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In the present study, we used eye-tracking to investigate formality-register and morphosyntactic congruence during sentence reading. While research frequently covers participants' processing of lexical, (morpho-)syntactic, or semantic knowledge (e.g., operationalized by means of violations to which we can measure responses relative to felicitous stimuli), less attention has been devoted to the full breadth of pragmatic and context-related aspects. One such aspect is sensitivity to formality-register congruence, i.e., the match or mismatch between the register of a target word and the formality conveyed by the (linguistic) context. In particular, we investigated how congruence of linguistic register with context formality, as well as its interplay with morphosyntactic knowledge, may unfold during reading and be reflected in eye movements. In our study, 40 native German speakers read context sentences conveying a formal or informal situation, and a target sentence containing a high- or low-register verb (e.g., Engl. transl. The policeman detained the activist vs. The policeman nabbed the activist) which matched or mismatched the formality of the preceding context sentences. We additionally manipulated subject-verb agreement, with either a match (see examples above) or a mismatch thereof (e.g., Engl. transl. *The policeman detain the activist; *The policeman nab the activist). We predicted that a violation of formality-register congruence would be reflected in longer reading times at the verb and post-verbal object region, as this would be in line with previous research on context violations (e.g., Lüdtke & Kaup, 2006; Reali et al., 2015; Traxler & Pickering, 1996). We found effects of morphosyntactic congruence on late processing stages at the verb and on earlier processing stages at the post-verbal object region. As far as formality-register congruence is concerned, only late (in total reading time analysis, in the post-verbal object region) and subtle effects emerged. The results suggest that, compared to morphosyntactic violations, formality-register congruence effects emerge quite subtly and slowly during reading.

Background Physician transfer is an alternate option to patient transfer for expedient performance of mechanical thrombectomy in patients with acute ischemic stroke. Methods and Results We conducted a systematic review to identify studies that evaluate the effect of physician transfer in patients with acute ischemic stroke who undergo mechanical thrombectomy. A search of PubMed, Scopus, and Web of Science was undertaken, and data were extracted. A statistical pooling with random‐effects meta‐analysis was performed to examine the odds of reduced time interval between stroke onset and recanalization, functional independence, death, and angiographic recanalization. A total of 12 studies (11 nonrandomized observational studies and 1 nonrandomized controlled trial) were included, with a total of 1894 patients. Physician transfer was associated with a significantly shorter time interval between stroke onset and recanalization with a pooled mean difference estimate of −62.08 (95% CI, −112.56 to −11.61]; P=0.016; 8 studies involving 1419 patients) with high between‐study heterogeneity in the estimates (I2=90.6%). The odds for functional independence at 90 days were significantly higher (odds ratio, 1.29 [95% CI, 1.00–1.66]; P=0.046; 7 studies with 1222 patients) with physician transfer with low between‐study heterogeneity (I2=0%). Physician transfer was not associated with higher odds of near‐complete or complete angiographic recanalization (odds ratio, 1.18 [95% CI, 0.89–1.57; P=0.25; I2=2.8%; 11 studies with 1856 subjects). Conclusions Physician transfer was associated with a significant reduction in the mean of time interval between symptom onset and recanalization and increased odds for functional independence at 90 days with physician transfer compared with patient transfer among patients who undergo mechanical thrombectomy.

Introduction There is some data suggesting vasodilatory effect of sympathetic blockade in patients with aneurysmal subarachnoid hemorrhage but the effect on medium‐sized intracranial arteries remains unclear. Methods Serial ipsilateral intracranial angiograms were obtained before and after percutaneous inferior sympathetic ganglion block. The angiogram files were imported to a DICOM reader, Horos Open‐Source Medical Image Viewer (Version 3.3.6).The percent change of arterial diameter (compared with pre‐blockage image) was calculated in intracranial internal carotid (ICA), middle (MCA) and anterior cerebral (ACA) arteries. We also assessed the inter‐observer reliability of arterial diameter change using the Bland‐Altman method after two raters independently measured the arterial diameter in 2 images with a total of 12 arterial measurements. Results In Patient 1, there was an increase in diameter of intracranial ICA, MCA and ACA at 1 minute (9.62%, 10.34%, 8.64%), 5 minutes (11.38%, 12.22%, 14.42%) and 10 minutes (8.66%, 11.30%, 5.50%), respectively.In Patient 2, there was an increase in diameter at 1 minute (0.72%, 2.08%, ‐1.75%), 5 minutes (12.04%, 0.64%, 4.50%), 10 minutes (6.86%, 7.23%, 10.38%), 20 minutes (9.45%, ‐2.16%, 13.32%), and 30 minutes (7.31%, 12.02%, 6.50%), respectively. The Bland‐Altman coefficient of variation was 1.32 (range 0.01 ‐5.57) with majority (5 out of 6, 83%) of the data points within the upper and lower limits of acceptance. Conclusions We observed vasodilation in medium‐sized intracranial arteries ipsilateral to the percutaneous inferior sympathetic ganglion block as early as one minute post treatment and persisting for at least until 30 minutes post blockade.

