Exploring Interspeaker Variation in Creaky Voice in Dutch.

OBJECTIVES: This study explored the extent and discriminatory potential of interspeaker variation in creaky voice in Dutch men. METHODS: Intervals of creaky voice for 30 speakers were manually segmented and annotated from a corpus of spontaneous speech data. For each speaker, at least 1500 syllables were analyzed. Total creakiness was calculated based on the proportion of creaky syllables. Creaky intervals were categorized into subtypes based on the degree of periodicity. Furthermore, acoustic measurements were taken from the intervals and tested for speaker-discriminating capacity by means of a linear discriminant analysis (LDA). RESULTS: Speakers differed in what percentage of syllables they realized with creaky voice, with a range of roughly 0-5% of all syllables. They likewise differed in the proportion with which they used different subtypes of creaky voice, such that some speakers have very distinctive profiles. The LDA resulted in correct classifications of creaky intervals to speakers at a rate above chance level. CONCLUSIONS: Interspeaker variation in creaky voice in Dutch male speech was confirmed and allowed for moderate speaker classification on the basis of speech acoustics.

Binge drinking: an exploration of a confused concept.

Binge drinking is a matter of current social, media and political concern, and the focus of much policy activity in the UK. Binge drinking is associated with causing a wide range of harm to individuals (e.g. accidents), and the wider community (e.g. crime and disorder). Within the current discourse, binge drinking is seen primarily as a youth issue. Binge drinking is sometimes portrayed as a recent phenomenon, but we know from history that heavy drinking has been endemic in British society over many centuries. Using a contemporary history perspective, this paper explores the concept of binge drinking. It considers the definitions in use, recent shifts in meaning and also the way in which different definitions of binge drinking impact on perceptions of the extent and nature of binge drinking. The paper concludes with some thoughts and questions about the usefulness of the concept of binge drinking as it currently used, and areas for further research.

Population-based chest X-ray screening for pulmonary tuberculosis in people living with HIV/AIDS, An Giang, Vietnam.

SETTING: Human immunodeficiency virus/acquired immune-deficiency syndrome (HIV/AIDS) program, An Giang Province, Vietnam. OBJECTIVE: To evaluate the coverage and yield of a chest radiography (CXR) screening program for tuberculosis (TB) among people living with HIV/AIDS (PLHA), risk factors for a TB CXR, inter-rater reliability of CXR readings and direct costs. DESIGN: Retrospective review of routine public health program records and CXRs. RESULTS: An increasing proportion of PLHAs received a screening CXR each year of the program (range 21% in 2001 to 61% in 2004, P<0.001). Of 876 screening CXRs performed, 191 (22%) were classified as suspicious for active TB ('TB CXR'). Compared to PLHAs with a CXR not suspicious for active TB, PLHAs with a TB CXR were more likely to be aged between 24 and 64 years, male and previously treated for TB (P<0.01 for each comparison). Agreement between the expert and local program CXR readings was 81% (kappa 0.50). Direct costs were approximately US$40 per TB suspect identified. Among TB suspects, <10% were followed up with sputum smear examination and enrolled for treatment. CONCLUSION: In An Giang Province, a large proportion of PLHAs are screened for TB annually, and one in five persons screened is classified as a TB suspect based on CXR. Annual CXRs may be a high-yield, inexpensive method for TB screening in PLHAs, but the follow-up of TB suspects to confirm diagnosis and initiate treatment is crucial.

Exploring young men's drinking using the AUDIT questionnaire.

This paper reports the findings of an AUDIT questionnaire administered to a sample of young (16-24-year-old) white males. Of the sample, 65% were drinking at potentially harmful levels. Averaging 45 U/week, 18-21 years was the age of highest alcohol consumption. Compared with 16-17- and 22-24-year-olds, this group recorded the highest proportion of hazardous drinkers and most negative consequences of drinking.

Identifying alcohol-related harm in young drinkers: the role of accident and emergency departments.

