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The second European Rhinology Reserach Forum organized by the European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA) was held on 9-10th November 2017, combined with a specific symposium on air pollution and mobile Health technology (mHealth) with the GARD (Global Alliance against Chronic Respiratory Diseases) initiative of WHO (World Health Organization). Physicians from different specialities, researchers, as well as patients and industry representatives from more than 40 countries took part in the Forum. Relevant topics were debated with the aim of allowing the implementation of precision medicine (PM) in daily respiratory care. All debates started with positioning the current state of the art: identification of current gaps in practice, the current consensus and the need for implementation of novel approaches such as endotype-driven treatment, patient empowerment and eHealth tools. This report provides a summry of the outcomes of the brainstorming sessions of the European Rhinology Research Forum 2017, highlighting the research needs in PM, with personalized care, prediction of success of treatment, participation of the patient and prevention of disease as key drivers for improving current clinical practice.

Contains fulltext : 220931.pdf (Publisher’s version ) (Closed access) AIMS AND OBJECTIVES: To identify interventions to prevent and treat malnutrition in older adults, which can be integrated in nursing care, and to evaluate the effects of these interventions on outcomes related to malnutrition. BACKGROUND: Older adults are at great risk for malnutrition, which can lead to a number of serious health problems. Nurses have an essential role in nutritional care for older adults. Due to a lack of evidence for nursing interventions, adequate nursing nutritional care still lags behind. DESIGN: Systematic review. METHOD: We searched for and included randomised controlled trials on interventions, which can be integrated in nursing care for older adults, to prevent and treat malnutrition. We assessed the risk of bias with the Cochrane tool and evidence for outcomes with the GRADE. The PRISMA statement was followed for reporting. RESULTS: We included 21 studies of which 14 studies had a high risk of bias. Identified interventions were oral nutritional supplements, food/fluid fortification or enrichment, dietary counselling and educational interventions. In evaluating the effects of these interventions on 11 outcomes related to malnutrition, significant and nonsignificant effects were found. We graded the certainty of evidence as very low to moderate. CONCLUSION: Although slight effects were found in protein intake and body mass index, there is no convincing evidence about the effectiveness of the four identified interventions. There seems no harm in using these interventions, although it should be kept in mind that the evidence is sparse. Therefore, there is a need for high-quality research in building evidence for interventions in nursing nutritional care. RELEVANCE TO CLINICAL PRACTICE: Nurses can safely provide oral nutritional supplements and food/fluid fortification or enrichment, and give dietary counselling and education to older adults, as they are well placed to lead the essential processes of nutritional care to older adults.

Metaphor is, at root, a problem of knowing. It can serve a crucial role in the development of knowing, both for an individual and for a community. It is a powerful vehicle for recasting identity, for apprehending structure in novel ways. While metaphor can serve this role in perception and in action, its linguistic forms are especially powerful. Since language can be a powerful means for promoting changes in knowing, commitments on epistemic issues are as important for a theory of language as they are for theories of perception and action. Traditional views of metaphor have focused on the sentences that occasion metaphoric thought. Analyses are typically directed at determining the formal properties by which a metaphoric sentence may be identified, and explaining how the meaning of the sentence is related to its form.

International audience; The first European Rhinology Research Forum organized by the European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA) was held in the Royal Academy of Medicine in Brussels on 17th and 18th November 2016, in collaboration with the European Rhinologic Society (ERS) and the Global Allergy and Asthma European Network (GA2LEN). One hundred and thirty participants (medical doctors from different specialties, researchers, as well as patients and industry representatives) from 27 countries took part in the multiple perspective discussions including brainstorming sessions on care pathways and research needs in rhinitis and rhinosinusitis. The debates started with an overview of the current state of the art, including weaknesses and strengths of the current practices, followed by the identification of essential research needs, thoroughly integrated in the context of Precision Medicine (PM), with personalized care, prediction of success of treatment, participation of the patient and prevention of disease as key principles for improving current clinical practices. This report provides a concise summary of the outcomes of the brainstorming sessions of the European Rhinology Research Forum 2016.

To develop a benchmark measure of US physicians' level of knowledge and extent of use of pharmacogenomic testing, we conducted an anonymous, cross-sectional, fax-based, national survey. Of 397,832 physicians receiving the survey questionnaire, 10,303 (3%) completed and returned it; the respondents were representative of the overall US physician population. The factors associated with the decision to test were evaluated using χ(2) and multivariate logistic regression. Overall, 97.6% of responding physicians agreed that genetic variations may influence drug response, but only 10.3% felt adequately informed about pharmacogenomic testing. Only 12.9% of physicians had ordered a test in the previous 6 months, and 26.4% anticipated ordering a test in the next 6 months. Early and future adopters of testing were more likely to have received training in pharmacogenomics, but only 29.0% of physicians overall had received any education in the field. Our findings highlight the need for more effective physician education on the clinical value, availability, and interpretation of pharmacogenomic tests.

Objectives: This study was designed to determine whether genotype testing for patients initiating warfarin treatment will reduce the incidence of hospitalizations, including those due to bleeding o...

