Brain 'talks over' boring quotes: top-down activation of voice-selective areas while listening to monotonous direct speech quotations

In human communication, direct speech (e.g., Mary said, "I'm hungry") is perceived as more vivid than indirect speech (e.g., Mary said that she was hungry). This vividness distinction has previously been found to underlie silent reading of quotations: Using functional magnetic resonance imaging (fMRI), we found that direct speech elicited higher brain activity in the temporal voice areas (TVA) of the auditory cortex than indirect speech, consistent with an "inner voice" experience in reading direct speech. Here we show that listening to monotonously spoken direct versus indirect speech quotations also engenders differential TVA activity. This suggests that individuals engage in top-down simulations or imagery of enriched supra-segmental acoustic representations while listening to monotonous direct speech. The findings shed new light on the acoustic nature of the "inner voice" in understanding direct speech.     

Death-Related Versus Fond Memories of a Deceased Attachment Figure: Examining Emotional Arousal

Grieving is infused by memories and emotions. In this study, bereaved participants recalled either death-related or fond memories of their loved ones. Their emotional arousal was examined via physiologic and voice analytic measures. Both death-related and fond memories generated an acoustic profile indicative of sadness (reflected by voice quality related parameters). Death-related memories, moreover, lead to bodily tension reflected by increased diastolic blood pressure levels and mean fundamental frequency of the voice signal. Consistent with the continuing bond and attachment perspectives, “death,” a reminder of the irrevocability of the loss, induced distress/anxiety. In contrast, fond memories lead to more moderate, melancholic sadness, presumably because of their association with the soothing qualities of the attachment figure.     

Quality of life of patients after total laryngectomy: the struggle against stigmatization and social exclusion using speech synthesis

In this article, we deal with the problem of potential stigmatization and social exclusion of people that have voice/speech problems due to neck cancer, especially those who have lost their voice because of total laryngectomy, and we analyze how this potential stigmatization could be alleviated by personalized speech synthesis. We used a mixed-method approach, consisting of quality of life questionnaires and in-depth semi-structured interviews, in order to provide more generalizable as well as rich information. We found out that people with speech problems feel depressed because of their health status and anxiety during social interactions, as they think that other people perceive them as abnormal, or they directly experience symbolic violence. For overcoming these negative feelings, the crucial factors are family relationships and maintaining employment. In both factors, speech synthesis can help significantly.

• Implications for rehabilitation

• Personalized speech synthesis can help considerably to people with severe voice impairment in their (re)integration into society.

• Where possible and appropriate, personalized speech synthesis should be offered as an option to “traditional” voice substitutions.

     

Clinical investigation of the Global Voice Therapy Model

The purpose of this study was to investigate the effect of the Global Voice Therapy Model (GVTM) on acoustic, aerodynamic, and perceptual voice measures of four adults seeking voice therapy for a voice disorder. A speech-language pathologist facilitated speaking voice therapy with the four participants using the GVTM. Participants completed acoustic, aerodynamic, and perceptual voice measures at pre- and post-therapy time points. Differences were seen in the voice measures from pre- to post-therapy. The GVTM was successful in facilitating an improvement in the acoustic, aerodynamic, and perceptual measures of the participants.     

舌癌术后语言功能训练及效果评价

目的　提高舌癌术后患者的语音清晰度 ,从而提高患者的生活质量。方法　利用“汉语语音普通话测试字表”作为对患者语音清晰度的检测标准。对 13例舌癌术后患者进行较系统的语音训练 ,采用集中时间进行舌功能训练、纠正异常发音、练习困难发音 ,并对被训练患者语音清晰度的检测及训练前后录音对比。结果　 13例患者经过 1个疗程 (1个月 )的训练 ,语音清晰度从平均 5 6 .9%提高到 91.4 % ,平均提高了 34.4 %。结论　通过系统、集中地对舌癌术后患者进行语音功能训练 ,能在较短时间内达到提高语音清晰度 ,改善了因手术造成的语音功能障碍。     

