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V magistrski nalogi bom predstavil šolo poučevanja roga Philipa Farkasa. Šola se nanaša na vse mlade in tudi odrasle horniste, saj je delo zaradi svoje vsebine postalo temelj za vse horniste širom sveta. Delo opisuje probleme, pristop k rešitvam ter skrivnosti uspešnega poučevanja in poustvarjanja na rog. This master's thesis describes the teaching of French horn according to the school of Philip Farkas, which applies to all young and adult horn players. His book became an important foundation for horn players all over the world because of its content. It describes the problems, solutions and secrets to successful teaching and playing the French horn.

Background: Drug inhalation is common mode of treatment for chronic obstructive pulmonary disease (COPD). The aim of this study was to evaluate the efficiency of aerosol devices in a simulated COPD adult lung model using five commercially available hand-held mesh nebulizers. Materials and Methods: Five nebulizers (PARI VELOX®, Omron NE-U22, Aeroneb® Go, APEX PY001, and Pocket Air®) were tested with a unit dose of 5.0 mg/2.5 mL salbutamol. An in vitro lung model (compliance: 0.06 L/cm H2O, resistance: 20 cm H2O/L/sec) was constructed to simulate parameters (tidal volume of 500 mL, respiratory rate of 15 breaths/min, inspiratory time of 1 second) of an adult patient with COPD. A bacterial filter was attached at the bronchi level for drug collection, referring as inhaled mass. After nebulization, the inhaled mass (%), dose remaining on each component (%), particle size characteristics, and nebulizer performances were analyzed. Particle size characteristics were analyzed using an 8-stage Anderson Cascade Impactor. The salbutamol particles deposited were eluted and analyzed using a spectrophotometer at 276 nm. The inhaled mass (%), dose remaining on each component (%), particle size distribution, and nebulizer performance were statistically analyzed using analysis of variance (ANOVA) with Sheffee post hoc tests. Results: Pocket Air and APEX PY001 showed the greatest inhaled mass and the lowest dose in the mouthpiece connection. The largest and smallest mass median aerodynamic diameters were found with Omron NE-U22 and PARI VELOX, respectively. In addition, the output rate and inhaled aerosol rate (IAR) of PARI VELOX were higher than those of other nebulizers. Conclusions: This study showed that the performance of commercially available mesh nebulizers varied. Aerosol particles deposited on different auxiliary equipment directly influenced the output rate and IAR of the mesh nebulizer. Clinical validation of the drug IAR is necessary to avoid overdose and reduce drug wastage.

Brass instruments mouthpieces have been historically built using metal materials, usually brass. With the auge of additive manufacturing technologies new possibilities have arisen, both for testing alternative designs and for using new materials. This work assesses the use of polymers for manufacturing trombone mouthpieces, specifically PLA and Nylon. The acoustical behavior of these two mouthpieces has been compared with the obtained from a third one, built from brass. Both additive and subtractive manufacturing techniques were used, and the whole manufacturing process is described. The mouthpieces were acoustically assessed in an anechoic chamber with the collaboration of a professional performer. The harmonic analysis confirmed that all the manufactured mouthpieces respect the harmonic behavior of the instrument. An energy analysis of the harmonics revealed slight differences between the mouthpieces, which implies differences in the timbre of the instrument. Although these subtle differences would not be acceptable when performing with the instrument in an orchestra, they could be perfectly valid for early learners, personal rehearsals or any kind of alternative performance.

Expiratory tasks may facilitate transversus abdominis (TrA) activity for spinal stabilization. The purpose of this study was to verify whether a combination of pursed-lip breathing (PLB) and use of an expiratory threshold loading (ETL) device to increase expiratory resistance would promote TrA contraction comparable to that for a stabilization exercise.Twenty healthy men performed expiratory tasks or an abdominal drawing-in maneuver (ADIM). Expiratory tasks comprised combinations of ETL settings with 0%, 5%, or 15% of maximum expiratory pressure, and mouthpieces with a normal shape or pursed-lip shape. B-mode ultrasound imaging of the TrA, internal oblique, and external oblique muscles was performed to determine percentage changes in muscle thickness. Percentage changes among tasks were statistically compared for each muscle.TrA thickness increased with normal lips at 15% ETL, with PLB with 5% ETL, and with ADIM (p 0.01 each). Internal oblique thickness increased under all PLB conditions (p 0.01 each). No significant differences in external oblique thickness were seen for any tasks. The total thickness of the lateral abdominal muscles was significantly increased not only for 15% ETL tasks and ADIM, but also for PLB with 5% ETL (p 0.02 each).These results indicated that PLB with 5% ETL could facilitate the same level of TrA activity as the ADIM. PLB with 5% ETL was the only task that simultaneously increased overall lateral abdominal muscles, including the internal obliques, and might be readily applicable in clinical situations.

Introduction: Fugitive aerosol concentrations generated by different nebulizers and interfaces in vivo, and mitigation of aerosol dispersion into the environment with various commercially available devices are not known. Methods: Nine healthy volunteers were given 3 mL saline with a small volume nebulizer (SVN) or vibrating mesh nebulizer (VMN) with a mouthpiece, a mouthpiece with an exhalation filter, an aerosol mask with open ports for SVN and a valved facemask for VMN, and a facemask with a scavenger (Exhalo) in random order. Five of the participants received treatments using a face tent scavenger (Vapotherm) and a mask with exhalation filter with SVN and VMN in a random order. Treatments were performed in an ICU room, with 2 particle counters positioned 1 and 3 feet from participants measuring aerosol concentrations at sizes of 0.3-10 µm at baseline, before, during and after each treatment. The Ethics Committee at Rush University approved this study. Results: Fugitive aerosol concentrations were higher with SVN than VMN and higher with a facemask than a mouthpiece. Adding an exhalation filter to a mouthpiece reduced aerosol concentrations of 0.3-1.0 µm in size for VMN and 0.3-3.0 µm for SVN (all p

Introduction New training devices have been introduced to help in inhaler counseling by addressing the inspiratory flow through the metered-dose inhaler (MDI), which is the most important problem of the MDI inhalation technique. This study aims to compare the effects of MDI traditional verbal counseling and advanced counseling using training devices with a smartphone application in pediatric asthmatic patients. Methods A total of 201 pediatric asthmatic subjects (8–18 years) were divided into two groups: a verbal counseling group, who received only MDI verbal counseling training (n = 101), and an advanced counseling group who received counseling using a training device (Flo-Tone with Trainhaler smartphone application) in addition to the traditional MDI verbal counseling (n = 100). Every patient in the two groups attended three counseling visits, 1 month apart. At each visit, pulmonary functions [peak expiratory flow (PEF), forced expiratory volume in 1 s (FEV1) as % of predicted] were measured. Also, patients were asked to perform their normal inhalation technique using their MDI, and mistakes were detected and recorded by the investigator. Then, patients were trained on the correct steps of the MDI inhalation technique using either verbal counseling or advanced counseling depending on their study group. In the advanced group, the Flo-Tone was connected to the mouthpiece of the MDI to blow a whistle while the patient inhaled from the MDI. That whistle was detected by the Trainhaler smartphone application and the duration of inhalation determined by the application was recorded. Results Both groups showed a gradual significant decrease (p

The results of theoretical and experimental studies on the creation of a screw press composite mouthpiece screw press for 3D-forming of peat pieces of a tubular type in the field for intensifying the process of field drying of material in a complex mechanized pit are presented. The main purpose of the study was to substantiate the geometric and design parameters of the screw press composite mouthpiece of the spread machine for the production of peat-agglomerated products of the tubular type. The parameters of the mouthpiece are selected based on the geometric characteristics of the peat pieces. An increase in moisture loss during drying of peat-agglomerated products is provided by forming a peat piece in the form of a thick-walled pipe made of a peat raw materials composed of low and high decomposition degrees in a ratio of 1:3. Additive production of polymer-fiber peat composites by extrusion allows to produce products with improved mechanical properties in comparison with non-reinforced raw materials. The vertical arrangement of the peat tubular piece on the drying field allows to increase the loading of the field area by 10 %, increase the convective heat supply to the piece and reduce the contact coefficient of the piece with the field by three times in comparison with the peat spreading of the pieces in the form of a horizontal tape. Based on the analysis of the shape and size of the agglomerated products, the design of a screw press composite mouthpiece consisting of two conditional molding zones of various configurations has been developed. The article presents a parametric analysis of the volumetric productivity of a screw press with a composite mouthpiece of a tubular type, the energy intensity of mechanical processing is determined, the degree of mechanical processing of peat raw materials is estimated with the optimization of the screw parameters for the production of agglomerated products of a tubular type.