Study Objectives. To review the labels of United States Food and Drug Administration (FDA)-approved drugs to identify those that contain pharmacogenomic biomarker information, and to collect prevalence information on the use of those drugs for which pharmacogenomic information is included in the drug labeling. Design. Retrospective analysis. Data Sources. The Physicians' Desk Reference Web site, Drugs@FDA Web site, and manufacturers' Web sites were used to identify drug labels containing pharmacogenomic information, and the prescription claims database of a large pharmacy benefits manager (insuring > 55 million individuals in the United States) was used to obtain drug utilization data. Measurements and Main Results. Pharmacogenomic biomarkers were defined, FDA-approved drug labels containing this information were identified, and utilization of these drugs was determined. Of 1200 drug labels reviewed for the years 1945–2005, 121 drug labels contained pharmacogenomic information based on a key word search and follow-up screening. Of those, 69 labels referred to human genomic biomarkers, and 52 referred to microbial genomic biomarkers. Of the labels referring to human biomarkers, 43 (62%) pertained to polymorphisms in cytochrome P450 (CYP) enzyme metabolism, with CYP2D6 being most common. Of 36.1 million patients whose prescriptions were processed by a large pharmacy benefits manager in 2006, about 8.8 million (24.3%) received one or more drugs with human genomic biomarker information in the drug label. Conclusion. Nearly one fourth of all outpatients received one or more drugs that have pharmacogenomic information in the label for that drug. The incorporation and appropriate use of pharmacogenomic information in drug labels should be tested for its ability to improve drug use and safety in the United States.

Objective: This study examines demographic trends in the use of medications to treat ADHD in adult and pediatric populations. Method: Using pharmacy claims data for a large population of commercially insured Americans, the study measures ADHD treatment prevalence and drug use from 2000 to 2005. Results: In 2005, 4.4% of children (ages 0 to 19) and 0.8% of adults (ages 20 and older) used ADHD medications. Treatment rates were higher in boys (6.1%) than in girls (2.6%), but the rates for men and women were approximately equal (0.8%). During the period of the study, treatment prevalence increased rapidly (11.8% per year) for the population as a whole. Treatment rates grew more rapidly for adults than for children, more rapidly for women than for men, and more rapidly for girls than for boys. Conclusion: Improved identification of ADHD in adult and female patients has contributed to rapid growth in ADHD medication use. ( J. of Att. Dis. 2007; 10(4) 335-342)

In day-to-day practice, asthma treatment and self-management often fall short of the objectives defined by clinical practice guidelines. The objective of this study was to determine whether a population-based asthma disease management program, using broad-based educational interventions, can have a favorable impact on physician and patient adherence to guidelines-based care. A longitudinal, before-and-after design was used to evaluate program impacts on pharmacotherapy and health status. Patients with asthma (n = 35 450) were enrolled in the program from September 2000 through to June 2001. Patients were identified for the study based on a 12-month retrospective analysis of pharmacy claims. Patients were members of prescription benefit plans managed by Medco Health and were aged 5 years and older. Patients in the intervention group received asthma education materials during the 12-month period following enrollment. The materials emphasized guidelines-based principles of asthma pharmacotherapy, self-management, trigger avoidance and patient-physician partnership. Physicians received guidelines-based flow sheets to facilitate therapy tracking, and pharmacotherapy review. Asthma drug utilization was measured during the 12-month period prior to enrollment and the 12-month period following enrollment. Utilization data on controller and reliever medications were derived from a pharmacy claims database. Drug utilization changes for the intervention group were compared with those for matched controls. A health survey was conducted on a random sample of program participants at enrollment and at 12-month follow-up. The health survey included questions on asthma-related quality of life (QOL), medical utilization, productivity, and self-management skills. The percentage of patients who started controller therapy during the study period was significantly higher for the intervention group than the control group (20.7% versus 18.1%, p < 0.001). The controller prescription fill rate increased significantly in the intervention group compared with controls (p < 0.0001); the increase was primarily driven by increased refill rates for patients already using controllers. Reliever prescription fill rates decreased for both the intervention group and controls. Program participants reported significant improvements in asthma-related QOL (p < 0.05) and self-management skills. Self-reported medical utilization decreased for office visits (p < 0.05) and emergency room visits (p < 0.01). A population-based asthma disease management program can improve controller prescribing rates (new therapy starts), controller adherence rates (refill persistency), and self-management skills. These changes in physician and patient behavior help close the gaps between guidelines and practice in asthma therapy.

Chronic obstructive pulmonary disease (COPD) is a highly prevalent condition with broad economic impacts. It presents a major opportunity for healthcare cost reduction and improved functional status. This study measures the gaps between current treatment practices and recently issued guidelines, and identifies the primary opportunities for COPD disease management. COPD patients (n = 1,036) were initially identified using pharmacy claims data on outpatient respiratory medication use. Through a health assessment survey, they confirmed their diagnosis and reported on their medical resource use, vaccinations, smoking, and health-related quality of life (QOL). Drug utilization was measured using a 12-month retrospective review of prescription claims. Patients were stratified by severity level based on QOL scores. A large subset of patients (25.7%) did not use inhaled bronchodilators, the preferred first-line therapy in COPD guidelines; instead, these patients used oral bronchodilators (8.1%) or no bronchodilat...

OBJECTIVE: To evaluate the impact of an asthma disease management program conducted by a pharmacy benefit management (PBM) organization. DESIGN: A prospective analysis of the outcomes of an education-based disease management program for a large population of asthma medication users, compared to the outcomes for a matched longitudinal control group. SETTING: Merck-Medco Managed Care, L.L.C., a national PBM that manages prescription benefits and provides mail-service and online pharmacy services. PATIENTS: The intervention group consisted of 19,289 patients with asthma, aged 6 and older, divided into high-risk, low-risk, and maintenance subgroups based on history of asthma medication use. The control group consisted of 19,253 asthma patients matched on age and gender. INTERVENTIONS: Patients in the intervention group received asthma education materials and had call-in access to pharmacists trained in optimal asthma care. Physicians were notified when their patients were enrolled, and they received asthma therapy guidelines if their patients’ medications or self-reported status indicated suboptimal therapy. MAIN OUTCOME MEASURES: Antiinflammatory controller medication (AICM) use and inhaled short-acting beta-agonist medication use. RESULTS: Intervention group patients showed larger increases in AICM use than control group patients (17.8% versus 13.6%, for high-risk patients, p

