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The World Health Organisation estimate there are about 1 billion migrants in the world today. The scale of population movement and a global refugee crisis presents an enormous challenge for healthcare provision, and too often the specific health needs of refugees and migrants are not met. This study assessed refugee, asylum seeker and vulnerable migrants’ (AMRs') experience of front line primary healthcare in a region of the United Kingdom designated as a ‘City of Sanctuary’. A questionnaire study explored the views of people seeking refuge and third sector workers supporting them. The majority of AMRs were registered with a GP and positive about their consultations. The views of third sector workers provided a less favourable window into their experience of primary care. In conclusion, the work highlighted patchy experience of primary care, even in a region of the UK designated as a ‘City of Sanctuary’ for people seeking refuge. There is a need for further education of rights to care in the UK, information for people on how to navigate local healthcare systems, consistent access to routine health checks and translation services.

The COVID-19 pandemic has significantly impacted on doctors’ education and opportunities for professional development with almost all education now offered on virtual platforms. Houghton et al 1 have outlined how this poses a particular challenge for teaching the practical aspects of medicine compared with theoretical, declarative knowledge. However, in their article they encourage medical educators to embrace these changes and ‘make a virtue out of necessity ’ . We share an example where being forced to move to a virtual platform improved doctors’ training in the practical management of medical emergencies in the community, and has led to a permanent change in how we will deliver this training in future years. General practitioners (GPs) have a responsibility to provide prompt and effective care when attending to life threatening emergencies in their surgeries. These are relatively uncommon and previous research has shown this is an area where some doctors lack confidence and competence.2–4 In the current National Health Service crisis, with stretched resources, it is particularly important that GPs are equipped to manage time critical emergencies, because GP surgeries are deemed a place of safety and 999 ambulances can be redirected to other emergencies, thereby delaying transfer to secondary care for patients in GP settings. In previous years, the Dorset GP training scheme provided classroom based training in managing …

Peer-led teaching is well established within many undergraduate medical courses but relatively underutilised in postgraduate training, despite the fact it can be useful for both teachers and learners. A significant number of doctors training to be GPs bring expertise and experience from other specialities and in this paper we explore the potential of using 'expert trainees' to teach their peers on postgraduate GP training programmes. A GP trainee with expertise in Lifestyle Medicine taught alongside local and national experts and delivered workshops to her peers. Questionnaires were used to establish the acceptability and quality of 'expert trainee' peer-led education. This was a positive experience for the 'expert trainee' who felt valued both as a trainee and as someone with expert knowledge, and for her peers with excellent feedback on her workshop. The knowledge and skills of 'expert trainees' represent an untapped resource which could be more systematically and effectively used within GP education.

The value of arts based medical education is becoming increasingly well established in\ud undergraduate curricula. However, little is known about its value, and acceptability, to\ud qualified doctors undertaking postgraduate training. In this work we examined GP trainees’\ud views on whether arts based education was useful for their professional development and,\ud if so, what they perceived its value to be. All first and second year GP trainees on the Dorset\ud Vocational Training Scheme attended a one day course which showcased how the arts (film,\ud poetry, painting, photography, theatre) could enhance their professional development as\ud doctors. GP trainees rated the day as interesting, enjoyable and thought proving. The\ud majority felt that the arts could contribute to making them more competent and humane\ud doctors’. Following this, we ran a mandatory six months arts based course for six GP\ud trainees, and evaluated their feedback through qualitative analysis of a focus group\ud discussion. Overall, GP trainees found the course enjoyable and valuable to their learning. It\ud not only gave them a deeper appreciation of the patient’s perspective, but also encouraged\ud them to think about their own health and wellbeing

The capacity and the commitment to reflect are integral to the practice of medicine and are core components of most general practitioners (GP) training programmes. Teaching through the humanities is a growing area within medical education, but one which is often considered a voluntary ‘add-on’ for the interested doctor. This article describes an evaluation of a highly innovative pedagogical project which used photography as a means to enhance GP trainees’ reflective capacity, self-awareness and professional development. Photography was used as a tool to develop GP trainees’ skills in recognising and articulating the attitudes, feelings and values that might impact on their clinical work and to enhance their confidence in their ability to deal with these concerns/issues. We submit that photography is uniquely well suited for facilitating insight and self-reflection because it provides the ability to record ‘at the touch of a button’ those scenes and images to which our attention is intuitively drawn without the need for—or the interference of—conscious decisions. This allows us the opportunity to reflect later on the reasons for our intuitive attraction to these scenes. These photography workshops were a compulsory part of the GP training programme and, despite the participants’ traditional scientific backgrounds, the results clearly demonstrate the willingness of participants to accept—even embrace—the use of art as a tool for learning. The GP trainees who took part in this project acknowledged it to be beneficial for both their personal and professional development.

