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PubMed2005

Neural basis for generalized quantifier comprehension.

Generalized quantifiers like "all cars" are semantically well understood, yet we know little about their neural representation. Our model of quantifier processing includes a numerosity device, operations that combine number elements and working memory. Semantic theory posits two types of quantifiers: first-order quantifiers identify a number state (e.g. "at least 3") and higher-order quantifiers additionally require maintaining a number state actively in working memory for comparison with another state (e.g. "less than half"). We used BOLD fMRI to test the hypothesis that all quantifiers recruit inferior parietal cortex associated with numerosity, while only higher-order quantifiers recruit prefrontal cortex associated with executive resources like working memory. Our findings showed that first-order and higher-order quantifiers both recruit right inferior parietal cortex, suggesting that a numerosity component contributes to quantifier comprehension. Moreover, only probes of higher-order quantifiers recruited right dorsolateral prefrontal cortex, suggesting involvement of executive resources like working memory. We also observed activation of thalamus and anterior cingulate that may be associated with selective attention. Our findings are consistent with a large-scale neural network centered in frontal and parietal cortex that supports comprehension of generalized quantifiers.

Adult↗

PubMed2006

Hemispheric differences in the activation of perceptual information during sentence comprehension.

Previous research has suggested that perceptual information about objects is activated during sentence comprehension [Zwaan, R. A., Stanfield, R. A., & Yaxley, R. H. (2002). Language comprehenders mentally represent the shapes of objects. Psychological Science, 13(2), 168-171]. The goal in the current study was to examine the role of the two hemispheres in the activation of such information. Participants read sentences that conveyed information about the shape of an object (e.g., the egg was in the pan versus the egg was in the carton) and then received a picture of the object that was either consistent or inconsistent with the shape implied by the sentence (e.g., a fried egg versus a whole egg). In Experiment 1, pictures were presented briefly in either the left-visual field or the right-visual field. Participants showed a mismatch effect, slower responses when the picture was inconsistent with the shape of the object implied by the sentence than when it was consistent, but only when the pictures appeared in the right-visual field (left hemisphere). In Experiment 2, the sentences were revised such that the shape of the object was described explicitly. Participants showed a mismatch effect in both visual fields. These findings suggest that the right hemisphere activates shape information during sentence comprehension when a shape description is explicit, whereas the left hemisphere activates such information both when the shape is described explicitly and when it is implied.

Adolescent↗

PubMed2005

Evidence-based patient information about treatment of multiple sclerosis--a phase one study on comprehension and emotional responses.

OBJECTIVE: This study analysis the comprehension and emotional responses of people suffering from multiple sclerosis when provided with an evidence-based information module. It is a core module of a comprehensive decision aid about immunotherapy. The core module is designed to enable patients to process scientific uncertainty without adverse effects. It considers existing standards for risk communication and presentation of data. METHODS: Using a mailing approach we investigated 169 patients with differing courses of disease in a before-after design. Items addressed the competence in processing relative and absolute risk information and patients' emotional response to the tool, comprising grade of familiarity with the information, understanding, relevance, emotional arousal, and certainty. RESULTS: Overall, numeracy improved (p < 0.001), although 99 of 169 patients did not complete the numeracy task correctly. Understanding depended on the relevance related to the course of disease. A moderate level of uncertainty was induced. No adverse emotional responses could be shown, neither in those who did comprehend the information, nor in those who did not develop numeracy skills. CONCLUSION: In conclusion, the tool supports people suffering from multiple sclerosis to process evidence-based medical information and scientific uncertainty without burdening them emotionally. PRACTICE IMPLICATIONS: This study is an example for the documentation of an important step in the development process of a complex intervention.

Adult↗

PubMed2006

Computational principles of working memory in sentence comprehension.

