Neonatal hearing screening with the Echosensor automated device for otoacoustic emissions. A comparative study

Following the recommendations of the United States National Institutes of Health Consensus Conference in 1993, otoacoustic emissions (OAE) are now used internationally for hearing screening. The use of recording systems as well as the interpretation of results requires specially trained personnel although measurements are easier to perform than other recording methods available. To date, no objective method for general hearing screening, has been introduced in Germany, for neonates or children at risk, even though it would be desirable to detect and rehabilitate children with congenital hearing loss as early as possible (incidence, 1-6 per 1000). The Echosensor provides the means for carrying out OAE recordings within a short period of time and includes an automatic evaluation of results. Recordings can also be made by trained personnel. As a comparison test, audiologically trained staff recorded otoacoustic emissions in 111 new-born children in order to compare the results of the Echosensor with the results of a conventional OAE measurements device (the ILO88). The aim of this pilot study was to determine the reliability and validity of the recordings in comparison with available standards in brainstem audiometry. Our study showed that the results of the Echosensor corresponded well with the ILO88 results. Consequently, an OAE measuring method is now available is also provides high sensitivity and specificity and is easy to use. Our findings show that the Echosensor can meet the demands of systematic hearing screening in Germany.     

Examination reform at the grassroots: teacher as the change agent

It is a common practice in many hospitals to have all skeletal radiographs read by a second physician, usually a radiologist, as well as by the treating physician. A two-part study was performed in order to examine the cost and clinical benefit of this practice for plain films ordered by orthopedists. In the first part of this study, the attending orthopedic surgeons were surveyed about the clinical usefulness and effect on patient care of 1000 radiologic reports from plain films ordered on orthopedic patients. In the second part, the charts of 272 patients who had 704 radiographs were reviewed with the goal of identifying any discrepancies between the orthopedic interpretation and the radiologic reading. Thirty-eight reports were discarded because they were not reports of plain skeletal films. One hundred twenty-nine of the remaining 962 radiologic reports were never read by the attending orthopedist. The average time between the taking of the film and an orthopedic attending reading the printed report was 6.1 days. Three radiology reports contained findings that were incorrect. Only one report contained findings that the orthopedist was unaware, and one report may have led to an alteration in treatment. No reports resulted in an unplanned trip to the operating room or a patient being called back to the clinic. Of the 272 chart reviews (704 reports), 70 had no orthopedic interpretation recorded and 94 had no radiologic report in the chart. Twelve discrepancies were noted in the cases that had both reports. Four fracture displacements were identified by orthopedists, but not on the written radiology report; three of these required a return to the operating room. Four instances of hardware displacement or breakage were noted by orthopedists, but not commented on by the radiologists. Three incidental injuries (two fractures and an acromioclavicular injury) were noted on printed reports of films taken for other reasons, but not commented on by the orthopedist, and not treated. A dorsal bunion was noted on one film by the orthopedist, but not by the radiologist. From this study, one can conclude that the benefit of routine duplicate radiograph interpretation by a second physician does not justify its cost.     

Computed tomography, magnetic resonance imaging, and digital radiography

There are three milestones in the history of thoracic radiology. Thoracic radiology started in 1897 when Williams developed thoracic fluoroscopy and introduced the basic concepts of roentgenologic interpretation. At the same time, the first chest films were performed allowing decisive improvement in the diagnosis of many chest diseases. Continuous technical improvement is responsible for the fact that, even today, the conventional chest film remains a highly accurate and frequently used imaging modality. A third milestone was the development of digital radiography and its use in the chest. Computerised tomography changed thoracic imaging dramatically; in a first step mainly as a tool to visualise soft tissue abnormalities and, later on, also as a modality to study lung disease. The recent development of the digital chest radiograph has again added new perspectives to the approach and diagnosis of chest disease.     

"A preliminary evaluation of SOLVE: Addressing psychosocial problems at work": Correction to Probst et al. (2008).

