Balance Right in Multiple Sclerosis (BRiMS): a feasibility randomised controlled trial of a falls prevention programme

Background

Balance, mobility impairments and falls are problematic for people with multiple sclerosis (MS). The “Balance Right in MS (BRiMS)” intervention, a 13-week home and group-based exercise and education programme, aims to improve balance and minimise falls. This study aimed to evaluate the feasibility of undertaking a multi-centre randomised controlled trial and to collect the necessary data to design a definitive trial.

Methods

This randomised controlled feasibility study recruited from four United Kingdom NHS clinical neurology services. Patients ≥ 18 years with secondary progressive MS (Expanded Disability Status Scale 4 to 7) reporting more than two falls in the preceding 6 months were recruited. Participants were block-randomised to either a manualised 13-week education and exercise programme (BRiMS) plus usual care, or usual care alone.

Feasibility assessment evaluated recruitment and retention rates, adherence to group assignment and data completeness. Proposed outcomes for the definitive trial (including impact of MS, mobility, quality of life and falls) and economic data were collected at baseline, 13 and 27 weeks, and participants completed daily paper falls diaries.

Results

Fifty-six participants (mean age 59.7 years, 66% female, median EDSS 6.0) were recruited in 5 months; 30 randomised to the intervention group. Ten (18%) participants withdrew, 7 from the intervention group. Two additional participants were lost to follow up at the final assessment point. Completion rates were > 98% for all outcomes apart from the falls diary (return rate 62%).

After adjusting for baseline score, mean intervention—usual care between-group differences for the potential primary outcomes at week 27 were MS Walking Scale-12v2: − 7.7 (95% confidence interval [CI] − 17.2 to 1.8) and MS Impact Scale-29v2: physical 0.6 (CI − 7.8 to 9), psychological − 0.4 (CI − 9.9 to 9). In total, 715 falls were reported, rate ratio (intervention:usual care) for falls 0.81 (0.41 to 2.26) and injurious falls 0.44 (0.41 to 2.23).

Conclusions

Procedures were practical, and retention, programme engagement and outcome completion rates satisfied a priori progression criteria. Challenges were experienced in completion and return of daily falls diaries. Refinement of methods for reporting falls is therefore required, but we consider a full trial to be feasible.

Trial registration

ISRCTN13587999

Date of registration: 29 September 2016

Genetic modifiers of menopausal hormone replacement therapy and breast cancer risk: a genome-wide interaction study

Women using menopausal hormone therapy (MHT) are at increased risk of developing breast cancer (BC). To detect genetic modifiers of the association between current use of MHT and BC risk, we conducted a meta-analysis of four genome-wide case-only studies followed by replication in 11 case-control studies. We used a case-only design to assess interactions between single-nucleotide polymorphisms (SNPs) and current MHT use on risk of overall and lobular BC. The discovery stage included 2920 cases (541 lobular) from four genome-wide association studies. The top 1391 SNPs showing P values for interaction (Pint) <3.0 × 10(-3) were selected for replication using pooled case-control data from 11 studies of the Breast Cancer Association Consortium, including 7689 cases (676 lobular) and 9266 controls. Fixed-effects meta-analysis was used to derive combined Pint. No SNP reached genome-wide significance in either the discovery or combined stage. We observed effect modification of current MHT use on overall BC risk by two SNPs on chr13 near POMP (combined Pint≤8.9 × 10(-6)), two SNPs in SLC25A21 (combined Pint≤4.8 × 10(-5)), and three SNPs in PLCG2 (combined Pint≤4.5 × 10(-5)). The association between lobular BC risk was potentially modified by one SNP in TMEFF2 (combined Pint≤2.7 × 10(-5)), one SNP in CD80 (combined Pint≤8.2 × 10(-6)), three SNPs on chr17 near TMEM132E (combined Pint≤2.2×10(-6)), and two SNPs on chr18 near SLC25A52 (combined Pint≤4.6 × 10(-5)). In conclusion, polymorphisms in genes related to solute transportation in mitochondria, transmembrane signaling, and immune cell activation are potentially modifying BC risk associated with current use of MHT. These findings warrant replication in independent studies.

Large-scale genotyping identifies 41 new loci associated with breast cancer risk

Breast cancer is the most common cancer among women. Common variants at 27 loci have been identified as associated with susceptibility to breast cancer, and these account for ∼9% of the familial risk of the disease. We report here a meta-analysis of 9 genome-wide association studies, including 10,052 breast cancer cases and 12,575 controls of European ancestry, from which we selected 29,807 SNPs for further genotyping. These SNPs were genotyped in 45,290 cases and 41,880 controls of European ancestry from 41 studies in the Breast Cancer Association Consortium (BCAC). The SNPs were genotyped as part of a collaborative genotyping experiment involving four consortia (Collaborative Oncological Gene-environment Study, COGS) and used a custom Illumina iSelect genotyping array, iCOGS, comprising more than 200,000 SNPs. We identified SNPs at 41 new breast cancer susceptibility loci at genome-wide significance (P < 5 × 10(-8)). Further analyses suggest that more than 1,000 additional loci are involved in breast cancer susceptibility.

