Thrombolytic therapy and prophylactic anticoagulation in pregnant patients.
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Adult↗
Biomedical subjects
A Cutler
Publications and source records attributed to A Cutler.
Optimal treatment for duodenal ulcer disease: a cost-decision analysis in Malaysian patients.
The aim of the present study was to determine the cost-efficiency of different duodenal ulcer disease treatment practices in Malaysia. Six Malaysian gastroenterologists met to discuss the direct costs related to Helicobacter pylori (HP) eradication treatment. Five treatment strategies were compared: (i) histamine H2 receptor antagonists (H2RA), acid suppression therapy for 6 weeks followed by maintenance therapy as needed; (ii) bismuth triple + proton pump inhibitor (PPI), bismuth (120 mg, q.i.d.), metronidazole (400 mg; t.i.d.), tetracycline (500 mg, q.i.d.) for 7 days and PPI, b.i.d., for 7 days; (iii) OAC, omeprazole (20 mg, b.i.d.), amoxycillin (1000 mg, b.i.d.) and clarithromycin (500 mg, b.i.d.) for 7 days; (iv) OMC, omeprazole (20mg, b.i.d.), metronidazole (400mg, b.i.d.) and clarithromycin (500 mg, b.i.d.) for 7 days; and (v) OAM, omeprazole (20 mg, b.i.d.), amoxycillin (1000 mg, b.i.d.) and metronidazole (400 mg, b.i.d.) for 7 days. A decision tree model was created to determine which therapy would be the most cost-effective. The model considered eradication rates, resistance to anti-microbial agents, compliance and cost implications of treatment regimens, physician visits and ulcer recurrences during a 1 year time period assumption. The H2RA maintenance therapy was the most expensive treatment at Malaysian Ringgit (MR) 2335, followed by bismuth triple therapy (MR 1839), OMC (MR 1786), OAM (MR 1775) and OAC, being the most cost-effective therapy, at MR 1679. In conclusion, HP eradication therapy is superior to H2RA maintenance therapy in the treatment of duodenal ulcer disease. Of the HP eradication regimens, OAC is the most cost-effective.
Amoxicillin↗
Ten-day triple therapy with ranitidine bismuth citrate, amoxicillin, and clarithromycin in eradicating Helicobacter pylori.
OBJECTIVE: Fourteen-day therapy with ranitidine bismuth citrate, amoxicillin, and clarithromycin has been shown to have a high Helicobacter pylori eradication rate (> 90%) in U.S. trials. The aim of this study was to determine the H. pylori eradication rate of a ranitidine bismuth citrate-based triple regimen of shorter duration (10 days), which has been shown to be effective in Europe. METHODS: Dyspeptic patients who had a positive baseline 13C-urea breath test and either a positive antral rapid urease test or positive IgG serology were studied. Treatment consisted of ranitidine bismuth citrate 400 mg, clarithromycin 500 mg, and amoxicillin 1 g, all given b.i.d. for 10 days. Eradication was determined >4 wk after completion of therapy by the 13C-urea breath test (enrichment <2.4%). Results are expressed for intent-to-treat (all patients randomized even if they did not take the drug) and per-protocol (major protocol violators excluded) analyses. RESULTS: Seventy-seven patients with a mean age of 48 +/- 1.8 yr were studied. Forty-eight patients had eradication of H. pylori with this regimen (62%), 16 patients (21%) did not have eradication, and 13 patients (17%) did not return for breath testing. By intent-to-treat analysis the eradication rate was 62% (95% confidence intervals [CI], 51%, 73%) and by per-protocol analysis the eradication rate was 75% (95% CI, 63%, 85%). CONCLUSIONS: Ten-day, twice-daily therapy with ranitidine bismuth citrate, amoxicillin, and clarithromycin has an eradication rate that ranges from 62-75%. Fourteen-day therapy may be preferable because of higher eradication rates.
Amoxicillin↗
Pitch accent in spoken-word recognition in Japanese.
Three experiments addressed the question of whether pitch-accent information may be exploited in the process of recognizing spoken words in Tokyo Japanese. In a two-choice classification task, listeners judged from which of two words, differing in accentual structure, isolated syllables had been extracted (e.g., ka from baka HL or gaka LH); most judgments were correct, and listeners' decisions were correlated with the fundamental frequency characteristics of the syllables. In a gating experiment, listeners heard initial fragments of words and guessed what the words were; their guesses overwhelmingly had the same initial accent structure as the gated word even when only the beginning CV of the stimulus (e.g., na- from nagasa HLL or nagashi LHH) was presented. In addition, listeners were more confident in guesses with the same initial accent structure as the stimulus than in guesses with different accent. In a lexical decision experiment, responses to spoken words (e.g., ame HL) were speeded by previous presentation of the same word (e.g., ame HL) but not by previous presentation of a word differing only in accent (e.g., ame LH). Together these findings provide strong evidence that accentual information constrains the activation and selection of candidates for spoken-word recognition.
