Pitch in native and non-native Lombard speech

Lombard speech, speech produced in noise, is typically produced with a higher fundamental frequency (F0, pitch) compared to speech in quiet. This paper examined the potential differences in native and non-native Lombard speech by analyzing median pitch in sentences with early- or late-focus produced in quiet and noise. We found an increase in pitch in late-focus sentences in noise for Dutch speakers in both English and Dutch, and for American-English speakers in English. These results show that non-native speakers produce Lombard speech, despite their higher cognitive load. For the early-focus sentences, we found a difference between the Dutch and the American-English speakers. Whereas the Dutch showed an increased F0 in noise in English and Dutch, the American-English speakers did not in English. Together, these results suggest that some acoustic characteristics of Lombard speech, such as pitch, may be language-specific, potentially resulting in the native language influencing the non-native Lombard speech

Added Complexity of Social Entrepreneurship: A Knowledge-Based Approach

Social entrepreneurship evades easy definition and conceptualization. In this paper we attempt to advance social entrepreneurship theoretically by examining it conceptually, from a theory of the firm perspective. If social entrepreneurship entails pursuit of a double bottom line (Dees 1998), the added complexity of the social entrepreneurial venture identified by Tracey and Phillips (2007) should be discoverable from a theory of the firm perspective. Applying the knowledge-based theory of the firm to social entrepreneurship, we aver that social entrepreneurship’s added complexity is manifest when social entrepreneurs make decisions about their knowledge. In contrast to ordinary entrepreneurs, social entrepreneurs have to balance two incommensurable objectives when they form their attitude toward protection of their knowledge

The Lombard intelligibility benefit of native and non-native speech for native and non-native listeners

Speech produced in noise (Lombard speech) is more intelligible than speech produced in quiet (plain speech). Previous research on the Lombard intelligibility benefit focused almost entirely on how native speakers produce and perceive Lombard speech. In this study, we investigate the size of the Lombard intelligibility benefit of both native (American-English) and non-native (native Dutch) English for native and non-native listeners (Dutch and Spanish). We used a glimpsing metric to measure the energetic masking potential of speech, which predicted that both native and non-native Lombard speech could withstand greater amounts of masking to a similar extent, compared to plain speech. In an intelligibility experiment, native English, Spanish, and Dutch listeners listened to the same words, mixed with noise. While the non-native listeners appeared to benefit more from Lombard speech than the native listeners did, each listener group experienced a similar benefit for native and non-native Lombard speech. Energetic masking, as captured by the glimpsing metric, only accounted for part of the Lombard benefit, indicating that the Lombard intelligibility benefit does not only result from a shift in spectral distribution. Despite subtle native language influences on non-native Lombard speech, both native and non-native speech provides a Lombard benefit

Is there any relationship between the exposure to mycophenolic acid and the clinical status in children with lupus?

International audienc

Cost and Utilization of Behavioral Health Medications Associated with Rescission of an Exemption for Prior Authorization for Severe and Persistent Mental Illness in the Vermont Medicaid Program

BACKGROUND: In recent years, many state Medicaid programs have implemented preferred drug lists (PDL) to control pharmaceutical costs by generating supplemental rebate revenues and directing providers to the most cost-effective treatments. Two states, Michigan and Vermont, sought approval from the Centers for Medicare and Medicaid Services for supplemental rebates for their Medicaid fee-for-service programs in 2002. Behavioral health medications were largely excluded from PDLs and other managed care initiatives implemented by state Medicaid programs because of significant opposition to any impact on this vulnerable population. In November 2001, the Vermont Medicaid program implemented the Vermont Health Access Pharmacy Benefit Management Program, a PDL designed to promote cost-effective use of medications. Despite the potential cost savings resulting from implementation of a PDL, behavioral health providers and advocates in the state of Vermont opposed the implementation of the managed care initiative for beneficiaries with severe mental illness, and after January of 2002, Vermont\u27s program was changed to exempt beneficiaries meeting the severe and persistent mental illness (SPMI) criteria from prior authorization (PA) for behavioral health medications not on the Medicaid PDL. The SPMI exemption was phased out by June 30, 2006. OBJECTIVES: To determine the effects of the rescission of the PA exemption on utilization and costs of 3 classes of behavioral health medications (antidepressants, antipsychotics, and anxiolytics/sedatives). Secondary analyses were conducted to assess the association between rescission of the PA exemption and 2 quality measures that might be associated with pharmacy management policy: (a) behavioral health hospitalizations and (b) high-dose prescribing of antipsychotics, defined as dosing that exceeded the manufacturer-recommended maximum dose by 25%. METHODS: This was a retrospective analysis of pharmacy claims for beneficiaries of the Office of Vermont Health Access Medicaid Program for dates of service from July 1, 2005, through December 31, 2007. The 12-month PA exemption period for 3 categories of drugs (antidepressants, antipsychotics, and anxiolytics/sedatives) was July 1, 2005, through June 30, 2006; and the post-PA exemption period was the 12 months from January 1, 2007, through December 31, 2007, following rescission of the SPMI exemption. Costs in this analysis were defined as the amount paid by Medicaid, excluding federal drug rebates paid by drug manufacturers and supplemental rebates associated with the PDL program. Costs were adjusted for inflation using the Consumer Price Index for medical costs. Frequencies were used to identify trends between medication classes and time periods. Medical claims from the 2 time periods were used to assess inpatient hospitalization trends. Descriptive statistics, Pearson chi-square tests (for categorical data), and t-tests (for continuous data) were used to assess the 2 study cohorts. RESULTS: 17.8% (n=22,130) of 124,169 eligible beneficiaries in the PA exemption period had 1 or more pharmacy claims in the 3 classes of medications exempt from PA versus 19.2% (n=23,717) of 123,499 eligible beneficiaries in the post-PA exemption period. Utilization of behavioral medications per member per month (PMPM) increased by 14.3% from 0.14 claims PMPM in the PA exemption period to 0.16 claims PMPM in the post-PA exemption period, similar to the 14.1% increase in the utilization of nonbehavioral medications (from 0.64 to 0.73 claims PMPM). Utilization changed little between the PA exemption period and the post-PA exemption period for the 3 individual classes of behavioral health drugs, 0.08 claims PMPM versus 0.09 claims PMPM for antidepressants and 0.03 for both study periods for both antipsychotics and anxiolytics/sedative hypnotics. PMPM costs for the 3 drug classes exempt from PA increased by 2.1% from $12.76 to$13.03, compared with a 12.2% increase from $42.58 PMPM to$47.79 PMPM for nonbehavioral health medications. The small 2.1% increase in PMPM costs for the 3 formerly PA-exempt drug classes was attributable in part to a 12.9% reduction in average cost per pharmacy claim, from $94.05 to$81.92, including a 24.8% reduction in the average cost per antidepressant claim, from $65.59 to$49.33. For the subgroup of beneficiaries taking atypical antipsychotic medications, the percentage with high-dose prescriptions decreased from 3.1% to 2.2%. Mental health inpatient hospitalizations also decreased from 0.6% of beneficiaries in the PA exemption period to 0.4% in the post-PA exemption period. CONCLUSIONS: In a Medicaid population excluding Medicare dual-eligible beneficiaries, the rescission of a PA exemption for 3 major classes of behavioral health medications in a PDL was not associated with decreased utilization of formerly PA-exempt behavioral health medications. The increase in PMPM spending for the formerly PA-exempt behavioral health medications was small compared with the increase in PMPM cost for nonbehavioral health medications, and there were fewer beneficiaries with hospitalization for mental health reasons in the period after rescission of the PA exemption

