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Voice diagnostics before and after phonosurgical interventions should aim at detailed planning of surgical techniques and evaluability of postoperative outcome. They should consider multimodal concepts and include measurements of perceptual voice analysis, laryngostroboscopy, voice acoustics, aerodynamics, and self-evaluation by the patients. Selected methods for voice diagnostics should reflect current knowledge and define the departmental procedure.Stimmdiagnostische Untersuchungen vor und nach phonochirurgischen Eingriffen dienen zum einen der detaillierten Planung der chirurgischen Vorgehensweise und zum anderen der Nachvollziehbarkeit des postoperativen Ergebnisses. Die Stimmdiagnostik verfolgt dabei eine vielschichtige Vorgehensweise und umfasst Aspekte aus perzeptiver Stimmklangbeurteilung, Laryngostroboskopie, Stimmakustik, Aerodynamik und der Selbsteinschätzung durch die Patient*innen. Die Auswahl stimmdiagnostischer Methoden sollte sich dabei immer am aktuellen Wissensstand orientieren und das einrichtungsinterne Vorgehen prägen.

This paper presents the first systematic study of the spatial transmission of the 1929–33 epidemic of meningococcal meningitis and its association with local coal mining communities in three adjacent high incidence counties of England; Nottinghamshire, Derbyshire and the West Riding of Yorkshire. Drawing on a robust method of spatial epidemiological analysis (swash-backwash model), we demonstrate a gradient response with local levels of employment in coal mining for each of three key parameters of the epidemic wave: spatial velocity of transmission; duration of infectivity; and spatial reach. Partial least squares (PLS) regression analysis identifies the relatively young and fertile demographic of local mining communities as the principal determinant of the resulting epidemic burden. Other sociodemographic parameters, including established risk factors for invasive meningococcal disease (low social class, high residential density and overcrowding) are found to play little, or no, role in the spatial distribution of the disease. Our findings have importance for understanding the historic links between the coal mining industry and epidemic meningococcal meningitis, and point to possible present-day opportunities for intervention through the designation of coal mining communities as defined risk groups for meningococcal vaccines.

Objectives The goal of the retrospective study was to investigate the 3-month-outcome after treatment of patients with early unilateral vocal fold paralysis (UVFP) with either standard voice therapy (VT) or selective electrical stimulation of the larynx (SES). Design Non-randomised retrospective study. Setting 1519 patients who underwent thyroid surgery between 2015 and 2018 were analysed according vocal fold mobility; UVFP patients were treated either by VT or SES. Participants 51 UVFP patients. Main outcome measures 51 UVFP patients have been advised regarding treatment options like either VT (group 1) or SES (group 2). The patients of group 1 (n = 26) and 2 (n = 25) were re-assessed up to 3 months post-operatively regarding UVFP persistence/recovery and perceptive voice sound quality. At follow-ups, perceptual analysis of voice sound (using roughness=R/breathiness=B/hoarseness=H scale) and endoscopic laryngoscopy have been performed. Position of immobile vocal fold, shape of glottal closure and RBH parameters have been considered for statistical analyses. Results Restitution of UVFP with regular respiratory vocal fold mobility of both vocal folds occurred in 53.8% of group 1 (VT), and in 40.0% of group 2 (SES) after 3 months of therapy between both groups. No difference could be seen for RBH, type of glottal closure and position of ailing vocal folds in patients with persisting UVFP within both groups and between the groups. Conclusions The study reveals that SES can achieve similar functional outcome in early UVFP. Thus, it should be considered as an equivalent therapy alternative to VT for treatment of early UVFP patients since no significant difference in vocal outcome and glottal configuration between the two groups could be demonstrated.

Purpose This paper describes a first attempt to quantify LEMG data based on turn number calculation. The results obtained for both healthy and ailing thyroarytenoid (TA) muscles of patients with unilateral vocal fold immobility (UVFI) were compared with the respective qualitative evaluation concerning volitional activity to determine whether the two types of analyses deliver similar results. Methods LEMG data obtained from 44 adults with UVFI were considered for the study. Semiquantitative evaluation of TA volitional activity and turn number were assessed for the ailing and the healthy TA and the difference in percentage was calculated. Paired data were compared with the Wilcoxon signed-rank test. The volitional activity assessment and the turn number evaluation were compared with the Kruskal–Wallis test, and their relationship was tested with the Kendall rank correlation. Results Datasets of 27 patients were considered compatible with turns/s calculation. The results showed that complete paralysis correlated with no turns; single fiber volitional activity with 62–208 turns/s, strongly decreased volitional activity with 198–501 turns/s; and dense volitional activity with 441–1234 turns/s. On the ailing VF only, the Kruskal–Wallis test showed a statistically significant difference (p = 0.0001), and the Kendall rank correlation a positive relationship (r = 0.853,p ≤ 0.0001) between the volitional activity rating and the turn number assessment. Conclusions Our preliminary results showed that turn number evaluation is an effective tool to confirm LEMG qualitative analysis, and that, in combination with laryngostroboscopy and voice assessment, can help improving the accuracy of the diagnosis and prognosis and the effectiveness of the chosen therapy.

Background and aims: Patients with acute intermittent porphyria (AIP) may suffer from acute non-specific attacks that often result in hospitalizations or emergency room (ER) visits. Prior to the re...

Purpose Persistent unilateral vocal fold paralysis (UFVP) with glottal insufficiency often requires type I medialization thyroplasty (MT). Previous implants cannot be adjusted postoperatively if necessary. The newly developed APrevent® VOIS implant (VOIS) can provide postoperative re-adjustment to avoid revision MT. The objective of this pilot study is to evaluate the VOIS intraoperatively concerning voice improvement, surgical feasibility and device handling. Methods During routine MT, VOIS was applied short time in eight patients before the regular implantation of the Titanium Vocal Fold Medialization Implant (TVFMI™). In all patients, perceptual voice sound analysis using R(oughness)–B(reathiness)–H(oarseness)-scale, measurement of M(aximum)–P(honation)–T(ime) and glottal closure in videolaryngoscopy were performed before and after implanting VOIS/TVFMI™. Acoustic analyses of voice recordings were performed using freeware praat. Surgical feasibility, operative handling and device fitting of VOIS and TVFMI™ were assessed by the surgeon using V(isual)-A(nalog)-S(cale). Data were statistically analyzed with paired t test. Result All patients showed significant improvement of voice sound parameters after VOIS/TVFMI™ implantation. The mean RBH-scale improved from preoperative R = 2.1, B = 2.3, H = 2.5 to R = 0.6, B = 0.3, H = 0.8 after VOIS and R = 0.5, B = 0.3, H = 0.8 after TVFMI™ implantation. The mean MPT increased from preoperative 7.9 to 14.6 s after VOIS and 13.8 s after TVFMI™ implantation. VOIS/TVFMI™ achieved complete glottal closure in 7/8 patients. The satisfaction with intraoperative device fitting and device handling of VOIS was as good as that of TVFMI™. Conclusion The novel APrevent® VOIS implant showed similar intraoperative voice improvement compared to routinely used TVFMI™ without adverse device events and with safe device fitting.

