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PubMed2003

Managing the transcription revolution. Industry forces shape future of field.

You may be struggling with contract issues with a vendor. Or maybe you're contemplating the pros and cons of working with outsource, at-home, or overseas transcriptionists. It's a fact: if transcription processes aren't working efficiently, the entire HIM department may be adversely affected. Factor in additional concerns such as data capture for electronic health records, compliance, and patient safety, and the importance of ensuring quality and cost-efficient transcription becomes even more apparent. To help you answer some of these questions, the Journal of AHIMA is launching a four-part series dedicated to transcription issues from the HIM professional's point of view. In this issue, we begin with MTIA president Scott Faulkner's overview of the industry and where it's going next. In upcoming issues, other experts will look at controlling cost and monitoring quality, navigating new technologies, and dealing with contract-related issues.

Computer Communication Networks↗
PubMed2001

Phase-locked gamma band responses to semantic violation stimuli.

This paper addresses the role of gamma-band activity in semantic networks associated with the processing of words and sentences in humans. Magnetoencephalography (MEG) was used to compare the responses of eleven normal volunteers to semantically congruous and incongruous words at the end of syntactically correct sentences. The averaged low frequency responses evoked by the two word classes were clearly different within the latency range associated with N400 components. The oscillatory characteristics of the evoked responses were analysed using Gabor transform techniques in conjunction with statistical re-sampling. This revealed transient gamma-oscillations ( approximately 35 Hz) that were significantly phase-locked to both types of stimuli but preferentially present at intermediate ( approximately 300 ms) and long (>500 ms) latencies for incongruous words. This stimulus dependent phase locked gamma-activity occurred at latencies that were distinct from the short latency and evoked N400 components. The findings suggest that synchronised oscillations provide independent information about brain dynamics and that some semantic processes may dissociate into distinct functional stages.

Adult↗
PubMed1988

Evaluation of two speech enhancement techniques to improve intelligibility for hearing-impaired adults.

This study reports the effects on speech intelligibility of two types of digital speech processing: amplitude enhancement of consonants to produce near-zero consonant/vowel intensity ratios and increased duration of consonants to provide an additional 30 ms of sound. Compensatory vowel shortening accompanied duration increases to maintain original overall duration. One hundred words from the California Consonant Test (CCT) list were recorded. The target consonant in each word was processed in four ways to produce tape recordings of (a) unenhanced speech, (b) speech with increased consonant amplitude, (c) speech with increased consonant duration, and (d) speech with increased consonant amplitude and duration. The tapes were played to a group of 20 listeners with moderate sensorineural hearing loss at 65 dB SPL and to another group of 10 such listeners at 95 dB SPL. Results indicated that amplitude processing was associated with 10% to 12% improvement in intelligibility at the lower level but failed to yield any significant effect at the high level of presentation. Increasing consonant duration, by contrast, provided no benefit at the low level but gave modest benefit (5%) at 95 dB. Further development of the speech-processing techniques is necessary before they can be incorporated into a useful hearing aid.

Adult↗
PubMed2001

Walking or talking? Behavioral and neurophysiological correlates of action verb processing.

Brain activity elicited by visually presented words was investigated using behavioral measures and current source densities calculated from high-resolution EEG recordings. Verbs referring to actions usually performed with different body parts were compared. Behavioral data indicated faster processing of verbs referring to actions performed with the face muscles and articulators (face-related words) compared to verbs referring to movements involving the lower half of the body (leg-related words). Significant topographical differences in brain activity elicited by verb types were found starting approximately 250 ms after word onset. Differences were seen at recording sites located over the motor strip and adjacent frontal cortex. At the vertex, close to the cortical representation of the leg, leg-related verbs (for example, to walk) produced strongest in-going currents, whereas for face-related verbs (for example, to talk) the most in-going activity was seen at more lateral electrodes placed over the left Sylvian fissure, close to the representation of the articulators. Thus, action words caused differential activation along the motor strip, with strongest in-going activity occurring close to the cortical representation of the body parts primarily used for carrying out the actions the verbs refer to. Topographically specific physiological signs of word processing started earlier for face-related words and lasted longer for verbs referring to leg movements. We conclude that verb types can differ in their processing speed and can elicit neurophysiological activity with different cortical topographies. These behavioral and physiological differences can be related to cognitive processes, in particular to lexical semantic access. Our results are consistent with associative theories postulating that words are organized in the brain as distributed cell assemblies whose cortical distributions reflect the words' meanings.

Adolescent↗
PubMed2004

Electrophysiological evidence for reversed lexical repetition effects in language processing.

