Acoustic Intensity and Speech Breathing Kinematics in a Patient with Parkinson’s Disease

Parkinson’s disease (PD) is a neurodegenerative disease which affects the basal ganglia control circuit (Duffy, 2013). The motor speech disorder most strongly associated with PD is hypokinetic dysarthria, which presents with distinctive speech characteristics including reduced loudness and the inability to adequately maintain loud speech (Darley, Aronson, & Brown 1969; Duffy 2013). This is due to the variable kinematics for speech breathing associated with PD, which may result in abnormal muscular excursions, reduced vital capacity, and irregular breathing cycles (Duffy, 2013). The impaired ventilatory control can be attributed to the rigidity of muscles of inhalation and exhalation, as well as bradykinesia and hypokinesia. The study aimed to evaluate whether a patient with PD was able to manipulate their acoustic intensity, and if such intensity changes were accompanied by changes in speech breathing kinematics in a novel intraoperative environment. The study’s data were collected intra-operatively during surgery for deep brain stimulation and recordings from the subthalamic nucleus and cortex. The patient was instructed to modulate acoustic intensity while repeating three syllable CV triplets. Speech breathing kinematics of the rib cage were obtained using a Piezo Crystal Effort Sensor with a double buckle band throughout speech production. The speech breathing kinematics of interest were duration, displacement, and peak velocity of inhalation, peak velocity of exhalation, and duration from onset of exhalation to onset of speech, as well as a descriptive comparison between tidal breathing and speech breathing. Spearman Rho correlations indicated that there were weak to no relationships observed between speech breathing kinematics and intensity in this specific participant. However, a medium effect size (Hedge’s g) was observed between tidal and speech breathing for inhalation duration, and small to medium effect size for inhalation displacement and peak velocity. While previous literature suggests that people with PD can manipulate intensity when cued as a result of kinematic modulations for speech breathing, the current study does not support these findings for this one patient. However, previously reported differences between tidal and speech breathing were supported. Potential explanations for the lack of intensity modulation are explored, including constraints induced by the intra-operative environment

Aligning National Approaches to Digital Preservation

The "Aligning National Approaches to Digital Preservation" (ANADP) conference was held at the National Library of Estonia, from May 23-25, 2011. More than 125 delegates from more than 20 countries were gathered in Tallinn, Estonia and explored how to create and sustain international collaborations to support the preservation of digital cultural memory. This publication contains a collection of peer-reviewed essays that were developed by conference panels and attendees in the months following ANADP

Automated detection of bird roosts using NEXRAD radar data and Convolutional neural networks

Although NEXRAD radars have proven to be an effective tool for detecting airborne animals, detecting biological phenomena in radar images often involves a manual, time‐ consuming data‐extraction process. This paper focuses on applying machine learning to automatically find radar data that snapshots large aggregations of birds (specifically Purple Martins and Tree Swallows) as they depart en masse from roosting sites. These aggregations are evident in radar images as rings of elevated reflectivity that appear early in the morning as birds depart from roost sites. Our goal was to develop an algorithm that could determine whether an individual radar image contained at least one Purple Martin or Tree Swallow roost. We use a dataset of known roost locations to train three machine learning algorithms that employed (1) a traditional Artificial Neural Network (ANN), (2) a sophisticated preexisting Convolutional Neural Network (CNN) called Inception‐v3, and (3) a shallow CNN built from scratch. The resulting programs were all effective at finding bird roosts, with both the shallow CNN and the Inception‐v3 network making correct determinations about 90 per cent of the time with an AUC above .9. To the best of our knowledge, this study is the first to apply neural networks in the analysis of bird roosts in radar imagery, and these analytical tools offer new avenues of research into the ecology and behavior of flying animals, with practical applications to wind farm placement, air traffic administration and wildlife conservation. The NEXRAD radar network offers a tremendous archive of continental‐scale data and has the potential to capture entire vertebrate populations. We apply existing machine learning models to a new dataset which constitutes a valuable approach to extracting information from this archive.The funding from the NSF-DGE-1545261 grant helped make this research possible. We thank Sandra Pletschet for her time spent collecting the roost data and Dr. Phillip Chilson for his advice on the project. Some of the computing for this project was performed at the OU Supercomputing Center for Education & Research (OSCER) at the University of Oklahoma (OU). Article processing charges for this publication funded in part by the University of Oklahoma Libraries Open Access Fund.Ye

