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Cultural sensitivity in public health: defined and demystified.

There is consensus that health promotion programs should be culturally sensitive (CS). Yet, despite the ubiquitous nature of CS within public health research and practice, there has been surprisingly little attention given to defining CS or delineating a framework for developing culturally sensitive programs and practitioners. This paper describes a model for understanding CS from a public health perspective; describes a process for applying this model in the development of health promotion and disease prevention interventions; and highlights research priorities. Cultural sensitivity is defined by two dimensions: surface and deep structures. Surface structure involves matching intervention materials and messages to observable, "superficial" characteristics of a target population. This may involve using people, places, language, music, food, locations, and clothing familiar to, and preferred by, the target audience. Surface structure refers to how well interventions fit within a specific culture. Deep structure involves incorporating the cultural, social, historical, environmental and psychological forces that influence the target health behavior in the proposed target population. Whereas surface structure generally increases the "receptivity" or "acceptance" of messages, deep structure conveys salience. Techniques, borrowed from social marketing and health communication theory, for developing culturally sensitive interventions are described. Research is needed to determine the effectiveness of culturally sensitive programs.

Black or African American↗

From computing with numbers to computing with words. From manipulation of measurements to manipulation of perceptions.

Interest in issues relating to consciousness has grown markedly during the last several years. And yet, nobody can claim that consciousness is a well-understood concept that lends itself to precise analysis. It may be argued that, as a concept, consciousness is much too complex to fit into the conceptual structure of existing theories based on Aristotelian logic and probability theory. An approach suggested in this paper links consciousness to perceptions and perceptions to their descriptors in a natural language. In this way, those aspects of consciousness which relate to reasoning and concept formation are linked to what is referred to as the methodology of computing with words (CW). Computing, in its usual sense, is centered on manipulation of numbers and symbols. In contrast, computing with words, or CW for short, is a methodology in which the objects of computation are words and propositions drawn from a natural language (e.g., small, large, far, heavy, not very likely, the price of gas is low and declining, Berkeley is near San Francisco, it is very unlikely that there will be a significant increase in the price of oil in the near future, etc.). Computing with words is inspired by the remarkable human capability to perform a wide variety of physical and mental tasks without any measurements and any computations. Familiar examples of such tasks are parking a car, driving in heavy traffic, playing golf, riding a bicycle, understanding speech, and summarizing a story. Underlying this remarkable capability is the brain's crucial ability to manipulate perceptions--perceptions of distance, size, weight, color, speed, time, direction, force, number, truth, likelihood, and other characteristics of physical and mental objects. Manipulation of perceptions plays a key role in human recognition, decision and execution processes. As a methodology, computing with words provides a foundation for a computational theory of perceptions: a theory which may have an important bearing on how humans make--and machines might make--perception-based rational decisions in an environment of imprecision, uncertainty, and partial truth. A basic difference between perceptions and measurements is that, in general, measurements are crisp, whereas perceptions are fuzzy. One of the fundamental aims of science has been and continues to be that of progressing from perceptions to measurements. Pursuit of this aim has led to brilliant successes. We have sent men to the moon; we can build computers that are capable of performing billions of computations per second; we have constructed telescopes that can explore the far reaches of the universe; and we can date the age of rocks that are millions of years old. But alongside the brilliant successes stand conspicuous underachievements and outright failures. We cannot build robots that can move with the agility of animals or humans; we cannot automate driving in heavy traffic; we cannot translate from one language to another at the level of a human interpreter; we cannot create programs that can summarize non-trivial stories; our ability to model the behavior of economic systems leaves much to be desired; and we cannot build machines that can compete with children in the performance of a wide variety of physical and cognitive tasks. It may be argued that underlying the underachievements and failures is the unavailability of a methodology for reasoning and computing with perceptions rather than measurements. An outline of such a methodology--referred to as a computational theory of perceptions--is presented in this paper. The computational theory of perceptions (CTP) is based on the methodology of CW. In CTP, words play the role of labels of perceptions, and, more generally, perceptions are expressed as propositions in a natural language. CW-based techniques are employed to translate propositions expressed in a natural language into what is called the Generalized Constraint Language (GCL). In this language, the meaning of a proposition is expressed as a generalized constraint, X isr R, where X is the constrained variable, R is the constraining relation, and isr is a variable copula in which r is an indexing variable whose value defines the way in which R constrains X. Among the basic types of constraints are possibilistic, veristic, probabilistic, random set, Pawlak set, fuzzy graph, and usuality. The wide variety of constraints in GCL makes GCL a much more expressive language than the language of predicate logic. In CW, the initial and terminal data sets, IDS and TDS, are assumed to consist of propositions expressed in a natural language. These propositions are translated, respectively, into antecedent and consequent constraints. Consequent constraints are derived from antecedent constraints through the use of rules of constraint propagation. The principal constraint propagation rule is the generalized extension principle. (ABSTRACT TRUNCATED)