Purpose We investigated the immobilization accuracy of a new type of thermoplastic mask—the Double Shell Positioning System (DSPS)—in terms of geometry and dose delivery. Methods Thirty‐one consecutive patients with 1–5 brain metastases treated with stereotactic radiotherapy (SRT) were selected and divided into two groups. Patients were divided into two groups. One group of patients was immobilized by the DSPS (n = 9). Another group of patients was immobilized by a combination of the DSPS and a mouthpiece (n = 22). Patient repositioning was performed with cone beam computed tomography (CBCT) and six‐degree of freedom couch. Additionally, CBCT images were acquired before and after treatment. Registration errors were analyzed with off‐line review. The inter‐ and intrafractional setup errors, and planning target volume (PTV) margin were also calculated. Delivered doses were calculated by shifting the isocenter according to inter‐ and intrafractional setup errors. Dose differences of GTV D99% were compared between planned and delivered doses against the modified PTV margin of 1 mm. Results Interfractional setup errors associated with the mouthpiece group were significantly smaller than the translation errors in another group (p = 0.03). Intrafractional setup errors for the two groups were almost the same in all directions. PTV margins were 0.89 mm, 0.75 mm, and 0.90 mm for the DSPS combined with the mouthpiece in lateral, vertical, and longitudinal directions, respectively. Similarly, PTV margins were 1.20 mm, 0.72 mm, and 1.37 mm for the DSPS in the lateral, vertical, and longitudinal directions, respectively. Dose differences between planned and delivered doses were small enough to be within 1% for both groups. Conclusions The geometric and dosimetric assessments revealed that the DSPS provides sufficient immobilization accuracy. Higher accuracy can be expected when the immobilization is combined with the use of a mouthpiece.

Background Intrapulmonary percussive ventilation (IPV) facilitates the mobilization and clearance of bronchial secretions. Cricothyroidotomy using a Mini-Trach II device is a minimally invasive method used for secretion clearance. To our knowledge, there are no previous reports regarding IPV combined with Mini-Trach II. Case presentation An 82-year-old man underwent controlled mechanical ventilation and IPV via an endotracheal tube to treat atelectasis following emergency surgical repair of a traumatic diaphragm laceration. He underwent cricothyroidotomy using Mini-Trach II for ensuring airway management after extubation. On resumption, IPV through a mouthpiece or face mask was unsuccessful owing to air leakage from his mouth. However, IPV via the already inserted Mini-Trach II could deliver the percussion flow and led to a marked improvement in his condition. Conclusion This experience indicates that Mini-Trach II is beneficial as a minimally invasive interface for IPV that can deliver percussion flow efficiently.

The burial traditions that began as a special farewell ceremony in the Sanidar Cave were shaped around the thought that the end was actually a beginning and thusly retained their importance in both pagan and theistic religions. The class distinctions created by production, trade, and technological advancements were reflected in burial traditions in the form of variety in grave goods and tomb architecture. Advancements in the military and politics triggered intercultural exchanges that further increased this variety. When described in relation to burial traditions, mouth/eye bands and decorative appliques are referred to as Funeral/Burial Jewelry in this article. Made of gold leaf, the fact that these objects were unfit for use in daily life supports this identification. These bands, made of gold leaf and appearing in Mesopotamia during the Bronze Age, spread from there to Anatolia, Cyprus, Greece, and the entire Mediterranean Basin. In terms of both form and decoration, some of the richest examples of this group of artifacts, which were preserved in situ in the tombs at Kültepe, were recovered from the necropolises of Cyprus. While death masks were preferred in Mycenaean burial traditions, mouth and eye bands came into fashion in Greece during the Iron Age. Gold leaf appliques, decorated with motifs and cut into various forms, were once again used within the framework of burial traditions as clothing decorations from the Classical Period to the Roman Era. In this article we have examined 17 artifacts consisting of gold leaf mouth and eye bands, decorative appliques, and a fragment of diadem found in the collection of the Adana Museum. The 10 gold leaf appliques with an oval shape suitable for covering the mouth and eyes were categorized in to two groups: decorated and undecorated. The remaining samples, shaped like equilateral rectangles, lack decoration and are therefore identified as mouth bands. The decorated group consists of seven mouth bands with three having their form and decoration previous defined in the literature. The four strip-shaped samples (cat. no. 5-7), with measurements varying from 3 cm to 6 cm, are unique in that they are shaped to minimize their diadems. Stylistic similarities were reflected in the pattern repertoire and like on the diadems, scenes depicting large gatherings of auxiliary figures together with main figures were preferred. The lip decorations featured on the four mouth bands of standard form (cat. no. 1-4) include depictions of bee and plant motifs. Of the undecorated samples, four are oval shaped (cat. no. 8-11), and one is an equilateral rectangle (cat. no. 12). The only round gold leaf sample was identified as an eye band (cat. no. 13). The other groups of artifacts analyzed are the rhombus and square appliques made of gold leaf. One of the appliques depicts Nemea and Young Hercules holding the coat of a lion (cat. no. 14), the other depicts Fortuna sitting on a diphros while a female figure presents her with an offering (cat. no. 15). The applique featuring Hercules is exactly the same as the pattern used on Alexander’s silver coins. The other applique depicts one of Fortuna’s characteristic narrations that was used extensively during the Roman Period yet left unrecorded in the literature. The last applique to be analyzed is rectangular and features a row of six central holes sitting one on top of another (cat. no. 16). On the last example, which is thought to belong to the edge of the diadem, there are groups of couple figures (female-male) given face-to-face (cat. no. 17). Since we do not know the location and context in which these artifacts were found, they have been dated using the analogy method. The lip-shaped mouth bands from Cyprus were dated to the Late Bronze Age/Early Iron Age for their resemblance to period samples. The sharp-edged oval mouth bands have been dated Classical and Hellenistic Periods, and equilateral rectangle-shaped mouth bands have been dated to the Late Roman Imperial Period. For Gorgo/Medusa and Athena Parthenos with female figures mouth band has been suggested Late Hellenistic and Early Roman Period. The applique with the bust of Hercules was dated to the end of the 4th century BCE, and the gold leaf applique depicting the figure of a woman presenting an offering to Fortuna was dated to the 1st century BCE. The fragment of diadem is dated to 3th and 2nd and BCE.

[ES] La afinación es uno de los parámetros más importantes en la interpretación musical. En la fabricación de la trompeta, al igual que en el resto de los instrumentos de viento metal, se siguen procesos artesanales que producen unos ligeros defectos en este parámetro que el músico debe corregir personalmente, siendo la boquilla una pieza clave en la afinación del instrumento. En este contexto, en el presente trabajo se han introducido herramientas del ámbito de la ingeniería para diseñar boquillas de trompeta que ayuden a mejorar su afinación. Además, para su fabricación, se ha utilizado la tecnología de impresión 3D con el fin de fabricarlas en plástico como sustituto del metal., [EN] Tuning is one of the most important parameters in musical performance. In manufacture of trumpets, as in the rest of the brass instruments, artisanal processes produce slight defects in this parameter that the musician must correct personally, and mouthpiece is a very important piece in the tuning of the instrument. In this context, in this project engineering tools have been introduced to design trumpet mouthpieces that help improve their tuning. In addition, for its manufacture, 3D printing technology has been used to make them in plastic replacing metal.

