The comprehension benefit of noun-contingent eye movements in the visual world

When we listen to someone talking, we try, at any given point in time, to make the connection between what is being said and the real world. Language processing incorporates information from various different sources and modalities in order to create an immediate and adequate representation of the conveyed meaning. Language processing also affects the information processing in other modalities, specifically visual perception: looks to entities in one’s visual environment while listening to spoken utterances closely mirror one’s comprehension of referring expressions in the speech stream. This behavior - noun-contingent eye movements - has been observed consistently in psycholinguistic research and has been used as a window into the conceptual layer of the language comprehension process, shedding light onto an extremely wide range of language processing phenomena. The phenomenon of noun-contingent eye movements itself is not yet fully understood though. Drawing back on concepts from spatial indexing, lexical access and priming we motivate the search for and investigation of a beneficial effect of noun-contingent referent looks on the noun’s speed of comprehension. This thesis utilizes a novel experimental methodology which makes it possible to simultaneously observe and manipulate participants’ inclination to make noun-contingent eye movements as well as record the speed of comprehension for the spoken noun that would trigger these eye movements. This is necessary if one wants to investigate a potential effect of eye movements on noun comprehension. The methodology is a combination of a classical visual-world setting, where participants listen to single spoken nouns and inspect an array of objects that may be related to the noun, and of a lexical decision task which is performed on that spoken noun and assesses the speed of its recognition. With the experiments presented in this thesis we manage to provide reliable empirical evidence for a beneficial effect of noun-contingent referent looks on the speed of noun comprehension. It is also shown that this benefit arises from the perception of the referent’s visual image (as opposed to the activation of internal referent representations or avoidance of interference from unrelated visual images) during the comprehension of the spoken noun (as opposed to a benefit from the initial recognition and encoding of the referent object). Finally, it is proposed that a spatial-indexing mechanism plays a role in mediating the strength of the effect that the visual image provided by a noun-contingent eye movement can have on the comprehension of the spoken noun.Die Verarbeitung von sprachlichen und bildlichen Reizen ist beim Menschen eng miteinander verwoben. Wer gleichzeitig gesprochener Sprache zuhört und dazu passende Dinge in seiner Umgebung sieht, wird häufig seinen Blick davon steuern lassen, welche Worte er gerade versteht. Das heißt beispielsweise, dass man, während man eine Objektbezeichnung hört, seinen Blick auf das benannte Objekt richtet. In einer Situation, in der auf ein Objekt gezeigt wird ("Schau mal, der Apfel!"), ist die Motivation für solch ein Verhalten intuitiv verständlich. Aber auch in Situationen, in denen sich gesprochene Äußerungen nicht unmittelbar auf die Umgebung beziehen, blicken Zuhörer verlässlich auf Objekte, die zu den gerade geäußerten Worten passen. Solche Blicke sind nicht unmittelbar pragmatisch motiviert, möglicherweise aber dadurch, dass das Sprachverstehen von diesem Blickverhalten profitiert. Dieser Möglichkeit gehen wir in der vorliegenden Arbeit auf den