How Chronic Pain Patients' and Physicians' Communication Influences Patients' Uncertainty: A Pre- and Post-Consultation Study.

Chronic pain is a health problem that is difficult to diagnose, treat, and manage, partly owing to uncertainty surrounding ambiguous causes, few treatment options, and frequent misunderstandings in clinical encounters. Pairing uncertainty management theory with medical communication competence, we predicted that both physicians and patients are influential to patients' uncertainty appraisals and uncertainty management. We collected pre- and post-consultation data from 200 patients with chronic neck and spine/back pain and their physicians. Patients' reports of their physician's communication were a consistent predictor of their post-consultation uncertainty outcomes. Physicians' reports of both their own and patients' communication competence were associated with patients' positive uncertainty appraisals. Physicians' reports of patients' communication competence were also associated with reductions in patients' uncertainty. Findings illustrate how both interactants' perceptions of communication competence-how they view their own (for physicians) and the other's-are associated with patients' post-consultation outcomes.

Healing Health Care Disparities: Development and Pilot Testing of a Virtual Reality Implicit Bias Training Module for Physicians in the Context of Black Maternal Health.

Grounded in communication models of cultural competence, this study reports on the development and testing of the first module in a larger virtual reality (VR) implicit bias training for physicians to help them better: (a) recognize implicit bias and its effects on communication, patients, and patient care; (b) identify their own implicit biases and exercise strategies for managing them; and (c) learn and practice communicating with BIPOC patients in a culture-centered manner that demonstrates respect and builds trust. Led by communication faculty, a large, interdisciplinary team of researchers, clinicians, and engineers developed the first module tested herein focused on training goal (a). Within the module, participants observe five scenes between patient Marilyn Hayes (a Black woman) and Dr. Richard Flynn (her obstetrician, a White man) during a postpartum visit. The interaction contains examples of implicit bias, and participants are asked to both identify and consider how implicit bias impacts communication, the patient, and patient care. The team recruited 30 medical students and resident physicians to participate in a lab-based study that included a pretest, a training experience of the module using a head-mounted VR display, and a posttest. Following the training, participants reported improved attitudes toward implicit bias instruction, greater importance of determining patients' beliefs and perspectives for history-taking, treatment, and providing quality health care; and greater communication efficacy. Participants' agreement with the importance of assessing patients' perspectives, opinions, and psychosocial and cultural contexts did not significantly change. Implications for medical education about cultural competency and implicit bias are discussed.

When Native Speakers Are Not "Native-Like:" Chunking Ability Predicts (Lack of) Sensitivity to Gender Agreement During Online Processing.

Previous work on individual differences has revealed limitations in the ability of existing measures (e.g., working memory) to predict language processing. Recent evidence suggests that an individual's sensitivity to detect the statistical regularities present in language (i.e., "chunk sensitivity") may significantly modulate online sentence processing. We investigated whether individual chunk sensitivity predicted the online processing of gender cues, a core linguistic feature of Spanish. In a self-paced reading task, we examined native speakers' processing of relative clauses in which gender cues were variably exploited to induce processing costs. Even after considering the effect of working memory and cognitive control, the results revealed a significant effect of chunking ability in modulating online sentence processing. Critically, higher-chunking ability speakers' reading times showed online sensitivity to core linguistic cues online; while low-chunking ability readers showed no sensitivity to manipulations, indicating shallow real-time processing of their native language.

Challenges to the Educational "Digital Divide" in Spanish Prisons.

Education within prisons is one of the most complex scenarios in the field of education in Spain. Education is conceived in spatial and temporal coordinates that are totally alien to life in prison and often clash with economic or security and order-related contraindications that frustrate the right to education in the twenty-first century. This is an education that cannot be unconnected with digital competition, and one of its aims is to eliminate the "digital divide". On the one hand, it has been analysed by the Spanish and European authorities that there is a need for education to respond to the challenges of today's society, which is characterised by having moved from the analogue era to the digital era. This digital drive is designed to limit social differences. On the other hand, Spanish prison legislation guarantees the right to education, but without forgetting the special circumstances limiting rights in prisons. In Spain, the 1996 regulation does not seem to be able to respond to the existing difficulties, since its wording has become obsolete on this point. In this regard, the Council of Europe recalled different aspects which lead us to question how the right to comprehensive education should be skilfully combined with that of the restrictions specific to the prison environment. The study of these two aspects leads to the conclusion that it is a difficult challenge. The administration must therefore seek a fair balance between the public policy objectives pursued and respect for the rights of persons deprived of their liberty.