Genetic susceptibility to triple-negative breast cancer

Triple-negative breast cancers (TNBC), defined by the absence of estrogen receptor, progesterone receptor, and HER-2 expression, account for 12% to 24% of all breast cancers. TNBC is associated with early recurrence of disease and poor outcome. Germline mutations in the BRCA1 and BRCA2 breast cancer susceptibility genes have been associated with up to 15% of TNBC, and TNBC accounts for 70% of breast tumors arising in BRCA1 mutation carriers and 16% to 23% of breast tumors in BRCA2 carriers. Whether germline mutations in other breast cancer susceptibility genes also predispose to TNBC remains to be determined. Common variation in a subset of the 72 known breast cancer susceptibility loci identified through genome-wide association studies and other large-scale genotyping efforts have also been associated with risk of TNBC (TOX3, ESR1, RAD51L1, TERT, 19p13.1, 20q11, MDM4, 2p24.1, and FTO). Furthermore, variation in the 19p13.1 locus and the MDM4 locus has been associated with TNBC, but not other forms of breast cancer, suggesting that these are TNBC-specific loci. Thus, TNBC can be distinguished from other breast cancer subtypes by a unique pattern of common and rare germline predisposition alleles. Additional efforts to combine genetic and epidemiologic data are needed to better understand the etiology of this aggressive form of breast cancer, to identify prevention and therapeutic targets, and to impact clinical practice through the development of risk prediction models.

A meta-analysis of genome-wide association studies of breast cancer identifies two novel susceptibility loci at 6q14 and 20q11

Genome-wide association studies (GWAS) of breast cancer defined by hormone receptor status have revealed loci contributing to susceptibility of estrogen receptor (ER)-negative subtypes. To identify additional genetic variants for ER-negative breast cancer, we conducted the largest meta-analysis of ER-negative disease to date, comprising 4754 ER-negative cases and 31 663 controls from three GWAS: NCI Breast and Prostate Cancer Cohort Consortium (BPC3) (2188 ER-negative cases; 25 519 controls of European ancestry), Triple Negative Breast Cancer Consortium (TNBCC) (1562 triple negative cases; 3399 controls of European ancestry) and African American Breast Cancer Consortium (AABC) (1004 ER-negative cases; 2745 controls). We performed in silico replication of 86 SNPs at P ≤ 1 × 10(-5) in an additional 11 209 breast cancer cases (946 with ER-negative disease) and 16 057 controls of Japanese, Latino and European ancestry. We identified two novel loci for breast cancer at 20q11 and 6q14. SNP rs2284378 at 20q11 was associated with ER-negative breast cancer (combined two-stage OR = 1.16; P = 1.1 × 10(-8)) but showed a weaker association with overall breast cancer (OR = 1.08, P = 1.3 × 10(-6)) based on 17 869 cases and 43 745 controls and no association with ER-positive disease (OR = 1.01, P = 0.67) based on 9965 cases and 22 902 controls. Similarly, rs17530068 at 6q14 was associated with breast cancer (OR = 1.12; P = 1.1 × 10(-9)), and with both ER-positive (OR = 1.09; P = 1.5 × 10(-5)) and ER-negative (OR = 1.16, P = 2.5 × 10(-7)) disease. We also confirmed three known loci associated with ER-negative (19p13) and both ER-negative and ER-positive breast cancer (6q25 and 12p11). Our results highlight the value of large-scale collaborative studies to identify novel breast cancer risk loci.

Evaluation of chromosome 6p22 as a breast cancer risk modifier locus in a follow-up study of BRCA2 mutation carriers

Several common germline variants identified through genome-wide association studies of breast cancer risk in the general population have recently been shown to be associated with breast cancer risk for BRCA1 and/or BRCA2 mutation carriers. When combined, these variants can identify marked differences in the absolute risk of developing breast cancer for mutation carriers, suggesting that additional modifier loci may further enhance individual risk assessment for BRCA1 and BRCA2 mutation carriers. Recently, a common variant on 6p22 (rs9393597) was found to be associated with increased breast cancer risk for BRCA2 mutation carriers [hazard ratio (HR) = 1.55, 95 % confidence interval (CI) 1.25-1.92, p = 6.0 × 10(-5)]. This observation was based on data from GWAS studies in which, despite statistical correction for multiple comparisons, the possibility of false discovery remains a concern. Here, we report on an analysis of this variant in an additional 6,165 BRCA1 and 3,900 BRCA2 mutation carriers from the Consortium of Investigators of Modifiers of BRCA1/2 (CIMBA). In this replication analysis, rs9393597 was not associated with breast cancer risk for BRCA2 mutation carriers (HR = 1.09, 95 % CI 0.96-1.24, p = 0.18). No association with ovarian cancer risk for BRCA1 or BRCA2 mutation carriers or with breast cancer risk for BRCA1 mutation carriers was observed. This follow-up study suggests that, contrary to our initial report, this variant is not associated with breast cancer risk among individuals with germline BRCA2 mutations.