Context: According to the World Health Organisation 'more people are on the move now than ever before with an estimated 1 billion migrants in the world today and 68 million forcibly displaced people'. GPs are on the frontline of healthcare in the UK and have a responsibility to provide free and equitable access for everyone. Aim: The main aim of our work was to assess GP trainees' current experience, knowledge and attitudes towards caring for refugees, asylum seekers and undocumented migrants. Description: 30 final year GP trainees on the Dorset Vocational Training Scheme (VTS) were asked to participate by completing a questionnaire. Outcomes: The results show that GP trainees lack knowledge regarding migrants health needs, rights to care, including whether there is a duty to disclose an illegal immigrant and what to do if a patient could not provide proof of identification. They lacked experience and confidence in caring for this group of patients, with the biggest perceived challenge being language barriers. Conclusions: Education in primary care needs to respond to meet the challenge of population movement (5), and this project highlighted a need to improve education on migrants' rights to care, local support groups, as well as common health problems. In response, we have reviewed our curriculum and introduced an education session on refugee health for all our GP trainees in Dorset.

General Practitioners (GPs) have a responsibility to provide prompt and effective care when attending to life threatening emergencies in their GP surgeries. Primary care staff undertake mandatory, annual basic life support training. However, most emergencies are peri-arrest situations, and this is an area where GPs lack confidence and competence [1, 2]. The importance of effective, early intervention in peri-arrest scenarios was highlighted by the NCEPOD report “Time to Intervene (2012)” [3]. This report suggested that better early assessment and intervention may have prevented progression to cardiorespiratory arrest. GPs need to be equipped to manage ‘time critical’ emergencies, particularly as GP surgeries are deemed a place of safety and 999 ambulances can be redirected to other emergencies, thereby delaying transfer to secondary care for patients in GP settings. In previous work, we demonstrated that GPs’ confidence in managing time critical emergencies was initially low, and significantly improved immediately after attending ‘real-world’, simulation based workshops [1]. The value of real-world, in-house simulation based training has also been shown to increase “practical preparedness” in the context of resuscitation training (4). However, there is relatively little data regarding the long term value of simulation based training in primary care (5). In the current paper, we assessed whether our workshops had any longer-term benefit on participants’ confidence in managing emergencies and if it led to any changes in clinical practice.

Malnutrition means ‘poor nutrition’ when there is a deficiency of energy and nutrients in the diet that causes a measurable clinical outcome or impact on body composition or function.1 As such, malnutrition can refer to people who are overweight but the term is more often used to apply to people who are underweight. Malnutrition (as undernutrition) affects an estimated 3 million people in the UK (those either malnourished or at risk), the majority of whom are living in the community (93%).2 It can be a cause and consequence of illness, and is a common clinical and public health problem that has largely been ignored in primary care.3,4 This may be because the reverse problems of overeating, and obesity, have been the focus of attention in regard to weight management and nutritional status.\ud \ud Malnutrition can have a profound detrimental impact on disease risk, progression, and prognosis, as well as increasing complications after injury and delaying recovery from illness. It results in greater healthcare needs in the community, including more frequent access to GP services and increased needs at home. Recent estimates suggest that the health and social care cost of malnutrition in both adults and children in England alone exceeds £19 billion, and half of this expenditure is due to people >65 years.3 Overall, the cost of treating a malnourished patient is over three times more than treating a non-malnourished patient. It is only set to increase with an ageing population and the rising cost of health and social care services.

Much has been written about the current crisis in UK general practice.1 GPs in the UK report finding their job more stressful than GPs in other countries2 and the reasons for the pressures in UK primary care have been well rehearsed in the literature and media, including management of patients with increasingly complex needs and expectations, increasing numbers of face-to-face consultations, work that is more intense, and longer working days.3 Compounding these pressures, GP practices are finding it difficult to recruit and retain GPs, resulting in a concurrent workforce crisis.1 This is all contributing to the destabilisation of the traditional structure of primary care based on the partnership model.1,4,5 The King’s Fund report on the state of English general practice1 found that GPs in training intended to work as locums (44%) or salaried doctors (48%) after qualification, with only 3% intending to work as partners. Another study reporting similar results4 found that less than a third of GP trainees hoped to work full time a year after qualification. Only 33% of GP trainees reported that they would become a doctor if they had the chance to go back and 34% stated they would consider specialties other than general practice. Fewer than half reported that they would recommend general practice to junior doctors. Reasons included workload, job-related stress, …

