Purpose: To assess the feasibility and effectiveness of a newly developed assistive technology system, Lee Silverman Voice Treatment Companion (LSVTR CompanionTM, hereafter referred to as ..."Companion"), to support the delivery of LSVTRLOUD, an efficacious speech intervention for individuals with Parkinson disease (PD). Method: Sixteen individuals with PD were randomized to an immediate ( n = 8) or a delayed ( n = 8) treatment group. They participated in 9 LSVT LOUD sessions and 7 Companion sessions, independently administered at home. Acoustic, listener perception, and voice and speech rating data were obtained immediately before (pre), immediately after (post), and at 6 months post treatment (follow-up). System usability ratings were collected immediately post treatment. Changes in vocal sound pressure level were compared to data from a historical treatment group of individuals with PD treated with standard, in-person LSVT LOUD. Results: All 16 participants were able to independently use the Companion. These individuals had therapeutic gains in sound pressure level, pre to post and pre to follow-up, similar to those of the historical treatment group. Conclusions: This study supports the use of the Companion as an aid in treatment of hypokinetic dysarthria in individuals with PD. Advantages and disadvantages of the Companion, as well as limitations of the present study and directions for future studies, are discussed. (Contains 1 figure and 4 tables.)
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
Purpose: The aim of this study was to investigate how a child's fundamental frequency (F0) and estimated voice level (dB SPL) change in distinct speaking environments. Method: A child age 5;7 ...(years;months) wore a National Center for Voice and Speech voice dosimeter for 4 days. The 2 parameters measured were F0 and dB SPL. During analysis, the F0 and dB SPL data were segmented to represent 4 typical speaking environments of school-age children: (a) free-play (2.5 hr), (b) preschool (3 hr), (c) home (10.7 hr), and (d) adult (5.6 hr). Unique to this study, the child's voice data were presented as voice use profiles. Results: The child's F0 and dB SPL patterns within an adult environment were similar to that found in the literature but showed much greater variation in the free-play environment. The preschool environment elicited speech of a lower modal F0 than did the home, but a higher median and mean F0, as well as a somewhat elevated mean dB SPL. Conclusion: The child produced significantly different F0 and dB SPL patterns across 4 different speaking environments. If future studies substantiate this pattern, clinicians and researchers must be aware of this difference when working with children.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
Purpose. This study investigated whether clinicians could detect voice changes reported by teachers, from self-ratings teachers conducted of their inability to produce soft voice (IPSV). Methods. Ten ...teachers wore a vocal dosimeter and completed daily IPSV ratings approximately every 2 hours for 14 days. Following the 2 weeks of dosimetry, two speech clinicians specialized in voice rated the teachers' IPSV from dosimeter recordings. Teacher and clinician ratings were compared for each participant. Results. Although agreement between teacher and clinician ratings was not significant, descriptive analyses demonstrated an average difference score of 1.7 (SD 1.4) between teacher and clinician ratings. Conclusions. This study supports the potential usefulness of the IPSV as a simple tool to detect voice changes in oneself or others.
The Sustainable Development Goals (SDGs) mandate systematic monitoring of the health and wellbeing of all children to achieve optimal early childhood development. However, global epidemiological data ...on children with developmental disabilities are scarce. The Global Burden of Diseases, Injuries, and Risk Factors Study 2016 provides a comprehensive assessment of prevalence and years lived with disability (YLDs) for development disabilities among children younger than 5 years in 195 countries and territories from 1990 to 2016.
We estimated prevalence and YLDs for epilepsy, intellectual disability, hearing loss, vision loss, autism spectrum disorder, and attention deficit hyperactivity disorder. YLDs were estimated as the product of the prevalence estimate and the disability weight for each mutually exclusive disorder, corrected for comorbidity. We used DisMod-MR 2.1, a Bayesian meta-regression tool, on a pool of primary data derived from systematic reviews of the literature, health surveys, hospital and claims databases, cohort studies, and disease-specific registries.
