with medication.
What is the recovery like after undergoing a brow lift?
The recovery after a brow lift takes about one week. Patients should expect some swelling and bruising which will start to fade in about one week. While discomfort is generally mild, medication can be taken to control this.
How much time should I plan to take off from work after my brow lift?
You should plan on being out of work for about one week after your brow lift procedure.
Can I exercise after my brow lift procedure?
Light exercise can usually be resumed within one week after the brow lift procedure, though strenuous activities and exercise will need to be put off for about two weeks.
Are there any risks of undergoing a brow lift?
All surgery carries some risk. For the brow lift, this may include the risk of cosmetic asymmetry and temporary numbness of the forehead which may last for one to three months.
Will my insurance company cover the cost of a brow lift?
Patients will need to check with their own insurer. In general, brow lifts which are solely cosmetic in nature are usually not covered by insurance.
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Tidy Ruler for the super neat
There are many different kinds of people in this world with various personalities, and all of us do things in our very own quirky way (which we deem as 'normal', of course). Well, some of us are extremely tidy, and would love to have everything in its proper place, being incapable of standing just a bit of a mess, while others feel that being more 'random' (that's a nice way of calling it 'a mess') is the way to go. Well, for those who are extremely tidy, you might want to check out the $11.99 Tidy Ruler.
This rather interesting piece of stationary will feature a built-in hand-cranked pencil sharpener as well as a place for you to stash away your pencil in the ruler itself when you do not need it. Made out of beautiful, sturdy rosewood, this is one modern piece of school stationary that is old school in nature. Perfect for any math class that you have enrolled your little one in, that's for sure.