2020 International Consensus on First Aid Science With Treatment Recommendations.

This is the summary publication of the International Liaison Committee on Resuscitation's 2020 International Consensus on First Aid Science With Treatment Recommendations. It addresses the most recent published evidence reviewed by the First Aid Task Force science experts. This summary addresses the topics of first aid methods of glucose administration for hypoglycemia; techniques for cooling of exertional hyperthermia and heatstroke; recognition of acute stroke; the use of supplementary oxygen in acute stroke; early or first aid use of aspirin for chest pain; control of life- threatening bleeding through the use of tourniquets, haemostatic dressings, direct pressure, or pressure devices; the use of a compression wrap for closed extremity joint injuries; and temporary storage of an avulsed tooth. Additional summaries of scoping reviews are presented for the use of a recovery position, recognition of a concussion, and 6 other first aid topics. The First Aid Task Force has assessed, discussed, and debated the certainty of evidence on the basis of Grading of Recommendations, Assessment, Development, and Evaluation criteria and present their consensus treatment recommendations with evidence-to-decision highlights and identified priority knowledge gaps for future research. The 2020 International Consensus on Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC) Science With Treatment Recommendations (CoSTR) is the fourth in a series of annual summary publications from the International Liaison Committee on Resuscitation (ILCOR). This 2020 CoSTR for first aid includes new topics addressed by systematic reviews performed within the past 12 months. It also includes updates of the first aid treatment recommendations published from 2010 through 2019 that are based on additional evidence evaluations and updates. As a result, this 2020 CoSTR for first aid represents the most comprehensive update since 2010.

Modeling measured glottal volume velocity waveforms.

The source-filter theory of speech production describes a glottal energy source (volume velocity waveform) that is filtered by the vocal tract and radiates from the mouth as phonation. The characteristics of the volume velocity waveform, the source that drives phonation, have been estimated, but never directly measured at the glottis. To accomplish this measurement, constant temperature anemometer probes were used in an in vivo canine constant pressure model of phonation. A 3-probe array was positioned supraglottically, and an endoscopic camera was positioned subglottically. Simultaneous recordings of airflow velocity (using anemometry) and glottal area (using stroboscopy) were made in 3 animals. Glottal airflow velocities and areas were combined to produce direct measurements of glottal volume velocity waveforms. The anterior and middle parts of the glottis contributed significantly to the volume velocity waveform, with less contribution from the posterior part of the glottis. The measured volume velocity waveforms were successfully fitted to a well-known laryngeal airflow model. A noninvasive measured volume velocity waveform holds promise for future clinical use.

Preliminary results on the influence of engineered artificial mucus layer on phonation.

PURPOSE Previous studies have confirmed the influence of dehydration and an altered mucus (e.g., due to pathologies) on phonation. However, the underlying reasons for these influences are not fully understood. This study was a preliminary inquiry into the influences of mucus architecture and concentration on vocal fold oscillation. METHOD Two excised human larynges were investigated in an in vitro setup. The oscillations of the vocal folds at various airflow volume rates were recorded through the use of high-speed imaging. Engineered mucus containing polymers (interconnected polymers and linear polymers) was applied to the vocal folds. From the high-speed footage, glottal parameters were extracted through the use of objective methods and were compared to a gold standard (physiological saline solution). RESULTS Variations were found for all applications of mucus. Fundamental frequency dropped and the oscillatory behavior (speed quotient [SQ], closing quotient [CQ]) changed for both larynges. The 2 applied mucus architectures displayed different effects on the larynges. The interconnected polymer displayed clear low-pass filter characteristics not found for the linear polymer. Increase of polymer concentration affected parameters to a certain point. CONCLUSION The data confirm results found in previous studies. Furthermore, the different effects-comparing architecture and concentration-suggest that, in the future, synthetic mucus can be designed to improve phonation.

Mechanisms of irregular vibration in a physical model of the vocal folds.

Previous investigations have shown that one mechanism of irregular vocal fold vibration may be a desynchronization of two or more vibratory modes of the vocal fold tissues. In the current investigation, mechanisms of irregular vibration were further examined using a self-oscillating, physical model of vocal fold vibration, a hemi-model methodology, and high-speed, stereoscopic, digital imaging. Using the method of empirical eigen-functions, a spatiotemporal analysis revealed mechanisms of irregular vibration in subharmonic phonation and biphonation, which were not disclosed in a standard acoustic spectrum.