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Following the first descriptions of culture in primates, widespread agreement has developed that the term can be applied to nonhumans as group-specific, socially learned behaviors. While behaviors such as those involving extractive tool use have been researched intensively, we propose that behaviors that are more subtle, less likely to be ecologically constrained, and more likely to be socially shaped, such as cultural forms of communication, provide compelling evidence of culture in nonhuman primates. Additionally, cultural forms of communication can provide novel insights into animal cognition such as the capacity for conformity, conventionalized meanings, arbitrariness in signal forms, and even symbolism. In this paper we focus on evidence from studies conducted on wild great apes. First, we provide a thorough review of what exactly we do know, and by extension don't know, about great ape cultural communication. We argue that detailed research on both vocal and gestural communication in wild great apes shows a more nuanced and variable repertoire than once assumed, with increasing support for group-specific variation. Second, we discuss the relevance of great ape cultural communication and its potential for illustrating evolutionary continuity for human-like cultural attributes, namely cumulative culture and symbolism. In sum, a concerted effort to examine cultural forms of communication in great apes could reveal novel evidence for cultural capacities that have thus far been heavily debated in the literature and can simultaneously contribute to an improved understanding of the complex minds of our closest living relatives., (© 2023 The Authors. American Journal of Primatology published by Wiley Periodicals LLC.)

Objectives: To compare the presurgical to postsurgical voice quality (VQ) outcomes of types I, II, III, and VI transoral laser cordectomies (TLC)., Study Design: Prospective uncontrolled study., Setting: Multicenter study., Methods: Patients treated with TLC for a cT1 glottic squamous cell carcinoma were recruited from 2 European hospitals. The pre- to 3-, 6-, and 12-month post-TLC VQ was investigated with the voice handicap index (VHI), GRBAS, speech rate, maximal phonation time (MPT), and acoustic parameters. VQ was compared between types of TLC (types I, II, III, VI)., Results: Ninety-six patients completed the evaluations (16 females). The TLC consists of type I (N = 30), II (N = 27), III (N = 19), and VI (N = 20), respectively. The mean ages of groups ranged from 55.3 to 65.5 years. The VQ significantly improved from pre- to 3-, and 12-month post-TLC in types I, II, and III TLC groups. Only grade of dysphonia was significantly improved in type VI TLC after 6- and 12-month post-TLC. Type VI TLC reported higher values of F0, breathiness, and percent jitter than types I to III TLC 6- and 12-month after the surgery. Percent jitter, F0, and the breathiness were the voice outcomes that highlight the differences in VQ between TLC groups., Conclusion: The pre- to 12-month post-TLC evolution of VQ is better in types I-II TLC compared to types III and VI. Type VI TLC reported the worse VQ at baseline and throughout the follow-up., (© 2024 American Academy of Otolaryngology–Head and Neck Surgery Foundation.)

To evaluate the repeatability of a novel automated technique called Smart ERA (Smart Endometrial Receptivity Analysis) for the automated segmentation and volume calculation of the endometrium in patients with normal uteri,, and to compare the agreement of endometrial volume measurements between Smart ERA, the semi-automated Virtual Organ Computer-aided Analysis (VOCAL) technique and manual segmentation. This retrospective study evaluated endometrial volume measurement in infertile patients who underwent frozen-thawed embryo transfer (FET). Transvaginal three-dimensional ultrasound scans were performed using a Resona R9 ultrasound machine. Data was collected from patients between 2021 and 2022. Patients with normal uteri and optimal ultrasound images were included. Endometrial volumes were measured using Smart ERA, VOCAL at 15° rotation, and manual segmentation. Intra-observer repeatability and agreement between techniques were assessed using the intraclass correlation coefficient (ICC) and Bland-Altman analysis. A total of 407 female patients were evaluated (mean age 33.2 ± 4.7 years). The repeatability of Smart ERA showed an ICC of 0.983 (95% CI 0.984-0.991). The agreement between Smart ERA and the manual method, Smart ERA and VOCAL, and VOCAL and the manual method, as assessed by ICC, were 0.986 (95% CI 0.977-0.990), 0.943 (95% CI 0.934-0.963), and 0.951 (95% CI 0.918-0.969), respectively. The Smart ERA technique required approximately 3 s for endometrial volume calculation, while VOCAL took around 5 min and the manual segmentation method took approximately 50 min. The Smart-ERA software, which employs a novel three-dimensional segmentation algorithm, demonstrated excellent intra-observer repeatability and high agreement with both VOCAL and manual segmentation for endometrial volume measurement in women with normal uteri. However, these findings should be interpreted with caution, as the algorithm's performance may not be generalizable to populations with different uterine characteristic. Additionally, Smart ERA required significantly less time compared to VOCAL and manual segmentation., (© 2024. The Author(s).)

Objective: To estimate the current prevalence of voice disorders among adults in the United States; to determine the association of individual factors with voice disorders., Methods: The 2022 National Health Interview Survey (NHIS) was analyzed to identify adults reporting voice problems in the past 12 months. Demographics were assessed, as well as the duration, severity, and resolution of the voice problem. The relationship between voice problems, gender, lost workdays, and long COVID was investigated. A comparison to the 2012 NHIS was made to determine changes in voice disorder prevalence., Results: 29.9 million Americans (95%CI[28.3-31.5]) annually report a voice problem, representing 12.2% of the population (95%CI[11.7-12.8%]). Overall, 26.8% and 13.2% reported the severity of their voice problem as moderate or severe, respectively. Only 5.1% (95%CI[4.3-6.0%]) of respondents sought treatment. Most voice problems were resolved within 1 week (53.0%,95%CI[50.9-55.1%]). Females were more likely than males to report a voice problem (14.4% vs. 10.0%,95%CI[13.7-15.1] and [9.3-10.7], respectively). The 17.6 million Americans with long COVID symptoms were more likely to have voice complaints than those without (21.1% vs. 11.6%,95%CI[18.9-23.5%] and [11.1-12.1%], respectively). Lost workdays were not significantly higher for those with voice disorders compared to those without (17.1 vs. 12.9 days,95%CI[12.0-22.1] and [11.0-14.8], respectively)., Conclusions: Voice problems affect approximately 1 in 8 adults in the U.S. annually, demonstrating an alarming increased prevalence since 2012 using the same survey methodology. Relatively few individuals seek care for their voice problem, despite significant self-reported impact. Further study is required regarding the impact of COVID and changes in voice use patterns on voice disorders., Level of Evidence: 3 Laryngoscope, 134:3713-3718, 2024., (© 2024 The American Laryngological, Rhinological and Otological Society, Inc.)

Background: The escalating global prevalence of obesity has necessitated the exploration of novel diagnostic approaches. Recent scientific inquiries have indicated potential alterations in voice characteristics associated with obesity, suggesting the feasibility of using voice as a noninvasive biomarker for obesity detection., Objective: This study aims to use deep neural networks to predict obesity status through the analysis of short audio recordings, investigating the relationship between vocal characteristics and obesity., Methods: A pilot study was conducted with 696 participants, using self-reported BMI to classify individuals into obesity and nonobesity groups. Audio recordings of participants reading a short script were transformed into spectrograms and analyzed using an adapted YOLOv8 model (Ultralytics). The model performance was evaluated using accuracy, recall, precision, and F 1 -scores., Results: The adapted YOLOv8 model demonstrated a global accuracy of 0.70 and a macro F 1 -score of 0.65. It was more effective in identifying nonobesity (F 1 -score of 0.77) than obesity (F 1 -score of 0.53). This moderate level of accuracy highlights the potential and challenges in using vocal biomarkers for obesity detection., Conclusions: While the study shows promise in the field of voice-based medical diagnostics for obesity, it faces limitations such as reliance on self-reported BMI data and a small, homogenous sample size. These factors, coupled with variability in recording quality, necessitate further research with more robust methodologies and diverse samples to enhance the validity of this novel approach. The findings lay a foundational step for future investigations in using voice as a noninvasive biomarker for obesity detection., (©Jingyi Huang, Peiqi Guo, Sheng Zhang, Mengmeng Ji, Ruopeng An. Originally published in JMIR AI (https://ai.jmir.org), 25.07.2024.)

