Loading

By Z. Marus. Siena College.

For example buy generic atorlip-5 5mg on line, Marwick (2003) outlines similar views and responses as having greeted the introduction in the USA of the privacy rule of the Health Insurance Portability and Accountability Act buy 5mg atorlip-5 with amex. However health organisations need to increasingly strive to create a culture that respects and protects health information, and seek to demonstrate and reinforce that culture through a number of basic or initial communication, human resource or technical steps. These include creating with, and communicating to, their communities clear open policies around the nature and purpose of health information flows and utilisation. These include the risks and benefits of information flowing or not flowing and respective privacy versus sub-optimal care risks. In pragmatic terms this may take the form of conversations, leaflets, posters or web-sites. Human resource processes may include training and development and professionalisation of all healthcare workers in terms of their attitude to health information and clear disciplinary procedures for malicious use. Anderson (1996) has highlighted the impor- tance of training and procedures for the high-risk area of providing patient information on the telephone. Davis, Domm, Konikoff and Miller (1999) have suggested the need for specific medical education on the ethical and legal aspects of the use of computerised patient records. Technical processes may include ensuring that an electronic information system has at least an audit trail that allows who has viewed or accessed a particular piece of health data to be monitored, providing some degree of psychological reassurance to patients and psychological deterrence against malicious use. While having highlighted some of the concerns around restriction of information flows, particularly if the clinician is not advised of the suppression there is of course a place for restricted access for sensitive information. This may include allocating graded access levels to certain categories of information and graded access levels for providers or users, with the user only able to access information for which they have an appropriate level of clearance. The system may also include a “break glass” or override facility for emergencies, which allows access to restricted information, but triggers a formal audit or justification process. Denley & Smith (1999) discuss the use of access controls as proposed by Anderson (1996). However for all these processes we can predict an inverse relationship between complexity and utility (and subsequent uptake or compliance). When planning privacy or security developments, we should strive to make it easier to do the right thing. This can include making login processes as fast and intuitive as possible, so as to decrease the behavioural drivers for clinicians to leave themselves logged in, or the sharing of Copyright © 2005, Idea Group Inc. Copying or distributing in print or electronic forms without written permission of Idea Group Inc.