Effects of word repetition are extremely robust, but can these effects be modulated by discourse context? We examined this in an ERP experiment that tested coreferential processing (when two expressions refer to the same person) with repeated names. ERPs were measured to repeated names and pronoun controls in two conditions: (1) In the prominent condition the repeated name or pronoun coreferred with the subject of the preceding sentence and was therefore prominent in the preceding discourse (e.g., "John went to the store after John/he."); (2) in the nonprominent condition the repeated name or pronoun coreferred with a name that was embedded in a conjoined noun phrase, and was therefore nonprominent (e.g., "John and Mary went to the store after John/he."). Relative to the prominent condition, the nonprominent condition always contained two extra words (e.g., "and Mary"), and the repetition lag was therefore smaller in the prominent condition. Typically, effects of repetition are larger with smaller lags. Nevertheless, the amplitude of the N400 was reduced to a coreferentially repeated name when the antecedent was nonprominent as compared to when it was prominent. No such difference was observed for the pronoun controls. Because the N400 effect reflects difficulties in lexical integration, this shows that the difficulty of achieving coreference with a name increased with the prominence of the referent. This finding is the reverse of repetition lag effects on N400 previously found with word lists, and shows that language context can override general memory mechanisms.

Adolescent↗
PubMed1993

The effects of computer monitoring on the medical transcriptionist's performance and stress.

This study serves to evaluate the effects of computer monitoring on the performance of medical transcriptionists. The results of the study show that performance increases in the monitored state but that perceived levels of stress decrease in the monitored state. Previous studies are discussed in light of health information managers' use of monitoring technology to increase the effectiveness of medical transcriptionists.

Electronic Data Processing↗
PubMed2005

A transfer appropriate processing approach to investigating implicit memory for emotional words in the cerebral hemispheres.

Forty undergraduate students participated in two experiments designed to investigate the impact of perceptual and conceptual encoding manipulations on implicit memory for emotional words in each cerebral hemisphere. Adopting a transfer appropriate processing approach, the encoding manipulations were designed to promote processing of the surface features of stimuli in Experiment 1, and their semantic meaning in Experiment 2. In both experiments, participants completed the designated encoding task, followed by a lexical decision task where primed and unprimed words were presented to the left (LVF) and right visual fields (RVF). In Experiment 1, implicit memory was observed for RVF presentations of words primed according to their perceptual features. Word valence did not impact on visual field of presentation for primed or unprimed words. In Experiment 2, participation in the conceptual encoding task differentially impacted on processing and implicit memory for emotional words presented in the LVF, where priming the conceptual meaning of words facilitated the processing of positive, relative to negative and non-emotional words. In addition, implicit memory for conceptually primed negative words was reflected in inhibition of primed relative to unprimed negatively valenced words presented in the LVF. In contrast, for RVF presentations, there was evidence of implicit memory for conceptually primed non-emotional words, but not for emotional words. The results are generally consistent with the right hemisphere model of emotion, which posits greater right hemisphere involvement in both the processing and implicit memory of emotional stimuli. The results also support Nagae and Moscovitch's suggestion [Nagae, S., & Moscovitch, M. (2002). Cerebral hemispheric differences in memory of emotional and non-emotional words in normal individuals. Neuropsychologia, 40, 1601-1607] that level of processing be incorporated into studies examining the veracity of the right hemisphere and valence models of emotional processing. The study demonstrated the usefulness of adopting a transfer appropriate processing approach to investigating memory for word valence in each hemisphere.

Cerebral Cortex↗
PubMed1983

Further study of the electrophysiological correlates of lexical decision.

Discriminations were required between words, pseudohomophones, and visually matched nonwords. Two tasks were employed, one which could be accomplished on the basis of a visual code (the REAL task, involving discrimination between words and both types of nonword) and another necessitating the use of a phonological code (the REAL/PSEUD task, words and pseudohomophones vs. non-words). ERPs were recorded from three midline sites and from left and right inferior parietal sites. Two principal results were observed, (i) the peak latency of a late positive component, P637, covaried with RT, with variations in latency of around one half the corresponding RT variations, and (ii) the peak-to-peak amplitude of N100-P187 interacted with stimulus and task, such that it was larger for nonwords in the REAL task and words in the REAL/PSEUD task. No task- or stimulus-dependent asymmetries were observed in any ERP component. The P637 latency data support a model of RT variation based on the interaction of changes in parallel response preparation and stimulus evaluation processes. The observations with respect to N100-P187 suggest that ERPs are sensitive to factors related to the early processing of words and word-like visual material.

Action Potentials↗
PubMed2004

A word-stem completion task to assess implicit processing of appearance-related information.

OBJECTIVE: This paper reports on the development and utility of a new implicit measure of appearance-related information processing. METHODS: A 20-item word-stem completion task was constructed, in which each word stem could be completed with either an appearance-related word or at least one non-appearance alternative. The measure was tested in four different experiments, most investigating the impact of acute exposure to media-portrayed thin idealised female images. RESULTS: Exposure to media images or other appearance-related material led to the generation of more appearance- or weight-related words in both female and male samples. CONCLUSION: It was concluded that the word-stem task has empirical utility as a simple, self-paced and sensitive outcome measure in experimental studies of media exposure. We conceptualise the word-stem task as a measure of appearance- and weight-schema activation.