Memory recall and guidance are essential for motor skill acquisition. Like humans learning to speak, male zebra finches learn to sing by first memorizing and then matching their vocalization to the tutor's song (TS) during specific developmental periods. Yet, the neuroanatomical substrate supporting auditory-memory-guided sensorimotor learning has remained elusive. Here, using a whole-brain connectome analysis with activity-dependent viral expression, we identified a transient projection into the motor region, HVC, from neuronal ensembles responding to TS in the auditory forebrain, the caudomedial nidopallium (NCM), in juveniles. Virally induced cell death of the juvenile, but not adult, TS-responsive NCM neurons impaired song learning. Moreover, isolation, which delays closure of the sensory, but not the motor, learning period, did not affect the decrease of projections into the HVC from the NCM TS-responsive neurons after the song learning period. Taken together, our results suggest that dynamic axonal pruning may regulate timely auditory-memory-guided vocal learning during development., Competing Interests: Declaration of interests The authors declare no competing interests., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Autistic youth display difficulties in emotion recognition, yet little research has examined behavioral and neural indices of vocal emotion recognition (VER). The current study examines behavioral and event-related potential (N100, P200, Late Positive Potential [LPP]) indices of VER in autistic and non-autistic youth. Participants (N = 164) completed an emotion recognition task, the Diagnostic Analyses of Nonverbal Accuracy (DANVA-2) which included VER, during EEG recording. The LPP amplitude was larger in response to high intensity VER, and social cognition predicted VER errors. Verbal IQ, not autism, was related to VER errors. An interaction between VER intensity and social communication impairments revealed these impairments were related to larger LPP amplitudes during low intensity VER. Taken together, differences in VER may be due to higher order cognitive processes, not basic, early perception (N100, P200), and verbal cognitive abilities may underlie behavioral, yet occlude neural, differences in VER processing., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Objectives: This study aimed to provide a comprehensive overview of the systematic reviews that focus on the prevalence of voice disorders (VDs), associated risk factors, and the demographic characteristics of patients with dysphonia. An umbrella review was conducted to identify general research themes in voice literature that might guide future research initiatives and contribute to the classification of VDs as a worldwide health concern., Study Design: Umbrella review of systematic reviews., Methods: Pubmed/Medline and Embase were searched for eligible systematic reviews by two authors independently. Extracted data items included the study publication details, study design, characteristics of the target population, sample size, region/country, and incidence and/or prevalence of the VD(s) of interest., Results: Forty systematic reviews were included. Sixteen reported a meta-analysis. Great heterogeneity in methods was found. A total of 277,035 patients across the included studies were included with a prevalence ranging from 0%-90%. The countries represented best were the United States and Brazil, with 13 studies each. Aging, occupational voice use, lifestyle choices, and specific comorbidities, such as obesity or hormonal disorders, seem to be associated with an increased prevalence of dysphonia., Conclusions: This review underscores the influence of VDs on distinct patient groups and the general population. A variety of modifiable or non-modifiable risk factors, having varied degrees of impact on voice qualities, have been identified. The overall effect of VDs is probably underestimated due to factors, such as sample size, patient selection, underreporting of symptoms, and asymptomatic cases. Employing systematic reviews with consistent methodologies and criteria for diagnosing VDs would enhance the ability to determine the prevalence of VDs and their impact., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Background: The digital era has witnessed an escalating dependence on digital platforms for news and information, coupled with the advent of "deepfake" technology. Deepfakes, leveraging deep learning models on extensive data sets of voice recordings and images, pose substantial threats to media authenticity, potentially leading to unethical misuse such as impersonation and the dissemination of false information., Objective: To counteract this challenge, this study aims to introduce the concept of innate biological processes to discern between authentic human voices and cloned voices. We propose that the presence or absence of certain perceptual features, such as pauses in speech, can effectively distinguish between cloned and authentic audio., Methods: A total of 49 adult participants representing diverse ethnic backgrounds and accents were recruited. Each participant contributed voice samples for the training of up to 3 distinct voice cloning text-to-speech models and 3 control paragraphs. Subsequently, the cloning models generated synthetic versions of the control paragraphs, resulting in a data set consisting of up to 9 cloned audio samples and 3 control samples per participant. We analyzed the speech pauses caused by biological actions such as respiration, swallowing, and cognitive processes. Five audio features corresponding to speech pause profiles were calculated. Differences between authentic and cloned audio for these features were assessed, and 5 classical machine learning algorithms were implemented using these features to create a prediction model. The generalization capability of the optimal model was evaluated through testing on unseen data, incorporating a model-naive generator, a model-naive paragraph, and model-naive participants., Results: Cloned audio exhibited significantly increased time between pauses (P<.001), decreased variation in speech segment length (P=.003), increased overall proportion of time speaking (P=.04), and decreased rates of micro- and macropauses in speech (both P=.01). Five machine learning models were implemented using these features, with the AdaBoost model demonstrating the highest performance, achieving a 5-fold cross-validation balanced accuracy of 0.81 (SD 0.05). Other models included support vector machine (balanced accuracy 0.79, SD 0.03), random forest (balanced accuracy 0.78, SD 0.04), logistic regression, and decision tree (balanced accuracies 0.76, SD 0.10 and 0.72, SD 0.06). When evaluating the optimal AdaBoost model, it achieved an overall test accuracy of 0.79 when predicting unseen data., Conclusions: The incorporation of perceptual, biological features into machine learning models demonstrates promising results in distinguishing between authentic human voices and cloned audio., (©Nikhil Valsan Kulangareth, Jaycee Kaufman, Jessica Oreskovic, Yan Fossat. Originally published in JMIR Biomedical Engineering (http://biomsedeng.jmir.org), 21.03.2024.)

Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

The objective of this manuscript was to review the indications, efficacy, and safety of a 585 nm pulsed dye laser (PDL) in non-malignant laryngeal lesions. Following the PRISMA statement recommendations, three independent authors searched for articles published in PubMed/MEDLINE, the Cochrane Library, Google Scholar, Scielo, and Web of Science. A bias analysis was performed following NICE guidance tools. From the 506 identified publications, 19 observational studies met the inclusion criteria. The PDL improves vocal quality objectively and subjectively in vascular lesions ( p < 0.005) and improves vocal quality in patients with dysplasia/leukoplasia without changing the natural history of the disease compared to other treatments. Reinke's edema and granulomas require an average of 1.5 PDL sessions for resolution. Treatment of recurrent respiratory papillomatosis requires multiple sessions, with complete remission achieved in 50-70% of patients. Regardless of the lesion, the tolerance of the procedure under local anesthesia is exceptional (84-97%), and the results in terms of regression and vocal quality are promising. The complication rate is minimal, and the procedure does not interfere with other treatment alternatives. There is no consensus on laser settings. The lack of consistent use in evaluating vocal outcomes, whether objective or subjective, prevents the comparability between studies. The 585 nm pulsed dye laser appears to be an effective and safe therapeutic option in patients with non-malignant laryngeal pathology. Future controlled studies are needed to compare the 585 nm pulsed dye laser with other lasers or cold instrument procedures.

Observing someone perform an action automatically activates neural substrates associated with executing that action. This covert response, or automatic imitation, is measured behaviourally using the stimulus-response compatibility (SRC) task. In an SRC task, participants are presented with compatible and incompatible response-distractor pairings (e.g., an instruction to say "ba" paired with an audio recording of "da" as an example of an incompatible trial). Automatic imitation is measured as the difference in response times (RT) or accuracy between incompatible and compatible trials. Larger automatic imitation effects have been interpreted as a larger covert imitation response. Past results suggest that an action's biological status affects automatic imitation: Human-produced manual actions show enhanced automatic imitation effects compared with computer-generated actions. Per the integrated theory for language comprehension and production, action observation triggers a simulation process to recognize and interpret observed speech actions involving covert imitation. Human-generated actions are predicted to result in increased automatic imitation because the simulation process is predicted to engage more for actions produced by a speaker who is more similar to the listener. We conducted an online SRC task that presented participants with human and computer-generated speech stimuli to test this prediction. Participants responded faster to compatible than incompatible trials, showing an overall automatic imitation effect. Yet the human-generated and computer-generated vocal stimuli evoked similar automatic imitation effects. These results suggest that computer-generated speech stimuli evoke the same covert imitative response as human stimuli, thus rejecting predictions from the integrated theory of language comprehension and production., (© 2022. The Author(s).)

Background: Vocal biomarker-based machine learning approaches have shown promising results in the detection of various health conditions, including respiratory diseases, such as asthma., Objective: This study aimed to determine whether a respiratory-responsive vocal biomarker (RRVB) model platform initially trained on an asthma and healthy volunteer (HV) data set can differentiate patients with active COVID-19 infection from asymptomatic HVs by assessing its sensitivity, specificity, and odds ratio (OR)., Methods: A logistic regression model using a weighted sum of voice acoustic features was previously trained and validated on a data set of approximately 1700 patients with a confirmed asthma diagnosis and a similar number of healthy controls. The same model has shown generalizability to patients with chronic obstructive pulmonary disease, interstitial lung disease, and cough. In this study, 497 participants (female: n=268, 53.9%; <65 years old: n=467, 94%; Marathi speakers: n=253, 50.9%; English speakers: n=223, 44.9%; Spanish speakers: n=25, 5%) were enrolled across 4 clinical sites in the United States and India and provided voice samples and symptom reports on their personal smartphones. The participants included patients who are symptomatic COVID-19 positive and negative as well as asymptomatic HVs. The RRVB model performance was assessed by comparing it with the clinical diagnosis of COVID-19 confirmed by reverse transcriptase-polymerase chain reaction., Results: The ability of the RRVB model to differentiate patients with respiratory conditions from healthy controls was previously demonstrated on validation data in asthma, chronic obstructive pulmonary disease, interstitial lung disease, and cough, with ORs of 4.3, 9.1, 3.1, and 3.9, respectively. The same RRVB model in this study in COVID-19 performed with a sensitivity of 73.2%, specificity of 62.9%, and OR of 4.64 (P<.001). Patients who experienced respiratory symptoms were detected more frequently than those who did not experience respiratory symptoms and completely asymptomatic patients (sensitivity: 78.4% vs 67.4% vs 68%, respectively)., Conclusions: The RRVB model has shown good generalizability across respiratory conditions, geographies, and languages. Results using data set of patients with COVID-19 demonstrate its meaningful potential to serve as a prescreening tool for identifying individuals at risk for COVID-19 infection in combination with temperature and symptom reports. Although not a COVID-19 test, these results suggest that the RRVB model can encourage targeted testing. Moreover, the generalizability of this model for detecting respiratory symptoms across different linguistic and geographic contexts suggests a potential path for the development and validation of voice-based tools for broader disease surveillance and monitoring applications in the future., (©Savneet Kaur, Erik Larsen, James Harper, Bharat Purandare, Ahmet Uluer, Mohammad Adrian Hasdianda, Nikita Arun Umale, James Killeen, Edward Castillo, Sunit Jariwala. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 14.04.2023.)