Consciousness↗

Updating the nurse's bedside manner.

The current tendency for nurses to be on a first name basis with their patients and to wear less professional clothing provides new metaphors for interpreting nurses' work status. We argue that this prevailing social informality in communications and dress perpetuates themes that diminish the professional image of nurses, masks the cognitive nature of their work, threatens nurses' therapeutic effectiveness, and continues to reinforce the hierarchical relationship between nurses and physicians. Strategies are presented to help nurse educators, administrators, and clinicians transform nurses' work environments into clinical settings that enhance their professional presentation.

Clothing↗

Discourse deficits following right hemisphere damage in deaf signers.

Previous findings have demonstrated that hemispheric organization in deaf users of American Sign Language (ASL) parallels that of the hearing population, with the left hemisphere showing dominance for grammatical linguistic functions and the right hemisphere showing specialization for non-linguistic spatial functions. The present study addresses two further questions: first, do extra-grammatical discourse functions in deaf signers show the same right-hemisphere dominance observed for discourse functions in hearing subjects; and second, do discourse functions in ASL that employ spatial relations depend upon more general intact spatial cognitive abilities? We report findings from two right-hemisphere damaged deaf signers, both of whom show disruption of discourse functions in absence of any disruption of grammatical functions. The exact nature of the disruption differs for the two subjects, however. Subject AR shows difficulty in maintaining topical coherence, while SJ shows difficulty in employing spatial discourse devices. Further, the two subjects are equally impaired on non-linguistic spatial tasks, indicating that spared spatial discourse functions can occur even when more general spatial cognition is disrupted. We conclude that, as in the hearing population, discourse functions involve the right hemisphere; that distinct discourse functions can be dissociated from one another in ASL; and that brain organization for linguistic spatial devices is driven by its functional role in language processing, rather than by its surface, spatial characteristics.

Aged↗

Qualitative modelling of the response of cytoskeletal actin filaments in endothelial cells subjected to shear stress.

An approach to modelling cytoskeletal function based on qualitative process theory and qualitative algebra is presented. A computer environment for qualitative modelling and simulation of physical systems, specifically oriented to the construction of biomedical knowledge bases, is used. The system that is being set up for the cytoskeleton is intended to serve as a tool for testing assumptions about cytoskeletal function, for the evaluation of experimental data and for planning experimental work. The aspects of cytoskeletal function that have been modelled so far are focal adhesion and the reorganisation of the vascular endothelial cell cytoskeleton in response to fluid-imposed shear stress. Starting from a natural language description, the subsequent levels of analysis leading to the formal structural description and the resulting implementation for these aspects within the development environment are presented.

Actins↗

Converging evidence in support of common dynamical principles for speech and movement coordination.

We suggest that a principled analysis of language and action should begin with an understanding of the rate-dependent, dynamical processes that underlie their implementation. Here we present a summary of our ongoing speech production research, which reveals some striking similarities with other work on limb movements. Four design themes emerge for articulatory systems: 1) they are functionally rather than anatomically specific in the way they work; 2) they exhibit equifinality and in doing so fall under the generic category of a dynamical system called point attractor; 3) across transformations they preserve a relationally invariant topology; and 4) this, combined with their stable cyclic nature, suggests that they can function as nonlinear, limit cycle oscillators (periodic attractors). This brief inventory of regularities, though not mean to be inclusive, hints strongly that speech and other movements share a common, dynamical mode of operation.

Animals↗

Carbon - the first frontier of information processing.