Purpose Laryngeal electromyography (LEMG) has been considered as gold standard in diagnostics of vocal fold movement impairment, but is still not commonly implemented in clinical routine. Since the signal interpretation of LEMG signals (LEMGs) is often a subjective and semi-quantitative matter, the goal of this study was to evaluate the inter-rater reliability of neurolaryngologists on LEMGs of volitional muscle activity. Methods For this study, 52 representative LEMGs of 371 LEMG datasets were selected from a multicenter registry for a blinded evaluation by 7 experienced members of the neurolaryngology working group of the European Laryngological Society (ELS). For the measurement of the observer agreement between two raters, Cohen’s Kappa statistic was calculated. For the interpretation of agreements of diagnoses among the seven examiners, we used the Fleiss’ Kappa statistic. Result When focusing on the categories “no activity”, “single fiber pattern”, and “strongly decreased recruitment pattern”, the inter-rater agreement varied from Cohen’s Kappa values between 0.48 and 0.84, indicating moderate to near-perfect agreement between the rater pairs. Calculating with Fleiss’ Kappa, a value of 0.61 showed good agreement among the seven raters. For the rating categories, the Fleiss’ Kappa value ranged from 0.52 to 0.74, which also showed a good agreement. Conclusion A good inter-rater agreement between the participating neurolaryngologists was achieved in the interpretation of LEMGs. More instructional courses should be offered to broadly implement LEMG as a reliable diagnostic tool in evaluating vocal fold movement disorders in clinical routine and to develop future algorithms for therapy and computer-assisted examination.

Menstrual function is strongly affected by nutritional status and energy availability in female athletes, and impaired menstrual function can impact bone mineral density. Nutritional interventions have been proposed to mitigate menstrual dysfunction. The purpose of this systematic review was to assess the ability of nutritional interventions, directed at improving energy availability, to restore normal menstrual status in female athletes. PubMed, Cinahl, and SportDiscus databases were comprehensively searched. Included studies had to investigate the impact of increasing energy availability in female athletes through a nutritional intervention. The primary outcome measure of interest was menstrual status. Included studies were reviewed for methodological rigor using the American Academy of Dietetics Quality Criteria Checklist. Five studies met the inclusion criteria. Of the athletes who completed the interventions in the studies, 0–100% resumed normal menses. For those that improved, the mean length of time for return to menses ranged from 2.63 to 15.6 months. The length of the interventions (3–9 months), mean ages of the participants (17–1-22.6 years), and particular dietary intervention(s) (counseling, education, and nutritional supplementation) varied between the studies. Nutritional interventions may restore normal menses in some female athletes. Educational strategies targeted at improved eating and understanding the energy demands of sport, as well as weekly interaction with athletes should be considered.

Purpose In clinical practice, laryngo(strobo)scopy (LS) is still mainly used for diagnostics and management of unilateral vocal fold paralysis (UFVP), although only laryngeal electromyography (LEMG) can provide information on causes of vocal fold immobility, especially on possible synkinetic reinnervation after recurrent laryngeal nerve (RLN) injury. The goal of this retrospective study was the evaluation whether signs of synkinetic reinnervation in LS can be objectified in comparison to LEMG data. Methods Between 1/2015 and 2/2018, 50 patients with laryngostroboscopically suspected UVFP received routine LEMG examination. The LEMG findings were retrospectively compared with LS findings. The LEMG data analysis focused on the diagnosis of synkinetic reinnervation of the TA/LCA and/or PCA. The digital LS recordings were retrospectively re-evaluated by phoniatricians considering 22 selected laryngostroboscopic parameters. Results LEMG revealed synkinesis in 23 (46%) and absence of synkinesis in 27 (54%) patients. None of the 22 parameters showed significant association between patients with synkinetic reinnervation and LS findings. The only laryngostroboscopic parameter that was significantly associated with a silent LEMG signal compared to single fiber activity in LEMG was a length difference on the side of the UVFP (p-value 0.0001; OR 14.5 (95% CI 3.047–66.81; Sensitivity 0.5; Specificity 0.9355). Conclusion Our findings show that synkinesis cannot be diagnosed using only LS. This study underlines the importance of LEMG in clinical routine for detection of laryngeal synkinesis in patients with UVFP before any further therapeutic steps are initiated to avoid later therapy failure.

Professional interpreters are an essential part of the healthcare team in providing high-quality care to all patients. However, interprofessional skills for working with professional interpreters are often not developed until after entering the workforce. Little is known about the educational impact of working with interpreters in a pro bono setting during graduate education. Therefore, the purpose of this study was to investigate students’ perceptions of their training and experiences working with a professional interpreter in a pro bono physical therapy setting. Eighteen physical therapy students participated in one of five focus groups. Students who took part in the study had volunteered in a pro bono physical therapy clinic and worked with a professional interpreter. Four primary themes emerged from the data: Value, Patient-Centered Care, Challenges, and Professional Development. Based on student feedback, key findings were: 1) an increase in student confidence in working with a professional interpreter, 2) the safe learning environment of a supervised hands-on experience promoted learning through challenges, and 3) the value of professional interpreters as part of the healthcare team and their assistance in developing interprofessional communication skills. When considering Doctor of Physical Therapy education, offering a low-stakes hands-on experience with professional interpreters may offer distinct growth opportunities for students as they develop their professional skills.

