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Rough weather ahead for Walter the farting dog
When an expert on animal gas tries to cure Walter, his farts keep building up until he floats away and is blown by the wind to a distant place, where he once again proves himself a hero.
Book
Factors that influence the implementation of e-health: a systematic review of systematic reviews (an update)
Background
There is a significant potential for e-health to deliver cost-effective, quality health care, and spending on e-health systems by governments and healthcare systems is increasing worldwide. However, there remains a tension between the use of e-health in this way and implementation. Furthermore, the large body of reviews in the e-health implementation field, often based on one particular technology, setting or health condition make it difficult to access a comprehensive and comprehensible summary of available evidence to help plan and undertake implementation. This review provides an update and re-analysis of a systematic review of the e-health implementation literature culminating in a set of accessible and usable recommendations for anyone involved or interested in the implementation of e-health.
Methods
MEDLINE, EMBASE, CINAHL, PsycINFO and The Cochrane Library were searched for studies published between 2009 and 2014. Studies were included if they were systematic reviews of the implementation of e-health. Data from included studies were synthesised using the principles of meta-ethnography, and categorisation of the data was informed by the Consolidated Framework for Implementation Research (CFIR).
Results
Forty-four reviews mainly from North America and Europe were included. A range of e-health technologies including electronic medical records and clinical decision support systems were represented. Healthcare settings included primary care, secondary care and home care. Factors important for implementation were identified at the levels of the following: the individual e-health technology, the outer setting, the inner setting and the individual health professionals as well as the process of implementation.
Conclusion
This systematic review of reviews provides a synthesis of the literature that both acknowledges the multi-level complexity of e-health implementation and provides an accessible and useful guide for those planning implementation. New interpretations of a large amount of data across e-health systems and healthcare settings have been generated and synthesised into a set of useable recommendations for practice. This review provides a further empirical test of the CFIR and identifies areas where additional research is necessary.
Trial registration
PROSPERO,
CRD42015017661
Journal Article
جنرالات صدام : وجهات نظر عن الحرب العراقية-الإيرانية
يتناول كتاب (جنرالات صدام : وجهات نظر عن الحرب العراقية-الإيرانية) والذي قام بتأليفه (كيفن م. وودز، وليامسن موراي، إليزابيث أ. ناثان، ليلى صبارا، آنا م. فينيغاس) في حوالي (408) صفحة من القطع المتوسط موضوع (الحرب الإيرانية العراقية) مستعرضا المحتويات التالية : الخليفة، أصول الحرب والتخطيط لشنها، تعليم صدام في الحرب، تأقلم القوات المسلحة العراقية مع واقع الحرب، السياق التاريخي ولائحة الأحداث بحسب تسلسلها الزمني، حوار مع الفريق الركن مجيد رشيد الحمداني، القيادة العامة للقوات المسلحة المساعدة الأجنبية.
BOOK
The Neural Circuitry Underlying the “Rhythm Effect” in Stuttering
Purpose: Stuttering is characterized by intermittent speech disfluencies, which are dramatically reduced when speakers synchronize their speech with a steady beat. The goal of this study was to characterize the neural underpinnings of this phenomenon using functional magnetic resonance imaging. Method: Data were collected from 16 adults who stutter and 17 adults who do not stutter while they read sentences aloud either in a normal, self-paced fashion or paced by the beat of a series of isochronous tones (\"rhythmic\"). Task activation and task-based functional connectivity analyses were carried out to compare neural responses between speaking conditions and groups after controlling for speaking rate. Results: Adults who stutter produced fewer disfluent trials in the rhythmic condition than in the normal condition. Adults who stutter did not have any significant changes in activation between the rhythmic condition and the normal condition, but when groups were collapsed, participants had greater activation in the rhythmic condition in regions associated with speech sequencing, sensory feedback control, and timing perception. Adults who stutter also demonstrated increased functional connectivity among cerebellar regions during rhythmic speech as compared to normal speech and decreased connectivity between the left inferior cerebellum and the left prefrontal cortex. Conclusions: Modulation of connectivity in the cerebellum and prefrontal cortex during rhythmic speech suggests that this fluency-inducing technique activates a compensatory timing system in the cerebellum and potentially modulates top-down motor control and attentional systems. These findings corroborate previous work associating the cerebellum with fluency in adults who stutter and indicate that the cerebellum may be targeted to enhance future therapeutic interventions.
Journal Article
Relationships between vocal pitch perception and production: a developmental perspective
The purpose of this study was to examine the relationships between vocal pitch discrimination abilities and vocal responses to auditory pitch-shifts. Twenty children (6.6–11.7 years) and twenty adults (18–28 years) completed a listening task to determine auditory discrimination abilities to vocal fundamental frequency (
f
o
) as well as two vocalization tasks in which their perceived
f
o
was modulated in real-time. These pitch-shifts were either unexpected, providing information on auditory feedback control, or sustained, providing information on sensorimotor adaptation. Children were subdivided into two groups based on their auditory pitch discrimination abilities; children within two standard deviations of the adult group were classified as having adult-like discrimination abilities (N = 11), whereas children outside of this range were classified as having less sensitive discrimination abilities than adults (N = 9). Children with less sensitive auditory pitch discrimination abilities had significantly larger vocal response magnitudes to unexpected pitch-shifts and significantly smaller vocal response magnitudes to sustained pitch-shifts. Children with less sensitive auditory pitch discrimination abilities may rely more on auditory feedback and thus may be less adept at updating their stored motor programs.
