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Millions of people search online for medical text, but these texts are often too complicated to understand. Readability evaluations are mostly based on surface metrics such as character or words counts and sentence syntax, but content is ignored. We compared four types of documents, easy and difficult WebMD documents, patient blogs, and patient educational material, for surface and content-based metrics. The documents differed significantly in reading grade levels and vocabulary used. WebMD pages with high readability also used terminology that was more consumer-friendly. Moreover, difficult documents are harder to understand due to their grammar and word choice and because they discuss more difficult topics. This indicates that we can simplify many documents by focusing on word choice in addition to sentence structure, however, for difficult documents this may be insufficient.

Repetition and semantic-associative priming effects have been demonstrated for words in nonstructured contexts (i.e., word pairs or lists of words) in numerous behavioral and electrophysio-logical studies. The processing of a word has thus been shown to benefit from the prior presentation of an identical or associated word in the absence of a constraining context. An examination of such priming effects for words that are embedded within a meaningful discourse context provides information about the interaction of different levels of linguistic analysis. This article reviews behavioral and electrophysiological research that has examined the processing of repeated and associated words in sentence and discourse contexts. It provides examples of the ways in which eye tracking and event-related potentials might be used to further explore priming effects in discourse. The modulation of lexical priming effects by discourse factors suggests the interaction of information at different levels in online language comprehension.

Native Chinese readers’ eye movements were monitored as they read text that did or did not demark word boundary information. In Experiment 1, sentences had 4 types of spacing: normal unspaced text, text with spaces between words, text with spaces between characters that yielded nonwords, and finally text with spaces between every character. The authors investigated whether the introduction of spaces into unspaced Chinese text facilitates reading and whether the word or, alternatively, the character is a unit of information that is of primary importance in Chinese reading. Global and local measures indicated that sentences with unfamiliar word spaced format were as easy to read as visually familiar unspaced text. Nonword spacing and a space between every character produced longer reading times. In Experiment 2, highlighting was used to create analogous conditions: normal Chinese text, highlighting that marked words, highlighting that yielded nonwords, and highlighting that marked each character. The data from both experiments clearly indicated that words, and not individual characters, are the unit of primary importance in Chinese reading.

Two experiments examined parafoveal preview for words located in the middle of sentences and at sentence boundaries. Parafoveal processing was shown to occur for words at sentence-initial, mid-sentence, and sentence-final positions. Both Experiments 1 and 2 showed reduced effects of preview on regressions out for sentence-initial words. In addition, Experiment 2 showed reduced preview effects on first-pass reading times for sentence-initial words. These effects of sentence position on preview could result from reduced parafoveal processing for sentence-initial words, or other processes specific to word reading at sentence boundaries. In addition to the effects of preview, the experiments also demonstrate variability in the effects of sentence wrap-up on different reading measures, indicating that the presence and time course of wrap-up effects may be modulated by text-specific factors. We also report simulations of Experiment 2 using version 10 of E-Z Reader (Reichle, Warren, & McConnell, 2009), designed to explore the possible mechanisms underlying parafoveal preview at sentence boundaries.

This study examined neural activity associated with establishing causal relationships across sentences during online comprehension. ERPs were measured while participants read and judged the relatedness of three-sentence scenarios in which the final sentence was highly causally related, intermediately related and causally unrelated to its context. Lexico-semantic co-occurrence was matched across the three conditions using a Latent Semantic Analysis. Critical words in causally unrelated scenarios evoked a larger N400 than words in both highly causally related and intermediately related scenarios, regardless of whether they appeared before or at the sentence-final position. At midline sites, the N400 to intermediately related sentence-final words was attenuated to the same degree as to highly causally related words, but otherwise the N400 to intermediately related words fell in between that evoked by highly causally related and intermediately related words. No modulation of the Late Positivity/P600 component was observed across conditions. These results indicate that both simple and complex causal inferences can influence the earliest stages of semantically processing an incoming word. Further, they suggest that causal coherence, at the situation level, can influence incremental word-by-word discourse comprehension, even when semantic relationships between individual words are matched.

Background

Phonologic text alexia (PhTA) is a reading disorder in which reading of pseudowords is impaired, but reading of real words is impaired only when reading text. Oral reading accuracy remains well preserved when words are presented individually, but when presented in text the part-of-speech effect that is often seen in phonologic alexia (PhA) emerges.

