Estimation and probabilistic projection of age- and sex-specific mortality rates across Brazilian municipalities between 2010 and 2030.

BACKGROUND: Mortality rate estimation in small areas can be difficult due the low number of events/exposure (i.e. stochastic error). If the death records are not completed, it adds a systematic uncertainty on the mortality estimates. Previous studies in Brazil have combined demographic and statistical methods to partially overcome these issues. We estimated age- and sex-specific mortality rates for all 5,565 Brazilian municipalities in 2010 and forecasted probabilistic mortality rates and life expectancy between 2010 and 2030. METHODS: We used a combination of the Tool for Projecting Age-Specific Rates Using Linear Splines (TOPALS), Bayesian Model, Spatial Smoothing Model and an ad-hoc procedure to estimate age- and sex-specific mortality rates for all Brazilian municipalities for 2010. Then we adapted the Lee-Carter model to forecast mortality rates by age and sex in all municipalities between 2010 and 2030. RESULTS: The adjusted sex- and age-specific mortality rates for all Brazilian municipalities in 2010 reveal a distinct regional pattern, showcasing a decrease in life expectancy in less socioeconomically developed municipalities when compared to estimates without adjustments. The forecasted mortality rates indicate varying regional improvements, leading to a convergence in life expectancy at birth among small areas in Brazil. Consequently, a reduction in the variability of age at death across Brazil's municipalities was observed, with a persistent sex differential. CONCLUSION: Mortality rates at a small-area level were successfully estimated and forecasted, with associated uncertainty estimates also generated for future life tables. Our approach could be applied across countries with data quality issues to improve public policy planning.

Cross-cultural experiences and self-development: a psychobiographical study of Bruce Lee.

A common challenge people face in today's cross-cultural world is how to solve a series of adaptation problems caused by cultural conflict. Exploring Bruce Lee's successful cross-cultural experiences through psychobiography offers some inspiration and thoughts. How did Bruce Lee successfully integrate martial arts, symbolising the Eastern culture, with films representing the Western culture, finally propelling kung fu films onto the international stage? Numerous publicly available materials about Bruce Lee were collected for this study, and the research data were evaluated using thematic analysis. Bruce Lee's success benefitted from reconstructing cultural environment information and exercising his initiative to shape a new cultural environment. His life experiences reflect individual cognition behaviour and social and cultural environments as two aspects of a dynamic circulation system and show that the two have reached internal and spiralling harmony through mutual integration. In the context of the Oriental collectivism culture's family narrative, Chinese adults' personality development features the unique theme of 'inheritance and innovation'. Dealing with the relationship between self-actualisation and familism is another important and challenging task in developing the Chinese personality.

Glutamine increases stability of TPH1 mRNA via p38 mitogen-activated kinase in mouse mastocytoma cells.

Expression changes for tryptophan hydroxylase 1 (TPH1), the rate-limiting enzyme in serotonin synthesis, by environmental glutamine (GLN) were examined in mouse mastocytoma-derived P815-HTR cells. GLN-treated cells exhibited a robust increase in TPH1 mRNA after a 6 h exposure to GLN. 6-Diazo-5-oxo-L-norleucine (DON), a glutamine-utilizing glutaminase inhibitor, significantly inhibited the GLN-induction of TPH1 mRNA. Nuclear run-on assays and mRNA decay experiments demonstrated that the primary mechanism leading to increased TPH1 mRNA levels was not due to transcriptional changes, but rather due to increased TPH1 RNA stability induced by GLN. Treatment with GLN also led to activation of p38 MAP kinase, but not p42/44 MAPK. In addition, SB203580, a p38 MAP kinase specific inhibitor, completely abolished the GLN-mediated increase of TPH1 mRNA levels, suggesting the pathway stabilizing TPH1 mRNA might be mediated by the activated p38 MAP kinase pathway. Additionally, SB203580 significantly reduced the stability of TPH1 mRNA, and this reduction of the stability was not affected by GLN in the culture medium, implying a sequential signaling from GLN being mediated by p38 MAP kinase, resulting in alteration of TPH1 mRNA stability. TPH1 mRNA stability loss was also dependent on de novo protein synthesis as shown by treatment of cells with a transcriptional/translational blocker. We provide evidence that TPH1 mRNA levels are increased in response to increased exogenous GLN in mouse mastocytoma cells via a stabilization of TPH1 mRNA due to the activity of the p38 MAP kinase.