effective 5 mg atorlip-5

Some of the absorbed NE The main task of epinephrine is to mobilize enters intracellular vesicles (! To enhance the blood flow in the Presynaptic α2-adrenoceptors can also be muscles involved purchase atorlip-5 5mg without a prescription, the body increases the car- found on cholinergic nerve endings purchase atorlip-5 5mg line, e. Adrenalep- atrium (negative dromotropic effect), whereas inephrine and neuronal NE begin to stimulate presynaptic M-cholinoceptors are present on the secretion of hormones responsible for re- noradrenergic nerve terminals. Adrenal Medulla Non-cholinergic, Non-adrenergic Transmitters After stimulation of preganglionic sympa- thetic nerve fibers (cholinergic transmission; In humans, gastrin-releasing peptide (GRP)! Compared to (SIH) are the ones involved in postganglionic noradrenergic neurons (see above), NE synthe- fibers. Postganglionic parasympathetic fibers sis in the adrenal medulla is similar, but most utilize the peptides enkephalin, substance P of the NE leaves the vesicle and is enzymati- (SP) and/or NPY as co-transmitters. Modulation of postsynaptic neurons seems Special vesicles called chromaffin bodies then tobetheprimarygoalofpreganglionicpeptide actively store E and get ready to release it and secretion. There is substantial evidence dem- co-transmitters (enkephalin, neuropeptide Y) onstrating that ATP (adenosine triphosphate), 86 by exocytosis. Adrenoceptors Norepinephrine Natural agonists Epinephrine Agonists: Iso- Salbu- Phenylephrine Clonidine tamol proterenol Antagonists: Prazosin Yohimbine Atenolol Adrenergic receptors: 1 2 3 4 α1 α2 β1 β2 Gq Gq Go Gi Gs Gs PIP2 cAMP cAMP PLCβ cAMP K+ 2+ K+ PKA DAG Ca PKA IP3 PKA PKC Ca2+? Ca2+ Hyper- [Ca2+] [Ca2+] Hyper- [Ca2+] [Ca2+] polarization i i polarization i i Inhibition of gastrointestinal α β β motility α Inhibition of 2 1 2 1 Drives heart Dilatationof exocytosis α1 or secretion • Vessels Contractionof • Blood vessels • Salivary glands • Bronchioles • Bronchioles • Insulin • Uterus • Sphincters • Norepinephrine Renin release etc. Within the gastrointestinal tract, VIP (along with nitric oxide) induces the slackening of the circular muscle layer and sphincter muscles and (with the co-transmit- ters dynorphin and galanin) enhances intesti- 87 Despopoulos, Color Atlas of Physiology © 2003 Thieme All rights reserved. The binding of small The blood volume of an adult correlates with molecules to plasma proteins reduces their his or her (fat-free) body mass and amounts to osmotic efficacy. The functions of blood Serum forms when fibrinogen separates from include the transport of various molecules (O,2 plasma in the process of blood clotting. CO, nutrients, metabolites, vitamins, electro-2 Theformationofbloodcellsoccursinthered lytes, etc. The suescontainpluripotentstemcells which,with blood consists of a fluid (plasma) formed el- the aid of hematopoietic growth factors (see ements: Red blood cells (RBCs) transport O2 below), develop into myeloid, erythroid and and play an important role in pH regulation. Since pluripotent White blood cells (WBCs) can be divided into stemcellsareautoreproductive,theirexistence neutrophilic, eosinophilic and basophilic is ensured throughout life. Hematocrit (Hct) is the volume ratio precursorcellsareproducedbymyelocytopoie- of red cells to whole blood (! Twohormones,er- tamins, hormones, gases, and proteins are dis- ythropoietinandthrombopoietin,areinvolved solved.

order atorlip-5 5mg with visa

While it is relatively inert in individuals without a While it is not possible at present to assign a thera- mood disorder discount atorlip-5 5mg overnight delivery, lithium carbonate is effective in 60 to peutic role to this action of Li atorlip-5 5mg line, it is a step toward ex- 80% of all acute manic episodes within 5 to 21 days of plaining the stabilizing actions of this drug. Because of its delayed onset of ac- eral neurotransmitter receptors share common G tion in the manic patient, Li is often used in conjunc- protein–regulated second-messenger signaling systems, tion with low doses of high-potency anxiolytics (e. It is presently unclear to what extent often maintained on low stabilizing doses of Li indefi- inhibition of inositol phosphate metabolism contributes nitely as a prophylaxis to future mood disturbances. Antidepressant medications are required in addition to Li for the treatment of breakthrough depression. Pharmacokinetics and Therapeutic Drug Mechanism of Action Monitoring Lithium is a monovalent cation that can replace Na in Lithium is readily absorbed from the gastrointestinal some biological processes. In this regard, the failure the blood-brain barrier is limited, so that cerebrospinal of Li to maintain a normal membrane potential be- fluid levels are 50% of plasma levels at steady state. However, this action of Li would not hours, and more than 90% of the dose of Li is excreted explain its relatively selective effects on the CNS, spar- into the urine. Thus, ity would be so general that the entire pool of brain competition between Li and Na for uptake sites can neurons would be affected by Li. It seems more rea- alter the elimination of Li and its concentration in to- sonable that Li produces its psychotropic actions by tal body water. Na loading enhances Li clearance, perturbation of molecular events common to a few CNS while Na depletion promotes Li retention. This im- synapses that might have been disturbed during the portant relationship explains the appearance of Li tox- course of the manic-depressive illness. Lithium can simultaneously alter the flow of synaptic information through several receptor- mediated systems by diminishing coupling between the receptor recognition site and its specific G proteins. This model explains the stabilizing actions of Li at both ends of the mood spectrum through a single action at the G-protein level. Attenuating actions of Li have been demonstrated through G-protein interactions at the -adrenoceptor and the acetylcholine M1 muscarinic receptor systems of the CNS. A second action of Li as an inhibitor of inositol diphosphate (IP ) 2 phosphatase may further attenuate the flow of synaptic information through the M1 muscarinic receptor by the eventual depletion of membrane phosphatidyl inositol-bis-phosphate (PIP2). IP3, inositol triphosphate; DAG, diacylglycerol; ATP, adenosine triphosphate; cAMP, cyclic adenosine monophosphate; 5 -AMP,5-adenosine monophosphate; NE, norepinephrine; ACh, acetylcholine. Since Li has a low therapeutic index (approxi- physical activities (those that induce sweating) that de- mately 3) and a narrow therapeutic window (0.