Aims

To determine whether repetition priming could strengthen and/or maintain the activation of words during text reading.

Methods & Procedures

We trained NYR, a patient with PhTA, to use a strategy, Sentence Building, designed to improve accuracy of reading words in text. The strategy required NYR to first read the initial word, and then build up the sentence by adding on sequential words, in a step-wise manner, utilizing the benefits of repetition priming to enhance accuracy.

Outcomes & Results

When using the strategy, NYR displayed improved accuracy not only for sentences she practiced using the strategy, but unpracticed sentences as well. Additionally, NYR performed better on a test of comprehension when using the strategy, as compared to without the strategy.

Conclusions

In light of research linking repetition priming to increased neural processing efficiency, our results suggest that use of this compensatory strategy improves reading accuracy and comprehension by temporarily boosting phonologic activation levels.

Extracting key concepts from clinical texts for indexing is an important task in implementing a medical digital library. Several methods are proposed for mapping free text into standard terms defined by the Unified Medical Language System (UMLS). For example, natural language processing techniques are used to map identified noun phrases into concepts. They are, however, not appropriate for real time applications. Therefore, in this paper, we present a new algorithm for generating all valid UMLS concepts by permuting the set of words in the input text and then filtering out the irrelevant concepts via syntactic and semantic filtering. We have implemented the algorithm as a web-based service that provides a search interface for researchers and computer programs. Our preliminary experiment shows that the algorithm is effective at discovering relevant UMLS concepts while achieving a throughput of 43K bytes of text per second. The tool can extract key concepts from clinical texts for indexing.

Previous research has demonstrated that properties of a currently fixated word and of adjacent words influence eye movement control in reading. In contrast to such local effects, little is known about the global effects on eye movement control, for example global adjustments caused by processing difficulty of previous sentences. In the present study, participants read text passages in which voice (active vs. passive) and sentence structure (embedded vs. non-embedded) were manipulated. These passages were followed by identical target sentences. The results revealed effects of previous sentence structure on gaze durations in the target sentence, implying that syntactic properties of previously read sentences may lead to a global adjustment of eye movement control.

In two experiments the effects of word repetition, synonymy, and coreference on event-related brain potentials during text processing were studied. Participants read one (Experiment 1) or two sentence (Experiment 2) texts in which critical nouns were preceded by the definite (the) or indefinite (a) articles. Experiment 1 was run as a control to verify that differences in article processing in the second sentences of Experiment 2 would not contaminate the ERPs to critical noun items. They did not. In Experiment 2, an initial sentence was used to set up a context and contained either a first presentation or synonym of the critical word from the second sentence. N400 (but not Late Positive Component; LPC) priming effects were found for repetitions and synonyms (larger for repetitions) in second sentences. This extends observations of priming in word lists and single sentences to two-sentence texts. There was also a greater left anterior negativity or “LAN” for coreferential critical nouns (those following the article “The”) compared to non-coreferential critical nouns (those following the article “A”) suggesting that ERPs are sensitive to working memory processes engaged during referential assignment. In response to the articles themselves, there was a greater N400-700 elicited by the article “A” vs. “The.” Finally, there was a greater N400-like negativity to the final words of non-coreferential sentences implying that the meanings of these sentences were difficult to integrate with the discourse level representation established by the prior sentence.

Research on written language comprehension has generally assumed that the phonological properties of a word have little effect on sentence comprehension beyond the processes of word recognition. Two experiments investigated this assumption. Participants silently read relative clauses in which two pairs of words either did or did not have a high degree of phonological overlap. Participants were slower reading and less accurate comprehending the overlap sentences compared to the non-overlapping controls, even though sentences were matched for plausibility and differed by only two words across overlap conditions. A comparison across experiments showed that the overlap effects were larger in the more difficult object relative than in subject relative sentences. The reading patterns showed that phonological representations affect not only memory for recently encountered sentences but also the developing sentence interpretation during on-line processing. Implications for theories of sentence processing and memory are discussed.

