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In order to examine whether children adjust their phonetic speech categories, children of two age groups, five-year-olds and eight-year-olds, were exposed to a video of a face saying /aba/ or /ada/ accompanied by an auditory ambiguous speech sound halfway between /b/ and /d/. The effect of exposure to these audiovisual stimuli was measured on subsequently delivered auditory-only speech identification trials. Results were compared to a control condition in which the audiovisual exposure stimuli contained non-ambiguous and congruent sounds /aba/ or /ada/. The older children learned to categorize the initially ambiguous speech sound in accord with the previously seen lip-read information (i.e. recalibration), but this was not the case for the younger age group. Moreover, all children displayed a tendency to report the stimulus that they were exposed to during the exposure phase. Methodological improvements for adjusting such a response bias are discussed. [ABSTRACT FROM AUTHOR]

Resyllabification is a phonological process in which consonants are attached to syllables other than those from which they originally came. In four experiments, we investigated whether resyllabified words, such as 'my bike is' pronounced as 'mai.bai.kis,' are more difficult to recognize than nonresyllabified words. Using a phoneme-monitoring task, we found that phonemes in resyllabified words were detected more slowly than those in nonresyllabified words. This difference increased when recognition of the carrier word was made more difficult. Acoustic differences between the target words themselves could not account for the results, because cross-splicing the resyllabified and nonresyllabified carrier words did not change the pattern. However, when nonwords were used as carriers, the effect disappeared. It is concluded that resyllabification increases the lexical-processing demands, which then interfere with phoneme monitoring. [ABSTRACT FROM AUTHOR]

Abstract Background Crisis is a term frequently used in dementia care lacking a standardized definition. This article systematically reviews existing definitions of crisis in dementia care literature to create a standardized definition that can be utilized for research, policy and clinical practice. Methods We systematically searched for articles containing definitions of crisis in the context of dementia care. We created an operational framework of crisis based on retrieved definitions. Recommendations to address crisis situations were reviewed and classified according to care settings. Results Abstracts and titles of 1,113 articles, screened from PubMed and EMBASE, were narrowed down to 27 articles. After review, crisis in dementia was defined as a process where a stressor causes an imbalance requiring an immediate decision to be made which leads to a desired outcome and therefore a resolution of the crisis. If the crisis is not resolved, the cycle continues. Recommendations for resolving crisis involving persons with dementia and their caregivers include awareness therapy after diagnosis and increased contact with general practitioners, case manager consultations, caregiver support and education. Furthermore, nursing home staff should be attuned to the environmental, physical and psychological needs of persons with dementia. Conclusions This is the first article to review the definition of crisis in the context of dementia care. A review of the literature indicated that the definition of a crisis is idiosyncratic. Therefore, it is difficult to prevent or plan for all crises. We used an operational framework to compile types of crisis stressors and recommendations from the crisis literature based on three different perspectives; the person with the dementia, the caregiver and the healthcare providers.

Auditory speech can be difficult to understand but seeing the articulatory movements of a speaker can drastically improve spoken-word recognition and, on the longer-term, it helps listeners to adapt to acoustically distorted speech. Given that individuals with developmental dyslexia (DD) have sometimes been reported to rely less on lip-read speech than typical readers, we examined lip-read-driven adaptation to distorted speech in a group of adults with DD ( N = 29) and a comparison group of typical readers ( N = 29). Participants were presented with acoustically distorted Dutch words (six-channel noise-vocoded speech, NVS) in audiovisual training blocks (where the speaker could be seen) interspersed with audio-only test blocks. Results showed that words were more accurately recognized if the speaker could be seen (a lip-read advantage), and that performance steadily improved across subsequent auditory-only test blocks (adaptation). There were no group differences, suggesting that perceptual adaptation to disrupted spoken words is comparable for dyslexic and typical readers. These data open up a research avenue to investigate the degree to which lip-read-driven speech adaptation generalizes across different types of auditory degradation, and across dyslexic readers with decoding versus comprehension difficulties.

Our percept of the world is not solely determined by what we perceive and process at a given moment in time, but also depends on what we processed recently. In the present study, we investigate whether the perceived emotion of a spoken sentence is contingent upon the emotion of an auditory stimulus on the preceding trial (i.e., serial dependence). Thereto, participants were exposed to spoken sentences that varied in emotional affect by changing the prosody that ranged from 'happy' to 'fearful'. Participants were instructed to rate the emotion. We found a positive serial dependence for emotion processing whereby the perceived emotion was biased towards the emotion on the preceding trial. When we introduced 'no-go' trials (i.e., no rating was required), we found a negative serial dependence when participants knew in advance to withhold their response on a given trial (Experiment 2) and a positive serial dependence when participants received the information to withhold their response after the stimulus presentation (Experiment 3). We therefore established a robust serial dependence for emotion processing in speech and introduce a methodology to disentangle perceptual from post-perceptual processes. This approach can be applied to the vast majority of studies investigating sequential dependencies to separate positive from negative serial dependence., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Trust is an aspect critical to human social interaction and research has identified many cues that help in the assimilation of this social trait. Two of these cues are the pitch of the voice and the width-to-height ratio of the face (fWHR). Additionally, research has indicated that the content of a spoken sentence itself has an effect on trustworthiness; a finding that has not yet been brought into multisensory research. The current research aims to investigate previously developed theories on trust in relation to vocal pitch, fWHR, and sentence content in a multimodal setting. Twenty-six female participants were asked to judge the trustworthiness of a voice speaking a neutral or romantic sentence while seeing a face. The average pitch of the voice and the fWHR were varied systematically. Results indicate that the content of the spoken message was an important predictor of trustworthiness extending into multimodality. Further, the mean pitch of the voice and fWHR of the face appeared to be useful indicators in a multimodal setting. These effects interacted with one another across modalities. The data demonstrate that trust in the voice is shaped by task-irrelevant visual stimuli. Future research is encouraged to clarify whether these findings remain consistent across genders, age groups, and languages.

