A longitudinal study of very young children's vowel production.

PURPOSE: Ecologically realistic, spontaneous, adult-directed, longitudinal speech data of young children were described by acoustic analyses. METHOD: The first 2 formant frequencies of vowels produced by 6 children from different American English dialect regions were analyzed from ages 18 to 48 months. The vowels were from largely conversational contexts and were classified according to dictionary pronunciation. RESULTS: Within-subject formant frequency variability remained relatively constant for the span of ages studied. It was often difficult to detect overall decreases in the first 2 formant frequencies between ages 30 and 48 months. A study of the movement of the corner vowels with respect to the vowel centroid showed that the shape of the vowel space remained qualitatively constant from 30 through 48 months. CONCLUSIONS: The shape of the vowel space is established early in life. Some aspects of regional dialect were observed in some of the subjects at 42 months of age. The present study adds to the existing data on the development of vowel spaces by describing ecologically realistic speech.

Implications of peripheral muscular and anatomical development for the acquisition of lingual control for speech production: a review.

OBJECTIVES: Normally developing children learn to produce intelligible speech during rapid, non-uniform growth of their articulators and other vocal tract structures. The purpose of this review is to focus attention on the consequences of peripheral growth and development for the acquisition of lingual control for speech production. This paper (1) reviews physiological underpinnings of tongue shaping and movements that are likely to be changing in young children; (2) estimates, from previously published studies, the net consequences of growth of multiple vocal tract structures on lingual control; (3) integrates our findings with the example of [R] production, and (4) highlights areas where further investigations would be most helpful. PATIENTS AND METHODS: The authors searched the literature, including the PubMed database, for studies of the development of muscle proteins, muscle fibers, and motor units of the tongue, and of the growth of the tongue, jaw, adenoids, soft and hard palates, oral and pharyngeal cavities, and the vocal tract as a whole. CONCLUSIONS: Substantial anatomical and muscular data sets focused on children from 1-4 years of age, and rigorous definitions of the tongue boundaries are needed.

'The sick note': a qualitative study of sickness certification in general practice in Ireland.

BACKGROUND: Sickness certification is a common task undertaken by General Practitioners (GPs) in most developed countries. Research suggests that they find this task complex and difficult. Primary health care structures and sickness certification practices differ across Europe and little research explores GPs certifying practices in the Republic of Ireland. OBJECTIVES: The aim of the study was to explore GPs' views on sickness certification, the strategies used to issue sickness certificates to patients and scope for improvement in the current system. METHODS: A qualitative thematic approach used one to one in-depth interviews with 14 individual GPs, across 11 primary health care practices in Ireland. Analysis of the data was conducted using NVivo 8 qualitative software. RESULTS: GPs can find their role as certifier problematic, and a source of conflict during the consultation process with patients. GPs were concerned with breaching patient confidentiality and in particular disclosing illness to employers. They reported feeling inadequate in dealing with some cases requesting sickness leave, including certification for adverse social circumstances. Sickness certification was often given in response to patient demand. GPs felt a need for better communication between themselves, employers and relevant government departments. CONCLUSION: This study highlights the various complexities and challenges that GPs face when dealing with patients requiring sickness certification. Issues in assessment of fitness for work and problems within the social welfare structure were recurrent themes. The study highlights the opportunities to improve the system and how these might be achieved. Further research is now warranted in Ireland.

Sagittal area of the vocal tract in young female children.

OBJECTIVE: To measure the sagittal areas of the front and back cavities of the vocal tract in children acquiring speech. PATIENTS AND METHODS: Ten female children were selected from the Serial Experimental collection of the Burlington Growth Centre in Toronto, Canada. Each of the 10 children was seen annually from ages 3 through 8. Data collections included lateral cephalograms in occlusion. We traced those cephalograms and identified landmarks to delineate the front and back cavities. The sagittal areas of the front and back cavities were calculated. A measure of the angle of the head to the cervical vertebrae was made. RESULTS: Front cavities were larger and grew faster. For both front and back cavities, age, angle measure, and the interaction of age and angle measure were significant. CONCLUSION: Space available for the tongue to maneuver is greater anteriorly than posteriorly even when the jaw is maximally elevated.

