LETter To the EditoR Standards (LETTERS): Considerations for Authors, Reviewers, and Editors.

Correspondence in the form of letters to the editor serves multiple scholarly purposes, including critiquing previously published articles, engaging in discourse with other correspondents, commenting on the journal's structure or style, and contributing insights for future publications. The composition of such letters warrants meticulous attention, as they play a crucial role in fostering communication between the journal and its readership. Adherence to specific principles is essential in crafting an effective letter to the editor. These communications should be concise, lucid, and adhere to a professional tone. The content should be constructive in nature and substantiated by rigorous scientific evidence and appropriate citations. The structure of a letter to the editor typically encompasses several key components: a title, an opening section, the main body of the correspondence, a closing statement, and a list of references. This article aims to establish Letter to the Editor Standards as a comprehensive guide for authors, reviewers, and editorial boards, thereby enhancing the quality and impact of this crucial form of academic discourse.

The effect of inter-letter spacing on the N170 during visual word recognition: An event-related potentials experiment.

Previous behavioral studies have shown that inter-letter spacing affects visual word recognition and reading. While condensed spacing may hinder the early stages of letter encoding because of increased crowding effects, the impact of expanded inter-letter spacing is still unclear. To examine the electrophysiological signature of inter-letter spacing on visual word recognition, we presented words in three different inter-letter spacing conditions (default, condensed [-1.5 points] or expanded [+1.5 points]) in an event-related potentials go/no-go semantic categorization task. Our focus was on the N170, an event-related potentials component associated with the early encoding of orthographic information, which also is sensitive to crowding effects. Results revealed that the N170 amplitude reached the largest values for the condensed condition than for the default and expanded spacing conditions, which did not differ. While increased crowding impacted the early encoding of orthographic information, extra letter spacing (compared with default spacing) did not. This outcome is consistent with the Modified Receptive Field hypothesis, in which letter receptors adapt their size to cope with letter crowding. These findings reveal that reducing the space between letters more than the default spacing impairs the ability to process written words, whereas slightly expanding the space between letters does not provide any additional benefit.

Letters, Words, Sentences, and Reading.

In this personal, and therefore highly selective, review article I summarize work performed in collaboration with numerous colleagues on how skilled adult readers perform identification tasks and speeded binary decision tasks involving single letters and visually presented words and sentences. The overarching aim is to highlight similarities in the processing performed at three key levels involved in written language comprehension (in languages that use an alphabetic script): letters, words, and sentences. The comparisons are made using behavioral data obtained with: i) speeded (response-limited) binary decision tasks; and ii) the effects of simultaneous surrounding context on letter and word identification using both data-limited (non-speeded) and response-limited procedures. I then propose a general framework that combines the three levels of processing, and that connects core processes at each level with the processing involved in tasks designed to reflect those core processes, and I end by suggesting possible avenues for future research with an aim to extend this general framework.

Parafoveal letter identification in Russian: Confusion matrices based on error rates.

In the present study, we introduce parafoveal letter confusion matrices for the Russian language, which uses the Cyrillic script. To ensure that our confusion rates reflect parafoveal processing and no other effects, we employed an adapted boundary paradigm (Rayner, 1975) that prevented the participants from directly fixating the letter stimuli. Additionally, we assessed confusability under isolated and word-like (crowded) conditions using two modern fonts, since previous research showed that letter recognition depended on crowding and font (Coates, 2015; Pelli et al., 2006). Our additional goal was to gain insight into what letter features or configurational patterns might be essential for letter recognition in Russian; thus, we conducted exploratory clustering analysis on visual confusion scores to identify groups of similar letters. To support this analysis, we conducted a comprehensive review of over 20 studies that proposed crucial properties of Latin letters relevant to character perception. The summary of this review is valuable not only for our current study but also for future research in the field.

Mirror invariance in the subsequent acquisition of a script with separate forms for reading and writing.

PURPOSE: Does suppression of mirror-invariance in one script generalize to a subsequently learned script? METHOD: We examined mirror invariance in writing and recognition among native Latin-scriptal children and adults (n = 181) learning the Hebrew print script (for reading), and among a subset (n = 92) also learning the Hebrew cursive script (for writing). Hebrew-Latin biscriptal Israeli adults (n = 17) provided comparison. RESULTS: For the most part, mirror invariance was more evident in Hebrew print than in Latin in both writing and recognition among native Latin-scriptals. The number of previously acquired scripts had no effect. Letters' text-frequency inversely affected written mirror-error frequency. Written reversal errors were less frequent in cursive; orientation recognition was more fluent in print. CONCLUSIONS: Mirror-invariance suppression in one's native script does not generalize to a subsequently acquired script. Factors affecting mirror-invariance suppression in the subsequent script include its form and function and individual letters' text-frequency.

Readers encode absolute letter positions.