Reports an error in "A preliminary evaluation of SOLVE: Addressing psychosocial problems at work" by Tahira M. Probst, David Gold and Joannah Caborn (Journal of Occupational Health Psychology, 2008[Jan], Vol 13[1], 32-42). In the aforementioned article, the copyright attribution is incorrect. The article is in the public domain. (The following abstract of the original article appeared in record 2008-00533-004.) The International Labour Organization (ILO) has developed a workplace intervention known as SOLVE, aimed at reducing the incidence of psychosocial problems related to job stress, workplace violence, tobacco use, drug and alcohol abuse, and HIV/AIDS. Although this ILO intervention is widely implemented, this article reports the first attempt to empirically assess its effectiveness. Using pre- and posttests of knowledge related to the course content gathered from 268 individuals in 7 countries who attended 1 of 15 SOLVE courses, analyses show that participant learning significantly improved as a function of attending the training. Knowledge gains were consistent regardless of course attended, language used to deliver the training program, and country in which the training took place. Implications of the SOLVE program are discussed, and future steps for further intervention development and assessment are recommended. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of background noise on click-evoked otoacoustic emissions

OBJECTIVE: To investigate the effect of increased levels of background noise on click-evoked otoacoustic emission (CEOAE) recordings and to compare the effectiveness of the default CEOAE program with the QuickScreen CEOAE program in increased levels of noise, using an Otodynamics ILO88 recording device. DESIGN: The right ears of 40 young adult women with normal hearing were assessed using CEOAEs under four different noise conditions and with two different methods of data collection. The noise conditions were in quiet, 50 dB A, 55 dB A, and 60 dB A of white noise. Data were collected at each noise level in the default mode and also using the ILO88 QuickScreen program. RESULTS: There was a significant change in a number of important CEOAE output parameters with increased noise. In the default mode, mean whole wave reproducibility was 89.2% in quiet but declined to 85% with 50 dB A of white noise, 65% at 55 dB A and 20% at 60 dB A. The QuickScreen program proved more robust to the effects of noise than the default. In that mode, mean whole wave reproducibility was 91.7% in quiet, 92.5% with 50 dB A of white noise, 82.5% at 55 dB A and 45% at 60 dB A. CONCLUSIONS: The findings of the study indicate ambient noise levels for accurate CEOAE recording should not exceed 50 to 55 dB A of noise and alternatives to the default program should be considered in non-sound-treated situations.     

A preliminary evaluation of SOLVE: Addressing psychosocial problems at work.

[Correction Notice: An erratum for this article was reported in Vol 13(2) of Journal of Occupational Health Psychology (see record 2008-03497-009). In the aforementioned article, the copyright attribution is incorrect. The article is in the public domain.] The International Labour Organization (ILO) has developed a workplace intervention known as SOLVE, aimed at reducing the incidence of psychosocial problems related to job stress, workplace violence, tobacco use, drug and alcohol abuse, and HIV/AIDS. Although this ILO intervention is widely implemented, this article reports the first attempt to empirically assess its effectiveness. Using pre- and posttests of knowledge related to the course content gathered from 268 individuals in 7 countries who attended 1 of 15 SOLVE courses, analyses show that participant learning significantly improved as a function of attending the training. Knowledge gains were consistent regardless of course attended, language used to deliver the training program, and country in which the training took place. Implications of the SOLVE program are discussed, and future steps for further intervention development and assessment are recommended. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Kurt Lewin as filmmaker and methodologist.

K. Lewin made films for 3 often interchangeable purposes: as a methodological tool for analyzing human (social) behavior, as a rhetorical device for illustrating his presentations and aiding the dissemination of his theoretical concepts, and as personal records of family and friends. The linkage of these films to key concepts such as life-space is described. A recently re-discovered feature-length documentary, "Das Kind und die Welt" (1931), whose production Lewin supervised, dramatizes the development of the child, in keeping with Lewinian concepts and the broader contextual concerns at the time for the world of the child in a big city such as Berlin. Finally, Lewin's meetings with Russian filmmaker S. Eisenstein while this film was in production are detailed, along with a discussion of their mutual influences in psychology and filmmaking. (French abstract) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Water Distribution Network Renewal Planning