Natural language processing is an important tool in biomedicine, and fails without successful segmentation of words and sentences. Tokenization is a form of segmentation that identifies boundaries separating semantic units, for example words, dates, numbers and symbols, within a text. We sought to construct a highly generalizeable tokenization algorithm with no prior knowledge of characters or their function, based solely on the inherent statistical properties of token and sentence boundaries. Tokenizing clinician-entered free text, we achieved precision and recall of 92% and 93%, respectively compared to a whitespace token boundary detection algorithm. We classified over 80% of punctuation characters correctly, based on manual disambiguation with high inter-rater agreement (kappa = 0.916). Our algorithm effectively discovered properties of whitespace and punctuation in the corpus without prior knowledge of either. Given the dynamic nature of biomedical language, and the variety of distinct sublanguages used, the effectiveness and generalizability of our novel tokenization algorithm make it a valuable tool.

This study was a comparison of the effects of oral speech with total communication (speech plus sign language) training on the ability of mentally retarded children to repeat 4-word sentences. Three children were chosen who used single words to communicate but who did not combine words into complete sentences. Three sentence pairs were trained, with each pair having one sentence trained using oral methods and an equivalent one trained using the total communication approach. Both training procedures involved chaining sentence parts, reinforcement, and prompting. Oral methods involved presenting vocal stimuli and requiring vocal responses whereas total communication methods involved presenting vocal and signed stimuli and requiring vocal and signed responses. For the initial sentence pair with each child, an alternating treatments design was used to determine the relative efficacy of the two language training approaches. This was repeated with a second and third sentence pair using a multiprobe technique within a multiple baseline design. Results pointed to the superiority of the total communication approach in facilitating sentence repetition. Possible explanations of these results are offered and the utility of the alternating treatments experimental design is discussed.

Background

Recently several studies have shown that people use contextual information to make predictions about the rest of the sentence or story as the text unfolds. Using event related potentials (ERPs) we tested whether these on-line predictions are based on a message-level representation of the discourse or on simple automatic activation by individual words. Subjects heard short stories that were highly constraining for one specific noun, or stories that were not specifically predictive but contained the same prime words as the predictive stories. To test whether listeners make specific predictions critical nouns were preceded by an adjective that was inflected according to, or in contrast with, the gender of the expected noun.

Results

When the message of the preceding discourse was predictive, adjectives with an unexpected gender inflection evoked a negative deflection over right-frontal electrodes between 300 and 600 ms. This effect was not present in the prime control context, indicating that the prediction mismatch does not hinge on word-based priming but is based on the actual message of the discourse.

Conclusion

When listening to a constraining discourse people rapidly make very specific predictions about the remainder of the story, as the story unfolds. These predictions are not simply based on word-based automatic activation, but take into account the actual message of the discourse.

Purpose

This study investigated the impact of lexical processes on target word recall in sentence span tasks in children with and without specific language impairment (SLI).

Method

Participants were 42 children (ages 8;2–12;3), 21 with SLI and 21 typically developing peers matched on age and nonverbal IQ. Children completed a sentence span task where target words to be recalled varied in word frequency and neighborhood density. Two measures of lexical processes were examined, the number of non-target competitor words activated during a gating task (lexical cohort competition) and word definitions.

Results

Neighborhood density had no effect on word recall for either group. However, both groups recalled significantly more high than low frequency words. Lexical cohort competition and specificity of semantic representations accounted for unique variance in the number of target word recalled in the SLI and CA groups combined.

Conclusions

Performance on verbal working memory span tasks for both SLI and CA children is influenced by word frequency, lexical cohorts, and semantic representations. Future studies need to examine the extent to which verbal working memory capacity is a cognitive construct independent of extant language knowledge representations.

Background

Finding useful high-grade professional orthopaedic information on the Internet is often difficult. Orthopaedic Web Links (OWL) is a searchable database of vetted online orthopaedic resources. OWL uses a subject directory (OWL Directory) and a custom search engine (OWL Web) to provide a list of resources. The most effective way to find readily accessible, full text on-subject material suitable for education of an orthopaedic surgeon or trainee has not been defined.

Questions/purposes

We therefore (1) proposed a method for selecting topics and evaluating searches and (2) compared the search results from an orthopaedic-specific directory (OWL Directory), a custom search engine (OWL Web), and standard Google searches.

