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Introduction: The 2024 Voice AI Symposium, presented by the Bridge2AI-Voice Consortium, featured deep-dive educational workshops conducted by experts from diverse fields to explore the latest advancements in voice biomarkers and artificial intelligence (AI) applications in healthcare. Through five workshops, attendees learned about topics including international standardization of vocal biomarker data, real-world deployment of AI solutions, assistive technologies for voice disorders, best practices for voice data collection, and deep learning applications in voice analysis. These workshops aimed to foster collaboration between academia, industry, and healthcare to advance the development and implementation of voice-based AI tools. Methods: Each workshop featured a combination of lectures, case studies, and interactive discussions. Transcripts of audio recordings were generated using Whisper (Version 7.13.1) and summarized by ChatGPT (Version 4.0), then reviewed by the authors. The workshops covered various methodologies, from signal processing and machine learning operations (MLOps) to ethical concerns surrounding AI-powered voice data collection. Practical demonstrations of AI-driven tools for voice disorder management and technical discussions on implementing voice AI models in clinical and non-clinical settings provided attendees with hands-on experience. Results: Key outcomes included the discussion of international standards to unify stakeholders in vocal biomarker research, practical challenges in deploying AI solutions outside the laboratory, review of Bridge2AI-Voice data collection processes, and the potential of AI to empower individuals with voice disorders. Additionally, presenters shared innovations in ethical AI practices, scalable machine learning frameworks, and advanced data collection techniques using diverse voice datasets. The symposium highlighted the successful integration of AI in detecting and analyzing voice signals for various health applications, with significant advancements in standardization, privacy, and clinical validation processes. Discussion: The symposium underscored the importance of interdisciplinary collaboration to address the technical, ethical, and clinical challenges in the field of voice biomarkers. While AI models have shown promise in analyzing voice data, challenges such as data variability, security, and scalability remain. Future efforts must focus on refining data collection standards, advancing ethical AI practices, and ensuring diverse dataset inclusion to improve model robustness. By fostering collaboration among researchers, clinicians, and technologists, the symposium laid a foundation for future innovations in AI-driven voice analysis for healthcare diagnostics and treatment. [ABSTRACT FROM AUTHOR]

Introduction: Accuracy and validity of voice AI algorithms rely on substantial quality voice data. Although commensurable amounts of voice data are captured daily in voice centers across North America, there is no standardized protocol for acoustic data management, which limits the usability of these datasets for voice artificial intelligence (AI) research. Objective: The aim was to capture current practices of voice data collection, storage, analysis, and perceived limitations to collaborative voice research. Methods: A 30‐question online survey was developed with expert guidance from the voicecollab.ai members, an international collaborative of voice AI researchers. The survey was disseminated via REDCap to an estimated 200 practitioners at North American voice centers. Survey questions assessed respondents' current practices in terms of acoustic data collection, storage, and retrieval as well as limitations to collaborative voice research. Results: Seventy‐two respondents completed the survey of which 81.7% were laryngologists and 18.3% were speech language pathologists (SLPs). Eighteen percent of respondents reported seeing 40%–60% and 55% reported seeing >60 patients with voice disorders weekly (conservative estimate of over 4000 patients/week). Only 28% of respondents reported utilizing standardized protocols for collection and storage of acoustic data. Although, 87% of respondents conduct voice research, only 38% of respondents report doing so on a multi‐institutional level. Perceived limitations to conducting collaborative voice research include lack of standardized methodology for collection (30%) and lack of human resources to prepare and label voice data adequately (55%). Conclusion: To conduct large‐scale multi‐institutional voice research with AI, there is a pertinent need for standardization of acoustic data management, as well as an infrastructure for secure and efficient data sharing. Level of Evidence: 5 Laryngoscope, 134:1333–1339, 2024 [ABSTRACT FROM AUTHOR]

