Clinical performance of serum prostate-specific antigen isoform [-2]proPSA (p2PSA) and its derivatives, %p2PSA and the prostate health index (PHI), in men with a family history of prostate cancer: results from a multicentre European study, the PROMEtheuS project.

OBJECTIVES: To test the sensitivity, specificity and accuracy of serum prostate-specific antigen isoform [-2]proPSA (p2PSA), %p2PSA and the prostate health index (PHI), in men with a family history of prostate cancer (PCa) undergoing prostate biopsy for suspected PCa. To evaluate the potential reduction in unnecessary biopsies and the characteristics of potentially missed cases of PCa that would result from using serum p2PSA, %p2PSA and PHI. PATIENTS AND METHODS: The analysis consisted of a nested case-control study from the PRO-PSA Multicentric European Study, the PROMEtheuS project. All patients had a first-degree relative (father, brother, son) with PCa. Multivariable logistic regression models were complemented by predictive accuracy analysis and decision-curve analysis. RESULTS: Of the 1026 patients included in the PROMEtheuS cohort, 158 (15.4%) had a first-degree relative with PCa. p2PSA, %p2PSA and PHI values were significantly higher (P < 0.001), and free/total PSA (%fPSA) values significantly lower (P < 0.001) in the 71 patients with PCa (44.9%) than in patients without PCa. Univariable accuracy analysis showed %p2PSA (area under the receiver-operating characteristic curve [AUC]: 0.733) and PHI (AUC: 0.733) to be the most accurate predictors of PCa at biopsy, significantly outperforming total PSA ([tPSA] AUC: 0.549), free PSA ([fPSA] AUC: 0.489) and %fPSA (AUC: 0.600) (P ≤ 0.001). For %p2PSA a threshold of 1.66 was found to have the best balance between sensitivity and specificity (70.4 and 70.1%; 95% confidence interval [CI]: 58.4-80.7 and 59.4-79.5 respectively). A PHI threshold of 40 was found to have the best balance between sensitivity and specificity (64.8 and 71.3%, respectively; 95% CI 52.5-75.8 and 60.6-80.5). At 90% sensitivity, the thresholds for %p2PSA and PHI were 1.20 and 25.5, with a specificity of 37.9 and 25.5%, respectively. At a %p2PSA threshold of 1.20, a total of 39 (24.8%) biopsies could have been avoided, but two cancers with a Gleason score (GS) of 7 would have been missed. At a PHI threshold of 25.5 a total of 27 (17.2%) biopsies could have been avoided and two (3.8%) cancers with a GS of 7 would have been missed. In multivariable logistic regression models, %p2PSA and PHI achieved independent predictor status and significantly increased the accuracy of multivariable models including PSA and prostate volume by 8.7 and 10%, respectively (P ≤ 0.001). p2PSA, %p2PSA and PHI were directly correlated with Gleason score (ρ: 0.247, P = 0.038; ρ: 0.366, P = 0.002; ρ: 0.464, P < 0.001, respectively). CONCLUSIONS: %p2PSA and PHI are more accurate than tPSA, fPSA and %fPSA in predicting PCa in men with a family history of PCa. Consideration of %p2PSA and PHI results in the avoidance of several unnecessary biopsies. p2PSA, %p2PSA and PHI correlate with cancer aggressiveness.

Investigation of fatigue, delayed-onset muscle soreness, and spectral-based cepstral measurements in healthy speakers after neuromuscular electrical stimulation.