Denying and Accepting a Family Member's Illness: Uncertainty Management as a Process.

Doubt is a common, yet challenging form of uncertainty to have about another's illness. Although navigating illness uncertainty is a process of continual (re)appraisal and management, existing research narrowly examines windows of uncertainty experience. To illustrate how uncertainty management in the context of doubt is recursive, nonlinear, and ongoing, we apply a process approach to communication to uncertainty management theory. Drawing on interviews with 33 U.S. adults, our findings explicate a prominently teleological (i.e., goal-driven) process wherein participants' uncertainty management served to accept or deny illness, depending on the extent individuals valued their own and the other's identity and the relationship. Participants generally moved through this process along one of three trajectories: growth, stagnation, or resentment. We also observed dialectical, evolutionary, and life cycle processes in the data. Findings demonstrate the heuristic value of studying uncertainty management as a multiple motor process.

La dimensión espiritual en el anciano desde el modelo de la gerotrascendencia y su abordaje desde la terapia ocupacional: revisión bibliográfica / A dimensão espiritual nos idosos a partir do modelo de gerotranscendência e sua abordagem a partir da terapia ocupacional: uma revisão da literatura / The spiritual dimension in the elderly from the model of gerotranscendence and its approach from Occupational Therapy: a literature review

Resumen Introducción El campo de estudio del envejecimiento conoce un marco teórico conocido como gerotrascendencia. La gerotrascendencia entiende la vejez como la etapa final de una progresión natural que lleva a alcanzar la madurez y la sabiduría. La ancianidad es, así, una etapa de introspección entendida como espiritualidad que se explica también en un contexto religioso. Objetivo Comprobar desde la literatura científica la implementación de la gerotrascendencia y sus aspectos fundamentales en el marco de la terapia ocupacional. Metodología Estudio bibliográfico ejecutado por un estudio previo de Google Trends para conocer el tráfico de datos. Su usan bases de datos especializadas en ciencias de la salud (Pubmed, Medline, EMBASE, CINAHL complete, LILACS, Medes, CUIDENplus, Cuidatge, Cochrane Library, Trip medical database, Epistemonikos e IBECS), en el área de psicología (Psicodoc, PsycArticles, PsycBooks, PsycInfo y Psychology and Behavioral Sciences Collection), y multidisciplinares (Google Scholar, Web of Science y Scopus) a partir de una exploración booleana/frase (operadores: AND, OR, NOT). Se utilizan los tesauros especializados (MeSH, DeCS y HONselect) usando palabras clave en español e inglés: gerotrascendencia, enfermería, terapia ocupacional. El uso de bases de datos y un sistema de cribado basado en objetivos da como resultado el estudio especifico de seis artículos. Resultados La gerotrascendencia conoce una bibliografía consolidada en inglés, pero que es casi inexistente en español. De entre los estudios en español existen estudios sólidos con resultados que plantean una alternativa a los modelos materialistas que plantean un enfoque que se reducen al paradigma biomédico. Estos estudios plantean una ética de las necesidades y un enfoque centrado en la atención al usuario, donde la espiritualidad (religión interna) y su vivencia religiosa externa tienen una gran importancia. Conclusión La terapia ocupacional no puede olvidar los modelos teóricos centrados en la persona, de modo que puedan salir del corsé biomédico, al que pertenecen, pero al que no se reducen. Parece necesario realizar más abordajes teóricos y estudios cuantitativos y cualitativos que revelen la operatividad de la implementación de modelos que entiendan la fenomenología del envejecimiento de forma holística, como es el caso de la gerotrascendencia.

