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Objectives: We reviewed 594 consecutive patients with Coronavirus Disease 2019 supported with extracorporeal membrane oxygenation at 49 hospitals within 21 states and examined patient characteristics, treatments, and variation in outcomes over the course of the pandemic., Methods: A multi-institutional database was used to assess all patients with Coronavirus Disease 2019 cannulated for extracorporeal membrane oxygenation between March 17, 2020, and December 20, 2021, inclusive, and separated from ECMO on or prior to January 14, 2022. Descriptive analysis was stratified by 4 time categories: group A = March 2020 to June 2020, group B = July 2020 to December 2020, group C = January 2021 to June 2021, group D = July 2021 to December 2021. A Bayesian mixed-effects logistic regression was used to assess continuous trends in survival where time was operationalized as the number of days between each patient's cannulation and that of the first patient in March 2020, controlling for multiple variables and risk factors., Results: At hospital discharge, of 594 patients, 221 survived (37.2%) and 373 died. Throughout the study, median age [interquartile range] declined (group A = 51.0 [41.0-60.0] years, group D = 39.0 [32.0-48.0] years, P < .001); median days between Coronavirus Disease 2019 diagnosis and intubation increased (group A = 4.0 [1.0-8.5], group D = 9.0 [5.0-14.5], P < .001); and use of medications (glucocorticoids, interleukin-6 blockers, antivirals, antimalarials) and convalescent plasma fluctuated significantly (all P < .05). Estimated odds of survival varied over the study period with a decline between April 1, 2020, and November 21, 2020 (odds ratio, 0.39, 95% credible interval, 0.18-0.87, probability of reduction in survival = 95.7%), improvement between November 21, 2020, and May 17, 2021 (odds ratio, 1.85, 95% credible interval, 0.86-4.09, probability of improvement = 93.4%), and decline between May 17, 2021, and December 1, 2021 (odds ratio, 0.49, 95% credible interval, 0.19-1.44, probability of decrease = 92.1%)., Conclusions: Survival for patients with Coronavirus Disease 2019 supported with extracorporeal membrane oxygenation has fluctuated during the stages of the pandemic. Minimizing variability by adherence to best practices may refine the optimal use of extracorporeal membrane oxygenation in a pandemic response., (Copyright © 2022 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)

Background: Carcinoid heart disease (CaHD) develops from vasoactive substances released by neuroendocrine tumors, which can cause significant patient morbidity and mortality without surgical intervention. We performed a systematic review and meta-analysis to elucidate granular perioperative details and long-term outcomes in these patients., Methods: Electronic search of Ovid, Scopus, Cumulative Index of Nursing and Allied Health Literature, and Cochrane Controlled Trials Register was performed to examine surgical treatment of carcinoid disease. Nine articles comprising 416 patients were selected. Study-level data were extracted and pooled for meta-analysis., Results: Mean patient age was 63 years (95% confidence interval, 57-70) with 53% (95% confidence interval, 46-61) of patients being male. In addition, 75% (95% confidence interval, 54-96) of neuroendocrine tumors originated from the small bowel or colon and 98% (95% confidence interval, 93-100) had liver metastases. Right heart failure was present in 48% (95% confidence interval, 14-81). Moderate or severe regurgitation was present in 97% (95% confidence interval, 95-99) of tricuspid and 72% (95% confidence interval, 58-83) of pulmonary valves. In addition, 99% (95% confidence interval, 98-100) of tricuspid and 59% (95% confidence interval, 38-79) of pulmonary valves were replaced. Bioprosthetic valves were used in 80% (95% confidence interval, 68-93) of tricuspid positions. Mean hospital duration of stay was 16 days (95% confidence interval, 7-25). Thirty-day mortality was 9% (95% confidence interval, 6-12). Mean follow-up was 25 months (95% confidence interval, 11-39). Median survival was 3 years (95% confidence interval, 2.5-3.5)., Conclusion: For patients >18 years of age, surgical treatment of carcinoid heart disease can be performed with a reasonable safety profile. However, overall survival appears to have ongoing effects of the primary disease., (Copyright © 2021. Published by Elsevier Inc.)

