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[Physiology, psychology and pathology of writing and spelling--an overview].

Writing and spelling are conceived as concerted actions comprising cognitive planning, motor action and an expressive content. In literate societies the individual use of alphabetic systems is acquired immediately after speech as a "cultural technique". As such these systems demand specific cognitive and motor skills which have been analysed primarily on the basis of neurological and psychiatric syndromes. We distinguish primary developmental disturbances and secondarily acquired disturbances of writing and spelling, categorizing the latter into four essential disturbance areas: linguistic command, motor execution, automatism control and dynamic tonus regulation. The clinical significance of writing and spelling is not confined to its possible disturbances. In pathologically induced restrictions of cognitive functions or of social skills the fact is rather that the written language frequently contributes to the development of individual coping strategies. From the psychodynamic aspect, written communication is characterized principally by its proximity-regulating function.

Handwriting↗

Postwar writing and the literature of the women's liberation movement.

This article explores the relationship between both popular and scholarly writing about women in the postwar years 1946 to 1962, and the literature of the women's liberation movement written from 1963 to the early 1970s. The current feminist movement was particularly eager to discredit Freudian theories of female psychosexual maturation. This women's liberationist focus was entirely appropriate, since Freudian theories about women represented the last respectable academic prop upholding a dichotomous estimation of the socio-politico-economic potential of the sexes--i.e., sexism, as it has come to be called. Postwar scholarship had manifested a split perspective--that is, it was anti-Freudian and pro-feminist or pro-Freudian and anti-feminist. What is more, considerable academic writing about the "woman question" proposed an expanded role for females, advocating a point of view quite similar to that of contemporary feminists. In contrast, the popular literature--e.g., Life, Look, Ladies Home Journal, and the like--proposed only a Freudian (dichotomous) answer to the question, "What are the proper roles of the sexes?" While the findings with regard to popular writing are not too surprising, the extent of early scholarly support (i.e., prior to the women's liberation movement--roughly before 1963) for an expanded role for women was entirely anticipated.

Female↗

Agraphia with abnormal writing stroke sequences due to cerebral infarction.

A 65-year-old, right-handed man presented with speech and gait disturbances. He was alert and cooperative, showing mild right hemiparesis and sensory disturbance. Spontaneous speech was fluent; object naming, word fluency and reading were fully preserved. Sentence repetition and verbal comprehension were mildly impaired. Writing was slow, hesitant and difficult for both spontaneous writing and dictation. Copying was better, although he had some difficulty in copying letters and also complex figures. Sequences of strokes in forming written characters were abnormal; strokes were formed by piecing together several fragments. Computed tomography and magnetic resonance imaging showed a subcortical infarct in the left frontoparietal region. Characteristics of agraphia resembled 'apractic agraphia' and agraphia may have resulted largely from loss or unavailability of the memory of motor patterns necessary for writing letters.

Aged↗

Premature thoughts on writing disorders.

Three papers appeared in the 19th century describing the dissociation between speech and writing: Marce (1856), Ogle (1867), and Pitres (1884). An account of the convincing evidence of dissociations put forward in these papers is presented. Three explanations are proposed as to the reason why the observations reported by these authors were overlooked or rejected by their contemporaries, namely: (a) in the first half of the century it seems that very little knowledge of the processes underlying writing (as opposed to speech) was available, (b) the debates focussed on the independence of speech versus motor control and language versus the intellect, (c) parallelisms between phylogeny, ontogeny and aphasia impeded the application of the principle of double dissociations, including the dissociations between speech and writing. It is argued that this phenomenon in the history of aphasia is best captured by the concept of prematurity in scientific discovery proposed by Stent (1972, 2003).

Agraphia↗

Attempts to switch the writing hand: relationships to age and side of hand preference.

The recent suggestion that left-handedness is a mortality risk factor has prompted extensive media attention and has renewed research interest in generational differences in hand preference incidence and training. It is argued that differential generational training effects (the modification hypothesis), rather than decreased survival fitness (the elimination hypothesis), account for the lower numbers of individuals classified as left-handers in contemporary samples over the age of 60 years. A total of 633 individuals (aged 13-83 years) were queried about attempts to switch hand preference. Forty-one (6.5%) described efforts to shift preference in the rightward direction; of these, 21 (3.3%) reported attempted rightward writing hand shifts. The percentage of older adult left-handers, who reported right shifts in writing, was greater than the percentage of younger left-handers who described such attempts. Comparisons between the group reporting right shifts and those reporting no shift experiences suggested that the age-related decrease in leftward preference was specific to a decrease in the incidence of left-hand writing among older adults.