Within Relevance Theory, it has been suggested that extended metaphors might be processed differently relative to single metaphoric uses. While single metaphors are hypothesized to be understood via the creation of an ad hoc concept, extended metaphors have been claimed to require a switch to a secondary processing mode, which gives greater prominence to the literal meaning. Initial experimental evidence has supported a distinction by showing differences in reading times between single and extended metaphors. However, beyond potential differences in comprehension speed, Robyn Carston’s ‘lingering of the literal’ account seems to predict qualitative differences in the interpretative mechanisms involved. In the present work, we test the hypothesis that during processing of extended metaphors, the mechanisms of enhancement and suppression of activation levels of literal-related features operate differently relative to single metaphors. We base our work on a study by Paula Rubio-Fernández, which showed that processing single metaphors involves suppressing features related exclusively to the literal meaning of the metaphoric vehicle after 1000 milliseconds of encountering the metaphor. Our goal was to investigate whether suppression is also involved in the comprehension of extended metaphors, or whether the ‘lingering of the literal’ leads to continued activation of literal-related features, as we take Carston’s account to predict. We replicate existing results, in as much as we find that activation levels of literal-related features are reduced after 1000 milliseconds. Critically, we also show that the pattern of suppression does not hold for extended metaphors, for which literal-related features remain activated after 1000 milliseconds. We see our results as providing support for Carston’s view that extended metaphor processing involves a prominent role of literal meaning, contributing towards explicating the links between theoretical predictions within Relevance Theory and online sentence processing.

In the present review paper by members of the collaborative research center “Register: Language Users' Knowledge of Situational-Functional Variation” (CRC 1412), we assess the pervasiveness of register phenomena across different time periods, languages, modalities, and cultures. We define “register” as recurring variation in language use depending on the function of language and on the social situation. Informed by rich data, we aim to better understand and model the knowledge involved in situation- and function-based use of language register. In order to achieve this goal, we are using complementary methods and measures. In the review, we start by clarifying the concept of “register”, by reviewing the state of the art, and by setting out our methods and modeling goals. Against this background, we discuss three key challenges, two at the methodological level and one at the theoretical level: (1) To better uncover registers in text and spoken corpora, we propose changes to established analytical approaches. (2) To tease apart between-subject variability from the linguistic variability at issue (intra-individual situation-based register variability), we use within-subject designs and the modeling of individuals' social, language, and educational background. (3) We highlight a gap in cognitive modeling, viz. modeling the mental representations of register (processing), and present our first attempts at filling this gap. We argue that the targeted use of multiple complementary methods and measures supports investigating the pervasiveness of register phenomena and yields comprehensive insights into the cross-methodological robustness of register-related language variability. These comprehensive insights in turn provide a solid foundation for associated cognitive modeling.