Grund. Hierzu nutzen wir eine neuartige Kombination von Forschungsmethoden, mit der man gleichzeitig Einblicke sowohl in das Sprachverstehen als auch in die visuelle Verarbeitung gewinnt. Mit dem ’Visual World’-Paradigma werden in der psycholinguistischen Forschung Erkenntnisse über zahlreiche Aspekte der Sprachverarbeitung gewonnen: In Studien zum Sprachverstehen wird der Blick eines Zuhörers zu einem Objekt, das in einer Beziehung zu einem zeitnah geäußerten Wort steht, als Zeichen dafür verstanden, dass der Zuhörer dem Wort (wenigstens zeitweise) die Bedeutung dieses Objekts zuordnet. Indem man nun mittels Eyetracking beobachtet, welche Objekte in Ihrer Umgebung Menschen anschauen, während sie gesprochene Sprache verstehen, erfährt man in einer hohen zeitlichen Auflösung, wie gesprochene Äußerungen interpretiert werden. Mit Studien dieser Art werden Blickbewegungen als Konsequenz der Sprachverarbeitung genutzt; man kann also erfahren, wie das Verstehen gesprochener Sprache die Blickbewegungen steuert. Die zweite Seite unserer zentralen Forschungsfrage ist die nach dem Einfluss der visuellen auf die sprachliche Verarbeitung. Wie wird das Verstehen eines Wortes davon beeinflusst, was man gerade sieht? Solchen Fragestellungen widmen sich Priming- und Lexical-Decision-Studien. Im Priming-Paradigma wird mit verschiedenartigen Aufgaben erforscht, wie sich die Verarbeitung eines Konzept (des Targets) durch den Kontext eines weiteren Konzepts (des Primes) verändert: Indem man Probanden beispielsweise zusätzlich zu einem zu benennenden Objekt ein weiteres Bild zeigt, das in einer engen Beziehung zu dem zu benennenden Objekt steht, gewinnt man Aufschluss darüber, wie ähnliche bildliche Informationen den Benennensprozess beeinflussen. Die lexikalische Entscheidungsaufgabe (Lexical Decision) besteht darin, zu einer kurzen Laut-oder Buchstabenfolge zu entscheiden, ob es sich dabei um ein echtes Wort handelt. Auf unsere Fragestellung angewandt ermöglichen es diese Methoden, herauszufinden, wie Blicke zu verschiedenen Arten von Objekten (Primes) das Verstehen eines gesprochenen Wortes (Targets), erfasst durch die lexikalische Entscheidungsaufgabe, beeinflussen. Wir finden mit dieser Arbeit in mehreren Experimenten Belege dafür, dass Blickbewegungen zu verwandten Objekten beim Verstehen einer Objektbezeichnung eine Auswirkung auf die Geschwindigkeit des Sprachverstehens haben. Schaut man während des Verstehens eines Wortes auf seinen Referenten, kann das den Verstehensprozess beschleunigen. Dabei profitiert man direkt davon, zeitgleich mit dem Verstehensprozess passende visuelle Informationen aufzunehmen. Vermutlich kommt in diesem Verhältnis den \u27Spatial Indices\u27 eine regulierende Rolle zu. Im Rahmen von Theorien über Spatial Indexing und External Memory (Spivey, Richardson, & Fitneva, 2004) wird angenommen, dass man auf Objekte in seiner visuellen Umgebung jederzeit aufgabenbasiert und effektiv zugreift, indem man sie über Indizes in der Umwelt verortet und dem jeweiligen Aufgabenkontext entsprechend intern benennt. Auch Blickbewegungen während des Sprachverstehens können so erklärt werden. Wenn das beginnende Verstehen eines gesprochenen Wortes zu der Benennung vorhandener Indizes passt, werden diese aktiviert, mit ihnen die assoziierten Positionen im Raum, und dadurch werden Blicke zu diesen Positionen ausgelöst. Als Erweiterung dieser bekannten Theorie findet die vorliegende Arbeit Hinweise darauf, dass ein visuelles Objekt nur dann mit dem Verstehen eines gesprochenen Wortes interagieren kann, wenn die Fixation des Objekts durch die Aktivierung eines zum gesprochenen Wort passenden Indizes ausgelöst wurde

