Use of speech production repair strategies to improve diver communication.

The purpose of this investigation was to determine if speech intelligibility improved when divers made specific modifications to their speaking patterns while in a hyperbaric helium-oxygen (heliox) environment. Divers were trained to produce a variety of sentences using speech with three types of alterations: (1) slowed rate, (2) increased loudness, and (3) a combination of slightly slowed rate, a minimal increase in loudness, increased pause time, and greater mouth opening (composite strategy). Both diver and non-diver listeners judged these sentences for intelligibility. In addition, acoustic analysis of the cues for the identification of voicing, place, and manner of articulation was conducted to determine if such cues might become more audible in the speech signal when repair strategies were used. Both perceptual and acoustic results showed the composite method to be the best for natural-sounding, intelligible speech. It had the effect of slowing rate and increasing loudness just enough to increase intelligibility without causing distortion. It was concluded that teaching divers to produce speech using this method would be a worthwhile investment for improving speech intelligibility.

Speech intelligibility assessment in a helium environment. II. The speech intelligibility index.

The Speech Intelligibility Index (SII) was measured for Navy divers participating in two saturation deep dives and for a group of nondivers to test different communication systems and their components. These SIIs were validated using the Speech Perception in Noise (SPIN) test and the Griffiths version of the Modified Rhyme Test (GMRT). Our goal was to determine if either of these assessments was sensitive enough to provide an objective measure of speech intelligibility when speech was processed through different helmets and helium speech unscramblers (HSUs). Results indicated that SII values and percent intelligibility decreased incrementally as background noise level increased. SIIs were very reliable across the different groups of subjects indicating that the SII was a strong measurement for predicting speech intelligibility to compare linear system components such as helmets. The SII was not useful in measuring intelligibility through nonlinear devices such as HSUs. The speech intelligibility scores on the GMRT and SPIN tests were useful when the system component being compared had a large measurable difference, such as in helmet type. However, when the differences were more subtle, such as differences in HSUs, neither the SPIN nor the GMRT appeared sensitive enough to make such distinctions. These results have theoretical as well as practical value for measuring the quality and intelligibility of helium speech enhancement systems.

A guide to safe corporotomy incisions in the presence of underlying inflatable penile cylinders: results of in vitro and in vivo studies.

PURPOSE: Because iatrogenic injury to an underlying inflatable implant may be induced by electrocautery incision of the tunica during tunical release or cylinder reexploration, safe electrocautery guidelines are needed. MATERIALS AND METHODS: For the in vitro model silicone and polyurethane elastomer lined inflatable penile prosthetic cylinders were used, and cutting and coagulation electrocautery was applied directly on the device, on a tissue-implant interface, and at minimal, partial or full inflation with saline. For the in vivo study 10 patients with underlying inflatable prosthetic cylinders underwent tunical releases for treatment of secondary penile curvature (7) and reexploration for a malpositioned device (3) with a minimum 1 year of followup. RESULTS: In the in vitro study electrocautery injuries either did not occur when applied directly to silicone and polyurethane elastomer lined devices, occurred in both devices in the presence of a tissue-implant interface, occurred in polyurethane elastomer lined devices at a far less thermal energy setting than with silicone, occurred in both implants at lower wattages with increasing saline inflation or did not occur in 100% of polyurethane elastomer lined devices when coagulation electrocautery was less than 65 watts. In the in vivo study, by adhering to the aforementioned principles and using novel surgical techniques, no device malfunctions were created intraoperatively or observed within a mean followup of 22 months. CONCLUSIONS: Electrocautery can be used safely to create a tunical incision with any underlying inflatable cylinder. To avoid electrocautery injury, based on the clinical study results in polyurethane elastomer lined devices, one should deflate the cylinder before electrocautery, use coagulation current at 35 watts, apply the electrocautery only to the outer longitudinal tunical layer, bluntly dissect through the inner circular layer, and elevate the tunica, protect the device and incise the tissue under direct vision.

