Maternal triglyceride levels and newborn weight in pregnant women with normal glucose tolerance

OBJECTIVE

To determine the predictive value of serum triglyceride levels (TG) for neonatal weight in pregnant women with positive diabetic screening but normal glucose tolerance.

RESEARCH DESIGN AND METHODS

We enrolled 180 pregnant Caucasian women with positive diabetic screening. All women underwent a 3-h 100-g oral glucose tolerance test (OGTT) at 27th +/- 4 week of gestation. At the time of OGTT, we measured: fasting plasma glucose, fasting lipids profile and determined ApoE polymorphisms to evaluate the effects on lipid levels. In 83 women with normal glucose tolerance and at term delivery we evaluated the association between maternal serum TG, specific maternal parameters known to affect fetal growth and newborn weight.

RESULTS

Based on OGTT, gestational diabetes mellitus (GDM) was diagnosed in 36 women (20%), impaired glucose tolerance (IGT) in 23 (13%), and normal glucose tolerance (NGT) in 121 (67%). Serum TG concentration was significantly higher in women with GDM (2.47 +/- 0.77 mmol/l) as compared with NGT (1.99 +/- 0.64 mmol/l) or IGT (1.98 +/- 0.81 mmol/l) (P < 0.01). ApoE3 allelic frequency was 86%, ApoE2 and ApoE4 were 5 and 9%, respectively. We found no clear-cut association between apoE genotype and serum TG concentration. Macrosomia and LGA newborns were more frequent in IGT than in GDM or NGT (P < 0.01). In the 83 women with positive diabetic screening but normal glucose tolerance who delivered at term, the incidence of LGA infants was significantly higher in those with TG levels higher than the 75th percentile (> 2.30 mmol/l) (21%) than in mothers who had normal TG levels (4.5%) (P < 0.05). Pre-pregnancy BMI (r(2) = 0.067), weight gain during pregnancy (r(2) = 0.062), fasting serum TG (r(2) = 0.09), and 2-h post-OGTT glucose levels (r(2) = 0.044) were all associated with neonatal body weight (all P < 0.05 or less). However, on a multiple regression analysis, only pre-pregnancy BMI (F-test = 7.26, P < 0.01), and fasting serum TG (F-test = 4.07, P < 0.01) were independently associated with birth weight.

CONCLUSIONS

Pre-pregnancy BMI and fasting maternal serum TG determined in the last trimester of gestation were independently associated with neonatal birth weight in women with normal glucose tolerance, but positive screening test. TG levels measured in the third trimester of pregnancy are independent of the genetic polymorphism of ApoE.

Prevalence and risk factors for gestational diabetes assessed by universal screening

In order to evaluate the prevalence of gestational diabetes mellitus (GDM) and the presence of risk factors for GDM, we conducted a retrospective study of a cohort of Italian women. In addition, we compared universal versus selective screening to validate the ADA's recommendations in our population. From June 1st, 1995 to December 31st, 2001, universal screening for GDM was performed in 3950 women. The glucose challenge test (GCT) was positive (GCT+) in 1389 cases (35.2%). The 1-h glucose level after GCT enabled us to diagnose GDM directly in 24 pregnant women. Oral glucose tolerance test (OGTT) was performed in 1221 GCT+ women (144 cases with GCT+ dropped out) and GDM was diagnosed in 284 (23.2%) of them. OGTT was also performed in 391 randomly chosen, women from the GCT negative (GCT-) group. In this last group 25 (6.3%) women had GDM. Thus, the total number of subjects with GDM was 333 out of 3806 with a prevalence of 8.74% in the entire cohort. Assuming that the rate of GDM observed in the random sample of GCT- women is applicable to the whole group of 2561 GCT- women, then 161 GCT- patients could also have GDM. This will further increase the estimated prevalence for the whole cohort up to 12.3% (i.e. 469 out of 3806 pregnant women). There were 236 (5.6%) women with a low risk for GDM (normal weight, age less than 25 years and without a family history of diabetes). In this group we found 34 cases and five cases with positive screening test and GDM, respectively. Thus, if we excluded low risk women from the screening test, as suggested by ADA recommendations, only five women with GDM would have been missed. However, about 95% of our population were at medium or high risk for GDM and, therefore, would have been screened. The rate of GDM was significantly higher in women with a positive history of diabetes, increasing age, previous pregnancies, pre-pregnancy overweight and short stature. After logistic regression analysis, GDM diagnosis was significantly correlated with age (P<0.0001), pre-pregnancy BMI (P<0.0001), weight gain (P<0.0001) and family history of diabetes (P<0.01).