Gastroesophageal reflux is associated with numerous pathologic conditions of the upper aerodigestive tract. GERD can be subclassified into esophageal and extraesophageal syndromes. Extraesophageal manifestations can be either pulmonary or otorhinolaryngological.

Phoniatricians usually have the key role when dealing with a voice disorder, supported by logopedists/speech-language pathologists. Cooperation with other medical or non-medical disciplines may contribute when needed. Fundamentals, general goals and the structure of voice therapy are followed by a survey of specific methods and techniques. No matter what kind of technique is used, treatment strategy is inevitably based on pathophysiological mechanisms of a disorder and the patient’s state as a whole. Voice therapy is a dynamic process and not an application procedure for a stable phonatory pattern or a list of exercises for every patient. This integrative model for treatment of voice disorders includes additional skills and knowledge of mechanisms of applications, stages of behavioural treatment, phases of motor learning, stages of voice therapy and steps of a given technique. Functional disorders of the singing voice (dysodia) require additional and specific expertise, especially in emergency situations in the frame of cancellation policy regarding the opera and theatre business. Drug treatment and physiotherapy/osteopathy as more therapeutic approaches to voice disorders are presented, as well as phonosurgical procedures, i.e. functional surgical interventions aiming exclusively, or in part, at improvement, restoration or preservation of vocal function. Methods comprise of phonomicrosurgery (endoscopic microsurgery), laryngeal injection and laryngeal framework surgery that modify the cartilaginous framework of the larynx (laryngoplastic phonosurgery, open-neck surgery). Pacing and reinnervation are also discussed as alternatives in bilateral vocal fold palsies, and vocal rehabilitation after head and neck surgery, including the use of personalised computer speech synthesis for laryngectomised patients, is considered. Indications for tracheostomy and tracheostoma care refer to clinical practice. The prognosis of voice rehabilitation depends on the various factors that are included in voice production and should be considered accordingly.

Background Airway management during repair of laryngotracheal stenosis is demanding, and there is currently no accepted standard of care. Recently an increasing number of airway centers have started to use a laryngeal mask until the airway is surgically exposed and cross-table ventilation can be initiated. However detailed data on this approach are missing in the literature. Methods Patients receiving laryngotracheal surgery from November 2011 until October 2018 were retrospectively included in this single-center study, except for patients who presented with a preexisting tracheostomy at time of surgery. Airway management uniformly consisted of laryngeal mask ventilation until cross-table ventilation was established. Clinical variables, perioperative complications, and airway complications were analyzed. Results One hundred eight patients (65 women, 43 men) receiving tracheal resection (n = 50), cricotracheal resection (n = 49), or single-stage laryngotracheal reconstruction (n = 9) were included in the analysis. Of the included patients 23 (21.3%) had malignant disease and 85 (78.7%) a benign pathology. In the subgroup of patients with subglottic disease 85.1% had high-grade stenosis (Myer-Cotton III°). Airway management with a laryngeal mask was successful in all except 1 patient (99.1%). Mean pulse oximetry and mean end-tidal CO2 during laryngeal mask ventilation was 98.7% ± 2.4% and 34.8 ± 7.6 mm Hg, respectively. At the end of surgery 95 patients (88%) were successfully weaned from the respirator using the laryngeal mask. Conclusions The laryngeal mask as the primary airway device is feasible and safe in patients undergoing laryngotracheal surgery even in cases with high-grade stenosis.

Background: Physical therapists commonly treat individuals with anterior knee pain (AKP) and anterior cruciate ligament (ACL) injuries. Despite the suggestion for including hip strengthening or neuromuscular control exercises in preventative programs to change knee mechanics and reduce AKP and ACL injuries and in the treatment of AKP, no previous systematic review has addressed the impact of these exercises on frontal plane knee mechanics.Objective: The purpose of this systematic review was to determine the level of evidence associated with hip strengthening or neuromuscular control exercises as an intervention to improve frontal plane knee mechanics during dynamic activity in females.Methods: Databases searched included PubMed, CINAHL Plus with full text, and SportDiscus with full text; specific search terms were used. All studies were to include females without any current knee pain or injury. Studies had to investigate the impact of a hip strengthening or a hip neuromuscular control program or a combin...

Objectives: Functional Massage (FM) is a therapeutic technique that incorporates joint motion with massage to treat musculotendinous pain and impairments. The purpose of this study was to determine the effectiveness of FM to decrease pain and improve range of motion (ROM) in patients.Methods: A test re-test design was utilized to identify the effects of FM as measured by the numeric pain rating scale (NPRS) and ROM. Twenty patients were treated by one of three participating orthopedic manual physical therapists (OMPT) and data was collected for five sessions.Results: One hundred and five data points collected from the twenty patients included: shoulder (55), knee (40), and ankle (10). The average change in NPRS (1.68) was statistically significant but not clinically significant (change ≥2). The majority of the FM treatments resulted in a positive NPRS change 82/105(78.1%). The average change in ROM (7.08°) was statistically (P 4°).Conclusions: FM resulted in st...

Summary A prospective, noninterventional survey was conducted among Clostridium difficile positive patients identified in the time period of July until October 2012 in 18 hospitals distributed across all nine Austrian provinces. Participating hospitals were asked to send stool samples or isolates from ten successive patients with C.difficile infection to the National Clostridium difficile Reference Laboratory at the Austrian Agency for Health and Food Safety for PCR-ribotyping and in vitro susceptibility testing. A total of 171 eligible patients were identified, including 73 patients with toxin-positive stool specimens and 98 patients from which C. difficile isolates were provided. Of the 159 patients with known age, 127 (74.3 %) were 65 years or older, the median age was 76 years (range: 9–97 years), and the male to female ratio 2.2. Among these patients, 73 % had health care-associated and 20 % community-acquired C. difficile infection (indeterminable 7 %). The all-cause, 30-day mortality was 8.8 % (15/171). Stool samples yielded 46 different PCR-ribotypes, of which ribotypes 027 (20 %), 014 (15.8 %), 053 (10.5 %), 078 (5.3 %), and 002 (4.7 %) were the five most prevalent. Ribotype 027 was found only in the provinces Vienna, Burgenland, and Lower Austria. Severe outcome of C. difficile infection was found to be associated with ribotype 053 (prevalence ratio: 3.04; 95 % CI: 1.24, 7.44), not with the so-called hypervirulent ribotypes 027 and 078. All 027 and 053 isolates exhibited in vitro resistance against moxifloxacin. Fluoroquinolone use in the health care setting must be considered as a factor favoring the spread of these fluoroquinolone resistant C. difficile clones.

