Main Concepts for Two Picture Description Tasks: An Addition to Richardson and Dalton, 2016

Background: Proposition analysis of the discourse of persons with aphasia (PWAs) has a long history, yielding important advancements in our understanding of communication impairments in this population. Recently, discourse measures have been considered primary outcome measures, and multiple calls have been made for improved psychometric properties of discourse measures. Aims: To advance the use of discourse analysis in PWAs by providing Main Concept Analysis checklists and descriptive statistics for healthy control performance on the analysis for the Cat in the Tree and Refused Umbrella narrative tasks utilized in the AphasiaBank database protocol. Methods & Procedures: Ninety-two control transcripts, stratified into four age groups (20–39 years; 40–59; 60–79; 80+), were downloaded from the AphasiaBank database. Relevant concepts were identified, and those spoken by at least one-third of the control sample were considered to be a main concept (MC). A multilevel coding system was used to determine the accuracy and completeness of the MCs produced by control speakers. Outcomes & Results: MC checklists for two discourse tasks are provided. Descriptive statistics are reported and examined to assist readers with evaluation of the normative data. Conclusions: These checklists provide clinicians and researchers with a tool to reliably assess the discourse of PWAs. They also help address the gap in available psychometric data with which to compare PWAs to healthy controls

A Large-Scale Comparison of Main Concept Production Between Persons with Aphasia and Persons Without Brain Injury

Purpose: The purposes of this study are to provide clinicians and researchers with introductory psychometric data for the main concept analysis (MCA), a measure of discourse informativeness, and specifically, to provide descriptive and comparative statistical information about the performance of a large sample of persons not brain injured (PNBIs) and persons with aphasia (PWAs) on AphasiaBank discourse tasks. Method: Transcripts of 5 semi-spontaneous discourse tasks were retrieved from the AphasiaBank database and scored according to detailed checklists and scoring procedures. Transcripts from 145 PNBIs and 238 PWAs were scored; descriptive statistics, median tests, and effect sizes are reported. Results: PWAs demonstrated overall lower informativeness scores and more frequent production of statements that were inaccurate and/or incomplete. Differences between PNBIs and PWAs were observed for all main concept measures and stories. Comparisons of PNBIs and aphasia subtypes revealed significant differences for all groups, although the pattern of differences and strength of effect sizes varied by group and discourse task. Conclusions: These results may improve the investigative and clinical utility of the MCA by providing descriptive and comparative information for PNBIs and PWAs for standardized discourse tasks that can be reliably scored. The results indicate that the MCA is sensitive to differences in discourse as a result of aphasia

Optimizing the Allocation of Vaccines in the Presence of Multiple Strains of the Influenza Virus

During the annual flu season, multiple strains of the influenza virus are often present within a population. It is a significant challenge for health care administrators to determine the most effective allocation of two different vaccines to combat the various strains when treating the public. We employ a mathematical model, a system of differential equations, to find a strategy for vaccinating a population in order to minimize the number of infected individuals. We consider various strengths of transmission of the disease, availability of vaccine doses, vaccination rates, and other model parameters. This research may lead to more effective health care policies for vaccine administration

Moving Toward Non-transcription Based Discourse Analysis in Stable and Progressive Aphasia

Measurement of communication ability at the discourse level holds promise for predicting how well persons with stable (e.g., stroke-induced), or progressive aphasia navigate everyday communicative interactions. However, barriers to the clinical utilization of discourse measures have persisted. Recent advancements in the standardization of elicitation protocols and the existence of large databases for development of normative references have begun to address some of these barriers. Still, time remains a consistently reported barrier by clinicians. Non-transcription based discourse measurement would reduce the time required for discourse analysis, making clinical utilization a reality. The purpose of this article is to present evidence regarding discourse measures (main concept analysis, core lexicon, and derived efficiency scores) that are well suited to non-transcription based analysis. Combined with previous research, our results suggest that these measures are sensitive to changes following stroke or neurodegenerative disease. Given the evidence, further research specifically assessing the reliability of these measures in clinical implementation is warranted