Sputum phagocytes from healthy individuals are functional and activated: a flow cytometric comparison with cells in bronchoalveolar lavage and peripheral blood

Cells in the bronchial airways of healthy individuals are continuously exposed to inhaled particulates in the size range 2-5 microm, which preferentially deposit in the bronchial rather than the alveolar lung. Induced sputum obtains cells primarily from the surfaces of bronchial airways. Using flow cytometry, we investigated whether sputum phagocytes demonstrate phenotypes indicative of increased functional activation and inflammation compared to phagocytes from the alveolar airways and peripheral blood (PB) in healthy subjects (N = 17). Sputum macrophages demonstrated increased levels of CD11b, increased oxidative burst, and greater phagocytosis than autologous alveolar macrophages. Expression of CD11b, CD64, and HLA-DR in sputum monocytes was upregulated compared to that in PB monocytes. Sputum neutrophils showed increased expression of CD11b, CD64, CD14, and HLA-DR and were more phagocytic than PB neutrophils. In conclusion sputum/bronchial phagocytes from healthy individuals express an inflammatory phenotype and are functionally more active than phagocytes from the alveolar airways and peripheral blood.

C-reactive protein and metabolic syndrome in women with previous gestational diabetes

BACKGROUND

This study evaluates the presence of metabolic syndrome (MS) and its association with C-reactive protein (CRP) and other cardiovascular (CV) risk factors, in a sample of women with and without previous Gestational Diabetes (pGDM).

METHODS

One hundred and sixty-six women with pGDM and 98 women (controls) with uncomplicated pregnancy were studied 16 months after delivery. In all women, plasma glucose, insulin, lipid profile, serum uric acid, C-reactive protein, fibrinogen and homocysteine were measured. MS was defined according to NCEP ATPIII criteria.

RESULTS

MS was identified in 15 pGDM women (9%) versus 1 control (1%) (p < 0.001). The more frequent metabolic traits were abdominal obesity (36% vs 17%) and low HDL-cholesterol (34% vs 17% in pGDM women and controls, respectively; all p < 0.01). HOMA-R, LDL-cholesterol, fibrinogen, serum uric acid and CRP resulted significantly higher in pGDM women with MS as compared to those without MS after adjustment for BMI. In women with no criteria for MS, only CRP levels were found to be higher in pGDM women compared to controls (p < 0.05). Seventeen percent of pGDM women with no criteria for MS had CRP levels >or=1 mg/L (all controls showed CRP levels <1 mg/L). After a stepwise regression analysis, CRP levels were independently correlated to HOMA-R (r2 = 0.27, p < 0.001) and fibrinogen (r2 = 0.30, p < 0.001).

CONCLUSIONS

In our population, MS occurs in a sizable proportion of pGDM women and is associated with increased levels of CRP, fibrinogen, uric acid and LDL-cholesterol. Moreover, higher levels of CRP, a marker of chronic low-grade inflammation, are present in a subset of women with pGDM, independently of MS.

[Dysarthria across Parkinson's disease progression. Natural history of its components: dysphonia, dysprosody and dysarthria]

Dysarthria refers to a collective name for a group of neurologic motor speech disorders, resulting from central and/or peripheral nervous system abnormalities. Speech alteration in Parkinson's disease, so-called hypokinetic dysarthria, presents with prosodic insufficiency, related to a monotony of pitch and intensity, a reduction of accentuation, variable speech rate and possible phoneme imprecision. In most cases, voice is harsh and breathy. This symptom can affect both voice and speech quality, as well as prosody and intelligibility. As a consequence, many patients complain about speech impairments, which affect their communication in daily living activities. Perceptual and instrumental assessments require different and numerous investigation methods, which use may help to further understand the specific dysarthria pathophysiology. This is of importance in order to adjust treatments for dysarthria; as a matter of fact, dopa-therapy, functional neurosurgery or even behavioural speech therapy have variable effects on voice and speech quality in Parkinson's disease.

