Partial Cricotracheal Resection in Children: Potential Pitfalls and Avoidance of Complications.

OBJECTIVES: To delineate the various factors contributing to failure or delay in decannulation after partial cricotracheal resection (PCTR) in children. STUDY DESIGN: Case series. SETTING: Academic tertiary medical center. SUBJECTS AND METHODS: A retrospective case review of 100 children who underwent PCTR between 1978 and 2008 for severe subglottic stenosis using an ongoing database. RESULTS: Ninety of 100 (90%) patients were decannulated. Six patients needed secondary tracheostomy. The results of the preoperative evaluation showed grade II stenosis in four patients, grade III in 64 patients, and grade IV in 32 patients. The overall decannulation rate was 100 percent in grade II, 95 percent in grade III, and 78 percent in grade IV stenosis. Fourteen (14%) patients required revision open surgery. The most common cause of revision surgery was posterior glottic stenosis. Partial anastomotic dehiscence was seen in four patients. Delayed decannulation (>1 year) occurred in nine patients. Overall mortality rate in the whole series was 6 percent. No deaths were directly related to the surgery. No iatrogenic recurrent laryngeal nerve injury was present in the entire series. CONCLUSION: Comorbidities and associated syndromes should be addressed before PCTR is planned to improve the final postoperative outcome in terms of decannulation. Perioperative morbidity due to anastomotic dehiscence, to a certain extent, can be avoided by intraoperative judgment in the selection of double-stage surgery when more than five tracheal rings need to be resected. Subglottic stenosis with glottic involvement continues to pose a difficult challenge to pediatric otolaryngologists, often necessitating revision procedures.

A non-linear VAD for noisy environments

This paper deals with non-linear transformations for improving the performance of an entropy-based voice activity detector (VAD). The idea to use a non-linear transformation has already been applied in the field of speech linear prediction, or linear predictive coding (LPC), based on source separation techniques, where a score function is added to classical equations in order to take into account the true distribution of the signal. We explore the possibility of estimating the entropy of frames after calculating its score function, instead of using original frames. We observe that if the signal is clean, the estimated entropy is essentially the same; if the signal is noisy, however, the frames transformed using the score function may give entropy that is different in voiced frames as compared to nonvoiced ones. Experimental evidence is given to show that this fact enables voice activity detection under high noise, where the simple entropy method fails.

Classification of indian classical vocal styles from melodic contours

A prominent categorization of Indian classical music is the Hindustani and Carnatic traditions, the two styleshaving evolved under distinctly different historical andcultural influences. Both styles are grounded in the melodicand rhythmic framework of raga and tala. The styles differ along dimensions such as instrumentation,aesthetics and voice production. In particular, Carnatic music is perceived as being more ornamented. The hypothesisthat style distinctions are embedded in the melodic contour is validated via subjective classification tests. Melodic features representing the distinctive characteristicsare extracted from the audio. Previous work based on the extent of stable pitch regions is supported by measurements of musicians’ annotations of stable notes. Further, a new feature is introduced that captures thepresence of specific pitch modulations characteristic ofornamentation in Indian classical music. The combined features show high classification accuracy on a database of vocal music of prominent artistes. The misclassifications are seen to match actual listener confusions.

Assimilation des expériences problématiques: une étude de cas de psychothérapie psychodynamique limitée dans le temps [Assimilation of problematic experiences: a case study on short-term dynamic psychotherapy].

The assimilation model is a qualitative and integrative approach that enables to study change processes that occur in psychotherapy. According to Stiles, this model conceives the individual's personality as constituent of different voices; the concept of voice is used to describe traces left by past experiences. During the psychotherapy, we can observe the progressive integration of the problematic voices into the patient's personality. We applied the assimilation model to a 34-session-long case of an effective short-term dynamic psychotherapy. We've chosen eight sessions we transcribed and analyzed by establishing points of contact between the case and the theory. The results are presented and discussed in terms of the evolution of the main voices in the patient.

