Validity of Acoustic Measures Obtained Using Various Recording Methods Including Smartphones With and Without Headset Microphones.

PURPOSE: The goal of this study was to assess various recording methods, including combinations of high- versus low-cost microphones, recording interfaces, and smartphones in terms of their ability to produce commonly used time- and spectral-based voice measurements. METHOD: Twenty-four vowel samples representing a diversity of voice quality deviations and severities from a wide age range of male and female speakers were played via a head-and-thorax model and recorded using a high-cost, research standard GRAS 40AF (GRAS Sound & Vibration) microphone and amplification system. Additional recordings were made using various combinations of headset microphones (AKG C555 L [AKG Acoustics GmbH], Shure SM35-XLR [Shure Incorporated], AVID AE-36 [AVID Products, Inc.]) and audio interfaces (Focusrite Scarlett 2i2 [Focusrite Audio Engineering Ltd.] and PC, Focusrite and smartphone, smartphone via a TRRS adapter), as well as smartphones direct (Apple iPhone 13 Pro, Google Pixel 6) using their built-in microphones. The effect of background noise from four different room conditions was also evaluated. Vowel samples were analyzed for measures of fundamental frequency, perturbation, cepstral peak prominence, and spectral tilt (low vs. high spectral ratio). RESULTS: Results show that a wide variety of recording methods, including smartphones with and without a low-cost headset microphone, can effectively track the wide range of acoustic characteristics in a diverse set of typical and disordered voice samples. Although significant differences in acoustic measures of voice may be observed, the presence of extremely strong correlations (rs > .90) with the recording standard implies a strong linear relationship between the results of different methods that may be used to predict and adjust any observed differences in measurement results. CONCLUSION: Because handheld smartphone distance and positioning may be highly variable when used in actual clinical recording situations, smartphone + a low-cost headset microphone is recommended as an affordable recording method that controls mouth-to-microphone distance and positioning and allows both hands to be available for manipulation of the smartphone device.

Assessment of Babesia spp. prevalence in various domestic animals across Southern Punjab, Pakistan.

Parasitic diseases, notably babesiosis, exert a substantial impact on the global cattle industry, posing challenges to commerce, economies, and human health. This study, conducted in Southern Punjab, Pakistan, aimed to assess the prevalence of Babesia spp. across various livestock species using microscopic and PCR methods. A total of 180 blood samples (60 from each district) were systematically collected from apparently healthy animals, with 36 samples obtained from each domestic animal species, including camel, cattle, buffalo, goat, and sheep, noting that 12 samples were collected from each district for each animal species. Overall prevalence was determined to be 32.8% (59/180), with varying rates among species: 25.0% in cattle, 41.66% in buffalo, 30.55% in goats, 33.3% in sheep, and 33.3% in camels. Microscopic examination revealed slightly varied infection rates among large and small domestic animals (22.2%), while PCR results indicated a 32.8% overall infection rate in both large and small domestic animals, with no statistical significance. District-wise analysis showed regional variations, with Muzaffargarh recording a prevalence rate of 23.33% through microscopic examination, while Lodhran and Bahawalpur recorded 21.67%. PCR results revealed higher rates (38.33%, 26.67%, and 33.33%, respectively), underlining the importance of employing PCR for accurate detection. Examining ruminant types, large ruminants exhibited a 32.4% infection rate, while small domestic animals showed 33.3%, with no significant difference (p=0.897). District-wise prevalence showcased significant variation, with Muzaffargarh demonstrating a 25% prevalence, Lodhran 22%, and Bahawalpur 22%, through microscopic examination. PCR results displayed 38.33%, 27%, and 33.3%, respectively, with no statistical significance. Detailed analysis of individual districts highlighted variations in infection rates among camels, cattle, buffalo, goats, and sheep. The binomial test indicated significant differences through microscopic analysis (P=0.011) but non-significant variations through PCR (P=0.065), emphasizing the precision of PCR. Regional variations in prevalence, notably with Punjab exhibiting the highest frequency (33.87%) and KPK the lowest (13.24%), suggest potential influences from varying veterinary practices and environmental factors. This study underscores the pivotal role of PCR alongside microscopy for accurate babesiosis diagnosis. These findings contribute to the broader understanding of babesiosis prevalence, emphasizing the necessity of advanced molecular techniques for informed control measures.