We provide a study comparison between two-dimensional measurement and volumetric (3D) segmentation of the lateral ventricles and brain structures in fetuses with isolated and non-isolated ventriculomegaly with 3D virtual organ computer-aided analysis (VOCAL) ultrasonography vs. magnetic resonance imaging (MRI) analyzed with 3D-Slicer software. In this cross-sectional study, 40 fetuses between 20 and 38 gestational weeks with various degrees of ventriculomegaly were included. A total of 71 ventricles were measured with ultrasound (US) and with MRI. A total of 64 sonographic ventricular volumes, 80 ventricular and 40 fetal brain MR volumes were segmented and analyzed using both imaging modalities by three observers. Sizes and volumes of the ventricles and brain parenchyma were independently analyzed by two radiologists, and interobserver correlation of the results with 3D fetal ultrasound data was performed. The semiautomated rotational multiplanar 3D VOCAL technique was performed for ultrasound volumetric measurements. Results were compared to manually extracted ventricular and total brain volumes in 3D-Slicer. Segmentation of fetal brain structures (cerebral and cerebellar hemispheres, brainstem, ventricles) performed independently by two radiologists showed high interobserver agreement. An excellent agreement between VOCAL and MRI volumetric and two-dimensional measurements was established, taking into account the intraclass correlation coefficients (ICC), and a Bland-Altman plot was established. US and MRI are valuable tools for performing fetal brain and ventricular volumetry for clinical prognosis and patient counseling. Our datasets could provide the backbone for further construction of quantitative normative trajectories of fetal intracranial structures and support earlier detection of abnormal brain development and ventriculomegaly, its timing and progression during gestation.

Background: Type 1 Arnold Chiari is a neurological malformation that may be associated with vocal cord paralysis in Children. In most cases, the vocal cord paralysis is related to protrusion of medulla and cerebellum in the foramen magnum, which led to compression on the vagus nerve. Case report: A 12-year-old child underwent suboccipital decompression and C1 laminectomy for a symptomatic type 1 Arnold Chiari malformation. After the surgery, patient reported severe dyspnea, aphonia, and dysphagia. The videolaryngostroboscopy and neurological examinations reported a postoperative bilateral vocal cord abduction paralysis due to bilateral IX and X cranial nerve paralyzes and a bilateral paralysis of the tongue. Discussion: The type 1 Arnold Chiari malformation clinical picture may present with unilateral or bilateral vocal cord paralysis, which may resolve with an adequate management of the disease. However, the neurosurgical decompression and C1 laminectomy may result in bilateral lesion of the IX, X, and XII cranial nerves, and related severe swallowing, aspiration and vocal cord disorders. Conclusion: We reported the first case of bilateral vocal cord abduction paralysis occurring post-neurosurgical decompression and C1 laminectomy in a child with type 1 Arnold Chiari malformation. This case highlights the importance of surgical steps of the procedure in front of the C1 vertebrae where there are IX, X, and XII cranial nerves., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Nasotracheal intubation is commonly performed under general anesthesia in oral and maxillofacial surgery. For the convenience of surgery, nasal Ring-Adair-Elwyn (RAE) tubes are mainly used. Because the nasal RAE tubes were bent in an "L" shape, the insertion depth was limited. Particularly, it is necessary to accurately determine the appropriate depth of the RAE tubes in children. Several types of nasal RAE tubes are used in the medical market, which vary in material and length. We performed endotracheal intubation using a nasal RAE tube for double-jaw surgery, but air leakage persisted even when the air pressure in the cuff was increased. When checked with a laryngoscope, it was confirmed that the tube was pushed out, and the cuff was caught on the vocal cords, causing air leakage. Since inserting the tube deeply did not solve the problem, replacing it with a nasal RAE tube (Polar™, Preformed Tracheal Tube, Smith Medical, Inc., USA) did not cause air leakage; thus, we reported this case., Competing Interests: DECLARATION OF INTEREST: The authors declare no conflicts of interest., (Copyright © 2023 Journal of Dental Anesthesia and Pain Medicine.)

Background: Dual-task training is an emerging field used for people with Parkinson disease (PD) to improve their physical and cognitive well-being, but the patients' acceptability, safety, and adherence to such training in online settings are unknown., Objective: This study aims to evaluate the acceptability of a dual-task cognitive and motor online training program for people with PD as a group online community program., Methods: People with PD were invited to participate in an online program (PD3 Move) consisting of physical and vocal exercises in response to different cognitive challenges displayed as dynamic backgrounds on Zoom. The program ran twice per week for 16 weeks. Patient acceptability was assessed at 4 months by monitoring attendance rates and feedback from an exit questionnaire emailed to all participants assessing satisfaction, perceived benefit, safety, and willingness to continue and recommend to others., Results: The online program was delivered to 15 participants (n=9, 60%, females) with a diagnosis of PD, a mean age of 69.4 (SD 9.3) years, and Hoehn and Yahr (H&Y) stages I-IV. The attendance rate was high, with participants coming to more than 13 (81%) of the sessions. Participants were very satisfied (n=8, 53%) or satisfied (n=7, 47%) with the program. Participants reported that what they most liked were the new cognitive physical challenges. The 3 main facilitators to participating were perceiving the benefits, instructor's flexibility and engagement, and the social interaction moments with others. The 3 main difficulties were dealing with motor fluctuations (n=3, 20%), difficulties in using technology (n=2, 13%), and difficulty hearing instructions due to hearing loss (n=2, 13%). Patients had favorable perceived benefits of the program, with 14 (93%) considering it very useful for the current management of health and 1 (7%) moderately useful. No adverse events were reported, and all participants said that they were willing to continue the program and recommend it to others., Conclusions: Our findings suggest that the online cognitive and motor program was well received, safe, and perceived to be of benefit to this group of medically stable people with PD in H&Y stages I-IV. Access to specialized care and enhancement of long-term adherence to regular exercise can be achieved with online community group programs., (©Josefa Domingos, John Dean, Júlio Belo Fernandes, Catarina Godinho. Originally published in JMIR Aging (https://aging.jmir.org), 22.12.2022.)

Vocal communication is used across extant vertebrates, is evolutionarily ancient, and been maintained, in many lineages. Here I review the neural circuit architectures that support intraspecific acoustic signaling in representative anuran, mammalian and avian species as well as two invertebrates, fruit flies and Hawaiian crickets. I focus on hindbrain motor control motifs and their ties to respiratory circuits, expression of receptors for gonadal steroids in motor, sensory, and limbic neurons as well as divergent modalities that evoke vocal responses. Hindbrain and limbic participants in acoustic communication are highly conserved, while forebrain participants have diverged between anurans and mammals, as well as songbirds and rodents. I discuss the roles of natural and sexual selection in driving speciation, as well as exaptation of circuit elements with ancestral roles in respiration, for producing sounds and driving rhythmic vocal features. Recent technical advances in whole brain fMRI across species will enable real time imaging of acoustic signaling partners, tying auditory perception to vocal production., Competing Interests: The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Kelley.)

