Tonal and syllabic encoding in overt Cantonese Chinese speech production: An ERP study.

This study was conducted to investigate how syllables and lexical tones are processed in Cantonese speech production using the picture-word interference task with concurrent recording of event-related brain potentials (ERPs). Cantonese-speaking participants were asked to name aloud individually presented pictures and ignore an accompanying auditory word distractor. The target and distractor either shared the same word-initial syllable with the same tone (Tonal-Syllable related), the same word-initial syllable without the same tone (Atonal-Syllable related), the same tone only (Tone alone related), or were phonologically unrelated. Participants' naming responses were faster, relative to an unrelated control, when the target and distractor shared the same tonal- or atonal-syllable but null effect was found in the Tone alone related condition. The mean ERP amplitudes (per each 100-ms time window) were subjected to stimulus-locked (i.e., time-locked to stimulus onset) and response-locked (i.e., time-locked to response onset) analyses. Significant differences between related and unrelated ERP waves were similarly observed in both Tonal-Syllable related and Atonal-Syllable related conditions in the time window of 400-500 ms post-stimulus. However, distinct ERP effects were observed in these two phonological conditions within the 500-ms pre-response period. In addition, null effects were found in the Tone alone related condition in both stimulus-locked and response-locked analyses. These results suggest that in Cantonese spoken word production, the atonal syllable of the target is retrieved first and then associated with the target lexical tone, consistent with the view that tone has an important role to play at a late stage of phonological encoding in tonal language production.

Use of the Free Endometriosis Risk Advisor App as a Non-Invasive Screening Test for Endometriosis in Patients with Chronic Pelvic Pain and/or Unexplained Infertility.

Endometriosis is a prevalent condition that affects millions of individuals globally, leading to various symptoms and significant disruptions to their quality of life. However, the diagnosis of endometriosis often encounters delays, emphasizing the pressing need for non-invasive screening. This retrospective cross-sectional study aimed to evaluate the utility of the Endometriosis Risk Advisor (EndoRA) mobile application in screening for endometriosis in patients with chronic pelvic pain and/or unexplained infertility. The study consisted of 293 patients who met specific criteria: they were English-speaking individuals with chronic pelvic pain and/or unexplained infertility, owned smartphones, and had no prior diagnosis of endometriosis. The results demonstrated that the EndoRA score exhibited a high sensitivity of 93.1% but a low specificity of 5.9% in detecting endometriosis. The positive predictive value was 94.1%, while the negative predictive value was 5.0%. Although the study had limitations and potential selection bias, its findings suggest that EndoRA can serve as a valuable screening tool for high-risk individuals, enabling them to identify themselves as being at an increased risk for endometriosis. EndoRA's non-invasive nature, free access, and easy accessibility have the potential to streamline evaluation and treatment processes, thereby empowering individuals to seek timely care and ultimately improving patient outcomes and overall well-being.

Cost-effectiveness of the add-on exenatide to conventional treatment in patients with Parkinson's disease when considering the coexisting effects of diabetes mellitus.

OBJECTIVE: This study aims to investigate the cost-effectiveness of the add-on exenatide to conventional pharmacotherapy in patients with Parkinson's disease (PD) when considering the coexistence of diabetes mellitus (DM). METHODS: We used the Keelung and Community-based Integrated Screening databases to understand the medical utilisation in the Hoehn and Yahr stages of patients with PD. A Markov model with 1-year cycle length and 50-year time horizon was used to assess the cost-effectiveness of add-on exenatide to conventional pharmacotherapy compared to conventional pharmacotherapy alone. All costs were adjusted to the value of the new Taiwanese dollar (NT$) as of the year 2020. One-way sensitivity and probability analyses were performed to test the robustness of the results. RESULTS: From a societal perspective, the add-on exenatide brought an average of 0.39 quality-adjusted life years (QALYs) gained, and a cost increment of NT$104,744 per person in a 50-year horizon compared to conventional pharmacotherapy. The incremental cost-effectiveness ratio (ICER) was NT$268,333 per QALY gained. As the ICER was less than the gross domestic product per capita (NT$839,558), the add-on exenatide was considered to be very cost-effective in the two models, according to the World Health Organization recommendation. Add-on exenatide had a 96.9% probability of being cost-effective in patients with PD, and a 100% probability of being cost-effective in patients with PD and DM. CONCLUSION: Add-on exenatide is cost-effective in PD combined with DM. Considering that DM may be a risk factor for neurodegenerative diseases, exenatide provides both clinical benefits and cost-effectiveness when considering both PD and DM.