Emergence of acute promyelocytic leukemia in a patient with granulomatosis with polyangiitis during treatment with cyclophosphamide: a rare case report.

Granulomatosis with polyangiitis (GPA) is a rare autoimmune disease that affects multiple organs and causes inflammation, necrosis, and vasculitis in small blood vessels. Treatment for GPA involves achieving and maintaining remission. In recent studies, cyclophosphamide-based regimens have been linked to comorbidity hazards, including an increased risk of malignancies, especially hematological ones. Acute myeloid leukemia is the main hematologic malignancy that can complicate GPA. In this context, we report the case of a middle-aged woman with GPA who developed acute promyelocytic leukemia (APL) during maintenance with cyclophosphamide. She was treated with all-trans retinoic acid at 50 mg/day and arsenic trioxide at 10 mg/day, along with steroids. This case highlights the unique emergence of APL in a GPA patient during cyclophosphamide therapy. A single case has previously been reported on the development of APL in a patient with GPA while using azathioprine monotherapy for 2 years.

The Influence of Multisensory Input On Voice Perception and Production Using Immersive Virtual Reality.

OBJECTIVES: The purpose was to examine the influence of auditory vs visual vs combined audiovisual input on perception and production of one's own voice, using immersive virtual reality technology. METHODS: Thirty-one vocally healthy men and women were investigated under 18 sensory input conditions, using immersive virtual reality technology. Conditions included two auditory rooms with varying reverberation times, two visual rooms with varying volumes, and the combination of audiovisual conditions. All conditions were repeated with and without background noise. Speech tasks included counting, sustained vowel phonation, an all-voiced sentence from the Consensus Auditory-Perceptual Evaluation of Voice, and the first sentence from the Rainbow Passage, randomly ordered. Perception outcome measures were participants' self-reported perceptions of their vocal loudness, vocal effort, and vocal comfort in speech. Production outcome measures were sound pressure level (SPL) and spectral moments (spectral mean and standard deviation in Hz, skewness, and kurtosis). Statistical analyses used self-reported vocal effort, vocal loudness, and vocal comfort in percent (0 = "not at all," 100 = extremely), SPL in dB, and spectral moments in Hz. The reference level was a baseline audiovisual deprivation condition. RESULTS: Results suggested (i) increased self-perceived vocal loudness and effort, and decreased comfort, with increasing room volume, speaker-to-listener distance, audiovisual input, and background noise, and (ii) increased SPL and fluctuations in spectral moments across conditions. CONCLUSIONS: Not only auditory, but also visual and audiovisual input influenced voice perception and production in ways that have not been previously documented. Findings contribute to the basic science understanding the role of visual, audiovisual and auditory input in voice perception and production, and also to models of voice training and therapy. The findings also set the foundation for the use of virtual reality in voice and speech training, as a potentially power solution to the generalization problem.

Smartphone Recordings are Comparable to "Gold Standard" Recordings for Acoustic Measurements of Voice.