Objectives: Many studies have investigated listener perceptions of speakers who use vocal fry, but results remain mixed. This study aimed to investigate how vocal fry and speaker gender impact listener perceptions of a speaker's likeability, intelligence, attractiveness, and salary-attainment, described as "attributes." We hypothesized speakers with vocal fry would be evaluated more negatively on all attributes than speakers without vocal fry, with female speakers rated more negatively than male speakers., Methods: Twenty nine listeners rated male and female speakers with and without vocal fry on these attributes using a five-point Likert scale., Study Design: This experiment used a randomized mixed methods design with Vocal Fry and Speaker Gender as independent variables predicting attribute ratings., Results: Results of a MANOVA revealed a significant main effect for Fry (Λ = 0.607; F(4,29) = 4.691; η p  = 0.393; P = 0.005), where speakers with vocal fry were rated significantly more negatively than speakers without vocal fry. Additionally, there was a significant Fry by Speaker Gender interaction where female speakers without vocal fry were rated as significantly more attractive [F(1,36) = 13.964; P= 0.003; η 2  = 0.393; P = 0.005), where speakers with vocal fry were rated significantly more negatively than speakers without vocal fry. Additionally, there was a significant Fry by Speaker Gender interaction where female speakers without vocal fry were rated as significantly more attractive [F(1,36) = 13.964; P= 0.003; η p  = 0.251] than female speakers with vocal fry. There was no significant difference between ratings of male speakers in either fry condition.2  = 0.304] and intelligent [F(1,36) = 10.740; P = 0.001; η p 2  = 0.251] than female speakers with vocal fry. There was no significant difference between ratings of male speakers in either fry condition., Conclusions: Female speakers with vocal fry were rated as less attractive and intelligent than female speakers without vocal fry, but perception of male speakers did not change whether or not vocal fry was present in the acoustic signal., Competing Interests: Declaration of Competing Interest None., (Copyright © 2022 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

As Darwin first recognized, the study of emotional communication has the potential to improve scientific understanding of the mechanisms of signal production as well as how signals evolve. We examined the relationships between emotional arousal and selected acoustic characteristics of coo and scream vocalizations produced by female rhesus macaques, Macaca mulatta , during development. For coos, arousal was assessed through measures of stress-induced elevations of plasma cortisol exhibited in response to the human intruder test. In the analysis of screams, arousal was evaluated from the intensity of aggression experienced by the vocalizer during natural social interactions. Both call types showed a positive relationship between arousal and overall fundamental frequency (F0, perceived as pitch in humans). In coos, this association was dampened over development from infancy (6 months) to the juvenile, prepubertal period (16 months) and further to menarche (21.3-31.3 months), perhaps reflecting developmental changes in physiology, anatomy and/or call function. Heightened arousal was also associated in coos with increases in an acoustic dimension related to F0 modulation and noisiness. As monkeys matured, coos showed decreases in overall F0 as well as increased noisiness and F0 modulation, likely reflecting growth of the vocal apparatus and changes in vocal fold oscillation. Within screams, only one acoustic dimension (related to F0 modulation) showed developmental change, and only within one subclass of screams within one behavioural context. Our results regarding the acoustic correlates of arousal in both call types are broadly consistent with findings in other species, supporting the hypothesis of evolutionary continuity in emotion expression. We discuss implications for broader theories of how vocal acoustics respond to selection pressures., Competing Interests: Declarations of Interest None.

Adaptation to the sensory environment is essential in everyday life, to anticipate future events and quickly detect and respond to changes; and to distinguish vocal variations in congeners, for communication. The aim of the current study was to explore the effects of the nature (vocal/non-vocal) of the information to be encoded, on the establishment of auditory regularities. In electrophysiology, neural adaptation is measured by the 'Repetition Positivity' (RP), which refers to an increase in positive potential, with the increasing number of repetitions of a same stimulus. The RP results from the combined variation of several ERP components; the P1, the first positivity (∼100 ms) may reflect the onset of repetition effects. We recorded auditory evoked potentials during a roving paradigm in which trains of 4, 8 or 16 repetitions of the same stimulus were presented. Sequences of vocal and non-vocal complex stimuli were delivered, to study the influence of the type of stimulation on the characteristics of the brain responses. The P1 to each train length, and the RP responses were recorded between 90 and 200 ms, reflecting adaptation for both vocal and non-vocal stimuli. RP was not different between vocal and non-vocal sequences (in latency, amplitude and spatial organization) and was found to be similar to that found in previous studies using pure tones, suggesting that the repetition suppression phenomena is somehow independent of the nature of the stimulus. However, results showed faster stabilization of the P1 amplitude for non-vocal stimuli than for vocal stimuli, which require more repetitions. This revealed different dynamics for the establishment of regularity encoding for non-vocal and vocal stimuli, indicating that the richness of vocal sounds may require further processing before full neural adaptation occurs., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Negative schizotypal traits potentially can be digitally phenotyped using objective vocal analysis. Prior attempts have shown mixed success in this regard, potentially because acoustic analysis has relied on small, constrained feature sets. We employed machine learning to (a) optimize and cross-validate predictive models of self-reported negative schizotypy using a large acoustic feature set, (b) evaluate model performance as a function of sex and speaking task, (c) understand potential mechanisms underlying negative schizotypal traits by evaluating the key acoustic features within these models, and (d) examine model performance in its convergence with clinical symptoms and cognitive functioning. Accuracy was good (> 80%) and was improved by considering speaking task and sex. However, the features identified as most predictive of negative schizotypal traits were generally not considered critical to their conceptual definitions. Implications for validating and implementing digital phenotyping to understand and quantify negative schizotypy are discussed., Competing Interests: Declaration of Conflicting Interests The author(s) declared that there were no conflicts of interest with respect to the authorship or the publication of this article.

Parent's infant-directed vocalizations are highly dynamic and emotive compared to their adult-directed counterparts, and correspondingly, more effectively capture infants' attention. Infant-directed singing is a specific type of vocalization that is common throughout the world. Parents tend to sing a small handful of songs in a stereotyped way, and a number of recent studies have highlighted the significance of familiar songs in young children's social behaviors and evaluations. To date, no studies have examined whether infants' responses to familiar versus unfamiliar songs are modulated by singer identity (i.e., whether the singer is their own parent). In the present study, we investigated 9- to 12-month-old infants' (N = 29) behavioral and electrodermal responses to relatively familiar and unfamiliar songs sung by either their own mother or another infant's mother. Familiar songs recruited more attention and rhythmic movement, and lower electrodermal levels relative to unfamiliar songs. Moreover, these responses were robust regardless of whether the singer was their mother or a stranger, even when the stranger's rendition differed greatly from their mothers' in mean fundamental frequency and tempo. Results indicate that infants' interest in familiar songs is not limited to idiosyncratic characteristics of their parents' song renditions, and points to the potential for song as an effective early signifier of group membership., (© 2021 John Wiley & Sons Ltd.)

Background: The development of the fetal central nervous system is one of the most important fields of research in perinatology. Since the early 1980s, 3 D ultrasound has become one of the major research tools in obstetrics and gynecology., Objective: The aim of this study was to reconstruct thalamus, cerebellum and Cortex volumes of fetal brain and generate, for these volumes, growth curves related to gestational age., Methods: We enrolled 344 pregnant women. Using "Tomographic Ultrasound Imaging" (TUI), in all cases we obtained a satisfying 3 D acquisition of fetal brain. We reconstructed offline thalamus, cerebellum and cortex volumes using "Virtual Organ Computer-Aided AnaLysis" (VOCAL) or 4 D View (GE Healthcare)., Results: Among the 344 fetuses examined, we obtained 314 thalamus volumes, 252 cerebellum volumes and 261 cortex volumes and we constructed the reference growth curves., Conclusion: Our study confirms the reliability of cerebral volumes evaluation using 3 D technology and how these cerebral structures grow through gestation.

The aim of this study was to investigate the effects of maternal, hormonal, and fetal factors on early fetal volume (FV) measurements in mares obtained by three-dimensional (3D) ultrasound. Furthermore, postpartum parameters were explored in regard to their association with early FV. For this purpose, 149 German warmblood mares that were artificially inseminated and confirmed to be pregnant between days 14-16 of gestation, were examined transrectally at day 45 ± 1 of gestation with the portable 3D ultrasound device Voluson® i (GE, Zipf, Austria). FV was calculated by using the extension software Virtual Organ Computer-aided AnaLysis (VOCAL™). Two different mixed linear models were used to analyze associations between the investigated maternal and fetal factors and the FV. Explanatory variables investigated in the first model were: maternal age, parity, maternal weight, and body condition score, type of pregnancy (recipient or biological mother), barren status (lactating or non-lactating), fetal sex, progesterone (P4) and equine chorionic gonadotropin (eCG) concentrations; and in the second model outcome variables such as gestational length, birth weight, placental weight, fetal sex, and abortion were included in the analysis. The final models revealed a significant relation between FV and eCG (b = 0.011, P = 0.030), as well as with P4 (b = -0.053, P = 0.016), but interestingly P4 was negatively related to FV. Fetal sex showed the most prominent effect on FV (b = -0.256, P = 0.039), with female fetuses being smaller than male fetuses. In the second model none of the investigated parameters were related to early FV except for fetal sex (b = -0.328, P = 0.047), again with female fetuses being smaller. In summary, it was found that FV is related with eCG, P4 and fetal sex, but was no suitable predicting factor for the investigated outcome parameters. Furthermore, the findings suggest that sex specific growth differences exist already in early gestation. The detailed biological mechanism by which P4 and eCG affect fetal size has to be investigated in prospective studies., (Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)

Animal communication has long been thought to be subject to pressures and constraints associated with social relationships. However, our understanding of how the nature and quality of social relationships relates to the use and evolution of communication is limited by a lack of directly comparable methods across multiple levels of analysis. Here, we analysed observational data from 111 wild groups belonging to 26 non-human primate species, to test how vocal communication relates to dominance style (the strictness with which a dominance hierarchy is enforced, ranging from 'despotic' to 'tolerant'). At the individual-level, we found that dominant individuals who were more tolerant vocalized at a higher rate than their despotic counterparts. This indicates that tolerance within a relationship may place pressure on the dominant partner to communicate more during social interactions. At the species-level, however, despotic species exhibited a larger repertoire of hierarchy-related vocalizations than their tolerant counterparts. Findings suggest primate signals are used and evolve in tandem with the nature of interactions that characterize individuals' social relationships., (© 2021 The Authors.)