Resumo Introdução O campo de estudo do envelhecimento está familiarizado com uma estrutura teórica conhecida como gerotranscendência. A gerotranscendência entende a velhice como o estágio final de uma progressão natural em direção à maturidade e à sabedoria. A velhice é, portanto, um estágio de introspecção entendido como espiritualidade que também é explicada em um contexto religioso. Objetivo Verificar na literatura científica a implementação da gerotranscendência e seus aspectos fundamentais no âmbito da terapia ocupacional. Metodologia Estudo bibliográfico realizado por um estudo prévio do Google Trends para conhecer o tráfego de dados. Utiliza bases de dados especializadas em ciências da saúde (Pubmed, Medline, EMBASE, CINAHL complete, LILACS, Medes, CUIDENplus, Cuidatge, Cochrane Library, Trip medical database, Epistemonikos e IBECS), na área de psicologia (Psicodoc, PsycArticles, PsycBooks, PsycInfo e Psychology and Behavioral Sciences Collection) e multidisciplinar (Google Scholar, Web of Science e Scopus) com base em uma exploração booleana/frase (operadores: AND, OR, NOT). São usados tesauros especializados (MeSH, DeCS e HONselect) usando palavras-chave em espanhol e inglês: gerotranscendência, enfermagem, terapia ocupacional. O uso de bancos de dados e um sistema de triagem baseado em metas resulta no estudo específico de seis artigos. Resultados A gerotranscendência tem uma bibliografia consolidada em inglês, mas é quase inexistente em espanhol. Entre os estudos em espanhol, há estudos sólidos com resultados que propõem uma alternativa aos modelos materialistas que propõem uma abordagem que se reduz ao paradigma biomédico. Esses estudos propõem uma ética das necessidades e uma abordagem centrada no usuário, em que a espiritualidade (religião interna) e a experiência religiosa externa são de grande importância. Conclusão A terapia ocupacional não pode se esquecer dos modelos teóricos centrados na pessoa, para que ela possa sair do espartilho biomédico, ao qual pertence, mas ao qual não se reduz. Parece necessário realizar mais abordagens teóricas e estudos quantitativos e qualitativos que revelem a operacionalidade da implementação de modelos que compreendam a fenomenologia do envelhecimento de forma holística, como é o caso da gerotranscendência.

Abstract Introduction The field of the study of ageing is familiar with a theoretical framework known as gerotranscendence. Gerotranscendence understands old age as the final stage of a natural progression towards maturity and wisdom. Old age is thus a stage of introspection understood as spirituality explained in a religious context. Objective To verify from the scientific literature the implementation of gerotranscendence and its fundamental aspects within the occupational therapy framework. Methodology Bibliographic study carried out by a previous study of Google Trends to know the data traffic. It uses databases specialised in health sciences (Pubmed, Medline, EMBASE, CINAHL complete, LILACS, Medes, CUIDENplus, Cuidatge, Cochrane Library, Trip medical database, Epistemonikos and IBECS) in the area of psychology (Psicodoc, PsycArticles, PsycBooks, PsycInfo and Psychology and Behavioral Sciences Collection), and multidisciplinary (Google Scholar, Web of Science and Scopus) based on a Boolean/phrase exploration (operators: AND, OR, NOT). Specialised thesauri (MeSH, DeCS and HONselect) are used using keywords in Spanish and English: gerotranscendence, nursing, and occupational therapy. The use of databases and a target-based screening system results in the specific study of six articles. Results Gerotranscendence has a consolidated bibliography in English but is almost nonexistent in Spanish. Among the studies in Spanish, there are solid studies with results that propose an alternative to the materialistic models that propose an approach that is reduced to the biomedical paradigm. These studies propose an ethics of needs and a user-centred approach, where spirituality (internal religion) and external religious experience are essential. Conclusion: Occupational therapy must remember the theoretical models centred on the person so that they can get out of the biomedical corset to which they belong but to which they are not reduced. It seems necessary to carry out more theoretical approaches and quantitative and qualitative studies that reveal the operability of implementing models that holistically understand the phenomenology of ageing, as is the case of gerotranscendence.

Communication between persons with multiple sclerosis and their health care providers: A scoping review.