Identification of a novel percent mammographic density locus at 12q24

Percent mammographic density adjusted for age and body mass index (BMI) is one of the strongest risk factors for breast cancer and has a heritable component that remains largely unidentified. We performed a three-stage genome-wide association study (GWAS) of percent mammographic density to identify novel genetic loci associated with this trait. In stage 1, we combined three GWASs of percent density comprised of 1241 women from studies at the Mayo Clinic and identified the top 48 loci (99 single nucleotide polymorphisms). We attempted replication of these loci in 7018 women from seven additional studies (stage 2). The meta-analysis of stage 1 and 2 data identified a novel locus, rs1265507 on 12q24, associated with percent density, adjusting for age and BMI (P = 4.43 × 10(-8)). We refined the 12q24 locus with 459 additional variants (stage 3) in a combined analysis of all three stages (n = 10 377) and confirmed that rs1265507 has the strongest association in the 12q24 region (P = 1.03 × 10(-8)). Rs1265507 is located between the genes TBX5 and TBX3, which are members of the phylogenetically conserved T-box gene family and encode transcription factors involved in developmental regulation. Understanding the mechanism underlying this association will provide insight into the genetics of breast tissue composition.

The role of genetic breast cancer susceptibility variants as prognostic factors

Recent genome-wide association studies identified 11 single nucleotide polymorphisms (SNPs) associated with breast cancer (BC) risk. We investigated these and 62 other SNPs for their prognostic relevance. Confirmed BC risk SNPs rs17468277 (CASP8), rs1982073 (TGFB1), rs2981582 (FGFR2), rs13281615 (8q24), rs3817198 (LSP1), rs889312 (MAP3K1), rs3803662 (TOX3), rs13387042 (2q35), rs4973768 (SLC4A7), rs6504950 (COX11) and rs10941679 (5p12) were genotyped for 25 853 BC patients with the available follow-up; 62 other SNPs, which have been suggested as BC risk SNPs by a GWAS or as candidate SNPs from individual studies, were genotyped for replication purposes in subsets of these patients. Cox proportional hazard models were used to test the association of these SNPs with overall survival (OS) and BC-specific survival (BCS). For the confirmed loci, we performed an accessory analysis of publicly available gene expression data and the prognosis in a different patient group. One of the 11 SNPs, rs3803662 (TOX3) and none of the 62 candidate/GWAS SNPs were associated with OS and/or BCS at P<0.01. The genotypic-specific survival for rs3803662 suggested a recessive mode of action [hazard ratio (HR) of rare homozygous carriers=1.21; 95% CI: 1.09-1.35, P=0.0002 and HR=1.29; 95% CI: 1.12-1.47, P=0.0003 for OS and BCS, respectively]. This association was seen similarly in all analyzed tumor subgroups defined by nodal status, tumor size, grade and estrogen receptor. Breast tumor expression of these genes was not associated with prognosis. With the exception of rs3803662 (TOX3), there was no evidence that any of the SNPs associated with BC susceptibility were associated with the BC survival. Survival may be influenced by a distinct set of germline variants from those influencing susceptibility.

19p13.1 is a triple-negative-specific breast cancer susceptibility locus

The 19p13.1 breast cancer susceptibility locus is a modifier of breast cancer risk in BRCA1 mutation carriers and is also associated with the risk of ovarian cancer. Here, we investigated 19p13.1 variation and risk of breast cancer subtypes, defined by estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor-2 (HER2) status, using 48,869 breast cancer cases and 49,787 controls from the Breast Cancer Association Consortium (BCAC). Variants from 19p13.1 were not associated with breast cancer overall or with ER-positive breast cancer but were significantly associated with ER-negative breast cancer risk [rs8170 OR, 1.10; 95% confidence interval (CI), 1.05-1.15; P = 3.49 × 10(-5)] and triple-negative (ER-, PR-, and HER2-negative) breast cancer (rs8170: OR, 1.22; 95% CI, 1.13-1.31; P = 2.22 × 10(-7)). However, rs8170 was no longer associated with ER-negative breast cancer risk when triple-negative cases were excluded (OR, 0.98; 95% CI, 0.89-1.07; P = 0.62). In addition, a combined analysis of triple-negative cases from BCAC and the Triple Negative Breast Cancer Consortium (TNBCC; N = 3,566) identified a genome-wide significant association between rs8170 and triple-negative breast cancer risk (OR, 1.25; 95% CI, 1.18-1.33; P = 3.31 × 10(-13)]. Thus, 19p13.1 is the first triple-negative-specific breast cancer risk locus and the first locus specific to a histologic subtype defined by ER, PR, and HER2 to be identified. These findings provide convincing evidence that genetic susceptibility to breast cancer varies by tumor subtype and that triple-negative tumors and other subtypes likely arise through distinct etiologic pathways.

Common variation in Nemo-like kinase is associated with risk of ovarian cancer

BACKGROUND

Overexpression of mitotic kinases has been associated with prognosis, histologic grade, and clinical stage in ovarian cancer, but the relationship between inherited variation in these genes and ovarian cancer risk has not been well defined.