Safety and Precision of Two Different Flap-morphologies Created During Low Energy Femtosecond Laser-assisted LASIK

Purpose: Currently, two major principles exist to create LASIK flaps: firstly, a strictly horizontal (2D) cut similar to the microkeratome-cut and secondly an angled cut with a “step-like” edge (3D). The strictly horizontal (2D) cut method can be performed using apparatus such as the low-energy FEMTO LDV Z8 laser and its predecessors which are specific to this type. Alternatively, the low-energy FEMTO LDV Z8 laser’s 3D flap design creates an interlocking flap-interface surface which potentially contributes toward flap stability. In addition, the FEMTO LDV Z8 offers flap-position adjustments after docking (before flap-creation). The current study analyzed precision, safety, efficacy, as well as patient self-reported pain and comfort levels after applying two different types of LASIK flap morphologies which were created with a low-energy, high-frequency femtosecond (fs) laser device. Methods: A prospective, interventional, randomized, contralateral eye, single-center comparison study was conducted from November 2019 to March 2020 at the Hamburg vision clinic/ zentrumsehstärke, Hamburg, Germany. Eleven patients and 22 eyes received low-energy fs LASIK treatment for myopia or myopic astigmatism in both eyes. Before the treatment, the eyes were randomized (one eye was treated with the 2D, the other eye with the 3D method). Results: The mean central flap thickness one month after surgery was 110.7 ± 1.6 μm (2D) and 111.2 ± 1.7 μm (3D); P = 0.365 (2D vs 3D). Flap thickness measured at 13 different points resulted in no statistically significant differences between any of the measurement points within/between both groups; demonstrating good planarity of the flap was achieved using both methods. Despite not being statistically significant, the surgeons recognized an increase in the presence of an opaque bubble layer in the 3D flap eyes during surgery and some patients reported higher, yet not statistically significant, pain scores in the 3D flap eyes during the first hours after the treatment. Overall, safety- and efficacy indices were 1.03 and 1.03, respectively. Conclusion: In this prospective, randomized, contralateral eye study, the low-energy fs laser yielded predictable lamellar flap thicknesses and geometry at one-month followup. Based on these results, efficacy and safety of the corresponding laser application, that is, 2D vs 3D, are equivalen

Bevölkerungsprognose für Mecklenburg-Vorpommern auf Kreisebene bis zum Jahr 2030

"In order to make precise and forward-looking decisions in nearly all social fields, detailed information on the size and structure of prospective populations in specific regional areas is needed. For that purpose, this article will show how current trends of demographic parameters affect the development of the population in administrative districts of the federal state of Mecklenburg-Western Pomerania until 2030. Based upon population data from 1982 until 2005, provided by the Federal State Agency of Statistics of Mecklenburg-Western Pomerania, this paper presents a projection of the population as well as the aging and the sex proportion of the federal state until 2030. The development of off-county cities, counties and the whole federal state were calculated by applying the cohort-survival- method and prediction module of the Federal State Agency of Statistics of Mecklenburg-Western Pomerania. The fertility and migration assumptions chosen, are following the assumptions of the last coordinated population projection of the Federal State Agency of Statistics of Mecklenburg-Western Pomerania (2007). The mortality assumptions enter the analysis analogously to the county- and sex-specific projections of life expectancy, as they are used within the Lee-Carter-method (1982 - 2005). The results show a population decrease of about 180.000 inhabitants until 2030 for the entire federal state with strongest population loss until 2012. In the following years the outflow of people strongly decreases, because cohorts in migration relevant ages are missing. The population development of the six off-county cities is rather different. Rostock and Greifswald will note a population increase until 2030, whereas the number of residents in Wismar and Stralsund will be stable. Schwerin and Neubrandenburg will lose residents. Every county will diminish enormously; except Bad Doberan which has to count on a population increase, while Uecker-Randow and Demmin will lose most inhabitants. In the forthcoming years the counties will not only be shrinking, but they will also age above average. The mean age of all counties will grow by 10.5 years until 2030. In the cities it will increase by 4.4 years and for entire Mecklenburg-Western Pomerania it will increase by 8.2 years. Counties with positive population development will age most slightly. The absolute quantity as well as the relative proportion of seniors (aged 64+) and oldest old (aged 79+) will grow in all counties. A similar picture can be seen in the cities, where the absolute quantities of oldest old and seniors will also increase, wheras the relative proportions are smaller. In 2030 the proportion of seniors of all cities will be below the federal state mean, except for Neubrandenburg. Overall, inhabitants aged 50 and older will increase, whilst persons in reproductive ages between 15 and 49 years will exhibit a declining proportion of population. Hence, the birth deficit will be further intensified. Moreover, a high predominance of men within the younger population could be discovered for the 1990s. This predominance of men will be put forward as a cohort effect in older age groups during the following years. At county level it can be shown, that the projected values for the cities comparatively turn out to be more positive, whilst the projections for some counties give a more pessimistic outlook. The latter finding has to be traced back to the migration assumptions. This projection is on par with results of previous projections which also showed shrinkage and aging trends for Mecklenburg-Western Pomerania. Updated federal state population quantities reflect both processes as well. The projected, further increasing absolute quantities of older and the decreasing quantities of young people in urban and less populated regions, imply an urgent need for action from political and economical decision makers. An age-appropriate infrastructure as well as a good performing care- and health system for the growing number of further aging persons are required to absorb the ongoing and projected trends. Political decisions have especially to be made for sparsely populated regions to maintain security of supply and infrastructure." (author's abstract

