Objective Test Results Research Articles

Cardiovascular Impairment Evaluation: Sixth Edition

Abstract To assess medical impairments, the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) divides cardiovascular diseases into the following eight groups, each of which has its own grid: valvular heart disease; coronary artery disease; cardiomyopathies, pericardial heart disease, dysrhythmias, hypertensive cardiovascular disease, vascular diseases affecting the extremities, and diseases of the pulmonary artery. An accompanying table shows the criteria for rating permanent impairment due to valvular heart disease. Within the grids, the rows are divided into three main impairment variables: history, physical findings, and objective test results. The latter are essential in assigning cardiovascular impairment ratings. The AMA Guides names the objective test results variable as the key factor to underscore its role in assigning the impairment class in the cardiovascular chapter. For cardiovascular impairments, objective test results are always used to place the injury in its impairment class; therefore, objective test results are never used to modify the rating once the evaluator chooses the impairment class. Not all internal medicine chapters designate objective test results as the key factor, but all use one key factor that is clearly indicated in a footnote and one or two non-key factors. This rating scheme emphasizes objective test results, history, and physical findings and avoids incorporating variables twice.

Tests of Eustachian tube function: a review.

Eustachian tube (ET) dysfunction is a common but poorly understood cause of patient symptoms, and an important aetiological factor in the development of middle ear pathology. Despite this, there are no specific tests of ET function in widespread clinical use and no identified 'gold standard' with which to diagnose the disease. This review aims to review the literature to identify currently available tests of ET function and, where possible, report on their accuracy. Narrative systematic review. MEDLINE, EMBASE, Biosis and the Cochrane library were searched and reference lists reviewed for relevant articles. Tests in included studies were required to measure a physiological function of the ET, or play a role in the diagnosis of poor ET function. Significant variation in demographic characteristics, disease presentation and severity, and technological approaches only permitted narrative systematic review. While many tests of ET function have been developed, with some in routine clinical use, all have significant limitations. Published accuracy data are limited and of differing quality due to the variability incomparative tests, and the spectrum of otological disorders associated with ET dysfunction. Currently, no single test could be considered a 'gold standard' for the diagnosis of ET dysfunction, but there is some evidence that diagnostic accuracy can be improved by combining the results of different objective tests and patient-reported outcome measures. Further development of ET function tests is required to facilitate the accurate diagnosis of patients and allow outcome reporting for new interventions.

안구건조증 설문지의 일치도 연구

목적: 안구건조증 평가를 위한 세 종류의 설문지와 타각적 검사의 일치도를 비교하였다. 방법: 성인 90명을 대상으로 세 종류의 설문지(SPEED, OSDI, TERTC-DEQ)와 타각적 검사(NIBUT, Schirmer test)를 시행하여 건성안과 정상안을 구분하고 세 설문지와 타각적 검사의 일치도를 비교, 분석하였다. 결과: NIBUT 검사와 각 설문지 간의 일치도는 SPEED의 경우 83.3%, OSDI의 경우 77.8%, TERTC의 경우 72.3%로, SPEED가 가장 높은 일치도를 보였다. Schirmer test와 각 설문지 간의 일치도는 SPEED의 경우 57.8%, OSDI의 경우 58.9%, TERTC의 경우 73.3%로, TERTC가 일치도는 높았지만 전반적으로 Schirmer test에서는 NIBUT 검사보다 낮은 일치도를 나타냈다. 결론: 안구건조증은 SPEED의 설문지가 타각적 검사와 가장 높은 일치도를 보였으며, SPEED가 안구건조증 평가에 유용하게 사용할 수 있을 것으로 사료된다. Purpose: This study is to evaluate the accuracy of dry eye screening test by comparing coincidences between three types of questionnaires and objective tests. Methods: 90 adults were classified into the normal and dry eye groups using evaluations of three types of questionnaires (SPEED, OSDI, TERTC-DEQ) and objective tests (NIBUT, Schirmer test). Coincidences-between the results of objective tests and questionnaires were compared and analyzed for dry eye diagnosis. Results: Coincidences between NIBUT test and each questionnaire were 83.3% by SPEED, 77.8% by OSDI and 72.3% by TERTC-DEQ, respectively. Concordance by SPEED was highest among three types of questionnaire. Coincidences between the Schirmer test and each questionnaire were 57.8% by SPEED, 58.9% by OSDI and 73.3% by TERTC-DEQ, respectively, thus coincidence by TERTC was higher than by others. But coincidences by Schirmer test were generally lower than those by NIBUT test. Conclusions: SPEED questionnaire showed the highest concordance with objective test as compared with others. Therefore, SPEED is expected to be used usefully to diagnose dry eyes.

