Referral practices and treatment of obstructive sleep apnea in pregnancies with obesity.

Objective: Obstructive sleep apnea (OSA) affects maternal and neonatal health during pregnancy. This study aimed to identify characteristics and comorbidities associated with sleep clinic referral in high-risk pregnancies with Body Mass Index (BMI) ≥35 kg/m2. Method: Retrospective cohort study for individuals in a high-risk pregnancy clinic at a tertiary Australian hospital from 1 January to 31 December 2020 with BMI≥35 kg/m2. The primary outcome measure was sleep clinic referral. Exposure data included multiple comorbidities and formal tools (Epworth Sleepiness Scale and STOP-BANG). Multivariable analysis was used to identify factors associated with referral. Descriptive data on barriers to diagnosis and treatment were collected. Results: Of 161 pregnant individuals, 38.5% were screened using formal tools and 13.7% were referred to sleep clinic. Having STOP-BANG performed was associated with sleep clinic referral (Odds Ratio: 18.04, 95% Confidence Interval:4.5-71.7, p < 0.001). No clinical characteristics were associated with the likelihood of performing STOP-BANG. The COVID-19 pandemic was a treatment barrier for three individuals. Conclusions: Current screening practices identify pregnant individuals with the highest pre-test probability of having OSA. Future research should evaluate real-world strategies to improve identification and management in this high-risk population.

Patient characteristics, treatment outcomes and rehabilitation practices for patients admitted with hip fractures using multiple data set analysis.

AIMS: For older patients with hip fracture, we explored patient characteristics, outcomes and osteoporosis treatments for those admitted to rehabilitation compared to those discharged directly from hospital, using data set analysis. METHODS: Retrospective cohort study including all consecutive patients (65 years and over) admitted to Christchurch Hospital over one year. Outcomes were compared for patients in four groups: 1) aged residential care (ARC) residents and 2) not ARC residents discharge from acute orthopaedics, and those discharged from 3) orthogeriatric or 4) general geriatric rehabilitation. Clinical data was extracted from hospital data warehouse using signals from noise. RESULTS: Over 12 months, 415 patients were admitted with hip fracture. Over half (n=282) were transferred for inpatient rehabilitation. Thirty-day mortality was 10%. Mortality at 180 days was 7% in orthogeriatric rehabilitation group and 8% in general rehabilitation group. Length of stay was shorter in orthogeriatric compared with general rehabilitation (median 12.9 vs 20.4 days). Osteoporosis treatment was addressed in 88% of patients in the orthogeriatric group compared with 62% in general rehabilitation group. More patients in orthogeriatric group discharged home compared with general rehabilitation group (70% vs 43%), but functional improvements were similar. For ARC residents discharged following acute admission, length of stay was short (median 6.5 day), but overall 180-day mortality was 7%. The not-ARC resident group discharged directly from hospital was less comorbid than the other groups with lower 180-day mortality (4%). Osteoporosis treatment rates were lower in patients discharged from acute admission (15-42%). CONCLUSION: Mortality was highest in ARC residents discharged from acute orthopaedics. Patients admitted for orthogeriatric rehabilitation had shorter length of stay, lower 30-day mortality, were more likely to return home and most likely to be offered osteoporosis treatment (88%), noting less underlying comorbidity and better baseline functional status in this group. This paper supports further study (eg, randomised trials) to examine the effects of targeted post-surgical rehabilitation for patients with hip fracture and explore measures to increase uptake of osteoporosis treatment.

The Stakeholder Model of voice research: Acknowledging barriers to human rights of all stakeholders in a communicative exchange.

The act of communication is a complex, transient and often abstract phenomenon that involves many stakeholders, each of whom has their own perspective: the speaker, the listener, the observer and the researcher. Current research practices in voice disorder are frequently framed through a single lens - that of the researcher/clinician or their participant/patient. This single lens approach risks overlooking significant barriers to the basic human right of freedom of expression for those with a voice disorder as it omits consideration of the impact of voice disorder on the listener, and consideration of the wider impact of the voice in the occupational context. Recent research in the area of voice has developed a multiple lens and subsequent Stakeholder Model that acknowledges the experience and reality of multiple stakeholders viewing the same phenomenon, the voice. This research paradigm is built on Article 19 of the Universal Declaration of Human Rights as it considers the realities of all stakeholders in forming a deeper understanding of the causality, impact and aspects of communication disorder. The Stakeholder Model will be presented as a suggestion for future investigations of communication disorders more widely.

