Botulinum Toxin Injection for Retrograde Cricopharyngeal Dysfunction: A Prospective Cohort Study.

OBJECTIVES: Retrograde Cricopharyngeal Dysfunction (RCPD) is treated by botulinum toxin (BTX) injection into the cricopharyngeus. This prospective study compares the effectiveness and side effects of operating room (OR) and in-office (IO) injections. METHODS: Patients over 18 years of age with inability to burp, abdominal, thoracic, or cervical gurgling sounds, bloating, and excessive flatulence were diagnosed with RCPD and included in the study. Injections were performed in the OR (80U) or IO (30U) by the senior author. An RCPD questionnaire quantifying major and minor symptoms on a Likert scale, Eating Assessment Tool-10 (EAT-10), and Generalized Anxiety Score-7 (GAD-7), were completed preinjection; at 1, 2, and 3 weeks; and 3 months postoperatively. Linear mixed models were used to analyze effects of BTX injection on RCPD symptoms, the EAT-10, and the GAD-7. RESULTS: 108 (55 M/53F) patients completed the pretreatment survey, 53 (31 OR vs. 22 IO) completed the 3-week follow-up, and 36 (22 OR vs. 14 IO) completed the 3-month questionnaire. Average posttreatment RCPD scores were significantly lower in both groups at 3 weeks and 3 months (p < 0.0001), There was no difference between IO or OR (p = 0.4924). GAD-7 scores were significantly lower in both groups at week 3 (p = 0.0018) and month 3 (p = 0.0012). Postinjection EAT-10 scores were significantly higher in OR compared with IO (p = 0.0379). CONCLUSION: OR and IO injections are equally effective in the treatment of RCPD. Postinjection dysphagia is more severe after the OR injections which may be related to higher doses of BTX used. General anxiety levels decrease with treatment. LEVEL OF EVIDENCE: 2 Laryngoscope, 2024.

Duration of Clinical Response After In-Office Steroid Injection for Vocal Fold Scar.

OBJECTIVE: To assess the duration of clinical response after in-office vocal fold steroid injection (VFSI) for vocal fold (VF) scar. METHODS: Demographic and clinical data for in-office VFSI occurring from 2017 to 2020 were collected. Two Speech-Language Pathologists (SLPs) used perceptual evaluation of voice and functional scales to evaluate blinded voice and laryngovideostroboscopy (LVS) samples collected pre- and post-injection across multiple timepoints. RESULTS: Blinded SLP ratings were used for 30 individual VFs undergoing initial injection in 18 patients. Persistent improvement in voice past 6 months was seen in 57% of patients after VFSI. Multiple measures of voice and amplitude, percent vibrating tissue, and closed phase predominance significantly improved at various follow-up timepoints on average. CONCLUSION: Accounting for patient heterogeneity and disease progression, in-office VFSI for VF scar is associated with sustained improvement in a subset of patients. Approximately half of patients can expect to experience a lasting improvement in voice. Future studies of larger scale are required to identify patient factors associated with long-term benefit. LEVEL OF EVIDENCE: 4 Laryngoscope, 133:2333-2339, 2023.

Divergent semantic integration (DSI): Extracting creativity from narratives with distributional semantic modeling.

We developed a novel conceptualization of one component of creativity in narratives by integrating creativity theory and distributional semantics theory. We termed the new construct divergent semantic integration (DSI), defined as the extent to which a narrative connects divergent ideas. Across nine studies, 27 different narrative prompts, and over 3500 short narratives, we compared six models of DSI that varied in their computational architecture. The best-performing model employed Bidirectional Encoder Representations from Transformers (BERT), which generates context-dependent numerical representations of words (i.e., embeddings). BERT DSI scores demonstrated impressive predictive power, explaining up to 72% of the variance in human creativity ratings, even approaching human inter-rater reliability for some tasks. BERT DSI scores showed equivalently high predictive power for expert and nonexpert human ratings of creativity in narratives. Critically, DSI scores generalized across ethnicity and English language proficiency, including individuals identifying as Hispanic and L2 English speakers. The integration of creativity and distributional semantics theory has substantial potential to generate novel hypotheses about creativity and novel operationalizations of its underlying processes and components. To facilitate new discoveries across diverse disciplines, we provide a tutorial with code (osf.io/ath2s) on how to compute DSI and a web app ( osf.io/ath2s ) to freely retrieve DSI scores.

Voice-Gender Incongruence and Voice Health Information-Seeking Behaviors in the Transgender Community.