Objective: The vocal biomarkers market was worth $1.9B in 2021 and is projected to exceed $5.1B by 2028, for a compound annual growth rate of 15.15%. The investment growth demonstrates a blossoming interest in voice and artificial intelligence (AI) as it relates to human health. The objective of this study was to map the current landscape of start‐ups utilizing voice as a biomarker in health‐tech. Data Sources: A comprehensive search for start‐ups was conducted using Google, LinkedIn, Twitter, and Facebook. A review of the research was performed using company website, PubMed, and Google Scholar. Review Methods: A 3‐pronged approach was taken to thoroughly map the landscape. First, an internet search was conducted to identify current start‐ups focusing on products relating to voice as a biomarker of health. Second, Crunchbase was utilized to collect financial and organizational information. Third, a review of the literature was conducted to analyze publications associated with the identified start‐ups. Results: A total of 27 start‐up start‐ups with a focus in the utilization of AI for developing biomarkers of health from the human voice were identified. Twenty‐four of these start‐ups garnered $178,808,039 in investments. The 27 start‐ups published 194 publications combined, 128 (66%) of which were peer reviewed. Conclusion: There is growing enthusiasm surrounding voice as a biomarker in health‐tech. Academic drive may complement commercialization to best achieve progress in this arena. More research is needed to accurately capture the entirety of the field, including larger industry players, academic institutions, and non‐English content. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study is to determine the effect of background noise on the intelligibility of dysphonic speech and to examine the relationship between intelligibility in noise and an acoustic measure of dysphonia--cepstral peak prominence (CPP). Method: A study of speech perception was conducted using speech samples from 6 adult speakers with typical voice and 6 adult speakers with dysphonia. Speech samples were presented to 30 listeners with typical hearing in 3 noise conditions: quiet, signal-to-noise ratio (SNR)+5, and SNR+0. Intelligibility scores were obtained via orthographic transcription as the percentage of correctly identified words. Speech samples were acoustically analyzed using CPP, and the correlation between the CPP measurements and intelligibility scores was examined. Results: The intelligibility of both typical and dysphonic speech was reduced as the level of background noise increased. The reduction was significantly greater in dysphonic speech. A strong correlation was noted between CPP and intelligibility score at SNR+0. Conclusions: Dysphonic speech is relatively harder to understand in the presence of background noise as compared with typical speech. CPP may be a useful predictor of this intelligibility deficit. Future work is needed to confirm these findings with a larger number of speakers and speech materials with known predictability.

Here we examine the role of the exchange protein directly activated by cAMP (Epac) in ß-adrenergic-dependent associative odor preference learning in rat pups. Bulbar Epac agonist (8-pCPT-2-O-Me-cAMP, or 8-pCPT) infusions, paired with odor, initiated preference learning, which was selective for the paired odor. Interestingly, pairing odor with Epac activation produced both short-term (STM) and long-term (LTM) odor preference memories. Training using ß-adrenergic-activation paired with odor recruited rapid and transient ERK phosphorylation consistent with a role for Epac activation in normal learning. An ERK antagonist prevented intermediate-term memory (ITM) and LTM, but not STM. Epac agonist infusions induced ERK phosphorylation in the mitral cell layer, in the inner half of the dendritic external plexiform layer, in the glomeruli and, patchily, among granule cells. Increased CREB phosphorylation in the mitral and granule cell layers was also seen. Simultaneous blockade of both ERK and CREB pathways prevented any long-term ß-adrenergic activated odor preference memory, while LTM deficits associated with blocking only one pathway were prevented by stronger ß-adrenergic activation. These results suggest that Epac and PKA play parallel and independent, as well as likely synergistic, roles in creating cAMP-dependent associative memory in rat pups. They further implicate a novel ERK-independent pathway in the mediation of STM by Epac.

Mechanisms to engage lay citizens in science and technology are currently in vogue worldwide. While some engagement exercises aim to influence policy making, research suggests that they have had little discernable impacts in this regard. We explore the potentials and challenges of facilitating citizen engagement in nanotechnology from the "top-down," addressing the following questions: Can academics and others within institutions "initiate" meaningful engagement with unorganized lay citizens from the top-down? Can they facilitate effective engagement among citizens, scientists, and policy makers while building citizen engagement capacities? Is it possible to create "independent" bottom-up citizen engagement in scientific and technological issues from the top-down, and what are the challenges in doing so? Our experiences show that although academics can build citizens' individual, collective, and political capacities to engage with each other, scientists, and policy makers, this work is enormously time and energy intensive, and institutional support is needed to sustain it. (Contains 5 tables and 15 notes.)