Several case studies and anecdotal reports have shown assorted motor and quality of life benefits from use of a dental mouthpiece among people with Parkinson disease (PD). A larger exploratory study is necessary to assess potential efficacy and feasibility of this treatment strategy. If shown to be effective and feasible in a larger sample of people with PD, mechanistic studies may be warranted to examine a potential relationship between orofacial sensory input and motor function in people with PD.This study was registered on clinicaltrials.gov (NCT: 04082663). Twenty people with PD, Hoehn and Yahr stages I-III, participated in this study. Each participant completed various baseline motor and quality of life assessments before being fitted with a custom mouthpiece. Motor assessments were completed a second time after 25 min of mouthpiece wear. Participants were asked to wear the mouthpiece for 1 month before completing follow-up quality of life assessments and providing feedback about the mouthpiece. Wilcoxon signed-rank tests were used to compare results across conditions.Gait velocity and cadence showed significant (These results do not provide adequate evidence to pursue further this type of mouthpiece as a treatment strategy for motor signs and symptoms or quality of life in people with PD.

Man is powered by the senses of skin, mouth, eyes, nose and ears. While depicting God in human form, the Alvars sang hymns in a way that emphasized the special nature of God and the use of human organs. Especially in Tirumal's Maniyalakam, Vayalaka is mentioned and he is spoken as a sweet speaker. In every incarnation of Tirumala his vayalaku is narrated. Although Vayalaku is meant to represent the Lordship of the Lord in a positive light, it is also shown to have the two properties of being the mouthpiece that feeds the milk objects which are meant to teach, hear and enjoy the virtues for the benefit of human beings. Eating and speaking are actions of the mouth. On the basis of these deeds the Alvars are distinguished as the mouthpiece of the Lord.

What is the delivered dose with jet and mesh nebulisers during spontaneous breathing (SB), noninvasive ventilation (NIV), and mechanical ventilation (MV) using an adult lung model with exhaled humidity (EH)? The delivery of salbutamol sulfate (2.5 mg per 3 mL) with jet (Mistymax10) and mesh nebulisers (Aerogen Solo) was compared during SB, NIV, and MV using breathing parameters (tidal volume 450 mL, respiratory rate 20 breaths per min, inspiratory:expiratory ratio 1:3) with three lung models simulating exhaled humidity. A manikin was attached to a sinusoidal pump via a filter at the bronchi to simulate an adult with SB. A ventilator (V60) was attached via a facemask to a manikin with a filter at the bronchi connected to a test lung to simulate an adult receiving NIV. A ventilator-dependent adult was simulated through a ventilator (Servo-i) operated with a heated humidifier (Fisher & Paykel) attached to an endotracheal tube (ETT) with a heated-wire circuit. The ETT was inserted into a filter (Respirgard II). A heated humidifier was placed between the filter and test lung to simulate exhaled humidity (35±2°C, 100% relative humidity). Nebulisers were placed at the Y-piece of the inspiratory limb during MV and positioned between the facemask and the leak-port during NIV. A mouthpiece was used during SB. The delivered dose was collected in an absolute filter that was attached to the bronchi of the mannequin during each aerosol treatment and measured with spectrophotometry. Drug delivery during MV was significantly greater than during NIV and SB with a mesh nebuliser (p=0.0001) but not with a jet nebuliser (p=0.384). Delivery efficiency of the mesh nebuliser was greater than the jet nebuliser during MV (p=0.0001), NIV (p=0.0001), and SB (p=0.0001). Aerosol deposition obtained with a mesh nebuliser was greater and differed between MV, NIV, and SB, while deposition was low with a jet nebuliser and similar between the modes of ventilation tested., Delivered dose distal to the trachea of an adult lung model is similar or greater with MV than NIV and SB, suggesting that the artificial airway may provide a similar or better pathway for medical aerosols to the lung https://bit.ly/3gAk7nd

Our aim was to synthesize the published literature on factors that potentially affect the delivery of bronchodilators using valved holding chambers (VHC) in preschool children. We also aimed to identify those attributes that are not yet incorporated or clearly stated in the guidelines and those topics that are still lacking sufficient data. There is strong evidence supporting several recommendations in current guidelines. Based on present knowledge, bronchodilators should be delivered by VHC administering each puff separately. Face mask should be omitted as soon as the child can hold the mouthpiece of the VHC tightly between the lips and teeth. Based on the review, we suggest adding a specific note to current guidelines about the effect of chamber volume and the impact of co-operation during drug administration. Calming the child and securing a tight face-to-mask seal is critical for successful drug delivery. There is not enough evidence to make specific recommendations on the most reliable VHC and face mask for children. There is an urgent need for studies that evaluate and compare the effectiveness of VHCs in various clinical settings in wide age-groups and respiratory patterns. In addition, there is insufficient data on ideal chamber volume, material, and effective antistatic treatment. What is Known:• Valved holding chambers (VHC) should not be considered interchangeable when used with pressurized metered dose inhalers (pMDI).• Drug delivery is influenced by VHC volume, aerodynamic and electrostatic properties; mask fit; respiratory pattern and co-operation during inhalation; and the number of puffs actuated.What is New:• The impact of co-operation, VHC volume, and good mask-to-face fit during drug inhalation is not stressed enough in the guidelines.• Studies are urgently needed to evaluate the effectiveness of different VHCs in various clinical settings focusing on VHC electrostatic properties, respiratory patters, face masks, and ideal pMDI+VHC combinations.

BACKGROUND: High-flow nasal cannula (HFNC) oxygen therapy has been broadly used. However, no consensus has been achieved on the practical implementation of HFNC and how to provide aerosol delivery during HFNC therapy in adult patients. METHODS: An online anonymous questionnaire survey endorsed by 4 academic societies from America, Europe, mainland China, and Taiwan was administered from May to December 2019. Clinicians who had worked in adult ICUs for > 1 year and had used HFNC to treat patients within 30 days were included. RESULTS: A total of 2,279 participants clicked on the survey link, 1,358 respondents completed the HFNC section of the questionnaire, whereas 1,014 completed the whole survey. Postextubation hypoxemia and moderate hypoxemia were major indications for HFNC. The initial flow was mainly set at 40–50 L/min. Aerosol delivery via HFNC was used by 24% of the participants (248/1,014), 30% (74/248) of whom reported reducing flow during aerosol delivery. For the patients who required aerosol treatment during HFNC therapy, 40% of the participants (403/1,014) reported placing a nebulizer with a mask or mouthpiece while pursuing HFNC (a method shown to reduce inhaled dose), whereas 33% (331/1,014) discontinued HFNC to use conventional aerosol devices. A vibrating mesh nebulizer was the most commonly used nebulizer (40%) and was mainly placed at the inlet of the humidifier. CONCLUSIONS: The clinical utilization of HFNC was variable, as were indications, flow settings, and criteria for adjustment. Many practices associated with concomitant aerosol therapy were not consistent with available evidence for optimal use. More efforts are warranted to close the knowledge gap.

The aim of this study was to compare the estimated public medical care cost of measures to address metallic dental restorations (MDRs) for head and neck radiotherapy using high-energy mega-voltage X-rays. This was considered a first step to clarify which MDR measure was more cost-effective. We estimated the medical care cost of radiotherapy for two representative MDR measures: (i) with MDR removal or (ii) without MDR removal (non-MDR removal) using magnetic resonance imaging and a spacer. A total of 5520 patients received head and neck radiation therapy in 2018. The mean number of MDRs per person was 4.1 dental crowns and 1.3 dental bridges. The mean cost per person was estimated to be 121 720 yen for MDR removal and 54 940 yen for non-MDR removal. Therefore, the difference in total public medical care cost between MDR removal and non-MDR removal was estimated to be 303 268 800 yen. Our results suggested that non-MDR removal would be more cost-effective than MDR removal for head and neck radiotherapy. In the future, a national survey and cost-effectiveness analysis via a multicenter study are necessary; these investigations should include various outcomes such as the rate of local control, status of oral mucositis, frequency of hospital visits and efforts of the medical professionals.