Information is often encoded as an aperiodic chain of building blocks. Modern digital computers use bits as the building blocks, but in general the choice of building blocks depends on the nature of the information to be encoded. What are the optimal building blocks to encode structural information? This can be analysed by substituting the operations of addition and multiplication of conventional arithmetic with translation and rotation. It is argued that at the molecular level, the best component for encoding discretized structural information is carbon. Living organisms discovered this billions of years ago, and used carbon as the back-bone for constructing proteins that function according to their structure. Structural analysis of polypeptide chains shows that an efficient and versatile structural language of 20 building blocks is needed to implement all the tasks carried out by proteins. Properties of amino acids indicate that the present triplet genetic code was preceded by a more primitive one, coding for 10 amino acids using two nucleotide bases.

Amino Acid Sequence↗

Pantomimes are special gestures which rely on working memory.

The case of a patient is reported who presented consistently with overt deficits in producing pantomimes in the absence of any other deficits in producing meaningful gestures. This pattern of spared and impaired abilities is difficult to reconcile with the current layout of cognitive models for praxis. This patient also showed clear impairment in a dual-task paradigm, a test taxing the co-ordination aspect of working memory, though performed normally in a series of other neuropsychological measures assessing language, visuo-spatial functions, reasoning function, and executive function. A specific working memory impairment associated with a deficit of pantomiming in the absence of any other disorders in the production of meaningful gestures suggested a way to modify the model to account for the data. Pantomimes are a particular category of gestures, meaningful, yet novel. We posit that by their very nature they call for the intervention of a mechanism to integrate and synthesise perceptual inputs together with information made available from the action semantics (knowledge about objects and functions) and the output lexicon (stored procedural programmes). This processing stage conceived as a temporary workspace where gesture information is actively manipulated, would generate new motor programmes to carry out pantomimes. The model of gesture production is refined to include this workspace.

Aged↗

Learning fuzzy decision trees.

We present a recurrent neural network which learns to suggest the next move during the descent along the branches of a decision tree. More precisely, given a decision instance represented by a node in the decision tree, the network provides the degree of membership of each possible move to the fuzzy set z.Lt;good movez.Gt;. These fuzzy values constitute the core of the probability of selecting the move out of the set of the children of the current node.This results in a natural way for driving the sharp discrete-state process running along the decision tree by means of incremental methods on the continuous-valued parameters of the neural network. The bulk of the learning problem consists in stating useful links between the local decisions about the next move and the global decisions about the suitability of the final solution. The peculiarity of the learning task is that the network has to deal explicitly with the twofold charge of lighting up the best solution and generating the move sequence that leads to that solution. We tested various options for the learning procedure on the problem of disambiguating natural language sentences.

Journal Article↗

Correlations of functional capacity and neuropsychological performance in older patients with schizophrenia: evidence for specificity of relationships?

BACKGROUND: Neuropsychological (NP) performance is a consistent correlate of everyday functioning in schizophrenia, but it is unclear whether relationships between individual NP ability areas and domains of everyday functioning are general or specific. Assessments of real-world everyday functioning may be influenced by environmental and social factors (e.g., social security, disability status, opportunities and restrictions in living situations). This study examined the specificity of the relationships between different NP abilities and performance-based measures of social and living skills. METHODS: 181 ambulatory older (age>50) patients with schizophrenia were examined with NP tests measuring episodic and working memory, executive functioning, verbal fluency, and processing speed. All subjects performed tasks examining social (Social Skills Performance Assessment: SSPA) and everyday living (UCSD Performance Based Skills Assessment: UPSA) skills. RESULTS: Using canonical analysis, the NP variables were used to predict the functional capacity measures. The analysis found that 37% of the variance in the functional capacity and NP measures was shared, X(2) (54)=106.29, p<.001. Two canonical roots described the cognitive variables and the roots were differentially associated with everyday living and social skills. The root loading on processing speed, episodic memory, and executive functions were associated with UPSA scores, while the root loading on working and episodic memory and verbal fluency were associated most strongly with social competence. IMPLICATIONS: Social and everyday living skills deficits in patients with schizophrenia may reflect generally independent domains of functional outcome, linked through cognitive performance. The data suggest that somewhat different cognitive processes are associated with these two domains of functional capacity, although there appears to be some overlap, which may be due to the nature of the NP tests employed.

