Exposure to Canadian French Cued Speech Improves Consonant Articulation in Children With Cochlear Implants: Acoustic and Articulatory Data.

PURPOSE: One of the strategies that can be used to support speech communication in deaf children is cued speech, a visual code in which manual gestures are used as additional phonological information to supplement the acoustic and labial speech information. Cued speech has been shown to improve speech perception and phonological skills. This exploratory study aims to assess whether and how cued speech reading proficiency may also have a beneficial effect on the acoustic and articulatory correlates of consonant production in children. METHOD: Eight children with cochlear implants (from 5 to 11 years of age) and with different receptive proficiency in Canadian French Cued Speech (three children with low receptive proficiency vs. five children with high receptive proficiency) are compared to 10 children with typical hearing (from 4 to 11 years of age) on their production of stop and fricative consonants. Articulation was assessed with ultrasound measurements. RESULTS: The preliminary results reveal that cued speech proficiency seems to sustain the development of speech production in children with cochlear implants and to improve their articulatory gestures, particularly for the place contrast in stops as well as fricatives. CONCLUSION: This work highlights the importance of studying objective data and comparing acoustic and articulatory measurements to better characterize speech production in children.

Speech rehabilitation in children with cochlear implants using a multisensory (French Cued Speech) or a hearing-focused (Auditory Verbal Therapy) approach.

Introduction: Early exposure to a rich linguistic environment is essential as soon as the diagnosis of deafness is made. Cochlear implantation (CI) allows children to have access to speech perception in their early years. However, it provides only partial acoustic information, which can lead to difficulties in perceiving some phonetic contrasts. This study investigates the contribution of two spoken speech and language rehabilitation approaches to speech perception in children with CI using a lexicality judgment task from the EULALIES battery. Auditory Verbal Therapy (AVT) is an early intervention program that relies on auditory learning to enhance hearing skills in deaf children with CI. French Cued Speech, also called Cued French (CF), is a multisensory communication tool that disambiguates lip reading by adding a manual gesture. Methods: In this study, 124 children aged from 60 to 140 months were included: 90 children with typical hearing skills (TH), 9 deaf children with CI who had participated in an AVT program (AVT), 6 deaf children with CI with high Cued French reading skills (CF+), and 19 deaf children with CI with low Cued French reading skills (CF-). Speech perception was assessed using sensitivity (d') using both the hit and false alarm rates, as defined in signal-detection theory. Results: The results show that children with cochlear implants from the CF- and CF+ groups have significantly lower performance compared to children with typical hearing (TH) (p < 0.001 and p = 0.033, respectively). Additionally, children in the AVT group also tended to have lower scores compared to TH children (p = 0.07). However, exposition to AVT and CF seems to improve speech perception. The scores of the children in the AVT and CF+ groups are closer to typical scores than those of children in the CF- group, as evidenced by a distance measure. Discussion: Overall, the findings of this study provide evidence for the effectiveness of these two speech and language rehabilitation approaches, and highlight the importance of using a specific approach in addition to a cochlear implant to improve speech perception in children with cochlear implants.

Comparing the selectivity of vowel representations in cortical auditory vs. motor areas: A repetition-suppression study.

A computational model of speech perception, COSMO (Laurent et al., 2017), predicts that speech sounds should evoke both auditory representations in temporal areas and motor representations mainly in inferior frontal areas. Importantly, the model also predicts that auditory representations should be narrower, i.e. more focused on typical stimuli, than motor representations which would be more tolerant of atypical stimuli. Based on these assumptions, in a repetition-suppression study with functional magnetic resonance imaging data, we show that a sequence of 4 identical vowel sounds produces lower cortical activity (i.e. larger suppression effects) than if the last sound in the sequence is slightly varied. Crucially, temporal regions display an increase in cortical activity even for small acoustic variations, indicating a release of the suppression effect even for stimuli acoustically close to the first stimulus. In contrast, inferior frontal, premotor, insular and cerebellar regions show a release of suppression for larger acoustic variations. This "auditory-narrow motor-wide" pattern for vowel stimuli adds to a number of similar findings on consonant stimuli, confirming that the selectivity of speech sound representations in temporal auditory areas is narrower than in frontal motor areas in the human cortex.

Language familiarity influences own-race face recognition in 9- and 12-month-old infants.

