The social spa concept design. An investigation of innovative experience services which need to be included in a spa concept to encourage socializing. A case study of Germany

http://www.ester.ee/record=b4743041*es

Validation and Classification of the 9-Item Voice Handicap Index (VHI-9i)

The international nine-item Voice Handicap Index (VHI-9i) is a clinically established short-scale version of the original VHI, quantifying the patients’ self-assessed vocal handicap. However, the current vocal impairment classification is based on percentiles. The main goals of this study were to establish test–retest reliability and a sound statistical basis for VHI-9i severity levels. Between 2009 and 2021, 17,660 consecutive cases were documented. A total of 416 test–retest pairs and 3661 unique cases with complete multidimensional voice diagnostics were statistically analyzed. Classification candidates were the overall self-assessed vocal impairment (VHIs) on a four-point Likert scale, the dysphonia severity index (DSI), the vocal extent measure (VEM), and the auditory–perceptual evaluation (GRB scale). The test–retest correlation of VHI-9i total scores was very high (r = 0.919, p < 0.01). Reliability was excellent regardless of gender or professional voice use, with negligible dependency on age. The VHIs correlated best with the VHI-9i, whereas statistical calculations proved that DSI, VEM, and GRB are unsuitable classification criteria. Based on ROC analysis, we suggest modifying the former VHI-9i severity categories as follows: 0 (healthy): 0 ≤ 7; 1 (mild): 8 ≤ 16; 2 (moderate): 17 ≤ 26; and 3 (severe): 27 ≤ 36

Pathology-Related Influences on the VEM: Three Years’ Experience since Implementation of a New Parameter in Phoniatric Voice Diagnostics

The vocal extent measure (VEM) represents a new diagnostic tool to express vocal capacity by quantifying the dynamic performance and frequency range of voice range profiles (VRPs). For VEM calculation, the VRP area is multiplied by the quotient of the theoretical perimeter of a circle with equal VRP area and the actual VRP perimeter. Since different diseases affect voice function to varying degrees, pathology-related influences on the VEM should be investigated more detailed in this retrospective study, three years after VEM implementation. Data was obtained in a standardized voice assessment comprising videolaryngostroboscopy, voice handicap index (VHI-9i), and acoustic-aerodynamic analysis with automatic calculation of VEM and dysphonia severity index (DSI). The complete dataset comprised 1030 subjects, from which 994 adults (376 male, 618 female; 18-86 years) were analyzed more detailed. The VEM differed significantly between pathology subgroups (p<0.001) and correlated with the corresponding DSI values. Regarding VHI-9i, the VEM reflected the subjective impairment better than the DSI. We conclude that the VEM proved to be a comprehensible and easy-to-use interval-scaled parameter for objective VRP evaluation in all pathology subgroups. As expected, exclusive consideration of the measured pathology-related influences on the VEM does not allow conclusions regarding the specific underlying diagnosis

The economic impact of the bacterial blight of soybean under European agroclimatic conditions

The economic impact of the bacterial blight of soybean caused by Pseudomonas syringae pv. glycinea has been investigated in three countries belonging to the European Union: Italy, France and Spain. Weather and growing conditions have been monitored over three years of field experiments (1992-1994) and the data analysed in order to evaluate possible yield losses and in view of the production of pathogen free seed. In Italy and France, using different cultivars and seed with a contamination level of 0.5-20% no significant yield losses were found. In Italy the initial seed contamination level was positively correlated with the contamination of the harvested seed by the pathogen; both in Italy and in France on some cultivars, it was possible to correlate seed contamination level with the epiphytic population of the pathogen and the intensity of symptoms affecting plants in the field. No epiphytic contamination by the pathogen was observed in Spain, even at the highest seed contamination rate (20%), and there was no disease in the field and no yield reduction. The pathogen seemed not to become systemic since no contamination was observed on seed aseptically taken in the field just before harvest. The experiments highlighted the low impact of soybean bacterial blight under European climatic conditions, but suggested the choice of dry and warm regions for the production of quality seed to prevent the accumulation of effective inoculum on the seed year by year

Evaluation of the long-term use of VHI-9i and VEM in multidimensional phoniatric voice function diagnostics

