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Nonadherence to medication in tuberculosis (TB) hampers optimal treatment outcomes. Digital health technology (DHT) seems to be a promising approach to managing problems of nonadherence to medication and improving treatment outcomes. This paper systematically reviews the effect of DHT in improving medication adherence and treatment outcomes in patients with TB. A literature search in PubMed and Cochrane databases was conducted. Randomized controlled trials (RCTs) that analyzed the effect of DHT interventions on medication adherence outcomes (treatment completion, treatment adherence, missed doses, and noncompleted rate) and treatment outcomes (cure rate and smear conversion) were included. Adult patients with either active or latent TB infection were included. The Jadad score was used for evaluating the study quality. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guideline was followed to report study findings. In all, 16 RCTs were selected from 552 studies found, and 6 types of DHT interventions for TB were identified: 3 RCTs examined video directly observed therapy (VDOT), 1 examined video-observed therapy (VOT), 1 examined an ingestible sensor, 1 examined phone call reminders, 2 examined medication monitor boxes, and 8 examined SMS text message reminders. The outcomes used were treatment adherence, including treatment completion, treatment adherence, missed dose, and noncompleted rate, as well as clinical outcomes, including cure rate and smear conversion. In treatment completion, 4 RCTs (VDOT, VOT, ingestible sensor, SMS reminder) found significant effects, with odds ratios and relative risks (RRs) ranging from 1.10 to 7.69. Treatment adherence was increased in 1 study by SMS reminders (RR 1.05; 95% CI 1.04-1.06), and missed dose was reduced in 1 study by a medication monitor box (mean ratio 0.58; 95% CI 0.42-0.79). In contrast, 3 RCTs of VDOT and 3 RCTs of SMS reminders did not find significant effects for treatment completion. Moreover, no improvement was found in treatment adherence in 1 RCT of VDOT, missed dose in 1 RCT of SMS reminder, and noncompleted rate in 1 RCT of a monitor box, and 2 RCTs of SMS reminders. For clinical outcomes such as cure rate, 2 RCTs reported that phone calls (RR 1.30; 95% CI 1.07-1.59) and SMS reminders (OR 2.47; 95% CI 1.13-5.43) significantly affected cure rates. However, 3 RCTs found that SMS reminders did not have a significant impact on cure rate or smear conversion. It was found that DHT interventions can be a promising approach. However, the interventions exhibited variable effects regarding effect direction and the extent of improving TB medication adherence and clinical outcomes. Developing DHT interventions with personalized feedback is required to have a consistent and beneficial effect on medication adherence and outcomes among patients with TB.

This study examines Voice Onset Time (VOT) in word-initial stops produced by six Slovenian (L1) students of English (L2) with C1/C2-level proficiency. Using acoustic and linear mixed-model analysis, the research compares the production of these stops in both languages. The results confirm Slovenian as a lead (for /b d g/) vs short-lag language (for /p t k/). In their L2 English, the speakers establish new phonetic categories by lengthening VOT in voiceless stops, reflecting the acquisition of aspiration characteristic of English. In contrast, the voiced series shows strong L1 transfer, as the speakers largely retain prevoicing instead of achieving the target short-lag realizations. The findings of this exploratory study indicate that the L2 English system functions as an upward-shifted version of the L1 Slovenian system: while the acquisition of aspirated /p t k/ is supported, the Slovenian prevoiced /b d g/ remain largely resistant to change, even in highly proficient L2 English speakers.  

•Decoding VOT using listeners’ EEG data.•Decoded VOT is linearly correlated with actual VOT at early stages.•Decoded VOT is longer in female contexts than in male contexts.•Context effects extend to all VOT sounds, not just some ambiguous sounds.•Early context effects are in the opposite direction of behavioral responses. Contextual information plays a significant role in shaping our perception of speech, yet it remains uncertain at which level of processing such information integrates with acoustic cues. A key area of debate is whether top-down information influences acoustic encoding within the lower levels of the speech-processing hierarchy. This study employed a machine learning algorithm to decode the voice onset time (VOT) of speech and investigated how the gender of the speaker of a precursor sentence impacted subsequent speech perception. Using EEG recordings, we examined neural responses to a VOT continuum following male and female voices. Our results reveal that a linear representation of the VOT continuum emerged at an early EEG time window and that gender-based contextual cues modulated speech perception at this stage. Notably, since context information was not involved in the decoding procedure itself, we conclude that this modulation reflected the true effects of context on the perception of VOT. Moreover, the contextual influence extended across the entire VOT continuum, not just at specific sounds, suggesting a broad and consistent modulation of speech perception by gender-based context. These findings support the idea of a general acoustic-level mechanism through which contextual information influences the early stage of speech processing, contributing to ongoing debates about the interaction between top-down and bottom-up processes in speech perception.