Purpose Voice-gender incongruence has predominantly been investigated in the past through the perspective of feminine-identifying individuals seeking feminine-sounding voices. The purpose of this study was to determine the prevalence of self-reported voice-gender incongruence in the transgender, nonbinary, and gender-nonconforming (TNG) community and to describe health information-seeking behaviors exhibited when individuals attempt to address their voice and communication challenges. Method An online survey was designed with questions targeting the self-reported prevalence of voice-gender incongruence, characteristics of this complaint, and health information-seeking behaviors. Valid standardized measures, including the Voice Handicap Index and the Barriers to Help-Seeking Scale, were also included. Results Four hundred five participants were sorted into three groups based on gender identity (feminine, masculine, gender-neutral) to facilitate comparative analysis. Ninety-six percent of participants reported the experience of voice-gender incongruence in the past, and 88% reported that they currently experience voice-gender incongruence. There were no significant differences in reported voice-gender incongruence between groups. Voice Handicap Index scores were significantly higher for those who currently experience voice-gender incongruence (p < .0001) and reflected differences in how much this concern bothers participants, as rated on a Likert scale, ranging from no problem to a very big problem (p < .0001). Barriers to Help-Seeking Scale scores indicated that the masculine group perceived greater barriers to seeking help as compared to the feminine group. Discussion We present foundational evidence for the prevalence of voice-gender incongruence within the TNG community and barriers encountered when individuals attempt to access care. Future work should investigate the specific needs of subgroups within the TNG community and whether those who desire feminine-, masculine-, and/or androgynous-sounding voices experience voice-gender incongruence and access to services differently. Supplemental Material https://doi.org/10.23641/asha.12462422.

Discrimination between Modal, Breathy and Pressed Voice for Single Vowels Using Neck-Surface Vibration Signals.

The purpose of this study was to investigate the feasibility of using neck-surface acceleration signals to discriminate between modal, breathy and pressed voice. Voice data for five English single vowels were collected from 31 female native Canadian English speakers using a portable Neck Surface Accelerometer (NSA) and a condenser microphone. Firstly, auditory-perceptual ratings were conducted by five clinically-certificated Speech Language Pathologists (SLPs) to categorize voice type using the audio recordings. Intra- and inter-rater analyses were used to determine the SLPs' reliability for the perceptual categorization task. Mixed-type samples were screened out, and congruent samples were kept for the subsequent classification task. Secondly, features such as spectral harmonics, jitter, shimmer and spectral entropy were extracted from the NSA data. Supervised learning algorithms were used to map feature vectors to voice type categories. A feature wrapper strategy was used to evaluate the contribution of each feature or feature combinations to the classification between different voice types. The results showed that the highest classification accuracy on a full set was 82.5%. The breathy voice classification accuracy was notably greater (approximately 12%) than those of the other two voice types. Shimmer and spectral entropy were the best correlated metrics for the classification accuracy.

Simulated visual field loss does not alter turning coordination in healthy young adults.

Turning, while walking, is an important component of adaptive locomotion. Current hypotheses regarding the motor control of body segment coordination during turning suggest heavy influence of visual information. The authors aimed to examine whether visual field impairment (central loss or peripheral loss) affects body segment coordination during walking turns in healthy young adults. No significant differences in the onset time of segments or intersegment coordination were observed because of visual field occlusion. These results suggest that healthy young adults can use visual information obtained from central and peripheral visual fields interchangeably, pointing to flexibility of visuomotor control in healthy young adults. Further study in populations with chronic visual impairment and those with turning difficulties are warranted.

Energy balance for kids with play: design and implementation of a multi-component school-based obesity prevention program.

BACKGROUND: Improving nutrition and physical activity behaviors associated with childhood obesity are significant national public health goals. Energy Balance for Kids with Play (EB4K with Play), developed through a partnership between the Academy of Nutrition and Dietetics Foundation and Playworks, is a multi-component school-based intervention designed to address youth's nutrition and physical activity behaviors. This article describes the EB4K with Play intervention and evaluation study and presents the baseline data. METHODS: The evaluation is a 2-year cluster-randomized design targeting third- to fifth-grade students enrolled in a low-income, urban school district in northern California. Six schools were recruited to participate. Four were randomized to the intervention group and two into a control group. Baseline student-level data pertaining to nutrition, physical activity, fitness, and BMI were collected in the fall of 2011. The EB4K with Play program, which includes direct-to-student nutrition and physical activity interventions, a school wellness component, and parent/community partner outreach components, began immediately after baseline data collection. RESULTS: An ethnically diverse sample of students (n=844) was recruited to participate in the study. Baseline data showed a higher percent of eligibility for free and reduced-price school lunch and higher rates of obesity/overweight than the California state averages. Fitness levels and levels of moderate-to-vigorous physical activity were comparable to state averages. CONCLUSIONS: End-point data will be collected after 2 years of the intervention. The findings from this study should help guide future efforts to design effective intervention programs to support the prevention of pediatric obesity.