We examined eye movements in a patient, FK, who has action disorganisation syndrome (ADS), as he performed the everyday task of making a cup of tea. We compared his eye movements with those of a person with Alzheimer's disease and with healthy volunteers. Despite showing very disorganised behaviour many aspects of FK's eye movements were relatively normal. However, unlike normal participants FK made no advance glances to objects that were about to be used, and he made increased numbers of fixations to irrelevant objects during the task. There were also differences in the durations of his eye movements during correct actions and during his perseverative and task-addition responses. We discuss the implications for understanding ADS and the cognitive processes required for correctly performing everyday tasks.

Category-specific impairments of object recognition and naming are among the most intriguing disorders in neuropsychology, affecting the retrieval of knowledge about either living or nonliving things. They can give us insight into the nature of our representations of objects: Have we evolved different neural systems for recognizing different categories of object? What kinds of knowledge are important for recognizing particular objects? How does visual similarity within a category influence object recognition and representation? What is the nature of our semantic knowledge about different objects? We review the evidence on category-specific impairments, arguing that deficits even for one class of object (e.g., living things) cannot be accounted for in terms of a single information processing disorder across all patients; problems arise at contrasting loci in different patients. The same apparent pattern of impairment can be produced by damage to different loci. According to a new processing framework for object recognition and naming, the hierarchical interactive theory (HIT), we have a hierarchy of highly interactive stored representations. HIT explains the variety of patients in terms of (1) lesions at different levels of processing and (2) different forms of stored knowledge used both for particular tasks and for particular categories of object.

Life threatening emergencies in the community are relatively infrequent and therefore provide a challenge for doctors in keeping up-to-date and maintaining confidence. Training in managing emergencies typically takes place through role play and classroom based simulation. In this project, we took simulation out of the classroom and into community environments where emergencies actually occur creating 'real-life' scenarios. These included the practical management of meningitis, anaphylaxis, hypoglycaemia, convulsions and cardiac arrest. Doctors had to find and utilize the equipment in their surgeries and were asked to physically draw up the appropriate medication. The simulation training was led by a GP and a Consultant in Intensive Care Medicine. Participants' confidence in managing emergencies significantly increased after the workshops. Qualitative feedback illustrated the need for more simulation based learning: "I hope this can be done regularly as it will make a huge difference to patient care", "Excellent - life like to make more memorable", "Good to use the actual surgery equipment". Many of the participants knew the theory of what to do but lacked the practical skills to efficiently manage emergency scenarios. Training doctors through simulation needs to be taken out of the classroom and into real life environments. This is particularly important for 'time critical illnesses' where delays can have a direct impact on morbidity and mortality.

We report a study on a patient (DW) with integrative visual agnosia and a category-specific recognition impairment for living things. We assessed DW's local and global processing and tested if his integrative agnosia could have led directly to his category-specific impairment. The main findings were: (i) DW was faster at identifying local compared to global letters. (ii) DW showed no local-to-global (or global-to-local) interference effects in selective attention tasks. (iii) DW showed a congruency effect in a divided attention task, suggesting that, when his attention was cued to both levels, he could process information simultaneously and integrate local and global information. (iv) Controls were poorer at naming nonliving compared to living things when presented with silhouettes. These data suggest that local and global information are differentially weighted in the visual recognition of living and nonliving things, and that an impairment in processing the overall shape of an object can lead to a category-specific deficit for living things. Crucially, this implies that category-specific impairments do not necessarily reflect damage to the semantic system, and models of semantic memory based on this assumption need to be revised.

We report data on patient FK, who presented with a marked deficit in accessing semantic knowledge about objects when tested across a range of input and output modalities. FK also showed a high degree of item-specific consistency in object identification, over and above effects due to object familiarity. We show that, despite being better at naming some objects than others, FK was equally poor at discriminating the superordinate categories of the stimuli. Also, he tended to be better at matching nameable items to a base-level label than to a superordinate-level label. We discuss the implications of the data for models of semantic memory.

