Similar Letters Research Articles

The Massachusetts BMI letter: A qualitative study of responses from parents of obese children

ObjectivesMassachusetts (MA) public schools conduct mandated body-mass index (BMI) screening and until recently, communicated results in a letter to parents/caregivers, to encourage primary care visits and provide aggregate data to the state Department of Public Health. This study assessed the letter's readability and qualitatively explored parents’ responses to it. MethodsReadability of the BMI letter was calculated. Audio-taped 1-h focus groups were conducted with parents/caregivers of 8- to 14-year-old obese (≥95th BMI-for-age percentile) children. A semi-structured interview guide was used to elicit responses. Qualitative content analysis was conducted on transcripts to identify emergent themes. ResultsReadability analysis showed higher grade levels than recommended. Eight focus groups consisting of two to six parents each were conducted (n=29); 83% were female, mean age 41±9years, and 65% self-identified as Hispanic/Latino. Key themes identified included usefulness of the BMI letter, concerns about utility of BMI for screening, concerns about impacting self-esteem, and failure to understand the letter. ConclusionsThe MA BMI letter may not have been achieving its desired goal with some parents. Practice implicationsEmergent themes from this study could be used to test effectiveness of similar BMI letters nationwide and develop strategies to improve communication to parents.

Methylene Blue Does Not Have to Be Considered Only as Rescue Therapy for Distributive Shock

Dear Editor Jang and colleagues [1] published a recent review considering methylene blue (MB) as a “potential new use of an old antidote” to treat distributive shock. The review included three concise concluding remarks. (1) Increased nitric oxide (NO), and cyclic guanosine monophosphate (cGMP) production is well documented in various conditions of distributive shock such as sepsis and anaphylaxis; (2) The NO–cGMP pathway plays a central pathophysiology role; and (3) There are experimental and clinical evidences that support MB use in cases of refractory vasodilatory shock with no response to conventional treatment. This third conclusion, considering MB as a last rescue therapeutic option, deserves some consideration. In 2009, targeting MB for distributive shock treatment in heart surgery, we published a personal report including 15 years (now 19 years) of questions, answers, doubts, and certainties [2]. I have reported, over and over, some pivotal observations: (1) In the recommended doses, MB is safe (the lethal dose is 40 mg/kg); (2) MB did not cause endothelial dysfunction; (3) The MB effect appears in cases of NO upregulation; and (4) MB is not a vasoconstrictor, by blocking the cGMP pathway, it releases the cAMP pathway, facilitating the norepinephrine vasoconstrictor effect; (5) The most used dosage is 2 mg/kg as IV bolus followed by the same continuous infusion because plasma concentrations strongly decays in the first 40 min; and (6) There is a possible “window of opportunity” for the MB’s effectiveness [2]. Blacker and Whalen reported a distributive shock case during an on-pump coronary artery bypass grafting with no response to MB [3]. A possible explanation was given based on Fernandes and colleagues’ academic thesis using a mouse sepsis model that evidenced three 8-h windows of guanylate cyclase (GC) activity [4]. In the first 8 h, there is increased nitric oxide synthase (NOS) activity and GC upregulation. In the second 8 h, there is an absence of GC expression and a downregulation of NOS. In the third 8-h window, there is an upregulation of GC and NOS. The authors emphasized two practical and education fundamental aspects: (1) The disclosure in using the MB treatment considering the window opportunity and (2) The need for the establishment of this window in humans, perhaps choosing cGMP as biomarker since our attempt to use nitrite/nitrate, measured by chemiluminescence, was frustrating [5]. I wrote another quite similar letter (still under review) with congratulations to Blacker and Whalen by the attitude of seeking, in retrospect, why MB had only a transient effect and not just dismissing its action as often happens. In addition, I tried to introduce an easier concept to understand the Window of Opportunity definition… “MB action to treat distributive shock is time-dependent.” In conclusion, MB use as a last rescue therapeutic option is against the above mentioned concepts, and it is possible that MB does not act (second window), or acts too late (third window) when the circulatory shock is metabolically irreversible presenting high lactate levels and intractable metabolic acidosis. Maybe it is more sensible to consider MB not as a late rescue treatment, but as an adjuvant drug to be used precociously (window 1).