Olfactory dysfunction in children with Kallmann syndrome: relation of smell tests with brain magnetic resonance imaging.

Kallmann syndrome (KS) is a genetic disorder with the distinctive features of hyposmia or anosmia and hypogonadotropic hypogonadism. Though hyposmia/anosmia can be evaluated by both objective and subjective smell tests, there is no study comparing these two methods in KS. The aim of the present case series was to discuss the results of objective and subjective smell tests and compare them to volumetric magnetic resonance imaging (MRI). A total of six adolescent males (aged between 14-18 years) with KS were examined by objective and subjective olfactometry to test smell function and by specific MRI sequences to measure the olfactory bulbs. The objective smell test showed anosmia in all six of the patients. However, the subjective test revealed anosmia in five patients and hyposmia in one patient. Brain MRI showed olfactory bulb aplasia in all six cases. MRI provides robust evaluation of the olfactory bulb volume. Our data show excellent compatibility between the results obtained via objective olfactometry and those obtained by measuring olfactory bulb volume as determined by MRI and therefore demonstrate that objective olfactometry remains a highly reliable test. Furthermore, although the number of subjects studied was small, these data also suggest that cheaper and more easily available subjective tests could be used in preference to the more expensive as well as labor-intensive and time-consuming objective smell tests. In the event of doubts as to the validity of the subjective tests, the objective olfactometry tests can confirm the diagnosis. The bulb volumetric MRI may be also used in difficult cases.

Development of Android apps for cognitive assessment of dementia and delirium.

The next generation of medical technology applications for hand-held portable platforms will provide a core change in performance and sophistication, transforming the way health care professionals interact with patients. This advance is particularly apparent in the delivery of cognitive patient assessments, where smartphones and tablet computers are being used to assess complex neurological conditions to provide objective, accurate and reproducible test results. This paper reports on two such applications (apps) that have been developed to assist healthcare professionals with the detection and diagnosis of dementia and delirium.

Noninvasive ventilation in the treatment of sleep-related breathing disorders: concise clinical review

Non-invasive mechanical ventilation (NIV) was originally used in patients with acute respiratory compromises or exacerbations of chronic respiratory diseases, as an alternative to the endotracheal tube. Over the last thirty years NPPV has been also used during the night in patients with stable chronic lung disease such as obstructive sleep apnea, the overlap syndrome (COPD and obstructive sleep apnea), neuromuscular disorders, obesity-hypoventilation syndrome, and in other conditions such as sleep disorders associated with congestive heart failure (Cheyne-Stokes respiration). In this review we discuss the different types of NPPV, the specific conditions in which they can be used and the indications, recommendations and evidence supporting the efficacy of NIV. Obstructive sleep apnea syndrome (OSA) is characterized commonly by instability of upper airway during sleep, reduction or elimination of airflow, daytime hypersomnolence, sleep disruption. It is a risk factor for cardiovascular and cerebrovascular disorders including hypertension, myocardial infarction and stroke. Optimizing patient acceptance and adherence to non-invasive ventilation treatment is challenging. The treatment of sleep-related disorders is a life-threatening condition. The optimal level of treatment should be determinate in a sleep laboratory. Side effects directly affecting the patient’s adherence to treatment are known. The most common are nasopharyngeal symptoms including increased congestion and rhinorrhea; these effects are related to reduced humidity of inspired gas. Humidification of delivered gas may improve these symptoms. Sleep specialists should review the results of objective testing with the patient. Education of the patient concerning the nature of the disorder and treatment options is important. General education on the impact of weight loss, sleep position, alcohol avoidance, risk factor modification and medication effects should be discussed. The patient should be counseled on the risks and management of drowsy driving. Patient education should optimally be delivered as a part of a multidisciplinary chronic disease management team.

Does radiation dose to the vestibule predict change in balance function and patient perceived dizziness following stereotactic radiotherapy for vestibular schwannoma?