This study evaluates the differences between women and men in medication use, medication adherence, and prescribing alignment with clinical guidelines.We conducted an analysis of pharmacy and medical claims for 29.5 million adults with prescription benefits administered by a pharmacy benefits manager in the United States, age 18 and older, between January 1, 2010, and December 31, 2010. Prevalence and intensity of medication use were evaluated by sex, age group, and medication type (acute vs. chronic). Medication adherence was measured by the percentage of patients with a medication possession ratio (MPR) ≥80%. The percentage of patients receiving guideline-based treatment was measured for diabetes and select cardiovascular conditions.The study population comprised 16.0 million women and 13.5 million men with continuous pharmacy benefit eligibility. Women were significantly more likely than men to use one or more medications during the analysis period (68% vs. 59%, respectively, p0.001), and women used more unique medications, on average, than men (5.0 vs. 3.7 medications per year, respectively, p0.001). Differences in drug utilization were observed for all age groups and medication types. For all clinical metrics evaluated, women were less likely than men to be adherent in their use of chronic medications, and they were less likely to receive the medication treatment and monitoring recommended by clinical guidelines.There are significant disparities between women and men in their intensity of medication use, their adherence to medications, and their likelihood of receiving guideline-based drug therapy. These differences may indicate a need for more personalized drug selection and therapeutic management to improve clinical outcomes.

Since the beginning of the third millennium the incidence of Sexually Transmitted Infections (STIs) is rising in Europe and in Belgium, and this after a steady decline in the second half of last century. It concerns new or lesser known diseases such as Hepatitis C and Lymphogranuloma venereum (LGV) and 'old' diseases such as gonorrhoea and syphilis, occurring in specific risk groups. In this article we give an update of the diagnostic means and therapeutic challenges that are of interest for the clinician. Besides these (re)-emerging diseases we touch on Human Papillomavirus (HPV) and Herpes Simplex (HSV). This selection of diseases is based on the daily experience of the clinicians working in the STI clinic of the Institute of Tropical Medicine in Antwerp. Data and clinical guidelines are derived from the Scientific Institute of Public Health in Brussels, the European and American Centers for Disease Control and Prevention, and the Guidelines of the Flemish Agency for Care and Health. New evolutions in diagnostics, prevention and treatment options make it necessary to regularly update the knowledge of this group of diseases, especially when they are complicated by HIV co-infection. As the incidence of neither HIV nor STIs seem to decrease in Belgium and Europe, it remains necessary to stay aware of the state-of-the-art management.

This study was designed to determine whether genotype testing for patients initiating warfarin treatment will reduce the incidence of hospitalizations, including those due to bleeding or thromboembolism.Genotypic variations in CYP2C9 and VKORC1 have been shown to predict warfarin dosing, but no large-scale studies have prospectively evaluated the clinical effectiveness of genotyping in naturalistic settings across the U.S.This national, prospective, comparative effectiveness study compared the 6-month incidence of hospitalization in patients receiving warfarin genotyping (n = 896) versus a matched historical control group (n = 2,688). To evaluate for temporal changes in the outcomes of warfarin treatment, a secondary analysis compared outcomes for 2 external control groups drawn from the same 2 time periods.Compared with the historical control group, the genotyped cohort had 31% fewer hospitalizations overall (adjusted hazard ratio [HR]: 0.69, 95% confidence interval [CI]: 0.58 to 0.82, p0.001) and 28% fewer hospitalizations for bleeding or thromboembolism (HR: 0.72, 95% CI: 0.53 to 0.97, p = 0.029) during the 6-month follow-up period. Findings from a per-protocol analysis were even stronger: 33% lower risk of all-cause hospitalization (HR: 0.67, 95% CI: 0.55 to 0.81, p0.001) and 43% lower risk of hospitalization for bleeding or thromboembolism (HR: 0.57, 95% CI: 0.39 to 0.83, p = 0.003) in patients who were genotyped. During the same period, there was no difference in outcomes between the 2 external control groups.Warfarin genotyping reduced the risk of hospitalization in outpatients initiating warfarin. (The Clinical and Economic Impact of Pharmacogenomic Testing of Warfarin Therapy in Typical Community Practice Settings [MHSMayoWarf1]; NCT00830570).

Introduction Assuming that STI patients visiting SHC have different risk profiles triggered STI surveillance by GP. The aim was to compare patient characteristics and to explore the contribution of the different health care settings to STI control. Methods STI surveillance exists since 2000 by voluntary participation of gynaecologists, dermatologists, medical centres for sex workers (SW), STI clinics, and aids reference centres (ARC), collecting socio-demographic, testing and behavioural data. They are defined as SHC. In order to compare STI patients consulting GP and SHC, the GP sentinel network was invited to participate STI surveillance in 2013. Chi2-test for proportions was used to test for significant differences. Results GP (N = 160) and SHC (N = 30) reported respectively 158 and 855 episodes. Patients did not differ in gender, age, education and STI diagnosis. GP patients consulted because of a STI plaints (GP: 67%; SHC: 42%), SHC performed more screening (GP: 17%, SHC: 36%). SHC patients mentioned more multi partnership (GP: 36%; SHC: 73%) and used more condoms (GP: 20%; SHC: 46%). The proportion of MSM, SW and drug users was higher in SHC (resp. GP: 39%, SHC: 66%; GP: 1%, SHC: 15%; GP: 0%, SHC: 3%). The proportion of MSM by STI, with exception of genital warts, was always higher in SHC and was strongest for syphilis (GP: 60%, SHC: 92%). Conclusion STI patients were analogue for age and gender in the 2 types of health care settings. GP screened less for STI and diagnosis was made in case of a particular plaint. High risk groups (MSM, SW and drug users) were more seen in SHC than in the GP network,. The probable lower risk profile of GP patients could be dedicated to lower STI knowledge and risk awareness, by as well GP and patient not belonging to a known risk group. GP training in STI consulting and opportunistic screening with risk factor awareness and strengthen condom use in general are recommended. Disclosure of interest statement Nothing to Declare.