A widely touted approach to involving laypeople in science and technology policy-related decisions is the consensus conference. Virtually nothing written on the topic provides detailed discussion of the many steps from citizen recruitment to citizen report. Little attention is paid to how and why the mechanics of the consensus conference process might influence the diversity of the participants in theses fora, the quality of the deliberation in the citizen sessions, the experiences of the participants and organizers, and other outcomes that affect democratic decision making within the conference and more broadly over the long term. As an aid to those interested in utilizing the consensus conference format, the authors outline in detail how they set about organizing their consensus conference on nanotechnology in the spring of 2005. They discuss what specific aspects of their consensus conference worked, and why, and also consider what they learned of relevance to future application. (Contains 1 note.)

Objective: The purpose of this study was to quantitatively compare the effectiveness of unilateral and bilateral botulinum toxin A (BTX‐A) injections for mitigating undesirable weak/breathy voice quality and dysphagia for patients with adductor spasmodic dysphonia and/or essential tremor of voice (ETV). Methods: Data were collected from the medical records of 319 patients, yielding three treatment cohorts: patients who received an equal dose bilateral injection regimen (BL=) throughout their course of treatment at VUMC, patients who switched to a unilateral injection regimen (UL), and patients who switched to an unequal dose bilateral injection regimen (BL≠). Changes in length of improvement, duration of weak/breathy voice, and dysphagia severity were compared. Results: The BL = treatment group reported the longest duration of improved voice. Shorter periods of improved voice were reported at baseline by patients who later switched to UL or BL ≠ injection regimens. Patients receiving UL injections reported significantly reduced weak/breathy voice and dysphagia. Patients receiving BL ≠ injections reported increased length of improved voice; however, dysphagia symptoms increased. Ninety‐two percent of patients with ETV switched to a UL regimen, with 61% of patients transitioning within the first three injections. Conclusions: Patients with pronounced dysphagia and extended periods of weak/breathy voice may benefit from a UL injection approach to mitigate side effects from BTX‐A without sacrificing improved voice outcomes. For patients seeking to extend their length of improved voice, a BL ≠ injection regimen may be effective provided the adverse side effects from BTX‐A are minimal. Patients with ETV may benefit from a UL injection approach at the outset of their course of treatment with BTX‐A. Level of evidence: III. [ABSTRACT FROM AUTHOR]

Canada's Criminal Code (1) does not criminalize the sale of sex, but instead regulates the activities which surround commercial sexual acts. In 2007, Terri Jean Bedford, Amy Lebovitch and Valerie [...]

Abstract AIDS-associated, CCR5-tropic (R5) HIV-1 clones, isolated from a patient that never developed CXCR4-tropic HIV-1, replicate to a greater extent and cause greater cytopathic effects than R5 HIV-1 clones isolated before the onset of AIDS. Previously, we showed that HIV-1 Env substantially contributed to the enhanced replication of an AIDS clone. In order to determine if Nef makes a similar contribution, we cloned and phenotypically analyzed nef genes from a series of patient ACH142 derived R5 HIV-1 clones. The AIDS-associated Nef contains a series of residues found in Nef proteins from progressors 1. In contrast to other reports 123, this AIDS-associated Nef downmodulated MHC-I to a greater extent and CD4 less than pre-AIDS Nef proteins. Additionally, all Nef proteins enhanced infectivity similarly in a single round of replication. Combined with our previous study, these data show that evolution of the HIV-1 env gene, but not the nef gene, within patient ACH142 significantly contributed to the enhanced replication and cytopathic effects of the AIDS-associated R5 HIV-1 clone.