Impact of COVID-19 pandemic on accessibility of Taiwanese medical care.

OBJECTIVES: Whether and how the COVID-19 pandemic affected utilization of routine medical care in areas with low infection risk, such as Taiwan, has not been widely addressed. We aimed to evaluate the impact of the COVID-19 pandemic on access to medical care. STUDY DESIGN: Before and after exposure (COVID-19 pandemic) design with a historical control group for comparison of clinical visits based on a retrospective cohort of 6722 customary patients of a community hospital in Zhunan, Taiwan. METHODS: Repeated measurements of medical utilization in 4-month periods (January to April) of 2019 and 2020 in light of the emerging COVID-19 pandemic were collected. Access to medical care was defined as the mean frequencies of clinical visits. The impacts of the COVID-19 pandemic on access in the overall and specific groups were quantified with a multivariable Poisson regression model. RESULTS: The overall outpatient visits per month declined by 39% (rate ratio [RR], 0.61; P < .0001) after adjusting for demographics. A notable reduction in visits was observed in foreign patients (RR, 0.50; P < .0001). The visits of the elderly (≥ 80 years) were the most frequent before the COVID-19 pandemic but were reduced by 44% (RR, 0.56; P < .0001) after it began. Most disease categories revealed a declining trend, but the size of reduction varied by International Classification of Diseases codes. CONCLUSIONS: The COVID-19 pandemic prevented some individuals from keeping regular medical appointments even in an area with a low infection risk. Our findings imply that more research is required to mitigate the effects of delayed medical care for patients who infrequently utilized medical care during and after the long-lasting pandemic period.

Stroke Encoding Processes of Chinese Character During Sentence Reading.

The present study was conducted to examine whether traditional and simplified Chinese readers (TCRs and SCRs) differed in stroke encoding in character processing by an eye-tracking experiment. We recruited 66 participants (32 TCRs and 34 SCRs) to read sentences comprising characters with different proportions and types of strokes removed in order to explore whether any visual complexity effect existed in their processing of simplified and traditional Chinese characters. The present study found a cross-script visual complexity effect and that SCRs were more influenced by visual complexity change in lexical access than were TCRs. In addition, the stroke-order effect appeared to be more salient for TCRs than for SCRs.

Behavioural evidence for segments as subordinate units in Chinese spoken word production: The form-preparation paradigm revisited.

It is widely acknowledged that phonemic segments are primary phonological units, processed serially, in spoken word production of Germanic languages. However, evidence for a behavioural effect of single-segment overlap on Chinese spoken word production is lacking. The current study adopted the form-preparation paradigm to investigate the effects of segment predictability and segment repetition separately, which were mixed in previous studies. Native Mandarin Chinese speakers named pictures in the following conditions: predictable, unpredictable, and no segment repetition. Different positions in words (i.e., the onset and the rhyme) were examined at the same time. Results revealed a facilitation effect of onset predictability masked by an inhibition tendency of onset repetition, indicating Chinese speakers' ability to prepare the predictable onset. In contrast, rhyme predictability showed a non-significant effect. This pattern of results did not change no matter whether the conditions of unpredictable onset repetition and unpredictable rhyme repetition were mixed in the same context (Experiment 1) or extracted from different blocked contexts (Experiment 2). The finding provides essential support to the claim that phonemic segments are functionally engaged in Chinese spoken word production, and thus adds original evidence to the universal aspect of spoken word production.