PURPOSE: The purpose of this study was to assess the relationship and comparability of cepstral and spectral measures of voice obtained from a high-cost "flat" microphone and precision sound level meter (SLM) vs. high-end and entry level models of commonly and currently used smartphones (iPhone i12 and iSE; Samsung s21 and s9 smartphones). Device comparisons were also conducted in different settings (sound-treated booth vs. typical "quiet" office room) and at different mouth-to-microphone distances (15 and 30 cm). METHODS: The SLM and smartphone devices were used to record a series of speech and vowel samples from a prerecorded diverse set of 24 speakers representing a wide range of sex, age, fundamental frequency (F0), and voice quality types. Recordings were analyzed for the following measures: smoothed cepstral peak prominence (CPP in dB); the low vs high spectral ratio (L/H Ratio in dB); and the Cepstral Spectral Index of Dysphonia (CSID). RESULTS: A strong device effect was observed for L/H Ratio (dB) in both vowel and sentence contexts and for CSID in the sentence context. In contrast, device had a weak effect on CPP (dB), regardless of context. Recording distance was observed to have a small-to-moderate effect on measures of CPP and CSID but had a negligible effect on L/H Ratio. With the exception of L/H Ratio in the vowel context, setting was observed to have a strong effect on all three measures. While these aforementioned effects resulted in significant differences between measures obtained with SLM vs. smartphone devices, the intercorrelations of the measurements were extremely strong (r's > 0.90), indicating that all devices were able to capture the range of voice characteristics represented in the voice sample corpus. Regression modeling showed that acoustic measurements obtained from smartphone recordings could be successfully converted to comparable measurements obtained by a "gold standard" (precision SLM recordings conducted in a sound-treated booth at 15 cm) with small degrees of error. CONCLUSIONS: These findings indicate that a variety of commonly available modern smartphones can be used to collect high quality voice recordings usable for informative acoustic analysis. While device, setting, and distance can have significant effects on acoustic measurements, these effects are predictable and can be accounted for using regression modeling.

Comparative Analysis of Two Methods of Perceptual Voice Assessment.

OBJECTIVES: The primary aim was to compare two methods for perceptual evaluation of voice - paired comparison (PC) and visual analog scale (VAS) ratings. Secondary aims were to assess the correspondence between two dimensions of voice- overall severity of voice quality and resonant voice, and to investigate the influence of rater experience on perceptual rating scores and rating confidence scores. STUDY DESIGN: Experimental design. METHODS: Voice samples from six children (pre and post therapy) were rated by 15 Speech-Language Pathologists specialized in voice. Raters completed four tasks corresponding to the two rating methods and voice qualities: PC-severity, PC-resonance, VAS-severity, and VAS-resonance. For PC tasks, raters chose the better of two voice samples (better voice quality or better resonance, depending on the task) and indicated the degree of confidence in each choice. Rating and confidence score were combined to produce a number on a 1-10 scale (PC-confidence adjusted). VAS ratings involved rating voices on a scale for degree of severity and resonance, respectively. RESULTS: PC-confidence adjusted and VAS ratings were moderately correlated for overall severity and also vocal resonance. VAS ratings were normally distributed and had greater rater consistency than PC-confidence adjusted ratings. VAS scores reliably predicted binary PC choices (choice of voice sample only). Overall severity and vocal resonance were weakly correlated and rater experience was not linearly related to rating scores or confidence. CONCLUSIONS: Results suggest that the VAS rating method holds advantages over PC, including normally distributed ratings, superior consistency of ratings, and the ability to provide more finely grained detail regarding the auditory perception of voice. Overall severity and vocal resonance were not redundant in the current data set, suggesting that resonant voice and overall severity are not isomorphic. Finally, the number of years of clinical experience was not linearly related to perceptual ratings or rating confidence.

Investigation of the Cepstral Spectral Acoustic Analysis for Classifying the Severity of Dysphonia.

