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A previous study found that spatial release from masking (SRM) could be observed under virtual reverberant environments using a first order Ambisonic-based sound reproduction system, however, poor localisation accuracy made it difficult to examine effect of varying reverberation time on SRM. The present study follows on using higher order Ambisonics (HOA) to examine how benefits from SRM vary in different spatial acoustics. Subjective speech intelligibility was measured where four room acoustics:reverberation time (RT)= 0.7 s (clarity (C50)= 16 dB, 7 dB); RT= 1.8 s (C50= 8 dB, 2 dB) were simulated via a third order Ambisonic system with a 16 channel spherical loudspeaker array. The masker was played from 8 azimuthal angles (0, +-45, +-90, +-135, 180 degrees) while the target speech was played from 0 degree. The listeners are deemed to benefit from SRM if their intelligibility scores were higher when the masker comes from a different angle than that of the target. We found while listeners could benefit from SRM at C50 = 16 dB and 8 dB, the benefit starts to diminish at C50 = 7 dB, and listeners could no longer benefit from SRM at C50 = 2 dB.

This study acoustically analyses the vowel space of adult New Zealand English speakers from a predominantly Pasifika suburb in Auckland (Papatoetoe). These speakers (n = 13) are compared to two equivalent groups from non-Pasifika Auckland suburbs, Mount Roskill (n = 14) and Titirangi (n = 6). All participants are New Zealand English speakers aged 16–25. There were equal numbers of male and female participants. For the acoustic analysis vowels with sentence stress were identified and extracted and formant values were calculated at the vowel target. This study looks at over 8000 monophthongs and 4000 diphthongs. The study found minimal differences between speakers from different suburbs, but all groups had notable differences from the traditional New Zealand English (NZE) vowel space. These differences align with previous comments regarding the vowels of Pasifika New Zealand English. The paper concludes by contemplating what these results say about Pasifika New Zealand English and New Zealand English in Auckland.

Māori, the threatened language of the indigenous people of New Zealand, has been undergoing revitalisation since the 1970s. The MAONZE project (Māori and New Zealand English) has studied sound change in Māori by comparing the speech of historical elders, present-day elders and young speakers. Here we analyse the read speech from nine present-day elders and twelve young speakers and compare it with the results from our previous analysis of their conversational material to investigate whether style shift occurs in more careful Māori speech. Pronunciation change was restricted to the backing of long /u:/, a sound whose fronting had been stigmatised and of which older female speakers seemed to be particularly aware. We conclude that, although there is some indication of style-shift in the read material, ‘first wave’ (Eckert 2012) sociolinguistic methodology is not appropriate for Māori speakers whose notion of class and prestige differ from that of previously articulated sociolinguistic norms.

Breast surgery increases the risk for difficulties with milk production and breastfeeding. Research on lactation outcomes of breast augmentation with implants is reassuring, but reveals a significant risk of low milk production that varies with the type of surgery and position of the implants. Understanding the potential effects of breast implants on breastfeeding can help lactation professionals optimize outcomes for families with a history of augmentation mammaplasty.

One of the major factors that affect the acceptance of robots in Human-Robot Interaction applications is the type of voice with which they interact with humans. The robot’s voice can be used to express empathy, which is an affective response of the robot to the human user. In this study, the aim is to find out if social robots with empathetic voice are acceptable for users in healthcare applications. A pilot study using an empathetic voice spoken by a voice actor was conducted. Only prosody in speech is used to express empathy here, without any visual cues. Also, the emotions needed for an empathetic voice are identified. It was found that the emotions needed are not only the stronger primary emotions, but also the nuanced secondary emotions. These emotions are then synthesised using prosody modelling. A second study, replicating the pilot test is conducted using the synthesised voices to investigate if empathy is perceived from the synthetic voice as well. This paper reports the modelling and synthesises of an empathetic voice, and experimentally shows that people prefer empathetic voice for healthcare robots. The results can be further used to develop empathetic social robots, that can improve people’s acceptance of social robots.