Adolescent↗
PubMed1994

Word recognition in the human inferior temporal lobe.

Studies of primates and of patients with brain lesions have shown that the visual system represents the external world in regions and pathways specialized to compute visual features and attributes. For example, object recognition is performed by a ventral pathway located in the inferior portion of the temporal lobe. We studied visual processing of words and word-like stimuli (letter-strings) by recording field potentials directly from the human inferior temporal lobe. Our results showed that two discrete portions of the fusiform gyrus responded preferentially to letter-strings. A region of the posterior fusiform gyrus responded equally to words and non-words, and was unaffected by the semantic context in which words were presented. In contrast, a region of the anterior fusiform gyrus was sensitive to these stimulus dimensions. These regions were distinct from areas that responded to other types of complex visual stimuli, including faces and coloured patterns, and thus form a functionally specialized stream within the ventral visual pathway.

Adult↗
PubMed2000

Event-related potential indices of semantic priming using masked and unmasked words: evidence that the N400 does not reflect a post-lexical process.

Several authors have contended that the N400 is a reflection of a post-lexical event such as that proposed by Neely and Keefe [J.H. Neely, D.E. Keefe, Semantic context effects on visual word processing: a hybrid prospective/retrospective processing theory, in: G.H. Bower (Ed.), The Psychology of Learning and Motivation: Advances in Research and Theory, Vol. 23, Academic Press, New York, 1989, pp. 207-248.], whereby the subject compares the word on the current trial to the "context" provided by the word on the preceding trial [M. Besson, M. Kutas, The many facets of repetition: A cued-recall and event-related potential analysis of repeating words in same versus different sentence contexts, Journal of Experimental Psychology: Learning, Memory and Cognition, 19 (5) (1993), 1115-1133; C. Brown, P. Hagoort, The processing nature of the N400: Evidence from masked priming. Journal of Cognitive Neuroscience, 5(1) (1993), 34-44; P.J. Holcomb, Semantic priming and stimulus degradation: Implications for the role of the N400 in language processing, Psychophysiology 30 (1993), 47-61; M.D. Rugg, M.C. Doyle, Event-related potentials and stimulus repetition in indirect and direct tests of memory, in: H. Heinze, T. Munte, G.R. Mangun (Eds), Cognitive Electrophysiology, Birkhauser Boston, Cambridge, MA, 1994]. A study which used masked primes to directly test this possibility has been reported by Brown and Hagoort [C. Brown, P. Hagoort, The processing nature of the N400: evidence from masked priming. Journal of Cognitive Neuroscience, 5(1) (1993), 34-44]. When the primes were masked, no priming effect was observed on the N400. When behavioral data were collected in the same paradigm, from another group of subjects, the usual priming effect on RT was obtained. Considered together, the data from the two groups of subjects indicated that activation of semantic representations had occurred without conscious awareness. As no N400 priming effect was observed, it was suggested that N400 must reflect a post-lexical process. This interpretation, however, is at odds with the findings of other studies which have reported N400 priming effects under conditions where post-lexical processes would not be thought to operate[J. Anderson, P. Holcomb, Auditory and visual semantic priming using different stimulus onset asynchronies: an event-related brain potential study. Psychophysiology 32 (1995), 177-190; J. Boddy, Event-related potentials in chronometric analysis of primed word recognition with different stimulus onset asynchronies, Psychophysiology 23 (1986), 232-245; D. Deacon, T. Uhm, W. Ritter, S. Hewitt, The lifetime of automatic priming effects may exceed two seconds, Cognitive Brain Research 7 (1999), 465-472; P.J. Holcomb, Automatic and attentional process: an event-related brain potential analysis of semantic priming. Brain and Language 35 (1998) 66-85]. The present study replicated Brown and Hagoort using a repeated measures design, a shorter SOA (stimulus onset asynchrony), and a slightly different threshold setting procedure. Significant priming effects were obtained on the mean amplitude of the N400 regardless of whether the words were masked or unmasked. The findings imply that the processing subserving the N400 is not postlexical, since the N400 was manipulated without the subjects being aware of the identity of the words.

Adolescent↗
PubMed1997

Event-related potentials in a two-choice task involving within-form comparisons of pictures and words.