Journal Article↗

Writing cognitive educational objectives and multiple-choice test questions.

Guidelines for writing cognitive objectives and multiple-choice test questions for pharmacy educational programs are suggested. Cognitive educational objectives relate to intellectual skills and can usually be tested with multiple-choice questions. Pharmacy educators writing cognitive objectives should focus on the major, not minor, knowledge or skills that participants in an educational program are expected to acquire; ensure that the objectives are supported by instruction; define the desired performance of the learners; ensure that the objectives are observable and measurable; and define the learning level for each objective (i.e., knowledge, comprehension, application, analysis, synthesis, or evaluation). Each multiple-choice test question should be written with a view to assessing the learner's achievement of one of the stated objectives. Educators should write test questions that are clear and concise, are in the form of complete sentences, include one clearly correct or best response, are phrased positively rather than negatively, and give no clues as to the correct answer. The learning level of each question should match that of the objective the question is designed to test. Educators should weight tests fairly by including the same number of questions for each objective. It may be necessary to include some higher-level questions to ensure assessment of the competence level at which the program is aimed. Cognitive educational objectives should be observable and measurable; multiple-choice test questions should correspond to specific objectives and be based on the appropriate learning level.

Education, Pharmacy↗

A PET study of the functional neuroanatomy of writing impairment in Alzheimer's disease. The role of the left supramarginal and left angular gyri.

A dissociation in the central processes of spelling, with preferentially lexical over phonological impairment, frequently affects patients with early Alzheimer's disease. The aim of this work was to test whether dissociations in the language domain in Alzheimer's disease can be exploited with PET to assess the neural basis of cognition. To this end, we studied the functional neuroanatomy of writing impairment in Alzheimer's disease by means of PET measurements of the local cerebral glucose utilization and neuropsychological tests specially designed to assess the phonological and lexical components of writing. We analysed the performance in written spelling of irregular words and non-words of 11 right-handed patients with mild-to-moderate Alzheimer's disease. For each patient, we calculated a residual phonological score and a residual lexical score, based on a cognitive interpretation of the errors according to the item category. In each of these 11 patients, using PET, we measured the resting-state utilization of glucose in the left supramarginal gyrus and the left angular gyrus, two cortical regions selected a priori because of their presumed role in the central processes for spelling, and identified on CT scans obtained according to stereotaxic references and coregistered with PET. To assess the relationships between the neuropsychological scores and the metabolic data, we used the 'ratio paradigm', the sensitivity of which has been previously documented in cognitive-metabolic correlative PET studies of Alzheimer's disease that were less focused than the present study in both cognitive and anatomical terms. We found a highly significant positive correlation between phonological score:lexical score neuropsychological ratios and corresponding supramarginal gyrus:angular gyrus metabolic ratios. These findings further support the role of these two left-sided temporo-parietal regions in the central processes of writing and show that the neuropsychological dissociations in early Alzheimer's diseases can be exploited to further our understanding of the functional neuroanatomy of cognitive operations. The role of focal, as compared with more diffuse, brain damage in the development of impaired written language of central origin in Alzheimer's disease is also discussed.

Aged↗

Participation of the left posterior inferior temporal cortex in writing and mental recall of kanji orthography: A functional MRI study.

To examine the neuropsychological mechanisms involved in writing kanji (morphograms), we used functional MRI (fMRI) in 10 normal volunteers, all right-handed, native Japanese speakers. The experimental paradigms consisted of kana-to-kanji transcription, mental recall of kanji orthography and oral reading and semantic judgement of kana words. The first two tasks require manual and mental transcription of visually presented kana words into kanji, respectively, whereas the last two tasks involve language processing of the same set of stimulus words without recall of kanji. The transcription and mental recall tasks yielded lateralized activation of the left posterior inferior temporal cortex (PITC). By contrast, neither oral reading nor semantic judgement produced similar activation of the area. These results, in good accordance with lesion data, provide converging evidence that the left PITC plays an important role in writing kanji through retrieval of their visual graphic images, and suggest language-specific cerebral organization of writing. The set of fMRI experiments also provides new neuroimaging data on the cortical localization of basic language functions in people using a non-alphabetical language.

Adult↗

Medical students' and housestaff's opinions of computerized order-writing.

