Is voice therapy an effective treatment for dysphonia? A randomised controlled trial

OBJECTIVES: To assess the overall efficacy of voice therapy for dysphonia. DESIGN: Single blind randomised controlled trial. SETTING: Outpatient clinic in a teaching hospital. Participants: 204 outpatients aged 17-87 with a primary symptom of persistent hoarseness for at least two months. INTERVENTIONS: After baseline assessments, patients were randomised to six weeks of either voice therapy or no treatment. Assessments were repeated at six weeks on the 145 (71%) patients who continued to this stage and at 12-14 weeks on the 133 (65%) patients who completed the study. The assessments at the three time points for the 70 patients who completed treatment and the 63 patients in the group given no treatment were compared. MAIN OUTCOME MEASURES: Ratings of laryngeal features, Buffalo voice profile, amplitude and pitch perturbation, voice profile questionnaire, hospital anxiety and depression scale, clinical interview schedule, SF-36. RESULTS: Voice therapy improved voice quality as assessed by rating by patients (P=0.001) and rating by observer (P<0.001). The treatment effects for these two outcomes were 4.1 (95% confidence interval 1.7 to 6.6) points and 0.82 (0.50 to 1.13) points. Amplitude perturbation showed improvement at six weeks (P=0.005) but not on completion of the study. Patients with dysphonia had appreciable psychological distress and lower quality of life than controls, but voice therapy had no significant impact on either of these variables. CONCLUSION: Voice therapy is effective in improving voice quality as assessed by self rated and observer rated methods

Supporting adolescent athletes' dual careers: The role of an athlete's social support network

Objectives The objectives of this study were to, (a) understand the role of the social support network in facilitating adolescent athletes' dual careers in sport and education, and; (b) gain insights into the factors that may optimize the provision of such support. Design A two-stage qualitative study. Method In stage one, four different sport and education settings in the UK were examined: A tennis academy, a football academy, a national field hockey squad, and a high-performance swimming squad. Interviews were conducted with two athletes and associated significant others from each setting. In stage two, nine current or former international athletes from a variety of sports and countries recalled their experiences of managing a dual career. Analysis was conducted following the procedures outlined by Miles, Huberman, and Saldaña (2014). Results Overall, athletes in stage one and two perceived that to maintain their dual careers, they were heavily dependent upon the support of significant others. The role of the support network was to recognize the demands of a dual career, anticipate problems, value education, minimize barriers, and create autonomy-supportive environments. Key factors to optimize such support were focusing on the whole person, providing integrated support, and fostering a culture that promotes continuing education. Conclusions Results indicate that athletes require particular types of support within their home, at school, and in their sport context to be able to manage their dual career. However, a range of individual and group-level factors may influence the extent to which such support is available to athletes

Risk factors for chest infection in acute stroke: a prospective cohort study

<p><b>Background and Purpose:</b> Pneumonia is a major cause of morbidity and mortality after stroke. We aimed to determine key characteristics that would allow prediction of those patients who are at highest risk for poststroke pneumonia.</p> <p><b>Methods:</b> We studied a series of consecutive patients with acute stroke who were admitted to hospital. Detailed evaluation included the modified National Institutes of Health Stroke Scale; the Abbreviated Mental Test; and measures of swallow, respiratory, and oral health status. Pneumonia was diagnosed by set criteria. Patients were followed up at 3 months after stroke.</p> <p><b>Results:</b> We studied 412 patients, 391 (94.9%) with ischemic stroke and 21 (5.1%) with hemorrhagic stroke; 78 (18.9%) met the study criteria for pneumonia. Subjects who developed pneumonia were older (mean±SD age, 75.9±11.4 vs 64.9±13.9 years), had higher modified National Institutes of Health Stroke Scale scores, a history of chronic obstructive pulmonary disease, lower Abbreviated Mental Test scores, and a higher oral cavity score, and a greater proportion tested positive for bacterial cultures from oral swabs. In binary logistic-regression analysis, independent predictors (P<0.05) of pneumonia were age >65 years, dysarthria or no speech due to aphasia, a modified Rankin Scale score ≥4, an Abbreviated Mental Test score <8, and failure on the water swallow test. The presence of 2 or more of these risk factors carried 90.9% sensitivity and 75.6% specificity for the development of pneumonia.</p> <p><b>Conclusions:</b> Pneumonia after stroke is associated with older age, dysarthria/no speech due to aphasia, severity of poststroke disability, cognitive impairment, and an abnormal water swallow test result. Simple assessment of these variables could be used to identify patients at high risk of developing pneumonia after stroke.</p&gt

Optical addressing of an individual erbium ion in silicon

The detection of electron spins associated with single defects in solids is a critical operation for a range of quantum information and measurement applications currently under development. To date, it has only been accomplished for two centres in crystalline solids: phosphorus in silicon using electrical readout based on a single electron transistor (SET) and nitrogen-vacancy centres in diamond using optical readout. A spin readout fidelity of about 90% has been demonstrated with both electrical readout and optical readout, however, the thermal limitations of the electrical readout and the poor photon collection efficiency of the optical readout hinder achieving the high fidelity required for quantum information applications. Here we demonstrate a hybrid approach using optical excitation to change the charge state of the defect centre in a silicon-based SET, conditional on its spin state, and then detecting this change electrically. The optical frequency addressing in high spectral resolution conquers the thermal broadening limitation of the previous electrical readout and charge sensing avoids the difficulties of efficient photon collection. This is done with erbium in silicon and has the potential to enable new architectures for quantum information processing devices and to dramatically increase the range of defect centres that can be exploited. Further, the efficient electrical detection of the optical excitation of single sites in silicon is a major step in developing an interconnect between silicon and optical based quantum computing technologies.Comment: Corrected the third affiliation. Corrected one cross-reference of "Fig. 3b" to "Fig. 3c". Corrected the caption of Fig. 3a by changing (+-)1 to