In present-day Seoul Korean, the primary phonetic feature for the lenis-aspirated stop distinction is shifting from VOT to F0. Some previous studies have considered this sound change to be a tonogenesis, whereby the low-level F0 perturbation has developed into tonal features (L for the lenis and H for the aspirated) in the segmental phonology. They, however, have examined the stop distinction only at a phrase- or utterance-initial position. We newly explore the sound change in relation to various prosodic structural factors (position and prominence). Apparent-time production data were recorded from four speaker groups: young female, young male, old female, old male. The way the speakers use VOT versus F0 indeed varies as a function of position and prominence. Crucially, in all groups, VOT is still used for the lenis-aspirated distinction phrase-medially due to the lenis stop voicing. This role of VOT, however, is found only in the non-prominent (unfocused) condition, in which the F0 difference is reduced to a low-level perturbation effect. In the prominent (focused) context in which tones come into play, the role of VOT diminishes, led by young female speakers. These can be interpreted as a prosodically-conditioned, complementary use of the features to maintain sufficient contrast. Importantly, however, the tonal difference under focus is not bidirectionally polarized, so that F0 is not lowered for the lenis stop. A lack of direct enhancement of the distinctive L tone weakens a possibility that F0 is transphonologized to the phonemic feature system of the language. As an alternative to the view that tonal features are newly introduced in the segmental phonology, we propose a prosodic account: the sound change is best characterized as a prosodically-conditioned change in the use of the segmental voicing feature (implemented by VOT) versus already available post-lexical tones in the intonational phonology of Korean.

Communicating with a speaker with a different accent can affect one’s own speech. Despite the strength of evidence for perception-production transfer in speech, the nature of transfer has remained elusive, with variable results regarding the acoustic properties that transfer between speakers and the characteristics of the speakers who exhibit transfer. The current study investigates perception-production transfer through the lens of statistical learning across passive exposure to speech. Participants experienced a short sequence of acoustically variable minimal pair (beer/pier) utterances conveying either an accent or typical American English acoustics, categorized a perceptually ambiguous test stimulus, and then repeated the test stimulus aloud. In the canonical condition, /b/–/p/ fundamental frequency (F0) and voice onset time (VOT) covaried according to typical English patterns. In the reverse condition, the F0xVOT relationship reversed to create an “accent” with speech input regularities atypical of American English. Replicating prior studies, F0 played less of a role in perceptual speech categorization in reverse compared with canonical statistical contexts. Critically, this down-weighting transferred to production, with systematic down-weighting of F0 in listeners’ own speech productions in reverse compared with canonical contexts that was robust across male and female participants. Thus, the mapping of acoustics to speech categories is rapidly adjusted by short-term statistical learning across passive listening and these adjustments transfer to influence listeners’ own speech productions.

The ventral occipitotemporal (vOT) cortex serves as a core region for visual processing, and specific areas of this region show preferential activation for various visual categories such as faces and print. The emergence of such functional specialization in the human cortex represents a pivotal developmental process, which provides a basis for targeted and efficient information processing. For example, functional specialization to print in the left vOT is an important prerequisite for fluent reading. However, it remains unclear, which processes initiate the preferential cortical activations to characters arising in the vOT during child development. Using a multimodal neuroimaging approach with preschool children at familial risk for developmental dyslexia, we demonstrate how varying levels of expertise modulate the neural response to single characters, which represent the building blocks of print units. The level of expertise to characters was manipulated firstly through brief training of false-font speech–sound associations and secondly by comparing characters for which children differed in their level of familiarity and expertise accumulated through abundant exposure in their everyday environment. Neural correlates of character processing were tracked with simultaneous high-density electroencephalography and functional magnetic resonance imaging in a target detection task. We found training performance and expertise-dependent modulation of the visual event-related potential around 220 ms (N1) and the corresponding vOT activation. Additionally, trained false-font characters revealed stronger functional connectivity between the left fusiform gyrus (FFG) seed and left superior parietal/lateral occipital cortex regions with higher training performance. In sum, our results demonstrate that learning artificial-character speech–sound associations enhances activation to trained characters in the vOT and that the magnitude of this activation and the functional connectivity of the left FFG to the parieto-occipital cortex depends on learning performance. This pattern of results suggests emerging development of the reading network after brief training that parallels network specialization during reading acquisition. •Artificial character-speech sound training induced preferred N1 and vOT activation.•N1 and vOT BOLD tuning depends on training performance in prereaders.•Functional connectivity of left FFG and SPL also depends on training performance.•Level of expertise to character types modulates the N1 and vOT BOLD activation.•Results suggest a phonologically guided N1 and vOT tuning in children.