BACKGROUND/OBJECTIVES:. To investigate the effect of the occurrence of early hyperchloremia on death or severe disability at 180 days in patients with severe traumatic brain injury (TBI). DESIGN:. Post hoc analysis of Resuscitation Outcomes Consortium Hypertonic Saline (ROC HS)-TBI trial. SETTING:. A total of 114 North American emergency medical services agencies in the ROC. PATIENTS:. A total of 991 patients with severe TBI and Glasgow Coma Scale score of less than or equal to 8. INTERVENTIONS:. Prehospital resuscitation with single IV dose (250 cc) of 7.5% saline in 6% dextran-70, 7.5% saline (no dextran), or crystalloid. MEASUREMENTS AND MAIN RESULTS:. Patients with increased serum chloride concentrations (110 mmol/L or greater) 24 hours after randomization were identified. Hyperchloremia was graded into one or greater than or equal to 2 occurrences in the first 24 hours. Logistic regression analyses were performed to determine the effects of hyperchloremia on: 1) death or severe disability at 180 days and 2) death within 180 days after adjusting for confounders. Compared with patients without hyperchloremia, patients with greater than or equal to 2 occurrences of hyperchloremia had significantly higher odds of death or severe disability at 180 days (odds ratio [OR], 1.81; 95% CI, 1.19–2.75) and death within 180 days (OR, 1.89; 95% CI, 1.14–3.08) after adjustment for confounders. However, the total volume of fluids administered during the first 24 hours was an independent predictor of death within 180 days; therefore, after adding an interaction term between the total volume of fluids administered during the first 24 hours and greater than or equal to 2 occurrences of hyperchloremia, patients with greater than or equal to 2 occurrences of hyperchloremia had significantly higher odds of death within 180 days (OR, 2.35; 95% CI, 1.21–4.61 d) but not of composite outcome of death or severe disability at 180 days. CONCLUSIONS:. After modifying for the effect of the total volume of fluids administered during the first 24 hours, multiple occurrences of hyperchloremia in the first 24 hours were associated with higher odds of death within 180 days in patients with severe TBI.

We describe a very young child who developed an acute ischemic stroke from a LAO, while affected by COVID-19 and MIS-C, and whom we treated successfully with thrombectomy. We compare his clinical and imaging findings with those of the existing case reports, and we explore the multifactorial nature of such a neurovascular complication, particularly in the context of the most recent publications regarding the multifactorial endothelial derangements produced by the illness.

Upon hearing the phrase Some cats meow, a listener might pragmatically infer that ‘Some but not all cats meow’. This is known as a scalar implicature and it often arises when a speaker produces a weak linguistic expression instead of a stronger one. Several L2 studies claim that pragmatic inferences are generated by default and their comprehension presents no challenges to L2 learners. However, the evidence obtained from these studies largely stems from offline-based tasks that provide limited information about how scalar implicatures are processed. This study investigated scalar implicature processing among L2 speakers of English and the degree to which differences in L2 proficiency and Theory of Mind abilities would modulate pragmatic responding. The experiment used an online sentence verification paradigm that required participants to judge, among multiple control items, the veracity of under-informative sentences, such as Some cats are mammals, and to respond as quickly as possible. A true response to this item is indicative of a logical some and perhaps all reading and a false response to a pragmatic some but not all reading. Our results showed evidence that scalar inferences are not generated by default. The answer linked to the pragmatic reading some but not all took significantly longer to make relative to the answer that relies on the logical interpretation some and perhaps all. This processing slowdown was also significantly larger among participants with lower English proficiency. Further exploratory analyses of participants’ Theory of Mind, as measured by the Social Skill subscale in the Autism Spectrum Quotient, revealed that socially inclined participants are more likely than the socially disinclined to derive a scalar inference. These results together provide new empirical insights into how L2 learners process scalar implicatures and thus implications for processing theories in experimental pragmatics and second language acquisition.

When a word is used metaphorically (for example “walrus” in the sentence “The president is a walrus”), some features of that word's meaning (“very fat,” “slow-moving”) are carried across to the metaphoric interpretation while other features (“has large tusks,” “lives near the north pole”) are not. What happens to these features that relate only to the literal meaning during processing of novel metaphors? In four experiments, the present study examined the role of the feature of physical containment during processing of verbs of physical containment. That feature is used metaphorically to signify difficulty, such as “fenced in” in the sentence “the journalist's opinion was fenced in after the change in regime.” Results of a lexical decision task showed that video clips displaying a ball being trapped by a box facilitated comprehension of verbs of physical containment when the words were presented in isolation. However, when the verbs were embedded in sentences that rendered their interpretation metaphorical in a novel way, no such facilitation was found, as evidenced by two eye-tracking reading studies. We interpret this as suggesting that features that are critical for understanding the encoded meaning of verbs but are not part of the novel metaphoric interpretation are ignored during the construction of metaphorical meaning. Results and limitations of the paradigm are discussed in relation to previous findings in the literature both on metaphor comprehension and on the interaction between language comprehension and the visual world.

