Vibration within the vocal tract during speech is transmitted through body tissue to the skin surface and can be used to transmit speech. Achieving quality speech signals using skin vibration is desirable but problematic, primarily due to the different sources of sound during speech. The objective of this study was to characterize the frequency content of speech signals at various locations on the head and neck. Signals were recorded using accelerometers attached to 15 locations on the heads and necks of 14 males and 10 females as well as a microphone to record audible speech. The subjects produced several isolated phonemes and one phrase. The power spectral densities (PSDs) of the phonemes were used to determine a quality ranking for each location and sound. A spectrogram of the phrase was used to compare the response at selected locations. A perceptual listening test was conducted and compared to the PSD rankings. The PSD rankings were also calculated for signals recorded with background noise in order to identify locations that are least sensitive to external noise. With background noise, the frequency response of the skin was also used to study how the skin itself responds to external noise. The signal-to-noise ratio (SNR) was found for various sounds and locations with and without the presence of background noise. The frequency response of a concentrated area of the neck was also studied. Notably, while high frequency content was found to be attenuated at locations on the throat near the thyroid cartilage, it was detectable at some other locations. The best locations for speech transmission were found to be generally common to males and females in quiet environments but varied with background noise. During speech in the presence of background noise, the accelerometers performed better than the microphone when compared to the PSD of a clean microphone recording of the same sound. All SNR of all locations were influenced somewhat by external noise, some considerably more than others. Some neck locations may be better suited for contact microphone placement other than directly over the thyroid cartilage (where many commercial contact microphones are currently worn) if the neck is the preferred location for contact microphone placement.

No description available.

Bakgrund: Information är en viktig del i anestesisjuksköterskans möte med patienten. Information som verktyg, syftar till en bättre omvårdnad och patientsäkerhet. Vid en sövning kontrolleras patienters luftväg och andning varvid halsont och heshet kan upplevas postoperativt. Postoperativt halsont och heshet är vanligt och drabbar flertalet patienter. Att ge preoperativ information om luftvägshantering samt eventuella postoperativa halsbesvär kan därför vara av betydelse för patienters välbefinnande. Syfte: Att undersöka patienters upplevelser av preoperativ information gällande luftvägshantering samt postoperativa halsbesvär. Metod: Kvalitativ intervjustudie. 8 semistrukturerade intervjuer genomfördes på patienter som opererats i generell anestesi. Resultat: Intervjuerna resulterade i tre olika kategorier med respektive underkategorier. Känslor inför operation; i en stressad situation kände patienterna förtroende och tillit samt att lugn och trygghet ingavs. Vikten av att avväga informationsmängd; vissa upplevde för mycket information, andra för lite och det är viktigt med individanpassad information efter vad respektive patient vill veta. Informationssätt; hur, när och var information ges, påverkar patienterna, kontinuerlig och kortfattad information med möjlighet att få ställa frågor upplevs positivt. Slutsats: Patienter är olika och reagerar olika på informationsmängd samt informationssätt. Det är därför viktigt att anpassa informationsmängden och ge individanpassad information format efter patienten. Att få ingående information om luftvägsförfarande upplevs av vissa som obehagligt. Information om postoperativa halsbesvär lugnar. / Background: Information is an important part of the nurse anesthetist’s encounterwith the patient. Information as a tool, aims for a better care and safety for the patient. During an anesthesia, the patients airway and breathing is controlled, wherein sore throat and hoarsness can occur post operative. Post operative sore throat and hoarsness are common and affect many patients. Giving preoperative information regarding airway management and probable postoperative sore throat inconvenience, can be of importance of the patients well-being. Objectives: To analyze patients experiences of preoperative information regarding airway management and postoperative throat inconvenience. Methods: Qualitative interviews study. 8 semi structured interviews, were conducted on patients who had been operated in general anesthesia. Results: The interviews resulted in three different categories with respectively sub categories. Feelings before surgery; in a stressful situation the patients felt confidence and trust, and also that calm and safety were submitted. The importance of estimating amount of information; some experienced too much information, others too little and that it is important with personalized information, fitted for what each and other patient wants to know. Means of information; where, when and how the information is given, affects the patients. Continious and concised information, with opportunity to ask questions, is experienced as positive. Conclusions: Patients are different and reacts different on the amount of information and means of information. It is therefor important to adjust the amount of information and to give personalized information suited for each and other patient. Given thorough information about airway management is experienced by some patients as unpleasant. Given information about postoperative throat inconvenience soothes.Keywords preoperative information; airway management; postoperative throatinconvenience; feelings; amount of information; means of information.