During their first year, infants attune to the faces and language(s) that are frequent in their environment. The present study investigates the impact of language familiarity on how French-learning 9- and 12-month-olds recognize own-race faces. In Experiment 1, infants were familiarized with the talking face of a Caucasian bilingual German-French speaker reciting a nursery rhyme in French (native condition) or in German (non-native condition). In the test phase, infants' face recognition was tested by presenting a picture of the speaker's face they were familiarized with, side by side with a novel face. At 9 and 12 months, neither infants in the native condition nor the ones in the non-native condition clearly recognized the speaker's face. In Experiment 2, we familiarized infants with the still picture of the speaker's face, along with the auditory speech stream. This time, both 9- and 12-month-olds recognized the face of the speaker they had been familiarized with, but only if she spoke in their native language. This study shows that at least from 9 months of age, language modulates the way faces are recognized.

Development of fricative production in French-speaking school-aged children using cochlear implants and children with normal hearing.

In the course of productive phonological development, fricatives are among the last speech sounds to emerge and to be mastered by children, probably because of the high degree of articulatory precision they require or because of difficulties with their perception. Children with cochlear implants (CI) face additional difficulties with fricative perception, since high spectral frequency components are shown to be especially difficult to perceive with a cochlear implant. Studying fricative production in children with CIs allows to study how the partial transmission of speech sounds by cochlear implants influences children's speech production, and therefore to explore how perceptual abilities influence the late stages of phonological development. This acoustic study focuses on fricative production at three places of articulation (i.e., /f/, /s/ and /ʃ/), comparing productions by two groups of children (20 children with normal hearing (NH) vs. 13 children with CIs, all aged 5;7 to 10;7 years), and taking into account their consistency in coarticulation and the stability of their production across two different tasks (word-repetition and picture-naming). Statistical analyses were carried out by means of linear mixed-effect models. The results show that while both groups produce /ʃ/ with similar acoustic characteristics, between-group differences are found for /f/ and /s/. Furthermore, effects of consonant-vowel coarticulation are found for children with NH, and are absent for children with CIs. Effects of chronological age are only found for children with CIs (production in older children with CIs nearing that of children with NH). Our study shows that the development of fricative production of five- to 11-year-old children with CIs is affected by the children's hearing abilities and late access to auditory information. These limitations however do not prevent the children from eventually reaching a consistency similar to that of children with NH, as suggested by the fact that their production is still evolving during that age span. The results also show that the acquisition of coarticulation strategies can be impeded by degraded or delayed access to audio.

Long-term effects of cochlear implantation on the intelligibility of speech in French-speaking children.

Our study compares the intelligibility of French-speaking children with a cochlear implant (N = 13) and age-matched children with typical hearing (N = 13) in a narrative task. This contrasts with previous studies in which speech intelligibility of children with cochlear implants is most often tested using repetition or reading tasks. Languages other than English are seldom considered. Their productions were graded by naive and expert listeners. The results show that (1) children with CIs have lower intelligibility, (2) early implantation is a predictor of good intelligibility, and (3) late implantation after two years of age does not prevent the children from eventually reaching good intelligibility.

Oral Immunotherapy for Hazelnut Allergy: A Single-Center Retrospective Study on 100 Patients.

BACKGROUND: Oral immunotherapy (OIT) protects patients with IgE-mediated food allergies from food-induced allergic reactions due to accidental exposure and may improve their quality of life. This approach has never been evaluated for hazelnut, a major cause of food allergy in Europe. OBJECTIVE: To determine the proportion of hazelnut-desensitized patients after 6 months of OIT and to identify predictors of successful desensitization. METHODS: In a retrospective single-center study, we included patients younger than 18 years who underwent at least 6 months of hazelnut OIT for IgE-mediated allergy, defined by history of hypersensitivity reaction after hazelnut ingestion, positive hazelnut skin prick test result or specific IgE, and positive double-blind, placebo-controlled food challenge. Patients able to tolerate 1635 mg of hazelnut protein (∼8 hazelnuts) were considered to be hazelnut desensitized. We determined the proportion of desensitized patients after 6 months of OIT, searched for associations between baseline variables and successful desensitization, and estimated the frequency and severity of OIT-related adverse reactions. RESULTS: One hundred patients were included (64% males; median age, 5 years). History of severe reactions was noted in 7% of cases. At 6 months, the proportion of desensitized patients was 34% (95% CI, 25-44). The median eliciting dose (defined as the amount of hazelnut protein provoking a hypersensitivity reaction during the double-blind, placebo-controlled food challenge) increased from 106 mg (interquartile range, 51-249) at baseline to 523 mg (interquartile range, 190-1635) after 6 months of OIT (P < .0001). With longer therapy, the proportion of desensitized patients increased. Using multivariate analysis, successful desensitization was associated with older age (odds ratio [OR], 1.5; 95% CI, 1.2-2.2), smaller hazelnut skin prick test wheal diameter (OR, 0.61; 95% CI, 0.4-0.8), lower hazelnut specific IgE level (OR, 0.86; 95% CI, 0.72-0.98), and absence of cashew allergy (OR, 0.42; 95% CI, 0.12-0.64). Adverse reactions occurred in 30% of patients; none were severe. CONCLUSIONS: In a cohort of 100 patients aged 3 to 9 years, our results show for the first time that hazelnut OIT is associated with hazelnut desensitization and may be safe in most patients undergoing this therapy.

