Peak Vary, Endpoints Don't: Implications for Intonation Theory

Proceedings of the Fifth Annual Meeting of the Berkeley Linguistics Society (1979), pp. 373-38

Intraspeaker Comparisons of Acoustic and Articulatory Variability in American English /r/ Productions

The purpose of this report is to test the hypothesis that speakers utilize an acoustic, rather than articulatory, planning space for speech production. It has been well-documented that many speakers of American English use different tongue configurations to produce /r/ in different phonetic contexts. The acoustic planning hypothesis suggests that although the /r/ configuration varies widely in different contexts, the primary acoustic cue for /r/, a dip in the F3 trajectory, will be less variable due to tradeoffs in articulatory variability, or trading relations, that help maintain a relatively constant F3 trajectory across phonetic contexts. Acoustic data and EMMA articulatory data from seven speakers producing /r/ in different phonetic contexts were analyzed. Visual inspection of the EMMA data at the point of F3 minimum revealed that each speaker appeared to use at least two of three trading relation strategies that would be expected to reduce F3 variability. Articulatory covariance measures confirmed that all seven speakers utilized a trading relation between tongue back height and tongue back horizontal position, six speakers utilized a trading relation between tongue tip height and tongue back height, and the speaker who did not use this latter strategy instead utilized a trading relation between tongue tip height and tongue back horizontal position. Estimates of F3 variability with and without the articulatory covariances indicated that F3 would be much higher for all speakers if the articulatory covariances were not utilized. These conclusions were further supported by a comparison of measured F3 variability to F3 variabilities estimated from the pellet data with and without articulatory covariances. In all subjects, the actual F3 variance was significantly lower than the F3 variance estimated without articulatory covariances, further supporting the conclusion that the articulatory trading relations were being used to reduce F3 variability. Together, these results strongly suggest that the neural control mechanisms underlying speech production make elegant use of trading relations between articulators to maintain a relatively invariant acoustic trace for /r/ across phonetic contexts

Intraspeaker Comparisons of Acoustic and Articulatory Variability in American English /r/ Productions

The purpose of this report is to test the hypothesis that speakers utilize an acoustic, rather than articulatory, planning space for speech production. It has been well-documented that many speakers of American English use different tongue configurations to produce /r/ in different phonetic contexts. The acoustic planning hypothesis suggests that although the /r/ configuration varies widely in different contexts, the primary acoustic cue for /r/, a dip in the F3 trajectory, will be less variable due to tradeoffs in articulatory variability, or trading relations, that help maintain a relatively constant F3 trajectory across phonetic contexts. Acoustic data and EMMA articulatory data from seven speakers producing /r/ in different phonetic contexts were analyzed. Visual inspection of the EMMA data at the point of F3 minimum revealed that each speaker appeared to use at least two of three trading relation strategies that would be expected to reduce F3 variability. Articulatory covariance measures confirmed that all seven speakers utilized a trading relation between tongue back height and tongue back horizontal position, six speakers utilized a trading relation between tongue tip height and tongue back height, and the speaker who did not use this latter strategy instead utilized a trading relation between tongue tip height and tongue back horizontal position. Estimates of F3 variability with and without the articulatory covariances indicated that F3 would be much higher for all speakers if the articulatory covariances were not utilized. These conclusions were further supported by a comparison of measured F3 variability to F3 variabilities estimated from the pellet data with and without articulatory covariances. In all subjects, the actual F3 variance was significantly lower than the F3 variance estimated without articulatory covariances, further supporting the conclusion that the articulatory trading relations were being used to reduce F3 variability. Together, these results strongly suggest that the neural control mechanisms underlying speech production make elegant use of trading relations between articulators to maintain a relatively invariant acoustic trace for /r/ across phonetic contexts

Speaker-independent Speech Inversion for Estimation of Nasalance

The velopharyngeal (VP) valve regulates the opening between the nasal and oral cavities. This valve opens and closes through a coordinated motion of the velum and pharyngeal walls. Nasalance is an objective measure derived from the oral and nasal acoustic signals that correlate with nasality. In this work, we evaluate the degree to which the nasalance measure reflects fine-grained patterns of VP movement by comparison with simultaneously collected direct measures of VP opening using high-speed nasopharyngoscopy (HSN). We show that nasalance is significantly correlated with the HSN signal, and that both match expected patterns of nasality. We then train a temporal convolution-based speech inversion system in a speaker-independent fashion to estimate VP movement for nasality, using nasalance as the ground truth. In further experiments, we also show the importance of incorporating source features (from glottal activity) to improve nasality prediction.Comment: Interspeech 202