OBJECTIVES: This study undertakes a scoping review of research about communication between persons with MS and their health care providers. DESIGN: PubMed, PsycInfo, Communication Source, Socindex, Sociological Abstracts, Cinahl, and Proquest Dissertations and Theses were used to identify studies since each database's inception. Research team members engaged in study selection, coding for communication issues, and data extraction for descriptive information. RESULTS: Of the 419 empirical articles identified, 175 were included. Codes represented all elements of ecological and pathway models, emphasizing emerging technologies for facilitating communication, uncertainty and anxiety for persons with MS, and communication issues surrounding diagnosis, information seeking, and decision making. CONCLUSION: This review synthesizes and organizes influences on communication, communication processes, and health outcomes of communication for persons with MS and their providers. Findings extend the ecological model with illness context and the pathway model with communication breakdowns and provider outcomes. PRACTICE IMPLICATIONS: Health care providers should consider the complexity of communication when interacting with persons with MS, including the larger context in which it occurs, communication processes and their purposes, and short-term and long-term consequences of interactions. Ecological and pathway models can be frameworks for developing educational materials, as they succinctly capture key communication issues and outcomes.

Inference in epidemiological agent-based models using ensemble-based data assimilation.

To represent the complex individual interactions in the dynamics of disease spread informed by data, the coupling of an epidemiological agent-based model with the ensemble Kalman filter is proposed. The statistical inference of the propagation of a disease by means of ensemble-based data assimilation systems has been studied in previous works. The models used are mostly compartmental models representing the mean field evolution through ordinary differential equations. These techniques allow to monitor the propagation of the infections from data and to estimate several parameters of epidemiological interest. However, there are many important features which are based on the individual interactions that cannot be represented in the mean field equations, such as social network and bubbles, contact tracing, isolating individuals in risk, and social network-based distancing strategies. Agent-based models can describe contact networks at an individual level, including demographic attributes such as age, neighborhood, household, workplaces, schools, entertainment places, among others. Nevertheless, these models have several unknown parameters which are thus difficult to prescribe. In this work, we propose the use of ensemble-based data assimilation techniques to calibrate an agent-based model using daily epidemiological data. This raises the challenge of having to adapt the agent populations to incorporate the information provided by the coarse-grained data. To do this, two stochastic strategies to correct the model predictions are developed. The ensemble Kalman filter with perturbed observations is used for the joint estimation of the state and some key epidemiological parameters. We conduct experiments with an agent based-model designed for COVID-19 and assess the proposed methodology on synthetic data and on COVID-19 daily reports from Ciudad Autónoma de Buenos Aires, Argentina.

Impact of Thermal Dissipation on the Lighting Performance and Useful Life of LED Luminaires Applied to Urban Lighting: A Case Study.

Currently, LED technology is an established form of lighting in our cities and homes. Its lighting performance, durability, energy efficiency and light, together with the economic savings that its use implies, are displacing other classic forms of lighting. However, some problems associated with the durability of the equipment related to the problems of thermal dissipation and high temperature have begun to be detected, which end up affecting their luminous intensity and the useful life. There are many studies that show a direct relationship between the low quality of LED lighting and the aging of the equipment or its overheating, observing the depreciation of the intensity of the light and the visual chromaticity performance that can affect the health of users by altering circadian rhythms. On the other hand, the shortened useful life of the luminaires due to thermal stress has a direct impact on the LCA (Life Cycle Analysis) and its environmental impact, which indirectly affects human health. The purpose of this article is to compare the results previously obtained, at different contour temperatures, by theoretical thermal simulation of the 3D model of LED street lighting luminaires through the ANSYS Fluent simulation software. Contrasting these results with the practical results obtained with a thermal imaging camera, the study shows how the phenomenon of thermal dissipation plays a fundamental role in the lighting performance of LED technology. The parameter studied in this work is junction temperature (Tj), and how it can be used to predict the luminous properties in the design phase of luminaires in order to increase their useful life.

Why Is It Difficult for Social Network Members to Support People Living with Mental Illnesses?: Linking Mental Illness Uncertainty to Support Provision.

For people living with mental illness, support from social network members, including family, romantic partners, and friends, is critical but often inadequate. However, robust theoretical explanations for why it might it be difficult to support people living with mental illness are lacking. We assessed an appraisal-based model of uncertainty, hypothesizing that fear and anxiety and supportive communication efficacy mediate the association between mental illness uncertainty and support provision (i.e., quantity and quality). We also predicted that perceptions of others' communication about their mental illness (i.e., ambiguity and volume) would exacerbate feelings of fear and anxiety in relation to uncertainty. Analyses of data gathered from 300 individuals across the United States (Mage = 34.07, SD = 9.49; 50% female) supported our central prediction; uncertainty had a negative direct or indirect effect on all support types and overall support quality, partly through decreases in supportive communication efficacy. Counter to predictions, fear and anxiety positively predicted support quantity for all types. Findings of this study point to a difficult situation for social network members: although uncertainty seems to motivate support provision by activating fear and anxiety, this effect could be undermined for forms of support that require complex communication skills (e.g., emotional, esteem, overall quality) through corresponding decreases in supportive communication efficacy. We discuss the theoretical and practical implications of this research for social support and relationships within the context of mental illness.