Objective: The purpose of this study was to examine the relationship between frontal plane kinematics of the single leg squat and strength of the trunk and hip in females. Participants: Forty healthy females participated in this study. Methods: An isometric “make” test using a dynamometer was used to assess peak force normalized to body weight for hip abduction, hip extension, hip external rotation, and a sidelying plank test. Twodimensional software was used to analyze the frontal plane projection angle (FPPA) and pelvic angle during a single leg squat to 60 � . Results: All 4 strength factors were significantly correlated with the FPPA, ranging from r ¼ 0.396 to r ¼ 0.466. During multiple regression analysis, hip abduction strength was the greatest predictor of the variation in FPPA at r 2 ¼ 0.22, p ¼ 0.002. Thus, hip abduction strength accounted for 22% of the variation in the FPPA during the single leg squat. The only strength factor demonstrating a significant correlation with the pelvic angle was hip extension strength (r ¼ 0.550, p < 0.001). Conclusion: Clinicians should consider the role of the hip abductors, hip external rotators, hip extensors and core musculature on the impact on the FPPA during a single squat, with focus on the hip abductors.

A sensitive and specific screen for Duchenne muscular dystrophy (DMD) has been clinically confirmed, but the acceptability of adding DMD to the newborn screening (NBS) program has been controversial due to a lack of evidence that early diagnosis improves clinical outcome. With promising new gene therapies currently in clinical trials, it is reasonable to consider NBS for DMD for early pharmaceutical intervention. It is our objective to assess parents’ attitudes toward the acceptability of including DMD, the milder and allelic Becker muscular dystrophy (BMD), and spinal muscular atrophy (SMA) in the NBS panel, as well as to determine which factors (early diagnosis, family planning, parent-child bonding, anxiety, decision regret, time to prepare) are the most influential in parents’ opinions. Methods: Two cohorts were recruited separately and surveyed about their attitudes toward NBS for DMD/BMD/SMA. Expectant parents were recruited with no regard to family history, and their opinions were compared to those of parents of children with DMD, BMD, or SMA. Results: Of the 65 parents of children with DMD, BMD, or SMA that were surveyed, 63 (97%) supported NBS for DMD/BMD/SMA, either as a mandatory screen or with parental permission. Of the 400 expectant parents surveyed, 369 (92.5%) would have their child screened at birth for an incurable, life-shortening disease such as DMD/BMD/SMA. Expectant parents, especially those who would choose to have their child screened, viewed the benefits of early diagnosis (58.9%) as the most influential factor in their decision. Conclusions: There is strong support for NBS for DMD/BMD/SMA in both cohorts, which is not contingent on further therapeutic development. The consideration of including non-treatable diseases in NBS should include consideration of parental opinions on the beneficence of screening. Although there is currently no direct medical benefit to early diagnosis in DMD/BMD/SMA, parents responded that early diagnosis could have other, less tangible benefits. Parental opinions, along with promising clinical trials, make the implementation of an optional screen ideal for DMD, BMD, and SMA. Public Health Importance: NBS is the foremost intersection of genetics and public health. It is imperative to involve public opinion when assessing the acceptability of adding a potentially controversial disease to a standard panel.

Gastro-oesophageal reflux disease (GERD) is defined as a condition when the reflux of gastric content causes troublesome symptoms or complications. Gastro-oesophageal reflux is associated with numerous pathologic conditions of the upper aerodigestive tract. GERD can be subclassified into oesophageal and extraoesophageal syndromes. Extraoesophageal manifestations can be either pulmonary or otorhinolaryngological. This review provides an overview of most important extra-oesophageal reflux manifestations in GERD patients.

Since its introduction in 1999 by Friedrich, the titanium vocal fold medialization implant (TVFMI) is widely used for medialization thyroplasty in glottal closure insufficiency. The purpose of this study was to investigate the long-term functional outcome after medialization thyroplasty using TVFMI. Between 1999 and 2009 123 patients (mean age 55.3 years, 76 male and 47 female) underwent medialization thyroplasty with the TVFMI (96 left, 27 right). For purpose of long-term follow-up, 33 patients could be examined. Prior to surgery, about 8 weeks and at least 1 year after surgery perceptual, acoustic, aerodynamic and videolaryngostroboscopic examinations have been performed. The interval between surgery and long-term follow-up was on average 57 (23-120) months. None of the 123 patients presented early major postoperative complications (e.g. implant dislocation, dyspnoea with need of tracheostomy, wound infection, postoperative bleeding). In three patients the TVFMI had to be removed 2-6 months after surgery due to granulation tissue formation. In one patient a subepithelial localization of the implant could be seen without necessity of removal. Perceptual and acoustic parameters were significantly improved after surgery with long-lasting effect even years after surgery. Airway resistance (R(aw)) showed an increase over time without a relevant negative impact on the peak expiratory flow (PEF). Medialization thyroplasty using TVFMI allows precise and save positioning of the implant with stable perceptual and acoustic improvement. The only postoperative complication was the development of endolaryngeal granulation tissue resulting in removal of the implant.

We determined the role of carboxyl-terminal regulation of NOPR (nociceptin, orphanin FQ receptor) signaling and function. We mutated C-terminal serine and threonine residues and examined their role in NOPR trafficking, homologous desensitization, and arrestin-dependent MAPK signaling. The NOPR agonist, nociceptin, caused robust NOPR-YFP receptor internalization, peaking at 30 min. Mutation of serine 337, 346, and 351, had no effect on NOPR internalization. However, mutation of C-terminal threonine 362, serine 363, and threonine 365 blocked nociceptin-induced internalization of NOPR. Furthermore, point mutation of only Ser-363 was sufficient to block NOPR internalization. Homologous desensitization of NOPR-mediated calcium channel blockade and inhibition of cAMP were also shown to require Ser-363. Additionally, NOPR internalization was absent when GRK3, and Arrestin3 were knocked down using siRNA, but not when GRK2 and Arrestin2 were knocked down. We also found that nociceptin-induced NOPR-mediated JNK but not ERK signaling requires Ser-363, GRK3, and Arrestin3. Dominant-positive Arrestin3 but not Arrestin2 was sufficient to rescue NOPR-S363A internalization and JNK signaling. These findings suggest that NOPR function may be regulated by GRK3 phosphorylation of Ser-363 and Arrestin3 and further demonstrates the complex nature of G-protein-dependent and -independent signaling in opioid receptors.