嗓音训练对职业用声者声带息肉术后发音质量的效果观察

目的 探讨动态喉镜下嗓音训练对职业用声者声带息肉术后发声质量的疗效评估。 方法 选取2016年3月-2017年1月收治的98例职业用声声带息肉患者作为研究对象,按照随机数字表将患者分为实验组和对照组,对照组给予常规治疗及护理,实验组在对照组基础上给予嗓音训练。2组患者在训练前及训练3个月后行嗓音声学检测,采用嗓音障碍指数量表(pediatric voice handicap index-30,VHI-30)评估并分析效果。 结果 训练3个月后,实验组患者的声学值基频微扰(jitter)、振幅微扰(shimmer)及VHI-30各项评分低于对照组,嗓音障碍严重指数(dysphonia severity index, DSI)和最长发音时间(maximum phonation time,MPT)高于对照组。 结论 嗓音训练可以降低职业用声者嗓音障碍程度,提供发声时呼吸动力支持,改善职业用声者声带息肉术后的嗓音质量。     

Service user involvement in undergraduate mental health nursing in New Zealand

This paper describes a service user role in the mental health component of an undergraduate nursing programme in New Zealand. The paper provides a background to mental health nursing education in New Zealand and discusses the implications of recent reforms in the mental health sector. The undergraduate nursing programme at the University of Auckland has a strong commitment to service user involvement. The programme aims to educate nurses to be responsive and skilful in meeting the mental health needs of service users in all areas of the health sector and to present mental health nursing as an attractive option for nurses upon graduation. We outline the mental health component of the programme, with an emphasis on the development of the service user role. In the second half of the paper, we present a summary of responses to a student satisfaction questionnaire. The responses indicate that the service user role is an important element of the programme and is well received by a substantial proportion of students. We consider the implications for nursing education and for recruitment into mental health nursing. Finally, we discuss some issues related to service user involvement in the development of new models of mental health service delivery.     

Current knowledge,controversies and future directions in hyperfunctional voice disorders

Taking the preceding five papers in this special issue of the International Journal of Speech-Language Pathology as a starting point, this paper synthesizes key aspects of hyperfunctional voice disorders (HFVD). Aetiological and contributing factors, defining features, prevention, assessment and intervention are canvassed, while controversial issues and future directions in research and clinical practice are discussed. Despite disagreements and inconsistencies in terminology surrounding HFVD, there is broad agreement that musculoskeletal tension is the hallmark of these voice disorders. There is also reasonable consensus that the pathogenesis and persistence of HFVD are associated with multiple and overlapping factors, some of which are likely to interact in as yet unknown ways. In addition to dysregulated laryngeal muscle functioning, key processes in the psychosocial and sensory domains are canvassed as likely contributors to HFVD. Vocal fatigue is considered as an intriguing relative of HFVD, the role of laryngopharyngeal reflux is debated and the proposition that particular individuals are psychologically and/or physiologically predisposed to HFVD is discussed. New directions in assessment highlight the use of client-centred measures to consider insider perspectives of psychological factors, vocal effort and vocal fatigue. Emerging psychosocial and physical-manipulative interventions are emphasized and the future educational needs of voice care professionals are considered.     

Mental health nurses' and psychiatrists' views on addressing parenthood issues among service users

Mental health professionals (MHPs) are in a central position to provide support for mental health service users (MHSUs) in regard to parental needs, from preconception to caring for children. This study aims to examine whether mental health nurses and psychiatrists regard the issue of having children and being a parent as relevant to be considered in a clinical setting, how they describe the MHPs' roles and responsibilities in this regard, and to what extent they feel willing and able to fulfil these demands. A qualitative approach was undertaken by conducting four focus groups with 30 MHPs (15 nurses and 15 psychiatrists) within an inpatient mental health service in south Germany. We found that MHPs generally acknowledged the importance of parenting issues for psychiatric treatment. However, they assessed the talks between MHPs and MHSUs about parenting as less relevant in routine practice; the issue of the desire for children in particular was seen as generally not important. Addressing parenthood issues was restricted to mainly two areas: clarifying children's situations during inpatient treatment and considering medication issues among (potentially) pregnant service users. MHPs' focus on the adult service user, privacy, and historical issues were the main arguments against addressing parenthood issues.     

