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Patients with posttraumatic stress disorder (PTSD) exhibit smaller regional brain volumes in commonly reported regions including the amygdala and hippocampus, regions associated with fear and memory processing. In the current study, we have conducted a voxel-based morphometry (VBM) meta-analysis using whole-brain statistical maps with neuroimaging data from the ENIGMA-PGC PTSD working group.
Methods
T1-weighted structural neuroimaging scans from 36 cohorts (PTSD n = 1309; controls n = 2198) were processed using a standardized VBM pipeline (ENIGMA-VBM tool). We meta-analyzed the resulting statistical maps for voxel-wise differences in gray matter (GM) and white matter (WM) volumes between PTSD patients and controls, performed subgroup analyses considering the trauma exposure of the controls, and examined associations between regional brain volumes and clinical variables including PTSD (CAPS-4/5, PCL-5) and depression severity (BDI-II, PHQ-9).
Results
PTSD patients exhibited smaller GM volumes across the frontal and temporal lobes, and cerebellum, with the most significant effect in the left cerebellum (Hedges’ g = 0.22, pcorrected = .001), and smaller cerebellar WM volume (peak Hedges’ g = 0.14, pcorrected = .008). We observed similar regional differences when comparing patients to trauma-exposed controls, suggesting these structural abnormalities may be specific to PTSD. Regression analyses revealed PTSD severity was negatively associated with GM volumes within the cerebellum (pcorrected = .003), while depression severity was negatively associated with GM volumes within the cerebellum and superior frontal gyrus in patients (pcorrected = .001).
Conclusions
PTSD patients exhibited widespread, regional differences in brain volumes where greater regional deficits appeared to reflect more severe symptoms. Our findings add to the growing literature implicating the cerebellum in PTSD psychopathology.
Pronunciation teaching is often based on assumptions that learners are monolingual speakers, with the sound system of their native language determining the segmental and suprasegmental difficulties that mark learners’ foreign accents. However, many, if not a majority of speakers of other languages come to pronunciation with more than one language under their command. These bilingual/multilingual speakers are the norm in a globalized world, but how we teach pronunciation rarely accounts for the knowledge and skills these speakers bring to the learning of pronunciation. This chapter describes how the characteristics of bilingual speakers suggest how pronunciation teaching can be reimagined to take into account the range and flexibility of bilingual speakers in using multiple languages. Specifically, we argue that taking a nativeness viewpoint is inconsistent with taking a bilingual viewpoint and calls for pedagogical techniques that build on the kinds of needs bilingual speakers have in pronouncing additional languages.
The United Nations (UN) established an umbrella of organizations to manage distinct clusters of humanitarian aid. The World Health Organization (WHO) oversees the health cluster, giving it responsibility for global, national, and local medical responses to natural disasters. However, this centralized structure insufficiently engages local players, impeding robust local implementation. The Gorkha earthquake struck Nepal on April 25, 2015, becoming Nepal’s most severe natural disaster since the 1934 Nepal-Bihar earthquake. In coordinated response, 2 organizations, Empower Nepali Girls and International Neurosurgical Children’s Association, used a hybrid approach integrating continuous communication with local recipients. Each organization mobilized its principal resource strengths—material medical supplies or human capital—thereby efficiently deploying resources to maximize the impact of the medical response. In addition to efficient resource use, this approach facilitates dynamic medical responses from highly mobile organizations. Importantly, in addition to future earthquakes in Nepal, this medical response strategy is easily scalable to other natural disaster contexts and other medical relief organizations. Preemptively identifying partner organizations with complementary strengths, continuous engagement with recipient populations, and creating disaster- and region-specific response teams may represent viable variations of the WHO cluster model with greater efficacy in local implementation of treatment in acute disaster scenarios.
Recurrent laryngeal nerve injury leading to vocal cord paralysis is a known complication of cardiothoracic surgery. Its occurrence during interventional catheterisation procedures has been documented in case reports, but there have been no studies to determine an incidence.
Objective:
To establish the incidence of left recurrent laryngeal nerve injury leading to vocal cord paralysis after left pulmonary artery stenting, patent ductus arteriosus device closure and the combination of the procedures either consecutively or simultaneously.
Methods:
Members of the Congenital Cardiovascular Interventional Study Consortium were asked to perform a retrospective analysis to identify cases of recurrent laryngeal nerve injury after the aforementioned procedures. Twelve institutions participated in the analysis. They also contributed the total number of each procedure performed at their respective institutions for statistical purposes.
Results:
Of the 1337 patients who underwent left pulmonary artery stent placement, six patients (0.45%) had confirmed vocal cord paralysis. 4001 patients underwent patent ductus arteriosus device closure, and two patients (0.05%) developed left vocal cord paralysis. Patients who underwent both left pulmonary artery stent placement and patent ductus arteriosus device closure had the highest incidence of vocal cord paralysis which occurred in 4 of the 26 patients (15.4%). Overall, 92% of affected patients in our study population had resolution of symptoms.
