Cortical integration of audio-visual speech and non-speech stimuli.

Using fMRI we investigated the neural basis of audio-visual processing of speech and non-speech stimuli using physically similar auditory stimuli (speech and sinusoidal tones) and visual stimuli (animated circles and ellipses). Relative to uni-modal stimuli, the different multi-modal stimuli showed increased activation in largely non-overlapping areas. Ellipse-Speech, which most resembles naturalistic audio-visual speech, showed higher activation in the right inferior frontal gyrus, fusiform gyri, left posterior superior temporal sulcus, and lateral occipital cortex. Circle-Tone, an arbitrary audio-visual pairing with no speech association, activated middle temporal gyri and lateral occipital cortex. Circle-Speech showed activation in lateral occipital cortex, and Ellipse-Tone did not show increased activation relative to uni-modal stimuli. Further analysis revealed that middle temporal regions, although identified as multi-modal only in the Circle-Tone condition, were more strongly active to Ellipse-Speech or Circle-Speech, but regions that were identified as multi-modal for Ellipse-Speech were always strongest for Ellipse-Speech. Our results suggest that combinations of auditory and visual stimuli may together be processed by different cortical networks, depending on the extent to which multi-modal speech or non-speech percepts are evoked.

The effectiveness of hospital-based diabetes case management: an example from a northern Taiwan regional hospital.

The aim of this study was to design, implement and evaluate disease outcomes at a regional hospital- based case management program of care for patients with type 2 diabetes. A medical team and practice guidelines were established in line with the health insurance strategy of Taiwan's Bureau of National Health Insurance (BNHI) and American Diabetes Association (ADA) Standards of Care for Diabetes (2003 edition). Also, a set of self-care booklets was designed suitable for use by the subject group. The study was prospective and followed the patients from enrollment to one year. Patient outcomes were determined based on laboratory examinations and recorded self-care behavior. Data were collected at enrollment and over 4 follow-up times within a one year period. Generalized Estimating Equation (GEE) multiple linear regression and logistic regression were used for repeated measurements and adjustments of the effects of specific prognostic factors. Sixty subjects diagnosed with type 2 diabetes (mean duration 3.25 years) were recruited. All participants were married with a mean age of 52.5 years. A majority (58.3%) was male and 65% were ethnic Hakka. Self-care knowledge and behavior accomplishment rates were: taking medications by oneself, 91.3% (knowing medicines, 25.4%); hypoglycemia management, 23.3%; monitoring blood sugar, 46.7%; exercise, 35.8%; diet management, 51.7% and foot care, 92.8%. Significantly improved ADA diabetes care standard items included HbA1C (p< .0001), fasting glucose (p< .01) and triglycerides (p< .05). The study incorporated evidence-based guidelines, public health insurance strategies and self-care booklets into a protocol to provide comprehensive care. The implemented diabetes program achieved diabetes care goals and improved patient self-care.