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Objective(s): This study examined the agreement in maximal expiratory (MEP) and inspiratory (MIP) pressure readings between two digital manometers: (1) the MicroRPM – the gold‐standard manometer for respiratory muscle strength testing; and (2) the LDM – a low‐cost, commercially available, alternative manometer. Methods: Positive (MEP) and negative (MIP) pressures were simultaneously applied to the MicroRPM and LDM using a 3‐liter syringe within a controlled laboratory setting. Pressure readings were compared, and agreement was analyzed using Lin's concordance correlation (ρc). Agreement was interpreted as 'poor' if <0.90, 'moderate' if 0.90 – <0.95, 'substantial' if 0.95 – <0.99, and 'excellent' if ≥0.99. Twenty percent of the pressure trials were repeated by a second researcher to examine test–retest reliability. Results: A total of 150 trials were completed, ranging from −167 to +208 cmH2O. There was a median absolute difference of 0.3 cmH2O in pressure readings between the MicroRPM and the LDM. Lin's concordance correlation revealed 'excellent' agreement between the LDM and MicroRPM devices, with test–retest reliability assessment revealing 'substantial‐to‐excellent' agreement between the LDM and MicroRPM devices, with a concordance correlation coefficient of ρc = 0.999 (95% CI: 0.999–0.999). Conclusions: There was a median difference of 1.0% in MEP and MIP pressure readings consistently observed between the LDM and MicroRPM. Despite these relatively small differences, excellent agreement between the two manometers was present. These data suggest the LDM may be a valid, lower cost alternative to the MicroRPM for objectively assessing respiratory strength in clinical practice; however, additional research is needed in healthy adults and in patient populations. Level of Evidence: NA Laryngoscope, 134:1831–1836, 2024 [ABSTRACT FROM AUTHOR]

Objective: High‐resolution esophageal manometry (HRM) is the gold standard for the diagnosis of esophageal motility disorders. HRM is typically performed in the office with local anesthesia only, and many patients find it unpleasant and painful. The aim of this study was to examine the effects of the use of a virtual reality (VR) headset on pain and anxiety outcomes in patients with dysphagia undergoing HRM. Methods: Patients with dysphagia were prospectively recruited and randomized to undergo HRM with and without VR distraction. Data collected included the State‐Trait Anxiety Inventory‐6 (STAI‐6), the Short‐Form McGill Pain Questionnaire, heart rate, and galvanic skin response (GSR) tracings. Results: Forty subjects completed the study, including 20 subjects in the intervention arm and 20 in the control arm. There was evidence of a significant positive effect of VR on calmness (p = 0.0095) STAI‐6 rating, as well as on physiologic measures of pain with significantly decreased GSR rise time (p = 0.0137) and average rate of change of conductance change (p = 0.0035). Conclusion: The use of VR during HRM catheter insertion increased calmness compared to control. Change of skin conductance was also reduced in the VR group, suggesting decreased physiologic pain. This study supports the consideration of the use of VR as a distraction tool to improve patient comfort during HRM. Level of Evidence: 2 Laryngoscope, 134:1118–1126, 2024 [ABSTRACT FROM AUTHOR]

Objective: Expiratory muscle strength training (EMST) and sensorimotor training of airway protection (smTAP) are two exercises intended to improve cough and swallowing in people with Parkinson's Disease (PwPD). The aims of this study were to (1) examine whether EMST or smTAP elicit changes to vocal fold bowing; and (2) describe the safety of EMST and smTAP as it relates to the development of vocal fold lesions. Method(s): This was a secondary analysis of data from PwPD who completed EMST or smTAP as part of a prospective randomized controlled trial. Vocal fold bowing (BI) and the presence of laryngeal lesions were blindly analyzed from flexible endoscopic evaluation of swallowing (FEES) using ImageJ software and operational definitions. Linear regression was used to examine the influence time (pre‐ vs. post‐therapy) and therapy (EMST vs. smTAP) on vocal fold bowing. Descriptive statistics were used to describe the presence of laryngeal lesions. Result(s): Overall, 56 participants were included, 28 per group. The median BI scores pre‐ and post‐therapy were 8.2% and 8.3% for the EMST group and 11.3% and 8.4% for the smTAP group, respectively. Statistical analyses revealed insufficient evidence to suggest an effect of time and treatment type on BI (p > 0.05) or on the presence of vocal fold lesions (p > 0.05). Conclusion: Based on these and previous findings, it appears that changes in vocal fold bowing do not drive treatment effects following EMST and smTAP. Also, this study further supports the safety of smTAP and EMST despite the required forceful exhalation and repetitive coughing. Level of Evidence: 4 Laryngoscope, 134:1127–1132, 2024 [ABSTRACT FROM AUTHOR]

