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Tanner K, Robison HJ, Stevens ME, Merrill RM, Dromey C, Barkmeier-Kraemer J, Ben Christensen M. Corticosteroid-LABA inhalers increase phonation threshold pressure (PTP) and flow (PTF) in rabbits. Laryngoscope 2023; 133:2680-2686. [PMID: 36757019 PMCID: PMC10409873 DOI: 10.1002/lary.30585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 01/09/2023] [Accepted: 01/11/2023] [Indexed: 02/10/2023]
Abstract
OBJECTIVES This study examined the effects of a combination corticosteroid plus long-acting beta2 -adrenergic agonist inhaler (IC) on rabbit phonation. METHODS White New Zealand male rabbits were assigned randomly to experimental and control groups (n = 11 per group). The experimental group received twice-daily doses of Advair HFA™ (fluticasone propionate 45 mcg and salmeterol 21 mcg) via a veterinary facemask with 1-way valve and spacer; the control group received aerosolized saline. After 8 weeks, animals were euthanized, larynges excised, frozen, and subsequently thawed and mounted on a standard bench apparatus. Phonation was elicited during 15 successive trials, and phonation threshold pressure (PTP; cmH2 O) and flow (PTF; L/min) were quantified. RESULTS Repeated measures analysis of variance indicated significant differences between the experimental and control groups (p < 0.05). Mean PTP and PTF values were higher (worse) for rabbits that received Advair HFA™. CONCLUSION Following 8-week exposure to ICs, rabbit larynges required greater air pressure and flow to initiate phonation. Because even modest phonation onset differences can have a meaningful clinical impact on voice function, these findings suggest that LABA ICs may put patients at risk for voice disorders. Furthermore, these voice disorders may occur within a relatively short timeframe. The results from this study have important clinical implications for voice care in those who use ICs. LEVEL OF EVIDENCE NA Laryngoscope, 133:2680-2686, 2023.
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Affiliation(s)
- Kristine Tanner
- Department of Communication Disorders, Brigham Young University
- Department of Surgery, Otolaryngology—Head & Neck Surgery, The University of Utah
| | | | - Maya Elena Stevens
- Department of Communication Sciences & Disorders, The University of Utah
| | | | | | - Julie Barkmeier-Kraemer
- Department of Surgery, Otolaryngology—Head & Neck Surgery, The University of Utah
- Department of Communication Sciences & Disorders, The University of Utah
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Weller M, Ellingson B, Alexander B, Wen P, Sulman E, Colman H, Berry D, Tanner K, Khasraw M, Lim M, Perry J, Lassman A, Cloughesy T, Yung WKA, Lee EQ, Mellinghoff I, Gordon G, de Groot J, Mikkelsen T, Cavenee W, Nelli A, Buxton M, Li W. P11.65.B GBM AGILE: A global, phase 2/3 adaptive platform trial to evaluate multiple treatment regimens in newly diagnosed and recurrent glioblastoma. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
GBM AGILE (Glioblastoma Adaptive, Global, Innovative Learning Environment) is a biomarker based, multi-arm, international, seamless Phase 2/3 Response Adaptive Randomization platform trial designed to rapidly identify experimental therapies that improve overall survival and confirm efficacious experimental therapies and associated biomarker signatures to support new drug approvals and registration. It is a collaboration between academic investigators, patient organizations and industry, under the sponsorship of the non-profit organization, Global Coalition for Adaptive Research, to support new drug applications for newly diagnosed and recurrent GBM.
Material and Methods
The primary objective of GBM AGILE is to identify therapies that effectively improve overall survival in patients with newly diagnosed or recurrent GBM. Bayesian response adaptive randomization is used within subtypes of the disease to assign participants to investigational arms based on their performance. Operating under a master protocol, GBM AGILE allows multiple drugs from different pharmaceutical companies to be evaluated simultaneously and/or over time against a common control arm. Based on performance, a drug may graduate and move to a Stage 2 (Phase 3) within the trial, and the totality of the data can be used for a new drug application and registration process. New experimental therapies are added as information about promising new drugs is identified while other therapies are removed as they complete their evaluation. The master protocol/ trial infrastructure includes efficiencies through an adaptive trial design, shared control arm and operational processes such as risk-based monitoring and enhanced remote activities. With its adaptable structure, GBM AGILE has continued trial activation, inclusion of new investigational therapies, and enrollment globally through the challenges of a global pandemic.GBM AGILE provides an efficient mechanism to screen and develop robust information regarding the efficacy of proposed novel therapeutics and associated biomarkers for GBM and to quickly move therapies and biomarkers into clinic. GBM AGILE received initial approval from the United States FDA in April 2019, and in Europe through the Voluntary Harmonization Procedure (VHP) in April, 2021. As of 2022, AGILE has screened over 1000 patients studying multiple investigational treatments. Enrollment rates are 3 to 4 times greater than traditional GBM trials, with active sites averaging 0.75 to 1 patients/site/month.
Currently, there are 41 sites activated in the US, 4 in Canada and 2 in Switzerland and an estimated 24 sites yet to open in Germany, France, Switzerland, Italy and Austria. In addition to the continued expansion in Europe, effort is undergoing to extend the trial to China and Australia as well. Clinical trial information: NCT03970447
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Affiliation(s)
- M Weller
- Universitätsspital Zürich , Klinik für Neurologie, Zürich , Switzerland
| | - B Ellingson
- University of California , Los Angeles, CA , United States
| | - B Alexander
- Dana Farber Cancer Institute, Harvard University , Boston, MA , United States
| | - P Wen
- Dana Farber Cancer Institute , Boston, MA , United States
| | - E Sulman
- NYU Grossman School of Medicine , New York, NY , United States
| | - H Colman
- University of Utah, Salt Lake City, UT , United States
| | - D Berry
- Berry Consultants , Austin, TX , United States
| | - K Tanner
- National Brain Tumor Society , Newton, MA , United States
| | - M Khasraw
- Duke Cancer Institute, Duke University , Durham, NC , United States
| | - M Lim
- Stanford University , Stanford, CA , United States
| | - J Perry
- University of Toronto, Toronto , ON , Canada
| | - A Lassman
- Columbia University, New York City, NY , United States
| | - T Cloughesy
- University of California Los Angeles , Los Angeles, CA , United States
| | - W K A Yung
- UT MD Anderson Cancer Center , Houston, TX , United States
| | - E Q Lee
- Dana Farber Cancer Institute , Boston, MA , United States
| | - I Mellinghoff
- Memorial Sloan Kettering, New York City, NY , United States
| | - G Gordon
- Global Coalition for Adaptive Research , Larkspur, CA , United States
| | - J de Groot
- University of California, San Francisco , San Francisco, CA , United States
| | - T Mikkelsen
- Henry Ford Health , Detroit, MI , United States
| | - W Cavenee
- University of California San Diego , La Jolla, CA , United States
| | - A Nelli
- Global Coalition for Adaptive Research , Larkspur, CA , United States
| | - M Buxton
- Global Coalition for Adaptive Research , Larkspur, CA , United States
| | - W Li
- Beijing Tiantan Hospital, Capital Medical University , Beijing , China
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Pierce JL, Tanner K, Merrill RM, Shnowske L, Roy N. Acoustic Variability in the Healthy Female Voice Within and Across Days: How Much and Why? J Speech Lang Hear Res 2021; 64:3015-3031. [PMID: 34269598 DOI: 10.1044/2021_jslhr-21-00018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Purpose The aims of this study were (1) to quantify variability in voice production (as measured acoustically) within and across consecutive days in vocally healthy female speakers, (2) to identify which acoustic measures are sensitive to this variability, and (3) to identify participant characteristics related to such voice variability. Method Participants included 45 young women with normal voices who were stratified by age, specifically 18-23, 24-29, and 30-35 years. Following an initial acoustic and auditory-perceptual voice assessment, participants performed standardized field voice recordings 3 times daily across a 7-day period. Acoustic analyses involved 32 cepstral-, spectral-, and time-based measures of connected speech and sustained vowels. Relationships among acoustic data and select demographic, health, and lifestyle (i.e., participant-based) factors were also examined. Results Significant time-of-day effects were observed for acoustic analyses within speakers (p < .05), with voices generally being worse in the morning. No significant differences were observed across consecutive days. Variations in voice production were associated with several participant factors, including improved voice with increased voice use; self-perceived poor voice function, minimal or no alcohol consumption, and extroverted personality; and worse voice with regular or current menstruation, depression, and anxiety. Conclusions This acoustic study provides essential information regarding the nature and extent to which healthy voices vary throughout the day and week. Participant-based factors that were associated with improved voice over time included increased voice use, self-perceived poor voice function, minimal or no alcohol consumption, and extroverted personality. Factors associated with worse voice production over time included regular or current menstruation, and depression and anxiety.
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Affiliation(s)
- Jenny L Pierce
- Department of Surgery, The University of Utah, Salt Lake City
- Department of Communication Sciences and Disorders, The University of Utah, Salt Lake City
| | - Kristine Tanner
- Department of Communication Disorders, Brigham Young University, Provo, UT
| | - Ray M Merrill
- Department of Public Health, Brigham Young University, Provo, UT
| | - Lauren Shnowske
- Department of Communication Sciences and Disorders, The University of Utah, Salt Lake City
- Department of Communication Sciences and Disorders, University of Kentucky, Lexington
| | - Nelson Roy
- Department of Communication Sciences and Disorders, The University of Utah, Salt Lake City
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Simonyan K, Barkmeier-Kraemer J, Blitzer A, Hallett M, Houde JF, Jacobson Kimberley T, Ozelius LJ, Pitman MJ, Richardson RM, Sharma N, Tanner K. Laryngeal Dystonia: Multidisciplinary Update on Terminology, Pathophysiology, and Research Priorities. Neurology 2021; 96:989-1001. [PMID: 33858994 DOI: 10.1212/wnl.0000000000011922] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 02/17/2021] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To delineate research priorities for improving clinical management of laryngeal dystonia, the NIH convened a multidisciplinary panel of experts for a 1-day workshop to examine the current progress in understanding its etiopathophysiology and clinical care. METHODS The participants reviewed the current terminology of disorder and discussed advances in understanding its pathophysiology since a similar workshop was held in 2005. Clinical and research gaps were identified, and recommendations for future directions were delineated. RESULTS The panel unanimously agreed to adopt the term "laryngeal dystonia" instead of "spasmodic dysphonia" to reflect the current progress in characterizations of this disorder. Laryngeal dystonia was recognized as a multifactorial, phenotypically heterogeneous form of isolated dystonia. Its etiology remains unknown, whereas the pathophysiology likely involves large-scale functional and structural brain network disorganization. Current challenges include the lack of clinically validated diagnostic markers and outcome measures and the paucity of therapies that address the disorder pathophysiology. CONCLUSION Research priorities should be guided by challenges in clinical management of laryngeal dystonia. Identification of disorder-specific biomarkers would allow the development of novel diagnostic tools and unified measures of treatment outcome. Elucidation of the critical nodes within neural networks that cause or modulate symptoms would allow the development of targeted therapies that address the underlying pathophysiology. Given the rarity of laryngeal dystonia, future rapid research progress may be facilitated by multicenter, national and international collaborations.