Globally, 52·9 million (95% uncertainty interval UI 48·7–57·3; or 8·4% 7·7–9·1) children younger than 5 years (54% males) had developmental disabilities in 2016 compared with 53·0 million (49·0–57·1; or 8·9% 8·2–9·5) in 1990. About 95% of these children lived in low-income and middle-income countries. YLDs among these children increased from 3·8 million (95% UI 2·8–4·9) in 1990 to 3·9 million (2·9–5·2) in 2016. These disabilities accounted for 13·3% of the 29·3 million YLDs for all health conditions among children younger than 5 years in 2016. Vision loss was the most prevalent disability, followed by hearing loss, intellectual disability, and autism spectrum disorder. However, intellectual disability was the largest contributor to YLDs in both 1990 and 2016. Although the prevalence of developmental disabilities among children younger than 5 years decreased in all countries (except for North America) between 1990 and 2016, the number of children with developmental disabilities increased significantly in sub-Saharan Africa (71·3%) and in North Africa and the Middle East (7·6%). South Asia had the highest prevalence of children with developmental disabilities in 2016 and North America had the lowest.
The global burden of developmental disabilities has not significantly improved since 1990, suggesting inadequate global attention on the developmental potential of children who survived childhood as a result of child survival programmes, particularly in sub-Saharan Africa and south Asia. The SDGs provide a framework for policy and action to address the needs of children with or at risk of developmental disabilities, particularly in resource-poor countries.
The Bill & Melinda Gates Foundation.
Communication is often impaired in individuals with Parkinson’s disease (PD), typically secondary to sensorimotor deficits impacting voice and speech. Language may also be diminished in PD, ...particularly for production and comprehension of verbs. Evidence exists that verb processing is influenced by motor system modulation suggesting that verb deficits in PD are underpinned by similarities in the neural representations of actions that span motor and semantic systems. Conversely, subtle differences in cognition in PD may explain difficulty in processing of complex syntactic forms, which increases cognitive demand and is linked to verb use. Here we investigated whether optimizing motor system support for vocal function (improving loudness) affects change in lexical semantic, syntactic, or informativeness aspects of spoken discourse. Picture description narratives were compared for 20 Control participants and 39 with PD, 19 of whom underwent Lee Silverman Voice Treatment (LSVT LOUD®). Treated PD narratives were also contrasted with those of untreated PD and Control participants at Baseline and after treatment. Controls differed significantly from the 39 PD participants for verbs per utterance, but this difference was largely driven by untreated PD participants who produced few utterances but with verbs, inflating their verbs per utterance. Given intervention, there was a significant increase in vocal loudness but no significant changes in language performance. These data do not support the hypothesis that targeting this speech motor system results in improved language production. Instead, the data provide evidence of considerable variability in measures of language production across groups, particularly in verbs per utterance.
We present the redshift distribution of the Submillimetre Common-User Bolometer Array (SCUBA) Half Degree Survey (SHADES) galaxy population based on the rest-frame radio–mm–far-infrared (FIR) colours ...of 120 robustly detected 850 μm sources in the Lockman Hole East (LH) and Subaru XMM–Newton Deep Field (SXDF). The redshift distribution derived from the full spectral energy distribution (SED) information is shown to be narrower than that determined from the radio–sub-mm spectral index, as more photometric bands contribute to a higher redshift accuracy. The redshift distribution of sources derived from at least two photometric bands peaks at z≈ 2.4 and has a near-Gaussian distribution, with 50 per cent (interquartile range) of sources at z= 1.8–3.1. We find a statistically significant difference between the measured redshift distributions in the two fields; the SXDF peaking at a slightly lower redshift (median z≈ 2.2) than the LH (median z≈ 2.7), which we attribute to the noise properties of the radio observations. We demonstrate, however, that there could also be field-to-field variations that are consistent with the measured differences in the redshift distributions and, hence, that the incomplete area observed by SHADES with SCUBA, despite being the largest sub-mm survey to date, may still be too small to fully characterize the bright sub-mm galaxy population. Finally, we present a brief comparison with the predicted, or assumed, redshift distributions of sub-mm galaxy formation and evolution models, and we derive the contribution of these SHADES sources and the general sub-mm galaxy population to the star formation rate density at different epochs.