We report data on stored knowledge of everyday tasks in a patient, FK, with 'action disorganisation syndrome'. In section 1, we analysed his explicit knowledge of the component actions, and their temporal order. FK showed generally impaired knowledge of everyday tasks relative to controls, and, when knowledge of the temporal order of the actions was probed, he showed particular impairments for the actions making up the final steps in tasks. In section 2 we assessed FK's implicit knowledge of the tasks, by evaluating how knowledge of the tasks influenced his ability to act out sets of instructions. We demonstrate that FK had some implicit knowledge of the tasks, but also, when actions had to be performed in the order as instructed, there was better knowledge of order for actions performed early rather than late in the task. We suggest that disordered task schema contributed to FK's deficits, with impairments on 'end' actions being vulnerable when task order was important for performance.

Patients with category specific recognition impairments for living and non living things have played a crucial role in developing current theories of semantic memory and object recognition. This paper reviews a number of the classic cases and discusses the theories that have been developed to account for these impairments. The first reports of patients with category specific recognition impairments for living and non living things were documented by Nielsen, who argued that they arose because living and non living things were stored in functionally and anatomically separate systems. Although this hypothesishas been reiterated in some recent papers, the most widespread view hasbeen that they emerge because living andnon living thingshave contrasting processing demands. The latter accounts include those which stress the relative importance of: the 'weighting of sensory and functional features associated with living and non living things; the role of structural similarity between objects; the role of direct ...

Why living things, such as animals, fruit, and vegetables, can pose recognition or naming problems compared to nonliving things for certain patients has intrigued neuropsychologists for a number of years. We report a further case study of a patient (SRB) with a category-specific impairment in naming living things, which occurred in naming from vision, taste, touch, and when auditory definitions stressed the visual properties of objects. In addition, SRB was particularly poor at retrieving the perceptual attributes of living things when asked to draw from memory, make perceptual comparisons, or name associated colours. In contrast to this, SRB's performance on standard tests of semantic memory was relatively unimpaired, although when asked to give definitions about living things (and faces) he showed interference effects from visually and semantically similar exemplars from the same category. Also, the problem in naming was not necessarily confined to living things, but also occurred with faces and when no...

We investigated four paranoid schizophrenic patients diagnosed with Frégoli delusion, and four matched psychotic controls. Neuropsychological testing included visual and verbal recognition memory, in addition to a comparison of left and right hemispheric processing of two different classes of stimuli, animate and inanimate objects. Performance on the recognition memory test failed to discriminate between the two psychotic groups on the basis of facial recognition, however, the patients with Frégoli delusion failed to show the right hemisphere processing advantage for the animate class of stimuli found for the set of norms and also present in the psychotic control group. These results are discussed in the context of both current theories of the delusional misidentification syndromes in general, and models of facial recognition in particular.

A single case study is reported of a global aphasic patient, JM, with impaired access to semantic information which was particularly severe for the class of proper names. JM's ability to perform matching tasks with printed words and pictures to auditory words deteriorated when items were repeated, especially when the response-stimulus interval was short. Performance was also inconsistent across items. The effect of repeated testing on items generalised to other, previously untested members of the same category. Despite this, JM was able to access general semantic information about stimuli from the affected categories (e.g. to categorise boys' and girls' names), and showed good ability to access an input lexicon concerning these stimuli. There was also a close relationship between the categories affected when he was tested with pictures and printed words. We propose that JM's deficit can be attributed to his semantic system entering an abnormal refractory state once semantic access for a particular item has been achieved, and with this stage being isolated from the procedures providing access to stored lexical knowledge. Furthermore, the representations affected seem common to pictures and printed words. We discuss the implications of the results for understanding the nature of semantic representations in general and for proper names in particular, and for the distinction between access and storage deficits in neuropsychology.

We describe a patient (J.M.) who showed "refractory" behavior in picture-word matching tasks--that is, his performance became poorer when items were repeated. This contrasts with the facilitatory effects of repetition usually observed in normal participants. We show for the first time that there can be facilitatory effects of repetition on some tasks, even though refractory behavior is shown on the same items in other tasks. In particular, in Experiments 1 and 2, we demonstrate that J.M. showed contrasting effects of repetition across different components of the language system: There were facilitatory effects of repetition priming on lexical decision but refractory behavior on picture-word matching. In Experiments 3 and 4, we demonstrate that J.M. showed contrasting effects of repetition within the same system (semantic memory). His performance became refractory when items were repeated in picture-word matching (Experiment 3), but it was facilitated when items were repeated in superordinate categorization (Experiment 4). These contrasting patterns of facilitation and interference from repetition priming have implications for understanding the nature of refractory behavior and for constraining theoretical accounts of semantic memory.