The Garrett Lee Smith Memorial Act: A Description and Review of the Suicide Prevention Initiative.

The Garrett Lee Smith (GLS) Memorial Act, continuously funded since 2004, has supported comprehensive, community-based youth suicide prevention efforts throughout the United States. Compared to matched communities, communities implementing GLS suicide prevention activities have lower population rates of suicide attempts and lower mortality among young people. Positive outcomes have been more pronounced with continuous years of implementation and in less densely populated communities. Cost analyses indicate that implementation of GLS suicide prevention activities more than pays for itself in reduced health care costs associated with fewer emergency department visits and hospitalizations. Although findings are encouraging, the heterogeneity of community suicide prevention programs and the lack of randomized trials preclude definitive determination of causal effects associated with GLS. The GLS initiative has never been brought fully to scale (e.g., simultaneously impacting all communities in the United States), so beneficial effects on nationwide suicide rates have not been realized.

The Dangers of Drawing Cohort Profiles From Period Data: A Research Note.

Drawing cohort profiles and cohort forecasts from grids of age-period data is common practice in demography. In this research note, we (1) show how demographic measures artificially fluctuate when calculated from the diagonals of age-period rates because of timing and cohort-size bias, (2) estimate the magnitude of these biases, and (3) illustrate how prediction intervals for cohort indicators of mortality may become implausible when drawn from Lee-Carter methods and age-period grids. These biases are surprisingly large, even when the cohort profiles are created from single-age, single-year period data. The danger is that we overinterpret deviations from expected trends that were induced by our own data manipulation.

Validation of a short version of the Lee fatigue scale in adults living in Norway: a cross-sectional population survey.

BACKGROUND: Due to the nature of fatigue, a brief reliable measure of fatigue severity is needed. Thus, the aim of our study was to evaluate a short version of the Lee Fatigue Scale (LFS) in the Norwegian general population. METHODS: This cross-sectional survey consists of a representative sample from the Norwegian population drawn by The National Population Register in Norway. The study is part of a larger study (NORPOP) aimed at collecting normative data from several questionnaires focused on health in adults living in Norway. Registered citizens between 18 and 94 years of age were randomly selected stratified by age, sex and geographic region. Of the 4971 respondents eligible for the study, 1792 (36%) responded to the survey. In addition to age and sex, we collected responses on a 5-item version of the LFS measuring current fatige severity. The psychometric properties focusing on internal structure and precision of the LFS items were analyzed by a Rasch rating scale model. RESULTS: Complete LFS scores for analyses were available for 1767 adults. Women had higher LFS-scores than men, and adults < 55 years old had higher scores than older respondents. Our analysis of the LFS showed that the average category on each item advanced monotonically. Two of the five items demonstrated misfit, while the three other items demonstrated goodness-of-fit to the model and uni-dimensionality. Items #1 and #4 (tired and fatigue respectively) showed differential item functioning (DIF) by sex, but no items showed DIFs in relation to age. The separation index of the LFS 3-item scale showed that the sample could be separated into three different groups according to the respondents' fatigue levels. The LFS-3 raw scores correlated strongly with the Rasch measure from the three items. The core dimensions in these individual items were very similarly expressed in the Norwegian language version and this may be a threat to the cultural-related or language validity of a short version of the LFS using these particular items. CONCLUSIONS: The study provides validation of a short LFS 3-item version for estimating fatigue in the general population.

Application of aortic allograft in trachea transplantation.

BACKGROUND: The use of tracheal implants for tracheal reconstruction remains a challenge in thoracic medicine due to the complex structure of the trachea in mammalian organisms, including smooth muscles, cartilage, mucosa, blood vessels, cilia, and other tissues, and the difficulty in achieving tracheal regeneration using implants from either allografts or synthetic biomaterials. METHODS: This project used the Lee-Sung strain pig, a swine breed local to Taiwan, as the experimental subject. The aorta of the pig was harvested, decellularized to form the scaffold, and transplanted into the trachea of allogeneic pigs together with growth factors. Postoperative physiological function and tissue changes were observed. The postoperative physiological parameters of the LSP were monitored, and they were sacrificed after a certain period to observe the pathological changes in the tracheal epithelial cells and cartilages. RESULTS: Overall, six LSP tracheal transplantations were performed between March 4, 2020, and March 10, 2021. These included aortic patch anastomosis for pig 1 and aortic segmental anastomosis for pigs 2-6. The shortest and longest survival periods were 1 day and 147 days, respectively. Excluding the pig that survived for only 1 day due to a ruptured graft anastomosis, all other subjects survived for over 1 month on average. CONCLUSION: In this study, we grafted a decellularized porcine aorta into a recipient pig with a tracheal defect. We found cryopreservation of the allogeneic aorta transplantation was a feasible and safe method for the management of airway disease, and immunosuppressants were unnecessary during the treatment course.