Politics, policies, and patient care: Rehabilitation therapists' experiences during the COVID-19 Pandemic

The year 2020 represents a historically turbulent period for the United States marked by the COVID-19 pandemic, a contentious political season, and heightened awareness of racism among citizens. This intersection of medicine, politics, and social unrest generated a demanding clinical environment for healthcare workers, including understudied groups such as physical therapists, occupational therapists, and speech-language pathologists. This descriptive qualitative study focused on experiences and perspectives of clinical rehabilitation therapists working in inpatient rehabilitation and acute-care units from September to November, 2020. Thirteen participants completed individual, semi-structured interviews focused on clinical practice and coping strategies. The analysis included a multi-step, inductive process. Four interconnecting factors chronicling participants' experiences emerged: sociopolitical, institutional, hospital unit, and personal. Stressors and buffers were noted that further shaped individual experiences. Utilization of an ecological framework provided a way to recognize the impact of a complex range of social and environmental factors affecting participants' experiences on personal and professional levels. Awareness of rehabilitation therapists' experiences enriches understanding of the pandemic's effect on healthcare workers and presents clinical implications for healthcare systems to promote therapist well-being

Increasing Efficiency and Quality by Consolidation of Clinical Chemistry and Immunochemistry Systems with MODULAR ANALYTICS SWA

MODULAR ANALYTICS Serum Work Area (in USA Integrated MODULAR ANALYTICS, MODULAR ANALYTICS is a trademark of a member of the Roche Group) represents a further approach to automation in the laboratory medicine. This instrument combines previously introduced modular systems for the clinical chemistry and immunochemistry laboratory and allows customised combinations for various laboratory workloads. Functionality, practicability, and workflow behaviour of MODULAR ANALYTICS Serum Work Area were evaluated in an international multicenter study at six laboratories. Across all experiments, 236000 results from 32400 samples were generated using 93 methods. Simulated routine testing which included provocation incidents and anomalous situations demonstrated good performance and full functionality. Heterogeneous immunoassays, performed on the E-module with the electrochemiluminescence technology, showed reproducibility at the same level of the general chemistry tests, which was well within the clinical demands. Sample carryover cannot occur due to intelligent sample processing. Workflow experiments for the various module combinations, with menus of about 50 assays, yielded mean sample processing times of <38 minutes for combined clinical chemistry and immunochemistry requests; <50 minutes including automatically repeated samples. MODULAR ANALYTICS Serum Work Area offered simplified workflow by combining various laboratory segments. It increased efficiency while maintaining or even improving quality of laboratory processes

Treatment effect heterogeneity following type 2 diabetes treatment with GLP1-receptor agonists and SGLT2-inhibitors:a systematic review

Background: A precision medicine approach in type 2 diabetes requires the identification of clinical and biological features that are reproducibly associated with differences in clinical outcomes with specific anti-hyperglycaemic therapies. Robust evidence of such treatment effect heterogeneity could support more individualized clinical decisions on optimal type 2 diabetes therapy.Methods: We performed a pre-registered systematic review of meta-analysis studies, randomized control trials, and observational studies evaluating clinical and biological features associated with heterogenous treatment effects for SGLT2-inhibitor and GLP1-receptor agonist therapies, considering glycaemic, cardiovascular, and renal outcomes. After screening 5,686 studies, we included 101 studies of SGLT2-inhibitors and 75 studies of GLP1-receptor agonists in the final systematic review.Results: Here we show that the majority of included papers have methodological limitations precluding robust assessment of treatment effect heterogeneity. For SGLT2-inhibitors, multiple observational studies suggest lower renal function as a predictor of lesser glycaemic response, while markers of reduced insulin secretion predict lesser glycaemic response with GLP1-receptor agonists. For both therapies, multiple post-hoc analyses of randomized control trials (including trial meta-analysis) identify minimal clinically relevant treatment effect heterogeneity for cardiovascular and renal outcomes.Conclusions: Current evidence on treatment effect heterogeneity for SGLT2-inhibitor and GLP1-receptor agonist therapies is limited, likely reflecting the methodological limitations of published studies. Robust and appropriately powered studies are required to understand type 2 diabetes treatment effect heterogeneity and evaluate the potential for precision medicine to inform future clinical care.</p