While realistic in vitro testing of dry powder inhalers (DPIs) can be used to establish in vitro–in vivo correlations (IVIVCs) and predict in vivo lung doses, the aerodynamic particle size distributions (APSDs) of those doses and their regional lung deposition remains unclear. Four studies were designed to improve testing centered on the behavior of Novolizer®. Different oropharyngeal geometries were assessed by testing different mouth-throat (MT) models across a realistic range of inhalation profiles (IPs) with Salbulin® Novolizer®. Small and large Virginia Commonwealth University (VCU) and Oropharyngeal Consortium (OPC) models produced similar ranges for total lung dose in vitro (TLDin vitro), while results for medium models differed significantly. While either group may be selected to represent variations in oropharyngeal geometry, OPC models were more difficult to use, indicating that VCU models were preferable. To facilitate simulation of human IPs through DPIs, inhalation profile data from a VCU clinical trial were analyzed. Equations were developed to represent the range of flow rate vs. time curves for use with DPIs of known airflow resistance. A new method was developed to couple testing using VCU MT models and simulated IPs with cascade impaction to assess the APSDs of TLDin vitro for Budelin® Novolizer®. This method produced IVIVCs for Budelin’s total lung dose, TLD, and was sufficiently precise to distinguish between values of TLDin vitro and their APSDs, resulting from tests using appropriately selected MT models and IPs. For example, for slow inhalation, TLD values were comparable in vivo and in vitro; TLDin vitro ranged from 12.2±2.9 to 66.8±1.7 mcg aerosolized budesonide while APSDs in vitro had mass median aerodynamic diameters of 3.26±0.27 and 2.17±0.03 µm, respectively. To explore the clinical importance of these variations, a published computational fluid dynamic (CFD) model was modified and coupled to accept the output of realistic in vitro tests as initial conditions at the tracheal inlet. While simplified aerosol size metrics and flow conditions used to shorten CFD simulations produced small differences in theoretical predictions of regional lung deposition, the results broadly agreed with the literature and were generally consistent with the median values reported clinically for Budelin.

Bakgrund: Halsont och heshet är några av de vanligaste postoperativa komplikationerna hos patienter som erhållit endotrakealtub eller larynxmask under generell anestesi. Syfte: Att kartlägga anestesisjuksköterskans perioperativa åtgärder för att förebygga och lindra patientens postoperativa halsont och heshet. Metod: En litteraturöversikt med deskriptiv design. Resultat sammanställdes utifrån 18 granskade artiklar av kvantitativ ansats, eftersökta i databaserna PudMed och Cinahl. Resultat: Litteraturöversikten visade flertalet åtgärder som kunde minska både incidens och svårighetsgrad av postoperativ halsont och heshet. En mindre endotrakealtub, användning av kontinuerlig tryckregulator, administrering av glukokortikoider och användning av larynxmask gav minskad incidens av halsont och heshet. Även videolaryngoskop, minskad kraft vid extraktion av ledare och vissa naturläkemedel visade sig minska incidensen. Åtgärderna visade på goda effekter i nära anslutning till operationen och inom första postoperativa dygnet, emellertid gav få artiklar resultat med bibehållen effekt över tid. Slutsats: Studien gav goda indikationer för åtgärder som kunde minska patienters förekomst av halsont och heshet och därigenom deras lidande. Resultatet visade på stor spridning vilket gjorde det svårt bedöma vilka åtgärder som var lämpliga att applicera i kliniken. Att minska storleken på endotrakealtuben och använda larynxmask när operationen tillåter var åtgärder som ansågs användbara. Även användning av glukokortikoider/antiinflammatoriska läkemedel samt att i större utsträckning utnyttja videolaryngoskopstekniken ansågs som adekvata åtgärder för att minska patientens lidande orsakat av postoperativ halsont och heshet. / Background: Sore throat and hoarseness are some of the most common postoperative complications in patients receiving endotracheal tube or laryngeal mask during general anesthesia. Aim: To investigate the anesthetic nurse's perioperative measures to prevent and alleviate the patient's suffering from postoperative sore throat and hoarseness. Method: A literature review with descriptive design. Results were compiled based on 18 