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Affiliation(s)
- Kristina Simonyan
- From the Department of Otolaryngology-Head and Neck Surgery (K.S.), Harvard Medical School and Massachusetts Eye and Ear, Boston, MA, Department of Neurology (K.S., L.J.O., N.S.), Massachusetts General Hospital, Boston, MA; Division of Otolaryngology (J.B.-K.), University of Utah, Salt Lake City, UT; New York Center for Voice and Swallowing Disorders and Department of Neurology (A.B.), Icahn School of Medicine at Mount Sinai, New York, NY; Human Motor Control Section (M.H.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD; Department of Otolaryngology-Head and Neck Surgery (J.H.), University of California San Francisco, San Francisco, CA; School of Rehabilitation and Health Sciences (T.J.K.), Massachusetts General Hospital Institute of Health Professions, Boston, MA; Department of Otolaryngology-Head and Neck Surgery (M.J.P.), Columbia University Irving Medical Center, New York, NY; Department of Neurosurgery (R.M.R.), Massachusetts General Hospital, Boston, MA; and Department of Communication Disorders (K.T.), Brigham Young University, Provo, UT.
| | - Julie Barkmeier-Kraemer
- From the Department of Otolaryngology-Head and Neck Surgery (K.S.), Harvard Medical School and Massachusetts Eye and Ear, Boston, MA, Department of Neurology (K.S., L.J.O., N.S.), Massachusetts General Hospital, Boston, MA; Division of Otolaryngology (J.B.-K.), University of Utah, Salt Lake City, UT; New York Center for Voice and Swallowing Disorders and Department of Neurology (A.B.), Icahn School of Medicine at Mount Sinai, New York, NY; Human Motor Control Section (M.H.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD; Department of Otolaryngology-Head and Neck Surgery (J.H.), University of California San Francisco, San Francisco, CA; School of Rehabilitation and Health Sciences (T.J.K.), Massachusetts General Hospital Institute of Health Professions, Boston, MA; Department of Otolaryngology-Head and Neck Surgery (M.J.P.), Columbia University Irving Medical Center, New York, NY; Department of Neurosurgery (R.M.R.), Massachusetts General Hospital, Boston, MA; and Department of Communication Disorders (K.T.), Brigham Young University, Provo, UT
| | - Andrew Blitzer
- From the Department of Otolaryngology-Head and Neck Surgery (K.S.), Harvard Medical School and Massachusetts Eye and Ear, Boston, MA, Department of Neurology (K.S., L.J.O., N.S.), Massachusetts General Hospital, Boston, MA; Division of Otolaryngology (J.B.-K.), University of Utah, Salt Lake City, UT; New York Center for Voice and Swallowing Disorders and Department of Neurology (A.B.), Icahn School of Medicine at Mount Sinai, New York, NY; Human Motor Control Section (M.H.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD; Department of Otolaryngology-Head and Neck Surgery (J.H.), University of California San Francisco, San Francisco, CA; School of Rehabilitation and Health Sciences (T.J.K.), Massachusetts General Hospital Institute of Health Professions, Boston, MA; Department of Otolaryngology-Head and Neck Surgery (M.J.P.), Columbia University Irving Medical Center, New York, NY; Department of Neurosurgery (R.M.R.), Massachusetts General Hospital, Boston, MA; and Department of Communication Disorders (K.T.), Brigham Young University, Provo, UT
| | - Mark Hallett
- From the Department of Otolaryngology-Head and Neck Surgery (K.S.), Harvard Medical School and Massachusetts Eye and Ear, Boston, MA, Department of Neurology (K.S., L.J.O., N.S.), Massachusetts General Hospital, Boston, MA; Division of Otolaryngology (J.B.-K.), University of Utah, Salt Lake City, UT; New York Center for Voice and Swallowing Disorders and Department of Neurology (A.B.), Icahn School of Medicine at Mount Sinai, New York, NY; Human Motor Control Section (M.H.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD; Department of Otolaryngology-Head and Neck Surgery (J.H.), University of California San Francisco, San Francisco, CA; School of Rehabilitation and Health Sciences (T.J.K.), Massachusetts General Hospital Institute of Health Professions, Boston, MA; Department of Otolaryngology-Head and Neck Surgery (M.J.P.), Columbia University Irving Medical Center, New York, NY; Department of Neurosurgery (R.M.R.), Massachusetts General Hospital, Boston, MA; and Department of Communication Disorders (K.T.), Brigham Young University, Provo, UT
| | - John F Houde
- From the Department of Otolaryngology-Head and Neck Surgery (K.S.), Harvard Medical School and Massachusetts Eye and Ear, Boston, MA, Department of Neurology (K.S., L.J.O., N.S.), Massachusetts General Hospital, Boston, MA; Division of Otolaryngology (J.B.-K.), University of Utah, Salt Lake City, UT; New York Center for Voice and Swallowing Disorders and Department of Neurology (A.B.), Icahn School of Medicine at Mount Sinai, New York, NY; Human Motor Control Section (M.H.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD; Department of Otolaryngology-Head and Neck Surgery (J.H.), University of California San Francisco, San Francisco, CA; School of Rehabilitation and Health Sciences (T.J.K.), Massachusetts General Hospital Institute of Health Professions, Boston, MA; Department of Otolaryngology-Head and Neck Surgery (M.J.P.), Columbia University Irving Medical Center, New York, NY; Department of Neurosurgery (R.M.R.), Massachusetts General Hospital, Boston, MA; and Department of Communication Disorders (K.T.), Brigham Young University, Provo, UT
| | - Teresa Jacobson Kimberley
- From the Department of Otolaryngology-Head and Neck Surgery (K.S.), Harvard Medical School and Massachusetts Eye and Ear, Boston, MA, Department of Neurology (K.S., L.J.O., N.S.), Massachusetts General Hospital, Boston, MA; Division of Otolaryngology (J.B.-K.), University of Utah, Salt Lake City, UT; New York Center for Voice and Swallowing Disorders and Department of Neurology (A.B.), Icahn School of Medicine at Mount Sinai, New York, NY; Human Motor Control Section (M.H.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD; Department of Otolaryngology-Head and Neck Surgery (J.H.), University of California San Francisco, San Francisco, CA; School of Rehabilitation and Health Sciences (T.J.K.), Massachusetts General Hospital Institute of Health Professions, Boston, MA; Department of Otolaryngology-Head and Neck Surgery (M.J.P.), Columbia University Irving Medical Center, New York, NY; Department of Neurosurgery (R.M.R.), Massachusetts General Hospital, Boston, MA; and Department of Communication Disorders (K.T.), Brigham Young University, Provo, UT
| | - Laurie J Ozelius
- From the Department of Otolaryngology-Head and Neck Surgery (K.S.), Harvard Medical School and Massachusetts Eye and Ear, Boston, MA, Department of Neurology (K.S., L.J.O., N.S.), Massachusetts General Hospital, Boston, MA; Division of Otolaryngology (J.B.-K.), University of Utah, Salt Lake City, UT; New York Center for Voice and Swallowing Disorders and Department of Neurology (A.B.), Icahn School of Medicine at Mount Sinai, New York, NY; Human Motor Control Section (M.H.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD; Department of Otolaryngology-Head and Neck Surgery (J.H.), University of California San Francisco, San Francisco, CA; School of Rehabilitation and Health Sciences (T.J.K.), Massachusetts General Hospital Institute of Health Professions, Boston, MA; Department of Otolaryngology-Head and Neck Surgery (M.J.P.), Columbia University Irving Medical Center, New York, NY; Department of Neurosurgery (R.M.R.), Massachusetts General Hospital, Boston, MA; and Department of Communication Disorders (K.T.), Brigham Young University, Provo, UT
| | - Michael J Pitman
- From the Department of Otolaryngology-Head and Neck Surgery (K.S.), Harvard Medical School and Massachusetts Eye and Ear, Boston, MA, Department of Neurology (K.S., L.J.O., N.S.), Massachusetts General Hospital, Boston, MA; Division of Otolaryngology (J.B.-K.), University of Utah, Salt Lake City, UT; New York Center for Voice and Swallowing Disorders and Department of Neurology (A.B.), Icahn School of Medicine at Mount Sinai, New York, NY; Human Motor Control Section (M.H.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD; Department of Otolaryngology-Head and Neck Surgery (J.H.), University of California San Francisco, San Francisco, CA; School of Rehabilitation and Health Sciences (T.J.K.), Massachusetts General Hospital Institute of Health Professions, Boston, MA; Department of Otolaryngology-Head and Neck Surgery (M.J.P.), Columbia University Irving Medical Center, New York, NY; Department of Neurosurgery (R.M.R.), Massachusetts General Hospital, Boston, MA; and Department of Communication Disorders (K.T.), Brigham Young University, Provo, UT
| | - Robert Mark Richardson
- From the Department of Otolaryngology-Head and Neck Surgery (K.S.), Harvard Medical School and Massachusetts Eye and Ear, Boston, MA, Department of Neurology (K.S., L.J.O., N.S.), Massachusetts General Hospital, Boston, MA; Division of Otolaryngology (J.B.-K.), University of Utah, Salt Lake City, UT; New York Center for Voice and Swallowing Disorders and Department of Neurology (A.B.), Icahn School of Medicine at Mount Sinai, New York, NY; Human Motor Control Section (M.H.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD; Department of Otolaryngology-Head and Neck Surgery (J.H.), University of California San Francisco, San Francisco, CA; School of Rehabilitation and Health Sciences (T.J.K.), Massachusetts General Hospital Institute of Health Professions, Boston, MA; Department of Otolaryngology-Head and Neck Surgery (M.J.P.), Columbia University Irving Medical Center, New York, NY; Department of Neurosurgery (R.M.R.), Massachusetts General Hospital, Boston, MA; and Department of Communication Disorders (K.T.), Brigham Young University, Provo, UT
| | - Nutan Sharma
- From the Department of Otolaryngology-Head and Neck Surgery (K.S.), Harvard Medical School and Massachusetts Eye and Ear, Boston, MA, Department of Neurology (K.S., L.J.O., N.S.), Massachusetts General Hospital, Boston, MA; Division of Otolaryngology (J.B.-K.), University of Utah, Salt Lake City, UT; New York Center for Voice and Swallowing Disorders and Department of Neurology (A.B.), Icahn School of Medicine at Mount Sinai, New York, NY; Human Motor Control Section (M.H.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD; Department of Otolaryngology-Head and Neck Surgery (J.H.), University of California San Francisco, San Francisco, CA; School of Rehabilitation and Health Sciences (T.J.K.), Massachusetts General Hospital Institute of Health Professions, Boston, MA; Department of Otolaryngology-Head and Neck Surgery (M.J.P.), Columbia University Irving Medical Center, New York, NY; Department of Neurosurgery (R.M.R.), Massachusetts General Hospital, Boston, MA; and Department of Communication Disorders (K.T.), Brigham Young University, Provo, UT
| | - Kristine Tanner
- From the Department of Otolaryngology-Head and Neck Surgery (K.S.), Harvard Medical School and Massachusetts Eye and Ear, Boston, MA, Department of Neurology (K.S., L.J.O., N.S.), Massachusetts General Hospital, Boston, MA; Division of Otolaryngology (J.B.-K.), University of Utah, Salt Lake City, UT; New York Center for Voice and Swallowing Disorders and Department of Neurology (A.B.), Icahn School of Medicine at Mount Sinai, New York, NY; Human Motor Control Section (M.H.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD; Department of Otolaryngology-Head and Neck Surgery (J.H.), University of California San Francisco, San Francisco, CA; School of Rehabilitation and Health Sciences (T.J.K.), Massachusetts General Hospital Institute of Health Professions, Boston, MA; Department of Otolaryngology-Head and Neck Surgery (M.J.P.), Columbia University Irving Medical Center, New York, NY; Department of Neurosurgery (R.M.R.), Massachusetts General Hospital, Boston, MA; and Department of Communication Disorders (K.T.), Brigham Young University, Provo, UT
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Pierce JL, Tanner K, Merrill RM, Shnowske L, Roy N. A Field-Based Approach to Establish Normative Acoustic Data for Healthy Female Voices. J Speech Lang Hear Res 2021; 64:691-706. [PMID: 33561361 DOI: 10.1044/2020_jslhr-20-00490] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Purpose The primary aim of this study was to obtain high-quality acoustic normative data in natural field environments for female voices. A secondary aim was to examine acoustic measurement variability in field environments. Method This study employed a within-subject repeated-measures experimental design that included 45 young female adults with normal voices. Participants were stratified by age (18-23, 24-29, and 30-35 years). After initial evaluation and instruction, participants completed voice recordings during seven consecutive days using a standard protocol, including both connected speech and sustained vowels. Thirty-two cepstral-, spectral-, and time-based acoustic measures were acquired using Praat and the Analysis of Dysphonia in Speech and Voice. Results Among the 958 total recordings, greater than 90% satisfied inclusion criteria based on protocol compliance, peak clipping, and signal-to-noise ratio. Significant differences were observed for age (p < .05). For 19 acoustic measures, values improved significantly as signal-to-noise ratio increased. Cepstral- and spectral-based measures demonstrated less measurement variability as compared with time-based measures. Conclusions With adequate training, field audio recordings represent a viable option for clinical voice management. The significant age effects observed in this study support the need for more specific criteria when collecting and applying normative data. Cepstral- and spectral-based measures demonstrated the least measurement variability. This study provides additional evidence for multiparameter acoustic voice measurement, specifically toward ecologically valid sampling in natural environments. Future studies should expand on these findings in other populations with normal and disordered voices.
