Vibrotactile Presentation of Musical Notes to the Glabrous Skin for Adults with Normal Hearing or a Hearing Impairment: Thresholds, Dynamic Range and High-Frequency Perception

Presentation of music as vibration to the skin has the potential to facilitate interaction between musicians with hearing impairments and other musicians during group performance. Vibrotactile thresholds have been determined to assess the potential for vibrotactile presentation of music to the glabrous skin of the fingertip, forefoot and heel. No significant differences were found between the thresholds for sinusoids representing notes between C1 and C6 when presented to the fingertip of participants with normal hearing and with a severe or profound hearing loss. For participants with normal hearing, thresholds for notes between C1 and C6 showed the characteristic U-shape curve for the fingertip, but not for the forefoot and heel. Compared to the fingertip, the forefoot had lower thresholds between C1 and C3, and the heel had lower thresholds between C1 and G2; this is attributed to spatial summation from the Pacinian receptors over the larger contactor area used for the forefoot and heel. Participants with normal hearing assessed the perception of high-frequency vibration using 1s sinusoids presented to the fingertip and were found to be more aware of transient vibration at the beginning and/or end of notes between G4 and C6 when stimuli were presented 10dB above threshold, rather than at threshold. An average of 94% of these participants reported feeling continuous vibration between G4 and G5 with stimuli presented 10dB above threshold. Based on the experimental findings and consideration of health effects relating to vibration exposure, a suitable range of notes for vibrotactile presentation of music is identified as being from C1 to G5. This is more limited than for human hearing but the fundamental frequencies of the human voice, and the notes played by many instruments, lie within it. However, the dynamic range might require compression to avoid the negative effects of amplitude on pitch perception.

The prevalence and correlates of haematological abnormalities in adult inpatients with anorexia nervosa

Introduction

There is only limited literature concerning haematological abnormalities in anorexia nervosa (AN), with little past investigation into these abnormalities in adult AN patients admitted to inpatient eating disorder (ED) units.

Objectives

This study sought to determine the prevalence and severity of haematological abnormalities in admitted AN patients, and to examine correlates of these abnormalities.

Methods

All adult patients with a clinical diagnosis of AN admitted to the Cotswold House specialist ED inpatient unit between November 2013 and December 2014 were included in the study. Demographic, anthropometric and haematological parameters were systematically recorded for the duration of each admission. The proportions of patients affected by haematological abnormalities (anaemia, leucocytopaenia, neutropaenia, thrombocytopaenia and pancytopaenia) were selected as primary outcomes, and binary logistic regression was performed using SPSS 22.0.

Results

A total of 37 AN patients (91.9% female; mean age: 29.7 years) were included in this study, with a mean admission BMI of 13.7 kg/m2 (SD: 1.8) and a mean admission duration of 128 days; 54.1% of patients were anaemic, 64.9% of patients experienced leucocytopaenia, 56.8% of patients developed neutropaenia, 16.2% of patients suffered thrombocytopaenia, and 8.1% of patients were pancytopaenic. Logistic regression identified low admission BMI (P = 0.009) and low serum albumin level (P = 0.017) as significant correlates of anaemia, and isolated increased age (P = 0.034) as a significant associate of leucocytopaenia.

Conclusions

Haematological abnormalities occur frequently in AN inpatients. Given the frequency at which abnormalities occurred in this cohort, further large-scale and prospective studies examining haematological abnormalities in inpatient AN populations are warranted.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

The prevalence of depression and its correlates in ankylosing spondylitis: A systematic review and meta-analysis

Introduction

Ankylosing spondylitis (AS) is a chronic inflammatory disease, associated with significant pain, functional impairment, and diminished quality of life. However, there is significant uncertainty regarding the prevalence of depression in AS and its associations.

Objectives

We performed a meta-analysis to examine the prevalence of depression in AS and its associated correlates.

Methods

The study protocol was prospectively registered with PROSPERO (CRD42015019676). EMBASE, Medline, PsycINFO and Web of Science were systematically searched for cross-sectional studies with ≥ 50 adult AS patients, which reported depression prevalence using diagnostic criteria or a validated screening tool. Depression prevalence, tool and threshold used, age, gender, disease duration, as well as measures of disease activity, functional impairment, pain and innate inflammation, were abstracted. OpenMeta was used to calculate pooled prevalence estimates and to conduct meta-regression.

Results

Eight hundred and seventy-seven texts were identified and 17 studies satisfied inclusion criteria, totalling 3187 participants (75.2% male). Six diagnostic tools and 10 different thresholds were reported, with depression prevalence estimates ranging from 4.9–55.5%. In studies using the depression subscale of the Hospital Anxiety and Depression Scale (HADS-D), 37.1% of participants satisfied criteria for mild (≥ 8) and 8.2% met criteria for moderate depression (≥ 11). Multivariate meta-regression demonstrated significant positive correlations between depression and, respectively, disease activity (P < 0.001) and C-reactive protein (P < 0.001).