A Novel Role of the Two-Component System Response Regulator UvrY in Enterohemorrhagic Escherichia coli O157:H7 Pathogenicity Regulation.

Enterohemorrhagic Escherichia coli (EHEC) O157:H7 is an important human pathogen causing severe diseases, such as hemorrhagic colitis and lethal hemolytic uremic syndrome. The signal-sensing capability of EHEC O157:H7 at specific host colonization sites via different two-component systems (TCSs) is closely related to its pathogenicity during infection. However, the types of systems involved and the regulatory mechanisms are not fully understood. Here, we investigated the function of the TCS BarA/UvrY regulator UvrY in the pathogenicity regulation of EHEC O157:H7. Our results showed that UvrY acts as a positive regulator of EHEC O157:H7 for cellular adherence and mouse colonization through the transcriptional activation of the locus for enterocyte effacement (LEE) pathogenic genes. Furthermore, this regulation is mediated by the LEE island master regulator, Ler. Our results highlight the significance of UvrY in EHEC O157:H7 pathogenicity and underline the unknown importance of BarA/UvrY in colonization establishment and intestinal adaptability during infection.

Efficient and Selective Removal of Organic Cationic Dyes by Peel of Brassica juncea Coss. var. gemmifera Lee et Lin-Based Biochar.

The design and preparation of cheaper, greener and more efficient adsorbents is essential for the removal of pollutants by adsorption. In this study, biochar was prepared from peel of Brassica juncea var. gemmifera Lee et Lin (PoBJ) using a facile, low-temperature and vacuum pyrolysis, and the adsorption mechanism toward organic dyes in aqueous solution was elucidated. The adsorbent was characterized by XPS, FT-IR and SEM, and zeta potential techniques. The adsorption ability of PoBJ biochar for cationic dyes (methylene blue, brilliant green, calcein-safranine, azure I, rhodamine B), anionic dyes (alizarin yellow R), and neutral dyes (neutral red) revealed that the biochar exhibited adsorption selectivity toward cationic dyes. The effects of different factors on the adsorption performance of PoBJ biochar, as well as the adsorption kinetics and thermodynamics, were further investigated by using methylene blue as the model adsorbate. These factors included temperature, pH, contact time and dye concentration. The experimental results showed that BJ280 and BJ160 (prepared at 280 °C and 160 °C, respectively) possessed relatively higher adsorption capacity of 192.8 and 167.40 mg g-1 for methylene blue (MB), respectively, demonstrating the possibility of utilization of PoBJ biochar as a superior bio-adsorbent. The experimental data of BJ160 toward MB were correlated with various kinetic and isothermal models. The results indicated that the adsorption process was consistent with the Langmuir isotherm model and nonlinear pseudo-second-order kinetic model. Thermodynamic parameters indicated that the adsorption of MB onto BJ160 was exothermic. Thus, the low-temperature prepared PoBJ biochar was an environmentally friendly, economic and efficient cationic dye adsorbent.

The Doctor Is In-Listed: TriCare in Civilian Practice.

North Carolina's TriCare Reserve Select is used by more than 4,000 members, and TriCare Retired Reserve is used by less than 400 members. The purpose of this article is to identify strengths, weaknesses, opportunities, and threats to quality TriCare delivery for active and nonactive military and their families in North Carolina.

Pics or It Didn't Happen: Reading Photographs in the Reef Tank Community.

In 1961, Lee Chin Eng jumpstarted the reef hobby, a hobby dedicated to the modeling of coral reefs in captivity, with an article in Tropical Fish Hobbyist. He illustrated the article with eight photographs; these images were meaningful to the hobbyists viewing them and they conveyed both information about the tank system and also claims about Lee's expertise. This paper examines three genres of photographs-landscapes, active, and passive portraiture-that appeared in Lee's article and how and why they have proliferated in the reef hobbyist community over the last sixty years. By tracing the history of these genres, we can better understand natural knowledge producers rely on photographs to exchange knowledge and cement community identity.