Examining the Interplay between Queerness and Teacher Wellbeing: A Qualitative Study Based on Foreign Language Teacher Trainers.

Oftentimes, teachers who identify themselves as LGTBIQ+ may feel unsafe at work, which may upset their wellbeing and destabilize their key psychological traits. Hence, feelings such as insecurity, lack of self-confidence, anxiety, and fear are on loop in their everyday lives. Thus, in this study we pursued an examination of the interplay between sexual orientation and teacher wellbeing in a cohort of seven university foreign language teacher trainers in a Spanish context. To gain insight into this issue, a qualitative study in line with the ecological paradigm was designed for the elaboration of semi-structured in-depth interviews and for the analysis of results. The main findings display teacher wellbeing as a complex interwoven system in which sexual orientation had played a core role in their identities, competences, private and professional relationships, and in the cultural and political spheres. We conclude by stating that although homophobic discrimination was a hard trial to overcome, the psychosocial capital of the participants allowed them to transform this negativity into positive assets such as queer activism in their private and political lives and in their profession as foreign language teacher trainers.

The role of plant species on runoff and soil erosion in a Mediterranean shrubland.

Shrubland is a Mediterranean biome characterized by densely growing evergreen shrubs adapted to fire events. To date, scientific research has focused on the impact of vegetation on soil erosion mainly through the control that plant biomass or plant cover exerts on sediment delivery and runoff discharge, being the individual plant species influence on hydrological and erosional processes not achieved in detail. The objective of this research is to determine: i) runoff and soil losses in a shrubland-covered rangeland at Sierra de Enguera, Spain; and ii) how four plant species affect soil and water losses. We measured soil cover, soil properties, runoff discharge and sediment yield under natural rainfall for five years (2010-2014) in a typical shrubland burnt in 1999. Four plant species were selected with 4 plots each: Ulex parviflorus Pourr., Pistacia lentiscus L., Quercus coccifera L. and Rosmarinus officinalis L. Despite that the soil properties and plant cover did not exhibit statistically significant differences among plant species, the runoff discharge was lower on Q. coccifera (4.87%, SE 0.24) and P. lentiscus (6.24%, SE 0.51) than on U. parviflorus (13.41%, SE 0.58) and R. officinalis (13.84%, SE 1.23). Sediment concentrations were, respectively, 3.91, 4.33, 4.31 and 4.88 g l-1, and the differences between R. officinalis and the other species were statistically significant. The runoff discharge determined differences in soil erosion rates among the plant species with lower rates on P. lentiscus (1.36 Mg ha-1 y-1) and Q. coccifera (1.53 Mg ha-1 y-1), than on U. parviflorus (3.17 Mg ha-1 y-1) and R. officinalis (3.85 Mg ha-1 y-1). This long term in situ study indicated that Q. coccifera and P. lentiscus are more efficient in controlling runoff discharge and soil losses than U. parviflorus and R. officinalis one decade after a fire. We discuss these results in light of the recent findings by the scientific community of the role of the canopy cover (rainfall interception), soil macropore and root system, and the water repellency that control the hydrological response of the soil (e.g. runoff generation, infiltration). The information supplied by 5 years of research is relevant for restoration and rehabilitation programs and advise that Q. coccifera and P. lentiscus are the most efficient plant species to control soil and water losses within the Mediterranean shrubland. This is an applied science approach for a better management of rangelands.

The role of soils in regulation and provision of blue and green water.