ObjectiveTo date, the majority of the vestibular schwannoma (VS) literature has focused on tumor control rates, facial nerve function and hearing preservation. Other factors that have been shown to significantly affect quality-of-life (QOL), such as dizziness, remain understudied. The primary objective of the current study is to investigate the association between radiation dose to the vestibule and post-treatment changes in vestibular function and patient reported dizziness handicap. Materials and methodsThis is a prospective observational pilot study at a tertiary academic referral center including all subjects that underwent linear accelerator-based stereotactic radiotherapy (SRS) for sporadic VS and completed pre-treatment and post-treatment vestibular testing and Dizziness Handicap Inventory (DHI) questionnaires. Associations between objective vestibular test results, patient-reported DHI scores and radiation dose parameters were investigated. ResultsTen patients met inclusion criteria. Tumor control was achieved in all individuals. There were no statistically significant associations or identifiable trends between radiation dose and change in vestibular function or DHI scores. Notably, the four ears receiving the highest vestibular dose had minimal changes in vestibular function tests and DHI scores. ConclusionsTo the best of our knowledge, no previous reports have described the association between radiation dose to the vestibule and post-treatment changes in vestibular function and patient reported DHI. Based on these preliminary data, radiation dose to the vestibule does not reliably predict change in objective or subjective vestibular outcome measures.

Objective measures of blind source separation and the intelligibility of separated speech

When multiple acoustic sources are present in an environment monitored by multiple microphones, each microphone’s response signal is typically a weighted and delayed mixture of the active source signals. Subject to important constraints, these mixtures can be processed using Blind Source Separation (BSS) methods to construct output signals representative of each of the “hidden” acoustic sources in isolation. An important objective measure of the quality of a given “separation solution” is the amount of mutual information remaining in the BSS output channels: the less mutual information across channels, the better the separation. Often, the acoustic signals of interest in a complex acoustic environment are speech sources, and the measure of separation quality that really matters to listeners is speech intelligibility—a subjective (perceptual) measure that cannot be directly computed by a signal processing system. Thus, it would be useful to know how well objective measures of separation quality, such as mutual information, correlate with intelligibility. We present results of perceptual and objective tests exploring the relationship between objective separation metrics and word intelligibility as estimated by listeners’ responses in word identification tasks, for target-word-in-carrier-phrase utterances recorded in an acoustic environment with masking speech babble and broadband noise sources.

Subjective Assessment of Region of Interest-Aware Adaptive Multimedia Streaming Quality

Adaptive multimedia streaming relies on adjusting the video content's bit-rate meet network conditions in the quest to reduce packet loss and resulting video quality degradations. Current multimedia adaptation schemes uniformly adjust the compression over the entire image area. However, research has shown that user attention is focused mostly on certain image areas, denoted areas of maximum user interest (AMUI), and their interest decreases with the increase in distance to the AMUI. The region of interest-based adaptive multimedia streaming scheme (ROIAS) is introduced to perform bit-rate adaptation to network conditions by adjusting video quality relative to the AMUI location. This paper also extends ROIAS to support multiple areas of maximum user interest within the same video frame. This paper presents the performance analysis of ROIAS in terms of the impact on user perceived video quality measured using subjective video quality assessment techniques based on human subjects. The tests use a wide range of video clips, which differ in terms of spatial and temporal complexity and region of interest location and variation. A comparative evaluation of both subjective and objective video quality test results is performed and demonstrate the benefit of using ROIAS for adaptive video quality delivery.

Everyday uses of standardized test information in a geriatric setting: a qualitative study exploring occupational therapist and physiotherapist test administrators’ justifications

BackgroundHealth professionals are required to collect data from standardized tests when assessing older patients’ functional ability. Such data provide quantifiable documentation on health outcomes. Little is known, however, about how physiotherapists and occupational therapists who administer standardized tests use test information in their daily clinical work. This article aims to investigate how test administrators in a geriatric setting justify the everyday use of standardized test information.MethodsQualitative study of physiotherapists and occupational therapists on two geriatric hospital wards in Norway that routinely tested their patients with standardized tests. Data draw on seven months of fieldwork, semi-structured interviews with eight physiotherapists and six occupational therapists (12 female, two male), as well as observations of 26 test situations. Data were analyzed using Systematic Text Condensation.ResultsWe identified two test information components in everyday use among physiotherapist and occupational therapist test administrators. While the primary component drew on the test administrators’ subjective observations during testing, the secondary component encompassed the communication of objective test results and test performance.ConclusionsThe results of this study illustrate the overlap between objective and subjective data in everyday practice. In clinical practice, by way of the clinicians’ gaze on how the patient functions, the subjective and objective components of test information are merged, allowing individual characteristics to be noticed and made relevant as test performance justifications and as rationales in the overall communication of patient needs.