This paper provides an overview of the writers' previous work in formulating a comprehensive approach to the important problem of water distribution network renewal planning, with a particular emphasis on the computing aspects involved. As pipes in a water distribution network age in service, they are characterized by increased frequency of breakage and decreased hydraulic capacity. The resulting service failures incur utility costs for the repair or rehabilitation of the pipe systems and consumer costs for degraded system performance. The challenge to the decision maker is to determine the most cost-effective plan in terms of what pipes in the network to rehabilitate, by which rehabilitation alternative and at what time in the planning horizon, subject to the constraints of service requirements (system reliability, service pressure, etc.) A dynamic programming approach, combined with partial and implicit enumeration schemes, was used to search the vast combinatorial solution space that this problem presents. A computer program was written to implement these concepts. A hydraulic network solver is used by the program to assure the network conformance to hydraulic constraints during the search for a solution. The outcome is a strategy that identifies, for each pipe in the network, the optimal rehabilitation∕renewal alternative and its optimal time of implementation. The significance of this method is in its ability to identify an optimal rehabilitation strategy while considering the deterioration of both structural integrity and hydraulic capacity of the entire network. The best current heuristic method is limited in practical studies to a network of up to 15–20 pipe links. A more efficient heuristic method is required for implementing these principles in a larger-scale water distribution system and is the subject of current research.     

Hemostasis in children undergoing liver transplantation

Faculty workload determination formulas are a means by which program directors can justify their time and that of other faculty. This article is written to assist faculty in this necessary yet time-consuming endeavor. A table of calculations (time/activity ratio) for determination of committed hours, examples of actual workload determination, and a worksheet are provided.     

The reconstruction and dose-rate calculation of radium needle implants

A comprehensive computer program has been developed for carrying out the various tasks associated with radium needle implants. Data input for the program are obtained by digitizing an orthogonal pair of radiographs with an analogue tracing system. Corresponding needles in the two radiographs are automatically located, and the implant may be rotated to any desired position in three dimensional space, at the same time presenting a view of the rotation on a storage oscilloscope. Automatic determination of the mean plane of a planar implant is possible, and the dose-rate distribution may be calculated in any specified plane. A Paterson--Parker exposure rate calculation may be performed with a biological dose and treatment time correction incorporated. The program is written in Fortran and runs on a small interactive computer system.     

Comparison of outcomes following transhiatal or Ivor Lewis esophagectomy for esophageal carcinoma

Transhiatal esophagectomy (THO) may be a valid alternative to the traditional Ivor Lewis (ILO) procedure, but there have been reservations about procedure mortality, nodal clearance, and survival. ILO is preferred for bulky midesophageal lesions and THO in frail patients, making randomization difficult. This retrospective study compares results of a 10-year period from January 1985 with a minimum follow-up period of 12 months. Four patients were lost to follow-up. Preoperative nutritional markers were similar in the two groups, as were the age and sex distribution. Altogether 33 ILOs and 65 THOs were performed. TNM staging was similar between groups, there being 43% stage II and 45% stage III lesions among the ILO patients and 53% stage II and 32% stage III disease in the THO group. Operating time was shorter for THO (256 +/- 58 minutes vs. 279 +/- 50 minutes) (p = 0.05); if two surgeons operated concurrently, THO could be performed 40 minutes quicker than THO or ILO performed by a single surgeon (p = 0.018). The mean initial intensive care unit stay was 2.9 days for ILO versus 1.7 days for THO (p = 0.014). The 30-day mortality was 5.1%; total in-hospital mortality was 7.1% with no difference for operation type. There were similar morbidity rates for the procedures. Kaplan-Meier survival analysis indicated no significant effect of surgical technique; there were no apparent advantages for either operation when patients were compared by tumor type or matched for stage. Hence THO is a valid alternative to ILO, particularly for stage II and III cancer.     

A program which automatically quantitates gel electrophoretic autoradiograms

The use of a computer-coupled film scanner to measure and analyze autoradiograms of gel electropherograms is described. A program has been written which fits Gaussian curves to the complex band pattern that constitutes a density profile without the need for estimated parameters in the input. The great majority of the fits are satisfactory. This program, which is written in FORTRAN, runs on a small, inexpensive computer. Another program which approximates a Gaussian least squares fit has been run for comparison; this procedure can also be used to refine occasional unsatisfactory fits. Finally, a program has been written which sums the density profile within specified limits, so that the integrated intensities of bands due to isolated protein components may be found.     

Computer-assisted analysis of adenosine triphosphate data

A computer program has been written to assist in the analysis of adenosine 5'-triphosphate data. The program is designed to calculate a dilution curve and to correct sample and adenosine 5'-triphosphate standard data for background and dilution effects. In addition, basic statistical parameters and estimates of biomass carbon are also calculated for each group of samples and printed in a convenient format. The versatility of the program to analyze data from both qauatic and terrestrial samples is noted as well as its potential use with various types of instrumentation and extraction techniques.     