Objectives/hypothesis: The purpose of this project was to determine the spectral and electroglottograph (EGG) differences exhibited by classically trained female singers when singing through their primo passaggio. The hypotheses were that the singers would exhibit relatively steady EGG levels and minimal changes in speech spectra when singing through their primo passaggio. It also was hypothesized that EGG and spectral measurements at the crest and trough of the vibrato cycles would be similar to each other., Study Design: The study is an observational case-control study., Methods: Singers at training levels from undergraduate university students through professionals sang an A3-A4 scale using an /ɑ:/ vowel while standing. Contact quotient (CQEGG), amplitudes of the first five harmonics (H1-H5), and the number of the harmonics with greatest energy in the frequency region around 3000 Hz were measured at vibrato crests and troughs for each note., Results: The data at the vibrato crests and troughs exhibited similar patterns across the notes that differed in the percentage CQEGG and harmonic amplitude. The mean CQEGG exhibited a slight decline from the lowest note to the highest, with a few of the singers exhibiting different patterns. The strongest harmonic for the four lowest notes was H3 with a transition to H2 being strongest for the four highest notes., Conclusions: The patterns of all the singers' averaged glottal and vocal tract adjustments through their primo passaggio generally followed what was hypothesized for the CQEGG, harmonic amplitudes, and harmonic of the frequency region around 3000 Hz. However, differences occurred between the measurements at the vibrato peaks and troughs., (Copyright © 2016 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objectives/hypothesis: Few studies have reported the acoustic characteristics of youth choirs. In addition, scant data are available on youth choruses making the adjustments needed to sing at different dynamic levels in different registers. Therefore, the purpose of this study was to acoustically analyze the singing of a youth chorus to observe the evidence of the adjustments that they made to sing at two dynamic levels in three singing registers., Study Design: Single-group observational study., Methods: The participants were 47 members of the Brooklyn Youth Chorus who sang the same song sample in head, mixed, and chest voice at piano and forte dynamic levels. The song samples were recorded and analyzed using long-term average spectra and related spectral measures., Results: The spectra revealed different patterns among the registers. These differences imply that the singers were making glottal adjustments to sing the different register and dynamic level versions of the song. The duration of the closed phase, as estimated from the amplitudes of the first two harmonics, differed between the chest and head register singing at both dynamic levels. In addition, the spectral slopes differed among all three registers at both dynamic levels., Conclusions: These choristers were able to change registers and dynamic levels quickly and with minimal prompting. Also, these acoustic measures may be a useful tool for evaluating some singing skills of young choristers., (Copyright © 2012 The Voice Foundation. Published by Mosby, Inc. All rights reserved.)

Objective: To examine the effects of initiating oral contraceptive (OC) use on spectrally based acoustic measures., Study Design: Case history., Methods: A 23-year-old female volunteered to participate in the study. Voice recordings were obtained during eight consecutive menstrual cycles: two cycles before the onset of OC use and six cycles after the initiation of OC use. Recordings consisted of three trials of the sustained vowel /æ/ and were obtained during the follicular phase (preovulation, days 9-11) and luteal phase (premenstruation, days 20-22) of each cycle. Measurements obtained included the following: (1) H1-H2, the ratio of the amplitude of the first harmonic to the amplitude of the second harmonic, which correlates to closed quotient duration; (2) H1-A1, the ratio of the amplitude of the first harmonic to the amplitude of the first formant, which correlates to glottal width; and (3) H1-A3, the ratio of the first harmonic to the amplitude of the third formant, which correlates to the abruptness of vocal fold closure. In addition, acoustic measures of voice perturbation, jitter, shimmer, and noise-to-harmonic ratio were measured., Results: The participant exhibited changes in glottal characteristics in conjunction with initiation of OC use. Both the H1-H2 and H1-A1 differences changed with OC use relative to menstrual cycle phase. These two measures have been correlated with the glottal measures of closed quotient and glottal width, respectively. However, there was no significant change in the H1-A3 difference, indicating no effect of OC use on the speed of vocal fold closure., Conclusions: The results of this study indicate that the onset of OC use can result in vocal changes as noted by different patterns of glottal adjustment across menstrual cycle phases., (Copyright © 2011 The Voice Foundation. Published by Mosby, Inc. All rights reserved.)