Comparison of Complications after Coronavirus Disease and Seasonal Influenza, South Korea.

We conducted a retrospective cohort study using claims data to determine the number and types of complications from coronavirus disease (COVID-19) that patients experience and which patients are more vulnerable to those complications compared with complications in patients with influenza. Among the cohort, 19.6% of COVID-19 patients and 28.5% of influenza patients had >1 new complication. In most complications, COVID-19 patients had lower or similar relative risk compared with influenza patients; exceptions were hair loss, heart failure, mood disorder, and dementia. Young to middle-aged adult COVID-19 patients and patients in COVID-19 hotspots had a higher risk for complications. Overall, COVID-19 patients had fewer complications than influenza patients, but caution is necessary in high-risk groups. If the fatality rate for COVID-19 is reduced through vaccination, management strategies for this disease could be adapted, similar to those for influenza management, such as easing restrictions on economic activity or requirements for close-contact isolation.

SARS-CoV-2 B.1.619 and B.1.620 Lineages, South Korea, 2021.

We report the rapid emergence of severe acute respiratory syndrome coronavirus 2 lineages B.1.619 and B.1.620 in South Korea. The surge in frequency in a relatively short time emphasizes the need for ongoing monitoring for new lineages to track potential increases in transmissibility and disease severity and reductions in vaccine efficacy.

Photoprotection conferring plant tolerance to freezing stress through rescuing photosystem in evergreen Rhododendron.

Light stress is one of the important stresses for winter survival in evergreens, especially for plants with broad leaves, like evergreen rhododendrons. Photoprotection has been shown to upregulate dramatically in rhododendrons during winter, but whether it directly contributes to enhancing the freezing tolerance is still unknown. In this study, we found that the expression and circadian rhythm of an early light-induced protein (ELIP)-RhELIP3-which exerts photoprotection in Rhododendron 'Elsie Lee', could be impacted by both photoperiod and low temperature, with low temperature being the predominant inducer. Arabidopsis overexpressing RhELIP3 displayed significantly stronger freezing tolerance and better photosystem II function after a 3-day recovery from freezing treatment. Moreover, RhHY5 binds with the RhELIP3 promoter to activate its expression. Arabidopsis overexpressing RhHY5 exhibited stronger freezing tolerance and better photosystem II function. AtELIP1 and AtELIP2 were significantly induced in RhHY5-overexpressed Arabidopsis at low temperatures. We also discovered that RhBBX24 binds directly to RhELIP3 promoter and suppresses its expression. RhBBX24 can also interact with RhHY5 and inhibit the interaction of RhHY5-RhELIP3. RhELIP3, RhHY5, and RhBBX24 exhibited similar circadian rhythms under low temperature with short period. Overall, our investigation highlights that photoprotection is involved in improving the freezing tolerance of evergreen rhododendrons.

Swallowing Outcomes Following Voice Therapy in Multiple System Atrophy with Dysphagia: Comparison of Treatment Efficacy with Parkinson's Disease.

Difficulties with speech and swallowing occur in patients with Parkinsonism. Lee Silverman Voice Treatment (LSVT) is proven as an effective treatment for speech and swallowing function in idiopathic Parkinson's disease (IPD). The effect of LSVT on swallowing function in multiple system atrophy-cerebellar type (MSA-C) is unknown. We sought to determine LSVT's effect on swallowing function in MSA-C patients compared to IPD patients. LSVT-LOUD was performed on 13 patients with Parkinsonism (6 IPD and 7 MSA-C). Maximum phonation time (MPT), voice intensity, Speech Handicap Index-15 (SHI-15), Swallowing-Quality of Life (SWAL-QOL), National Institutes of Health-swallowing safety scale (NIH-SSS), and videofluoroscopic dysphagia scale (VDS) before and after LSVT were analyzed and reevaluated three months after treatment. The IPD and MSA-C groups showed significant improvements in overall speech and swallowing measures after LSVT. In particular, pharyngeal phase score and total score of VDS improved significantly in both groups. A two-way repeated-measure ANOVA revealed a significant main effect for time in the MPT, voice intensity, NIH-SSS, pharyngeal phase score and total score of VDS, psychosocial subdomain of SHI-15, and SWAL-QOL. The MSA-C group experienced less overall improvement in swallowing function, but the two groups had an analogous pattern of improvement. In conclusion, LSVT is effective for enhancing swallowing function, particularly in the pharyngeal phase, in both IPD and MSA-C patients. This study demonstrated that LSVT elicits significant improvements in MSA-C patients. We deemed LSVT to be an effective treatment for IPD and MSA-C patients who suffer from dysphagia.

