An Individual Differences Examination of the Relation between Reading Processes and Comprehension.

Previous research has generally focused on understanding individual variation in either on-line processing or off-line comprehension even though some theories explicitly link difficulty in processing to comprehension problems. The goal of the current study was to examine individual variation in performance both during on-line and off-line reading measures. A battery of psycholinguistic and cognitive tests was administered to community college and university students. In addition, participants read texts in an eye-tracker and answered comprehension questions about them. Multi-level modeling was used to determine the individual-difference factors that modulated the relation between word-level characteristics (e.g., length, frequency, surprisal) and fixation durations. The analyses showed that language experience, decoding, and WMC interacted with word characteristics to influence fixation durations, whereas language experience and reasoning predicted comprehension. The results suggest that individual variation in processing does not map directly to variation in comprehension as some theories predict.

The use of context in resolving syntactic ambiguity: Structural and semantic influences.

Verb bias facilitates parsing of temporarily ambiguous sentences, but it is unclear when and how comprehenders use probabilistic knowledge about the combinatorial properties of verbs in context. In a self-paced reading experiment, participants read direct object/sentential complement sentences. Reading time in the critical region was investigated as a function of three forms of bias: structural bias (the frequency with which a verb appears in direct object/sentential complement sentences), lexical bias (the simple co-occurrence of verbs and other lexical items), and global bias (obtained from norming data about the use of verbs with specific noun phrases). For reading times at the critical word, structural bias was the only reliable predictor. However, global bias was superior to structural and lexical bias at the post-critical word and for offline acceptability ratings. The results suggest that structural information about verbs is available immediately, but that context-specific, semantic information becomes increasingly informative as processing proceeds.

Adaptation to Animacy Violations during Listening Comprehension.

The goal of this study was to examine adaptation to various types of animacy violations in cartoon-like stories. We measured the event-related potentials (ERPs) elicited by words at the beginning, middle, and end of four-sentence stories in order to examine adaptation over time to conflicts between stored word knowledge and context-derived meaning (specifically, to inanimate objects serving as main characters, as they might in a cartoon). The fourth and final sentence of each story contained a predicate that required either an animate or an inanimate subject. The results showed that listeners quickly adapted to stories in the Inanimate Noun conditions, consistent with previous research (Filik & Leuthold, 2008; Nieuwland & Van Berkum, 2006). They showed evidence of processing difficulty for animacy-requiring predicates in the Inanimate Noun conditions in Sentence 1, but the effect dissipated in Sentences 2 and 3. In Sentences 2 and 4, we measured ERPs at three critical points where it was possible to observe the influence of both context-based expectations and expectations from prior knowledge on processing. Overall, the pattern of results demonstrates how listeners flexibly adapt to unusual, conflict-ridden input, using previous context to generate expectations about upcoming input, but that current context is weighted appropriately in combination with expectations from background knowledge and prior language experience.

Responding to a Community's Concern: A Comparison of Breast Cancer Characteristics and Initial Treatment in Three Selected North Carolina Counties.

BACKGROUND A 2007 national report identified North Carolina's Edgecombe County as having among the highest breast cancer incidence and mortality rates nationally, motivating the initiation of a task force and other local efforts to address the problem. The goal of this study is to examine county breast cancer characteristics before and after the report, including whether geographic variation may mask racial disparities in this majority African American community.METHOD With guidance from community partners, breast cancer cases from 2000 to 2012 in Edgecombe, Nash, and Orange Counties (N = 2,641) were obtained from the North Carolina Central Cancer Registry. Bivariate and trend analyses of tumor and treatment characteristics were examined by county and race.RESULTS Women in Edgecombe and Nash Counties were diagnosed with more advanced stage, higher grade tumors. African Americans in Edgecombe and Nash Counties were diagnosed with advanced disease more often than African Americans in Orange County. Average time-to-treatment was well within guideline recommendations. Incidence and mortality rates appear to have declined, with variation in measures of racial differences over time.LIMITATIONS Changes in coding standards across the observation period required reliance on coarse measures that may partially mute useful findings.CONCLUSIONS Racial disparities remain a concern in North Carolina; however, they appear to be less profound than in the 2007 national report. The portentous statistics in the report represent an all-time high, after which some, but not all, measures reflect positive change amidst ongoing local efforts to improve breast cancer knowledge and care.

Comprehension in Proficient Readers: The Nature of Individual Variation.

