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

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

Revenue raising taxes : general equilibrium evaluation of alternative taxation in U.S. petroleum industries

Should the United States increase taxes and tariffs in the energy sector to reduce its federal deficit? This paper uses a twelve sector general equilibrium model to estimate the fiscal effects, and the effects on welfare and employment, of : (i) a 25 percent import tax on imported crude petroleum oil; (ii) a 15 percent excise tax on petroleum products; and (iii) a combination of the two. The excise tax would be the most efficient revenue raising instrument. The 25 percent import tariff would raise US$7.3 billion, while the 15 percent excise tax would raise US$35 billion. Moreover, each dollar raised through a tariff would come at a loss of 25 cents in welfare. Each dollar raised through an excise tax would come at a loss of only one cent in welfare. Acombination of excise taxes, subsidies, and import tariffs would be the least costly way (in terms of welfare) to raise US$20 billion. The optimal tax structure would involve a tariff and a small subsidy on petroleum products to counteract the distortion induced by a tax on oil - the most important input for petroleum products.Economic Theory&Research,Oil Refining&Gas Industry,Public Sector Economics&Finance,Energy and Environment,Environmental Economics&Policies

The economic consequences of divorce in six OECD countries

This report presents a cross-national comparison of the short- and medium-term economic effects of divorce. Overview This paper uses longitudinal data to estimate the short- and medium-term economic effects of divorce in the USA, the UK, Switzerland, Korea, Germany and Australia during the first decade of the 21st century. While the data, collected during the 2000s, were generally consistent with the findings from the existing literature, they reveal that the effects of divorce differ between the six countries included in this study

Growth oriented adjustment programs : a statistical analysis

After the fall in average per capita GDP growth that took place in the 1980s, adjustment lending programs supported by the International Monetary Fund (IMF) and the World Bank (WB) were launched in response to the deteriorating external environment. The purpose of this paper is to evaluate and to assess statistically the extent to which adjustment programs supported by the IMF and the WB have restored growth. The evaluation relied on a large sample of countries (93) and controls for some of the statistical difficulties associated with measuring the effectiveness of adjustment programs. The paper reviews the environment under which IMF-WB lending took place, the rationale for adjustment lending, and the distribution of adjustment loans through time. The results of the statistical evaluation suggest that, after controlling for external factors and for initial conditions, growth is not higher in countries that receive IMF-WB funds, but that investment was significantly lower than for non-recipient countries. The paper also examines further long-term growth prospects.Economic Theory&Research,Country Strategy&Performance,Environmental Economics&Policies,Achieving Shared Growth,International Terrorism&Counterterrorism

ECONOMIC IMPACTS RESULTING FROM CO-FIRING BIOMASS FEEDSTOCKS IN SOUTHEASTERN UNITED STATES COAL-FIRED PLANTS

Economic impacts of using biomass in Southeast United States coal-fired plants are estimated using a county-level biomass database; ORCED, a dynamic electricity distribution model that estimates feedstock value; ORIBAS, a GIS model that estimates feedstock transportation costs; and IMPLAN, an input-output model that determines the impacts of co-firing on economic activity.Resource /Energy Economics and Policy,

The meaning and implications of Ruth 4:5 : a grammatical, socio-cultural and juridical investigation

Uncertainty about the meaning of the problematic word compilation in its specific context in Ruth 4:5 creates a lack of clarity on the events which take place in Ruth 4. Such lack of clarity is reflected in the diversity of ancient and modern translations of this verse. It is uncertain whether the Moabite immigrant Ruth is described as also selling the land or whether she is merely seen as part of the sale transaction. The traditional view implies that a levirate marriage is involved in the narrative of this chapter. This interpretation creates multiple juridical problems. This article proposes that a usufruct is sold rather than land. Understanding and applying this legal concept can correct the misunderstanding of the verse. The problem is approached through a syntactical and grammatical analysis and justified in terms of the ideology in the book of Ruth. It is suggested that Ruth 4:5 should be rendered with, “The day you acquire the (right/usufruct in respect of) the field from the hand of Naomi and from (the hand of) Ruth, the Moabite woman, the wife of the deceased, you (also) acquire (her) in order to maintain the name of the deceased over his inheritance.”http://reference.sabinet.co.za/sa_epublication/oldtestam201

Brand personality as a consistency factor in the pillars of CSR management in the new normal

ABSTRACT During such a complex crisis as the one experienced by humanity since the first quarter of 2020, it is necessary to develop tools that contribute to creating the corporate image for organizations that are currently interested in being identified as brands with high social and environmental commitment. Likewise, elements that contribute to building strong brands during a context that has changed consumption priorities are required. For this reason, this paper aims at adapting the dimension of socially responsible brand personality (SRBP), proposed by Mayorga (2017), taking the situationexperienced dueto theCOVID-19 pandemicas anew context. The objectiveof thisresearch is to contribute to the management of corporate social responsibility (CSR) by providing, from a communicative perspective, a tool that optimizes the creation of a socially responsible image by the different stakeholders. The results allow us to conclude that there is a structural modification of the brand personality proposed by Mayorga, which can be presumed to be generated by the current environment, and which, therefore, can be established as a pillar of CSR management in the new normal, from a relational point of view. The findings clearly identify the virtue of integrity in brand personality, which is made up of two attributes, which, in turn, are made up of 17 traits that can identify a socially responsible brand

Human factors implications of vehicle automation: Current understanding and future directions

Advances in vehicle-based technology are currently progressing at an ever- increasing rate and innovations in this area are no longer restricted to Original Equipment Manufacturers or the automotive industry, with service providers such as Google and a number of research institutes in Europe and North America also offering possibilities for new approaches to mobility (see http://www.driverless-future.com/?page_id=155). The race to test the first fleet of such vehicles on public roads is currently underway, with Volvo Cars announcing the start of its Drive Me project by 2017 (Volvo Cars, 2013) and the UK Government recently encouraging cities to engage in demonstrating trials of such vehicles on public roads from January 2015 (BBC, 2014). However, the homogeneous global implementation of fully autonomous vehicles is unlikely in the near to distant future