Objective: It is generally accepted that patients who require biventricular assist device support have poorer outcomes than those requiring isolated left ventricular assist device support. However, it is unknown how the timing of biventricular assist device insertion affects outcomes. We hypothesized that planned biventricular assist device insertion improves survival compared with delayed conversion of left ventricular assist device support to biventricular assist device support., Methods: We reviewed and compared outcomes of 266 patients undergoing left ventricular assist device or biventricular assist device placement at the University of Pennsylvania from April 1995 to June 2007. We subdivided patients receiving biventricular assist devices into planned biventricular assist device (P-BiVAD) and delayed biventricular assist device (D-BiVAD) groups based on the timing of right ventricular assist device insertion. We defined the D-BiVAD group as any failure of isolated left ventricular assist device support., Results: Of 266 patients who received left ventricular assist devices, 99 (37%) required biventricular assist device support. We compared preoperative characteristics, successful bridging to transplantation, survival to hospital discharge, and Kaplan-Meier 1-year survival between the P-BiVAD (n = 71) and D-BiVAD (n = 28) groups. Preoperative comparison showed that patients who ultimately require biventricular support have similar preoperative status. Left ventricular assist device (n = 167) outcomes in all categories exceeded both P-BiVAD and D-BiVAD group outcomes. Furthermore, patients in the P-BiVAD group had superior survival to discharge than patients in the D-BiVAD group (51% vs 29%, P < .05). One-year and long-term Kaplan-Meier survival distribution confirmed this finding. There was also a trend toward improved bridging to transplantation in the P-BiVAD (n = 55) versus D-BiVAD (n = 22) groups (65% vs 45%, P = .10)., Conclusion: When patients at high risk for failure of isolated left ventricular assist device support are identified, proceeding directly to biventricular assist device implantation is advised because early institution of biventricular support results in dramatic improvement in survival.

Previous studies of the effect of hormonal changes across phases of the menstrual cycle on voice onset time (VOT) have not considered the variable of oral contraceptive use. The purpose of this study was to examine both the effects of menstrual cycle phase and that of oral contraceptive use on VOT. It was hypothesized that women taking oral contraceptives would exhibit smaller VOT differences across the phases of their menstrual cycles. The study was a prospective matched-group experimental design. Participants were 10 women who were on oral contraceptives and 10 who were not. The participants were recorded over two menstrual cycles, on the 10th and 20th day to evaluate their speech during the preovulation and premenstrual phases of their menstrual cycle. Participants produced 10 repetitions of the phrase "Speak &#95;&#95;&#95; to me" containing the target syllables /bae/ and /pae/. Repeated measure ANOVAs revealed no significant differences in VOT between the two groups. Statistical results showed significant interactions between the menstrual cycle phase and the 2 recording months. It is possible that month-to-month differences in hormonal levels and other factors that can affect speech may have a greater effect on VOT than either the taking of oral contraceptives or the phase differences within a menstrual cycle.

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.

Objectives/hypothesis: The purpose of this study was to examine the temporal-acoustic differences between trained singers and nonsingers during speech and singing tasks., Methods: Thirty male participants were separated into two groups of 15 according to level of vocal training (ie, trained or untrained). The participants spoke and sang carrier phrases containing English voiced and voiceless bilabial stops, and voice onset time (VOT) was measured for the stop consonant productions., Results: Mixed analyses of variance revealed a significant main effect between speech and singing for /p/ and /b/, with VOT durations longer during speech than singing for /p/, and the opposite true for /b/. Furthermore, a significant phonatory task by vocal training interaction was observed for /p/ productions., Conclusions: The results indicated that the type of phonatory task influences VOT and that these influences are most obvious in trained singers secondary to the articulatory and phonatory adjustments learned during vocal training.

This study was designed to examine the temporal acoustic differences between male trained singers and nonsingers during speaking and singing across voiced and voiceless English stop consonants. Recordings were made of 5 trained singers and 5 nonsingers, and acoustically analyzed for voice onset time (VOT). A mixed analysis of variance showed that the male trained singers had significantly longer mean VOT than did the nonsingers during voiceless stop production. Sung productions of voiceless stops had significantly longer mean VOTs than did the spoken productions. No significant differences were observed for the voiced stops, nor were any interactions observed. These results indicated that vocal training and phonatory task have a significant influence on VOT.