OBJECTIVES: We observed whether 30 minutes of neuromuscular electrical stimulation applied to the necks of healthy speakers would result in significant acoustic changes and perceptions of fatigue and/or delayed-onset muscle soreness (DOMS). METHODS: Twelve participants were assigned to experimental (n=6; 3 male and 3 female) and control groups (n=6; 3 male and 3 female). Neuromuscular electrical stimulation was applied to the anterior neck in the experimental group only. All participants produced 3 trials of the vowel /a/ and the Rainbow Passage before and after completing a 30-minute phonation protocol. Recorded samples were analyzed for measures of the cepstral peak prominence, the ratio of low- to high-frequency spectral energy, and their respective standard deviations. Perceptions of fatigue and DOMS were rated on visual analog scales before, 5 minutes after, and 24 hours after completion of the phonation protocol. RESULTS: Statistically significant acoustic findings reflecting reduced relative sound pressure level, increased high-frequency noise, and phonatory instability were observed in the experimental group. In addition, reports of fatigue and DOMS were also reported by some participants. CONCLUSIONS: A 30-minute dosage may be too high for some people experiencing neuromuscular electrical stimulation for the first time.

Aerodynamic assessment of young women's voices as a function of oral contraceptive use.

OBJECTIVE: To examine possible differences in glottal airflow parameters according to oral contraceptive (OC) use. SUBJECTS AND METHODS: The participants included 16 women, 20-24 years of age. Eight women were taking a triphasic OC; the remaining 8 women were not taking any form of oral contraception (NOC). All participants were recorded on days 7 and 14 of their menstrual cycle. Three repetitions of the sustained vowel /a/ were obtained using a circumferentially vented respiratory face mask connected to a wide-band pressure transducer. Measures of peak flow, minimum flow, alternating flow, fundamental frequency (F(0)) and relative sound pressure level were obtained. RESULTS: A multivariate analysis of variance with sound pressure level as a covariate revealed no significant effect of day of recording upon the dependent measures. As a group, the OC women exhibited significantly higher F(0), peak and alternating flow rates compared to the NOC women. Removal of data outliers from the OC women resulted in similar airflow rates for both groups. CONCLUSION: The findings from this preliminary study did not support the use of glottal airflow measures to distinguish OC women from NOC women. Differences in F(0) findings may reflect hormonally mediated changes in laryngeal tissue and warrant further investigation.

Comparison of fundamental frequency nasalance between trained singers and nonsingers for sung vowels.

OBJECTIVES: The purpose of this study was to determine the effect of vocal training on fundamental frequency nasalance measures under selected vowel and frequency conditions. METHODS: Fundamental frequency nasalance measures were reported for 2 groups of women: 36 trained singers and 36 nonsingers. Each group sang and sustained the vowels (/i/, /ae/, /u/, /a/) for 6 seconds' duration at 3 frequency levels. A 3-second segment from the middle of each vowel was measured to generate fundamental frequency nasalance scores. RESULTS: No significant differences were found in the mean fundamental frequency nasalance scores between the trained singers and the nonsingers. The fundamental frequency nasalance scores were significantly higher for front vowels for both groups. Additionally, both groups displayed a pattern of producing significantly higher fundamental frequency nasalance scores at lower fundamental frequencies than at higher fundamental frequencies. CONCLUSIONS: These findings support the practice of training singers to elevate the velum when singing at high frequencies but not when singing at low ones.

Acoustic analysis of the interaction of choral arrangements, musical selection, and microphone location.

Acoustic differences were evaluated among three choral arrangements and two choral textures recorded at three microphone locations. A choir was recorded when singing two musical selections of different choral texture, one homophonic and one polyphonic. Both musical selections were sung in three choral arrangements: block sectional, sectional-in-columns, and mixed. Microphones were placed at the level of the choristers, the conductor, and the audience. The recordings at each location were analyzed using long-term average spectrum (LTAS). The LTAS from the mixed arrangement exhibited more signal amplitude than the other arrangements in the range of 1000-3500Hz. When considering the musical selections, the chorus produced more signal amplitude in the region of 1800-2200Hz for the homophonic selection. In addition, the LTAS produced by the choir for the homophonic selection varied across the microphone locations. As for the microphone location, the LTAS of the signal detected directly in front of the chorus had a greater slope than the other two locations. Thus, the acoustic signal near the choristers differed from the signals near the conductor and in the audience. Conductors may be using acoustic information from the region of the second and third formants when they decide how to arrange a choir for a particular musical selection.

