Background: Foreign accent syndrome (FAS) is a rare speech disorder leading to a perceived presence of a new accent in a speaker's speech. Until now, around 100 cases of FAS have been reported. It is striking that in most cases the perception of the accent is in one consistent direction, namely from languages like English or Dutch to accents of Romance, Germanic, Eastern European or tonal languages. Aims: In this article, we will try to come up with an overarching explanation for the accent changes seen in FAS, relating these changes to force of articulation. Main Contribution: We assume that the foreign accent in FAS is interpreted on the basis of the stereotypical segmental and prosodic characteristics that relate to the phonetics and phonology of specific languages. We hypothesise that the direction in perception of a FAS accent will go from a language characterised by relatively more lenition processes, into languages with relatively more fortition characteristics in their phonetic realisations and phonological system and not the other way around. Accents are expected to change from stress-timed to syllable-timed languages, from weight-sensitive stress systems to weight-insensitive systems, from non-aspirated to aspirated systems, and within these language groups from languages characterised by, for example, relatively more reduction and assimilation processes to languages with relatively less lenition. We have tested our hypothesis with the already described FAS cases. We restricted ourselves to the cases of neurogenic FAS described in English and to which enough details were provided in order to be able to judge the change of accent. Conclusions: From the 58 cases that fitted with these criteria, almost 90% showed a change of accent in the expected direction or did not contradict our hypothesis. Only six accent changes did not directly support it. The reported phonetic descriptions of the cases, if available, nevertheless suggest that they do not seem to completely violate our hypothesis.

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sociated with treatment and productivity loss over a one year period at vaccine steady state (i.e. when all women are vaccinated), current vs. future burden assuming 95% vaccine coverage. The MR incidence data on abnormal PAP and CINs were extrapolated from the relative proportion of abnormal PAP, precancerous lesions and CC previously published. Vaccination effectiveness was based on clinical trial data and HPV distribution for Russia and Eastern Europe. Medical costs were estimated from resources used and listed Russian price. Indirect costs include unpaid taxes, illness allowance and regional GDP foregone. No discount was applied. Sensitivity analyses were conducted on main parameters (number of lesions, vaccine effectiveness, costs). RESULTS: Vaccination with the bivalent HPV vaccine in the MR was estimated to prevent 13,737 abnormal PAP (112.6 m.rub.), 11,750 CIN1 (296.1 m.rub.), 4,222 CIN2/3 (259.3 m.rub.), 504 CC (98.9 m.rub.), 199 cases of lifelong disability (44.6 m.rub.) and 276 cases of CC deaths annually. Total cost offsets could amount to 811.6 m.rub. (664.8 m.rub. treatment cost only) representing 2.5x annual cost of vaccinating one cohort of 12 year-old girls (328.9 m.rub.) (2.0x vs. treatment cost only). The benefit-to-cost ratio (cost offset/vaccination cost) ranged from 1.8 to 3.1 over the sensitivity analyses. CONCLUSIONS: Implementation of HPV vaccination in the MR could significantly decrease cervical HPV-infection disease-related burden. The cost of vaccination, at steady state, could be fully compensated by the cost offset.

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