Cohesion-Establishment in Text Comprehension: A Case-Study of Anomaly Detection

This thesis develops the view that establishing a cohesive mental representation from a text demands elaboration by inference. Such cohesion-based inferential activity is necessarily incomplete, since there is no limit to information potentially relevant to coherence tests. Hence, cohesion is only more or less complete, possibly varying as a function of textual and contextual factors. Text-based anomalies which pass undetected during reading act as signals for shallow underlying cohesion. The rate of detection for any particular anomaly is an index of processing depth. The detection rates for several manipulations of one anomaly are investigated. Cross condition comparison of the obtained rates allows evaluation of manipulation effects. Over a series of eight experiments, considerable non-detection is observed, supporting the above views. The results suggest that the contribution any word makes to overall coherence is not a simple function of its own properties. Rather, these interact with more global constraints such as the background interpretative scenario and the pragmatic status of the message. These factors have a controlling effect on on-line processing. Since pragmatic status, for example, may only emerge gradually over message presentation, selective influences on prior information can be delayed, even across sentence boundaries. These effects suggest that the time-course of full interpretation may be longer than has previously been thought to be the case. Implications for inference measurement and models of text processing are discussed

CBT for difficult-to-treat depression: self-regulation model

Background:Cognitive behavioural therapy (CBT) is an effective treatment for depression but a significant minority of clients do not complete therapy, do not respond to it, or subsequently relapse. Non-responders, and those at risk of relapse, are more likely to have adverse childhood experiences, early-onset depression, co-morbidities, interpersonal problems and heightened risk. This is a heterogeneous group of clients who are currently difficult to treat.Aim:The aim was to develop a CBT model of depression that will be effective for difficult-to-treat clients who have not responded to standard CBT.Method:The method was to unify theory, evidence and clinical strategies within the field of CBT to develop an integrated CBT model. Single case methods were used to develop the treatment components.Results:A self-regulation model of depression has been developed. It proposes that depression is maintained by repeated interactions of self-identity disruption, impaired motivation, disengagement, rumination, intrusive memories and passive life goals. Depression is more difficult to treat when these processes become interlocked. Treatment based on the model builds self-regulation skills and restructures self-identity, rather than target negative beliefs. A bespoke therapy plan is formed out of ten treatment components, based on an individual case formulation.Conclusions:A self-regulation model of depression is proposed that integrates theory, evidence and practice within the field of CBT. It has been developed with difficult-to-treat cases as its primary purpose. A case example is described in a concurrent article (Barton et al., 2022) and further empirical tests are on-going

Measuring access to effective care among elderly medicare enrollees in managed and fee-for-service care: a retrospective cohort study

BACKGROUND: Our aim was to compare access to effective care among elderly Medicare patients in a Staff Model and Group Model HMO and in Fee-for-Service (FFS) care. METHODS: We used a retrospective cohort study design, using claims and automated medical record data to compare achievement on quality indicators for elderly Medicare recipients. Secondary data were collected from 1) HMO data sets and 2) Medicare claims files for the time period 1994–95. All subjects were Medicare enrollees in a defined area of New England: those enrolled in two divisions of a managed care plan with different physician payment arrangements: a staff model, and a group model; and the Medicare FFS population. We abstracted information on indicators covering several domains: preventive, diagnosis-specific, and chronic disease care. RESULTS: On the indicators we created and tested, access in the single managed care plan under study was comparable to or better than FFS care in the same geographic region. Percent of Medicare recipients with breast cancer screening was 36 percentage points higher in the staff model versus FFS (95% confidence interval 34–38 percentage points). Follow up after hospitalization for myocardial infarction was 20 percentage points higher in the group model than in FFS (95% confidence interval 14–26 percentage points). CONCLUSION: According to indicators developed for use in both claims and automated medical record data, access to care for elderly Medicare beneficiaries in one large managed care organization was as good as or better than that in FFS care in the same geographic area