Methods

A scoring system for evaluation of the search results was developed for standardized comparison. Single words and sets of three words from randomly selected examination questions provided the search strings to compare the three strategies.

Results

For single keyword searches, the OWL Directory scored highest (16.4/50) of the three methods. For the three keywords searches, OWL Web had the highest mean score (26.0/50), followed by Google (22.8/50), and the OWL Directory (1.0/50). OWL Web searches had higher scores than Google searches, while returning 800 times fewer search results.

Conclusion

The OWL Directory of orthopaedic subjects on the Internet provides a simple browsable category structure to find information. The OWL Web search engine scored higher than Google and resulted in a greater proportion of valid, on-subject, and accessible resources in the search results.

Electronic supplementary material

The online version of this article (doi:10.1007/s11999-011-1875-1) contains supplementary material, which is available to authorized users.

Background

Although more individuals are sharing their experiences with chronic pain or illness through blogging (writing an Internet web log), research on the psychosocial effects and motivating factors for initiating and maintaining a blog is lacking.

Objective

The objective was to examine via online questionnaire the perceived psychosocial and health benefits of blogging among patients who use this media to communicate their experience of chronic pain or illness.

Methods

A 34-item online questionnaire was created, tested, and promoted through online health/disease forums. The survey employed convenience sampling and was open from May 5 to July 2, 2011. Respondents provided information regarding demographics, health condition, initiation and upkeep of blogs, and dynamics of online communication. Qualitative data regarding respondents’ blogging experiences, expectations for blogging, and the perceived effects from blogging on the blogger’s health, interpersonal relationships, and quality of life were collected in the form of written narrative.

Results

Out of 372 respondents who started the survey, 230 completed the entire questionnaire. Demographic data showed survey respondents to be predominantly female (81.8%) and highly educated (97.2% > high school education and 39.6% with graduate school or professional degrees). A wide spectrum of chronic pain and illness diagnoses and comorbidities were represented. Respondents reported that initiating and maintaining an illness blog resulted in increased connection with others, decreased isolation, and provided an opportunity to tell their illness story. Blogging promoted accountability (to self and others) and created opportunities for making meaning and gaining insights from the experience of illness, which nurtured a sense of purpose and furthered their understanding of their illness.

Conclusions

Results suggest that blogging about chronic pain and illness may decrease a sense of isolation through the establishment of online connections with others and increases a sense of purpose to help others in similar situations. Further study involving a larger sample size, a wider range of education levels, and respondents with different types and magnitudes of illnesses will be needed to better elucidate the mechanism of the observed associations in this understudied area.

Linguistic processing–especially syntactic processing–is often considered a hallmark of human cognition, thus the domain-specificity or domain-generality of syntactic processing has attracted considerable debate. These experiments address this issue by simultaneously manipulating syntactic processing demands in language and music. Participants performed self-paced reading of garden-path sentences in which structurally unexpected words cause temporary syntactic processing difficulty. A musical chord accompanied each sentence segment, with the resulting sequence forming a coherent chord progression. When structurally unexpected words were paired with harmonically unexpected chords, participants showed substantially enhanced garden-path effects. No such interaction was observed when the critical words violated semantic expectancy, nor when the critical chords violated timbral expectancy. These results support a prediction of the shared syntactic integration resource hypothesis (SSIRH, Patel, 2003), which suggests that music and language draw on a common pool of limited processing resources for integrating incoming elements into syntactic structures.

Words in human language interact in sentences in non-random ways, and allow humans to construct an astronomic variety of sentences from a limited number of discrete units. This construction process is extremely fast and robust. The co-occurrence of words in sentences reflects language organization in a subtle manner that can be described in terms of a graph of word interactions. Here, we show that such graphs display two important features recently found in a disparate number of complex systems. (i) The so called small-world effect. In particular, the average distance between two words, d (i.e. the average minimum number of links to be crossed from an arbitrary word to another), is shown to be d approximately equal to 2-3, even though the human brain can store many thousands. (ii) A scale-free distribution of degrees. The known pronounced effects of disconnecting the most connected vertices in such networks can be identified in some language disorders. These observations indicate some unexpected features of language organization that might reflect the evolutionary and social history of lexicons and the origins of their flexibility and combinatorial nature.