METHODS

We measured associations between 397 single nucleotide polymorphisms (SNPs) from 67 mitotic kinases and invasive epithelial ovarian cancer risk in two case-control studies (n = 671 cases; n = 939 controls). Thirty-six candidate SNPs (P < 0.05) were assessed in a replication analysis consisting of three additional studies (n = 1,094 cases; n = 829 controls).

RESULTS

In initial analysis, thirty-six SNPs were suggestive of association with risk of serous ovarian cancer, all subtypes of ovarian cancer, or both (P < 0.05). Replication analyses suggested an association between rs2125846 in the Nemo-like kinase (NLK) gene and ovarian cancer (serous OR = 1.36, 95% CI: 1.11-1.67, P = 1.77 × 10(-3); all subtypes OR = 1.30, 95% CI: 1.08-1.56, P = 2.97 × 10(-3)). Furthermore, rs2125846 was associated with risk in the combined discovery and replication sets (serous OR = 1.33, 95% CI: 1.15-1.54; all subtypes OR = 1.27, 95% CI: 1.12-1.45).

CONCLUSIONS

Variation in NLK may be associated with risk of invasive epithelial ovarian cancer. Further studies are needed to confirm and understand the biologic relationship between this mitotic kinase and ovarian cancer risk.

IMPACT

An association between SNPs in NLK and ovarian cancer may provide biologic insight into the development of this disease.

No evidence for association of inherited variation in genes involved in mitosis and percent mammographic density

Introduction

Increased mammographic breast density is one of the strongest risk factors for breast cancer. While two-thirds of the variation in mammographic density appears to be genetically influenced, few variants have been identified. We examined the association of inherited variation in genes from pathways that mediate cell division with percent mammographic density (PMD) adjusted for age, body mass index (BMI) and postmenopausal hormones, in two studies of healthy postmenopausal women.

Methods

We investigated 2,058 single nucleotide polymorphisms (SNPs) in 378 genes involved in regulation of mitosis for associations with adjusted PMD among 484 unaffected postmenopausal controls (without breast cancer) from the Mayo Clinic Breast Cancer Study (MCBCS) and replicated the findings in postmenopausal controls (n = 726) from the Singapore and Sweden Breast Cancer Study (SASBAC) study. PMD was assessed in both studies by a computer-thresholding method (Cumulus) and linear regression approaches were used to assess the association of SNPs and PMD, adjusted for age, BMI and postmenopausal hormones. A P-value threshold of 4.2 × 10^-5 based on a Bonferroni correction of effective number of independent tests was used for statistical significance. Further, a pathway-level analysis was conducted of all 378 genes using the self-contained gene-set analysis method GLOSSI.

Results

A variant in PRPF4, rs10733604, was significantly associated with adjusted PMD in the MCBCS (P = 2.7 × 10^-7), otherwise, no single SNP was associated with PMD. Additionally, the pathway analysis provided no evidence of enrichment in the number of associations observed between SNPs in the mitotic genes and PMD (P = 0.60). We evaluated rs10733604 (PRPF4), and 73 other SNPs at P < 0.05 from 51 genes in the SASBAC study. There was no evidence of an association of rs10733604 (PRPF4) with adjusted PMD in SASBAC (P = 0.23). There were, however, consistent associations (P < 0.05) of variants at the putative locus, LOC375190, Aurora B kinase (AURKB), and Mini-chromosome maintenance complex component 3 (MCM3) with adjusted PMD, although these were not statistically significant.

Conclusions

Our findings do not support a role of inherited variation in genes involved in regulation of cell division and adjusted percent mammographic density in postmenopausal women.

Common breast cancer susceptibility loci are associated with triple-negative breast cancer

Triple-negative breast cancers are an aggressive subtype of breast cancer with poor survival, but there remains little known about the etiologic factors that promote its initiation and development. Commonly inherited breast cancer risk factors identified through genome-wide association studies display heterogeneity of effect among breast cancer subtypes as defined by the status of estrogen and progesterone receptors. In the Triple Negative Breast Cancer Consortium (TNBCC), 22 common breast cancer susceptibility variants were investigated in 2,980 Caucasian women with triple-negative breast cancer and 4,978 healthy controls. We identified six single-nucleotide polymorphisms, including rs2046210 (ESR1), rs12662670 (ESR1), rs3803662 (TOX3), rs999737 (RAD51L1), rs8170 (19p13.1), and rs8100241 (19p13.1), significantly associated with the risk of triple-negative breast cancer. Together, our results provide convincing evidence of genetic susceptibility for triple-negative breast cancer.

No association between germline allele-specific expression of TGFBR1 and colorectal cancer risk in Caucasian and Ashkenazi populations

Background:

Germline allele-specific expression (ASE) of the TGFBR1 gene has been reported as a strong risk factor for colorectal cancer (CRC) with an odds ratio close to 9. Considering the potential implications of the finding, we undertook the task of validating the initial results in this study.

Methods:

Allele-specific expression was measured using the highly quantitative and robust technique of pyrosequencing. Individuals from two different populations were studied, one Caucasian-dominated and the other of Ashkenazi Jewish descent, with different sources of non-tumoral genetic material in each.

