Measurement of forces applied during Macintosh direct laryngoscopy compared with GlideScope® videolaryngoscopy.

Laryngoscopy can induce stress responses that may be harmful in susceptible patients. We directly measured the force applied to the base of the tongue as a surrogate for the stress response. Force measurements were obtained using three FlexiForce Sensors(®) (Tekscan Inc, Boston, MA, USA) attached along the concave surface of each laryngoscope blade. Twenty-four 24 adult patients of ASA physical status 1-2 were studied. After induction of anaesthesia and neuromuscular blockade, laryngoscopy and tracheal intubation was performed using either a Macintosh or a GlideScope(®) (Verathon, Bothell, WA, USA) laryngoscope. Complete data were available for 23 patients. Compared with the Macintosh, we observed lower median (IQR [range]) peak force (9 (5-13 [3-25]) N vs 20 (14-28 [4-41]) N; p = 0.0001), average force (5 (3-7 [2-19]) N vs 11 (6-16 [1-24]) N; p = 0.0003) and impulse force (98 (42-151 [26-444]) Ns vs 150 (93-207 [17-509]) Ns; p = 0.017) with the GlideScope. Our study shows that the peak lifting force on the base of the tongue during laryngoscopy is less with the GlideScope videolaryngoscope compared with the Macintosh laryngoscope.

Evidence of neurodegeneration in brains of older adults who do not yet fulfill MCI criteria.

We sought to determine whether there are structural and metabolic changes in the brains of older adults with cognitive complaints yet who do not meet MCI criteria (i.e., preMCI). We compared the volumes of regional lobar gray matter (GM) and medial temporal lobe structures, including the hippocampus, entorhinal cortex (ERC), fusiform and parahippocampal gyri, and metabolite ratios from the posterior cingulate in individuals who had a Clinical Demetia Rating (CDR) of 0.5, but who did not meet MCI criteria (preMCI, N=17), patients with mild cognitive impairment (MCI, N=13), and cognitively normal controls (N=18). Controls had more ERC, fusiform, and frontal gray matter volume than preMCI and MCI subjects and greater parahippocampal volume and more posterior cingulate N-acetylaspartate (NAA)/myoinosotil (mI) than MCI. There were no significant differences between MCI and preMCI subjects on any of these measures. These findings suggest there are neurodegenerative changes in the brains of older adults who have cognitive complaints severe enough to qualify for CDR=0.5 yet show no deficits on formal neuropsychological testing. The results further support the hypothesis that detection of individuals with very mild forms of Alzheimer's disease (AD) may be facilitated by use of the CDR, which emphasizes changes in cognition over time within individuals rather than comparison with group norms.

Selective effect of Apo e4 on CA3 and dentate in normal aging and Alzheimer's disease using high resolution MRI at 4 T.

BACKGROUND: Details of the internal hippocampal structure visible at 4 T allow for in vivo volumetry of subfields. The aims of this study were: 1. To determine if Apo e4 has subfield specific effects in controls. 2. To study the influence of Apo e4 on hippocampal subfields in AD. METHODS: 81 subjects (66 controls, mean age 60.8+/-13.6, range: 28-85 years), and 15 AD (mean age 67.5+/-9.3) were studied. Entorhinal cortex, subiculum, CA1, CA1-CA2 transition zone, CA3-4 and dentate gyrus (CA3&DG) and total hippocampal volume were determined using a manual marking strategy. RESULTS: Significant effects for Apo e4 on the CA3&DG were found in the total control population (p=0.042) and in older controls (61-85 years) (p=0.036) but not in younger (28-60 years) controls. Significant effects for Apo e4 (p=0.0035) on CA3&DG were also found in a subgroup of older subjects and AD subjects. AD with Apo e4 had smaller CA3&DG than AD without Apo e4 (p=0.027). CONCLUSIONS: These findings suggest that Apo e4 exerts a regionally selective effect on CA3&DG in normal aging and AD.

Connectionism and developmental psychology.

What features of brain processing and neural development support linguistic and cognitive development in young children? To what extent are the profile and timing of development in young children determined by a preordained genetic programme? Does the environment play a crucial role in determining the patterns of change observed in children growing up? These questions have been of central concern to developmental psychologists for well over a century. Yet none of them have received answers that are generally accepted by the profession. This article reviews some recent computational modelling of developmental change in children that promises to contribute to a deeper understanding of the issues behind these questions. The modelling work exploits artificial neural networks that mimic some of the basic properties of neural processing in the brain. These networks involve densely connected webs of simple processing units that propagate and transform complex patterns of activity. When exposed to a training environment, they undergo a process of self-organisation, yielding information processing systems that support new forms of behaviour. The study of the dynamics of these systems and their learning capabilities promises to provide us with important clues as to the nature of the mechanisms underlying development in infants and young children.