Training Students on the Pharmacist Patient Care Process using an Electronic Health Record and Simulations

Objective: To measure the impact of an electronic health record (EHR) and simulated physician encounters on student knowledge and skills related to the implementation phase of the Pharmacist Patient Care Process (PPCP). Secondary objectives were to measure students’ self-perceived abilities. Methods: Students enrolled in a therapeutics course worked-up patient cases within an EHR. Students entered orders/ prescriptions into the computerised provider order entry (CPOE) platform. Faculty graded student work using a rubric. Students completed an instructor-developed pre-post attitudes survey and knowledge quiz. Results: Two hundred students participated in this study and worked-up seven cases. Scores ranged from 67.7% to 88.2% on the case work-ups and 78.6% to 91.1% on the order/prescription-entry components. Individual scores on the quiz improved from 15.3/20 to 17.3/20 (p\u3c0.001). Aggregate ratings on the attitudes survey increased from 23.2 to 31.0 (p\u3c0.001). Conclusion: Use of an EHR coupled with simulation was well-received and improved student understanding of the PPCP

Articulatory Tradeoffs Reduce Acoustic Variability During American English /r/ Production

Acoustic and articulatory recordings reveal that speakers utilize systematic articulatory tradeoffs to maintain acoustic stability when producing the phoneme /r/. Distinct articulator configurations used to produce /r/ in various phonetic contexts show systematic tradeoffs between the cross-sectional areas of different vocal tract sections. Analysis of acoustic and articulatory variabilities reveals that these tradeoffs act to reduce acoustic variability, thus allowing large contextual variations in vocal tract shape; these contextual variations in turn apparently reduce the amount of articulatory movement required. These findings contrast with the widely held view that speaking involves a canonical vocal tract shape target for each phoneme.National Institute on Deafness and Other Communication Disorders (1R29-DC02852-02, 5R01-DC01925-04, 1R03-C2576-0l); National Science Foundation (IRI-9310518

Longitudinal follow–up of chronic hemodialysis patients without vitamin supplementation

Longitudinal follow–up of chronic hemodialysis patients without vitamin supplementation. Vitamin supplementation for dialysis patients is still controversial. In our study, we followed longitudinally over a period of a year, 15 patients on chronic hemodialysis who were deprived of vitamin supplementation. Microbiological assays were used to determine the levels of five vitamins of the B group (folate, niacin, B12, B6, and thiamine). Vitamin C was measured chemically. During the observation period when vitamins were not supplemented, a marked drop of many of these vitamins in blood levels were encountered. For vitamins B12 and C, the plasma levels remained within the normal range in all the subjects studied. For the other vitamins, the blood levels were found to be low in a few patients. Our data suggest that vitamin supplementation is probably not needed in most stable hemodialysis patients as it is recommended now, and that perhaps, if supplementation is indicated, less should be given than is presently prescribed. Further research is needed in this area

Impact of program characteristics on weight loss in adult behavioral weight management interventions: systematic review and component network meta-analysis

Objective: Behavioral weight management programs (BWMPs) for adults lead to greater weight loss at 12 months than minimal-intervention control treatments. However, there is considerable heterogeneity in the content of BWMPs and outcomes of treatment. This study assessed the contribution of individual components of BWMPs, using Bayesian component network meta-analysis. Methods: Randomized controlled trials of BWMPs in adults were identified (latest search: December 2019) and arms coded for presence or absence of 29 intervention components grouped by type, content, provider, mode of delivery, and intensity. Results: A total of 169 studies (41 judged at high risk of bias) were included in the main analysis. Six components had effect estimates indicating clinically significant benefit and credible intervals (CrIs) excluding no difference: change in diet (mean difference [MD] = −1.84 kg, 95% CrI: −2.91 to −0.80); offering partial (MD = −2.12 kg, 95% CrI: −3.39 to −0.89) or total meal replacements (MD = −2.63 kg, 95% CrI: −4.58 to −0.73); delivery by a psychologist/counselor (MD = −1.45 kg, 95% CrI: −2.81 to −0.06) or dietitian (MD = −1.31 kg, 95% CrI: −2.40 to −0.24); and home setting (MD = −1.05 kg, 95% CrI: −2.02 to −0.09). Conclusions: Future program development should consider including these components; other approaches continue to warrant evaluation of effectiveness

