An ERP Study on the Processing of Subject-Verb and Object-Verb Gender Agreement in Punjabi.

This study was conducted with the aim of exploring the general parsing mechanisms involved in processing different kinds of dependency relations, namely verb agreement with subjects versus objects in Punjabi, an SOV Indo-Aryan language. Event related brain potentials (ERPs) were recorded as twenty-five native Punjabi speakers read transitive sentences. Critical stimuli were either fully acceptable as regards verb agreement, or alternatively violated gender agreement with the subject or object. A linear mixed-models analysis confirmed a P600 effect at the position of the verb for all violations, regardless of whether subject or object agreement was violated. These results thus suggest that an identical mechanism is involved in gender agreement computation in Punjabi regardless of whether the agreement is with the subject or the object argument.

A perceptual glitch in serial perception generates temporal distortions.

Precisely estimating event timing is essential for survival, yet temporal distortions are ubiquitous in our daily sensory experience. Here, we tested whether the relative position, duration, and distance in time of two sequentially-organized events-standard S, with constant duration, and comparison C, with duration varying trial-by-trial-are causal factors in generating temporal distortions. We found that temporal distortions emerge when the first event is shorter than the second event. Importantly, a significant interaction suggests that a longer inter-stimulus interval (ISI) helps to counteract such serial distortion effect only when the constant S is in the first position, but not if the unpredictable C is in the first position. These results imply the existence of a perceptual bias in perceiving ordered event durations, mechanistically contributing to distortion in time perception. We simulated our behavioral results with a Bayesian model and replicated the finding that participants disproportionately expand first-position dynamic (unpredictable) short events. Our results clarify the mechanisms generating time distortions by identifying a hitherto unknown duration-dependent encoding inefficiency in human serial temporal perception, something akin to a strong prior that can be overridden for highly predictable sensory events but unfolds for unpredictable ones.

Implementation strategy in collaboration with people with lived experience of mental illness to reduce stigma among primary care providers in Nepal (RESHAPE): protocol for a type 3 hybrid implementation effectiveness cluster randomized controlled trial.

BACKGROUND: There are increasing efforts for the integration of mental health services into primary care settings in low- and middle-income countries. However, commonly used approaches to train primary care providers (PCPs) may not achieve the expected outcomes for improved service delivery, as evidenced by low detection rates of mental illnesses after training. One contributor to this shortcoming is the stigma among PCPs. Implementation strategies for training PCPs that reduce stigma have the potential to improve the quality of services. DESIGN: In Nepal, a type 3 hybrid implementation-effectiveness cluster randomized controlled trial will evaluate the implementation-as-usual training for PCPs compared to an alternative implementation strategy to train PCPs, entitled Reducing Stigma among Healthcare Providers (RESHAPE). In implementation-as-usual, PCPs are trained on the World Health Organization Mental Health Gap Action Program Intervention Guide (mhGAP-IG) with trainings conducted by mental health specialists. In RESHAPE, mhGAP-IG training includes the added component of facilitation by people with lived experience of mental illness (PWLE) and their caregivers using PhotoVoice, as well as aspirational figures. The duration of PCP training is the same in both arms. Co-primary outcomes of the study are stigma among PCPs, as measured with the Social Distance Scale at 6 months post-training, and reach, a domain from the RE-AIM implementation science framework. Reach is operationalized as the accuracy of detection of mental illness in primary care facilities and will be determined by psychiatrists at 3 months after PCPs diagnose the patients. Stigma will be evaluated as a mediator of reach. Cost-effectiveness and other RE-AIM outcomes will be assessed. Twenty-four municipalities, the unit of clustering, will be randomized to either mhGAP-IG implementation-as-usual or RESHAPE arms, with approximately 76 health facilities and 216 PCPs divided equally between arms. An estimated 1100 patients will be enrolled for the evaluation of accurate diagnosis of depression, generalized anxiety disorder, psychosis, or alcohol use disorder. Masking will include PCPs, patients, and psychiatrists. DISCUSSION: This study will advance the knowledge of stigma reduction for training PCPs in partnership with PWLE. This collaborative approach to training has the potential to improve diagnostic competencies. If successful, this implementation strategy could be scaled up throughout low-resource settings to reduce the global treatment gap for mental illness. TRIAL REGISTRATION: ClinicalTrials.gov, NCT04282915 . Date of registration: February 25, 2020.