Understanding a sentence requires a working memory of the partial products of comprehension, so that linguistic relations between temporally distal parts of the sentence can be rapidly computed. We describe an emerging theoretical framework for this working memory system that incorporates several independently motivated principles of memory: a sharply limited attentional focus, rapid retrieval of item (but not order) information subject to interference from similar items, and activation decay (forgetting over time). A computational model embodying these principles provides an explanation of the functional capacities and severe limitations of human processing, as well as accounts of reading times. The broad implication is that the detailed nature of cross-linguistic sentence processing emerges from the interaction of general principles of human memory with the specialized task of language comprehension.

Attention↗

PubMed2004

Comprehension of sentences with stylistic inversion by French aphasic patients.

Three French-speaking agrammatic aphasics and three French-speaking Conduction aphasics were tested for comprehension of Active, Passive, Cleft-Subject, Cleft-Object, and Cleft-Object sentences with Stylistic Inversion using an object manipulation test. The agrammatic patients consistently reversed thematic roles in the latter sentence type, and the Conduction aphasics performed at chance. The results are discussed in relationship to existing models of aphasic impairments in assigning syntactic structures and using them to determine thematic roles in sentences. We conclude that the results for the agrammatic patients demonstrate the importance of compensatory mechanisms underlying aphasic comprehension and the results in the Conduction aphasics indicate the importance of working memory deficits in determining such deficits. The results are also relevant to models of normal syntactic structure.

Aged↗

PubMed2004

Auditory comprehension: is multiple choice really good enough?

Auditory comprehension is commonly measured with multiple choice tasks. The sensitivity of these tasks in identifying deficits, however, is limited by credit given for correct guesses by forced choice. In this study, we compare performance on the multiple choice task to an alternative word/picture verification task, in 122 subjects with acute left hemisphere stroke. As predicted, word/picture verification identifies significantly more subjects with deficits in auditory comprehension. Furthermore, the pattern of errors in the two tasks is consistent with a current distributed model of semantic memory, and inconsistent with alternative local models.

Adolescent↗

PubMed1997

Impact of a comprehensive heart failure management program on hospital readmission and functional status of patients with advanced heart failure.

OBJECTIVES: To assess the impact of a comprehensive heart failure management program, functional status, hospital readmission rate and estimated hospital costs were determined and compared for the 6 months before and the 6 months after referral. BACKGROUND: The course of advanced heart failure is characterized by progressive clinical deterioration reflected in frequent hospital admissions, which comprise the major financial cost. METHODS: Over a 3-year period, 214 patients were accepted for heart transplantation and discharged after evaluation, which included adjustments in medical therapy and intensive patient education. Patients were in New York Heart Association functional class III or IV (94 and 120 patients, respectively), with a mean left ventricular ejection fraction of 0.21, peak oxygen consumption of 11 ml/kg per min and a total of 429 hospital admissions in the previous 6 months (average 2.0 per patient). Changes in the medical regimen included a 98% increase in angiotensin-converting enzyme inhibitor dose and a flexible diuretic regimen after 4.2-liter net diuresis, with counseling also regarding diet and progressive exercise. RESULTS: During the 6 months after referral, there were only 63 hospital readmissions (85% reduction), with 0.29/patient (p < 0.0001). Functional status improved as assessed by functional class (p < 0.0001) and peak oxygen consumption (15.2 vs. 11.0 ml/kg per min, p < 0.001). The same results were seen after excluding the 35 patients without full 6-month follow-up (9 deaths, 14 urgent transplant procedures during hospital readmission, 12 elective transplant procedures from home); 34 hospital admissions occurred after referral, compared with 344 before referral. Even when adding in the initial hospital admission after referral for these 179 patients, there was a 35% decrease in total hospital admissions in the 6-month period. The estimated savings in hospital readmission costs after subtracting the initial hospital costs for management was $9,800 per patient. CONCLUSIONS: Comprehensive heart failure management led to improved functional status and an 85% decrease in the hospital admission rate for transplant candidates discharged after evaluation. The potential to reduce both symptoms and costs suggests that referral to a heart failure program may be appropriate not only for potential heart transplantation, but also for medical management of persistent functional class III and IV heart failure.

Comprehensive Health Care↗

PubMed2004

The effect of format modifications and reading comprehension on recall of informed consent information by low-income parents: a comparison of print, video, and computer-based presentations.