An Introduction to Bayesian Multilevel Models Using brms: A Case Study of Gender Effects on Vowel Variability in Standard Indonesian.

Purpose Bayesian multilevel models are increasingly used to overcome the limitations of frequentist approaches in the analysis of complex structured data. This tutorial introduces Bayesian multilevel modeling for the specific analysis of speech data, using the brms package developed in R. Method In this tutorial, we provide a practical introduction to Bayesian multilevel modeling by reanalyzing a phonetic data set containing formant (F1 and F2) values for 5 vowels of standard Indonesian (ISO 639-3:ind), as spoken by 8 speakers (4 females and 4 males), with several repetitions of each vowel. Results We first give an introductory overview of the Bayesian framework and multilevel modeling. We then show how Bayesian multilevel models can be fitted using the probabilistic programming language Stan and the R package brms, which provides an intuitive formula syntax. Conclusions Through this tutorial, we demonstrate some of the advantages of the Bayesian framework for statistical modeling and provide a detailed case study, with complete source code for full reproducibility of the analyses ( https://osf.io/dpzcb /). Supplemental Material https://doi.org/10.23641/asha.7973822.

The role of production abilities in the perception of consonant category in infants.

The influence of motor knowledge on speech perception is well established, but the functional role of the motor system is still poorly understood. The present study explores the hypothesis that speech production abilities may help infants discover phonetic categories in the speech stream, in spite of coarticulation effects. To this aim, we examined the influence of babbling abilities on consonant categorization in 6- and 9-month-old infants. Using an intersensory matching procedure, we investigated the infants' capacity to associate auditory information about a consonant in various vowel contexts with visual information about the same consonant, and to map auditory and visual information onto a common phoneme representation. Moreover, a parental questionnaire evaluated the infants' consonantal repertoire. In a first experiment using /b/-/d/ consonants, we found that infants who displayed babbling abilities and produced the /b/ and/or the /d/ consonants in repetitive sequences were able to correctly perform intersensory matching, while non-babblers were not. In a second experiment using the /v/-/z/ pair, which is as visually contrasted as the /b/-/d/ pair but which is usually not produced at the tested ages, no significant matching was observed, for any group of infants, babbling or not. These results demonstrate, for the first time, that the emergence of babbling could play a role in the extraction of vowel-independent representations for consonant place of articulation. They have important implications for speech perception theories, as they highlight the role of sensorimotor interactions in the development of phoneme representations during the first year of life.

Statistical Methodology for the Analysis of Repeated Duration Data in Behavioral Studies.

Purpose: Repeated duration data are frequently used in behavioral studies. Classical linear or log-linear mixed models are often inadequate to analyze such data, because they usually consist of nonnegative and skew-distributed variables. Therefore, we recommend use of a statistical methodology specific to duration data. Method: We propose a methodology based on Cox mixed models and written under the R language. This semiparametric model is indeed flexible enough to fit duration data. To compare log-linear and Cox mixed models in terms of goodness-of-fit on real data sets, we also provide a procedure based on simulations and quantile-quantile plots. Results: We present two examples from a data set of speech and gesture interactions, which illustrate the limitations of linear and log-linear mixed models, as compared to Cox models. The linear models are not validated on our data, whereas Cox models are. Moreover, in the second example, the Cox model exhibits a significant effect that the linear model does not. Conclusions: We provide methods to select the best-fitting models for repeated duration data and to compare statistical methodologies. In this study, we show that Cox models are best suited to the analysis of our data set.

Realisation of voicing by French-speaking CI children after long-term implant use: An acoustic study.