Background Gastroenteropancreatic neuroendocrine tumours (GEP-NETs) are slow-growing cancers that arise from diffuse endocrine cells in the gastrointestinal tract (GI-NETs) or the pancreas (P-NETs). They are relatively uncommon, accounting for 2% of all gastrointestinal malignancies. The usual treatment options in advanced GEP-NET patients with metastatic disease include chemotherapy, biological therapies, and peptide receptor radionuclide therapy. Understanding the impact of treatment on GEP-NET patients is paramount given the nature of the disease. Health-related quality of life (HRQoL) is increasingly important as a concept reflecting the patients' perspective in conjunction with the disease presentation, severity and treatment. Aim To conduct a systematic literature review to identify literature reporting HRQoL data in patients with GEP-NETs between January 1985 and November 2019. Methods The PRISMA guiding principles were applied. MEDLINE, Embase and the Cochrane library were searched. Data extracted from the publications included type of study, patient population data (mid-gut/hind-gut/GI-NET/P-NET), sample size, intervention/comparators, HRQoL instruments, average and data spread of overall and sub-scores, and follow-up time for data collection. Results Forty-three publications met the inclusion criteria. The heterogeneous nature of the different study populations was evident; the percentage of female participants ranged between 30%-60%, whilst average age ranged from 53.8 to 67.0 years. Eight studies investigated GI-NET patients only, six studies focused exclusively on P-NET patients and the remaining studies involved both patient populations or did not report the location of the primary tumour. The most commonly used instrument was the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-C30 (n = 28) with consistent results across studies; the GI-NET-specific module Quality of Life Questionnaire-GINET21 was used in six of these studies. A number of randomised trials demonstrated no HRQoL changes between active treatment and placebo arms. The Phase III NETTER-1 study provides the best data available for advanced GEP-NET patients; it shows that peptide receptor radionuclide therapy can significantly improve GEP-NET patients' HRQoL. Conclusion HRQoL instruments offer a means to monitor patients' general disease condition, disease progression and their physical and mental well-being. Instruments including the commonly used European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-C30 and GINET21 lack, however, validation and a defined minimal clinical important difference specifically for GI-NET and P-NET patients.

Te reo Māori (referred to as Māori), New Zealand's indigenous language, is under-resourced in language technology. Māori speakers are bilingual, where Māori is code-switched with English. Unfortunately, there are minimal resources available for Māori language technology, language detection and code-switch detection between Māori-English pair. Both English and Māori use Roman-derived orthography making rule-based systems for detecting language and code-switching restrictive. Most Māori language detection is done manually by language experts. This research builds a Māori-English bilingual database of 66,016,807 words with word-level language annotation. The New Zealand Parliament Hansard debates reports were used to build the database. The language labels are assigned using language-specific rules and expert manual annotations. Words with the same spelling, but different meanings, exist for Māori and English. These words could not be categorised as Māori or English based on word-level language rules. Hence, manual annotations were necessary. An analysis reporting the various aspects of the database such as metadata, year-wise analysis, frequently occurring words, sentence length and N-grams is also reported. The database developed here is a valuable tool for future language and speech technology development for Aotearoa New Zealand. The methodology followed to label the database can also be followed by other low-resourced language pairs., Submitted to Springer Language Resources and Evaluation Journal 2022

Automated dysarthria intelligibility assessment offers the opportunity to develop reliable, low-cost, and scalable tools, which help to solve current shortcomings of manual and subjective intelligibility assessments. This paper reviews the literature regarding automated intelligibility assessment, identifying the highest performing published models and concluding on promising avenues for further research. Our review shows that most of the existing work were able to achieve very high accuracies. However, we have found that most of these studies validated their models using speech samples of the same speakers used in training, making their results less generalizable. Furthermore, there is a lack of study on how well these models perform on speakers from different datasets or different microphone setups. This lack of generalizability has implications to the real-life application of these models. Future research directions could include the use of more robust methods of validation such as using unseen speakers, as well as incorporating speakers from different datasets. This would provide confidence that the models are generalized and therefore allow them to be used in real-world clinical practice.