Albugranin fusion protein is recombinant granulocyte colony stimulating factor (rG-CSF) genetically fused at its N-terminus to the C-terminus of recombinant serum human albumin and is expected to ...have a relatively long half-life compared with rG-CSF alone. In this study, the pharmacodynamics and pharmacokinetics of Albugranin were evaluated in BDF1 mice and cynomolgus monkeys.
Single doses of Albugranin (0.25-5 mg/kg) or Filgrastim (methionyl rG-CSF, 0.25, or 1.25 mg/kg) were administered subcutaneously (SC) to mice and multiple doses of Albugranin (25-100 microg/kg every 4 or 7 days) or Filgrastim (5 microg/kg daily) were administered SC for 14 days to monkeys for hematologic evaluation. For pharmacokinetics studies, mice were injected intravenously (IV) or SC with single doses of Albugranin (0.25-1.25 mg/kg) or Filgrastim (0.25 mg/ kg) and monkeys were injected SC with multiple doses of Albugranin (100-1,000 microg/kg once weekly for 5 weeks). Plasma levels of Albugranin and Filgrastim were measured by enzyme-linked immunosorbent assay.
In mice, administration of Albugranin effectively increased the number of peripheral granulocytes and mobilized hematopoietic progenitor cells for up to 5 days. The magnitude and duration of this effect were dose-dependent. In contrast, administration of Filgrastim resulted in a small increase in both cell types on day 1 only. Albugranin administered to cynomolgus monkeys caused an increase in peripheral neutrophils, with a less prominent increase in peripheral monocytes. Albugranin-induced neutrophilia peaked 24 h following each dose administration. Administration of Filgrastim daily in monkeys resulted in moderate increases in neutrophils that were maximal on days 8-12 during the course of treatment. Compared with Filgrastim, Albugranin had a longer terminal half-life (t(1/2,term)) and mean residence time (MRT), and slower clearance (CL/F) in mice. The t(1/2,term), MRT, and CL/F of Albugranin following SC administration to BDF1 mice were 5.6-5.7 h, 16.7-20.7 h, and 6.37-12.2 mL/h/kg, respectively, compared with 2.54 h, 4.9 h, and 164 mL/h/kg, respectively for Filgrastim. In cynomolgus monkeys, the corresponding values of t(1/2,term), MRT, and CL/F for Albugranin were 7.73-133 h, 19.4-27.3 h, and 7.90-27.5 mL/h/kg, respectively, for doses of 100-1000 microg/kg. An exposure-response relationship that could be empirically described with a simple Emax model with baseline was found between day 15 absolute neutrophil count and area under the curve following the first dose in cynomolgus monkeys.
The sustained activity of Albugranin in mice and monkeys demonstrated in these studies suggests that this agent could be given less frequently than Filgrastim to achieve similar therapeutic effects in patients.
Why conscientious objection merits respect Goligher, Ewan C; Del Sorbo, Lorenzo; Cheung, Angela M ...
Canadian Medical Association journal (CMAJ),
08/2016, Letnik:
188, Številka:
11
Journal Article
Recenzirano
Odprti dostop
In his important commentary on respecting conscientious objection to the provision of physician-assisted death (PAD), Dr. Fletcher cites the long-standing tradition of tolerance within the Canadian ...medical community.1 We wish to point out several more reasons for respecting conscientious objection to PAD. Third, the ethical justification of PAD remains debatable because it relies on uncertain metaphysical assumptions about the benefit of death3-5 and contravenes widely held basic moral intuitions about the inestimable intrinsic value of humans.6 Because it remains distinctly possible that PAD is unethical, objecting physicians should not be forced to facilitate access to PAD for their patients. Fifth, respect for conscientious objection upholds the moral integrity of physicians,8,9 the foundation for society's confidence in the profession. Disregarding conscientious objection prioritizes moral conformity over moral integrity, undermining the trustworthiness of the profession. Prioritizing moral integrity by respecting conscientious objection can foster quality medical care and enhance patient safety.10
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