Proinflammatory cytokines increase in sepsis after anti-adhesion molecule therapy

Cytokine mediators and leukocyte-endothelial cell adhesion molecules are critical and interdependent components of the acute inflammatory response in sepsis. We hypothesized that the administration of monoclonal antibodies to intercellular adhesion molecule-1 (CD54) or E- and L-selectin (CD62E/L) would decrease serum levels of the proinflammatory cytokines interleukin-1beta (IL-1), IL-6, and IL-8 and tumor necrosis factor receptor (TNFR-1) in baboons during sepsis. Adult male baboons received infusions of 1 x 10(9) colony forming units (CFU)/kg heat-killed Escherichia coli (E. coli) followed 12 h later by live E. coli (1 x 10(10) CFU/kg). At the time of live bacterial infusion, six septic animals were treated with a monoclonal antibody to CD54 and six with an antibody to CD62E and L (1 mg/kg). Eight untreated septic animals served as controls. Sequentially drawn serum samples were assayed for IL-1, IL-6, IL-8, and TNFR-1 using enzyme-linked immunoassay (ELISA). Data were compared using Mann-Whitney U tests and Chi-square analyses. Median survival was decreased in both treatment groups compared to controls (P < 0.05). Peak IL-1 level was higher than controls in septic animals treated with anti-CD54 but not anti-CD62E/L (P < 0.05, P = NS, respectively). Elevations in IL-6, IL-8, and TNFR-1 were increased and prolonged in both antibody treated groups compared to controls (P < 0.05). These results provide the first in vivo evidence that leukocyte-endothelial adhesion molecules CD54 and CD62E/L regulate cytokine production in sepsis.

French adaptation of the "Frenchay Dysarthria Assessment 2" speech intelligibility test

OBJECTIVES

Speech intelligibility can be defined as "the degree to which a speaker's intended message is recovered by a listener". Loss of intelligibility is one of the most frequent complaints in patients suffering from speech disorder, impairing communication. Measurement of intelligibility is therefore an important parameter in follow-up. We developed a French version of the "Frenchay Dysarthria Assessment, 2nd edition" (FDA-2), an intelligibility test recognized internationally in its English version. The present study details the construction of the test and its preliminary validation.

MATERIALS AND METHODS

We first compiled a set of words and phrases in French, based on the criteria defined in FDA-2. In a second step, we validated the test in healthy subjects in normal and noisy conditions, to check sensitivity to speech signal degradation.

RESULTS

The test proved valid and sensitive, as scores were significantly lower for noise-degraded stimuli.

CONCLUSION

This French-language intelligibility test can be used to evaluate speech disorder: for example, in dysarthria, head and neck cancer or after cochlear implantation.

Glucagon-like peptide-1 secretion in women with gestational diabetes mellitus during and after pregnancy

Gestational diabetes mellitus (GDM) predisposes women to future development of Type 2 diabetes mellitus (DM2) and the two conditions share similar metabolic alterations. Recent observations suggest that a defective glucose stimulated insulin secretion by glucagon-like peptide-1 (GLP- 1) plays a role in the pathogenesis of DM2. Whether such a defect is impaired in GDM remains to be ascertained.

AIM

We have determined GLP-1 secretion in response to oral glucose tolerance test (OGTT) in GDM and normal glucose tolerance (NGT) during and after pregnancy.

MATERIALS AND METHODS

100-g-3h OGTT was performed in 12 GDM and 16 NGT women at 27.3 ± 4.1 weeks of gestation, for determination of plasma GLP-1, glucose, insulin, and C-peptide. Insulin sensitivity (ISI) and insulin secretion (first and second phase); as well as ISI-secretion index (ISSI) were also derived.

