Outcomes of transient evoked otoacoustic emission testing in 6-year-old school children: A comparison with pure tone screening and tympanometry

Objectives: (1) To establish test performance measures for Transient Evoked Otoacoustic Emission testing of 6-year-old children in a school setting; (2) To investigate whether Transient Evoked Otoacoustic Emission testing provides a more accurate and effective alternative to a pure tone screening plus tympanometry protocol. Methods: Pure tone screening, tympanometry and transient evoked otoacoustic emission data were collected from 940 subjects (1880 ears), with a mean age of 6.2 years. Subjects were tested in non-sound-treated rooms within 22 schools. Receiver operating characteristics curves along with specificity, sensitivity, accuracy and efficiency values were determined for a variety of transient evoked otoacoustic emission/pure tone screening/tympanometry comparisons. Results: The Transient Evoked Otoacoustic Emission failure rate for the group was 20.3%. The failure rate for pure tone screening was found to be 8.9%, whilst 18.6% of subjects failed a protocol consisting of combined pure tone screening and tympanometry results. In essence, findings from the comparison of overall Transient Evoked Otoacoustic Emission pass/fail with overall pure tone screening pass/fail suggested that use of a modified Rhode Island Hearing Assessment Project criterion would result in a very high probability that a child with a pass result has normal hearing (true negative). However, the hit rate was only moderate. Selection of a signal-to-noise ratio (SNR) criterion set at greater than or equal to 1 dB appeared to provide the best test performance measures for the range of SNR values investigated. Test performance measures generally declined when tympanometry results were included, with the exception of lower false alarm rates and higher positive predictive values. The exclusion of low frequency data from the Transient Evoked Otoacoustic Emission SNR versus pure tone screening analysis resulted in improved performance measures. Conclusions: The present study poses several implications for the clinical implementation of Transient Evoked Otoacoustic Emission screening for entry level school children. Transient Evoked Otoacoustic Emission pass/fail criteria will require revision. The findings of the current investigation offer support to the possible replacement of pure tone screening with Transient Evoked Otoacoustic Emission testing for 6-year-old children. However, they do not suggest the replacement of the pure tone screening plus tympanometry battery. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved.

Granulocyte-colony-stimulating factor (G-CSF)-primed allogeneic bone marrow: significantly less graft-versus-host disease and comparable engraftment to G-CSF-mobilized peripheral blood stem cells

Prospective studies have shown rapid engraftment using granulocyte-colony-stimulating factor-mobilized peripheral blood stem cells (G-PBSCs) for allogeneic transplantation, though the risks for graft-versus-host disease (GVHD) may be increased. It was hypothesized that the use of G-CSF to prime bone marrow (GBM) would allow rapid engraftment without increased risk for GVHD compared with G-PBSC. Patients were randomized to receive G-BM or G-PBSCs for allogeneic stem cell transplantation. The study was designed (beta < .8) to detect a difference in the incidence of chronic GVHD of 33% ( < .05). The plan was to recruit 100 patients and to conduct an interim analysis when the 6-month follow-up point was reached for the first 50 patients. Fifty-seven consecutive patients were recruited (G-BM, n = 28; G-PBSC, n = 29). Patients in the G-PBSC group received 3-fold more CD34(+) and 9-fold more CD3(+) cells. Median times to neutrophil (G-BM, 16 days; G-PBSC, 14 days; P < .1) and platelet engraftment (G-BM, 14 days; G-PBSC, 12 days; P < .1) were similar. The use of G-PBSC was associated with steroid refractory acute GVHD (G-BM, 0%; G-PBSC, 32%; P < .001), chronic GVHD (G-BM, 22%; G-PBSC, 80%; P < .02), and prolonged requirement for immunosuppressive therapy (G-BM, 173 days; G-PBSC, 680 days; P < .009). Survival was similar for the 2 groups. Compared with G-PBSC the use of G-BM resulted in comparable engraftment, reduced severity of acute GVHD, and less subsequent chronic GVHD. (Blood. 2001;98:3186-3191) (C) 2001 by The American Society of Hematology.

Canopy carbon and oxygen isotope composition of 9-year-old hoop pine families in relation to seedling carbon isotope composition, growth, field growth performance, and canopy nitrogen concentration

Carbon isotope composition (delta C-13), oxygen isotope composition (delta O-18), and nitrogen concentration (N-mass) of branchlet tissue at two canopy positions were assessed for glasshouse seedlings and 9-year-old hoop pine (Araucaria cunninghamii Ait. ex D. Don) trees from 22 open-pollinated families grown in 5 blocks of a progeny test at a water-limited and nitrogen-deficient site in southeastern Queensland, Australia. Significant variations in canopy delta C-13, delta O-18, and N-mass existed among the 9-year-old hoop pine families, with a heritability estimate of 0.72 for branchlet delta C-13 from the upper inner canopy position. There was significant variation in canopy delta C-13 of glasshouse seedlings between canopy positions and among the families, with a heritability estimate of 0.66. The canopy delta C-13 was positively related to canopy N-mass only for the upper outer crown in the field (R = 0.62, p < 0.001). Phenotypic correlations existed between tree height and canopy delta C-13 (R = 0.37-0.41, p < 0.001). Strong correlations were found between family canopy delta C-13 at this site and those at a wetter site and between field canopy delta C-13 and glasshouse seedling delta C-13. The mechanisms of the variation in canopy delta C-13 are discussed in relation to canopy photosynthetic capacity as reflected in the N-mass and stomatal conductance as indexed by canopy delta O-18.