This study investigated selected acoustic cues in the speaking voices of five professional singers; cues that may have enabled naïve listeners to differentiate them from nonsingers and other trained singers who were not consistently identified from their speaking voices. Subjects were divided into three groups based on listeners' perceptual judgments. Group I, the identified singers, consisted of five professional singers, three males and two females, with an average identification score, from their speaking utterances, of 79%. Group II, the unidentified singers, consisted of 15 trained singers, seven males and eight females, who, as a group, were identified correctly from their speaking utterances only 52% of the time. Group III consisted of 20 nonsingers who were incorrectly identified from their speaking utterances as singers only 36% of the time, that is, they were correctly identified as nonsingers from their speech 64% of the time. Acoustic parameters chosen for measurement from vowel productions were: (1) percent jitter, (2) percent shimmer, and (3) noise-to-harmonic ratio. The second sentence of the "Rainbow Passage" was selected to compare several frequency and duration measures between the three groups. These were: (1) mean speaking fundamental frequency, (2) standard deviation of the fundamental frequency, (3) sentence duration, (4) word duration, and (5) consonant/vowel ratio. The data indicated that the acoustic parameters that most consistently distinguished the identified singers from the unidentified singers and the nonsingers were fundamental frequency variation and durational differences. The identified singers varied their speaking fundamental frequency significantly more than did both the unidentified singers and the nonsingers. The identified singers also had longer vocalic segments than did the others.

Objective: The first months after orthotopic heart transplantation are associated with the highest risk of acute allograft rejection. This study explores the utility and reliability of linear and novel nonlinear metrics of heart rate variability as predictors of graft rejection. The underlying hypothesis is that the transplanted heart, in response to inflammatory mediators, alters the dynamic properties of its rhythm-generating system., Methods: In a cross-sectional study of 45 patients who had undergone heart transplantation, spanning a period of 4 months after the operation, heart rate variability was examined by time- and frequency-domain analysis. The nonlinear features of heart rate variability were studied by computing a pointwise correlation dimension of R-R interval time series. The results of heart rate variability analysis were compared with those of endomyocardial surveillance biopsy studies using the International Society for Heart and Lung Transplantation scoring system., Results: Duration of heart transplantation itself exhibited a significant (P<.05) association with the onset of rejection. Specific predictors of acute rejection based on heart rate variability were identified, including shortening of the R-R interval (from 700 +/- 68 to 648 +/- 72 ms), an increase in the ratio of low-frequency (0.04-0.15 Hz) to high-frequency (0.15-0.40 Hz) spectral power (from 0.3 +/- 0.2 to 0.6 +/- 0.4), and a decrease in pointwise correlation dimension values (from 1.7 +/- 0.7 to 0.9 +/- 0.3 units). Multivariable logistic regression analysis (R (2) = 0.4) revealed that the only significant independent risk predictors were pointwise correlation dimension (odds ratio, 2.2 per 0.1 unit) and duration of heart transplantation (odds ratio, 1.7 per week)., Conclusion: Nonlinear measures of heart rate variability provide noninvasive means for identifying patients undergoing cardiac transplantation with acute rejection, thereby enabling the assessment of the time-dependent adaptive response of the donor heart to its host.

This study was designed to ascertain the intrasubject variability across multiple recording sessions-most often disregarded in reporting group mean data or unavailable because of single sample experimental designs. Intrasubject variability was assessed within and across several experimental sessions from measures of speaking fundamental frequency, vocal intensity, and reading rate. Three age groups of men and women--young, middle-aged, and elderly--repeated the vowel /a/, read a standard passage, and spoke extemporaneously during each experimental session. Statistical analyses were performed to assess each speaker's variability from his or her own mean, and that which consistently varied for any one speaking sample type, both within or across days. Results indicated that intrasubject variability was minimal, with approximately 4% of the data exhibiting significant variation across experimental sessions.