Benzoic Acid, Chlorine Dioxide, and 1-Methylcyclopropene Induce Flavonoid Metabolic Shifts in Postharvest Flowering Chinese Cabbage Revealed by High-Dimensional Analytical Data.

Flowering Chinese cabbage (Brassica campestris L. ssp. chinensis var. utilis Tsen et Lee) is one of the most popular vegetables in China. However, the loss of the functional ingredients in postharvest flowering Chinese cabbage during storage is still serious, owing to the unclear causes of the metabolic shifts. Herein, benzoic acid, chlorine dioxide, and 1-methylcyclopropene (1-MCP) could maintain the quality of postharvest flowering Chinese cabbage, and 1-MCP showed the best effect. Furthermore, transcript-metabolite profiling of the treatments revealed a transcript-metabolite correlation network of the flavonoid biosynthesis pathways with a range of 3 to 3662 differentially expressed genes (DEGs) and a range of 23 to 37 differentially accumulated metabolites (DAMs). Surprisingly, 1-MCP had the best effect on shelf life among the treatments, although chlorine dioxide could stimulate the expression of four critical differential genes (Bra007142, Bra008792, Bra009358, and Bra027457) involved in delaying flavonoid degradation (hesperetin, chalcone, rutin, baicalein). As a result, our findings will help to improve our understanding of the regulation of flavonoid production in relation to the quality of postharvest flowering Chinese cabbage during storage.

Factors affecting freezing tolerance: a comparative transcriptomics study between field and artificial cold acclimations in overwintering evergreens.

Cold acclimation (CA) is a well-known strategy employed by plants to enhance freezing tolerance (FT) in winter. Global warming could disturb CA and increase the potential for winter freeze-injury. Thus, developing robust FT through complete CA is essential. To explore the molecular mechanisms of CA in woody perennials, we compared field and artificial CAs. Transcriptomic data showed that photosynthesis/photoprotection and fatty acid metabolism pathways were specifically enriched in field CA; carbohydrate metabolism, secondary metabolism and circadian rhythm pathways were commonly enriched in both field and artificial CAs. When compared with plants in vegetative growth in the chamber, we found that the light signals with warm air temperatures in the fall might induce the accumulation of leaf abscisic acid (ABA) and jasmonic acid (JA) concentrations, and activate Ca2+ , ABA and JA signaling transductions in plants. With the gradual cooling occurrence in winter, more accumulation of anthocyanin, chlorophyll degradation, closure/degradation of photosystem II reaction centers, and substantial accumulation of glucose and fructose contributed to obtaining robust FT during field CA. Moreover, we observed that in Rhododendron 'Elsie Lee', ABA and JA decreased in winter, which may be due to the strong requirement of zeaxanthin for rapid thermal dissipation and unsaturated fatty acids for membrane fluidity. Taken together, our results indicate that artificial CA has limitations to understand the field CA and field light signals (like short photoperiod, light intensity and/or light quality) before the low temperature in fall might be essential for complete CA.

The Surgical Legacy of Randolph Lee Clark Jr, MD: First Surgeon-in-Chief and Director of University of Texas MD Anderson Cancer Center I. Training and Surgical Practice Before Recruitment to University of Texas MD Anderson Hospital.