Studies of speech production in French-speaking cochlear-implanted (CI) children are very scarce. Yet, difficulties in speech production have been shown to impact the intelligibility of these children. The goal of this study is to understand the effect of long-term use of cochlear implant on speech production, and more precisely on the coordination of laryngeal-oral gestures in stop production. The participants were all monolingual French children: 13 6;6- to 10;7-year-old CI children and 20 age-matched normally hearing (NH) children. We compared /p/, /t/, /k/, /b/, /d/ and /g/ in word-initial consonant-vowel sequences, produced in isolation in two different tasks, and we studied the effects of CI use, vowel context, task and age factors (i.e. chronological age, age at implantation and duration of implant use). Statistical analyses show a difference in voicing production between groups for voiceless consonants (shorter Voice Onset Times for CI children), with significance reached only for /k/, but no difference for voiced consonants. Our study indicates that in the long run, use of CI seems to have limited effects on the acquisition of oro-laryngeal coordination needed to produce voicing, except for specific difficulties located on velars. In a follow-up study, further acoustic analyses on vowel and fricative production by the same children reveal more difficulties, which suggest that cochlear implantation impacts frequency-based features (second formant of vowels and spectral moments of fricatives) more than durational cues (voicing).

Phenotypical characterization of peanut allergic children with differences in cross-allergy to tree nuts and other legumes.

BACKGROUND: Peanut allergy in children is often associated with allergies to tree nuts and/or legumes. The aim of this study was to analyze in cluster a cohort of children allergic to peanuts and assessed for cross-reactivity to nuts and legumes and to identify different phenotypes. METHODS: We included retrospectively 317 children with peanut allergy evaluated at the Allergy Unit of the Saint Vincent Hospital of Lille in the last 12 years. A complete workup for peanut allergy and nuts and legumes was carried out for each patient. A hierarchical agglomerative clustering method was used to search for clusters of individuals in the evaluated cohort. RESULTS: Cross-allergy to TN and/or other legumes was identified in 137 patients (43.2%), atopic dermatitis being a major risk factor (adjusted OR = 16 [95% CI: 7.4-37]; p < 0.001). Three phenotypes emerged from cluster analysis. Cluster 1 (72 patients) is characterized by high level of rAra h 2, low threshold reactive doses for peanut and high proportion of asthma; Cluster 2 (93 patients) is characterized by high threshold reactive doses for peanut and the lowest proportion of cross-allergy to TN and/or legumes; Cluster 3 (152 patients) has a high risk of cross-allergy to TN and/or legumes and most patients suffer from eczema. CONCLUSIONS: The three phenotypes highlighted by this study could be useful to identify children with high risk of cross-allergic reaction to TNs and legumes early after PA diagnosis.

Accuracy of the days' supply and the number of refills allowed recorded in Québec prescription claims databases for inhaled corticosteroids.

OBJECTIVES AND HYPOTHESES: Adherence to inhaled corticosteroids (ICS) is a major issue in asthma. This study aimed to estimate the accuracy of the days' supply and number of refills allowed, variables recorded in Québec claims databases and used to estimate adherence, and to develop correction factors, if required. We hypothesised that the accuracy of the days' supply for ICS would be low whereas the accuracy of the number of refills allowed would be high. SETTING: 40 community pharmacies in Québec (Canada) and a medication registry. PARTICIPANTS: We collected data for 1108 ICS original prescriptions stored in the 40 pharmacies (sample 1), and we obtained a second sample of 2676 ICS prescriptions selected from reMed, a medication registry (sample 2). PRIMARY AND SECONDARY OUTCOMES: We estimated the concordance of the days' supply and number of refills between Québec claims databases and the original prescription from sample 1. We developed a correction factor for the days' supply in sample 1 and validated it in sample 2. Analyses were stratified by age: 0-11 and 12-64 years. RESULTS: In sample 1, the concordance for the days' supply was 39.6% (95% CI 37.6% to 41.6%) in those aged 0-11 years and 56% (54.9% to 57.2%) in those aged 12-64 years. The concordance increased to 59.4% (58.2% to 60.5%) in those aged 0-11 years and 74.2% (73.5% to 74.9%) in those aged 12-64 years after applying the correction factors in sample 2. The concordance for the refills allowed was 92.1% (91% to 93.1%) in those aged 0-11 years and 93.1% (92.5% to 93.7%) in those aged 12-64 years in sample 1. CONCLUSIONS: The accuracy of the days' supply was moderate among those aged 0-11 years and substantial among those aged 12-64 years after applying the correction factors. The accuracy of the number of refills was almost perfect in both groups.

