Brittany Bernal - Sensorimotor Adaptation of Vowel Production in Stop Consonant Contexts

The purpose of this research is to measure the compensatory and adaptive articulatory response to shifted formants in auditory feedback to compare the resulting amount of sensorimotor learning that takes place in speakers upon saying the words /pep/ and /tet/. These words were chosen in order to analyze the coarticulatory effects of voiceless consonants /p/ and /t/ on sensorimotor adaptation of the vowel /e/. The formant perturbations were done using the Audapt software, which takes an input speech sample and plays it back to the speaker in real-time via headphones. Formants are high-energy acoustic resonance patterns measured in hertz that reflect positions of articulators during the production of speech sounds. The two lowest frequency formants (F1 and F2) can uniquely distinguish among the vowels of American English. For this experiment, Audapt shifted F1 down and F2 up, and those who adapt were expected to shift in the opposite direction of the perturbation. The formant patterns and vowel boundaries were analyzed using TF32 and S+ software, which led to conclusions about the adaptive responses. Manipulating auditory feedback by shifting formant values is hypothesized to elicit sensorimotor adaptation, a form of short-term motor learning. The amount of adaptation is expected to be greater for the word /pep/ rather than /tet/ because there is less competition for articulatory placement of the tongue during production of bilabial consonants. This methodology could be further developed to help those with motor speech disorders remedy their speech errors with much less conscious effort than traditional therapy techniques.https://epublications.marquette.edu/mcnair_2013/1008/thumbnail.jp

Brittany Bernal - Sensorimotor Adaptation of Speech Through a Virtually Shortened Vocal Tract

The broad objective of this line of research is to understand how auditory feedback manipulations may be used to elicit involuntary changes in speech articulation. We examine speech sensorimotor adaptation to supplement the development of speech rehabilitation applications that benefit from this learning phenomenon. By manipulating the acoustics of one’s auditory feedback, it is possible to elicit involuntary changes in speech articulation. We seek to understand how virtually manipulating participants’ perception of vowel space affects their speech movements by assessing acoustic variables such as formant frequency changes. Participants speak through a digital audio processing device that virtually alters the perceived size of their vocal tract. It is hypothesized that this modification to auditory feedback will facilitate adaptive changes in motor behavior as indicated by acoustic changes resulting from speech articulation. This study will determine how modifying the perception of vocal tract size affects articulatory behavior, indicated by changes in formant frequencies and changes in vowel space area. This work will also determine if and how the size of the virtual vowel space affects the magnitude and direction of sensorimotor adaptation for speech. The ultimate aim is to determine how important it is for the virtual vowel space to mimic the talker’s real vowel space, and whether or not perturbing the size of the perceived vowel space may facilitate or impede involuntary adaptive learning for speech. Sensorimotor Adaptation of Speech Through a Virtually Shortened Vocal Tract by Brittany Bernal is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.https://epublications.marquette.edu/mcnair_2014/1009/thumbnail.jp

Consonant Context Effects on Vowel Sensorimotor Adaptation

Speech sensorimotor adaptation is the short-term learning of modified articulator movements evoked through sensory-feedback perturbations. A common experimental method manipulates acoustic parameters, such as formant frequencies, using real time resynthesis of the participant\u27s speech to perturb auditory feedback. While some studies have examined phrases comprised of vowels, diphthongs, and semivowels, the bulk of research on auditory feedback-driven sensorimotor adaptation has focused on vowels in neutral contexts (/hVd/). The current study investigates coarticulatory influences of adjacent consonants on sensorimotor adaptation. The purpose is to evaluate differences in the adaptation effects for vowels in consonant environments that vary by place and manner of articulation. In particular, we addressed the hypothesis that contexts with greater intra-articulator coarticulation and more static articulatory postures (alveolars and fricatives) offer greater resistance to vowel adaptation than contexts with primarily inter-articulator coarticulation and more dynamic articulatory patterns (bilabials and stops). Participants completed formant perturbation-driven vowel adaptation experiments for varying CVCs. Results from discrete formant measures at the vowel midpoint were generally consistent with the hypothesis. Analyses of more complete formant trajectories suggest that adaptation can also (or alternatively) influence formant onsets, offsets, and transitions, resulting in complex formant pattern changes that may reflect modifications to consonant articulatio

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Hit me with your Best Shot: A Comparison of the Z-track and Air-bubble Intramuscular Injection Techniques

The nursing profession has a long history of using the traditional methods of intramuscular injections (IM), including the z-track and air-bubble methods. This evidence-based project examined the PICOT question: In the adult patient, how does the z-track method compare to the air-bubble method when preventing seepage of medication and patient pain via intramuscular injections? An extensive literature review was conducted using medical databases including: CINAHL, EbscoHOST, and Medline. From these databases, eleven articles were located and five were selected for review. Of the five articles examined, four randomized control trials indicated that the z-track method reduces patient pain and prevents the seepage of medication. Current research indicates that nurses should administer IM injections via the z-track method; however, more research is needed to further influence evidence-based practice

Acute Effects of Concurrent Exercise on Biomarkers of Angiogenesis and Cardioprotection in Sedentary Adults: Preliminary Findings