Syllable retrieval precedes sub-syllabic encoding in Cantonese spoken word production.

Two experiments were conducted to investigate the time course of syllabic and sub-syllabic processing in Cantonese spoken word production by using the picture-word interference task. Cantonese-speaking participants were asked to name individually presented pictures aloud and ignore an auditory word distractor. The targets and distractors were either phonologically related (i.e., sharing two identical word-initial phonemes) or unrelated. In Experiment 1, the target syllables were all consonant-vowel (CV)-structured. The phonological distractor was either a CV syllable (i.e., Full Syllable Overlap) or a CVC (consonant-vowel-consonant) syllable (i.e., Sub-syllable Overlap). Relative to the unrelated control, Full Syllable Overlap distractors facilitated naming in all stimuli onset asynchronies (SOAs) (-175, 0, or +175 ms) whereas Sub-syllable Overlap distractors exhibited facilitation only at 0-ms and +175-ms SOAs. Experiment 2 adopted a similar design to examine the possible influence of syllabic structure similarity on the results of Experiment 1. The target syllables were all CVC-structured. The phonological distractor was either a CVC (i.e., Syllable-structure Consistent) or CV (i.e., Syllable-structure Inconsistent) syllable. Comparable priming was observed between the two distractor conditions across the three SOAs. These results indicated that an earlier priming effect was observed with full syllable overlap than sub-syllabic overlap when the degree of segmental overlap was held constant (Experiment 1). The earlier syllable priming observed in Experiment 1 could not be attributed to the effect of syllabic-structure (Experiment 2), thereby suggesting that the syllable unit is important in Cantonese and is retrieved earlier than sub-syllabic components during phonological encoding.

Risk Factors for the Development of Obstetric Anal Sphincter Injuries in Modern Obstetric Practice.

OBJECTIVE: To characterize the rate of obstetric anal sphincter injuries and identify key risk factors of obstetric anal sphincter injuries, including duration of the second stage of labor. METHODS: This retrospective cohort study included all singleton, term, cephalic vaginal deliveries within Kaiser Permanente Northern California between January 2013 and December 2014 (N=22,741). Incidence of obstetric anal sphincter injuries, defined as third- or fourth-degree perineal lacerations, was the primary outcome. Multiple logistic regression models were conducted to identify obstetric anal sphincter injury risk factors and high-risk subpopulations. RESULTS: The overall incidence rate of obstetric anal sphincter injuries was 4.9% (3.6% of women who delivered spontaneously vs 24.0% of women who had a vacuum-assisted vaginal delivery, P<.001, CI 18.1-22.6%). In bivariate and multivariate analyses, obstetric anal sphincter injury incidence was higher among women with second stage of labor longer than 2 hours, Asian race, nulliparity, vaginal birth after cesarean delivery, episiotomy, and vacuum delivery. Women with a vacuum-assisted vaginal delivery had four times the odds of obstetric anal sphincter injury (adjusted odds ratio [OR] 4.23, 95% CI 3.59-4.98) and those whose second stage of labor lasted at least 180 minutes vs less than 60 minutes had three times the odds of incurring obstetric anal sphincter injury (adjusted OR 3.20, 95% CI 2.62-3.89). CONCLUSION: Vacuum-assisted vaginal delivery conferred the highest odds of obstetric anal sphincter injury followed by prolonged duration of the second stage of labor, particularly among certain subpopulations. Understanding these risk factors and their complex interactions can inform antepartum and intrapartum decision-making with the goal of reducing obstetric anal sphincter injury incidence.

MELD-SCH: A megastudy of lexical decision in simplified Chinese.