Work related stress and European policy--a comparative exploration of contextual stressors in the rehabilitation sector in five European countries.

BACKGROUND: Dealing with work related stress is a declared priority of European Union mental health policy. A particularly under-researched sector in this regard is the community vocational support sector for people with mental health and intellectual disability problems. AIMS: To report on the organisational profile of the vocational support and rehabilitation sector for people with mental health and intellectual disabilities as this relates to occupational stress, in five European countries (Austria, Ireland, Italy, Romania and UK). METHODS: A sector profile questionnaire was distributed to representative organisations in five countries and a short face-to-face survey was conducted with 25 local managers (five from each country) to draw up a profile and facilitate a comparative description and analysis. RESULTS: It was found that there is no national and European data collected at any level in this sector upon which to base effective policy interventions to combat occupational stress specific to professionals working in this sector. Results indicate that the sector in a number of the countries sampled does not have effective mechanisms in place to deal with occupational stress. CONCLUSION: Developing effective transnational occupational stress management policy that supports staff working in this sector and measuring its success is greatly impaired by a failure to effectively define the purpose of the sector and collect and collate national data to support it.

Developing a web-based stress management intervention for occupational support workers.

BACKGROUND: Occupational support workers in the mental healthcare sector are exposed to considerable occupational stress and have little access to stress management facilities. AIMS: This article describes the process behind creating a web-based stress management intervention (SMI) for occupational support workers in the mental healthcare sector. METHOD: Mixed methods were used to inform the content of the web-based SMI, following MRC strategy for designing interventions and PRIMA-EF guidelines for best practice in SMI design. We conducted a literature review to ascertain the content of interventions that had been shown to be successful in reducing stress in mental healthcare populations. In addition, we conducted focus groups in order to assess specific stressors that individuals in the occupational support sector deemed to be important. RESULTS: The literature review showed that a variety of methods had been successful for reducing occupational stress in the mental healthcare sector including: Relaxation and Cognitive Behavioural Therapy techniques, and skills training in; time management, problem-solving and communication. Individuals in the focus groups identified both personal and organisational stressors to be addressed in the intervention. CONCLUSIONS: This intervention was developed with reference to a design strategy, using input from the target population.

Perception and production of /r/ allophones improve with hearing from a cochlear implant.

Tongue shape can vary greatly for allophones of /r/ produced in different phonetic contexts but the primary acoustic cue used by listeners, lowered F3, remains stable. For the current study, it was hypothesized that auditory feedback maintains the speech motor control mechanisms that are constraining acoustic variability of F3 in /r/; thus the listener's percept remains /r/ despite the range of articulatory configurations employed by the speaker. Given the potential importance of auditory feedback, postlingually deafened speakers should show larger acoustic variation in /r/ allophones than hearing controls, and auditory feedback from a cochlear implant could reduce that variation over time. To test these hypotheses, measures were made of phoneme perception and of production of tokens containing /r/, stop consonants, and /r/+stop clusters in hearing controls and in eight postlingually deafened adults pre- and postimplant. Postimplant, seven of the eight implant speakers did not differ from the control mean. It was also found that implant users' production of stop and stop+/r/ blend improved with time but the measured acoustic contrast between these was still better in the control speakers than for the implant group even after the implant users had experienced a year of improved auditory feedback.

Matching purpose with practice: revolutionising nurse education with mita.

Multiple intelligences have only recently entered the teaching dialogue in nurse education and research. It is argued that despite the rhetoric of a student centred approach nurse education remains wedded to conventional teaching approaches that fail to engage with the individual and unwittingly silence the student's voice. This paper will examine the concept of multiple intelligences (MI) and outline Gardner's contention that the brain functions using eight intelligences which can be employed to improve learning at an individual level. It will then outline the use of MI using a five phase model, developed by Weber, known as a multiple intelligence teaching approach (MITA). It is contended that MITA has great potential in nurse education, particularly in terms of reinforcing learning beyond the educational domain and into the individual's professional development and clinical practice.

Effects of short- and long-term changes in auditory feedback on vowel and sibilant contrasts.