Conclusions

The prevalence of depression in AS is comparable with that of other rheumatic and degenerative diseases. Moreover, depression demonstrates significant associations with age, inflammation and disease activity, which require further investigation in prospective studies.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

How should individual participant data (IPD) from publicly funded clinical trials be shared?

BACKGROUND

Individual participant data (IPD) from completed clinical trials should be responsibly shared to support efficient clinical research, generate new knowledge and bring benefit to patients. The Medical Research Council (MRC) Hubs for Trials Methodology Research (HTMR) has developed guidance to facilitate the sharing of IPD from publicly funded clinical trials.

METHODS

Development of the guidance was completed over four phases which included a focussed review of policy documents, a web-based survey of the UK Clinical Research Collaboration (CRC) Registered Clinical Trials Units (CTU) Network, participation of an expert committee and an open consultation with the UKCRC Registered CTU Network. The project was funded by the MRC HTMR (MR/L004933/1-R39).

RESULTS

Good practice principles include: (i) the use of a controlled access approach, using a transparent and robust system to review requests and provide secure data access; (ii) seeking consent for sharing IPD from trial participants in all future clinical trials with adequate assurance that patient privacy and confidentiality can be maintained; and (iii) establishing an approach to resource the sharing of IPD which would include support from trial funders, sponsor organisations and users of IPD. The guidance has been endorsed by Cancer Research UK, MRC Methodology Research Programme Advisory Group, Wellcome Trust and the Executive Group of the UKCRC Registered CTU Network. The National Institute for Health Research (NIHR) has confirmed it is supportive of the application of this guidance.

CONCLUSIONS

Implementation of these principles will improve transparency, increase the coherent sharing of IPD from publicly funded trials, and help publicly funded trials to adhere to trial funder and journal requirements for data sharing.

Comparison of high-intensity sound and mechanical vibration for cleaning porous titanium cylinders fabricated using selective laser melting

Orthopedic components, such as the acetabular cup in total hip joint replacement, can be fabricated using porous metals, such as titanium, and a number of processes, such as selective laser melting. The issue of how to effectively remove loose powder from the pores (residual powder) of such components has not been addressed in the literature. In this work, we investigated the feasibility of two processes, acoustic cleaning using high‐intensity sound inside acoustic horns and mechanical vibration, to remove residual titanium powder from selective laser melting‐fabricated cylinders. With acoustic cleaning, the amount of residual powder removed was not influenced by either the fundamental frequency of the horn used (75 vs. 230 Hz) or, for a given horn, the number of soundings (between 1 and 20). With mechanical vibration, the amount of residual powder removed was not influenced by the application time (10 vs. 20 s). Acoustic cleaning was found to be more reliable and effective in removal of residual powder than cleaning with mechanical vibration. It is concluded that acoustic cleaning using high‐intensity sound has significant potential for use in the final preparation stages of porous metal orthopedic components. © 2015 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 117–123, 2017.

Does time to endoscopic sinus surgery impact outcomes in Chronic Rhinosinusitis? Prospective findings from the National Comparative Audit of Surgery for Nasal Polyposis and Chronic Rhinosinusitis

OBJECTIVES

Patients with chronic rhinosinusitis refractory to medical management undergo elective surgery. The time from initial diagnosis to surgery varies considerably. The impact of this delay on surgical success has never previously been evaluated.

DESIGN

First-time patients within the National Comparative Audit of Surgery for Nasal Polyposis and Chronic Rhinosinusitis were grouped based on time to surgery: 1) Early cohort: %lt; 12 months; 2) Mid cohort: 12-60 months; and 3) Late cohort: > 60 months. Co-morbidities and preoperative CT scores were analysed for all patients.

MAIN OUTCOME MEASURES

The 22-item Sino-Nasal Outcome Test scores (SNOT-22) were collected at 0, 3, 12 and 60-months. Absolute and relative SNOT-22 changes from baseline were evaluated.

RESULTS

Asthma and allergies were significantly more prevalent in the Late versus the Early and Mid-cohorts. In addition, patients in the Late cohort had greater symptom burden on the SNOT-22 and more extensive preoperative radiographic disease as determined by Lund-Mackay (LM) scores. SNOT-22 scores demonstrated greater percentage improvements in the Early versus the Mid- and Late cohorts, at all time points after surgery. At 12 and 60 months after surgery, significantly more patients in the Early group achieved a clinically important change in SNOT-22 scores compared with the other groups. These differences were maintained when cohorts were matched for preoperative co-morbidities.

CONCLUSION

Patients with asthma and/or allergies are more likely to experience delayed surgical intervention versus other patients. Overall, patients with delayed surgery reported less improvement in SNOT-22 scores than patients treated at earlier time points, regardless of co-morbid status. Delaying surgical intervention may worsen long term clinical outcomes.