The clarinet has undergone many changes throughout history until it reached its present form, and has also been produced in different forms and materials. Since the B flat clarinets used in classical music were first made, there were no different equipment options and technological developments, so the performers were able to present their performances at a certain level. But over time, thanks to the new fret mechanisms in the clarinet developed by the Germans and the French, the performers gained more skill on their instruments. As a result of these developments, not only the B flat clarinet, but also the equipment used on the clarinet underwent improvements and changes. For instrument performers, performing successfully is a process that proceeds in parallel with the use of the right instrument and the right equipment. Incorrect selection of equipment can lead to numerous problems. The selection of appropriate instruments and equipment for the performer is of great importance in this context. B flat clarinet players, which is a wind instrument, also search for the best way to express themselves musically. They try to find the most beautiful timbre by trying different equipment for years so that the tone and tone coming out of the instrument is pleasing to them first and then to the listeners. The equipment of clarinets has developed and changed over the years with the advancement of technology. As a result of these developments, musical companies, which are instrument manufacturers, have gone to develop different products for each equipment in order to enable the performers to reach the timbres they want. In this article, it is aimed to present a detailed examination in order to eliminate the lack of information about the usage areas and differences of these equipments. The information about the equipment that is the subject of the article was obtained by scanning the literature and discussed in detail. Mouthpieces, ligatures, reeds and barrels will be discussed as equipment used in B flat clarinet, and detailed information will be presented about the differences in usage areas by grouping them according to model, brand and features. In addition, during the research, different models of equipment produced by various world-renowned clarinet brands were examined and comparisons were made. In this research, an answer is sought to the question of whether the B flat clarinet players’ knowledge of the equipment creates a positive improvement in their performance. Available information and research findings have confirmed the conclusion that choosing the right equipment will have a positive impact on the performer’s performance. Equipment changes that seem like minor changes can make a huge difference in the tone and comfort of the instrument. It has been concluded that it will be advantageous for educators and performers to have sufficient knowledge of the technical details of the equipment and production materials in solving the problems they experience. It has been concluded that thanks to the information about all the equipment, brand models and technical features in the article, it can bring a different perspective by providing benefits to the trainers who give B flat clarinet training, and also contribute by being a motivation factor. It is thought that this research is a useful resource that will positively change the performances of clarinet players., Enstrüman icracıları için başarılı performans sergileyebilmek, doğru enstrüman ve doğru ekipman kullanımıyla paralel olarak ilerleyen bir süreçtir. İcracı için uygun enstrüman ve ekipman seçimi bu bağlamda büyük önem taşımaktadır. Üflemeli bir enstrüman olan si bemol klarnet icracıları da, kendilerini müzikal açıdan ifade etmenin en iyi yolunu bulmak için farklı arayışlara girmektedirler. Enstrümandan çıkan tonun ve ses renginin önce kendisine daha sonra da dinleyenlere güzel gelmesi için yıllarca farklı ekipmanları deneyerek en güzel tınıyı bulmaya çalışırlar. Klarnetlerin ekipmanları teknolojinin de ilerlemesiyle yıllar içinde gelişim ve değişiklik göstermiştir. Bu gelişmeler neticesinde icracıların istedikleri tınılara ulaşmalarını sağlamak için enstrüman üreticisi olan müzik şirketleri her ekipman için farklı ürün geliştirme yoluna gitmişlerdir. Makalede bu ekipmanların kullanım alanları, farklılıkları gibi konulardaki bilgi eksikliğinin giderilmesi adına detaylı bir inceleme sunulması amaçlanmıştır. Makaleye konu olan ekipmanlar ile ilgili bilgilere literatür taraması yapılarak ulaşılmış ve detaylı olarak ele alınmıştır. Si bemol klarnette kullanılan ağızlıklar, bilezikler, kamışlar ve bariller incelenmiş; model, marka ve özelliklerine göre gruplandırılıp kullanım alanlarındaki farklılıklar hakkında detaylı bilgi sunulmuştur. Ayrıca araştırma sırasında dünyaca tanınmış çeşitli klarnet markalarının ürettiği farklı model ekipmanlar incelenerek karşılaştırmalar yapılmıştır. Bu araştırmanın klarnet icracılarının performanslarını olumlu anlamda değiştirecek yararlı bir kaynak niteliği taşıdığı düşünülmektedir.

金属アレルギーとは金属が皮膚や粘膜に接触し，その部位から溶出した金属イオンが体内に取り込まれることで起きるアレルギー反応である。今回われわれは，楽器のチューバのマウスピースによる金属アレルギーが原因と疑われる口腔粘膜炎を発症した1例を経験したのでその概要を報告する。 患児は10歳8か月女児。小学校の金管バンドクラブに所属して以降，歯肉の腫脹や口腔内の炎症所見を認めたため，近医にてパッチテストや血液検査を施行されるも金属アレルギーおよび自己免疫疾患は否定された。当科初診時には，唇頰側歯肉と頰粘膜に軽度自発痛ならびに発赤を伴う瀰漫性腫脹を認めた。歯肉は易出血性で，増殖し仮性ポケットが形成されていた。歯周病原細菌検査にて歯周病原細菌は基準値以下であった。歯肉増殖部位の病理組織検査は，歯肉炎の診断であり口腔衛生指導を徹底したが，症状の改善はみられなかった。ところが，楽器（チューバ）とマウスピースの変更を契機に口腔内の炎症が劇的に改善し，その1か月後には，健全な口腔粘膜の状態を呈していた。新旧のマウスピースを比較したところ，旧マウスピースではめっきが剥がれている箇所が多数みられた。金属組成分析ならびに金属パッチテスト検査を行ったところ，Crにアレルギーがある可能性が高いことが明らかとなり，金属アレルギーが原因で引き起こされた口腔粘膜炎と診断した。口腔内はマウスピースの変更以降，良好な状態が継続している。, Metal allergy is an allergic reaction that occurs when metal touches the skin or mucous membranes, and eluted metal ions are taken into the body. Here we report a case of metal allergy caused by the mouthpiece of a musical instrument. The patient was a girl of 10 years and 8 months. Since joining the brass band club of her elementary school, gingival swelling and inflammation in the oral cavity had appeared. Therefore, a patch test and a blood test were performed by a local clinic, but both metal allergies and autoimmune diseases were denied. At the first visit to our hospital, the labial and buccal gingiva and buccal mucosa presented mild spontaneous pain and diffuse swelling with redness. The gingiva bled easily, and had grown over, forming false pockets. The periodontopathic bacteria were below reference values in the periodontopathic bacteria test. Histopathological examination revealed that the gingival overgrowth was periodontitis. Although we started to provide professional oral care, her condition did not improve. Eleven months later, the inflammation in the oral cavity drastically improved. We found that the musical instrument (tuba) had been changed to a new one. After that, the condition of the oral mucosa was healthy. The old mouthpieces had some spots where the plating had peeled off. Energy dispersive X-ray fluorescence spectrometry was carried out for an element analysis of the mouthpieces, and a metal patch test was also performed. The results showed that she may have had an allergic response to Cr. Finally, we diagnosed oral mucositis caused by metal allergies. The patient made steady progress after the mouthpiece was changed.

A model of a single reed instrument is studied in which the reed is described as an Euler-Bernoulli beam, and the air flow through the instrument is calculated using the Navier-Stokes equations. The hypothetical instrument resembles a clarinet, but is smaller than a real clarinet to keep the numerical modeling feasible on available supercomputers. This article explores the conditions under which the frequency of the reed oscillations and the emitted sound are determined by the resonant frequency of the bore of the instrument. The effect of the contact between the reed and the player's lips is also studied, and quantitative results for the air density and pressure in the mouthpiece and throughout the instrument bore are also presented.