The Premonitory Urge for Tics Scale in a large sample of children and adolescents: psychometric properties in a developmental context. An EMTICS study

Premonitory urges are uncomfortable physical sensations preceding tics that occur in most individuals with a chronic tic disorder. The Premonitory Urge for Tics Scale (PUTS) is the most frequently used self-report measure to assess the severity of premonitory urges. We aimed to evaluate the psychometric properties of the PUTS in the largest sample size to date (n = 656), in children aged 3–16 years, from the baseline measurement of the longitudinal European Multicenter Tics in Children Study (EMTICS). Our psychometric evaluation was done in three age-groups: children aged 3–7 years (n = 103), children between 8 and 10 years (n = 253), and children aged 11–16 years (n = 300). The PUTS exhibited good internal reliability in children and adolescents, also under the age of 10, which is younger than previously thought. We observed significant but small correlations between the severity of urges and severity of tics and obsessive–compulsive symptoms, and between severity of urges and ratings of attention-deficit/hyperactivity disorder and internalizing and externalizing behaviors, however, only in children of 8–10 years. Consistent with previous results, the 10th item of the PUTS correlated less with the rest of the scale compared to the other items and, therefore, should not be used as part of the questionnaire. We found a two-factor structure of the PUTS in children of 11 years and older, distinguishing between sensory phenomena related to tics, and mental phenomena as often found in obsessive–compulsive disorder. The age-related differences observed in this study may indicate the need for the development of an age-specific questionnaire to assess premonitory urges

Tic disorders in children and adolescents: does the clinical presentation differ in males and females? A report by the EMTICS group

Tic disorders have a strong male predominance, with a male-to-female ratio of 4:1 in Tourette syndrome (TS) and 2:1 in persistent tic disorders. In other neurodevelopmental conditions, such as autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD), the disparity in sex distribution has been partially related to differences in symptom presentation between males and females. In tic disorders, however, little research has been conducted on this topic, probably due to the limited access to large samples with a significant proportion of females. The aim of this study was to describe sex differences in the clinical presentation of tic disorders in children and adolescents in one of the largest pediatric samples with TS/persistent tic disorders (n = 709, 23.3% females) recruited as part of the European Multicenter Tics in Children Study (EMTICS). Validated measures assessed the severity of tics and comorbid psychiatric symptoms. Using mixed-effect models, we found that sex had a significant influence on the severity of tics, ADHD symptoms, ASD symptoms, and emotional problems. Males had more severe symptoms than females, except for emotional problems. We also observed a statistically significant interaction between sex and age on the severity of tics and compulsions, with females showing higher symptom severity with increasing age than males. These findings indicate that the clinical presentation of TS/persistent tic disorders varies with sex. Males seem to exhibit a more noticeable pattern of clinical symptoms at a younger age that may contribute to their earlier detection in comparison to females

Association of Group A Streptococcus Exposure and Exacerbations of Chronic Tic Disorders

