Overview of Evidence-Based Treatment of Stuttering in Bulgaria and in the USA and Canada

Introduction: The move towards evidence-based practice (EBP) requires speech-language pathologists (logopedists) to understand the types of studies that build an evidence base for the field as well as the standards for assessing the quality of evidence. Objectives: This article discusses the conceptual and methodological issues associated with EBP in Bulgaria, the USA, and Canada related to clinical stuttering intervention. This article discusses how the movement towards the current high-level standards of practice established in North America may challenge some of the traditional Bulgarian beliefs regarding stuttering treatment. Method: Theoretical overview and analysis of the existing literature data sources including systematic meta-analysis articles on EBP on stuttering. Results: The study outlines the steps of EBP accepted in SLP. Thirteen systematic reviews and meta-analyses are discussed concerning the application of research evidence to clinical decision making. These issues remain problematic for Bulgarian logopedists who received their training before or during the recent professional shift from a special education subspecialty to a health profession specialty as represented by speech-language pathology (SLP). Conclusions: The professional bodies that govern clinical practice in the Bulgarian health fields are not currently guided by EBP concepts. In Bulgaria, there is no evidence-based framework for the prevention, diagnosis, and treatment of stuttering as there is in the USA and Canada. In Bulgaria EBP stands as a fundamental way to promote changes appropriate for SLP as a health profession

Hospital Board Infrastructure and Functions: The Role of Governance in Financial Performance

Increased stake of boards in the leadership of the hospitals makes them play a significant role in the financial health of their institutions. Understanding of the correct approach to successfully fulfill this purpose is critical for preparing their organizations for positioning adequately in the health care market. Governmental agencies and public companies, including insurers, will be interested in the extent to which hospital boards have adopted the provisions of accounting reform laws like those introduced by the Sarbanes-Oxley Act. It will remain for the boards to balance their oversight role for financial performance with the pressures of financial accountability

A Hybrid Machine-Learning-Based Method for Analytic Representation of the Vocal Fold Edges during Connected Speech

Investigating the phonatory processes in connected speech from high-speed videoendoscopy (HSV) demands the accurate detection of the vocal fold edges during vibration. The present paper proposes a new spatio-temporal technique to automatically segment vocal fold edges in HSV data during running speech. The HSV data were recorded from a vocally normal adult during a reading of the “Rainbow Passage.” The introduced technique was based on an unsupervised machine-learning (ML) approach combined with an active contour modeling (ACM) technique (also known as a hybrid approach). The hybrid method was implemented to capture the edges of vocal folds on different HSV kymograms, extracted at various cross-sections of vocal folds during vibration. The k-means clustering method, an ML approach, was first applied to cluster the kymograms to identify the clustered glottal area and consequently provided an initialized contour for the ACM. The ACM algorithm was then used to precisely detect the glottal edges of the vibrating vocal folds. The developed algorithm was able to accurately track the vocal fold edges across frames with low computational cost and high robustness against image noise. This algorithm offers a fully automated tool for analyzing the vibratory features of vocal folds in connected speech

An Empirical Taxonomy of Hospital Governing Board Roles

To develop a taxonomy of governing board roles in U.S. hospitals. Data Sources . 2005 AHA Hospital Governance Survey, 2004 AHA Annual Survey of Hospitals, and Area Resource File. Study Design . A governing board taxonomy was developed using cluster analysis. Results were validated and reviewed by industry experts. Differences in hospital and environmental characteristics across clusters were examined. Data Extraction Methods . One-thousand three-hundred thirty-four hospitals with complete information on the study variables were included in the analysis. Principal Findings . Five distinct clusters of hospital governing boards were identified. Statistical tests showed that the five clusters had high internal reliability and high internal validity. Statistically significant differences in hospital and environmental conditions were found among clusters. Conclusions . The developed taxonomy provides policy makers, health care executives, and researchers a useful way to describe and understand hospital governing board roles. The taxonomy may also facilitate valid and systematic assessment of governance performance. Further, the taxonomy could be used as a framework for governing boards themselves to identify areas for improvement and direction for change.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/75623/1/j.1475-6773.2008.00835.x.pd

Cepstral analysis of hypokinetic and ataxic voices : correlations with perceptual and other acoustic measures