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Affiliation(s)
- Jenny L Pierce
- Department of Surgery, The University of Utah, Salt Lake City
- Department of Communication Sciences & Disorders, The University of Utah, Salt Lake City
| | - Kristine Tanner
- Department of Communication Disorders, Brigham Young University, Provo, UT
| | - Ray M Merrill
- Department of Public Health, Brigham Young University, Provo, UT
| | - Lauren Shnowske
- Department of Communication Sciences & Disorders, The University of Utah, Salt Lake City
- Department of Communication Sciences and Disorders, University of Kentucky, Lexington
| | - Nelson Roy
- Department of Communication Sciences & Disorders, The University of Utah, Salt Lake City
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Tanner K, Malik F, Smith T, Cosgriff R, Medhurst N, Keogh R. P066 Development of an online tool to provide accessible and personalised information on life expectancy in cystic fibrosis. J Cyst Fibros 2020. [DOI: 10.1016/s1569-1993(20)30402-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Malik F, Tanner K, Smith T, Cosgriff R, Medhurst N, Keogh R. P065 Perspectives on personalised life expectancy information and how it should be presented: a qualitative study. J Cyst Fibros 2020. [DOI: 10.1016/s1569-1993(20)30401-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Taylor S, Dromey C, Nissen SL, Tanner K, Eggett D, Corbin-Lewis K. Age-Related Changes in Speech and Voice: Spectral and Cepstral Measures. J Speech Lang Hear Res 2020; 63:647-660. [PMID: 32097060 PMCID: PMC7229708 DOI: 10.1044/2019_jslhr-19-00028] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 10/15/2019] [Accepted: 11/21/2019] [Indexed: 06/02/2023]
Abstract
Purpose This study examined differences in selected acoustic measures of speech and voice according to age and sex and across families. Method Participants included 169 individuals, 79 men and 90 women, from 18 families, ranging in age from 17 to 87 years. Participants reported no history of articulation disorders, stroke or active neurologic disease, or severe-to-profound hearing loss. They read aloud two passages to facilitate examination of the following speech and voice acoustic parameters: fricative spectral moments (center of gravity, standard deviation, skewness, and kurtosis), the proportion of time spent speaking, mean speaking fundamental frequency, semitone standard deviation (STSD), and cepstral peak prominence smoothed. Results The results indicated a significant age effect for fricative spectral center of gravity, spectral skewness, and speaking STSD. There was a significant sex effect for spectral center of gravity, spectral kurtosis, and mean fundamental frequency. Familial relationship was significant for spectral skewness, STSD, and cepstral peak prominence smoothed. Conclusions These findings revealed that certain speech and voice features change with age and some change differently for men and women. Additionally, speakers from the same family units may demonstrate similar patterns for prosody, voicing, and articulatory behavior. The results also demonstrated normal differences in speech and voice variation across age, sex, and family unit. Understanding patterns and differences across these demographic variables in healthy speakers is important to distinguishing more confidently between normal and disordered speech and voice patterns clinically.
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Affiliation(s)
- Sammi Taylor
- Department of Communication Disorders, Brigham Young University, Provo, UT
| | - Christopher Dromey
- Department of Communication Disorders, Brigham Young University, Provo, UT
| | - Shawn L. Nissen
- Department of Communication Disorders, Brigham Young University, Provo, UT
| | - Kristine Tanner
- Department of Communication Disorders, Brigham Young University, Provo, UT
| | - Dennis Eggett
- Department of Statistics, Brigham Young University, Provo, UT
| | - Kim Corbin-Lewis
- Department of Communicative Disorders and Deaf Education, Utah State University, Logan
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Morgan A, Jones J, Tanner K, Lakin K. Adoption of a radical treatment proforma early in the patient pathway can improve documentation of risks and improve adherence to national guidelines. Lung Cancer 2020. [DOI: 10.1016/s0169-5002(20)30079-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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10
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Eneli I, Watowicz R, Xu J, Tindall A, Walston M, Tanner K, Worthington J, Pratt K. Rationale and design of a pilot study to evaluate the acceptability and effectiveness of a revised protein sparing modified fast (rPSMF) for severe obesity in a pediatric tertiary care weight management clinic. Contemp Clin Trials Commun 2019; 15:100388. [PMID: 31431932 PMCID: PMC6580089 DOI: 10.1016/j.conctc.2019.100388] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 05/21/2019] [Accepted: 05/27/2019] [Indexed: 02/05/2023] Open
Abstract
Aggressive dietary interventions may provide an accessible treatment option for children and adolescents with severe obesity who are not successful with traditional lifestyle behavioral interventions or do not want or qualify for weight loss surgery. One such intensive dietary option is the protein sparing modified fast (PSMF). The PSMF involves minimal carbohydrate intake to induce ketosis, while maintaining adequate or high protein intake to minimize catabolism. The PSMF, under medical supervision, can be an effective and safe intervention for children and adolescents, yet the PSMF diet is not regularly used in the treatment of pediatric severe obesity. This paper describes the rationale and design for a pilot study to evaluate the acceptability and effectiveness of a revised PSMF (rPSMF) implemented as a weight loss treatment option for children and adolescents with severe obesity in a pediatric tertiary care weight management clinic. The primary aim of the study is to evaluate the acceptability of the rPSMF as assessed by adherence, satisfaction with the intervention, and participation rate using quantitative and qualitative methods. The secondary aim is to investigate the effectiveness of the rPSMF on improving a) anthropometric measures (weight, body mass index [BMI], BMI z-score); b) metabolic measures (lipid profile, glycosylated hemoglobin, liver function tests); and c) quality of life. Results of this study will provide guidance for the standardization of a pediatric rPSMF protocol in a clinic setting, delineate which factors improve or hinder adherence and weight loss and provide preliminary data for a multicenter randomized controlled trial. Clinicaltrialsgov identifier NCT03899311.
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Affiliation(s)
- I.U. Eneli
- Center for Healthy Weight and Nutrition, Nationwide Children's Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University, Columbus, OH, USA
- Corresponding author. Center for Healthy Weight and Nutrition, Nationwide Children's Hospital, Columbus, OH, USA.
| | - R.P. Watowicz
- Department of Nutrition, Case Western University, Cleveland, OH, USA
| | - J. Xu
- Center for Healthy Weight and Nutrition, Nationwide Children's Hospital, Columbus, OH, USA
| | - A. Tindall
- Center for Healthy Weight and Nutrition, Nationwide Children's Hospital, Columbus, OH, USA
| | - M. Walston
- Department of Pediatrics, Akron Children's Hospital, Akron, OH, USA
| | - K. Tanner
- Division of Clinical Therapies, Nationwide Children's Hospital, Columbus, OH, USA
| | - J. Worthington
- Division of Clinical Therapies, Nationwide Children's Hospital, Columbus, OH, USA
| | - K.J. Pratt
- Department of Human Sciences, The Ohio State University, Columbus, OH, USA
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Abstract
Objective: People with subglottic stenosis (SGS) may experience laryngeal symptoms that pose significant challenges to management. This study surveyed the use and effects of nebulized treatments on laryngeal symptoms in a large cohort of adults with SGS. Methods: A survey of nebulized treatment practices was distributed to an online international community of over 2000 members; 316 individuals (298 female, 1 male, 17 declined to specify; age 25+ years) completed the survey. Results: Nearly half (144) of participants had tried a nebulizer in the past. Among those, half currently used nebulized treatments; the majority used these treatments regularly and for greater than 1 year. The most frequently reported treatments included isotonic saline (0.9% Na+Cl–) or hypertonic saline (3% Na+Cl–). Symptoms improved by these treatments included thick mucus (69%), cough (57%), throat dryness (31%), stridor (28%), and voice (15%). The most frequently reported limitations to nebulizer use included time, noise, and portability. Conclusion: Among those individuals with SGS who have tried nebulized treatments, nearly half experienced relief from secondary laryngeal symptoms. Additional efficacy research is needed, particularly with respect to treatment type and dosage. The results are encouraging given the adverse impact these laryngeal symptoms can have on activities of daily living and quality of life.
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Affiliation(s)
- Kristine Tanner
- Department of Communication Disorders, Brigham Young University, Provo, UT, USA
- Division of Otolaryngology—Head & Neck Surgery, The University of Utah, Salt Lake City, UT, USA
| | | | - Marshall E. Smith
- Division of Otolaryngology—Head & Neck Surgery, The University of Utah, Salt Lake City, UT, USA
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Morgan A, Berair R, Mathew S, Lakin K, Tanner K, Jones J. Reducing pathway length in lung cancer by multidisciplinary intervention: Wolverhampton Intervention in Lung cancer Daily, ‘The WILD project’. Lung Cancer 2019. [DOI: 10.1016/s0169-5002(19)30056-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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13
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Jones J, Lakin K, Tanner K, Morgan A. Does molecular analysis alter treatment options for patients in Wolverhampton? Lung Cancer 2019. [DOI: 10.1016/s0169-5002(19)30156-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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14
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Marathe M, Tanner K, Jones J, Russon H, Morgan A. Assessment of a new small cell lung cancer pathway at New Cross Hospital, Wolverhampton. Lung Cancer 2018. [DOI: 10.1016/s0169-5002(18)30055-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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15
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Aslibekyan S, Do AN, Xu H, Li S, Irvin MR, Zhi D, Tiwari HK, Absher DM, Shuldiner AR, Zhang T, Chen W, Tanner K, Hong C, Mitchell BD, Berenson G, Arnett DK. CPT1A methylation is associated with plasma adiponectin. Nutr Metab Cardiovasc Dis 2017; 27:225-233. [PMID: 28139377 PMCID: PMC5330786 DOI: 10.1016/j.numecd.2016.11.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 10/24/2016] [Accepted: 11/14/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIMS Adiponectin, an adipose-secreted protein that has been linked to insulin sensitivity, plasma lipids, and inflammatory patterns, is an established biomarker for metabolic health. Despite clinical relevance and high heritability, the determinants of plasma adiponectin levels remain poorly understood. METHODS AND RESULTS We conducted the first epigenome-wide cross-sectional study of adiponectin levels using methylation data on 368,051 cytosine-phosphate-guanine (CpG) sites in CD4+ T-cells from the Genetics of Lipid Lowering Drugs and Diet Network (GOLDN, n = 991). We fit linear mixed models, adjusting for age, sex, study site, T-cell purity, and family. We have identified a positive association (regression coefficient ± SE = 0.01 ± 0.001, P = 3.4 × 10-13) between plasma adiponectin levels and methylation of a CpG site in CPT1A, a key player in fatty acid metabolism. The association was replicated (n = 474, P = 0.0009) in whole blood samples from the Amish participants of the Heredity and Phenotype Intervention (HAPI) Heart Study as well as White (n = 592, P = 0.0005) but not Black (n = 243, P = 0.18) participants of the Bogalusa Heart Study (BHS). The association remained significant upon adjusting for BMI and smoking in GOLDN and HAPI but not BHS. We also identified associations between methylation loci in RNF145 and UFM1 and plasma adiponectin in GOLDN and White BHS participants, although the association was not robust to adjustment for BMI or smoking. CONCLUSION We have identified and replicated associations between several biologically plausible loci and plasma adiponectin. These findings support the importance of epigenetic processes in metabolic traits, laying the groundwork for future translational applications.