Handicap vocal : mesura i relació amb el neuroticisme

La valoració del handicap vocal és un element important en l’avaluació de la disfonia. Molts factors poden estar presents en la aparició de la disfonia i un d’ells poden ser els trets de la personalitat. El present estudi pretén valorar el grau de validesa del Voice Handicap Index-10 en la detecció d’alteracions de la veu i determinar-ne una puntuació de tall, constatar la influència dels trets de personalitat neuroticisme i extraversió en la patologia vocal funcional i conèixer com afecten aquests trets de personalitat en les diferents subescales del VHI-10. S’han administrat el qüestionari EPQ-RS d’Eysenck i el VHI-10 a una mostra de 115 persones amb alteracions de la veu i 74 persones sanes. Els resultats obtinguts ens permeten concloure que el VHI-10 és un instrument fiable, vàlid i consistent de la percepció de l’handicap vocal. Podem afirmar també que el tret definit per Eysenck com neuroticisme està més present en les persones amb alteració vocal i que s’observa en aquest grup una major tendència cap a la introversió. Finalment, podem afirmar que aquests trets de personalitat no influeixen de manera diversa en les tres subescales que els seus creadors van definir.

Correlations between Vocal Input and Visual Response Apparently Enhance Presence in a Virtual Environment

This work investigates novel alternative means of interaction in a virtual environment (VE).We analyze whether humans can remap established body functions to learn to interact with digital information in an environment that is cross-sensory by nature and uses vocal utterances in order to influence (abstract) virtual objects. We thus establish a correlation among learning, control of the interface, and the perceived sense of presence in the VE. The application enables intuitive interaction by mapping actions (the prosodic aspects of the human voice) to a certain response (i.e., visualization). A series of single-user and multiuser studies shows that users can gain control of the intuitive interface and learn to adapt to new and previously unseen tasks in VEs. Despite the abstract nature of the presented environment, presence scores were generally very high.

Residents' Rights

Resident rights are guaranteed by the federal Nursing Home Reform Law of 1987, which requires nursing facilities to promote and protect the rights of each resident and places a strong emphasis on individual dignity and self-determination. Residents’ rights include, but are not limited to: • Being treated with respect and dignity • Being free from abuse and chemical and physical restraints • Participating in one’s own care and treatment • Being ensured information is being kept confidential • Managing one’s own finances • Being free to voice grievances, without fear of retaliation • Being able to associate and communicate privately with any person • Being able to send and receive personal mail • Making independent choices • Being able to apply for state and federal assistance without discrimination • Being informed of rights, services available and all charges prior to admission • Being given advance notice of a transfer or discharge

Resident & Family Councils in Nursing Facilities

Resident and family councils are vital to the operation of a nursing home, providing a voice for residents and their families. Resident and family councils provide an organized method of creating change, providing support and improving the quality of life for nursing home residents. A resident council is an independent, organized group of residents who live in a nursing home and meet on a regular basis to promote and enhance the quality of life for all residents. A family council is a group of family members and friends of nursing home residents who work to maintain or improve the quality of life for nursing home residents.

Volunteer Ombudsman Program

The Volunteer Ombudsman Program places volunteers in long-term care facilities across Iowa to assist the state’s team of Local Long- Term Care Ombudsmen carry out the duties of the Older Americans Act of 1965. The Office of the State Long-Term Care Ombudsman coordinates the Volunteer Ombudsman Program (VOP) to train and certify individuals who are interested in listening, empowering and serving as a voice for long-term care residents. Unlike facility volunteers, VOP volunteers do not assist residents with daily activities. Rather, they are responsible for making several unannounced visits to a specific facility each month to talk to residents and family members and identify concerns.

Personas adultas mayores y comunicación móvil: voz y SMS

Todavía sabemos poco sobre las formas de adopción, o rechazo, de la comunicación móvil por parte de las personas adultas mayores. ¿De qué manera utilizan la telefonía móvil? ¿Cuáles son los motivos de rechazo de este tipo de telefonía, si los hay?Discutimos los resultados de un caso de estudio cualitativo con personas adultas mayores (60 años o más), desarrollado en el área metropolitana de Montevideo en 2012. Los y las participantes valoran la conectividad permanente que brinda el teléfono móvil. Lo utilizan en combinación con otros canales, como el teléfono fijo, para una diversidad de objetivos y con diferentes interlocutores. Además de las llamadas de voz, los SMS son de uso habitual. Entre los no usuarios encontramos tanto el discurso del rechazo como el de la indiferencia hacia el celular. Finalmente, todos los usuarios de Internet son, también, usuarios de teléfono celular.