Background: The Voice Handicap Index 30 (VHI-30) is a much-used voice specific quality of life questionnaire. A shortened 10 item version has been developed by eliminating redundant items using item analyses. This is the first Danish translation of the VHI-10., Objectives: To evaluate the psychometric properties of the Danish VHI-10 questionnaire., Study Design: Cross-sectional survey study., Methods: A Danish translation of the VHI-10 was answered by 72 patients with voice disorders of different etiology (neurogenic, functional, and structural) and by a control group of 94 vocally healthy individuals. Thirty-two patients and 68 controls participated in a test-retest reliability analysis. The internal consistency, test-retest reliability, and clinical validity were assessed., Results: Excellent internal consistency was found in the patient group with a Cronbach's α of >0.90. In the control group the internal consistency was good with a Cronbach's α of 0.88. Test-retest reliability was good with intra class correlation coefficient of 0.94 (95% confidence interval [95%CI]: 0.88-0.97) for patients and 0.82 (95%CI: 0.73-0.89) for the control group. This indicates a sufficient reliability of the questionnaire. The correlation between the Danish VHI-10 score and the patient's perception of the severity of the voice disorder was 0.75 (P < 0.001) indicating good clinical validity of the Danish VHI-10., Conclusion: The newly translated Danish VHI-10 was validated and performs similar to the original VHI-10. It showed good internal consistency, test-retest reliability, and clinical validity. The questionnaire is preferably for use in patients with moderate to severe voice complaints as its ability to distinguish mild voice changes from healthy voices is limited. However, the questionnaire is capable of assessing patients' perception of the severity of their voice disorder and is available for use in daily practice and in research projects., (Copyright © 2019 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Stereotypies are among the core symptoms of Autism spectrum disorder (ASD) and can cause significant clinical impairment. At present, phonic stereotypies in ASD have been scarcely explored. This study investigates the frequency, variability, and typologies of phonic and motor stereotypies in children with ASD and their association with clinical neurological variables. We examined 35 patients by recording standardized video sessions and administering the Autism Diagnostic Observation Schedule-Second Edition (ADOS-2). Phonic stereotypies were present in 83.0% of the patients. The most prevalent subtypes were noncommunicative vocalizations (60.0%), single syllables (37.1%), and echolalic stereotypies (22.9%). Noncommunicative vocalizations were more frequent in nonverbal patients (OR = 4.629, p = 0.008), while echolalic stereotypies were more represented in verbal patients (OR = 0.279, p = 0.028). Patients with intellectual disability (ID) showed a higher number (F(1,26) = 9.406, p = 0.005) and variability (F(1,25) = 7.174, p = 0.013) of motor stereotypies, with a higher number (F(1,26) = 13.268, p = 0.005) and variability (F(1,26) = 9.490, p = 0.005) of stereotypies involving the head/trunk/shoulders category. Patients with guttural stereotypies showed a higher variability of total motor stereotypies (OR = 1.487, p = 0.032) and self-directed motor stereotypies (OR = 4.389, p = 0.042). These results, combined with a standardized video-analysis, document the frequency and variability of phonic stereotypies among children with ASD. Correlations between specific phonic stereotypies and verbal abilities should be investigated further.

Background: To establish the normal reference range of fetal thorax by two-dimensional (2D) and three-dimensional (3D) ultrasound VOCAL technique and evaluate the application in diagnosing fetal thoracic malformations., Methods: A prospective cross-sectional study was undertaken involving 1077 women who have a normal singleton pregnancy at 13-40 weeks gestational age (GA). 2D ultrasound and 3D ultrasound VOCAL technique were utilized to assess fetal thoracic transverse diameter, thoracic anteroposterior diameter, thoracic circumference, thoracic area, lung volume, thoracic volume and lung-to-thoracic volume ratio. The nomograms of 2D and 3D fetal thoracic measurements were created to GA. 50 cases were randomly selected to calculate intra- and inter-observer reliability and agreement. In addition, the case groups including congenital skeletal dysplasia (SD) (15), congenital diaphragmatic hernia (CDH) (30), pulmonary sequestration (PS) (25) and congenital cystic adenomatoid malformation (CCAM) (36) were assessed by the nomograms and followed up subsequently., Results: Both 2D and 3D fetal thoracic parameters increased with GA using a quadratic regression equation. The intra- and inter-observer reliability and agreement of each thoracic parameter were excellent. 2D fetal thoracic parameters could initially evaluate the fetal thoracic development and diagnose the skeletal thoracic deformity, and lung volume, thoracic volume and lung-to-thorax volume ratio were practical to diagnose and differentiate CDH, PS and CCAM., Conclusion: We have established the normal fetal thoracic reference range at 13-40 weeks, which has a high value in diagnosing congenital thoracic malformations.

Objective: To investigate the feasibility and the outcomes of transoral laser CO 2 microsurgery (TLM) for resection of early-stage squamous cell carcinoma (SCC) of the vocal folds through several additional surgical procedures and tips improving the glottic exposure., Methods: Retrospective chart review of patients treated by TLM cordectomy in a single European University Hospital for early-stage vocal fold SCCs (Tis, T1a, T1b, and T2). The following TLM outcomes were studied regarding the tumor size (Tis and T1a vs T1b and T2) and the margin status (negative vs positive/suspicious): patient position; type of laryngoscope; requirement to external counter pressure; resection of supraglottic structures (eg, ventricular band, epiglottic petiole, and suprahyoid epiglottis); pre- and postoperative complications; overall survival; disease-specific survival (DSS); and disease-free survival (DFS)., Results: A total of 148 patients were included. The TLM was realized in 95.3% of cases. External counter pressure, partial, or total vestibulectomy were necessary in 65.9%, 57.4%, and 4.2% of cases, respectively. A resection of the epiglottic petiole was required in 24.8% of cases. The realization of both epiglottis petiole resection and vestibulectomies were significantly higher in patients with T2 and T1b SCCs compared to those with T1a and Tis SCCs ( P = .01). Different procedure tips were described for improving the laryngeal exposition. The 5-year laryngeal preservation rate, DSS, and DFS were significantly better in patients without SCC involvement of the anterior commissure, and did not vary according to the margin status. The laryngeal exposure difficulties did not impact the margin status., Conclusion: The exposure of glottis is possible in 95% of cases of early-stage vocal cord SCC but requires the use of several additional surgical procedures, especially for anterior commissure SCCs. The SCC involvement of the vocal fold anterior commissure is associated with lower DSS, DFS, and laryngeal preservation rate.

Objective: To investigate the indications, efficacy, safety, and outcomes of potassium-titanyl-phosphate (KTP) laser procedures for treatment of laryngeal disease., Methods: PubMed, Cochrane Library, and Scopus were searched for studies providing information about the indications, efficacy, and safety of both in-office and operative suspension microlaryngoscopy KTP laser procedure in treatment of laryngeal disease. Diagnostic criteria and clinical outcome evaluation of included studies were analyzed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria., Results: Of the initial screened 140 papers, 17 met our inclusion criteria. Six papers involved KTP laser procedures for benign and malignant vocal fold lesions in suspension microlaryngoscopy only, 10 papers focused on only in-office KTP laser procedures for benign vocal fold lesions, and 1 paper included both in-office and suspension microlaryngoscopy procedures. The following lesions may be considered as indications for KTP laser procedures: Reinke's edema, sulcus vocalis, vocal fold hemorrhage, polyp, granuloma, cyst, scar, papillomatosis, dysplasia, leukoplakia, and early vocal fold malignancies. Irrespective of the types of procedure (in-office vs suspension microlaryngoscopy), the KTP laser is associated with a low complication rate and overall good vocal fold vibration recovery. There is an important heterogeneity among studies concerning laser settings, indications, and outcomes used for the assessment of treatment effectiveness. There are no controlled studies directly comparing KTP laser with other lasers (ie, carbon dioxide laser)., Conclusion: The use of KTP laser procedures for treatment of laryngeal disease has increased over the past decade, especially for office-based management of vocal fold lesions. Future controlled studies are needed to compare the safety and outcomes of the KTP laser to other techniques.

