There is considerable evidence that the hippocampal system contributes both to the temporary maintenance of memories and to the processing of a particular type of memory representation. The findings on amnesia suggest that these two distinguishing features of hippocampal memory processing are orthogonal. Together with anatomical and physiological data, the neuropsychological findings support a model of cortico-hippocampal interactions in which the temporal and representational properties of hippocampal memory processing are mediated separately. We propose that neocortical association areas maintain shortterm memories (...) for specific items and events prior to hippocampal processing as well as providing the final repositories of long-term memory. The parahippocampal region supports intermediate-term storage of individual items, and the hippocampal formation itself mediates an organization of memories according to relevant relationships among items. Hippocampal-cortical interactions produce strong and persistent memories for events, including their constituent elements and the relationships among them, and a capacity to express memories flexibly across a wide range of circumstances. (shrink)

Research is ongoing concerning the medical risks and benefits of routine neonatal male circumcision. Interpretation of the data, however, is controversial. Circumcision presents a number of challenges in obtaining informed consent because of a variety of interesting issues. It is a nonemergent, elective procedure that allows for evaluation and discussion over time. In this respect, observation of the informed consent process for circumcision is relevant to other medical decisions, such as advance directives, discussed between primary care providers and patients. Obtaining (...) informed consent for circumcision has its constraints. The process generally occurs over a brief hospital stay. There have been recent changes in the official position regarding the procedure by professional medical societies, and it raises considerable psychologic issues for the provider and may Impact the way in which Information is provided. (shrink)

Gray's account is remarkable in its depth and scope but too little attention is paid to poor correspondences with the literature on hippocampal/subicular damage, the theta rhythm, and novelty detection. An alternative account, focusing on hippocampal involvement in organizing memories in a way that makes them accessible to conscious recollection but not in access to consciousness per se, avoids each of these limitations.

Continuing commentary raised several issues concerning our proposal that the hippocampus, parahippocampal region, and cortical association areas mediate different aspects of memory function. Recent relevant findings strengthen our argument that neocortical areas and the parahippocampal region maintain persistent encodings of specific single items and that the hippocampus mediates representations of the relations among these items. The reciprocally and closely interconnected structures that compose the hippocampal memory system work interactively to support flexible memory expression that is relevant to the natural behavior (...) of animals and to conscious recollection in humans. (shrink)

The question of whether Do Not Resuscitate orders should be sustained in the operating room was brought to our ethics committee by a pulmonologist and involved one of his patients for whom he serves as a primary care physician. His patient, a woman with chronic obstructive lung disease was electing, for comfort purposes, to have a hip pinning following a fracture. At the same time, she wished to have a DNR order covering her entire hospital stay. The anesthesiologist described her (...) direction as “improper” and refused to participate in surgical procedures if DNR orders extended to the operating room. The patient refused to rescind the order during surgery. As a result, the surgery was canceled to the great chagrin of the patient. (shrink)

The following description is based upon an actual case in which a patient initiated legal action after suffering a complication subsequent to an invasive diagnostic procedure performed by a senior fellow. Named as codefendants were the senior fellow, attending physician, and the hospital. Because any hospital with house staff is potentially vulnerable to similar litigation, Ethics Committees at Work is addressing the questions raised by this dilemma.

Ruchkin et al. ascribe a pivotal role to long-term memory representations and binding within working memory. Here we focus on the interaction of working memory and long-term memory in supporting on-line representations of experience available to guide on-going processing, and we distinguish the role of frontal-lobe systems from what the hippocampus contributes to relational long-term memory binding.

Although O'Regan & Noë (O&N) claim that the world may serve as the viewers' external visual memory, findings from the field of memory research have demonstrated the existence of internal visual representations. These representations are stored in the viewer's brain, contain information regarding visual objects and their relations, guide subsequent exploration of the visual world and promote change detection.