Die drei Studien dieser kumulativen Dissertation widmen sich der multiparametrischen phoniatrischen Stimmfunktionsdiagnostik, wobei der besondere Fokus auf den Kurzfassungen des Voice Handicap Index (VHI-9i, VHI-12) sowie dem Stimmumfangsmaß (SUM) liegt. Die erste Studie beschäftigte sich mit der Validierung des VHI-9i als subjektives diagnostisches Instrument in der Stimmanalyse. Der Fragebogen stellte sich als äußerst reliabel heraus. Durch die Korrelation mit anderen etablierten Stimmfunktionsparametern und die Klassifikation mittels statistischer Verfahren konnte der VHI-9i erfolgreich validiert werden, wobei sich die Selbsteinschätzung der aktuellen Stimmbeeinträchtigung (VHIs) als geeignetster Kandidat für eine Klassifizierung erwies. Aufgrund unserer Studienergebnisse empfehlen wir die folgende VHI-9i-Klassifikation: Schweregrad 0 (keine Stimmstörung): 0 ≤ 7 Punkte; Schweregrad 1 (geringgradige Stimmstörung): 8 ≤ 16 Punkte; Schweregrad 2 (mittelgradige Stimmstörung): 17 ≤ 26 Punkte; Schweregrad 3 (hochgradige Stimmstörung): 27 ≤ 36 Punkte. Die zweite Studie untersuchte die Zusammenhänge zwischen den Stimmfunktionsparametern Dysphonia Severity Index (DSI), SUM, VHI-12 und der auditiv-perzeptiven Beurteilung der Rauigkeit (R), Behauchtheit (B) bzw. Gesamtheiserkeit (H) bei Patienten mit verschiedensten stimmlichen Beeinträchtigungen. Besonderes Augenmerk lag dabei auf dem SUM als einem neuen, einfach handhabbaren und potentiell stabileren Parameter im Vergleich zum etablierten DSI. Die Studie zeigte, dass prinzipiell alle untersuchten Stimmfunktionsparameter zur Evaluation des Therapieerfolgs geeignet sind, wobei das SUM als objektives Maß zur Quantifizierung der stimmlichen Leistungsfähigkeit auch die subjektiven Einschätzungen mittels VHI-12 und RBH-Systematik widerspiegelt. Die dritte Studie befasste sich mit dem onkologischen und stimmbezogenen Outcome nach transoraler CO2-Lasermikrochirurgie (TOLMS) bei Patienten mit T1a-Stimmlippenkarzinomen. Dazu wurden die Stimmen prä- und posttherapeutisch multiparametrisch untersucht. Mittels TOLMS ließen sich sehr gute onkologische Behandlungsergebnisse erzielen: Die 5-Jahres-Wahrscheinlichkeiten für das rezidivfreie, das Gesamt- und das krankheitsspezifische Überleben nach Kaplan-Meier betrugen 71,4%, 94,4% und 100%. Alle subjektiven Stimmfunktionsparameter (VHI-9i, VHIs, RBH) verbesserten sich postoperativ signifikant. Von den objektiven Parametern verbesserte sich nur das SUM signifikant in der Gesamtkohorte, bei allen Chordektomie-Typen und bei getrennter Betrachtung beider Geschlechter. Außerdem repräsentierte das SUM die subjektive Stimmbeeinträchtigung am besten aufgrund seiner hohen Korrelation mit dem VHI-9i. Insgesamt kann aus den Studien geschlussfolgert werden, dass VHI-9i und SUM hervorragende Ergänzungen zu den etablierten Parametern DSI, RBH sowie der originalen VHI-Langfassung darstellen. Beide Parameter quantifizieren zuverlässig die subjektive stimmliche Beeinträchtigung bzw. die objektive Leistungsfähigkeit der Stimme und eignen sich zur verlässlichen Dokumentation von Behandlungsergebnissen. Ihr universeller Einsatz in der multiparametrischen phoniatrischen Stimmfunktionsdiagnostik erscheint sinnvoll und erstrebenswert, da sie die aktuelle Stimmdiagnostik erweitern und verbessern.The three studies in this cumulative dissertation deal with multidimensional phoniatric voice function diagnostics and focus on the short forms of the Voice Handicap Index (VHI-9i, VHI-12) and the Vocal Extent Measure (VEM). The first study addressed the validation of the VHI-9i as a subjective diagnostic tool in voice analysis. The questionnaire was found to be highly reliable. The VHI-9i was successfully validated by correlation with other established vocal parameters and statistical classification methods. The current self-assessed voice impairment (VHIs) proved to be the most appropriate candidate for classification. Based on our results, we recommend the following VHI-9i categories: severity level 0 (no impairment): 0 ≤ 7 points; level 1 (mild impairment): 8 ≤ 16 points; level 2 (moderate impairment): 17 ≤ 26 points; level 3 (severe impairment): 27 ≤ 36 points. The second study investigated the relationships between the vocal parameters Dysphonia Severity Index (DSI), VEM, VHI-12, and the auditory-perceptual assessment of roughness (R), breathiness (B), and overall grade of hoarseness (G) in patients with various voice disorders. Particular emphasis was placed on the VEM as a new, easy-to-use and potentially more stable parameter than the established DSI. The study showed that all investigated vocal parameters are suitable for evaluating therapy success. The VEM as an objective measure for quantifying vocal performance closely mirrored subjective VHI-12 and GRB assessments. The third study examined oncological and vocal outcomes after transoral CO2 laser microsurgery (TOLMS) in T1a vocal fold cancer patients. Therefore, voices were evaluated pre- and post-therapeutically using a multidimensional approach. Oncological treatment results via TOLMS were excellent: The 5-year Kaplan-Meier estimates for recurrence-free, overall, and disease-specific survival were 71.4%, 94.4%, and 100%. Postoperatively, all subjective vocal parameters (VHI-9i, VHIs, GRB) improved significantly. Among the objective parameters, only the VEM improved significantly in the overall cohort, all cordectomy types, and both genders. Additionally, the VEM represented subjective voice impairment the best because of its high correlation with the VHI-9i. We conclude that VHI-9i and VEM are excellent additions to the established DSI, GRB, and the original VHI questionnaire. Both parameters reliably quantify subjective voice impairment as well as objective vocal performance and are suitable for documenting treatment results. Their widespread use in multidimensional phoniatric voice function diagnostics seems reasonable and desirable, since they expand and enhance current voice diagnostics