A randomized trial comparing the amount of knowledge orally recalled from four different presentations of the same consent information was conducted in a non-clinic sample of 233 low-income parents who displayed a range of reading comprehension skill. The study simulated recruitment of children into one of two actual studies underway at another location: one involved high risk to participants, the other did not. Use of a non-clinic sample controlled for prior knowledge of the conditions, and avoiding discussion of the information further assured that differences in recalled information could be attributed more confidently to the format itself. The formats included the original written forms, enhanced print (simpler language, topic headings, pictures), narrated videotapes, and self-paced PowerPoint presentations via laptop computer with bulleted print information, pictures, and narration. No format-related differences in recalled information were found in the full sample but for the 124 individuals with reading comprehension scores at or below the 8th grade level, the enhanced print version tended to be more effective than either the original form or the video. Across all formats, more information was recalled about the low-risk study. The findings emphasize the necessity for clinicians and researchers to verify understanding of consent information, especially when there is risk of reduced literacy skill. Reliance on video to convey information in preference to well-done print media appeared questionable.

Adult↗

PubMed1998

Effect of comprehensive care on pregnancy outcomes.

The purpose of the study was to compare pregnancy outcomes of low socioeconomic pregnant women receiving prenatal care at a prototype, comprehensive, multidisciplinary tertiary clinic with outcomes of a matched sample who received prenatal care from a variety of area public health clinics. Multidisciplinary clinic subjects were matched by age, race, and parity to 175 control subjects selected from labor and delivery logs of the general hospital that services the entire community. There were significant differences between groups on the measures of gestational age (t[174] = 2.50, p < .01), maternal risk factors (t[174] = 11.12, p < .0), and infant complications (t[174] = 5.86, p < .01). Infant birthweight and APGAR scores were not significantly different between the multidisciplinary clinic subjects and the matched sample. This study showed the importance of comprehensive prenatal care for low socioeconomic women at high risk for obstetrical and medical complications.

Adult↗

PubMed2003

Short-term semantic retention during on-line sentence comprehension. Brain potential evidence from filler-gap constructions.

In filler-gap sentences, a phrase ('filler') is separated by intervening words from a subsequent phrase ('gap') with which it is integrated. The filler-gap interval provides a useful model for the study of short-term retention processes during sentence comprehension. Kluender and Kutas [J. Cogn. Neurosci. 5 (1993) 29] used event-related brain potentials (ERPs) to show that a filler phrase places a demand on short-term retention processes in the filler-gap interval, but left the processing level at which this demand arises unspecified. Here we use ERPs to address the issue of whether the filler places a demand on the semantic component of short-term retention processes in the filler-gap interval. Participants read filler-gap sentences, which began with a filler phrase and, in the filler-gap interval, contained a subject and object that were either semantically related or unrelated. There was also a control condition in which the filler phrase was absent (i.e. less memory demand). The main result was that during the filler-gap interval, bilateral posterior electrodes displayed a larger positivity for unrelated than related words. Moreover, during the same interval, posterior electrodes displayed a larger positivity for filler-gap sentences than for control sentences. In the control condition (non-filler gap sentences), manipulation of semantic relatedness did not produce differences in ERP activity. Our results suggest that a filler phrase places a demand on the semantic component of verbal working memory during on-line sentence comprehension.

Adult↗

PubMed2002

An evaluation of the evidence base related to critical care outreach teams--2 years on from Comprehensive Critical Care.

It is now 2 years since the publication of Department of Health [Comprehensive Critical Care: A Review of Adult Critical Care Services (2000a)] document 'Comprehensive Critical Care'. One of its' main recommendations was the introduction of critical care outreach services. Many hospitals have since established such services and are providing education for ward nurses and house officers, and follow-up for patients discharged from intensive care when they return to a general ward. Early Warning Scoring (EWS) systems have also been introduced onto the wards to improve the identification of patients deteriorating into critical illness. However, as yet there appears to be little evidence that this investment has been worthwhile in terms of improving patient outcomes, such as reduction in cardiac arrests on the wards, reduction in unplanned admissions to critical care or earlier referrals to critical care. With many outreach teams hoping to expand their services in the future there is a pressing need to demonstrate an impact. We must remember however that some outreach teams have only been in post for 12 months and so it may therefore be far too early to reliably demonstrate any effect.