Pioglitazone and bladder cancer: two studies, same database, two answers

Various studies have used the UK Clinical Practice Research Datalink (CPRD) to evaluate the same side effects of drugs, often with opposite conclusions. The CPRD was formerly known as the General Practice Research Database. Examples include third generation pills and venous thromboembolism, proton pump inhibitors and fracture [1], oral bisphosphonates and gastrointestinal cancers [2] and now, pioglitazone and bladder cancer [3, 4]. Only rarely have CPRD data been re-analyzed to find out why results vary so much. The judge requested re-analysis during the third generation pill lawsuit, but the results were not published as a scientific paper. The other examples are our re-analysis of statins and fracture risk [5] and our paper on confounding by respiratory disease severity [6]. We were quite surprised to read the recent CPRD study on pioglitazone and bladder cancer without a proper re-analysis or even a discussion [3] of the findings of Azoulay and colleagues [4]. They used almost the same study population but a different study design. A re-analysis of CPRD is often unrewarding. It requires more resources than conducting an original study. Major clinical journals are less likely to publish a third or fourth CPRD study on the same topic and the paper is less likely to be cited. However, to remove the confusion, both groups of researchers could re-analyze each other's data and this journal and the BMJ could reward these efforts with two new publications. A similar letter about bisphosphonates and oesophageal cancer was published in the BMJ in 2010 [2] and the journal has recently published a re-analysis of the data [7].

Language-specific cortical activation patterns for verbal fluency tasks in Japanese as assessed by multichannel functional near-infrared spectroscopy

In Japan, verbal fluency tasks are commonly utilized as a standard paradigm for neuropsychological testing of cognitive and linguistic abilities. The Japanese “letter fluency task” is a mora/letter fluency task based on the phonological and orthographical characteristics of the Japanese language. Whether there are similar activation patterns across languages or a Japanese-specific mora/letter fluency pattern is not certain. We investigated the neural correlates of overt mora/letter and category fluency tasks in healthy Japanese. The category fluency task activated the bilateral fronto-temporal language-related regions with left-superior lateralization, while the mora/letter fluency task led to wider activation including the inferior parietal regions (left and right supramarginal gyrus). Specific bilateral supramarginal activation during the mora/letter fluency task in Japanese was distinct from that of similar letter fluency tasks in syllable-alphabet-based languages: this might be due to the requirement of additional phonological processing and working memory, or due to increased cognitive load in general.

Multiple interpretations by using pixel resonance concept

Human vision is highly sensitive to perceive the contrast for interpreting images, so that the neurons of the brain will be excited to make recognition of the surroundings. In this study, the test patterns were inspired to reach the neurons excitation via the proposed pixel resonance concept, and then the quantum concept of physics was employed with random walk behaviour to analyse the test patterns for multiple interpretations. In simulation, similar alphabetic letters (C, O) and Chinese characters (玉, 王) are selected. Subsequently, various extents of noise are added including the different mean values and related standard deviations for the two test patterns. The results showed that the corresponding resonance maps with various morphologies can generate multiple resonance outputs. Furthermore, the simulation results indicated that the peak signal-to-noise ratio curves match those of the resonance maps perceived by using human vision. Based on this approach, it is concluded that the proposed pixel resonance algorithm can effectively simulate the multiple interpretations of the human vision system. Further, a novel physical model was presented to generate multi-output patterns for a single image.

How Does Type of Orthography Affect Reading in Arabic and Hebrew as First and Second Languages?