Activities of Daily Living↗

The development of walking: new findings and old assumptions.

I have argued that a behavioral-cognitive perspective may shed light on some aspects of motor development generally, and unaided walking, specifically. Individual components of walking-stepping, standing, and placing, for example-are present at birth and can be maintained with practice. Moreover, consistent use can produce an earlier onset of unaided walking. Nonetheless, independent erect locomotion rarely occurs before about 9 months in most societies, implying that there is a maturational constraint. Independent research on changes in the quality of object use imply that the maturational limitation may be cognitive, in part. Changes in motor development-both the onset of unaided walking and the emergence of functional use-may be dictated by an underlying change in information processing ability. It is hypothesized that the infant's capacity to generate ideas or access different associations from memory rapidly may define the nature of this change. Improved access to memory may permit the necessary integrative capacity for balance and coordination to occur, thereby permitting unaided walking to develop. Weiss and Zelazo found that the capacity to perform two distinct actions in rapid succession in an independent environment-water-also appears to emerge from about 9 through 12 months. Not only may a cognitive change influence motor development, but mental and motor ability may develop asynchronously in some instances-a particularly important implication for developmental assessment. Procedures to distinguish information processing ability independent of gross and fine motor measures and productive language can lead to treatment that will reduce delays on conventional tests and contribute to the validity of this argument.

Journal Article↗

The hidden truths of the belly: the uncertainties of pregnancy in early modern Europe. (Society for the Social History of Medicine Student Prize Essay 1999, runner-up.).

For early modern men and women and their medical practitioners, the experience and understanding of pregnancy was primarily uncertain. This uncertainty extended to the whole process of pregnancy--from the moment of conception to delivery, the detection and bearing of a 'true fruit' was doubtful. This 'uncertainty' was heightened by the fact that both body and language could conceal the truth. The woman herself was frequently uncertain and could be mistaken in her interpretation of the condition of her belly. This ambiguity is expressed in the vague and faltering language used to describe such experiences. Women's bodies were believed to conceal the truth more readily than their male counterparts. Equally a woman's physical narrative was more likely to be distrusted. Tensions surrounding the appropriate nature of women's 'knowledge' of such hidden 'secrets' also affected the ways in which women and their practitioners described the 'truths' of the belly. This article traces the ambiguities faced by women and their midwives/accoucheurs through three areas of pregnancy: quickening, false conceptions, and the threat of miscarriage. The much-neglected source of medical texts and observations is drawn upon, alongside letters and diaries and judicial material.

Diagnosis↗

Fundamental nature of human infant's brain asymmetry.

Morphological speech zone asymmetry in man cannot be due to environmental or developmental factors after birth. The functional implication of such a finding is not yet clear. Morphological asymmetry of the human brain is paralleled by electrophysiological evidence of cerebral hemispheric asymmetries. The results of our analysis of 50 infants suggest that clear occipital-temporal coherency asymmetry similar, but not identical to the adult pattern, also exists at or near birth. These asymmetries are generated by stimuli with no verbal content and in infants who presumably have no or an undeveloped capability for language. It is suggested that language is only a part of much more fundamental asymmetries which include the processing of auditory and visual information. Our results, and those of other, are consistent with the assumption that the left hemisphere is more able to relate stimuli to past experience, either short or long-term, while the right hemisphere is more able to process, stimuli which are not easily identifiable or referable. These capabilities would not be based on language, and hence would be expected to develop independently and possibly before speech. The demonstration that reversing electrophysiological asymmetries can be generated with non-speech stimuli in the visual and auditory modalities, and in neonates, supports such an assumption.

Acoustic Stimulation↗

Tangled webs: tracing the connections between genes and cognition.

