A Pilot Study Assessing the Therapeutic Potential of a Vibratory Positive Expiratory Pressure Device (Acapella Choice) in the Treatment of Voice Disorders

Introduction Semioccluded vocal tract exercises (SOVTEs) can involve a single source of vibration (eg, vocal folds in the straw exercise) or a dual source of vibration (eg, vocal folds and water bubbling in tube phonation) in the vocal tract. Oftentimes, this secondary source of vibration causes large oscillations in intraoral pressure and has been likened to a "massage effect." This study assesses the implementation of a positive expiratory pressure device (Acapella Choice) as a possible alternative SOVTE, which presents a secondary source of vibration without the need of a water container. Methods Twenty-two normophonic participants underwent acoustic, electroglottographic, and aerodynamic assessment before, during, and after phonation with two different established SOTVEs (silicone tube in water and straw in air) in addition to Acapella Choice. Results Acapella Choice produced the largest peak-to-peak amplitudes of intraoral pressure oscillation. Straw in air produced the largest static intraoral pressure. Straw in air and Acapella Choice presented significantly larger ranges of static pressures than tube in water phonation. Post-exercise condition showed a statistically larger sound pressure level for Acapella Choice. Conclusions Positive expiratory pressure devices, such as Acapella Choice, may be a promising alternative to established SOVTEs as it promotes large oscillatory pressures in the vocal tract without the need for a water container. This exercise also produces larger sound pressure level with no significant changes in glottic contact quotient, indicating improved vocal economy

Vero per finta. Scrittura e invenzione nella narrativa di Domenico Starnone.

La tesi è uno studio monografico sullo scrittore Domenico Starnone. È organizzata in due parti: nella prima la opere dello scrittore vengono analizzata a partire dal suo esordio con Ex Cattedra nel 1987 e fino al 2021, anno di pubblicazione di Vita mortale e immortale della bambina di Milano. È divisa in due parte: la prima è dedicata all’analisi delle singole opere secondo l’ordine cronologico di pubblicazione; nella seconda parte, invece, vengono messe in evidenza le forme e le strutture delle opere dello scrittore in ottica intertestuale. Divisa in quattro capitoli, si apre con l’ipotesi che alla base della scrittura di Starnone esista un repertorio di immagini narrative; tra queste immagini ricorrenti, ispirate a fatterelli dell’esperienza dell’autore, la figura della bambina di Milano verrà utilizzata come metafora di un modo dello scrittore di azionare l’invenzione e che tiene insieme la sua narrativa. Successivamente vengono affrontati tre tra i temi più presenti nel corpus: l’infanzia, Napoli e la scrittura; a questi temi verrà riconosciuto non solo il loro valore in quanto contenuto, ma anche la funzione strutturante che rivestono rispetto alle opere dello scrittore.Cette thèse est une étude monographique sur l'écrivain italien Domenico Starnone. L'écrivain est actuellement l'une des voix les plus influentes de la littérature italienne contemporaine : sa production a débuté en 1987 avec la publication de Ex Cattedra, un livre sur l'école italienne. Le roman qui a établi sa renommée est Via Gemito, lauréat du prix littéraire le plus prestigieux d'Italie, le Strega. La thèse est divisée en deux parties principales : la première est dédiée à l'étude des œuvres narratives de l’auteur selon l'ordre chronologique, la seconde met en évidence les formes et les structures de l'écriture de Starnone dans une perspective intertextuelle. La seconde partie est divisée en quatre chapitres dans lesquels sont abordées des questions décisives: le répertoire, l'enfance, la langue et l'écriture et la réception. Les résultats les plus significatifs de la recherche ont été obtenus dans cette partie : certaines figures récurrentes ont été identifiées dans le corpus, dont la lecture ne se limite pas à celle d'une trace autobiographique. L'exemple le plus pertinent est celui de « la petite fille de Milan », protagoniste de la dernière histoire de Starnone, qui était déjà apparue dans quelques livres précédents. Notre hypothèse est que la petite fille de Milan incarne le genre de littérature que Starnone veut écrire. Le chapitre sur l'enfance, quant à lui, se concentre sur le caractère fondateur de l'enfance par rapport à la connaissance et à la perception. La thèse se termine par deux questions auxquelles il serait profitable de donner plus d'espace : la présence constante de Naples et de son dialecte dans les textes de Starnone, ainsi que les influences que cette ville a eu sur son écriture, et la question de la réception, à laquelle se joint une réflexion sur l'identité de l'écrivain Elena Ferrante