Subnanometer-Diameter Wires Isolated in a Polymer Matrix by Fast Polymerization

The preparation and analysis of inorganic-organic polymer nanocomposites consisting of inorganic nanowires and multiwire "cables" in a random-coil organic polymer host is reported. Dissolution of inorganic (LiMo3Se3)n wires in a strongly coordinating monomer, vinylene carbonate, and the use of a rapid polymerization in the presence of a cross-linking agent produce nanocomposites without phase separation. Polymerization of dilute solutions yields a material containing mostly (Mo3Se3(-))n mono- and biwires, 6 to 20 angstroms in diameter and 50 to 100 nanometers long. Polymerization of more concentrated liquid crystalline solutions yields a nanocomposite containing oriented multiwire cables, 20 to 40 angstroms in diameter and up to 1500 nanometers long, that display optical anisotropy and electrical conductivity.

Learning and morphological change.

An account is offered to change over time in English verb morphology, based on a connectionist approach to how morphological knowledge is acquired and used. A technique is first described that was developed for modeling historical change in connectionist networks, and that technique is applied to model English verb inflection as it developed from the highly complex past tense system of Old English towards that of the modern language, with one predominant "regular" inflection and a small number of irregular forms. The model relies on the fact that certain input-output mappings are easier than others to learn in a connectionist network. Highly frequent patterns, or those that share phonological regularities with a number of others, are learned more quickly and with lower error than low-frequency, highly irregular patterns. A network is taught a data set representative of the verb classes of Old English, but learning is stopped before reaching asymptote, and the output of this network is used as the teacher of a new net. As a result, the errors in the first network were passed on to become part of the data set of the second. Those patterns that are hardest to learn led to the most errors, and over time are "regularized" to fit a more dominant pattern. The results of the networks simulations were highly consistent with the major historical developments. These results are predicted from well-understood aspects of network dynamics, which therefore provide a rationale for the shape of the attested changes.

Learning and development in neural networks: the importance of starting small.

It is a striking fact that in humans the greatest learning occurs precisely at that point in time--childhood--when the most dramatic maturational changes also occur. This report describes possible synergistic interactions between maturational change and the ability to learn a complex domain (language), as investigated in connectionist networks. The networks are trained to process complex sentences involving relative clauses, number agreement, and several types of verb argument structure. Training fails in the case of networks which are fully formed and 'adultlike' in their capacity. Training succeeds only when networks begin with limited working memory and gradually 'mature' to the adult state. This result suggests that rather than being a limitation, developmental restrictions on resources may constitute a necessary prerequisite for mastering certain complex domains. Specifically, successful learning may depend on starting small.

Learning the hidden structure of speech.

In the work described here, the backpropagation neural network learning procedure is applied to the analysis and recognition of speech. This procedure takes a set of input/output pattern pairs and attempts to learn their functional relationship; it develops the necessary representational features during the course of learning. A series of computer simulation studies was carried out to assess the ability of these networks to accurately label sounds, to learn to recognize sounds without labels, and to learn feature representations of continuous speech. These studies demonstrated that the networks can learn to label presegmented test tokens with accuracies of up to 95%. Networks trained on segmented sounds using a strategy that requires no external labels were able to recognize and delineate sounds in continuous speech. These networks developed rich internal representations that included units which corresponded to such traditional distinctions as vowels and consonants, as well as units that were sensitive to novel and nonstandard features. Networks trained on a large corpus of unsegmented, continuous speech without labels also developed interesting feature representations, which may be useful in both segmentation and label learning. The results of these studies, while preliminary, demonstrate that backpropagation learning can be used with complex, natural data to identify a feature structure that can serve as the basis for both analysis and nontrivial pattern recognition.

Treatment of elevated intraocular pressure with concurrent levobunolol and pilocarpine.