Reading research has long been concerned with the question of whether the reading brain accesses lexical representations via absolute or relative letter position information. In recent years, important results have been obtained with the flanker lexical decision task. Studies have shown faster decisions about target words (e.g., 'rock') when flanked by related letters ('ro rock ck') than unrelated letters ('st rock ep')-and crucially, equal facilitation upon switching flanker positions ('ck rock ro'), pointing to relative rather than absolute letter position coding. Yet, a later study employing longer targets and flankers yielded detrimental effects of switching flanker positions. In order to get a better grasp on the equivocal evidence thus far, here we carried out an extensive test of flanker relatedness and position effects, using various target and flanker lengths, all within a single experiment. We observed a clear reduction of flanker relatedness effects upon switching flanker positions, and this held true across target and flanker lengths. The present results unambiguously suggest that lexical access is driven by absolute letter position information, and furthermore, are accurately predicted by the recent PONG model (Snell, 2024b).

Parent-Reported Academic Outcomes After a Mild Traumatic Brain Injury in the Pediatric Population.

BACKGROUND: Millions of children are diagnosed with a traumatic brain injury (TBI) each year, most being mild TBI (mTBI). The effect of mTBIs on academic performance is of significant importance. We investigate mTBI's impact on parent-reported academic outcomes in school-aged pediatric participants. METHODS: This cross-sectional survey study queried parents (N = 285) regarding letter grade performance and the presence or absence of academic accommodations before and after an mTBI, including complicated mTBI (c-mTBI, or mTBI with radiographic abnormality). RESULTS: We found a parent-reported decline in letter grades following c-mTBI (p < .001), with no significant change following uncomplicated mTBIs. Degree and length of recovery were also associated with grade changes (p < .05). Those with no academic accommodations prior to the injury showed significant decreases in grades after injury regardless of post-injury accommodation status (p < .05). IMPLICATIONS OF SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: This study underscores the need for an improved framework of support to maximize academic performance of children following mTBI, especially in those with a c-mTBI and still recovering from their injury. CONCLUSION: Our study identifies children who are at risk for adverse academic outcomes following mTBI. We encourage efforts to better support school nurses in this effort, including improved communication between health care teams and school teams.

Proposal for a Patient Centered Health Information Framework for Clinical and Personal Data Movement.

This paper focuses on defining a framework to allow individual patients to track their own health related data. We propose a Patient Centered Information Framework (PCIF) allowing patient to manage their own data by using discharge letters. Discharge letters summarize information from a hospital stay, such as medical history, diagnoses, treatments and follow up, needed for continuity of care. It enables patients to share data with different organizations ensuring personal data protection, even when moving from different places and countries. A record of clinical management may thus be guaranteed when moving among different health structures as well as simplifying obtaining medications. We propose an approach to allow citizens to manage their health related data in a cross borders fashion. We compare the regulation of discharge letters among a sample of countries. We propose a management protocol for using a commonly adopted patient discharge letter framework within a PCIF.

Increasing inter-word spacing reduces migration errors and improves reading comprehension in students with dyslexia.

We report a small study in which we explored the effects of manipulating narrative text on levels of comprehension for students with and without dyslexia. Using two pieces of standardised narrative text deemed to be of similar difficulty and length, we manipulated the texts such that we could present two texts to each participant, one in each condition. The first condition was text using standard inter-word spacing; the second condition used increased inter-word spacing. Scores on standardised comprehension questions were significantly improved for participants with dyslexia. Additionally, given that there is evidence of delayed visual attention disengagement in individuals with specific forms of dyslexia, we hypothesised that the phenomena of migration of letters and words for some readers might be mitigated by increasing inter-word spacing. We did indeed find that incidence of migration was significantly reduced in this condition for all participants.

Tracking the brain signature of (mis)spelled logotypes via letter transpositions and replacements.

All leading models of visual word recognition assume a hierarchical process that progressively converts the visual input into abstract letter and word representations. However, the results from recent behavioral studies suggest that the mental representations of words with a highly consistent visual format, such as logotypes, may comprise not only purely abstract information but also perceptual information. This hypothesis would explain why participants often misperceive transposed-letter misspellings with the original base words to a larger degree in logotypes (e.g., SASMUNG, but not SARVUNG, is perceived as SAMSUNG) than in common words. The present experiment examined the electrophysiological signature behind the identification of correctly spelled and misspelled logotypes (via letter transposition or replacement) in an ERP go/no-go semantic categorization experiment. Results showed that N400 amplitudes for transposed-letter misspelled logotypes (SASMUNG) and intact logotypes (SAMSUNG) did not differ significantly across various time windows (until 600 ms), whereas replacement-letter misspelled logotypes (SARVUNG) yielded consistently larger N400 amplitudes. These findings reveal that the mental representations of logotypes are particularly resistant to minor orthographic changes, which has important theoretical and applied (e.g., marketing) implications.

Modulation of audiovisual integration in the left and right sides: effects of side and spatial coherency.