Results:

Our results showed no statistically significant differences in the degree of ASE between CRC patients and controls, considering ASE as either a quantitative or a binary trait. Using defined cutoff values to categorise ASE, 1.0% of blood lymphocytes from informative Israeli cases (total n=96) were ASE positive (median 1.00; range 0.76–1.31) and 2.2% of informative matched controls (total n=90) were ASE positive (median 1.00; range 0.76–1.87). Likewise, normal mucosae from Spanish patients (median 1.03; range: 0.68–1.43; n=75) did not show significant differences in the degree of ASE when compared with the Israeli patients or controls.

Conclusions:

Taken together, these results suggest that ASE of TGFBR1 does not confer an increased risk of CRC.

Allele-specific expression of APC in adenomatous polyposis families

BACKGROUND & AIMS

Germline mutations in the APC gene cause of most cases of familial adenomatous polyposis (FAP) and a lesser proportion of attenuated FAP (AFAP). Systematic analysis of APC at the RNA level could provide insight into the pathogenicity of identified mutations and the molecular basis of FAP/AFAP in families without identifiable mutations. Here, we analyzed the prevalence of imbalances in the allelic expression of APC in polyposis families with germline mutations in the gene and without detectable mutations in APC and/or MUTYH.

METHODS

Allele-specific expression (ASE) was determined by single nucleotide primer extension using an exon 11 polymorphism as an allele-specific marker. In total, 52 APC-mutation-positive (36 families) and 24 APC/MUTYH-mutation-negative (23 families) informative patients were analyzed. Seventy-six controls also were included.

RESULTS

Of the APC-mutation-positive families, most of those in whom the mutation was located before the last exon of the gene (12 of 14) had ASE imbalance, which is consistent with a mechanism of nonsense-mediated decay. Of the APC/MUTYH-mutation-negative families, 2 (9%) had ASE imbalance, which might cause the disease. Normal allele expression was restored shortly after lymphocytes were cultured with puromycin, supporting a 'nonsense-mediated' hypothesis.

CONCLUSIONS

ASE analysis might be used to determine the pathogenesis of some cases of FAP and AFAP in which APC mutations are not found. ASE also might be used to prioritize the order in which different areas of APC are tested. RNA-level studies are important for the molecular diagnosis of FAP.

Network modeling links breast cancer susceptibility and centrosome dysfunction

Many cancer-associated genes remain to be identified to clarify the underlying molecular mechanisms of cancer susceptibility and progression. Better understanding is also required of how mutations in cancer genes affect their products in the context of complex cellular networks. Here we have used a network modeling strategy to identify genes potentially associated with higher risk of breast cancer. Starting with four known genes encoding tumor suppressors of breast cancer, we combined gene expression profiling with functional genomic and proteomic (or 'omic') data from various species to generate a network containing 118 genes linked by 866 potential functional associations. This network shows higher connectivity than expected by chance, suggesting that its components function in biologically related pathways. One of the components of the network is HMMR, encoding a centrosome subunit, for which we demonstrate previously unknown functional associations with the breast cancer-associated gene BRCA1. Two case-control studies of incident breast cancer indicate that the HMMR locus is associated with higher risk of breast cancer in humans. Our network modeling strategy should be useful for the discovery of additional cancer-associated genes.

An acoustical study of the fricative /s/ in the speech of individuals with dysarthria

This paper reports on measurements of several acoustic attributes of the fricative consonant /s/ produced in word-initial position by normally speaking adults and by speakers with neuromotor dysfunctions. Several acoustic properties are evaluated: the spectrum shape of the fricative and its amplitude in relation to the following vowel, the presence or absence of voicing, the time variation of the spectrum during the fricative and in the transition to the following vowel, and the presence of inappropriate acoustic patterns preceding the /s/. Some of these properties are based on quantitative measurements of the spectrum of the /s/, and others are based on observations of the time-varying acoustic patterns in spectrograms. For the individuals with dysarthria, deviations of each of these properties from the normal range are interpreted in terms of specific deficits in the control of the speech-production system. For the most part, these parameters are highly correlated with the speakers' overall intelligibility, with the intelligibility of words containing the fricative /s/, and with perceptual ratings of the adequacy of the fricative production. The parameters that show the best correlation with intelligibility and perceptual ratings are (a) measures of deviations from normalcy in the time variation of the acoustic pattern within the consonant and at the consonant-vowel boundary and (b) the spectrum shape of the frication noise. These acoustic parameters are related to deviations in the temporal pattern of control of the articulators in producing fricative-vowel sequences and to lack of fine control of the tongue blade in achieving an appropriate target configuration for the fricative.