List of Contributors. Preface. L.R. Santos, A. Caramazza, The Domain-specific Hypothesis: A Developmental and Comparative Perspective on Category-specific Deficits. G. Sartori, R. Job, S. Zago, A Case of Domain-specific Semantic Deficit. G.W. Humphreys, M.J. Riddoch, E.M.E. Forde, The Principle of Target-competitor Differentiation in Object Recognition and Naming. M. Arguin, Visual Processing and the Dissociation between Biological and Man-made Categories. H.E. Moss, L.K. Tyler, J.T. Devlin, The Emergence of Category-specific Deficits in a Distributed Semantic System. P. Garrard, M.A. Lambon-Ralph, J.R. Hodges, Semantic Dementia: A Category-specific Paradox. C. Whatmough, H. Chertkow, Category-specific Recognition Impairments in Alzheimer's Disease. K. McRae, G.S. Cree, Factors Underlying Category-specific Impairments. T.T. Rogers, D.C. Plaut, Connectionist Perspectives on Category-Specific Deficits. K. Lamberts, L. Shapiro, Exemplar Models and Category-specific Deficits. J.M. Mandler, On the Foundations of the Semantic System. K. Subrahmanyam, R. Gelman, A. Lafosse, Distinguishing Between Animates and Other Worldly Things. F. Keil, N.S. Kim, M.L. Grief, Categories and Levels of Information. G. Gainotti, The Relationships Between Anatomical and Cognitive Locus of Lesion in Category-specific Disorders for Living and Non-Living Things. C. Price, K. Friston, Functional Imaging Studies of Category-Specificity.

Recognition of orally spelt words is an unusual task, not commonly encountered in everyday life, but it can be surprising well preserved in patients with brain damage. There is, however, considerable debate over the cognitive abilities that are required to successfully perform this task. The main controversy has centred on whether oral spelling recognition is parasitic on the processes normally involved in spelling aloud or in reading. We describe a patient (FL) who showed a similar pattern of performance on reading and oral spelling recognition and was better at both tasks relative to spelling. We describe a second patient (FK) who was good at reading and reasonable at spelling but poor at reverse spelling. The patient data are not consistent with either of the following hypotheses: that oral spelling recognition is dependent either on a reading system that is functionally separate from a spelling system, or on a spelling system that is functionally separate from reading. We propose that the findings can, however, be accommodated by a model in which spelling and reading are not functionally independent systems, but share important cognitive components such as a graphemic buffer.

Although food allergy can have serious health consequences, little is currently known about people’s perceptions of food allergy. The present study examined the differences in awareness and perceptions of food allergy and anxiety between young people with and without a food allergy. Participants completed a questionnaire which asked about their perceptions and knowledge of allergies, perceived health competence and anxiety. Of the 162 participants 24 reported they were allergic to at least one food; these people perceived that their allergy had significantly less of an impact on their lives than others believed it would. Allergy status interacted with perceived health competence to affect anxiety. People with an allergy and with high health competence reported the greatest anxiety levels. Very few of the sample knew the meaning of the term ‘anaphylaxis’. Findings are discussed in terms of health education implications and possibilities.

We report a 12-year longitudinal case study on a 60-year-old male patient (DW) with category-specific agnosia. The extent to which DW's impairment has changed over time was evaluated using identical tests at time 1 (1988) and time 2 (2000). In particular, we assessed his ability to identify pictures and real objects, to draw from memory, and to access stored semantic information about living and non-living things. The principal findings were: (i). DW was significantly better at identifying real objects in comparison with line drawings. (ii). DW presented with a category-specific impairment for living things that remained consistent over the 12-year period. (iii). He significantly improved in his ability to identify real non-living objects over the 12-year period but real living objects remained at floor. (iv). His ability to access stored visual knowledge declined over time. On the basis of these data, we suggest that visual perception is required to maintain intact visual memories over a period of time. We also suggest that integrative visual agnosia co-occurs with a category-specific impairment for living things because the recognition of these items requires more global processing than for non-living things. In addition, we suggest that degradation to stored visual knowledge can cause category-specific naming impairments for living compared with non-living things because naming living things requires access to more detailed visual knowledge.

In this paper we examine the role of stored semantic knowledge in recall from short-term memory. We assessed the performance of a patient (FK), who showed a consistent lack of semantic knowledge for some words (‘unknown’) but not others (‘known’) on a range of serial recall tasks using both spoken and written words. Overall, FK was significantly better at recalling lists of known compared with unknown words. His recall of unknown words was characterized by numerous phonological errors, such as repeating ‘bear skunk’ as ‘bunk scare’. FK showed a relatively normal primacy effect in immediate recall, but a striking lack of a recency effect. This pattern of performance is useful for constraining theoretical accounts of language production and verbal short-term memory and for understanding the role that long-term semantic knowledge may play in maintaining information in short-term memory.