Experience Versus Report: Where Are Changes Seen After Exposure-Based Cognitive-Behavioral Therapy? A Randomized Controlled Group Treatment of Childhood Social Anxiety Disorder

A considerable number of children and adolescents with social anxiety disorder (SAD) do not benefit from treatment as much as expected. However, treatment success should not be measured with social anxiety reports alone; the cognitive, behavioral, and physiological components of social stress should also be assessed. The authors examined an exposure-based SAD-specific group cognitive behavioral therapy (CBT) in a randomized controlled trial (N = 67, age 9-13 years, blind randomized allocation to treatment [CBT; n = 31] and waitlist control [WLC; n = 36] groups). Success was operationalized as a clinically significant reduction of symptoms measured with SAD-specific questionnaires, structured interviews, and changes in response to the Trier Social Stress Test (TSST). In the CBT group, there was a trend toward a significant increase in positive cognitions in the TSST after treatment (d = 0.37), whereas these positive cognitions decreased in the WLC group (d = 0.40). No significant results involving group appeared for negative cognitions, behavior and physiology. Children in the CBT group, but not parents, further reported less social anxiety in one questionnaire from pre- to post-treatment (d = 0.89). A structured interview confirmed a decrease in severity of SAD in the CBT group. While the gold standard of a blind interview showed efficacy of treatment, not all trait and state measures demonstrated similar success patterns.Trial registration Eligibility criteria and some of the dependent variables (cognitions, physiology) for treatment success were registered with the German Research Foundation (TU 78/5-2, HE 3342/4-2) prior to recruitment. Clinical assessment of diagnosis and behavioral data were not a priori planned as outcome measures for this trial and therefore analyzed in a post-hoc approach

Aggressiveness of eight Venturia inaequalis isolates virulent or avirulent to the major resistance gene Rvi6 on a non-Rvi6 apple cultivar

For sustainable management of scab-resistant apple cultivars, it is necessary to understand the role of aggressiveness in the adaptation of Venturia inaequalis populations and particularly the costs to the organism of acquiring additional virulence. The aims of the present study were (i) to identify the quantitative variables that are most important in determining the differences in aggressiveness among groups of V. inaequalis isolates, and (ii) to ascertain whether virulent and avirulent isolates of V. inaequalis differ significantly in aggressiveness. The aggressiveness of eight isolates that differed in their virulence to the major resistance gene Rvi6 was compared on the non-Rvi6 apple cv. Gala. Three components of aggressiveness, namely lesion density, the number of spores per square centimetre of leaf area, and the number of spores per lesion, were evaluated 21 days after inoculation, and the kinetics of lesion density over time were analysed in terms of maximum lesion density, length of latent period and rate of lesion appearance. On the second youngest but fully developed leaf at the time of inoculation, maximum lesion density in the virulent group was 20% lower and the latent period 7% longer, than in the avirulent group. However, the alternative hypothesis, namely that isolates had adapted to quantitative resistance present in cv. Gala depending on their cultivar of origin, could not be rejected. The analysis of the kinetics of lesion density by a non-linear mixed-effect model proved useful in the assessment of aggressiveness

Magic traits drive the emergence of pathogens

An important branch of evolutionary biology strives to understand how divergent selection for an ecologically important trait can foster the emergence of new species specialized on different niches. Such ecological speciation is usually difficult to achieve because recombination between different subsets of a population that are adapting to different environments counteracts selection for locally adapted gene combinations. Traits pleiotropically controlling adaptation to different environments and reproductive isolation are therefore the most favourable for ecological speciation, and are thus called “magic traits”. We used genetic markers and cross-inoculations to show that pathogenicity-related loci are responsible for both host adaptation and reproductive isolation in emerging populations of Venturia inaequalis, the fungus causing apple scab disease. Because the fungus mates within its host and because the pathogenicity-related loci prevent infection of the non-host trees, host adaptation pleiotropically maintains genetic differentiation and adaptive allelic combinations between sympatric populations specific to different apple varieties. Such “magic traits” are likely frequent in fungal pathogens, and likely drive the emergence of new diseases.