Prevalência e fatores associados à alteração vocal em idosos institucionalizados com capacidade cognitiva preservada

Voice disorders (VD) in the elderly can interfere negatively in communication, emotional well-being and quality of life, conditions that correspond to greater exposure to illness and social isolation bringing consequent economic impact for the health system. It is assumed that institutionalized confinement, weakness and morbidity associated to nursing home (NH) contribute to transform VD an especially prevalent condition in institutionalized elderly, including those without cognitive impairment. Thus, the aim of this study was to determine the prevalence and associated factors of VD in NH elderly residents without cognitive impairment. There is no epidemiological diagnostic instruments of VD for elderly populations, so the first step of this study was dedicated to prepare and analyze the psychometric properties of a short, inexpensive and easy to use questionnaire named Screening for Voice Disorders in Older Adults (Rastreamento de Alterações Vocais em Idosos—RAVI). The methodological procedures of this step followed the guidelines of the Standards for Educational and Psychological Testing and contemplated validity evidence based on test content, based on response processes, based on internal structure and based on relations with other variables, as well as reliability analysis and clinical consistency. The result of the validation process showed that the RAVI final score generate valid and reliable interpretations for the epidemiological diagnosis of VD in the elderly, which endorsed the use of the questionnaire in the second stage of the study, performed in ten NH located in the city of Natal, Rio Grande do Norte. At this stage, data from socioeconomic and demographic variables, lifestyle, general health conditions and characterization of the institution were collected. It was performed a bivariate analysis and it was calculated the prevalence ratio as a magnitude association measure, with a confidence interval of 95%. The variables with p-value less than 0.20 were included in the multiple logistic regression model that followed the Forward selection method. The odds ratio found in the multivariate model was converted into prevalence ratio and the level of significance was 5%. The sample consisted of 117 subjects with predominance of females and average of 79.68 (± 7.92) years old. The prevalence of VD was 39.3% (95% CI: 30.4-48.1%). The multivariate model showed statistically significant association between VD and depressive symptoms, smoking for a year or more and selfreported hearing loss. In conclusion, VD is a prevalent health condition in NH elderly residents without cognitive impairment and is associated with factors involving psychosocial, lifestyle and communicative disability that require attention of managers and professionals involved with NH environment. Strategies to encourage communication and social integration, actions to combat smoking and minimizing the effects of hearing loss could stimulate the physical well-being, emotional and mental health of institutionalized elderly population, contributing to the vocal and communicative maintenance, a more effective social inclusion and better overall health condition.

Sociophonetic deception: the elements of vocal disguise

The focus of my research is vocal disguise within forensic linguistics. Specifically, I answer the question of what individuals are most likely to do with their voice when they do not want to be recognized by a listener. I also focus on whether specific sociolinguistic characteristics – gender and place of origin – have an effect on the disguise choices that individuals make. My research has found that participants show a preference for altering pitch and/or duration across conditions, as well as taking on a foreign accent. Gender and origin were found to be significant for respect to differences in duration, and significance was also found between origin and pitch. These results suggest that disguise might contain elements of style shifting, and that a speaker's choice is more systematic than random.

Pre-eclampsia is associated with a two-fold increase in diabetes : a systematic review and meta-analysis

Peer reviewed

Pre-eclampsia is associated with a two-fold increase in diabetes : a systematic review and meta-analysis

Peer reviewed

The sound of whiteness: early music vocal performance practice in Britain

American Musicological Society annual meeting, San Francisco, 10 Nov. 2011

The Pratt Pouch Provides a Three-Fold Access Increase to Antiretroviral Medication for Births outside Health Facilities in Southern Zambia.

INTRODUCTION: Modern day antiretroviral therapy allows HIV+ pregnant women to lower the likelihood of viral transmission to their infants before, during, and after birth from 20-45% to less than 5%. In developing countries, where non-facility births may outnumber facility births, infant access to safe antiretroviral medication during the critical first three days after birth is often limited. A single-dose, polyethylene pouch ("Pratt Pouch") addresses this challenge by allowing the medication to be distributed to mothers during antenatal care. METHODS: The Pratt Pouch was introduced as part of a one year clinical feasibility study in two districts in Southern Province, Zambia. Participating nurses, community health workers, and pharmacists were trained before implementation. Success in achieving improved antiretroviral medication access was assessed via pre intervention and post intervention survey responses by HIV+ mothers. RESULTS: Access to medication for HIV-exposed infants born outside of a health facility increased from 35% (17/51) before the introduction of the pouch to 94% (15/16) after (p<0.05). A non-significant increase in homebirth rates from 33% (pre intervention cohort) to 50% (post intervention cohort) was observed (p>0.05). Results remained below the national average homebirth rate of 52%. Users reported minimal spillage and a high level of satisfaction with the Pratt Pouch. CONCLUSION: The Pratt Pouch enhances access to infant antiretroviral medication in a rural, non-facility birth setting. Wide scale implementation could have a substantial global impact on HIV transmission rates from mother to child.

