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BACKGROUND: The present study investigated the possible effects of language background (monolinguals, simultaneous bilinguals, and sequential bilinguals) and parental education (no/low, medium, high, and highest parental education) on measures of cognitive ability provided by the Wechsler Primary and Preschool Scale-Fourth Edition (WPPSI-IV). METHODS: Statistical analyses were based on a sample of 290 children (130 females, 160 males). Three multivariate variance analyses were conducted to identify possible effects. In cases of statistically significant main effects, post hoc analyses were additionally performed to identify group differences. RESULTS: The results indicated that simultaneous bilinguals performed more similarly to monolinguals than sequential bilinguals. On average, sequential bilinguals achieved significantly lower scores on the Verbal Comprehension Index (VCI), the Vocabulary Acquisition Index (VAI), and the associated subtests than monolinguals and simultaneous bilinguals. Significantly lower average scores on VAI and the associated subtests were found for simultaneous bilinguals compared to monolinguals. Children with parents having no, a lower, or a medium educational level achieved significantly lower scores on VCI, VAI, and the FSIQ than children with parents having a high or highest educational level on average. CONCLUSIONS: The present findings suggest that the WPPSI-IV represents a suitable and reliable test battery for the assessment of cognitive skills in children with different language backgrounds and parental educational levels.

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Objective: In Germany, only a few standardized evaluation tools for assessing the usability of mobile Health apps exist so far. This study aimed to translate and validate the English patient version for standalone apps of the mHealth App Usability Questionnaire (MAUQ) into a German version. Methods: Following scientific guidelines for translation and cross-cultural adaptation, the patient version for standalone apps was forward and back-translated from English into German by an expert panel. In total, 53 participants who were recruited as part of the beta testing process of the recently developed mHealth app HerzFit, answered the questions of the German version of the MAUQ (GER-MAUQ) and the System Usability Scale. Subsequently, a descriptive as well as a psychometric analysis was performed to test validity and reliability. Results: After conducting three cognitive interviews, five items were modified. The values for Cronbach alpha for the entire questionnaire and the three subscales (0.966, 0.814, 0.910, and 0.909) indicate strong internal consistency. The correlation analysis revealed that the scores of the GER-MAUQ, the subscales and the SUS were strongly correlated with each other. The correlation coefficient of the SUS and the GER-MAUQ overall score was r = 0.854, P < 0.001 and the coefficients of the subscales and the SUS were r = 0.642, P < 0.001; r = 0.866, P < 0.001 and r = 0.643, P < 0.001. Conclusions: We have developed a novel German version of the MAUQ and demonstrated it as a reliable and valid measurement tool for assessing the usability of standalone mHealth apps from the patients' perspective. The GER-MAUQ allows a new form of standardized assessment of usability of mHealth apps for patients with cardiovascular disease in Germany. Further research with a larger sample and other samples is recommended.

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We here report on one of the outcomes of a large-scale German research program, the Medical Informatics Initiative (MII), aiming at the development of a solid data and software infrastructure for German-language clinical natural language processing. Within this framework, we have developed 3000PA, a national clinical reference corpus composed of patient records from three clinical university sites and annotated with a multitude of semantic annotation layers (including medical named entities, semantic and temporal relations between entities, as well as certainty and negation information related to entities and relations). This non-sharable corpus has been complemented by three sharable ones (JSYNCC, GGPONC, and GRASCCO). Overall, 3000PA, JSYNCC and GRASCCO feature about 2.1 million metadata points.