Analysis by synthesis spatial audio coding

This study presents a novel spatial audio coding (SAC) technique, called analysis by synthesis SAC (AbS-SAC), with a capability of minimising signal distortion introduced during the encoding processes. The reverse one-to-two (R-OTT), a module applied in the MPEG Surround to down-mix two channels as a single channel, is first configured as a closed-loop system. This closed-loop module offers a capability to reduce the quantisation errors of the spatial parameters, leading to an improved quality of the synthesised audio signals. Moreover, a sub-optimal AbS optimisation, based on the closed-loop R-OTT module, is proposed. This algorithm addresses a problem of practicality in implementing an optimal AbS optimisation while it is still capable of improving further the quality of the reconstructed audio signals. In terms of algorithm complexity, the proposed sub-optimal algorithm provides scalability. The results of objective and subjective tests are presented. It is shown that significant improvement of the objective performance, when compared to the conventional open-loop approach, is achieved. On the other hand, subjective test show that the proposed technique achieves higher subjective difference grade scores than the tested advanced audio coding multichannel.

Speech enhancement using generalized weighted β-order spectral amplitude estimator

In this paper, a single-channel speech enhancement method based on generalized weighted β-order spectral amplitude estimator is proposed. First, we derive a new kind of generalized weighted β-order Bayesian spectral amplitude estimator, which takes full advantage of both the traditional perceptually weighted estimators and β-order spectral amplitude estimators and can obtain flexible and effective gain function. Second, according to the masking properties of human auditory system, the adaptive estimation methods for the perceptually weighted order p is proposed, which is based on a criterion that inaudible noise may be masked rather than removed. Thereby, the distortion of enhanced speech is reduced. Third, based on the compressive nonlinearity of the cochlea, the spectral amplitude order β can be interpreted as the compression rate of the spectral amplitude, and then the adaptive calculation method of parameter β is proposed. In addition, due to one frame delay, the a priori SNR estimation of decision-directed method in speech activity periods is inaccurate. In order to overcome the drawback, we present a new a priori SNR estimation method by combining predicted estimation with decision-directed rule. The subjective and objective test results indicate that the proposed Bayesian spectral amplitude estimator combined with the proposed a priori SNR estimation method can achieve a more significant segmental SNR improvement, a lower log-spectral distortion and a better speech quality over the reference methods.

Mepolizumab for Severe Eosinophilic Asthma (DREAM): A Multicentre, Double-Blind, Placebo-Controlled Trial

To elucidate the efficacy, safety, and patient characteristics of responsiveness to mepolizumab (a humanized monoclonal antibody against interleukin 5). Previous small, proof-of-concept studies in subjects with severe, eosinophilic asthma revealed that mepolizumab decreased exacerbation rates.From 81 multinational centers, 621 pa-tients were enrolled. Major inclusion criteria included: age 12 to 74 years, asthma diagnosis with objective measures, ≥2 asthma exacerbations requiring oral corticosteroids in the last year, refractory asthma as defined by the American Thoracic Society criteria, and signs of eosinophilic inflammation (sputum eosinophil count ≥3%, an exhaled nitric oxide concentration ≥50 ppb, peripheral blood eosinophil count ≥0.3 × 109/L, or prompt deterioration of asthma control with inhaled or oral steroid weaning). Smokers, present or former (≥10 pack-years), were excluded.Subjects were randomized to receive placebo or 1 of 3 doses of mepolizumab (75, 250, or 750 mg). Every 4 weeks for 13 cycles, patients received infusions. Asthma symptom scores, objective lung testing results, and blood eosinophil counts were collected at baseline and follow-up visits. The primary outcome of verified, clinically significant exacerbations during treatment and 4 weeks thereafter was defined a priori.All mepolizumab-treated groups demonstrated a significant decrease in clinically significant exacerbations (75 mg: –48% [P < .0001]; 250 mg: –39% [P = .005]; 750 mg: –52% [P < .0001]). Visits to emergency departments and admissions also decreased; however, no significant changes in spirometry or asthma control scores were noted. No treatment-associated deaths occurred, and other potential adverse events were equivocal in the placebo and treatment groups.Mepolizumab is generally safe and reduces exacerbation rates in select patients with asthma who have the severe, refractory, eosinophilic subtype.Using more clinically available inclusion criteria and a larger cohort, mepolizumab provides another tool in select patients with severe, eosinophilic asthma. The study supports the clinical importance of asthma phenotyping in effectively treating asthma subjects but provides no insight for efficacy in other asthma phenotypes. The equivalent responses from the 75- and 750-mg dose might improve the cost to benefit ratio of mepolizumab depending on the manufacturer’s pricing strategy. Despite seemly optimized design and execution, all results must be viewed through a scrutinizing lens because the manufacturer participated in all aspects ranging from design to writing.