Humans↗
Use caution with serologic testing for Helicobacter pylori infection in children.
Commercial serologic assays accurately detect adult Helicobacter pylori infection. Their use in children remains controversial. An ELISA to detect H. pylori IgG in children was developed and compared with three commercial assays. ELISA standardization was done with sera from all ages and validation was done with another cohort of sera with known H. pylori status. Three commercial serologic assays were subsequently compared against this pediatric ELISA at independent sites, at which 142 pediatric serum samples from different countries were evaluated. The pediatric ELISA was 91.4% sensitive. Assay 3 demonstrated a sensitivity of 78%. Less sensitivity was observed for assay 1 (70%) and assay 2 (63%). Accuracy of commercial assays was greatly reduced when sera from developing countries and younger ages were evaluated. Results of serologic tests used to diagnose H. pylori should be interpreted with caution when evaluating children with abdominal pain. Accurate serologic assays in children may be more important for epidemiologic research than for clinical decision making.
Adolescent↗
Effects of phoneme repertoire on phoneme decision.
In three experiments, listeners detected vowel or consonant targets in lists of CV syllables constructed from five vowels and five consonants. Responses were faster in a predictable context (e.g., listening for a vowel target in a list of syllables all beginning with the same consonant) than in an unpredictable context (e.g., listening for a vowel target in a list of syllables beginning with different consonants). In Experiment 1, the listeners' native language was Dutch, in which vowel and consonant repertoires are similar in size. The difference between predictable and unpredictable contexts was comparable for vowel and consonant targets. In Experiments 2 and 3, the listeners' native language was Spanish, which has four times as many consonants as vowels; here effects of an unpredictable consonant context on vowel detection were significantly greater than effects of an unpredictable vowel context on consonant detection. This finding suggests that listeners' processing of phonemes takes into account the constitution of their language's phonemic repertoire and the implications that this has for contextual variability.
Humans↗
The possible-word constraint in the segmentation of continuous speech.
We propose that word recognition in continuous speech is subject to constraints on what may constitute a viable word of the language. This Possible-Word Constraint (PWC) reduces activation of candidate words if their recognition would imply word status for adjacent input which could not be a word--for instance, a single consonant. In two word-spotting experiments, listeners found it much harder to detect apple, for example, in fapple (where [f] alone would be an impossible word), than in vuffapple (where vuff could be a word of English). We demonstrate that the PWC can readily be implemented in a competition-based model of continuous speech recognition, as a constraint on the process of competition between candidate words; where a stretch of speech between a candidate word and a (known or likely) word boundary is not a possible word, activation of the candidate word is reduced. This implementation accurately simulates both the present results and data from a range of earlier studies of speech segmentation.
Analysis of Variance↗
Lexical tone in Cantonese spoken-word processing.
In three experiments, the processing of lexical tone in Cantonese was examined. Cantonese listeners more often accepted a nonword as a word when the only difference between the nonword and the word was in tone, especially when the F0 onset difference between correct and erroneous tone was small. Same-different judgments by these listeners were also slower and less accurate when the only difference between two syllables was in tone, and this was true whether the F0 onset difference between the two tones was large or small. Listeners with no knowledge of Cantonese produced essentially the same same-different judgment pattern as that produced by the native listeners, suggesting that the results display the effects of simple perceptual processing rather than of linguistic knowledge. It is argued that the processing of lexical tone distinctions may be slowed, relative to the processing of segmental distinctions, and that, in speeded-response tasks, tone is thus more likely to be misprocessed than is segmental structure.
Adult↗
Interaction with autonomy: multiple output models and the inadequacy of the Great Divide.
There are currently a number of psycholinguistic models in which processing at a particular level of representation is characterized by the generation of multiple outputs, with resolution--but not generation--involving the use of information from higher levels of processing. Surprisingly, models with this architecture have been characterized as autonomous within the domain of word recognition but as interactive within the domain of sentence processing. We suggest that the apparent confusion is not, as might be assumed, due to fundamental differences between lexical and syntactic processing. Rather, we believe that the labels in each domain were chosen in order to obtain maximal contrast between a new model and the model or models that were currently dominating the field. The contradiction serves to highlight the inadequacy of a simple autonomy/interaction dichotomy for characterizing the architectures of current processing models.