Data are presented from a screening study of ambulant attendees at two London Accident and Emergency (A&E) departments. Among young people (aged 16-24 years), 37.2% were drinking harmfully [an Alcohol-Use Disorders Identification Test (AUDIT) score of 8 or more]; 17.3% admitted to drinking alcohol in the 6 h prior to attendance; and 14.6% considered that their attendance was alcohol related. Young women were as likely as men to score 8 or over. This age group had nearly twice the odds of scoring highly on the AUDIT, compared to those over 25 years old, and were more likely to report that their attendance was alcohol related. Screening in A&E departments would identify considerable numbers of young people who might benefit from brief intervention, but the problems of doing so are acknowledged.

Perceptions of alcohol-related attendances in accident and emergency departments in England: a national survey.

The results from a survey, conducted in February and March 1997, of all Accident and Emergency (A&E) departments in England are presented. The survey examined staff perceptions of the preventive role of A&E departments in screening and intervention in alcohol-related attendances. Perceptions of the prevalence of alcohol-related attendances were also included. Attitudes towards developing a preventive response were positive. Few departments currently screen or offer intervention and considerable barriers to the implementation of a preventive response were reported.

Changes in the binding characteristics of the mu, delta and kappa subtypes of the opioid receptor in the hypothalamus of the normal cyclic ewe and in the ovariectomised ewe following treatment with ovarian steroids.

The mu, delta and kappa opioid receptor subtypes were measured across the oestrous cycle of the ewe and in ovariectomised (OVX) ewes treated with oestrogen and/or progesterone. We have used a subtype-specific opioid receptor binding assay, in which [3H]diprenorphine non-preferentially labelled each receptor subtype in the presence of blocking concentrations of site-specific opioid analogues. The density and affinity of each receptor subtype was measured in the preoptic area (POA) of the hypothalamus and the mediobasal hypothalamus (MBH). Normally cycling ewes were killed during the luteal phase of the oestrous cycle and at various times after an injection of a synthetic prostaglandin (cloprostenol) to synchronise the onset of the follicular phase. OVX ewes were either untreated as controls (n = 4) or treated with oestrogen (n = 4), progesterone (n = 4) or oestrogen and progesterone combined (n = 4). The total number of opioid receptors did not alter across the oestrous cycle or with steroid hormone treatment. In the POA, the mean (+/- S.E.M.) number of delta receptors was significantly (P < 0.05) greater during the luteal phase than 24 h into the follicular phase (133 +/- 45 vs 35 +/- 8 fmol/mg protein). A significantly (P < 0.05) greater number of delta receptors was also found in the OVX progesterone-treated ewes compared with the control animals (172 +/- 9 vs 39 +/- 4 fmol/mg protein). In the MBH, the number of delta receptors was significantly (P < 0.01) greater in ewes killed 56 h after prostaglandin than luteal-phase ewes (184 +/- 40 vs 51 +/- 7 fmol/mg protein). The number of mu receptors in both the POA and the MBH was also significantly (P < 0.05) higher in the 56-h group than in the 12-h group. A similar trend was also observed in the steroid-treated animals, although differences did not reach statistical significance. The delta:mu ratio in the POA was significantly (P < 0.05) higher in the luteal-phase animals than any of the other groups killed after a cloprostenol injection that causes luteolysis. Similarly the ratio of delta receptor density to mu receptor density was greater (P < 0.05) in the OVX progesterone-treated ewes than in the OVX control ewes. No differences were found in the kappa receptor density across the cycle or with different steroid treatments. These data suggest that the relative proportions of the delta and mu subtypes of the opioid receptor in the hypothalamus change during the oestrous cycle. Regulation appears to be due to the feedback effects of ovarian steroids with progesterone altering the delta:mu ratio. In the MBH, there was a general increase in both delta and mu subtypes during the follicular phase of the oestrous cycle. This may explain, in part, how the responsiveness of the GnRH/LH axis to opioid peptides and antagonists changes across the cycle.

Investigation of hepatitis B virus transmission in a health care setting: application of direct sequence analysis.