Le document qui suit est la traduction intégrale du compte rendu établi à l’occasion du 252eatelier international ENMC consacré, du 6 ou 8 mars 2020, au « Développement de recommandations pour l’utilisation de la ventilation par embout buccal dans les maladies neuromusculaires », et publié très récemment dans la revueNeuromuscular Disorders(M. Chatwin, M. Gonçalves, J. Gonzalez-Bermejo, M. Toussaint, et al. 252ndENMC international workshop: Developing best practice guidelines for management of mouthpiece ventilation in neuromuscular disorders. March 6thto 8th2020, Amsterdam, the Netherlands.Neuromuscular Disorders2020 ; 30 : 772–81.https://doi.org/10.1016/j.nmd.2020.07.008).

Chronic obstructive pulmonary disease (COPD) is a disease whose prevalence tends to increase annually, with the World Health Organization (WHO) data predicting in 2020 the disease is the cause of the third-highest mortality worldwide. The assessment of the recurrence of COPD patients is very important, as it will accelerate the decline of lung function and health status. The purpose of this research is to design a spirometer by utilizing the MPXV7002DP sensor and equipped with a graphical display as well as lung health status on the Nextion TFT LCD. A portable Spirometer design has been done using the MPXV7002DP pressure sensor out as a transducer with a display on the Nextion TFT LCD. The design aims to determine the health of lung function by knowing the volume of lung Forced Vital Capacity (FVC), Forced Expired Volume in one second (FEV1), and Vital Capacity (VC). The working principle of this tool is to process the pressure from the results of the user blowing to the sensor through a mouthpiece which is designed based on Venturimeter law, the data will be processed by the Arduino microcontroller 2560 to be displayed on the LCD TFT and Nextion stored in SD card memory. The result of module validation data against a Spirometer 3L calibrator Benchmarking tool was obtained 1.58% VC error. The value is still below the 5% error tolerance limit so that the VC parameters in the secure module is used.

Background Fluid Resistant Surgical Masks have been implemented in UK personal protective equipment (PPE) guidelines for COVID-19 for all care sites that do not include aerosol-generating procedures (AGPs). FFP3 masks are used in AGP areas. Concerns from the ENT and plastic surgery communities out with intensive care units have questioned this policy. Emerging evidence on cough clouds and health care worker deaths has suggested that a review is required. Aims To test the efficacy of Fluid Resistant Surgical Mask with and without adaptions for respiratory protection. To test the efficacy of FFP and FFP3 regarding fit testing and usage. Methods A smoke chamber test of 5 min to model an 8-h working shift of exposure while wearing UK guideline PPE using an inspiratory breathing mouthpiece under the mask. Photographic data were used for comparison. Results The Fluid Resistant Surgical Mask gave no protection to inhaled smoke particles. Modifications with tape and three mask layers gave slight benefit but were not considered practical. FFP3 gave complete protection to inhaled smoke but strap tension needs to be ‘just right’ to prevent facial trauma. Facial barrier creams are an infection risk. Conclusions Surgical masks give no protection to respirable particles. Emerging evidence on cough clouds and health care worker deaths suggests the implementation of a precautionary policy of FFP3 for all locations exposed to symptomatic or diagnosed COVID-19 patients. PPE fit testing and usage policy need to improve to include daily buddy checks for FFP3 users

Purpose This study aimed to reduce radiation doses to the tongue, a patient-specific semi-customized tongue immobilization device (SCTID) was developed using a 3D printer for helical tomotherapy (HT) of nasopharyngeal cancer (NPCa). Dosimetric characteristics and setup stability of the SCTID were compared with those of a standard mouthpiece (SMP).Materials and Methods For displacement and robust immobilization of the tongue, the SCTID consists of four parts: upper and lower tooth stoppers, tongue guider, tongue-tip position guide bar, and connectors. With the SCTID and SMP, two sets of planning computed tomography and HT plans were obtained for 10 NPCa patients. Dosimetric and geometric characteristics were compared. Position reproducibility of the tongue with SCTID was evaluated by comparing with planned dose and adaptive accumulated dose of the tongue and base of the tongue based on daily setup mega-voltage computed tomography.Results Using the SCTID, the tongue was effectively displaced from the planning target volume compared to the SMP. The median mucosa of the tongue (M-tongue) dose was significantly reduced (20.7 Gy vs. 27.8 Gy). The volumes of the M-tongue receiving a dose of 15 Gy, 30 Gy, and 45 Gy and the volumes of the mucosa of oral cavity and oropharynx (M-OC/OP) receiving a dose of 45 Gy and 60 Gy were significantly lower than using the SMP. No significant differences was observed between the planned dose and the accumulated adaptive dose in any dosimetric characteristics of the tongue and base of tongue.Conclusion SCTID can not only reduce the dose to the M-tongue and M-OC/OP dramatically, when compared to SMP, but also provide excellent reproducibility and easy visual verification.

Highlights • Pre workshop international survey on MPV • Best practice guidline on the provision of MPV in NMD's by reviewing and recommend the most appropriate monitoring, mode, settings and equipment required for MPV. • Best practice algorithm on MPV for daytime ventilatory support (see Figure 1 ).Figure 1Figure 1 shows the best practice algorithm for the initiation of mouthpiece ventilation (MPV) in the long-term setting. For each stage of the algorithm there is a description to assist in the provision of this service.Figure 1 • Future studies in MPV.

Introduction Personalized therapy for patients with COPD requires appropriate choice of drug and delivery device. Inhalers and nebulizers vary in their drug delivery characteristics, particularly the need for passive or active patient inhalation for appropriate drug dispersal and delivery. In this in vitro analysis, we assessed the aerosol performance and drug delivery of two long-acting muscarinic antagonists, glycopyrrolate (GLY; 25 µg solution; 1 ml) and tiotropium (TIO; 18 µg powder) through their respective delivery systems: the eFlow® Closed System (CS) vibrating membrane nebulizer and the HandiHaler® dry-powder inhaler (DPI). Methods The aerosol performances of the eFlow® CS nebulizer and the HandiHaler® were determined using the Next Generation cascade Impactor. The delivered dose of GLY and TIO was determined using different breathing patterns, which varied in tidal volume and peak inspiratory flow rate, respectively, to simulate breathing conditions ranging from normal to severe obstruction. Results Aerodynamic particle analysis showed generally similar mass median aerodynamic diameter (MMAD, range, 3.6–4.6 µm) and fine particle fraction (FPF, range, 48.2%–63.7%) with GLY delivered using the eFlow® CS nebulizer under all breathing patterns tested. TIO, delivered via the HandiHaler®, showed variations in MMAD (range, 3.8–5.8 µm) and FPF (range, 16.1%–32.4%) under different inspiratory flow rates. The majority of GLY was deposited in stages 2–5 of the impactor, which corresponds with particle sizes in the respirable range (

PURPOSE: This study was intended to determine the effect of skin cooling on breath-hold duration and predicted emergency air supply duration during immersion.METHODS: While wearing a helicopter transport suit with a dive mask, 12 subjects (29 ± 10 yr, 78 ± 14 kg, 177 ± 7 cm, 2 women) were studied in 8 and 20°C water. Subjects performed a maximum breath-hold, then breathed for 90 s (through a mouthpiece connected to room air) in five skin-exposure conditions. The first trial was out of water for Control (suit zipped, hood on, mask off). Four submersion conditions included exposure of the: Partial Face (hood and mask on); Face (hood on, mask off); Head (hood and mask off); and Whole Body (suit unzipped, hood and mask off).RESULTS: Decreasing temperature and increasing skin exposure reduced breath-hold time (to as low as 10 ± 4 s), generally increased minute ventilation (up to 40 ± 15 L · min−1), and decreased predicted endurance time (PET) of a 55-L helicopter underwater emergency breathing apparatus. In 8°C water, PET decreased from 2 min 39 s (Partial Face) to 1 min 11 s (Whole Body).CONCLUSION: The most significant factor increasing breath-hold and predicted survival time was zipping up the suit. Face masks and suit hoods increased thermal comfort. Therefore, wearing the suits zipped with hoods on and, if possible, donning the dive mask prior to crashing, may increase survivability. The results have important applications for the education and preparation of helicopter occupants. Thermal protective suits and dive masks should be provided.Madu VC, Carnahan H, Brown R, Ennis K-A, Tymko KS, Hurrie DMG, McDonald GK, Cornish SM, Giesbrecht GG. Skin cooling on breath-hold duration and predicted emergency air supply duration during immersion. Aerosp Med Hum Perform. 2020; 91(7):578–585.