Individual-difference research on reading comprehension is challenging because reader characteristics are as correlated with each other as they are with comprehension. This study was conducted to determine which abilities are central to explaining comprehension and which are secondary to other abilities. A battery of psycholinguistic and cognitive tests was administered to community college and university students. Seven constructs were identified: word decoding, working-memory capacity (WMC), general reasoning, verbal fluency, perceptual speed, inhibition, and language experience. Only general reasoning and language experience had direct effects; these two variables accounted for as much variance in comprehension as did the complete set. Direct effects of WMC and decoding were found only when general reasoning and language experience were deleted from the models. The authors question the need to include WMC in our theories of variability in adult reading comprehension and highlight the need to understand precisely how vocabulary facilitates comprehension.

Language context processing deficits in schizophrenia: The role of attentional engagement.

Individuals with schizophrenia exhibit problems in language comprehension that are most evident during discourse processing. We hypothesized that deficits in cognitive control contribute to these comprehension deficits during discourse processing, and investigated the underlying cognitive-neural mechanisms using EEG (alpha power) and ERPs (N400). N400 amplitudes to globally supported or unsupported target words near the end of stories were used to index sensitivity to previous context. ERPs showed reduced sensitivity to context in patients versus controls. EEG alpha-band activity was used to index attentional engagement while participants listened to the stories. We found that context effects varied with attentional engagement in both groups, as well as with negative symptom severity in patients. Both groups demonstrated trial-to-trial fluctuations in alpha. Relatively high alpha power was associated with compromised discourse processing in participants with schizophrenia when it occurred during any early portion of the story. In contrast, discourse processing was only compromised in controls when alpha was relatively high for longer segments of the stories. Our results indicate that shifts in attention from the story context may be more detrimental to discourse processing for participants with schizophrenia than for controls, most likely due to an impaired ability to benefit from global context.

Word-Decoding Skill Interacts With Working Memory Capacity to Influence Inference Generation During Reading.

The aim of this study was to examine predictions derived from a proposal about the relation between word-decoding skill and working memory capacity, called verbal efficiency theory. The theory states that poor word representations and slow decoding processes consume resources in working memory that would otherwise be used to execute high-level comprehension processes, such as the generation of inferences. Previous research has yielded inconsistent findings about the importance of word decoding in adult readers, and the hypothesis has never been tested experimentally. Verbal efficiency theory was tested in this experiment by manipulating the difficulty of grapheme-phoneme conversion and assessing the extent to which readers made bridging inferences. Participants read two-sentence passages and then responded to lexical decision targets. Some of the passages required a bridging inference to integrate the first and second sentences. Decoding difficulty was manipulated such that the second sentence in some passages was written using pseudohomophones. Participants also received tasks to assess their working memory capacity and decoding ability. Inference priming was found in both the Standard American English and pseudohomophone contexts but was stronger in the former than in the latter. The advantage in priming for the Standard English relative to the pseudohomophone condition was predicted by an interaction between decoding skill and working memory capacity. Poor decoders who scored high on the span tests were less impaired by the pseudohomophone manipulation than were poor decoders who scored low on the tests. The results suggest that working memory capacity compensates for poor decoding skills even among proficient adult readers.

Factors associated with the successful removal of indwelling urinary catheters post-operatively in the fragility hip fracture patient.

INTRODUCTION: Patients presenting to hospital with a fragility hip fracture are routinely catheterized in the emergency department. Studies have found that the duration of catheterization is the greatest and most important risk factor for developing a urinary tract infection. Whilst there is a considerable body of evidence around correct techniques for insertion of urinary catheters, there appears to be little evidence as to the timing of their removal. AIM OF THE STUDY: To describe the current practice of indwelling catheter (IDC) removal post operatively in the fragility hip fracture patient and to identify factors associated with the successful removal of IDCs post operatively in the same cohort of patients. METHODS: This study was a retrospective cohort analysis of patients admitted to a large, tertiary hospital with an established ortho-geriatric model of care. RESULTS: Aperient regime was the only factor that appeared to have a significant impact on the successful IDC removal. The patient commenced on the aperient regime was three times more likely to have an unsuccessful IDC removal than the patient on a limited or no aperient regime. CONCLUSION: This study highlights the need for redesigning care that is patient focused, evidence-based, effective and efficient. The argument that a patient's bowel is required to be emptied prior to the successful removal of an IDC appears to be false, as in this study it was not identified as a predictor of successful IDC removal. A prospective clinical trial may be the next step forward in developing a clinical guideline for the successful removal of IDCs in the fragility hip fracture patient and/or surgical patient. Nurses have a crucial role to play in contributing to evidence-based practice and are continually challenged to do so.

