Andrew Slater

Aspects of non-native pronunciation in a case of altered accent following stroke (foreign accent syndrome)

Foreign accent syndrome (FAS) refers to a disorder that involves foreign sounding speech, usually following stroke. This paper presents a case study of an English patient allegedly speaking with a Scottish English accent after right-hemisphere stroke. The results of detailed impressionistic and acoustic analyses are reported, based on a direct comparison of the patients pre-stroke and post-stroke speech samples. The emphasis is on a comparison of the typical features of Scottish English and phonetic features actually found in the patients post-stroke speech. The respective roles of prosodic and segmental features in the post-stroke speech sample are also discussed. Rather untypically, prosodic features seem to be affected to a much lesser extent than segmental phonetic features in the patients post-stroke speech. They are, therefore, less likely to contribute to the perception of a foreign accent.

Non-segmental analysis and synthesis based on a speech database

The paper reports on experiments in non segmental speech analysis and synthesis using parameters derived from a speech database of British English monosyllables. The database includes almost every onset, nucleus and coda, and almost all onset nucleus and nucleus consonant combinations occurring in English. Acoustic parameters including f0, formant frequencies and bandwidths, and amplitude of voicing were determined for each token in the database. Fine duration differences within minimal pairs are analyzed using dynamic time warping techniques, avoiding the need for manual segmentation. For each parameter, a matrix of distances between all samples of the two words is calculated, together with a minimal path through the matrix (the warp path). The set of warp paths for all parameters identifies the nature and location of acoustic differences between the words, including locations of temporal expansion and compression. Preliminary experiments using dynamic time warping for non segmental synthesis are also discussed.

Diagnostic accuracy of magnetic resonance enterography and small bowel ultrasound for the extent and activity of newly diagnosed and relapsed Crohn's disease (METRIC): a multicentre trial

Summary Background Magnetic resonance enterography (MRE) and ultrasound are used to image Crohns disease, but their comparative accuracy for assessing disease extent and activity is not known with certainty. Therefore, we did a multicentre trial to address this issue. Methods We recruited patients from eight UK hospitals. Eligible patients were 16 years or older, with newly diagnosed Crohns disease or with established disease and suspected relapse. Consecutive patients had MRE and ultrasound in addition to standard investigations. Discrepancy between MRE and ultrasound for the presence of small bowel disease triggered an additional investigation, if not already available. The primary outcome was difference in per-patient sensitivity for small bowel disease extent (correct identification and segmental localisation) against a construct reference standard (panel diagnosis). This trial is registered with the International Standard Randomised Controlled Trial, number ISRCTN03982913, and has been completed. Findings 284 patients completed the trial (133 in the newly diagnosed group, 151 in the relapse group). Based on the reference standard, 233 (82%) patients had small bowel Crohns disease. The sensitivity of MRE for small bowel disease extent (80% [95% CI 72–86]) and presence (97% [91–99]) were significantly greater than that of ultrasound (70% [62–78] for disease extent, 92% [84–96] for disease presence); a 10% (95% CI 1–18; p=0·027) difference for extent, and 5% (1–9; p=0·025) difference for presence. The specificity of MRE for small bowel disease extent (95% [85–98]) was significantly greater than that of ultrasound (81% [64–91]); a difference of 14% (1–27; p=0·039). The specificity for small bowel disease presence was 96% (95% CI 86–99) with MRE and 84% (65–94) with ultrasound (difference 12% [0–25]; p=0·054). There were no serious adverse events. Interpretation Both MRE and ultrasound have high sensitivity for detecting small bowel disease presence and both are valid first-line investigations, and viable alternatives to ileocolonoscopy. However, in a national health service setting, MRE is generally the preferred radiological investigation when available because its sensitivity and specificity exceed ultrasound significantly. Funding National Institute of Health and Research Health Technology Assessment.

An unusual case of dyspnoea in an elderly man

Defective closure of the posterolateral pleuroperitoneal canal during embryogenesis gives rise to a congenital hernia (usually left sided) which was originally described by Bochdalek in 1948. It manifests primarily in children with respiratory symptoms and pulmonary hypoplasia. It is exceptionally rare for this defect to present in adulthood, with just over 50 symptomatic cases being described in the literature. Most adolescent and adult cases are diagnosed incidentally during imaging for upper gastrointestinal symptoms. It is unusual for adults to present with respiratory symptoms. We describe the case of a 71-year-old man who presented with features of left ventricular failure due to an exceptionally large, right sided Bochdalek hernia. This is the oldest clinical presentation of a right sided Bochdalek hernia, which uniquely included trans-diaphragmatic herniation of the pancreas.

Transanal endoscopic microsurgery for rectal cancer

Since its introduction in the 1980s, total mesorectal excision (TME) has been the standard surgical technique for treating rectal cancer. This procedure involves removing the rectum and the surrounding envelope of fat along the plane of the mesorectal fascia. Resecting this embryological unit reduces the local recurrence rate by removing all local lymph nodes, including those with occult metastatic disease; however, this surgery is associated with mortality and morbidity. Complications include incontinence for patients given an anastomosis, long-term stoma formation, and sexual and bladder dysfunction. Local excision of rectal cancer using the transanal endoscopic microsurgery (TEM) technique is associated with fewer complications, and therefore, is used as an alternative in specific circumstances. We outline the technique, its indications, imaging appearances and complications.

Estimation of Parameters for the Klatt Synthesizer from a Speech Database

We present a practical guide to estimating reasonable parameter values for the Klatt synthesizer, focusing on practical success, rather than theoretical finesse. We employ a combination of techniques, including automatic analysis of acoustic properties from a speech database, using commonly available speech analysis tools, as well as ‘tricks of the trade’ learned through the trials of bitter experience.