EFFECTS OF HYPER- AND HYPOCAPNIA ON PHONATORY LARYNGEAL RESISTANCE

The larynx has a challenging dual role in the simultaneous regulation of gas flow into and out of the lungs while also establishing resistance required for vocal fold vibration in voiced communication. Particular challenges may arise when the larynx is required to alter upper airway resistance to meet respiratory demands in a way that conflicts with requirements for voice production. Little if anything is known about reciprocal relations between these functions, particularly under conditions of respiratory abnormality that affect large sectors of the population- an estimated 25% of the US population who experience respiratory abnormalities and also relies on the larynx for voiced communication. In order to address this gap, the current study investigated two specific aims in a single within-subjects experiment: Specific Aim 1 (SA1) assessed spontaneous fluctuations in phonatory laryngeal resistance during states of (a) induced hypocapnia (low arterial carbon dioxide) and (b) induced hypercapnia (high arterial carbon dioxide), in comparison to a eupneic control condition and Specific Aim 2 (SA2) investigated the reciprocal effects of laryngeal resistance modulations on respiratory homeostasis. Results of the first aim demonstrated that phonatory laryngeal resistance remained stable and did not significantly change despite manipulations of inspired gas concentrations causing significant increases and decreases in carbon dioxide (CO2) levels. For the second aim, results showed that phonation significantly increased levels of end-tidal carbon dioxide (PetCO2) in all experimental conditions, compared to PetCO2 levels during rest breathing. Findings provide support for a theory of voice motor control suggesting that phonatory laryngeal resistance may be an essential, relatively immutable control parameter in phonation (except perhaps under extreme conditions not tested herein), and provides data on the influence of phonation on respiration. The current work sets the foundation for future studies of laryngeal function during phonation in individuals with lower airway disease

The Influence of Clinical Terminology on Self-Efficacy for Voice

AbstractThe present study sought (1) to determine if any evidence could be found of an influence of clinical language on self-efficacy for voice in adults with voice problems; and (2) to determine the number of subjects that would be required to undertake future large-scale study around this question, if warranted, based on effect sizes determined in the present investigation. The study¡¦s relevance has to do with prior concerns raised in the literature that common clinical language in voice care¡Xspecifically language indicating vocal ¡§abuse and misuse¡¨ as causal factors in selected voice disorders--has potential to harm self-efficacy for voice, which in turn may compromise patient compliance with treatment and thus clinical outcome (Verdolini, 1999). Fourteen teachers with self-reported voice disorders of unknown etiology were recruited as participants. Subjects were randomly assigned to one of two 15-min standardized, videotaped educational exposures by an unbiased clinician who was unaware of the experimental questions. One exposure described the origins of common voice problems in teachers in terms of vocal ¡§abuse/misuse¡¨ (N=7). The other exposure described the problems in terms of ¡§phonotraumatic behaviors and muscular tension¡¨ (N=7). Before and immediately after exposures, subjects completed a visual analogue scale Voice Self-Efficacy Questionnaire that was specially designed for the study, that assessed situation-neutral self-efficacy for voice. Psychometric evaluation of the tool indicated strong intra-rater and test-retest reliability (r „d. 99; r „d .78 respectively). The groups were also found to have no significant differences between them at the pre-test level, thus showing that amount of change on the post-test Voice Self-Efficacy Questionnaire were not influenced by individual subject differences on the pre-test. More conceptually interesting, binomial tests indicated that the majority of responses to self-efficacy questions reliably increased pre- to post exposure in the ¡§phonotrauma/muscle tension¡¨ (20/28 responses; p < .05), whereas no reliable change in scores was seen in the ¡§abuse/misuse¡¨ group (11/28 responses increased; non-significant). A Chi-Square test was conducted, and as with the binomial test, found a statistical difference between the 11 increased/28 possible self-efficacy responses of the ¡§abuse/misuse¡¨ group, and the 20/28 increased self-efficacy responses of the ¡§phonotrauma¡¨ group to the < .05 level. Results provide preliminary support for the hypothesis that clinical exposure to ¡§abuse/misuse¡¨ language may harm patients¡¦ self-efficacy for voice, not necessarily by decreasing pre-exposure self-efficacy but by compromising increases in self-efficacy that may normally be expected with patient education, as reported for other domains. The issue of self-efficacy for voice should be pursued in larger-scale studies in other laboratories. Effect sizes based on the present data indicated that at least 20 subjects per group (N=40 total) would be required to assess the effects of the noted terminology on voice-related self-efficacy shifts parametrically, using a similar experimental design

Structure based evolution of a novel series of positive modulators of the AMPA receptor

Starting from compound 1, we utilized biostructural data to successfully evolve an existing series into a new chemotyope with a promising overall profile, exemplified by

Shared genetic risk between eating disorder- and substance-use-related phenotypes:Evidence from genome-wide association studies

First published: 16 February 202

The genetic architecture of the human cerebral cortex

The cerebral cortex underlies our complex cognitive capabilities, yet little is known about the specific genetic loci that influence human cortical structure. To identify genetic variants that affect cortical structure, we conducted a genome-wide association meta-analysis of brain magnetic resonance imaging data from 51,665 individuals. We analyzed the surface area and average thickness of the whole cortex and 34 regions with known functional specializations. We identified 199 significant loci and found significant enrichment for loci influencing total surface area within regulatory elements that are active during prenatal cortical development, supporting the radial unit hypothesis. Loci that affect regional surface area cluster near genes in Wnt signaling pathways, which influence progenitor expansion and areal identity. Variation in cortical structure is genetically correlated with cognitive function, Parkinson's disease, insomnia, depression, neuroticism, and attention deficit hyperactivity disorder