Background

Both healthy and sick people increasingly use electronic media to obtain medical information and advice. For example, Internet users may send requests to Web-based expert forums, or so-called “ask the doctor” services.

Objective

To automatically classify lay requests to an Internet medical expert forum using a combination of different text-mining strategies.

Methods

We first manually classified a sample of 988 requests directed to a involuntary childlessness forum on the German website “Rund ums Baby” (“Everything about Babies”) into one or more of 38 categories belonging to two dimensions (“subject matter” and “expectations”). After creating start and synonym lists, we calculated the average Cramer’s V statistic for the association of each word with each category. We also used principle component analysis and singular value decomposition as further text-mining strategies. With these measures we trained regression models and determined, on the basis of best regression models, for any request the probability of belonging to each of the 38 different categories, with a cutoff of 50%. Recall and precision of a test sample were calculated as a measure of quality for the automatic classification.

Results

According to the manual classification of 988 documents, 102 (10%) documents fell into the category “in vitro fertilization (IVF),” 81 (8%) into the category “ovulation,” 79 (8%) into “cycle,” and 57 (6%) into “semen analysis.” These were the four most frequent categories in the subject matter dimension (consisting of 32 categories). The expectation dimension comprised six categories; we classified 533 documents (54%) as “general information” and 351 (36%) as a wish for “treatment recommendations.” The generation of indicator variables based on the chi-square analysis and Cramer’s V proved to be the best approach for automatic classification in about half of the categories. In combination with the two other approaches, 100% precision and 100% recall were realized in 18 (47%) out of the 38 categories in the test sample. For 35 (92%) categories, precision and recall were better than 80%. For some categories, the input variables (ie, “words”) also included variables from other categories, most often with a negative sign. For example, absence of words predictive for “menstruation” was a strong indicator for the category “pregnancy test.”

Conclusions

Our approach suggests a way of automatically classifying and analyzing unstructured information in Internet expert forums. The technique can perform a preliminary categorization of new requests and help Internet medical experts to better handle the mass of information and to give professional feedback.

Multiple-word biomedical terms may point to concepts in bibliographic citations with greater precision than individual words. The barrier word method detects multiple-word terms at first encounter in narrative text. Words with low biomedical information content (prepositions, articles, etc.) are designated as barrier words; each word sequence occurring between consecutive barrier words is a candidate multiple-word term. In 1407 consecutive titles and abstracts listed under DNA, RECOMBINANT (D13.444.308.460), there were 1,275 barrier words, and 13,548 multiple-word terms were selected. Results demonstrate an effective method for detecting multiple-word terms in molecular biology narrative text.

Background

We have witnessed a rapid increase in the use of Web-based 'collaborationware' in recent years. These Web 2.0 applications, particularly wikis, blogs and podcasts, have been increasingly adopted by many online health-related professional and educational services. Because of their ease of use and rapidity of deployment, they offer the opportunity for powerful information sharing and ease of collaboration. Wikis are Web sites that can be edited by anyone who has access to them. The word 'blog' is a contraction of 'Web Log' – an online Web journal that can offer a resource rich multimedia environment. Podcasts are repositories of audio and video materials that can be "pushed" to subscribers, even without user intervention. These audio and video files can be downloaded to portable media players that can be taken anywhere, providing the potential for "anytime, anywhere" learning experiences (mobile learning).

Discussion

Wikis, blogs and podcasts are all relatively easy to use, which partly accounts for their proliferation. The fact that there are many free and Open Source versions of these tools may also be responsible for their explosive growth. Thus it would be relatively easy to implement any or all within a Health Professions' Educational Environment. Paradoxically, some of their disadvantages also relate to their openness and ease of use. With virtually anybody able to alter, edit or otherwise contribute to the collaborative Web pages, it can be problematic to gauge the reliability and accuracy of such resources. While arguably, the very process of collaboration leads to a Darwinian type 'survival of the fittest' content within a Web page, the veracity of these resources can be assured through careful monitoring, moderation, and operation of the collaborationware in a closed and secure digital environment. Empirical research is still needed to build our pedagogic evidence base about the different aspects of these tools in the context of medical/health education.

