社区1~3岁儿童语言发育与屏幕暴露的相关性调查研究

目的 分析研究社区1~3岁儿童语言发育与屏幕暴露的相关性,为儿童屏幕暴露现状提供改进意见。方法 选取2016年1月-2018年7月于本院儿童保健门诊随访的1~3岁幼儿共827例,男童406例,女童421例,平均年龄为(24.5±5.3)月。采用自制式调查问卷,由本科保健医生指导调查对象的父母或抚养人现场完成,并结合Gesell 婴幼儿发育量表评估调查对象语言发育情况。结果 827例儿童中,93例诊断为语言发育迟缓,734例语言发育正常。两组儿童接触屏幕年龄段、儿童性别、家庭情况、母亲文化程度、父亲文化程度、母亲年龄、屏幕暴露时间、入睡是否规律、接触屏幕时家长陪同和限制屏幕暴露时间差异均有统计学意义(P＜0.05),控制混杂因素影响后多因素Logistic回归分析结果显示,屏幕暴露时间>2 h(OR=1.687,95%CI:1.022~2.236,P<0.001)、接触屏幕时无家长陪同(OR=2.035,95%CI:1.588~2.634,P=0.002)、未限制屏幕暴露时间(OR=1.475,95%CI:1.087~2.156,P=0.035)为语言发育迟缓的重要危险因素。结论 长时间的屏幕暴露会影响家庭语言环境和儿童睡眠,不利于儿童的语言发育,建议家长禁止小于18月的儿童接触屏幕,大于18月的儿童在家长陪同讲解下接触屏幕,时间控制在2 h以内,严格避免睡觉前观看电子屏幕。     

语感教学:语文教育新视角

语文能力的核心是语言能力,语言能力的培养首先表现在如何提高学生的语感素质。加强语文教育中的语感教学,构建培养语感的教学实践体系,势在必行。     

Natural language processing and entrustable professional activity text feedback in surgery: A machine learning model of resident autonomy

BackgroundEntrustable Professional Activities (EPAs) contain narrative ‘entrustment roadmaps’ designed to describe specific behaviors associated with different entrustment levels. However, these roadmaps were created using expert committee consensus, with little data available for guidance. Analysis of actual EPA assessment narrative comments using natural language processing may enhance our understanding of resident entrustment in actual practice.MethodsAll text comments associated with EPA microassessments at a single institution were combined. EPA—entrustment level pairs (e.g. Gallbladder Disease—Level 1) were identified as documents. Latent Dirichlet Allocation (LDA), a common machine learning algorithm, was used to identify latent topics in the documents associated with a single EPA. These topics were then reviewed for interpretability by human raters.ResultsOver 18 months, 1015 faculty EPA microassessments were collected from 64 faculty for 80 residents. LDA analysis identified topics that mapped 1:1 to EPA entrustment levels (Gammas >0.99). These LDA topics appeared to trend coherently with entrustment levels (words demonstrating high entrustment were consistently found in high entrustment topics, word demonstrating low entrustment were found in low entrustment topics).ConclusionsLDA is capable of identifying topics relevant to progressive surgical entrustment and autonomy in EPA comments. These topics provide insight into key behaviors that drive different level of resident autonomy and may allow for data-driven revision of EPA entrustment maps.     

Employing computational linguistics techniques to identify limited patient health literacy: Findings from the ECLIPPSE study

ObjectiveTo develop novel, scalable, and valid literacy profiles for identifying limited health literacy patients by harnessing natural language processing.Data SourceWith respect to the linguistic content, we analyzed 283 216 secure messages sent by 6941 diabetes patients to physicians within an integrated system''s electronic portal. Sociodemographic, clinical, and utilization data were obtained via questionnaire and electronic health records.Study DesignRetrospective study used natural language processing and machine learning to generate five unique “Literacy Profiles” by employing various sets of linguistic indices: Flesch‐Kincaid (LP_FK); basic indices of writing complexity, including lexical diversity (LP_LD) and writing quality (LP_WQ); and advanced indices related to syntactic complexity, lexical sophistication, and diversity, modeled from self‐reported (LP_SR), and expert‐rated (LP_Exp) health literacy. We first determined the performance of each literacy profile relative to self‐reported and expert‐rated health literacy to discriminate between high and low health literacy and then assessed Literacy Profiles’ relationships with known correlates of health literacy, such as patient sociodemographics and a range of health‐related outcomes, including ratings of physician communication, medication adherence, diabetes control, comorbidities, and utilization.Principal FindingsLP_SR and LP_Exp performed best in discriminating between high and low self‐reported (C‐statistics: 0.86 and 0.58, respectively) and expert‐rated health literacy (C‐statistics: 0.71 and 0.87, respectively) and were significantly associated with educational attainment, race/ethnicity, Consumer Assessment of Provider and Systems (CAHPS) scores, adherence, glycemia, comorbidities, and emergency department visits.ConclusionsSince health literacy is a potentially remediable explanatory factor in health care disparities, the development of automated health literacy indicators represents a significant accomplishment with broad clinical and population health applications. Health systems could apply literacy profiles to efficiently determine whether quality of care and outcomes vary by patient health literacy; identify at‐risk populations for targeting tailored health communications and self‐management support interventions; and inform clinicians to promote improvements in individual‐level care.     