HeAlth System StrEngThening in four sub-Saharan African countries (ASSET) to achieve high-quality, evidence-informed surgical, maternal and newborn, and primary care: protocol for pre-implementation phase studies.

To achieve universal health coverage, health system strengthening (HSS) is required to support the of delivery of high-quality care. The aim of the National Institute for Health Research Global Research Unit on HeAlth System StrEngThening in Sub-Saharan Africa (ASSET) is to address this need in a four-year programme, with three healthcare platforms involving eight work-packages. Key to effective health system strengthening (HSS) is the pre-implementation phase of research where efforts focus on applying participatory methods to embed the research programme within the existing health system. To conceptualise the approach, we provide an overview of the key methods applied across work-package to address this important phase of research conducted between 2017 and 2021.Work-packages are being undertaken in publicly funded health systems in rural and urban areas in Ethiopia, Sierra Leone, South Africa, and Zimbabwe. Stakeholders including patients and their caregivers, community representatives, clinicians, managers, administrators, and policymakers are the main research participants.In each work-package, initial activities engage stakeholders and build relationships to ensure co-production and ownership of HSSIs. A mixed-methods approach is then applied to understand and address determinants of high-quality care delivery. Methods such as situation analysis, cross-sectional surveys, interviews and focus group discussions are adopted to each work-package aim and context. At the end of the pre-implementation phase, findings are disseminated using focus group discussions and participatory Theory of Change workshops where stakeholders from each work package use findings to select HSSIs and develop a programme theory.ASSET places a strong emphasis of the pre-implementation phase in order to provide an in-depth and systematic diagnosis of the existing heath system functioning, needs for strengthening and stakeholder engagement. This common approach will inform the design and evaluation of the HSSIs to increase effectiveness across work packages and contexts, to better understand what works, for whom, and how.

Full throttle: Demonstrating the speed, accuracy, and validity of a new method for continuous two-dimensional self-report and annotation.

Research on fine-grained dynamic psychological processes has increasingly come to rely on continuous self-report measures. Recent studies have extended continuous self-report methods to simultaneously collecting ratings on two dimensions of an experience. For all the variety of approaches, several limitations are inherent to most of them. First, current methods are primarily suited for bipolar, as opposed to unipolar, constructs. Second, respondents report on two dimensions using one hand, which may produce method driven error, including spurious relationships between the two dimensions. Third, two-dimensional reports have primarily been validated for consistency between reporters, rather than the predictive validity of idiosyncratic responses. In a series of tasks, the study reported here addressed these limitations by comparing a previously used method to a newly developed two-handed method, and by explicitly testing the validity of continuous two-dimensional responses. Results show that our new method is easier to use, faster, more accurate, with reduced method-driven dependence between the two dimensions, and preferred by participants. The validity of two-dimensional responding was also demonstrated in comparison to one-dimensional reporting, and in relation to post hoc ratings. Together, these findings suggest that our two-handed method for two-dimensional continuous ratings is a powerful and reliable tool for future research.

Salience-weighted agreement feature hierarchy modulates language comprehension.

The brain establishes relations between elements of an unfolding sentence in order to incrementally build a representation of who is doing what based on various linguistic cues. Many languages systematically mark the verb and/or its arguments to imply the manner in which they are related. A common mechanism to this end is subject-verb agreement, whereby the marking on the verb covaries with one or more of the features such as person, number and gender of the subject argument in a sentence. The cross-linguistic variability of these features would suggest that they may modulate language comprehension differentially based on their relative weightings in a given language. To test this, we investigated the processing of subject-verb agreement in simple intransitive Arabic sentences in a visual event-related brain potential (ERP) study. Specifically, we examined the differences, if any, that ensue in the processing of person, number and gender features during online comprehension, employing sentences in which the verb either showed full agreement with the subject noun (singular or plural) or did not agree in one of the features. ERP responses were measured at the post-nominal verb. Results showed a biphasic negativity-late-positivity effect when the verb did not agree with its subject noun in either of the features, in line with similar findings from other languages. Crucially however, the biphasic effect for agreement violations was systematically graded based on the feature that was violated, which is a novel finding in view of results from other languages. Furthermore, this graded effect was qualitatively different for singular and plural subjects based on the differing salience of the features for each subject-type. These results suggest that agreement features, varying in their salience due to their language-specific weightings, differentially modulate language comprehension. We postulate a Salience-weighted Feature Hierarchy based on our findings and argue that this parsimoniously accounts for the diversity of existing cross-linguistic neurophysiological results on verb agreement processing.