Objectives: Incomplete healing of the uterine scar after cesarean section may result in formation of a niche. The aim of this study is to identify the potential risk factors for the improper uterine healing after cesarean section in women with single layer, full thickness uterine closure with the use of two- and three-dimensional transvaginal ultrasonography., Material and Methods: 204 women with a history of at least one low transverse cesarean section (CS) with a single layer uterine closure participated in the study. Residual myometrial thickness (RMT), adjacent myometrial thickness (AMT), width (W), depth (D) and volume of the niche, RMT/AMT, RMT/D, RMT/W ratio and clinical characteristics were analyzed., Results: A niche after cesarean section was found in 153 cases. However only five patients had a RMT < 2.2 mm, and 35 had an RMT/AMT ratio ≤ 0.5. The RMT and RMT/AMT ratio among women who had undergone more than one cesarean section was lower than among women who underwent the first cesarean section. No statistically significant relationship was found between the incidence of niche, its parameters and cervical dilation, uterine contractions, cesarean section in the second stage of labor, type of uterus incision expansion and flexion, operator's experience., Conclusion: Healing of the uterine cesarean section scar in women with single-layer continuous suture covering the entire thickness of the myometrium, excluding the decidua is not affected by the mode of caesarean section, type of uterine incision expansion and flexion, operator's experience, stage of labor at the time of caesarean section.

Follicle size is closely related to ovarian function and is an important biomarker in transvaginal ultrasound examinations for assessing follicular maturity during an assisted reproduction cycle. However, manual measurement is time consuming and subject to high inter- and intra- observer variability. Based on the deep learning model CR-Unet described in our previous study, the aim of our present study was to investigate further the feasibility of using this model in clinical practice by validating its performance in reducing the inter- and intra-observer variability of follicle diameter measurement. This study also investigated whether follicular area is a better biomarker than diameter in assessing follicular maturity. Data on 106 ovaries and 230 follicles collected from 80 cases of single follicular cycles and 26 cases of multiple follicular cycles constituted the validation set. Intra-observer variability was 0.973 and 0.982 for the senior sonographer and junior sonographer in single follicular cycles and 0.979 (0.971, 0.985) and 0.920 (0.892, 0.943) in multiple follicular cycles, respectively, while CR-Unet had no intra-group variation. Bland-Altman plot analysis indicated that the 95% limits of agreement between senior sonographer and CR-Unet (-2.1 to 1.1 mm, -2.02 to 0.75 mm) were smaller than those between senior sonographer and junior sonographer (-1.51 to 1.15 mm, -2.1 to 1.56 mm) in single and multiple follicular cycles. The average operating times of diameter measurement taken by the junior sonographer, senior sonographer and CR-Unet were 7.54 ± 1.8, 4.87 ± 0.84 and 1.66 ± 0.76 s, respectively (p < 0.001). Correlation analysis indicated that both manual and automated follicular area correlated better with follicular volume than diameter. The deep learning algorithm and the new biomarker of follicular area hold potential for clinical application of ultrasonic follicular monitoring., Competing Interests: Conflict of interest disclosure No author has any potential conflict of interest., (Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: Chronic rhinosinusitis (CRS) has long been associated with vocal dysfunction. However, studies quantifying the presence of voice dysfunction in CRS patients or the effects of functional endoscopic sinus surgery (FESS) are sparse. The goal of this study was to determine the voice-related quality of life in patients undergoing FESS for CRS using the validated Voice Related Quality of Life Survey (VRQL). We correlated the preoperative VRQL scores to the Sino-Nasal Outcome Test (SNOT-22) scores, and we determined the effect of FESS on postoperative VRQL scores., Methods: Consecutive patients undergoing FESS were preoperatively administered both the VRQL and the SNOT-22 surveys. Spearman (ρ) and Pearson ( r ) correlation coefficients were calculated. The VRQL was mailed to patients postoperatively between 3 and 6 months. The paired t-test was used to compare pre- and post-FESS scores., Results: A total of 102 patients were enrolled, and 81 patients completed the two surveys. A total of 51 (62.9%) patients had raw VRQL score ≥ 10, signifying presence of significant vocal symptoms. The mean ± standard deviation (SD) raw VRQL score of the entire study population was 12.4 ± 4.6, and the mean SNOT-22 score was 37.8 ± 19.2. The Spearman correlation coefficient between VRQL and the total SNOT-22 score was 0.34 ( P =.002), and the Pearson correlation coefficient was 0.36 ( P = .001). Both correlations were similar, demonstrating that increasing severity of CRS symptoms correlates with decreasing voice-related quality of life (QOL). Seventy patients completed the postoperative survey for an 86% retention rate. Thirty-six of these patients had abnormal preoperative VRQL scores, and these patients improved significantly after FESS. The mean preoperative versus postoperative raw scores were 15.2 ± 5.6 versus 12.5 ± 4.1, respectively ( P = .003)., Conclusion: This study demonstrates the increasing presence of vocal complaints with increasing severity of CRS. It also demonstrates that VRQL scores improve after FESS in those patients with preoperative vocal complaints., Level of Evidence: IV.

Objective: The purpose of this study was to replicate a previous investigation to assess with two intact children's choirs and a high school choir the potential effects of three choral warm-up procedures (vocal-only, physical-only, physical/vocal combination) on acoustic and perceptual measures of choral sound., Methods: The researchers tested three videotaped, 5-minute, choral warm-up procedures on two children's and one high school choir. After participating in a warm-up procedure, each choir was recorded singing a folk song for long-term average spectra and pitch analysis. Singer participants responded to a questionnaire about preferences after each warm-up procedure. Warm-up procedures and recording sessions occurred during each choir's regular rehearsal time and in each choir's regular rehearsal space during three consecutive rehearsals., Results: Long-term average spectra results demonstrated more resonant singing after the physical/vocal warm-up for two of the three choirs. Pitch analysis results indicated that two of the three choirs sang "in-tune" after participating in the physical/vocal warm-up and two choirs sang "in-tune" after participating in the physical-only warm-up. Singer questionnaire responses showed a preference for the physical/vocal combination warm-up, and singer ranking of the three procedures indicated the physical/vocal warm-up as the most favored for readiness to sing., Conclusions: This study replication indicates similar conclusions as the original investigation with university choruses: a combination choral warm-up that includes both physical and vocal aspects is preferred by singers of all ages, enables more resonant singing, and more in-tune singing. Findings from these investigations provide choral educators with compelling information concerning efficient and effective choral warm-up procedures., (Published by Elsevier Inc.)

Objective: Voice tremor represents a common but frequently overlooked clinical feature of neurological disease. Therefore, we aimed to quantitatively and objectively assess the characteristics of voice tremor in a large sample of patients with various progressive neurological diseases., Methods: Voice samples were acquired from 240 patients with neurological disease and 40 healthy controls. The robust automated method was designed, allowing precise tracking of multiple tremor frequencies and distinguish pathological from the physiological tremor., Results: Abnormal tremor was revealed in Huntington's disease (65%), essential tremor (50%), multiple system atrophy (40%), cerebellar ataxia (40%), amyotrophic lateral sclerosis (40%), progressive supranuclear palsy (25%), Parkinson's disease (20%), cervical dystonia (10%), and multiple sclerosis (8%) but not in controls. Low-frequency voice tremor (<4 Hz) was common in all investigated diseases, whereas medium tremor frequencies (4-7 Hz) were specific for movement disorders of Parkinson's disease, multiple system atrophy, essential tremor, and cervical dystonia., Conclusions: Careful estimation of vocal tremor may help with accurate diagnosis and tailored treatment., Significance: This study provides (i) more insights into the pathophysiology of vocal tremor in a wide range of neurological diseases and (ii) an accurate method for estimation of vocal tremor suitable for clinical practice., Competing Interests: Declaration of Competing Interest The authors declare to have no conflict of interest., (Copyright © 2020 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.)

Purpose: The aim of this study was to compare volumetric parameters in the abnormal and normal posterior fossa using the Virtual Organ Computer-aided AnaLysis (VOCAL™) technique to determine whether fetuses with an abnormal posterior fossa have different volumes. Methods: A prospective study was conducted on 17 fetuses with an abnormal posterior fossa including, Dandy Walker malformation (DWM) ( n  = 6), vermian hypoplasia (VH) ( n  = 3), mega cisterna magna (MCM) ( n  = 8), and 99 healthy control fetuses from 20 to 34 weeks' gestation. Measurement of the fetal cisterna magna and cerebellar volume was performed in the standard transcerebellar plane through the VOCAL™ method. To establish the correlation of volumes with gestational age, polynomial regression analysis was performed. For comparison between groups, univariate ANCOVA was performed using gestational age as a covariate. The reliability was analyzed by the intraclass correlation coefficient (ICC). Results: Cerebellar volume and cisterna magna volume were correlated with gestational age. Posterior fossa volume was significantly larger in DWM ( p  < .0001) and MCM ( p  < .0001) in comparison to the control group. In VH group, cisterna magna volume does not seem to expand ( p  = .298). Cerebellar volume does not seem to change in subgroups when the influence of gestational age is discarded ( p  = .09). The ratio of cerebellar volume to the cisterna magna volume decreases significantly in abnormal fetuses ( p  < .0001). Good intraobserver and interobserver reliabilities were found for both cerebellum and cisterna magna measurements. Conclusions: Volume analysis may have a role in discrimination of different posterior fossa pathologies.