Mother-infant interactions form a strong basis for emotion regulation development in infants. These interactions can be affected by various factors, including maternal postnatal anxiety. Electroencephalography (EEG) hyperscanning allows for simultaneous assessment of mother-infant brain-to-behavior association during stressful events, such as the still-face paradigm (SFP). This study aimed at investigating dyadic interactive behavior and brain-to-behavior association across SFP and identifying neural correlates of mother-infant interactions in the context of maternal postnatal anxiety. We measured frontal alpha asymmetry (FAA), a physiological correlate of emotion regulation and a potential marker of risk for psychopathology. To emulate real-life interactions, EEG and behavioral data were collected from 38 mother-infant dyads during a smartphone-adapted dual-SFP. Although the behavioral data showed a clear still-face effect for the smartphone-adapted SFP, this was not reflected in the infant or maternal FAA. Brain-to-behavior data showed higher infant negative affect being associated with more infant leftward FAA during the still-face episodes. Finally, mothers with higher postnatal anxiety showed more right FAA during the first still-face episode, suggesting negative affectivity and a need to withdraw from the situation. Our results form a baseline for further research assessing the effects of maternal postnatal anxiety on infants' FAA and dyadic interactive behavior., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

We examined the neural correlates of facial attractiveness by presenting pictures of male or female faces (neutral expression) with low/intermediate/high attractiveness to 48 male or female participants while recording their electroencephalogram (EEG). Subjective attractiveness ratings were used to determine the 10% highest, 10% middlemost, and 10% lowest rated faces for each individual participant to allow for high contrast comparisons. These were then split into preferred and dispreferred gender categories. ERP components P1, N1, P2, N2, early posterior negativity (EPN), P300 and late positive potential (LPP) (up until 3000 ms post-stimulus), and the face specific N170 were analysed. A salience effect (attractive/unattractive > intermediate) in an early LPP interval (450-850 ms) and a long-lasting valence related effect (attractive > unattractive) in a late LPP interval (1000-3000 ms) were elicited by the preferred gender faces but not by the dispreferred gender faces. Multi-variate pattern analysis (MVPA)-classifications on whole-brain single-trial EEG patterns further confirmed these salience and valence effects. It is concluded that, facial attractiveness elicits neural responses that are indicative of valenced experiences, but only if these faces are considered relevant. These experiences take time to develop and last well beyond the interval that is commonly explored., Competing Interests: Conflicts of interest This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. There are no conflicts of interest., (Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)

When listening to distorted speech, does one become a better listener by looking at the face of the speaker or by reading subtitles that are presented along with the speech signal? We examined this question in two experiments in which we presented participants with spectrally distorted speech (4-channel noise-vocoded speech). During short training sessions, listeners received auditorily distorted words or pseudowords that were partially disambiguated by concurrently presented lipread information or text. After each training session, listeners were tested with new degraded auditory words. Learning effects (based on proportions of correctly identified words) were stronger if listeners had trained with words rather than with pseudowords (a lexical boost), and adding lipread information during training was more effective than adding text (a lipread boost). Moreover, the advantage of lipread speech over text training was also found when participants were tested more than a month later. The current results thus suggest that lipread speech may have surprisingly long-lasting effects on adaptation to distorted speech., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2022 Pourhashemi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Being able to classify experienced emotions by identifying distinct neural responses has tremendous value in both fundamental research (e.g. positive psychology, emotion regulation theory) and in applied settings (clinical, healthcare, commercial). We aimed to decode the neural representation of the experience of two discrete emotions: sadness and disgust, devoid of differences in valence and arousal. In a passive viewing paradigm, we showed emotion evoking images from the International Affective Picture System to participants while recording their EEG. We then selected a subset of those images that were distinct in evoking either sadness or disgust (20 for each), yet were indistinguishable on normative valence and arousal. Event-related potential analysis of 69 participants showed differential responses in the N1 and EPN components and a support-vector machine classifier was able to accurately classify (58%) whole-brain EEG patterns of sadness and disgust experiences. These results support and expand on earlier findings that discrete emotions do have differential neural responses that are not caused by differences in valence or arousal., (Copyright © 2022 The Author(s). Published by Elsevier B.V. All rights reserved.)

Healthy interaction between parent and child is foundational for the child's socioemotional development. Recently, an innovative paradigm shift in electroencephalography (EEG) research has enabled the simultaneous measurement of neural activity in caregiver and child. This dual-EEG or hyperscanning approach, termed parent-child dual-EEG, combines the strength of both behavioral observations and EEG methods. In this review, we aim to inform on the potential of dual-EEG in parents and children (0-6 years) for developmental researchers. We first provide a general overview of the dual-EEG technique and continue by reviewing the first empirical work on the emerging field of parent-child dual-EEG, discussing the limited but fascinating findings on parent-child brain-to-behavior and brain-to-brain synchrony. We then continue by providing an overview of dual-EEG analysis techniques, including the technical challenges and solutions one may encounter. We finish by discussing the potential of parent-child dual-EEG for the future of developmental research. The analysis of multiple EEG data is technical and challenging, but when performed well, parent-child EEG may transform the way we understand how caregiver and child connect on a neurobiological level. Importantly, studying objective physiological measures of parent-child interactions could lead to the identification of novel brain-to-brain synchrony markers of interaction quality., (© 2022 Wiley Periodicals LLC.)

Bruns et al. (2020) provide new research that suggests that the ventriloquism after-effect (VAE: an enduring shift of the perceived location of a sound toward a previously seen visual stimulus) and multisensory enhancement (ME: an improvement in the precision of sound localization) may dissociate depending on the rate at which exposure stimuli are presented. They reported that the VAE, but not the ME, was diminished when exposure stimuli were presented at 10 Hz rather than at 2 Hz. To the authors, this suggested that different neural structures underlie the VAE and ME. In our view, however, this needs to be tested more extensively because alternative and simpler explanations have not yet been checked., (© 2020 The Authors. European Journal of Neuroscience published by Federation of European Neuroscience Societies and John Wiley & Sons Ltd.)