With the rise of robotics and artificial intelligence, good communication between humans and machines becomes more important. However, users with language and hearing disadvantages may find synthetic speech systems to be difficult to understand. In this study, we explore the types of sentence structure and level of word complexity that affect intelligibility of speech in unfamiliar context. Using semantically unpredictable sentences, we found that sentence with more complex syntax such as relative pronouns and question words are harder to comprehend, while on the word level, it is the shorter and simpler words that contribute to misunderstandings. We found that although word frequency affects how well a word is recognised, the effect from the occurring frequency is much less than the effect of how phonetically distinctive the word is. There was also evidence of significant difference between native speakers and non-native speakers on how well they could understand the sentences. These results may help us in designing better dialogue system for machine to human interactions, especially in the healthcare arena, where often users have disadvantages in language and hearing abilities.

Purpose More than 80% of U.S. mothers initiate breastfeeding; for many of them, direct breastfeeding is an important goal. Speech-language pathologists (SLPs) who assess infants with feeding concerns, however, are generally much more familiar with assessing bottle-feeding. The purpose of this tutorial is to assist SLPs in building on their existing assessment skills in order to provide effective, evidence-based options for mothers who wish to breastfeed their infants. Conclusion SLPs can assist families in meeting their breastfeeding goals through effective assessment of breastfeeding dyads.

e18674 Background: Unanticipated healthcare resource utilization, in the form of either emergency department utilization (EDUs) or hospital admission (HA), is an indicator of lower quality of cancer care. The objective of this study was to develop a comprehensive predictive model for emergency department utilization and hospital admission (HA) for patients with solid tumors who received chemotherapy within 30 days. Methods: We abstracted electronic health data on oncology encounters from all patients receiving systemic therapy chemotherapy for solid tumors from March 01, 2015 to August 21, 2020. Patients included in the cohort met the following criteria:1) Ages > = 18 years old 2) Diagnosed with any solid tumor (3) Had any oncology treatment plan related to their solid tumor diagnosis; 4) Received at least one chemotherapy during March 01, 2015 through August 21, 2020. We defined a primary composite outcome of emergency visit or unanticipated hospitalization within 30 days after the encounter. Patient information was abstracted. We developed a predictive model for the primary outcome using LASSO logistic regression modeling. To evaluate the model, we calculated the Area Under the Receiver Operator Characteristic (AUROC) and the calibration slope. Results: 12,917 unique patients with 134,641 encounters were included. Of these, 9100 (6.7%) of encounters were ED visits or hospitalizations. 714 patients (5.5%) had at least one ED visit or hospitalization within 30 days of treatment; patients at highest risk for this outcome included those with pancreatic cancer, lung cancer and ovarian/endometrial cancer (9.1%, 7.4% and 6.8% respectively). 38 variables were identified as contributing to the LASSO model. The top predictors, in order of importance, were fever, hypernatremia, hypotension and low albumin. The model’s AUC was 0.83, indicating good model sensitivity to outcome. Conclusions: Approximately 7% of healthcare encounters in patients undergoing treatment for solid malignancies were ED visits or hospitalizations. Identifying patients at highest risk for this outcome may prevent unnecessary resource utilization and optimize patient care during cancer treatment. The model developed in this study demonstrated good sensitivity and could be implemented in clinical practice to allow for preventive outpatient interventions. Work is ongoing to integrate this model into clinical care at our institution.[Table: see text]

