Reducing Disparities in Cancer Screening and Prevention through Community‐Based Participatory Research Partnerships with Local Libraries: A Comprehensive Dynamic Trial

Reduction of cancer‐related disparities requires strategies that link medically underserved communities to preventive care. In this community‐based participatory research project, a public library system brought together stakeholders to plan and undertake programs to address cancer screening and risk behavior. This study was implemented over 48 months in 20 large urban neighborhoods, selected to reach diverse communities disconnected from care. In each neighborhood, Cancer Action Councils were organized to conduct a comprehensive dynamic trial, an iterative process of program planning, implementation and evaluation. This process was phased into neighborhoods in random, stepped‐wedge sequence. Population‐level outcomes included self‐reported screening adherence and smoking cessation, based on street intercept interviews. Event‐history regressions (n = 9374) demonstrated that adherence outcomes were associated with program implementation, as were mediators such as awareness of screening programs and cancer information seeking. Findings varied by ethnicity, and were strongest among respondents born outside the U.S. or least engaged in care. This intervention impacted health behavior in diverse, underserved and vulnerable neighborhoods. It has been sustained as a routine library system program for several years after conclusion of grant support. In sum, participatory research with the public library system offers a flexible, scalable approach to reduce cancer health disparities.     

Review of first trial responses in balance control: influence of vestibular loss and Parkinson's disease

The reaction to an unexpected balance disturbance is unpractised, often startling and frequently associated with falls. This everyday situation can be reproduced in an experimental setting by exposing standing humans to sudden, unexpected and controlled movements of a support surface. In this review, we focus on the responses to the very first balance perturbation, the so-called first trial reactions (FTRs). Detailed analysis of FTRs may have important implications, both for clinical practice (providing new insights into the pathophysiological mechanisms underlying accidental falls in real life) and for understanding human physiology (what triggers and mediates these FTRs, and what is the relation to startle responses?). Several aspects of the FTRs have become clear. FTRs are characterized by an exaggerated postural reaction, with large EMG responses and co-contracting muscles in multiple body segments. This balance reaction is associated with marked postural instability (greater body sway to the perturbation). When the same perturbation is repeated, the size of the postural response habituates and the instability disappears. Other issues about FTRs remain largely unresolved, and these are addressed here. First, the functional role of FTRs is discussed. It appears that FTRs produce primarily increased trunk flexion during the multi-segmental response to postural perturbations, thus producing instability. Second, we consider which sensory signals trigger and modulate FTRs, placing specific emphasis on the role of vestibular signals. Surprisingly, vestibular signals appear to have no triggering role, but vestibular loss leads to excessive upper body FTRs due to loss of the normal modulatory influence. Third, we address the question whether startle-like responses are contributing to FTRs triggered by proprioceptive signals. We explain why this issue is still unresolved, mainly because of methodological difficulties involved in separating FTRs from ‘pure’ startle responses. Fourth, we review new work about the influence of perturbation direction on FTRs. Recent work from our group shows that the largest FTRs are obtained for toe-up support surface rotations which perturb the COM in the posterior direction. This direction corresponds to the directional preponderance for falls seen both in the balance laboratory and in daily life. Finally, we briefly touch upon clinical diagnostic issues, addressing whether FTRs (as opposed to habituated responses) could provide a more ecologically valid perspective of postural instability in patients compared to healthy subjects. We conclude that FTRs are an important source of information about human balance performance, both in health and disease. Future studies should no longer discard FTRs, but routinely include these in their analyses. Particular emphasis should be placed on the link between FTRs and everyday balance performance (including falls), and on the possible role played by startle reactions in triggering or modulating FTRs.     

'Unwilling' versus 'unable': chimpanzees' understanding of human intentional action

Understanding the intentional actions of others is a fundamental part of human social cognition and behavior. An important question is therefore whether other animal species, especially our nearest relatives the chimpanzees, also understand the intentional actions of others. Here we show that chimpanzees spontaneously (without training) behave differently depending on whether a human is unwilling or unable to give them food Chimpanzees produced more behaviors and left the testing station earlier with an unwilling compared to an unable (but willing) experimenter These data together with other recent studies on chimpanzees' knowledge about others' visual perception show that chimpanzees know more about the intentional actions and perceptions of others than previously demonstrated     

Using the picture exchange communication system (PECS) with children with autism: assessment of PECS acquisition,speech, social-communicative behavior,and problem behavior

