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Sentence comprehension requires the assignment of thematic relations between the verb and its noun arguments in order to determine who is doing what to whom. In some languages, such as English, word order is the primary syntactic cue. In other languages, such as German, case-marking is additionally used to assign thematic roles. During development children have to acquire the thematic relevance of these syntactic cues and weigh them against semantic cues. Here we investigated the processing of syntactic cues and semantic cues in 2- and 3-year-old children by analyzing their behavioral and neurophysiological responses. Case-marked subject-first and object-first sentences (syntactic cue) including animate and inanimate nouns (semantic cue) were presented auditorily. The semantic animacy cue either conflicted with or supported the thematic roles assigned by syntactic case-marking. In contrast to adults, for whom semantics did not interfere with case-marking, children attended to both syntactic and to semantic cues with a stronger reliance on semantic cues in early development. Children’s event-related brain potentials indicated sensitivity to syntactic information but increased processing costs when case-marking and animacy assigned conflicting thematic roles. These results demonstrate an early developmental sensitivity and ongoing shift towards the use of syntactic cues during sentence comprehension.
Regulatory focus is a motivational construct that describes humans’ motivational orientation during goal pursuit. It is conceptualized as a chronic, trait-like, as well as a momentary, state-like orientation. Whereas there is a large number of measures to capture chronic regulatory focus, measures for its momentary assessment are only just emerging. This paper presents the development and validation of a measure of Momentary–Chronic Regulatory Focus. Our development incorporates the distinction between self-guide and reference-point definitions of regulatory focus. Ideals and ought striving are the promotion and prevention dimension in the self-guide system; gain and non-loss regulatory focus are the respective dimensions within the reference-point system. Three-survey-based studies test the structure, psychometric properties, and validity of the measure in its version to assess chronic regulatory focus (two samples of working participants, N = 389, N = 672; one student sample [time 1, N = 105; time 2, n = 91]). In two further studies, an experience sampling study with students (N = 84, k = 1649) and a daily-diary study with working individuals (N = 129, k = 1766), the measure was applied to assess momentary regulatory focus. Multilevel analyses test the momentary measure’s factorial structure, provide support for its sensitivity to capture within-person fluctuations, and provide evidence for concurrent construct validity.
It is a common finding across languages that young children have problems in understanding patient-initial sentences. We used Tagalog, a verb-initial language with a reliable voice-marking system and highly frequent patient voice constructions, to test the predictions of several accounts that have been proposed to explain this difficulty: the frequency account, the Competition Model, and the incremental processing account. Study 1 presents an analysis of Tagalog child-directed speech, which showed that the dominant argument order is agent-before-patient and that morphosyntactic markers are highly valid cues to thematic role assignment. In Study 2, we used a combined self-paced listening and picture verification task to test how Tagalog-speaking adults and 5- and 7-year-old children process reversible transitive sentences. Results showed that adults performed well in all conditions, while children’s accuracy and listening times for the first noun phrase indicated more difficulty in interpreting patient-initial sentences in the agent voice compared to the patient voice. The patient voice advantage is partly explained by both the frequency account and incremental processing account.
Previous studies have shown that multilingual speakers are influenced by their native (L1) and non-native (L2) grammars when learning a new language. But, so far, these studies have mostly used untimed metalinguistic tasks. Here we examine whether multilinguals’ prior grammars also affect their sensitivity to morphosyntactic constraints during processing. We use speeded judgment and self-paced reading tasks to examine the comprehension of German possessive pronouns. To investigate whether native and non-native grammars differentially affect participants’ performance, we compare two groups of non-native German speakers with inverse L1–L2 distributions: a group with L1 Spanish – L2 English, and a group with L1 English – L2 Spanish. We show that the reading profiles of both groups are modulated by their L1 grammar, with L2 proficiency selectively affecting participants’ judgment accuracy but not their reading times. We propose that reading comprehension is mainly influenced by multilinguals’ native grammar, but that knowledge of an L2 grammar can further increase sensitivity to morphosyntactic violations in an additional language.
Background: Telerehabilitation can contribute to the maintenance of successful rehabilitation regardless of location and time. The aim of this study was to investigate a specific three-month interactive telerehabilitation routine regarding its effectiveness in assisting patients with physical functionality and with returning to work compared to typical aftercare.
Objective: The aim of the study was to investigate a specific three-month interactive telerehabilitation with regard to effectiveness in functioning and return to work compared to usual aftercare.
Methods: From August 2016 to December 2017, 111 patients (mean 54.9 years old; SD 6.8; 54.3% female) with hip or knee replacement were enrolled in the randomized controlled trial. At discharge from inpatient rehabilitation and after three months, their distance in the 6-minute walk test was assessed as the primary endpoint. Other functional parameters, including health related quality of life, pain, and time to return to work, were secondary endpoints.