Gesture's body orientation modulates the N400 for visual sentences primed by gestures.

Body orientation of gesture entails social-communicative intention, and may thus influence how gestures are perceived and comprehended together with auditory speech during face-to-face communication. To date, despite the emergence of neuroscientific literature on the role of body orientation on hand action perception, limited studies have directly investigated the role of body orientation in the interaction between gesture and language. To address this research question, we carried out an electroencephalography (EEG) experiment presenting to participants (n = 21) videos of frontal and lateral communicative hand gestures of 5 s (e.g., raising a hand), followed by visually presented sentences that are either congruent or incongruent with the gesture (e.g., "the mountain is high/low…"). Participants underwent a semantic probe task, judging whether a target word is related or unrelated to the gesture-sentence event. EEG results suggest that, during the perception phase of handgestures, while both frontal and lateral gestures elicited a power decrease in both the alpha (8-12 Hz) and the beta (16-24 Hz) bands, lateral versus frontal gestures elicited reduced power decrease in the beta band, source-located to the medial prefrontal cortex. For sentence comprehension, at the critical word whose meaning is congruent/incongruent with the gesture prime, frontal gestures elicited an N400 effect for gesture-sentence incongruency. More importantly, this incongruency effect was significantly reduced for lateral gestures. These findings suggest that body orientation plays an important role in gesture perception, and that its inferred social-communicative intention may influence gesture-language interaction at semantic level.

Selective dorsal rhizotomy; evidence on cost-effectiveness from England.

OBJECTIVES: Selective dorsal rhizotomy (SDR) has gained interest as an intervention to reduce spasticity and pain, and improve quality of life and mobility in children with cerebral palsy mainly affecting the legs (diplegia). We evaluated the cost-effectiveness of SDR in England. METHODS: Cost-effectiveness was quantified with respect to Gross Motor Function Measure (GMFM-66) and the pain dimension of the Cerebral Palsy Quality of Life questionnaire for Children (CPQOL-Child). Data on outcomes following SDR over two years were drawn from a national evaluation in England which included 137 children, mean age 6.6 years at surgery. The incremental impact of SDR on GMFM-66 was determined through comparison with data from a historic Canadian cohort not undergoing SDR. Another single centre provided data on hospital care over ten years for 15 children undergoing SDR at a mean age of 7.0 years, and a comparable cohort managed without SDR. The incremental impact of SDR on pain was determined using a before and after comparison using data from the national evaluation. Missing data were imputed using multiple imputation. Incremental costs of SDR were determined as the difference in costs over 5 years for the patients undergoing SDR and those managed without SDR. Uncertainty was quantified using bootstrapping and reported as the cost-effectiveness acceptability curve. RESULTS: In the base case, the incremental cost-effectiveness ratios (ICERs) for SDR are £1,382 and £903 with respect to a unit improvement in GMFM-66 and the pain dimension of CPQOL-Child, respectively. Inclusion of data to 10 years indicates SDR is cheaper than management without SDR. Incremental costs and ICERs for SDR rose in sensitivity analysis applying an alternative regression model to cost data. CONCLUSIONS: Data on outcomes from a large observational study of SDR and long-term cost data on children who did and did not receive SDR indicates SDR is cost-effective.

Seven-year-olds recall non-adjacent dependencies after overnight retention.

Becoming a successful speaker depends on acquiring and learning grammatical dependencies between neighboring and non-neighboring linguistic elements (non-adjacent dependencies; NADs). Previous studies have demonstrated children's and adults' ability to distinguish NADs from NAD violations right after familiarization. However, demonstrating NAD recall after retention is crucial to demonstrate a lasting effect of NAD learning. We tested 7-year-olds' NAD learning in a natural, non-native language on one day and NAD recall on the next day by means of event-related potentials (ERPs). Our results revealed ERPs with a more positive amplitude to NAD violations than correct NADs after familiarization on day one, but ERPs with a more negative amplitude to NAD violations on day two. This change from more positive to more negative ERPs to NAD violations possibly indicates that children's representations of NADs changed during an overnight retention period, potentially associated with children's NAD learning. Indeed, our descriptive analyses showed that both ERP patterns (i.e., day one: positive, day two: negative) were related to stronger behavioral improvement (i.e., more correct answers on day two compared to day one) in a grammaticality judgment task from day one to day two. We suggest these findings to indicate that children successfully built associative representations of NADs on day one and then strengthened these associations during overnight retention, revealing NAD recall on day two. The present results suggest that 7-year-olds readily track NADs in a natural, non-native language and are able to recall NADs after a retention period involving sleep, providing evidence of a lasting effect of NAD learning.