Treatment of uncertainty and developing conceptual models for environmental risk assessments and radioactive waste disposal safety cases.

The common approach to performing quantitative risk assessments in the contaminated land industry in the UK lacks a formal methodology for the treatment of the full range of uncertainties and for documenting decisions regarding the development of conceptual models and the selection of computer codes. The approach presented here represents an alternative, more detailed, and systematic approach for developing conceptual models and addressing uncertainties when undertaking contaminated land risk assessments. It is intended that the advantages of this approach are recognised by practitioners in the contaminated land industry and adopted, where appropriate, to help improve the quality of contaminated land risk assessments. The identification of features, events, and processes (FEPs) has been applied to safety assessments of deep geological and near-surface disposal of radioactive wastes. One of the primary benefits of using this approach is in the development of conceptual models. The approach identifies the FEPs that need to be addressed during the development of conceptual models and in the selection of suitable computer codes that can be used to represent the conceptual models. This approach has been applied by BNFL at the low-level radioactive waste disposal site at Drigg in Cumbria and is currently being adopted for a contaminated land study at the Sellafield site, also in Cumbria. This paper presents the advantages of using FEPs in the development of conceptual models and the treatment of uncertainties. The paper also discusses the application of this approach to contaminated land studies and provides an example to demonstrate the application of the approach. BNFL's approach at the Drigg site involves the identification of components (features) and phenomena (events and processes) that govern interactions and dependencies between the components by arranging them in a matrix format.

An exploratory study of voice change associated with healthy speakers after transcutaneous electrical stimulation to laryngeal muscles.

OBJECTIVES: The purpose of this study was to determine if measurable changes in fundamental frequency (F(0)) and relative sound level (RSL) occurred in healthy speakers after transcutaneous electrical stimulation (TES) as applied via VitalStim (Chattanooga Group, Chattanooga, TN). STUDY DESIGN: A prospective, repeated-measures design. METHODS: Ten healthy female and 10 healthy male speakers, 20-53 years of age, participated in the study. All participants were nonsmokers and reported negative history for voice disorders. Participants received 1 hour of TES while engaged in eating, drinking, and conversation to simulate a typical dysphagia therapy protocol. Voice recordings were obtained before and immediately after TES. The voice samples consisted of a sustained vowel task and reading of the Rainbow Passage. Measurements of F(0) and RSL were obtained using TF32 (Milenkovic, 2005, University of Wisconsin). The participants also reported any sensations 5 minutes and 24 hours after TES. RESULTS: Measurable changes in F(0) and RSL were found for both tasks but were variable in direction and magnitude. These changes were not statistically significant. Subjective comments ranged from reports of a vocal warm-up feeling to delayed onset muscle soreness. CONCLUSIONS: These findings demonstrate that application of TES produces measurable changes in F(0) and RSL. However, the direction and magnitude of these changes are highly variable. Further research is needed to determine factors that may affect the extent to which TES contributes to significant changes in voice.

Laryngeal aerodynamics associated with oral contraceptive use: preliminary findings.

UNLABELLED: The purpose of this study was to examine possible differences in laryngeal aerodynamic measures during connected speech associated with oral contraceptive (OC) use. Eight women taking an OC, and eight others not taking an OC, participated in the study. Three trials of syllable /p/repetitions were obtained using a circumferentially vented face mask and small translabial tube. All participants were recorded on or near days 7 and 14 of their menstrual cycle. Subglottal pressure (P(SG)) and average airflow rates were obtained to determine laryngeal airway resistance. Glottal airflow measures of peak flow, minimum flow, alternating flow, as well as relative sound level (RSL) were obtained. P(SG) was obtained from the pressure peak associated with/p/. All airflow parameters and RSL were obtained from the vowel portion. No significant differences were found related to day of recording or OC use, indicating that OC use does not significantly affect laryngeal airflow regulation. LEARNING OUTCOMES: The reader will better understand the effects of hormones and oral contraceptives on the female voice, as well as the specific changes in vocal function that may occur in conjunction with the use of oral contraceptives.