An epidemiologically linked cluster of hepatitis B virus (HBV) infections was investigated using HBV DNA amplification by a nested polymerase chain reaction with primers complementary to the region around the immunodominant a determinant of the surface gene, part of the X and core genes, and precore region and direct nucleotide sequence analysis. The cluster, in which 2 persons died of fulminant hepatitis, comprised 1 blood donor, 2 patients, and 2 health care workers. The Kimura two-parameter method was used to compare variance among the cluster with that in the control samples, which were collected from 7 patients infected with the same HBV subtype. Significantly less variation occurred within the cluster than in the control group (unpaired t test, P < .05). In an unrooted phylogenetic tree analysis, the 5 study samples formed a cluster distinct from the controls. This direct molecular approach of analyzing conserved regions of the HBV genome differentiated between viruses involved in HBV transmission events.

'Special units for common problems': the birth of alcohol treatment units in England.

In 1962 the Ministry of Health issued a memorandum entitled The Hospital Treatment of Alcoholism. The memorandum was the first official statement specifically regarding the treatment of alcoholism within the National Health Service. It marked the end of an era characterized by Ministry of Health rejection of the need to review policies regarding alcohol consumption and alcoholism treatment and the entry of the Ministry into the emerging alcohol arena. This paper uses documentary sources and interview material to examine the events leading up to the memorandum and its recommendation to Regional Health Authorities to establish specialist alcoholism treatment units. The development of such units was not supported by everyone in the alcohol field at that time and the paper discusses the pressures on Department of Health officials which appear to have influenced policy choices. The fact that pressures come from different sources, some advocating different policy options, raises the question: did medical perspectives and evidence for the specialist treatment approach influence policy or did policy makers select the option best fitted to existing Departmental interests?

Engaging patients with alcohol problems in treatment: the first consultation.

This paper considers the impact of the first consultation at a specialist alcohol clinic on patients' perceptions of their drink problem and on their expectations of help from three sources: an alcohol clinic, general practitioners and Alcoholics Anonymous. At intake, males had higher expectations than females of help from the alcohol clinic while people in manual occupations and those in the 'less heavy' drinking category had higher expectations of general practitioner help than other patients. Change was found to occur during the first clinic consultation so that by the end of the session patients had raised their rating of problem severity and their expectations of help from the three sources examined. Overall, patient perceptions of the clinic assessment session were positive. The study highlights the importance of obtaining a full understanding of the process of engagement in treatment and indicates the potential of a clinical assessment to effect change in patient attitudes.

The use of services for alcohol problems: general practitioner and specialist alcohol clinic.

A sample of 40 patients referred to a specialist alcohol clinic were given a full assessment by a clinician and then randomly allocated to one of two groups. The first group received continuing care from the clinic. The second group were returned to the management of their general practitioners who were offered specialist support in caring for their patients. Patients and general practitioners were followed-up 6 months after the clinic assessment. This paper reports on the uptake of clinic and general practice services by patients and examines the possible factors associated with continuing attendance, including patient attributes, service activity, patients' self-assessments of their drink problem and their expectations of help from services. Qualitative data is used to examine patients' perceptions and experiences of clinic and general practice-based care for drinking problems. The findings highlight some of the difficulties reported by patients in receiving help for their problems particularly from general practitioners.

Specialist versus general practitioner treatment of problem drinkers.

The efficacy of specialist versus general practitioner (GP) treatment of problem drinkers was assessed in a randomised controlled trial. 40 problem drinkers referred consecutively to a specialist alcohol clinic by their GP were, after assessment, randomly allocated to either GP or specialist clinic treatment groups. All subjects received initial advice and counselling in the clinic about their drinking. The specialist clinic group received continued care from the clinic including, if necessary, admission to hospital. Patients in the GP group were returned to the care of the GP who was contacted and supported by the specialist. After 6 months of follow-up, there were significant reductions in alcohol consumption and alcohol-related problems in both groups. No significant difference was found between the two groups with respect to the main outcome measures. No differential treatment effect was found with the more severely dependent drinkers. The findings show that after an initial detailed assessment and advice session, the treatment provided by GPs is at least as effective as that from a specialist clinic with respect to improvements in drinking behaviour and alcohol-related problems. After initial assessment and advice, specialist clinics should encourage GPs to become more involved in the subsequent care of problem drinkers. Such a practice should be based on the individual patient's needs and the adequacy of support offered to GPs.