Diverse acoustic cues at consonantal landmarks

The consonantal segments that underlie an utterance are manifested in the acoustic signal by abrupt discontinuities or dislocations in the spectral pattern. There are potentially two such discontinuities for each consonant, corresponding to the formation and release of a constriction in the oral cavity by the lips, the tongue blade, or the tongue body. Acoustic cues for the various consonant features of place, voicing and nasality reside in the signal in quite different forms on the two sides of each acoustic discontinuity. Examples of these diverse cues and their origin in acoustic theory are reviewed, with special attention to place features and features related to the laryngeal state and to nasalization. A listener appears to have the ability to integrate these diverse, brief acoustic cues for the features of consonants, although the mechanism for this integration process is unclear.

Tongue surface displacement during bilabial stops

The goals of this study were to characterize tongue surface displacement during production of bilabial stops and to refine current estimates of vocal-tract wall impedance using direct measurements of displacement in the vocal tract during closure. In addition, evidence was obtained to test the competing claims of passive and active enlargement of the vocal tract during voicing. Tongue displacement was measured and tongue compliance was estimated in four subjects during production of /aba/ and /apa/. All subjects showed more tongue displacement during /aba/ than during /apa/, even though peak intraoral pressure is lower for /aba/. In consequence, compliance estimates were much higher for /aba/, ranging from 5.1 to 8.5 x 10(-5) cm3/dyn. Compliance values for /apa/ ranged from 0.8 to 2.3 x 10(-5) cm3/dyn for the tongue body, and 0.52 x 10(-5) for the single tongue tip point that was measured. From combined analyses of tongue displacement and intraoral pressure waveforms for one subject, it was concluded that smaller tongue displacements for /p/ than for /b/ may be due to active stiffening of the tongue during /p/, or to intentional relaxation of tongue muscles during /b/ (in conjunction with active tongue displacement during /b/).

Critique: articulatory-acoustic relations and their role in speech perception

These remarks are in response to "Role of articulation in speech perception: Clues from production"ony Björn Lindblom. It is suggested that the form in which the lexicon is stored includes both segments and distinctive features, and this representation is neutral with respect to articulatory and the acoustic domains. The process by which features are determined from the sound requires that patterns of acoustic properties be identified. In developing models of speech perception, knowledge of articulatory-acoustic relations can be a guide in defining these properties, but it is not necessary for the models to assign primary status to articulation.

Linguistic experience alters phonetic perception in infants by 6 months of age

Linguistic experience affects phonetic perception. However, the critical period during which experience affects perception and the mechanism responsible for these effects are unknown. This study of 6-month-old infants from two countries, the United States and Sweden, shows that exposure to a specific language in the first half year of life alters infants' phonetic perception.

Spectral characteristics of sound transmission in the human respiratory system

The amplitude of sound transmission from the mouth to a site overlying the extrathoracic trachea and two sites on the right posterior chest wall over the 100-600 Hz frequency range was measured in eight healthy adult subjects. An acoustic driver and a rigid tube were employed to introduce sound into the mouths of the subjects at resting lung volume, and the transmission measurements were performed using lightweight accelerometers. Similar spectral characteristics of acceleration were observed in all of the subjects showing peaks in the transmission. These characteristics included 1) two regions of increased transmission over the frequency range of the measurements, 2) a decrease in the magnitude of acceleration of the chest wall as compared to the tracheal site of roughly 20 dB at lower frequencies, 3) a strong trend of decreasing acceleration of the chest wall with increasing frequency. These spectra agreed favorably with the predictions of a theoretical model of the acoustical properties of the respiratory system. The model suggests the primary structural determinants of a number of the observed characteristics including the importance of the lung parenchyma in sound attenuation.

A model of acoustic transmission in the respiratory system

A theoretical model of sound transmission from within the respiratory tract to the chest wall due to the motion of the walls of the large airways was developed. The vocal tract, trachea, and the first five bronchial generations are represented over the frequency range from 100 to 600 Hz by an equivalent acoustic circuit. This circuit allows the estimation of the magnitude of airway wall motion in response to an acoustic perturbation at the mouth. The radiation of sound through the surrounding lung parenchyma is represented as a cylindrical wave in a homogeneous mixture of air bubbles in water. The effect of thermal losses associated with the polytropic compressions and expansions of these bubbles by the acoustic wave is included and the chest wall is represented as a massive boundary to the wave propagation. The model estimates the magnitude of acceleration over the extrathoracic trachea and at three locations on the posterior chest wall in the same vertical plane. The predicted spectral characteristics of transmission are consistent with previous experimental observations. This theoretical approach suggests that the locations of the spectral peaks are a strong function of the geometry and the wall properties of the airways, while the attenuation at higher frequencies is primarily associated with the absorption of sound in the parenchyma.

Calibration of ear canals for audiometry at high frequencies

A procedure is described for determining the absolute sound pressure at the inner end of the ear canal when a sound source is coupled to the ear, for frequencies in the range 8-20 kHz. The transducer that generates the sound is coupled to the ear canal through a lossy tube, yielding a source impedance that is approximately matched to the characteristic impedance of the ear canal. A small microphone is located in the coupling tube close to the entrance to the ear canal. Calibration is carried out by measuring the response at this microphone when an impulse is applied at the transducer. To estimate the sound pressure at the medial end of the ear canal, the Fourier transform of this impulse response is corrected by an all-pole function in which the poles are estimated from the minima in this Fourier transform. Data on individual ear canals are presented in terms of gain functions relating the sound pressure at the medial end of the ear canal to the sound pressure when the coupling tube is blocked. The average gain function for a group of adult ears increases from 2 to 12 dB over the frequency range 8-20 kHz, in rough agreement with data from ear-canal models. Possible sources of error in the calibration procedure are discussed.