Results: Patients in the intervention group performed telerehabilitation for an average of 55.0 minutes (SD 9.2) per week. Adherence was high, at over 75%, until the 7th week of the three-month intervention phase. Almost all the patients and therapists used the communication options. Both the intervention group (average difference 88.3 m; SD 57.7; P=.95) and the control group (average difference 79.6 m; SD 48.7; P=.95) increased their distance in the 6-minute-walk-test. Improvements in other functional parameters, as well as in quality of life and pain, were achieved in both groups. The higher proportion of working patients in the intervention group (64.6%; P=.01) versus the control group (46.2%) is of note.
Conclusions: The effect of the investigated telerehabilitation therapy in patients following knee or hip replacement was equivalent to the usual aftercare in terms of functional testing, quality of life, and pain. Since a significantly higher return-to-work rate could be achieved, this therapy might be a promising supplement to established aftercare.
Presupposition triggers differ with respect to whether their presupposition is easily accommodatable. The presupposition of focus-sensitive additive particles like also or too is often classified as hard to accommodate, i.e., these triggers are infelicitous if their presupposition is not entailed by the immediate linguistic or non-linguistic context. We tested two competing accounts for the German additive particle auch concerning this requirement: First, that it requires a focus alternative to the whole proposition to be salient, and second, that it merely requires an alternative to the focused constituent (e.g., an individual) to be salient. We conducted two experiments involving felicity judgments as well as questions asking for the truth of the presupposition to be accommodated. Our results suggest that the latter account is too weak: mere previous mention of a potential alternative to the focused constituent is not enough to license the use of auch. However, our results also suggest that the former account is too strong: when an alternative of the focused constituent is prementioned and certain other accommodation-enhancing factors are present, the context does not have to entail the presupposed proposition. We tested the following two potentially accommodation-enhancing factors: First, whether the discourse can be construed to be from the perspective of the individual that the presupposition is about, and second, whether the presupposition is needed to establish coherence between the host sentence of the additive particle and the preceding context. The factor coherence was found to play a significant role. Our results thus corroborate the results of other researchers showing that discourse participants go to great lengths in order to identify a potential presupposition to accommodate, and we contribute to these results by showing that coherence is one of the factors that enhance accommodation.
Objective: We aimed to characterize patients after an acute cardiac event regarding their negative expectations around returning to work and the impact on work capacity upon discharge from cardiac rehabilitation (CR).
Methods: We analyzed routine data of 884 patients (52±7 years, 76% men) who attended 3 weeks of inpatient CR after an acute coronary syndrome (ACS) or cardiac surgery between October 2013 and March 2015. The primary outcome was their status determining their capacity to work (fit vs unfit) at discharge from CR. Further, sociodemographic data (eg, age, sex, and education level), diagnoses, functional data (eg, exercise stress test and 6-min walking test [6MWT]), the Hospital Anxiety and Depression Scale (HADS) and self-assessment of the occupational prognosis (negative expectations and/or unemployment, Würzburger screening) at admission to CR were considered.
Results: A negative occupational prognosis was detected in 384 patients (43%). Out of these, 368 (96%) expected not to return to work after CR and/or were unemployed before CR at 29% (n=113). Affected patients showed a reduced exercise capacity (bicycle stress test: 100 W vs 118 W, P<0.01; 6MWT: 380 m vs 421 m, P<0.01) and were more likely to receive a depression diagnosis (12% vs 3%, P<0.01), as well as higher levels on the HADS. At discharge from CR, 21% of this group (n=81) were fit for work (vs 35% of patients with a normal occupational prognosis (n=175, P<0.01)). Sick leave before the cardiac event (OR 0.4, 95% CI 0.2–0.6, P<0.01), negative occupational expectations (OR 0.4, 95% CI 0.3–0.7, P<0.01) and depression (OR 0.3, 95% CI 0.1–0.8, P=0.01) reduced the likelihood of achieving work capacity upon discharge. In contrast, higher exercise capacity was positively associated.
Conclusion: Patients with a negative occupational prognosis often revealed a reduced physical performance and suffered from a high psychosocial burden. In addition, patients’ occupational expectations were a predictor of work capacity at discharge from CR. Affected patients should be identified at admission to allow for targeted psychosocial care.