The acquisition of antibiotic resistant coagulase-negative staphylococci by aortic graft recipients.

The staphylococcal flora of the groin and perianal area was studied in 12 patients undergoing aortic grafts and 3 patients having repair of ventral abdominal hernias. A total of 892 isolates of coagulase-negative staphylococci (CNS) were identified and their antibiotic resistance determined. The species most frequently isolated were S. epidermidis and S. haemolyticus with the latter showing the highest incidence of antibiotic resistance. Five of 15 patients had CNS resistant to methicillin and gentamicin on admission. The effect of pre-operative bathing with chlorhexidine was studied in 6 patients and appeared to reduce the acquisition of multi-resistant CNS in the week after operation.

Detection of antibodies to the human immunodeficiency virus by a rapid fluorescence-labelled immunosorbent assay.

The development and assessment of a fluorescence-labelled immunosorbent assay for the detection of antibodies to the human immunodeficiency virus is described. Test serum is incubated in microtitre wells on which antigens have been coated. If present in the test serum, antibodies to the human immunodeficiency virus bind to the solid-phase antigens. In turn the antibodies are quantified with anti-human immunoglobulin labelled with fluorescein. Positive samples produce an intense fluorescence which is measured in a spectrofluorimeter. When used to test a panel consisting of normal serum and antibody-positive serum from infected patients the assay proved to be 100% specific and to have a sensitivity of 100%. The assay has many of the advantages of micro enzyme-linked immunosorbent assays, but does not suffer from the drawbacks associated with the use of an enzyme label. It requires fewer manipulations and is quicker to carry out than an equivalent enzyme-linked test.

Rethinking drug policies in the context of the acquired immunodeficiency syndrome.

This article presents a policy analysis of the needed responses to the problems associated with the acquired immunodeficiency syndrome and drug misuse that are now being experienced in the United Kingdom of Great Britain and Northern Ireland. Among the issues considered is the overall organizational and administrative capacity of a country to deal with a new acute demand and the probable need for more national centralization of planning and effort in the drug field. Policies must aim at small multiple gains rather than at master-strokes. International communication must be strengthened. The human immunodeficiency virus (HIV) epidemic requires re-examination of the penal handling of drug misusers. Treating more patients earlier may contribute significantly to prevention strategies, and methods for "harm reduction" deserve attention. Compulsory treatment or testing of HIV infection is not favoured. The importance of professional training and of research is stressed. Although the immediate focus is on one particular country's policy needs, the issues raised are of wider relevance.

Cefotetan compared with gentamicin and tinidazole in acute abdominal surgery.

In a prospective randomised trial 190 consecutive admissions undergoing emergency abdominal surgery were allocated to receive a 24-h peri-operative prophylactic regime of either cefotetan or gentamicin and tinidazole. Wound sepsis developed in 14 patients in each group and one patient in each group developed intra-abdominal abscess. Nine patients in the cefotetan group and 10 patients in the gentamicin and tinidazole group died within 1 month of surgery. The death of one patient in each group was directly related to sepsis. Sixty-five per cent of aerobes isolated at operation were sensitive to cefotetan and 62% sensitive to gentamicin. The in vitro anaerobic cover of tinidazole was complete, whereas 13% of anaerobes isolated at operation were resistant to cefotetan. Anaerobes, predominantly Bacteroides fragilis, were isolated from six of the 14 infected wounds following cefotetan prophylaxis and two of the 14 infected wounds in the gentamicin and tinidazole group. It is therefore recommended that cefotetan should be combined with a nitroimidazole in patients undergoing emergency colo-rectal procedures.