RESULTS

NGT and GDM women were comparable for age pre-pregnancy body mass index (BMI) and weight gain. GDM had higher glucose area under the curve (AUC): 27,575.5 ± 3448 vs 20,685.88 ± 2715 mg/dl min (p<0.01), but lower first-phase insulin secretion (993.12±367 vs 1376.61 ± 423, p<0.05) and ISSI compared to controls (3873.23 ± 1185 vs 6232.13 ± 1734, p<0.001). When we examined GLP-1 mean levels in relation to mean glycemic values, GLP-1 secretion was inappropriately low with respect to mean glycemic values in GDM compared to NGT. At follow-up, AUCGLP-1 was significantly lower in post-partum GDM compared to post-partum NGT women (2542 ± 273 vs 10,092 ± 7367 pmol·l-1·min-1, p<0.05, respectively).

CONCLUSIONS

Our study suggests that GLP-1 secretion in GDM women is inadequate for the prevailing glycemic levels both in pregnancy and post partum. Moreover, we cannot exclude that other important aspects of the incretin effect may be involved in GDM development.

[Postural study on healthy subjects during experimental vocal effort]

INTRODUCTION

The objective of the study was to assess how posture and vocal acoustics are modified when one needs to communicate despite environmental obstacles (i.e. vocal effort performance).

METHOD

20 healthy young women participated to this study. They had to communicate numbers to a listener. Environmental obstacles were the distance between the subject and the auditor, and the noise. Segmental posture modifications were recorded and analyzed using the numerical infra-red system for movement analysis SMART. Vocal acoustics and electroglottography were also recorded and analyzed using the EVA system.

RESULTS

The study showed the presence of objective postural modifications during vocal effort. Their amplitude increased when the environmental obstacles to communications increased, and they anticipated the vocal production.

DISCUSSION

The vocal effort concept and its relation with the posture, the voice and the subject's feeling are reviewed on the basis of these results. Laryngeal effort is not isolated, but belongs to a global behavioral strategy which aims to improving the efficiency of the communication.

Influence of phonetic context on the dysphonic event: contribution of new methodologies for the analysis of pathological voice

Widely studied in terms of perception, acoustics or aerodynamics, dysphonia stays nevertheless a speech phenomenon, closely related to the phonetic composition of the message conveyed by the voice. In this paper, we present a series of three works with the aim to understand the implications of the phonetic manifestation of dysphonia. Our first study proposes a new approach to the perceptual analysis of dysphonia (the phonetic labeling), which principle is to listen and evaluate each phoneme in a sentence separately. This study confirms the hypothesis of Laver that the dysphonia is not a constant noise added to the speech signal, but a discontinuous phenomenon, occurring on certain phonemes, based on the phonetic context. However, the burden of executing the task has led us to look to the techniques of automatic speaker recognition (ASR) to automate the procedure. With the collaboration of the LIA, we have developed a system for automatic classification of dysphonia from the techniques of ASR. This is the subject of our second study. The first results obtained with this system suggest that the unvoiced consonants show predominant performance in the task of automatic classification of dysphonia. This result is surprising since it is often assumed that dysphonia occurs only on laryngeal vibration. We started looking for explanations of this phenomenon and we present our assumptions and experiences in the third work we present.

[Preliminary experimental studies of whispered voice: subglottal pressure and postural aspects]

OBJECTIVES

Whispered voice is investigated from the energetic point of view. Our hypothese is that whispered voice, and mainly the forced whispers are very similar to vocal effort, for non acoustic vocal parameters, and body movements.

DESIGN

Two experiments are combined. The first experiment focused on the laryngeal aspects, mainly the subglottal pressure, and also the electroglottography. The second experiment analyzed the body movements associated with loud whispered voice.

RESULTS

No electroglottograhic wave was observed during the two experiments. The vocal intensity was always lower during whispered voice than during comfortable voice (p < 0.001). In experiment 1, subglottal pressure was significantly higher during forced whisper than during the other conditions (p < 0.001). In experiment 2, the amplitude of the trunk movements in the sagittal plane were greater during loud whisper than during comfortable voice (p < 0.001).