generic 5 mg atorlip-5 fast delivery

Further separation yields Whole Blood Transfusions serum albumin that is available in solutions of 5% or 25% The transfer of whole human blood from a healthy person concentration purchase atorlip-5 5 mg visa. Possi- creased because these blood components can be treated ble causes of chronic blood loss include bleeding ulcers purchase 5mg atorlip-5 otc, with heat to prevent transmission of viral diseases. When frozen plasma is thawed, a white precipitate called cryoprecipi- Hemolytic anemia Anemia caused by the excessive de- tate (kri-o-pre-SIP-ih-tate) forms in the bottom of the struction of red cells is called hemolytic (he-mo-LIH-tik) container. Certain inherited diseases that cause the production Antibodies play an important role in the immune system of abnormal hemoglobin may also result in hemolytic (see Chap. When these cells give up their oxygen to the tissues, they are transformed from the normal disk Checkpoint 13-14 How is blood commonly separated into its shape into a sickle shape (Fig. Anemia Anemia may result from loss of red cells, as through ex- Sickle- cessive bleeding (hemorrhage), or from conditions that shaped cause the cells to hemolyze (rupture). It is only when the involved gene is that may injure the marrow include x-rays, atomic radia- transmitted from both parents that the clinical disease tion, radium, and radioactive phosphorus. One drug or white cells, so that the anemia is accompanied by has been found to reduce the frequency of painful crisis leukopenia (lu-ko-PE-ne-ah), a drop in the number of in certain adults. Removal of the toxic agent, followed by blood some hemoglobin of an alternate form (fetal hemoglo- transfusions until the marrow is able to resume its activ- bin) so that the red cells are not as susceptible to sick- ity, may result in recovery. Some Impaired Production of Red Cells or Hemoglo- medications are now available to stimulate bone marrow bin Many factors can interfere with normal red cell pro- production of specific types of blood cells. The average diet usually provides It is characterized by an enormous increase in the num- enough iron to meet the needs of the adult male, but this ber of white cells. Although the cells are high in number, diet often is inadequate to meet the needs of growing they are incompetent and cannot perform their normal children and women of childbearing age. If this wild proliferation of white cells stems ficiency anemia occurs in people with alcoholism, in eld- from cancer of the bone marrow, the condition is called erly people on poor diets, and in infants or others suffer- myelogenous (mi-eh-LOJ-en-us) leukemia. When the ing from intestinal disorders that interfere with the cancer arises in the lymphoid tissue, so that most of the absorption of this water-soluble vitamin. Both inborn fac- ficiency of intrinsic factor, a gastric juice secretion that tors and various environmental agents have been impli- is responsible for vitamin B12 absorption from the in- cated.