Stimmstorungen im Kindesalter treten verhaltnismasig haufig auf. Intensive Aufklarung von Familie, Erziehern und Arzten uber Ursachen und Behandlungsmoglichkeiten kindlicher Stimmstorungen haben zu einer Sensibilisierung gegenuber dem Thema kindlicher Heiserkeit und zu einer besseren Fruherkennung von Stimmerkrankungen im Kindesalter gefuhrt. Kindliche Heiserkeit wird haufig durch Phonationsverdickungen infolge funktioneller Dysphonien verursacht. Weitere Ursachen konnen angeborene Kehlkopfdysplasien, Stimmlippenzysten und Larynxpapillomatosen sein. Im Fall kindlicher Heiserkeit ist eine facharztliche Abklarung notwendig, um entsprechende Therapieschritte einleiten zu konnen. Bei Stimmlippenzysten und Larynxpapillomatosen sind phonochirurgische Interventionen indiziert. Phonationsverdickungen sollten zunachst konservativ logopadisch und bei Therapieresistenz auch phonochirurgisch behandelt werden, da sie nicht selten die Stimmqualitat bis ins Erwachsenenalter beeintrachtigen konnen.

Summary Background Call center agents (CCAs) are at high risk of voice disorders because of high-demanding vocal load and work-related stress factors. Goal of this prospective study was to examine the voice use at work and to introduce biofeedback software into real-life workplace situation to improve vocal performance. Individual fundamental frequency, sound pressure level (SPL) of speaking voice, and syllables per second should be optimized by visualization on-screen. Further, its impact on vocal attrition and vocal constitution should be investigated. Methods Over a period of 6 months, 76 call center advisors voluntarily participated in this study (37 female, 39 male, mean age 29.3 years). At the beginning of the study, all the subjects received voice range profile (VRP) measurements and acoustic voice analyses at the beginning and at the end of shift. Additionally, several questionnaires have been completed. The subjects were classified into either the study group (group 1) or the control group (group 2). Group 1 had open access to results of the biofeedback software program at their workplace, and group 2 did not. The VRP measurements, questionnaires, and acoustic voice analyses were repeated 4 weeks later again at the beginning and at the end of shift. Results All the subjects confirmed a rather high vocal load. In contrast, almost none of the subjects received any voice training before entering the floor. The percentage of voice-related hoarseness and regular throat clearing was rather high in both groups. The statistical analyses revealed a significant improvement of vocal performance in subjects with vocal fatigue in the study group when compared with the control group after a 4-week biofeedback intervention. All the subjects with vocal hypofunction defined as maximum SPLs lower than 90 dB in VRP measurements improved to normal voice constitution at the end of the study in contrast to the control group. Conclusion Biofeedback is a suitable method to improve vocal awareness and vocal performance of CCAs.

What's known on the subject? and What does the study add? A vast literature has been published on the prevalence, morbidity and microbiology of catheter-associated urinary tract infections. Research and development in recent years has focused on producing antibacterial coatings for the indwelling Foley catheter with insufficient attention to its design. This article provides a critical examination of the design of the indwelling Foley catheter. Design specifications are outlined for a urine collection device that should reduce the vulnerability of catheterised urinary tract to infection. The indwelling urinary catheter is the most common cause of infections in hospitals and other healthcare facilities [1]. As long ago as 1958, Paul Beeson [2] warned '… the decision to use this instrument should be made with the knowledge that it involves the risk of producing a serious disease which is often difficult to treat'. Since then, scientific studies have progressed revealing a greater understanding of the bladder's defence mechanisms against infection and how they are undermined by the Foley catheter [3-5]. In addition, the complications caused by the development of bacterial biofilms on catheters have been recognised and the ways in which these bacterial communities develop on catheters have become clear [5,6]. It is now obvious that fundamental problems with the basic design of the catheter, which has changed little since it was introduced into urological practice by Dr Fredricc Foley in 1937 [7], induce susceptibility to infection. These issues need to be addressed urgently if we are to produce a device suitable for use in the 21st century.

The purpose if this study was to investigate the positive predictive value and sensitivity of the ICD-10 code G12.2, which is used to identify patients who have possibly died from ALS. All patients with a motor neuron disease diagnosis code during the study period (2001-2005) were identified using administrative data. South Carolina death certificate data were used to assess the positive predictive value and sensitivity of the ICD-10 code G12.2. Two hundred and seventy known cases of ALS linked to the death certificate data file. G12.2 was coded as either the underlying or contributing cause of death for 229 cases, sensitivity = 85%. There were 318 deaths due to ALS identified by the G12.2 code where a medical record was available for review. Of those, 205 contained information supporting the diagnosis of ALS, positive predictive value = 65%. This evaluation raises questions concerning the validity of using mortality data in forming epidemiological conclusions in this patient population. However, it does appear that mortality data can be used in the development of case-finding algorithms to identify ALS patients through the use of administrative data sets.

The goal of this study was to estimate the incidence of temporary and permanent unilateral recurrent laryngeal nerve paralysis (URLNP) after esophagectomies with cervical anastomosis and to determine the impact of surgical technique, tumor type, tumor localization and age on the incidence of URLNP. From March 2002 to November 2009, 84 patients underwent a laryngoscopical evaluation before and after esophagectomy with cervical anastomosis prospectively. If the postoperative URLNP recovered within 6 months, the paresis was classified as transient; if not, it was defined as permanent. The results indicate that the overall incidence of postoperative URLNP was 50% (42/84). Twenty-four of the 84 patients (28.6%) showed a transient URLNP. A permanent URLNP was observed in 9 of the 84 patients (10.7%). The remaining 9 of the 84 patients (10.7%) were categorized as paresis with unknown clinical outcome due to missing follow-up. There were significantly more postoperative URLNPs in the group operated by transthoracic esophagectomy than by transhiatal esophagectomy (p