Objective(s): This study examined the concurrent validity of two orofacial strength manometers: (1) the Iowa Oral Performance Instrument (IOPI) – the current, gold standard orofacial manometer; and (2) the Tongueometer – a newly‐available, lower cost, orofacial manometer. Methods: This study compared IOPI and Tongueometer pressure readings across three experimental conditions. Experiment 1 compared full setup (manometer + tongue bulb) pressure readings between the IOPI and Tongueometer. Experiment 2 compared IOPI tongue bulb and Tongueometer tongue bulb pressure readings, while controlling for manometer. Experiment 3 compared IOPI manometer and Tongueometer manometer pressure readings, while controlling for tongue bulb. Pressures were applied manually within a laboratory setting. Lin's concordance correlation (ρc) was used to calculate level of agreement, with ρc interpreted as 'poor' if <0.90, 'moderate' if 0.90 to <0.95, 'substantial' if 0.95 to <0.99, and 'excellent' if ≥0.99. Results: 539 trials were analyzed. There was a median absolute difference of 2.4 kPa in pressure readings between the IOPI and Tongueometer full setups (manometer + tongue bulb). Correlations revealed substantial agreement between IOPI and Tongueometer full setups (experiment 1: n = 292; ρc = 0.986), tongue bulbs (experiment 2: n = 146; ρc = 0.987–0.992), and manometers (experiment 3: n = 101; ρc = 0.970). Conclusions: Differences in pressures were consistently observed between the Tongueometer and IOPI. Despite these differences, substantial agreement was present. These data suggest the Tongueometer may be a valid, lower cost alternative to the IOPI for objectively assessing orofacial strength in clinical practice. Level of Evidence: Level 2 Laryngoscope, 133:3123–3131, 2023 [ABSTRACT FROM AUTHOR]

Conversion of solar energy into chemical energy through natural photosynthesis plays a crucial role in sustainable energy transformation, bioresource production, and CO2 biofixation. Nevertheless, the overall solar energy to chemical energy (biomass) conversion efficiency in the photosynthetic organisms is still unsatisfactory because of their inefficient utilization of solar light. Here, a photonic method to improve photosynthesis of a unicellular green microalga, Chlamydomonas reinhardtii, a photosynthetic organism model is reported. For this purpose, an easy‐to‐fabricate microphotonic film is developed to improve the spectral quality of solar light reaching the microalgae through photon management (i.e., simultaneous solar spectral conversion and directional fluorescent emission). This study demonstrates that the short‐term oxygen evolution rate and the long‐duration biomass production of microalgae in 200‐mL laboratory photobioreactors are enhanced by a factor of 38% and 54%, respectively. In 5000‐mL scaled‐up bubble column photobioreactors placed outdoor under natural sunlight and weather conditions, the biomass yield is improved by more than 20% when compared to the control experiments conducted in parallel in an optically clear bubble column photobioreactor. Based on such experimental observations, the work here demonstrates the potential of photon management for promoting the solar energy‐to‐biomass conversion process of microalgae and other photosynthetic organisms. [ABSTRACT FROM AUTHOR]

Background: Disorders of airway protection (cough and swallowing) are pervasive in Parkinson's disease (PD) resulting in a high incidence of aspiration pneumonia and death. However, there are no randomized controlled trials comparing strength and skill‐based approaches to improve airway protection in PD. Objectives: The aim of this study was to compare expiratory muscle strength training (EMST) and sensorimotor training for airway protection (smTAP) to improve cough‐related outcomes in people with PD. Methods: Participants with PD and dysphagia were recruited for this prospective phase II randomized‐blinded controlled clinical trial. Participants completed baseline assessment, 5 weeks of EMST or smTAP, and a post‐training assessment. Primary outcome measures included maximum expiratory pressure (MEP) and voluntary cough peak expiratory flow rate (PEFR). Mixed effects models were used to assess the effects of EMST and smTAP on outcomes. Results: A total of 65 participants received either EMST (n = 34) or smTAP (n = 31). MEP improved from pre‐ to post‐treatment for smTAP (P < 0.001, d = 0.19) and EMST (P < 0.001, d = 0.53). Voluntary PEFR increased from pre‐ to post‐treatment for smTAP (P < 0.001, d = 0.19) and EMST (P < 0.001, d = 0.06). Moreover, reflex cough PEFR (P < 0.001, d = 0.64), reflex cough expired volume (P < 0.001, d = 0.74), and urge to cough (P = 0.018, OR = 2.70) improved for the smTAP group but not for the EMST group. Conclusions: This clinical trial confirmed the efficacy of smTAP to improve reflex and voluntary cough function, above and beyond EMST, the current gold standard. © 2022 International Parkinson and Movement Disorder Society. [ABSTRACT FROM AUTHOR]