Breathing tracking is critical for the assessment of lung functions, exercise physiologies, and energy expenditure. Conventional methods require using a face mask or mouthpiece that is connected to a stationary equipment through a tube, restricting the location, movement, or even the posture. To obtain accurate breathing physiology parameters that represent the true state of the patient during different scenarios, a wearable technology that has less intervention to patient’s activities in free-living conditions is highly preferred. Here, we propose a miniaturized, reliable, and wide-dynamic ranged flow sensing technology that is immune to orientation, movement, and noise. As far as we know, this is the first work of introducing a fully integrated mask device focusing on breath tracking in free-living conditions. There are two key challenges for achieving this goal: miniaturized flow sensing and motion-induced artifacts elimination. To address these challenges, we come up with two technical innovations: 1) in hardware wise, we have designed an integrated flow sensing technique based on differential pressure Pneumotach approach and motion sensing; 2) in software wise, we have developed comprehensive algorithms based baseline tracking and orientation and motion compensation. The effectiveness of the proposed technology has been proven by the experiments. Experimental results from simulator and real breath conditions show high correlation (R(2) = 0.9994 and 0.9964 respectively) and mean error within 2.5% for Minute Volume (VE), when compared to values computed from reference methods. These results show that the proposed method is accurate and reliable to track the key breath parameters in free-living conditions.

Background: Thelarynx is an inevitable mouthpiece of the human body which has to execute very associated assignment like protection, respiration, and phonation. To fulfill this mission, the larynx should be accommodated, integrated, and sensible. The vocal cord is the concern of larynx, which served all-purpose. If any occurrence due to iatrogenic, idiopathic, or any other causes shut down the vocal cord mobility, the patient is facing miserable complexity in their life. Methods: It is a cohort retrospective study of 67 cases in the department of otolaryngology and Head-Neck Surgery, Bangladesh, from 01 July 2016 to 31 June 2019. Results: Incidence among outpatient was 0.06%, inpatient was 0.37%, and total laryngeal disorder, and thyroid operation was 6.51%. Of them unilateral was 64(95.52%) in which both right and left were equal 32(50%) bilateral were 3(2.99%), male were 28(41.79%), and females were 39(58.21%). Amidst them 00-18 years were 2(2.99%), 19-40 years were 21(31.34), 41-60 years 36(53.73%) and above 60 years 8(11.94%), smokers were 34(50.74%), betel leaf chewer 26(38.81%), diabetic were 27(40.30%), hypertensive were 19(28.36%), iatrogenic were 33(49.25%), idiopathic 20(29.85%) and others 14(20.90%), 61(91.05%) treated conservatively, 5(7.46%) surgical, and 1(1.49%) denied the repeated surgery.

Background: Dry powder inhalers (DPIs) offer a number of advantages, such as rapid delivery of high-dose inhaled medications; however, DPI use in children is often avoided due to low lung delivery efficiency and difficulty in operating the device. The objective of this study was to develop a high-efficiency inline DPI for administering aerosol therapy to children with the option of using either an oral or trans-nasal approach. Methods: An inline DPI was developed that consisted of hollow inlet and outlet capillaries, a powder chamber, and a nasal or oral interface. A ventilation bag or compressed air was used to actuate the device and simultaneously provide a full deep inspiration consistent with a 5-year-old child. The powder chamber was partially filled with a model spray-dried excipient enhanced growth powder formulation with a mass of 10 mg. Device aerosolization was characterized with cascade impaction, and aerosol transmissions through oral and nasal in vitro models were assessed. Results: Best device performance was achieved when all actuation air passed through the powder chamber (no bypass flow) resulting in an aerosol mean mass median aerodynamic diameter (MMAD)

PURPOSE: Motion artifact limits the clinical translation of high-field MR. We present an optical prospective motion correction system for 7 Tesla MRI using a custom-built, within-coil camera to track an optical marker mounted on a subject. METHODS: The camera was constructed to fit between the transmit-receive coils with direct line of sight to a forehead-mounted marker, improving upon prior mouthpiece work at 7 Tesla MRI. We validated the system by acquiring a 3D-IR-FSPGR on a phantom with deliberate motion applied. The same 3D-IR-FSPGR and a 2D gradient echo were then acquired on 7 volunteers, with/without deliberate motion and with/without motion correction. Three neuroradiologists blindly assessed image quality. In 1 subject, an ultrahigh-resolution 2D gradient echo with 4 averages was acquired with motion correction. Four single-average acquisitions were then acquired serially, with the subject allowed to move between acquisitions. A fifth single-average 2D gradient echo was acquired following subject removal and reentry. RESULTS: In both the phantom and human subjects, deliberate and involuntary motion were well corrected. Despite marked levels of motion, high-quality images were produced without spurious artifacts. The quantitative ratings confirmed significant improvements in image quality in the absence and presence of deliberate motion across both acquisitions (P < .001). The system enabled ultrahigh-resolution visualization of the hippocampus during a long scan and robust alignment of serially acquired scans with interspersed movement. CONCLUSION: We demonstrate the use of a within-coil camera to perform optical prospective motion correction and ultrahigh-resolution imaging at 7 Tesla MRI. The setup does not require a mouthpiece, which could improve accessibility of motion correction during 7 Tesla MRI exams.

Metachronous cancer rate in the pharynx is high before and after the treatment of esophageal cancer. Endoscopic observation is difficult in the pharynx especially in the postcricoid area. Pharyngeal cancer in the postcricoid area has been often found in advanced stage. Valsalva maneuver has been reported to improve the visibility. From May 2017 we introduced a dedicated mouthpiece to conduct Valsalva maneuver. One hundred consecutive patients who had been observed throughout the pharynx by one endoscopist were enrolled. A total of 200 image files before and after introduction were made and reviewed by three endoscopists. We retrospectively evaluated the utility and safety of Valsalva maneuver. The visibility before introduction was Good in three cases, Moderate in 12 cases and Poor in 85 cases. Meanwhile, the visibility after introduction was Good in 58 cases, Moderate in 23 cases, and Poor in 19 cases (P

A 66-year-old man had been intubated for 21 days for severe COVID-19 infection. He then underwent tracheotomy, retained the tube for 2 months, then was discharged home on 10 L/O2/min breathing via a tracheostomy collar. We were consulted for tracheostomy tube decannulation. Mechanical insufflation exsufffation was used via the tracheostomy tube to clear secretions, increase vital capacity, and normalize O2 saturation. He practiced nasal and mouthpiece noninvasive ventilatory support (NVS) once a capped fenestrated cuffless tracheostomy tube was placed although he did not need NVS after decannulation. He was decannulated despite O2 dependence. While he required antibiotics for almost 3 months prior to decannulation and after it, he had no further episodes of lung infection for at least the next 4 months from the point of decannulation.

Introduction Research in the field of noninvasive ventilation (NIV) has contributed to the development of new NIV interfaces. However, interface tolerance plays a crucial role in determining the beneficial effects of NIV therapy. Areas covered This systematic review explores the most significant scientific research on NIV interfaces, with a focus on the potential impact that their design might have on treatment adherence and clinical outcomes. The rationale on the choice of the right interface among the wide variety of devices that are currently available is discussed here. Expert opinion The paradigm 'The right mask for the right patient' seems to be difficult to achieve in real life. Ranging from acute to chronic settings, the gold standard should include the tailoring of NIV interfaces to patients' needs and preferences. However, such customization may be hampered by issues of economic nature. High production costs and the increasing demand represent consistent burdens and have to be considered when dealing with patient-tailored NIV interfaces. New research focusing on developing advanced and tailored NIV masks should be prioritized; indeed, interfaces should be designed according to the specific patient and clinical setting where they need to be used.