Here we report on MELD-SCH (MEgastudy of Lexical Decision in Simplified CHinese), a dataset that contains the lexical decision data of 1,020 one-character, 10,022 two-character, 949 three-character, and 587 four-character simplified Chinese words obtained from 504 native Chinese users. It also includes a number of word-level and character-level variables. Analyses showed that the reliability of the dataset is satisfactory, as indicated by split-half correlations and comparisons with other datasets. Item-based regression showed that both word-level and character-level variables contributed significantly to the reaction times and error rates of lexical decision. Moreover, we discovered a U-shape relationship between word-length and reaction times, which has not been reported in Chinese before. MELD-SCH can facilitate research in Chinese word recognition by providing high quality normative data and information of different linguistic variables. It also encourages researchers to extend their empirical findings, which are mostly based on one-character and two-character words, to words of different lengths.

Time course of syllabic and sub-syllabic processing in Mandarin word production: Evidence from the picture-word interference paradigm.

The time course of phonological encoding in Mandarin monosyllabic word production was investigated by using the picture-word interference paradigm. Participants were asked to name pictures in Mandarin while visual distractor words were presented before, at, or after picture onset (i.e., stimulus-onset asynchrony/SOA = -100, 0, or +100 ms, respectively). Compared with the unrelated control, the distractors sharing atonal syllables with the picture names significantly facilitated the naming responses at -100- and 0-ms SOAs. In addition, the facilitation effect of sharing word-initial segments only appeared at 0-ms SOA, and null effects were found for sharing word-final segments. These results indicate that both syllables and subsyllabic units play important roles in Mandarin spoken word production and more critically that syllabic processing precedes subsyllabic processing. The current results lend strong support to the proximate units principle (O'Seaghdha, Chen, & Chen, 2010), which holds that the phonological structure of spoken word production is language-specific and that atonal syllables are the proximate phonological units in Mandarin Chinese. On the other hand, the significance of word-initial segments over word-final segments suggests that serial processing of segmental information seems to be universal across Germanic languages and Chinese, which remains to be verified in future studies.

Primary phonological planning units in spoken word production are language-specific: Evidence from an ERP study.

It is widely acknowledged in Germanic languages that segments are the primary planning units at the phonological encoding stage of spoken word production. Mixed results, however, have been found in Chinese, and it is still unclear what roles syllables and segments play in planning Chinese spoken word production. In the current study, participants were asked to first prepare and later produce disyllabic Mandarin words upon picture prompts and a response cue while electroencephalogram (EEG) signals were recorded. Each two consecutive pictures implicitly formed a pair of prime and target, whose names shared the same word-initial atonal syllable or the same word-initial segments, or were unrelated in the control conditions. Only syllable repetition induced significant effects on event-related brain potentials (ERPs) after target onset: a widely distributed positivity in the 200- to 400-ms interval and an anterior positivity in the 400- to 600-ms interval. We interpret these to reflect syllable-size representations at the phonological encoding and phonetic encoding stages. Our results provide the first electrophysiological evidence for the distinct role of syllables in producing Mandarin spoken words, supporting a language specificity hypothesis about the primary phonological units in spoken word production.

Syllabic encoding during overt speech production in Cantonese: Evidence from temporal brain responses.

The time course of phonological encoding in overt Cantonese disyllabic word production was investigated using a picture-word interference task with concurrent recording of the event-related brain potentials (ERPs). Participants were asked to name aloud individually presented pictures and ignore a distracting Chinese character. Participants' naming responses were faster, relative to an unrelated control, when the distractor overlapped with the target's word-initial or word-final syllables. Furthermore, ERP waves in the syllable-related conditions were more positive-going than those in the unrelated control conditions from 500ms to 650ms post target onset (i.e., a late positivity). The mean and peak amplitudes of this late positivity correlated with the size of phonological facilitation. More importantly, the onset of the late positivity associated with word-initial syllable priming was 44ms earlier than that associated with word-final syllable priming, suggesting that phonological encoding in overt speech runs incrementally and the encoding duration for one syllable unit is approximately 44ms. Although the size of effective phonological units might vary across languages, as suggested by previous speech production studies, the present data indicate that the incremental nature of phonological encoding is a universal mechanism.

Dynamic brain architectures in local brain activity and functional network efficiency associate with efficient reading in bilinguals.