An Improved Multi-Band Spectral Subtraction Algorithm for Enhancing Speech in Various Noise Environments

This paper proposes an improved multi-band spectral subtraction algorithm with the goal of improving the quality of speech signal in various noise environments. In the proposed enhancement algorithm, the whole speech spectrum is divided into different uniformly spaced continuous frequency bands and spectral over-subtraction is performed in each band, independently. The proposed algorithm uses a novel approach to estimate the noise from each band continuously, without using speech pause detection. The noise is estimated and updated by adaptively smoothing the noisy signal power in each uniformly spaced frequency band. The smoothing parameter is controlled by a linear function of a-posteriori signal-to-noise ratio (SNR). The experiments are conducted for various types of noises and the results of proposed algorithm are compared with the reference multi-band spectral subtraction algorithm. To test the performance of the proposed speech enhancement algorithm, objective quality measurement tests (SNR, segmental SNR (Seg.SNR), and perceptual evaluation of speech quality (PESQ)) and spectrogram with informal listening tests are conducted for various noise types at different SNRs. Experimental results and objective quality evaluation test results confirmed the performance of proposed enhancement algorithm. The proposed enhancement algorithm provides sufficient noise reduction and good perceptual quality, without causing considerable signal distortion and remnant musical noise.

Non-Invasive Ventilation in the Treatment of Sleep-Related Breathing Disorders: Concise Clinical Review

Non-invasive mechanical ventilation (NIV) was originally used in patients with acute respiratory compromises or exacerbations of chronic respiratory diseases, as an alternative to the endotracheal tube. Over the last thirty years NPPV has been also used during the night in patients with stable chronic lung disease such as obstructive sleep apnea, the overlap syndrome (COPD and obstructive sleep apnea), neuromuscular disorders, obesity-hypoventilation syndrome, and in other conditions such as sleep disorders associated with congestive heart failure (Cheyne-Stokes respiration). In this review we discuss the different types of NPPV, the specific conditions in which they can be used and the indications, recommendations and evidence supporting the efficacy of NIV. Obstructive sleep apnea syndrome (OSA) is characterized commonly by instability of upper airway during sleep, reduction or elimination of airflow, daytime hypersomnolence, sleep disruption. It is a risk factor for cardiovascular and cerebrovascular disorders including hypertension, myocardial infarction and stroke. Optimizing patient acceptance and adherence to non-invasive ventilation treatment is challenging. The treatment of sleep-related disorders is a life-threatening condition. The optimal level of treatment should be determinate in a sleep laboratory. Side effects directly affecting the patient’s adherence to treatment are known. The most common are nasopharyngeal symptoms including increased congestion and rhinorrhea; these effects are related to reduced humidity of inspired gas. Humidification of delivered gas may improve these symptoms. Sleep specialists should review the results of objective testing with the patient. Education of the patient concerning the nature of the disorder and treatment options is important. General education on the impact of weight loss, sleep position, alcohol avoidance, risk factor modification and medication effects should be discussed. The patient should be counseled on the risks and management of drowsy driving. Patient education should optimally be delivered as a part of a multidisciplinary chronic disease management team.