generic atorlip-5 5mg free shipping

When the task was performed using familiar stimuli atorlip-5 5mg generic, 17% of neurons showed task-related activity 5mg atorlip-5 fast delivery. These increases and decreases in activity were either transient in nature or were sustained for long after the association had been learned. This pattern of activity is reminiscent of changes observed in the neocortex,105,106 and neurons that showed such task relations were distributed nonpreferentially over the caudate nucleus, the putamen, and the ventral striatum. Recent data from Brasted and Wise111 not only confirm the presence of learning-related activity in striatal (putamen) neurons, but also showed that the time course of these changes in striatal neurons is similar to that seen in the dorsal premotor cortex, with changes in activity typically occurring in close correspondence with the learning curve. Finally, there is evidence for learning-related changes in neuronal activity in cells in the globus pallidus. Monkeys were required to maintain a center hold position with the manipulator until the cue appeared in the center of the screen. The cue was then replaced by a neutral stimulus for a variable delay period before the appearance of a trigger cue instructed monkeys to make Copyright © 2005 CRC Press LLC their response. In a control condition, monkeys performed the task using three familiar stimuli that instructed well-learned associations. In a learning condition performed in a separate blocks of trials, one of the familiar stimuli was replaced by a novel stimulus, which required the same response as the replaced familiar stimuli. A difference between learning and control conditions was seen for 17/23 inhibited neurons, and for 10/26 excited neurons. The majority of the cells (21/27) that were sensitive to novel stimuli were located in the dorsal medial aspect of the internal segment of the globus pallidus, which projects indirectly to the dorsolateral PF according to Middleton and Strick. Animals were presented with one of two visual stimuli on a monitor and were required either to tap the screen three times or to withhold such movement. Thus, 22% (19/87) of neurons demonstrated differential changes in activity for the two trial types as learning progressed, while 45% (39/87) of neurons showed only a transient difference between the two trial types, akin to the learning-selective neurons reported in SEF,106 as illustrated in Figure 10. In their experiment, a complex scene filled a video monitor and four potential eye-movement targets were superimposed on that scene. They describe their task as a scene–location association, but it does not differ from the tasks described above for studies of the premotor cortex.

By Z. Marus. Siena College.

For example buy generic atorlip-5 5mg on line, Marwick (2003) outlines similar views and responses as having greeted the introduction in the USA of the privacy rule of the Health Insurance Portability and Accountability Act buy 5mg atorlip-5 with amex. However health organisations need to increasingly strive to create a culture that respects and protects health information, and seek to demonstrate and reinforce that culture through a number of basic or initial communication, human resource or technical steps. These include creating with, and communicating to, their communities clear open policies around the nature and purpose of health information flows and utilisation. These include the risks and benefits of information flowing or not flowing and respective privacy versus sub-optimal care risks. In pragmatic terms this may take the form of conversations, leaflets, posters or web-sites. Human resource processes may include training and development and professionalisation of all healthcare workers in terms of their attitude to health information and clear disciplinary procedures for malicious use. Anderson (1996) has highlighted the impor- tance of training and procedures for the high-risk area of providing patient information on the telephone. Davis, Domm, Konikoff and Miller (1999) have suggested the need for specific medical education on the ethical and legal aspects of the use of computerised patient records. Technical processes may include ensuring that an electronic information system has at least an audit trail that allows who has viewed or accessed a particular piece of health data to be monitored, providing some degree of psychological reassurance to patients and psychological deterrence against malicious use. While having highlighted some of the concerns around restriction of information flows, particularly if the clinician is not advised of the suppression there is of course a place for restricted access for sensitive information. This may include allocating graded access levels to certain categories of information and graded access levels for providers or users, with the user only able to access information for which they have an appropriate level of clearance. The system may also include a “break glass” or override facility for emergencies, which allows access to restricted information, but triggers a formal audit or justification process. Denley & Smith (1999) discuss the use of access controls as proposed by Anderson (1996). However for all these processes we can predict an inverse relationship between complexity and utility (and subsequent uptake or compliance). When planning privacy or security developments, we should strive to make it easier to do the right thing. This can include making login processes as fast and intuitive as possible, so as to decrease the behavioural drivers for clinicians to leave themselves logged in, or the sharing of Copyright © 2005, Idea Group Inc. Copying or distributing in print or electronic forms without written permission of Idea Group Inc.