Transancestral GWAS of alcohol dependence reveals common genetic underpinnings with psychiatric disorders

Liability to alcohol dependence (AD) is heritable, but little is known about its complex polygenic architecture or its genetic relationship with other disorders. To discover loci associated with AD and characterize the relationship between AD and other psychiatric and behavioral outcomes, we carried out the largest genome-wide association study to date of DSM-IV-diagnosed AD. Genome-wide data on 14,904 individuals with AD and 37,944 controls from 28 case-control and family-based studies were meta-analyzed, stratified by genetic ancestry (European, n = 46,568; African, n = 6,280). Independent, genome-wide significant effects of different ADH1B variants were identified in European (rs1229984; P = 9.8 x 10(-13)) and African ancestries (rs2066702; P = 2.2 x 10(-9)). Significant genetic correlations were observed with 17 phenotypes, including schizophrenia, attention deficit-hyperactivity disorder, depression, and use of cigarettes and cannabis. The genetic underpinnings of AD only partially overlap with those for alcohol consumption, underscoring the genetic distinction between pathological and nonpathological drinking behaviors.Peer reviewe

Behavioral Treatment of Voice Disorders in Teachers

INTRODUCTION: The purpose of this paper is to review the literature on the behavioral treatment of voice disorders in teachers. The focus is on phonogenic disorders, that is voice disorders thought to be caused by voice use. METHODS: Review of the literature and commentary. RESULTS: The review exposes distinct holes in the literature on the treatment of voice problems in teachers. However, emerging trends in treatment are noted. For example, most studies identified for review implemented a multiple-therapy approach in a group setting, in contrast to only a few studies that assessed a single-therapy approach with individual patients. Although the review reveals that the evidence around behavioral treatment of voice disorders in teachers is mixed, a growing body of data provides some indicators on how effectively rehabilitation of teachers with phonogenic voice problems might be approached. Specifically, voice amplification demonstrates promise as a beneficial type of indirect therapy and vocal function exercises as well as resonant voice therapy show possible benefits as direct therapies. Finally, only a few studies identified even remotely begin to meet guidelines of the Consolidated Standards of Reporting Trials statement, a finding that emphasizes the need to increase the number of investigations that adhere to strict research standards. CONCLUSIONS: Although data on the treatment of voice problems in teachers are still limited in the literature, emerging trends are noted. The accumulation of sufficient studies will ultimately provide useful evidence about this societally important issue

Development and Validation of a 3-Dimensional Flexible Laryngoscopy Training Simulator

The objective of this study was to validate the use of a 3-Dimensional Flexible Laryngoscopy Training Simulator. This is a simulation device development and validation study. Anonymized CT scan data from a head/neck CT of a patient with normal anatomy was imported and a head/neck digital model was created. A 3D simulation model was printed using a stiff (Stratasys Vero) and flexible (Stratasys Agilus) material combination with a ShoreA hardness value of 60. Novices and experts were instructed and provided 5 trials to pass the laryngoscope. The videos of the first and the last trial were recorded and evaluated by three different evaluators. Performances were measured by the amount of time spent and precision of the task. Repeated measures of ANOVA and generalized linear model with binomial proportion was used were utilized to analyze the data. The post training scores were statistically significantly higher than pre training scores (Mean: 15.57 vs. 13.01, p  &lt;0.0001) controlling for trainee experience. The time taken to complete a successful pass post training was statistically significantly lesser than pre training (Mean: 62.55 secs vs. 36.36 secs, p-value = 0.0007) controlling for individual’s experience. The odds of becoming skilled at the task was 4 times higher post training in comparison to pre training, controlling for individual’s experience (OR: 4.05, p-value: 0.0026). The 3-Dimensional Flexible Laryngoscopy Training Simulator is a valid trainer for both novice and experienced individuals. The simulator can improve technical skill performance and is critical for medical training

Development and Validation of a 3-Dimensional Flexible Laryngoscopy Training Simulator

The objective of this study was to validate the use of a 3-Dimensional Flexible Laryngoscopy Training Simulator. This is a simulation device development and validation study. Anonymized CT scan data from a head/neck CT of a patient with normal anatomy was imported and a head/neck digital model was created. A 3D simulation model was printed using a stiff (Stratasys Vero) and flexible (Stratasys Agilus) material combination with a ShoreA hardness value of 60. Novices and experts were instructed and provided 5 trials to pass the laryngoscope. The videos of the first and the last trial were recorded and evaluated by three different evaluators. Performances were measured by the amount of time spent and precision of the task. Repeated measures of ANOVA and generalized linear model with binomial proportion was used were utilized to analyze the data. The post training scores were statistically significantly higher than pre training scores (Mean: 15.57 vs. 13.01, p  &lt;0.0001) controlling for trainee experience. The time taken to complete a successful pass post training was statistically significantly lesser than pre training (Mean: 62.55 secs vs. 36.36 secs, p-value = 0.0007) controlling for individual’s experience. The odds of becoming skilled at the task was 4 times higher post training in comparison to pre training, controlling for individual’s experience (OR: 4.05, p-value: 0.0026). The 3-Dimensional Flexible Laryngoscopy Training Simulator is a valid trainer for both novice and experienced individuals. The simulator can improve technical skill performance and is critical for medical training