Top-down processes during auditory phoneme categorization in dyslexia: a PET study

While persistence of subtle phonological deficits in dyslexic adults is well documented, deficit of categorical perception of phonemes has received little attention so far. We studied learning of phoneme categorization during an activation H(2)O(15) PET experiment in 14 dyslexic adults and 16 normal readers with similar age, handedness and performance IQ. Dyslexic subjects exhibited typical, marked impairments in reading and phoneme awareness tasks. During the PET experiment, subjects performed a discrimination task involving sine wave analogues of speech first presented as pairs of electronic sounds and, after debriefing, as syllables /ba/ and /da/. Discrimination performance and brain activation were compared between the acoustic mode and the speech mode of the task which involved physically identical stimuli; signal changes in the speech mode relative to the acoustic mode revealed the neural counterparts of phonological top-down processes that are engaged after debriefing. Although dyslexic subjects showed good abilities to learn discriminating speech sounds, their performance remained lower than those of normal readers on the discrimination task over the whole experiment. Activation observed in the speech mode in normal readers showed a strongly left-lateralized pattern involving the superior temporal, inferior parietal and inferior lateral frontal cortex. Frontal and parietal subparts of these left-sided regions were significantly more activated in the control group than in the dyslexic group. Activations in the right frontal cortex were larger in the dyslexic group than in the control group for both speech and acoustic modes relative to rest. Dyslexic subjects showed an unexpected large deactivation in the medial occipital cortex for the acoustic mode that may reflect increased effortful attention to auditory stimuli.     

Spatiotemporal properties of the BOLD response in the songbirds' auditory circuit during a variety of listening tasks

Auditory fMRI in humans has recently received increasing attention from cognitive neuroscientists as a tool to understand mental processing of learned acoustic sequences and analyzing speech recognition and development of musical skills. The present study introduces this tool in a well-documented animal model for vocal learning, the songbird, and provides fundamental insight in the main technical issues associated with auditory fMRI in these songbirds. Stimulation protocols with various listening tasks lead to appropriate activation of successive relays in the songbirds' auditory pathway. The elicited BOLD response is also region and stimulus specific, and its temporal aspects provide accurate measures of the changes in brain physiology induced by the acoustic stimuli. Extensive repetition of an identical stimulus does not lead to habituation of the response in the primary or secondary telencephalic auditory regions of anesthetized subjects. The BOLD signal intensity changes during a stimulation and subsequent rest period have a very specific time course which shows a remarkable resemblance to auditory evoked BOLD responses commonly observed in human subjects. This observation indicates that auditory fMRI in the songbird may establish a link between auditory related neuro-imaging studies done in humans and the large body of neuro-ethological research on song learning and neuro-plasticity performed in songbirds.     

Potential problems associated with use of speech recognition products

Commercial speech recognition products are being used increasingly as alternate input devices for computers, particularly by persons with physical disabilities. These discrete speech dictation systems require the user to insert brief but distinct pauses after each spoken word. Anecdotal evidence suggests that some persons using these products experience moderate to severe problems with their voices, such as hoarseness, sore throats, and even complete loss of voice. This preliminary study, which includes data gathered from survey dissemination and clinical studies, indicates that persons with cumulative trauma disorder may be the most susceptible to these voice problems. Also, we hypothesized that in using these discrete speech recognition systems, there may be a tendency to maintain constant pitch, volume, and inflection, keeping the vocal tract musculature in a fixed position. Maintaining this fixed position for extended periods may result in muscle fatigue and, eventually, injury to the laryngeal musculature. Further studies are needed, however, to investigate the effects suggested here. In the meantime, we recommend that users become informed about the unnatural speech patterns used with discrete speech recognition systems; learn to use good vocal hygiene, such as performing warm-up and cool-down voice exercises; and use alternate methods of input along with the speech recognition product.     