Data visualisation approaches for component network meta-analysis:visualising the data structure

Abstract Background Health and social care interventions are often complex and can be decomposed into multiple components. Multicomponent interventions are often evaluated in randomised controlled trials. Across trials, interventions often have components in common which are given alongside other components which differ across trials. Multicomponent interventions can be synthesised using component NMA (CNMA). CNMA is limited by the structure of the available evidence, but it is not always straightforward to visualise such complex evidence networks. The aim of this paper is to develop tools to visualise the structure of complex evidence networks to support CNMA. Methods We performed a citation review of two key CNMA methods papers to identify existing published CNMA analyses and reviewed how they graphically represent intervention complexity and comparisons across trials. Building on identified shortcomings of existing visualisation approaches, we propose three approaches to standardise visualising the data structure and/or availability of data: CNMA-UpSet plot, CNMA heat map, CNMA-circle plot. We use a motivating example to illustrate these plots. Results We identified 34 articles reporting CNMAs. A network diagram was the most common plot type used to visualise the data structure for CNMA (26/34 papers), but was unable to express the complex data structures and large number of components and potential combinations of components associated with CNMA. Therefore, we focused visualisation development around representing the data structure of a CNMA more completely. The CNMA-UpSet plot presents arm-level data and is suitable for networks with large numbers of components or combinations of components. Heat maps can be utilised to inform decisions about which pairwise interactions to consider for inclusion in a CNMA model. The CNMA-circle plot visualises the combinations of components which differ between trial arms and offers flexibility in presenting additional information such as the number of patients experiencing the outcome of interest in each arm. Conclusions As CNMA becomes more widely used for the evaluation of multicomponent interventions, the novel CNMA-specific visualisations presented in this paper, which improve on the limitations of existing visualisations, will be important to aid understanding of the complex data structure and facilitate interpretation of the CNMA results

Pharmacological and electronic cigarette interventions for smoking cessation in adults: component network meta-analyses