Aftercare↗

PubMed2003

Individual differences in rCBF correlates of syntactic processing in sentence comprehension: effects of working memory and speed of processing.

Positron emission tomography (PET) was used to determine the effect of working memory and speed of sentence processing on regional cerebral blood flow (rCBF) during syntactic processing in sentence comprehension. PET activity associated with making plausibility judgments about syntactically more complex subject-object (SO) sentences (e.g., The juice that the child spilled stained the rug) was compared to that associated with making judgments about synonymous syntactically simpler object-subject (OS) sentences (e.g., The child spilled the juice that stained the rug). Two groups of nine subjects differing in working memory and matched for speed of sentence processing both showed increases in rCBF in lateral posteroinferior frontal lobe bilaterally. The subjects were reclassified to form two groups of eight subjects who were matched for working memory but who differed in speed of sentence processing. Fast-performing subjects activated lateral posteroinferior frontal lobe bilaterally and slow-performing subjects showed activation of left superior temporal lobe. The results indicate that rCBF responses to syntactic comprehension tasks vary as a function of speed of sentence processing but not as a function of working memory.

Adult↗

PubMedDate not supplied

Comprehensive care and the sanatoria: Cuba's response to HIV/AIDS.

The authors present an overview of Cuba's response to HIV/AIDS including: (a) the development of comprehensive health care in Cuba; (b) the epidemiology of AIDS in Cuba; (c) the sanatoria approach to treatment and recent changes; (d) the idea of comprehensive HIV/AIDS care as a basic human right; (e) the effects of the special period on the HIV/AIDS program and containment of the epidemic; and (f) a critique of Cuba's HIV/AIDS program.

Acquired Immunodeficiency Syndrome↗

PubMed2001

A comprehensive inner-city asthma program reduces hospital and emergency room utilization.

OBJECTIVE: To evaluate the efficacy of a comprehensive asthma program on emergency department (ED) visits and hospital admission rates in an inner-city pediatric population. DESIGN: A12-month prospective randomized trial. METHODS: Three hundred asthma patients, ages 2 to 17 years, were recruited and randomized in an inner-city pediatric ED, to obtain asthma care in a specialty clinic or to continue receiving care by other health resources. The specialty clinic provided intensive medical and environmental control, education, close monitoring, and 24-hour availability. For the prospective study, monthly questionnaires were sent to the caregivers of these children to evaluate use of hospital facilities for asthma care. For the retrospective study, use of hospital resources by the study participants was analyzed using a hospital database. RESULTS: One hundred twenty-nine patients (60 in the treatment group and 69 in the control group) were included in the final analysis. Asthma severity index was significantly higher for the patients in the treatment versus the control group (35% versus 16.2%, P = .05). Fewer patients in the treatment group visited the ED at least once during the first study year, 32 versus 46, (P = .11), and they made fewer visits, 73 versus 269. The mean number of ED visits of the patients who used the ED was 0.1 versus 0.326 for the control group (P = .01). There were also fewer admissions in the treatment group, 22 versus 29 (P < .59). The 53 patients remaining in the treatment group in the second study year made fewer visits to the ED versus the control group (P < .03). In comparison to the first year, fewer patients in the treatment group visited the ED or were hospitalized in the second year (P = .007 and P = .04, respectively). CONCLUSIONS: A comprehensive asthma care program is efficacious in reducing hospital utilization.

Adolescent↗

PubMed2000

Initial extractions and tooth loss during supportive care in a periodontal population seeking comprehensive care.