PURPOSE: To assess the effects of short- and long-term changes in auditory feedback on vowel and sibilant contrasts and to evaluate hypotheses arising from a model of speech motor planning. METHOD: The perception and production of vowel and sibilant contrasts were measured in 8 postlingually deafened adults prior to activation of their cochlear implant speech processors, 1 month postactivation, and 1 year postactivation. Measures were taken postactivation both with and without auditory feedback. Contrast measures were also made for a group of speakers with reportedly normal hearing speaking with masked and unmasked auditory feedback. RESULTS: Vowel and sibilant contrasts, measured in the absence of auditory feedback after 1 month of prosthesis use, were diminished compared with their values measured before prosthesis. Contrasts measured in the absence of auditory feedback after 1 year's experience with the prosthesis were increased compared with their values after 1 month's experience. In both time samples, contrasts were enhanced when auditory feedback was restored. CONCLUSION: The provision of prosthetic hearing to postlingually deafened adults impaired their phonemic contrasts at first, as their auditory feedback had novel characteristics. Once auditory feedback became recalibrated with prosthesis use, it could, in turn, revise feedforward commands that control the contrasts in its absence.

Interactions of speaking condition and auditory feedback on vowel production in postlingually deaf adults with cochlear implants.

This study investigates the effects of speaking condition and auditory feedback on vowel production by postlingually deafened adults. Thirteen cochlear implant users produced repetitions of nine American English vowels prior to implantation, and at one month and one year after implantation. There were three speaking conditions (clear, normal, and fast), and two feedback conditions after implantation (implant processor turned on and off). Ten normal-hearing controls were also recorded once. Vowel contrasts in the formant space (expressed in mels) were larger in the clear than in the fast condition, both for controls and for implant users at all three time samples. Implant users also produced differences in duration between clear and fast conditions that were in the range of those obtained from the controls. In agreement with prior work, the implant users had contrast values lower than did the controls. The implant users' contrasts were larger with hearing on than off and improved from one month to one year postimplant. Because the controls and implant users responded similarly to a change in speaking condition, it is inferred that auditory feedback, although demonstrably important for maintaining normative values of vowel contrasts, is not needed to maintain the distinctiveness of those contrasts in different speaking conditions.

Time course of speech changes in response to unanticipated short-term changes in hearing state.

The timing of changes in parameters of speech production was investigated in six cochlear implant users by switching their implant microphones off and on a number of times in a single experimental session. The subjects repeated four short, two-word utterances, /dV1n#SV2d/ (S = /s/ or /S/), in quasi-random order. The changes between hearing and nonhearing states were introduced by a voice-activated switch at V1 onset. "Postural" measures were made of vowel sound pressure level (SPL), duration, F0; contrast measures were made of vowel separation (distance between pair members in the formant plane) and sibilant separation (difference in spectral means). Changes in parameter values were averaged over multiple utterances, lined up with respect to the switch. No matter whether prosthetic hearing was blocked or restored, contrast measures for vowels and sibilants did not change systematically. Some changes in duration, SPL and F0 were observed during the vowel within which hearing state was changed, V1, as well as during V2 and subsequent utterance repetitions. Thus, sound segment contrasts appear to be controlled differently from the postural parameters of speaking rate and average SPL and F0. These findings are interpreted in terms of the function of hypothesized feedback and feedforward mechanisms for speech motor control.

On the structure of phoneme categories in listeners with cochlear implants.

PURPOSE: To describe cochlear implant users' phoneme labeling, discrimination, and prototypes for a vowel and a sibilant contrast, and to assess the effects of 1 year's experience with prosthetic hearing. METHOD: Based on naturally produced clear examples of "boot," "beet," "said," and "shed" by 1 male and 1 female speaker, continua with 13 stimuli were synthesized for each contrast. Seven hearing controls labeled those stimuli and assigned them goodness ratings, as did 7 implant users at 1-month postimplant. One year later, these measures were repeated, and within category discrimination, d', was assessed. RESULTS: Compared with controls, implant users' vowel and sibilant labeling slopes were substantially shallower but improved over 1 year of prosthesis use. Their sensitivity to phonetic differences within phoneme categories was about half that of controls. The slopes of their goodness rating functions were shallower and did not improve. Their prototypes for the sibilant contrast (but not the vowels) were closer to one another and did not improve by moving apart. CONCLUSIONS: Implant users' phoneme labeling and within-category perceptual structure were anomalous at 1-month postimplant. After 1 year of prosthesis use, phoneme labeling categories had sharpened but within category discrimination was well below that of hearing controls.