Quality, quantity and harmony: the DataSHaPER approach to integrating data across bioclinical studies.

BACKGROUND: Vast sample sizes are often essential in the quest to disentangle the complex interplay of the genetic, lifestyle, environmental and social factors that determine the aetiology and progression of chronic diseases. The pooling of information between studies is therefore of central importance to contemporary bioscience. However, there are many technical, ethico-legal and scientific challenges to be overcome if an effective, valid, pooled analysis is to be achieved. Perhaps most critically, any data that are to be analysed in this way must be adequately 'harmonized'. This implies that the collection and recording of information and data must be done in a manner that is sufficiently similar in the different studies to allow valid synthesis to take place. METHODS: This conceptual article describes the origins, purpose and scientific foundations of the DataSHaPER (DataSchema and Harmonization Platform for Epidemiological Research; http://www.datashaper.org), which has been created by a multidisciplinary consortium of experts that was pulled together and coordinated by three international organizations: P³G (Public Population Project in Genomics), PHOEBE (Promoting Harmonization of Epidemiological Biobanks in Europe) and CPT (Canadian Partnership for Tomorrow Project). RESULTS: The DataSHaPER provides a flexible, structured approach to the harmonization and pooling of information between studies. Its two primary components, the 'DataSchema' and 'Harmonization Platforms', together support the preparation of effective data-collection protocols and provide a central reference to facilitate harmonization. The DataSHaPER supports both 'prospective' and 'retrospective' harmonization. CONCLUSION: It is hoped that this article will encourage readers to investigate the project further: the more the research groups and studies are actively involved, the more effective the DataSHaPER programme will ultimately be.

Inhaled corticosteroids during pregnancy: a review of methodologic issues.

BACKGROUND: There is evidence in the literature that inhaled corticosteroids (ICSs) are safe for pregnant women with asthma and their infants. Although this is useful information about ICS use during pregnancy, some articles must be viewed cautiously because of lack of power and adjustment for potentially important confounding variables. OBJECTIVE: To summarize evidence on the potential effects of ICSs to treat asthma in pregnant mothers and their children with particular focus on study power. METHODS: Studies published before September 1, 2007, and focusing mainly on ICS use for asthma treatment during pregnancy were researched in Pubmed and the Cochrane Library. Post hoc power calculations were completed using data reported in the published articles. RESULTS: Twenty-three studies that evaluated the associations between ICS use during pregnancy and maternal and/or perinatal outcomes were retained. Only six studies on the association between ICS use and maternal outcomes reported significant results; five studies found significant associations between ICS use and perinatal outcomes. Regarding non-significant results, two studies on maternal outcomes and seven studies on perinatal outcomes had a power higher than 80% to detect a relative risk of 1.5 or a mean birth weight difference of 500 g. CONCLUSION: While there currently is some degree of evidence to support the safety of ICS use during pregnancy, this review highlights the limited statistical power of several studies published in this area.

Agreement between administrative databases and medical charts for pregnancy-related variables among asthmatic women.

PURPOSE: To determine the validity of pregnancy variables recorded in administrative databases of Quebec using patient medical charts as the gold standard among asthmatic pregnant women. METHODS: Three administrative databases were linked and provided information on maternal, pregnancy and infant characteristics for 726 pregnant asthmatic women who delivered in 1990-2000. Algorithms were developed to measure variables that were not recorded directly in the databases or to minimize the number of missing values for variables recorded in two or more databases. Medical file data were collected by two trained research nurses in 43 hospitals. The validity of categorical variables was assessed with sensitivity, specificity, predictive positive values (PPVs) and predictive negative values (PNVs), whereas the validity of continuous variables was assessed with Pearson correlation using the medical chart as the gold standard. RESULTS: The sensitivity of the sex of the baby, previous live birth and previous pregnancy ranged from 0.97 to 0.99. Corresponding figures were 0.92-0.98 for specificity. We also found high correlation coefficients, ranging from 0.875 to 0.999 for the length of gestation, dates of last menstruation and delivery, maternal age and birth weight. CONCLUSION: Pregnancy-related variables recorded in administrative databases or derived from algorithms based on two or more databases were found to be highly valid as compared to the medical chart among asthmatic women.