Цель статьи – сравнительный анализ зарубежных методов обучения игре на медных духовых, позволяющий обобщить теорию и практику работы с мундштуком и выявить оптимальную силу давления воздуха и напряжения мышц губ для качественного звукоизвлечения на духовых инструментах. Методы исследования: теоретический анализ научно-методической литературы, наблюдение и обобщение педагогического опыта, моделирование учебно-творческого процесса, оценка и сравнение результатов образовательного процесса. В процессе исследования делается вывод о том, что вопросы развития технического мастерства нельзя решать каким-то односторонним методом. Необходима специальная работа по активизации художественного мышления, музыкально-слуховых представлений, воспитанию культуры мышечных ощущений и объединению этих компонентов в звуко-двигательный комплекс. Результатами работы стал обзор, сравнительный анализ и выявление специфики методов обучения игре на медных духовых Ж.-Б. Арбана, Г. Кларка, Ф. Фаркаса, Д. Рейнхарта, Дж. Стэмпа, А. Джейкобса., The objective of the article is a comparative analysis of foreign training methods of playing the wind brass, which allows to generalize the theory and practice of working with a mouthpiece and identify the optimal force of air pressure and lip muscle tension for high-quality sound production at wind instruments. The tasks of the work are to consider the approaches of leading foreign teachers to learning to play wind brass; clarification of their terminology on mouthpiece air pressure. Research methods include a theoretical analysis of scientific, methodological literature, observation and generalization of pedagogical experience, modeling of the educational and creative process, assessment and comparison of the results of the educational process. In the process of research, it is concluded that the issues of the development of technical mastery cannot be solved by any unilateral method. Special work is needed to activate artistic thinking, musical and auditory representations, educate the culture of muscle sensations and combine these components into a sound-motor complex. The results of the work are a review, comparative analysis and identification of the specifics of teaching methods for playing the wind brass by J.-B. Arban, G.L. Clarke, P. Farkas, D. Reinhart, J. Stamp, A. Jacobs. The conclusions of the study: the strength of air pressure and the touch of the mouthpiece with the lips is important both in terms of the quality of sound production and in terms of optimizing the actions of the performer, which contribute to solving many technical problems. The education method of playing the wind brass should be flexible, and the pedagogical approach should vary depending on the artistic tasks, technical difficulties, capabilities and abilities of the student.

Background: Aerosol delivery via high-flow nasal cannula (HFNC) has attracted clinical interests in recent years. However, both HFNC and nebulization are categorized as aerosol generating procedures (AGPs). In-vitro studies raised concerns that AGPs had high transmission risk. Very few in-vivo studies examined fugitive aerosols with HFNC and nebulization via HFNC, and effective methods to mitigate aerosol dispersion are unknown.Method: Two HFNC devices (Airvo2 and Vapotherm) with or without a vibrating mesh nebulizer (VMN) were compared; HFNC alone, surgical mask over HFNC interface, and HFNC with face tent scavenger were used in a random order for nine healthy volunteers. Fugitive aerosol concentrations at sizes of 0.3-10 µm were continuously measured by particle sizers placed at one and three feet from participants. On a different day, six of the nine participants received six additional nebulizer treatments via VMN or small volume nebulizer (SVN) with mouthpiece with/without an expiratory filter or facemask. In-vitro simulation was employed to quantify inhaled dose with VMN via Airvo2 and Vapotherm.Results: Compared to baseline, neither HFNC device generated higher aerosol concentrations. Compared to HFNC alone, VMN via Airvo2 generated higher 0.3-1.0 µm particles (all p

Purpose: To investigate how the materials of mouthpieces used for proton therapy of head and neck cancer affect the dose distribution in surrounding normal tissue by focusing on the CT values of the materials.Methods: Six dental materials were used to measure CT values: temporary relining resin, tissue conditioner, vinyl polysiloxane, thermoplastic ethylene vinyl acetate copolymer splint, silicone rubber impression material, and a composite impression material. Among these materials, three of the dental materials were investigated further: one material with the CT value closest to water, and the materials with the highest and lowest CT values. Based on these results, we investigated the effect of the CT value of the mouthpiece on the dose distribution in 17 cases in which a mouthpiece was used during proton therapy for head and neck cancers, the treatment plans were recalculated by changing the CT values of the mouthpiece to that of the three identified dental materials. For each cancer case, the irradiation dose to normal tissue was calculated for the treatment plans. The evaluation indices were set to the mandible max dose (GyE), the mandible mean dose (GyE), the volume of the mandible irradiated above 60 GyE (mandible V-60GyE), the parotid affected side mean dose (GyE), the parotid unaffected side mean dose (GyE), and the oral mean dose (GyE). The Wilcoxon’s rank sum test was used to analyze the significance of the differences between treatment plans.Results: The temporary relining resin with the CT value closest to water was 36.9 HU, the vinyl polysiloxane with the highest CT value was 985 HU, and the thermoplastic ethylene vinyl acetate copolymer splint with the lowest CT value was -89.7 HU. The maximum absolute difference among the treatment plans per case was 4.18 GyE for the oral mean dose. The radiation dose for the evaluation indices did not differ significantly among the treatment plans. Conclusion: In the range of CT values from -89.7 HU to 985.0 HU covered in this study, the effect of the CT value of the mouthpiece on the dose distribution may be considered to have no clinical impact.

Incentive spirometer (IS) is a popular choice for chest physiotherapy. It is used to optimize preoperative respiratory status and prevent postoperative pulmonary complications. However, the use of conventional forms of IS pose a challenging task in children due to the lack of cooperation, compliance, and submaximal effort on the part of pediatric patients. To tackle this problem, we describe an innovative and fascinating technique of spirometry. It employs a toy as a better acceptable incentive spirometry device in pediatric population. This toy has a mouthpiece and a long inflatable plastic strip at the other end. As the child blows into the mouthpiece, a captivating sound from the toy keeps buzzing progressively till the air is being blown during exhalation and is accompanied with inflation of the strip in an elongated fashion. Hence, this device incorporates the two best enjoyed incentives for children, namely, visual and audio to ensure patient compliance and participation.

Ice hockey has one of the highest concussion rates among youth sports. Sensor technology has been implemented in contact and collision sports to inform the frequency and severity of head impacts experienced on-ice. However, existing studies have utilized helmet-mounted sensors with limited accuracy. The objective of this study was to characterize head kinematics of contact events in a sample of youth boys' hockey players using a validated instrumented mouthpiece with improved accuracy. Head kinematics from 892 video-verified events were recorded from 18 athletes across 127 sessions. Median peak resultant linear acceleration, rotational velocity, and rotational acceleration of video-verified events were 7.4 g, 7.7 rad/s, and 576 rad/s2, respectively. Contact events occurred at a higher rate in games (2.48 per game) than practices (1.30 per practice). Scenarios involving head contact had higher peak kinematics than those without head contact. This study improves our understanding of head kinematics in boys' youth hockey.

OBJECTIVE This study aimed to assess if a color scale in the endotracheal tube (ETT) can help operators to correctly select the size and depth of placement of the ETT and decrease the time required to complete the procedure and compared with the usual numeric ETT scale in a mannequin model. STUDY DESIGN The study was conducted in eight centers. Each size of the ETT was identified with a different color. The experimental ETTs had two different colored areas, one for the mouthpiece and another to identify where the ETT should be taped above the lip (an area of 1 cm. The operators were trained as part of the protocol using an instructional video. Four clinical scenarios requiring endotracheal intubation were designed and randomly assigned. Each operator had to select the size and depth of ETT based on the birth weight (BW), and then had to perform four intubations. RESULTS A total of 108 operators performed 432 intubations. No differences were found in the correct placement and selection of the ETT. Median time (in seconds) required for intubation using numeric versus experimental tube was: for ETT O NRP (Neonatal Resuscitation Program) 2.5, 11.5 versus 8 (p