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Affiliation(s)
- S Aslibekyan
- Department of Epidemiology, University of Alabama at Birmingham, USA.
| | - A N Do
- Department of Epidemiology, University of Alabama at Birmingham, USA
| | - H Xu
- Department of Medicine, University of Maryland School of Medicine, USA
| | - S Li
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, USA
| | - M R Irvin
- Department of Epidemiology, University of Alabama at Birmingham, USA
| | - D Zhi
- Department of Biostatistics, University of Alabama at Birmingham, USA
| | - H K Tiwari
- Department of Biostatistics, University of Alabama at Birmingham, USA
| | - D M Absher
- HudsonAlpha Institute for Biotechnology, USA
| | - A R Shuldiner
- Department of Medicine, University of Maryland School of Medicine, USA
| | - T Zhang
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, USA
| | - W Chen
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, USA
| | - K Tanner
- Department of Medicine, University of Maryland School of Medicine, USA
| | - C Hong
- Department of Medicine, University of Maryland School of Medicine, USA
| | - B D Mitchell
- Department of Medicine, University of Maryland School of Medicine, USA; Geriatrics Research and Education Clinical Center, Baltimore Veterans Administration Medical Center, Baltimore, MD, USA
| | - G Berenson
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, USA
| | - D K Arnett
- Department of Epidemiology, University of Alabama at Birmingham, USA
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Boucher D, Newsome D, Takemoto D, Hillier S, Wang Y, Arimoto R, Maxwell J, Charifson P, Fields SZ, Tanner K, Penney MS. Abstract P5-06-05: Preclinical characterization of VX-984, a selective DNA-dependent protein kinase (DNA-PK) inhibitor in combination with doxorubicin in breast and ovarian cancers. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p5-06-05] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The efficacy of chemotherapeutic agents such as doxorubicin, which cause lethal DNA double-strand breaks (DSBs), is diminished by efficient repair of the damaged DNA in cancer cells. DNA-PK is a key regulator of the non-homologous end joining (NHEJ) pathway, which is responsible for repairing DSBs. Studies of nonselective inhibitors of DNA-PK have shown that cancer cells depend on DNA-PK for survival following treatment with DSB-inducing agents. However, a comprehensive characterization of DNA-PK inhibition has been hampered by a lack of selective inhibitors. Here we describe VX-984, a potent and selective inhibitor of DNA-PK, and its preclinical profile in combination with doxorubicin both in vitro and in vivo.
Methods: VX-984 was examined as a single agent and in combination with doxorubicin or pegylated liposomal doxorubicin (PLD) in a panel of breast cancer cell lines and in mouse xenograft models, respectively.
Results: In vitro, inhibition of DNA-PK by VX-984 enhanced the cytotoxic activity of doxorubicin in established breast cancer cell lines and in primary ovarian tumor explants. Notably, mean Bliss DE >10% (strong synergy) were observed for doxorubicin in the presence of VX-984 in 22 of 35 breast cancer cell lines and 21 of 44 ovarian cancer cell lines in a broad cancer cell line screen. Further, the efficacy observed with VX-984 was associated with increased DNA damage as measured by phosphorylated histone H2AX (gamma-H2AX) and phosphorylated Kruppel-associated protein (pKAP1) in DU4475, MDA-MB-436 and MDA-MB-468 breast cancer cell lines, which is consistent with diminished DSB repair. In vivo, VX-984 significantly enhanced the efficacy of PLD in ovarian cancer patient-derived xenograft models and in cell line xenograft models.
Conclusions: These data provide evidence that inhibition of DNA-PK by VX-984 enhances the efficacy of doxorubicin in preclinical models and support the use of VX-984 in combination with DSB agents such as anthracyclines including PLD for the treatment of breast and ovarian cancers. VX-984 is currently in a Phase 1 clinical trial in combination with PLD.
Sponsored by Vertex Pharmaceuticals Incorporated.
Citation Format: Boucher D, Newsome D, Takemoto D, Hillier S, Wang Y, Arimoto R, Maxwell J, Charifson P, Fields SZ, Tanner K, Penney MS. Preclinical characterization of VX-984, a selective DNA-dependent protein kinase (DNA-PK) inhibitor in combination with doxorubicin in breast and ovarian cancers [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-06-05.
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Affiliation(s)
- D Boucher
- Vertex Pharmaceuticals Incorporated, Boston, MA
| | - D Newsome
- Vertex Pharmaceuticals Incorporated, Boston, MA
| | - D Takemoto
- Vertex Pharmaceuticals Incorporated, Boston, MA
| | - S Hillier
- Vertex Pharmaceuticals Incorporated, Boston, MA
| | - Y Wang
- Vertex Pharmaceuticals Incorporated, Boston, MA
| | - R Arimoto
- Vertex Pharmaceuticals Incorporated, Boston, MA
| | - J Maxwell
- Vertex Pharmaceuticals Incorporated, Boston, MA
| | - P Charifson
- Vertex Pharmaceuticals Incorporated, Boston, MA
| | - SZ Fields
- Vertex Pharmaceuticals Incorporated, Boston, MA
| | - K Tanner
- Vertex Pharmaceuticals Incorporated, Boston, MA
| | - MS Penney
- Vertex Pharmaceuticals Incorporated, Boston, MA
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Backman JD, Yerges-Armstrong LM, Horenstein RB, Newcomer S, Shaub S, Morrisey M, Donnelly P, Drolet M, Tanner K, Pavlovich MA, O'Connell JR, Mitchell BD, Lewis JP. Prospective Evaluation of Genetic Variation in Platelet Endothelial Aggregation Receptor 1 Reveals Aspirin-Dependent Effects on Platelet Aggregation Pathways. Clin Transl Sci 2017; 10:102-109. [PMID: 28075528 PMCID: PMC5355965 DOI: 10.1111/cts.12438] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 12/13/2016] [Indexed: 12/04/2022] Open
Abstract
Genetic variation in the platelet endothelial aggregation receptor 1 (PEAR1) gene, most notably rs12041331, is implicated in altered on‐aspirin platelet aggregation and increased cardiovascular event risk. We prospectively tested the effects of aspirin administration at commonly prescribed doses (81, 162, and 324 mg/day) on agonist‐induced platelet aggregation by rs12041331 genotype in 67 healthy individuals. Prior to aspirin administration, rs12041331 minor allele carriers had significantly reduced adenosine diphosphate (ADP)‐induced platelet aggregation compared with noncarriers (P = 0.03) but was not associated with other platelet pathways. In contrast, rs12041331 was significantly associated with on‐aspirin platelet aggregation when collagen and epinephrine were used to stimulate platelet aggregation (P < 0.05 for all associations), but not ADP. The influence of PEAR1 rs12041331 on platelet aggregation is pathway‐specific and is altered by aspirin at therapeutic doses, but not in a dose‐dependent manner. Additional studies are needed to determine the impact of PEAR1 on cardiovascular events in aspirin‐treated patients.
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Affiliation(s)
- J D Backman
- Division of Endocrinology, Diabetes, and Nutrition, and Program for Personalized and Genomic Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - L M Yerges-Armstrong
- Division of Endocrinology, Diabetes, and Nutrition, and Program for Personalized and Genomic Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - R B Horenstein
- Division of Endocrinology, Diabetes, and Nutrition, and Program for Personalized and Genomic Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - S Newcomer
- Division of Endocrinology, Diabetes, and Nutrition, and Program for Personalized and Genomic Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - S Shaub
- Division of Endocrinology, Diabetes, and Nutrition, and Program for Personalized and Genomic Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - M Morrisey
- Division of Endocrinology, Diabetes, and Nutrition, and Program for Personalized and Genomic Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - P Donnelly
- Division of Endocrinology, Diabetes, and Nutrition, and Program for Personalized and Genomic Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - M Drolet
- Division of Endocrinology, Diabetes, and Nutrition, and Program for Personalized and Genomic Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - K Tanner
- Division of Endocrinology, Diabetes, and Nutrition, and Program for Personalized and Genomic Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - M A Pavlovich
- Division of Endocrinology, Diabetes, and Nutrition, and Program for Personalized and Genomic Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - J R O'Connell
- Division of Endocrinology, Diabetes, and Nutrition, and Program for Personalized and Genomic Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - B D Mitchell
- Division of Endocrinology, Diabetes, and Nutrition, and Program for Personalized and Genomic Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA.,Geriatrics Research and Education Clinical Center, Baltimore Veterans Administration Medical Center, Baltimore, Maryland, USA
| | - J P Lewis
- Division of Endocrinology, Diabetes, and Nutrition, and Program for Personalized and Genomic Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
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Tanner K, Dromey C, Berardi ML, Mattei LM, Pierce JL, Wisco JJ, Hunter EJ, Smith ME. Effects of voice-sparing cricotracheal resection on phonation in women. Laryngoscope 2016; 127:2085-2092. [PMID: 27882558 DOI: 10.1002/lary.26429] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 08/30/2016] [Accepted: 10/10/2016] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Individuals with idiopathic subglottic stenosis (SGS) are at risk for voice disorders prior to and following surgical management. This study examined the nature and severity of voice disorders in patients with SGS before and after a revised cricotracheal resection (CTR) procedure designed to minimize adverse effects on voice function. METHOD Eleven women with idiopathic SGS provided presurgical and postsurgical audio recordings. Voice Handicap Index (VHI) scores were also collected. Cepstral, signal-to-noise, periodicity, and fundamental frequency (F0 ) analyses were undertaken for connected speech and sustained vowel samples. Listeners made auditory-perceptual ratings of overall quality and monotonicity. RESULTS Paired samples statistical analyses revealed that mean F0 decreased from 215 Hz (standard deviation [SD] = 40 Hz) to 201 Hz (SD = 65 Hz) following surgery. In general, VHI scores decreased after surgery. Voice disorder severity based on the Cepstral Spectral Index of Dysphonia (KayPentax, Montvale, NJ) for sustained vowels decreased (improved) from 41 (SD = 41) to 25 (SD = 21) points; no change was observed for connected speech. Semitone SD (2.2 semitones) did not change from pre- to posttreatment. Auditory-perceptual ratings demonstrated similar results. CONCLUSION These preliminary results indicate that this revised CTR procedure is promising in minimizing adverse voice effects while offering a longer-term surgical outcome for SGS. Further research is needed to determine causal factors for pretreatment voice disorders, as well as to optimize treatments in this population. LEVEL OF EVIDENCE 4. Laryngoscope, 127:2085-2092, 2017.