Despite guidelines, many individuals are not routinely tested for HIV within healthcare settings. Our objective was to quantify and characterize preceding clinical encounters by newly-diagnosed persons living with HIV in southern Alberta, Canada. We discuss the clinical impact of missed HIV testing, and options for remediation. Clinical encounters prior to HIV diagnosis including the discharge diagnosis were collected between 1 April 2011 and 1 April 2016. We followed the HIV Indicator Diseases across Europe Study criteria to identify HIV Clinical Indicator Conditions (HCICs) present at clinical encounters. Patients accessing prior care were compared to those who had not previously accessed care. Of 393 individuals, 231 (58.7%) had ≥1 encounter prior to diagnosis; 224 (57%) of encounters occurred in outpatient clinics, 130 (33.1%) in emergency departments, and 39 (9.9%) in urgent care clinics. Approximately 25% (n = 57) of patients who engaged healthcare had ≥ 1 recognized HCIC but did not receive HIV testing. The most frequent HCICs were infection (n = 34; 60%) and hematological disorders (n = 12; 21%). The median CD4 cell count at HIV diagnosis for patients with an HCIC was 127 cells/mm3. In this population, three of five patients had accessed healthcare prior to diagnosis with one of four presenting with HCICs but were not offered HIV testing. Protocols beyond the current recommendations are urgently required to address missed HIV diagnostic opportunities who engaged healthcare. [ABSTRACT FROM AUTHOR]

Objective: Acoustic analysis of voice has the potential to expedite detection and diagnosis of voice disorders. Applying an image‐based, neural‐network approach to analyzing the acoustic signal may be an effective means for detecting and differentially diagnosing voice disorders. The purpose of this study is to provide a proof‐of‐concept that embedded data within human phonation can be accurately and efficiently decoded with deep learning neural network analysis to differentiate between normal and disordered voices. Methods: Acoustic recordings from 10 vocally‐healthy speakers, as well as 70 patients with one of seven voice disorders (n = 10 per diagnosis), were acquired from a clinical database. Acoustic signals were converted into spectrograms and used to train a convolutional neural network developed with the Keras library. The network architecture was trained separately for each of the seven diagnostic categories. Binary classification tasks (ie, to classify normal vs. disordered) were performed for each of the seven diagnostic categories. All models were validated using the 10‐fold cross‐validation technique. Results: Binary classification averaged accuracies ranged from 58% to 90%. Models were most accurate in their classification of adductor spasmodic dysphonia, unilateral vocal fold paralysis, vocal fold polyp, polypoid corditis, and recurrent respiratory papillomatosis. Despite a small sample size, these findings are consistent with previously published data utilizing deep neural networks for classification of voice disorders. Conclusion: Promising preliminary results support further study of deep neural networks for clinical detection and diagnosis of human voice disorders. Current models should be optimized with a larger sample size. Levels of Evidence: Level III [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: Vocal fold scar is a major cause of dysphonia, and optimal treatments do not currently exist. Small intestinal submucosa (SIS) is a biomaterial developed for the treatment of a variety of pathologies. The purpose of this study was to investigate the effects of SIS implantation on tissue remodeling in scarred vocal folds using routine staining, immunohistochemistry, and high-speed videoendoscopy (HSV).Study Design: Prospective, blinded group analysis.Methods: Thirteen New Zealand White rabbits underwent a vocal fold scarring procedure followed by microflap elevation with or without SIS implantation. Seven months later, they underwent a phonation procedure with HSV and laryngeal harvest. Alcian blue and elastica van Gieson staining and immunohistochemistry for collagen types I and III were used to evaluate histological healing outcomes. Dynamic functional remodeling of the scarred vocal fold in the presence of SIS implants was evaluated using HSV imaging to capture restoration of vibratory amplitude, amplitude ratio, and left-right phase symmetry.Results: Density of collagen I was significantly decreased in SIS versus microflap-treated vocal folds. No differences were found between groups for hyaluronic acid, elastin, or collagen type III. Organization of elastin in the subepithelial region appeared to affect amplitude of vibration and the shape of the vocal fold edge.Conclusions: SIS implantation into chronic scar reduced the density of collagen I deposits. There was no evidence of a negative impact or complication from SIS implantation. Regardless of treatment type, organization of elastin in the subepithelial region may be important to vibratory outcomes.Level Of Evidence: NA. Laryngoscope, 128:901-908, 2018. [ABSTRACT FROM AUTHOR]