This study aimed to examine the effects of visual characteristics of Arabic orthography on learning to read compared to Hebrew among Arabic and Hebrew bilinguals in an elementary bilingual education framework. Speed and accuracy measures were examined in reading words and non-words in Arabic and Hebrew as follows: Arabic words and non-words composed of connected and similar letters, words and non-words composed of connected and non-similar letters, and words and non-words composed of unconnected letters. In Hebrew, words and non-words composed of similar letters and non-similar letters. It was found that Arabic speakers showed an almost equal control in all reading tasks in both languages whereas, Hebrew speakers showed better performance in their mother tongue in all reading tasks. In Arabic, the best performance was in reading words and non-words that was unconnected. Based on these findings, it was concluded that Hebrew speakers did not succeed in transferring their good ability in reading their mother tongue to reading the second language, apparently due to the unique nature of the Arabic orthography. Our findings with regard to the cross-linguistic research literature as well as the specific features of Arabic language are discussed.

A new Gujarati language logMAR visual acuity chart: Development and validation

Aims:Gujarati is the main spoken language of a large proportion of the population of India. The aim of this study was to develop and validate a new Minimum Angle of Resolution (logMAR) visual acuity chart in the Gujarati language.Materials and Methods:A new Gujarati visual acuity chart was designed to logMAR specifications using Gujarati optotypes experimentally selected to have similar relative letter legibility under spherical and cylindrical defocus. The chart validation study was carried out using 153 adult subjects in a large clinical setting in India. Subjects who were literate in English and Gujarati participated in the study. Visual acuity was measured with the new Gujarati logMAR chart and a modified Early Treatment of Diabetic Retinopathy Study-(m-ETDRS) logMAR chart. The method of presentation was randomized between the charts. Repeat visual acuity was measured on a subsequent day with a second version of the Gujarati logMAR chart.Results:The Gujarati chart correlated highly with the m-ETDRS logMAR chart (r2 = 0.974). The mean visual acuity difference (Gujarati – m-ETDRS logMAR) was equal to three letters (–0.06 logMAR). The Gujarati logMAR chart also proved to be highly repeatable (r2 = 0.994, test-retest) with 95% CI of ± 0.04 logMAR.Conclusions:The new Gujarati logMAR visual acuity chart provides a valid and repeatable tool for the measurement of visual acuity in native Gujarati language speakers.

Dyslexia and fluency: Parafoveal and foveal influences on rapid automatized naming.

The ability to coordinate serial processing of multiple items is crucial for fluent reading but is known to be impaired in dyslexia. To investigate this impairment, we manipulated the orthographic and phonological similarity of adjacent letters online as dyslexic and nondyslexic readers named letters in a serial naming (RAN) task. Eye movements and voice onsets were recorded. Letter arrays contained target item pairs in which the second letter was orthographically or phonologically similar to the first letter when viewed either parafoveally (Experiment 1a) or foveally (Experiment 1b). Relative to normal readers, dyslexic readers were more affected by orthographic confusability in Experiment 1a and phonological confusability in Experiment 1b. Normal readers were slower to process orthographically similar letters in Experiment 1b. Findings indicate that the phonological and orthographic processing problems of dyslexic readers manifest differently during parafoveal and foveal processing, with each contributing to slower RAN performance and impaired reading fluency.

Improving Health Outcomes Through Education

By the time you read this message, it will have been several months since its submission to the publisher; however, I feel that it is important to keep American Academy of Pain Medicine (AAPM) members and colleagues abreast of several issues affecting the Academy's membership and the patients we treat. As many of you may know, the AAPM received a letter in May from Senator Max Baucus, Chairman of the United States Senate Committee on Finance, and Senator Charles Grassley who also serves on this committee. The letter requested information regarding the relationship between opioid manufacturers and nonprofit health care organizations. Similar letters were also sent to several other entities. AAPM made immediate contact with Senator Baucus' staff and gave assurance of AAPM's support of the committee's efforts, as well as underscoring our commitment to addressing the problem of prescription drug abuse and misuse as well …

Boys Will Be Boys . . .

