Acoustical properties in inhaling singing : a case-study

A highly experienced versatile female professional singer displaying no apparent vocal complaint, developed inhaling singing, an innovative approach to reverse phonation. Although there are some reports in literature that describe the characteristics of ingressive phonation and sounds, to the best of our knowledge, no reports on actual inhaling singing are available in literature. This paper reports a case study on the acoustical analysis of inhaling singing, comparing this innovative technique with traditional exhaling singing. As this is rather undiscovered territory, we have decided to address several questions: is it possible to match the same pitches using inhaling singing compared to exhaling singing? Is the harmonic structure and energy distribution similar? Is it possible to maintain the same phonation duration in both techniques? Are there differences in volume and tessitura (vocal range)? This paper, reporting on the experience of one individual, demonstrates that a tessitura can be mastered in inhaling singing. Spectral analysis reveals a similar frequency distribution in both conditions. However, in inhaling singing the energy of the harmonics is significantly lower for the first 3 overtones, while the maximum phonation time is larger, than in exhaling singing. The singer reports that less effort is required for inhaling singing in the high register. As such, inhaling singing offers new possibilities for vocal performance

Driving pressure during general anesthesia for open abdominal surgery (DESIGNATION) : study protocol of a randomized clinical trial

Background Intraoperative driving pressure (Delta P) is associated with development of postoperative pulmonary complications (PPC). When tidal volume (V-T) is kept constant, Delta P may change according to positive end-expiratory pressure (PEEP)-induced changes in lung aeration. Delta P may decrease if PEEP leads to a recruitment of collapsed lung tissue but will increase if PEEP mainly causes pulmonary overdistension. This study tests the hypothesis that individualized high PEEP, when compared to fixed low PEEP, protects against PPC in patients undergoing open abdominal surgery. Methods The "Driving prESsure durIng GeNeral AnesThesIa for Open abdomiNal surgery trial" (DESIGNATION) is an international, multicenter, two-group, double-blind randomized clinical superiority trial. A total of 1468 patients will be randomly assigned to one of the two intraoperative ventilation strategies. Investigators screen patients aged >= 18 years and with a body mass index <= 40 kg/m(2), scheduled for open abdominal surgery and at risk for PPC. Patients either receive an intraoperative ventilation strategy with individualized high PEEP with recruitment maneuvers (RM) ("individualized high PEEP") or one in which PEEP of 5 cm H2O without RM is used ("low PEEP"). In the "individualized high PEEP" group, PEEP is set at the level at which Delta P is lowest. In both groups of the trial, V-T is kept at 8 mL/kg predicted body weight. The primary endpoint is the occurrence of PPC, recorded as a collapsed composite of adverse pulmonary events. Discussion DESIGNATION will be the first randomized clinical trial that is adequately powered to compare the effects of individualized high PEEP with RM versus fixed low PEEP without RM on the occurrence of PPC after open abdominal surgery. The results of DESIGNATION will support anesthesiologists in their decisions regarding PEEP settings during open abdominal surgery

Well being of obstetric patients on minimal blood transfusions (WOMB trial)

Background: Primary postpartum haemorrhage is an obstetrical emergency often causing acute anaemia that may require immediate red blood cell (RBC) transfusion. This anaemia results in symptoms such as fatigue, whic

Protective intraoperative ventilation with higher versus lower levels of positive end-expiratory pressure in obese patients (PROBESE): study protocol for a randomized controlled trial

Background: Postoperative pulmonary complications (PPCs) increase the morbidity and mortality of surgery in obese patients. High levels of positive end-expiratory pressure (PEEP) with lung recruitment maneuvers may improve intraoperative respiratory function, but they can also compromise hemodynamics, and the effects on PPCs are uncertain. We hypothesized that intraoperative mechanical ventilation using high PEEP with periodic recruitment maneuvers, as compared with low PEEP without recruitment maneuvers, prevents PPCs in obese patients. Methods/design The PRotective Ventilation with Higher versus Lower PEEP during General Anesthesia for Surgery in OBESE Patients (PROBESE) study is a multicenter, two-arm, international randomized controlled trial. In total, 2013 obese patients with body mass index ≥35 kg/m2 scheduled for at least 2 h of surgery under general anesthesia and at intermediate to high risk for PPCs will be included. Patients are ventilated intraoperatively with a low tidal volume of 7 ml/kg (predicted body weight) and randomly assigned to PEEP of 12 cmH2O with lung recruitment maneuvers (high PEEP) or PEEP of 4 cmH2O without recruitment maneuvers (low PEEP). The occurrence of PPCs will be recorded as collapsed composite of single adverse pulmonary events and represents the primary endpoint. Discussion To our knowledge, the PROBESE trial is the first multicenter, international randomized controlled trial to compare the effects of two different levels of intraoperative PEEP during protective low tidal volume ventilation on PPCs in obese patients. The results of the PROBESE trial will support anesthesiologists in their decision to choose a certain PEEP level during general anesthesia for surgery in obese patients in an attempt to prevent PPCs. Trial registration ClinicalTrials.gov identifier: NCT02148692. Registered on 23 May 2014; last updated 7 June 2016. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-1929-0) contains supplementary material, which is available to authorized users