High-frequency audiometric assessment of a young adult population

The hearing thresholds of 37 young adults (18-26 years) were measured at 13 frequencies (8, 9,10,...,20 kHz) using a newly developed high-frequency audiometer. All subjects were screened at 15 dB HL at the low audiometric frequencies, had tympanometry within normal limits, and had no history of significant hearing problems. The audiometer delivers sound from a driver unit to the ear canal through a lossy tube and earpiece providing a source impedance essentially equal to the characteristic impedance of the tube. A small microphone located within the earpiece is used to measure the response of the ear canal when an impulse is applied at the driver unit. From this response, a gain function is calculated relating the equivalent sound-pressure level of the source to the SPL at the medial end of the ear canal. For the subjects tested, this gain function showed a gradual increase from 2 to 12 dB over the frequency range. The standard deviation of the gain function was about 2.5 dB across subjects in the lower frequency region (8-14 kHz) and about 4 dB at the higher frequencies. Cross modes and poor fit of the earpiece to the ear canal prevented accurate calibration for some subjects at the highest frequencies. The average SPL at threshold was 23 dB at 8 kHz, 30 dB at 12 kHz, and 87 dB at 18 kHz. Despite the homogeneous nature of the sample, the younger subjects in the sample had reliably better thresholds than the older subjects. Repeated measurements of threshold over an interval as long as 1 month showed a standard deviation of 2.5 dB at the lower frequencies (8-14 kHz) and 4.5 dB at the higher frequencies.

Effect of burst amplitude on the perception of stop consonant place of articulation

We have examined the effects of the relative amplitude of the release burst on perception of the place of articulation of utterance-initial voiceless and voiced stop consonants. The amplitude of the burst, which occurs within the first 10-15 ms following consonant release, was systematically varied in 5-dB steps from -10 to +10 dB relative to a "normal" burst amplitude for two labial-to-alveolar synthetic speech continua--one comprising voiceless stops and the other, voiced stops. The distribution of spectral energy in the bursts for the labial and alveolar stops at the ends of the continuum was consistent with the spectrum shapes observed in natural utterances, and intermediate shapes were used for intermediate stimuli on the continuum. The results of identification tests with these stimuli showed that the relative amplitude of the burst significantly affected the perception of the place of articulation of both voiceless and voiced stops, but the effect was greater for the former than the latter. The results are consistent with a view that two basic properties contribute to the labial-alveolar distinction in English. One of these is determined by the time course of the change in amplitude in the high-frequency range (above 2500 Hz) in the few tens of ms following consonantal release, and the other is determined by the frequencies of spectral peaks associated with the second and third formants in relation to the first formant.

Acoustic correlates of some phonetic categories

Some of the acoustic properties that distinguish one speech sound from another are reviewed. The point of view is that the auditory system responds to sound with different acoustic properties in distinctive ways, and that these special responses play an important role in selection and classification of the inventory of sounds that are used in language. Examples of several of these acoustic properties are discussed and illustrated, including the presence or absence of rapid spectrum change, abruptness and amplitude change, voicing and aspiration, and gross spectral properties relating to place of articulation for consonant and vowels.

Perceptual invariance and onset spectra for stop consonants in different vowel environments

A series of listening tests with brief synthetic consonant-vowel syllables was carried out to determine whether the initial part of a syllable can provide cues to place of articulation for voiced stop consonants independent of the remainder of the syllable. The data show that stimuli as short as 10-20 ms sampled from the onset of a consonant-vowel syllable, can be reliably identified for consonantal place of articulation, whether the second and higher formants contain moving or straight transitions and whether or not an initial burst is present. In most instances, these brief stimuli also contain sufficient information for vowel indentification. Stimulus continua in which formant transitions ranged from values appropriate to [b], [d], [g] in various vowel environments, and in which stimulus durations were 20 and 46 ms, yielded categorical labeling functions with a few exceptions. These results are consistent with a theory of speech perception in which consonant place of articulation is cued by invariant properties derived from the spectrum sampled in a 10-20 ms time window adjacent to consonantal onset or offset.