Speech intelligibility assessment in a helium environment.

The purpose of this study was to compare the appropriateness and effectiveness of the speech perception in noise (SPIN) test and the Griffiths version of the modified rhyme test (GMRT) in assessing Navy divers' speech understanding using communication systems containing different helium speech unscramblers (HSUs), one of which produces, by subjective observations, more intelligible output than the other. Divers participating in a saturation deep dive and a group of nondivers using digital audio tape recordings of the stimuli used by the divers were tested. Mean percent correct scores on the SPIN and GMRT lists within two listening conditions (taped, topside-diver and live-voice, diver-diver) were almost identical. Listeners scored better on both tests in the topside-diver condition than in the diver-diver condition. The majority of the SPIN errors were on low-predictability items that are void of context. Context clearly played a role in measuring the performance of these subjects, at least for the SPIN test. No significant differences were measured between the two HSUs, although a trend was seen favoring one HSU over the other for the divers. These results have theoretical as well as practical value for measuring the quality and intelligibility of helium speech enhancement systems.

Hereditary persistence of fetal hemoglobin presenting as fetal-maternal hemorrhage.

This report describes a case of hereditary persistence of fetal hemoglobin (HPFH) presenting initially as a marginal placental abruption in a primiparous woman at 27 weeks gestation. Persistent but erratic elevation of percent hemoglobin F positive cells, as determined by a modified Kleihauer-Betke method, complicated the remainder of her pregnancy. The clinical impression of placental abruption with possible extension could not be documented by ultrasound or examination of the placenta at delivery. Hemoglobin electrophoresis followed by quantitative fetal hemoglobin first suggested the diagnosis of HPFH, which was confirmed seven months postpartum. Furthermore, the magnitude of percent positive F-cells could be profoundly altered by subtle changes in pH of the acid elution reagent. This case demonstrates that positive acid elution tests for maternal-fetal transfusion may be caused by elevated maternal hemoglobin F. Erratic results, elevated quantitative hemoglobin-F and sensitivity to reagent pH should alert the pathologist to this diagnosis and alter clinical management.

Comparing two methods of preschool and kindergarten hearing screening.

Preschool and kindergarten hearing screening programs rely primarily on pure tone audiometry though its reliability with this population has been questioned. Some experts have suggested speech reception testing may be a better indicator of hearing in young children. This study compared screening results on 576 students tested with both pure tone and Verbal Auditory Screening for Children (VASC), a speech reception-based audiometer, and findings of 43 students who could not respond to pure tone testing but did complete VASC. Data indicate VASC was more effective in identifying possible hearing deficits in young children being tested in a screening environment.

Detection of factor VIII von Willebrand factor in endothelial cells in first-trimester fetuses.

Factor VIII von Willebrand factor was studied by the immunoperoxidase method in 38 cases of first-trimester therapeutic abortion and two cases of early second-trimester therapeutic abortion. Positive immunostaining was observed in endothelial cells at all gestational ages studied. The findings demonstrate the presence of factor VIII von Willebrand factor in endothelial cells as early as four weeks' gestational age.

Functional and antigenic maturation of Brugia malayi microfilariae.

Brugia malayi microfilariae of specified ages were obtained from gerbils implanted with fertile adult worms. Such microfilariae were tested for their capacity to infect mosquitoes. A strong age dependence was found for the microfilariae's capacity to: penetrate the mosquito midgut, exsheath in response to 20 mM calcium, and develop to third stage larvae in the mosquito. In addition, differences were found between 2-day-old microfilariae and controls (from larva-infected gerbils) in their reactivities with a series of monoclonal antibodies. Thus, defined immunochemical changes occur in microfilariae as they assume functional maturity.

Evaluation of the capillary microhematocrit as a screening test for anemia in pediatric office practice.