articles of quantitative approaches, requested in the databases PudMed and Cinahl. Result: The literature review showed several measures that could reduce both incidence and severity of postoperative sore throat and hoarseness. A minor endotracheal tube, the use of continuous cuff pressure regulator, administration of glucocorticoids and use of laryngeal mask reduced the incidence of sore throat and hoarseness. Also, video laryngoscopes, reduced force when extracting stylet removal and some herbal medications seemed to give good results in reducing the incidence. The measures showed good effects close to surgery and within the first postoperative day, however, few studies gave results with retained effect over time. Conclusions: The study provided good indications for measures that could reduce patients' incidence of sore throat and hoarseness and thereby their suffering. The results showed a large spread, which made it difficult to assess which measures were suitable for application in the clinic. Reducing the size of the endotracheal tube and using the laryngeal mask when the operation allows was implications that considered useful. Also, the use of glucocorticoids / anti-inflammatory drugs and to a greater extent utilizing the video laryngoscope technique was considered adequate measures to reduce the suffering of patients caused by postoperative sore throat and hoarseness.

Avaliação ambiental, biológica e otorrinolaringológica foi realizada em 461 trabalhadores de 22 galvânicas com diferentes processos de tratamento de superficie: anodização, cromo duro, cromo decorativo, zincagem e processos diversos. O ar do ambiente de trabalho foi coletado individualmente e em pontos fixos, durante a semana de trabalho, para se avaliarem névoas sulfúricas e clorídricas, além daquelas referentes a cromo, níquel e zinco. Amostras de urina dos trabalhadores, foram coletadas no início e final do período de trabalho, para se determinar a concentração de Cr-U, Ni-U e Zn-U. Utilizou-se a técnica de espectrofotometria de absorção atômica com forno de grafite para determinação de Cr-U e Ni-U; o Zn-ar, Ni-ar e o Zn-U foram determinados pela mesma técnica mas utilizando-se na atomização do analito, a chama. Os limites de detecção foram semelhantes aos encontrados na literatura internacional. Os resultados ambientais situaram-se, na sua maioria, bem abaixo dos limites de tolerância estabelecido pela legislação brasileira e internacional, ressaltando-se que, dos contaminantes avaliados, existem LTs apenas para o cromo e névoas clorídricas enquanto que limite biológico apenas para o Cr-U. Os resultados otorrinolaringológicos dos trabalhadores foram surpreendentes, considerando-se todos os processos avaliados: 35,5% de lesões médias e avançadas nas vias aéreas superiores e 40,1% de lesões iniciais e inespecíficas. Estes resultados relacionados com os obtidos nas avaliações ambientais e biológicas, dão-nos a certeza de que os limites de tolerância não são parâmetros seguros para proteger a saúde do trabalhador. / Environmental, biological, and otolaryngology evaluations were carried out on 461 workers from 22 electroplaters with different processes for the treatment of surfaces. Air from the working environment was collected both individually end from fixed points, during the working week, for evaluation of sulphuric and hydrochloric acid mists, as well as for mists of chrome, nickel and zinc. Samples of worker\'s urine were collected at the beginning and end of the work shift in order to determine the concentrations of U-Cr, U-Ni and U-Zn. Electrothermal atomic absorption spectrometry was used to determine air-Cr, U-Cr, and U-Ni; air-Zn, air-Ni and U-Zn were determined using the atomic absorption spectrometry. The detection limits were similar to those found in the intemational literature. The environmental and biological results were in most cases below the limits set by the Brazilian and International legislation. Note that, of the contaminants evaluated, TLs are available for only chrome and hydrochloric acid mists and Biological Limits for only U-Cr. The otolaryngology results for the workers were surprising, taking into account all of the processes evaluated: 35.5% with medium and advanced lesions of the upper respiratory tract, and 40.1% with initial or non-specific lesions. These results, taken together with those obtained in the environmental and biological evaluations show that the tolerance limits are not safe parameters to protect worker\'s health.