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Affiliation(s)
- Kristine Tanner
- Department of Communication Disorders, Brigham Young University, Provo, Utah, U.S.A
| | - Christopher Dromey
- Department of Communication Disorders, Brigham Young University, Provo, Utah, U.S.A
| | - Mark L Berardi
- the Department of Physics and Astronomy, Brigham Young University, Provo, Utah, U.S.A
| | - Lisa M Mattei
- Department of Communication Disorders, Brigham Young University, Provo, Utah, U.S.A
| | - Jenny L Pierce
- Department of Communication Sciences and Disorders, University of Utah, Salt Lake City, Utah, U.S.A
| | - Jonathan J Wisco
- Department of Physiology and Developmental Biology, Brigham Young University, Provo, Utah, U.S.A
| | - Eric J Hunter
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing, Michigan, U.S.A
| | - Marshall E Smith
- Division of Otolaryngology, Head and Neck Surgery, The University of Utah School of Medicine, Salt Lake City, Utah, U.S.A
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19
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Boucher D, Hillier S, Newsome D, Wang Y, Takemoto D, Gu Y, Markland W, Hoover R, Arimoto R, Maxwell J, Fields S, Charifson P, Penney M, Tanner K. Preclinical characterization of the selective DNA-dependent protein kinase (DNA-PK) inhibitor VX-984 in combination with chemotherapy. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw368.25] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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20
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Hancock J, Tanner K, Roden K, Morgan A. 28 Where and why do patients with advanced lung cancer present in Wolverhampton? Lung Cancer 2016. [DOI: 10.1016/s0169-5002(16)30045-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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21
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Tanner K, Pierce JL, Merrill RM, Miller KL, Kendall KA, Roy N. The Quality of Life Burden Associated With Voice Disorders in Sjögren's Syndrome. Ann Otol Rhinol Laryngol 2015; 124:721-7. [PMID: 25841042 DOI: 10.1177/0003489415579911] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVES This study examined quality of life burden of voice disorders in Sjögren's syndrome (SS). METHODS Patients with SS (n = 101) completed interviews involving patient-reported histories of voice disorders, specific voice symptoms, SS disease severity, the Voice-Related Quality of Life (V-RQOL), and the general health-related quality of life Short Form 36 (SF-36) questionnaires. Relationships among voice symptoms, disease severity, and quality-of-life measures were examined and compared with patient-reported voice disorders. RESULTS Significant correlations were observed among voice symptoms, disease severity, V-RQOL, SF-36, and patient-reported voice disorders (P < .05). Patients with SS who reported a voice disorder experienced a greater burden on general quality of life as compared with those without voice disorders. Specific voice symptoms significantly correlated with reduced SF-36 scores included frequent throat-clearing, throat soreness, difficulty projecting, and vocal discomfort. Despite the added burden of a voice disorder on quality of life in SS, voice-related treatment seeking was low (15.8%). However, the majority of patients who received voice treatment reported voice improvement. CONCLUSIONS Individuals with SS frequently experience voice disorders and specific voice-related symptoms that are associated with reduced quality of life. These findings have important implications for voice referral practices and voice disorder symptom management in this population.
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Affiliation(s)
- Kristine Tanner
- Department of Communication Disorders, Brigham Young University, Provo, UT, USA
| | - Jenny L Pierce
- Department of Communication Sciences & Disorders, The University of Utah, Salt Lake City, UT, USA
| | - Ray M Merrill
- Department of Health Science, Brigham Young University, Provo, UT, USA
| | - Karla L Miller
- Division of Rheumatology, The University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Katherine A Kendall
- Division of Otolaryngology, Head & Neck Surgery, The University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Nelson Roy
- Department of Communication Sciences & Disorders, The University of Utah, Salt Lake City, UT, USA
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22
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Tanner K, Nissen SL, Merrill RM, Miner A, Channell RW, Miller KL, Elstad M, Kendall KA, Roy N. Nebulized isotonic saline improves voice production in Sjögren's syndrome. Laryngoscope 2015; 125:2333-40. [PMID: 25781583 DOI: 10.1002/lary.25239] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 01/12/2015] [Accepted: 02/09/2015] [Indexed: 12/15/2022]
Abstract
OBJECTIVE This study examined the effects of a topical vocal fold hydration treatment on voice production over time. STUDY DESIGN Prospective, longitudinal, within-subjects A (baseline), B (treatment), A (withdrawal/reversal), B (treatment) experimental design. METHODS Eight individuals with primary Sjögren's syndrome (SS), an autoimmune disease causing laryngeal dryness, completed an 8-week A-B-A-B experiment. Participants performed twice-daily audio recordings of connected speech and sustained vowels and then rated vocal effort, mouth dryness, and throat dryness. Two-week treatment phases introduced twice-daily 9-mL doses of nebulized isotonic saline (0.9% Na(+)Cl(-)). Voice handicap and patient-based measures of SS disease severity were collected before and after each 2-week phase. Connected speech and sustained vowels were analyzed using the Cepstral Spectral Index of Dysphonia (CSID). Acoustic and patient-based ratings during each baseline and treatment phase were analyzed and compared. RESULTS Baseline CSID and patient-based ratings were in the mild-to-moderate range. CSID measures of voice severity improved by approximately 20% with nebulized saline treatment and worsened during treatment withdrawal. Posttreatment CSID values fell within the normal-to-mild range. Similar patterns were observed in patient-based ratings of vocal effort and dryness. CSID values and patient-based ratings correlated significantly (P < .05). CONCLUSION Nebulized isotonic saline improves voice production based on acoustic and patient-based ratings of voice severity. Future work should optimize topical vocal fold hydration treatment formulations, dose, and delivery methodologies for various patient populations. This study lays the groundwork for future topical vocal fold hydration treatment development to manage and possibly prevent dehydration-related voice disorders. LEVEL OF EVIDENCE 2b.
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Affiliation(s)
- Kristine Tanner
- Department of Communication Disorders, Brigham Young University, Provo; the Division of Rheumatology, Salt Lake City, Utah, U.S.A
| | - Shawn L Nissen
- Department of Communication Disorders, Brigham Young University, Provo; the Division of Rheumatology, Salt Lake City, Utah, U.S.A
| | - Ray M Merrill
- Department of Health Science, Brigham Young University, Provo; the Division of Rheumatology, Salt Lake City, Utah, U.S.A
| | - Alison Miner
- Department of Communication Disorders, Brigham Young University, Provo; the Division of Rheumatology, Salt Lake City, Utah, U.S.A
| | - Ron W Channell
- Department of Communication Disorders, Brigham Young University, Provo; the Division of Rheumatology, Salt Lake City, Utah, U.S.A
| | - Karla L Miller
- Department of Health Science, Brigham Young University, Provo; the Division of Rheumatology, Salt Lake City, Utah, U.S.A
| | - Mark Elstad
- Division of Respiratory, Critical Care and Occupational Pulmonary Medicine, Salt Lake City, Utah, U.S.A.,George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah, U.S.A
| | - Katherine A Kendall
- Division of Otolaryngology, Head and Neck Surgery, The University of Utah School of Medicine, Salt Lake City, Utah, U.S.A
| | - Nelson Roy
- Department of Communication Sciences and Disorders, The University of Utah, Salt Lake City, Utah, U.S.A
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Pierce JL, Tanner K, Merrill RM, Miller KL, Ambati BK, Kendall KA, Roy N. Voice disorders in Sjögren's syndrome: Prevalence and related risk factors. Laryngoscope 2014; 125:1385-92. [DOI: 10.1002/lary.25112] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 11/18/2014] [Accepted: 12/01/2014] [Indexed: 11/08/2022]
Affiliation(s)
- Jenny L. Pierce
- Department of Communication Sciences and Disorders; The University of Utah; Salt Lake City Utah U.S.A
| | - Kristine Tanner
- Department of Communication Disorders; Brigham Young University; Provo Utah U.S.A
| | - Ray M. Merrill
- Department of Health Science; Brigham Young University; Provo Utah U.S.A
| | - Karla L. Miller
- Division of Rheumatology; Department of Internal Medicine; The University of Utah; Salt Lake City Utah U.S.A
| | - Bala K. Ambati
- Department of Ophthalmology and Visual Sciences; The University of Utah; Salt Lake City Utah U.S.A
| | - Katherine A. Kendall
- Department of Surgery; Division of Otolaryngology-Head and Neck Surgery; The University of Utah; Salt Lake City Utah U.S.A
| | - Nelson Roy
- Department of Communication Sciences and Disorders; The University of Utah; Salt Lake City Utah U.S.A
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Abstract
OBJECTIVES/HYPOTHESIS The purpose of this study was to investigate the effect of emotional expression on several acoustic measures of vibrato, including its rate, extent, and steadiness. We hypothesized that singing a passage with emotional content would influence these variables. STUDY DESIGN This study used a within-subjects, repeated-measures design. Singer performance under different conditions was analyzed. METHODS Ten graduate student singers (eight women, two men) completed a series of tasks including sustained sung vowels at several pitch and loudness levels, an assigned song that was judged to have relatively neutral emotion, and a personal selection that included passages of intense emotion. Vowel tokens were extracted from the recordings and averaged for each task. Dependent measures included the mean fundamental frequency (F0), mean intensity, frequency modulation (FM) rate, FM extent, and measures of FM rate and extent variability. RESULTS The FM rate and extent were higher and the modulation variability was lower for the more emotional song than for the sustained vowels. Mean F0 and intensity were higher for the emotional song than for the neutral song. CONCLUSIONS Singing an emotional passage influences acoustic features of vibrato when compared with isolated, sustained vowels. The wider dynamic and pitch ranges for emotional passages only partly explain vibrato differences between emotional and neutral singing.
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Affiliation(s)
- Christopher Dromey
- Department of Communication Disorders, Brigham Young University, Provo, Utah.
| | - Sharee O Holmes
- Department of Communication Disorders, Brigham Young University, Provo, Utah
| | | | - Kristine Tanner
- Department of Communication Disorders, Brigham Young University, Provo, Utah
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Johnson J, Ascierto ML, Newsome D, Mittal S, Kang L, Briggs M, Tanner K, Berens ME, Marincola FM, Vande Woude GF, Xie Q. BI-14 * GENOMIC PROFILING OF A PREDICTIVE SIGNATURE FOR MET-TARGETED THERAPY IN GLIOBLASTOMA. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou239.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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26
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Kendall KA, Tanner K, Kosek SR. Timing of events during deglutition after chemoradiation therapy for oropharyngeal carcinoma. Head Neck 2014; 37:1193-9. [DOI: 10.1002/hed.23735] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2013] [Revised: 01/27/2014] [Accepted: 04/29/2014] [Indexed: 11/08/2022] Open
Affiliation(s)
| | - Kristine Tanner
- Department of Communication Disorders; Brigham Young University; Provo Utah
- Voice Disorders Center; University of Utah; Salt Lake City Utah
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Heller A, Tanner K, Roy N, Nissen SL, Merrill RM, Miller KL, Houtz DR, Ellerston J, Kendall K. Voice, Speech, and Laryngeal Features of Primary Sjögren’s Syndrome. Ann Otol Rhinol Laryngol 2014; 123:778-85. [DOI: 10.1177/0003489414538762] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Objective: This study examined voice, speech, and laryngeal characteristics in primary Sjögren’s syndrome (pSS). Methods: Eleven patients (10 female, 1 male; mean [SD] age = 57 [14] years) from The University of Utah Division of Rheumatology provided connected speech and sustained vowel samples. Analyses included the Multi-Dimensional Voice Profile, the Analysis of Dysphonia in Speech and Voice, and dysphonia severity, speech clarity, and videolaryngostroboscopy ratings. Results: Shimmer, amplitude perturbation quotient, and average fundamental frequency differed significantly from normative values ( P < .01). Cepstral Spectral Index of Dysphonia values indicated mild-to-moderate dysphonia in connected speech (mean [SD] = 20.26 [8.36]) and sustained vowels (mean [SD] = 16.91 [11.08]). Ratings of dysphonia severity and speech clarity using 10-cm visual analog scales suggested mild-to-moderate dysphonia in connected speech (mean [SD] = 2.11 [1.72]) and sustained vowels (mean [SD] = 3.13 [2.20]) and mildly reduced speech clarity (mean [SD] = 1.46 [1.36]). Videolaryngostroboscopic ratings indicated mild-to-moderate dryness and mild reductions in overall laryngeal function. Voice Handicap Index scores indicated mild-to-moderate voice symptoms (mean [SD] = 43 [23]). Conclusion: Individuals with pSS may experience dysphonia and articulatory imprecision, typically in the mild-to-moderate range. These findings have implications for diagnostic and referral practices in pSS.