Cowen writes about his experiences in doing research on the social life of Queen's College and coming across a 1776 letter by a twenty-year old student, Simeon DeWitt (1756-1834), who became Geographer of the Revolutionary Army, Surveyor General of New York, and Chancellor of the University of the State of New York. (There are others articles about him in this journal.) DeWitt writes about a romantic fantasy which Cowen compares to a similar letter by Washington Irving written in 1804. Both letters are reproduced in full.

Visuospatial Perceptual Sequence Learning and Eye Movements

We examined perceptual sequence learning by means of an adapted serial reaction time task in which eye movements were unnecessary for performing the sequence learning task. Participants had to respond to the identity of a target letter pair ("OX" or "XO") appearing in one of four locations. On the other locations, similar distractor letter pairs ("QY" or "YQ") were shown. While target identity changed randomly, target location was structured according to a deterministic sequence. To render eye movements superfluous, (1) stimulus letter pairs appeared around a fixation cross with a visual angle of 0.63°, which means that they appeared within the foveal visual area and (2) the letter pairs were presented for only 100 ms, a period too short to allow proper eye movements. Reliable sequence knowledge was acquired under these conditions, as responses were both slower and less accurate when the trained sequence was replaced by an untrained sequence. These results support the notion that perceptual sequence learning can be based on shifts of attention without overt oculomotor movements.

Orthographic Processing in Baboons ( Papio papio )

Skilled readers use information about which letters are where in a word (orthographic information) in order to access the sounds and meanings of printed words. We asked whether efficient processing of orthographic information could be achieved in the absence of prior language knowledge. To do so, we trained baboons to discriminate English words from nonsense combinations of letters that resembled real words. The results revealed that the baboons were using orthographic information in order to efficiently discriminate words from letter strings that were not words. Our results demonstrate that basic orthographic processing skills can be acquired in the absence of preexisting linguistic representations.

Does working memory change with age? The interactions of concurrent articulation with the effects of word length and acoustic confusion

ABSTRACT The effects of acoustic confusion (phonological similarity), word length, and concurrent articulation (articulatory suppression) are cited as support for Working Memory's phonological loop component (e.g., Baddeley, 2000, Psychonomic Bulletin and Review, 7, 544). Research has focused on younger adults, with no studies examining whether concurrent articulation reduces the word length and acoustic confusion effects among older adults. In the current study, younger and older adults were given lists of similar and dissimilar letters (Experiment 1) or long and short words (Experiment 2) for immediate serial reconstruction of order. Items were presented visually or auditorily, with or without concurrent articulation. As expected, younger and older adults demonstrated effects of acoustic confusion, word length, and concurrent articulation. Further, concurrent articulation reduced the effects of acoustic confusion and word length equally for younger and older adults. This suggests that age-related differences occur in overall performance, but do not reflect an age-related deficiency in the functioning of the phonological loop component of working memory.

Writing English and Bengali with SUS (Sarma's Unified Script)

In the process of thinking how we can read and write the scripts more easily and use the same scripts in writing more than one language, I (Bijon B. Sarma) and my sister (Mira Rani Sarma Parai) suddenly devised a new system. After finishing the firsthand work on it we started searching related information. We came to learn that devising a single script with the capability of writing all languages of the world is a long cherished dream of the language experts and that, they denote it by the term “Unified Script”. We studied a number of unified scripts and discovered that those lacked the essential qualities for being used in this dimension. We were amazed to see that the one we devised possesses these qualities. Let us explain the matter in plain language. In the earlier unified scripts the experts proceeded more or less in the following manner: (i) They picked up the same or similar sounding letters from different languages, (ii) They assigned a common sound to denote each of those and (iii) And finally, they assigned scripts of their choice to denote those. The problems associated with their approach were: (a) Exactly the same sounding letters in fact do not exist in different languages. Thus “B” of English, “Ba” ( ব ) of Bengali and “Be or Baa” ( ب ) of Arabic does not make exactly the same sound. Naturally any endeavor to express such letters by a single or common sound was sure to change their original sounds. When the scripts for the ‘letters’ of any language was proposed to be replaced by another scripts without any apparent reason or advantage, the users failed to understand why they should change their script. As a great deviation, in ‘SUS’ we proceeded in the following manner: (i) The original sounds of all the letters of the alphabets of the language were retained as those were. (ii) A new set of simple, easy and “self-growing” (i.e. capable of developing gradually on the basis of simple principles) scripts was designed. (iii) The letters or more precisely the sounds of the letters were assigned to the designed scripts chronologically, i.e. on the basis of the location of each letter in their alphabet.