The population over 65 years of age is increasing and health in elderly has been a subject of research for decades but voice function and vocal health has not been prioritized. The purpose of this study is to obtain reference value for the Swedish version of Voice Handicap Index (RHI) and the Throat Scale among people over 65 years of age and assess voice function and vocal health for this age group. The questions were as followed: 1) What is the reference value of RHI for people over 65 years of age? 2) What is the reference value of the Throat Scale for people over 65 years of age? 3) Is there a correlation between a self-rated VA-scale on the perceived degree of voice problems, and the self-rated RHI-/Throat Scale result? 4) Does age, gender or previous profession matter for the self-perceived voice? In total 100 individuals participated in the study, 50 women and 50 men, between 65 and 92 years old. The reference value of RHI for people over 65 years of age was 13,4 points and the reference value for the Throat Scale was 7,7 points. Both reference values are higher than reference values for younger people. The reference value of RHI is mainly described from the high points of the participants over 85 years of age. There was a correlation between the results of the RHI/the Throat Scale and the VA-scale concerning the perceived degree of voice problems, p < .01. Age is a significant factor for self-perceived voice problems. The older the subject, the higher points scored, both on the RHI, p < .05 and the Throat Scale. The results of the Throat Scale, however, were not significant. Even though most of the participants were active the reference value of RHI and the Throat Scale was higher than the reference value for younger people. The conclusion is that the voice changes in elderly affect voice experience. / Befolkningsgruppen över 65 år ökar i storlek och äldre personer är allt friskare. Äldre människors hälsa har sedan länge varit föremål för forskning men röstfunktion och rösthälsa hos de äldre har inte varit prioriterade områden. Syftet med föreliggande studie är att fastställa normalvärden för Rösthandikappindex och Halsskalan hos personer över 65 år samt kartlägga röstfunktion och rösthälsa i denna åldersgrupp. Frågeställningarna var följande: 1) Hur ser normalvärdet av RHI ut för personer över 65 år? 2) Hur ser normalvärdet av Halsskalan ut för personer över 65 år? 3) Finns det något samband mellan en självskattad VAS-skala för upplevd grad av röstproblem och det självskattade RHI-/Halsskaleresultatet? 4) Har ålder, kön eller tidigare yrke betydelse för den subjektiva röstupplevelsen? 100 personer, 50 kvinnor och 50 män, mellan 65 och 92 år, deltog i föreliggande studie. Normalvärdet av RHI för personer över 65 år är 13,4 poäng och normalvärdet av Halsskalan är 7,7 poäng. Båda dessa normalvärden är högre än normalvärden för yngre personer. Normalvärdet av RHI förklaras främst av höga värden för deltagarna över 85 år. Det fanns ett samband mellan resultaten på RHI/Halsskalan och VAS-skalan för grad av röstproblem, p < .01. Ålder har betydelse för den subjektiva röstupplevelsen. Ju äldre deltagarna var, desto högre poäng fick de på både RHI, p < .05 och Halsskalan. Åldersskillnaderna på Halsskalan var dock inte signifikanta. Trots att det i föreliggande studie till största del var aktiva äldre som deltog blev normalvärdet av RHI och Halsskalan högre än för yngre personer. Slutsasten är att de röstförändringar som sker med åren faktiskt har betydelse för röstupplevelsen.