Effects of masking noise on vowel and sibilant contrasts in normal-hearing speakers and postlingually deafened cochlear implant users.

The role of auditory feedback in speech production was investigated by examining speakers' phonemic contrasts produced under increases in the noise to signal ratio (N/S). Seven cochlear implant users and seven normal-hearing controls pronounced utterances containing the vowels /i/, /u/, /e/ and /ae/ and the sibilants /s/ and /I/ while hearing their speech mixed with noise at seven equally spaced levels between their thresholds of detection and discomfort. Speakers' average vowel duration and SPL generally rose with increasing N/S. Average vowel contrast was initially flat or rising; at higher N/S levels, it fell. A contrast increase is interpreted as reflecting speakers' attempts to maintain clarity under degraded acoustic transmission conditions. As N/S increased, speakers could detect the extent of their phonemic contrasts less effectively, and the competing influence of economy of effort led to contrast decrements. The sibilant contrast was more vulnerable to noise; it decreased over the entire range of increasing N/S for controls and was variable for implant users. The results are interpreted as reflecting the combined influences of a clarity constraint, economy of effort and the effect of masking on achieving auditory phonemic goals-with implant users less able to increase contrasts in noise than controls.

Effects of bite blocks and hearing status on vowel production.

This study explores the effects of hearing status and bite blocks on vowel production. Normal-hearing controls and postlingually deaf adults read elicitation lists of /hVd/ syllables with and without bite blocks and auditory feedback. Deaf participants' auditory feedback was provided by a cochlear prosthesis and interrupted by switching off their implant microphones. Recording sessions were held before prosthesis was provided and one month and one year after. Long-term absence of auditory feedback was associated with heightened dispersion of vowel tokens, which was inflated further by inserting bite blocks. The restoration of some hearing with prosthesis reduced dispersion. Deaf speakers' vowel spaces were reduced in size compared to controls. Insertion of bite blocks reduced them further because of the speakers' incomplete compensation. A year of prosthesis use increased vowel contrast with feedback during elicitation. These findings support the inference that models of speech production must assign a role to auditory feedback in error-based correction of feedforward commands for subsequent articulatory gestures.

Psychosocial interventions for panic disorder after coronary artery bypass graft: a case study.

It is increasingly recognized that patients with cardiovascular disease may also suffer from concurrent psychological problems. Many patients present to emergency services and cardiologists with a history of panic disorder. Because of the similarity of presenting symptoms, these patients are often undiagnosed and consequently have slower recovery times and are costly to the healthcare system. Panic disorder is a significant public health problem; however, it is a treatable condition. Healthcare providers should be aware of its occurrence in cardiovascular disease. This case study describes the use of psychosocial interventions, such as the cognitive behavior therapy, in the management of panic disorder after coronary artery bypass graft. A 64-year-old man was treated with 9 sessions of cognitive behavior therapy over a 5-month period. Baseline assessment showed significant distress and deficit in functioning. Following intervention, there was marked reduction in objective and subjective measurement of distress and overall improvement in functioning. Healthcare providers, particularly nurses, need to consider the integration of psychosocial interventions into areas of critical care to provide effective and holistic care. Preoperative screening would be helpful as well.

The use of computer assisted technology to enhance student psychiatric nurses learning during a practice placement.

Despite the available literature that identifies the value of integrating computer-assisted learning into the curriculum, psychiatric nurse education lags behind in this area of curriculum development. The purpose of this paper is to report on a pilot project involving the use of a computer assisted learning (CAL) interactive multimedia (IMM) package called 'Admissions,' as a self-directed learning tool with two-second year psychiatric nursing students. The students were on a practice placement in an Irish mental health service. The aim of using the multimedia resource was to augment the students' learning during their practice placement and enable them to re-examine the issue of psychosis from a multiplicity of perspectives. This paper provides a brief description of the interactive multimedia package, together with a discussion on the support offered to the students during its use. experiential taxonomy is used as a framework to guide the discussion on the learning and evaluation process used. Feedback from the students suggests that the CAL package is easy to use, informative and promoted independence and self-directed study.