All languages have demonstratives—grammatical words like ‘this' and ‘that' in English, which are a universal tool to establish joint attention on a referent. Demonstratives are acquired early, but their mature use has a protracted development, with recent studies showing that 10- and 11-year-old children do not yet use demonstratives like adults do. Here we investigated demonstrative use by teenagers (ages 12-17) and adults with a focus on two social parameters affecting demonstrative choice in Spanish: Listener Position and Listener Attention. The results of two experiments using an online demonstrative-choice task revealed that teenagers use Spanish demonstratives comparably to adults in most conditions. However, teenagers seem to still be adjusting the relative weight of the social parameters affecting demonstrative choice in Spanish, supporting the view that acquiring and regularly using demonstratives trains social cognition through communicative interaction.

Irony is a heavily context-dependent pragmatic phenomenon. But what is it about context that facilitates or blocks irony comprehension? Based on the echoic account, we suggest that a context facilitates irony comprehension when it makes manifest a speaker's intentions and attitude, i.e., when a context makes it easy for participants to engage their mindreading abilities. In two pre-registered self-paced reading experiments, we investigated the comprehension of sentences in English that could be understood as ironic or literal, according to the story frame that participants read leading to the target sentence. In Experiment 1, we found that when the story frames prevent participants from anticipating the speaker's intention, literal readings of critical sentences are - not surprisingly - faster than ironic ones. Importantly, when the story frames gave access to the speaker's intentions, we find cases in which ironic readings are actually faster than literal ones, resulting in a novel finding for the irony comprehension literature. Further, when the speaker was described as having a sincere attitude towards their utterance, participants tended to understand the utterances literally. They tended to understand them ironically when it was not clear what the speaker's attitude was. In Experiment 2 we investigated whether the findings of Experiment 1 could be linked to individual differences in participants' mindreading abilities. We found that participants who scored higher on a standard Theory of Mind task (the "Reading the mind in the Eyes" task) were significantly more likely to derive ironic - but not literal - interpretations. We see these results as supporting the echoic account of irony comprehension. This work discusses the relevance of our findings to the long-standing debate on the processing effort of ironic versus literal sentences.

Significant advances in our understanding of transient ischemic attack (TIA) have taken place since it was first recognized as a major risk factor for stroke during the late 1950's. Recently, numerous studies have consistently shown that patients who have experienced a TIA constitute a heterogeneous population, with multiple causative factors as well as an average 5–10% risk of suffering a stroke during the 30 days that follow the index event. These two attributes have driven the most important changes in the management of TIA patients over the last decade, with particular attention paid to effective stroke risk stratification, efficient and comprehensive diagnostic assessment, and a sound therapeutic approach, destined to reduce the risk of subsequent ischemic stroke. This review is an outline of these changes, including a discussion of their advantages and disadvantages, and references to how new trends are likely to influence the future care of these patients.

Stroke is the third leading cause of death and a leading cause of disability in the United States, with a particularly high burden on the residents of the southeastern states, a region dubbed the Stroke Belt. These five states Alabama, Arkansas, Louisiana, Mississippi, and Tennessee have formed the Delta States Stroke Consortium to direct efforts to reduce this burden. The consortium is proposing an approach to identify domains where interventions may be instituted and an array of activities that can be implemented in each of the domains. Specific domains include 1) risk factor prevention and control; 2) identification of stroke signs and symptoms and encouragement of appropriate responses; 3) transportation, Emergency Medical Services care, and acute care; 4) secondary prevention; and 5) recovery and rehabilitation management. The array of activities includes 1) education of lay public; 2) education of health professionals; 3) general advocacy and legislative actions; 4) modification of the general environment; and 5) modification of the health care environment. The Delta States Stroke Consortium members propose that together these domains and activities define a structure to guide interventions to reduce the public health burden of stroke in this region.