Summary and conclusion

If effectively deployed, wikis, blogs and podcasts could offer a way to enhance students', clinicians' and patients' learning experiences, and deepen levels of learners' engagement and collaboration within digital learning environments. Therefore, research should be conducted to determine the best ways to integrate these tools into existing e-Learning programmes for students, health professionals and patients, taking into account the different, but also overlapping, needs of these three audience classes and the opportunities of virtual collaboration between them. Of particular importance is research into novel integrative applications, to serve as the "glue" to bind the different forms of Web-based collaborationware synergistically in order to provide a coherent wholesome learning experience.

Background

Zipf's law states that the relationship between the frequency of a word in a text and its rank (the most frequent word has rank , the 2nd most frequent word has rank ,…) is approximately linear when plotted on a double logarithmic scale. It has been argued that the law is not a relevant or useful property of language because simple random texts - constructed by concatenating random characters including blanks behaving as word delimiters - exhibit a Zipf's law-like word rank distribution.

Methodology/Principal Findings

In this article, we examine the flaws of such putative good fits of random texts. We demonstrate - by means of three different statistical tests - that ranks derived from random texts and ranks derived from real texts are statistically inconsistent with the parameters employed to argue for such a good fit, even when the parameters are inferred from the target real text. Our findings are valid for both the simplest random texts composed of equally likely characters as well as more elaborate and realistic versions where character probabilities are borrowed from a real text.

Conclusions/Significance

The good fit of random texts to real Zipf's law-like rank distributions has not yet been established. Therefore, we suggest that Zipf's law might in fact be a fundamental law in natural languages.

This brief report presents an innovative method for capturing the content of adolescents’ electronic communication on handheld devices: text messaging, email, and Instant Messaging. In an ongoing longitudinal study, adolescents were provided with BlackBerry devices with service plans paid by the investigators, and use of text messaging was examined when participants were 15 years old and in the 10th grade (N=175, 81 girls). BlackBerries are configured so that the content of all text messages, email messages, and Instant Messages is saved to a secure server and organized in a highly secure, searchable, online archive. This paper describes the technology used to devise this method and ethical considerations. Evidence for validity is presented, including information on use of text messaging to show that participants used these devices heavily and frequencies of profane and sexual language in a two-day sample of text messaging to demonstrate that they were communicating openly.

Active reading requires coordination between frequent eye-movements (saccades) and short fixations in text. Yet, the impact of saccades on word processing remains unknown, as neuroimaging studies typically employ constant eye fixation. Here we investigate eye-movement effects on word recognition processes in healthy human subjects using anatomically-constrained magnetoencephalography, psychophysical measurements, and saccade detection in real-time. Word recognition was slower and brain responses were reduced to words presented early vs. late after saccades, suggesting an overall transient impairment of word processing after eye-movements. Response reductions occurred early in visual cortices and later in language regions, where they co-localized with repetition priming effects. Qualitatively similar effects occurred when words appeared early vs. late after background-movement that mimicked saccades, suggesting that retinal motion contributes to postsaccadic inhibition. Further, differences in postsaccadic and background-movement effects suggest that central mechanisms also contribute to postsaccadic modulation. Together, these results suggest a complex interplay between visual and central saccadic mechanisms during reading.

Purpose

The purpose of this study was to examine the influence of phonotactic probability, the frequency of different sound segments and segment sequences, on the overall fluency with which words are produced by preschool children who stutter (CWS), as well as to determine whether it has an effect on the type of stuttered disfluency produced.

Method

A 500+ word language sample was obtained from 19 CWS. Each stuttered word was randomly paired with a fluently produced word that closely matched it in grammatical class, word length, familiarity, word and neighborhood frequency, and neighborhood density. Phonotactic probability values were obtained for the stuttered and fluent words from an online database.

Results

Phonotactic probability did not have a significant influence on the overall susceptibility of words to stuttering, but it did impact the type of stuttered disfluency produced. In specific, single-syllable word repetitions were significantly lower in phonotactic probability than fluently produced words, as well as part-word repetitions and sound prolongations.

Conclusions

In general, the differential impact of phonotactic probability on the type of stuttering-like disfluency produced by young CWS provides some support for the notion that different disfluency types may originate in the disruption of different levels of processing.