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Affiliation(s)
- Amanda Heller
- Department of Communication Sciences & Disorders, The University of Utah, Salt Lake City, Utah, USA
- Voice Disorders Center, The University of Utah, Salt Lake City, Utah, USA
| | - Kristine Tanner
- Voice Disorders Center, The University of Utah, Salt Lake City, Utah, USA
- Department of Communication Disorders, Brigham Young University, Provo, Utah, USA
| | - Nelson Roy
- Department of Communication Sciences & Disorders, The University of Utah, Salt Lake City, Utah, USA
- Voice Disorders Center, The University of Utah, Salt Lake City, Utah, USA
| | - Shawn L. Nissen
- Department of Communication Disorders, Brigham Young University, Provo, Utah, USA
| | - Ray M. Merrill
- Department of Health Science, Brigham Young University, Provo, Utah, USA
| | - Karla L. Miller
- Division of Rheumatology, The University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Daniel R. Houtz
- Voice Disorders Center, The University of Utah, Salt Lake City, Utah, USA
| | - Julia Ellerston
- Voice Disorders Center, The University of Utah, Salt Lake City, Utah, USA
| | - Katherine Kendall
- Voice Disorders Center, The University of Utah, Salt Lake City, Utah, USA
- Division of Otolaryngology–Head & Neck Surgery, The University of Utah School of Medicine, Salt Lake City, Utah, USA
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28
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Ibison K, Roden K, Tanner K, Hancock J, Morgan A. 71 Twelve months experience of a telephone clinic follow up service for incidental pulmonary nodules. Lung Cancer 2014. [DOI: 10.1016/s0169-5002(14)70071-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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29
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Kendall KA, Kosek SR, Tanner K. Quality-of-life scores compared to objective measures of swallowing after oropharyngeal chemoradiation. Laryngoscope 2013; 124:682-7. [DOI: 10.1002/lary.24344] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 07/15/2013] [Accepted: 07/15/2013] [Indexed: 11/12/2022]
Affiliation(s)
| | - Steven R. Kosek
- Department of Speech Language Pathology; Minneapolis VA Medical Center; Minneapolis Minnesota
| | - Kristine Tanner
- Voice Disorders Center; University of Utah; Salt Lake City Utah
- Department of Communication Disorders; Brigham Young University; Provo Utah U.S.A
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Tanner K, Roy N, Merrill RM, Kendall K, Miller KL, Clegg DO, Heller A, Houtz DR, Elstad M. Comparing nebulized water versus saline after laryngeal desiccation challenge in Sjögren's Syndrome. Laryngoscope 2013; 123:2787-92. [DOI: 10.1002/lary.24148] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Revised: 03/20/2013] [Accepted: 03/20/2013] [Indexed: 11/11/2022]
Affiliation(s)
- Kristine Tanner
- Department of Communication Disorders; Brigham Young University; Salt Lake City Utah U.S.A
- Voice Disorders Center; Salt Lake City Utah U.S.A
| | - Nelson Roy
- Voice Disorders Center; Salt Lake City Utah U.S.A
- Department of Communication Sciences and Disorders; Salt Lake City Utah U.S.A
| | - Ray M. Merrill
- Department of Health Science (R.M.M.); Brigham Young University; Salt Lake City Utah U.S.A
| | - Katherine Kendall
- Voice Disorders Center; Salt Lake City Utah U.S.A
- Division of Otolaryngology-Head and Neck Surgery; Salt Lake City Utah U.S.A
| | | | | | - Amanda Heller
- Voice Disorders Center; Salt Lake City Utah U.S.A
- Department of Communication Sciences and Disorders; Salt Lake City Utah U.S.A
| | | | - Mark Elstad
- Division of Respiratory, Critical Care and Occupational Pulmonary Medicine (M.E.); The University of Utah; Salt Lake City Utah U.S.A
- George E. Wahlen Department of Veterans Affairs Medical Center; Salt Lake City Utah U.S.A
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Morgan A, Roden K, Tanner K. 102 The importance of clinical triage of lung cancer referrals – a retrospective audit. Lung Cancer 2013. [DOI: 10.1016/s0169-5002(13)70102-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Recently research offers new insights into the pathogenesis, pathophysiology, and socioemotional implications of spasmodic dysphonia (SD). Among these advances are epidemiologic studies clarifying (1) SD onset and course, (2) SD risk factors, and (3) the relationships among SD course, treatment, and psychosocial impact. In this paper, I will provide a summary of recent epidemiologic and socioemotional research advances involving the onset, course, risk factors, and psychosocial impact of SD.
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Affiliation(s)
- Kristine Tanner
- Department of Communication Disorders, Brigham Young University Provo, Utah
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33
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Yang FH, Zhang B, Zhou DJ, Bie L, Tom MW, Drummond DC, Nicolaides T, Mueller S, Banerjee A, Park JW, Prados MD, James DC, Gupta N, Hashizume R, Strohbehn GW, Zhou J, Fu M, Patel TR, Piepmeier JM, Saltzman WM, Xie Q, Johnson J, Bradley R, Ascierto ML, Kang L, Koeman J, Marincola FM, Briggs M, Tanner K, Vande Woude GF, Tanaka S, Klofas LK, Wakimoto H, Borger DR, Iafrate AJ, Batchelor TT, Chi AS, Madhankumar AB, Slagle-Webb B, Rizk E, Harbaugh K, Connor JR, Sarkar G, Curran GL, Jenkins RB, Kurozumi K, Ichikawa T, Onishi M, Fujii K, Ishida J, Shimazu Y, Date I, Ebsworth K, Walters MJ, Ertl LS, Wang Y, Berahovich RD, Zhang P, Powers JP, Liu SC, Al Omran R, Sullivan TJ, Jaen JC, Brown M, Schall TJ, Yusuke N, Shimizu S, Shishido-Hara Y, Shiokawa Y, Nagane M, Wang J, Sai K, Chen FR, Chen ZP, Shi Z, Zhang J, Zhang K, Han L, Chen L, Qian X, Zhang A, Wang G, Jia Z, Pu P, Kang C, Kong LY, Doucette TA, Ferguson SD, Hachem J, Yang Y, Wei J, Priebe W, Fuller GN, Qiao W, Rao G, Heimberger AB, Chen PY, Ozawa T, Drummond D, Santos R, Torre JD, Ng C, Lepe EL, Butowski N, Prados M, Bankiewicz K, James CD, Cheng Z, Gong Y, Ma Y, Muller-Knapp S, Knapp S, Wang J, Fujii K, Kurozumi K, Ichikawa T, Onishi M, Shimazu Y, Ishida J, Antonio Chiocca E, Kaur B, Date I, Yu JS, Judkowski V, Bunying A, Ji J, Li Z, Bender J, Pinilla C, Srinivasan V, Dombovy-Johnson M, Carson-Walter E, Walter K, Xu Z, Popp B, Schlesinger D, Gray L, Sheehan J, Keir ST, Friedman HS, Bigner DD, Kut C, Tyler B, McVeigh E, Li X, Herzka D, Grossman S, Lasky JL, Wang Y, Panosyan E, Meisen WH, Hardcastle J, Wojton J, Wohleb E, Alvarez-Breckenridge C, Nowicki M, Godbout J, Kaur B, Lee SY, Slagle-Webb B, Sheehan JM, Connor JR, Yin S, Kaluz S, Devi SN, de Noronha R, Nicolaou KC, Van Meir EG, Lachowicz JE, Demeule M, Che C, Tripathy S, Jarvis S, Currie JC, Regina A, Nguyen T, Castaigne JP, Zielinska-Chomej K, Mohanty C, Viktorsson K, Lewensohn R, Driscoll JJ, Alsidawi S, Warnick RE, Rixe O, deCarvalho AC, Irtenkauf S, Hasselbach L, Xin H, Mikkelsen T, Sherman JH, Siu A, Volotskova O, Keidar M, Gibo DM, Dickinson P, Robertson J, Rossmeisl J, Debinski W, Nair S, Schmittling R, Boczkowski D, Archer G, Bigner DD, Sampson JH, Mitchell DA, Miller IS, Didier S, Murray DW, Issaivanan M, Coniglio SJ, Segall JE, Al-Abed Y, Symons M, Fotovati A, Hu K, Wakimoto H, Triscott J, Bacha J, Brown DM, Dunn SE, Daniels DJ, Peterson TE, Dietz AB, Knutson GJ, Parney IF, Diaz RJ, Golbourn B, Picard D, Smith C, Huang A, Rutka J, Saito N, Fu J, Yao J, Wang S, Koul D, Yung WKA, Fu J, Koul D, Yao J, Wang S, Yuan Y, Sulman EP, Colman H, Lang FF, Yung WKA, Slat EA, Herzog ED, Rubin JB, Brown M, Carminucci AS, Amendolara B, Leung R, Lei L, Canoll P, Bruce JN, Wojton JA, Chu Z, Kwon CH, Chow LM, Palascak M, Franco R, Bourdeau T, Thornton S, Qi X, Kaur B, Kitange GJ, Mladek AC, Su D, Carlson BL, Schroeder MA, Pokorny JL, Bakken KK, Gupta SK, Decker PA, Wu W, Sarkaria JN, Colman H, Oddou MP, Mollard A, Call LT, Vakayalapati H, Warner SL, Sharma S, Bearss DJ, Chen TC, Cho H, Wang W, Hofman FM, Flores CT, Snyder D, Sanchez-Perez L, Pham C, Friedman H, Bigner DD, Sampson JH, Mitchell DA, Woolf E, Abdelwahab MG, Turner G, Preul MC, Lynch A, Rho JM, Scheck AC, Salphati L, Heffron TP, Alicke B, Barck K, Carano RA, Cheong J, Greve J, Lee LB, Nishimura M, Pang J, Plise EG, Reslan HB, Zhang X, GOuld SG, Olivero AG, Phillips HS, Zadeh G, Jalali S, Voce D, Wei Z, Shijun K, Nikolai K, Josh W, Clayton C, Bakhtiar Y, Alkins R, Burgess A, Ganguly M, Wels W, Hynynen K, Li YM, Jun H, Daniel V, Walter HA, Nakashima H, Nguyen TT, Shalkh I, Goins WF, Chiocca EA, Pyko IV, Nakada M, Furuyama N, Lei T, Hayashi Y, Kawakami K, Minamoto T, Fedulau AS, Hamada JI. LAB-EXPERIMENTAL (PRE-CLINICAL) THERAPEUTICS AND PHARMACOLOGY. Neuro Oncol 2012; 14:vi25-vi37. [PMCID: PMC3488776 DOI: 10.1093/neuonc/nos222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2023] Open
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Tanner K, Roy N, Merrill RM, Sauder C, Houtz DR, Smith ME. Case-control study of risk factors for spasmodic dysphonia: A comparison with other voice disorders. Laryngoscope 2012; 122:1082-92. [PMID: 22253036 DOI: 10.1002/lary.22471] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2011] [Revised: 10/23/2011] [Accepted: 10/26/2011] [Indexed: 11/08/2022]
Affiliation(s)
- Kristine Tanner
- Department of Communication Sciences and Disorders, The University of Utah, Salt Lake City, Utah, USA.
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35
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Tanner K, Roy N, Merrill RM, Sauder C, Houtz DR, Smith ME. Spasmodic dysphonia: onset, course, socioemotional effects, and treatment response. Ann Otol Rhinol Laryngol 2011; 120:465-73. [PMID: 21859056 DOI: 10.1177/000348941112000708] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES This investigation explored the onset, progression, socioemotional effects, and treatment outcomes of spasmodic dysphonia (SD). METHODS A cross-sectional epidemiological approach was used to examine questionnaire responses from 150 individuals with SD. RESULTS Symptoms of SD (mean age at onset, 46 years) began gradually in 76% of cases and were progressive (ie, failed to plateau) in 34% of cases. Botulinum toxin A (Botox) helped to attenuate voice symptoms in 91% of cases; however, the scores on the Voice-Related Quality of Life questionnaire (V-RQOL) were not associated with this effect. The V-RQOL scores improved with time since symptom onset, independent of age and treatment. The patients with only SD experienced onset, course, and progression of symptoms similar to those of the patients with SD and coexisting vocal tremor. CONCLUSIONS The symptoms of SD begin gradually and worsen over time. New evidence indicates that SD symptoms may continue to progress without plateau in at least a subset of patients. Individuals with SD and coexisting vocal tremor experience symptom trajectories similar to those of patients with SD only. Although Botox may attenuate voice symptoms, these effects do not appear to be strongly related to the V-RQOL scores. These results provide new and valuable insights regarding the onset, course, progression, and treatment of SD.