Crossed aphasia. An update

The aim of this article is to present an update of a rare but interesting problem: crossed aphasia. This term indicates the presence of aphasia after unilateral cerebral lesion of the hemisphere ipsilateral to the patient's dominant hand. We report two cases, review the most relevant literature, and analyze clinical, neuroanatomical, and neurophysiological aspects, taking in consideration the various interpretations proposed to explain this unusual language disorder.     

Intra-Operative Direct Electrical Stimulations of the Central Nervous System: The Salpêtrière Experience With 60 Patients

Indications of surgical treatment for lesions in the central nervous system depend on the risk of a definitive neurological deficit, related to the benefit of resection. Detection of eloquent areas is then necessary because of major individual variability. Neuro-imaging functional techniques are in development and are beginning to be efficient for cortical sensorymotor mapping, but still lack sensitivity and specificity for language mapping, and remain unable to give real-time data during surgery and to perform sub-cortical mapping. The more precise and reliable method of functional mapping is represented by the intra-operative direct electrical stimulations (DES), which allow identification and preservation of essential pathways for motricity, sensibility and language, at each level of the central nervous system (cortico-subcortical). We report our experience of DES in the surgery of tumours and vascular malformations located in supra-tentorial brain eloquent areas, with a consecutive series of 60 patients operated on under general or local anaesthesia, from November 1996 until May 1999 in our department at La Salpêtrière Hospital. Presenting symptoms in the 60 subjects (39 males, 21 females, mean age: 45 years) were seizures in 37 cases with normal clinical examination, and mild neurological deficit in 29 cases. MRI showed 60 supra-tentorial brain lesions: 30 precentral, 12 postcentral, 14 perisylvian in the dominant hemisphere, 4 deep-seated. All subjects underwent surgical resection using DES, with supratentorial cortico-subcortical mapping under general anaesthesia for motor areas detection in 43 cases and under local anaesthesia for sensori-motor and/or language tasks in 17 cases. The final histological diagnosis was 44 gliomas (31 low-grade and 13 high-grade), 9 metastasis, 3 cavernomas, 4 arteriovenous malformations (AVM). Resection was total or subtotal in 52 cases (87%) and partial in 8 cases (13%). 29 patients had no post-operative deficit, while the other 31 patients were impaired post-operatively, with in all cases, except 3, a complete recovery delayed for 15 days to 3 months (overall morbidity: 5%). The median follow up was 14 months. Intra-operative direct electrical stimulations of the central nervous system constitute a reliable, precise and safe method, allowing the realization of a functional mapping useful for all operations of lesions located in eloquent areas. This technique allows a minimization of definitive post-operative neurological deficit, and concurrently an improvement in the quality of resection.     

Can Young People with Autism Refer to Knowledge States? Evidence from Their Understanding of "Know" and "Guess"

A number of studies have reported that most individuals with autism have difficulty in attributing mental states. The primary aim of the present study was to compare the ability of children with autism to refer to knowledge states with that of mainstream school children and children with Down's syndrome. The second aim was to investigate the role of verbal mental age in referring to knowledge states. The third aim was to compare the ease with which the children referred to their own mental state and to that of others. The results suggest that some individuals with autism are able to attribute knowledge to themselves and others but that they need to have higher verbal skills than is necessary in normal individuals. The level of language skill predicted the performance of the individuals with autism, but not that of the children in the other groups. There was no good evidence that referring to one's own mental states was easier than referring to another person's, a finding which supports representational theory rather than the simulationist position.     

论谓项量化、主项质化理论在语言逻辑中的价值与影响

哈米尔顿的谓项量化理论揭示了量化命题中的简单换位规律 ,突破了原有三段论的规则 ,增加了大量新的三段论式。德摩根的主项质化理论给传统的逻辑方阵增添了新的内容 ,八个命题之间存在着紧密的内在联系 ,谓项量化、主项质化命题有着广泛的思维空间和运用价值 ,且语言表达灵活多样。哈米尔顿和德摩根都对联项“是”作了深入研究、赋予新的内涵 ,给逻辑注入了新的活力。     

母语为汉语者听觉性语言中枢的定位

目的采用脑磁图(magnetoencephalography,MEG)的等价偶极子定位法(equivalent current dipole,ECD)和合成孔径磁场定位法(synthetic aperture magnetometry,SAM)定位母语为汉语健康自愿者的听觉性语言中枢,探讨汉字的语言加工过程。方法对15例母语为汉语的健康受试者采用北京大学附属第一医院制定的利手评定标准进行利手评定,采用给予听动物名称、植物名称的语言任务刺激,用MEG记录刺激后产生的诱发磁场,将采集的数据与MRI叠加,定位听觉性语言中枢。结果所有受试者听到动物名称、植物名称后均在双侧大脑半球诱发出明显的晚发磁反应波,其中左侧大脑半球磁反应波分化较右侧大脑半球好。结论母语为汉语的正常人听觉性语言中枢与经典的语言中枢基本相符,即听觉性语言中枢定位于左侧颞中回、颞上回、缘上回。     

谈日语二外教学中实际运用能力的培养

学习外语的第一目的是与人交流，二外亦是如此。特别是当前中国经济快速发展，对日语人才的需求越来越大的环境下，如何提高日语二外学习者的语言实际运用能力成为一个重要课题。结合笔者的实践，本文着重从听、说以及跨文化交际三方面探讨了日语实际运用能力的培养。