Stereo Laryngoscopic Impact Site Prediction for Droplet-Based Stimulation of the Laryngeal Adductor Reflex

The laryngeal adductor reflex (LAR) is a vital reflex of the human larynx. LAR malfunctions may cause life-threatening aspiration events. An objective, noninvasive, and reproducible method for LAR assessment is still lacking. Stimulation of the larynx by droplet impact, termed Microdroplet Impulse Testing of the LAR (MIT-LAR), may remedy this situation. However, droplet instability and imprecise stimulus application thus far prevented MIT-LAR from gaining clinical relevance. We present a system comprising two alternative, custom-built stereo laryngoscopes, each offering a distinct set of properties, a droplet applicator module, and image/point cloud processing algorithms to enable a targeted, droplet-based LAR stimulation. Droplet impact site prediction (ISP) is achieved by droplet trajectory identification and spatial target reconstruction. The reconstruction and ISP accuracies were experimentally evaluated. Global spatial reconstruction errors at the glottal area of (0.3±0.3) mm and (0.4±0.3) mm and global ISP errors of (0.9±0.6) mm and (1.3±0.8) mm were found for a rod lens-based and an alternative, fiberoptic laryngoscope, respectively. In the case of the rod lens-based system, 96% of all observed ISP error values are inferior to 2 mm; a value of 80% was found with the fiberoptic assembly. This contribution represents an important step towards introducing a reproducible and objective LAR screening method into the clinical routine

High Fidelity Computational Modeling and Analysis of Voice Production

This research aims to improve the fundamental understanding of the multiphysics nature of voice production, particularly, the dynamic couplings among glottal flow, vocal fold vibration and airway acoustics through high-fidelity computational modeling and simulations. Built upon in-house numerical solvers, including an immersed-boundary-method based incompressible flow solver, a finite element method based solid mechanics solver and a hydrodynamic/aerodynamic splitting method based acoustics solver, a fully coupled, continuum mechanics based fluid-structure-acoustics interaction model was developed to simulate the flow-induced vocal fold vibrations and sound production in birds and mammals. Extensive validations of the model were conducted by comparing to excised syringeal and laryngeal experiments. The results showed that, driven by realistic representations of physiology and experimental conditions, including the geometries, material properties and boundary conditions, the model had an excellent agreement with the experiments on the vocal fold vibration patterns, acoustics and intraglottal flow dynamics, demonstrating that the model is able to reproduce realistic phonatory dynamics during voice production. The model was then utilized to investigate the effect of vocal fold inner structures on voice production. Assuming the human vocal fold to be a three-layer structure, this research focused on the effect of longitudinal variation of layer thickness as well as the cover-body thickness ratio on vocal fold vibrations. The results showed that the longitudinal variation of the cover and ligament layers thicknesses had little effect on the flow rate, vocal fold vibration amplitude and pattern but affected the glottal angle in different coronal planes, which also influenced the energy transfer between glottal flow and the vocal fold. The cover-body thickness ratio had a complex nonlinear effect on the vocal fold vibration and voice production. Increasing the cover-body thickness ratio promoted the excitation of the wave-type modes of the vocal fold, which were also higher-eigenfrequency modes, driving the vibrations to higher frequencies. This has created complex nonlinear bifurcations. The results from the research has important clinical implications on voice disorder diagnosis and treatment as voice disorders are often associated with mechanical status changes of the vocal fold tissues and their treatment often focus on restoring the mechanical status of the vocal folds

Patterns of injury and violence in Yaoundé Cameroon: an analysis of hospital data.

BackgroundInjuries are quickly becoming a leading cause of death globally, disproportionately affecting sub-Saharan Africa, where reports on the epidemiology of injuries are extremely limited. Reports on the patterns and frequency of injuries are available from Cameroon are also scarce. This study explores the patterns of trauma seen at the emergency ward of the busiest trauma center in Cameroon's capital city.Materials and methodsAdministrative records from January 1, 2007, through December 31, 2007, were retrospectively reviewed; information on age, gender, mechanism of injury, and outcome was abstracted for all trauma patients presenting to the emergency ward. Univariate analysis was performed to assess patterns of injuries in terms of mechanism, date, age, and gender. Bivariate analysis was used to explore potential relationships between demographic variables and mechanism of injury.ResultsA total of 6,234 injured people were seen at the Central Hospital of Yaoundé's emergency ward during the year 2007. Males comprised 71% of those injured, and the mean age of injured patients was 29 years (SD = 14.9). Nearly 60% of the injuries were due to road traffic accidents, 46% of which involved a pedestrian. Intentional injuries were the second most common mechanism of injury (22.5%), 55% of which involved unarmed assault. Patients injured in falls were more likely to be admitted to the hospital (p < 0.001), whereas patients suffering intentional injuries and bites were less likely to be hospitalized (p < 0.001). Males were significantly more likely to be admitted than females (p < 0.001)DiscussionPatterns in terms of age, gender, and mechanism of injury are similar to reports from other countries from the same geographic region, but the magnitude of cases reported is high for a single institution in an African city the size of Yaoundé. As the burden of disease is predicted to increase dramatically in sub-Saharan Africa, immediate efforts in prevention and treatment in Cameroon are strongly warranted