CONCLUSION

Whispered voice can be close to vocal loading, especially the loud whispered voice.

[The role of laryngeal kinesthetic feedback in the control of pitch in speech production]

OBJECTIVES

Pitch change during voice production is under the control of auditive and kinesthetic feedback phenomenona. The aim of the study was to determine the role of larynx kinesthetic feedback in speech production control.

MATERIALS AND METHODS

To validate our laryngeal model, five porcine larynges were excised and placed on a test bench consisting of a blower and a laser photoglottometer for measurement of vocal cord vibration. We applied vibratory stimuli to the cricothyroid muscles to determine whether vibrators supplied by a generator alter the biomechanics of the larynx. Fundamental frequency (F0) was recorded under three conditions--larynx on vibration--larynx on vibration with vibrators activation--larynx on rest and vibrators activation. Once validated, 7 male and 7 female, mean age 29 years, were enrolled. Vibrators were positioned on cricothyroid muscles, cricoid and thyroid cartilages. Masking noise was used. Fundamental frequency, intensity and speech time production was measured during speech production under three conditions--normal speech, vibrators activation, and masking activation.

RESULTS

The preliminary study demonstrated that larynx on vibration with vibrators activation doesn't alter the vocal fold F0. For the human trial, between normal speech and vibrators activation conditions, we found a significant difference (p= 0.045 for male, p= 0.010 for female) in intonation, and no significant difference for intensity and speech time. Between normal speech and masking activation conditions, no significant differences were measured for any condition.

CONCLUSION

Use of the vibrators is a reliable method to allow the evaluation of larynx kinesthetic feedback in speech production control.

[Importance of tussometry in unilateral laryngeal paralysis]

Cough is a physiological gesture witch requires a perfect laryngeal competence. Tussometry was described as a reliable and reproducible method of analysis based on the measure of oral air flow rate during cough. This test allows to quantify the efficiency of laryngeal occlusion in normal situation and in case of unilateral laryngeal paralysis. The measure of the time lag between the beginning of the cough and the maximal air flow rate (peak value time) is the most reliable parameter (8). Present study is designed to asses the reproducibility of tussometry realized on a vocal analysis workstation EVA II and to test the efficiency of intracordal injection of autologus fat in case of unilateral laryngeal paralysis following thoracotomy. 10 control subjects were recorded at two moments. 6 patients presenting unilateral laryngeal paralysis following thoracic surgery were recorded before and after injection of autologus fat in the paralysed vocal cord. Reproducibility of tussometry is good (r = 0.96). The mean peak value time is significantly improved (p = 0.048). In conclusion, tussometry is a reliable routine test on EVA III workstation. Intracordal autologus fat injection improves occlusive function of larynx during cough in case of unilateral paralysis.

[Social consequence of a dysphonic voice, design and validation of a questionnaire and first results]

In our society, based on communication, dysphonia becomes a handicap that could be responsible of work discrimination. Actually, several commercial services are provided by phone only, and voice quality is mandatory for the employees. This work aim was to determine the social picture relayed by dysphonia. Our hypothesis was that dysphonia sounds pejorative compared to normal voice. 40 voice samples (30 dysphonic and 10 normal) were presented randomly to a perceptual jury of 20 naïve listener. The task was for each of them to fill a questionnaire, designed specifically to describe the speaker's look and personality. 20 items were evaluated, divided into 4 categories: health, temperament, appearance, and way of life. The results showed significant differences between normal subjects and dysphonic patients. For instance, the pathological voices were depicted as more tired, introverted, sloppy than normal voices, and less trustable. No significant differences were found according to the severity of voice disorders. This work is presently continued. It allowed to validate our questionnaire and has offers great perspectives on patient's management and voice therapy.