Background Tobacco smoking is the leading preventable cause of death and disease worldwide. Stopping smoking can reduce this harm and many people would like to stop. There are a number of medicines licenced to help people quit globally, and e‐cigarettes are used for this purpose in many countries. Typically treatments work by reducing cravings to smoke, thus aiding initial abstinence and preventing relapse. More information on comparative effects of these treatments is needed to inform treatment decisions and policies. Objectives To investigate the comparative benefits, harms and tolerability of different smoking cessation pharmacotherapies and e‐cigarettes, when used to help people stop smoking tobacco. Search methods We identified studies from recent updates of Cochrane Reviews investigating our interventions of interest. We updated the searches for each review using the Cochrane Tobacco Addiction Group (TAG) specialised register to 29 April 2022. Selection criteria We included randomised controlled trials (RCTs), cluster‐RCTs and factorial RCTs, which measured smoking cessation at six months or longer, recruited adults who smoked combustible cigarettes at enrolment (excluding pregnant people) and randomised them to approved pharmacotherapies and technologies used for smoking cessation worldwide (varenicline, cytisine, nortriptyline, bupropion, nicotine replacement therapy (NRT) and e‐cigarettes) versus no pharmacological intervention, placebo (control) or another approved pharmacotherapy. Studies providing co‐interventions (e.g. behavioural support) were eligible if the co‐intervention was provided equally to study arms. Data collection and analysis We followed standard Cochrane methods for screening, data extraction and risk of bias (RoB) assessment (using the RoB 1 tool). Primary outcome measures were smoking cessation at six months or longer, and the number of people reporting serious adverse events (SAEs). We also measured withdrawals due to treatment. We used Bayesian component network meta‐analyses (cNMA) to examine intervention type, delivery mode, dose, duration, timing in relation to quit day and tapering of nicotine dose, using odds ratios (OR) and 95% credibility intervals (CrIs). We calculated an effect estimate for combination NRT using an additive model. We evaluated the influence of population and study characteristics, provision of behavioural support and control arm rates using meta‐regression. We evaluated certainty using GRADE. Main results Of our 332 eligible RCTs, 319 (835 study arms, 157,179 participants) provided sufficient data to be included in our cNMA. Of these, we judged 51 to be at low risk of bias overall, 104 at high risk and 164 at unclear risk, and 118 reported pharmaceutical or e‐cigarette/tobacco industry funding. Removing studies at high risk of bias did not change our interpretation of the results. Benefits We found high‐certainty evidence that nicotine e‐cigarettes (OR 2.37, 95% CrI 1.73 to 3.24; 16 RCTs, 3828 participants), varenicline (OR 2.33, 95% CrI 2.02 to 2.68; 67 RCTs, 16,430 participants) and cytisine (OR 2.21, 95% CrI 1.66 to 2.97; 7 RCTs, 3848 participants) were associated with higher quit rates than control. In absolute terms, this might lead to an additional eight (95% CrI 4 to 13), eight (95% CrI 6 to 10) and seven additional quitters per 100 (95% CrI 4 to 12), respectively. These interventions appeared to be more effective than the other interventions apart from combination NRT (patch and a fast‐acting form of NRT), which had a lower point estimate (calculated additive effect) but overlapping 95% CrIs (OR 1.93, 95% CrI 1.61 to 2.34). There was also high‐certainty evidence that nicotine patch alone (OR 1.37, 95% CrI 1.20 to 1.56; 105 RCTs, 37,319 participants), fast‐acting NRT alone (OR 1.41, 95% CrI 1.29 to 1.55; 120 RCTs, 31,756 participants) and bupropion (OR 1.43, 95% CrI 1.26 to 1.62; 71 RCTs, 14,759 participants) were more effective than control, resulting in two (95% CrI 1 to 3), three (95% CrI 2 to 3) and three (95% CrI 2 to 4) additional quitters per 100 respectively. Nortriptyline is probably associated with higher quit rates than control (OR 1.35, 95% CrI 1.02 to 1.81; 10 RCTs, 1290 participants; moderate‐certainty evidence), resulting in two (CrI 0 to 5) additional quitters per 100. Non‐nicotine/placebo e‐cigarettes (OR 1.16, 95% CrI 0.74 to 1.80; 8 RCTs, 1094 participants; low‐certainty evidence), equating to one additional quitter (95% CrI ‐2 to 5), had point estimates favouring the intervention over control, but CrIs encompassed the potential for no difference and harm. There was low‐certainty evidence that tapering the dose of NRT prior to stopping treatment may improve effectiveness; however, 95% CrIs also incorporated the null (OR 1.14, 95% CrI 1.00 to 1.29; 111 RCTs, 33,156 participants). This might lead to an additional one quitter per 100 (95% CrI 0 to 2). Harms There were insufficient data to include nortriptyline and non‐nicotine EC in the final SAE model. Overall rates of SAEs for the remaining treatments were low (average 3%). Low‐certainty evidence did not show a clear difference in the number of people reporting SAEs for nicotine e‐cigarettes, varenicline, cytisine or NRT when compared to no pharmacotherapy/e‐cigarettes or placebo. Bupropion may slightly increase rates of SAEs, although the CrI also incorporated no difference (moderate certainty). In absolute terms bupropion may cause one more person in 100 to experience an SAE (95% CrI 0 to 2). Authors' conclusions The most effective interventions were nicotine e‐cigarettes, varenicline and cytisine (all high certainty), as well as combination NRT (additive effect, certainty not rated). There was also high‐certainty evidence for the effectiveness of nicotine patch, fast‐acting NRT and bupropion. Less certain evidence of benefit was present for nortriptyline (moderate certainty), non‐nicotine e‐cigarettes and tapering of nicotine dose (both low certainty). There was moderate‐certainty evidence that bupropion may slightly increase the frequency of SAEs, although there was also the possibility of no increased risk. There was no clear evidence that any other tested interventions increased SAEs. Overall, SAE data were sparse with very low numbers of SAEs, and so further evidence may change our interpretation and certainty. Future studies should report SAEs to strengthen certainty in this outcome. More head‐to‐head comparisons of the most effective interventions are needed, as are tests of combinations of these. Future work should unify data from behavioural and pharmacological interventions to inform approaches to combined support for smoking cessation