The use of basic fibroblast growth factor to improve vocal function: A systematic review and meta-analysis

OBJECTIVES: This systematic review and meta-analysis examines if intralaryngeal injection of basic fibroblast growth factor 2 (FGF2) can improve voice outcomes in those with vocal disability. DESIGN: A Systematic review of original human studies reporting voice outcomes following intra-laryngeal injection of basic fibroblast growth factor 2 in those with vocal dysfunction. Databases searched were Medline (1946-July 2022), Embase (1947-July 2022), Cochrane database and Google Scholar. SETTING: Secondary or tertiary care centres that undertook the management of voice pathology Hospital. PARTICIPANTS: Inclusion criteria were original human studies reporting voice outcome measurements following intralaryngeal injection of FGF2 to treat vocal fold atrophy, vocal fold scarring, vocal fold sulcus or vocal fold palsy. Articles not written in English, studies that did not include human subjects and studies where voice outcome measures were not recorded before and after FGF2 injection were excluded from the review. MAIN OUTCOME MEASURES: The primary outcome measure was maximum phonation time. Secondary outcome measures included acoustic analysis, glottic closure, mucosal wave formation, voice handicap index and GRBAS scale. RESULTS: Fourteen articles were included out of a search of 1023 and one article was included from scanning reference lists. All studies had a single arm design without control groups. Conditions treated were vocal fold atrophy (n = 186), vocal cord paralysis (n = 74), vocal fold fibrosis (n = 74) and vocal fold sulcus (n = 56). A meta-analysis of six articles reporting on the use of FGF2 in patients with vocal fold atrophy showed a significant increase of mean maximum phonation time of 5.2 s (95% CI: 3.4-7.0) at 3-6 months following injection. A significant improvement in maximum phonation time, voice handicap index and glottic closure was found following injection in most studies assessed. No major adverse events were reported following injection. CONCLUSIONS: To date, intralaryngeal injection of basic FGF2 appears to be safe and it may be able to improve voice outcomes in those with vocal dysfunction, especially vocal fold atrophy. Randomised controlled trials are needed to further evaluate efficacy and support the wider use of this therapy

Examining Thermal Response of Steel Structural Elements with Fire Protection through Heat Transfer Analysis

Fires that affect buildings can have disastrous impacts, including significant losses to people, property, and the environment. Understanding how fires can impact structures provides the foundation to prevent structural collapse in fire. It is critical that the effect of fire is studied to protect the safety and welfare of civilians. The goal is to improve the resilience of structural systems affected by fire hazards. For steel structures, thermal barriers can be used as a method to prevent steel from exceeding critical temperatures during a fire. Spray-on fire protection is widely used to protect steel structures against fire since spray-on protective materials can efficiently slow down heat transfer from the fire to steel components, and hence lower the rate of temperature increase in steel components. To better understand the behavior of steel structures in fire, the effects of strength loss induced by increasing temperatures can be investigated. Examining the structure’s column capacity represents a core aspect of designing a fire-safe structure since column failure under the thermal load of fire can lead to high instability throughout the structure. The thermal response of structural members during exposure to a fire can be determined by using the principles of heat transfer. The goal of thesis is to quantify the relationship between thickness of fire protection and structural load carrying capacity of steel columns through the properties of conductive heat transfer during varying design-basis fire scenarios. To quantify the increase in fire resistance capacity of steel columns, two-dimensional heat transfer analyses were performed with varying thicknesses of fire protection, varying fire scenarios, and varying column section sizes. The results of this study indicate that spray-on fire protection can aid in increased protection against elevated temperatures in the event of a fire, helping to maintain the structural integrity of a building.Keywords: steel, column, heat transfer, fire, fire safety, fire protectio

Comparisons of Aerosol Generation Across Different Musical Instruments and Loudness