effective 5 mg atorlip-5

Some of the absorbed NE The main task of epinephrine is to mobilize enters intracellular vesicles (! To enhance the blood flow in the Presynaptic α2-adrenoceptors can also be muscles involved purchase atorlip-5 5mg without a prescription, the body increases the car- found on cholinergic nerve endings purchase atorlip-5 5mg line, e. Adrenalep- atrium (negative dromotropic effect), whereas inephrine and neuronal NE begin to stimulate presynaptic M-cholinoceptors are present on the secretion of hormones responsible for re- noradrenergic nerve terminals. Adrenal Medulla Non-cholinergic, Non-adrenergic Transmitters After stimulation of preganglionic sympa- thetic nerve fibers (cholinergic transmission; In humans, gastrin-releasing peptide (GRP)! Compared to (SIH) are the ones involved in postganglionic noradrenergic neurons (see above), NE synthe- fibers. Postganglionic parasympathetic fibers sis in the adrenal medulla is similar, but most utilize the peptides enkephalin, substance P of the NE leaves the vesicle and is enzymati- (SP) and/or NPY as co-transmitters. Modulation of postsynaptic neurons seems Special vesicles called chromaffin bodies then tobetheprimarygoalofpreganglionicpeptide actively store E and get ready to release it and secretion. There is substantial evidence dem- co-transmitters (enkephalin, neuropeptide Y) onstrating that ATP (adenosine triphosphate), 86 by exocytosis. Adrenoceptors Norepinephrine Natural agonists Epinephrine Agonists: Iso- Salbu- Phenylephrine Clonidine tamol proterenol Antagonists: Prazosin Yohimbine Atenolol Adrenergic receptors: 1 2 3 4 α1 α2 β1 β2 Gq Gq Go Gi Gs Gs PIP2 cAMP cAMP PLCβ cAMP K+ 2+ K+ PKA DAG Ca PKA IP3 PKA PKC Ca2+? Ca2+ Hyper- [Ca2+] [Ca2+] Hyper- [Ca2+] [Ca2+] polarization i i polarization i i Inhibition of gastrointestinal α β β motility α Inhibition of 2 1 2 1 Drives heart Dilatationof exocytosis α1 or secretion • Vessels Contractionof • Blood vessels • Salivary glands • Bronchioles • Bronchioles • Insulin • Uterus • Sphincters • Norepinephrine Renin release etc. Within the gastrointestinal tract, VIP (along with nitric oxide) induces the slackening of the circular muscle layer and sphincter muscles and (with the co-transmit- ters dynorphin and galanin) enhances intesti- 87 Despopoulos, Color Atlas of Physiology © 2003 Thieme All rights reserved. The binding of small The blood volume of an adult correlates with molecules to plasma proteins reduces their his or her (fat-free) body mass and amounts to osmotic efficacy. The functions of blood Serum forms when fibrinogen separates from include the transport of various molecules (O,2 plasma in the process of blood clotting. CO, nutrients, metabolites, vitamins, electro-2 Theformationofbloodcellsoccursinthered lytes, etc. The suescontainpluripotentstemcells which,with blood consists of a fluid (plasma) formed el- the aid of hematopoietic growth factors (see ements: Red blood cells (RBCs) transport O2 below), develop into myeloid, erythroid and and play an important role in pH regulation. Since pluripotent White blood cells (WBCs) can be divided into stemcellsareautoreproductive,theirexistence neutrophilic, eosinophilic and basophilic is ensured throughout life. Hematocrit (Hct) is the volume ratio precursorcellsareproducedbymyelocytopoie- of red cells to whole blood (! Twohormones,er- tamins, hormones, gases, and proteins are dis- ythropoietinandthrombopoietin,areinvolved solved.