Development of a treatment selection algorithm for SGLT2 and DPP-4 inhibitor therapies in people with type 2 diabetes:a retrospective cohort study

Background: Current treatment guidelines do not provide recommendations to support the selection of treatment for most people with type 2 diabetes. We aimed to develop and validate an algorithm to allow selection of optimal treatment based on glycaemic response, weight change, and tolerability outcomes when choosing between SGLT2 inhibitor or DPP-4 inhibitor therapies. Methods: In this retrospective cohort study, we identified patients initiating SGLT2 and DPP-4 inhibitor therapies after Jan 1, 2013, from the UK Clinical Practice Research Datalink (CPRD). We excluded those who received SGLT2 or DPP-4 inhibitors as first-line treatment or insulin at the same time, had estimated glomerular filtration rate (eGFR) of less than 45 mL/min per 1·73 m2, or did not have a valid baseline glycated haemoglobin (HbA1c) measure (&lt;53 or ≥120 mmol/mol). The primary efficacy outcome was the HbA1c value reached 6 months after drug initiation, adjusted for baseline HbA1c. Clinical features associated with differential HbA1c outcome on the two therapies were identified in CPRD (n=26 877), and replicated in reanalysis of 14 clinical trials (n=10 414). An algorithm to predict individual-level differential HbA1c outcome on the two therapies was developed in CPRD (derivation; n=14 069) and validated in head-to-head trials (n=2499) and CPRD (independent validation; n=9376). In CPRD, we further explored heterogeneity in 6-month weight change and treatment discontinuation. Findings: Among 10 253 patients initiating SGLT2 inhibitors and 16 624 patients initiating DPP-4 inhibitors in CPRD, baseline HbA1c, age, BMI, eGFR, and alanine aminotransferase were associated with differential HbA1c outcome with SGLT2 inhibitor and DPP-4 inhibitor therapies. The median age of participants was 62·0 years (IQR 55·0–70·0). 10 016 (37·3%) were women and 16 861 (62·7%) were men. An algorithm based on these five features identified a subgroup, representing around four in ten CPRD patients, with a 5 mmol/mol or greater observed benefit with SGLT2 inhibitors in all validation cohorts (CPRD 8·8 mmol/mol [95% CI 7·8–9·8]; CANTATA-D and CANTATA-D2 trials 5·8 mmol/mol [3·9–7·7]; BI1245.20 trial 6·6 mmol/mol [2·2–11·0]). In CPRD, predicted differential HbA1c response with SGLT2 inhibitor and DPP-4 inhibitor therapies was not associated with weight change. Overall treatment discontinuation within 6 months was similar in patients predicted to have an HbA1c benefit with SGLT2 inhibitors over DPP-4 inhibitors (median 15·2% [13·2–20·3] vs 14·4% [12·9–16·7]). A smaller subgroup predicted to have greater HbA1c reduction with DPP-4 inhibitors were twice as likely to discontinue SGLT2 inhibitors than DPP-4 inhibitors (median 26·8% [23·4–31·0] vs 14·8% [12·9–16·8]). Interpretation: A validated treatment selection algorithm for SGLT2 inhibitor and DPP-4 inhibitor therapies can support decisions on optimal treatment for people with type 2 diabetes. Funding: BHF-Turing Cardiovascular Data Science Award and the UK Medical Research Council

The Effectiveness of Alcohol Screening and Brief Intervention in Emergency Departments: A Multicentre Pragmatic Cluster Randomized Controlled Trial