Dr R. Lee Clark Jr was the first Surgeon-in-Chief and permanent Director of the University of Texas MD Anderson Cancer Hospital, leading the institution from 1946 to 1978. He is known for his visionary leadership as President, but much less about his prodigious activity as a general surgeon and for his academic contributions as a clinical researcher and surgical educator. His general surgery training at the Mayo Clinic from 1935 to 1939 was extensive, having been involved in over 2000 operations. Dr Clark then began a prodigious surgery practice for 2 years in Jackson, MS. He described his clinical practice: "I have done more than 600 major operations a year, of all types-from the brain to the colon". He was commissioned into the Army Air Force in 1942, as Chief of Surgical Services, with 30 surgeons at a 1000-bed hospital in North Carolina. In 1944, he transferred to Wright Patterson Field in Dayton, OH, as Chief of the Experimental Surgical Unit. He published numerous articles about surgical problems in aviation medicine and edited the journal Air Surgeon's Bulletin. His final assignment in 1945 was Chairman of the Department of Surgery at Randolph Field in San Antonio, TX. On 12 July 1946, after a rather turbulent and vacillating recruitment process, Dr Clark received a unanimous vote by the University of Texas Board of Regents to become the first permanent Director and Surgeon-in-Chief, and so, Randolph Lee Clark Jr began the most productive and impactful phase of his career.

Biofilm formation by LEE-negative Shiga Toxin-Producing Escherichia coli strains.

Shiga toxin-producing Escherichia coli (STEC) include several serotypes isolated from cases of hemorrhagic colitis and, hemolytic uremic syndrome. Although O157:H7 is the most predominant STEC serotype, more than 100 non-O157 serogroups cause diseases in humans. Some STEC carry a Locus of Enterocyte Effacement (LEE-positive); however, STEC that do not carry LEE (LEE-negative) have also been associated with illness, mainly those harbouring the Locus of Adhesion and Autoaggregation (LAA). LAA carry some genes such as hes, iha, tpsA, and agn43, related with pathogenicity. One of them is the ability to form biofilms on different environments, which can contaminate food and generate infections while protecting themselves against adverse conditions. Considering that LAA could be responsible for some adherence mechanisms, the aims of this study were to compare different serogroup of LEE-negative STEC strains in their ability to form biofilms and to evaluate the participation of some genes encoding in LAA. A total of 348 LEE-negative STEC strains was analyzed. The presence of hes, iha, tpsA and agn43 were determined by monoplex PCR. From them, 48 STEC strains belonging to serogroups O113, O130, O171, O174 and, O178 were assayed for their ability to form biofilm. The most prevalent genes detected were agn43 (72.1%) and tpsA (69.5%). The iha and hes genes were present in 63.7% and 54% of the strains, respectively. Although all STEC strains were able to form biofilm, it was found a high variability between them. The relation between the biofilm formation and the presence of each gene was not statistically significant, suggesting that biofilm formation is independent of the presence of those genes. Highlighting that there is no treatment for HUS, it is once again notable that prevention measures and control strategies to prevent biofilm formation are important factors in reducing STEC transmission.

Speech and language therapy treatment on hypokinetic dysarthria in Parkinson disease: Systematic review and meta-analysis.

OBJECTIVE: To assess the effect of speech and language therapy (SLT) on Hypokinetic dysarthria (HD) in Parkinson's disease. DESIGN: Systematic review and meta-analysis of randomized controlled trials. METHODS: We performed a literature search of randomized controlled trials using PubMed, Web of Science, Science Direct and Cochrane database (last search October 2020). Quality assessment and risk of bias were assessed using the Downs and Black scale and the Cochrane tool. The data were pooled and a meta-analysis was completed for sound pressure levels, perceptual intelligibility and inflection of voice fundamental frequency. RESULTS: We selected 15 high to moderate quality studies, which included 619 patients with Parkinson's disease. After pooling the data, 7 studies, which compared different speech language therapies to no treatment, control groups and 3 of their variables, (sound pressure level, semitone standard deviation and perceptual intelligibility) were included in the analysis.Results showed significant differences in favor of SLT for sound pressure level sustained phonation tasks (standard mean difference = 1.79; 95% confidence interval = 0.86, 2.72; p ⩽ 0.0001). Significant results were also observed for sound pressure level and semitone standard deviation in reading tasks (standard mean difference = 1.32; 95% confidence interval = 1.03, 1.61; p ⩽ 0.0001). Additionally, sound pressure levels in monologue tasks showed similar results when SLT was compared to other treatments (standard mean difference = 0.87; 95% confidence interval = 0.46, 1.28; p ⩽ 0.0001). CONCLUSION: This meta-analysis suggests a beneficial effect of SLT for reducing Hypokinetic Dysarthria in Parkinson's disease, improving perceptual intelligibility, sound pressure level and semitone standard deviation.