Objective: To examine prospectively the association between group A Streptococcus (GAS) pharyngeal exposures and exacerbations of tics in a large multicenter population of youth with chronic tic disorders (CTD) across Europe. Methods: We followed up 715 children with CTD (age 10.7 ± 2.8 years, 76.8% boys), recruited by 16 specialist clinics from 9 countries, and followed up for 16 months on average. Tic, obsessive-compulsive symptom (OCS), and attention-deficit/hyperactivity disorder (ADHD) severity was assessed during 4-monthly study visits and telephone interviews. GAS exposures were analyzed using 4 possible combinations of measures based on pharyngeal swab and serologic testing. The associations between GAS exposures and tic exacerbations or changes of tic, OC, and ADHD symptom severity were measured, respectively, using multivariate logistic regression plus multiple failure time analyses and mixed effects linear regression. Results: A total of 405 exacerbations occurred in 308 of 715 (43%) participants. The proportion of exacerbations temporally associated with GAS exposure ranged from 5.5% to 12.9%, depending on GAS exposure definition. We did not detect any significant association of any of the 4 GAS exposure definitions with tic exacerbations (odds ratios ranging between 1.006 and 1.235, all p values >0.3). GAS exposures were associated with longitudinal changes of hyperactivity-impulsivity symptom severity ranging from 17% to 21%, depending on GAS exposure definition. Conclusions: This study does not support GAS exposures as contributing factors for tic exacerbations in children with CTD. Specific workup or active management of GAS infections is unlikely to help modify the course of tics in CTD and is therefore not recommended

Clinical precursors of tics: an EMTICS study

Background: Children with Tourette syndrome (TS) often have comorbid disorders, particularly attention-deficit/ hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD). While subtle premorbid symptoms have been described in various psychiatric disorders, the presence of clinical precursors that may exist before the onset of tics is unknown. This longitudinal study aimed to find clinical precursors of tics by assessing a range of clinical characteristics prior to tic onset in comparison with children without onset of tics. Methods: A sample of 187 3- to 10-year-old first-degree unaffected relatives of children with TS were followed up to 7 years in the European Multicentre Tics in Children Study (EMTICS). We investigated whether clinical characteristics assessed at baseline predicted tic onset, comparing 126 children without tic onset to 61 children who developed tics. We used the least absolute shrinkage and selection operator (LASSO) method, a penalised logistic regression approach. We also explored sex differences and repeated our analyses in an age- and sex-matched subsample. Results: Children with tic onset were more frequently male (b = 0.36), had higher baseline severity of conduct problems (b = 0.23), autism spectrum disorder symptoms (ASD; b = 0.08), compulsions (b = 0.02) and emotional problems (b = 0.03) compared to children without tic onset. Conduct and ASD problems were male-specific predictors, whereas severity of compulsions and oppositional (b = 0.39) and emotional problems were female-specific predictors. Conclusion: This study supports the presence of clinical precursors prior to tic onset and highlights the need of sex-specific monitoring of children at risk of developing tics. This may aid in the earlier detection of tics, particularly in females. We moreover found that tics most often persisted one year after tic onset, in contrast to the common belief that tics are mostly transient

European Multicentre Tics in Children Studies (EMTICS): protocol for two cohort studies to assess risk factors for tic onset and exacerbation in children and adolescents