To measure the timing and frequency of follow-up care during the initiation phase of antidepressant therapy, and to compare the typical pattern of care with current product guidelines.Retrospective cohort study.The study included 84514 adult and pediatric patients who started a new course of antidepressant therapy for any indication between July 2001 and September 2003. Patients were members of a large managed care organization in the northeastern United States. Ambulatory visits during the first 12 weeks of treatment were identified using medical claims data. Outcome measures were time to first follow-up visit, frequency of follow-up visits, and percentage of patients receiving recommended levels of care.During the first 4 weeks of treatment with antidepressants, only 55.0% of patients saw a healthcare provider for any purpose, and only 17.7% saw a provider for mental healthcare. Ambulatory visit rates during the first 4, 8, and 12 weeks were significantly lower than the minimum levels recommended in product labeling (P.0001). Only 14.9% of patients received the Food and Drug Administration-recommended level of follow-up care during the first 4 weeks, 18.1% at 8 weeks, and 22.6% at 12 weeks.Adults and children who begin a new course of antidepressant therapy tend to receive far less monitoring than is recommended in current product labeling. Given safety concerns during the initiation phase, earlier and more frequent follow-up care appears desirable. Further research is needed to identify the most cost-effective schedule of care.

Objective: The objective of this study was to evaluate the impact of medication adherence on healthcare utilization and cost for 4 chronic conditions that are major drivers of drug spending: diabetes, hypertension, hypercholesterolemia, and congestive heart failure. Research Design: The authors conducted a retrospective cohort observation of patients who were continuously enrolled in medical and prescription benefit plans from June 1997 through May 1999. Patients were identified for disease-specific analysis based on claims for outpatient, emergency room, or inpatient services during the first 12 months of the study. Using an integrated analysis of administrative claims data, medical and drug utilization were measured during the 12-month period after patient identification. Medication adherence was defined by days’ supply of maintenance medications for each condition. Patients: The study consisted of a population-based sample of 137,277 patients under age 65. Measures: Disease-related and all-cause medical costs, drug costs, and hospitalization risk were measured. Using regression analysis, these measures were modeled at varying levels of medication adherence. Results: For diabetes and hypercholesterolemia, a high level of medication adherence was associated with lower disease-related medical costs. For these conditions, higher medication costs were more than offset by medical cost reductions, producing a net reduction in overall healthcare costs. For diabetes, hypercholesterolemia, and hypertension, cost offsets were observed for all-cause medical costs at high levels of medication adherence. For all 4 conditions, hospitalization rates were significantly lower for patients with high medication adherence. Conclusions: For some chronic conditions, increased drug utilization can provide a net economic return when it is driven by improved adherence with guidelines-based therapy.

Background Sentinel STI surveillance with clinicians exists since 2000. STI within HIV patients triggered STI surveillance in ARC, specialised in care of HIV patients and patients at risk. No STI-HIV screening guidelines exist. STI is a driving force for HIV epidemics. Methods STI surveillance registers STI episodes, including questions on HIV serology, HIV testing and risk behaviour. HIV testing circumstances are analysed in both networks. Results In 2011, 744 STI patients were registered by the network of clinicians and 250 STI coinfected HIV patients by the ARC. HIV testing circumstances are known for 95% of the STI patients from the clinicians network. 51% was tested during STI consultation, 19% were never tested, being postponed, refused or not proposed. The remaining 30% was tested previously of whom 49% was HIV negative and not retested. Within the clinicians network, HIV serology was reported in 79% of the cases: 21% are HIV positive of whom 14% discovered their seropositivity at STI consultation. Within the ARC, 7% of the coinfected HIV patients discovered their HIV positivity simultaneously with the STI diagnosis. Among STI patients in the ARC with at first negative/unknown HIV status, 57% was tested for STI-HIV simultaneously: 15% were found HIV positive. 11% of the seronegative STI patients were not retested. For the other 32% of the STI patients, their HIV status remains unknown. Conclusions Surveillance of STI in both networks shows that HIV testing is not always performed during STI consultation, the HIV status may remain unknown and/or patients are not retested. Nevertheless, HIV positivity and STI are regularly found simultaneously. Knowing the HIV status of STI patients and screening HIV patients for STI is important for reducing HIV-STI transmission. National STI-HIV screening guidelines should be developed and implemented. Besides screening, condom use remains the most important preventive factor.