Introduction The first-aid training necessary for obtaining a drivers license in Austria has a regulated and predefined curriculum but has been targeted for the implementation of a new course structure with less theoretical input, repetitive training in cardiopulmonary resuscitation (CPR) and structured presentations using innovative media. Methods The standard and a new course design were compared with a prospective, participant- and observer-blinded, cluster-randomized controlled study. Six months after the initial training, we evaluated the confidence of the 66 participants in their skills, CPR effectiveness parameters and correctness of their actions. Results The median self-confidence was significantly higher in the interventional group [IG, visual analogue scale (VAS:“0” not-confident at all,“100” highly confident):57] than in the control group (CG, VAS:41). The mean chest compression rate in the IG (98/min) was closer to the recommended 100 bpm than in the CG (110/min). The time to the first chest compression (IG:25s, CG:36s) and time to first defibrillator shock (IG:86s, CG:92s) were significantly shorter in the IG. Furthermore, the IG participants were safer in their handling of the defibrillator and started with countermeasures against developing shock more often. The management of an unconscious person and of heavy bleeding did not show a difference between the two groups even after shortening the lecture time. Conclusions Motivation and self-confidence as well as skill retention after six months were shown to be dependent on the teaching methods and the time for practical training. Courses may be reorganized and content rescheduled, even within predefined curricula, to improve course outcomes.

Although treatment fidelity strategies for enhancing the integrity of behavioral interventions have been well described, little has been written about monitoring data collection integrity. This article describes the principles and strategies developed to monitor data collection integrity of the “Stories and Music for Adolescent/Young Adult Resilience During Transplant” study (R01NR008583, U10CA098543, and U10CA095861)—a multi-site Children's Oncology Group randomized clinical trial of a music therapy intervention for adolescents and young adults undergoing stem cell transplant. The principles and strategies outlined in this article provide one model for development and evaluation of a data collection integrity monitoring plan for behavioral interventions that may be adapted by investigators and may be useful to funding agencies and grant application reviewers in evaluating proposals. © 2011 Wiley Periodicals, Inc. Res Nurs Health 34:362–371, 2011

In Kiel kreuzt ein Versorgungstunnel zum Gemeinschaftskraftwerk Kiel die Kieler Foerde. Infolge starker Alkali-Kieselsaeure-Reaktionen waren an der Betonkonstruktion des Versorgungstunnels starke Schaeden aufgetreten, die mittelfristig die Tragfaehigkeit gefaehrdeten. Dies bedeutete, dass der Tunnel nachhaltig instand gesetzt werden musste. Die durchgefuehrten Ertuechtigungsmassnahmen und die dazu erforderlichen Vor- und Nebenarbeiten werden beschrieben. Der Tunnel war 1990 durch Vorpressen von Betonrohren mit einem Innendurchmesser von 4,10 m hergestellt worden. Im Innern verlaufen zwei Fernwaermerohre DN 700 und eine 110-kV-Stromleitung. Wegen des relativ grossen Durchmessers des Tunnels war der Einbau einer zusaetzlichen Innenschale moeglich. Die Ausschreibung sah daher zur Ertuechtigung den Einbau einer aus Betontuebbingen hergestellten Tunnelinnenschale vor, die gegen den bestehenden Tunnel mit einer PE-Folie abgedichtet werden sollte. Zur Ausfuehrung kam jedoch ein Nebenangebot, das vorsah, die Innenschale aus Vortriebsrohren herzustellen, die ueber die ganze Laenge des Tunnels von 1.368 m auf einer Verschubbahn vorzuschieben waren. Infolge des hoeheren Vorfertigungsgrades, des Verbleibens der Versorgungsleitungen im Tunnel und einer kuerzeren Bauzeit bot diese Loesung sowohl technische als auch wirtschaftliche Vorteile. Bei einem Tuebbingausbau haetten die Leitungen zunaechst ausgebaut und dann wieder eingebaut werden muessen. Da der Verschub der Betonrohre ueber die erhebliche Laenge von 1.368 m vorzunehmen war, wurden auf einem Versuchsstand an der Baustelle alle wichtigen Parameter des Vorschubs getestet. Dabei ging es insbesondere darum, die geeignete Gleitpaarung und den zu verwendenden Schmierstoff herauszufinden. Die Verschubbahn erlaubte ein Hin- und Herschieben der Betonrohre, sodass beliebige Vorschubstrecken simuliert werden konnten. Als Grenzkriterium wurde eine mindestens von der Gleitpaarung zu bewaeltigende Vorschubstrecke von 1,5 Kilometer festgelegt. Entsprechend den Versuchsergebnissen zeigte von den drei untersuchten Gleitpaarungen die Gleitpaarung Teflon auf Stahl mit Schmierung die besten Ergebnisse. Diese Gleitpaarung wurde daher als planmaessig anzuwenden ausgewaehlt; insbesondere weil in Langzeitversuchen ueber eine Versuchsvorschubstrecke von 1,5 Kilometer kaum ein Verschleiss des Teflons festzustellen war. Das Schmieren beim Verschub erfolgte ueber Schmieroeffnungen von der Rohrinnenseite aus. Als Verschubbahn dienten Schienen, die an der Bestandsroehre befestigt wurden. Mit der Gleitpaarung Teflon auf Stahl konnte ein Reibungsbeiwert von 0,03 erreicht werden. Da die Tunnelgradiente vom oestlichen Startschacht aus zunaechst mit einer Neigung von 10 Prozent abfaellt, konnten die Betonrohre dort alleine infolge des Eigengewichts gleiten. Dies erforderte ein Bremsen, das durch Spannlitzen, die an der Stirnseite des ersten Rohres befestigt waren und zu einer Bremsvorrichtung im Startschacht fuehrten, realisiert wurde. Da die Schaeden an der Bestandsroehre deutlich groesser als erwartet waren, mussten die zum Vorschub notwendigen Pressenkraefte auf 10 Prozent der urspruenglich geplanten Pressenkraft reduziert und vier Zwischenpressstationen eingerichtet werden. Abschliessend wird kurz auf die Bemessung der Vorschubrohre, die Optimierung der neuen Lage der Fernwaermerohre und den Bauablauf eingegangen.