Conclusion:
Recurrent laryngeal nerve injury is a rare complication of left pulmonary artery stent placement or patent ductus arteriosus device closure. However, the incidence is highest in patients undergoing both procedures either consecutively or simultaneously. Additional research is necessary to determine contributing factors that might reduce the risk of recurrent laryngeal nerve injury.
The ice-cored Galena Creek Rock Glacier, Wyoming, USA, has been the subject of a number of studies that sought to determine the origin of its ice. We present new observations of the rock glacier's internal structure from ground-penetrating radar to constrain ice and debris distribution and accumulation. We imaged dipping reflectors in the center of the glacier that are weak and discontinuous, in contrast to strong reflectors toward the edge of the cirque beneath large debris-avalanche chutes. These reflectors form a network of concave-up, up-glacier dipping layers. We interpret these as englacial debris bands formed by large debris falls buried by subsequent ice and snow accumulation. They are discontinuous where ice outpaces debris accumulation, but with sufficient debris accumulation an interleaved pattern of ice and debris layers can form. We propose a model in which the ice in these interleaved layers is snowfall preserved by debris-facilitated accumulation. Large debris falls that occur in early spring bury sections of the snowpack, which are then preserved through summer and incorporated into the rock glacier body over time. This study highlights the importance of sequential accumulation of ice and debris for understanding the dynamics of rock glaciers and debris-covered glaciers.
Item 9 of the Patient Health Questionnaire-9 (PHQ-9) queries about thoughts of death and self-harm, but not suicidality. Although it is sometimes used to assess suicide risk, most positive responses are not associated with suicidality. The PHQ-8, which omits Item 9, is thus increasingly used in research. We assessed equivalency of total score correlations and the diagnostic accuracy to detect major depression of the PHQ-8 and PHQ-9.
Methods
We conducted an individual patient data meta-analysis. We fit bivariate random-effects models to assess diagnostic accuracy.
Results
16 742 participants (2097 major depression cases) from 54 studies were included. The correlation between PHQ-8 and PHQ-9 scores was 0.996 (95% confidence interval 0.996 to 0.996). The standard cutoff score of 10 for the PHQ-9 maximized sensitivity + specificity for the PHQ-8 among studies that used a semi-structured diagnostic interview reference standard (N = 27). At cutoff 10, the PHQ-8 was less sensitive by 0.02 (−0.06 to 0.00) and more specific by 0.01 (0.00 to 0.01) among those studies (N = 27), with similar results for studies that used other types of interviews (N = 27). For all 54 primary studies combined, across all cutoffs, the PHQ-8 was less sensitive than the PHQ-9 by 0.00 to 0.05 (0.03 at cutoff 10), and specificity was within 0.01 for all cutoffs (0.00 to 0.01).
Conclusions
PHQ-8 and PHQ-9 total scores were similar. Sensitivity may be minimally reduced with the PHQ-8, but specificity is similar.
Rhythm, and its related connected speech modifications, were once central to pronunciation teaching, but more recently have been relegated to the sidelines, especially in English as a lingua franca. This chapter argues that rhythm is central to intelligibility in production and perception. In regard to perception, the chapter agrees with almost every other approach. L2 learners need to be able to understand the speech of others, especially native speakers, whose stress-based rhythm is often challenging. In regard to production, research on lexical segmentation (the identification of words in connected speech) has shown that all listeners, native as well as nonnative, struggle to segment speech (i.e., they struggle with intelligibility) when they have to process speech with unfamiliar rhythm. Rhythmic differences can cause difficulties for native listeners but also for nonnative listeners. Rhythm underlies how listeners process speech and segment the stream of speech into identifiable words and messages, both key elements of intelligibility. This indicates that rhythm is critical for intelligibility, and affects how listeners access words and messages. Different rhythmic structures across languages guarantee that rhythm will affect how listeners and speaker understand each other.
Consonant clusters need to be produced and perceived accurately or intelligibility may be reduced. However, they are inadequately addressed even in traditional pronunciation materials. Because languages differ in the degree that they permit multiple consonants to occur as the onset or coda in a syllable, L2 learners may need to learn to produce and perceive different types of syllables when learning an L2. This may not only result in substitutions of sounds within the clusters, but also deletions of sounds or insertions of vowels to make words more pronounceable. This can, and often does, affect intelligibility because of the effects of mispronunciations on syllable structure. Because the exact nature of syllable structure is a matter of language-specific phonotactics, it creates the potential for unique types of intelligibility problems. The chapter argues that consonant clusters are important in word identification, and thus are important for intelligibility. But their pronunciation may be subject to cluster simplifications, either through deletion or epenthesis. Second, the chapter argues that final clusters may be affected by inflectional endings (especially –ed, –s, –’s), where simplifications may cause problems with intelligibility because of the loss of grammatical information.