The amplitude of the auditory N1 component of the event-related potential (ERP) is typically suppressed when a sound is accompanied by visual anticipatory information that reliably predicts the timing and identity of the sound. While this visually induced suppression of the auditory N1 is considered an early electrophysiological marker of fulfilled prediction, it is not yet fully understood whether this internal predictive coding mechanism is primarily driven by the temporal characteristics, or by the identity features of the anticipated sound. The current study examined the impact of temporal and identity predictability on suppression of the auditory N1 by visual anticipatory motion with an ecologically valid audiovisual event (a video of a handclap). Predictability of auditory timing and identity was manipulated in three different conditions in which sounds were either played in isolation, or in conjunction with a video that either reliably predicted the timing of the sound, the identity of the sound, or both the timing and identity. The results showed that N1 suppression was largest when the video reliably predicted both the timing and identity of the sound, and reduced when either the timing or identity of the sound was unpredictable. The current results indicate that predictions of timing and identity are both essential elements for predictive coding in audition., (© 2020 Tilburg University. Psychophysiology published by Wiley Periodicals LLC on behalf of Society for Psychophysiological Research.)

Background: Dementia care in the Netherlands is increasingly dependent on informal care and has the aim to keep persons with dementia at home for as long as possible. However, little is known about the preferences and needs of people with dementia living at home. Including people with dementia and their informal caregivers in research and policy creation could help to identify necessary forms of support, and tailor care to their personal preferences and needs., Objective: To identify important components of in-home care for persons with dementia and their informal caregivers in the Netherlands., Design: Semi-structured interviews across the Netherlands, between March and June 2019 using thematic analysis., Setting and Participants: Persons with dementia (n = 5) and informal caregivers (n = 14) were primarily recruited through dementia care organizations. Additionally, a case manager was recruited to reflect upon the semi-structured interviews findings., Results: Five themes concerning important care components were identified including the need for: a social network, formal care, information, emotional support and easier access to care. The complexity of the dementia care system posed a common difficulty for persons with dementia and informal caregivers., Conclusion: This study suggests that a dementia care package should be developed that includes both informal and formal care, the provision of information and emotional support, and help with access to care. The creation of this care package could help to tailor dementia care to the preferences and needs of the persons with dementia and their informal caregivers., (© 2020 The Authors Health Expectations published by John Wiley & Sons Ltd.)

A sound can cause 2 visual streaming objects appear to bounce (the audiovisual bounce-inducing effect, ABE). Here we examined whether the stream/bounce percept affects perception of audiovisual synchrony. Participants saw 2 disks that either clearly streamed, clearly bounced, or were ambiguous, and heard a sound around the point of contact (POC). They reported, on each trial, whether they perceived the disks to 'stream' or 'bounce', and whether the sound was 'synchronous' or 'asynchronous' with the POC. Results showed that the optimal time of the sound to induce a bounce was before the POC (-59 msec), whereas audiovisual synchrony was maximal when the sound came after the POC (+16 msec). The range of temporal asynchronies perceived as 'synchronous', the temporal binding window (TBW), was wider when disks were perceived as bouncing than streaming, with no difference between ambiguous and non-ambiguous visual displays. These results demonstrate 1) that causality differs from synchrony, 2) that causality widens the TBW, and 3) that the ABE is perceptually real., Competing Interests: Declaration of competing interest The authors declare no competing interests., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Lay Abstract: Many autistic individuals experience difficulties in processing sensory information (e.g. increased sensitivity to sound). Here we show that these difficulties may be related to an inability to process unexpected sensory stimulation. In this study, 29 older adolescents and young adults with autism and 29 age-matched individuals with typical development participated in an electroencephalography study. The electroencephalography study measured the participants' brain activity during unexpected silences in a sequence of videos of a handclap. The results showed that the brain activity of autistic individuals during these silences was increased compared to individuals with typical development. This increased activity indicates that autistic individuals may have difficulties in processing unexpected incoming sensory information, and might explain why autistic individuals are often overwhelmed by sensory stimulation. Our findings contribute to a better understanding of the neural mechanisms underlying the different sensory perception experienced by autistic individuals.

Background: One potentially relevant neurophysiological marker of internalizing problems (anxiety/depressive symptoms) is the late positive potential (LPP), as it is related to processing of emotional stimuli. For the first time, to our knowledge, we investigated the value of the LPP as a neurophysiological marker for internalizing problems and specific anxiety and depressive symptoms, at preschool age., Method: At age 4 years, children (N = 84) passively viewed a series of neutral, pleasant, and unpleasant pictures selected from the International Affective Pictures System. Affective picture processing was measured via the LPP (EEG recorded) and mothers reported on child behavior via the Child Behavior Checklist 1 ½ - 5 (internalizing, DSM-anxiety, DSM-affective/depression subscales). Difference scores between the neutral and affective pictures (i.e., neutral-pleasant and neutral-unpleasant) were computed for posterior, central and anterior brain locations for early (300-700 ms), middle (700-1200 ms) and late (1200-2000 ms) time windows., Results: Greater LPP difference scores for pleasant images in the anterior recording site, in the middle time window, were associated with greater internalizing behaviors. Greater DSM-anxiety symptoms were associated with greater LPP difference scores for unpleasant and pleasant images. After correcting for multiple testing, only the association between greater DSM-affective/depression symptoms and greater LPP difference scores for unpleasant images in the anterior recording site (early time window) remained significant., Discussion: Our study has identified a potential neural marker of preschool internalizing problems. Children with larger LPPs to unpleasant images may be at greater risk of internalizing problems, potentially due to an increased emotional reactivity., (Copyright © 2020 The Authors. Published by Elsevier B.V. All rights reserved.)

Humans quickly adapt to variations in the speech signal. Adaptation may surface as recalibration , a learning effect driven by error-minimisation between a visual face and an ambiguous auditory speech signal, or as selective adaptation , a contrastive aftereffect driven by the acoustic clarity of the sound. Here, we examined whether these aftereffects occur for vowel identity and voice gender. Participants were exposed to male, female, or androgynous tokens of speakers pronouncing /e/, /ø/, (embedded in words with a consonant-vowel-consonant structure), or an ambiguous vowel halfway between /e/ and /ø/ dubbed onto the video of a male or female speaker pronouncing /e/ or /ø/. For both voice gender and vowel identity, we found assimilative aftereffects after exposure to auditory ambiguous adapter sounds, and contrastive aftereffects after exposure to auditory clear adapter sounds. This demonstrates that similar principles for adaptation in these dimensions are at play.