Acoustic invariance in speech production: evidence from measurements of the spectral characteristics of stop consonants

On the basis of theoretical considerations and the results of experiments with synthetic consonant-vowel syllables, it has been hypothesized that the short-time spectrum sampled at the onset of a stop consonant should exhibit gross properties that uniquely specify the consonantal place of articulation independent of the following vowel. The aim of this paper is to test this hypothesis by measuring the spectrum sampled at the onsets and offsets of a large number of consonant-vowel (CV) and vowel-consonant (VC) syllables containing both voiced and voiceless stops produced by several speakers. Templates were devised in an attempt to capture three classes of spectral shapes: diffuse-rising, diffuse-falling, and compact, corresponding to alveolar, labial, and velar consonants, respectively. Spectra were derived from the utterances by sampling at the consonantal release of CV syllables and at the implosion and burst release of VC syllables, and these spectra (smoothed by a linear prediction algorithm) were matched against the templates. It was found that about 85% of the spectra at initial consonant release and at final burst release were correctly classified by the templates, although there was some variability across vowel contexts. The spectra sampled at the implosion were not consistently classified. A preliminary examination of spectra sampled at the release of nasal consonants in CV syllables showed a somewhat lower accuracy of classification by the same templates. Overall, the results support an hypothesis that, in natural speech, the acoustic characteristics of stop consonants, specified in terms of the gross spectral shape sampled at the discontinuity in the acoustic signal, show invariant properties independent of the adjacent vowel or of the voicing characteristics of the consonant. The implication is that the auditory system is endowed with detectors that are sensitive to these kinds of gross spectral shapes, and that the existence of these detectors helps the infant to organize the sounds of speech into their natural classes.

Invariant cues for place of articulation in stop consonants

In a series of experiments, identification responses for place of articulation were obtained for synthetic stop consonants in consonant-vowel syllables with different vowels. The acoustic attributes of the consonants were systematically manipulated, the selection of stimulus characteristics being guided in part by theoretical considerations concerning the expected properties of the sound generated in the vocal tract as place of articulation is varied. Several stimulus series were generated with and without noise bursts at the onset, and with and without formant transitions following consonantal release. Stimuli with transitions only, and with bursts plus transitions, were consistently classified according to place of articulation, whereas stimuli with bursts only and no transitions were not consistently identified. The acoustic attributes of the stimuli were examined to determine whether invariant properties characterized each place of atriculation independent of vowel context. It was determined that the gross shape of the spectrum sampled at the consonantal release showed a distinctive shape for each place of articulation: a prominent midfrequency spectral peak for velars, a diffuse-rising spectrum for alveolars, and a diffuse-falling spectrum for labials. These attributes are evident for stimuli containing transitions only, but are enhanced by the presence of noise bursts at the onset.

Assessment of nasalization in the speech of deaf children

Nasality is widely recognized as a problem in the speech of many deaf people. This paper describes one approach to the assessment of nasalization and to the development of visual aids to assist in training of velopharyngeal control. The approach involves detection of the velopharyngeal opening during voiced sounds by means of a small accelerometer attached to the nose, and presentation of the accelerometer output on a computer-controlled visual display. The display may be used as a training aid, or for the purpose of analyzing either recorded or live speech. Objective data are presented on some of the properties of the accelerometer output for the speech of people with normal hearing and of a number of children whose hearing is severely impaired. These data show inadequate velopharyngeal control, particularly improper nasalization of certain vowels, for a significant number of the deaf children. For a group of the hearing-impaired children, subjective judgments of the adequacy of velopharyngeal control and of other speech attributes were obtained. Correlations among these judgments and relations between judgments of adequacy of velopharyngeal control and the objective measures of nasalization are shown. Some comments are made on the development of procedures for the training of velopharyngeal control using the display as an aid.

Computer-aided speech training for the deaf

An effort to develop a computer-based system of speech-training aids for the deaf is reported. The system is described, as are four different types of visual displays that have been programmed to date. The use of the system in a school for the deaf and an attempt to evaluate its effectiveness are described. The importance of close collaboration between researchers and teachers on efforts to develop innovative training aids is emphasized, as is the need to resolve some basic pedagogical issues.

A miniature accelerometer for detecting glottal waveforms and nasalization

A lightweight accelerometer has been used to obtain a waveform related to the glottal acoustic output when attached to the neck of a speaker, and to provide an indication of acoustic coupling to the nasal cavities when attached to the external surface of the nose. Examples of signals produced by the accelerometer are shown, and possible clinical applications are discussed.

Crosslanguage study of vowel perception

This study examines the discrimination and identification of synthetic rounded and unrounded vowels by speakers of two languages (English and Swedish). The unrounded vowels are phonemic in both languages, whereas the rounded vowels are phonemic only in Swedish. A subsidiary aim of the study is to compare the perception of the synthetic vowels with that of synthetic consonant-vowel syllables in which the consonants are stops arranged along a continuum from /b/ to /d/ to /g/. The data indicate that the ability of subjects to discriminate between the vowels is relatively independent of their linguistic experience: Swedish and American English subjects exhibit similar performance in the discrimination tests, though they have somewhat different identification functions. The discrimination functions are characterized by peaks and valleys, suggesting that listeners can discriminate given shifts in the vowel formant frequencies more readily in some vowel regions than in others. Comparison of the data on stop-consonant and vowel perception is consistent with earlier findings: the number of discriminable tokens along the stop-consonant continuum is roughly equal to the number of absolutely identifiable items (three in this case) ; on the other hand, the number of discriminable vowels is much greater than the number that can be absolutely identified. The data are in accord with the view that a human listener uses different modes in the perception of steady-state vowels and stop consonants.