The United Nations Sustainable Development Goal 6 aims for clean water and sanitation for all by 2030, through eight subgoals dealing with four themes: (i) water quantity and availability, (ii) water quality, (iii) finding sustainable solutions and (iv) policy and governance. In this opinion paper, we assess how soils and associated land and water management can help achieve this goal, considering soils at two scales: local soil health and healthy landscapes. The merging of these two viewpoints shows the interlinked importance of the two scales. Soil health reflects the capacity of a soil to provide ecosystem services at a specific location, taking into account local climate and soil conditions. Soil is also an important component of a healthy and sustainable landscape, and they are connected by the water that flows through the soil and the transported sediments. Soils are linked to water in two ways: through plant-available water in the soil (green water) and through water in surface bodies or available as groundwater (blue water). In addition, water connects the soil scale and the landscape scale by flowing through both. Nature-based solutions at both soil health and landscape-scale can help achieve sustainable future development but need to be embedded in good governance, social acceptance and economic viability. This article is part of the theme issue 'The role of soils in delivering Nature's Contributions to People'.

Long-term monitoring of soil bulk density and erosion rates in two Prunus Persica (L) plantations under flood irrigation and glyphosate herbicide treatment in La Ribera district, Spain.

Early season fruit production for the northern European market is highly intensive in fertilization, machinery, irrigation and the use of herbicides. Those conditions increase the soil losses and soil compaction and threaten the Sustainable Goals for Development of the United Nations by 2030. Long-term soil erosion measurements are necessary to determine the sustainability of agriculture managements. Moreover, soil erosion on flood irrigation land is a topic that request more surveys and research as rainfed sloping terrains attracted all the attention of scientists and research investment. Improved Stock Unearthing Method (ISUM) was applied to two 15 years-old herbicide treated fields of Saturn peaches (Prunus persica var. platycarpa) to determine long-term soil erosion rates (2004-2019). Using ISUM, a 1 mm thick nylon rope (700 mm length) was used to connect trees perpendicular to the direction of rows at the height of the graft. To detection soil lowering, the vertical distance of the rope to the soil surface was measured at 10 cm intervals along the rope. The ring method (264 samples at 0-6 cm) was used to determine the soil bulk density, which was in average 1.15 gr cm-3 for both plots. There was found a compaction in the centre of both plots due to the pass of machinery with mean bulk density values of 1.23 gr cm-3, meanwhile underneath of the trees, the soil bulk density was 1.05 gr cm-3. The topography survey carried out with ISUM (2508 sampling points) informed that flood irrigation redistributed the soil from the upper to the lower field position, where a sedimentation layer was measured. We found that the two studied fields showed a contrasted response, with low soil erosion values in Benimodo and high in L'Alcúdia study sites. Soil erosion rates were in average 1.46 Mg ha-1 yr-1 and 8.02 Mg ha-1 yr-1 for Benimodo and L'Alcúdia, respectively. However, the maps development using ISUM allow to inform that the pattern of soil redistribution is similar for both fields as the highest soil lowering was found in the upper field part, where the flood discharge detach soil particles. In the lower field position sedimentation takes place. The dataset allows us to conclude that soil erosion in Saturn peaches fields is non-sustainable and more soil conservation management should be applied to reduce the soil erosion rates due to the bare soils as a consequence of the use of herbicides. This research informs that soil erosion in flood irrigated fields is a relevant process that needs more investigations around the world, where 94% of the irrigated land is under flood or furrow irrigation, and where irrigation is growing year after year.

Native language inhibition predicts more successful second language learning: Evidence of two ERP pathways during learning.

How some individuals succeed in learning a second language as adults is still an unsolved question in cognitive neuroscience. At the brain level, adults' electrophysiological responses to input in a second language may differ after completing different types of training. However, there is limited understanding of what neural pathways are activated as learning unfolds, and which patterns of activation lead to successful learning. Using brain event-related potentials, this study explored whether individual brain responses to practice difficulty during second language learning predict learning outcomes. English-speaking learners of Spanish practiced completing newly learned phrases in their second language. For some learners, all the choices presented during practice were "easy" because non-target choices were unrelated distractors. In the more "difficult" practice mode, however, learners had to avoid choosing a competing word that would be acceptable based on their native language, but not in the second language being learned. Performance during practice was similar in both groups of learners. Critically, divergence in event-related potentials indicated alternative strategies to practice, based on the level of difficulty. At the group level, learners completing the easier practice revealed increased monitoring when making responses; in the difficult condition, learners showed inhibition of their native language (i.e., an N400 for phrases congruent with the native language) to avoid interference during word selection. Individual brain responses indexing the degree of native language inhibition predicted learning rates in tests.