Different inputs from a multisensory object or event are often integrated into a coherent and unitary percept, despite differences in sensory formats, neural pathways, and processing times of the involved modalities. Presumably, multisensory integration occurs if the cross-modal inputs are presented within a certain window of temporal integration where inputs are perceived as being simultaneous. Here, we examine the role of ongoing neuronal alpha (i.e. 10-Hz) oscillations in multimodal synchrony perception. While EEG was measured, participants performed a simultaneity judgement task with visual stimuli preceding auditory ones. At stimulus onset asynchronies (SOA's) of 160-200 ms, simultaneity judgements were around 50%. For trials with these SOA's, occipital alpha power was smaller preceding correct judgements, and the individual alpha frequency was correlated with the size of the temporal window of integration. In addition, simultaneity judgements were modulated as a function of oscillatory phase at 12.5 Hz, but the latter effect was only marginally significant. These results support the notion that oscillatory neuronal activity in the alpha frequency range, which has been taken to shape perceptual cycles, is instrumental in multisensory perception., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Learning new words entails, inter alia, encoding of novel sound patterns and transferring those patterns from short-term to long-term memory. We report a series of 5 experiments that investigated whether the memory systems engaged in word learning are specialized for speech and whether utilization of these systems results in a benefit for word learning. Sine-wave synthesis (SWS) was applied to spoken nonwords, and listeners were or were not informed (through instruction and familiarization) that the SWS stimuli were derived from actual utterances. This allowed us to manipulate whether listeners would process sound sequences as speech or as nonspeech. In a sound-picture association learning task, listeners who processed the SWS stimuli as speech consistently learned faster and remembered more associations than listeners who processed the same stimuli as nonspeech. The advantage of listening in "speech mode" was stable over the course of 7 days. These results provide causal evidence that access to a specialized, phonological short-term memory system is important for word learning. More generally, this study supports the notion that subsystems of auditory short-term memory are specialized for processing different types of acoustic information. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Speech perception is influenced by vision through a process of audiovisual integration. This is demonstrated by the McGurk illusion where visual speech (for example /ga/) dubbed with incongruent auditory speech (such as /ba/) leads to a modified auditory percept (/da/). Recent studies have indicated that perception of the incongruent speech stimuli used in McGurk paradigms involves mechanisms of both general and audiovisual speech specific mismatch processing and that general mismatch processing modulates induced theta-band (4-8 Hz) oscillations. Here, we investigated whether the theta modulation merely reflects mismatch processing or, alternatively, audiovisual integration of speech. We used electroencephalographic recordings from two previously published studies using audiovisual sine-wave speech (SWS), a spectrally degraded speech signal sounding nonsensical to naïve perceivers but perceived as speech by informed subjects. Earlier studies have shown that informed, but not naïve subjects integrate SWS phonetically with visual speech. In an N1/P2 event-related potential paradigm, we found a significant difference in theta-band activity between informed and naïve perceivers of audiovisual speech, suggesting that audiovisual integration modulates induced theta-band oscillations. In a McGurk mismatch negativity paradigm (MMN) where infrequent McGurk stimuli were embedded in a sequence of frequent audio-visually congruent stimuli we found no difference between congruent and McGurk stimuli. The infrequent stimuli in this paradigm are violating both the general prediction of stimulus content, and that of audiovisual congruence. Hence, we found no support for the hypothesis that audiovisual mismatch modulates induced theta-band oscillations. We also did not find any effects of audiovisual integration in the MMN paradigm, possibly due to the experimental design., Competing Interests: The authors have declared that no competing interests exist.

Recent studies suggest that sub-clinical levels of autistic symptoms may be related to reduced processing of artificial audiovisual stimuli. It is unclear whether these findings extent to more natural stimuli such as audiovisual speech. The current study examined the relationship between autistic traits measured by the Autism spectrum Quotient and audiovisual speech processing in a large non-clinical population using a battery of experimental tasks assessing audiovisual perceptual binding, visual enhancement of speech embedded in noise and audiovisual temporal processing. Several associations were found between autistic traits and audiovisual speech processing. Increased autistic-like imagination was related to reduced perceptual binding measured by the McGurk illusion. Increased overall autistic symptomatology was associated with reduced visual enhancement of speech intelligibility in noise. Participants reporting increased levels of rigid and restricted behaviour were more likely to bind audiovisual speech stimuli over longer temporal intervals, while an increased tendency to focus on local aspects of sensory inputs was related to a more narrow temporal binding window. These findings demonstrate that increased levels of autistic traits may be related to alterations in audiovisual speech processing, and are consistent with the notion of a spectrum of autistic traits that extends to the general population.

Background and Objectives: To assess whether medically supportive care partners modify the associations of symptomatic chronic conditions with the number of functional disabilities in a cohort of multimorbid older adults with cognitive impairment., Research Design and Methods: The research design is a prospective study of a nationally representative cohort of Medicare beneficiaries. National Health and Aging Trends Study (NHATS) data were linked with Medicare claims for years 2011-2015. Participants were aged 65 or older and had cognitive impairment with at least 2 chronic conditions ( N = 1,003). Annual in-person interviews obtained sociodemographic information at baseline and time-varying variables for caregiving, hospitalization, and 6 activities of daily living (ADL); these variables were merged with Center for Medicare and Medicaid Services data to ascertain 16 time-varying chronic conditions. A care partner was defined as a person who sat with their care recipient during doctor visits in the past year and/or who helped them with prescribed medications in the last month. Chronic condition associations and their potential effect modifications by care partner status were assessed using weighted generalized estimating equations accounting for the complex survey design of the longitudinal analytical sample., Results: Chronic kidney disease, depression, and heart failure were associated with an increased number of functional disabilities. Among these, only the association of chronic kidney disease with the number of functional disabilities (interaction p value = .001) was weakened by the presence of a care partner., Discussion and Implications: The presence of care partners showed limited modification of the associations of symptomatic chronic conditions with functional disability.

