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Assistant Professor, Touro University Nevada College of Osteopathic Medicine

Finally, the theory suggests ways to establish rehabilitation and treatment programs for the brain-injured patient and provides a strong theoretical basis for understanding clinical neuropsychology. Modern Neuropsychology Herman Ebbinghaus (1850­1909) proposed that psychology has a long past but a short history. Since Broca made his momentous discovery in the 1860s, a number of major achievements and influential concepts led to the evolution of neuropsychology as a discipline as we know it today. In the United States and Britain, the findings and conclusions of Lashley, Marie, and Jackson set up a general antilocalization bias. In particular, the field of aphasia remained divided between the "holists" and "diagram makers" such as Wernicke (Benton, 1994). The birth of modern psychosurgery was in 1935, when Moniz and Lima first attempted to alleviate mental suffering by operating on the human frontal lobes. In the 1940s, the apparently favorable effects of the surgery on the majority of severely disturbed patients led to its introduction in the United States by psychiatrist Walter Freeman and his surgical colleague James Watts. Currently, however, treating psychiatric patients with lobotomies is regarded as a step backward (Neuropsychology in Action 1. Clinical neuropsychology originally emerged in the medical setting within traditional neurosurgery and neurology services. Early research was primarily concerned with the cortical functioning of patients with penetrating missile wounds or the diagnosis of neurologic disorders such as brain tumors or strokes. For example, a famous neurosurgeon who was advancing an understanding of the relationship between brain anatomy and behavior was Wilder Penfield (1891­1976). Penfield was educated at Princeton, Johns Hopkins, and Oxford universities and was the founder and director of the renowned Montreal Neurological Institute. He pioneered direct electrical stimulation of the brain during surgery by systematic mapping of the brain as a technique for finding damaged areas of the brain. He also used the services of psychologists as consultants to help him with the diagnosis of neurologic behavioral conditions. In the 1930s, psychologists played a large role in diagnosing brain lesions, including stroke and tumor. For example, a friend and mentor of ours, Molly Harrower, a professor emeritus at the University of Florida and inventor of the Group Rorschach, was routinely asked in the 1930s to evaluate "organic patients. Currently, neuropsychologists play a smaller role in diagnosing neurologic disorders but an important part in evaluating functional impairment, prognosis, and recovery. In the late 1930s, neuropsychology engaged the interest of only a few neurologists, psychiatrists, and psychologists. Neuropsychology was loosely organized, and no journals reflected a focused interest in this area. But a number of scholars were working on issues that in time made decisively important contributions to the field and shaped neuropsychology as we know it today. The first neuropsychology laboratory in the United States was founded in 1935 by Ward Halstead at the University of Chicago. Halstead worked closely with neurosurgery patients and developed assessment devices that differentiated between patients with and without brain damage (Figure 1. Together with Ralph Reitan, Halstead later developed the popular Halstead-Reitan Neuropsychological Battery, an empirical approach to assessing brain damage (Halstead, 1947; Reitan & Wolfson, 1993). The term neuropsychology itself is of recent origin and was most likely first coined by Sir William Osler in 1913, when he used the word in an inaugural address for a new psychiatric clinic at Johns Hopkins Hospital in Baltimore, Maryland (Bruce, 1985). In 1936, Karl Lashley also used the term when he addressed the Boston Society of Psychiatry and Neurology (Bruce, 1985). Hans-Leukas Teuber (1916­1977) is credited for first using the term in a national forum during a presentation to the American Psychological Association in 1948, during which he described different aspects of brain­behavior relationships in war veterans with penetrating brain wounds (Teuber, 1950). Then, in 1949, Canadian Donald Hebb published his classic, the Organization of Behavior: A Neuropsychological Theory. The study of neuropsychology has drawn information and knowledge from many disciplines, including anatomy, biology, physiology, biophysics, and even philosophy. Thus, many interdisciplinary professionals, including neurologists, neuropsychiatrists, linguists, neuroscientists, speech pathologists, and school psychologists, are interested in the field of brain­behavior relationships and have contributed to its development.