A framework for causal discovery in non-intervenable systems.

Many frameworks exist to infer cause and effect relations in complex nonlinear systems, but a complete theory is lacking. A new framework is presented that is fully nonlinear, provides a complete information theoretic disentanglement of causal processes, allows for nonlinear interactions between causes, identifies the causal strength of missing or unknown processes, and can analyze systems that cannot be represented on directed acyclic graphs. The basic building blocks are information theoretic measures such as (conditional) mutual information and a new concept called certainty that monotonically increases with the information available about the target process. The framework is presented in detail and compared with other existing frameworks, and the treatment of confounders is discussed. While there are systems with structures that the framework cannot disentangle, it is argued that any causal framework that is based on integrated quantities will miss out potentially important information of the underlying probability density functions. The framework is tested on several highly simplified stochastic processes to demonstrate how blocking and gateways are handled and on the chaotic Lorentz 1963 system. We show that the framework provides information on the local dynamics but also reveals information on the larger scale structure of the underlying attractor. Furthermore, by applying it to real observations related to the El-Nino-Southern-Oscillation system, we demonstrate its power and advantage over other methodologies.

Individual Chunking Ability Predicts Efficient or Shallow L2 Processing: Eye-Tracking Evidence From Multiword Units in Relative Clauses.

Behavioral studies on language processing rely on the eye-mind assumption, which states that the time spent looking at text is an index of the time spent processing it. In most cases, relatively shorter reading times are interpreted as evidence of greater processing efficiency. However, previous evidence from L2 research indicates that non-native participants who present fast reading times are not always more efficient readers, but rather shallow parsers. Because earlier studies did not identify a reliable predictor of variability in L2 processing, such uncertainty around the interpretation of reading times introduces a potential confound that undermines the credibility and the conclusions of online measures of processing. The present study proposes that a recently developed modulator of online processing efficiency, namely, chunking ability, may account for the observed variability in L2 online reading performance. L1 English - L2 Spanish learners' eye movements were analyzed during natural reading. Chunking ability was predictive of overall reading speed. Target relative clauses contained L2 Verb-Noun multiword units, which were manipulated with regards to their L1-L2 congruency. The results indicated that processing of the L1-L2 incongruent units was modulated by an interaction of L2 chunking ability and level of knowledge of multiword units. Critically, the data revealed an inverse U-shaped pattern, with faster reading times in both learners with the highest and the lowest chunking ability scores, suggesting fast integration in the former, and lack of integration in the latter. Additionally, the presence of significant differences between conditions was correlated with individual chunking ability. The findings point at chunking ability as a significant modulator of general L2 processing efficiency, and of cross-language differences in particular, and add clarity to the interpretation of variability in the online reading performance of non-native speakers.

The Neural Correlates of Conflict Detection and Resolution During Multiword Lexical Selection: Evidence from Bilinguals and Monolinguals.

Previous studies have identified the Event Related Potential (ERP) components of conflict detection and resolution mechanisms in tasks requiring lexical selection at the individual word level. We investigated the brain potentials associated with these mechanisms in a lexical selection task based on multiword units made up of verb-noun combinations (e.g., eat breakfast, skip school). Native and non-native English speakers were asked to select a familiarized target verb-noun sequence (eat breakfast) between two choices. Trials were low-conflict, with only one plausible candidate (e.g., eat - shoot - breakfast) or high-conflict, with two plausible verbs (e.g., eat - skip - breakfast). Following the presentation of the noun, native English speakers showed a biphasic process of selection, with a conflict-detection centro-parietal negativity between 500 and 600 ms (Ninc), followed by a right frontal effect (RFE) between 600 and 800 ms preceding responses. Late Spanish-English bilinguals showed a similar but more sustained and more widespread effect. Additionally, brain activity was only significantly correlated with performance in native speakers. Results suggest largely similar basic mechanisms, but also that different resources and strategies are engaged by non-native speakers when resolving conflict in the weaker language, with a greater focus on individual words than on multiword units.

Is the fracture pattern in periprosthetic fractures around the knee related with the anterior femoral notch?