Core Lexicon and Main Concept Production during Picture Description

Discourse is a highly complex and individualized communication act wherein individuals not only transmit and receive information for survival and cooperation, but also use spoken language for ritual purposes (e.g., relationships, fellowship, co-participation; Carey, 1988; Dimbleby & Burton, 1998). Discourse in typical and clinical populations has been investigated with a variety of structuralist, functionalist, and hybrid techniques (see Armstrong, 2000), and is known to be a good predictor of quality of life and life participation in persons with aphasia (PWAs). Discourse analysis, however, generally requires specialized training and can be time-consuming. MacWhinney, Fromm Holland, Forbes, & Wright (2010) suggested that analysis of a core lexicon during structured narrative tasks could provide a time-efficient and informative index of functional communication abilities. For example, clinicians could bypass lengthy transcriptions, instead generating a list of words spoken during narration for later comparison to a core lexicon (CoreLex). Using various methods, CoreLex has so far been investigated for the Cinderella story, a monologic story retell narrative task (Author1, Dillow, & Author2, 2013; MacWhinney et al., 2010) and a procedural narrative task where patients describe how to make a PB&J sandwich (Fromm, Forbes, Holland, & MacWhinney, 2013). CoreLex performance is strongly correlated with main concept (MC) production, a measure of narrative adequacy, during Cinderella retelling (Author1, Dillow, & Author2, 2013). Similar investigations for other narrative tasks are needed. The aims of this study were to 1) determine the CoreLex of a picture sequence description task included in the AphasiaBank protocol (Breaking Window), 2) calculate a CoreLex score for controls and PWAs, and 3) determine how well CoreLex predicts narrative adequacy, as judged by MC analysis

Story Grammar Analysis in Persons with Mild Aphasia

Narratives are often the basis of daily conversational interactions. When narrative skills are compromised, functional conversation is negatively impacted. Narrative coherence can be impacted even in clinical populations with mild word-finding deficits, such as anomic aphasia (Andreetta, Cantagallo, & Marini, 2012). The narrative abilities of those individuals who have had a stroke (and perhaps a previous aphasia diagnosis) but who perform within the normal range on standardized aphasia assessment measures have not been characterized. As every clinician/clinical researcher knows, this subgroup still includes individuals who have difficulty in conversation, who cannot return to work, and whose life participation is negatively impacted. Using AphasiaBank categorization (as this study relies on AphasiaBank transcripts), we refer to this subgroup as “not aphasic by WAB” (NABW). In both persons with anomic aphasia (PWaAs) and NABWs, deficits may be so minor that they are not apparent on traditional standardized assessment measures, but it should not be assumed that they do not exist and do not affect functional communication abilities. Unfortunately, there is often very little help to be offered for this population. In order to continue progressive development of interventions for PWaAs and NABWs, more information regarding narrative strengths and weaknesses in this population is needed. Story grammar analysis is a well-known method of analyzing narrative discourse in several clinical populations and is likely to be sensitive to differences between closely matched groups. The specific aims of this study are to 1) determine if there are differences between PWaAs, NABW, and non-brain injured controls (NBIs) on production of story grammar components during retelling of the Cinderella story, and 2) to examine the relationship between story grammar measures and an easily and quickly derived discourse measure called CoreLex to further characterize the relationship between micro- and macro-level processes in persons with mild aphasia

Enhancing Missouri Traffic Safety with a Primary Enforcement Seat Belt Law

In 1984, New York became the first state to enact a mandatory seat belt law; since then, the District of Columbia and every state except New Hampshire have adopted similar laws. Of the 49 states with seat belt laws, eight states originally included primary enforcement provisions in seat belt laws, which allow police to stop a driver solely on the basis of not wearing a seat belt. In 1993, California upgraded their secondary seatbelt enforcement provision to a primary law. Since then, 12 more states and the District of Columbia have strengthened their belt laws by making them primary enforcement laws. Missouri continues to permit only secondary enforcement and allows a minimal $10 fine. In 2002, Missouri ranked 35th in the nation in belt use rate, and the fatality rate per 100,000 persons was 21.6 in Missouri versus 14.6 for the national average and 7.18 in the safest state. Further, according to the National Highway Traffic Safety Administration, the economic cost of motor vehicle crashes in Missouri was$4.7 billion in 2000. A 2004 study commissioned by the National Safety Council shows Missouri could save at least $103 million dollars over the next ten years in Medicaid costs once a primary enforcement seat belt law was adopted