OBJECTIVES: The advantages of cepstral measurements in the evaluation of dysphonia have been noted in previous studies. However, there is an unclarity regarding the results of cepstral analyzes effect in determining the severity of dysphonia. The aims of this study were to determine the cut-off values of cepstral peak prominence, cepstral peak prominence standard deviation, low frequency/ high frequency ratio, low frequency/high frequency ratio standard deviation, and cepstral spectral index of dysphonia for predicting the voice severity within a Turkish speaking population, as well as to confirm the discriminative power of these cut-off values. MATERIALS METHODS: One hundred ninety-five individuals with voice disorders and an equal number of age and gender-matched individuals without voice disorders were included. Included subjects had visited the Hacettepe University Hospitals Speech and Language Therapy Department for voice evaluation between January 2017 and September 2021. The voice recordings from all participants included the six CAPE-V/Turkish sentences and sustained vowel /a/. Three raters provided auditory perceptual ratings of the voice samples using the GRBAS scale (grade) and overall severity for the CAPE-V/Turkish. Participants were categorized into normal and mild, moderate, and severely dysphonic groups based on the auditory perceptual evaluation. Analysis of Dysphonia in Speech and Voice (ADSV) software was used for cepstral spectral acoustic analysis. RESULTS: In the sustained vowel context, the area under the curve (ROC) for the CSID value was >0.8, except for mild vs. moderate dysphonia groups. In connected speech contexts, the ROC of the CPP value was also >0.8, except for normal vs. mild dysphonia groups. The cut-off values of CPP and CSID demonstrated high sensitivity and specificity for predicting voice severities. CONCLUSION: The cut-off values for the parameters that predicted voice severities showed a significant degree of discriminative power for categorizing voice severities among Turkish-speaking people.

Enhancing the Vortex Whistle for Measures of Respiratory Capacity Via Computational Fluid Dynamics and Computational Aero-Acoustic Analysis.

A vortex whistle produces a fundamental frequency proportional to the inlet flowrate. Recent investigations using vortex whistles have focused on the use of this relationship to quantify aspects of respiratory function. Despite promising results, there is a lack of understanding of the physical mechanisms underlying vortex whistle function. This paper begins with a principled study of the aero-acoustic properties of the vortex whistle. First, a high-fidelity computational fluid dynamics (CFD) simulation was developed to predict the unsteady flow field induced by the vortex whistle when the expiratory flow is applied. A computational aero-acoustic analysis (CAA) was applied to predict the acoustic response of the vortex whistle and to capture the frequency and level of the signature spectral peaks. The CFD is validated against prior experimental data on the vortex whistle. The CFD was used to: (a) determine the source of the vortex whistle harmonics and (b) investigate the effect of an outlet tube terminator, proposed by Awan and Awan (2020, "Use of a Vortex Whistle for Measures of Respiratory Capacity," J. Voice). The CFD and CAA indicated that the harmonics are generated by the cylindrical cavity of the vortex whistle, and the outlet terminator increases harmonic signal-to-noise ratio by increasing the pressure fluctuation within the cylindrical cavity. These results support the addition of the outlet tube terminator and provide insight into future design modifications that will enhance the reliability of the vortex whistle analyses and enable additional measures of respiratory capacity.

The Effect of Microphone Frequency Response on Spectral and Cepstral Measures of Voice: An Examination of Low-Cost Electret Headset Microphones.

PURPOSE: The purpose of this study was to establish the frequency response of a selection of low-cost headset microphones that could be given to subjects for remote voice recordings and to examine the effect of microphone type and frequency response on key acoustic measures related to voice quality obtained from speech and vowel samples. METHOD: The frequency responses of three low-cost headset microphones were evaluated using pink noise generated via a head-and-torso model. Each of the headset microphones was then used to record a series of speech and vowel samples prerecorded from 24 speakers who represented a diversity of sex, age, fundamental frequency (F o), and voice quality types. Recordings were later analyzed for the following measures: smoothed cepstral peak prominence (CPP; dB), low versus high spectral ratio (L/H ratio; dB), CPP F o (Hz), and cepstral spectral index of dysphonia (CSID). RESULTS: The frequency response of the microphones under test was observed to have nonsignificant effects on measures of the CPP and CPP F o, significant effects on the CSID in speech contexts, and strong and significant effects on the measure of spectral tilt (L/H ratio). However, the correlations between the various headset microphones and a reference precision microphone were excellent (rs > .90). CONCLUSIONS: The headset microphones under test all showed the capability to track a wide range of diversity in the voice signal. Though the use of higher quality microphones that have demonstrated specifications is recommended for typical research and clinical purposes, low-cost electret microphones may be used to provide valid measures of voice, specifically when the same microphone and signal chain is used for the evaluation of pre- versus posttreatment change or intergroup comparisons.