The amplitude of the auditory N1 component of the event-related potential (ERP) is typically attenuated for self-initiated sounds, compared to sounds with identical acoustic and temporal features that are triggered externally. This effect has been ascribed to internal forward models predicting the sensory consequences of one's own motor actions. The predictive coding account of autistic symptomatology states that individuals with autism spectrum disorder (ASD) have difficulties anticipating upcoming sensory stimulation due to a decreased ability to infer the probabilistic structure of their environment. Without precise internal forward prediction models to rely on, perception in ASD could be less affected by prior expectations and more driven by sensory input. Following this reasoning, one would expect diminished attenuation of the auditory N1 due to self-initiation in individuals with ASD. Here, we tested this hypothesis by comparing the neural response to self- versus externally-initiated tones between a group of individuals with ASD and a group of age matched neurotypical controls. ERPs evoked by tones initiated via button-presses were compared with ERPs evoked by the same tones replayed at identical pace. Significant N1 attenuation effects were only found in the TD group. Self-initiation of the tones did not attenuate the auditory N1 in the ASD group, indicating that they may be unable to anticipate the auditory sensory consequences of their own motor actions. These results show that individuals with ASD have alterations in sensory attenuation of self-initiated sounds, and support the notion of impaired predictive coding as a core deficit underlying autistic symptomatology. Autism Res 2019, 12: 589-599. © 2019 The Authors. Autism Research published by International Society for Autism Research published by Wiley Periodicals, Inc. LAY SUMMARY: Many individuals with ASD experience difficulties in processing sensory information (for example, increased sensitivity to sound). Here we show that these difficulties may be related to an inability to anticipate upcoming sensory stimulation. Our findings contribute to a better understanding of the neural mechanisms underlying the different sensory perception experienced by individuals with ASD., (© 2019 The Authors. Autism Research published by International Society for Autism Research published by Wiley Periodicals, Inc.)

Humans can categorize vowels based on spectral quality (vowel identity) or pitch (speaker sex). Songbirds show similarities to humans with respect to speech sound discrimination and categorization, but it is unclear whether they can categorize harmonically structured vowel-like sounds on either spectrum or pitch, while ignoring the other parameter. We trained zebra finches in two experimental conditions to discriminate two sets of harmonic vowel-like sounds that could be distinguished either by spectrum or fundamental frequency (pitch). After the birds reached learning criterion, they were tested on new sounds that were either noise-vocoded versions of the trained sounds (sharing the spectral envelope with the trained sounds but lacking fine spectral detail from which pitch could be extracted) or sounds lacking the amplified harmonics (sharing only pitch with the trained sounds). Zebra finches showed no difference in the number of trials needed to learn each stimulus-response mapping. Birds trained on harmonic spectrum generalized their discrimination to vocoded sounds, and birds trained on pitch generalized their discrimination to harmonic sounds with a flat spectrum. These results demonstrate that, depending on the training requirements, birds can extract either fundamental frequency or spectral envelope of vowel-like sounds and use these parameters to categorize new sounds. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Objectives: There is a consensus that social connectedness is integral for a long, healthy life. However, studies of social support and survival have primarily relied on baseline social support measures, potentially missing the effects of fluctuations of perceived support over time. This is especially important for older adults who experience increased changes in disability. This study examined whether among older adults time-varying perceived social support was associated with time to death (main effect model of support) and whether time-varying disability was a modifier (stress-buffering model of support). Gender and marital status were also examined as modifiers., Methods: Older adults in the Cardiovascular Health Study ( N = 5,201) completed self- report measures of demographics and psychological health and clinical risk factors for mortality at baseline (1989-1990). Perceived social support and disability were measured from baseline through Wave 11 (1998-1999). Cox regression of time to death with time-varying covariates was performed., Results: Time-varying as well as baseline-only perceived social support was associated with greater survival in the unadjusted models but not after adjustment. Gender, marital status, and time-varying disability were not significant modifiers., Conclusions: In contrast with the previously reported association between baseline individual differences in perceived social support and time to death, older adults' baseline-only and fluctuating perceptions of perceived support over time were not associated with time to death after adjustment for other clinical physical and psychological risk factors. Research is needed to identify other relationship factors that may be more informative as time-varying predictors of health and longevity in large longitudinal data sets. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Perception of vocal affect is influenced by the concurrent sight of an emotional face. We demonstrate that the sight of an emotional face also can induce recalibration of vocal affect. Participants were exposed to videos of a 'happy' or 'fearful' face in combination with a slightly incongruous sentence with ambiguous prosody. After this exposure, ambiguous test sentences were rated as more 'happy' when the exposure phase contained 'happy' instead of 'fearful' faces. This auditory shift likely reflects recalibration that is induced by error minimization of the inter-sensory discrepancy. In line with this view, when the prosody of the exposure sentence was non-ambiguous and congruent with the face (without audiovisual discrepancy), aftereffects went in the opposite direction, likely reflecting adaptation. Our results demonstrate, for the first time, that perception of vocal affect is flexible and can be recalibrated by slightly discrepant visual information.

Upon hearing an ambiguous speech sound, listeners may adjust their perceptual interpretation of the speech input in accordance with contextual information, like accompanying text or lipread speech (i.e., phonetic recalibration; Bertelson et al., 2003). As developmental dyslexia (DD) has been associated with reduced integration of text and speech sounds, we investigated whether this deficit becomes manifest when text is used to induce this type of audiovisual learning. Adults with DD and normal readers were exposed to ambiguous consonants halfway between /aba/ and /ada/ together with text or lipread speech. After this audiovisual exposure phase, they categorized auditory-only ambiguous test sounds. Results showed that individuals with DD, unlike normal readers, did not use text to recalibrate their phoneme categories, whereas their recalibration by lipread speech was spared. Individuals with DD demonstrated similar deficits when ambiguous vowels (halfway between /wIt/ and /wet/) were recalibrated by text. These findings indicate that DD is related to a specific letter-speech sound association deficit that extends over phoneme classes (vowels and consonants), but - as lipreading was spared - does not extend to a more general audio-visual integration deficit. In particular, these results highlight diminished reading-related audiovisual learning in addition to the commonly reported phonological problems in developmental dyslexia.