BACKGROUND: Using event-related potentials (ERPs), we aimed to investigate audiovisual integration neural mechanisms during a letter identification task in the left and right sides. Unimodal (A,V) and bimodal (AV) stimuli were presented on either side, with ERPs from unimodal (A,V) stimuli on the same side being compared to those from simultaneous bimodal stimuli (AV). Non-zero results of the AV-(A + V) difference waveforms indicated audiovisual integration on the left/right side. RESULTS: When spatially coherent AV stimuli were presented on the right side, two significant ERP components in the integrated differential wave were noted. The N134 and N262, present in the first 300 ms of the AV-(A + V) integration difference wave, indicated significant audiovisual integration effects. However, when these stimuli were presented on the left side, there were no significant integration components. This audiovisual integration difference may stem from left/right asymmetry of cerebral hemisphere language processing. CONCLUSIONS: Audiovisual letter information presented on the right side was easier to integrate, process, and represent. Additionally, only one significant integrative component peaked at 140 ms in the parietal cortex for spatially non-coherent AV stimuli and provided audiovisual multisensory integration, which could be attributed to some integrative neural processes that depend on the spatial congruity of the auditory and visual stimuli.

Enhancing predictive accuracy in hypertriglyceridemia-induced acute pancreatitis: Role of red cell distribution width and prospective studies.

This letter addresses the study titled "Red cell distribution width: A predictor of the severity of hypertriglyceridemia-induced acute pancreatitis" by Lv et al published in the World Journal of Experimental Medicine. The study offers a valuable analysis of red cell distribution width (RDW) as a predictive marker for persistent organ failure in patients with hypertriglyceridemia-induced acute pancreatitis. The study results suggest that RDW, combined with the Bedside Index for Severity in Acute Pancreatitis score, could enhance the predictive accuracy for severe outcomes. Further investigation into the role of RDW in different severities of acute pancreatitis is recommended. Additionally, the need for large-scale and multicenter prospective studies to validate these findings is emphasized.

Comparison of the Quality of Discharge Letters Written by Large Language Models and Junior Clinicians: Single-Blinded Study.

BACKGROUND: Discharge letters are a critical component in the continuity of care between specialists and primary care providers. However, these letters are time-consuming to write, underprioritized in comparison to direct clinical care, and are often tasked to junior doctors. Prior studies assessing the quality of discharge summaries written for inpatient hospital admissions show inadequacies in many domains. Large language models such as GPT have the ability to summarize large volumes of unstructured free text such as electronic medical records and have the potential to automate such tasks, providing time savings and consistency in quality. OBJECTIVE: The aim of this study was to assess the performance of GPT-4 in generating discharge letters written from urology specialist outpatient clinics to primary care providers and to compare their quality against letters written by junior clinicians. METHODS: Fictional electronic records were written by physicians simulating 5 common urology outpatient cases with long-term follow-up. Records comprised simulated consultation notes, referral letters and replies, and relevant discharge summaries from inpatient admissions. GPT-4 was tasked to write discharge letters for these cases with a specified target audience of primary care providers who would be continuing the patient's care. Prompts were written for safety, content, and style. Concurrently, junior clinicians were provided with the same case records and instructional prompts. GPT-4 output was assessed for instances of hallucination. A blinded panel of primary care physicians then evaluated the letters using a standardized questionnaire tool. RESULTS: GPT-4 outperformed human counterparts in information provision (mean 4.32, SD 0.95 vs 3.70, SD 1.27; P=.03) and had no instances of hallucination. There were no statistically significant differences in the mean clarity (4.16, SD 0.95 vs 3.68, SD 1.24; P=.12), collegiality (4.36, SD 1.00 vs 3.84, SD 1.22; P=.05), conciseness (3.60, SD 1.12 vs 3.64, SD 1.27; P=.71), follow-up recommendations (4.16, SD 1.03 vs 3.72, SD 1.13; P=.08), and overall satisfaction (3.96, SD 1.14 vs 3.62, SD 1.34; P=.36) between the letters generated by GPT-4 and humans, respectively. CONCLUSIONS: Discharge letters written by GPT-4 had equivalent quality to those written by junior clinicians, without any hallucinations. This study provides a proof of concept that large language models can be useful and safe tools in clinical documentation.

Investigating the crowding effect on letters and symbols in deaf adults.

Reading requires the transformation of a complex array of visual features into sounds and meaning. For deaf signers who experience changes in visual attention and have little or no access to the sounds of the language they read, understanding the visual constraints underlying reading is crucial. This study aims to explore a fundamental aspect of visual perception intertwined with reading: the crowding effect. This effect manifests as the struggle to distinguish a target letter when surrounded by flanker letters. Through a two-alternative forced choice task, we assessed the recognition of letters and symbols presented in isolation or flanked by two or four characters, positioned either to the left or right of fixation. Our findings reveal that while deaf individuals exhibit higher accuracy in processing letters compared to symbols, their performance falls short of that of their hearing counterparts. Interestingly, despite their proficiency with letters, deaf individuals didn't demonstrate quicker letter identification, particularly in the most challenging scenario where letters were flanked by four characters. These outcomes imply the development of a specialized letter processing system among deaf individuals, albeit one that may subtly diverge from that of their hearing counterparts.