Purpose: Videostroboscopy (VS) uses an indirect physiological signal to predict the phase of the vocal fold vibratory cycle for sampling. Simulated stroboscopy (SS) extracts the phase of the glottal cycle directly from the changing glottal area in the high-speed videoendoscopy (HSV) image sequence. The purpose of this study is to determine the reliability of SS relative to VS for clinical assessment of vocal fold vibratory function in patients with mass lesions. Methods: VS and SS recordings were obtained from 28 patients with vocal fold mass lesions before and after phonomicrosurgery and 17 controls who were vocally healthy. Two clinicians rated clinically relevant vocal fold vibratory features using both imaging techniques, indicated their internal level of confidence in the accuracy of their ratings, and provided reasons for low or no confidence. Results: SS had fewer asynchronous image sequences than VS. Vibratory outcomes were able to be computed for more patients using SS. In addition, raters demonstrated better interrater reliability and reported equal or higher levels of confidence using SS than VS. Conclusion: Stroboscopic techniques on the basis of extracting the phase directly from the HSV image sequence are more reliable than acoustic-based VS. Findings suggest that SS derived from high-speed videoendoscopy is a promising improvement over current VS systems. [ABSTRACT FROM AUTHOR]

Consensus conferences have functioned well in small, relatively homogeneous countries such as Denmark. In the geographically sprawling and socially diverse United States, however, meaningful citizen deliberation and decision-making on science and technology depends upon the ability to bring more participants “into the room.” The National Citizens’ Technology Forum, held in March 2008, responded to this need by integrating panels of citizens from multiple US cities in structured face-to-face and online deliberation. We analyze the success of this experiment by focusing on the experience of participants during the online deliberation component. We conclude with recommendations for future organizers of online deliberation, focusing on the benefits of combining synchronous and asynchronous engagement and improving facilitation practice and software capabilities. [ABSTRACT FROM PUBLISHER]

In this paper, we explore conceptualizations of 'ordinary' citizens common in public engagement forums on emerging technologies and assumptions from deliberative theory that ordinary people are more likely to be appropriately 'changed' through deliberative processes facilitated by experts. Looking at a large US public forum event [the National Citizens Technology Forum (NCTF)], we asked: What were the goals for this exercise and how did they shape conceptualizations of ordinariness and representativeness? Whose goals and conceptualizations were they? Were the engaged citizens ordinary and representative-and were they changed by the exercise? Our exploration revealed that exercise organizers conceived of ordinary citizens as people lacking science and technology backgrounds, without advocacy or business connections to the technologies at hand, and demographically reflecting the US population. Exercise materials also implied that ideal ordinary participants would lack strong opinions and emotions about these technologies. Actual NCTF participants, however, tended to be more educated, have higher incomes, and to be more liberal than the US public, and participants from all backgrounds had a range of relevant knowledge, experiences and opinions about science and technology. They were changed by the exercise in complex and conflicting ways-based as much on their own knowledge and reflections on relational dynamics as on exercise processes, interactions with experts, and information provided in the exercise. We argue that inadequately explored ideas about ordinary citizens are highly problematic. Further, invisible assumptions about what is 'normal' among experts and status quo institutions serve to reify the lay-expert divide that engagement exercises are intended to counteract. [ABSTRACT FROM AUTHOR]

Citizen engagement in scientific and technological issues is in vogue in recent years, and a variety of projects intended to engage citizens in science and technology is occurring worldwide. However, few academics and governments attempting to "engage in engagement" are clear about their goals and desired outcomes, and whether or not the processes they facilitate are likely to meet these ends. What are the goals-explicit and implicit-of institutionally sponsored projects that aim to engage lay citizens in science and technology? Are these exercises likely to meet these goals? and what kinds of processes could nurture more meaningful engagement, what are the barriers to this kind of engagement, and how might these barriers be overcome? Based on the experience of the authors, this article explores these questions and provides 10 recommendations for more meaningful engagement of citizens in science and technology. [ABSTRACT FROM AUTHOR]