Background: Pneumonia, a leading cause of death in progressive supranuclear palsy (PSP), results from progressive and pervasive deficits of airway protection, including both cough and swallowing dysfunction. Cough protects the airway by expelling aspirate and may be an important therapeutic target to protect against pneumonia in the presence of dysphagia. However, cough has not been objectively characterized in PSP or compared to other common forms of parkinsonism, such as Parkinson's disease (PD). Objective: The purpose of this study was to examine voluntary and reflex cough function in PSP, as compared to patients with PD matched for disease duration. Methods: Twenty‐six patients with PSP and 26 with PD completed voluntary and reflex cough testing via spirometry. Linear mixed effects models examined comparisons between groups and within cough types across cough sensory and motor outcomes. Results: Patients with PSP demonstrated significantly reduced cough motor function compared to PD, specifically reduced peak expiratory flow rate (P < 0.001), cough expiratory volume (P < 0.001), and cough inspiratory volume (P = 0.008). Both groups showed similar reflex cough thresholds (P = 0.694), but PSP demonstrated an increased perception of cough stimuli (P = 0.041). Conclusions: These findings suggest that sensorimotor cough dysfunction is prevalent in PSP, and cough motor deficits, in particular, are worse in PSP than in PD. These deficits likely contribute to the pathogenesis of pneumonia in PSP. Therefore, cough should be integrated into assessments of airway protection and considered as a therapeutic target to potentially reduce adverse health events and improve quality of life in this population. © 2021 International Parkinson and Movement Disorder Society [ABSTRACT FROM AUTHOR]

Objectives: Progressive supranuclear palsy (PSP) is a neurodegenerative disease which results in cough and swallowing dysfunction and aspiration pneumonia. Relationships among vocal fold atrophy, cough, and swallowing have been identified in related diseases, but remain unknown in PSP. This study examined: 1) the prevalence of vocal fold bowing in PSP, and 2) the influence of vocal fold bowing on cough and swallowing in PSP.Study Design: Prospective Cohort Study.Methods: Twenty-three participants with PSP completed instrumental assessments of cough and swallowing. Vocal fold bowing (BI) and swallowing safety (PAS) was assessed using flexible laryngoscopy. Measures of cough effectiveness were obtained using spirometry. Statistical analyses were used to determine the frequency of mild-moderate (BI > 0) and severe (BI > 12.2) bowing, and to assess the influence of BI on PAS and cough effectiveness in PSP.Results: Fifty-two percent (n = 12) of participants exhibited severe bowing while 48% (n = 11) exhibited mild-to-moderate bowing. Voluntary cough peak expiratory flow rate (P = .01), as well as reflex (P = .02) and voluntary (P = .005) cough volume acceleration were lower for participants with severe BI when compared to mild-to-moderate BI. However, BI did not influence PAS (P > .05).Conclusions: Findings from this study suggest that vocal fold bowing is highly prevalent in PSP and associated with reduced reflex and voluntary cough effectiveness. These findings provide insight into the pathophysiology of compromised airway protection in this patient population. Future studies should examine vocal fold atrophy as a treatment target for behavioral and medical intervention in PSP.Level Of Evidence: 3 (Prospective Observational Study) Laryngoscope, 131:1217-1222, 2021. [ABSTRACT FROM AUTHOR]