Ergonomic automated anesthesia recordkeeper using a mobile touch screen with voice navigtion

Objective. To develop an ergonomically designed computerized recordkeeping tool for anesthesiologists that allows the clinician to maintain visual contact with the patient while performing recordkeeping. Methods.To simplify the human interface software, we developed two general use software components. All purpose menu type 1 (APM1) was used for entering events using a tree structured menu. APM1 was designed to adapt to the limits of human memory, by using Miller's rule of 7 to guide the input process. APM1 can be considered to be a three-dimensional table list consisting of 7 vertical and 7 horizontal choices, which has further 5 tree-structured divergences. APM1 is also completely configurable by the user. All purpose menu 2 (APM2) was used to implement the system-initiated human interface where the system will prompt the user by voice for each entry. When users touch a key on APM1 and APM2, the system was designed to respond with a voice prompt. A touch-screen was also utilized and designed to fit the anesthesia machine. The screen is equipped with a small speaker for voice response and a microphone for voice recognition. The positions of the screen are adjustable supported by a long flexible limb (85 cm). Results. After improving the design, systems were assembled for 10 operating rooms. Of the multiple features of the VOCAAR user interface, the following were well accepted by users and employed daily: touch-screen input, and voice response. The noncompulsory use rate was 87% during the initial 2 weeks, increased to 94% after 2 weeks and 100% after two months. The mean sound emission by voice response (n = 10, mean ± SD) was 8.2 ± 2.3 dB at the main anesthetist site (35 cm from the speaker mounted on the touch-screen), 2.2 ± 1.3 dB at the staff site (1.5 m from the touch-screen), which was only audible for anesthesiologist but for surgeon. Discussion. An EARK system was designed to allow the user to maintain visual contact with the patient while performing recordkeeping tasks. The combination of a mobile touch screen and voice response/recognition facilitated the design goals of the system. Although the system has enjoyed universal clinical acceptance, the voice functions remain too limited to satisfy the needs of a completely handsfree user interface. Enhancements to voice recognition technology will offer the potential for improved functionality. Additional research is also needed to better define the relationship between vigilance and visual contact with the patient.     

Parkinson-plus patients--an unknown group with severe symptoms.

The Parkinson-plus syndromes, which include multiple system atrophy (MSA), progressive supranuclear palsy (PSP), and corticobasal degeneration (CBD), are still not well-known. Research concerning diagnosis and treatment is ongoing; nursing studies are lacking. Therefore, the aims of this study were to survey the patients about their symptoms, their previous contacts with physicians and other caregivers, the questions about their disease that were of most importance to them, and their perceived quality of life. The mapping caregivers and symptoms (MCAS) questionnaire, which was constructed for the study, and the Nottingham Health Profile (NHP), were used. Twenty-three patients participated. Early in the course of the disease Parkinson-plus patients needed to consult physicians from different specialties and many other professional caregivers because of a multitude of problems such as slow movements, weak voice, stiffness, dysphagia, muscle pain, and incontinence. The NHP revealed that many participants ran out of energy, and this affected their everyday lives and leisure time. As the disease progressed, palliative needs successively increased. Patients in all stages wanted to know about the disease course and their prognosis and about issues that could give them hope. In accordance with palliative care philosophy, caregivers can help direct the patients' hope from cure to a palliative goal, with a focus on quality of life.     