The purpose of this study was to measure the variability of frequency and intensity of speech, using multiple voice samples obtained over a period of time at a speaker's "comfortable effort level." Variability in vocal output within and across several experimental sessions was assessed from measures of speaking fundamental frequency (SFF) and vocal intensity for utterances repeated three times a day over a 3-day period. Three distinct age groups of men and women-young, middle-aged and elderly-repeated the vowel /a/, read a standard passage, and spoke extemporaneously during each experimental session. Results indicated that variability in SFF and intensity were present across experimental sessions, age groups, gender, and speaking samples. Generally, group means indicated that approximately +/- 1 semitone of variability for SFF and approximately 2 db sound pressure level (SPL) variation in vocal intensity from any one experimental session to the next could be expected; individual variations within any group may reach two semitones and 6 db SPL.

The purpose of this paper was to evaluate the reliability of, and agreement among, six speech analysis systems in the determination of fundamental frequency. Five male and five female speakers provided oral reading and sustained vowel samples for analysis. Each sample was analyzed five times by each system. The results indicated high reliability for all of the systems for both sexes and both utterance types. Agreement among the systems was high for the male sustained vowels and the female oral reading samples. In contrast, poor agreement occurred among the systems for the male oral reading samples and the female sustained vowels. The findings indicate that the output of these automatic methods tends to be consistent over repeated trials within the systems in their extraction of fundamental frequency; however, agreement among these systems varies.

The purpose of this study was to determine the variability in speaking fundamental frequency (Fo) associated with sample type in two age groups of normal male and female speakers and a group with vocal-fold paralysis. Young and elderly normal control men and women produced a sustained vowel, read a passage, and spoke extemporaneously in the morning, early afternoon, and late afternoon on three different days. The vocal-fold-paralysis group produced two voice samples at different times on the same day. Two patterns of variability emerged in the normal groups. Young men produced sustained phonation at a significantly lower Fo than their reading or extemporaneous samples. Young and older women and older men produced sustained phonation with a higher Fo than their reading or extemporaneous samples. The eight subjects with unilateral vocal-fold paralysis (seven women, one man) produced samples with a pattern similar to that of the older normal groups but with greater differences between the sustained vowel and speech samples. The use of different sample types resulted in variations in mean speaking Fo in the normal subjects as well as in the vocal-fold-paralysis group. Within-day sampling of all normal subjects resulted in approximately the same variability as across-day sampling. In the vocal-fold-paralysis group, within-day sampling resulted in greater variability of mean Fo for vowels than for connected speech, following a pattern similar to the older normal control subjects and various speech materials for voice.(ABSTRACT TRUNCATED AT 250 WORDS)

The purpose of this study was to compare the mean speaking fundamental frequency (SFF), speaking frequency range, and mean speaking intensity for a group of trained male singers and a group of age-matched non-singers in three age ranges: 20 to 35 years old; 40 to 55 years old; and older than 65 years. Each subject was recorded as he read "The Rainbow Passage" and produced the vowel /a/ to the limits of his phonational frequency range. The data indicated that the mean SFF of the nonsingers was significantly lower among the middle-aged speakers than with the young or elderly. In contrast, the tenors exhibited no age-related SFF trends, and the young bass/baritones exhibited lower SFF levels than the middle-aged or elderly. The elderly nonsingers produced frequency ranges that were smaller than any other group. Finally, the young nonsingers used greater speech intensity than did the other groups.

Measures of the SFF, vocal intensity, phonational range, and habitual pitch level are reported for 39 professional singer and 39 nonsinger females, who were divided into three age groups (young, middle, and old age), with the professionals further divided into sopranos and altos. Each read the "Rainbow Passage" and spoke extemporaneously, from which measures of the SFF and vocal intensity were calculated; phonational range and habitual pitch levels were also determined. No significant differences were noted between the reading and speaking tasks. The SFF and intensity levels were significantly higher for the professionals in comparison to the nonsingers, but only for certain age groups. Moreover, whereas the nonsinger SFF levels varied significantly as a function of age, those for the professional singers did not. Although trends occurred, no significant differences were found for the mean phonational range or habitual pitch levels when the professionals and nonsingers were compared.