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

Do structured methods help eco-innovation: An evaluation of the product ideas tree diagram

This paper reports on the first test of the Product Ideas Tree diagram (PIT): a structured method aimed to help Eco-innovation. The PIT diagram structures ideas output from chaotic idea generating sessions. This study compared four ways of conducting an Eco-innovation workshop. The results show that structured methods help Eco-innovation by improving the constructive communication between the participants. Further development of the PIT diagram promises to contribute several new approaches to sustainable product and process design

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

Involute composite design evaluation using global design sensitivity derivatives

An optimization capability for involute structures has been developed. Its key feature is the use of global material geometry variables which are so chosen that all combinations of design variables within a set of lower and upper bounds correspond to manufacturable designs. A further advantage of global variables is that their number does not increase with increasing mesh density. The accuracy of the sensitivity derivatives has been verified both through finite difference tests and through the successful use of the derivatives by an optimizer. The state of the art in composite design today is still marked by point design algorithms linked together using ad hoc methods not directly related to a manufacturing procedure. The global design sensitivity approach presented here for involutes can be applied to filament wound shells and other composite constructions using material form features peculiar to each construction. The present involute optimization technology is being applied to the Space Shuttle SRM nozzle boot ring redesigns by PDA Engineering

Fully automated segmentation and tracking of the intima media thickness in ultrasound video sequences of the common carotid artery

Abstract—The robust identification and measurement of the intima media thickness (IMT) has a high clinical relevance because it represents one of the most precise predictors used in the assessment of potential future cardiovascular events. To facilitate the analysis of arterial wall thickening in serial clinical investigations, in this paper we have developed a novel fully automatic algorithm for the segmentation, measurement, and tracking of the intima media complex (IMC) in B-mode ultrasound video sequences. The proposed algorithm entails a two-stage image analysis process that initially addresses the segmentation of the IMC in the first frame of the ultrasound video sequence using a model-based approach; in the second step, a novel customized tracking procedure is applied to robustly detect the IMC in the subsequent frames. For the video tracking procedure, we introduce a spatially coherent algorithm called adaptive normalized correlation that prevents the tracking process from converging to wrong arterial interfaces. This represents the main contribution of this paper and was developed to deal with inconsistencies in the appearance of the IMC over the cardiac cycle. The quantitative evaluation has been carried out on 40 ultrasound video sequences of the common carotid artery (CCA) by comparing the results returned by the developed algorithm with respect to ground truth data that has been manually annotated by clinical experts. The measured IMTmean ± standard deviation recorded by the proposed algorithm is 0.60 mm ± 0.10, with a mean coefficient of variation (CV) of 2.05%, whereas the corresponding result obtained for the manually annotated ground truth data is 0.60 mm ± 0.11 with a mean CV equal to 5.60%. The numerical results reported in this paper indicate that the proposed algorithm is able to correctly segment and track the IMC in ultrasound CCA video sequences, and we were encouraged by the stability of our technique when applied to data captured under different imaging conditions. Future clinical studies will focus on the evaluation of patients that are affected by advanced cardiovascular conditions such as focal thickening and arterial plaques

NASTRAN as a resource in code development

A case history is presented in which the NASTRAN system provided both guidelines and working software for use in the development of a discrete element program, PATCHES-111. To avoid duplication and to take advantage of the wide spread user familiarity with NASTRAN, the PATCHES-111 system uses NASTRAN bulk data syntax, NASTRAN matrix utilities, and the NASTRAN linkage editor. Problems in developing the program are discussed along with details on the architecture of the PATCHES-111 parametric cubic modeling system. The system includes model construction procedures, checkpoint/restart strategies, and other features

Meixner polynomials of the second kind and quantum algebras representing su(1,1)

We show how Viennot's combinatorial theory of orthogonal polynomials may be used to generalize some recent results of Sukumar and Hodges on the matrix entries in powers of certain operators in a representation of su(1,1). Our results link these calculations to finding the moments and inverse polynomial coefficients of certain Laguerre polynomials and Meixner polynomials of the second kind. As an immediate consequence of results by Koelink, Groenevelt and Van Der Jeugt, for the related operators, substitutions into essentially the same Laguerre polynomials and Meixner polynomials of the second kind may be used to express their eigenvectors. Our combinatorial approach explains and generalizes this "coincidence".Comment: several correction

Letter from E. M. Stanton to John Muir, 1907 Aug 14.

[1]Chicago Aug 14 1907Mr John Muir-Martinez Calif.My Dear Sir;My visit to Yosemite some 20 years ago while living in Calif. and my only i[illegible] acquaintance with you was a never to be forgotten incident in my life, making me one of your many sincere admirers.I met your daughter last summer at Adamana Arizona, I very much desired to see you and deeply regreted the circumstances which prevented it.I would like very much to get your report on the Petrified forests of Arizona if you have as yet written one. Also if I am not imposing would like an autograph copy of each of your books. I have copys of them and can get them here of course03918 [2][letterhead]but would like an autograph copy from you.My visit last summer to the Yosemite and the old haunts increased, if possible my regard for you, the love for your books and the places and conditions they so faithfully describeYou will not remember me of course but never mind I remember you. If the enclosed check will not cover expenses kindly let me know and I will forward the [balance?]Yours Very TrulyE. M. Stanton.0391

Letter from E. W. Stanton

Letter of recommendation for E. D. Ball