Outcome measurement in complementary and alternative medicine: unpicking the effects

The issues of what outcomes to measure and how this is central to the development of a sound knowledge base for evidence-based practice are examined. Within complementary and alternative medicine (CAM) there is a crucial debate over what is meant by an "effect" of a set of CAM treatment sessions. The goal of this paper is promote debate and reflection on why outcome measurement is important, the range of specific effects that need to be measured, and ways to take forward their measurement. It is argued that monitoring the achievement of desired outcomes needs to be recognized as an essential step in evidence-based practice, with effectiveness, achieved effects/outcomes--both positive and negative--and quality assurance inextricably linked together in an evidence spiral. The choice of outcome measures must also match the desired outcomes of the key participants, specifically those of the user. Three types of effects of a CAM intervention are conceptualized: (1) those arising from the philosophy and practice of health and healing; (2) factors arising from the relationship between user and practitioner: and (3) those factors brought about by the set of techniques used to enhance the healing process. Their conceptual separation clarifies what should be measured and raises questions about the adequacy of available measuring instruments. This delineation of effects has relevance beyond CAM to conventional medicine and discussions over the nature of the placebo effect. Measurement of all three types of effect is essential, in research and in practice, if the full effect of a CAM discipline is to be recognized. Further work is needed to develop and validate measures that address the multiple effects of CAM and to explore the nature and form of the three types of effect within different CAM disciplines.     

Automatic ECG quality scoring methodology: mimicking human annotators

An algorithm to determine the quality of electrocardiograms (ECGs) can enable inexperienced nurses and paramedics to record ECGs of sufficient diagnostic quality. Previously, we proposed an algorithm for determining if ECG recordings are of acceptable quality, which was entered in the PhysioNet Challenge 2011. In the present work, we propose an improved two-step algorithm, which first rejects ECGs with macroscopic errors (signal absent, large voltage shifts or saturation) and subsequently quantifies the noise (baseline, powerline or muscular noise) on a continuous scale. The performance of the improved algorithm was evaluated using the PhysioNet Challenge database (1500 ECGs rated by humans for signal quality). We achieved a classification accuracy of 92.3% on the training set and 90.0% on the test set. The improved algorithm is capable of detecting ECGs with macroscopic errors and giving the user a score of the overall quality. This allows the user to assess the degree of noise and decide if it is acceptable depending on the purpose of the recording.     

Low-Cost Thermochromic Quality Assurance Phantom for Therapeutic Ultrasound Devices: A Proof of Concept

High-intensity focused ultrasound (HIFU) transducer acoustic output can vary over time as a result of an inconsistent power supply, damage to the transducer or deterioration over time. Therefore, easy implementation of a daily quality assurance (DQA) method is of great importance for pre-clinical research and clinical applications. We present here a thermochromic material-based phantom validated by thermal simulations and found to provide repeatable visual power output assessments in fewer than 15 s that are accurate to within 10%. Whereas current available methods such as radiation force balance measurements provide an estimate of the total acoustic power, we explain here that the thermochromic phantom is sensitive to the shape of the acoustic field at focus by changing the aperture of a multi-element transducer with a fixed acoustic power. The proposed phantom allows the end user to visually assess the transducer's functionality without resorting to expensive, time-consuming hydrophone measurements or image analysis.     

To record or not to record: documentation in clinical supervision

Despite the continued interest of nurses in clinical supervision there remain many unanswered questions and unresolved issues. One such key issue is that of record keeping within clinical supervision. Consequently, this article reviews the limited literature that addresses this issue. It is evident that there are three principle discrete positions regarding recording in supervision and these are summarized as (1) the superviser records minimum data to meet the needs of audit (2) the supervisee makes extensive notes for his/her learning journal, reflective diary and (3) the superviser records headings or key words to be used as an aide-mèmoire. The article then uses three case studies to illustrate particular concerns that the trainee supervisees have raised with regard to record keeping that centre around these three positions, and discusses the issues that arise from these concerns. As a result of this discussion, the author reasons that, when entering supervision, either as a new superviser or as a supervisee, it may well be necessary and beneficial to give mind to issues of recording. While it is unlikely that there is one 'perfect way' that will suit every practitioner, the article concludes with some general guidelines whih may help in this deliberation.