Research suggests that deliberative experiences may improve citizens' perceptions of their abilities to participate meaningfully in political and societal issues. Previous studies, however, have not looked in depth at citizens' perceptions after participating in consensus conferences. In this case study, drawing on in-depth interviews with participants of a consensus conference on nanotechnology, we consider the following questions: 1) How do citizen participants feel the consensus conference experience affected their knowledge and efficacy related to participation in nanotechnology issues? 2) Which aspects of the conference (if any) do citizens think shaped their knowledge and efficacy? 3) Are citizens motivated to engage in future participatory mechanisms related to nanotechnology issues, and why or why not? Although our case study is exploratory, it suggests that even if consensus conferences have little or no influence on policy or policymakers, they may empower citizens by improving their perceived abilities to participate meaningfully in technoscientific issues. [ABSTRACT FROM AUTHOR]

AIDS-associated, CCR5-tropic (R5) HIV-1 clones, isolated from a patient that never developed CXCR4-tropic HIV-1, replicate to a greater extent and cause greater cytopathic effects than R5 HIV-1 clones isolated before the onset of AIDS. Previously, we showed that HIV-1 Env substantially contributed to the enhanced replication of an AIDS clone. In order to determine if Nef makes a similar contribution, we cloned and phenotypically analyzed nef genes from a series of patient ACH142 derived R5 HIV-1 clones. The AIDS-associated Nef contains a series of residues found in Nef proteins from progressors. In contrast to other reports, this AIDS-associated Nef downmodulated MHC-I to a greater extent and CD4 less than pre-AIDS Nef proteins. Additionally, all Nef proteins enhanced infectivity similarly in a single round of replication. Combined with our previous study, these data show that evolution of the HIV-1 env gene, but not the nef gene, within patient ACH142 significantly contributed to the enhanced replication and cytopathic effects of the AIDS-associated R5 HIV-1 clone. [ABSTRACT FROM AUTHOR]

The article reports on the attitude of individuals concerning uncertainties about environmental health risks. The author cites the study which investigated the factors that shape people's attitude towards environmental health risks. Specifically, the study utilize secondary analysis of survey data in investigating issues of concern concerning environmental health challenges.

The author reflects of being a resident physician who is frequently involved in the care of patients having terminal illness. She mentions that she should shift the conversation to what can be done from what cannot be done in the face of life-limiting disease. She states that as a physician she needs to help patients understand that to prioritize quality of life does not entail sacrificing quantity of life when invasive treatments' benefit is negligible.

Abstract: This study systematically examined the viral long control region (LCR) activities and their responses to E2 for human papillomavirus (HPV) types 11, 16, and 18 as well as bovine papillomavirus 1 (BPV1) in a number of different cell types, including human cervical cancer cell lines, human oral keratinocytes, BJ fibroblasts, as well as CV1 cells. The study revealed cell- and virus-type specific differences among the individual LCRs and their regulation by E2. In addition, the integration of the LCR into the host genome was identified as a critical determinant for LCR activity and its response to E2. Collectively, these data indicate a more complex level of transcriptional regulation of the LCR by cellular and viral factors than previously appreciated, including a comparatively low LCR activity and poor E2 responsiveness for HPV16 in most human cells. This study should provide a valuable framework for future transcriptional studies in the papillomavirus field. [Copyright &y& Elsevier]

Background: Even after palatoplasty, the incidence of velopharyngeal dysfunction (VPD) can reach 30%; however, these estimates arise from high-income countries (HICs) where speech-language pathologists (SLP) are part of standardized cleft teams. The VPD burden in low- and middle-income countries (LMICs) is unknown. This study aims to develop a machine-learning model that can detect the presence of VPD using audio samples alone., Methods: Case and control audio samples were obtained from institutional and publicly available sources. A machine-learning model was built using Python software., Results: The initial 110 audio samples used to test and train the model were retested after format conversion and file deidentification. Each sample was tested 5 times yielding a precision of 100%. Sensitivity was 92.73% (95% CI: 82.41%-97.98%) and specificity was 98.18% (95% CI: 90.28%-99.95%). One hundred thirteen prospective samples, which had not yet interacted with the model, were then tested. Precision was again 100% with a sensitivity of 88.89% (95% CI: 78.44%-95.41%) and a specificity of 66% (95% CI: 51.23%-78.79%)., Discussion: VPD affects nearly 100% of patients with unrepaired overt soft palatal clefts and up to 30% of patients who have undergone palatoplasty. VPD can render patients unintelligible, thereby accruing significant psychosocial morbidity. The true burden of VPD in LMICs is unknown, and likely exceeds estimates from HICs. The ability to access a phone-based screening machine-learning model could expand access to diagnostic, and potentially therapeutic modalities for an innumerable amount of patients worldwide who suffer from VPD., Competing Interests: The authors report no conflicts of interest, (Copyright © 2024 by Mutaz B. Habal, MD.)