Reading fluency—the speed and accuracy of reading connected text—is foundational to educational success. The current longitudinal study investigates the neural correlates of fluency development using a connected‐text paradigm with an individualized presentation rate. Twenty‐six children completed a functional MRI task in 1st/2nd grade (time 1) and again 1–2 years later (time 2). There was a longitudinal increase in activation in the ventral occipito‐temporal (vOT) cortex from time 1 to time 2. This increase was also associated with improvements in reading fluency skills and modulated by individual speed demands. These findings highlight the reciprocal relationship of the vOT region with reading proficiency and its importance for supporting the developmental transition to fluent reading. These results have implications for developing effective interventions to target increased automaticity in reading. We conducted a longitudinal study to examine the neural correlates of fluency using a connected‐text paradigm with an individualized presentation rate during a critical period of time in children's reading development, as they transition from non‐fluent to fluent reading (1st/2nd to 3rd/4th grades). We show a developmental increase in activation of a key reading region, the ventral occipito‐temporal cortex over the span of 1–2 years. Importantly, increased activation was associated with larger gains in reading fluency and was modulated by task fluency demands.

The role of the left ventral occipitotemporal cortex (vOT) in reading is well-established in both sighted and blind readers. Its role in speech processing remains only partially understood. Here, we test the involvement of the left vOT in phonological processing of spoken language in the blind ( N = 50, age: 6.76–60.32) and in the sighted ( N = 54, age: 6.79–59.83) by means of whole-brain and region-of-interest (including individually identified) fMRI analyses. We confirm that the left vOT is sensitive to phonological processing (shows greater involvement in rhyming compared to control spoken language task) in both blind and sighted participants. However, in the sighted, the activation was observed only during the rhyming task and in the speech-specific region of the left vOT, pointing to task and modality specificity. In contrast, in the blind group, the left vOT was active during speech processing irrespective of task and in both speech and reading-specific vOT regions. Only in the blind, the left vOT presented a higher degree of sensitivity to phonological processing than other language nodes in the left inferior frontal and superior temporal cortex. Our results suggest a changed development of the left vOT sensitivity to spoken language, resulting from visual deprivation.

Purpose: Previous studies have shown enhanced pitch and impaired time perception in individuals with autism spectrum disorders (ASD). However, it remains unclear whether such deviated patterns of auditory processing depending on acoustic dimensions would transfer to the higher level linguistic pitch and time processing. In this study, we compared the categorical perception (CP) of lexical tones and voice onset time (VOT) in Mandarin Chinese, which utilize pitch and time changes, respectively, to convey phonemic contrasts. Method: The data were collected from 22 Mandarin-speaking adolescents with ASD and 20 age-matched neurotypical controls. In addition to the identification and discrimination tasks to test CP performance, all the participants were evaluated with their language ability and phonological working memory. Linear mixed-effects models were constructed to evaluate the identification and discrimination scores across different groups and conditions. Results: The basic CP pattern of cross-boundary benefit when perceiving both native lexical tones and VOT was largely preserved in high-functioning adolescents with ASD. The degree of CP of lexical tones in ASD was similar to that in typical controls, whereas the degree of CP of VOT in ASD was greatly reduced. Furthermore, the degree of CP of lexical tones correlated with language ability and digit span in ASD participants. Conclusions: These findings suggest that the unbalanced acoustic processing capacities for pitch and time can be generalized to the higher level linguistic processing in ASD. Furthermore, the higher degree of CP of lexical tones correlated with better language ability in Mandarin-speaking individuals with ASD.

Congenital amusia is a lifelong disorder of fine-grained pitch processing in music and speech. However, it remains unclear whether amusia is a pitch-specific deficit, or whether it affects frequency/spectral processing more broadly, such as the perception of formant frequency in vowels, apart from pitch. In this study, in order to illuminate the scope of the deficits, we compared the performance of 15 Cantonese-speaking amusics and 15 matched controls on the categorical perception of sound continua in four stimulus contexts: lexical tone, pure tone, vowel, and voice onset time (VOT). Whereas lexical tone, pure tone and vowel continua rely on frequency/spectral processing, the VOT continuum depends on duration/temporal processing. We found that the amusic participants performed similarly to controls in all stimulus contexts in the identification, in terms of the across-category boundary location and boundary width. However, the amusic participants performed systematically worse than controls in discriminating stimuli in those three contexts that depended on frequency/spectral processing (lexical tone, pure tone and vowel), whereas they performed normally when discriminating duration differences (VOT). These findings suggest that the deficit of amusia is probably not pitch specific, but affects frequency/spectral processing more broadly. Furthermore, there appeared to be differences in the impairment of frequency/spectral discrimination in speech and nonspeech contexts. The amusic participants exhibited less benefit in between-category discriminations than controls in speech contexts (lexical tone and vowel), suggesting reduced categorical perception; on the other hand, they performed inferiorly compared to controls across the board regardless of between- and within-category discriminations in nonspeech contexts (pure tone), suggesting impaired general auditory processing. These differences imply that the frequency/spectral-processing deficit might be manifested differentially in speech and nonspeech contexts in amusics-it is manifested as a deficit of higher-level phonological processing in speech sounds, and as a deficit of lower-level auditory processing in nonspeech sounds.