Structural evolution of the Lesser Himalayan fold-thrust belt of west central Nepal

The Lesser Himalayan fold-thrust belt on the south flank of the Jajarkot klippe in west central Nepal was mapped in detail between the Main Central thrust in the north and the Main Boundary thrust in the south. South of the Jajarkot klippe, the fold-thrust belt involves sandstone, shale and carbonate rocks that are unmetamorphosed in the foreland and increase in metamorphic grade with higher structural position to sub-greenschist facies towards the hinterland. The exposed stratigraphy is correlative with the Proterozoic Ranimata, Sangram, Galyang, Syangia Formations and Lakharpata Group of Western Nepal and overlain by the Paleozoic Tansen and Kali Gandaki Groups. Based on field mapping and cross-section construction, three distinct thrust sheets were identified separated by top-to-the-south thrust faults. From the foreland (south) to the hinterland (north), the first thrust sheet in the immediate hanging wall of the Main Boundary thrust defines an open syncline. The second thrust sheet contains a very broad synformal duplex, which is structurally stacked against the third thrust sheet containing a homoclinal panel of the oldest exposed Proterozoic stratigraphy. Outcrop scale folds throughout the study area are predominantly south vergent, open, and asymmetric reflecting the larger regional scale folding style, which corroborate the top-to-the-south deformation style seen in the faults of the region. Field techniques were complemented with microstructural and quartz crystallographic c-axis preferred orientation analyses using a petrographic microscope and a fabric analyzer, respectively. Microstructural analysis identified abundant strain-induced recrystallization textures and occasional occurrences of top-to-the-south shear-sense indicators primarily in the hinterland rocks in the immediate footwall of the Main Central Thrust. Top-to-the-south shearing is also supported by quartz crystallographic c-axis preferred orientations. Quartz recrystallization textures indicate an increase in deformation temperature towards the Main Central thrust. A line balance estimate indicates that approximately 15 km of crustal shortening was accommodated by folding and faulting in the fold-thrust belt south of the Jajarkot klippe. Additionally, estimations of shortening velocity suggest that the shortening velocity operating in this section of the fold-thrust belt between 23 to 14 Ma was slower than what is currently observed as a result of the ongoing deformation of the Sub-Himalayan fold-thrust belt.

Investigating Multiple Roles of Vocal Confidence in Persuasion

Although persuasion often occurs via oral communication, it remains a comparatively understudied area. This research tested the hypothesis that changes in three properties of voice influence perceptions of speaker confidence, which in turn differentially affects attitudes according to different underlying psychological processes that the Elaboration Likelihood Model (ELM, Petty & Cacioppo, 1984), suggests should emerge under different levels of thought. Experiment 1 was a 2 (Elaboration: high vs. low) x 2 (Vocal speed: increased speed vs. decreased speed) x 2 (Vocal intonation: falling intonation vs. rising intonation) between participants factorial design. Vocal speed and vocal intonation influenced perceptions of speaker confidence as predicted. In line with the ELM, under high elaboration, confidence biased thought favorability, which in turn influenced attitudes. Under low elaboration, confidence did not bias thoughts but rather directly influenced attitudes as a peripheral cue. Experiment 2 used a similar design as Experiment 1 but focused on vocal pitch. Results confirmed pitch influenced perceptions of confidence as predicted. Importantly, we also replicated the bias and cue processes found in Experiment 1. Experiment 3 investigated the process by which a broader spectrum of speech rate influenced persuasion under moderate elaboration. In a 2 (Argument quality: strong vs. weak) x 4 (Vocal speed: extremely slow vs. moderately slow vs. moderately fast vs. extremely fast) between participants factorial design, results confirmed the hypothesized non-linear relationship between speech rate and perceptions of confidence. In line with the ELM, speech rate influenced persuasion based on the amount of processing. Experiment 4 investigated the effects of a broader spectrum of vocal intonation on persuasion under moderate elaboration and used a similar design as Experiment 3. Results indicated a partial success of our vocal intonation manipulation. No evidence was found to support the hypothesized mechanism. These studies show that changes in several different properties of voice can influence the extent to which others perceive them as confident. Importantly, evidence suggests different vocal properties influence persuasion by the same bias and cue processes under high and low thought. Evidence also suggests that under moderate thought, speech rate influences persuasion based on the amount of processing.