Between July 1983 and January 1986, 54 patients with open-angle glaucoma or ocular hypertension were treated for 3 months with 2% pilocarpine hydrochloride (given four times daily) and one of two beta-adrenoceptor blocking drugs, levobunolol hydrochloride (0.5% [17 patients] or 1% [19 patients]) or 0.5% timolol maleate (18 patients), given twice daily. Before entry into the study all patients had had stable intraocular pressure (IOP) with treatment with 0.5% timolol and 2% pilocarpine. Stable IOP was successfully maintained in up to 88% of the patients in the two levobunolol-pilocarpine groups and in 83% of those in the timolol-pilocarpine group. Two patients experienced adverse reactions: one, who received timolol and pilocarpine, suffered blepharoconjunctivitis, and the other, who received 1% levobunolol and pilocarpine, experienced bradycardia. The results indicate that the levobunolol-pilocarpine regimens were as safe and effective as the timolol-pilocarpine regimen in stabilizing IOP.

Chorionic gonadotropin decreases intraocular pressure and aqueous humor flow in rabbit eyes.

The effect of human chorionic gonadotropin (hCG) on the rabbit eye was studied. Intravitreal injections of hCG in albino rabbits provoked a reduction of intraocular pressure (IOP). Intravenous administration of hCG in single doses of 5,000-10,000 units in male pigmented rabbits caused a significant reduction in IOP from 1.5-5 hr after injection. When two successive intravenous doses of 5,000 units of hCG were given at 0 and 3 hr to pigmented rabbits, a significant reduction of net aqueous flow occurred, as measured by scanning fluorophotometry. These results indicate that the decrease in aqueous flow rate in the rabbit eye after administration of hCG can account for the reduction in IOP.

Celiprolol versus timolol and placebo: a two week double-blind comparison.

Celiprolol (5%) was compared to timolol (0.5%) and placebo in patients with primary open angle glaucoma or ocular hypertension. A total of 28 patients participated in this double blind study and received treatment for two weeks. Intraocular pressure decreased an average of 4.4 mmHg with celiprolol and 7.1 mmHg with timolol two hours after instillation. This was maintained 12 hours after administration of timolol but not after celiprolol. There was a small but statistically significant decrease in pulse rate 2 hours after administration of timolol (from 72 to 64 beats per minute) which was not observed after celiprolol. Side effects were mild and similar for all 3 groups.

Interference between phonemes during phoneme monitoring: evidence for an interactive activation model of speech perception.

We explore the recent finding (Newman & Dell, 1978) that the time needed to detect a target phoneme in a phoneme monitoring task is increased when the preceding word contains a phoneme similar to the target. Normal adult native speakers of English monitored auditorily presented sentences and responded as quickly as possible whenever they detected a specified phoneme. We found that preceding word-initial phonemes, despite being processed more quickly, increased the response latency to the following target phoneme more than did preceding word-medial phonemes. There was also an increase in response latency even when the subject could be highly certain that the similar preceding phoneme was not an instance of the target phoneme. We argue that the interference effects are due to fundamental characteristics of perceptual processing and that more time is needed to categorize the target phoneme. We present a computer simulation using an interactive activation model of speech perception to demonstrate the plausibility of our explanation.

Oral vs. manual tapping with delayed auditory feedback as measures of cerebral dominance.

Two sets of findings have been reported which make contradictory claims about the cerebral lateralization of mechanisms for coordinating auditory feedback with motor control. One difficulty in evaluating the two sets of claims is that they result from experiments involving methodologies which are different enough to make direct comparisons difficult. The present study reports results of an experiment using a technique which partially bridges the gap between two of these paradigms. This technique involves examining the effect of delayed auditory feedback (DAF) on performance of both an oral and a manual tapping task. Ear of delivery of DAF, subject language background, and nature of the auditory stimulus were the experimental variables. The findings support the claim that the left hemisphere is differentially involved in the use of auditory feedback to control oral, but not manual, motor activity. No evidence was found to indicate that this functional cerebral asymmetry is stimulus- or language-dependent.

Effects of frequency-shifted feedback on the pitch of vocal productions.

Previous investigations into the effects of distorted auditory feedback on vocalizations have been limited to manipulations of intensity, background noise, temporal delay, or to selective filtering of frequency. The current study reports the results of real-time shifts of the frequency components of auditory feedback. Subjectively, such shifts are perceived primarily as an alteration in the fundamental frequency (F0) of the speech. Subjects performed a variety of tasks under conditions where they received either normal auditory feedback or frequency-shifted feedback. Under normal feedback conditions, subjects maintained approximately constant F0 as instructed. With frequency-shifted feedback, subjects attempted to compensate for the shift by adjusting their F0 up or down such that the resulting feedback appeared to be "normal."