Transient evoked otoacoustic emissions in infants: effects of gender, ear asymmetry and activity status

This study examined the effects of gender, ear asymmetry and activity status of infants on various measures of transient evoked otoacoustic emission (TEOAE), including signal-to-noise ratio (SNR) and reproducibility of emissions, using TEOAE as a mass screening procedure in a community health setting. Five hundred and sixty-eight infants were screened for hearing at two months of age, before immunization. The ILO88 Otodynamic Analyzer Quickscreen program was used for all testing with pass/fail criteria similar to those used in the Rhode Island hearing assessment project. The results indicated a significant difference in SNR across sex, with females showing a higher mean SNR. The right ear was found to have higher values in 'reproducibility' and 'response level' than the left ear. A significant difference in SNR across activity states was also evident. Implications from these findings, as applied to community-based screening programs, are discussed.     

An event recorder for infant feeding research

An Event Recorder program was developed for the HP 48 calculator to record the durational events associated with breastfeeding behavior. The Event Recorder menu structure is flexible and allows for the recording of response variables such as menstrual history and fertility symptoms. A Windows program was written in Visual C++ to give a graphical representation of the time-series data and to extract useful measures of breastfeeding activity from the raw data for each 24-h day postpartum. These time varying covariates include the mean and median bout length, median interbout interval, breastfeeding frequency and total 24-h suckling duration. The HP 48 calculator has proven to be a robust instrument for the self-recording of breastfeeding data collected as part of a prospective study on the factors that maintain postpartum amenorrhea. We have found also that the behavioral data collected are easily transferred electronically each month when our field workers make home visits.     

Correlation of radiologic and pathologic-anatomical findings in dust-induced pneumoconiosis in former coal miners

The ILO classification of small and large opacities is the basis for the compensation of patients with pneumoconiosis. In order to validate the radiological findings, we compared the ILO classification with the gradings of pneumoconiosis in the post mortem investigation (n = 126). An ILO classification of 1/0 used as the threshold value for accepting the diagnosis of a pneumoconiosis was 100% sensitive with a specificity of 2%. With a value of 2/3 the sensitivity decreased to 60% and specificity increased to 74%. The grading of large opacities in the radiograph correlated well with the post mortem findings (rs = 0.71; p < 0.001). For accepting the diagnosis pneumoconiosis from the radiograph alone a threshold value of 1/0 is not specific. The ROC-plot revealed that specificity reached acceptable levels with an ILO classification of at least 2/3.     

Reproducibility of coronary arteriographic reading in the coronary artery surgery study (CASS)

Eight hundred seventy arteriograms from the Coronary Artery Surgery Study (CASS) were independently read by readers at two different clinics to evaluate the reproducibility of the interpretation of coronary arteriograms. Among proximal segments, the interpretation of lesions of the left main coronary artery were the least reproducible, P less than .02. When one angiographer reads a stenosis of 50% or more in the left main coronary artery, it is estimated that a second reader will report no lesion 18.6% of the time. In 94.7% of the films, the number of significantly (greater than or equal to 70% stenosis) diseased vessels was the same for both readers (72.1%) or differed by one vessel (22.6%). The reproducibility of interpretation of films of good or acceptable quality or completeness was better than the reproducibility of readings of arteriograms judged to be of poor quality or incomplete studies. The mean absolute difference between readings of the percent stenosis decreased over the time of the patient enrollment, 1975 to 1978. This may have resulted from major collaborative efforts made during the course of the study to improve the quality of angiography and to standardize the reading of the cine films.     

Automation of data acquisition and of experiment control: application to the study of sleep-wake cycles and behavioral paradigms

The low cost of microcomputers allows them to be dedicated full time to data acquisition and analysis of experimental paradigms. The usual interfaces required for such interaction with the experiment are briefly explained, namely, analog-to-digital converters, input-output control lines and real time clocks. Some basic concepts on the use of microcomputers for the automation of data acquisition and control are summarized, including the characterization of waveshapes, the structure of data storage and on-line data reduction. Off-line, the matrices generated by the data acquisition program become the input for ad-hoc processing programs. Precision, flexibility and fluidity of analysis are outstanding advantages of computer controlled setups. A system for automation of sleep studies and a system for automation of scheduled-controlled behavior are presented as working examples.