Don’t Shoot the Messnger: Memory for Misspellings in Context

Misspellings in sentences are usually easy to understand by readers due to top-down influences. Although top-down processing allows for fluent reading of misspelled items, the nature of their representations in memory is not known. If representations of misspellings are distinct from representations of correctly spelled words, their influence should be seen in later recognition decisions. In this set of experiments, participants read words and misspellings embedded in sentences and were later given a recognition test. The sentences contained semantically biased or neutral contexts. In Experiment 1, misspellings were created by removing a single letter (e.g., drveway). In Experiment 2, the recognition items probes were presented in uppercase letters (e.g., DRVEWAY) to reduce the visual similarity between study and test items. In Experiment 3, the misspellings were created by substituting visually similar letters (e.g., driweway). In contrast to the previous experiments, in Experiment 4, participants were explicitly told about the memory test to see how response strategies affect performance. Overall, the results indicate that people retain surface feature information about misspellings which seem to inform their memory judgments, and that the processing of this information cannot be strategically controlled.

Offline OCR System for Machine-Printed Turkish Using Template Matching

One of the most important application these days in Pattern Recognition (PR) is Optical Character recognition (OCR) which is a system used to convert scanned printed or handwritten image files into machine readable and editable format such as text documents. The main motivation behind this study is to build an OCR system for offline machine-printed Turkish characters to convert any image file into a readable and editable format. This OCR system started from preprocessing step to convert the image file into a binary format with less noise to be ready for recognition. The preprocessing step includes digitization, binarization, thresholding, and noise removal. Next, horizontal projection method is used for line detection and word allocation and 8-connected neighbors’ schema is used to extract characters as a set of connected components. Then, the Template matching method is utilized to implement the matching process between the segmented characters and the template set stored in OCR database in order to recognize the text. Unlike other approaches, template matching takes shorter time and does not require sample training but it is not able to recognize some letters with similar shape or combined letters, for this reason, this OCR system combines both the template matching and the size feature of the segmented characters to achieve accurate results. Finally, upon a successful implementation of the OCR, the recognized patterns are displayed in notepad as readable and editable text. The Turkish machine-printed database consists of a list of 630 names of cities in Turkey written by using Arial font with different sizes in uppercase, lowercase and capitalizes the first character for each word. The proposed OCR’s result show that the accuracy of the system is from 96% to 100%.

On the use of event-related potentials to auditory stimuli in the Go/NoGo task

The N2 and P3 components of the event-related potential (ERP) are putative markers of inhibition in the Go/NoGo task. If this is the case, they should be unaffected by stimulus presentation modality. Theoretical researchers have suggested that the effect is smaller or absent with auditory stimuli, while others have shown that the effect depends on the perceptual similarity of the stimuli. Meanwhile, clinical researchers appear to be unaware of the debate. This study examined the N2 and P3 NoGo effects elicited by five sets of auditory stimuli varying in perceptual similarity. The N2 NoGo effect was significant for similar and different letters, and for similar tones, but not for different tones or novel sounds. As expected by the perceptual overlap hypothesis, the largest N2 NoGo effect was observed with the similar letters. In contrast, the P3 NoGo effect was significant and of a similar magnitude for all stimulus sets. The differential effect of the stimulus sets suggests separable underlying processes reflected in N2 and P3. Guidelines are provided for clinical researchers wishing to use auditory stimuli in the Go/NoGo task.