BACKGROUND: Greater use of computers has been touted as one way in which health care quality can be enhanced while reducing costs. The authors assessed factors associated with acceptance of computerized order-writing. METHOD: From April 1990 through October 1991 a survey was administered to 275 medical students and housestaff who used computer workstations to write all their orders on the general medicine wards at Wishard Memorial Hospital. The survey assessed computer literacy, ease of workstation use, effects on practice and time management, and usefulness of information provided. RESULTS: A total of 212 (77%) of the computer-workstation users responded. Opinions were generally positive. Those of junior students were the most positive, with opinions declining progressively for senior students, interns, and residents. The housestaff were most critical of time spent using the workstations, although they required less time to write orders than the students did. CONCLUSION: The favorableness of the respondents' opinions declined as the level of training increased, a trend that was independent of computer literacy. Hence, increasing computer use by physicians will probably require modification of the educational and socialization process rather than mere reliance on increasing computer literacy.

Analysis of Variance↗

Assessment and significance of Arthur Conan Doyle's medical writings.

Doyle's medical writings represent a valuable contribution to both the scientific and nonscientific aspects of medicine of the late 19th Century. Up to the present, accounts of these writings have been few, and none of them have been evaluative of their scientific merit. Analysis of Doyle's writings on infectious diseases in particular reveals a remarkable insight, for the 1880s, into the bacterial causation of disease and prevention through immunization.

Adolescent↗

Evaluation of a program to improve the prescription-writing quality in hospital.

This paper aims to evaluate the effectiveness of a program designed to improve the quality of drug prescription-writing at a university hospital in France. Improvement actions included feed-back from yearly audits and the dissemination of recommendations on how best to write the prescriptions. A random sample of 30 stays was selected from among the hospitalizations for the year 1996. From each patient, medical records were searched for the first prescription order of the stay and its quality was assessed according to standards. A total of 872 records were relevant and included 3,289 medications. The results were compared to those obtained for the two previous years. Actions to sensitize prescribers resulted in an insufficient improvement of most indicators of prescription-writing quality with results remaining well below ideal standards. The hospital staff concerned had a positive opinion of the program which led to an awareness of prescription problems. This assessment showed that the program had a moderate impact on prescribers' practice and efforts must be continued.

Drug Prescriptions↗

Handedness in children at school entry: does the 'Mesker test' provide a valid method for testing writing handedness?

The 'Mesker test', an experiment devised after the psycho-motor dominance test described by the Dutch paediatrician Mesker, was evaluated as a method for testing writing handedness in 145 children at school entry in Crewe Health Authority. Also included in the assessment was if, and how these children know their laterality. Positive outcome was measured as Mesker test result corresponding to spontaneous hand-preference in symbol copying. The correct indication of right arm or leg was evaluated in relation to the outcome by chance. The Mesker test could not confirm hand-preference in children at school entry. There was no significant relation to the child's maturity and no significant consistency in test performance. The sub-group of right-handed writers who confirmed their handedness showed an almost significant level of consistency. No more children who thought they knew the right side indicated the correct limb then could have been arrived at by chance. This was not significantly related to having been taught, writing handedness or maturity. It is concluded therefore, that at school entry age children don't have a good knowledge of their body's laterality. Although the Mesker test does not confirm writing handedness at school entry, it may be useful in older children with inconsistent laterality.

Child, Preschool↗

A picture of locational--occupational diversity: an analysis of the needs of rural and remote healthcare workers when writing RHSET applications. Rural Health Support Education and Training.

Methods for meeting the research needs of rural/remote health workers have been assessed on the assumption that these workers form a seemingly homogeneous group. This paper provides a picture of locational-occupational diversity not previously considered when addressing the needs of rural health workers writing research and project grant submissions. Rural/remote health workers and researchers were surveyed about their needs when seeking assistance with the development, implementation and evaluation of funded project/program proposals. New South Wales respondents were differentiated according to five geographical locations and 10 occupational categories. The results suggest that geographical location and occupational category are major factors in determining research requirements for rural/remote health workers and researchers, and should be considered when identifying barriers to the development and implementation of research projects in rural/remote health care issues. Those health workers most isolated required access to resource information and research and grant writing skills development, while researchers in metropolitan areas were more inclined to seek funding information and general assistance. Those in occupational categories who do not generally receive research and grant writing skills training are less likely to attract funding than their more 'academic' counterparts.

Attitude of Health Personnel↗

Headache in the writings of Moses Maimonides and other Hebrew sages.