e17596 Background: To describe the molecular profiles of tumors with a positive GIS status (GI+) in patients with newly diagnosed BRCA wild-type HGSOC and to examine possible associations between genomic mutations and survival outcomes in these patients. Methods: Genetic testing results of patients who underwent both somatic BRCA1/BRCA2 and germline multigene panel testing between 1/1/2015 and 12/1/2020 were prospectively collected. Patients had multigene panel germline testing in tandem with Myriad somatic BRCA1/2 testing and GIS assay. Expanded somatic NGS testing (108 gene panel) was then performed on GIS+ (GIS ≥42) tumor samples from women without somatic or germline BRCA mutations. The primary outcomes were the type and frequency of genomic mutations, which were grouped according to the following pathways: DNA-repair related (separated into homologous recombination (HR), Fanconi anemia (FA), other DNA repair related pathway) or non-DNA repair related. GIS and molecular profiles of tumors from patients who recurred versus those who did not recur were compared. Results: 143 women with HGSOC underwent both germline and somatic testing. 18/143 (12.5%) tumors with negative germline multigene panel and negative somatic BRCA1/2 testing were GIS+. 17/18 (94.4%) GIS+ tumors had pathogenic TP53 mutations. While all samples had at least one DNA repair related variant, only 22.2% had an HR-associated variant, and 16.7% had an FA variant. At time of analysis, 10 patients had recurred and 8 patients had not recurred. Median PFS of those who recurred was 15.8 months (range 4.8-30.1 months). Patients who recurred had lower GIS (median 47.5 vs. 69.5, p = 0.04), but they had no appreciable differences in gene or pathway alterations when compared to those who did not recur. Conclusions: Known pathogenic alterations in DNA repair pathways commonly associated with HR were rare in this cohort of BRCA negative HGSOC patients with GIS+ tumors. However, there was a high frequency of other DNA repair pathway alterations. Further investigation of the molecular signatures associated with recurrence are needed to identify potential novel targets. Lower GIS in this cohort were associated with higher risk of recurrence, although this finding must be validated in the setting of larger studies. [Table: see text]

Measures of vegetation structure are often key within ecological restoration monitoring programs because a change in structure is rapidly identifiable, measurements are straightforward, and structure is often a good surrogate for species composition. This paper investigates the use of drone-based digital aerial photogrammetry (DAP) for the characterization of the structure of regenerating vegetation as well as the ability to inform restoration programs through spatial arrangement assessment. We used cluster analysis on five DAP-derived metrics to classify vegetation structure into seven classes across three sites of ongoing restoration since linear disturbances in 2005, 2009, and 2014 in temperate and boreal coniferous forests in Alberta, Canada. The spatial arrangement of structure classes was assessed using land cover maps, mean patch size, and measures of local spatial association. We observed DAP heights of short-stature vegetation were consistently underestimated, but strong correlations (rs > 0.75) with field height were found for juvenile trees, shrubs, and perennials. Metrics of height and canopy complexity allowed for the extraction of relatively tall and complex vegetation structures, whereas canopy cover and height variability metrics enabled the classification of the shortest vegetation structures. We found that the boreal site disturbed in 2009 had the highest cover of classes associated with complex vegetation structures. This included early regenerative (22%) and taller (13.2%) wood-like structures as well as structures representative of tall graminoid and perennial vegetation (15.3%), which also showed the highest patchiness. The developed tools provide large-scale maps of the structure, enabling the identification and assessment of vegetational patterns, which is challenging based on traditional field sampling that requires pre-defined location-based hypotheses. The approach can serve as a basis for the evaluation of specialized restoration objectives as well as objectives tailored towards processes of ecological succession, and support prioritization of future inspections and mitigation measures.

Tongue motility is an essential physiological component of human feeding from infancy through adulthood. At present, it is a challenge to distinguish among the many pathologies of swallowing due to the absence of quantitative tools. We objectively quantified tongue kinematics from ultrasound imaging during infant and adult feeding. The functional advantage of this method is presented in several subjects with swallowing difficulties. We demonstrated for the first time the differences in tongue kinematics during breast‐ and bottle‐feeding, showing the arrhythmic sucking pattern during bottle‐feeding as compared with breastfeeding in the same infant with torticollis. The method clearly displayed the improvement of tongue motility after frenotomy in infants with either tongue‐tie or restrictive labial frenulum. The analysis also revealed the absence of posterior tongue peristalsis required for safe swallowing in an infant with dysphagia. We also analyzed for the first time the tongue kinematics in an adult during water bolus swallowing demonstrating tongue peristaltic‐like movements in both anterior and posterior segments. First, the anterior segment undulates to close off the oral cavity and the posterior segment held the bolus, and then, the posterior tongue propelled the bolus to the pharynx. The present methodology of quantitative imaging revealed highly conserved patterns of tongue kinematics that can differentiate between swallowing pathologies and evaluate treatment interventions. The method is novel and objective and has the potential to advance knowledge about the normal swallowing and management of feeding disorders., Tongue kinematics was objectively quantified from ultrasound imaging during feeding. Tongue and palate contours were traced in each frame of the video; tongue outlines were registered with respect to the hard anterior palate; and tongue motility characteristics were determined from intersections with polar coordinates in subsequent frames. Differences in tongue kinematics during breast‐ and bottle‐feeding are demonstrate in the same infant. The method detected improvement of tongue motility after frenotomy interventions and revealed absence of posterior tongue peristalsis in infant with dysphagia. It demonstrated tongue peristaltic‐like movements in both anterior and posterior segments in an adult during water bolus swallowing.

© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2020. Endowing robots with the role of social assistance in silver care could be a powerful tool to combat chronic loneliness in ageing adults. These robots can be tasked with functional and affective care to support quotidian living and grant companionship that helps lessen the burden of cognitive decline and impairment emerging from social isolation. To accomplish such imperative tasks, artificial agents must be adept at communicating naturally with the human elder. In this work, we aim to enable human–robot interaction by designing human-like verbal and nonverbal behaviours of an autonomous robot companion. We employed the robot on a trial run using customisable algorithms to address a range of needs, while thriving social and emotional attachment with the potential senior user, with the final intent being that such endeavours can help achieve quality ageing in place.

Background Diphtheria is a potentially fatal respiratory disease caused by toxigenic Corynebacterium diphtheriae. Although resistance to erythromycin has been recognized, β-lactam resistance in toxigenic diphtheria has not been described. Here, we report a case of fatal respiratory diphtheria caused by toxigenic C. diphtheriae resistant to penicillin and all other β-lactam antibiotics, and describe a novel mechanism of inducible carbapenem resistance associated with the acquisition of a mobile resistance element. Methods Long-read whole-genome sequencing was performed using Pacific Biosciences Single Molecule Real-Time sequencing to determine the genome sequence of C. diphtheriae BQ11 and the mechanism of β-lactam resistance. To investigate the phenotypic inducibility of meropenem resistance, short-read sequencing was performed using an Illumina NextSeq500 sequencer on the strain both with and without exposure to meropenem. Results BQ11 demonstrated high-level resistance to penicillin (benzylpenicillin minimum inhibitory concentration [MIC] ≥ 256 μg/ml), β-lactam/β-lactamase inhibitors and cephalosporins (amoxicillin/clavulanic acid MIC ≥ 256 μg/mL; ceftriaxone MIC ≥ 8 μg/L). Genomic analysis of BQ11 identified acquisition of a novel transposon carrying the penicillin-binding protein (PBP) Pbp2c, responsible for resistance to penicillin and cephalosporins. When strain BQ11 was exposed to meropenem, selective pressure drove amplification of the transposon in a tandem array and led to a corresponding change from a low-level to a high-level meropenem-resistant phenotype. Conclusions We have identified a novel mechanism of inducible antibiotic resistance whereby isolates that appear to be carbapenem susceptible on initial testing can develop in vivo resistance to carbapenems with repeated exposure. This phenomenon could have significant implications for the treatment of C. diphtheriae infection, and may lead to clinical failure.

There is increasing concern for the risk of hypernatremic dehydration in infants breastfeeding poorly. It is important to differentiate normal weight changes as infants adapt to extrauterine life from excessive weight loss from breastfeeding failure or mismanagement. We review recent data on normal weight changes in exclusively breastfeeding infants and those at risk for hypernatremic dehydration to help health professionals determine when infants require further scrutiny and supplementation. The data suggest that perinatal practices influence infant weight changes. Protecting normal birth and early initiation of breastfeeding should reduce the incidence of excessive weight loss and risk of hypernatremic dehydration

Speech-language pathologists (SLPs) who work with pediatric feeding/swallowing disorders may evaluate and treat breastfeeding infants. Many SLPs, however, receive little breastfeeding-related train...