Developing and Implementing a Citywide Asthma Action Plan: A Community Collaborative Partnership.

OBJECTIVES: Asthma affects 1 in 10 children in the United States, with higher prevalence among children living in poverty. Organizations in San Antonio, Texas, partnered to design and implement a uniform, citywide asthma action plan to improve asthma management capacity in schools. METHODS: The asthma action plan template was modified from that of the Global Initiative for Asthma. School personnel were trained in symptom recognition, actions to take, and use of equipment before the asthma action plan implementation. The annual Asthma Action Plan Summit was organized as a forum for school nurses, healthcare providers, and members of the community to exchange ideas and strategies on implementation, as well as to revise the plan. RESULTS: The asthma action plan was implemented in all 16 local school districts. Feedback received from school nurses suggests that the citywide asthma action plan resulted in improved asthma management and student health at schools. CONCLUSIONS: The evidence in this study suggests that community organizations can successfully collaborate to implement a citywide health initiative similar to the asthma action plan.

Cognitive Control of Episodic Memory in Schizophrenia: Differential Role of Dorsolateral and Ventrolateral Prefrontal Cortex.

BACKGROUND: Dorsal (DLPFC) and ventral (VLPFC) subregions in lateral prefrontal cortex play distinct roles in episodic memory, and both are implicated in schizophrenia. We test the hypothesis that schizophrenia differentially impairs DLPFC versus VLPFC control of episodic encoding. METHODS: Cognitive control was manipulated by requiring participants to encode targets and avoid encoding non-targets based upon stimulus properties of test stimuli. The more automatic encoding response (target versus non-target) was predicted to engage VLPFC in both groups. Conversely, having to overcome the prepotent encoding response (non-targets versus targets) was predicted to produce greater DLPFC activation in controls than in patients. Encoding occurred during event-related fMRI in a sample of 21 individuals with schizophrenia and 30 healthy participants. Scanning was followed by recognition testing outside the scanner. RESULTS: Patients were less successful differentially remembering target versus non-target stimuli, and retrieval difficulties correlated with more severe disorganized symptoms. As predicted, the target versus non-target contrast activated the VLPFC and correlated with retrieval success in both groups. Conversely, the non-target versus target contrast produced greater DLPFC activation in controls than in patients, and DLPFC activation correlated with performance only in controls. CONCLUSION: Individuals with schizophrenia can successfully engage the VLPFC to provide control over semantic encoding of individual items, but are specifically impaired at engaging the DLPFC to main context for task-appropriate encoding and thereby generate improved memory for target versus non-target items. This extends previous cognitive control models based on response selection tasks to the memory domain.

Sensitivity to Referential Ambiguity in Discourse: The Role of Attention, Working Memory, and Verbal Ability.

The establishment of reference is essential to language comprehension. The goal of this study was to examine listeners' sensitivity to referential ambiguity as a function of individual variation in attention, working memory capacity, and verbal ability. Participants listened to stories in which two entities were introduced that were either very similar (e.g., two oaks) or less similar (e.g., one oak and one elm). The manipulation rendered an anaphor in a subsequent sentence (e.g., oak) ambiguous or unambiguous. EEG was recorded as listeners comprehended the story, after which participants completed tasks to assess working memory, verbal ability, and the ability to use context in task performance. Power in the alpha and theta frequency bands when listeners received critical information about the discourse entities (e.g., oaks) was used to index attention and the involvement of the working memory system in processing the entities. These measures were then used to predict an ERP component that is sensitive to referential ambiguity, the Nref, which was recorded when listeners received the anaphor. Nref amplitude at the anaphor was predicted by alpha power during the earlier critical sentence: Individuals with increased alpha power in ambiguous compared with unambiguous stories were less sensitive to the anaphor's ambiguity. Verbal ability was also predictive of greater sensitivity to referential ambiguity. Finally, increased theta power in the ambiguous compared with unambiguous condition was associated with higher working-memory span. These results highlight the role of attention and working memory in referential processing during listening comprehension.

Graded expectations: Predictive processing and the adjustment of expectations during spoken language comprehension.