Humans↗
The representation of Japanese moraic nasals.
Nasal consonants in syllabic coda position in Japanese assimilate to the place of articulation of a following consonant. The resulting forms may be perceived as different realizations of a single underlying unit, and indeed the kana orthographies represent them with a single character. In the present study, Japanese listeners' response time to detect nasal consonants was measured. Nasals in coda position, i.e., moraic nasals, were detected faster and more accurately than nonmoraic nasals, as reported in previous studies. The place of articulation with which moraic nasals were realized affected neither response time nor accuracy. Non-native subjects who knew no Japanese, given the same materials with the same instructions, simply failed to respond to moraic nasals which were realized bilabially. When the nasals were cross-spliced across place of articulation contexts the Japanese listeners still showed no significant place of articulation effects, although responses were faster and more accurate to unspliced than to cross-spliced nasals. When asked to detect the phoneme following the (cross-spliced) moraic nasal, Japanese listeners showed effects of mismatch between nasal and context, but non-native listeners did not. Together, these results suggest that Japanese listeners are capable of very rapid abstraction from phonetic realization to a unitary representation of moraic nasals; but they can also use the phonetic realization of a moraic nasal effectively to obtain anticipatory information about following phonemes.
Humans↗
Speeded detection of vowels: a cross-linguistic study.
In four experiments, listeners' response times to detect vowel targets in spoken input were measured. The first three experiments were conducted in English. In two, one using real words and the other, nonwords, detection accuracy was low, targets in initial syllables were detected more slowly than targets in final syllables, and both response time and missed-response rate were inversely correlated with vowel duration. In a third experiment, the speech context for some subjects included all English vowels, while for others, only five relatively distinct vowels occurred. This manipulation had essentially no effect, and the same response pattern was again observed. A fourth experiment, conducted in Spanish, replicated the results in the first three experiments, except that miss rate was here unrelated to vowel duration. We propose that listeners' responses to vowel targets in naturally spoken input are effectively cautious, reflecting realistic appreciation of vowel variability in natural context.
Adult↗
Competition and segmentation in spoken-word recognition.
Spoken utterances contain few reliable cues to word boundaries, but listeners nonetheless experience little difficulty identifying words in continuous speech. The authors present data and simulations that suggest that this ability is best accounted for by a model of spoken-word recognition combining competition between alternative lexical candidates, and sensitivity to prosodic structure. In a word-spotting experiment, stress pattern effects emerged most clearly when there were many competing lexical candidates for part of the input. Thus, competition between simultaneously active word candidates can modulate the size of prosodic effects, which suggests that spoken-word recognition must be sensitive both to prosodic structure and to the effects of competition. A version of the Shortlist model (D. G. Norris, 1994b) incorporating the Metrical Segmentation Strategy (A. Cutler & D. Norris, 1988) accurately simulates the results using a lexicon of more than 25,000 words.
Adolescent↗
The strong/weak syllable distinction in English.
Strong and weak syllables in English can be distinguished on the basis of vowel quality, of stress, or of both factors. Critical for deciding between these factors are syllables containing unstressed unreduced vowels, such as the first syllable of automata. In this study 12 speakers produced sentences containing matched sets of words with initial vowels ranging from stressed to reduced, at normal and at fast speech rates. Measurements of the duration, intensity, F0, and spectral characteristics of the word-initial vowels showed that unstressed unreduced vowels differed significantly from both stressed and reduced vowels. This result held true across speaker sex and dialect. The vowels produced by one speaker were then cross-spliced across the words within each set, and the resulting words' acceptability was rated by listeners. In general, cross-spliced words were only rated significantly less acceptable than unspliced words when reduced vowels interchanged with any other vowel. Correlations between rated acceptability and acoustic characteristics of the cross-spliced words demonstrated that listeners were attending to duration, intensity, and spectral characteristics. Together these results suggest that unstressed unreduced vowels in English pattern differently from both stressed and reduced vowels, so that no acoustic support for a binary categorical distinction exists; nevertheless, listeners make such a distinction, grouping unstressed unreduced vowels by preference with stressed vowels.
Humans↗
Role of Helicobacter pylori serology in evaluating treatment success.