The capillary microhematocrit test is widely used to screen pediatric patients for anemia. Recently, it has been suggested that this method produces spuriously elevated values compared with venous hematocrits measured by a Coulter electronic counter and might consequently fail to detect children who are truly anemic. To address this issue we studied 66 white children 9 months to 14 years of age whose capillary hematocrits were either below, equal to, or one or two points above the lower limit of normal for age. Venous specimens were obtained simultaneously with the capillary sample; hemoglobin, hematocrit, and mean corpuscular volume results were obtained using a Coulter electronic counter. Using published standards of venous hemoglobin, we determined the sensitivity, specificity, and predictive values of the capillary microhematocrit in this population of patients with low or borderline values. Twenty of the 66 patients had venous hemoglobin values less than the lower limit of normal. The sensitivity of the microhematocrit was 90.0%; the specificity was 43.5%. The predictive values for a normal (negative) hematocrit was 90.1%; the predictive value for a low (positive) hematocrit was 40.9%. We conclude that the microhematocrit method using capillary blood will miss very few patients with significantly low venous hemoglobin values and is thus an acceptable screening test for anemia. Because it does not require expensive equipment or special skill to obtain the specimen or perform the test, it is ideal for physicians' offices or nonhospital-based clinics.

Synthesis of (E)-1-(5-chlorothien-2-yl)-2-(1H-imidazol-1-yl)ethanone 2,6-dichlorophenylhydrazone hydrochloride, a novel, orally active antifungal agent.

The preparation, determination of isomeric configuration, and antifungal properties of (E)-1-(5-chlorothien-2-yl)-2-(1H-imidazol-1-yl)ethanone 2,6-dichlorophenylhydrazone hydrochloride (1) are described. In vitro, compound 1 has been shown to have activity against Candida albicans comparable with miconazole. When administered orally to animals with experimentally induced vaginal candidiasis or systemic candidiasis, compound 1 produced results approaching those produced by ketoconazole. In addition, topical administration of compound 1 to rats with vaginal candidiasis produced results comparable with those produced by similar administration of clotrimazole. Unlike ketoconazole, which is active by a mechanism that is essentially fungistatic, compound 1 shares with miconazole a mode of action that is fungicidal. However, unlike miconazole, compound 1 exhibits activity following oral administration. Compound 1 has been found to be negative in the Ames test.

Brugia malayi microfilariae from the peritoneal cavity of jirds vary in their ability to penetrate the mosquito midgut.

Development in mosquitoes of Brugia malayi microfilariae obtained from the blood of jirds was compared to that of microfilariae from the peritoneal cavity. Penetration of the mosquito midgut wall as well as development into third-stage larvae was assessed. About 70% of blood-borne microfilariae penetrated the midgut wall whether ingested directly from a microfilaremic jird or from a membrane feeder containing blood from the same donor. In contrast, less than 30% of microfilariae from the peritoneal cavity penetrated the midgut wall. Microfilariae in the peritoneal cavity of jirds vary in ability to penetrate the midgut of mosquitoes; some penetrate as rapidly as do blood-borne microfilariae, others penetrate more slowly, and most fail to penetrate the midgut. Regardless of origin, microfilariae that penetrated the midgut wall developed into third-stage larvae.

The activation of blast transformation and DNA synthesis in human peripheral blood lymphocytes by wheat germ agglutinin.

Wheat germ agglutinin (WGA) has been shown to induce blast transformation and DNA synthesis in a minor subpopulation of human peripherl blood T lymphocytes (PBL). These cells enter DNA synthesis between 24 and 48 hr after stimulation, and demonstrate maximal blast transformation after 48 hr. In cultures of Ficoll/Hypaque purified PBL, the activation appears to be aborted 48 to 72 hr after WGA stimulation. After that time DNA synthesis is arrested and activated cells are rapidly lost from culture. The addition of N-acetyl glucosamine to cultures within 2 hr after WGA stimulation results in an increase in the proportion of cells activated and in the amount of DNA synthesized per cell. These experiments suggest that the abortive response may be due to the presentation of superimposed positive and negative signals.