Recurrent depression and relational trauma: a single case of memory processing

Cognitive behavioural therapy (CBT) is an effective treatment for depression, but a significant minority of clients are difficult to treat, including those with histories of relational trauma. The model of Beck et al. (1979) proposes that adverse childhood experiences lead to negative core beliefs, and these create a susceptibility to depression. However, Beck’s model does not identify trauma as a subset of adverse experiences. An alternative view is that traumatised clients internalise conflicting representations of self and it is conflict, interacting with trauma memories, that creates a vulnerability for depression. In this formulation, methods from the treatment of post-traumatic stress disorder (PTSD) could be incorporated into the treatment of depression, to emotionally process trauma memories and resolve self-identity conflicts. The aims of this study were to: (1) report the treatment of a 67-year-old man with recurrent depression and a history of prolonged relational trauma, and (2) to explore how memory processing from the treatment of PTSD can be incorporated into the treatment of recurrent depression. A single case observational design was used in the long-term treatment of a depressed traumatised client. The client received 47 individual sessions over 19 months in routine clinical practice in a tertiary CBT service. He completed repeated measures of mood, memory intrusions and sleep disruption. The client responded well to treatment with clinically significant improvements across measures of mood, memory and sleep. The effects were sustained over an 18-month follow-up. Memory processing was successfully integrated into a high-intensity treatment for recurrent depression. This is a promising approach for depressed clients with histories of relational trauma

Barriers to self-monitoring of blood glucose among adults with diabetes in an HMO: A cross sectional study

BACKGROUND: Recent studies suggest that patients at greatest risk for diabetes complications are least likely to self-monitor blood glucose. However, these studies rely on self-reports of monitoring, an unreliable measure of actual behavior. The purpose of the current study was to examine the relationship between patient characteristics and self-monitoring in a large health maintenance organization (HMO) using test strips as objective measures of self-monitoring practice. METHODS: This cross-sectional study included 4,565 continuously enrolled adult managed care patients in eastern Massachusetts with diabetes. Any self-monitoring was defined as filling at least one prescription for self-monitoring test strips during the study period (10/1/92–9/30/93). Regular SMBG among test strip users was defined as testing an average of once per day for those using insulin and every other day for those using oral sulfonylureas only. Measures of health status, demographic data, and neighborhood socioeconomic status were obtained from automated medical records and 1990 census tract data. RESULTS: In multivariate analyses, lower neighborhood socioeconomic status, older age, fewer HbA1c tests, and fewer physician visits were associated with lower rates of self-monitoring. Obesity and fewer comorbidities were also associated with lower rates of self-monitoring among insulin-managed patients, while black race and high glycemic level (HbA1c>10) were associated with less frequent monitoring. For patients taking oral sulfonylureas, higher dose of diabetes medications was associated with initiation of self-monitoring and HbA1c lab testing was associated with more frequent testing. CONCLUSIONS: Managed care organizations may face the greatest challenges in changing the self-monitoring behavior of patients at greatest risk for poor health outcomes (i.e., the elderly, minorities, and people living in low socioeconomic status neighborhoods)

The SISO CSPI PDG standard for commercial off-the-shelf simulation package interoperability reference models

For many years discrete-event simulation has been used to analyze production and logistics problems in manufactur-ing and defense. Commercial-off-the-shelf Simulation Packages (CSPs), visual interactive modelling environ-ments such as Arena, Anylogic, Flexsim, Simul8, Witness, etc., support the development, experimentation and visua-lization of simulation models. There have been various attempts to create distributed simulations with these CSPs and their tools, some with the High Level Architecture (HLA). These are complex and it is quite difficult to assess how a set of models/CSP are actually interoperating. As the first in a series of standards aimed at standardizing how the HLA is used to support CSP distributed simula-tions, the Simulation Interoperability Standards Organiza-tion’s (SISO) CSP Interoperability Product Development Group (CSPI PDG) has developed and standardized a set of Interoperability Reference Models (IRM) that are in-tended to clearly identify the interoperability capabilities of CSP distributed simulations

Optical Light Curve of the Type Ia Supernova 1998bu in M96 and the Supernova Calibration of the Hubble Constant