Duodenal ulcer recurrence and gastritis are reduced with successful Helicobacter pylori treatment. Serology is accurate in the diagnosis of H. pylori, but its value in determining eradication is unproved. To evaluate the usefulness of serology in monitoring treatment, we measured serial serum antibodies in three patient groups: eradication success (N = 57), eradication failure (N = 19), and untreated patients (N = 24). Eradication was determined by Warthin Starry staining of antral biopsies and repeat 13C breath tests at six weeks. Subsequent 13C breath tests were then performed at three-month intervals to monitor eradication. IgG antibody concentrations to H. pylori were determined by a commercially available ELISA kit. Serology concentrations remained constant throughout the study period in the untreated patients. IgG concentrations decreased slightly in the treatment failure group at six weeks but thereafter remained at baseline values. In the eradicated group, serum IgG concentrations decreased 26% by three months, 43% by six months and 55% at nine and 12 months (P < 0.001). A 20% reduction in IgG concentrations by six months was associated with successful treatment (sensitivity 86% and specificity 88%). We conclude that serology is a potentially useful way to monitor H. pylori treatment success.
Adult↗
Infants' preference for the predominant stress patterns of English words.
One critical aspect of language acquisition is the development of a lexicon that associates sounds and meanings; but developing a lexicon first requires that the infant segment utterances into individual words. How might the infant begin this process? The present study was designed to examine the potential role that sensitivity to predominant stress patterns of words might play in lexical development. In English, by far the majority of words have stressed (strong) initial syllables. Experiment 1 of our study demonstrated that by 9 months of age American infants listen significantly longer to words with strong/weak stress patterns than to words with weak/strong stress patterns. However, Experiment 2 showed that no significant preferences for the predominant stress pattern appear with 6-month-old infants, which suggests that the preference develops as a result of increasing familiarity with the prosodic features of the native language. In a third experiment, 9-month-olds showed a preference for strong/weak patterns even when the speech input was low-pass filtered, which suggests that their preference is specifically for the prosodic structure of the words. Together the results suggest that attention to predominant stress patterns in the native language may form an important part of the infant's process of developing a lexicon.
Female↗
The monolingual nature of speech segmentation by bilinguals.
Monolingual French speakers employ a syllable-based procedure in speech segmentation; monolingual English speakers use a stress-based segmentation procedure and do not use the syllable-based procedure. In the present study French-English bilinguals participated in segmentation experiments with English and French materials. Their results as a group did not simply mimic the performance of English monolinguals with English language materials and of French monolinguals with French language materials. Instead, the bilinguals formed two groups, defined by forced choice of a dominant language. Only the French-dominant groups showed syllabic segmentation and only with French language materials. The English-dominant group showed no syllabic segmentation in either language. However, the English-dominant group showed stress-based segmentation with English language materials; the French-dominant group did not. We argue that rhythmically based segmentation procedures are mutually exclusive, as a consequence of which speech segmentation by bilinguals is, in one respect at least, functionally monolingual.
Adult↗
Limits on bilingualism.
Speech, in any language, is continuous; speakers provide few reliable cues to the boundaries of words, phrases, or ther meaningful units. To understand speech, listeners must divide the continuous speech stream into portions that correspond to such units. This segmentation process is so basic to human language comprehension that psycholinguists long assumed that all speakers would do it in the same way. In previous research, however, we reported that segmentation routines can be language-specific: speakers of English do not. French has relatively clear syllable boundaries and syllable-based timing patterns, whereas English has relatively unclear syllable boundaries and stress-based timing; thus syllabic segmentation would work more efficiently in the comprehension of French than in the comprehension of English. Our present study suggests that at this level of language processing, there are limits to bilingualism: a bilingual speaker has one and only one basic language.
England↗
The perception of rhythm and word boundaries in noise-masked speech.
The present experiment tested the suggestion that human listeners may exploit durational information in speech to parse continuous utterances into words. Listeners were presented with six-syllable unpredictable utterances under noise-masking, and were required to judge between alternative word strings as to which best matched the rhythm of the masked utterances. For each utterance there were four alternative strings: (a) an exact rhythmic and word boundary match, (b) a rhythmic mismatch, and (c) two utterances with the same rhythm as the masked utterance, but different word boundary locations. Listeners were clearly able to perceive the rhythm of the masked utterances: The rhythmic mismatch was chosen significantly less often than any other alternative. Within the three rhythmically matched alternatives, the exact match was chosen significantly more often than either word boundary mismatch. Thus, listeners both perceived speech rhythm and used durational cues effectively to locate the position of word boundaries.
Cues↗