The human brain is organized as a dynamic network, in which both regional brain activity and inter-regional connectivity support high-level cognitive processes, such as reading. However, it is still largely unknown how the functional brain network organizes to enable fast and effortless reading processing in the native language (L1) but not in a non-proficient second language (L2), and whether the mechanisms underlying local activity are associated with connectivity dynamics in large-scale brain networks. In the present study, we combined activation-based and multivariate graph-theory analysis with functional magnetic resonance imaging data to address these questions. Chinese-English unbalanced bilinguals read narratives for comprehension in Chinese (L1) and in English (L2). Compared with L2, reading in L1 evoked greater brain activation and recruited a more globally efficient but less clustered network organization. Regions with both increased network efficiency and enhanced brain activation in L1 reading were mostly located in the fronto-temporal reading-related network (RN), whereas regions with decreased global network efficiency, increased clustering, and more deactivation in L2 reading were identified in the default mode network (DMN). Moreover, functional network efficiency was closely associated with local brain activation, and such associations were also modulated by reading efficiency in the two languages. Our results demonstrate that an economical and integrative brain network topology is associated with efficient reading, and further reveal a dynamic association between network efficiency and local activation for both RN and DMN. These findings underscore the importance of considering interregional connectivity when interpreting local BOLD signal changes in bilingual reading.

Activation of morphemic meanings in processing opaque words.

Two masked priming experiments were conducted to examine the activation of morphemic forms and meanings during opaque word processing. In Experiment 1, opaque primes significantly facilitated the recognition of transparent targets, which was consistent with previous results. However, transparent primes did not influence the recognition of opaque targets. This asymmetry could not be explained solely by morpho-orthographic processing, but it was consistent with models that have assumed early morpho-semantic activation. Experiment 2 directly tested whether the meanings of the constituent morphemes in opaque words were activated. In the critical condition, the targets were unrelated to the opaque primes at the lexical level, but were semantically related to their morphemes (e.g., "butterfly-bread"). Facilitation was observed in this condition, providing strong evidence of morpho-semantic activation during opaque-word recognition. These findings indicate that although initial morphological decomposition is determined by surface morphological form, it does not necessarily imply that morphemic meanings will be activated at later stages of processing. Rather, the morphemic meanings may be available automatically once segmentation is complete.

Right hemisphere advantage in processing Cantonese level and contour tones: evidence from dichotic listening.

The brain lateralization pattern of Cantonese tonal processing was examined with the dichotic listening (DL) paradigm. Three factors were manipulated systematically in the study. First, the processing of level tones was compared with that of contour tones. Second, the influence of a linguistic context in tonal processing was studied by contrasting the patterns of brain lateralization for real syllables, pseudo-syllables, and hums. Finally, the discrimination and the identification tasks were used to test how processing depth might modulate the results obtained. A right hemisphere advantage (RHA) was obtained regardless of tone type, stimulus type, and task. In addition, the performance on level tones was in general better than that on contour tones. These findings suggest that Cantonese speakers are highly sensitive to the acoustic features of lexical tones, which supports the acoustic view about tonal processing.

Cortical dynamics of semantic processing during sentence comprehension: evidence from event-related optical signals.

Using the event-related optical signal (EROS) technique, this study investigated the dynamics of semantic brain activation during sentence comprehension. Participants read sentences constituent-by-constituent and made a semantic judgment at the end of each sentence. The EROSs were recorded simultaneously with ERPs and time-locked to expected or unexpected sentence-final target words. The unexpected words evoked a larger N400 and a late positivity than the expected ones. Critically, the EROS results revealed activations first in the left posterior middle temporal gyrus (LpMTG) between 128 and 192 ms, then in the left anterior inferior frontal gyrus (LaIFG), the left middle frontal gyrus (LMFG), and the LpMTG in the N400 time window, and finally in the left posterior inferior frontal gyrus (LpIFG) between 832 and 864 ms. Also, expected words elicited greater activation than unexpected words in the left anterior temporal lobe (LATL) between 192 and 256 ms. These results suggest that the early lexical-semantic retrieval reflected by the LpMTG activation is followed by two different semantic integration processes: a relatively rapid and transient integration in the LATL and a relatively slow but enduring integration in the LaIFG/LMFG and the LpMTG. The late activation in the LpIFG, however, may reflect cognitive control.