Highlights•Aerosol number and mass concentrations measured during musical instrument playing.•A 1 dBA increase in sound pressure level yields ∼10% increase in number concentration.•Loudness of playing explains some but not all differences across instruments.•Musical instrument playing size distributions are consistent with those of breathing.•Simple songs sufficient to characterise aerosol emission during actual performance.AbstractRespiratory aerosols can serve as vectors for disease transmission, and aerosol emission is highly activity-dependent. COVID-19 severely impacted the performing arts due to concerns about disease spread by respiratory aerosols and droplets generated during singing and playing musical instruments. Aerosol generation from woodwind and brass performance is less understood compared to singing due to uncertainty about how the diverse range of musical instruments may impact respiratory aerosol concentrations and size distributions. Here, aerosol number and mass concentrations along with size distributions were measured for breathing, speaking, and playing four different woodwind and brass instruments by 23 professional instrumentalists. We find that a 1 dBA increase in sound pressure level corresponds to a ∼10% increase in aerosol number concentration. The aerosol size distribution is consistent with that of breathing. Differences in aerosol emission across musical instruments can be partly explained by the loudness of performance. Measuring aerosol generation from single notes or simple songs may be sufficient to characterise the aerosol emission range during actual performance, provided a range of loudnesses are accessed. These results provide insight into the factors contributing to aerosol emission during musical performance and facilitate risk assessments associated with infectious respiratory disease transmission in the performing arts

Community-acquired Klebsiella pneumoniae meningitis in an alcoholic patient with an infected pancreatic pseudocyst; a case report and review of literature

We report a case of a 49-year-old male with a history of chronic alcoholism and evidence of a pancreatic pseudocyst on CT scanning. He presented with a 3-days history of fever, loss of appetite and upper abdominal pain. Blood cultures grew Klebsiella pneumoniae and he improved clinically with a seven-day course of intravenous co-amoxiclav and metronidazole. Two weeks later he was readmitted to hospital with impaired consciousness and septic shock, and died three days later in intensive care. Post mortem examination revealed bacterial meningitis and an infected pancreatic pseudocyst. Klebsiella pneumoniae was isolated from the pancreas and meninges

Incidence and trends of blastomycosis-associated hospitalizations in the United States

We used the State Inpatient Databases from the United States Agency for Healthcare Research and Quality to provide state-specific age-adjusted blastomycosis-associated hospitalization incidence throughout the entire United States. Among the 46 states studied, states within the Mississippi and Ohio River valleys had the highest age-adjusted hospitalization incidence. Specifically, Wisconsin had the highest age-adjusted hospitalization incidence (2.9 hospitalizations per 100,000 person-years). Trends were studied in the five highest hospitalization incidence states. From 2000 to 2011, blastomycosis-associated hospitalizations increased significantly in Illinois and Kentucky with an average annual increase of 4.4% and 8.4%, respectively. Trends varied significantly by state. Overall, 64% of blastomycosis-associated hospitalizations were among men and the median age at hospitalization was 53 years. This analysis provides a complete epidemiologic description of blastomycosis-associated hospitalizations throughout the endemic area in the United States

Pulmonary fungal infections

This review details some of the advances that have been made in the recent decade in the diagnosis, treatment and epidemiology of pulmonary fungal infections. These advances have occurred because of increasing knowledge regarding the fungal genome, better understanding of the structures of the fungal cell wall and cell membrane and the use of molecular epidemiological techniques. The clinical implications of these advances are more rapid diagnosis and more effective and less toxic antifungal agents. For example, the diagnosis of invasive pulmonary aspergillosis, as well as histoplasmosis and blastomycosis, has improved with the use of easily performed antigen detection systems in serum and bronchoalveolar lavage fluid. Treatment of angioinvasive moulds has improved with the introduction of the new azoles, voriconazole and posaconazole that have broad antifungal activity. Amphotericin B is less frequently used, and when used is often given as lipid formulation to decrease toxicity. The newest agents, the echinocandins, are especially safe as they interfere with the metabolism of the fungal cell wall, a structure not shared with humans cells. Epidemiological advances include the description of the emergence of Cryptococcus gattii in North America and the increase in pulmonary mucormycosis and pneumonia due to Fusarium and Scedosporium species in transplant recipients and patients with haematological malignancies. The emergence of azole resistance among Aspergillus species is especially worrisome and is likely related to increased azole use for treatment of patients, but also to agricultural use of azoles as fungicides in certain countries.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/92435/1/j.1440-1843.2012.02150.x.pd