Acute neuropsychological consequences of coronary artery bypass surgery

This study examines a series of coronary artery bypass patients (CABS) for neuropsychological and regional cerebral blood flow (RCBF) changes at 8 days and 8 weeks post surgery. Seventy-three percent were found to have moderate or severe neuropsychological deficits at 8 days post operation and 37% at 8 weeks post surgery. A comparison group of major vascular and thoracic surgery patients was also found to have a significant proportion of neuropsychological deficit following surgery. The RCBF assessments indicated a significant drop in mean RCBF at 8 days post surgery in the coronary artery bypass group which did not persist to 8 weeks. The comparison group showed no changes in RCBF following surgery. The findings suggest different patterns of recovery and origins of the neuropsychological deficit in the two groups and emphasize the need for appropriate control groups in studies examining the cortical effects of extracorporeal circulation. In addition, the project received generous support from the special trustees of the Middlesex Hospital.     

The component awareness and accuracy of dual- and single-jointed actions

The accuracy with which people execute wrist and elbow movements were measured using three main conditions: (i) single-jointed (wrist or elbow) movements to targets, (ii) dual-jointed (wrist and elbow) movements to targets, and (iii) components of dual-jointed movements to targets, when the task for the subject was to perform the elbow or wrist constituent of the action in isolation, without displacing the second joint. Elbow precision was significantly worse under component than dual conditions, which is compatible with the notion that wrist and elbow activity are conjugately, rather than independently, programmed when a dual-jointed action is performed. The pattern of wrist accuracy was divergent, but possible reasons for this were discussed. In all cases, error was measured in terms of deviation from perfect posture; using this index, the hypothesis that incorporating more moving joints into an action serves to increase movement complexity and jeopardise precision was tested, but the results were ambiguous. Discussion also centered on the problems of using performance data to infer changes in motor programming, and the need for rigorous conceptualisation and research in this area.     

Control of responding by the location of an auditory stimulus: role of rise time of the stimulus

The control of responding by the location of tone bursts of 0.2- or 50-msec rise time was investigated in three albino rats. The apparatus consisted of an enclosure with two levers, two loudspeakers (in different locations), and a dipper feeder. The animal was exposed to tone bursts from either one or the other of the two speakers, and the speaker through which the tone bursts were delivered on any particular trial alternated in an irregular manner. Responses on one lever were reinforced with food in the presence of tone bursts from one speaker; responses on the second lever were reinforced with food in the presence of tone bursts from the second speaker. Responding came under the control of the location of 4-kHz tone bursts of 0.2-msec rise time within the first session. At this rise time, animals maintained a stable level of correct responding of greater than 95%. When the rise time was increased to 50 msec the percentage of correct responding fell to an average of 80 to 85%. It was concluded that location of an auditory stimulus is a powerful controller of responding in rats and that the degree of control is dependent upon rise time.     

Loss of negative priming following sleep deprivation

It has been argued that one night of sleep loss in young healthy adults produces changes similar to that associated with normal, healthy ageing—in particular, that young sleep-deprived adults perform similarly to 60-year-old sleep-satiated adults on some tasks of frontal lobe function. This proposition was examined using a protocol viewed by many to be a direct probe of nonvolitional attention mechanisms associated with frontal lobe function. A negative priming (NP) procedure was used to compare performance between non-sleep-deprived (NSD) and sleep-deprived (SD, 34 hr) young, healthy adults. This protocol allowed for exploration of two theories of the NP effect based on inhibitory or memorial processes. Under conditions believed to facilitate inhibitory processes a normal NP effect was found for NSD(16 ms) and SD (9 ms) participants. Under conditions believed to rely on memorial processes there was no NPeffect following SD, compared with a normal NP effect for NSD participants (11 ms). Distractor interference was also greater following SD. These findings do not suggest a similar pattern of change following sleep loss in healthy young adults to that of normal, healthy, non-sleep-deprived aged groups.     

Cigarette smoking and chewing gum: response to a laboratory-induced stressor.

The current study examined the anxiolytic effects of cigarette smoking and chewing gum on urge to smoke, withdrawal, and anxiety in response to a public speaking task in 45 undergraduate smokers. Participants were asked to smoke, chew gum, or do nothing in response to the stressor. Participants completed measures of anxiety, withdrawal symptoms, and urge to smoke pre- and poststressor. The smoke group reported fewer urges to smoke pre- and poststressor than the other groups. The smoke and gum groups reported fewer withdrawal symptoms than did the control group poststressor. Chewing gum was helpful in managing levels of withdrawal symptoms compared with the control group. Groups did not differ on measures of anxiety. Results suggest that smoking in response to a stressor may not reduce levels of affective stress. Furthermore, chewing gum may be helpful in managing withdrawal symptoms in response to a stressor.     

Adapting Cognitive Processing Therapy to Treat Co-Occurring Posttraumatic Stress Disorder and Mild Traumatic Brain Injury: A Case Study

This case study aims to provide evidence for the effectiveness of adapting a particular manualized cognitive behavioral therapy intervention to treat co-occurring posttraumatic stress disorder (PTSD) and mild traumatic brain injury (mTBI). This study presents the treatment of a woman who experienced co-occurring mTBI and PTSD following a motor vehicle accident, a dual diagnosis that was established through a flexible assessment approach involving interviews as well as standardized psychological, neuropsychological, and neurobehavioral testing. Treatment planning led to a-priori adaptation of Cognitive Processing Therapy (CPT) to treat both her PTSD symptoms and the sequelae associated with her mTBI. The therapist maintained fidelity to the manualized structure and content of CPT protocol, adapting portions of the treatment to add specific emphasis on issues of identity confusion and role loss in service of addressing these common functional impairments that can accompany mTBI. Discussion focuses on application of CPT for future treatment of comorbid PTSD and TBI amidst complicating factors, including role losses and medical and safety issues. This case study is especially relevant due to the prevalence of co-occurring PTSD and TBI across a variety of populations.     

Providers’ Perceptions and Practices Regarding <Emphasis Type="BoldItalic">BRCA1/2</Emphasis> Genetic Counseling and Testing in African American Women

We examined healthcare providers’ perceptions of genetic counseling and testing in African American women at moderate to high-risk of carrying a BRCA1/2 mutation. We conducted 20 in-depth interviews with genetic counselors (n = 5), medical oncologists (n = 8), obstetrician/gynecologists (n = 2) and surgeons (n = 5). Interviews were audiotaped, transcribed and independently coded by two individuals using a content analysis approach. Seven themes emerged relevant to providers’ perceptions of African American women’s use of BRCA1/2 genetic services: access factors, cultural beliefs and preferences, effects of testing, patient motivators for genetic counseling and testing, patient-provider communication, reasons for provider referral, and reasons for patient refusal. Providers identified individual- and system-level barriers to African American women’s use of genetic services, including lack of follow-up after referrals to genetic specialists and challenges to obtaining financial coverage for under- and uninsured high-risk women. Results have implications for physician and patient education regarding appropriate referrals to and uptake of genetic services in at-risk African American women.