Filling Polyhedral Molds

In the manufacturing industry, finding an orientation for a mold that eliminates surface defects and ensures a complete fill after termination of the gravity casting process, is an important and difficult problem. We study the problem of determining a favorable position of a mold (modeled as a polyhedron), such that when it is filled, no air pockets and ensuing surface defects arise. Given a polyhedron in a fixed orientation, we present a linear time algorithm that determines whether the mold can be filled from that orientation without forming air pockets

Filling polyhedral molds

In manufacturing industry, finding an orientation for a mold that eliminates surface defects and ensures a complete fill after termination of the gravity casting process is an important and difficult problem. We study the problem of determining a favorable position of a mold (modeled as a polyhedron) such that, when it is filled, no air pockets and ensuing surface defects arise. Given a polyhedron in a fixed orientation, we present a linear time algorithm that determines whether the mold can be filled from that orientation without forming air pockets. We also present an algorithm that determines the most favorable orientation for a polyhedral mold in O(n2) time. A reduction from a well-known problem indicates that improving the O(n2) bound is unlikely for general polyhedral molds. We relate fillability to some well known classes of polyhedra. For some of these classes of objects, an optimal direction of fillability can be determined in linear time. Finally, for molds that satisfy a local regularity condition, we give an improved algorithm that runs in time O(nklog2 nlog log(n/k)), where k is the number of venting holes needed to avoid air pockets in an optimal orientation

Filling Polyhedral Molds

In the manufacturing industry, finding an orientation for a mold that eliminates surface defects and insures a complete fill after termination of the gravity casting process, is an important and difficult problem. We study the problem of determining a favorable position of a mold (modeled as a polyhedron), such that when it is filled, no air bubbles and ensuing surface defects arise. Given a polyhedron in a fixed orientation, we present a linear time algorithm that determines whether the mold can be filled from that orientation without forming air bubbles. We also present an algorithm that determines the most favorable orientation for a polyhedral mold in O(n 2 ) time. A reduction from a well-known problem indicates that improving the O(n 2 ) bound is unlikely for general polyhedral molds. We relate fillability to some well known classes of polyhedra. For some of these classes of objects, an optimal direction of fillability can be determined in linear time. Finally, for molds that ..

Adoption of a Postoperative Pain Self-Report Tool: Qualitative Study

Background: With electronic technologies, patients are provided with tools to easily acquire information and to manage and record their own health status. eHealth interventions are already broadly applied to perioperative care. In a similar way, we aimed to utilize a smartphone application to enable postoperative patients to partially self-manage their postoperative pain. The results of a previously performed proof-of-concept study regarding the application were promising, and nurses as well as patients were optimistic regarding this innovative mobile application. Nevertheless, in reality, it appears that the usage and overall implementation of this application have stagnated since its introduction. Problems with innovation adoption are not novel; various studies have been conducted to explore the reasons for low implementation success of eHealth applications and indicated that adoption is influenced by multiple organizational factors. This study investigated the influence of these organizational factors on the adoption process, aiming to provide more insight in the dos and don'ts for implementing eHealth in the working processes of hospital care. Objective: This study aimed to provide insight in how to successfully implement a technological eHealth innovation in a general nonacademic hospital. Methods: A qualitative study was conducted to explore organizational factors affecting the innovation adoption process. Data were collected by conducting semistructured one-on-one interviews with 11 stakeholders. The data were analyzed using thematic analysis identifying overarching themes. Results: Absorptive capacity, referred to as an organization's dynamic capability pertaining to knowledge creation and utilization that enhances an organization's ability to gain and sustain a competitive advantage, was regarded as the most influential factor on the application's adoption. Accordingly, it appeared that innovation adoption is mainly determined by the capability and willingness to assimilate and transform new information into productive use and the ability to absorb a novel innovation. Absorptive capacity was found to be influenced by the innovation's benefit and the sense of ownership and responsibility. Organizational readiness and management support were also regarded as essential since absorptive capacity seemed to be mediated by these factors. The size of the hospital influenced eHealth adoption by the amount of resources available and by its organizational structure. Conclusions: In conclusion, absorptive capacity is essential for eHealth adoption, and it is mediated by management support and organizational readiness. It is recommended to increase the degree of willingness and ability to adopt an eHealth innovation by enhancing the relevance, engaging stakeholders, and assigning appropriate leaders to offer guidance