This chapter presents six principles to help decide whether a particular pronunciation problem is worth teaching. The principles are intended to begin to define what an intelligibility-based approach is like. The principles are sometimes ambiguous because no category of sounds is a priori either to be included or to be excluded in an intelligibility-based approach. Each general category includes more and less important features. There appears to be more important and less important consonant and vowel sounds, just as there appears to be more and less important elements of intonation or word stress. The guidelines are an explicit attempt to define parameters for informed intuition, an argument for a nuanced approach to priorities, and, hopefully, a way to have an impact upon classroom practice and help to use precious classroom time more effectively. The guidelines include prioritizing features that are explicitly connected to other areas of language use, that affect the ability to process speech, that privilege important lexical items, that carry a high functional load, that are more frequent, and that are easy to learn. Each of these principles is based both on research and informed intuition, and can help teachers to decide whether something is likely to be worth teaching.
English is a free-stress language, meaning that word stress can fall on various syllables, depending on the word. Stress also affects the way that vowels and consonants are pronounced, and influences the ways that listeners identify the words being spoken. Because of this, misplaced word stress in English can stop communication completely. When a word cannot be recognized, listeners may be slowed down or stop all other processing to decode the word that was not understood. The stressed syllable of words is particularly important in word recognition because it can lead listeners to look for words that are quite unrelated to the one that was spoken. Because listeners use segmentals and stress patterns to identify possible words before a word is fully articulated, wrong stresses may lead listeners to look for incorrect words, compromising intelligibility and/or comprehensibility. This chapter argues that word stress is essential in an intelligibility-based approach to teaching pronunciation. The chapter also argues that word stress is important for ESL and ELF contexts because of the impossibility of separating stress and segmentals, evidence that stress affects both native and nonnative listeners, and findings that show how misplaced word stress can severely impact intelligibility for various learners.
The language of adult foreign-language learners is rarely native-like, especially in their pronunciation, in which foreign-accented speech is the norm. Having a foreign accent, however, does not mean that a speaker will be unintelligible, nor that they cannot effectively communicate. Listeners are remarkably flexible in understanding varying pronunciation patterns. This chapter explores the relationship of intelligibility to pronunciation, especially with regard to foreign-accented speech. Intelligibility includes both actual understanding and the degree of effort involved in understanding (called comprehensibility). Research has demonstrated that pronunciation deviations are a major factor in loss of intelligibility. Despite opportunities for unintelligibility based on pronunciation differences, it may be surprising that foreign-accented speech is mostly intelligible, especially for listeners who are familiar with particular foreign accents. The ability of listeners to understand each other despite significant variations in pronunciation shows that people typically demonstrate a great deal of flexibility in communication. This flexibility is necessary for native accent differences, but more necessary for nonnative accents, in which pronunciation variations are more likely to be unexpected or outside the range of familiar native-speaker dialects. The chapter describe the types of pronunciation features that seem to be most important in intelligibility.
Vowel and consonant sounds are the heart of traditional pronunciation teaching, and they remain essential in teaching for intelligibility. One simply cannot speak clearly without sufficient accuracy in pronouncing segmentals. This is true for perception as well as production. This chapter describes segmentals from various perspectives, showing how they are distinct from, yet overlapping with, the suprasegmentals of the language. All segmentals are unavoidable in speaking, and how they are pronounced influences how well listeners understand speakers. This chapter also looks at segmentals from the perspective of L2 intelligibility and argues that they are most likely to affect the intelligibility of words. It describes how different errors affect intelligibility. First, segmentals are critical in judgments of intelligibility and comprehensibility. Second, some segmentals are more likely to cause misunderstandings than others, and different types of mispronunciations are likely to have varied effects on intelligibility, especially if they are combined with other errors. Finally, the chapter describes what is known about both naturalistic development of segmentals and the effects of instruction
This chapter discusses the implication of the Nativeness Principle and the Intelligibility Principle, and looks at how the shift from nativeness to intelligibility implies a different role for pronunciation in language teaching. Pronunciation has long been seen in terms of the Cinderella myth, suggesting that pronunciation does not have a proper and equal place in language teaching, while other skills are privileged in classrooms and teacher training. Pronunciation has changed with the times, however, and today’s approaches to pronunciation teaching, and the basic goals, have changed with them. This chapter discusses the Nativeness and Intelligibility Principles in detail, along with their implications for classroom practice, and describes six features that are essential to an intelligibility-based approach to teaching: selectivity in what is taught; instruction that takes account of individual needs rather than using a one-size-fits-all approach; multi-modality in teaching rather than auditory instruction alone; communicatively oriented instruction in which pronunciation is important to communicative goals; accuracy in how pronunciation is described both for teachers and for learners; and connections to socially significant uses of language rather than decontextualized pronunciation instruction.