Background The observation of STI in HIV-patients has triggered a STI-Surveillance in AIDS Reference Centres (ARC). The aim of this surveillance is to identify STI emerging in HIV-patients, to analyse STI-trends in this group and to describe patient characteristics. Methods There are nine ARC in Belgium. The ARC are specialised in HIV-patient care, STI-consultation and treatment. Since April 2007, seven ARC participate in the surveillance. STI included are limited to Chlamydia, gonorrhoea , syphilis, Lymphogranuloma Venerum (LGV), hepatitis B (HBV) and hepatitis C (HCV) among men having sex with men (MSM). Results In 2008, 6962 HIV-patients (36.8% women; 63.2% men) were followed and 7454 patients (35.7% women; 63.9% men) in 2009. The HIV-population under follow-up increased by 7.1% (8.3% in men; 4.7% in women). In 2008 as well as in 2009, 279 STI were reported among the HIV-patients. It concerns 250 men and two women in 2008 and 251 men and two women in 2009; 242 were MSM in 2008 and 244 in 2009 (96%). The finding observed in 2009, with 5.3% HIV-infected men presenting an STI vs 5.7% in 2008 prevails a lower incidence of STI. This decrease is not statistically significant (χ 2 =0.76, a=0.38). In 2008 as well as in 2009, 13 patients were diagnosed with more than 1 STI (4.6% of the STI patients) The most frequent STI was syphilis, with 171 cases (61% of STI diagnosis) in 2008 and 160 cases (59%) in 2009, of whom one woman; respectively 94% and 95% of the men were MSM. Chlamydia has been found in 30 men and two women in 2008 and in 28 men and one woman in 2009. LGV was confirmed in 12 men in 2008 and in 15 in 2009. Gonorrhoea was found in 29 men in 2008 and 32 in 2009. HBV and HCV were respectively diagnosed in 2 and 14 men in 2008 and in 7 and 17 men in 2009. All men reported with Chlamydia, LGV, gonorrhoea, HBV and HCV were MSM. 64% (2008) and 75 % (2009) of the homosexual men with STI mentioned having multiple partners. Conclusions The surveillance in 2008 and 2009 confirms an STI-problem among HIV-infected MSM. These results highlight unsafe sex behaviour among MSM, also reflected by the high proportion of MSM reporting multiple partners. HIV-positive MSM are particularly vulnerable for syphilis. The incidence of LGV and HCV among HIV-positive men should be followed closely and an adaptation of the international screening policy for LGV and HCV is needed. Chlamydia patients belonging to high risk groups should be tested for the LGV variant.

The vowel information present in initial and final regions of /b/—vowel—/b/ syllables was examined in this study. Vowels were identified for unedited syllables spoken by a man and a woman, for the initial 20% of those syllables, for the final 20% of the syllables, for the initial and final 20% of the syllables combined and separated by a 60% silent gap, and for the initial and final 20% of the syllables interchanged across talkers and separated by a 60% silent gap. Results indicate: (1) that there is considerable vowel information present in the dynamic regions at the beginnings and endings of syllables; (2) that the information is, to a large extent, carried relationally by those regions; (3) that the information is talker-independent in form; and (4) that the information is complementary to, and distinct from, formant frequency information present in a syllable's center. An experiment assessing the perceived source(s) of these stimuli suggests that source perception is influenced by as yet unspecified acoustic modulations defined at the syllable level.

Research in auditory perception has tended to emphasize the detection and processing of sound elements with quasi-stable spectral structure, such as tones, formants, and bursts of noise. In the spectral domain, these elements are distinguished by frequency peak or range, bandwidth, and amplitude. In the temporal domain, acoustic analysis has often focused on the durations of sound elements, the intervals and phase relations between them, and the influence of these on pitch and loudness perception, temporal acuity, masking, and localization. The auditory system has often been approached as an analyzer of essentially time-constant functions of frequency, amplitude, and duration, on the assumption that complex auditory percepts are compositions over sound elements having those properties, with certain temporal inter

To test the effect of linguistic experience on the perception of a cue that is known to be effective in distinguishing between [r] and [l] in English, 21 Japanese and 39 American adults were tested on discrimination of a set of synthetic speech-like stimuli. The 13 “speech” stimuli in this set varied in the initial stationary frequency of the third formant (F3) and its subsequent transition into the vowel over a range sufficient to produce the perception of [r a] and [l a] for American subjects and to produce [r a] (which is not in phonemic contrast to [l a ]) for Japanese subjects. Discrimination tests of a comparable set of stimuli consisting of the isolated F3 components provided a “nonspeech” control. For Americans, the discrimination of the speech stimuli was nearly categorical, i.e., comparison pairs which were identified as different phonemes were discriminated with high accuracy, while pairs which were identified as the same phoneme were discriminated relatively poorly. In comparison, discrimination of speech stimuli by Japanese subjects was only slightly better than chance for all comparison pairs. Performance on nonspeech stimuli, however, was virtually identical for Japanese and American subjects; both groups showed highly accurate discrimination of all comparison pairs. These results suggest that the effect of linguistic experience is specific to perception in the “speech mode.”

Subjects judged the similarities among a set of American English vowels (/i,I,q,1,v,a,c,o,0,u/) presented in isolation or in a /dVd/ consonantal frame. Individual differences scaling was employed to analyze these similarities data for each of the conditions separately and for the two conditions combined. In all cases, perceptual dimensions corresponding to the advancement, height, and tenseness vowel features were recovered. Given the determinacy of individual differences scaling, this finding is taken to provide strong evidence for the perceptual significance of those features. The perceptual dimensions are considered in relation to various acoustic parameters of the stimuli employed in this study. They are also considered in relation to perceptual dimensions that have been observed in other vowel scaling studies.

Is metaphor a late acquisition, or is it a process that is active throughout development? Recent research provides misleading answers.

