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While speakers tailor referring expressions to the knowledgeof their addressees, they do so imperfectly. Our goal here is toprovide an explanation for this type of pattern by extending aprobabilistic model introduced to explain perspective-takingbehavior in comprehension. Using novel production data froma type of knowledge mismatch not previously investigated inproduction, we show that production patterns can also beexplained as arising from the probabilistic combination of thespeaker’s and the addressee’s perspectives. These resultsshow the applicability of the multiple-perspectives approachto language production, and to different types of knowledgemismatch between conversational partners.

Eye tracking was used to explore the role of grammatical aspect and world knowledge in establishing temporal relationships across sentences in discourse. Younger and older adult participants read short passages that included sentences such as "Mrs. Adams was knitting/knitted a new sweater"..."She wore her new garment...". Readers had greater difficulty processing the second event ("She wore...") if it followed the imperfective ("was knitting") rather than the perfective ("knitted") version of the earlier-mentioned event. This suggests that aspect information is encoded online and that the "in progress" interpretation of the imperfective impeded integration of the second event into the discourse model. However, world knowledge modulated the effect: When the first event was of short duration (e.g., writing a check), the influence of aspect was not evident in the early moments of processing. These effects were independent of age group, suggesting that the mechanisms involved in coordinating temporal information in discourse are stable across the adult lifespan. (Contains 3 tables, 1 figure, and 2 footnotes.)

Background: Toxicity management is a challenge with cancer treatment, including oral anticancer drugs. A review of claims data showed that a majority of publically funded oral anticancer drugs were filled in the community where pharmacists may not necessarily possess the specialized knowledge, skills, and experience required to provide effective patient care. A survey of community pharmacists in Ontario was conducted to identify the behaviours and preferences of community pharmacists specific to the management of treatment-related toxicities in order to standardize cancer care in this area. Methods: An electronic questionnaire was distributed to approximately 5000 community pharmacists. The 21-question survey gathered information on the demographic profile of the pharmacists, basic geographic and socioeconomic variables associated with their practice setting, current toxicity management practices, education and training needs, and preferences for communicating with other providers. Results: Of 349 pharmacists, almost all (94.9%) were interested in managing chemotherapy-related toxicities as part of their work, but the majority (77.1%) did not feel that their current level of pharmacy training has provided them with an oncology education sufficient for the demands of their practice. Approximately 52% of respondents indicated that they have reached out to the health care provider at a cancer centre, and of those, 72.7% reported that their questions were resolved within 48 h. More than half of all survey respondents (53.9%) indicated that they would prefer to receive a response within 12 h from cancer centres. Conclusions: The results of this study support the need to provide community pharmacists with oncology-specific training and timely correspondences from providers at prescribing institutions in order to manage toxicities. [ABSTRACT FROM AUTHOR]

Background: Little research has focused on implementation of electronic Patient Reported Outcomes (e-PROs) for meaningful use in patient management in 'real-world' oncology practices. Our quality improvement collaborative used multi-faceted implementation strategies including audit and feedback, disease-site champions and practice coaching, core training of clinicians in a person-centered clinical method for use of e-PROs in shared treatment planning and patient activation, ongoing educational outreach and shared collaborative learnings to facilitate integration of e-PROs data in multi-sites in Ontario and Quebec, Canada for personalized management of generic and targeted symptoms of pain, fatigue, and emotional distress (depression, anxiety). Patients and methods: We used a mixed-methods (qualitative and quantitative data) program evaluation design to assess process/implementation outcomes including e-PROs completion rates, acceptability/use from the perspective of patients/clinicians, and patient experience (surveys, qualitative focus groups). We secondarily explored impact on symptom severity, patient activation and healthcare utilization (Ontario sites only) comparing a pre/post population cohort not exposed/exposed to our implementation intervention using Mann Whitney U tests. We hypothesized that the iPEHOC intervention would result in a reduction in symptom severity, healthcare utilization, and higher patient activation. We also identified key implementation strategies that sites perceived as most valuable to uptake and any barriers. Results: Over 6000 patients completed e-PROs, with sites reaching 51%–95% population completion rates depending on initial readiness. e-PROs were acceptable to patients for communicating symptoms (76%) and by clinicians for treatment planning (80%). Patient experience was better than the provincial average. Compared to the pre-population, we observed a significant reduction in levels of anxiety (p = 0.008), higher levels of patient activation (p = 0.045), and reduced hospitalization rates (12.3% not exposed vs 10.1% exposed, p = 0.034). A pre/post population trend towards significance for reduced emergency department visit rates (14.8% not exposed vs 12.8% exposed, p = 0.081) was also noted. Conclusion: This large-scale pragmatic quality improvement project demonstrates the impact of implementation strategies and a collaborative improvement approach on acceptability of using PROs in clinical practice and their potential for reducing anxiety and healthcare utilization; and improving patient experience and patient activation when implemented in 'real-world' multi-site oncology practices. [ABSTRACT FROM AUTHOR]

The majority of words in Cantonese are compounds, which seems likely to burden the process of identifying words in running speech. Cantonese is also a stress-timed language, which reduces the potential for durational contrasts to distinguish embedded constituents from self-standing words. The current study demonstrates the challenge of identifying words in spoken Cantonese. As a compound unfolds, listeners are more likely to consider an onset-embedded constituent as the intended word than the actual word they are hearing – a result that seems poorly adapted to the prevalence of compounds. However, the results also show these challenges are offset by sentence-based cues, such as those provided by noun classifiers. This occurs despite variability in classifier-noun pairings and the fact that adult speakers often show incomplete mastery of these pairings. Together the results demonstrate how even highly biased cases of lexical competition are overcome by sentence-level constraints that may be only moderate in strength. [ABSTRACT FROM PUBLISHER]