Genetic predisposition, autoimmunity and environmental factors [e.g. pre- and perinatal difficulties, Group A Streptococcal (GAS) and other infections, stress-inducing events] might interact to create a neurobiological vulnerability to the development of tics and associated behaviours. However, the existing evidence for this relies primarily on small prospective or larger retrospective population-based studies, and is therefore still inconclusive. This article describes the design and methodology of the EMTICS study, a longitudinal observational European multicentre study involving 16 clinical centres, with the following objectives: (1) to investigate the association of environmental factors (GAS exposure and psychosocial stress, primarily) with the onset and course of tics and/or obsessive-compulsive symptoms through the prospective observation of at-risk individuals (ONSET cohort: 260 children aged 3-10 years who are tic-free at study entry and have a first-degree relative with a chronic tic disorder) and affected individuals (COURSE cohort: 715 youth aged 3-16 years with a tic disorder); (2) to characterise the immune response to microbial antigens and the host's immune response regulation in association with onset and exacerbations of tics; (3) to increase knowledge of the human gene pathways influencing the pathogenesis of tic disorders; and (4) to develop prediction models for the risk of onset and exacerbations of tic disorders. The EMTICS study is, to our knowledge, the largest prospective cohort assessment of the contribution of different genetic and environmental factors to the risk of developing tics in putatively predisposed individuals and to the risk of exacerbating tics in young individuals with chronic tic disorders

Hair cortisol-a stress marker in children and adolescents with chronic tic disorders? A large European cross-sectional study

Background There is clear evidence that tic disorders (TDs) are associated with psychosocial stress as well as emotional and behavioral problems. Studies have shown that individuals with TDs have higher acute physiological stress responses to external, single stressors (as reflected by saliva cortisol). The aim of the present study was to examine a physiological marker of longer-term stress (as reflected by hair cortisol concentration) in children and adolescents with TDs and unaffected siblings of individuals with TDs. Methods Two samples of a European cohort were included in this study. In the COURSE sample, 412 children and adolescents aged 3–16 years with a chronic TD including Tourette syndrome according to DSM IV-TR criteria were included. The ONSET sample included 131 3–10 years old siblings of individuals with TDs, who themselves had no tics. Differences in hair cortisol concentration (HCC) between the two samples were examined. Within the COURSE sample, relations of HCC with tic severity and perceived psychosocial stress as well as potential effects and interaction effects of comorbid emotional and behavioral problems and psychotropic medication on HCC were investigated. Results There were no differences in HCC between the two samples. In participants with TDs, there were no associations between HCC and tic severity or perceived psychosocial stress. No main effects of sex, psychotropic medication status and comorbid emotional and behavioral problems on HCC were found in participants with TDs. Conclusion A link between HCC and TDs is not supported by the present result

Yale Global Tic Severity Scale (YGTSS): Psychometric Quality of the Gold Standard for Tic Assessment Based on the Large-Scale EMTICS Study

The Yale Global Tic Severity Scale (YGTSS) is a clinician-rated instrument considered as the gold standard for assessing tics in patients with Tourette's Syndrome and other tic disorders. Previous psychometric investigations of the YGTSS exhibit different limitations such as small sample sizes and insufficient methods. To overcome these shortcomings, we used a subsample of the large-scale “European Multicentre Tics in Children Study” (EMTICS) including 706 children and adolescents with a chronic tic disorder and investigated convergent, discriminant and factorial validity, as well as internal consistency of the YGTSS. Our results confirm acceptable convergent and good to very good discriminant validity, respectively, indicated by a sufficiently high correlation of the YGTSS total tic score with the Clinical Global Impression Scale for tics (rs = 0.65) and only low to medium correlations with clinical severity ratings of attention deficit/hyperactivity symptoms (rs = 0.24), obsessive–compulsive symptoms (rs = 27) as well as internalizing symptoms (rs = 0.27). Internal consistency was found to be acceptable (Ω = 0.58 for YGTSS total tic score). A confirmatory factor analysis supports the concept of the two factors “motor tics” and “phonic tics,” but still demonstrated just a marginal model fit (root mean square error of approximation = 0.09 [0.08; 0.10], comparative fit index = 0.90, and Tucker Lewis index = 0.87). A subsequent analysis of local misspecifications revealed correlated measurement errors, suggesting opportunities for improvement regarding the item wording. In conclusion, our results indicate acceptable psychometric quality of the YGTSS. However, taking the wide use and importance of the YGTSS into account, our results suggest the need for further investigations and improvements of the YGTSS. In addition, our results show limitations of the global severity score as a sum score indicating that the separate use of the total tic score and the impairment rating is more beneficial