Morpho-semantic processing in word recognition: evidence from balanced and biased ambiguous morphemes.

The role of morphemic meaning in Chinese word recognition was examined with the masked and unmasked priming paradigms. Target words contained ambiguous morphemes biased toward the dominant or the subordinate meanings. Prime words either contained the same ambiguous morphemes in the subordinate interpretations or were unrelated to the targets. In addition, the relative frequency of the alternative meanings of ambiguous morphemes could be balanced (i.e., the alternative meanings are of similar frequency) or biased (i.e., one of the meanings is used much more frequently). The recognition of subordinate targets was facilitated by the subordinate primes for both balanced and biased items, regardless of the priming procedure. However, the subordinate primes did not facilitate the recognition of dominant targets, except for biased items in masked priming. These results are interpreted as supporting the hypothesis that morphemic meaning is activated to constrain morphological priming even at the early stage of processing. Yet, morpho-semantic activation is modulated by the frequency of the intended morphemic interpretations. Therefore, because of the high frequency of use, the dominant meanings of biased ambiguous morphemes can nevertheless be activated by the subordinate primes.

Phonological units in spoken word production: insights from Cantonese.

Evidence from previous psycholinguistic research suggests that phonological units such as phonemes have a privileged role during phonological planning in Dutch and English (aka the segment-retrieval hypothesis). However, the syllable-retrieval hypothesis previously proposed for Mandarin assumes that only the entire syllable unit (without the tone) can be prepared in advance in speech planning. Using Cantonese Chinese as a test case, the present study was conducted to investigate whether the syllable-retrieval hypothesis can be applied to other Chinese spoken languages. In four implicit priming (form-preparation) experiments, participants were asked to learn various sets of prompt-response di-syllabic word pairs and to utter the corresponding response word upon seeing each prompt. The response words in a block were either phonologically related (homogeneous) or unrelated (heterogeneous). Participants' naming responses were significantly faster in the homogeneous than in the heterogeneous conditions when the response words shared the same word-initial syllable (without the tone) (Exps.1 and 4) or body (Exps.3 and 4), but not when they shared merely the same word-initial phoneme (Exp.2). Furthermore, the priming effect observed in the syllable-related condition was significantly larger than that in the body-related condition (Exp. 4). Although the observed syllable priming effects and the null effect of word-initial phoneme are consistent with the syllable-retrieval hypothesis, the body-related (sub-syllabic) priming effects obtained in this Cantonese study are not. These results suggest that the syllable-retrieval hypothesis is not generalizable to all Chinese spoken languages and that both syllable and sub-syllabic constituents are legitimate planning units in Cantonese speech production.

What and where is the word?

Examples from Chinese, Thai, and Finnish illustrate why researchers cannot always be confident about the precise nature of the word unit. Understanding ambiguities regarding where a word begins and ends, and how to model word recognition when many derivations of a word are possible, is essential for universal theories of reading applied to both developing and expert readers.

The role of gender information in pronoun resolution: evidence from Chinese.

Although previous studies have consistently demonstrated that gender information is used to resolve pronouns, the mechanisms underlying the use of gender information continue to be controversial. The present study used event-related potentials (ERPs) to investigate whether working memory modulates the effect of gender information on pronoun resolution. The critical pronoun agreed or disagreed with its antecedent in gender. Moreover, the distance between a pronoun and its antecedent was varied to assess the influence of working memory. Compared with the congruent pronouns, the incongruent pronouns elicited an N400 effect in the short distance condition and a P600 effect in the long distance condition. The results suggest that the effect of gender information on pronoun comprehension is modulated by working memory.