[Context influence on the perception of dysphonia: when the knowledge of the patient's clinical state can modify the results of perceptual voice quality assessment]

Two experiments were conducted to examine how knowledge of the patient's clinical state affects the results of perceptual voice quality assessment performed by specialists in voice therapy. This study involved 53 patients with a dysphonia. For each speaker, we selected a pair of recordings made in different circumstances. These pairs of voices were presented to seven listeners (ENT surgeons or speech therapists). The task was to perceptually compare the severity of the dysphonia between the 2 recordings of the pair. Stimuli were presented first in a blind test, then several weeks later with accompanying information about the patient; in particular, whether the voice was pre- or post- treatment was explicitly specified. We balanced this artificial contextual information in order to (alpha) reinforce the blind judgment (for example, voices perceived as better in the blind test were indicated as post treatment); (beta) be inconsistent (in a clinical point of view) compared to the blind test (for example, voices perceived as more disordered during the blind test were indicated as post treatment). Results revealed that in the clinical-consistent context alpha, the preference was amplified in a significant way. In clinical-inconsistent condition beta, we observed an inhibition effect or a change of decision. In this condition, the judgment was more dependant on the contextual information (pre/post treatment) than on the auditory sensation obtained in blind condition. These findings are discussed with reference to results in the literature on visual, olfactory or auditory perception in context. In the frame of perceptual voice assessment, results revealed that only blind tests can provide reliable results.

[From intelligibility to comprehension, which measurement in practice?]

The modelling of the tests assessing speech disorders in touch with the international classification of the functioning implies a reflection on measurement tools. The access to the sense of the message from decoding of the signal to the action infers at the interlocutor's justifies various methods. The objective of this work is to demonstrate the limit of the usual tests of intelligibility.

MATERIAL AND METHOD

A population of 10 subjects presenting a speech disorder secondary to a Head and Neck cancer and 2 subjects controls recorded a corpus of 80 syllables developed with the most frequent 16 French consonants and 5 vowels. The test of intelligibility consisted of a task of identification of consonants by a jury of 11 listeners.

RESULTS

About is the method used to estimate the informative value of the consonants tested, the uvular consonant /r/ and the nasal In/, /m/ are very well perceived. The weighting by the rate of confusion makes tipped over the position of labiodentales If/, /v/ and that of / p/. The just perception of the sound/p/ would be underestimated while sounds /v/ and /f/ would be overestimated. Sounds /g/, /k/, /j/ remain the least well received. This observation results probably from the profile of distortions produced by the selection of the population and probably from the frequency of the syllables containing these consonants in the french language for the sample of the corpus.

CONCLUSION

The rate of confusion appears as a fundamental element, inciting to look for more relevant methods of analysis of the results of the tests of intelligibility.

[Perceptual assessment of dysphonia: a training protocol with natural speech]

INTRODUCTION

In this study, we proposed and tested the effectiveness of a training procedure on perceptual evaluation of dysphonia. Participants were naive listeners who learned to judge the severity of vocal disorders.

MATERIALS AND METHODS

The corpus consisted of 142 female voices ranging from normal to severely dysphonic voices. A total of 38 naive listeners were tested, and the experiment was divided in 3 phases: (1) A pretest to assess the level of our listeners in the categorization of dysphonia, (2) the training phase and (3) a post-test to assess the improvement associated with the training. To examine the persistence of the training, the post-test was administrated twice: Immediately after the training session and one week later.

RESULTS

Improvement in the performance between the pretest and the post-test was found for moderate and severe dysphonia. No improvement was observed in the categorization of slightly dysphonic voices, which seem the more resistant to learning. Normal voices also showed no improvement, which is likely due to the high performance on these voices during the pre-test. The improvement observed in the categorization of moderate and severe dysphonia was still present even one week after the training.

DISCUSSION

The protocol tested in this study appears to be effective and could constitute an element of training courses for speech and voice therapists. The perception of the intermediate levels of dysphonia, however, remains difficult to quantify and needs to be improved.