There is evidence that performing brief bouts of aerobic-type exercise before each set of resistance exercise (i.e., integrated concurrent exercise) leads to superior health and fitness outcomes than when the modalities are performed independently (i.e., serial concurrent exercise). This advantage may be due in part to an exaggeration of functional hyperemia leading to an augmented cardiovascular adaptive response. PURPOSE: To analyze circulating levels of an endothelial shear stress-induced biomarker (microRNA-126) and a biomarker of cardiovascular development (microRNA-222) before and after volume- and time-matched serial and integrated concurrent exercise sessions in young, healthy, sedentary adults. METHODS: One female and three male participants (age = 27.8 ± 6 yrs; height = 172.8 ± 4.6 cm; weight = 71.8 ± 17.6 kg; BMI = 23.9 ± 4.9 kg/m2; VO2max = 30.13 ± 4.92 ml/kg/min) who were healthy and had performed no more than 1 hr of structured physical activity per week over the previous year completed all procedures. Participants performed one-repetition maximum tests on the Leg Press, Leg Curl, and Leg Extension exercises, and also completed a maximal cycling test. At least one week after testing, participants performed one of two exercise patterns: 3 sets of 10 repetitions of each resistance exercise followed by 20 min of cycling (serial), or 2 min of cycling performed before each set of resistance exercise (integrated). At least three weeks after the first exercise session, the participants performed the other session. Blood was collected before each exercise session, immediately after each exercise session, and 1 and 3 hours after each exercise session. RNA was extracted from the frozen plasma samples and microRNAs were quantified using PCR analysis. Values were normalized to a spike-in control and adjusted for plasma volume shifts. Fold-change of target microRNAs from baseline were calculated. Data were analyzed using a two-way ANOVA with repeated measures. Significance was set at 0.05. RESULTS: MicroRNA-126 changed 0.24 vs. 1.70-fold immediately post-exercise, 0.23 vs 0.75-fold 1 hr post-exercise, and 0.26 vs. 1.29-fold 3 hr post-exercise following serial and integrated concurrent exercise, respectively. There was no time effect (p = 0.34), no exercise effect (p = 0.85), and no interaction effect (p = 0.58). MicroRNA-222 changed 0.20 vs. 3.07-fold immediately post-exercise, 0.21 vs 1.21-fold 1 hr post-exercise, and 0.22 vs. 2.09-fold 3 hr post-exercise following serial and integrated concurrent exercise, respectively. There was no time effect (p = 0.26), no exercise effect (p = 0.73), and no interaction effect (p = 0.41). CONCLUSION: Although not statistically significant, a more robust response from integrated concurrent exercise compared to serial concurrent exercise was observed. At this early stage, it is unclear if these results will persist with the addition of more participants

Delaying surgery for patients with a previous SARS-CoV-2 infection

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A multinational Delphi consensus to end the COVID-19 public health threat

Abstract Despite notable scientific and medical advances, broader political, socioeconomic and behavioural factors continue to undercut the response to the COVID-19 pandemic . Here we convened, as part of this Delphi study, a diverse, multidisciplinary panel of 386 academic, health, non-governmental organization, government and other experts in COVID-19 response from 112 countries and territories to recommend specific actions to end this persistent global threat to public health. The panel developed a set of 41 consensus statements and 57 recommendations to governments, health systems, industry and other key stakeholders across six domains: communication; health systems; vaccination; prevention; treatment and care; and inequities. In the wake of nearly three years of fragmented global and national responses, it is instructive to note that three of the highest-ranked recommendations call for the adoption of whole-of-society and whole-of-government approaches , while maintaining proven prevention measures using a vaccines-plus approach that employs a range of public health and financial support measures to complement vaccination. Other recommendations with at least 99% combined agreement advise governments and other stakeholders to improve communication, rebuild public trust and engage communities in the management of pandemic responses. The findings of the study, which have been further endorsed by 184 organizations globally, include points of unanimous agreement, as well as six recommendations with >5% disagreement, that provide health and social policy actions to address inadequacies in the pandemic response and help to bring this public health threat to an end

A multinational Delphi consensus to end the COVID-19 public health threat

Abstract Despite notable scientific and medical advances, broader political, socioeconomic and behavioural factors continue to undercut the response to the COVID-19 pandemic 1,2 . Here we convened, as part of this Delphi study, a diverse, multidisciplinary panel of 386 academic, health, non-governmental organization, government and other experts in COVID-19 response from 112 countries and territories to recommend specific actions to end this persistent global threat to public health. The panel developed a set of 41 consensus statements and 57 recommendations to governments, health systems, industry and other key stakeholders across six domains: communication; health systems; vaccination; prevention; treatment and care; and inequities. In the wake of nearly three years of fragmented global and national responses, it is instructive to note that three of the highest-ranked recommendations call for the adoption of whole-of-society and whole-of-government approaches 1 , while maintaining proven prevention measures using a vaccines-plus approach 2 that employs a range of public health and financial support measures to complement vaccination. Other recommendations with at least 99% combined agreement advise governments and other stakeholders to improve communication, rebuild public trust and engage communities 3 in the management of pandemic responses. The findings of the study, which have been further endorsed by 184 organizations globally, include points of unanimous agreement, as well as six recommendations with >5% disagreement, that provide health and social policy actions to address inadequacies in the pandemic response and help to bring this public health threat to an end