In the history of philosophy, theology, and medicine, Maimonides shares the limelight with Arabic scholars such as Ibn Rushd, Ibn Sinna and Ibn Zuhr, chronologically between the great intellectuals of classical Greece and Rome and those of the later Middle Ages and early Renaissance. Maimonides was a very great philosopher and theologian, usually underrated by the historians. He was also an outstanding medical practitioner and teacher. Moses Maimonides had an incredible literary ability and an encyclopedic knowledge. He wrote extensively in the fields of theology, mathematics, law, philosophy, astronomy, ethics, and, of course, medicine. His medical writings are varied, comprising extracts from Greek medicine, a series of monographs on health in general and several diseases in particular, and a pharmacopoiea. The present essay extracts, primarily from Maimonides' medical writings, his pronouncements dealing with headache. Since most of Maimonides' pronouncements about headache in his Medical Aphorisms were derived from Graeco-Roman medical writers such as Hippocrates, and especially Galen, in regard to these statements Maimonides was merely a compiler--not an innovator. Some of his concepts about the causes of headaches being related to a dysequilibrium of the body humors are clearly medieval in origin. Other statements demonstrate this concern with preventive medicine and the maintenance of a healthy regimen of daily living. Medications to treat illness should only be used if non-medicinal means such as diet and exercise are not effective. The heritage of Maimonides' writings is being more and more appreciated.(ABSTRACT TRUNCATED AT 250 WORDS)

Headache↗

Reflex writing seizures in two siblings with juvenile myoclonic epilepsy.

We report on two siblings who presented with juvenile myoclonic epilepsy, and in whom myoclonic jerks of the right arm and hand were also triggered by writing tasks. Both patients underwent intensive video-electroencephalography monitoring, with simultaneous neuropsychological tests. In both patients, reflex epileptic myoclonus was more easily triggered by writing that required a higher degree of concentration. Conversely, other cognitive tasks, such as reading, typing, thinking, or calculation never elicited any seizures or myoclonus. Valproate was effective in controlling both spontaneous and reflex epileptic seizures. The results of this study further support the notion that 'praxis-induced' reflex epilepsy precipitated by specific stimuli occurs in the context of idiopathic generalized epilepsy. Our results also illustrate that writing tasks are more effective in eliciting seizures when they require higher levels of concentration and mental elaboration.

Adolescent↗

Writing as thinking.

In this article I try to sketch preliminary answers to several questions. (1) What is the role of writing in science? (2) How can rhetorical analysis illuminate the nature of scientific writing? (3) What is the role of models and metaphors in scientific thinking and writing? Since this is a preliminary inquiry, my remarks are brief and suggestive, but I think they point to some profitable directions for further study.

Journal Article↗

A nanoplotter with both parallel and serial writing capabilities

The development of an eight-pen nanoplotter capable of doing parallel dip-pen nanolithography (DPN) is reported. Because line width and patterning speed in DPN are independent of contact force, only one of the tips in the parallel writing mode (the "imaging" tip) has a feedback system to monitor tip position and to write the pattern; all other tips reproduce what occurs at the imaging tip in a passive fashion. Proof-of-concept experiments that demonstrate eight-pen parallel writing, ink and rinsing wells, and "molecular corralling" via a nanoplotter-generated structure are reported.

Journal Article↗

Attitudes towards and barriers to writing advance directives amongst cancer patients, healthy controls, and medical staff.

OBJECTIVES: After years of public discussion too little is still known about willingness to accept the idea of writing an advance directive among various groups of people in EU countries. We investigated knowledge about and willingness to accept such a directive in cancer patients, healthy controls, physicians, and nursing staff in Germany. METHODS: Cancer patients, healthy controls, nursing staff, and physicians (n = 100 in each group) were surveyed by means of a structured questionnaire. RESULTS: Only 18% and 19% of the patients and healthy controls respectively, and 10% of the medical staff had written an advance directive. However, 50-81% of those surveyed indicated that they wished to write one. This intention was associated with deteriorating health (p < 0.001). Only 29% of the healthy controls and 43% of the patients knew about the possibility of appointing a health care proxy. A majority in all groups believed that advance directives may influence the course of treatment (79-85%), yet half of those surveyed in all groups fear that patients could be pressurised into writing an advance directive, and 38-65% thought that relatives could abuse such documents. CONCLUSIONS: Only a minority of the participants had written an advance directive and knew about the possibility of authorizing a health care proxy. Deteriorating health was associated with increasing willingness to make a directive. Despite a majority belief that advance directives may influence treatment at the end of life, other factors limit their employment, such as fear of abuse.

Adult↗