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BACKGROUND: Nonspecific low back pain (NSLBP) carries significant socioeconomic relevance and leads to substantial difficulties for those who are affected by it. The effectiveness of app-based treatments has been confirmed, and clinicians are recommended to use such interventions. As 88.8% of the German population uses smartphones, apps could support therapy. The available apps in mobile app stores are poorly regulated, and their quality can vary. Overviews of the availability and quality of mobile apps for Australia, Great Britain, and Spain have been compiled, but this has not yet been done for Germany. OBJECTIVE: We aimed to provide an overview of the availability and content-related quality of apps for the treatment of NSLBP in the German language. METHODS: A systematic search for apps on iOS and Android was conducted on July 6, 2022, in the Apple App Store and Google Play Store. The inclusion and exclusion criteria were defined before the search. Apps in the German language that were available in both stores were eligible. To check for evidence, the apps found were assessed using checklists based on the German national guideline for NSLBP and the British equivalent of the National Institute for Health and Care Excellence. The quality of the apps was measured using the Mobile Application Rating Scale. To control potential inaccuracies, a second reviewer resurveyed the outcomes for 30% (3/8) of the apps and checked the inclusion and exclusion criteria for these apps. The outcomes, measured using the assessment tools, are presented in tables with descriptive statistics. Furthermore, the characteristics of the included apps were summarized. RESULTS: In total, 8 apps were included for assessment. Features provided with different frequencies were exercise tracking of prefabricated or adaptable workout programs, educational aspects, artificial intelligence-based therapy or workout programs, and motion detection. All apps met some recommendations by the German national guideline and used forms of exercises as recommended by the National Institute for Health and Care Excellence guideline. The mean value of items rated as "Yes" was 5.75 (SD 2.71) out of 16. The best-rated app received an answer of "Yes" for 11 items. The mean Mobile Application Rating Scale quality score was 3.61 (SD 0.55). The highest mean score was obtained in "Section B-Functionality" (mean 3.81, SD 0.54). CONCLUSIONS: Available apps in the German language meet guideline recommendations and are mostly of acceptable or good quality. Their use as a therapy supplement could help promote the implementation of home-based exercise protocols. A new assessment tool to obtain ratings on apps for the treatment of NSLBP, combining aspects of quality and evidence-based best practices, could be useful. TRIAL REGISTRATION: Open Science Framework Registries sq435; https://osf.io/sq435.

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In most gender-marked languages, the masculine form is used to refer to male people specifically as well as to people of any gender generically. This dual functionality was shown in behavioral studies to lead to male-biased mental representations. Here, using EEG, we targeted the neurophysiological basis of this bias by investigating whether and how the generic masculine influences the early perceptual and cognitive processing of anaphoric references to men and women. We found that ERP amplitudes in the P200 range were larger for references to women than to men after generic masculine role nouns, while amplitudes in the P300 range were larger for references to men than to women after the feminine-masculine pair form. These findings suggest that the generic masculine primes the perceptual system towards processing men and that neither this form nor the feminine-masculine pair form elicits gender-balanced computations during early processing in the human brain.

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We describe the adaptation of a non-clinical pseudonymization system, originally developed for a German email corpus, for clinical use. This tool replaces previously identified Protected Health Information (PHI) items as carriers of privacy-sensitive information (original names for people, organizations, places, etc.) with semantic type-conformant, yet, fictitious surrogates. We evaluate the generated substitutes for grammatical correctness, semantic and medical plausibility and find particularly low numbers of error instances (less than 1%) on all of these dimensions.

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OBJECTIVE: We present the Berlin-Tübingen-Oncology corpus (BRONCO), a large and freely available corpus of shuffled sentences from German oncological discharge summaries annotated with diagnosis, treatments, medications, and further attributes including negation and speculation. The aim of BRONCO is to foster reproducible and openly available research on Information Extraction from German medical texts. MATERIALS AND METHODS: BRONCO consists of 200 manually deidentified discharge summaries of cancer patients. Annotation followed a structured and quality-controlled process involving 2 groups of medical experts to ensure consistency, comprehensiveness, and high quality of annotations. We present results of several state-of-the-art techniques for different IE tasks as baselines for subsequent research. RESULTS: The annotated corpus consists of 11 434 sentences and 89 942 tokens, annotated with 11 124 annotations for medical entities and 3118 annotations of related attributes. We publish 75% of the corpus as a set of shuffled sentences, and keep 25% as held-out data set for unbiased evaluation of future IE tools. On this held-out dataset, our baselines reach depending on the specific entity types F1-scores of 0.72-0.90 for named entity recognition, 0.10-0.68 for entity normalization, 0.55 for negation detection, and 0.33 for speculation detection. DISCUSSION: Medical corpus annotation is a complex and time-consuming task. This makes sharing of such resources even more important. CONCLUSION: To our knowledge, BRONCO is the first sizable and freely available German medical corpus. Our baseline results show that more research efforts are necessary to lift the quality of information extraction in German medical texts to the level already possible for English.