Piezoelectric nanoelectromechanical resonators based on aluminum nitride thin films

We demonstrate piezoelectrically actuated, electrically tunable nanomechanical resonators based on multilayers containing a 100-nm-thin aluminum nitride (AlN) layer. Efficient piezoelectric actuation of very high frequency fundamental flexural modes up to ~80 MHz is demonstrated at room temperature. Thermomechanical fluctuations of AlN cantilevers measured by optical interferometry enable calibration of the transduction responsivity and displacement sensitivities of the resonators. Measurements and analyses show that the 100 nm AlN layer employed has an excellent piezoelectric coefficient, d_(31)=2.4 pm/V. Doubly clamped AlN beams exhibit significant frequency tuning behavior with applied dc voltage

Implications of Recent Controlled Substance Policy Initiatives

Recent legislative and regulatory activity designed to address controlled substance diversion and overuse of narcotics is having a significant impact on prescription drug utilization and patient care in the United States. Although providers and patients are the focus of these new requirements, the designers and implementers of formularies and medication use protocols need to be aware of salient features of these initiatives. Formulary drug product selection, prior authorization procedures and drug utilization strategies should be reconsidered in accordance with the changes in controlled substance oversight. The primary focus of this article involves recent approaches to controlling the illegal acquisition of licit prescriptions, particularly opioid pain relievers (OPR). According to the Centers for Disease Control and Prevention (CDC), in 2008 OPRs were involved in 74% of the 20,000 fatal prescription drug overdoses in the United States. This represents an increase of over 300% since 1999 and these fatalities now exceed death by cocaine and heroin combined. [Interestingly, the death rate varied five-fold by state, largely reflecting different levels of opioid regulation and oversight. They also noted that sales of OPRs quadrupled between 2000 and 2010 and that OPR abuse cost health insurers over $72 billion annually in healthcare costs

Large-Scale Integration of Nanoelectromechanical Systems for Gas Sensing Applications

We have developed arrays of nanomechanical systems (NEMS) by large-scale integration, comprising thousands of individual nanoresonators with densities of up to 6 million NEMS per square centimeter. The individual NEMS devices are electrically coupled using a combined series-parallel configuration that is extremely robust with respect to lithographical defects and mechanical or electrostatic-discharge damage. Given the large number of connected nanoresonators, the arrays are able to handle extremely high input powers (>1 W per array, corresponding to <1 mW per nanoresonator) without excessive heating or deterioration of resonance response. We demonstrate the utility of integrated NEMS arrays as high-performance chemical vapor sensors, detecting a part-per-billion concentration of a chemical warfare simulant within only a 2 s exposure period

Arytenoïdectomy in the horse. surgical indications. prognosis

L’inflammation chronique des cartilages aryténoïdiens du cheval est une pathologie qui peut ressembler à l’hémiplégie laryngée (cornage) du cheval. Le seul traitement chirurgical qui donne des résultats valables consiste à exciser partiellement ou totalement le cartilage aryténoïde. Le pronostic est réservé mais on peut espérer un succès total dans certains cas.The chronic inflammation of the arytenoid cartilage of the larynx in the horse can produce clinical signs similar to those encountered in laryngeal hemiplegia (roarer). The surgical treatment of the condition consists in removing part or the whole arytenoid cartilage. The prognosis is guarded although complete recovery is possible