Kuijer, PhD, Amsterdam, Netherlands (Abstract Co-Author) Nothing to Disclose For information about this presentation, contact: a. Evaluation this platform has been used since 2013 in several Dutch hospitals, successfully analyzing tens of thousands of datasets. Due to the open-source nature of the project, analysis modules are reviewed and imporved continually. Discussion this platform is a community driven, open source project, with only open source third party software requirements. Easy exchange of analysis modules and configurations between institutes resulted in a push from the user community towards generalizations to other models and brands. This pre-screening tool consists of a unique probe configuration including 8-sub-regional probes that are symmetrical distributed in a mirror reflection. Therefore, information regarding the extraction of local tissue distinguishability and quantify of tissue behaviour in the frequency domain during asymmetric pathways in the electrochemical profile can be readily assessed without the use of other invasive techniques. The pre-screening tool is also unique in that it utilizes the delivery and sensing channels in a single-probe electrochemical analytical measurement attached directly to external layers of the body. The results indicated that the tool enabled to sensitively detect, quantify and distinguish the simulated breast tissue and local asymmetrical distribution. The testing results are also quite reproducible and can be offer as a personalized measurement analysis. In future human studies, it has potential to build a new low-cost and easy-to-use tool for pre-screening several types of cancers. Harrison, Ludwigsburg, Germany (Abstract Co-Author) Research Consultant, General Electric Company For information about this presentation, contact: rmiyaoka@uw. The simulation included multiple energy emissions and collimator/detector response modeling. After creation of a high count projection sinogram, Poisson-resampling was used to generate sinograms of different noise levels. Monte Carlo simulation data sets have been created with full models of collimator detector response for testing DaTscan analysis packages and image reconstruction methodologies. While the accuracy of such maps has been investigated ex vivo in phantoms under optimized conditions, this study aimed to evaluate their accuracy in routine examinations. In addition, we developed a software that allows for automatic measurement of the anterior-posterior and left-right diameter of each patient and further, computes a three-compartment model of the examined tissue (fat, bone, lean); all parameters were considered as possible confounders in statistic assessment. When considering estimated concentrations for clinical decision making, increased caution is recommended in low concentrations, in skinny and obese patients and in images with presence of large amount of bone. Quantitative iron maps were obtained using an in-house material decomposition technique with the [25, 120] keV and [63-120] keV images assuming 3 base materials: liver, water and iron. A linear regression analysis was performed to compare measured iron concentrations in liver background with known true concentrations. Liver background from the iron-liver mixtures was assigned to the liver map, while water background from the iron-water mixtures was assigned to water map. Linear regression showed excellent correlation between measured and true iron concentrations in the iron-liver mixtures (slope = 1. Nodular fasciitis is a self-limited pseudosarcomatous proliferation that may cause clinical alarm due to its rapid growth. This lesion is typically 3-5 cm and composed of bland fibroblasts and myofibroblasts without significant cytologic atypia arranged in a loose storiform pattern with areas of extravasated red blood cells. Fibrous histiocytoma is a lesion composed of a polymorphous proliferation of foamy histiocytes, multinucleated giants cells (some of which can be Touton giant cells), bland spindle cells and inflammatory cells. One of the most helpful histologic clues to this diagnosis is the prominent collagen trapping at the edge of the lesion. Clinically, fibrous histiocytoma usually presents as a solitary slow-growing nodule in early or middle-adult life. Many variants of fibrous histiocytoma exist including cellular fibrous histiocytoma, aneurysmal fibrous histiocytoma, epithelioid fibrous histiocytoma and atypical fibrous histiocytoma.

Use with caution in hypertension, tachycardia, cardiovascular or cerebrovascular diseases, or with concurrent albuterol therapy. Increased risk of suicidal thinking has been reported; closely monitor for clinical worsening, agitation, aggressive behavior, irritability, suicidal thinking or behaviors and unusual changes in behavior when initiating (first few months) or at times of dose changes (increases or decreases). Reduce dose (initial and target doses) by 50% and 75% for patients with moderate (Child-Pugh Class B) and severe (Child-Pugh Class C) hepatic insufficiency, respectively. Hypersensitivity reactions, aggression, irritability, priapism, allergic reactions and severe liver injury have also been reported. Consider interrupting therapy in patients who are not growing or gaining weight satisfactorily. Not recommended in the treatment of severe pneumocystis jiroveci (lack of clinical data). Anemia, Stevens-Johnson syndrome, hepatitis, renal/urinary disorders, and pancreatitis have been reported. Metoclopramide, rifampin, rifabutin, and tetracycline may decrease atovaquone levels. Give one dose for mild symptoms and two additional doses (total 3 doses) in rapid succession 10 min after the first dose for severe symptoms as follows: Child < 6 mo (<7 kg): 0. Use injectable solution for