The purpose of this study was to compare the cost-effectiveness between the 2 types of general anesthesia, namely, laryngeal mask (LMA) and endotracheal intubation (ETT). The study included 353 patients who received general anesthesia during operation in a medical center in Kaohsiung City. Of these, 183 patients were assigned to the LMA group, while the remaining 170 were assigned to the ETT group. The norm of cost adopted by this study was calculated as the average expense per hour incurred by using the anesthetic and hygienic materials for medicinal use. The indices of effectiveness were physical reactions that were tracked at 2 h and 8¡V10 h postoperatively; these indices were acute pain, dizzyness, sore throat, nausea, and vomiting. These 5 indices were rated on a scale of 0¡V10. A low score was considered to represent lesser side-effects and greater effectiveness of the anesthetic. Besides, the shorter the recovery time of the patient was, the higher the effectiveness would be. The conclusion showed that the cost of the average expense per hour produced by the anesthesia and hygienic materials of medicinal use in the LMA group was 531 dollars while in the ETT group was 1,017 dollars. In the LMA group, at 2 h postoperatively, the mean tracking score for acute pain was 2.9 ¡Ó 2.6; for dizzyness, 1.4 ¡Ó 1.9; for sore throat, 0.4 ¡Ó 1.1; for nausea, 0.5 ¡Ó 1.4; and for vomiting, 0.2 ¡Ó 0.9. In the LMA group, at 8¡V10 h postoperatively, the mean tracking score for acute pain was 0.9 ¡Ó 1.5; for dizzyness, 0.6¡Ó1.3; for sore throat, 0.2 ¡Ó 0.7; for nausea, 0.1 ¡Ó 0.6; and for vomiting, 0.07 ¡Ó 0.4. In the ETT group, at 2 h postoperatively, the mean tracking score for acute pain was 4.9 ¡Ó 3.2; for dizzyness, 2.6 ¡Ó 2.5; for sore throat, 2.0 ¡Ó 2.1; for nausea, 1.3 ¡Ó 2.4; and for vomiting, 0.7 ¡Ó 1.9. In the ETT group, at 8¡V10 h postoperatively, the mean tracking score for acute pain was 2.82¡Ó 2.5; for dizzyness, 1.9 ¡Ó 1.9; for sore throat, 1.3 ¡Ó 1.9; for nausea, 1.1 ¡Ó 2.1; and for vomiting, 0.7 ¡Ó 1.9. The mean postoperative recovery time of the patients in the LMA group was 11.5¡Ó13.2 min and that for the patients in the ETT group was 25.9¡Ó16.0 min. T-test was performed to examine the hypothesis that LMA is more cost-effective than ETT when the same variables as those mentioned above are used; the results of all variables support the hypothesis that the p-value of every index was .000. Results of stepwise regression showed that LMA plays a significant positive role in every cost-effectiveness index.