The goal of this study was to investigate the use of the local and global contexts for incoming words during listening comprehension. Local context was manipulated by presenting a target noun (e.g., "cake," "veggies") that was preceded by a word that described a prototypical or atypical feature of the noun (e.g., "sweet," "healthy"). Global context was manipulated by presenting the noun in a scenario that was consistent or inconsistent with the critical noun (e.g., a birthday party). Event-related potentials (ERPs) were examined at the feature word and at the critical noun. An N400 effect was found at the feature word, reflecting the effect of compatibility with the global context. Global predictability and the local feature word consistency interacted at the critical noun: A larger N200 was found to nouns that mismatched predictions when the context was maximally constraining, relative to nouns in the other conditions. A graded N400 response was observed at the critical noun, modulated by global predictability and feature consistency. Finally, post-N400 positivity effects of context updating were observed to nouns that were supported by one contextual cue (global/local) but were unsupported by the other. These results indicate that (1) incoming words that are compatible with context-based expectations receive a processing benefit; (2) when the context is sufficiently constraining, specific lexical items may be activated; and (3) listeners dynamically adjust their expectations when input is inconsistent with their predictions, provided that the inconsistency has some level of support from either the global or the local context.

Evaluating a community-partnered cancer clinical trials pilot intervention with African American communities.

Cancer clinical trial (CCT) accrual and retention rates remain disproportionately low among African Americans. Awarenesss and access to trials are crucial facilitators of trial participation. Strategies developed within a community-based participatory framework (CBPR) are potential solutions to increase awareness and access to CCTs. In this study, we describe the pilot phase of three innovative community-centered modules to improve basic CCT knowledge, awareness of locations to access CCT information, and opportunities to participate in CCTs. Four community organizations completed Community Bridges to CCT training-of-the-trainer and recruited adult African American volunteers to participate in one of three CCT education modules: a workshop about CCTs, a role play describing one person's experience with CCTs, or a call and response session reviewing myths and facts about CCTs. Pre- and post-test surveys were collected and analyzed using McNemar agreement statistic to evaluate changes in knowledge and attitudes regarding trials. Trainers enrolled 125 participants in the call and response (n = 22), role play (n = 60), and workshop (n = 43) modules. Module participants were mostly African American, female, and with a mean age of 53 years. Comparison of pre- and post-test responses demonstrates favorable changes in awareness of CCTs and where to access CCTs across the sample. Analysis by module type indicates significant increases for participants in the call and response (p < 0.01) and role play modules (p < 0.001), but not the workshop module. Despite measures taken to increase the participation and retention rate of African Americans in clinical trials, little advancement has been made. Developing tailored community education modules on CCTs within the CBPR framework is a promising innovation to increase knowledge about CCTs and favorable attitudes about participation that are known precursors to trial enrollment.

Collaborative development of clinical trials education programs for African-American community-based organizations.

This paper describes the use of a unique "Learning and FeedbackË® approach to customize cancer clinical trials education programs for Community Bridges, a peer training intervention designed for African-American communities in North Carolina. Generic community education modules were demonstrated with key community leaders who were designated as trainers. Quantitative and qualitative assessments were provided on understanding of content, comfort with material, and cultural relevance. The generic materials were adapted into three revised modules, all featuring key messages about cancer clinical trials, discussion regarding distrust of medical research, common misconceptions about trials, patient protections, and a call to action to prompt increased inquiry about locally available trials. The revised modules were then used as part of a train-the-trainer program with 12 African-American community leaders. ENACCT's use of the Learning and Feedback process is an innovative method for culturally adapting clinical trials education.

Memory availability and referential access.

Most theories of coreference specify linguistic factors that modulate antecedent accessibility in memory; however, whether non-linguistic factors also affect coreferential access is unknown. Here we examined the impact of a non-linguistic generation task (letter transposition) on the repeated-name penalty, a processing difficulty observed when coreferential repeated names refer to syntactically prominent (and thus more accessible) antecedents. In Experiment 1, generation improved online (event-related potentials) and offline (recognition memory) accessibility of names in word lists. In Experiment 2, we manipulated generation and syntactic prominence of antecedent names in sentences; both improved online and offline accessibility, but only syntactic prominence elicited a repeated-name penalty. Our results have three important implications: first, the form of a referential expression interacts with an antecedent's status in the discourse model during coreference; second, availability in memory and referential accessibility are separable; and finally, theories of coreference must better integrate known properties of the human memory system.

Spared and impaired spoken discourse processing in schizophrenia: effects of local and global language context.