Does time to endoscopic sinus surgery impact outcomes in chronic rhinosinusitis? Retrospective analysis using the UK clinical practice research data

BACKGROUND

Patients with chronic rhinosinusitis (CRS) refractory to medical management may elect endoscopic sinus surgery (ESS). Recent data showed that clinical outcomes of patients treated earlier outperformed those of patients treated later in the disease continuum. In this study, CRS-related healthcare utilisation of patients treated early versus late was analysed using the UK-based Clinical Practice Research Database.

METHODS

Two cohorts ("Early Cohort": ESS within 12 months of first CRS diagnosis, versus "Late Cohort": ≥ 5 years from diagnosis to ESS) were matched for age, gender, asthma, polyposis. Healthcare needs related to CRS were analysed post-operatively for 5 years.

RESULTS

Patients in the Late cohort used significantly more CRS-related care than patients in the Early cohort visits and 0.54 prescriptions per patient per year. A sub-analysis of patients with and without asthma indicated that patients in the Late cohort without asthma had healthcare needs equivalent to patients in the Early cohort with asthma.

CONCLUSION

Delayed surgical intervention for CRS is associated with greater post-operative healthcare needs than ESS within 12 months of first CRS diagnosis.

Thresholds of information leakage for speech security outside meeting rooms

This paper describes an approach to provide speech security outside meeting rooms where a covert listener might attempt to extract confidential information. Decision-based experiments are used to establish a relationship between an objective measurement of the Speech Transmission Index (STI) and a subjective assessment relating to the threshold of information leakage. This threshold is defined for a specific percentage of English words that are identifiable with a maximum safe vocal effort (e.g., "normal" speech) used by the meeting participants. The results demonstrate that it is possible to quantify an offset that links STI with a specific threshold of information leakage which describes the percentage of words identified. The offsets for male talkers are shown to be approximately 10 dB larger than for female talkers. Hence for speech security it is possible to determine offsets for the threshold of information leakage using male talkers as the "worst case scenario." To define a suitable threshold of information leakage, the results show that a robust definition can be based upon 1%, 2%, or 5% of words identified. For these percentages, results are presented for offset values corresponding to different STI values in a range from 0.1 to 0.3.

Prediction of high-frequency vibration transmission across coupled, periodic ribbed plates by incorporating tunneling mechanisms

Prediction of structure-borne sound transmission on built-up structures at audio frequencies is well-suited to Statistical Energy Analysis (SEA) although the inclusion of periodic ribbed plates presents challenges. This paper considers an approach using Advanced SEA (ASEA) that can incorporate tunneling mechanisms within a statistical approach. The coupled plates used for the investigation form an L-junction comprising a periodic ribbed plate with symmetric ribs and an isotropic homogeneous plate. Experimental SEA (ESEA) is carried out with input data from Finite Element Methods (FEM). This indicates that indirect coupling is significant at high frequencies where bays on the periodic ribbed plate can be treated as individual subsystems. SEA using coupling loss factors from wave theory leads to significant underestimates in the energy of the bays when the isotropic homogeneous plate is excited. This is due to the absence of tunneling mechanisms in the SEA model. In contrast, ASEA shows close agreement with FEM and laboratory measurements. The errors incurred with SEA rapidly increase as the bays become more distant from the source subsystem. ASEA provides significantly more accurate predictions by accounting for the spatial filtering that leads to non-diffuse vibration fields on these more distant bays.

Prevalence of sinonasal outcome test (SNOT-22) symptoms in patients undergoing surgery for chronic rhinosinusitis in the England and Wales National prospective audit

OBJECTIVES

Review and evaluate the prevalence and severity of individual symptoms in patients with chronic rhinosinusitis (CRS) with or without nasal polyposis.

DESIGN AND SETTING

Retrospective analysis of data from the National Comparative Audit of Surgery for Nasal Polyposis and CRS, carried out across 87 hospitals in England and Wales between 2000 and 2001.

PARTICIPANTS

A total of 2573 patients with CRS (1784 had CRS with nasal polyposis, 789 without nasal polyposis) who had undergone sinus surgery.

MAIN OUTCOME MEASURES

Severity of clinical symptoms scores was graded on the Sino-Nasal Outcome Test 22 questionnaire. Prevalence of these symptoms and mean symptom scores were calculated for each group of patients at baseline and 3 months after surgery.

RESULTS

In both groups, nasal blockage/congestion had the highest mean symptom score, followed by altered smell/taste and then the need to blow nose. These three symptoms were the most prevalent in the group with nasal polyposis. In the group without nasal polyposis, nasal blockage was also the most prevalent individual symptom (93.5%) followed by altered smell/taste (75.7%). The third most prevalent symptom was waking up tired (69.9%). The average test score preoperatively was 41.5 (group with nasal polyposis) and 44.4 (group without nasal polyposis). This decreased to 18.3 and 14.1, respectively, 3 months after surgery (P < 0.001).

CONCLUSION

The leading three symptoms were nasal blockage/congestion, altered taste/smell and the need to blow the nose in terms of severity and prevalence. The total Sino-Nasal Outcome Test 22 and all individual symptom scores improved significantly after surgery.