Objectives: When swallowing function is compromised in patients with Parkinson's disease (PD), cough plays a crucial role in clearing the airway and preventing pulmonary complications. The aim of this study was to determine the influence of vocal fold atrophy severity as measured by the bowing index (BI) on airway protection in PD.Methods: Thirty participants with PD completed measures of voluntary and reflex cough. Flexible laryngoscopy with endoscopic evaluation of swallowing allowed for measurement of BI using ImageJ software. Swallowing safety was scored on the Penetration-Aspiration Scale (PAS). Regression and receiver operating characteristic (ROC) analyses were performed to test our study aim.Results: Twenty-four of 30 participants had some degree of vocal fold atrophy (BI >0). When controlling for age, disease duration did not significantly influence BI. BI was not predictive of any sensorimotor parameters of cough including measures of cough airflow, reflex cough threshold, or urge to cough. BI discriminated participants with near-normal (PAS 1-3) swallowing safety from participants with impaired (PAS 4-8) swallowing safety (P = .01, sensitivity: 87.0%, specificity: 71.4%, cutoff value BI >4.6).Conclusion: Vocal fold atrophy is a potential factor contributing to poor swallowing safety in PD. BI was not associated with cough function in this PD cohort, contrary to prior studies that have shown improved cough measures after vocal fold augmentation. Vocal fold atrophy in PD remains an important area of study as a targetable intervention for patients with airway protective dysfunction. Future studies should include measures of glottic closure during vocal fold adduction.Level Of Evidence: Level 3 Laryngoscope, 130:303-308, 2020. [ABSTRACT FROM AUTHOR]

This document is a response to a letter to the editor regarding the concurrent validity of the IOPI and Tongueometer orofacial strength measurement devices. The authors address various issues raised in the letter, including the listing of equipment cost, the labeling error of the Tongueometer, and the positioning of the coin during measurements. They also acknowledge errors in the manuscript, such as duplicated statistics in a table and incorrect labels in a figure, which have been corrected. The authors emphasize that they have no affiliations or biases towards either device and have provided transparent and unbiased research. [Extracted from the article]

Objectives/hypothesis: To evaluate the effect of medialization laryngoplasty (ML) performed alone compared to ML with arytenoid adduction (AA) on glottic gap and voice quality in unilateral vocal fold paralysis (UVFP) patients.Study Design: Retrospective case series.Methods: UVFP patients treated with ML alone and ML with AA at the University of California San Francisco Voice and Swallowing Center were identified. Demographic information and history of laryngeal procedures were collected. Preoperative and postoperative examinations were digitally analyzed using ImageJ for normalized anterior and posterior glottic gap and voice samples graded with CAPE-V scores.Results: Forty-seven patients underwent ML and 27 patients underwent ML with AA. Normalized anterior gap (AG) improved in both ML (preop: 4.4 pixel units (u), postop: 0.8 u; P < 0.001) and ML with AA groups (preop: 3.3 u, postop 0.6 u; P < 0.001). There was no statistically significant difference in normalized AG values between treatment groups. Postoperative normalized posterior gap (PG) improved in the ML with AA group only (preop: 1.8 u, postop: 0.5 u; P = 0.01). Overall severity, roughness, and strain voice parameters had acceptable reliability for analysis. Overall severity improved in ML (preop: 54, postop: 27; P < 0.001) and ML with AA (preop: 44, postop: 24; P = 0.005). There was no statistically significant difference in any voice parameter between treatment groups.Conclusion: UVFP patients undergoing ML may benefit from addition of AA when a large posterior glottic gap is present. In this study, ML with AA but not ML alone resulted in statistically significant improvement in PG.Level Of Evidence: 4. Laryngoscope, 127:2591-2595, 2017. [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: To determine the sensitivity and specificity for assessing pharyngeal residue, laryngeal penetration, and tracheal aspiration when comparing findings from the Static Endoscopic Evaluation of Swallowing (SEES) with findings from the Videofluoroscopic Swallow Study (VFSS).Methods: Retrospective study at a tertiary academic medical center. Records were reviewed consecutive outpatients who underwent both SEES and VFSS evaluations. Video segments from SEES and VFSS examinations were blindly judged by experienced clinicians on a categorical/ordinal rating form for the absence, quantitative presence, and location of postswallow residue, penetration, and aspiration. Statistical analysis was performed to identify intra- and interrater reliability and correlation between SEES and VFSS findings.Results: Thirty-nine patients were identified who met the above inclusion criteria, for a total of 206 video segments. Inter- and intrarater reliability was judged by Cronbach's alpha to be good to excellent. SEES findings revealed statistically significant correlations with VFSS findings (P < 0.001) with the absence, quantitative presence, and location of thin liquid and solid swallow residue, penetration, and aspiration. In addition, SEES was more sensitive to the presence of liquid residue, penetration, and aspiration than VFSS.Conclusion: SEES is an endoscopic screening procedure that strengthens the clinical swallowing evaluation by documenting the presence or absence of postswallow residue, penetration, and aspiration. Accurate identification of a patient's risk for aspiration helps to direct further workup. It is an expedient, repeatable, and clinical relevant procedure that can be easily incorporated into a clinician's practice.Level Of Evidence: 4. Laryngoscope, 126:2291-2294, 2016. [ABSTRACT FROM AUTHOR]