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Affiliation(s)
- Kristine Tanner
- Department of Communication Sciences and Disorders, the Division of Otolaryngology-Head and Neck Surgery, and the Voice Disorders Center, The University of Utah, Salt Lake City, UT 84108, USA
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36
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Lewis JP, Fisch AS, Ryan K, O'Connell JR, Gibson Q, Mitchell BD, Shen H, Tanner K, Horenstein RB, Pakzy R, Tantry US, Bliden KP, Gurbel PA, Shuldiner AR. Paraoxonase 1 (PON1) gene variants are not associated with clopidogrel response. Clin Pharmacol Ther 2011; 90:568-74. [PMID: 21881565 DOI: 10.1038/clpt.2011.194] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
A common functional variant in paraoxonase 1 (PON1), Q192R, was recently reported to be a major determinant of clopidogrel response. This variant was genotyped in 566 participants of the Amish Pharmacogenomics of Anti-Platelet Intervention (PAPI) study and in 227 percutaneous coronary intervention (PCI) patients. Serum paraoxonase activity was measured in a subset of 79 PAPI participants. PON1 Q192R was not associated with pre- or post-clopidogrel platelet aggregation in the PAPI study (P = 0.16 and P = 0.21, respectively) or the PCI cohort (P = 0.47 and P = 0.91, respectively). The Q192 allele was not associated with cardiovascular events (hazard ratio (HR) 0.46, 95% confidence interval (CI) 0.20-1.06; P = 0.07). No correlation was observed between paraoxonase activity and post-clopidogrel platelet aggregation (r(2) < 0.01, P = 0.78). None of 49 additional PON1 variants evaluated was associated with post-clopidogrel platelet aggregation. These findings do not support a role for PON1 as a determinant of clopidogrel response.
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Affiliation(s)
- J P Lewis
- Division of Endocrinology, Diabetes and Nutrition, University of Maryland School of Medicine, Baltimore, Maryland, USA
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Abstract
Studies suggest that occupational voice users have a greater incidence of vocal issues than the general population. Women have been found to experience vocal health problems more frequently than men, regardless of their occupation. Traditionally, it has been assumed that differences in the laryngeal system are the cause of this disproportion. Nevertheless, it is valuable to identify other potential gender distinctions which may make women more vulnerable to voice disorders. A search of the literature was conducted for gender-specific characteristics which might impact the vocal health of women. This search can be used by health care practitioners to help female patients avoid serious vocal health injuries, as well as to treat better those women who already suffer from such vocal health issues.
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Affiliation(s)
- Eric J Hunter
- National Center for Voice and Speech at the University of Utah, Salt Lake City, USA.
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38
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Tanner K, Roy N, Merrill RM, Muntz F, Houtz DR, Sauder C, Elstad M, Wright-Costa J. Nebulized isotonic saline versus water following a laryngeal desiccation challenge in classically trained sopranos. J Speech Lang Hear Res 2010; 53:1555-1566. [PMID: 20699338 DOI: 10.1044/1092-4388(2010/09-0249)] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
PURPOSE To examine the effects of nebulized isotonic saline (IS) versus sterile water (SW) on self-perceived phonatory effort (PPE) and phonation threshold pressure (PTP) following a surface laryngeal dehydration challenge in classically trained sopranos. METHOD In a double-blind, within-subject crossover design, 34 sopranos breathed dry air (relative humidity < 1%) transorally for 15 min and then nebulized 3 mL of IS or SW, or experienced a no-treatment control condition over 3 consecutive weeks. PPE and PTP were measured every 15 min from baseline through 2 hr postdesiccation. RESULTS PPE increased significantly following the laryngeal desiccation challenge in all 3 treatment conditions (p < .01). After nebulization, PPE returned to baseline for the IS condition only. For the SW and control conditions, PPE remained above baseline during the 2 hr after desiccation. No statistically significant changes in PTP following laryngeal desiccation were observed, although values for the IS condition remained below baseline for nearly 2 hr after nebulization. PPE and PTP were not significantly correlated. CONCLUSIONS Following a laryngeal surface dehydration challenge, classically trained sopranos reported increased vocal effort that persisted for at least 2 hr. Compared with SW, nebulized IS showed promise as an effective way to remediate the adverse, self-perceived effects of laryngeal desiccation.
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Affiliation(s)
- Kristine Tanner
- Department of Communication Sciences and Disorders, Division of Otolaryngology-Head & Neck Surgery, The University of Utah, Salt Lake City, UT 84112, USA.
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Sauder C, Roy N, Tanner K, Houtz DR, Smith ME. Vocal Function Exercises for Presbylaryngis: A Multidimensional Assessment of Treatment Outcomes. Ann Otol Rhinol Laryngol 2010; 119:460-7. [DOI: 10.1177/000348941011900706] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives Presbylaryngis, or aging of the larynx, can adversely affect vocal function and quality of life in the elderly. This preliminary investigation examined the effects of vocal function exercises, a physiologic voice therapy approach, as a primary treatment for presbylaryngis. Methods Nine consecutive elderly patients with presbylaryngis (2 female, 7 male) underwent a 6-week course of voice therapy employing vocal function exercises. Pretherapy-versus-posttherapy comparisons were made of self-ratings of voice handicap and phonatory effort level, as well as auditory-perceptual voice assessments, acoustic analyses, and visual-perceptual evaluations of laryngeal images. Results After treatment, patients reported significant reductions on Voice Handicap Index scores, phonatory effort levels, and voice disorder severity. Blinded listeners rated the posttreatment voices as significantly less breathy and strained. However, comparison of pretreatment and posttreatment maximum phonation times, acoustic measures, and laryngeal images did not reveal significant changes. Conclusions These preliminary data suggest that vocal function exercises produce significant functional and perceptual improvements in voice, and deserve further attention as a treatment for elderly patients with presbylaryngis.
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Affiliation(s)
- Cara Sauder
- University of Utah Voice Disorders Center, University Hospitals and Clinics, University of Utah, Salt Lake City, Utah
| | - Nelson Roy
- Department of Communication Sciences and Disorders, University of Utah, Salt Lake City, Utah
| | - Kristine Tanner
- University of Utah Voice Disorders Center, University Hospitals and Clinics, University of Utah, Salt Lake City, Utah
| | - Daniel R. Houtz
- University of Utah Voice Disorders Center, University Hospitals and Clinics, University of Utah, Salt Lake City, Utah
| | - Marshall E. Smith
- Division of Otolaryngology–Head and Neck Surgery, University of Utah, Salt Lake City, Utah
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Tanner K, Roy N, Merrill RM, Kimber K, Sauder C, Houtz DR, Doman D, Smith ME. Risk and protective factors for spasmodic dysphonia: a case-control investigation. J Voice 2010; 25:e35-46. [PMID: 20171836 DOI: 10.1016/j.jvoice.2009.09.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2009] [Accepted: 09/22/2009] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Spasmodic dysphonia (SD) is a chronic, incurable, and often disabling voice disorder of unknown pathogenesis. The purpose of this study was to identify possible endogenous and exogenous risk and protective factors uniquely associated with SD. STUDY DESIGN Prospective, exploratory, case-control investigation. METHODS One hundred fifty patients with SD and 150 medical controls (MCs) were interviewed regarding their personal and family histories, environmental exposures, illnesses, injuries, voice use patterns, and general health using a previously vetted and validated epidemiologic questionnaire. RESULTS Odds ratios and multiple logistic regression analyses (α<0.15) identified several factors that significantly increased the likelihood of having SD. These factors included (1) a personal history of mumps, blepharospasm, tremor, intense occupational and avocational voice use, and a family history of voice disorders; (2) an immediate family history of meningitis, tremor, tics, cancer, and compulsive behaviors; and (3) an extended family history of tremor and cancer. CONCLUSIONS SD is likely multifactorial in etiology, involving both genetic and environmental factors. Viral infections/exposures, along with intense voice use, may trigger the onset of SD in genetically predisposed individuals. Future studies should examine the interaction among genetic and environmental factors to determine the pathogenesis of SD.
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Affiliation(s)
- Kristine Tanner
- Voice Disorders Center, The University of Utah, Salt Lake City, Utah 84108, USA.
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Abstract
PURPOSE This investigation examined the effects of nebulized hypertonic saline, isotonic saline (IS), and sterile (hypotonic) water on phonation threshold pressure (PTP) and self-perceived phonatory effort (PPE) following a surface laryngeal dehydration challenge. METHOD In a double-blind, randomized experimental trial, 60 vocally healthy women (n = 15 per group) underwent a laryngeal desiccation challenge involving oral breathing for 15 min using medical-grade dry air (RH<1%). Three of the four groups then received nebulized isotonic saline (0.9% NaCl), hypertonic saline (7% NaCl), or sterile (hypotonic) water, respectively; the 4th group served as a nontreatment control. PTP and PPE were estimated for high-pitched productions at baseline, immediately postdesiccation, and at 5, 20, 35, and 50 min postnebulization. RESULTS PTP increased significantly for all groups following the desiccation challenge. PTP values were, on average, 0.5 cm H(2)O greater immediately postdesiccation versus baseline. In contrast, PTP values did not change significantly following the administration of nebulized treatments, although a temporary trend toward a reduction in PTP was observed for the IS group. Unexpectedly, PPE ratings decreased significantly after the desiccation challenge. In general, PPE ratings were poorly correlated with PTP measures. CONCLUSION A laryngeal desiccation challenge (i.e., temporary exposure to extremely low relative humidity while breathing transorally) significantly increased PTP. Although interesting trends emerged, none of the nebulized treatments significantly enhanced recovery from the negative effects of desiccation on PTP. In light of very low correlations between PTP and PPE, serious questions are raised regarding presumed associations between these measures.
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Affiliation(s)
- Kristine Tanner
- Department of Communication Sciences and Disorders, University of Utah, 390 South 1530 East, Room 1201 BEH SCI, Salt Lake City, UT 84112-0252, USA.
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Tanner K, Roy N, Merrill RM, Power D. Velopharyngeal port status during classical singing. J Speech Lang Hear Res 2005; 48:1311-24. [PMID: 16478373 DOI: 10.1044/1092-4388(2005/091)] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2004] [Revised: 03/03/2005] [Accepted: 04/28/2005] [Indexed: 05/06/2023]
Abstract
PURPOSE This investigation was undertaken to examine the status of the velopharyngeal (VP) port during classical singing. METHOD Using aeromechanical instrumentation, nasal airflow (mL/s), oral pressure (cm H2O), and VP orifice area estimates (cm2) were studied in 10 classically trained sopranos during singing and speaking. Each participant sang and spoke 3 nonsense words-/hampa/, /himpi/, and /humpu/-at 3 loudness levels (loud vs. comfortable vs. soft) and 3 pitches (high vs. comfortable vs. low), using a within-subject experimental design including all possible combinations. RESULTS In general, nasal airflow, oral pressure, and VP area estimates were significantly greater for singing as compared to speech, and nasal airflow was observed during non-nasal sounds in all participants. Anticipatory nasal airflow was observed in 9 of 10 participants for singing and speaking and was significantly greater during the first vowel in /hampa/ versus /himpi/ and /humpu/. The effect of vowel height on nasal airflow was also significantly influenced by loudness and pitch. CONCLUSIONS The results from this investigation indicate that at least some trained singers experience regular VP opening during classical singing. Vowel height seems to influence this effect. Future research should consider the effects of voice type, gender, experience level, performance ability, and singing style on VP valving in singers.
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Affiliation(s)
- Kristine Tanner
- Department of Communication Sciences and Disorders, The University of Utah, Salt Lake City 84112-0252, USA.