The current paper examines how native and non-native listeners of New Zealand English differ in terms of speech intelligibility in noise in a number of room acoustics reproduced by a first-order Ambisonics-based sound reproduction system. Speech intelligibility test was conducted under three room acoustics environments (living room, lecture theatre and church) using the sound reproduction system, where a pink noise masker was played from one of five azimuthal angles (0, 45, 90, 135, 180°) while the target speech was always played from 0°. We found significant two-way interactions between language nativeness and speech-noise separation, language nativeness and room acoustics, as well as between room acoustics and speech-noise separation. This suggests that native and non-native listeners respond differently to the virtually reproduced acoustic environments and they benefit from spatial release from masking in a different manner. Post-hoc results showed the native listeners performing significantly better than their non-native counterparts for all the angles of speech-noise separation and the room acoustics.

Tongue-tie can cause many serious breastfeeding problems and even lead to breastfeeding cessation. As the mothers’ stories listed in “When Tongue-Ties Were Missed: Mothers’ Stories” attest, healthcare providers often do not correctly identify when a baby has a tongue-tie. Assessing tongue-tie is essential. What should clinicians look for? Which professionals should be the ones identifying and identifying tongue-tie? Assessing tongue-tie is the focus of this article.

Do parents have any alternatives to surgery for addressing tongue-tie? Our panelists agree that latch issues should be assessed first. Other modalities include physical therapy, speech therapy, chiropractic, and craniosacral therapy. In addition, infants should be assessed for other issues, such as torticollis, that may co-occur with tongue-tie. For some parents, complementary techniques may be all that they need to address tongue-tie–related issues. For other parents, surgical release will still be necessary.

What is the prevalence of tongue-tie (the proportion of total cases in a population)? Is the incidence (occurrence of new cases) increasing or are clinicians simply identifying it more often? The most reliable way to estimate incidence and prevalence is through population-based epidemiological studies. So far, these are limited. However, there has been some research that allows us to approximate rates. Our expert panel offers their judgment on two questions: What is the approximate percentage of babies with tongue-tie? And is incidence increasing?

If a tongue-tie is to be revised, what is the best technique for accomplishing that? There is some debate in the field about whether scissors or laser is most effective. Both techniques seem efficacious. This section also addresses which professionals should be performing the revision. Our panelists represent a wide range of disciplines, so some refer, and others perform the revisions themselves.

BackgroundOXA-48-like carbapenemases have become increasingly prevalent in healthcare settings worldwide. Their low-level activity against carbapenems makes them difficult to identify, causing problems for infection control. Here we present an outbreak of Escherichia coli producing OXA-181 (part of the OXA-48 family of carbapenemases) in a Queensland Hospital, and describe how we used whole genome sequencing (WGS) to identify the outbreak strain, determine the extent of transmission within the hospital and support infection control responses.Methods116 isolates were collected and sequenced on an Illumina NextSeq to determine species, sequence type (ST) and presence of resistance genes. Core single nucleotide polymorphisms were used to determine strain relatedness. Three isolates were also sequenced on an Oxford Nanopore MinION to determine the context of the resistance genes.ResultsOf 116 isolates, 85 (84 E. coli and one K. pneumoniae) from 78 patients (and two environmental sources) were related to the ongoing outbreak. The outbreak E. coli strain was found to be ST38 and carried blaOXA-181, blaCTX-M-15 and qnrS1 genes. Long read sequencing revealed blaOXA-181 to be carried on an IncX3 plasmid with qnrS1. blaCTX-M-15 was chromosomally integrated (via ISEcp1 insertion) in close proximity to a second qnrS1 gene. A search of the laboratory database identified an isolate with an identical unusual antibiogram from a patient recently admitted to a hospital in Vietnam, suggesting that the strain was introduced to the hospital. This conclusion was supported by WGS, as comparison of the strain to public data identified a close match to an E. coli recovered from Vietnam in 2011.ConclusionA blaOXA-181-carrying E. coli ST38 strain was introduced to a Brisbane hospital and spread undetected throughout multiple wards over several months. Using WGS, we characterized the outbreak strain and unambiguously detected its presence throughout the hospital. We show how both WGS and infection control measures can be utilized to effectively terminate widespread transmission of an elusory pathogen.