Effectiveness of the progestin-only pill for migraine treatment in women: A systematic review and meta-analysis.

Background Migraine is highly prevalent in women (18%). Peak morbidity affects their most productive years, coinciding with peak fertility. Hormonal contraception is often tailored for migraine prevention. Estrogen-containing contraceptives may be contraindicated in women experiencing migraine with aura due to the risk of vascular events. While improvements in migraine with a progestin-only pill (POP), which inhibits ovulation are documented, the strength and quality of evidence has not been formally evaluated. Objectives To determine the effectiveness of progestin-only contraceptives for migraine treatment by systematic review and meta-analysis. Data sources and selection MEDLINE, EMBASE and Cochrane Libraries were searched (1980 to September 2016) for studies on progestin-only treatments for migraine. Studies in English on >4 non-menopausal women aged 18-50 with migraine diagnosed by formal criteria were included. Data extraction and analysis Data were quality-assessed using the GRADE system. A random effects model was used for pooled analyses. Results Pooled analyses of four studies demonstrated that desogestrel 75 mcg/day, POP significantly but modestly reduced the number of migraine attacks and migraine days. Reduced intensity and duration, reduced analgesic and triptan use were observed, along with improved headache-related quality of life. GRADE analysis indicated evidence was low to very low for each outcome measure. Adverse effects resulted in treatment cessation for <10% of participants. Two studies compared desogestrel POP to a combined oral contraceptive, demonstrating similar migraine outcomes for both treatments. Conclusions The desogestrel POP shows promise in improving migraine in women. Current evidence is observational and based on small samples of women using only one oral progestin-only formulation. Further randomized trials on additional progestin-only contraceptives are required to confirm their role in migraine management.

Perceptual and Acoustic Analyses of Good Voice Quality in Male Radio Performers.

OBJECTIVES: Good voice quality is an asset to professional voice users, including radio performers. We examined whether (1) voices could be reliably categorized as good for the radio and (2) these categories could be predicted using acoustic measures. PARTICIPANTS AND METHODS: Male radio performers (n = 24) and age-matched male controls performed "The Rainbow Passage" as if presenting on the radio. Voice samples were rated using a three-stage paired-comparison paradigm by 51 naive listeners and perceptual categories were identified (Study 1), and then analyzed for fundamental frequency, long-term average spectrum, cepstral peak prominence, and pause or spoken-phrase duration (Study 2). RESULTS: Study 1: Good inter-judge reliability was found for perceptual judgments of the best 15 voices (good for radio category, 14/15 = radio performers), but agreement on the remaining 33 voices (unranked category) was poor. Study 2: Discriminant function analyses showed that the SD standard deviation of sounded portion duration, equivalent sound level, and smoothed cepstral peak prominence predicted membership of categories with moderate accuracy (R2 = 0.328). CONCLUSIONS: Radio performers are heterogeneous for voice quality; good voice quality was judged reliably in only 14 out of 24 radio performers. Current acoustic analyses detected some of the relevant signal properties that were salient in these judgments. More refined perceptual analysis and the use of other perceptual methods might provide more information on the complex nature of judging good voices.

Quantitative measurement of vocal fold vibration in male radio performers and healthy controls using high-speed videoendoscopy.

PURPOSE: Acoustic and perceptual studies show a number of differences between the voices of radio performers and controls. Despite this, the vocal fold kinematics underlying these differences are largely unknown. Using high-speed videoendoscopy, this study sought to determine whether the vocal vibration features of radio performers differed from those of non-performing controls. METHOD: Using high-speed videoendoscopy, recordings of a mid-phonatory/i/ in 16 male radio performers (aged 25-52 years) and 16 age-matched controls (aged 25-52 years) were collected. Videos were extracted and analysed semi-automatically using High-Speed Video Program, obtaining measures of fundamental frequency (f0), open quotient and speed quotient. Post-hoc analyses of sound pressure level (SPL) were also performed (n = 19). Pearson's correlations were calculated between SPL and both speed and open quotients. RESULTS: Male radio performers had a significantly higher speed quotient than their matched controls (t = 3.308, p = 0.005). No significant differences were found for f0 or open quotient. No significant correlation was found between either open or speed quotient with SPL. DISCUSSION: A higher speed quotient in male radio performers suggests that their vocal fold vibration was characterised by a higher ratio of glottal opening to closing times than controls. This result may explain findings of better voice quality, higher equivalent sound level and greater spectral tilt seen in previous research. Open quotient was not significantly different between groups, indicating that the durations of complete vocal fold closure were not different between the radio performers and controls. Further validation of these results is required to determine the aetiology of the higher speed quotient result and its implications for voice training and clinical management in performers.