A Compendium of Core Lexicon Checklists

Core Lexicon (CoreLex) is a relatively new approach assessing lexical use in discourse. CoreLex examines the specific lexical items used to tell a story, or how typical lexical items are compared with a normative sample. This method has great potential for clinical utilization because CoreLex measures are fast, easy to administer, and correlate with microlinguistic and macrolinguistic discourse measures. The purpose of this article is to provide clinicians with a centralized resource for currently available CoreLex checklists, including information regarding development, norms, and guidelines for use

A cohort study of the recovery of health and wellbeing following colorectal cancer (CREW study): protocol paper

Background: the number of people surviving colorectal cancer has doubled in recent years. While much of the literature suggests that most people return to near pre-diagnosis status following surgery for colorectal cancer, this literature has largely focused on physical side effects. Longitudinal studies in colorectal cancer have either been small scale or taken a narrow focus on recovery after surgery. There is a need for a comprehensive, long-term study exploring all aspects of health and wellbeing in colorectal cancer patients. The aim of this study is to establish the natural history of health and wellbeing in people who have been treated for colorectal cancer. People have different dispositions, supports and resources, likely resulting in individual differences in restoration of health and wellbeing. The protocol described in this paper is of a study which will identify who is most at risk of problems, assess how quickly people return to a state of subjective health and wellbeing, and will measure factors which influence the course of recovery. Methods: this is a prospective, longitudinal cohort study following 1000 people with colorectal cancer over a period of two years, recruiting from 30 NHS cancer treatment centres across the UK. Questionnaires will be administered prior to surgery, and 3, 9, 15 and 24 months after surgery, with the potential to return to this cohort to explore on-going issues related to recovery after cancer. Discussion: outcomes will help inform health care providers about what helps or hinders rapid and effective recovery from cancer, and identify areas for intervention development to aid this process. Once established the cohort can be followed up for longer periods and be approached to participate in related projects as appropriate and subject to funding<br/

Treating Homeless Opioid Dependent Patients with Buprenorphine in an Office-Based Setting

CONTEXT Although office-based opioid treatment with buprenorphine (OBOT-B) has been successfully implemented in primary care settings in the US, its use has not been reported in homeless patients. OBJECTIVE To characterize the feasibility of OBOT-B in homeless relative to housed patients. DESIGN A retrospective record review examining treatment failure, drug use, utilization of substance abuse treatment services, and intensity of clinical support by a nurse care manager (NCM) among homeless and housed patients in an OBOT-B program between August 2003 and October 2004. Treatment failure was defined as elopement before completing medication induction, discharge after medication induction due to ongoing drug use with concurrent nonadherence with intensified treatment, or discharge due to disruptive behavior. RESULTS Of 44 homeless and 41 housed patients enrolled over 12 months, homeless patients were more likely to be older, nonwhite, unemployed, infected with HIV and hepatitis C, and report a psychiatric illness. Homeless patients had fewer social supports and more chronic substance abuse histories with a 3- to 6-fold greater number of years of drug use, number of detoxification attempts and percentage with a history of methadone maintenance treatment. The proportion of subjects with treatment failure for the homeless (21%) and housed (22%) did not differ (P=.94). At 12 months, both groups had similar proportions with illicit opioid use [Odds ratio (OR), 0.9 (95% CI, 0.5–1.7) P=.8], utilization of counseling (homeless, 46%; housed, 49%; P=.95), and participation in mutual-help groups (homeless, 25%; housed, 29%; P=.96). At 12 months, 36% of the homeless group was no longer homeless. During the first month of treatment, homeless patients required more clinical support from the NCM than housed patients. CONCLUSIONS Despite homeless opioid dependent patients' social instability, greater comorbidities, and more chronic drug use, office-based opioid treatment with buprenorphine was effectively implemented in this population comparable to outcomes in housed patients with respect to treatment failure, illicit opioid use, and utilization of substance abuse treatment