Reliability of GRBAS evaluation of voice quality in children who have a history of airway reconstruction surgery and how this compares to parental report of voice-related quality of life

Voice evaluation includes laryngoscopy, perceptual judgement of voice quality, evaluation of respiratory function, acoustic analysis of the voice signal and patient reported subjective impact of voice on quality of life. This is recommended in adults (Dejonkere et al 2001) and children (Cohen et al 2012). Perceptual evaluation of voice often follows the CAPE-V (ASHA 2002) or GRBAS (Hirano 1981). Children requiring laryngotracheal reconstruction (LTR) surgery tend to have this procedure during infancy, where subglottic stenosis forms following intubation in medically fragile or premature infants. Clinicians require reliable measures, particularly where there is a degree of subjectivity. Aspects of the CAPE-V show a high degree of reliability in rating of severity, pitch, breathiness and roughness (Krival et al 2007, Kelchner et al 2008). UK clinicians favour the GRBAS though there is little published information about reliability in a paediatric population. Comparison of clinician perceptual evaluation with patient report shows weak agreement in adults (Karnell et al 2006) reinforcing the need for both measurements. The extent to which the same is the case in children needs further exploration

What are We Talking About? Data Use Among Education Leaders of Change

In a time when fewer resources force school leaders to make critical decisions, the data-driven decision-making model continues to offer promise. This research project provides observations about factors used for decision making from 14 district leaders across five Iowa school districts. Placing these factors for decision making within the framework of a data driven decision making model provides insights for school leaders striving to increase the efficiency and effectiveness of decision making in their own districts. In doing so, educational leaders might ultimately implement educational change with greater effectiveness

Laryngoscopic and acoustic voice data of children following laryngo-tracheal reconstruction and cricotracheal resection surgery : a long term follow up

Objectives: Laryngeal airway narrowing from subglottic stenosis (SGS) may be congenital or acquired, with many cases of SGS acquired following intubation or laryngotracheal injury. Two main approaches to reconstructive surgical management exist: laryngotracheal reconstruction (LTR) and partial cricotracheal resection (CTR). Primary surgical outcome indicators continue to be survival or decannulation of the tracheostomy. LTR and CTR procedures have been undertaken in Glasgow since the early 1980s. A retrospective audit of parents’ perspectives on quality of life for their children showed overwhelming concerns relating to breathing, respiratory tract infections and voice quality in their children; in addition to concerns relating to independence and the ability to lead a normal life. This study evaluated the voice outcomes of children over the age of 5 who have had LTR/CTR at the hospital in Glasgow. This paper explores specifically the laryngeal vibratory mechanisms used by children who have undergone LTR or CTR in order to produce voice and how this relates to acoustic features of voice for each child compared to published normative acoustic data for an English speaking paediatric/adolescent population. Methods: Participants were recruited through a cohort analysis. All surviving children who had undergone LTR or CTR at the hospital and were >5years (n = 56) were invited to take part in this study through postal information leaflets. 16 participants opted in to the study, 12 attended for data collection appointments, 1 withdrew participation and 3 failed to attend the appointment. Awake laryngoscopy and voice recordings were taken for each participant. Audio recordings followed a standard protocol where each child produced a single sustained vowel sound [a] four times. The audio recordings took place in a sound-proofed audiology room located in the children’s hospital to reduce the impact of background noise on the stability of the audio files. Acoustic analysis was performed from the recording of the sustained vowel [a] using the acoustic analysis software Multi-Dimensional Voice Programme (MDVP). Fundamental frequency and three perturbation measures (jitter percentage, shimmer percentage and noise to harmonic ratio) were measured from the middle 3.5 seconds of the voiced segment produced in the fourth recording. Results: There was a range of vibratory mechanisms observed in all of the participants. For four children, all the acoustic analysis findings were within the normal range. These four participants are discussed in relation to the laryngeal visualisation observations. Conclusions: Normal voice outcome is a potential outcome for children evaluated long term following LTR/CTR. The extent to which these outcomes relates to initial surgical intervention is worthy of exploration

Cross-sectional follow up of voice outcomes in children who have a history of airway reconstruction surgery