Behavioral as well as electrophysiological evidence suggests that words are processed differently than pictures in a variety of tasks. In this study fifteen adult subjects were tested on a speeded "same-different" judgment task between printed names and drawings of common objects. In one condition, subjects decided on the identity between their internal image of the object that was named by S1 (word) and a subsequently presented drawing of an object (Word-Picture condition). In a second condition, comparisons were made on the basis of the name of the depicted object (Picture-Word trials). Event-related potentials (ERPs) were recorded from 12 scalp locations in response to the second item in each pair. No-match waveforms were characterized by larger N350 and P500 deflections compared to Match ERPs. The two responses could be distinguished on the basis of their lateral and anterior-posterior scalp distribution. Within-form comparisons involving pictures produced increased positivity between 150 and 600 ms poststimulus onset at posterior recording sites, whereas the opposite effect was noted at anterior sites during the early portion of the ERP. Decisions on word stimuli were associated with prolonged reaction time and longer N350 peak latency compared to decisions on pictures. These results demonstrate the existence of independent sources of ERP variability, each possibly reflecting a different aspect of cognitive comparisons. Latency and reaction time data provided valuable information regarding differences in the course of the comparison process when linguistic, as opposed to pictorial, stimuli/representations were involved.

Adolescent↗
PubMed2003

Multiple patterns of writing disorders in dementia of the Alzheimer type and their evolution.

This paper reports the results obtained from a writing task given to 23 Italian patients suffering from mild to moderate dementia of the Alzheimer's type (DAT). Spelling performance was tested with a task that taps the sub-word-level (spelling of regular words and nonwords), and the lexical route (spelling of regular and irregular words), in line with contemporary models of writing. Each patient's performance was classified according to the emergence of dissociated patterns of damage between regular words and nonwords and between regular and irregular words. The 23 DAT patients span the whole spectrum of dysgraphic taxonomy; five showed the characteristic pattern of impairment of surface dysgraphia, two showed the characteristics of phonological dysgraphia, while a mixed pattern (i.e. better performance on regular words compared to irregular words and regular nonwords) emerged in seven cases. Three patients presented undifferentiated writing disorders, two were completely agraphic, while four patients showed only minimal or no writing defects. The rate of dissociated impairments in the lexical and the sub-word-level routine is very similar to that observed after acute focal brain damage, which contradicts the hypothesis that degenerative brain damage selectively impairs writing performance along the lexical-semantic route. To test the hypothesis that surface sub-word-level processing abilities are affected only during the evolution of the disease, nine patients were tested longitudinally after an interval of 6-12 months. Once again, the data showed high variability across subjects, and do not seem to support involvement of the sub-word-level spelling routine only at a late stage in the development of the disease.

Aged↗
PubMed2002

Effects of concurrent cognitive processing on the fluency of word repetition: comparison between persons who do and do not stutter.

UNLABELLED: This study investigated how silent reading and word memorization may affect the fluency of concurrently repeated words. The words silently read or memorized were phonologically similar or dissimilar to the words of the repetition task. Fourteen adults who stutter and 16 who do not participated in the experiment. The two groups were matched for age, education, sex, forward and backward memory span and vocabulary. It was found that the disfluencies of persons who stutter significantly increased during word repetition when similar words were read or memorized concurrently. In contrast, the disfluencies of persons who do not stutter were not significantly affected by either secondary task. These results indicate that the speech of persons who stutter is more sensitive to interference from concurrently performed cognitive processing than that of nonstuttering persons. It is proposed that the phonological and articulatory systems of persons who stutter are protected less efficiently from interference by attention-demanding processing within the central executive system. Alternative interpretations are also discussed. EDUCATIONAL OBJECTIVES: Readers will learn how modern speech production theories and the concept of modularity can account for stuttering, and will be able to explain the greater vulnerability of stutterer's speech fluency to concurrent cognitive processing.

Adult↗
PubMed1992

An electronic medical record system with direct data-entry and research capabilities.

The transfer of medical records from a paper system to a computer-based system is inevitable. However, the widespread acceptance of electronic medical records has been delayed by problems such as high cost, inefficiency, data entry errors and poor physician acceptance. We have developed a database system that has overcome these difficulties and now serves as an electronic medical record. Our system has been in use for a year and a half, and currently contains information on over two thousand patients. The database provides an electronic radiation oncology chart containing patients' demographic information, technical treatment data and dictated reports. All dictated notes are captured, including consultation notes, treatment summaries, on-treatment visits, letters and follow up reports. The system provides data validation upon entry, required few additional software or hardware purchases, and allows for efficient retrieval of data. Unlike other database systems which require the hiring of data entry clerks to input the data, ours combines transcription and data entry. The database runs on a local area network of computers and uses a commercially available relational database package. It makes extensive use of mouse interface features such as pull-down menus, pop-up lists, buttons, multi-page forms, and scrolling fields, making the system easy to use with minimal training. Many custom features are built in, such as help screens, control functions, audit trails, and a system that keeps track of each patient's referring and other relevant physicians. For research purposes, the system has the capability to perform survival analyses on arbitrary user-defined subsets of patients. Data may also be exported transparently to statistical packages for other types of analyses.

Data Display↗