Gravity collapse structures in the Central Precordillera fold-andthrust belt, Argentina

Several landforms found in the fold-and-thrust belt area of Central Precordillera, Pre-Andes of Argentina, which were often associated with tectonic efforts, are in fact related to non-tectonic processes or gravitational superficial structures. These second-order structures, interpreted as gravitational collapse structures, have developed in the western flank of sierras de La Dehesa and Talacasto. These include rock-slides, rock falls, wrinkle folds, slip sheets and flaps, among others; which together constitute a monoclinal fold dipping between 30º and 60º to the west. Gravity collapse structures are parallel to the regional strike of the Sierra de la Dehesa and are placed in Ordovician limestones and dolomites. Their sloping towards the west, the presence of bed planes, fractures and joints; and the lithology (limestone interbedded with incompetent argillaceous banks) would have favored their occurrence. Movement of the detached structures has been controlled by lithology characteristics, as well as by bedding and joints. Detachment and initial transport of gravity collapse structures and rockslides in the western flank of the Sierra de la Dehesa were tightly controlled by three structural elements: 1) sliding surfaces developed on parallel bedded strata when dipping >30° in the slope direction; 2) Joint’s sets constitute lateral and transverse traction cracks which release extensional stresses and 3) Discontinuities fragmenting sliding surfaces.  Some other factors that could be characterized as local (lithology, structure and topography) and as regional (high seismic activity and possibly wetter conditions during the postglacial period) were determining in favoring the steady loss of the western mountain side in the easternmost foothills of Central Precordillera.

Anthropogenic noise affects vocal interactions

Animal communication plays a crucial role in many species, and it involves a sender producing a signal and a receiver responding to that signal. The shape of a signal is determined by selection pressures acting upon it. One factor that exerts selection on acoustic signals is the acoustic environment through which the signal is transmitted. Recent experimental studies clearly show that senders adjust their signals in response to increased levels of anthropogenic noise. However, to understand how noise affects the whole process of communication, it is vital to know how noise affects the receiver’s response during vocal interactions. Therefore, we experimentally manipulated ambient noise levels to expose male European robins (Erithacus rubecula) to two playback treatments consisting of the same song: one with noise and another one without noise. We found that males responding to a conspecific in a noise polluted environment increased minimum frequency and decreased song complexity and song duration. Thus, we show that the whole process of communication is affected by noise, not just the behaviour of the sender.

An Interdisciplinary Approach to the Management of Vocal Cord Dysfunction in an Elite Female Swimmer: a Case Study

Acute pulmonary disorders are commonplace within the athletic population, with exercise induced bronchoconstriction (EIB), and vocal cord dysfunction (VCD) common diagnoses. VCD is a condition that causes the adduction of the vocal folds during inhalation, causing obstruction at the larynx and thereby a severely impaired sporting performance. VCD can be brought on by laryngeal irritants, emotional and psychological stress and asthma. The gold standard of treatment for VCD centres on an interdisciplinary approach from specialists that often include a respiratory consultant, speech and language therapist (SLT) and a psychologist. The present case study details the interdisciplinary approach to the treatment of an elite female swimmer with VCD with an intervention programme that lasted nine weeks, instigated by a local general practitioner (G.P.) who chose to engage a Sport Psychology Consultant (SPC) due to the sport-specific nature of the psychological stress experienced by the individual. The steps involved in the design of the sport psychology interventions are outlined and the relationship of those interventions to the work of the other specialists is discussed. The 9 week intervention programme was aimed at reducing perfectionist tendencies and competitive state anxiety using a combination of cognitive behavioural therapy (CBT), goal-setting and imagery. Overall, the treatment programme was deemed a success as perfectionism and competitive state anxiety levels reduced over time along with the frequency of VCD occurrence. This case study demonstrates the breadth of roles that can be undertaken by a SPC and raises awareness of a complex respiratory disorder that is not yet fully understood.

Validade e fiabilidade do protocolo de avaliação da qualidade vocal da Universidade de Aveiro