Numerous studies have demonstrated that the vision of lip movements can alter the perception of auditory speech syllables (McGurk effect). While there is ample evidence for integration of text and auditory speech, there are only a few studies on the orthographic equivalent of the McGurk effect. Here, we examined whether written text, like visual speech, can induce an illusory change in the perception of speech sounds on both the behavioural and neural levels. In a sound categorization task, we found that both text and visual speech changed the identity of speech sounds from an /aba/-/ada/ continuum, but the size of this audiovisual effect was considerably smaller for text than visual speech. To examine at which level in the information processing hierarchy these multisensory interactions occur, we recorded electroencephalography in an audiovisual mismatch negativity (MMN, a component of the event-related potential reflecting preattentive auditory change detection) paradigm in which deviant text or visual speech was used to induce an illusory change in a sequence of ambiguous sounds halfway between /aba/ and /ada/. We found that only deviant visual speech induced an MMN, but not deviant text, which induced a late P3-like positive potential. These results demonstrate that text has much weaker effects on sound processing than visual speech does, possibly because text has different biological roots than visual speech., (© 2018 The Authors. European Journal of Neuroscience published by Federation of European Neuroscience Societies and John Wiley & Sons Ltd.)

Speech sound categorization in birds seems in many ways comparable to that by humans, but it is unclear what mechanisms underlie such categorization. To examine this, we trained zebra finches and humans to discriminate two pairs of edited speech sounds that varied either along one dimension (vowel or speaker sex) or along two dimensions (vowel and speaker sex). Sounds could be memorized individually or categorized based on one dimension or by integrating or combining both dimensions. Once training was completed, we tested generalization to new speech sounds that were either more extreme, more ambiguous (i.e., close to the category boundary), or within-category intermediate between the trained sounds. Both humans and zebra finches learned the one-dimensional stimulus-response mappings faster than the two-dimensional mappings. Humans performed higher on the trained, extreme and within-category intermediate test-sounds than on the ambiguous ones. Some individual birds also did so, but most performed higher on the trained exemplars than on the extreme, within-category intermediate and ambiguous test-sounds. These results suggest that humans rely on rule learning to form categories and show poor performance when they cannot apply a rule. Birds rely mostly on exemplar-based memory with weak evidence for rule learning.

Individuals with developmental dyslexia (DD) may experience, besides reading problems, other speech-related processing deficits. Here, we examined the influence of visual articulatory information (lip-read speech) at various levels of background noise on auditory word recognition in children and adults with DD. We found that children with a documented history of DD have deficits in their ability to gain benefit from lip-read information that disambiguates noise-masked speech. We show with another group of adult individuals with DD that these deficits persist into adulthood. These deficits could not be attributed to impairments in unisensory auditory word recognition. Rather, the results indicate a specific deficit in audio-visual speech processing and suggest that impaired multisensory integration might be an important aspect of DD., (© 2016 John Wiley & Sons Ltd.)

Perception of synchrony between one's own action (a finger tap) and the sensory feedback thereof (a visual flash or an auditory pip) can be recalibrated after exposure to an artificially inserted delay between them (temporal recalibration effect: TRE). TRE might be mediated by a compensatory shift of motor timing (when did I tap?) and/or the sensory timing of the feedback (when did I hear/see the feedback?). To examine this, we asked participants to voluntarily tap their index finger at a constant pace while receiving visual or auditory feedback (a flash or pip) that was either synced or somewhat delayed relative to the tap. Following this exposure phase, they then performed a simple reaction time (RT) task to measure the sensory timing of the exposure stimulus, and a sensorimotor synchronization (SMS) task (tapping in synchrony with a flash or pip as pacing stimulus) to measure the point of subjective synchrony between the tap and pacing stimulus. The results showed that after exposure to delayed auditory feedback, participants tapped earlier (~21.5 ms) relative to auditory pacing stimuli (= temporal recalibration) and reacted faster (~5.6 ms) to auditory stimuli. For visual exposure and test stimuli, there were no such compensatory effects. These results indicate that adjustments of audio-motor synchrony can to some extent be explained by a change in the speed of auditory sensory processing. We discuss this in terms of an attentional modulation of sensory processing.

Learning to read requires the formation of efficient neural associations between written and spoken language. Whether these associations influence the auditory cortical representation of speech remains unknown. Here we address this question by combining multivariate functional MRI analysis and a newly-developed 'text-based recalibration' paradigm. In this paradigm, the pairing of visual text and ambiguous speech sounds shifts (i.e. recalibrates) the perceptual interpretation of the ambiguous sounds in subsequent auditory-only trials. We show that it is possible to retrieve the text-induced perceptual interpretation from fMRI activity patterns in the posterior superior temporal cortex. Furthermore, this auditory cortical region showed significant functional connectivity with the inferior parietal lobe (IPL) during the pairing of text with ambiguous speech. Our findings indicate that reading-related audiovisual mappings can adjust the auditory cortical representation of speech in typically reading adults. Additionally, they suggest the involvement of the IPL in audiovisual and/or higher-order perceptual processes leading to this adjustment. When applied in typical and dyslexic readers of different ages, our text-based recalibration paradigm may reveal relevant aspects of perceptual learning and plasticity during successful and failing reading development.

A rare omission of a sound that is predictable by anticipatory visual information induces an early negative omission response (oN1) in the EEG during the period of silence where the sound was expected. It was previously suggested that the oN1 was primarily driven by the identity of the anticipated sound. Here, we examined the role of temporal prediction in conjunction with identity prediction of the anticipated sound in the evocation of the auditory oN1. With incongruent audiovisual stimuli (a video of a handclap that is consistently combined with the sound of a car horn) we demonstrate in Experiment 1 that a natural match in identity between the visual and auditory stimulus is not required for inducing the oN1, and that the perceptual system can adapt predictions to unnatural stimulus events. In Experiment 2 we varied either the auditory onset (relative to the visual onset) or the identity of the sound across trials in order to hamper temporal and identity predictions. Relative to the natural stimulus with correct auditory timing and matching audiovisual identity, the oN1 was abolished when either the timing or the identity of the sound could not be predicted reliably from the video. Our study demonstrates the flexibility of the perceptual system in predictive processing (Experiment 1) and also shows that precise predictions of timing and content are both essential elements for inducing an oN1 (Experiment 2)., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Background: As populations age, chronic geriatric conditions linked to progressive organ failure jeopardize health-related quality of life (HRQoL). Thus, this research assessed the validity and applicability of the EQ-5D (a common HRQoL instrument) across four major chronic geriatric conditions: hearing issues, joint damage, urinary incontinence, or dizziness with falls., Methods: The study sample comprised 25,637 community-dwelling persons aged 65 years and older residing in the Netherlands (Data source: TOPICS-MDS, www.topics-mds.eu ). Floor and ceiling effects were examined. To assess convergent validity, random effects meta-correlations (Spearman's rho) were derived between individual EQ-5D domains and related survey items. To further examine construct validity, the association between sociodemographic characteristics and EQ-5D summary scores were assessed using linear mixed models. Outcomes were compared to the overall study population as well as a 'healthy' subgroup reporting no major chronic conditions., Results: Whereas ceiling effects were observed in the overall study population and the 'healthy' subgroup, such was not the case in the geriatric condition subgroups. The majority of hypotheses regarding correlations between survey items and sociodemographic associations were supported. EQ-5D summary scores were lower in respondents who were older, female, widowed/single, lower educated, and living alone. Increasing co-morbidity had a clear negative effect on EQ-5D scores., Conclusion: This study supported the construct validity of the EQ-5D across four major geriatric conditions. For older persons who are generally healthy, i.e. reporting few to no chronic conditions, the EQ-5D confers poor discriminative ability due to ceiling effects. Although the overall dataset initially suggested poor discriminative ability for the EQ-5D, such was not the case within subgroups presenting with major geriatric conditions.