[Prosody and reading: Temporal and melodic characteristics in the dyslexic child in reading and narration]

Dyslexia is widely associated to a massive phonological awareness deficit. This deficit leads to difficulties in grapheme to phoneme conversions in reading and difficulties in words and sentences productions. The origin of the phonological deficit is partially explained by the magnocellular, cerebellar and articulatory theories. Recently, an increasing number of studies demonstrated the relationship between prosody and reading and, more specifically, the potential key role of suprasegmental phonology in the healthy development of phonological representations. The aim of this study is to explore part of prosodic features in dyslexics and normal developing children in reading and narration tasks, in French. We examined reading accuracy, reading rate, pauses frequency and duration, inter-pausal units (IPUs) duration and instantaneous variations of F0. Results show correct decoding skills for all subjects but a lack of automation of this procedure for dyslexics. Differences in pauses frequency and duration, IPUS duration and F0 variations observed between dyslexics and controls confirm the link between prosodic reading and automaticity. The longer pause duration in narrative form a temporal feature of dyslexic's production. This temporal characteristic reflects the cognitive cost done by a speech generation task involving lexical selection, syntactic planning and articulatory programming processes. This result is a first step towards evidence of a suprasegmental phonological deficit in spoken language that could be an early marker of later reading difficulties.

[Use of instrumental vocal analysis in phoniatrics]

The growing need for quantitative evaluation of health care intervention along with the pitfalls of perceptual analysis is leading clinicans to utilise different instrumental vocal analysis methods including acoustic and aerodynamic methods. The fact that perceptual analysis is most often presented as the gold standard for vocal evaluation remains paradoxical. The authors present the use of aerodynamic measurements in particular oral airflow and subglottic pressure.

[Prosodic features of computer-assisted presentations: a preliminary study]

INTRODUCTION

Computer-assisted presentations (CAP) seem to be characterized by changes of rhythm and melody of speech, compared to spontaneous speech, in many cases with periods with rapid and excessively regular breaks interspersed with long pauses.

METHODS

We analyzed the prosody and especially the pace in the temporal organization of prominences (distribution of stress, articulatory speed, pause duration) in 37 inexperienced subjects in a CAP corresponding to an actual review of graduation. The results were compared with a presentation without support (PWS) conducted immediately after the first. A jury had to propose a gradation of prosody (typical CAP, intermediate, non-typical). Accentual distribution was analyzed from a perceptual experiment. The articulatory speed and length of breaks were analyzed from the speech signal.

RESULTS

We found the main elements of prosodic style assumed in three-quarters of subjects. This style was characterized by a faster articulatory rate and a more regular and rhythmic breaks due to excessive elongation of silent pauses when changing view of the slide.

DISCUSSION

The assumption seems validated because the majority of subjects in our study are of particular prosodic rhythm (faster and more regular). Subjects with archetypal prosody of CAP appear to be those whose speech followed closely their slide presentation, which disrupted their communication.

[F0 characteristics in Parkinsonian speech: Contrast between the effect of hypodopaminergy due to Parkinson's disease and that of the therapeutic delivery of L-Dopa]

Voice and speech impairments are frequent in Parkinson's disease, particularly when the disease is at an advanced stage. These impairments affect spoken communication and may become a serious disability for someone with Parkinson's disease. Many studies based on auditory-perceptual or acoustic methods have been carried out to characterize dysarthria. The heterogeneity of evaluation methods and experimental bias however make results difficult to understand. For instance, in terms of phonatory impairments and with regard to F0, results are contradictory: PD speech may be characterized by either higher F0 or lower F0 compared to control subjects, or there may be no difference at all between the two population. In this study, we aim to provide a conceptual and methodological framework which allows for interpreting the results obtained from 44 speakers (29 PD and 15 control subjects) in relation to physiological (gender, age, PD subjects' pharmacologic state) and linguistic (speech production tasks) constraints. For the present corpus, we did not observe any F0 mean difference between the two groups. Our results however reveal a significant increase in F0 mean in PD subjects under L-dopa. We assume a double and opposite effect on F0 mean during drug withdrawal: low sub-glottal pressure, due to PD, results in a decrease in F0, while laryngeal rigidity leads to an increase in F0. These two effects thus mutually annihilate. Under L-Dopa, however, the drug effect increases sub-glottal pressure, which combined with an increase in F0 due to rigidity, leads to a global increase in F0.