This study focuses on gender segregation and its implications for the salaries assigned to male- and female-typed jobs. We used a between-subjects design to examine whether participants would assign different pay to 3 types of jobs wherein the actual responsibilities and duties carried out by men and women were the same, but the job was situated in either a traditionally masculine or traditionally feminine domain. We found pay differentials between jobs defined as “male” and “female,” which suggest that gender-based discrimination, arising from occupational stereotyping and the devaluation of the work typically done by women, influences salary allocation. The ways in which the results fit with contemporary theorizing about sexism and with the shifting standards model ( Biernat, 1995, 2003 ) are discussed. [ABSTRACT FROM AUTHOR]

Tobramycin-impregnated bone cement is frequently used in revision procedures of infected total hip and knee arthroplasties. Aminoglycoside-impregnated cement is typically fashioned into beads or block spacers, which are temporarily placed in infected joint spaces. The use of aminoglycoside-impregnated bone cement has allowed the local concentration to exceed the minimum inhibitory concentration breakpoint of susceptible organisms while serum concentrations after 48 hours were usually not detected. Nephrotoxic complications are rarely encountered with this type of antibiotic delivery method. However, we report the case of an 85-year-old man with a history of renal insufficiency who experienced acute renal failure after undergoing revision treatment of an infected knee arthroplasty with the combined use of tobramycin-cefazolin bone cement and a block spacer. Clinicians should be aware of the potential for aminoglycoside-induced nephrotoxicity from the use of this combination. [ABSTRACT FROM AUTHOR]

This paper extends Sigelman's (1977) analyses of cross-national patterns in reported levels of church attendance and subscription to selected religious beliefs. The analyses are extended in these ways: More countries are included in the comparisons; more measures of religious involvement are employed; and the data are for about 15 years later, from the same period in the 1980s, for each country. Also, we present multivariate controlled comparisons across nations, which were not provided in Sigelman's analyses. Among the results is evidence that Americans are comparably high, but not always first, in involvement levels, both before and after controls for six sociodemographic status measures. Nation of residence is considerably stronger than each control variable (educational attainment, employment status, age, marital status, community size, and broad categories of religious affiliation) as a predictor, for all of the measures of religious involvement. The different profiles of the nations on the social status controls, and their effects upon involvement, do not explain the cross-national patterns in involvement. Alternative interpretations of the comparative results are discussed. [ABSTRACT FROM AUTHOR]

The methylene groups in 2-(1-azulyl)ethyl tosylate are largely scrambled prior to formation of fragment ions in the mass spectrometer. This process also occurs in the 3-nitro analog, where it is dependent on sample residence time in the source and independent of electron energy. It could not be observed with the isomeric 6-substituted tosylates, the 1-substituted acetates or alcohols, or with 2-(p-anisyl)ethyl tosylate. Scrambling occurs in the neutral molecule prior to ionization and a mechanism involving absorption onto the metal surface and formation of a complexed ethylenazulonium ion is suggested. [ABSTRACT FROM AUTHOR]

Canadian rural sociologists have given very little attention to the status reports and reviews that poses a question of whether there should be a rural sociology at all. It is indeed confirmed that there are few reviews on the development and status of Canadian sociology that appeared in the literature. In this article, the authors present some existing data on the status of Canadian rural research activity. Findings from two surveys of social scientists provided the authors an estimate of the extent of the existence of rural sociology in Canada. The first work cited is a survey conducted by the Canadian Sociology and Anthropology Associations. In this survey, main method for data gathering is through sending questionnaires to the members of the association. This questionnaires are geared to come up with a preliminary estimate of the number of real rural sociologists in the country. The next study that provided another perspective on rural sociology is the preliminary findings of the Science Council of Canada Study Group on Agricultural Research. In the research cited by the authors, it was found that rural sociology is the most neglected of all the disciplines in the agricultural research in Canada. With the study cited by the authors of this article, they came up with several reasons that may have contributed to the lack of interest of sociologists in rural sociology in Canada.