Currently, there is limited data evaluating the coadministration of first-generation anticonvulsants for epilepsy treatment and direct-acting antivirals (DAAs) for the treatment of hepatitis C virus (HCV) infection. There is a potential risk of suboptimal DAA serum concentrations that could potentially lead to HCV treatment failure. In this report, we describe the case of an uninsured, non-Hispanic Black male in his mid-40s with a history of generalized epilepsy that was managed with phenytoin 100mg twice a day and divalproex 500mg extended-release once daily. He was diagnosed with an acute hepatitis C viral infection with a genotype of 1a. Due to the viral genotype, treatment naivety, and lack of cirrhosis , the recommended treatment is to start glecaprevir/pibrentasvir, but the concomitant use of phenytoin and glecaprevir/pibrentasvir is not recommended due to a drug-drug interaction that could lead to subtherapeutic DAA levels and possible treatment failure. Through shared decision-making and close follow-up, we slowly weaned the patient off phenytoin, replaced it with levetiracetam, and started glecaprevir/pibrentasvir. We successfully eradicated the patient’s HCV infection, and no breakthrough seizures were reported. Although an unprecedented case and with the limited data evaluating the coadministration of DAAs and treatment of acute HCV infection, we were able to successfully treat and achieve full remission of the HCV infection. By virtue of this case report, we hope to encourage others to report similar cases and spread awareness regarding the difficulties in management.
Language: The Cultural Tool by Daniel Everett covers a broad spectrum of issues concerning the nature of language from the perspective of an anthropological linguist who has had considerable fieldwork experience studying the language and culture of the Pirahã, an indigenous Amazonian tribe in Brazil, as well as a number of other indigenous languages and cultures. This review focuses mainly on the key elements of his approach to language: language as a solution to the communication problem; Everett's conception of language; what makes language possible; how language and culture influence each other.
A major focus of research on language acquisition in infancy involves experimental studies of the infant's ability to discriminate various kinds of speech or speech-like stimuli. This research has demonstrated that infants are sensitive to many fine-grained differences in the acoustic properties of speech utterances. Furthermore, these empirical findings have led investigators to theorize about how the infants internally process and represent speech stimuli. This paper examines one particular experimental protocol frequently used in these experiments: the Head-Turn Preference Procedure. It will be shown that this procedure is methodologically flawed and the theoretical conclusions drawn from its results are not adequately warranted.
Using the concept formation paradigm, two series of experiments were conducted to test the hypothesis that the critical band (CB) was a factor in learning to make absolute discriminations of vowels. The specific hypothesis being examined was that the CB is a psychoacoustic boundary in learning to make vowel categorizations, and that learning absolute discriminations of pairs of vowels that differ in one of their formants by one bark or more is significantly easier than learning absolute discriminations of vowels that differ by less than one bark. Subjects were given the task of learning to identify paired sets of synthesized vowels that differed in either F1 or F2 by 0.4, 0.6, 0.8, 1.0, or 1.2 bark. The results of these experiments suggest that the critical bandwidth is not a natural psychoacoustic boundary in the learning of vowel categories, and also that subjects seem better able to learn distinctions involving differences in F1 than distinctions involving differences in F2. The discussion raises the possibility that vowels that differ by less than one bark may not be perceptually viable because of such factors as ambient noise, articulatory constraints, and coarticulatory influences. Some evidence from Dutch and French is presented in support of this conjecture.
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