Acoustic characteristics of male commercial and public radio broadcast voices.

AIMS: Radio broadcasters need to have a voice that suits the station, which employs them. The aim of this study was to determine whether there are any acoustic measures that reflect differences between male broadcasters, who use their voices on commercial and public radio stations, and nonbroadcasting, male controls. METHOD: Male commercial (n = 4) and public (n = 11) broadcasters and two groups of male, age-matched controls were recorded while reading the "Rainbow Passage" as if presenting on radio. Reading productions were analyzed for equivalent sound level (L(eq)), two measures of the long-term average spectrum and two measures of cepstral peak prominence. A two-group (ie, commercial vs public) by two-paired (broadcaster/matching control) analysis of variance was performed for each measure. RESULTS: An interaction effect was observed such that commercial broadcasters had a higher peak in speaker's formant (SF) region and lower alpha ratio (AR) (lower level difference between 0 and 1 k Hz and 1 and 4 kHz ranges) than public broadcasters and controls. Post hoc discriminant function analyses showed that AR could predict whether a radio performer worked on commercial or public radio network to 81% accuracy (R(2) = 0.810, P < 0.001). DISCUSSION: Commercial broadcasters have a more prominent peak in the SF region and smaller AR than public broadcasters and controls, similar to levels documented in actors. Given these features were not found in the public broadcasters and either control group, these results indicate that voice quality requirements for broadcasters may distinctly differ based on their station of employment. Further research with a larger sample size is required to validate this hypothesis.

What makes a good voice for radio: perceptions of radio employers and educators.

AIM: To inform vocal training and management of voice disorders of professional radio performers in Australia by determining radio employers' and educators' qualitative perceptions on (1) what makes a good voice for radio and (2) what communication characteristics are important when employing radio performers. METHOD: Radio employers and educators (n=9) participated in semistructured interviews. Interview transcripts were coded line-by-line and analyzed for qualitative themes using principles of grounded theory. RESULTS/IMPLICATIONS: Radio performers sound easy-on-the-ear, natural, and have an ability to read and produce voices that suit the station. Many of these characteristics make them sound different to radio voices in the past. Content and personality are now also more significant than voice characteristics. A multidimensional model of these characteristics is presented. The model has implications for the training and management of voice disorders in radio performers and will guide future quantitative research on the vocal features of this population.

The vocal clarity of female speech-language pathology students: an exploratory study.

OBJECTIVES: This study investigated the production of a clear voice in speech pathology students using acoustic and auditory-perceptual analyses. STUDY DESIGN: A prospective study to evaluate the vocal quality of two groups of speech-language pathology students: first year (N=41) and final year, graduating (N=34) undergraduates was conducted. METHOD: Speakers were asked to produce a sustained vowel in two conditions: habitual speaking voice and a "clear" voice, as if they were modeling during voice therapy (performance voice). Acoustic and perceptual analyses were carried out on these voice samples. RESULTS: There were no differences in distribution of vocal clarity between student cohorts and the voice conditions. The graduating students' voices had significantly less jitter and shimmer than the voices of the beginning students. No significant differences in the acoustic measures were found between the two voice conditions. Clear voices had significantly higher harmonic-to-noise ratio (HNR) and lower jitter (%) and shimmer (%) than unclear voices. CONCLUSIONS: The graduating student SLPs did not produce perceptually clearer voices than the beginning student SLPs. The students' performance voices were not perceptually clearer than their habitual voices. Perceptually clear voice was associated with significantly higher HNR (dB) and lower jitter and shimmer, suggesting that acoustic noise and perturbation contribute to perceptual judgments of vocal clarity.