Foreign accent strength and intelligibility at the segmental level

The relationship between strength of foreign accent and intelligibility is not straightforward. This relationship resists a simple characterisation due in part to the multiplicity of cues that carry accent in the word- and sentence-level materials typically used in the study of accent. One of the principal conveyors of accent is the phonetic segment. The current study attempts to isolate this segmental contribution to foreign accent and consequently measure the relationship between segmental accent and intelligibility for listeners with differing linguistic correspondence to the target and accented language. English, Spanish and Czech listeners identified English words in which the initial consonant was either intact, or had been replaced by a Spanish-accented counterpart; in a second task, they rated the accent strength of the same tokens. All speech material was produced by an English-Spanish bilingual talker. Overall, Spanish listeners displayed a smaller loss of intelligibility due to the accented segment than native English listeners, while the Czech cohort experienced the largest intelligibility loss. However, the relationship between accent strength and intelligibility loss was not linear, varying with phoneme identity and its role in a listener’s first language. These findings suggest that how accented and intelligible a sound is depends strongly on the interactions between the phonological systems of speakers and listener

Is segmental foreign accent perceived categorically?

The second language learning process involves acquisition of sounds that differ to varying degrees from the sounds of a learner’s native language. Learners’ productions are strongly influenced by their native language par- ticularly for sounds which are similar but non-identical in the two languages. However, foreign accent is typically investigated at the level of utterances and as a consequence the segmental basis of foreign accent and its role in communication remain unclear. The principal issues addressed by the current study are whether accentedness at the segmental level is judged categorically by native listeners, and whether consonantal and vocalic segments are treated similarly. British English listeners judged as native or non-native a series of words in which a single vowel or consonant had been replaced by its Spanish-accented counterpart. The degree of segment accent was varied in equal amounts along a 21-step continuum using a blending technique based on native and non-native segments excised from words spoken by a balanced bilingual talker. Listeners assessed 24 distinct consonant and vowel continua. Averaged across all vowel or consonant continua, listeners’ nativeness judgements varied with segment nativeness in a non-categorical fashion. However, most individual consonant continua, as well as those vowel continua that involved durational changes, were perceived categorically. These results suggest that while overall segment-level foreign accent might be considered to vary in degree, in reality at the level of individ- ual segments –where second language learners’ pronunciation awareness and control has to be focussed–small acoustic changes can convey a foreign accent.This work was funded by the Spanish MINECO project DIACEX (FFI2012-31597)

Anticoagulant treatment and survival in cancer patients. The evidence from clinical studies

The association between cancer and an increased incidence of venous thromboembolism (Trousseau syndrome) is well characterized and recent studies have shown that the hemostatic system plays a key role at different stages in the process of tumorigenesis. Anticoagulant drugs therefore appear to be an attractive strategy in cancer therapy, with an effect that would surpass the benefit of preventing thrombosis. This hypothesis was initially supported by the post-hoc analysis of clinical trials not primarily designed to evaluate the effect of anticoagulants, mainly low molecular weight heparins (LMWH), on cancer survival. Other studies regarding the addition of unfractionated heparin or oral anticoagulants to standard cancer treatment offered controversial results. However, recent investigations among cancer patients without deep venous thrombosis, with cancer-related mortality as the primary end point, suggest that at least in some patients LMWH may exert an antineoplastic effect in vivo and alter the natural history of malignant disease by increasing the response rates and, therefore, improving survival. Additional research on this field is needed to clarify the biological mechanisms involved and to answer yet unsolved questions such as the types of tumor and stages of disease most suitable for this treatment as well as how to optimize treatment regimens

Generating segmental foreign accent

For most of us, speaking in a non-native language involves deviating to some extent from native pronunciation norms. However, the detailed basis for foreign accent (FA) remains elusive, in part due to methodological challenges in isolating segmental from suprasegmental factors. The current study examines the role of segmental features in conveying FA through the use of a generative approach in which accent is localised to single consonantal segments. Three techniques are evaluated: the first requires a highly-proficiency bilingual to produce words with isolated accented segments; the second uses cross-splicing of context-dependent consonants from the non-native language into native words; the third employs hidden Markov model synthesis to blend voice models for both languages. Using English and Spanish as the native/non-native languages respectively, listener cohorts from both languages identified words and rated their degree of FA. All techniques were capable of generating accented words, but to differing degrees. Naturally-produced speech led to the strongest FA ratings and synthetic speech the weakest, which we interpret as the outcome of over-smoothing. Nevertheless, the flexibility offered by synthesising localised accent encourages further development of the method

Regeneración meniscal tras extirpación completa del menisco medial y sustitución por una bandeleta de tendón rotuliano: Estudio experimental con conejos

Los autores estudian la regeneración meniscal tras meniscectomía total y sustitución del menisco por una plastia de tendón rotuliano. Realizan el estudio en 15 conejos, que fueron sacrificados a las 6 semanas (5 casos). Los estudios macroscópico e histológico de las piezas obtenidas tras el sacrificio demuestran que en el conejo adulto siempre se produce regeneración meniscal tras la extirpación total del menisco medial y sustitución por una plastia, aunque de menor tamaño que el menisco original resecado.The authors analyse the meniscal regeneration after complete menis-cectomy and posterior meniscal substitution by a patellar tendon plasty. The study is realized in15 rabbits that were sacrificed after 6 weeks (5 cases), 3 months (5 cases) and 6 months (5 cases). Macroscopic and histologic studies of the pieces obtained have demonstrated that in the adult rabbit meniscal regeneration is always produced after total meniscectomy of the medial meniscus and posterior substitution by patellar tendon plasty, but this meniscal regeneration is smaller than the resected primitive meniscus