Use of a Vortex Whistle for Measures of Respiratory Capacity.

OBJECTIVES: A vortex whistle produces a tone which has a frequency proportional to the inlet air flow rate. The objectives of this study were to replicate previous studies demonstrating the use of a vortex whistle as an accurate flow meter, and to assess the degree of relationship between measures of vital capacity (VC) obtained using low-cost methods (vortex whistle and hand-held spirometry) vs. pneumotach-based spirometry. METHODOLOGY: A vortex whistle was designed using 3D modeling software and manufactured using a 3D printer with non-toxic, biodegradable polylactic acid (PLA). The digitized vortex whistle tone was analyzed using custom software to produce a frequency vs. time contour. As the frequency is proportional to flow, the integral of this curve corresponds to the overall volume by a linear relationship. The accuracy of vortex whistle volume estimates were assessed using (1) controlled flow rates from a consistent volume calibration syringe, and (2) with 66 subjects between the ages of 18-30 yrs. in comparison to hand-held spirometry and two pneumotach systems. RESULTS: Observations from the calibration syringe experiment confirmed that the vortex whistle and software are able to effectively track the flow rate, with a correlation coefficient between the average flow and the average frequency of r2 = 0.9965. Results from the human VC testing showed that measures obtained using both vortex whistles and hand-held spirometry correlated very strongly (r > 0.94) with computerized pneumotach systems, and the strength of correlations obtained via vortex whistles vs. hand-held spirometry were highly comparable. DISCUSSION & CONCLUSIONS: When coupled with the analysis software described herein, valid and reliable frequency/flow curves and volume estimates may be obtained using a vortex whistle that are highly comparable to the hand-held spirometer. The use of the vortex whistle has the potential to bring measures of basic respiratory function to clinicians and patients alike at a fraction of the cost of currently used spirometric methods.

Singing In The Mask: Effects Of A Variably Occluded Face Mask On Singing.

OBJECTIVE: A limitation of traditional semi-occluded vocal tract exercises (SOVTE) is the single sustained vowel task that precludes co-articulated singing. This study investigated immediate effects of a variably occluded face mask (VOFM) on vocal effort, acoustic, and aerodynamic measures in sung low and high pitches of healthy singers. DESIGN: Single-group, pre-post intervention study. METHODS: The outlet ports of disposable anesthesia facemasks were fitted with plastic caps with two drilled openings sizes (9.6 mm, 6.4 mm). Twenty-three singers with no voice complaints provided baseline vocal effort, acoustic, and aerodynamic measures in high and low pitches. Participants trained in four conditions: two VOFM sizes (9.6 mm, 6.4 mm) in combination with the 20th and 80th percentile of the singer's pitch range. Participants were trained on three phonatory tasks: repeated consonant/vowel syllables, sung sentence, and sustained vowel. Vocal effort before and after training was compared using a visual-analog scale, while standardized mean differences captured acoustic and aerodynamic changes before and after training. RESULTS: Participants reported decreased vocal effort after VOFM training at all occlusion and pitch combinations. On average, consistent beneficial effect sizes were found in cepstral peak prominence (CPP) and cepstral spectral index of dysphonia (CSID) for all 4 occlusion-pitch combinations, and vocal intensity and mean estimated subglottal pressure increased for all 4 occlusion-pitch training combinations. Changes in mean phonatory airflow and resistance were less consistent. DISCUSSION: There was an immediate effect of decreased vocal effort in singing after VOFM training. Acoustic and aerodynamic effects were variable and modest. Future studies should explore changes in these outcomes after VOFM in singing voice therapy.

Cognitive Mechanisms in Pediatric Voice Therapy - An Initial Examination.