Background: Different forms of case management for dementia have emerged over the past few years. In the COMPAS study (Collaborative dementia care for patients and caregivers study), two prominent Dutch case management forms were studied: the linkage and the integrated care form., Aim of Study: Evaluation of the (cost)effectiveness of two dementia case management forms compared to usual care as well as factors that facilitated or impeded their implementation., Methods: A mixed methods design with a) a prospective, observational controlled cohort study with 2 years follow-up among 521 dyads of people with dementia and their primary informal caregiver with and without case management; b) interviews with 22 stakeholders on facilitating and impeding factors of the implementation and continuity of the two case management models. Outcome measures were severity and frequency of behavioural problems (NPI) for the person with dementia and mental health complaints (GHQ-12) for the informal caregiver, total met and unmet care needs (CANE) and quality adjusted life years (QALYs)., Results: Outcomes showed a better quality of life of informal caregivers in the integrated model compared to the linkage model. Caregivers in the control group reported more care needs than those in both case management groups. The independence of the case management provider in the integrated model facilitated the implementation, while the rivalry between multiple providers in the linkage model impeded the implementation. The costs of care were lower in the linkage model (minus 22 %) and integrated care model (minus 33 %) compared to the control group., Conclusion: The integrated care form was (very) cost-effective in comparison with the linkage form or no case management. The integrated care form is easy to implement.

Cost and effect data often have missing data because economic evaluations are frequently added onto clinical studies where cost data are rarely the primary outcome. The objective of this article was to investigate which multiple imputation strategy is most appropriate to use for missing cost-effectiveness data in a randomized controlled trial. Three incomplete data sets were generated from a complete reference data set with 17, 35 and 50 % missing data in effects and costs. The strategies evaluated included complete case analysis (CCA), multiple imputation with predictive mean matching (MI-PMM), MI-PMM on log-transformed costs (log MI-PMM), and a two-step MI. Mean cost and effect estimates, standard errors and incremental net benefits were compared with the results of the analyses on the complete reference data set. The CCA, MI-PMM, and the two-step MI strategy diverged from the results for the reference data set when the amount of missing data increased. In contrast, the estimates of the Log MI-PMM strategy remained stable irrespective of the amount of missing data. MI provided better estimates than CCA in all scenarios. With low amounts of missing data the MI strategies appeared equivalent but we recommend using the log MI-PMM with missing data greater than 35 %.

Objectives: The objective of this article was to compare the costs and cost-effectiveness of the two most prominent types of case management in the Netherlands (intensive case management and linkage models) against no access to case management (control group) for people with already diagnosed dementia and their informal caregivers., Methods: The economic evaluation was conducted from a societal perspective embedded within a two year prospective, observational, controlled, cohort study with 521 informal caregivers and community-dwelling persons with dementia. Case management provided within one care organization (intensive case management model, ICMM), case management where care was provided by different care organizations within one region (Linkage model, LM), and a group with no access to case management (control) were compared. The economic evaluation related incremental costs to incremental effects regarding neuropsychiatric symptoms (NPI), psychological health of the informal caregiver (GHQ-12), and quality adjusted life years (QALY) of the person with dementia and informal caregiver., Results: Inverse-propensity-score-weighted models showed no significant differences in clinical or total cost outcomes between the three groups. Informal care costs were significantly lower in the ICMM group compared to both other groups. Day center costs were significantly lower in the ICMM group compared to the control group. For all outcomes, the probability that the ICMM was cost-effective in comparison with LM and the control group was larger than 0.97 at a threshold ratio of 0 €/incremental unit of effect., Conclusion: This study provides preliminary evidence that the ICMM is cost-effective compared to the control group and the LM. However, the findings should be interpreted with caution since this study was not a randomized controlled trial., Competing Interests: The authors have declared that no competing interests exist.

Perception of synchrony between one's own action (e.g. a finger tap) and the sensory feedback thereof (e.g. a flash or click) can be shifted after exposure to an induced delay (temporal recalibration effect, TRE). It remains elusive, however, whether the same mechanism underlies motor-visual (MV) and motor-auditory (MA) TRE. We examined this by measuring crosstalk between MV- and MA-delayed feedbacks. During an exposure phase, participants pressed a mouse at a constant pace while receiving visual or auditory feedback that was either delayed (+150 ms) or subjectively synchronous (+50 ms). During a post-test, participants then tried to tap in sync with visual or auditory pacers. TRE manifested itself as a compensatory shift in the tap-pacer asynchrony (a larger anticipation error after exposure to delayed feedback). In experiment 1, MA and MV feedback were either both synchronous (MV-sync and MA-sync) or both delayed (MV-delay and MA-delay), whereas in experiment 2, different delays were mixed across alternating trials (MV-sync and MA-delay or MV-delay and MA-sync). Exposure to consistent delays induced equally large TREs for auditory and visual pacers with similar build-up courses. However, with mixed delays, we found that synchronized sounds erased MV-TRE, but synchronized flashes did not erase MA-TRE. These results suggest that similar mechanisms underlie MA- and MV-TRE, but that auditory feedback is more potent than visual feedback to induce a rearrangement of motor-sensory timing.