order atorlip-5 5mg with visa

While it is relatively inert in individuals without a While it is not possible at present to assign a thera- mood disorder discount atorlip-5 5mg overnight delivery, lithium carbonate is effective in 60 to peutic role to this action of Li atorlip-5 5mg line, it is a step toward ex- 80% of all acute manic episodes within 5 to 21 days of plaining the stabilizing actions of this drug. Because of its delayed onset of ac- eral neurotransmitter receptors share common G tion in the manic patient, Li is often used in conjunc- protein–regulated second-messenger signaling systems, tion with low doses of high-potency anxiolytics (e. It is presently unclear to what extent often maintained on low stabilizing doses of Li indefi- inhibition of inositol phosphate metabolism contributes nitely as a prophylaxis to future mood disturbances. Antidepressant medications are required in addition to Li for the treatment of breakthrough depression. Pharmacokinetics and Therapeutic Drug Mechanism of Action Monitoring Lithium is a monovalent cation that can replace Na in Lithium is readily absorbed from the gastrointestinal some biological processes. In this regard, the failure the blood-brain barrier is limited, so that cerebrospinal of Li to maintain a normal membrane potential be- fluid levels are 50% of plasma levels at steady state. However, this action of Li would not hours, and more than 90% of the dose of Li is excreted explain its relatively selective effects on the CNS, spar- into the urine. Thus, ity would be so general that the entire pool of brain competition between Li and Na for uptake sites can neurons would be affected by Li. It seems more rea- alter the elimination of Li and its concentration in to- sonable that Li produces its psychotropic actions by tal body water. Na loading enhances Li clearance, perturbation of molecular events common to a few CNS while Na depletion promotes Li retention. This im- synapses that might have been disturbed during the portant relationship explains the appearance of Li tox- course of the manic-depressive illness. Lithium can simultaneously alter the flow of synaptic information through several receptor- mediated systems by diminishing coupling between the receptor recognition site and its specific G proteins. This model explains the stabilizing actions of Li at both ends of the mood spectrum through a single action at the G-protein level. Attenuating actions of Li have been demonstrated through G-protein interactions at the -adrenoceptor and the acetylcholine M1 muscarinic receptor systems of the CNS. A second action of Li as an inhibitor of inositol diphosphate (IP ) 2 phosphatase may further attenuate the flow of synaptic information through the M1 muscarinic receptor by the eventual depletion of membrane phosphatidyl inositol-bis-phosphate (PIP2). IP3, inositol triphosphate; DAG, diacylglycerol; ATP, adenosine triphosphate; cAMP, cyclic adenosine monophosphate; 5 -AMP,5-adenosine monophosphate; NE, norepinephrine; ACh, acetylcholine. Since Li has a low therapeutic index (approxi- physical activities (those that induce sweating) that de- mately 3) and a narrow therapeutic window (0.