Objectives: To evaluate the outbreak size and hospital cost effects of bacterial whole-genome sequencing availability in managing a large-scale hospital outbreak. Methods: We built a hybrid discrete event/agent-based simulation model to replicate a serious bacterial outbreak of resistant Escherichia coli in a large metropolitan public hospital during 2017. We tested the 3 strategies of using whole-genome sequencing early, late (actual outbreak), or not using it and assessed their associated outbreak size and hospital cost. The model included ward dynamics, pathogen transmission, and associated hospital costs during a 5-month outbreak. Model parameters were determined using data from the Queensland Hospital Admitted Patient Data Collection (N = 4809 patient admissions) and local clinical knowledge. Sensitivity analyses were performed to address model and parameter uncertainty. Results: An estimated 197 patients were colonized during the outbreak, with 75 patients detected. The total outbreak cost was A$460 137 (US$317 117), with 6.1% spent on sequencing. Without sequencing, the outbreak was estimated to result in 352 colonized patients, costing A$766 921 (US$528 547). With earlier detection from use of routine sequencing, the estimated outbreak size was 3 patients and cost A$65 374 (US$45 054). Conclusions: Using whole-genome sequencing in hospital outbreak management was associated with smaller outbreaks and cost savings, with sequencing costs as a small fraction of total hospital costs, supporting the further investigation of the use of routine whole-genome sequencing in hospitals.

We report our clinical experience of sacubitril/valsartan (SV) use in heart failure (HF) patients at a large UK cardiac centre. Heart failure with reduced ejection fraction (HFrEF) patients seen in the HF clinic and started on SV from April 2016 to July 2017 were retrospectively evaluated.

The present study investigates the effect of noise on speech intelligibility under an Ambisonics-based sound reproduction system, which is a commonly used technique for realising audio virtual reality. The sound reproduction system was built in an anechoic chamber using a 16 channel spherical loudspeaker array. A commercially available first-order Ambisonics microphone array was utilised for collecting room impulse responses of rooms with different acoustic characteristics, and a decoder for generating signals rendered from the loudspeaker array. A subjective listening test was conducted in the sound reproduction system examining how intelligibility of sentences is compromised by noise under virtually reproduced acoustics environments with various acoustical conditions. Particular focus was given to investigating the effect of the amount of reverberation in rooms as well as the angular separation between the target speech and noise sources, both of which are known to have a significant effect on speech intelligibility in real (i.e. non-virtual) acoustic environment. The experimental results suggest that the intelligibility of speech masked by pink noise was significantly reduced under reverberant acoustical environments reproduced by the Ambisonics-based sound reproduction system compared to the baseline anechoic environment. However, only marginal differences were observed between the acoustical environments with different reverberation time. The effect of spatial release from masking was also observed under the reproduced acoustic environments and showed some correlation with the accuracy of source localisation realised by the sound reproduction system.

This article investigates sound change in the vowels of Māori, the indigenous language of New Zealand. It examines the relationship between sound changes in Māori and in New Zealand English, the more dominant language, with which Māori has been in close contact for nearly 200 years. We report on the analysis of three adult speaker groups whose birth dates span 100 years. All speakers were bilingual in Māori and New Zealand English. In total the speech of 31 men and 31 women was investigated. Analysis was done on the first and second formant values, extracted from the vowel targets. There has been considerable movement in the Māori vowel space. We find that the sound change in the Māori monophthongs can be directly attributed to the impact of New Zealand English, however the situation for the diphthongs is not so clear cut. There is some evidence that both New Zealand English monophthongs and diphthongs are impacting on the Māori diphthongs, but so too are the Māori monophthongs. We conclude that although New Zealand English has had a strong influence on Māori, there is very strong evidence that new generations of speakers of Māori are acquiring a phonemic system with its own internal parameters and consistencies.