VoIP: Making Secure Calls and Maintaining High Call Quality

Modern multimedia communication tools must have high security, high availability and high quality of service (QoS). Any security implementation will directly impact on QoS. This paper will investigate how end-to-end security impacts on QoS in Voice over Internet Protocol (VoIP). The QoS is measured in terms of lost packet ratio, latency and jitter using different encryption algorithms, no security and just the use of IP firewalls in Local and Wide Area Networks (LAN and WAN). The results of laboratory tests indicate that the impact on the overall performance of VoIP depends upon the bandwidth availability and encryption algorithm used. The implementation of any encryption algorithm in low bandwidth environments degrades the voice quality due to increased loss packets and packet latency, but as bandwidth increases encrypted VoIP calls provided better service compared to an unsecured environment.

The parties' voices in a therapeutic interview

Drawing on a dialogical approach inspired by Bakhtin, we start from the assumptionthat a concrete discussion is an intermingling between dialogue in praesentia and dialogue inabsentia, and we refer to the notion of 'enunciative positioning' to account for the variousrelations that a speaker may express towards the voices that he or she invokes. Our data arebased on a first therapeutic interview between a therapist, a mother and a child in a counselingcenter for children and adolescents. We identify the various voices invoked in this interviewand show that three levels of discursive process were involved: (a) the speakers invokedabsent speakers; (b) at the same time they developed their own discourse on the basis of theirinterlocutors' discourse which (c) itself drew on absent speakers or voices. We highlight thevarious discursive processes through which the speakers integrate their own voice into absentvoices, or integrate a distant voice so that it loses its property of being a distant (andborrowed) voice. As a theoretical and methodological contribution to dialogism, our resultsshow that absent voices and their specific intermingling with hic et nunc exchanges were amajor resource for therapeutic changes.

Langattoman Internet-puhelupalvelun tarjoaminen

Langattomalla Internetpuhelupalvelulla tarkoitetaan Internet-puheluiden (Voice over Internet Protocol, VoIP) siirtoa langattoman tiedonsiirtoverkon ylitse. Tälläisia langattomia verkkoja voivat olla esimerkiksi langattomat lähiverkot, WiMAX-verkot tai 450 megahertsin (MHz) taajuusalueella toimivat tiedonsiirtoverkot. VoIP-yhteyden toiminta voidaan jakaa kolmeen eri toiminta-alueeseen: yhteydenmuodostusprotokollaan, äänen koodaukseen sekä siirtotiehen. Yhteydenmuodostusprotokollia ovat esimerkiksi SIP (Session Initiation Protocol) sekä H.323. Yhteydenmuodostusprotokollantehtävänä on muodostaa yhteys käyttäjien välille sekä sopia yhteydessäkäytettävistä ominaisuuksista. Äänen koodauksessa ääni pakataan paketteihin, joita lähetetään siirtotietä pitkin eri käyttäjien välillä. Normaalissa Internetpuheluyhteydessä siirtotienä käytetään langallisia siirtoteitä. Tässä työssä on keskitytty langattomiin siirtoteihin ja niidentuomiin haasteisiin, kuten yhteyden luotettavuuteen ja laatuun, yhteyskapasiteetin riittävyyteen sekä siirtymiseen saman verkon eri tukiasemien sekä eri verkkojen välillä. Työssä rakennettiin yksinkertainen, mutta toimiva langaton Internetpuhelujärjestelmä sekä verrattiin sen ominaisuuksia normaaliin Internetpuhelujärjestelmään. Järjestelmää koekäytettiin oikeassa toimintatilanteessa varsinaisen puhelinjärjestelmän rinnalla tavallisessa toimistoympäristössä. Testaustulosten ja käyttäjäkokemusten perusteella on periaatteessa mahdollista rakentaa yksinkertainen langaton Internetpuhelujärjestelmä ja käyttää sitä puhelupalveluiden tarjoamiseen. Palvelun tarjoaminen vaatii kuitenkin vielä tiettyjen viestintäviraston määräysten täyttämistä ennen tuotantokäyttöön ottamista.

Outsourcing and Offshore Software Development in Africa

Globalization of software today is making many companies in the industrialized nations to outsource their work to low-wage countries. This thesis aims at obtaining an initial general overview of offshore software development in Africa. It seeks to explore the state of offshore software outsourcing in Africa with a focus on the factors contributing to the successes and challenges of offshore software development practicesin Africa. The thesis made use of electronic questionnaires and voice interviews to collect the data. Identified African vendors were interviewed, and the data was analyzed qualitatively. The study found that theAfrican software outsourcing industry is still at its infancy. It is expected that the industry will grow. However, a lot needs to be done, and African governments are called upon to actively implement supportive infrastructures that will promote the growth of the local and export software industries. Further research is recommended to cover the wide context ofthe topic.