The nature and treatment of stuttering as revealed by fMRI A within- and between-group comparison

This article reviews some of our recent functional magnetic resonance imaging (fMRI) studies of stuttering. Using event-related fMRI experiments, we investigated brain activation during speech production. Results of three studies comparing persons who stutter (PWS) and persons who do not stutter (PWNS) are outlined. Their findings point to a region in the right frontal operculum (RFO) that was consistently implicated in stuttering. During overt reading and before fluency shaping therapy, PWS showed higher and more distributed neuronal activation than PWNS. Immediately after therapy differential activations were even more distributed and left sided. They extended to frontal, temporal, and parietal regions, anterior cingulate, insula, and putamen. These over-activations were slightly reduced and again more right sided two years after therapy. Left frontal deactivations remained stable over two years of observation, and therefore possibly indicate a dysfunction. After therapy, we noted higher activations in persons who stutter moderately than in those who stutter severely. These activations might reflect patterns of compensation. We discuss why these findings suggest that fluency-inducing techniques might synchronize a disturbed signal transmission between auditory, speech motor planning, and motor areas.

Educational objectives: The reader will learn about and be able to: (1) identify regions of brain activations and deactivations specific for PWS; (2) describe brain activation changes induced by fluency shaping therapy; and (3) discuss the correlation between stuttering severity and brain activation.     

Discussion of “Melancholic Psychosis”

Derek Hook’s paper (this issue) represents an important discussion of the Lacanian perspective on melancholia and its close and often forgotten clinical link to psychosis. Hook’s paper provides a critical insight into how melancholia is understood as a surrender to the jouissance of the Other. The reviewer only disagrees with Hook’s idea that there is no object loss in melancholia because the melancholic knows whom he has lost but not what he has lost in the absent object. This unknown loss leaves him exposed to an erotogenic masochism proper and a self-annihilating kind of jouissance.     

Empowerment,Leadership, and Sustainability in a Faith-Based Partnership to Improve Health

Community-based participatory research is a noted approach for improving community health and reducing health disparities. Community partnerships can serve as a catalyst for change in public health efforts. This article will apply empowerment theory and sustainability principles to an existing faith-based partnership. BRANCH Out is a partnership among 13 African American churches, the City of Milwaukee Health Department—Community Nutrition, and the Medical College of Wisconsin. The partnership goal was to change inaccurate perceptions, knowledge and negative attitudes, and behaviors about chronic disease and promote healthy youth leadership. Faith-based empowerment can occur at the individual, organizational, and community level. BRANCH Out demonstrates how partnerships can be sustained in multiple ways. The partnership also highlights the unique contributions of churches to community health outcomes.     

Peer Assessment of Aviation Performance: Inconsistent for Good Reasons

Research into expertise is relatively common in cognitive science concerning expertise existing across many domains. However, much less research has examined how experts within the same domain assess the performance of their peer experts. We report the results of a modified think‐aloud study conducted with 18 pilots (6 first officers, 6 captains, and 6 flight examiners). Pairs of same‐ranked pilots were asked to rate the performance of a captain flying in a critical pre‐recorded simulator scenario. Findings reveal (a) considerable variance within performance categories, (b) differences in the process used as evidence in support of a performance rating, (c) different numbers and types of facts (cues) identified, and (d) differences in how specific performance events affect choice of performance category and gravity of performance assessment. Such variance is consistent with low inter‐rater reliability. Because raters exhibited good, albeit imprecise, reasons and facts, a fuzzy mathematical model of performance rating was developed. The model provides good agreement with observed variations.