Listeners adjust their phonetic categories to cope with variations in the speech signal (phonetic recalibration). Previous studies have shown that lipread speech (and word knowledge) can adjust the perception of ambiguous speech and can induce phonetic adjustments (Bertelson, Vroomen, & de Gelder in Psychological Science, 14(6), 592-597, 2003; Norris, McQueen, & Cutler in Cognitive Psychology, 47(2), 204-238, 2003). We examined whether orthographic information (text) also can induce phonetic recalibration. Experiment 1 showed that after exposure to ambiguous speech sounds halfway between /b/ and /d/ that were combined with text (b or d) participants were more likely to categorize auditory-only test sounds in accordance with the exposed letters. Experiment 2 replicated this effect with a very short exposure phase. These results show that listeners adjust their phonetic boundaries in accordance with disambiguating orthographic information and that these adjustments show a rapid build-up.

Objectives: To assess the independent association between health-related quality of life (HRQOL) at admission and mortality, functional decline, and institutionalization 3 and 12 months after admission in acutely hospitalized older adults., Design: Post hoc analysis of data from prospective cohort study, 2006 to 2009, 12-month follow-up., Setting: Eleven medical wards in three hospitals in the Netherlands., Participants: Medical patients aged 65 and older acutely hospitalized for 48 hours or longer (N = 473)., Outcomes: mortality, functional decline, and institutionalization, 3 and 12 months after admission. Main determinant was HRQOL (utility based on the EuroQol-5D at admission, reflecting the relative desirability of a particular health state and is measured on a scale from 0 (death) to 1 (full health). Some health states are regarded as being worse than death, resulting in negative utilities, with a minimum of -0.330). Participants were split into two groups based on median utility at admission. Unadjusted and adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using Cox and logistic regression analyses, adjusted for sociodemographic and health variables., Results: Median utility was 0.775 (interquartile range 0.399-0.861). Utility greater than 0.775, indicating high HRQOL, was associated with lower risk of mortality (hazard ratio = 0.38, 95% CI = 0.18-0.83) and functional decline (OR = 0.47, 95% CI = 0.28-0.79) at 3 months in the adjusted models. At 12 months, these associations were statistically significant in the crude models but not in the adjusted models. Utility was not associated with risk of institutionalization at 3 or 12 months., Conclusion: Higher HRQOL at admission was associated with lower risk of mortality and functional decline 3 months after admission. In older, acutely hospitalized individuals, the EQ-5D may provide a means of risk stratification and may ultimately guide individuals, their families, and professionals in treatment decisions during hospitalization., (© 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.)

Background/aims: Although caring for a person with dementia can be stressful, some caregivers appear to experience few negative consequences to their well-being. This study aimed to examine what proportion of caregivers demonstrates resilience under different challenging circumstances and to identify factors related to their resilience., Methods: Baseline data from 4 studies from the Netherlands and UK among informal caregivers of people with dementia were harmonized and integrated. Caregiver resilience was defined as high levels of psychological well-being despite different types of high caregiving demands. Multivariate regression analyses identified factors significantly related to caregiver resilience., Results: The integrated data set included 15 harmonized variables with data from 1,048 caregivers facing a high care demand. The prevalence of resilience varied between 35 and 43%, depending on the demand for high care. Being a male caregiver, caring for a female, living apart from your relative, and low caregiver burden were positively related to caregiver resilience., Conclusion: Caregivers have the capacity to demonstrate resilience despite significant challenges. This study demonstrates how harmonization of data from multiple existing studies can be used to increase power and explore the consistency of findings. This contributes to a better understanding of which factors are likely to facilitate caregiver resilience and offers insights for developing services., (© 2016 The Author(s) Published by S. Karger AG, Basel.)

The amplitude of auditory components of the event-related potential (ERP) is attenuated when sounds are self-generated compared to externally generated sounds. This effect has been ascribed to internal forward modals predicting the sensory consequences of one's own motor actions. Auditory potentials are also attenuated when a sound is accompanied by a video of anticipatory visual motion that reliably predicts the sound. Here, we investigated whether the neural underpinnings of prediction of upcoming auditory stimuli are similar for motor-auditory (MA) and visual-auditory (VA) events using a stimulus omission paradigm. In the MA condition, a finger tap triggered the sound of a handclap whereas in the VA condition the same sound was accompanied by a video showing the handclap. In both conditions, the auditory stimulus was omitted in either 50% or 12% of the trials. These auditory omissions induced early and mid-latency ERP components (oN1 and oN2, presumably reflecting prediction and prediction error), and subsequent higher-order error evaluation processes. The oN1 and oN2 of MA and VA were alike in amplitude, topography, and neural sources despite that the origin of the prediction stems from different brain areas (motor versus visual cortex). This suggests that MA and VA predictions activate a sensory template of the sound in auditory cortex. This article is part of a Special Issue entitled SI: Prediction and Attention., (Copyright © 2015 Elsevier B.V. All rights reserved.)

Objective: To evaluate outcomes for persons with dementia and primary informal caregivers of 2 types of implemented case management (intensive case management [ICMM] and linkage [LM] models) with no case management (control group)., Design: A pragmatic trial using a prospective, observational, controlled, cohort study., Setting: Community care in the Netherlands., Participants: A total of 521 dyads., Intervention: Case management provided within one care organization (ICMM), case management where multiple case management organizations are present within one region (LM), and a group with no access to case management (control)., Measurements: Neuropsychiatric problems in persons with dementia assessed by the Neuropsychiatric Inventory (NPI) and psychological health in informal caregivers as measured with the General Health Questionnaire (GHQ-12). Secondary outcomes included care and support needs, quality of life, and institutionalization. Comparability of groups at baseline was secured by inverse-propensity-score-weighted mixed models., Results: No significant differences in changes in total NPI or GHQ-12 scores between the groups over 2 years were found. Secondary outcomes showed better quality-of-life scores for informal caregivers in the ICMM than the LM. Total needs, met and unmet care needs were significantly less in the ICMM compared with the control group., Conclusion: Neither case management type affected clinical outcomes of dyads meaningfully. The ICMM has positive impact on caregivers' quality of life and patient's number of needs compared with persons in LM and persons without access to case management respectively., (Copyright © 2015 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)