Cost-effectiveness of staffing levels on conflict and containment on psychiatric wards in England.

WHAT IS KNOWN ON THE SUBJECT?: Literature on staffing levels and outcomes in psychiatric wards is limited and shows mixed associations Lack of economic evidence on conflicts and containment in psychiatric care Data from the City-128 study showed that regular qualified nurse staffing levels in the preceding shifts were associated with raised conflict and containment levels WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This is the first economic analysis using the City-128 data, with costs and outcomes data have been combined. Cost-effectiveness of different staffing levels in relation to conflicts and containments in England, using data from the City-128 study Both day and night shifts appeared to show that the low staff scenario was cost-effective in terms of conflicts and containment averted, even after attempts were made to adjust for patient severity WHAT ARE THE IMPLICATIONS FOR PRACTICE?: This paper could be an indication towards further investigation into how mental health inpatient care, specially nursing is organized in England. Abstract Introduction Evidence from City-128 study shows a positive association between staffing levels and conflicts/containment. Economic evidence on this topic is scarce, with no economic analyses combining costs and outcomes. Aim/Question To assess the cost-effectiveness of different staffing levels in relation to conflicts and containments in England, using City-128 study data. Methods Shifts were grouped into three groups based on staff-to-bed ratio. Cost information was combined with total conflicts and containment measures to assess cost-effectiveness. Results The cost-effectiveness analysis of the three staffing scenarios for both day and night shifts appeared to show that the low staff scenario was cost-effective in terms of conflicts and containment averted, even adjusting for patient severity. A production function analysis also revealed that increased staff numbers were associated with higher numbers of events. Discussion Causation cannot be attributed and neither can recommendations be made on optimal staffing levels. The impact on other outcomes such as symptoms, functioning and length of stay, and other factors should be explored, and these may all benefit from increased staff numbers. Implications for practice These results indicate that increasing staff numbers may not necessarily improve conflict and containment outcomes. They may produce positive outcomes in other domains.

Animacy-based predictions in language comprehension are robust: contextual cues modulate but do not nullify them.

Couldn׳t a humble coconut hurt a gardener? At least in the first instance, the brain seems to assume that it should not: we perceive inanimate entities such as coconuts as poor event instigators ("Actors"). Ideally, entities causing a change in another entity should be animate and this assumption not only influences event perception but also carries over to language comprehension. We present three auditory event-related brain potential (ERP) studies on the processing of inanimate and animate subjects and objects in simple transitive sentences in Tamil. ERP responses were measured at the second argument (event participant) in all three studies. Experiment 1 employed all possible animacy combinations of Actors and Undergoers (affected participants) in Actor- and Undergoer-initial verb-final orders. Experiments 2 and 3 employed a fairly novel context design that enabled us to compare ERPs evoked by identical auditory material to differing contextual expectations: Experiment 2 focussed on constructions in which an inanimate Actor acts upon an inanimate Undergoer, whereas Experiment 3 examined whether and how a preceding context modulates the prediction for an ideal Actor. Results showed an N400 effect when the prediction for an ideal (animate) Actor following an Undergoer was not met, thus further supporting the cross-linguistically robust nature of animacy preferences. In addition, though specific contextual cues that are indicative of a forthcoming non-ideal Actor may reduce this negativity in comparison to when such cues are not available, they nevertheless do not nullify it, suggesting that animacy-based predictions are stronger than contextual cues in online language comprehension.

Simulating dissolution of intravitreal triamcinolone acetonide suspensions in an anatomically accurate rabbit eye model.