Diagnóstico y tratamiento de la trombosis venosa profunda

Deep-vein thrombosis (DVT) is a common condition that can lead to complications such as postphlebitic syndrome, pulmonary embolism and death. Currently, an algorithm strategy combining pretest probability, D-dimer testing and compression ultrasonography imaging allows for safe and convenient estimation of suspected lower-limb thrombosis. The mainstay of treatment is anticoagulation therapy. The use of low-molecular-weight heparin or pentasaccharide (fondaparinux) allows for outpatient management of most patients with DVT. The duration of anticoagulation depends on whether the primary event was idiopathic or secondary to a transient risk factor. Interventions such as thrombolysis and placement of inferior vena cava filter are reserved for special situations

PICO Questions and DELPHI Methodology for the Management of Venous Thromboembolism Associated with COVID-19

COVID-19; Anticoagulació; Malaltia tromboembòlica venosaCOVID-19; Anticoagulación; Enfermedad tromboembólica venosaCOVID-19; Anticoagulation; Venous thromboembolic diseasePatients with coronavirus disease 2019 (COVID-19) have a higher risk of venous thromboembolic disease (VTE) than patients with other infectious or inflammatory diseases, both as macrothrombosis (pulmonar embolism and deep vein thrombosis) or microthrombosis. However, the use of anticoagulation in this scenario remains controversial. This is a project that used DELPHI methodology to answer PICO questions related to anticoagulation in patients with COVID-19. The objective was to reach a consensus among multidisciplinary VTE experts providing answers to those PICO questions. Seven PICO questions regarding patients with COVID-19 responded with a broad consensus: 1. It is recommended to avoid pharmacological thromboprophylaxis in most COVID-19 patients not requiring hospital admission; 2. In most hospitalized patients for COVID-19 who are receiving oral anticoagulants before admission, it is recommended to replace them by low molecular weight heparin (LMWH) at therapeutic doses; 3. Thromboprophylaxis with LMWH at standard doses is suggested for COVID-19 patients admitted to a conventional hospital ward; 4. Standard-doses thromboprophylaxis with LMWH is recommended for COVID-19 patients requiring admission to Intensive Care Unit; 5. It is recommended not to determine D-Dimer levels routinely in COVID-19 hospitalized patients to select those in whom VTE should be suspected, or as a part of the diagnostic algorithm to rule out or confirm a VTE event; 6. It is recommended to discontinue pharmacological thromboprophylaxis at discharge in most patients hospitalized for COVID-19; 7. It is recommended to withdraw anticoagulant treatment after 3 months in most patients with a VTE event associated with COVID-19. The combination of PICO questions and DELPHI methodology provides a consensus on different recommendations for anticoagulation management in patients with COVID-19.This work was carried out with the institutional support and unconditional financial assistance of Sanofi, which had no role in the design, interpretation, or writing of the manuscript

Perspectivas clínicas del manejo de la hemorragia en el paciente tratado con anticoagulante oral: estudio DECOVER

Objetivo. Evaluar el grado de acuerdo entre hematólogos y urgenciólogos respecto a las mejores prácticas para el manejo de hemorragias y la reversión de la anticoagulación oral. Método. Estudio Delphi multicéntrico español con médicos expertos en anticoagulación y manejo de hemorragias. Se realizaron dos rondas de preguntas entre abril y septiembre de 2015. Se obtenía consenso cuando el 75% o más de los panelistas puntuaban en el mismo tercil. Resultados. Se encuestó a 15 hematólogos y 17 urgenciólogos de 14 comunidades autónomas. La hemodiálisis y la administración de concentrados de complejo protrombínico (CCP) activado fueron tratamientos consensuados para antagonizar una hemorragia relevante/mayor en pacientes tratados con dabigatrán. Para rivaroxabán y apixabán solo se consideró el CCP. El panel no valoró ningún CCP como eficaz y seguro a la vez. Los tiempos de tromboplastina parcial activado, trombina, ecarina y de trombina diluido se indicaron para pacientes tratados con dabigatrán y la actividad anti-Xa específica para los tratados con rivaroxabán y apixabán cuando presentan una hemorragia. Disponer de un antídoto específico para el tratamiento de los anticoagulantes orales de acción directa (ACOD) sería útil en caso de hemorragia grave (97%) y supondría un cambio sustancial en el algoritmo de tratamiento actual (97%). Conclusiones. Los resultados estuvieron en general alineados con las guías de práctica clínica, pero mostraron que existen áreas de mejora en la unificación de criterios sobre el manejo de los pacientes con hemorragias, y destacan la necesidad de disponer de antídotos específicos para ACOD

Cancer-Associated Thrombosis : Beyond Clinical Practice Guidelines-A Multidisciplinary (SEMI-SEOM-SETH) Expert Consensus

Altres ajuts: This work has been performed with an unrestricted grant from Aspen, Leo-Pharma, Laboratorios Farmacéuticos Rovi, and Sanofi.Despite the growing interest and improved knowledge about venous thromboembolism in cancer patients in the last years, there are still many unsolved issues. Due to the limitations of the available literature, evidence-based clinical practice guidelines are not able to give solid recommendations for challenging scenarios often present in the setting of cancer-associated thrombosis (CAT). A multidisciplinary expert panel from three scientific societies-Spanish Society of Internal Medicine (SEMI), Spanish Society of Medical Oncology (SEOM), and Spanish Society Thrombosis and Haemostasis (SETH)-agreed on 12 controversial questions regarding prevention and management of CAT, which were thoroughly reviewed to provide further guidance. The suggestions presented herein may facilitate clinical decisions in specific complex circumstances, until these can be made leaning on reliable scientific evidence