O presente estudo teve como principal objetivo rever a versão original do Protocolo de Avaliação da Qualidade Vocal da Universidade de Aveiro (PAQVUA), criar o respetivo manual, comprovar a validade de conteúdo do PAQVUA assim como a sua fiabilidade inter e intra avaliador. Para rever a versão original do PAQVUA, foi efetuada uma revisão narrativa da literatura, com o objetivo de encontrar informação que revelasse a pertinência, da versão original do protocolo, para assim se efetuarem as alterações necessárias. Para analisar a validade de conteúdo recorreu-se a um painel de peritos, num total de seis, especialistas na área da voz que avaliaram as provas do PAQVUA, folha de registo e manual. Os peritos avaliaram todos os componentes do PAQVUA através do preenchimento de um questionário com o objetivo de se comprovar a relevância, clareza e precisão de cada uma das provas de avaliação e também o conteúdo do seu manual. Para além disso pretendeu-se também comprovar a fiabilidade inter e intra avaliador do PAQVUA. Para isso, o mesmo protocolo foi aplicado duas vezes por duas avaliadoras diferentes e também foi aplicado em dois momentos temporais diferentes por uma só avaliadora. A amostra teve um total de doze participantes. Para analisar estatisticamente os resultados da validade de conteúdo utilizou-se o método gráfico Bland e Altman modificado e o Coeficiente de Correlação Intraclasses (CCI). Para a fiabilidade inter e intra avaliador recorreu-se ao Coeficiente de Correlação de Spearman (ρ) e ao Kappa de Cohen (k). Relativamente aos resultados obtidos com o método Bland e Altman modificado, verificou-se a existência de concordância entre os peritos através da análise dos gráficos, sendo que a maioria dos pontos se encontrou dentro dos limites esperados de concordância. Quanto aos valores do CCI (entre 0.379 e 0.479), estes revelaram uma correlação regular. No que concerne à fiabilidade inter avaliador, os resultados de correlação e concordância apresentaram-se relevantes, com valores de ρ (de Spearman) superiores a 0.700 e valores de k (de Cohen) superiores a 0.600, na maioria dos casos. O mesmo foi constatado para a fiabilidade intra avaliador. Desta forma pode concluir-se que a nova versão do PAQVUA apresenta validade de conteúdo sendo tal comprovado pelo método de Bland-Altman modificado e pelos valores do CCI. Quanto à fiabilidade inter e intra avaliador, pode afirmar-se que o PAQVUA é fiável, porém como a amostra em estudo é pequena, o que a torna pouco representativa, esta conclusão carece de fundamento com base num estudo mais alargado. Apesar da limitação referida, acredita-se que este protocolo é uma mais-valia para o estudo da patologia vocal em ambiente clínico, assim como para a investigação científica nesta área, pois através do PAQVUA podem-se recolher diversas informações relacionadas com a voz, úteis para uma intervenção terapêutica baseada em evidências científicas.

A Tutorial on the Universality and Expressiveness of Fold

In functional programming, fold is a standard operator that encapsulates a simple pattern of recursion for processing lists. This article is a tutorial on two key aspects of the fold operator for lists. First of all, we emphasize the use of the universal property of fold both as a proof principle that avoids the need for inductive proofs, and as a definition principle that guides the transformation of recursive functions into definitions using fold. Secondly, we show that even though the pattern of recursion encapsulated by fold is simple, in a language with tuples and functions as first-class values the fold operator has greater expressive power than might first be expected.

Fold and Unfold for Program Semantics

In this paper we explain how recursion operators can be used to structure and reason about program semantics within a functional language. In particular, we show how the recursion operator fold can be used to structure denotational semantics, how the dual recursion operator unfold can be used to structure operational semantics, and how algebraic properties of these operators can be used to reason about program semantics. The techniques are explained with the aid of two main examples, the first concerning arithmetic expressions, and the second concerning Milner's concurrent language CCS. The aim of the paper is to give functional programmers new insights into recursion operators, program semantics, and the relationships between them.

W.A. Mozart's Die Zauberflöte An Arrangement and Performance Edition for Wind Instruments and Vocal Soloists

The purpose of this dissertation is to produce a new Harmonie arrangement of Mozart’s Die Zauberflöte suitable for modern performance, bringing Joseph Heidenreich’s 1782 arrangement—one of the great treasures of the wind repertoire—to life for future performers and audiences. I took advantage of the capabilities of modern wind instruments and performance techniques, and employed other instruments normally found in the modern wind ensemble to create a work in the tradition of Heidenreich’s that restored as much of Mozart’s original thinking as possible. I expanded the Harmonie band to include flute and string bass. Other instruments provide special effects, a traditional role for wind instruments in the Classical opera orchestra. This arrangement is conceived to be performed with the original vocal soloists, making it a viable option for concert performance or for smaller staged productions. It is also intended to allow the wind players to be onstage with the singers, becoming part of the dramatic action while simultaneously serving as the “opera orchestra.” This allows creative staging possibilities, and offers the wind players an opportunity to explore new aspects of performing. My arrangement also restores Mozart’s music to its original keys and retains much of his original wind scoring. This arrangement expands the possibilities for collaboration between opera studios, voice departments or community opera companies and wind ensembles. A suite for winds without voices (currently in production) will allow conductors to program this major work from the Classical era without dedicating a concert program to the complete opera. Excerpted arias and duets from this arrangement provide vocalists the option of using chamber wind accompaniment on recitals. The door is now open to arrangements of other operas by composers such as Mozart, Rossini and Weber, adding new repertoire for chamber winds and bringing great music to life in a new way.