The health needs of the majority versus the health needs of the individual: The reorganization of medical education in Colombia

The challenge of excellence in community health services has been taken up by medical educators in Colombia. Confronted with a nation where the primary indicators of disease mortality and morbidity (cardiovascular disease and infant mortality) were characteristic of First and Third World patterns, respectively, the Ministry of Health and La Asociacion Colombiana de Facultades de Medicina (ASCOFAME), representatives of institutions of medical education, have collaborated to conduct a needs assessment of the country's health needs and devised an implementation plan designed to better address the needs of the majority of that nation's people.As a model, the Colombian reorganization of medical education is an example which could be emulated by the U.S. where policy makers are struggling with troublesome questions of cost, equity and quality.     

The pathological left-handedness syndrome

A clinical syndrome of pathological left-handedness (PLH) is proposed to identify the pattern of correlative changes in lateral development associated with early brain injury in some manifest left-handers. This syndrome is believed to be caused by a hemispheric lesion that is predominantly left-sided (or bilateral asymmetric), which onsets before Age 6, and which encroaches upon the critical speech zones of the frontotemporal/frontoparietal cortex. The pattern of changes may include any or all of the following features: shifts in manual dominance, trophic changes in the extremities, transfer of hemispheric speech, and/or intrahemispheric reorganization of visuospatial cognitive functions. Although some of these correlates of PLH have long been known, they have not been recognized as an interrelated pattern of traits that constitute a clinical syndrome. Identification of these individuals, all manifest left-handers, will be shown to have implications for diagnosis/remediation and for models of recovery of function.     

Subcortical functions in language: A working model

The current paper explains a model of subcortical language functions that focuses on dynamic interactions between the cortex, the thalamus, and the basal ganglia in the production of spoken language. The model was derived from (a) studies of subcortical lesions and language, (b) studies of subcortical stimulation and language, (c) knowledge regarding neural pathways between various cortical and subcortical structures, and (d) indications that preverbal monitoring of language occurs. In the current model, the thalamus plays roles in cortical arousal and activation and in preverbal semantic monitoring. The basal ganglia function to regulate the degree of excitation conveyed from the thalamus to the cortex and to time the release of formulated language for motor programming. Consistency with classical syndromes of aphasia and potential applications to other areas in the neurosciences are discussed. The current theory, unlike previous formulations, is specific enough that testable hypotheses can be derived.     

Millon Clinical Multiaxial Inventory (MCMI) computer-generated diagnoses: How do they compare to clinician judgment?

During the past several decades, computers have achieved increasing prominence in psychological assessment procedures. This is particularly true for computer-based test interpretation and diagnosis. This study reports on a study designed to compare the accuracy of computer-based diagnoses with clinician-generated diagnoses. The Millon Clinical Multiaxial Inventory (MCMI) was administered to 151 consecutively admitted inpatients at a large private psychiatric hospital. The computer-generated diagnoses were compared with those generated by admitting psychiatrists. The results indicated that the MCMI diagnostic impressions underestimated the severity of depressive disorders when compared with clinician diagnoses on Axis I. Specifically, clinicians diagnosed major depression much more frequently than did the MCMI. In addition, clinicians diagnosed anxiety disorders much less frequently than did the MCMI.     

The effect of negative stimulus presentations on observing-response rates

Theories of observing differ in predicting whether or not a signal for absence of reinforcement (S−) is capable of reinforcing observing responses. Experiments in which S− was first removed from and then restored to the procedure have yielded mixed results. The present experiments suggest that failure to control for the direct effect of presenting S− may have been responsible. Pigeons and operant procedures were used. Experiment 1 showed that presentations of S−, even when not contingent on observing, can raise the rate of an observing response that was reinforced only by presentations of a signal (S+) that accompanied a schedule of food delivery. Experiment 2 showed that this effect resulted from bursts of responding that followed offsets of S−. Experiment 3 showed that, when the presence of S− was held constant, lower rates occurred when S− was dependent on, rather than independent of, observing. These results support theories that characterize S− as incapable of reinforcing observing responses.     