Journal Article
The Relationship Between Relative Fundamental Frequency and a Kinematic Estimate of Laryngeal Stiffness in Healthy Adults
Purpose: This study examined the relationship between the acoustic measure relative fundamental frequency (RFF) and a kinematic estimate of laryngeal stiffness. Method: Twelve healthy adults (mean age = 22.7 years, SD = 4.4; 10 women, 2 men) produced repetitions of /ifi/ while varying their vocal effort during simultaneous acoustic and video nasendoscopic recordings. RFF was determined from the last 10 voicing cycles before the voiceless obstruent (RFF offset) and the first 10 cycles of revoicing (RFF onset). A kinematic stiffness ratio was calculated for the vocal fold adductory gesture during revoicing by normalizing the maximum angular velocity by the maximum glottic angle during the voiceless obstruent. Results: A linear mixed effect model indicated that RFF offset and onset were significant predictors of the kinematic stiffness ratios. The model accounted for 52% of the variance in the kinematic data. Individual relationships between RFF and kinematic stiffness ratios varied across participants, with at least moderate negative correlations in 83% of participants for RFF offset but only 40% of participants for RFF onset. Conclusions: RFF significantly predicted kinematic estimates of laryngeal stiffness in healthy speakers and has the potential to be a useful clinical indicator of laryngeal tension. Further research is needed in individuals with voice disorders.
Journal Article
Standards for Reporting Implementation Studies (StaRI) Statement
Implementation studies are often poorly reported and indexed, reducing their potential to inform initiatives to improve healthcare services. The Standards for Reporting Implementation Studies (StaRI) initiative aimed to develop guidelines for transparent and accurate reporting of implementation studies. Informed by the findings of a systematic review and a consensus-building e-Delphi exercise, an international working group of implementation science experts discussed and agreed the StaRI Checklist comprising 27 items. It prompts researchers to describe both the implementation strategy (techniques used to promote implementation of an underused evidence-based intervention) and the effectiveness of the intervention that was being implemented. An accompanying Explanation and Elaboration document (published in BMJ Open, doi:10.1136/bmjopen-2016-013318) details each of the items, explains the rationale, and provides examples of good reporting practice. Adoption of StaRI will improve the reporting of implementation studies, potentially facilitating translation of research into practice and improving the health of individuals and populations.
Journal Article
Non-nutritive suck and voice onset time: Examining infant oromotor coordination
The variability of a child’s voice onset time (VOT) decreases during development as they learn to coordinate upper vocal tract and laryngeal articulatory gestures. Yet, little is known about the relationship between VOT and other early motor tasks. The aims of this study were to evaluate the relationship between infant vocalization and another early oromotor task, non-nutritive suck (NNS). Twenty-five full-term infants (11 male, 14 female) completed this study. NNS was measured with a customized pacifier at 3 months to evaluate this early reflex. Measures of mean VOT and variability of VOT (measured via coefficient of variation) were collected from 12-month-old infants using a Language Environmental Analysis device. Variability of VOTs at 12 months was significantly related to NNS measures at 3-months. Increased VOT variability was primarily driven by increased NNS intraburst frequency and increased NNS burst duration. There were no relationships between average VOT or range of VOT and NNS measures. Findings from this pilot study indicate a relationship between NNS measures of intraburst frequency and burst duration and VOT variability. Infants with increased NNS intraburst frequency and NNS burst duration had increased VOT variability, suggesting a relationship between the development of VOT and NNS in the first year of life. Future work is needed to continue to examine the relationship between these early oromotor actions and to evaluate how this may impact later speech development.
Journal Article
Pitch Shifting With the Commercially Available Eventide Eclipse: Intended and Unintended Changes to the Speech Signal
Purpose: This study details the intended and unintended consequences of pitch shifting with the commercially available Eventide Eclipse. Method: Ten vocally healthy participants (M = 22.0 years; 6 cisgender females, 4 cisgender males) produced a sustained /?/, creating an input signal. This input signal was processed in near real time by the Eventide Eclipse to create an output signal that was either not shifted (0 cents), shifted +100 cents, or shifted -100 cents. Shifts occurred either throughout the entire vocalization or for a 200-ms period after vocal onset. Results: Input signals were compared to output signals to examine potential changes. Average pitch-shift magnitudes were within 1 cent of the intended pitch shift. Measured pitch-shift length for intended 200-ms shifts was between 5.9% and 21.7% less than expected, based on the portion of shift selected for measurement. The delay between input and output signals was an average of 11.1 ms. Trials shifted +100 cents had a longer delay than trials shifted -100 or 0 cents. The first 2 formants (F1, F2) shifted in the direction of the pitch shift, with F1 shifting 6.5% and F2 shifting 6.0%. Conclusions: The Eventide Eclipse is an accurate pitch-shifting hardware that can be used to explore voice and vocal motor control. The pitch-shifting algorithm shifts all frequencies, resulting in a subsequent change in F1 and F2 during pitch-shifted trials. Researchers using this device should be mindful of stimuli selection to avoid confusion during data interpretation.
Journal Article