Objectives - This study reports vocal function in a cross-section of children with subglottic stenosis. Each child had a history of laryngotracheal reconstruction and/or cricotracheal resection surgery. Vocal function was measured using laryngoscopy, acoustic analysis, perceptual evaluation and impact of voice on quality of life.  Design - All patients aged >5 years with history of laryngotracheal reconstruction and/or cricotracheal resection surgery at the Scottish National Complex Airways service were invited to participate.  Setting - Data was gathered in the Royal Hospital for Children in Glasgow in a single out-patient appointment. Participants - Twelve out of fifty-six former patients (aged 5 – 27) provided a voice sample and eleven consented to awake laryngoscopy. All consented for detailed evaluation of their medical records.  Main outcome measures - Acoustic analysis of fundamental frequency and pitch perturbation was conducted on sustained vowel [a]. Perceptual evaluation was conducted by four trained listeners on a series of spoken sentences. Impact on quality of life was measured using the Paediatric Voice Related Quality of Life questionnaire. Laryngeal function was descriptively evaluated.  Results - Four children had normal voice acoustically, perceptually and in relation to voice related quality of life. One of these had vocal fold nodules unrelated to surgical history. Two other children had ‘near normal’ vocal function, defined where most voice measurements fell within the normal range.  Conclusions - Normal or ‘near normal’ voice is a possible outcome for children who have had this surgery. Where there is an ongoing complex medical condition, voice outcome may be poorer

Perceptual evaluation of voice disorder in children who have had laryngotracheal reconstruction surgery and the relationship between clinician perceptual rating of voice quality and parent proxy/child self-report of voice related quality of life

Reliability of the GRBAS tool for perceptual evaluation of paediatric voice disorder is measured in this study of children with a history of laryngotracheal reconstruction surgery (LTR). Additionally, the relationship between parent proxy/child self-report of voice related quality of life with clinician perceptual rating of voice quality is analysed. Eleven children with a history of LTR provided voice recordings following the stimuli set by the CAPE-V protocol. Subjective impact of voice quality on life was measured using the Pediatric Voice-Related Quality of Life Questionnaire. Four trained judges rated the sound files according to both the GRBAS and CAPE-V protocol. Intraclass correlation coefficients were high for both intrarater and interrater judgements across all parameters of the GRBAS protocol, and a strong correlation was found between the Grade rating of the GRBAS and the Overall Severity rating of the CAPE-V. Some elements of parent proxy reporting of VRQOL were significantly negatively correlated with clinician perceptual rating of voice quality, while there was no significant relationship between child self-report and clinician perceptual rating

X-ray Evolution of SNR 1987A: The Radial Expansion

We present the evolution of the radial expansion of SNR 1987A as measured using Chandra X-ray observations taken over the last 10 years. To characterize the complex structure of the remnant and isolate the expansion measurement, we fit the images to several empirical models including: a simple circular torus, a torus with bilateral lobes, and a torus with four tangentially extended lobes. We discuss the results of this measure in the context of the overall evolution of the supernova remnant, for which we believe we have measured the end of the free expansion phase and its transition to the adiabatic phase (at least along the equatorial ring). The timing of this event is in agreement with early predictions of the remnant evolution.Comment: Accepted for publication in ApJ, 21 pages, 4 figures, 3 table

Type Ia Supernova Nucleosynthesis: Metallicity-Dependent Yields

Type Ia supernova explosions (SNIa) are fundamental sources of elements for the chemical evolution of galaxies. They efficiently produce intermediate-mass (with Z between 11 and 20) and iron group elements - for example, about 70% of the solar iron is expected to be made by SNIa. In this work, we calculate complete abundance yields for 39 models of SNIa explosions, based on three progenitors - a 1.4M deflagration detonation model, a 1.0 double detonation model and a 0.8 M double detonation model - and 13 metallicities, with 22Ne mass fractions of 0, 1x10-7, 1x10-6, 1x10-5, 1x10-4, 1x10-3, 2x10-3, 5x10-3, 1x10-2, 1.4x10-2, 5x10-2, and 0.1 respectively. Nucleosynthesis calculations are done using the NuGrid suite of codes, using a consistent nuclear reaction network between the models. Complete tables with yields and production factors are provided online at Zenodo: Yields. We discuss the main properties of our yields in the light of the present understanding of SNIa nucleosynthesis, depending on different progenitor mass and composition. Finally, we compare our results with a number of relevant models from the literature.Comment: 42 pages, 21 figures. Accepted for publication in ApJS 21-06-2

Ecology of Feral Pigeons: Population Monitoring, Resource Selection, and Management Practices

Feral pigeons (Columba livia) are typically ignored by ornithologists but can be found roosting in the thousands within cities across the world. Pigeons have been known to spread zoonoses, through ectoparasites and excrement they produce. Along with disease, feral pigeons have an economic impact due to the cost of cleanup and maintenance of human infrastructure. Many organizations have tried to decrease pigeon abundances through euthanasia or use of chemicals that decrease reproductive output. However, killing pigeons has been unsuccessful in decreasing abundance, and chemical inhibition can be expensive and must be used throughout the year. A case study at Texas Tech University has found that populations fluctuate throughout the year, making it difficult to manage numbers. To successfully decrease populations, it is important to have a multifaceted approach that includes removing necessary resources (i. e. nest sites and roosting areas) and decreasing the number of offspring through humane techniques