Comprehension of directly and indirectly stated main ideas and details in discourse by brain-damaged and non-brain-damaged listeners

Aphasic, right-hemisphere-damaged, and non-brain-damaged subjects heard short narrative paragraphs. Each paragraph contained four main ideas and one or more details related to each main idea. After each paragraph was presented, subjects' comprehension and retention of main ideas and details from the paragraph were tested. Some of the test items directly restated information from paragraphs and others paraphrased information from paragraphs. All groups of subjects remembered main ideas better than they remembered details, and no group of subjects was significantly affected by whether test items directly or indirectly stated information from paragraphs. Disfluent aphasic and right-hemisphere-damaged subjects' overall paragraphs comprehension scores were not significantly poorer than those of non-brain-damaged subjects. Fluent and mixed aphasic subjects' overall paragraph comprehension scores were significantly worse than those of non-brain-damaged and right-hemisphere-damaged subjects. Token Test and Boston Diagnostic Aphasia Examination auditory comprehension scores did not predict aphasic subjects' paragraph comprehension scores. right-hemisphere-damaged subjects' overall paragraph comprehension scores were not significantly those of non-brain-damaged and right-hemisphere-damaged subjects. Token Test and Boston Diagnostic Aphasia Examination auditory comprehension scores did not predict aphasic subjects' paragraph comprehension scores.     

Comprehension of main ideas and details in coherent and noncoherent discourse by aphasic and nonaphasic listeners

Aphasic and nonaphasic listeners' comprehension of main ideas and details within coherent and noncoherent narrative discourse was examined. Coherent paragraphs contained one topic to which all sentences in the paragraph related. Noncoherent paragraphs contained a change in topic with every third or fourth sentence. Each paragraph contained four main ideas and one or more details that related to each main idea. Listeners' responses to yes/no questions following each paragraph yielded the following results: (1) Nonaphasic listeners comprehended the paragraphs better than aphasic listeners. (2) Both aphasic and nonaphasic listeners comprehended main ideas better than they comprehended details. (3) Coherence did not affect comprehension of main ideas for either group. (4) Coherence did not affect comprehension of details by nonaphasic subjects. (5) Coherence affected comprehension of details by aphasic subjects, and their comprehension of details in coherent paragraphs was worse than their comprehension of details in noncoherent paragraphs. There was no significant correlation between Token Test scores and measures of paragraph comprehension.     

Sensitivity to lexical denotation and connotation in brain-damaged patients: A double dissociation?

Sets of words can be grouped in terms of their denotation (cold and warm both refer literally to temperature) or in terms of their connotation (cold and warm connote remoteness and intimacy, respectively). To assess whether these two facets of meaning are dissociable, unilaterally left- and right-hemisphere-damaged patients were presented with word triads and asked to group together the two words that were closest in meaning. Right-hemisphere-damaged patients showed a preserved sensitivity to denotation, and a selective insensitivity to connotative facets of meanings. In contrast, left-hemisphere-damaged patients exhibited a preserved sensitivity to connotation as well as a selective insensitivity to denotative aspects of meanings. Inasmuch as normal control subjects displayed a flexible sensitivity to both denotative and connotative aspects of meaning, the results suggest that unilateral brain damage selectively curtails use of one or the other major aspect of word meaning.     

The nature of the phonological disorder in conduction aphasia

Sequences of attempts to name pictured objects were used to examine phonological dysfunction in three diagnostic subgroups of aphasia. A prevalence of "phonologically-oriented sequences" (i.e., those sequences that contained only attempts with a phonological resemblance to the target word) was found to be a diagnostic criterion for conduction aphasia. When compared to a group of Broca's (n = 7) and Wernicke's (n = 5) aphasics, all the conduction aphasics (n = 6) produced proportionately more of such phonologically-oriented sequences on a picture naming test. An examination of the phonologically-oriented sequences produced by the conduction aphasics indicates that speech production in conduction aphasia involves dysfunction at an early stage of sound-encoding. The theoretical implications of this view are discussed.