In two eye-tracking pilots during reading, we investigated real-time processing of formality-register congruence and subject-verb morphosyntactic congruence, and their relation. Participants read, in German, two context sentences conveying a formal or informal situation, followed by a target sentence containing a high- or low-register verb (e.g., Engl. transl. "The policeman detained the activist" vs. "The policeman grabbed the activist") which matched or mismatched context formality. The second pilot additionally manipulated subject-verb morphosyntactic congruence (e.g., Engl. transl. "*The policeman detain the activist"; "*The policeman grabbed the activist"). We observed main effects of formality-register and morphosyntactic congruence on verb reading times, as well as an interaction effect at the post-verbal object noun. Higher degrees of context and target sentence formality resulted in longer reading times. Ongoing investigation will further clarify our pilot findings, which suggest some interference between formality-register and morphosyntactic congruence processing.

Background and Purpose: Intraarterial thrombolysis as an adjunct to mechanical thrombectomy is increasingly being considered to enhance reperfusion in acute ischemic stroke patients. Intraarterial thrombolysis may increase the risk of post‐thrombectomy intracerebral hemorrhage (ICH) in certain patient subgroups. Methods: We analyzed acute ischemic stroke patients treated with mechanical thrombectomy in a multicenter registry. The occurrence of any (asymptomatic and symptomatic) post‐thrombectomy ICH was ascertained using standard definition requiring serial neurological examinations and computed tomographic scans acquired within 48 hours of the thrombectomy. We determined the risk of ICH in subgroups defined by clinical characteristics and the use of intravenous (IV) thrombolysis. Results: A total of 146 (7.5%) patients received intraarterial thrombolysis among 1953 acute ischemic stroke patients who underwent mechanical thrombectomy. The proportion of patients who developed any ICH was 26 (17.8%) and 510 (28.2%) among patients who were and were not treated with intraarterial thrombolysis, respectively (p =.006). The proportion of patients who developed symptomatic ICH was 4 (2.7%) and 30 (1.7%) among patients who were and were not treated with intraarterial thrombolysis, respectively (p =.34). Among patients who received IV thrombolysis (n = 1042), the proportion of patients who developed any ICH was 9 (16.7%) and 294 (30.7%) among patients who were and were not treated with intraarterial thrombolysis, respectively (p =.028). The risk was not different in strata defined by age, gender, location of occlusion, preprocedure National Institutes of Health Stroke Scale score, time interval between symptom onset and thrombectomy, Alberta Stroke Program Early CT Score, systolic blood pressure, and serum glucose concentrations. Conclusions: In patients undergoing mechanical thrombectomy, the risk of any ICH and symptomatic ICH was not increased with intraarterial thrombolysis, including in those who had already received IV thrombolytics. [ABSTRACT FROM AUTHOR]

Introduction Stage cT4a and cT4b squamous cell carcinomas (SCCa) typically require multimodal treatment with adjuvant or neoadjuvant therapy. This study aims to evaluate the impact of different treatment modalities on survival outcomes in patients with stage cT4a-b SCCa exclusively of the maxillary sinus. Methods A multivariate survival analysis was conducted, evaluating treatment modalities for patients diagnosed between 2004 and 2020 utilizing the National Cancer Database. Cox hazard regression was performed for variables. Results The study identified a total of 1,788 patients with SCCa of the maxillary sinuses, of which 71.2% were cT4a. Increasing age, Charlson–Deyo score ≥ 1, and undifferentiated/anaplastic grade were associated with worse rates of survival. Multivariate analysis revealed that neoadjuvant treatment exhibited the lowest hazard ratio ([HR]: 0.574, 95% confidence interval [CI]: 0.370–0.892) across the entire cohort (cT4a-b). Neoadjuvant treatment plus surgery, adjuvant treatment plus surgery, and surgery alone demonstrated the highest adjusted 5-year survival for cT4a-b tumors. On the other hand, radiation alone exhibited the highest HR (1.939, 95% CI: 1.555–2.418) in multivariate analysis and the lowest adjusted 5-year survival. Conclusion Multimodal treatment of advanced stage maxillary SCCa has a variable effect on outcomes by tumor stage. Our findings suggest that surgery plus neoadjuvant and surgery plus adjuvant treatment are associated with higher rates of survival. Increasing age, Charlson–Deyo score ≥ 1, and undifferentiated/anaplastic grade were associated with worse rates of survival. Further randomized controlled trials are required to quantify the therapeutic benefit of these treatments on survival and organ sparing in advanced stage disease. [ABSTRACT FROM AUTHOR]