It is commonly assumed that a listener identifies an unknown talker's vowels in terms of the relation between their acoustic structure and that of other vowels produced by the same talker: the listener “normalizes” the variant acoustic signals on the basis of information about their source (vocal‐tract characteristics). In order to measure the vowel ambiguity attributable to talker differences, we compared identification of nine vowels in /p—vowel—p/ environment produced by a single talker with the same vowels produced by 15 talkers (men, women, children) who differed widely in vocal‐tract sizes and characteristic fundamental frequency. Mean error rates were 9% and 17%, respectively. Acoustic differences attributable to talker accounted for fewer than half of the perceptual errors. Lieberman [Am. Anthropologist (1972)] has proposed that the point vowels, /i, a, u/, are the “primary calibrating signals” by which the listener determines the size of the talker's vocal tract and normalizes the acoustic signal. In a second study, one group of listeners received each test word preceded by syllables containing /i, a, u/ and another group heard the test words preceded by nonpoint vowels /I, ae, Λ/. There was no significant overall reduction in errors of vowel identification for words preceded either by point vowels or by nonpoint vowels. Although perception of certain vowels improved when preceding syllables were present, perception of other vowels deteriorated.

The theoretical problems posed by metaphoric comprehension are discussed in the context of experiments on prompted recall. Listeners heard sentences of the form “Topic is (like) Vehicle.” In most cases, a statement of the implicit resemblance (the “ground”) was very effective in prompting recall of its related metaphor. This result could not be attributed to the activation, transfer, or additive combination of pre-existing properties of the topic and vehicle terms or to pre-existing associations between grounds and sentence terms. It is argued that the vehicle domain guides a novel schematization of the topic domain, that the perceived resemblance is a higher-order relation among entities (both explicit and implicit) in each domain, and that this abstract relation constitutes the “functional memory unit.” Prompted recall may begin with recognition of this previously experienced relation.

Listeners make remarkably few errors in identification of randomly presented tokens of vowels produced by a panel of talkers in fixed consonantal environments. The present study was designed to investigate the sources of perceptual confusions among vowels and to determine whether or not the effects of talker differences on vowel identification are independent of consonantal environment. Tokens of nine American English vowels were spoken in three contexts: (1) in isolation, (2) in a variable consonantal environment (/C1—vowel—C2/, where C1,2 = /b, p, d, t, g, k/), and (3) in a fixed consonantal environment (/p—vowel—p/). Test lists were produced by three representative single talkers (man, woman, child) and by a panel of talkers who differed in vocal‐tract size and characteristic fundamental frequency. Whether produced by the panel or by a single talker, isolated vowels were significantly more often misidentified than were vowels in consonantal environments. Reliable differences in identification of medial...

The presence or absence of silence was found to be a relevant cue for the distinction between affricate /t∫/ and fricative /∫/ when it occurred in sentence-medial position, but not when it occurred at a sentence boundary. This was so in all cases in which target words and their precursors were both produced by the same talker and in some cases in which they were produced by different talkers. The effect was not dependent on specific durations of the silent interval, nor upon listeners' perceptions of the number of talkers who had produced the utterances. These results are, along with previous findings, taken to be consistent with the principle that silence can have phonetic significance for a listener only when it is perceived to have occurred in a stretch of speech that was articulated continuously.

The identifiability of isolated vowels (/V/) was compared to that of vowels in consonantal context (/pVp/) when subjects performed a monitoring task. On successive blocks of trials in a test series, the subjects listened for instances of one or another of nine monophthongal vowels (/i,I,q,1,v,a,c,U,u/) and identified each test item as being an instance or not. On average, resulting false alarm errors occurred significantly less often in the /pVp/ condition, consistent with the previous finding that vowel perception may be aided by consonantal context. This beneficial effect of context was found to be restricted to the class of open vowels, however, with perception of the close vowels being somewhat hindered by context. The error data for misses also showed an interaction between context and vowel height. Various accounts of the interaction are considered.

The mechanical events of bouncing and breaking are acoustically specified by single versus multiple damped quasi-periodic pulse patterns, with an initial noise burst in the case of breaking. Subjects show high accuracy in categorizing natural tokens of bouncing and breaking glass as well as tokens constructed by adjusting only the temporal patterns of components, leaving their spectral properties constant. Differences in average spectral frequency are, therefore, not necessary for perceiving this contrast, though differences in spectral consistency over successive pulses may be important. Initial noise corresponding to glass rupture appears unnecessary to categorize breaking and bouncing. The data indicate that higher order temporal properties of the acoustic signal provide information for the auditory perception of these events.

A differential pressure transducer has been developed for pressures up to 10 kbar. Both liquids and gases can be used as pressurizing media. A full‐scale deflection of the meter represents a pressure difference of less than 0.5 bar.

The third formant transition is an important acoustic dimension in the identification of /r/ and /l/ by English listeners [Miyawaki et al. (in preparation)]. In this study, six listeners showed a consistent decrease in “r” responses following repeated presentation of /r/ stimuli and a complementary increase following /l/ stimuli. These shifts are similar to those found for perceptual boundaries between stops. Further tests suggest the shifts are not due to adaptation of context‐independent formant‐transition detectors: (1) repeated presentation of the isolated third formants from the original adapting stimuli produced no consistent boundary shifts; (2) when the listeners were asked to categorize the full series of isolated third formants, the nonspeech boundaries often differed from the speech boundaries; (3) the nonspeech boundaries were unstable, and no consistent shifts could be induced by either speech or nonspeech adapting stimuli. Adaptation effects may be restricted to adapting and test stimuli which are members of the same natural class of events.