INTRODUCTION: Voice disorders are a common communication disorder in children. Behavioral voice therapy is recommended by both Otolaryngologists and Speech-Language Pathologists as a first-line approach for treatment of benign vocal fold lesions that affect children in large numbers. However, the role of cognitive mechanisms critical to voice therapy have not yet been explored. OBJECTIVE: This proof-of-concept study aims to provide preliminary data on the potential relation between cognitive abilities and behavioral results of voice therapy for children with benign phonotraumatic vocal fold lesions. METHODS: Six children (4;05 -9;02 years) diagnosed with vocal fold nodules completed a battery of cognitive tests from the NEuroPSYchological (NEPSY-II) Assessment and a standard course of "Adventures in Voice" therapy. Recordings pre and post intervention were analyzed acoustically using the Cepstral Spectral Index of Dysphonia (CSID) and perceptually using visual analog scales (VAS) for severity and resonance separately. Raw and age-corrected scaled scores from the NEPSY-II were then examined for their possible relation to voice outcomes. RESULTS: Multiple cognitive functions correlated with voice outcomes. Raw score measures for Design Fluency, Inhibition, Fingertip Tapping, and Narrative Memory correlated favorably with all voice outcome measures. Age correlated with all NEPSY-II raw scores and perceptual voice outcome measures. Scaled scores for Auditory Attention, Design Fluency, Fingertip Tapping (Dominant hand), and Narrative Memory correlated with all voice outcome measures. CONCLUSION: Results suggest that there is merit to further investigation of the relation between cognitive skills and their development and voice treatment outcomes in children with benign phonotraumatic lesions. Future studies with larger samples will build on present findings.

An overview of microscale indentation fatigue: Composites, thin films, coatings, and ceramics.

There are many applications from computer hardware and sensors to thin films and coatings in which parts are fabricated in small sizes and low thicknesses. Most of these applications could undergo cyclic loading and unloading conditions during their operation. Therefore, cyclic and fatigue evaluations of these components are an essential topic and should be fully understood. In these cases, due to the dimensional limitations, conventional methods of the fatigue experiments encounter challenges and mostly are not accurate or applicable. Nano- and micro-indentation fatigue tests are considered non- or semi-destructive experiments that have opened a new approach to study the cyclic response of these small-sized specimens and thin films. The objective of the present review paper is to evaluate a convenient, reliable, and non-destructive testing approach in the assessment of fatigue (cyclic) response of materials on a small scale. Along with conventional bulk scale fatigue testing methods (i.e. reverse bending, pull-push, multi-axial bending), the depth-sensing indentation testing technique can be employed to study the cyclic behavior of metallic and non-metallic materials especially when a limited volume of the material is available. In this paper, we tried to cover most of the previous studies performed on indentation fatigue of composites, thin films, coatings, and ceramics along with associated discussions and main findings. We covered the physics behind the indentation and the difference between the indentation and conventional fatigue analyses. Followed by that, microstructural evaluations of some of the studies are provided to give readers more insights into this approach. In most applications, the indentation fatigue technique could be a reliable solution due to its accuracy, simplicity, and nondestructive approach in finding out the fatigue and cyclic behavior of materials having a small size or volume. It is worth noting that the loading mode in the indentation fatigue is completely different than the traditional (bulk-scale) fatigue as the tensile segment of the load cycle is not produced in the indentation fatigue (it is a compression-compression loading cycle). Therefore, the controlling mechanisms of failure between small-scale fatigue and bulk-scale fatigue may not be the same.

A Two-Stage Cepstral Analysis Procedure for the Classification of Rough Voices.