INTRODUCTION: Periprosthetic fractures around the knee (PPF) are a devastating complication of total knee arthroplasty (TKA). Anterior femoral notching during TKA is considered a risk factor for PPF. The aim of this paper is to determine if an anterior femoral notch after total knee arthroplasty may affect the fracture pattern when a PPF appears postoperatively. MATERIAL AND METHODS: 50 patients diagnosed in our centre of a PPF from January 2010 to December 2013 were retrospectively enrolled. 100 patients who underwent a total knee arthroplasty without fracture were randomly obtained as a control group. Evidence of the notch was searched in both groups in postoperative X-rays. In the PPF group, distance from the shield of the femoral component to the most distal (d) and proximal (D) point of the fracture were measured. RESULTS: Two different groups were obtained: 1) d = 0 (33 out of 50 patients); the fracture is supposed to be related with the notch as it's a theoretically weaker area. 2) d > 0 (17 out of 50 patients); the fracture pattern has no relationship with the notch. Prevalence of patients suffering a fracture in the shield of the prosthesis (d = 0), was similar in both patients with notch (66,7%) and without it (68%). CONCLUSIONS: In conclusion, fracture pattern is not related with the existence of a femoral notch in the clinical setting.

Adherencia al tratamiento en pacientes mayores de 65 años que sufren reingresos precoces / Treatment adherence in patients more than 65 years who experience early readmissions

Objetivo: Analizar la frecuencia del incumplimiento terapéutico en pacientes que sufren reingresos hospitalarios precoces e identificar los factores asociados al mismo. Método: Estudio observacional descriptivo de tres meses de duración (marzo-mayo de 2014). Se incluyeron todos los pacientes mayores de 65 años que reingresaron en los 3-30 días siguientes al alta hospitalaria. Fueron excluidos los reingresos programados y los reingresos en la Unidad de Cuidados Intensivos. Las variables recogidas fueron: edad, sexo, servicio médico, categoría diagnóstica mayor, polimedicación, número de días desde el alta, presencia de hipertensión y/o diabetes. Se evaluó el cumplimiento terapéutico y la dificultad en la administración de medicación mediante el test de Morisky-Green y el test de Haynes-Sackett, respectivamente. Se realizó un análisis descriptivo de las variables y se relacionaron estas con la adherencia terapéutica. Las variables con significación estadística se incluyeron en un modelo de regresión logística multivariante. Resultados: El 57% de los pacientes presentaron falta de adherencia al tratamiento farmacológico. El 23% presentaba dificultad en la administración de la medicación. Un 86% presentaba comorbilidades (hipertensión y/o diabetes) y el 79% tenía cuidador. El 86% de los pacientes estaban polimedicados (≥ 5 fármacos). Existe relación entre la falta de adherencia y la dificultad en la administración de los medicamentos (p = 0,021), la polimedicación (p = 0,002) y la presencia de diabetes mellitus (p=0,018). Conclusiones: La polimedicación, la presencia de diabetes mellitus y la existencia de dificultad en la administración de la medicación se evidencian como factores pronósticos de la falta de adherencia al tratamiento en pacientes mayores de 65 años

Objective: To analyse the rate of therapeutic nonadherence in patients who experience early readmissions, and identify the factors associated with nonadherence. Methods: An observational descriptive 3-month study (March-May 2014), which included all patients more than 65 years who were readmitted between 3 to 30 days following the last hospital discharge. Exclusion criteria: programmed re-admissions and readmissions to the Intensive Care Unit. Variables included in the study: age, sex, medical service, major diagnostic category, polypharmacy, number of days since the last hospital discharge, and hypertension and diabetes. Therapeutic adherence and difficulty in taking medication were assessed using the Morisky-Green test and the Haynes-Sackett test, respectively. A descriptive analysis of the variables was conducted, showing they were associated with therapeutic adherence. Statistically significant variables were included in a multivariate logistic regression model. Results: In total, 57% of the patients were nonadherent to pharmacological treatment; 23% had difficulty taking their medication; 86% had comorbidities (hypertension and diabetes); 79% had a caregiver; and 86% were polymedicated (≥ 5 medications). There was an association between lack of adherence and difficulty in taking medications (P = 0.021), polypharmacy (P = 0.002), and diabetes mellitus (P = 0.018). Conclusions: Polymedication, diabetes mellitus, and difficulty in taking medication were shown to be prognostic factors of lack of adherence to treatment in patients more than 65 years