Variations in syllable stress create a constancy problem for vowel perception owing to the accompanying variations in formant structure. An earlier study [R. R. Verbrugge and D. P. Shankweiler, J. Acoust. Soc. Am. 61, 539 (1977)], failed to demonstrate perceptual “compensation” for stress changes, possibly because variation in the prosody of a carrier phrase was not effective in altering the perceived stress of the target syllables. In the present experiment, stress was varied by altering the acoustic structure of the target syllable itself. A male talker produced a set of carrier sentences containing either stressed or destressed /pVp/ syllables (V = /i, , e, ae, a, , , ν, u/). Two types of synthetic analogs were created using an OVE‐III synthesizer: (a) original formant analogs, matched in pitch, amplitude, duration, and formant frequencies to the original syllables, and (b) interchanged‐formant analogs, preserving the original prosody, but containing formants taken from the syllable of opposite stress. The synthetic syllables were embedded in the original carrier sentences for presentation to listeners. Vowel identification was influenced by perceived stress: errors on stressed formants increased somewhat when the prosody was inappropriately destressed, while errors on destressed formants were paradoxically lower in the presence of stressed prosody. The results demonstrate that vowel identity is perceived in relation to stress. Comparison of error patterns for stress‐interchanged and rate‐interchanged syllables suggests that the two transformations are not equivalent. [Research supported by NICHD.]

A male and a female talker each produced a set of /bVb/ syllables (V = /i,I,e,e,ae,a,ʌ,ɔ,o,ʋ,u/) at metronome‐controlled rates. The central 60% of the voiced regions of these syllables was edited out, producing single‐talker silent‐center syllables [cf. W. Strange, J. J. Jenkins, and T. R. Edman, J. Acoust. Soc. Am. 61, S39 (1977)]. Comparable “hybrid” silent‐center syllables were created by appending the final 20% of one talker's syllable to the initial 20% of the other talker's production of the same syllable, again with a 60% silent region intervening. Vowel identification errors were relatively low for both the single‐talker (22.4%) and the hybrid (27.0%) silent‐center syllables, though errors in each case exceeded those found for the original (unedited) syllables, though errors in each case exceeded those found for the original (unedited) syllables (9.3%). Hybrids were generally heard as coherent syllables from a single source; the error pattern for the hybrids could not be interpreted as a joint function of errors on the initial pieces (55.4% on average) and the final pieces (72.9%). Results indicate that considerable information for vowels is contained in the dynamic regions early and late in a syllable. Moreover, they suggest that this information does not simply subserve computation of an underlying normalized target. The information may specify properties of production dynamics that are invarient for a vowel for all talkers of a dialect. To the extent that such information is available, normalization in perception is unnecessary. [Research supported by NICHD.]

Earlier research suggests that prosodic information is utilized by listeners in identifying vowels. The effects of variation in stress and tempo need to be distinguished. In this study, an adult male talker recorded nine American English monophthongs in /p—p/ syllables in each of four sentence contexts: two levels of syllable stress (stressed, destressed) were crossed with two rates of sentence articulation (slow, fast). Listeners made more errors when identifying syllables in isolation (average of 15% errors) than in sentence context (5%). Errors on the isolated syllables showed a bias toward “short” vowels, suggesting that the effective tempo perceived by listeners was slower than appropriate. Tokens of each syllable type were interchanged between sentence pairs so as to misinform listeners about the syllables' tempo and stress value. When tempo was mismatched, errors increased substantially on the fast syllables, showing a bias toward shorter vowels. No change was found when stressed and destressed syllables were interchanged, though formant frequency differences were greater than those between fast and slow syllables. The results contribute to a growing body of evidence that vowels are specified as much by sentential stress‐timing structure as by cross‐sectional formant measures.

Quasi‐steady‐state vowels which attain representative formant frequency values for adult male speakers of General American might be regarded as good approximations to canonical form. Results of experiments on vowel perception do not support this assumption. Two speakers produced tokens of nine different vowels in isolation. Separate listening tests were made by random orders of six tokens of each vowel. A second pair of tests was created by digitizing the speech signals, abstracting a single pitch pulse (at the zero crossings) from each vowel center, and iterating to produce sets of pseudovowels matched in duration to the parent syllables. Listeners' judgments contained nearly twice as many errors for iterated pseudovowels than for the unedited natural versions. A third experiment with OVE‐synthesized vowels yielded error rates comparable to those for iterated pseudovowels, not to their natural counterparts. We conclude that natural vowels contain sources of information not captured by target formant freq...

Previous studies comparing the perception of isolated vowels with that of vowels produced in some consonantal context have generally focused on similarities and differences in the average performance of subjects in the two conditions. In this investigation, we wanted to look carefully at individual differences in vowel perception both within and between these conditions. We did so with the aid of a nonmetric individual differences scaling procedure developed by Takane et al. [Psychometrika 42, 7–67 (1977)]. The variance common to all subjects (in the two conditions combined) was modeled in a single multidimensional space, and the individual differences were represented as weights (or saliences) that each subject attached to the dimensions of the space. The data were similarity judgments collected (with the method of triadic comparisons) for a set of isolated vowels and for a set of vowels in context recorded by the same talker. The perceptual space had three dimensions. The first of these corresponded clo...

Earlier studies have shown that vowels spoken in isolation tend to be poorly perceived, even when they are produced by phonetically trained talkers. Listeners, however, generally make remarkably few errors in identification of vowels in CVC environment, even when each syllable is uttered by a different talker. Sets of nine American English vowels were spoken by a panel of talkers: in isolation and in a /p‐p/ environment. Measurements of the first three formant frequencies were obtained from spectrograms. Listening tests were made up by randomizing talkers and tokens, and these were presented to phonetically naive listeners. Percent recognition of the intended vowel (average over vowels) was 83% for the /p‐p/ condition and 58% for the isolated condition. When the formant frequencies of each talker's isolated and medial vowels are compared, the values are found to be highly similar. Another explanation must be sought for the perceptual difficulty of isolated steady‐state vowels.