OBJECTIVES: The objective of this study was to investigate the ability of a two-stage method of cepstral peak identification to effectively discriminate rough vs breathy vs typical voice in sustained vowel productions. It was hypothesized that a dual-stage search for cepstral peak prominences (CPP's) above and below specified quefrency/F0 cutoffs would result in a CPP difference that would be characteristic of the rough, diplophonic voice type. METHODOLOGY: Central one-second portions of sustained vowel /a/ productions were obtained from 90 subjects (rough, breathy, and normophonic voices). All voice samples were analyzed using a a two-stage cepstral analysis process in which a CPPHigh-Low difference value was obtained by identifying cepstral peaks above and below a lower limit for expected F0 (150 Hz for females and 90 Hz for males), called CPPHigh and CPPLow respectively. RESULTS: The CPPHigh-Low difference value was observed to be a highly significant predictor, with negative values for this parameter characteristic of a dominant subharmonic in the voice signal and the perception of diplophonic, rough voice. Correct classification of rough vs nonrough voice samples was 82.2% (sensitivity 0.80 and specificity 0.833). In the consideration of three group classification (breathy vs. normophonic vs. rough), models incorporating two predictors (the CPP obtained from a single search through a 60 to 300 Hz frequency range (CPPDefault) and the CPPHigh-Low difference value) correctly classified 78.88% of the voice samples. CONCLUSIONS: Rough, diplophonic voices were consistently observed to have a subharmonic peak that was greater in amplitude than the cepstral peak obtained within the region of the expected F0, resulting in a negative value for the CPPHigh-Low difference. The two-stage cepstral analysis process described herein is visually intuitive from the graphical display of a cepstrum and is a simple extended calculation derived from cepstral analysis procedures that have been recommended as essential in the acoustic description of vocal quality.

Persistent confirmed low-grade dysplasia in Barrett's esophagus is a risk factor for progression to high-grade dysplasia and adenocarcinoma in a US Veterans cohort.

Patients with Barrett's esophagus (BE) and low-grade dysplasia (LGD) are at increased risk of esophageal adenocarcinoma (EAC), although many regress to nondysplastic BE. This has significant clinical importance for patients being considered for endoscopic eradication therapy. Our aim is to determine the risk for progression in patients with confirmed persistent LGD. We performed a single-center retrospective cohort study of patients with BE and confirmed LGD between 2006 and 2016. Confirmed LGD was defined as LGD diagnosed by consensus conference with an expert GI pathologist or review by an expert GI pathologist and persistence as LGD present on subsequent endoscopic biopsy. The primary outcome was the incidence rate of HGD (high-grade dysplasia)/EAC. Secondary outcomes included risk factors for dysplastic progression. Risk factors for progression were assessed using univariate and multivariate analysis with logistic regression. Of 69 patients (mean age 65.2 years) with confirmed LGD were included. In total, 16 of 69 patients (23.2%) with LGD developed HGD/EAC during a median follow-up of 3.74 years (IQR, 1.24-5.45). For persistent confirmed LGD, the rate was 6.44 (95% confidence interval (CI), 2.61-13.40) compared to 2.61 cases per 100 patient-years (95% CI, 0.83-6.30) for nonpersistent LGD. Persistent LGD was found in only 29% of patients. Persistent LGD was an independent risk factor for the development of HGD/EAC (OR 4.18; [95% CI, 1.03-17.1]). Persistent confirmed LGD, present in only 1/3 of patients, was an independent risk factor for the development of HGD/EAC. Persistence LGD may be useful in decision making regarding the management of BE.

Spectral/Cepstral Analyses of Phonation in Parkinson's Disease before and after Voice Treatment: A Preliminary Study.

PURPOSE: This article examines cepstral/spectral analyses of sustained /α/ vowels produced by speakers with hypokinetic dysarthria secondary to idiopathic Parkinson's disease (PD) before and after Lee Silverman Voice Treatment (LSVT®LOUD) and the relationship of these measures with overall voice intensity. METHODOLOGY: Nine speakers with PD were examined in a pre-/post-treatment design, with multiple daily audio recordings before and after treatment. Sustained vowels were analyzed for cepstral peak prominence (CPP), CPP standard deviation (CPP SD), low/high spectral ratio (L/H SR), and Cepstral/Spectral Index of Dysphonia (CSID) using the KAYPENTAX computer software. RESULTS: CPP and CPP SD increased significantly and CSID decreased significantly from pre- to post-treatment recordings, with strong effect sizes. Increased CPP indicates increased dominance of harmonics in the spectrum following LSVT. After restricting the frequency cutoff to the region just above the first formant and second formant and below the third formant, L/H SR was observed to decrease significantly following treatment. Correlation analyses demonstrated that CPP was more strongly associated with CSID before treatment than after. CONCLUSION: In addition to increased vocal intensity following LSVT, speakers with PD exhibited both improved harmonic structure and voice quality as reflected by cepstral/spectral analysis, indicating that there was improved harmonic structure and reduced dysphonia following treatment.