Objective: To evaluate the effects of chorionic villus sampling (CVS) on placental volume (PV), perfusion, and vasculature in the first trimester of pregnancy. Method: Uterine artery pulsatility index (PI), PV, vascularization index (VI), flow index (FI), and Vascularization Flow Index (VFI) were serially measured in 38 pregnant women who underwent CVS. Thirty-eight women who did not undergo invasive prenatal diagnosis were recruited as controls. Results: CVS was associated with a mild reduction of PI, a reduction of placental VI, FI, and VFI and with an increase in PV detected one week after the procedure. The outcome of pregnancy was similar between women of the two groups. Conclusion: Our findings showed that CVS is associated with mild placental vascular and morphological changes. However, these changes do not seem to be associated with adverse outcome.

Fundamental frequency ( F 0, perceived as voice pitch) predicts sex and age, hormonal status, mating success and a range of social traits, and thus functions as an important biosocial marker in modal speech. Yet, the role of F 0 in human nonverbal vocalizations remains unclear, and given considerable variability in F 0 across call types, it is not known whether F 0 cues to vocalizer attributes are shared across speech and nonverbal vocalizations. Here, using a corpus of vocal sounds from 51 men and women, we examined whether individual differences in F 0 are retained across neutral speech, valenced speech and nonverbal vocalizations (screams, roars and pain cries). Acoustic analyses revealed substantial variability in F 0 across vocal types, with mean F 0 increasing as much as 10-fold in screams compared to speech in the same individual. Despite these extreme pitch differences, sexual dimorphism was preserved within call types and, critically, inter-individual differences in F 0 correlated across vocal types ( r = 0.36-0.80) with stronger relationships between vocal types of the same valence (e.g. 38% of the variance in roar F 0 was predicted by aggressive speech F 0). Our results indicate that biologically and socially relevant indexical cues in the human voice are preserved in simulated valenced speech and vocalizations, including vocalizations characterized by extreme F 0 modulation, suggesting that voice pitch may function as a reliable individual and biosocial marker across disparate communication contexts., Competing Interests: We declare we have no competing interests., (© 2020 The Authors.)

Galanin is a peptide that regulates pituitary hormone release, feeding, and reproductive and parental care behaviors. In teleost fish, increased galanin expression is associated with territorial, reproductively active males. Prior transcriptome studies of the plainfin midshipman (Porichthys notatus), a highly vocal teleost fish with two male morphs that follow alternative reproductive tactics, show that galanin is upregulated in the preoptic area-anterior hypothalamus (POA-AH) of nest-holding, courting type I males during spawning compared to cuckolding type II males. Here, we investigate possible differences in galanin immunoreactivity in the brain of both male morphs and females with a focus on vocal-acoustic and neuroendocrine networks. We find that females differ dramatically from both male morphs in the number of galanin-expressing somata and in the distribution of fibers, especially in brainstem vocal-acoustic nuclei and other sensory integration sites that also differ, though less extensively, between the male morphs. Double labeling shows that primarily separate populations of POA-AH neurons express galanin and the nonapeptides arginine-vasotocin or isotocin, homologues of mammalian arginine vasopressin and oxytocin that are broadly implicated in neural mechanisms of vertebrate social behavior including morph-specific actions on vocal neurophysiology in midshipman. Finally, we report a small population of POA-AH neurons that coexpress galanin and the neurotransmitter γ-aminobutyric acid. Together, the results indicate that galanin neurons in midshipman fish likely modulate brain activity at a broad scale, including targeted effects on vocal motor, sensory and neuroendocrine systems; are unique from nonapeptide-expressing populations; and play a role in male-specific behaviors., (© 2019 Wiley Periodicals, Inc.)

Rationale and Objectives: This study uses a three-dimensional energy Doppler technique combined with the Virtual Organ Computer-aided Analysis (VOCAL) method in order to determine the diagnostic threshold of blood flow index in breast tumors to provide a reference for evaluation and treatment options., Materials and Methods: We collected 322 solid lesions which had been operated. Each lesion met the definite pathological diagnosis; collected lesions included 262 cases of benign lesions and 60 cases of malignant lesions. All examinations were performed by using GE LOGIQ E9 with VOCAL software. Volume and four distinct vascular indices of gray mean (MG), power mean, ratio (R), and vascular flow index (VFI) were calculated by using the VOCAL software. Sampling and calculation were repeated three times and the mean value was calculated., Results: The average age and power of the malignant group were greater than those of the benign group, ie p < .01 which had significant differences. The gray mean of the malignant group was lower than that of the benign group, ie p > .05 which had no significant differences between benign and malignant groups. The ratio, vascular flow index and volume had significant differences, i.e. p < .01. The area under the receiver operating characteristic curve (AUC) were 0.864, 0.830, 0.800, 0.758, and 0.764 for age, power, ratio, vascular flow index, and volume, respectively. The research indicators were higher than 50% of the curve showing their diagnostic value. The cut-off points of age, power, ratio, vascular flow index, and volume were 37.5, 26.56, 0.031, 0.846, and 1.75, respectively. Their corresponding sensitivity were 93.3%, 75%, 81.7%, 68.3%, 63.3%, and the specificity were 68.7%, 81%, 70.2%, 75.6%, and 81.7%, respectively. Comparison of vascular indices combined with the Breast imaging reporting and data System (BI-RADS) score and simple BI-RADS method, the AUC of power + BI-RADS, ratio + BI-RADS, VFI + BI-RADS, and BI-RADS alone are 0.928, 0.903, 0.895, and 0.796, respectively, which were higher than 50% of the curve. Sensitivity was 81.7%, 80%, 88.3%, 86.7%, and specificity was 88.5%, 85.5%, 77.1%, 69.5%, respectively. The power + BI-RADS method has the highest AUC among these three methods., Conclusions: Quantitative measurement of blood flow and blood vessel distribution in breast tumors by three-dimensional power Doppler ultrasound combined with the VOCAL method is more accurate and sensitive than the traditional two-dimensional ultrasound. And this method has potential promising applications in many current active research areas, such as the studies of random distribution of intratumoral blood vessels or the normalization of tumor blood vessels. Three-dimensional power Doppler ultrasound combined with the VOCAL method provides a new approach to achieving accurate judgments and the method evaluates the curative effect in breast cancer patients., (Copyright © 2019 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.)

Background: The potential role of antinuclear antibodies (ANA) in recurrent pregnancy loss (RPL) pathogenesis is still debated, although some evidences suggest that they could affect pregnancy outcome, leading to a higher miscarriage rate in these patients. A hypothesized mechanism is through changes in uterine flow in pre-conceptional stage, by modifying endometrial receptivity in RPL. However, scant data are available, in pregnancy, about their role in RPL placental perfusion, also in relation to its potential treatments, such as low molecular weight heparin (LMWH). The aim of this study is to retrospectively further investigate the correlation between two-dimensional (2D) and three-dimensional (3D) uterine and placental flow indexes and the presence or the absence of ANA in women with unexplained RPL (uRPL), treated or not treated with LMWH., Methods: 2D Doppler measurement of pulsatility index (PI) of the uterine arteries and 3D ultrasonography determination of vascularization index (VI), flow index (FI) and vascularization flow index (VFI) was carried out with the aid of the virtual organ computer-aided analysis (VOCAL) technique in LMWH treated (n 24) and not treated-uRPL patients (n 20) and in the relative control group (n 27), each group divided in ANA+ and ANA- subgroups. Serum assay for the presence of ANA was performed in all women., Results: No differences were found in PI, VFI and VI values, by comparing the different groups. A difference in VI values was found for ANA- patients between RPL women not treated with LMWH and the treated ones (p = 0,01), which have lower VI values and similar to controls. By considering only ANA- treated and not treated RPL patients, the ROC curve shows an area of 0,80 and at the VI cut-off of 11,08 a sensitivity of 85% and a specificity of 67%., Conclusions: LMWH could exert a potential beneficial effect in restoring the physiological blood flow supply in terms of VI in uRPL ANA- status, suggesting to include ANA and VI investigations in the RPL diagnostic algorithm in a research context, since further studies are needed to clarify this challenging hypothesis in order to try to ameliorate ANA and abnormal placental vascularization negative influence on RPL pregnancy outcome .