We have previously reported that an individual differences scaling comparison of the perception of isolated vowels and the perception of vowels in a consonantal environment (/dVd/) indicated the following: vowels are processed in a more linguistically appropriate way when they occur in consonantal context [B. Rakerd and R. R. Verbrugge, J. Acoust, Soc. Am. Suppl. 1 71, S76 (1982)]. In the present investigation, the method of that earlier experiment was extended to a study of vowel memory. Subjects were asked to make similarity judgments about their memories of (a) isolated vowels, or (b) vowels in /dVd/ consonantal context, and the resulting similarities matrices were submitted to nonmetric individual differences scaling. The scaling analysis indicated (1) that vowel memory, like vowel perception, is to a measurable degree organized around the features of advancement, height, and tenseness; and (2) that the previously reported perceptual influence of consonantal context is largely to be explained in terms...

Interest in the perceptual equivalence of “static” and “dynamic” stimuli spans both speech and nonspeech domains. Previous investigations of speech stimuli have shown that, given matched sets of three‐formant steady‐state vowels and vowels flanked by consonantal transitions, phonetic equivalence is not defined by equal position along the two continua [B. Lindblom and M. Studdert‐Kennedy, J. Acoust. Soc. Am. 42, 830–843 (1967)]. For judgments of relative pitch, on the other hand, ramp tones are judged to be nearly equivalent in pitch to steady‐state tones at their endpoint frequencies [P. T. Brady et al., J. Acoust. Soc. Am. 33, 1357–1362 (1961)]. The present set of experiments demonstrates this difference in categorization of static and dynamic stimuli using a single type of stimulus. Two sets of sine wave stimuli (FLAT/CONTOUR) were constructed by modeling the frequency and relative amplitude characteristics of the aforementioned speech stimuli. When judged in terms of phonetic categories (/ᴜ/ vs /ɪ/), significantly greater proportion of /ᴜ/ judgments were observed for the FLAT than for the CONTOUR continuum. However, when the same two sets of stimuli were judged in terms of relative pitch (HIGH versus LOW), no significant difference in response pattern for the two continua was noted. Thus the experiments demonstrate that two distinct response patterns may be elicited for sine wave stimuli contingent only on the experimenter's instructions. [Work supported by NICHD.]

In rapid speech, acoustic analysis reveals that steady state vowel targets characteristically are not reached. Lindblom and Studdert‐Kennedy [J. Acoust. Soc. Am. 42, 830–843 (1967)] found in an experiment with synthetic speech that listeners showed a shift in the boundary between medial vowels /e/ and /U/ with variations in the rate and direction of formant transitions. Apparently, perceivers compensate for simulated articulatory undershoot by perceptual overshoot. An experiment with natural speech demonstrated shifts in the acoustic criteria listeners employed in vowel recognition as a function of perceived rate of utterance. Nine American English vowels in /p‐p/ environment were produced by a panel of 15 talkers in a fixed sentence frame. The unstressed, rapidly articulated /p‐p/ syllables were excised from the tape recording and assembled into listening tests. In one condition, the /p‐p/ targets were prefaced by three slowly articulated syllables /hi, ha, hu/. In the other test condition, no precursors...

Consonantal environment may aid in specifying vowel identity by supplying critical information about timing. Several vowel pairs in American English are distinguished by temporal as well as spectral variables, and these temporal differentia vary with articulatory rate. Two studies were designed to explore the following paradox: When consonantal formant transitions are introduced into a steady‐state vowel, holding syllable duration constant, a response shift is observed toward longer‐vowel alternatives, even though steady‐state duration has been reduced. The first study verified this finding for the vowel pair /e/‐/ae/ in comparisons of ♯V♯ and bVb continua. Pairs of continua were defined separately by F1 variation and by duration variation, and each continuum type evidenced the paradox. A second study varied the rate of symmetric consonantal transitions in F1‐varying CVC continua (V = /e, ae/, C = ♯, b, w/) in order to test whether transition rate might specify an articulatory rate that effectively scales vowel duration. Vowel responses did not vary monotonically with either transition rate or steady‐state duration, but interacted with the perceived identity of the initial consonant. Listeners' judgments may demonstrate a sensitivity to constraints on the relative timing of consonantal and vocalic gestures. [This work was supported by NIH grant HD‐01994 to Haskins Laboratories, and by the University of Michigan Society of Fellows.]

Consonantal environment does not aid vowel identification universally, but preserves and sharpens the information for vowels differentially. In a vowel recognition task, listeners heard one of two test series: /pVp/ syllables or isolated vowels. The test items were spoken by a single male talker and contained a balanced distribution of the vowels /i, ɪ, e, ae, a, ɔ, ʌ, ᴜ, u/. During each block of 90 test trials, listeners targeted for one of the nine vowel types, checking “Yes” when they recognized an instance and “No” otherwise. For both misses and false alarms, there was a strong interaction between vowel type (close versus open) and context type (/pVp/ vs /V/). The open vowel pairs (/ɛ/ae/ , /ʌ/a/) showed consistently superior recognition in the /pVp/ consonantal environment; others did not. Asymmetries in confusion errors were observed for several vowel pairs in both environments. A dynamic articulatory model of the syllable can provide a parsimonious account for these effects. Listeners may be sensitive to acoustic patterning that specifies vowels as dynamic gestures; vowel recognition will vary in precision depending on how the consonantal envirionment structures the dynamic information in sound. [Research supported by NIH grant HD‐01994 to Haskins Laboratories.]

Viewing the way society has defined its rules and mechanisms as “social software”, we want to understand how people behave given their understanding of the societal rules and given their wish to further their interest as they conceive it, and how social mechanisms should be designed to suit people furthering their interest as they conceive it. This chapter is written from the perspective of strategic game theory, and uses strategic game scenarios and game transformations to analyze societal mechanisms.