Background
Postoperative delirium is a common disorder in older adults that is associated with higher morbidity and mortality, prolonged cognitive impairment, development of dementia, higher institutionalization rates, and rising healthcare costs. The probability of delirium after surgery increases with patients’ age, with pre-existing cognitive impairment, and with comorbidities, and its diagnosis and treatment is dependent on the knowledge of diagnostic criteria, risk factors, and treatment options of the medical staff. In this study, we will investigate whether a cross-sectoral and multimodal intervention for preventing delirium can reduce the prevalence of delirium and postoperative cognitive decline (POCD) in patients older than 70 years undergoing elective surgery. Additionally, we will analyze whether the intervention is cost-effective.
Methods
The study will be conducted at five medical centers (with two or three surgical departments each) in the southwest of Germany. The study employs a stepped-wedge design with cluster randomization of the medical centers. Measurements are performed at six consecutive points: preadmission, preoperative, and postoperative with daily delirium screening up to day 7 and POCD evaluations at 2, 6, and 12 months after surgery. Recruitment goals are to enroll 1500 patients older than 70 years undergoing elective operative procedures (cardiac, thoracic, vascular, proximal big joints and spine, genitourinary, gastrointestinal, and general elective surgery procedures.
Discussion
Results of the trial should form the basis of future standards for preventing delirium and POCD in surgical wards. Key aims are the improvement of patient safety and quality of life, as well as the reduction of the long-term risk of conversion to dementia. Furthermore, from an economic perspective, we expect benefits and decreased costs for hospitals, patients, and healthcare insurances.
Trial registration
German Clinical Trials Register, DRKS00013311. Registered on 10 November 2017.
Speech and action sequences are continuous streams of information that can be segmented into sub-units. In both domains, this segmentation can be facilitated by perceptual cues contained within the information stream. In speech, prosodic cues (e.g., a pause, pre-boundary lengthening, and pitch rise) mark boundaries between words and phrases, while boundaries between actions of an action sequence can be marked by kinematic cues (e.g., a pause, pre-boundary deceleration). The processing of prosodic boundary cues evokes an Event-related Potentials (ERP) component known as the Closure Positive Shift (CPS), and it is possible that the CPS reflects domaingeneral cognitive processes involved in segmentation, given that the CPS is also evoked by boundaries between subunits of non-speech auditory stimuli. This study further probed the domain-generality of the CPS and its underlying processes by investigating electrophysiological correlates of the processing of boundary cues in sequences of spoken verbs (auditory stimuli; Experiment 1; N = 23 adults) and actions (visual stimuli; Experiment 2; N = 23 adults). The EEG data from both experiments revealed a CPS-like broadly distributed positivity during the 250 ms prior to the onset of the post-boundary word or action, indicating similar electrophysiological correlates of boundary processing across domains, suggesting that the cognitive processes underlying speech and action segmentation might also be shared.
Aim: The aim of the study was to identify common orthopedic sports injury profiles in adolescent elite athletes with respect to age, sex, and anthropometrics.
Methods: A retrospective data analysis of 718 orthopedic presentations among 381 adolescent elite athletes from 16 different sports to a sports medical department was performed. Recorded data of history and clinical examination included area, cause and structure of acute and overuse injuries. Injury-events were analyzed in the whole cohort and stratified by age (11–14/15–17 years) and sex. Group differences were tested by chi-squared-tests. Logistic regression analysis was applied examining the influence of factors age, sex, and body mass index (BMI) on the outcome variables area and structure (a = 0.05).
Results: Higher proportions of injury-events were reported for females (60%) and athletes of the older age group (66%) than males and younger athletes. The most frequently injured area was the lower extremity (47%) followed by the spine (30.5%) and the upper extremity (12.5%). Acute injuries were mainly located at the lower extremity (74.5%), while overuse injuries were predominantly observed at the lower extremity (41%) as well as the spine (36.5%). Joints (34%), muscles (22%), and tendons (21.5%) were found to be the most often affected structures. The injured structures were different between the age groups (p = 0.022), with the older age group presenting three times more frequent with ligament pathology events (5.5%/2%) and less frequent with bony problems (11%/20.5%) than athletes of the younger age group. The injured area differed between the sexes (p = 0.005), with males having fewer spine injury-events (25.5%/34%) but more upper extremity injuries (18%/9%) than females. Regression analysis showed statistically significant influence for BMI (p = 0.002) and age (p = 0.015) on structure, whereas the area was significantly influenced by sex (p = 0.005).
Conclusion: Events of soft-tissue overuse injuries are the most common reasons resulting in orthopedic presentations of adolescent elite athletes. Mostly, the lower extremity and the spine are affected, while sex and age characteristics on affected area and structure must be considered. Therefore, prevention strategies addressing the injury-event profiles should already be implemented in early adolescence taking age, sex as well as injury entity into account.