We present the UBVRI light curves of the Type Ia supernova SN 1998bu which appeared in the nearby galaxy M96 (NGC 3368). M96 is a spiral galaxy in the Leo I group which has a Cepheid-based distance. Our photometry allows us to calculate the absolute magnitude and reddening of this supernova. These data, when combined with measurements of the four other well-observed supernovae with Cepheid based distances, allow us to calculate the Hubble constant with respect to the Hubble flow defined by the distant Calan/Tololo Type Ia sample. We find a Hubble constant of 64.0 +/- 2.2(internal) +/- 3.5(external) km/s/Mpc, consistent with most previous estimates based on Type Ia supernovae. We note that the two well-observed Type Ia supernovae in Fornax, if placed at the Cepheid distance to the possible Fornax spiral NGC 1365, are apparently too faint with respect to the Calan/Tololo sample calibrated with the five Type Ia supernovae with Cepheid distances to the host galaxies.Comment: AAS LaTeX, 20 pages, 4 figures, 6 tables, accepted for publication in the Astronomical Journal. Figure 1 (finding chart) not include

Realisation of a low frequency SKA Precursor: The Murchison Widefield Array

The Murchison Widefield Array is a low frequency (80-300 MHz) SKA Precursor, comprising 128 aperture array elements distributed over an area of 3 km diameter. The MWA is located at the extraordinarily radio quiet Murchison Radioastronomy Observatory in the mid-west of Western Australia, the selected home for the Phase 1 and Phase 2 SKA low frequency arrays. The MWA science goals include: 1) detection of fluctuations in the brightness temperature of the diffuse redshifted 21 cm line of neutral hydrogen from the epoch of reionisation; 2) studies of Galactic and extragalactic processes based on deep, confusion-limited surveys of the full sky visible to the array; 3) time domain astrophysics through exploration of the variable radio sky; and 4) solar imaging and characterisation of the heliosphere and ionosphere via propagation effects on background radio source emission. This paper will focus on a brief discussion of the as-built MWA system, highlighting several novel characteristics of the instrument, and a brief progress report (as of June 2012) on the final construction phase. Practical completion of the MWA is expected in November 2012, with commissioning commencing from approximately August 2012 and operations commencing near mid 2013. A brief description of recent science results from the MWA prototype instrument is given

An Empirical Characterization of Extended Cool Gas Around Galaxies Using MgII Absorption Features

We report results from a survey of MgII absorbers in the spectra of background QSOs that are within close angular distances to a foreground galaxy at z<0.5, using the Magellan Echellette Spectrograph. We have established a spectroscopic sample of 94 galaxies at a median redshift of = 0.24 in fields around 70 distant background QSOs (z_QSO>0.6), 71 of which are in an 'isolated' environment with no known companions and located at rho <~ 120 h^-1 kpc from the line of sight of a background QSO. The rest-frame absolute B-band magnitudes span a range from M_B-5log h=-16.4 to M_B-5log h=-21.4 and rest-frame B_AB-R_AB colors range from B_AB-R_AB~0 to B_AB-R_AB~1.5. Of these 'isolated' galaxies, we find that 47 have corresponding MgII absorbers in the spectra of background QSOs and rest-frame absorption equivalent width W_r(2796)=0.1-2.34 A, and 24 do not give rise to MgII absorption to sensitive upper limits. Our analysis shows that (1) Wr(2796) declines with increasing distance from 'isolated' galaxies but shows no clear trend in 'group' environments; (2) more luminous galaxies possess more extended MgII absorbing halos with the gaseous radius scaled by B-band luminosity according to R_gas=75x(L_B/L_B*)^(0.35+/-0.03) h^{-1} kpc; (3) there is little dependence between the observed absorber strength and galaxy intrinsic colors; and (4) within R_gas, we find a mean covering fraction of ~70% for absorbers of Wr(2796)>=0.3 A and ~80% for absorbers of Wr(2796)>=0.1 A. The lack of correlation between Wr(2796) and galaxy colors suggests a lack of physical connection between the origin of extended MgII halos and recent star formation history of the galaxies. Finally, we discuss the total gas mass in galactic halos as traced by MgII absorbers. We also compare our results with previous studies.Comment: 20 pages, 13 figures; to appear in the Astrophysical Journal 2010 May 10 issue; a version with higher resolution figures can be found at http://lambda.uchicago.edu/public/tmp/mage_apj.pd