The picture exchange communication system (PECS) is an augmentative communication system frequently used with children with autism (Bondy & Frost, 1994; Siegel, 2000; Yamall, 2000). Despite its common clinical use, no well-controlled empirical investigations have been conducted to test the effectiveness of PECS. Using a multiple baseline design, the present study examined the acquisition of PECS with 3 children with autism. In addition, the study examined the effects of PECS training on the emergence of speech in play and academic settings. Ancillary measures of social-communicative behaviors and problem behaviors were recorded. Results indicated that all 3 children met the learning criterion for PECS and showed concomitant increases in verbal speech. Ancillary gains were associated with increases in social-communicative behaviors and decreases in problem behaviors. The results are discussed in terms of the provision of empirical support for PECS as well as the concomitant positive side effects of its use.     

Brain imaging of tongue-twister sentence comprehension: twisting the tongue and the brain

This study used fMRI to investigate the neural basis of the tongue-twister effect in a sentence comprehension task. Participants silently read sentences equated for the syntactic structure and the lexical frequency of the constituent words, but differing in the proportion of words that shared similar initial phonemes. The manipulation affected not only the reading times and comprehension performance, but also the amount of activation seen in a number of language-related cortical areas. The effect was not restricted to cortical areas known to be involved in articulatory speech programming or rehearsal processes (the inferior frontal gyrus and anterior insula), but also extended to areas associated with other aspects of language processing (inferior parietal cortex) associated with phonological processing and storage.     

Ambiguity in the brain: what brain imaging reveals about the processing of syntactically ambiguous sentences

Two fMRI studies investigated the time course and amplitude of brain activity in language-related areas during the processing of syntactically ambiguous sentences. In Experiment 1, higher levels of activation were found during the reading of unpreferred syntactic structures as well as more complex structures. In Experiments 2A and 2B higher levels of brain activation were found for ambiguous sentences compared with unambiguous sentences matched for syntactic complexity, even when the ambiguities were resolved in favor of the preferred syntactic construction (despite the absence of this difference in previous reading time results). Although results can be reconciled with either serial or parallel models of sentence parsing, they arguably fit better into the parallel framework. Serial models can admittedly be made consistent but only by including a parallel component. The fMRI data indicate the involvement of a parallel component in syntactic parsing that might be either a selection mechanism or a construction of multiple parses.     

One-year-olds’ understanding of nonverbal gestures directed to a third person

We investigated whether infants comprehend others’ nonverbal communicative intentions directed to a third person, in an ‘overhearing’ context. An experimenter addressed an assistant and indicated a hidden toy's location by either gazing ostensively or pointing to the location for her. In a matched control condition, the experimenter performed similar behaviors (absent-minded gazing and extended index finger) but did not communicate ostensively with the assistant. Infants could then search for the toy. Eighteen-month-old infants were skillful in using both communicative cues to find the hidden object, whereas 14-month-olds performed above chance only with the pointing cue. Neither age group performed above chance in the control condition. This study thus shows that by 14–18 months of age, infants are beginning to monitor and comprehend some aspects of third party interactions.     

Eighteen-Month-Old Infants Show Increased Helping Following Priming With Affiliation

ABSTRACT— We show that the mere hint of affiliation dramatically increases prosocial behavior in infants. Eighteen-month-old infants helped a person in need more often, and more spontaneously, when primed with photographs evoking affiliation than when primed with photographs evoking individuality. This study demonstrates that social primes can have an influence on infant behavior, and so opens up a wealth of possibilities for future research. In addition, these data have wide-ranging practical implications, suggesting that subtle changes to the social environment can promote prosocial behavior in children.     

Prelinguistic Infants, but Not Chimpanzees, Communicate About Absent Entities

ABSTRACT— One of the defining features of human language is displacement , the ability to make reference to absent entities. Here we show that prelinguistic, 12-month-old infants already can use a nonverbal pointing gesture to make reference to absent entities. We also show that chimpanzees—who can point for things they want humans to give them—do not point to refer to absent entities in the same way. These results demonstrate that the ability to communicate about absent but mutually known entities depends not on language, but rather on deeper social-cognitive skills that make acts of linguistic reference possible in the first place. These nonlinguistic skills for displaced reference emerged apparently only after humans' divergence from great apes some 6 million years ago.