The rise of molecular genetics is having a pervasive influence in a wide variety of fields, including research into neurodevelopmental disorders like dyslexia, speech and language impairments, and autism. There are many studies underway which are attempting to determine the roles of genetic factors in the aetiology of these disorders. Beyond the obvious implications for diagnosis, treatment and understanding, success in these efforts promises to shed light on the links between genes and aspects of cognition and behaviour. However, the deceptive simplicity of finding correlations between genetic and phenotypic variation has led to a common misconception that there exist straightforward linear relationships between specific genes and particular behavioural and/or cognitive outputs. The problem is exacerbated by the adoption of an abstract view of the nature of the gene, without consideration of molecular, developmental or ontogenetic frameworks. To illustrate the limitations of this perspective, I select two cases from recent research into the genetic underpinnings of neurodevelopmental disorders. First, I discuss the proposal that dyslexia can be dissected into distinct components specified by different genes. Second, I review the story of the FOXP2 gene and its role in human speech and language. In both cases, adoption of an abstract concept of the gene can lead to erroneous conclusions, which are incompatible with current knowledge of molecular and developmental systems. Genes do not specify behaviours or cognitive processes; they make regulatory factors, signalling molecules, receptors, enzymes, and so on, that interact in highly complex networks, modulated by environmental influences, in order to build and maintain the brain. I propose that it is necessary for us to fully embrace the complexity of biological systems, if we are ever to untangle the webs that link genes to cognition.

Autistic Disorder↗

The language environment of the young infant: implications for early perceptual development.

The purpose of this article is to review recent research on the young infant's use of voice-specific as well as voice-nonspecific auditory information during early language processing, to suggest a possible mechanism that biases the young infant towards this information, and to discuss potential implications of the early saliency of this information for later language development. Auditory preferences expressed by young infants are of interest because they demonstrate which properties of complex auditory events are effective in capturing the infant's attention. Moreover, the presence of such auditory preferences has led to speculations about their possible origins in both pre- and postnatal auditory experience. Research examining the role of early auditory experience in the formation of preferences is presented, along with a discussion of how the constrained nature of early auditory experience (particularly prenatal) may bias the young infant towards specific features of maternal as well as nonmaternal speech.

Arousal↗

Interferometers and decoherence matrices

It is shown that the Lorentz group is the natural language for two-beam interferometers if there are no decoherence effects. This aspect of the interferometer can be translated into six-parameter representations of the Lorentz group, as in the case of polarization optics where there are two orthogonal components of one light beam. It is shown that there are groups of transformations which leave the coherency or density matrix invariant, and this symmetry property is formulated within the framework of Wigner's little groups. An additional mathematical apparatus is needed for the transition from a pure state to an impure state. Decoherence matrices are constructed for this process, and their properties are studied in detail. Experimental tests of this symmetry property are possible.

Journal Article↗

Speech perception in perceivers with hearing loss: synergy of multiple modalities.

Although we would expect that the role of visible speech in multimodal speech perception would have the greatest relevance to individuals with hearing impairment, relatively few analytic studies have been done with these participants. Their adequate understanding of spoken language usually requires information from several modalities or other sources of information. The framework of the fuzzy logical model of perception (FLMP) is used to assess how individuals with hearing impairment evaluate and integrate multiple sources of information. Given this framework, a distinction can be made between information and information processing. Within this framework, we can ask what information differences and information-processing differences exist among individuals with normal hearing and those with hearing impairment. Four experimental studies from the literature are analyzed to address these questions. Test items are presented under both unimodal and bimodal conditions. Of central interest is the nature of the bimodal performance as a function of the unimodal performance. The findings show that, although information differences obviously exist across different populations, their information processing involved in pattern recognition appears to be the same and is well described by the FLMP.

Adolescent↗

Using cross-modal lexical decision tasks to investigate sentence processing.

Recent investigations of sentence processing have used the cross-modal lexical decision task to show that the antecedent of a phonologically empty noun phrase (specifically, WH-trace) is reactivated at the trace position. G. McKoon, R. Ratcliff, and G. Ward (1994) claimed that (a) a design feature concerning the choice of related and unrelated targets is a possible confound in this work and (b) the conclusions drawn from this previous research are therefore called into question. These claims are considered in light of both McKoon et al.'s experimental findings and results of our own experiments in which we test their linguistic materials. We argue that their results may be due to the nature of their materials. Additionally, we argue that a follow-up experiment reported by G. McKoon and R. Ratcliff (1994) used a technique that is not comparable to the cross-modal lexical decision task. It is concluded that current evidence supports the claim that structural information is using during on-line sentence processing and that the cross-modal technique is sensitive to this.

Cognition↗