BACKGROUND/AIMS: This retrospective survey was aimed at determining the prevalence of tooth extractions and the dental pathologies associated with them during both the active and maintenance phase of periodontal therapy in a periodontal population seeking comprehensive dental care. METHODS: A total of 273 randomly selected subjects from the oral prophylaxis clinic of the University of Berne were included. All subjects had received comprehensive care consisting of periodontal and restorative treatment and participated in a supervised maintenance program for an average of 67+/-46 months (range 5 to 278 months). The population consisted of 39.6% current smokers and 27.8% previous smokers. 6.2% of the patients had gingivitis, 20.5% mild periodontitis, 48.4% moderate and 24.9% severe periodontitis. The average frequency of the recall visits was 4.4+/-1.5 appointments/year (range 1.7-12 appointments/year). RESULTS: Results indicated that 574 out of a total of 6503 teeth were extracted; 311 teeth were extracted during active therapy and 263 during the supportive periodontal care (SPC) phase of therapy. 46% of patients received tooth extractions as part of their active treatment and 41% during their participation in the secondary prevention program. In the subgroup whose treatment plan included extractions the average number was 2.5+/-1.6 teeth per patient. Likewise, the patients who received extractions during recall lost an average of 2.35+/-1.9 teeth per subject with an incidence of 0.4+/-0.37 teeth per patient per year. These data reinforce the concept that a minority of the population is responsible for the majority of tooth extractions, both during active therapy and SPC. Periodontal disease was the only pathology observed at 57% of the extracted teeth; while caries, endodontic pathology and technical problems in the absence of periodontitis were observed in 29% of cases. CONCLUSIONS: These observations indicate that the rendered treatment was effective in the long-term maintenance of the dentition of these subjects and suggest that advanced periodontal disease represented the major cause of tooth loss in this population.

Adolescent↗

PubMed2005

Children's mental health as a primary care and concern: a system for comprehensive support and service.

In response to the serious crisis in mental health care for children in the United States, this article proposes as a priority for psychology a comprehensive approach that treats mental health as a primary issue in child health and welfare. Consistent with the principles of a system of care and applying epidemiological, risk-development, and intervention-research findings, this approach emphasizes 4 components: easy access to effective professional clinical services for children exhibiting disorders; further development and application of sound prevention principles for high-risk youths; support for and access to short-term intervention in primary care settings; and greater recognition and promotion of mental health issues in common developmental settings and other influential systems. Integral to this approach is the need to implement these components simultaneously and to incorporate family-focused, culturally competent, evidence-based, and developmentally appropriate services. This comprehensive, simultaneous, and integrated approach is needed to achieve real progress in children's mental health in this country.

Adolescent↗

PubMed2006

How does the brain support script comprehension? A study of executive processes and semantic knowledge in dementia.

The neuropsychological substrate of scripts, routines which guide much of human behavior, is unclear. We propose a model of script comprehension characterized by the interaction of semantic knowledge for script content, and executive resources that organize this knowledge into goal directed behavior. We examined these neuropsychological components by asking participants with Alzheimer's disease (AD) and frontotemporal dementia (behavioral disorder/dysexecutive syndrome (BDD) and semantic dementia (SD) subtypes), to judge the coherence of four-phrase scripts. The BDD group detected significantly fewer sequencing errors than semantic errors; the AD and SD groups detected these errors with equal frequency. Independent semantic measures predicted both semantic and sequencing script errors, while executive measures predicted sequencing errors only. Findings support a multi-component model of script comprehension.

Aged↗

PubMed2004

Reasoning, integration, inference alteration, and text comprehension.

This paper reports how the study of formal logical reasoning provides insight into more everyday types of reasoning, such as that involved in language comprehension. Both of these types of cognition are thought to involve the use of mental models, and so it is reasonable to think that the cognitive operations needed for formal logical reasoning would be involved in everyday reasoning as well. We focused on three aspects of formal reasoning: (a) the integration of information into a common mental model, (b) the drawing of inferences, and (c) the coordination of alternative possibilities. We were able to show that the integration and inference components were related to narrative comprehension processes, but the coordination of alternative models was not. Thus, there is evidence for some overlap in the mental processes used in formal and everyday reasoning. This further justifies the study of formal logical reasoning as a window into certain types of everyday reasoning.

Analysis of Variance↗