Background: Plectin crosslinks intermediate filaments to their targets in different tissues. Defects in plectin cause epidermolysis bullosa simplex (EBS), muscular dystrophy (MD), and sometimes pyloric atresia. Association of EBS with a myasthenic syndrome (MyS) was documented in a single patient in 1999. Objectives: To analyze the clinical, structural, and genetic aspects of a second and fatal case of EBS associated with a MyS and search for the genetic basis of the disease in a previously reported patient with EBS-MD-MyS. Methods: Clinical observations; histochemical, immunocytochemical, and electron microscopy studies of skeletal muscle and neuromuscular junction; and mutation analysis. Results: An African American man had EBS since early infancy, and progressive muscle weakness, hyperCKemia, and myasthenic symptoms refractory to therapy since age 3 years. Eventually he became motionless and died at age 42 years. At age 15 years, he had a marked EMG decrement, and a reduced miniature endplate potential amplitude. The myopathy was associated with dislocated muscle fiber organelles, structurally abnormal nuclei, focal plasmalemmal defects, and focal calcium ingress into muscle fibers. The neuromuscular junctions showed destruction of the junctional folds, and remodeling. Mutation analysis demonstrated a known p.Arg2319X and a novel c.12043dupG mutation in PLEC1 . The EBS-MD-MyS patient reported in 1999 also carried c.12043dupG and a novel p.Gln2057X mutation. The novel mutations were absent in 200 Caucasian and 100 African American subjects. Conclusions: The MyS in plectinopathy is attributed to destruction of the junctional folds and the myopathy to defective anchoring of muscle fiber organelles and defects in sarcolemmal integrity.

Zu den ursprunglichen Hochtemperaturanwendungen von technisch reinem Molybdan sind in den letzten Jahrzehnten zunehmend Anwendungen bei Raumtemperatur hinzugekommen, bei denen Molybdan als Hochleistungswerkstoff zum Einsatz kommt. Ein wichtiges Beispiel sind Sputtertargets, die fur die Herstellung von TFT-LCD (Thin Film Transistor-Liquid Crystal Display)-Flachbildschirmen benotigt werden. Aufgrund der Forderung nach immer groseren zu beschichtenden Glassubstraten haben sich neue Herausforderungen an die Produktion ergeben. Diese signifikanten Formatvergroserungen sowie die vom Markt geforderten immer hoheren Werkstoffreinheiten waren die Ursache, das Erholungs- und Rekristallisationsverhalten von Molybdan erneut zu untersuchen, zumal die in der Literatur auffindbaren Rekristallisationsdiagramme von Molybdan aus den 1960er Jahren stammen. Auserdem kann heute mittels ECCI (Electron Channelling Contrast Imaging) am Rasterelektronenmikroskop genauer zwischen rekristallisierten, erholten oder verformten Kornern unterschieden werden. Interessant ist dabei vor allem die Beurteilung der Substruktur in den Kornern, weil das kubisch-raumzentrierte Molybdan aufgrund seiner hohen Stapelfehlerenergie stark zu Erholungsvorgangen neigt. Diese Arbeit beschreibt die Erstellung eines Rekristallisationsdiagramms fur die heutige Qualitat von technisch reinem Molybdan und diskutiert es im Vergleich zu einem Rekristallisationsdiagramm von Pink aus dem Jahr 1965.

The National Science Foundation’s (NSF) Second Merit Criterion, or Broader Impacts Criterion (BIC), was introduced in 1997 as the result of an earlier Congressional movement to enhance the accountability and responsibility as well as the effectiveness of federally funded projects. We demonstrate that a robust understanding and appreciation of NSF BIC argues for a broader conception of research ethics in the sciences than is currently offered in Responsible Conduct of Research (RCR) training. This essay advocates augmenting RCR education with training regarding broader impacts. We demonstrate that enhancing research ethics training in this way provides a more comprehensive understanding of the ethics relevant to scientific research and prepares scientists to think not only in terms of responsibly conducted science, but also of the role of science in responding to identified social needs and in adhering to principles of social justice. As universities respond to the mandate from America COMPETES to “provide...

Zusammenfassung Wir haben von 1.10.2007 bis 31.03.2008 in unserem Krankenhaus eine aktive Erfassung von CDAD Fallen durchgefuhrt. Insgesamt wurden bei 15000 stationar aufgenommen Patienten (53% weiblich, 47% mannlich) im Beobachtungszeitraum 162 mal Clostridium difficile nachgewiesen (Erstnachweise). Davon waren jedoch nur 109 Patienten entsprechend der Definition der AGES (Osterreichische Agentur fur Gesundheit und Ernahrungssicherheit) [Pravention und Kontrolle von Clostridium difficile. AGES/Bundesministerium f. Gesundheit Familie u. Jugend, Wien. 1. Auflage, Sept. 2007; 1–75] als klinische Falle zu bezeichnen (73% weibliche, 27% mannlich). CDAD Falle waren mit einem Altersmedian von 79 Jahren deutlich alter als das Gesamtkollektiv (68 Jahren). Ein schwerer Verlauf wurde in 4 Fallen diagnostiziert, 1 Fall verlief letal. Rezidive fanden sich 11 mal, in 1 Fall traten 2 Rezidive auf. 90% der Falle waren als nosokomial zu werten. Es traten hiermit 7,3 Falle/1000 Patienten auf. (Inzidenzdichte 0,91/1000Patiententage). Falle konnten nur in 22 der insgesamt 33 Stationen nachgewiesen werden. Es wurden im Untersuchungszeitraum durch Analyse der Zeitraume, Lokalisation (Station, Zimmernummer) sowie mittel PCR-Ribotypisierung zwar einzelne Ubertragungen jedoch keine auffalligen Haufungen festgestellt.