nebulized use; can be mixed with albuterol for simultaneous administration. Severe anemia has been reported when used in combination with captopril or enalapril. Pancytopenia and bone marrow suppression have been reported with concomitant use of pegylated interferon and ribavirin in patients with hepatitis C. To minimize infant exposure via breastmilk, avoid breastfeeding for 4­6 hr after administering a maternal dose. Bitter taste, nausea, nasal burning, pharyngitis, weight gain, fatigue, nasal sores, and epistaxis may also occur. Soft contact lens users should wait at least 10 min after dose instillation before they insert their lenses. Contraindicated in hypersensitivity to macrolides and history of cholestatic jaundice/hepatic dysfunction associated with prior use. Nelfinavir may increase azithromycin levels; monitor for liver enzyme abnormalities and hearing impairment. Vomiting, diarrhea and nausea have been reported at higher frequency in otitis media with 1-day dosing regimen. Extended-release oral suspension should be taken on an empty stomach (at least 1 hr before or 2 hr following a meal). Typically indicated in multidrug-resistant aerobic gram-negative infections when -lactam therapy is contraindicated. Adverse reactions: thrombophlebitis, eosinophilia, leukopenia, neutropenia, thrombocytopenia, elevation of liver enzymes, hypotension, seizures, and confusion. Use the following order of administration: bronchodilator first, chest physiotherapy, other inhaled medications (if indicated) and aztreonam last. Ophthalmic dosage form may cause temporary blurred vision and retard corneal healing. For ophthalmic use, wash hands before use and avoid contact of tube tip with skin or eye. Adverse effects: Drowsiness, fatigue, nausea, vertigo, psychiatric disturbances, rash, urinary frequency, and hypotonia. Avoid abrupt withdrawal of intrathecal therapy to prevent potential life-threatening events (rhabdomyolysis, multiple organ-system failure and death). Cases of intrathecal mass at the tip of the implanted catheter leading to withdrawal symptoms have been reported. Inadvertent subcutaneous injection may occur with improper access of the reservoir refill septum and may result in an overdose.

Damilakis J, Theocharopoulos N, Perisinakis K, Manios E, Dimitriou P, Vardas P, Gourtsoyiannis N. Imaging the pregnant patient for nonobstetric conditions: algorithms and radiation dose considerations. A review of the current use of magnetic resonance imaging in pregnancy and safety implications for the fetus. Peripartum versus idiopathic dilated cardiomyopathy in young women-a comparison of clinical, pathologic and prognostic features. Szumowski L, Szufladowicz E, Orczykowski M, Bodalski R, Derejko P, Przybylski A, Urbanek P, Kusmierczyk M, Kozluk E, Sacher F, Sanders P, Dangel J, Haissaguerre M, Walczak F. A systematic review of the accuracy of first-trimester ultrasound examination for detecting major congenital heart disease. Developed in Collaboration with the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Prediction of complications in pregnant women with cardiac diseases referred to a tertiary center. Adverse neonatal and cardiac outcomes are more common in pregnant women with cardiac disease. The effect of levonorgestrel-releasing intrauterine device on menorrhagia in women taking anticoagulant medication after cardiac valve replacement. Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and 46. Changes in baroreceptor sensitivity for heart rate during normotensive pregnancy and the puerperium. Effects of pregnancy on first onset and symptoms of paroxysmal supraventricular tachycardia. Recurrence rates of arrhythmias during pregnancy in women with previous tachyarrhythmia and impact on fetal and neonatal outcomes. Signs of myocardial ischaemia after injection of oxytocin: a randomized double-blind 64. Antibiotics at the time of induced abortion: the case for universal prophylaxis based on a meta-analysis. A comparison of intravaginal misoprostol with prostaglandin E2 for termination of second-trimester pregnancy. Effect of prostaglandin E2 and F2alpha on the systemic and pulmonary circulation in pregnant anesthetized women. Has there been any progress made on pregnancy outcomes among women with pulmonary arterial hypertension? Outcome of pulmonary vascular disease in pregnancy: a systematic overview from 1978 through 1996. Risk of complications during pregnancy after Senning or Mustard (atrial) repair of complete transposition of the great arteries. Comparison of pregnancy outcomes in women with repaired versus unrepaired atrial septal defect. Guidelines for prevention of stroke in patients with ischemic stroke or transient ischemic attack: a statement for healthcare professionals from the American Heart Association/American Stroke Association Council on Stroke: co-sponsored by the Council on Cardiovascular Radiology and Intervention: the American Academy of Neurology affirms the value of this guideline. Pregnancy outcome in women with repaired versus unrepaired isolated ventricular septal defect. Cardiac complications relating to pregnancy and recurrence of disease in the offspring of women with atrioventricular septal defects. Noncardiac complications during pregnancy in women with isolated congenital pulmonary valvar stenosis. Pregnancy outcome in women with congenital heart disease and residual haemodynamic lesions of the right ventricular outflow tract. Congenital aortic stenosis in adults: rate of progression and predictors of clinical outcome. Aortic dissection in pregnancy: importance of pregnancy-induced changes in the vessel wall and bicuspid aortic valve in pathogenesis. Impact of pregnancy on the systemic right ventricle after a Mustard operation for transposition of the great arteries.