Waveform Interpolation-Based Speech Analysis/Synthesis for HMM-Based TTS Systems

This letter proposes an HMM-based Text-to-Speech (TTS) system using waveform interpolation (WI)-based speech analysis and synthesis. The synthesized speech quality of the proposed system is significantly improved due to adopting an enhanced excitation modeling technique. The decomposition of characteristic waveform (CW) into slowly evolving waveform (SEW) and rapidly evolving waveform (REW) is efficient not only for excitation modeling but also for training process of HMMs. Objective and subjective test results verify the superiority of the proposed approach to conventional ones.

Induction of cognitive fatigue in MS patients through cognitive and physical load

The objective of the study was to investigate whether cognitive fatigue in patients with multiple sclerosis (MS) is a spontaneous phenomenon or whether it can be provoked or exacerbated through cognitive effort and motor exercise. Thirty two patients with definite MS and cognitive fatigue according to the Fatigue Scale for Motor and Cognitive Functions (FSMC ≥ 22) performed attention tests (alertness, selective, and divided attention subtests from the TAP test battery for attention performance) twice during rest (baseline), and before and after treadmill training and cognitive load (a standardised battery of neuropsychological tests lasting 2.5 hours). Subjective exhaustion was assessed with a 10-point rating scale. Tonic alertness turned out to be the most sensitive test and showed significantly increased reaction times after treadmill training and after cognitive load. Patients' subjective assessment of exhaustion (10-point rating scale) and the objective test results were discrepant. In contrast, healthy control subjects (N = 20) did not show any decline of performance in the subtest alertness after cognitive or physical load. Data favour the concept that fatigue is induced by physical and mental load. Discrepancies between subjective and objective assessment offer therapeutic options. The common notion of a purely “subjective” lack of physical and/or mental energy should be reconsidered.

Speech enhancement via only mostly blind source separation

In environments in which multiple simultaneously-active acoustic sources contribute to sensor responses, Blind Source Separation (BSS) signal processing techniques may be employed to separate (that is, estimate or reconstruct) the signal characteristics of hidden sources. Only Mostly Blind Source Separation (OMBSS) involves the estimation of similar sources in important contexts in which non-acoustic information is also available about one or more of the contributing sources. Recently-reported objective source separation performance measures confirm that non-acoustic information can be used effectively to support high-quality separation in situations in which traditional BSS methods perform poorly (e.g., when more sources are active than there are microphones available). Here we present the results of additional perceptual and objective tests showing that OMBSS processing enhances the intelligibility of speech recorded in the presence of multiple simultaneous speech-babble and non-speech maskers.

Performance of personal active noise reduction devices

This paper presents the results of objective tests performed on 13 personal active noise reduction devices (earmuffs, headphones, headsets and insert earphones) divided into four groups based mainly on structure, using an acoustic test fixture (ATF). Each device was examined on its attenuation of broadband noise, overload response, internally generated noise, attenuation of impulse noise, and stability to movement. The results show a large range of responses between devices in terms of attenuation and overload, and highlight distinctive differences between the device groupings.

Kalman filter-based microphone array signal processing using the equivalent source model

This paper demonstrates that microphone array signal processing can be implemented by using adaptive model-based filtering approaches. Nearfield and farfield sound propagation models are formulated into state-space forms in light of the Equivalent Source Method (ESM). In the model, the unknown source amplitudes of the virtual sources are adaptively estimated by using Kalman filters (KFs). The nearfield array aimed at noise source identification is based on a Multiple-Input–Multiple-Output (MIMO) state-space model with minimal realization, whereas the farfield array technique aimed at speech quality enhancement is based on a Single-Input–Multiple-Output (SIMO) state-space model. Performance of the nearfield array is evaluated in terms of relative error of the velocity reconstructed on the actual source surface. Numerical simulations for the nearfield array were conducted with a baffled planar piston source. From the error metric, the proposed KF algorithm proved effective in identifying noise sources. Objective simulations and subjective experiments are undertaken to validate the proposed farfield arrays in comparison with two conventional methods. The results of objective tests indicated that the farfield arrays significantly enhanced the speech quality and word recognition rate. The results of subjective tests post-processed with the analysis of variance (ANOVA) and a post-hoc Fisher's least significant difference (LSD) test have shown great promise in the KF-based microphone array signal processing techniques.