BACKGROUND: Alcohol misuse is common in people attending emergency departments (EDs) and there is some evidence of efficacy of alcohol screening and brief interventions (SBI). This study investigated the effectiveness of SBI approaches of different intensities delivered by ED staff in nine typical EDs in England: the SIPS ED trial. METHODS AND FINDINGS: Pragmatic multicentre cluster randomized controlled trial of SBI for hazardous and harmful drinkers presenting to ED. Nine EDs were randomized to three conditions: a patient information leaflet (PIL), 5 minutes of brief advice (BA), and referral to an alcohol health worker who provided 20 minutes of brief lifestyle counseling (BLC). The primary outcome measure was the Alcohol Use Disorders Identification Test (AUDIT) status at 6 months. Of 5899 patients aged 18 or more presenting to EDs, 3737 (63·3%) were eligible to participate and 1497 (40·1%) screened positive for hazardous or harmful drinking, of whom 1204 (80·4%) gave consent to participate in the trial. Follow up rates were 72% (n?=?863) at six, and 67% (n?=?810) at 12 months. There was no evidence of any differences between intervention conditions for AUDIT status or any other outcome measures at months 6 or 12 in an intention to treat analysis. At month 6, compared to the PIL group, the odds ratio of being AUDIT negative for brief advice was 1·103 (95% CI 0·328 to 3·715). The odds ratio comparing BLC to PIL was 1·247 (95% CI 0·315 to 4·939). A per protocol analysis confirmed these findings. CONCLUSIONS: SBI is difficult to implement in typical EDs. The results do not support widespread implementation of alcohol SBI in ED beyond screening followed by simple clinical feedback and alcohol information, which is likely to be easier and less expensive to implement than more complex interventions

Alcohol-related risk and harm amongst young offenders aged 11-17

The authors affiliations can be found at the end of this article. Abstract Purpose -The purpose of this paper is to examine the prevalence of alcohol use disorders (AUDs) amongst young people in the criminal justice system (CJS) in the North East of England and to compare the ability of the Alcohol Use Disorders Identification Test (AUDIT) to the Youth Justice Board ASSET tool in identifying alcohol-related need in Youth Offending Team (YOT) clients. Design/methodology/approach -A validated screening tool (AUDIT) was used to identify alcohol-related health risk or harm. Findings from AUDIT were compared with those of the standard criminogenic risk screening tool used in CJS (ASSET). An anonymous cross-sectional questionnaire was administered during a one-month period in 2008. The questionnaires were completed by 11-17-year-old offenders who were in contact with three YOTs, one Youth Offending Institution and one Secure Training Estate. Findings -In total, 429 questionnaires were completed out of a possible 639 (67 per cent). The majority (81 per cent) of the young offenders were identified as experiencing alcohol-related health risk or harm and 77 per cent scored within a possibly alcohol-dependent range. In total, 77 (30 per cent) of young people completing both assessments were identified as having an AUD by AUDIT but not identified as needing alcohol-related treatment using ASSET. Research limitations/implications -This research was confined to one geographical area of England, however, the results show that even in this area of high drinking by young people the levels of AUDs amongst young people in the CJS are very high. Social implications -There are major social implications to this research. It is imperative for changes to be made to the care pathways in place in the UK for young people coming through the CJS with alcohol-related issues. Originality/value -This paper adds to the evidence base by using well-validated tools to measure alcohol use amongst young people in the CJS in the UK

Climate challenges, vulnerabilities, and food security

This paper identifies rare climate challenges in the long-term history of seven areas, three in the subpolar North Atlantic Islands and four in the arid-to-semiarid deserts of the US Southwest. For each case, the vulnerability to food shortage before the climate challenge is quantified based on eight variables encompassing both environmental and social domains. These data are used to evaluate the relationship between the &ldquo;weight&rdquo; of vulnerability before a climate challenge and the nature of social change and food security following a challenge. The outcome of this work is directly applicable to debates about disaster management policy