Perceived vocal morbidity in a problem asthma clinic

<p>Aims: Asthma treatment has the potential to affect patients' voices. We undertook detailed characterisation of voice morbidity in patients attending a problem asthma clinic, and we determined how patients' perceptions related to objective assessment by an experienced observer.</p> <p>Methods: Forty-three patients took part in the study. Subjects completed the self-administered voice symptom score (VoiSS) questionnaire and underwent digital voice recording. These voice recordings were scored using the grade–roughness–breathiness–asthenicity–strain system (GRBAS). Laryngoscopy was also performed.</p> <p>Results: The median VoiSS was 26 (range three to 83). VoiSS were significantly lower in the 17 patients with normal laryngeal structure and function (range four to 46; median 22), compared with the 26 patients with functional or structural laryngeal abnormality (range three to 83; median 33) (95 per cent confidence intervals for difference 0.0–21.0; p = 0.044). The overall grade score for the GRBAS scale did not differ between these two groups, and only 13 patients had a GRBAS score of one or more, recognised as indicating a voice problem. There were positive correlations between related GRBAS score and voice symptom score subscales. Although voice symptom scores were significantly more abnormal in patients with structural and functional abnormalities, this score performed only moderately well as a predictive tool (sensitivity 54 per cent; specificity 71 per cent). Nevertheless, the voice symptom score performed as well as the more labour-intensive GRBAS score (sensitivity 57 per cent; specificity 60 per cent). Patients' inhaled corticosteroid dose (median dose 1000 µg beclomethasone dipropionate or equivalent) had a statistically significant relationship with their overall grade score for the GRBAS scale (r = 0.56; p < 0.001), but not with their VoiSS. Only one patient had evidence of laryngeal candidiasis, and only two had any evidence of abnormality suggesting steroid-induced myopathy.</p> <p>Conclusions: Vocal morbidity is common in patients with asthma, and should not be immediately attributed to steroid-related candidiasis. The VoiSS merits further, prospective validation as a screening tool for ENT and/or speech and language therapy referral in patients with asthma.</p&gt

Quantum storage on subradiant states in an extended atomic ensemble

A scheme for coherent manipulation of collective atomic states is developed such that total subradiant states, in which spontaneous emission is suppressed into all directions due to destructive interference between neighbor atoms, can be created in an extended atomic ensemble. The optimal conditions for creation of such states and suitability of them for quantum storage are discussed. It is shown that in order to achieve the maximum signal-to-noise ratio the shape of a light pulse to be stored and reconstructed using a homogeneously broadened absorbtion line of an atomic system should be a time-reversed regular part of the response function of the system. In the limit of high optical density, such pulses allow one to prepare collective subradiant atomic states with near flat spatial distribution of the atomic excitation in the medium.Comment: V2: considerably revised (title, text). V3: minor changes - final version as published in PR

Reliability of perceptions of voice quality: evidence from a problem asthma clinic population

<p>Introduction: Methods of perceptual voice evaluation have yet to achieve satisfactory consistency; complete acceptance of a recognised clinical protocol is still some way off.</p> <p>Materials and methods: Three speech and language therapists rated the voices of 43 patients attending the problem asthma clinic of a teaching hospital, according to the grade-roughness-breathiness-asthenicity-strain (GRBAS) scale and other perceptual categories.</p> <p>Results and analysis: Use of the GRBAS scale achieved only a 64.7 per cent inter-rater reliability and a 69.6 per cent intra-rater reliability for the grade component. One rater achieved a higher degree of consistency. Improved concordance on the GRBAS scale was observed for subjects with laryngeal abnormalities. Raters failed to reach any useful level of agreement in the other categories employed, except for perceived gender.</p> <p>Discussion: These results should sound a note of caution regarding routine adoption of the GRBAS scale for characterising voice quality for clinical purposes. The importance of training and the use of perceptual anchors for reliable perceptual rating need to be further investigated.</p&gt

Role of contrast-enhanced ultrasound (CEUS) in paediatric practice: an EFSUMB position statement

The use of contrast-enhanced ultrasound (CEUS) in adults is well established in many different areas, with a number of current applications deemed off-label, but the use supported by clinical experience and evidence. Paediatric CEUS is also an off-label application until recently with approval specifically for assessment of focal liver lesions. Nevertheless there is mounting evidence of the usefulness of CEUS in children in many areas, primarily as an imaging technique that reduces exposure to radiation, iodinated contrast medium and the patient-friendly circumstances of ultrasonography. This position statement of the European Federation of Societies in Ultrasound and Medicine (EFSUMB) assesses the current status of CEUS applications in children and makes suggestions for further development of this technique