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Indicated Stress Prevention for Adolescents in the Group Setting - A manual based on Acceptance- and Commitment-Therapy Stress in adolescence has become a topic of interest in recent years. Long-term exposure to stress can play a significant role in the development and maintenance of mental disorders. Previous studies have shown that especially the more severely stressed adolescents benefit from targeted interventions. However, evidence-based treatment concepts targeting this group are scarce. In this article we introduce the first German-language treatment manual for indicated stress prevention, addressing adolescents based on Acceptance and Commitment Therapy (ACT). ACT is part of the third wave of behavioral therapies, designed for treatment across disorders, which makes it suitable for the treatment of chronic stress symptoms. Previous studies show good efficacy of the ACT-approach in the treatment of adult stress and first promising successes in treatment of adolescents in non-German-speaking countries. The focus of our training lies in practical exercises based on ACT which are conveyed by the use of metaphors, art therapy techniques, role plays and group discussions. The concept is complemented by psychoeducation on stress, mindfulness exercises and training in problem solving. Worksheets and tasks for the week facilitate the transfer into everyday life. Alongside the presentation of the treatment manual, first experiences in the implementation of the program are discussed.

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PURPOSE: We intended to assess the readability of the German versions of commonly used urological questionnaires and identify questions that are potentially demanding for patients. MATERIALS AND METHODS: The Guidelines of the European Association of Urology were analyzed for recommended questionnaires. Readability of the German versions of these questionnaires including their respective single-items was analyzed using established readability assessment tools. RESULTS: A total of 13 questionnaires were analyzed. The calculated readability scores ranged between the 4.3th and 10.3th grade level. Easiest readability as calculated by median grade levels was found for the short and long forms of the International Consultation on Incontinence Questionnaires-Female and -Male Lower Urinary Tract Symptoms and the SF-Qualiveen (all median grade level 5.0). The short form of the International Index of Erectile Function showed the hardest readability (median grade level 10.0). Readability of the single-items varied widely between the assessed questionnaires with up to 80% (the International Index of Erectile Function) of their single-items being written above recommended grade levels. CONCLUSIONS: The majority of commonly used German urological questionnaires comply with recommended readability levels. Some questionnaires as well as single-items of most of the questionnaires clearly exceed recommended readability levels. This should be considered for interpretation of their results and when revising questionnaires.

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During information processing, individuals benefit from bimodally presented input, as has been demonstrated for speech perception (i.e., printed letters and speech sounds) or the perception of emotional expressions (i.e., facial expression and voice tuning). While typically developing individuals show this bimodal benefit, school children with dyslexia do not. Currently, it is unknown whether the bimodal processing deficit in dyslexia also occurs for visual-auditory speech processing that is independent of reading and spelling acquisition (i.e., no letter-sound knowledge is required). Here, we tested school children with and without spelling problems on their bimodal perception of video-recorded mouth movements pronouncing syllables. We analyzed the event-related potential Mismatch Response (MMR) to visual-auditory speech information and compared this response to the MMR to monomodal speech information (i.e., auditory-only, visual-only). We found a reduced MMR with later onset to visual-auditory speech information in children with spelling problems compared to children without spelling problems. Moreover, when comparing bimodal and monomodal speech perception, we found that children without spelling problems showed significantly larger responses in the visual-auditory experiment compared to the visual-only response, whereas children with spelling problems did not. Our results suggest that children with dyslexia exhibit general difficulties in bimodal speech perception independently of letter-speech sound knowledge, as apparent in altered bimodal speech perception and lacking benefit from bimodal information. This general deficit in children with dyslexia may underlie the previously reported reduced bimodal benefit for letter-speech sound combinations and similar findings in emotion perception.

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We introduce 3000PA, a clinical document corpus composed of 3,000 EPRs from three different clinical sites, which will serve as the backbone of a national reference language resource for German clinical NLP. We outline its design principles, results from a medication annotation campaign and the evaluation of a first medication information extraction prototype using a subset of 3000PA.