New Zealand white rabbits ( Oryctolagus cuniculus ) are an established in vivo model for the study of structural and functional consequences of vocal-fold vibration. Research design requires invasive laryngotracheal procedures, and the presence of laryngospasms or pain responses (or both) hinder phonation-related data collection. Published anesthesia regimens report respiratory depression and muscle tone changes and have been unsuccessful in mitigating autonomic laryngeal responses in our protocol. Infusion of ketamine hydrochloride and dexmedetomidine hydrochloride in pediatric medicine provides effective analgesia and sedation for laryngotracheal procedures including intubation and bronchoscopy; however, data evaluating the use of ketamine-dexmedetomidine infusion in rabbits are unavailable. This study reports a new infusion regimen, which was used in 58 male New Zealand white rabbits that underwent a nonsurvival laryngotracheal procedure to induce phonotraumatic vocal-fold injury. Animals were sedated by using ketamine hydrochloride (20 mg/kg IM) and dexmedetomidine (0.125 mg/kg IM). Maintenance anesthesia was provided by using continuous rate intravenous infusion of ketamine hydrochloride (343 μg/kg/min) and dexmedetomidine (1.60 μg/kg/min). A stable plane of anesthesia with no autonomic laryngeal response (laryngospasm) was achieved in 32 of the 58 rabbits (55%). Laryngospasms occurred in 25 of 58 animals (43%) and were controlled in 20 cases (80%) by providing 0.33 mL 2% topical lidocaine, incremental increase in infusion rate, or both. Continuous rate infusion of ketamine hydrochloride-dexmedetomidine with prophylactic topical lidocaine provides a predictable and adjustable surgical plane of anesthesia, with minimal confounding respiratory and autonomic laryngeal responses, during extended-duration laryngotracheal surgery in rabbits. This regimen should be considered as an alternative to injection maintenance for prolonged, invasive procedures.

Objective: Acute kidney injury (AKI) is associated with death in critically ill patients, but this complication has not been well characterized after aneurysmal subarachnoid hemorrhage (aSAH). The purpose of this study was to determine the incidence of AKI after aSAH and to identify risk factors for renal dysfunction. Secondary objectives were to examine what effect AKI has on patient mortality and functional outcome at 12 weeks post-aSAH., Methods: The authors performed a post hoc analysis of the Clazosentan to Overcome Neurological Ischemia and Infarction Occurring After Subarachnoid Hemorrhage (CONSCIOUS-1) trial data set (clinical trial registration no.: NCT00111085, https://clinicaltrials.gov). The primary outcome of interest was the development of AKI, which was defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. Secondary outcomes of interest were death and a modified Rankin Scale score greater than 2 at 12 weeks post-aSAH. Propensity score matching was used to assess for a significant treatment effect related to clazosentan administration and AKI. Univariate analysis, locally weighted scatterplot smoothing (LOWESS) curves, and stepwise logistic regression models were used to evaluate for associations between baseline or disease-related characteristics and study outcomes., Results: One hundred fifty-six (38%) of the 413 patients enrolled in the CONSCIOUS-1 trial developed AKI during their ICU stay. A history of hypertension (p < 0.001) and the number of nephrotoxic medications administered (p = 0.029) were independent predictors of AKI on multivariate analysis. AKI was an independent predictor of death (p = 0.028) but not a poor functional outcome (p = 0.21) on multivariate testing. Unresolved renal dysfunction was the strongest independent predictor of death in this cohort (p < 0.001)., Conclusions: AKI is a common complication following aSAH. Patients with premorbid hypertension and those treated with nephrotoxic medications may be at greater risk for renal dysfunction. AKI appears to confer an increased probability of death after aSAH.