PURPOSE: A computational fluid dynamics (CFD) study examined the impact of particle size on dissolution rate and residence of intravitreal suspension depots of Triamcinolone Acetonide (TAC). METHODS: A model for the rabbit eye was constructed using insights from high-resolution NMR imaging studies (Sawada 2002). The current model was compared to other published simulations in its ability to predict clearance of various intravitreally injected materials. Suspension depots were constructed explicitly rendering individual particles in various configurations: 4 or 16 mg drug confined to a 100 microL spherical depot, or 4 mg exploded to fill the entire vitreous. Particle size was reduced systematically in each configuration. The convective diffusion/dissolution process was simulated using a multiphase model. RESULTS: Release rate became independent of particle diameter below a certain value. The size-independent limits occurred for particle diameters ranging from 77 to 428 microM depending upon the depot configuration. Residence time predicted for the spherical depots in the size-independent limit was comparable to that observed in vivo. CONCLUSIONS: Since the size-independent limit was several-fold greater than the particle size of commercially available pharmaceutical TAC suspensions, differences in particle size amongst such products are predicted to be immaterial to their duration or performance.

Outcomes of high volume cataract surgeries in a developing country.

AIM: To analyse the outcome of high volume cataract surgery in a developing country, community based, high volume eye hospital. METHODS: In a non-comparative interventional case series, the authors reviewed the surgical outcomes of 593 patients with cataract operated upon by three high volume surgeons on six randomly selected days. There were 318 female (54%) and 275 male (46%) patients. Their mean age was 59.57 (SD 10.13) years. The majority of the patients underwent manual small incision cataract surgery (manual SICS). Extracapsular cataract extraction with posterior chamber intraocular lens (ECCE-PCIOL) and intracapsular cataract extraction (ICCE) were also done on a few patients as clinically indicated. RESULTS: Best corrected visual acuity of >or=6/18 was achieved in 94% of the 520 patients who could be followed up on the 40th postoperative day (88% follow up rate). Intraoperative and immediate postoperative complications as defined by OCTET occurred in 11 (1.9%) and 75 (12.6%) patients, respectively. Average surgical time of 3.75 minutes per case (16-18 cases per hour) was achieved. Statistically significant risk factors for outcomes were found to be age >60, sex, and surgeon. CONCLUSION: High volume surgery using appropriate techniques and standardised protocols does not compromise quality of outcomes.

Economic cost of cataract surgery procedures in an established eye care centre in Southern India.

PURPOSE: To estimate the direct and indirect costs of three cataract surgery procedures: extracapsular cataract extraction with intra-ocular lens implantation (ECCE-IOL), phacoemulsification (PHACO) and manual small incision cataract surgery (MSICS) using economic costing principles in a well-established eye care programme (Aravind Eye Hospital) in Tamil Nadu, South India during 2000-01. Previous literature suggests that PHACO and MSICS have similar effectiveness. METHODS: The average unit cost for each surgical procedure was calculated from the societal perspective using economic costing methods. Total annual provider's direct costs for each input to surgery were calculated and apportioned appropriately to different cataract surgery techniques using a 'micro-costing approach'. The patient's direct and indirect costs for each procedure were calculated by interviewing staff and patients and by using assumptions about prices for relevant cost items such as transportation, food, medicine, spectacles and economic productivity loss. RESULTS: Average provider's direct costs were highest for PHACO procedures (25.55 US dollars) compared to MSICS (17.03 US dollars) and ECCE-IOL (16.25 US dollars). The difference can be attributed to the cost of equipment and materials. Average direct and indirect patient costs were highest for ECCE-IOL (19.85 US dollars), while the costs for PHACO and MSICS were identical (12.37 US dollars). ECCE-IOL had the highest total costs and MSICS had the lowest total costs from the societal perspective. CONCLUSIONS: Our results suggest that MSICS may have a lower societal cost than other options. Government and NGO hospitals providing cataract surgeries should invest in regular cost analyses, reviews of the literature on effectiveness, and formal cost-effectiveness analyses in order to plan economically efficient interventions. Considering the small incremental cost for providers (less than 1 US dollar), improved outcomes, and lower patient costs, we also believe that MSICS is an important technique to use in efforts to eliminate cataract blindness in India and this result may be generalised to other developing countries.

Spontaneous growth of fluctuations in the viscous flow of a fluid past a soft interface

The flow induced instability in the flow past a soft material is studied in the limit of low Reynolds number where inertial effects are insignificant. A transition from laminar flow to a more complicated flow profile is observed when the strain rate of the base flow increases beyond a critical value; the transition is found to be reproducible. The experimental results are compared with theoretical predictions and quantitative agreement is found with no adjustable parameters.