The complexities inherent in neuropsychological assessment require greater, not less, understanding of psychometric theory and application. An understanding of the reliability and validity of tests is essential to appreciating the limits to inferences that can be made from a test performances. In neuropsychology traditional concepts of normal curve performance distributions must be questioned, because at times highly skewed distributions are found. Additionally, it was argued that neuropsychology should not be bound by traditional norm-referenced tests and should move toward the modeling of the tails of sample distributions through operating characteristics. The reader should also understand that there is no way to get around the problem of collecting large samples to build norms so as to be able to appropriately interpret test per-formances. Much hard psychometric work lies ahead for the field of neuropsychological assessment. When diagnostic agreement is high, but reliability is low: Some paradoxes occurring in joint independent neuropsychological assessment. The dependability of behavioral measurements: Theory of generalizability for scores and profiles. At times, neuropsychological deficits have a direct bearing on legal issues-for example, establishment of damages in a personal injury case. At other times, a person may have impaired neuropsychological test scores, but the impairment alone does not provide the complete answer to the legal issue. Hence, an older person may have dementia, but still possess competency to execute a valid will; a person facing criminal charges may have neuropsychological impairment but be found competent to stand trial. The lack of a one-to-one correspondence between legal issues and neuropsychological test scores requires a high level of neuropsychological expertise, as well as experience dealing with a variety of civil and criminal issues. Moreover, the value of neuropsychology to the courts is growing, with neuropsychologists being asked to address a wider range of competencies. This expansion into new areas requires a close working relationship between the neuropsychologist and the attorney requesting the expert opinion. By working together, the expert neuropsychologist and the attorney can combine their respective expertise and better provide information to assist the trier of fact. Although this diploma is not held as prerequisite to engage in the clinical or forensic practice of neuropsychology, it is the clearest evidence of the type of expertise expected of a neuropsychologist wishing to provide forensic neuropsychology services. Rule 702 of the Federal Rules of Evidence allows a witness qualified as an expert by knowledge, skill, experience, training, or education to testify if scientific, technical or other specialized knowledge will assist the trier of fact to understand the evidence or determine a fact in issue. The Frye rule holds that admissible scientific evidence should be conditioned on having been sufficiently established that it is generally accepted in the particular scientific field to which it belongs. Consequently, admissibility of evidence is not dependent on general acceptance by the scientific field; rather, acceptability is based on an inference or assertion derived by the scientific method, and the court must decide whether the reasoning and methodology on which expert testimony is based are scientifically valid and can properly be applied to the facts in issue. Criteria for deciding acceptability include the testability of the theoretical basis, error rate of the methods used, and "Frye-like" factors such as approval by peer reviewers and level of acceptance by experts in the field. Neuropsychologists have encountered challenges regarding their qualifications for identifying the cause of, and prognosis for, conditions of the brain. Richardson and Adams (1992) and Adams and Rankin (1996) discussed these issues and noted that several states now allow neuropsychological testimony as to etiology and prognosis. Binder and Thompson (1994) discussed sections of the Ethics Code with direct relevance to neuropsychology. Key sections include Competence, Multiple Relationships, Validity of Test Results and Test Interpretation, Documentation of Assessment Results, Records and Confidentiality, Forensic Activities, Avoiding Harm, Supervision of Subordinates (technicians), and Fees. As recommended by Binder and Thompson (1994), fee arrangements should be made as early as possible in the professional relationship. In forensic cases, it is important to have an understanding between the neuropsychologist and referring attorney of what the fees and charges will be before examination is conducted, and before sworn testimony is provided in deposition or at trial. A fairly common practice in forensic neuropsychology is to request a retainer agreement specifying charges, and a prepayment, which is applied toward final charges after provision of services is completed. With a letter of protection, the psychologist can (and probably will) be portrayed by opposing counsel during testimony as having a vested interest in the outcome of the case. This practice is inadvisable on two major grounds: (a) the presence of third party observation or recording can affect the validity of test performance and (b) the confidentiality of the test instruments can be compromised if made a part of the public record.