Ilustraciones y fotografías a color En este trabajo se analiza y se entiende el sonido del corno francés desde una perspectiva vocal, a su vez, otorga una propuesta de producción del mismo a partir de ejercicios y técnicas producto de la experimentación y análisis de las distintas maneras de la producción de la voz asociadas tanto al canto como al uso de esta en el habla. Se propone una experimentación tímbrica a partir del encuentro con técnicas extendidas vocales como son la producción de multifónicos con el fin de encontrar un sonido proyectado y rico en armónicos. (Texto tomado de la fuente) In this work the sound of the French horn is analyzed and understood from a vocal perspective, in turn, it provides a proposal for its production based on exercises and techniques resulting from experimentation and analysis of the different ways of producing the voice associated with both singing and its use in speech. A timbral experimentation is proposed from the encounter with extended vocal techniques such as the production of horn chords in order to find a projected sound and rich in harmonics. Maestría Magíster en Interpretación y Pedagogía Instrumental

Background New training devices were introduced to help in the inhaler counseling by addressing the inspiratory flow through the metered-dose inhaler (MDI), which is the most important problem of the MDI inhalation technique. This study aimed to compare the effects of MDI traditional verbal counseling and advanced counseling using training devices with a smartphone application in pediatric asthmatic patients. Methods A total of 201 pediatric asthmatic subjects (8-18 years) were divided into 2 groups: a verbal counseling group, who received only MDI verbal counseling training (n=101), and an advanced counseling group who received counseling using a training device (Flo-Tone with Trainhaler smartphone application) in addition to the traditional MDI verbal counseling (n=100). Every patient in the 2 groups attended three counseling visits, one month apart. At each visit pulmonary functions [peak expiratory flow (PEF), forced expiratory volume in one second (FEV1 ) as % of predicted] were measured. Also, patients were asked to perform their normal inhalation technique using their MDI, and mistakes were detected and recorded by the investigator, then patients were trained on the correct steps of the MDI inhalation technique using either verbal counseling or advanced counseling depending on their study group. In the advanced group, the Flo-Tone was connected to the mouthpiece of the MDI to blow a whistle while the patient inhaling from MDI. That whistle was detected by the Trainhaler smartphone application and the duration of inhalation determined by the application was recorded. Results Both groups showed a gradual significant decrease (p Conclusion The addition of training devices and smartphone applications to traditional verbal counseling of MDI inhalation technique in asthmatic children resulted in significant improvements in lung functions, and duration of inhalation, and progressive decreases in the average number of MDI inhalation techniques errors compared to the verbal counseling group.

he standard treatment for patients with neuromuscular respiratory failure is non-invasive ventilation (NIV) as non-invasive ventilation support-setting (NVS). NVS is administered through a nasal or face mask and/or mouthpiece with the potential to cause nasal ulcers, discomfort, and/or aesthetic issues, resulting in poor compliance. We reported the observation of a 45-year-old woman with limb-girdle muscular dystrophy (LGMD), secondary to Dysferlin deficiency, who was on NVS since 2017 for nocturnal hypoventilation. In 2018, despite nocturnal ventilation, due to weight gain and daytime hypoventilation, a nasal mask was introduced. We initiated daytime intermittent abdominal pressure ventilation (IAPV) to mitigate cosmetic problems, improving in pO2 and decreasing in pCO2 versus baseline (52>84 mmHg, 46>33 mmHg respectively) at 6 (85 mmHg, 42 mmHg) and 18 months (93 mmHg, 38 mmHg), respectively. IAPV was effective, safe, and well-tolerated in our patients who did not tolerate standard daytime NVS with the known interface.

A great amount of research looks at whether information about lung mechanics can be obtained using spirometry, as these mechanics give clinically useful information about lung condition and disease progression. This study uses a time-varying elastance, single compartment lung model to calculate lung mechanics of 15 tidally breathing healthy subjects. A plethysmograph with a built-in shutter was used to induce an exponentially decaying airflow. Lung elastance and respiratory system resistance were separated from the decay rate of flow caused by the shutter. Occlusion resistance was calculated at shutter closure. To simulate upper airway obstruction, progressively larger resistances were added to the plethysmograph mouthpiece. Decay rates measured ranged from 5-42, with large intra-subject variation associated with muscular breathing effort. Measured lung elastance ranged from 3.9-21.2 cmH2O/L and often remained constant as resistance was increased. Resistance calculated from the decay rate was very small, ranging from 0.15-1.95 cmH2Os/L. The low resistance is due to the airflow measured originating from low resistance areas in the centre of airways. Occlusion resistance measurements were as expected for healthy subjects, and followed the expected resistance trend as resistance was increased.

BACKGROUND AND AIM Discomfort associated with the gag reflex during transoral endoscopy can be troublesome. To overcome this problem during esophagogastroduodenoscopy (EGD), we recently developed a novel mouthpiece. The aim of the present study was to compare acceptance and tolerability of transoral EGD with conventional and new mouthpieces in unsedated patients and analyze the effects of the new mouthpiece. METHODS This study consisted of two phases of cephalometric and EGD examinations to analyze the effects of the new mouthpiece. Cephalometry was carried out in six subjects to evaluate differences in the size of the pharynx (anteroposterior diameter of the oropharynx and longitudinal diameter of the oral cavity) when subjects held the conventional mouthpiece (MAJ674) or the new mouthpiece in their mouths. EGD was done in 10 subjects using the conventional or new mouthpiece to evaluate the number of times the gag reflex occurred, examinee discomfort, and endoscope operability during EGD using a visual analogue scale (VAS). RESULTS Anteroposterior diameter of the oropharynx and longitudinal diameter of the oral cavity were significantly larger with the new mouthpiece than with the conventional mouthpiece (oropharynx: P = 0.03; oral cavity: P = 0.03). With the new mouthpiece during EGD, subjects had significantly fewer instances of the gag reflex (P = 0.01); VAS score for discomfort was significantly lower (P

Background/objective Playing a wind instrument implies rhythmic jaw movements where the embouchure applies forces with different directions and intensities towards the orofacial structures. These features are relevant when comparing the differences between a clarinettist and a saxophone player embouchure, independently to the fact that both belong to the single-reed instrument group, making therefore necessary to update the actual classification. Methods Lateral cephalograms were taken to single-reed, double-reed and brass instrumentalists with the purpose of analyzing the relationship of the mouthpiece and the orofacial structures. Results The comparison of the different wind instruments showed substantial differences. Therefore the authors purpose a new classification of wind instruments: Class 1 single-reed mouthpiece, division 1– clarinet, division 2 –saxophone; Class 2 double-reed instruments, division 1– oboe, division 2– bassoon; Class 3 cup-shaped mouthpiece, division 1– trumpet and French horn, division 2- trombone and tuba; Class 4 aperture mouthpieces, division 1– flute, division 2 – transversal flute and piccolo. Conclusions Elements such as dental arches, teeth and lips, assume vital importance at a new nomenclature and classification of woodwind instruments that were in the past mainly classified by the type of mouthpiece and not taking into consideration its relationship with their neighboring structures.

Purpose To reduce radiation doses to the tongue, a patient-specific semi-customized tongue displacement device (SCTDD) was developed using a 3D printer (3DP) for head and neck (H&N) radiation therapy (RT). Dosimetric characteristics of the SCTDD were compared with those of a standard mouthpiece (SMP). Materials and methods The SCTDD consists of three parts: a mouthpiece, connector with an immobilization mask, and tongue displacer, which can displace the tongue to the contralateral side of the planning target volume. Semi-customization was enabled by changing the thickness and length of the SCTDD. The instrument was printed using a 3DP with a biocompatible material. With the SCTDD and SMP, two sets of planning computed tomography (CT) and tomotherapy plans were obtained for seven H&N cancer patients. Dosimetric and geometric characteristics were compared. Results Using the SCTDD, the tongue was effectively displaced from the planning target volume without significant tongue volume change compared to the SMP. The median tongue dose was significantly reduced (29.6 Gy vs. 34.3 Gy). The volumes of the tongue receiving a dose of 15 Gy, 30 Gy, 35 Gy, 45 Gy, and 60 Gy were significantly lower than using the SMP. Conclusion The SCTDD significantly decreased the radiation dose to the tongue compared to the SMP, which may potentially reduce RT-related tongue toxicity.