Individuals with schizophrenia are impaired in a broad range of cognitive functions, including impairments in the controlled maintenance of context-relevant information. In this study, we used ERPs in human subjects to examine whether impairments in the controlled maintenance of spoken discourse context in schizophrenia lead to overreliance on local associations among the meanings of individual words. Healthy controls (n = 22) and patients (n = 22) listened to short stories in which we manipulated global discourse congruence and local priming. The target word in the last sentence of each story was globally congruent or incongruent and locally associated or unassociated. ERP local association effects did not significantly differ between control participants and schizophrenia patients. However, in contrast to controls, patients only showed effects of discourse congruence when targets were primed by a word in the local context. When patients had to use discourse context in the absence of local priming, they showed impaired brain responses to the target. Our findings indicate that schizophrenia patients are impaired during discourse comprehension when demands on controlled maintenance of context are high. We further found that ERP measures of increased reliance on local priming predicted reduced social functioning, suggesting that alterations in the neural mechanisms underlying discourse comprehension have functional consequences in the illness.

The effects of two health information texts on patient recognition memory: a randomized controlled trial.

OBJECTIVE: To compare the effects of two health information texts on patient recognition memory, a key aspect of comprehension. METHODS: Randomized controlled trial (N=60), comparing the effects of experimental and control colorectal cancer (CRC) screening texts on recognition memory, measured using a statement recognition test, accounting for response bias (score range -0.91 to 5.34). The experimental text had a lower Flesch-Kincaid reading grade level (7.4 versus 9.6), was more focused on addressing screening barriers, and employed more comparative tables than the control text. RESULTS: Recognition memory was higher in the experimental group (2.54 versus 1.09, t=-3.63, P=0.001), including after adjustment for age, education, and health literacy (ß=0.42, 95% CI: 0.17, 0.68, P=0.001), and in analyses limited to persons with college degrees (ß=0.52, 95% CI: 0.18, 0.86, P=0.004) or no self-reported health literacy problems (ß=0.39, 95% CI: 0.07, 0.71, P=0.02). CONCLUSION: An experimental CRC screening text improved recognition memory, including among patients with high education and self-assessed health literacy. PRACTICE IMPLICATIONS: CRC screening texts comparable to our experimental text may be warranted for all screening-eligible patients, if such texts improve screening uptake.

Modeling Reader- and Text- Interactions During Narrative Comprehension: A Test of the Lexical Quality Hypothesis.

The goal of this study was to examine predictions derived from the Lexical Quality Hypothesis (Perfetti & Hart, 2002; Perfetti, 2007) regarding relations among word-decoding, working-memory capacity, and the ability to integrate new concepts into a developing discourse representation. Hierarchical Linear Modeling was used to quantify the effects of two text properties (length and number of new concepts) on reading times of focal and spillover sentences, with variance in those effects estimated as a function of individual difference factors (decoding, vocabulary, print exposure, and working-memory capacity). The analysis revealed complex, cross-level interactions that complement the Lexical Quality Hypothesis.

Effects of working memory span on processing of lexical associations and congruence in spoken discourse.

The goal of this study was to determine whether variability in working memory (WM) capacity and cognitive control affects the processing of global discourse congruence and local associations among words when participants listened to short discourse passages. The final, critical word of each passage was either associated or unassociated with a preceding prime word (e.g., "He was not prepared for the fame and fortune/praise"). These critical words were also either congruent or incongruent with respect to the preceding discourse context [e.g., a context in which a prestigious prize was won (congruent) or in which the protagonist had been arrested (incongruent)]. We used multiple regression to assess the unique contribution of suppression ability (our measure of cognitive control) and WM capacity on the amplitude of individual N400 effects of congruence and association. Our measure of suppression ability did not predict the size of the N400 effects of association or congruence. However, as expected, the results showed that high WM capacity individuals were less sensitive to the presence of lexical associations (showed smaller N400 association effects). Furthermore, differences in WM capacity were related to differences in the topographic distribution of the N400 effects of discourse congruence. The topographic differences in the global congruence effects indicate differences in the underlying neural generators of the N400 effects, as a function of WM. This suggests additional, or at a minimum, distinct, processing on the part of higher capacity individuals when tasked with integrating incoming words into the developing discourse representation.

Hemispheric differences in the organization of memory for text ideas.

The goal of this study was to examine hemispheric asymmetries in episodic memory for discourse. Access to previously comprehended information is essential for mapping incoming information to representations of "who did what to whom" in memory. An item-priming-in-recognition paradigm was used to examine differences in how the hemispheres represent discourse. Both hemispheres retained accurate information about concepts from short passages, but the information was organized differently. The left hemisphere was sensitive to the structural relations among concepts in a text, whereas the right hemisphere differentiated information that appeared in one passage from information that appeared in another. Moreover, the right hemisphere, but not the left hemisphere, retained information about the spatial/temporal proximity among concepts in a passage. Implications of these results for the roles of the right and left hemispheres in comprehending connected discourse are discussed.