Processing two tasks with varying task order: Central stage duration influences central processing order

In a recent study, Sigman and Dehaene (2006, PLoS Biology, 4, 1227–1238) reported that perceptual processing duration influences processing order of two tasks in the psychological refractory period paradigm (PRP). The present study examines whether the duration of central processes also influences processing order. For this purpose, we employed letter tasks with different central processing durations and varied task order in the PRP. In one part of the experiment, a tone discrimination task was combined with a similar time-consuming letter discrimination task. In the other part, the tone task was combined with a more time-consuming letter task, which required a mental rotation of the letter thereby prolonging central processing. If the duration of central processes influences processing order, participants should perform the tone task first more often when it is presented with the more time-consuming mental rotation task, than when it is presented with the similar time-consuming letter task. The results clearly confirm this prediction and thus show that not only perceptual processing duration but also central processing duration affects processing order in a dual-task situation. We suggest that the reported effect mirrors a tendency of participants to minimize total reaction time to both tasks by reducing slack time.

Varying Difficulty of Snellen Letters and Common Errors in Amblyopic and Fellow Eyes

To investigate the varying difficulty of Snellen letters in children with amblyopia. We tabulated the letter-by-letter responses of amblyopic and nonamblyopic fellow eyes on random, computer-generated Snellen lines. Participants were 60 children, aged 5 to 13 years, with a history of amblyopia. Main outcome measures were relative difficulties of Snellen letters and common misidentifications. Errors were 7.5 times more common with certain letters (B, C, F, S) than with others (A, L, Z, T), this difference increasing to 17.6-fold at threshold. Similar relative letter difficulty was demonstrated at lines above and at visual acuity thresholds, and both difficult and easy letters were the same for amblyopic and nonamblyopic fellow eyes. Specific misidentification errors were often repeated and were often reciprocal (eg, B for E and E for B). Since therapeutic decisions in amblyopia management are often based on small differences in visual acuities, the relative difficulties of letters used in their measurement should be considered. The Early Treatment Diabetic Retinopathy Study system should be considered for use in this clinical setting.

Determining the Optimal Approach for Government-Regulated Genetic Testing

With recent activity by both the US Food and Drug Administration (FDA)2 and the US Government Accountability Office (GAO), a new era of government-regulated genetic testing is upon us. In the past 10 years, the scope and volume of genetic tests [most falling into the category of laboratory-developed tests (LDTs)] being offered has increased dramatically. Traditionally, genetic tests have been for single-gene disorders, such as cystic fibrosis and Marfan syndrome. In recent years, the scope and complexity of genetic testing has increased, and there has been a shift in emphasis toward predicting disease, especially complex disease. This shift has been mainly due to the arrival of direct-to-consumer (DTC) testing to the genetic-testing market. DTC genetic tests, which have not been under the review of the FDA, are traditionally offered via the Internet and are performed in the manufacturers' accredited laboratories as LDTs. The FDA's first public foray into oversight of DTC genetic testing was in May 2010, after Pathway Genomics, a DTC genetic-testing company based in San Diego, announced the upcoming availability of their personal genetic-testing kits at Walgreens drugstores nationwide. After Pathway's announcement, the FDA promptly sent an enforcement letter to Pathway, in which they declared Pathway's testing kit a medical device, and asked them to respond within 15 days to explain why their test should not require premarket review (1). The FDA followed suit by sending similar letters to 19 additional genetic-testing companies in the following months. In July, the FDA held its 2-day “Public Meeting on Oversight of Laboratory Developed Tests,” at which many genetic-testing companies and genetics organizations participated (2). During this …