Avaliação ambiental, biológica e otorrinolaringológica foi realizada em 461 trabalhadores de 22 galvânicas com diferentes processos de tratamento de superficie: anodização, cromo duro, cromo decorativo, zincagem e processos diversos. O ar do ambiente de trabalho foi coletado individualmente e em pontos fixos, durante a semana de trabalho, para se avaliarem névoas sulfúricas e clorídricas, além daquelas referentes a cromo, níquel e zinco. Amostras de urina dos trabalhadores, foram coletadas no início e final do período de trabalho, para se determinar a concentração de Cr-U, Ni-U e Zn-U. Utilizou-se a técnica de espectrofotometria de absorção atômica com forno de grafite para determinação de Cr-U e Ni-U; o Zn-ar, Ni-ar e o Zn-U foram determinados pela mesma técnica mas utilizando-se na atomização do analito, a chama. Os limites de detecção foram semelhantes aos encontrados na literatura internacional. Os resultados ambientais situaram-se, na sua maioria, bem abaixo dos limites de tolerância estabelecido pela legislação brasileira e internacional, ressaltando-se que, dos contaminantes avaliados, existem LTs apenas para o cromo e névoas clorídricas enquanto que limite biológico apenas para o Cr-U. Os resultados otorrinolaringológicos dos trabalhadores foram surpreendentes, considerando-se todos os processos avaliados: 35,5% de lesões médias e avançadas nas vias aéreas superiores e 40,1% de lesões iniciais e inespecíficas. Estes resultados relacionados com os obtidos nas avaliações ambientais e biológicas, dão-nos a certeza de que os limites de tolerância não são parâmetros seguros para proteger a saúde do trabalhador. / Environmental, biological, and otolaryngology evaluations were carried out on 461 workers from 22 electroplaters with different processes for the treatment of surfaces. Air from the working environment was collected both individually end from fixed points, during the working week, for evaluation of sulphuric and hydrochloric acid mists, as well as for mists of chrome, nickel and zinc. Samples of worker\'s urine were collected at the beginning and end of the work shift in order to determine the concentrations of U-Cr, U-Ni and U-Zn. Electrothermal atomic absorption spectrometry was used to determine air-Cr, U-Cr, and U-Ni; air-Zn, air-Ni and U-Zn were determined using the atomic absorption spectrometry. The detection limits were similar to those found in the intemational literature. The environmental and biological results were in most cases below the limits set by the Brazilian and International legislation. Note that, of the contaminants evaluated, TLs are available for only chrome and hydrochloric acid mists and Biological Limits for only U-Cr. The otolaryngology results for the workers were surprising, taking into account all of the processes evaluated: 35.5% with medium and advanced lesions of the upper respiratory tract, and 40.1% with initial or non-specific lesions. These results, taken together with those obtained in the environmental and biological evaluations show that the tolerance limits are not safe parameters to protect worker\'s health.

This research was aimed at the development and validation of new in vitro methods capable of predicting in vivo drug deposition from dry powder inhalers, DPIs, in lung-normal human adults. Three physical models of the mouth, throat and upper airways, MT-TB, were designed and validated using the anatomical literature. Small, medium and large versions were constructed to cover approximately 95% of the variation seen in normal adult humans of both genders. The models were housed in an artificial thorax and used for in vitro testing of drug deposition from Budelin Novolizer DPIs using a breath simulator to mimic inhalation profiles reported in clinical trials of deposition from the same inhaler. Testing in the model triplet produced results for in vitro total lung deposition (TLD) consistent with the complete range of drug deposition results reported in vivo. The effect of variables such as in vitro flow rate were also predictive of in vivo deposition. To further assess the method’s robustness, in vitro drug deposition from 5 marketed DPIs was assessed in the “medium” MT-TB model. With the exception of Relenza Diskhaler, mean values for %TLD+SD differed by only < 2% from their literature in vivo. The relationship between inhaler orientation and in vitro regional airway deposition was determined. Aerosol drug deposition was found to depend on the angle at which an inhaler is inserted into the mouth although the results for MT deposition were dependent on both the product and the formulation being delivered. In the clinic, inhalation profiles were collected from 20 healthy inhaler naïve volunteers (10M, 10F) before and after they received formal inhalation training in the use of a DPI. Statistically significant improvements in Peak Inhalation Flow Rate (PIFR) and Inhalation Volume (V) were observed following formalized training. The shapes of the average inhalation profiles recorded in the clinic were found to be comparable to the simulated profiles used in the in vitro deposition studies described above. In conclusion, novel in vitro test methods are described that accurately predict both the average and range of aerosol airway drug deposition seen from DPIs in the clinic.