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Tanner K, Roy N, Ash A, Buder EH. Spectral moments of the long-term average spectrum: sensitive indices of voice change after therapy? J Voice 2005; 19:211-22. [PMID: 15907436 DOI: 10.1016/j.jvoice.2004.02.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2004] [Indexed: 11/20/2022]
Abstract
Voice clinicians require an objective, reliable, and relatively automatic method to assess voice change after medical, surgical, or behavioral intervention. This measure must be sensitive to a variety of voice qualities and severities, and preferably should reflect voice in continuous speech. The long-term average spectrum (LTAS) is a fast Fourier transform-generated power spectrum whose properties can be compared with a Gaussian bell curve using spectral moments analysis. Four spectral moments describe features of the LTAS: Spectral mean (Moment 1) and standard deviation (Moment 2) represent the spectrum's central tendency and dispersion, respectively. Skewness (based on Moment 3) and kurtosis (based on Moment 4) represent the spectrum's tilt and peakedness, respectively. To examine whether the first four spectral moments of the LTAS were sensitive to perceived voice improvement after voice therapy, this investigation compared pretreatment and posttreatment voice samples of 93 patients with functional dysphonia using spectral moments analysis. Inspection of the results revealed that spectral mean and standard deviation lowered significantly with perceived voice improvement after successful behavioral management (p < 0.001). However, changes in skewness and kurtosis were not significant. Furthermore, lowering of the spectral mean uniquely accounted for approximately 14% of the variance in the pretreatment to posttreatment changes observed in perceptual ratings of voice severity (p < 0.001), indicating that spectral mean (ie, Moment 1) of the LTAS may be one acoustic marker sensitive to improvement in dysphonia severity.
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Affiliation(s)
- Kristine Tanner
- Department of Communication Disorders, The University of Utah, Salt Lake City, Utah 84112-0252, USA.
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Brown KL, Walker G, Grant DJ, Tanner K, Ridout DA, Shekerdemian LS, Smith JH, Davis C, Firmin RK, Goldman AP. Predicting outcome in ex-premature infants supported with extracorporeal membrane oxygenation for acute hypoxic respiratory failure. Arch Dis Child Fetal Neonatal Ed 2004; 89:F423-7. [PMID: 15321962 PMCID: PMC1721757 DOI: 10.1136/adc.2003.033308] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To identify predictors of outcome in ex-premature infants supported with extracorporeal membrane oxygenation (ECMO) for acute hypoxic respiratory failure. METHODS Retrospective review of ex-premature infants with acquired acute hypoxic respiratory failure requiring ECMO support in the United Kingdom from 1992 to 2001. Review of follow up questionnaires completed by general practitioners and local paediatricians. RESULTS Sixty four ex-premature infants (5-10 each year) received ECMO support, despite increased use of advanced conventional treatments over the decade. The most common infective agent was respiratory syncytial virus (85% of cases). Median birth gestation was 29 weeks and median corrected age at the time of ECMO support was 42 weeks. Median ECMO support duration was relatively long, at 229 hours. Survival to hospital discharge and to 6 months was 80%, remaining similar throughout the period of review. At follow up, 60% had long term neurodisability and 79% had chronic pulmonary problems. Of pre-ECMO factors, baseline oxygen dependence, younger age, and inpatient status were associated with non-survival (p < or = 0.05). Of ECMO related factors, patient complications were independently associated with adverse neurodevelopmental outcome and death (p < 0.01). CONCLUSIONS Survival rates for ex-premature infants after ECMO support are favourable, but patients suffer a high burden of morbidity during intensive care and over the long term. At the time of ECMO referral, baseline oxygen dependence is the most important predictor of death, but no combination of the factors considered was associated with a mortality that would preclude ECMO support.
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Affiliation(s)
- K L Brown
- Cardiac Intensive Care Unit, Great Ormond Street Hospital for Children NHS Trust, London, UK
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Abstract
Clinicians frequently offer advice to performers and voice-disordered patients aimed ostensibly to manipulate the water content and/or viscosity of the mucus blanket covering the vocal folds. To evaluate the relative effects of three potential laryngeal lubricants on phonatory function (ie, water, Mannitol--an osmotic agent, and Entertainer's Secret Throat Relief (Kli Corp., Carmel, IN)--a glycerin-based product), phonation threshold pressure (PTP) was measured in 18 healthy, vocally normal female participants twice before (baseline) and then four times after 2 ml of each substance were nebulized. PTP is the minimum subglottal pressure required to initiate vocal fold oscillation, and the lowering of PTP is assumed to correspond to physiologically more efficient phonation and reduced phonatory effort. Over a 3-week period, participants were tested on three separate occasions (at 1-week intervals). On each occasion, a different nebulized treatment was administered. PTP for both comfortable and high fundamental frequency productions was measured using an oral pressure-flow system (Perci-Sars, MicroTronics Corp., Chapel Hill, NC). Analysis of the results revealed that Mannitol, an agent that encourages osmotic water flux to the luminal airway surface, lowered PTP immediately after its administration (ie, p = 0.071, for high-pitched productions only). However, the duration of its PTP lowering effect was less than 20 minutes. The other two substances did not demonstrate any significant postadministration effect on PTP.
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Affiliation(s)
- Nelson Roy
- Department of Communication Disorders, The University of Utah, Salt Lake City 84112-0252, USA.
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Roy N, Weinrich B, Gray SD, Tanner K, Stemple JC, Sapienza CM. Three treatments for teachers with voice disorders: a randomized clinical trial. J Speech Lang Hear Res 2003; 46:670-688. [PMID: 14696994 DOI: 10.1044/1092-4388(2003/053)] [Citation(s) in RCA: 153] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Voice problems are a common occupational hazard of teaching school, yet few studies exist that have objectively evaluated treatment approaches aimed at rehabilitating these occupation-related voice disorders. This randomized clinical trial used patient-based treatment outcome measures to evaluate the effectiveness of three treatment programs. Sixty-four teachers with voice disorders were randomly assigned to 1 of 3 treatment groups: voice amplification using the ChatterVox portable amplifier (VA; n = 25), resonance therapy (RT; n = 19), and respiratory muscle training (RMT; n = 20). Before and after a 6-week treatment phase, all teachers completed (a) the Voice Handicap Index (VHI; B. H. Jacobson et al., 1997), an instrument designed to appraise the self-perceived psychosocial consequences of voice disorders, and (b) a voice severity self-rating scale. Both intention-to-treat and as-treated analyses revealed that only the VA and RT groups reported significant reductions in mean VHI scores and in voice severity self-ratings following treatment. Furthermore, results from a posttreatment questionnaire regarding the perceived benefits of treatment showed that compared to RT and RMT, teachers in the VA group reported significantly more overall voice improvement, greater vocal clarity, and greater ease of speaking and singing voice following treatment. These findings replicate previous results from an earlier clinical trial confirming the efficacy of VA and provide new evidence to support RT as an effective treatment alternative for voice problems in teachers. The results are discussed in the context of uneven levels of self-reported compliance and disparate dropout rates among the treatment groups.
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Affiliation(s)
- Nelson Roy
- Department of Communication Disorders, The University of Utah, Salt Lake City, Utah 84112-0252, USA.
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Affiliation(s)
- K Tanner
- Department of Paediatric Infectious Diseases and Immunology, Newcastle upon Tyne NE4 6BE
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Roy N, Weinrich B, Gray SD, Tanner K, Toledo SW, Dove H, Corbin-Lewis K, Stemple JC. Voice amplification versus vocal hygiene instruction for teachers with voice disorders: a treatment outcomes study. J Speech Lang Hear Res 2002; 45:625-638. [PMID: 12199394 DOI: 10.1044/1092-4388(2002/050)] [Citation(s) in RCA: 106] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Voice problems are common among schoolteachers. This prospective, randomized clinical trial used patient-based treatment outcomes measures combined with acoustic analysis to evaluate the effectiveness of two treatment programs. Forty-four voice-disordered teachers were randomly assigned to one of three groups: voice amplification using the ChatterVox portable amplifier (VA, n = 15), vocal hygiene (VH, n = 15), and a nontreatment control group (n = 14). Before and after a 6-week treatment phase, all teachers completed: (a) the Voice Handicap Index (VHI), an instrument designed to appraise the self-perceived psychosocial consequences of voice disorders; (b) a voice severity self-rating scale; and (c) an audiorecording for later acoustic analysis. Based on pre- and posttreatment comparisons, only the amplification group experienced significant reductions on mean VHI scores (p = .045), voice severity self-ratings (p = .012), and the acoustic measures of percent jitter (p = .031) and shimmer (p = .008). The nontreatment control group reported a significant increase in level of vocal handicap as assessed by the VHI (p = .012). Although most pre- to posttreatment changes were in the desired direction, no significant improvements were observed within the VH group on any of the dependent measures. Between-group comparisons involving the three possible pairings of the groups revealed a pattern of results to suggest that: (a) compared to the control group, both treatment groups (i.e., VA and VH) experienced significantly more improvement on specific outcomes measures and (b) there were no significant differences between the VA and VH groups to indicate superiority of one treatment over another. Results, however, from a posttreatment questionnaire regarding the perceived benefits of treatment revealed that, compared to the VH group, the VA group reported more clarity of their speaking and singing voice (p = .061), greater ease of voice production (p = .001), and greater compliance with the treatment program (p = .045). These findings clearly support the clinical utility of voice amplification as an alternative for the treatment of voice problems in teachers.
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Affiliation(s)
- Nelson Roy
- Department of Communication Disorders, The University of Utah, Salt Lake City 84112-0252, USA.
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Tanner K. [Dimensions of diseases]. Krankenpfl J 2000; 38:402-3. [PMID: 11272992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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Celi FS, Negri C, Tanner K, Raben N, De Pablo F, Rovira A, Pallardo LF, Martin-Vaquero P, Stern MP, Mitchell BD, Shuldiner AR. Molecular scanning for mutations in the insulin receptor substrate-1 (IRS-1) gene in Mexican Americans with Type 2 diabetes mellitus. Diabetes Metab Res Rev 2000; 16:370-7. [PMID: 11025561 DOI: 10.1002/1520-7560(2000)9999:9999<::aid-dmrr129>3.0.co;2-b] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Insulin receptor substrate-1 (IRS-1) is an endogenous substrate for the insulin receptor tyrosine kinase, which plays an important role in insulin signaling. Mutations in the IRS-1 gene are associated in some populations with obesity and Type 2 diabetes. METHODS To determine whether variation in the IRS-1 gene contributes to genetic susceptibility to insulin resistance and Type 2 diabetes in Mexican Americans, the entire coding region of the IRS-1 gene was screened for variation in 31 unrelated subjects with Type 2 diabetes using single-stranded conformational polymorphism analysis (SSCP) and dideoxy sequence analysis. Variants encoding amino acid substitutions were genotyped in 27 unrelated nondiabetic Mexican Americans and in all family members of subjects containing these variants, and association analyses were performed. To trace the ancestral origins of the variants, Iberian Caucasians and Pima Indians were also genotyped. RESULTS Eight single base changes were found: four silent polymorphisms and four missense mutations (Ala94Thr, Ala512Pro, Ser892Gly and Gly971Arg). Allele frequencies were 0.009, 0.017, 0.017 and 0.043, respectively. There were no significant associations of any of these variants with diabetes, glucose or insulin levels during an oral glucose tolerance test, or with body mass index (BMI) in Mexican American families except for a modest association between the Ala94Thr variant and decreased BMI (30.4 kg/m(2) vs 24.0 kg/m(2); p=0.035). None of these four missense mutations were detected in Pima Indians. In Iberian Caucasians, neither Ala94Thr nor Ser892Gly were detected, and Ala512Pro was detected in only 0/60 diabetic patients and 1/60 nondiabetic controls. Gly971Arg was relatively more common in Iberian Caucasians with 12/58 diabetic patients and 7/60 nondiabetic controls being heterozygous for this variant (p=0.21 for comparison between diabetic and nondiabetic subjects). CONCLUSIONS Ala94Thr, Ala512Pro and Ser892Gly mutation are rare in the populations studied. Gly971Arg, is more common in Mexican Americans and Caucasians, but is not a major contributor to genetic susceptibility to Type 2 diabetes.
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Affiliation(s)
- F S Celi
- Dipartimento di Medicina Sperimentale e Patologia, Università di Roma 'La Sapienza' Rome, Italy
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