A biomarker panel predicts progression of Barrett's esophagus to esophageal adenocarcinoma.

Progression from Barrett's esophagus (BE) to esophageal adenocarcinoma (EAC) is uncommon but the consequences are serious. Predictors of progression are essential to optimize resource utilization. This study assessed the utility of a promising panel of biomarkers applicable to routine paraffin embedded biopsies (FFPE) to predict progression of BE to EAC in a large population-based, nested case-control study.We utilized the Amsterdam-based ReBus nested case-control cohort. BE patients who progressed to high-grade dysplasia (HGD)/EAC (n = 130) and BE patients who never progressed (n = 130) were matched on age, sex, length of the BE segment, and duration of endoscopic surveillance. All progressors had minimum 2 years of endoscopic surveillance without HGD/EAC to exclude prevalent neoplasia. We assessed abnormal DNA content, p53, Cyclin A, and Aspergillus oryzae lectin (AOL) in FFPE sections. We performed conditional logistic regression analysis to estimate odds ratio (OR) of progression based on biomarker status.Expert LGD (OR, 8.3; 95% CI, 1.7-41.0), AOL (3 vs. 0 epithelial compartments abnormal; OR, 3.6; 95% CI, 1.2-10.6) and p53 (OR, 2.3; 95% CI, 1.2-4.6) were independently associated with neoplastic progression. Cyclin A did not predict progression and DNA ploidy analysis by image cytometry was unsuccessful in the majority of cases, both were excluded from the multivariate analysis. The multivariable biomarker model had an area under the receiver operating characteristic curve of 0.73.Expert LGD, AOL, and p53 independently predict neoplastic progression in BE patients and are applicable to routine practice. These biomarkers can aid in selecting patients for endoscopic ablation or more intensive surveillance.

Dysplasia severity is associated with poor quality of life in patients with Barrett's esophagus referred for endoscopic eradication therapy.

Limited data exist regarding patient-reported outcomes and quality of life (QOL) experienced by patients with Barrett's esophagus (BE) referred for endoscopic eradication therapy (EET). Specifically, the impact of grade of dysplasia has not been explored. The purpose of this study is to measure patient-reported symptoms and QOL and identify factors associated with poor QOL in BE patients referred for EET. This was a prospective multicenter study conducted from January 2015 to October 2017, which included patients with BE referred for EET. Participants completed a set of validated questionnaires to measure QOL, symptom severity, and psychosocial factors. The primary outcome was poor QOL defined by a PROMIS score >12. Multivariable logistic regression analysis was performed to identify factors associated with poor QOL. In total, 193 patients participated (mean age 64.6 years, BE length 5.5 cm, 82% males, 92% Caucasians) with poor QOL reported in 104 (53.9%) participants. On univariate analysis, patients with poor QOL had lower use of twice daily proton pump inhibitor use (61.5% vs. 86.5%, P = 0.03), shorter disease duration (4.9 vs. 5.9 years, P = 0.04) and progressive increase in grade of dysplasia (high-grade dysplasia: 68.8% vs. 31.3%, esophageal adenocarcinoma: 75.5% vs. 24.5%, P < 0.001). Multivariate analysis demonstrated that high-grade dysplasia was independently associated with poor QOL (OR: 5.57, 95% CI: 1.05, 29.5, P = 0.04). In summary, poor QOL is experienced by the majority of patients with BE referred for EET and the degree of dysplasia was independently associated with poor QOL, which emphasizes the need to incorporate patient-centered outcomes when studying treatment of BE-related dysplasia.