Objectives Repair of laryngotracheal stenosis with pronounced side-to-side narrowing and involvement of the glottis is challenging and usually requires laryngotracheal reconstruction with rib cartilage interpositions. This technique, as first described by Couraud, needs prolonged postoperative stabilization with Montgomery T-tubes, imposing significant morbidity and discomfort on patients. We describe our initial experience with a modified laryngotracheal reconstruction technique that avoids the need for prolonged postoperative stenting. Methods From November 2012 through May 2015, a series of 5 adult patients with glottosubglottic stenosis were operated in our institution. All patients had pronounced scar formation in combination with advanced side-to-side narrowing extending up to the level of the vocal folds. Operative technique consisted of a complete anterior and posterior laryngeal split followed by rib cartilage interposition in the cricoid plate posteriorly to enlarge the glottosubglottic diameter. The lateral edges of the rib graft were trimmed in such a way that lateral flanges were created, which allowed stable positioning of the graft. The distal trachea was then slid into the larynx, and the posterior defect was completely covered with a liberal membranous flap. The anterior part of the larynx was enlarged with a V-shaped segment of the anterior tracheal wall. Results This technique provided immediate stability without the need for temporary endoluminal stenting. The perioperative course was uneventful in all patients, and functional outcome was excellent. Conclusions We conclude that this modified technique of laryngotracheal reconstruction represents a valid treatment option for patients with complex glottosubglottic stenosis, avoiding the need for prolonged postoperative stenting.

Objectives The management of paediatric airway stenosis is complex, and requires a dedicated team, consisting of thoracic surgeons, phoniatricians, logopaedics, paediatricians and anaesthetists. The majority of paediatric laryngotracheal stenosis is a sequela of prematurity and prolonged post-partal intubation/tracheostomy. Surgical correction is often difficult due to a frequent combination of glottic and subglottic defects. Methods In 2012, the Laryngotracheal Program Vienna was launched. Since then, 18 paediatric patients were surgically treated for (laryngo-)tracheal problems. Results The median age of our patients was 26 months (range 2-180 months). Laryngotracheal stenosis extending up to the level of the vocal cords was evident in 9 patients. Three children were diagnosed with an isolated subglottic, and four with a short-segment tracheal stenosis or malacia. Two patients had a long-segment congenital malformation together with vascular ring anomalies. Five children were pretreated by rigid endoscopy before surgical correction, 12 of our 18 patients had a tracheostomy, 3 children were intubated at the time of operation. Different techniques of corrections were applied: laryngotracheal reconstruction (n = 4), extended partial cricotracheal resection (n = 4), cricotracheal resection with or without anterior split or dorsal mucosal flap (n = 4), slide tracheoplasty (n = 2), tracheal resection (n = 4). In 8 patients, a rib cartilage interposition was necessary in order to obtain a sufficient lumen enlargement and in 7 of these patients, an LT-Mold was placed to stabilize the reconstruction. We lost 2 patients, who were referred to our institution after failure of multiple preceding interventions, 2 and 3 months after the operation. Twelve patients are currently in an excellent condition, one is in an acceptable condition without a need for an intervention. Two patients required an endoscopic reintervention 18 and 33 months after the operation, 1 child is currently still cannulated. Conclusions Paediatric airway surgery is complex, and requires a dedicated interdisciplinary team. An armamentarium of different resection and reconstruction techniques is necessary in order to achieve good long-term results.

em, decisions have been made by Petrobras to relocate various well placements. During the process we have taken the issues and incorporated them into a new revision of the system which shall also be explained, comparing the current “Next Generation” OptoSeis design to that which was installed on the Jubarte field. While the design changes are subtle they will lead to a more cost effective and reliable system in the future.

Background: Encrustation of urinary catheters is a frequent problem in patients with long-term indwelling catheters colonised with urease-positive bacteria such as Proteus mirabilis. Catheter blockage may follow catheter encrustation, potentially leading to systemic infection. Prevention of encrustation is difficult and avoidance of recurrence often unsuccessful. One possible preventative strategy is to use a catheter with an antimicrobial surface and development and assessment of such a surface was the aim of this research.\ud \ud Methods: Initial experiments assessed the antimicrobial activity of silicone impregnated with plant-derived antimicrobials and triclosan using agar diffusion. The longevity of activity of each antimicrobial silicone was examined over a period of 11 weeks following soaking individual pieces of antimicrobial silicone in an artificial urine solution before using agar diffusion to test remaining antimicrobial activity. Live/Dead staining of bacteria colonising the surface of each antimicrobial silicone was employed to determine the bactericidal properties of each antimicrobial silicone. Selected antimicrobial silicones were subsequently evaluated for their ability to prevent catheter encrustation in an in vitro bladder model.\ud \ud Results: Results showed that antimicrobial activity was obtained using 1% triclosan-impregnated silicone and that this antimicrobial activity was long-lasting (up to 11 weeks). Use of a dip coat silicone formulation, containing 0.2% triclosan, proved effective at delaying catheter encrustation with P. mirabilis metabolites in vitro. In 8 out of 13 independent experiments using dip-coated catheters, no catheter blockage occurred over 7 days, whilst all control catheters blocked during this period. Only on one occasion was delayed encrustation not evident with the treated catheters.\ud \ud Conclusions: In summary, a dip-coat silicone containing triclosan proved effective in preventing in vitro catheter encrustation caused by P. mirabilis infection. Further studies with triclosan silicone dip coat formulation are warranted, including those that investigate potential host cell toxicity and long-term benefits following its application to indwelling urinary catheters in clinical settings.

OBJECTIVES To test the ability of a sensor developed to signal infection by the organisms that generate the crystalline biofilms that encrust catheters, to give an early warning that encrustation was occurring on patients' catheters, as the care of many patients undergoing long-term bladder catheterization is complicated by the encrustation and blockage of their catheters PATIENTS AND METHODS Twenty patients were followed prospectively for the lifetime of one of their catheters. Sensors based on cellulose acetate/bromothymol blue were placed in the urine-collection bags, which were changed as usual at weekly intervals. The bacteriology was assessed and pH determined weekly on urine samples. Photographic records were made of the sensors twice weekly. On removal, each catheter was examined for encrustation and blockage. RESULTS Proteus mirabilis was not isolated from five patients and in these cases the sensor colour remained golden-yellow to brown. The catheters drained for the scheduled period and showed no signs of encrustation. By contrast, the sensors turned dark blue/black in the urine of all 15 patients infected with P. mirabilis. All these patients' catheters were encrusted and in 12 the catheters blocked. The mean interval between the sensor signalling and the catheter blocking was 12 days. CONCLUSION The cellulose acetate/bromothymol blue sensors placed in the urine collection bags are capable of signalling infection by P. mirabilis. They also signal the early stages of catheter encrustation and allow catheter replacement in ample time to avoid the clinical crises and emergency referrals caused by catheter blockage.