generic 5 mg atorlip-5 fast delivery

Further separation yields Whole Blood Transfusions serum albumin that is available in solutions of 5% or 25% The transfer of whole human blood from a healthy person concentration purchase atorlip-5 5 mg visa. Possi- creased because these blood components can be treated ble causes of chronic blood loss include bleeding ulcers purchase 5mg atorlip-5 otc, with heat to prevent transmission of viral diseases. When frozen plasma is thawed, a white precipitate called cryoprecipi- Hemolytic anemia Anemia caused by the excessive de- tate (kri-o-pre-SIP-ih-tate) forms in the bottom of the struction of red cells is called hemolytic (he-mo-LIH-tik) container. Certain inherited diseases that cause the production Antibodies play an important role in the immune system of abnormal hemoglobin may also result in hemolytic (see Chap. When these cells give up their oxygen to the tissues, they are transformed from the normal disk Checkpoint 13-14 How is blood commonly separated into its shape into a sickle shape (Fig. Anemia Anemia may result from loss of red cells, as through ex- Sickle- cessive bleeding (hemorrhage), or from conditions that shaped cause the cells to hemolyze (rupture). It is only when the involved gene is that may injure the marrow include x-rays, atomic radia- transmitted from both parents that the clinical disease tion, radium, and radioactive phosphorus. One drug or white cells, so that the anemia is accompanied by has been found to reduce the frequency of painful crisis leukopenia (lu-ko-PE-ne-ah), a drop in the number of in certain adults. Removal of the toxic agent, followed by blood some hemoglobin of an alternate form (fetal hemoglo- transfusions until the marrow is able to resume its activ- bin) so that the red cells are not as susceptible to sick- ity, may result in recovery. Some Impaired Production of Red Cells or Hemoglo- medications are now available to stimulate bone marrow bin Many factors can interfere with normal red cell pro- production of specific types of blood cells. The average diet usually provides It is characterized by an enormous increase in the num- enough iron to meet the needs of the adult male, but this ber of white cells. Although the cells are high in number, diet often is inadequate to meet the needs of growing they are incompetent and cannot perform their normal children and women of childbearing age. If this wild proliferation of white cells stems ficiency anemia occurs in people with alcoholism, in eld- from cancer of the bone marrow, the condition is called erly people on poor diets, and in infants or others suffer- myelogenous (mi-eh-LOJ-en-us) leukemia. When the ing from intestinal disorders that interfere with the cancer arises in the lymphoid tissue, so that most of the absorption of this water-soluble vitamin. Both inborn fac- ficiency of intrinsic factor, a gastric juice secretion that tors and various environmental agents have been impli- is responsible for vitamin B12 absorption from the in- cated.

generic atorlip-5 5mg free shipping

When the task was performed using familiar stimuli atorlip-5 5mg generic, 17% of neurons showed task-related activity 5mg atorlip-5 fast delivery. These increases and decreases in activity were either transient in nature or were sustained for long after the association had been learned. This pattern of activity is reminiscent of changes observed in the neocortex,105,106 and neurons that showed such task relations were distributed nonpreferentially over the caudate nucleus, the putamen, and the ventral striatum. Recent data from Brasted and Wise111 not only confirm the presence of learning-related activity in striatal (putamen) neurons, but also showed that the time course of these changes in striatal neurons is similar to that seen in the dorsal premotor cortex, with changes in activity typically occurring in close correspondence with the learning curve. Finally, there is evidence for learning-related changes in neuronal activity in cells in the globus pallidus. Monkeys were required to maintain a center hold position with the manipulator until the cue appeared in the center of the screen. The cue was then replaced by a neutral stimulus for a variable delay period before the appearance of a trigger cue instructed monkeys to make Copyright © 2005 CRC Press LLC their response. In a control condition, monkeys performed the task using three familiar stimuli that instructed well-learned associations. In a learning condition performed in a separate blocks of trials, one of the familiar stimuli was replaced by a novel stimulus, which required the same response as the replaced familiar stimuli. A difference between learning and control conditions was seen for 17/23 inhibited neurons, and for 10/26 excited neurons. The majority of the cells (21/27) that were sensitive to novel stimuli were located in the dorsal medial aspect of the internal segment of the globus pallidus, which projects indirectly to the dorsolateral PF according to Middleton and Strick. Animals were presented with one of two visual stimuli on a monitor and were required either to tap the screen three times or to withhold such movement. Thus, 22% (19/87) of neurons demonstrated differential changes in activity for the two trial types as learning progressed, while 45% (39/87) of neurons showed only a transient difference between the two trial types, akin to the learning-selective neurons reported in SEF,106 as illustrated in Figure 10. In their experiment, a complex scene filled a video monitor and four potential eye-movement targets were superimposed on that scene. They describe their task as a scene–location association, but it does not differ from the tasks described above for studies of the premotor cortex.