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Background: Dyslexia is a specific learning disorder affecting reading and spelling abilities. Its prevalence is ~5% in German-speaking individuals. Although the etiology of dyslexia largely remains to be determined, comprehensive evidence supports deficient phonological processing as a major contributing factor. An important prerequisite for phonological processing is auditory discrimination and, thus, essential for acquiring reading and spelling skills. The event-related potential Mismatch Response (MMR) is an indicator for auditory discrimination capabilities with dyslexics showing an altered late component of MMR in response to auditory input. Methods: In this study, we comprehensively analyzed associations of dyslexia-specific late MMRs with genetic variants previously reported to be associated with dyslexia-related phenotypes in multiple studies comprising 25 independent single-nucleotide polymorphisms (SNPs) within 10 genes. Results: First, we demonstrated validity of these SNPs for dyslexia in our sample by showing that additional inclusion of a polygenic risk score improved prediction of impaired writing compared with a model that used MMR alone. Secondly, a multifactorial regression analysis was conducted to uncover the subset of the 25 SNPs that is associated with the dyslexia-specific late component of MMR. In total, four independent SNPs within DYX1C1 and ATP2C2 were found to be associated with MMR stronger than expected from multiple testing. To explore potential pathomechanisms, we annotated these variants with functional data including tissue-specific expression analysis and eQTLs. Conclusion: Our findings corroborate the late component of MMR as a potential endophenotype for dyslexia and support tripartite relationships between dyslexia-related SNPs, the late component of MMR and dyslexia.

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The Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA), in use worldwide, is a 13-item measure assessing the biopsychosocial severity of mental health problems in children and adolescents. This article introduces the authorized German-language version of HoNOSCA, the HoNOSCA-D, and examines and discusses its psychometric properties based on a clinical sample of 1,533 children and adolescents aged 4;0 to 17;11 years. For the HoNOSCA-D total score (severity of mental health problems), internal consistency (Cronbach's alpha) was 0.63. The discriminative power of the items ranged from 0.07 to 0.44; the average interitem correlation was 0.11. Due to this stochastic independence, calculation of a total severity index is acceptable. Using factor analysis, the principal axis factoring and varimax rotation resulted in a four-factor structure, which with a Kaiser-Meyer-Olkin measure of sampling adequacy of 0.684 explained 30.62% of total variance. The convergent correlations with the German-language parent report version of the Strengths and Difficulties Questionnaire were as expected and showed a medium effect size. Gender and age differences in the HoNOSCA-D total score were small. Regarding the 13 items gender and age differences were negligible to medium. The highest severity was found for schizophrenia and psychotic disorders, followed by affective disorders and social behavior disorders. Overall, validity of HoNOSCA-D was clearly supported.

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The Prosodic Parallelism hypothesis claims adjacent prosodic categories to prefer identical branching of internal adjacent constituents. According to Wiese and Speyer (2015), this preference implies feet contained in the same phonological phrase to display either binary or unary branching, but not different types of branching. The seemingly free schwa-zero alternations at the end of some words in German make it possible to test this hypothesis. The hypothesis was successfully tested by conducting a corpus study which used large-scale bodies of written German. As some open questions remain, and as it is unclear whether Prosodic Parallelism is valid for the spoken modality as well, the present study extends this inquiry to spoken German. As in the previous study, the results of a corpus analysis recruiting a variety of linguistic constructions are presented. The Prosodic Parallelism hypothesis can be demonstrated to be valid for spoken German as well as for written German. The paper thus contributes to the question whether prosodic preferences are similar between the spoken and written modes of a language. Some consequences of the results for the production of language are discussed.

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We investigated the role of the syllable during speech processing in German, in an auditory-auditory fragment priming study with lexical decision and simultaneous EEG registration. Spoken fragment primes either shared segments (related) with the spoken targets or not (unrelated), and this segmental overlap either corresponded to the first syllable of the target (e.g., /teis/ - /teisti/), or not (e.g., /teis/ - /teistləs/). Similar prime conditions applied for word and pseudoword targets. Lexical decision latencies revealed facilitation due to related fragments that corresponded to the first syllable of the target (/teis/ - /teisti/). Despite segmental overlap, there were no positive effects for related fragments that mismatched the first syllable. No facilitation was observed for pseudowords. The EEG analyses showed a consistent effect of relatedness, independent of syllabic match, from 200 to 500 ms, including the P350 and N400 windows. Moreover, this held for words and pseudowords that differed however in the N400 window. The only specific effect of syllabic match for related prime-target pairs was observed in the time window from 200 to 300 ms. We discuss the nature and potential origin of these effects, and their relevance for speech processing and lexical access.

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On the basis of the analysis of the current situation of German as a second language teaching at medical colleges,this paper argues that the mode of communicative approach should be systematically constructed in an all-round way with the flexibility for teaching approaches taken according to the content modules such as the situational approach in the stage of oral practice learning,the practice and comparative learning in lexical and grammatical learning,the performancebased learning in the stage of cross-cultural learning.And finally,through a multi-level evaluation method,the implementation of the teaching objectives should be carried out to strengthen the medical students' cross-cultural ability and humanistic quality.