Vocalization is a common means of communication across vertebrates, but the evolutionary origins of the neural circuits controlling these behaviors are not clear. Peripheral mechanisms of sound production vary widely: fish produce sounds with a swimbladder or pectoral fins; amphibians, reptiles, and mammalians vocalize using a larynx; birds vocalize with a syrinx. Despite the diversity of vocal effectors across taxa, there are many similarities in the neural circuits underlying the control of these organs. Do similarities in vocal circuit structure and function indicate that vocal behaviors first arose in a single common ancestor, or have similar neural circuits arisen independently multiple times during evolution? In this review, we describe the hindbrain circuits that are involved in vocal production across vertebrates. Given that vocalization depends on respiration in most tetrapods, it is not surprising that vocal and respiratory hindbrain circuits across distantly related species are anatomically intermingled and functionally linked. Such vocal-respiratory circuit integration supports the hypothesis that vocal evolution involved the expansion and functional diversification of breathing circuits. Recent phylogenetic analyses, however, suggest vocal behaviors arose independently in all major tetrapod clades, indicating that similarities in vocal control circuits are the result of repeated co-options of respiratory circuits in each lineage. It is currently unknown whether vocal circuits across taxa are made up of homologous neurons, or whether vocal neurons in each lineage arose from developmentally and evolutionarily distinct progenitors. Integrative comparative studies of vocal neurons across brain regions and taxa will be required to distinguish between these two scenarios., (© 2020 Wiley Periodicals LLC.)

The ability to recognize others' emotions based on vocal emotional prosody follows a protracted developmental trajectory during adolescence. However, little is known about the neural mechanisms supporting this maturation. The current study investigated age-related differences in neural activation during a vocal emotion recognition (ER) task. Listeners aged 8 to 19 years old completed the vocal ER task while undergoing functional magnetic resonance imaging. The task of categorizing vocal emotional prosody elicited activation primarily in temporal and frontal areas. Age was associated with a) greater activation in regions in the superior, middle, and inferior frontal gyri, b) greater functional connectivity between the left precentral and inferior frontal gyri and regions in the bilateral insula and temporo-parietal junction, and c) greater fractional anisotropy in the superior longitudinal fasciculus, which connects frontal areas to posterior temporo-parietal regions. Many of these age-related differences in brain activation and connectivity were associated with better performance on the ER task. Increased activation in, and connectivity between, areas typically involved in language processing and social cognition may facilitate the development of vocal ER skills in adolescence.

Purpose : Cochlear implants (CIs) provide reasonable levels of speech recognition quietly, but voice pitch perception is severely impaired in CI users. The central question addressed here relates to how access to acoustic input pre-implantation influences vocal emotion production by individuals with CIs. The objective of this study was to compare acoustic characteristics of vocal emotions produced by prelingually deaf school-aged children with cochlear implants (CCIs) who were implanted at the age of 2 and had no usable hearing before implantation with those produced by children with normal hearing (CNH), adults with normal hearing (ANH), and postlingually deaf adults with cochlear implants (ACI) who developed with good access to acoustic information prior to losing their hearing and receiving a CI. Method : A set of 20 sentences without lexically based emotional information was recorded by 13 CCI, 9 CNH, 9 ANH, and 10 ACI, each with a happy emotion and a sad emotion, without training or guidance. The sentences were analyzed for primary acoustic characteristics of the productions. Results: Significant effects of Emotion were observed in all acoustic features analyzed (mean voice pitch, standard deviation of voice pitch, intensity, duration, and spectral centroid). ACI and ANH did not differ in any of the analyses. Of the four groups, CCI produced the smallest acoustic contrasts between the emotions in voice pitch and emotions in its standard deviation. Effects of developmental age (highly correlated with the duration of device experience) and age at implantation (moderately correlated with duration of device experience) were observed, and interactions with the children's sex were also observed. Conclusion: Although prelingually deaf CCI and postlingually deaf ACI are listening to similar degraded speech and show similar deficits in vocal emotion perception, these groups are distinct in their productions of contrastive vocal emotions. The results underscore the importance of access to acoustic hearing in early childhood for the production of speech prosody and also suggest the need for a greater role of speech therapy in this area., (Copyright © 2019 Chatterjee, Kulkarni, Siddiqui, Christensen, Hozan, Sis and Damm.)

Background/aim: This study aimed to evaluate the diagnostic value of vascular indices obtained using 3D power Doppler ultrasound (3D PDUS) in differentiation of benign and malignant thyroid nodules., Materials and Methods: Sixty-seven patients (56 female, 11 male, mean age 44.6) with 81 thyroid nodules exhibiting mixed (peripheral and central) vascularization patterns, with the largest diameter between 10 and 30 mm, were prospectively evaluated using 3D PDUS. Nodule volume, vascularization index (VI), flow index (FI), and vascularization flow index (VFI) were calculated using the Virtual Organ Computer-aided Analysis (VOCAL) software, and these indices were then compared with regard to the cytohistopathology-based diagnosis. The optimum cutoff values for the differentiation of benign and malignant nodules were identified, and diagnostic efficacy was calculated using receiver operating characteristic (ROC) analysis., Results: Fifty-six of the 81 nodules included in this study were diagnosed as benign and 25 as malignant. Vascular indices in malignant nodules were significantly higher than those in benign nodules (P < 0.05). In benign nodules, the mean VI was 11.61 ± 6.88, mean FI was 39.75 ± 3.93, and mean VFI was 4.82 ± 2.94, compared to 18.64 ± 12.81, 41.82 ± 4.43, and 8.17 ± 6.37, respectively, in malignant nodules. The area under the curves (AUCs) was calculated as 0.68, 0.61, and 0.67 for VI, FI, and VFI, respectively. At optimal cutoff values of 10.2 for VI, 40.8 for FI, and 5.5 for VFI, the sensitivity and specificity were 72%/55.4%, 68%/57.1%, and 68%/67.9%, respectively., Conclusion: 3D PDUS can be useful in the characterization of thyroid nodules., (This work is licensed under a Creative Commons Attribution 4.0 International License.)

The aim of this study was to investigate if transrectal three-dimensional (3D) ultrasound is a reliable technique to measure equine fetal volume (FV) during early gestation in mares. In total 149 warmblood mares were examined once transrectally on days 45 ± 1 of pregnancy with a portable 3D ultrasound device (Voluson ® i, GE Healthcare, Zipf, Austria). The following measurements were performed: Two-dimensional (2D) and 3D crown-rump length (CRL), FV using Virtual Organ Computer-aided AnaLysis (VOCAL™) software with rotational angles of 6° and 30°. To analyze intra- and inter-observer reliability (intraclass correlation coefficient (ICC)) and agreement (Bland-Altman's limits of agreement (LoA)) of FV measurements, images from 60 horse fetuses were selected and repeatedly analyzed by the same examiner (A) and by a second examiner (B). The time for each ultrasound examination (2D and 3D) and for the FV measurements was recorded. The 3D measured CRL was larger (P < 0.001) than the 2D CRL. Repeated measurements of 3D CRL showed a higher reliability (ICC = 0.91 (0.88-0.94), P < 0.001) and agreement (mean = 0.13%, 95% LoA: 7.45 to +7.19) compared to reliability (ICC = 0.50 (0.36-0.61), P < 0.001) and agreement (mean = -1.54%, 95% LoA: 23.29 to +20.21) of the CRL measurement in 2D mode. For intra-observer examinations, reliability was highest when using a rotational angle of 30° (ICC = 0.98 (0.97-0.99), P < 0.001). The inter-observer reliability of 3D measurements was good (ICC = 0.85 (0.67-0.92), P < 0.001). The extra time needed to perform the 3D scan ranged from 1 to 9 min and FV measurements lasted 03:30 ± 00:46 and 08:10 ± 01:05, for rotational angles of 30° and 6°, respectively. In conclusion, this study showed a high level of intra- and inter-observer reliability and agreement for FV measurements using VOCAL™. Furthermore, the 6° and 30° rotational angles can be used interchangeably, but test duration, reliability and agreement were better with the 30° rotational step method. The CRL measurements obtained with 3D mode probably reflects the true CRL, compared to the 2D measured CRL., (Copyright © 2018. Published by Elsevier Inc.)

Background: Respiratory distress is commonly encountered among premature babies immediately after birth resulting in significant neonatal morbidity or mortality., Objectives: To evaluate the possible correlation between three dimensional fetal lung volumes (FLVs) and neonatal respiratory outcomes., Study Design: A cohort study included 100 pregnant women who participated in the study and were divided into two groups; group A (n: 50 - women pregnant ±34-37 weeks) and group B (n: 50 - women pregnant ±37 +1 to 40 weeks). A three dimensional measurement of the right fetal lung was made using virtual organ computer-aided analysis (VOCAL) software then correlated to neonatal respiratory functions namely Apgar score at birth and the occurrence of respiratory distress syndrome (RDS)., Results: In group A, FLV was negatively correlated with Apgar score and the occurrence of RDS. In group B, FLV showed no statistical correlation with Apgar score and the occurrence of RDS., Conclusions: Three dimensional fetal lung volumes might be an accurate noninvasive predictor for the development of RDS among preterm fetuses.