To investigate the validity of cepstral analyses against other conventional acoustic measures of voice quality in determining the perceptual impression in different motor speech disorders—hypokinetic and ataxic dysarthria, and speech tasks—prolonged vowels and connected speech. Prolonged vowel productions and connected speech samples (reading passages and monologues) from 43 participants with Parkinson disease and 10 speakers with ataxia were analyzed perceptually by a trained listener using GRBAS. In addition, acoustic measures of cepstral peak prominence (CPP), smoothed CPP (CPPs), harmonics-to-noise ratio (HNR), shimmer %, shimmer dB, amplitude perturbation quotient (APQ), relative average perturbation (RAP), jitter, and pitch perturbation quotient (PPQ) were performed. Statistical analysis involved correlations between perceptual and acoustic measures, as well as determination of differences across speaker groups and elicitation tasks. CPP and CPPs results showed greater levels of correlation with overall dysphonia, breathiness, and asthenia ratings than the other acoustic measures, except in the case of roughness. Sustained vowel production produced a higher number of significant correlations across all parameters other than connected speech, but task choice did not affect CPP and CPPs results. There were no significant differences in any parameters across the two speaker groups. The results of this study are consistent with the results of other studies investigating the same measures in speakers with nonmotor-related voice pathologies. In addition, there was an indication that they performed better in relation to asthenia, which might be particularly relevant for the current speaker group. The results support the clinical and research use of CPP and CPPs as a quantitative measure of voice quality in populations with motor speech disorder

Is voice a marker for autism spectrum disorder? A systematic review and meta-analysis

Individuals with Autism Spectrum Disorder (ASD) tend to show distinctive, atypical acoustic patterns of speech. These behaviours affect social interactions and social development and could represent a non-invasive marker for ASD. We systematically reviewed the literature quantifying acoustic patterns in ASD. Search terms were: (prosody OR intonation OR inflection OR intensity OR pitch OR fundamental frequency OR speech rate OR voice quality OR acoustic) AND (autis* OR Asperger). Results were filtered to include only: empirical studies quantifying acoustic features of vocal production in ASD, with a sample size > 2, and the inclusion of a neurotypical comparison group and/or correlations between acoustic measures and severity of clinical features. We identified 34 articles, including 30 univariate studies and 15 multivariate machine-learning studies. We performed metaanalyses of the univariate studies, identifying significant differences in mean pitch and pitch range between individuals with ASD and comparison participants (Cohen’s d of 0.4-0.5 and discriminatory accuracy of about 61-64%). The multivariate studies reported higher accuracies than the univariate studies (63-96%). However, the methods used and the acoustic features investigated were too diverse for performing meta-analysis. We conclude that multivariate studies of acoustic patterns are a promising but yet unsystematic avenue for establishing ASD markers. We outline three recommendations for future studies: open data, open methods, and theory-driven research

Cantor Digitalis: chironomic parametric synthesis of singing

Cantor Digitalis is a performative singing synthesizer that is composed of two main parts: a chironomic control interface and a parametric voice synthesizer. The control interface is based on a pen/touch graphic tablet equipped with a template representing vocalic and melodic spaces. Hand and pen positions, pen pressure, and a graphical user interface are assigned to specific vocal controls. This interface allows for real-time accurate control over high-level singing synthesis parameters. The sound generation system is based on a parametric synthesizer that features a spectral voice source model, a vocal tract model consisting of parallel filters for vocalic formants and cascaded with anti-resonance for the spectral effect of hypo-pharynx cavities, and rules for parameter settings and source/filter dependencies between fundamental frequency, vocal effort, and formants. Because Cantor Digitalis is a parametric system, every aspect of voice quality can be controlled (e.g., vocal tract size, aperiodicities in the voice source, vowels, and so forth). It offers several presets for different voice types. Cantor Digitalis has been played on stage in several public concerts, and it has also been proven to be useful as a tool for voice pedagogy. The aim of this article is to provide a comprehensive technical overview of Cantor Digitalis

eHealth interventions for the prevention and treatment of overweight and obesity in adults: A systematic review with meta-analysis

A systematic review of randomized controlled trials was conducted to evaluate the effectiveness of eHealth interventions for the prevention and treatment of overweight and obesity in adults. Eight databases were searched for studies published in English from 1995 to 17September 2014. Eighty-four studies were included, with 183 intervention arms, of which 76% (n=139) included an eHealth component. Sixty-one studies had the primary aim of weight loss, 10 weight loss maintenance, eight weight gain prevention, and five weight loss and maintenance. eHealth interventions were predominantly delivered using the Internet, but also email, text messages, monitoring devices, mobile applications, computer programs, podcasts and personal digital assistants. Forty percent (n=55) of interventions used more than one type of technology, and 43.2% (n=60) were delivered solely using eHealth technologies. Meta-analyses demonstrated significantly greater weight loss (kg) in eHealth weight loss interventions compared with control (MD -2.70 [-3.33,-2.08], P<0.001) or minimal interventions (MD -1.40 [-1.98,-0.82], P<0.001), and in eHealth weight loss interventions with extra components or technologies (MD 1.46 [0.80, 2.13], P<0.001) compared with standard eHealth programmes. The findings support the use of eHealth interventions as a treatment option for obesity, but there is insufficient evidence for the effectiveness of eHealth interventions for weight loss maintenance or weight gain prevention