(2002). The Cognitive Neuropsychology of Everyday Actions. Neurocase: Vol. 8, No. 1-2, pp. 59-60.

Using group functional Magnetic Resonance Imaging (fMRI) and group Magnetoencephalography (MEG) we studied two cognitive paradigms: A language task involving covert letter fluency and a visual task involving biological motion direction discrimination. The MEG data were analyzed using an adaptive beam-former technique known as Synthetic Aperture Magnetometry (SAM), which provides continuous 3-D images of cortical power changes. These images were spatially normalized and averaged across subjects to provide a group SAM image in the same template space as the group fMRI data. The results show that frequency-specific, task-related changes in cortical synchronization, detected using MEG, match those areas of the brain showing an evoked cortical hemodynamic response with fMRI. The majority of these changes were event-related desynchronizations (ERDs) in the 5–10 Hz and 15–25 Hz frequency ranges. Our study demonstrates how SAM, spatial normalization, and intersubject averaging enable group MEG studies to be performed. SAM analysis also allows the MEG experiment to have exactly the same task design as the corresponding fMRI experiment. This new analysis framework represents an important advance in the use of MEG as a cognitive neuroimaging technique and also allows mutual cross-validation with fMRI.

We present a single case study of a patient, FK, who was severely impaired on routine, everyday tasks, such as preparing a cup of tea. We used the action coding system developed by Schwartz et al. to provide quantitative and qualitative measures of his performance in a number of experimental manipulations. In section A, we established FK's baseline performance on a range of tasks with (a) task-congruent objects only and (b) task-congruent objects and semantic distracters. In section B, we aimed to facilitate FK's performance by (a) giving him a pictorial representation of the goal, (b) giving him a set of written commands to follow, (c) giving him one command at a time, (d) demonstrating how the task should be performed and (e) dividing the task into smaller subgoals. We compared FK's performance with another patient, HG, to establish if there are qualitative differences between patients with 'action disorganization syndrome'. In section C, we aimed to hinder FK's performance by interrupting his execution of routine tasks. By comparing the factors that facilitated and impaired FK's performance in sections B and C, we hoped to isolate the key cognitive processes required to generate and control routine behaviour. In section D, we investigated how task demands impact on our ability to complete different everyday activities. The results of these experiments have important clinical implications for rehabilitation programmes for patients with action disorganization syndrome and can also help to distinguish between contemporary theoretical accounts of routine behaviour. In particular, we propose that patients who can be classified under the umbrella term of 'action disorganization syndrome' do not all have a reduction to 'non-specific cognitive resources' but can have qualitatively different impairments to a specialized action production system.

We summarise and respond to the main points made by the commentators on our target article, which concern: (1) whether structural similarity can play a causal role in normal object identification and in neuropsychological deficits for living things, (2) the nature of our structural knowledge of the world, (3) the relations between sensory and functional knowledge of objects, and the nature of our functional knowledge about living things, (4) whether we need to posit a “core” semantic system, (5) arguments that can be marshalled from evidence on functional imaging, (6) the causal mechanisms by which category differences can emerge in object representations, and (7) the nature of our knowledge about categories other than living and nonliving things. We also highlight points raised in our article that seem to be accepted.

We present a single case study of a patient, HG, who was severely impaired on routine everyday tasks, such as cleaning his teeth and preparing a cup of tea. We used the Action Coding System developed by Schwartz et al. (1991) to provide quantitative and qualitative measures of his performance in a number of experimental manipulations: (a) with task-congruent objects only, (b) with task-congruent objects and semantic distractors, (c) with a set of written commands to follow, (d) when he was given one command at a time, (e) when he was shown how the task should be performed before starting himself, and (f) when the task was divided into smaller subgoals. In general, the majority of HG's errors were step omissions, perseverations, sequence errors, and semantic errors. These semantic errors are particularly interesting since HG was able to name, gesture to, and define all the objects when they were presented in isolation or in task-congruent arrays. We suggest that semantic errors may arise for a number of reasons: (1) impaired access from semantic memory to a network representing action schema, (2) degradation of stored schema, and (3) behavior that is abnormally driven by the goal, by preceding actions, or by salient objects rather than by an appropriate association between these elements in working memory.