Denitrification, leaching and immobilisation of N-15-labelled nitrate in winter under windrowed harvesting residues in hoop pine plantations of 1-3 years old in subtropical Australia

A field study was carried out to investigate the impacts of windrowed harvesting residues on denitrification, immobilisation and leaching of N-15-labelled nitrate applied at 20 kg N ha(-1) to microplots in second-rotation hoop pine (Araucaria cunninghamii) plantations of 1-3 years old in southeast Queensland, Australia. The PVC microplots were 235 mm in diameter and 150 mm. long, and driven into the 100 mm soil. There were three replications of such microplots for each of the six treatments which were areas just under and between 1-, 2- and 3-year-old windrows of harvesting residues. Based on gaseous N losses estimated by the difference between the recoveries of bromide (Br) applied at 100 kg Br ha(-1) and N-15-labelled nitrate, denitrification was highest (23% based on N-15 loss) in the areas just under the 1-year-old windrows 25 days after a simulated 75 mm rainfall and following several natural rainfall events. There was no significant difference in N-15 losses (14-17%) among the other treatments. The N-15 immobilisation rate was highest for microplots in the areas between the 1-year-old windrows and generally higher for microplots in the areas just under the windrows (30-39%) than that (26-30%) between the windrows. Direct measurement of N-15 gas emissions (N-15(2) + (N2O)-N-15) confirmed that the highest denitrification rate occurred in the microplots under the 1-year-old windrows although the gaseous N-15 loss calculated by gas emission was only about one-quarter that estimated by the N-15 mass balance method. A significant, positive linear relationship (P < 0.05) existed between the gaseous N-15 losses measured by the two methods used. The research indicates that considerable mineral N could be lost via denitrification during the critical inter-rotation period and early phase of the second rotation. However, the impacts of windrowed harvesting residues on N losses via denitrification might only last for a period of about 2 years. Published by Elsevier Science B.V.

Masculine, feminine or neutral? In-company equal opportunities policies in Irish and French MNC retailing

Several problematic aspects of women's paid employment - e.g. low pay and lack of promotional opportunities - are exacerbated by the segregation of women and men into different occupations. In this article, the potential of in-store equal opportunities policies to break down such gender segregation will be explored, through consideration of the existence and implementation of these policies in twenty-two multinational retail companies in Dublin and Paris. It will be argued that, with one notable exception, the instore equal opportunities policies are effectively neutralized, and furthermore are neutralized in nationally specific ways which can be related to differences between France and Ireland in the organization of labour-market regulation and in women's labour-force participation (LFP). The case-study findings also suggest that the 'country' variable has a stronger effect on the existence and implementation of these policies than the extent of a shop's links to an overseas headquarters. The findings of this study have implications for both the equity of women's incorporation into the paid labour force and understanding of aspects of HRM in branches of multinational companies.

Mark-recapture may reveal more about ecology than about population trends: Demography of a threatened ghost bat (Macroderma gigas) population

Since European settlement in Australia, the geographical range of ghost bats (Macroderma gigas) has contracted northwards. Ghost bats are thought to occur in disjunct populations with little interpopulation migration, raising concerns over the current status and future viability of the southernmost colony, which has also been threatened by mining activity. To address these concerns, demographic parameters of the southernmost colony were estimated from a mark-recapture study conducted during 1975-1981. Female bats gave birth to a single young in late spring, but only 40% (22-70%, 95% CI) of females bred in their second year, increasing to 93% (87-97%, 95% CI) for females greater than or equal to 2 years old. Sixty-five percent of juveniles caught were female. Annual adult survival ranged between 0.57-0.77 for females and 0.43-0.66 for males, and was lowest over winter-spring and greatest in autumn-winter. Juvenile survival for the first year ranged between 0.35-0.46 for females and 0.29-0.42 for males. Adult survival varied among seasons, was negatively associated with rainfall, but was not associated with temperature beyond being lower in late winter. Poor survival may result from the inferior daytime roosts that bats must use if water seepage forces them to leave their normal roosts. Although these age-specific rates of fecundity and survival suggested a declining population, mark-recapture estimates of the population trend indicated stability over the study period. Counts at daytime roosts also suggested a population decline, but were considered unreliable because of an increasing tendency of bats to avoid detection. It is therefore likely that some assumptions in estimating survival were violated. These results provide a caution against the uncritical use of population projections derived from mark-recapture estimates of demographic parameters, and the use of untested indices as the basis for conservation decisions.

Seasonal Effects on Transient Evoked Otoacoustic Emission Screening Outcomes in Infants versus 6-Year-Old Children

The purpose of this study was to compare transient evoked otoacoustic emission (TEOAE) screening outcomes (pass/fail) across the seasons (spring, autumn, and winter) between infants and schoolchildren. A total of 526 infants (275 boys, 251 girls) with a mean age of 2.0 months (SD = 0.38 months) and 975 schoolchildren (513 boys, 462 girls) with a mean age of 6.2 years (SD = 0.36 years) were screened using the ILO Otodynamics Quickscreen program. The same TEOAE pass/fail criterion was applied to the two groups. The results indicated a significant difference in pass rates between infants (91.2% of 1052 ears) and schoolchildren (86.0% of 1950 ears). A seasonal effect was found only for schoolchildren, with a significantly lower pass rate in winter than in spring or autumn. There was no difference in pass rates between spring and autumn. Implications for the seasonal effect on TEOAE screening outcomes for infants and schoolchildren are discussed.

Thiazolidinediones and type 2 diabetes: new drugs for an old disease

Thiazolidinediones are a new class of drugs for the treatment of type 2 diabetes, and act by improving insulin sensitivity in adipose tissue, liver and skeletal muscle. Rosiglitazone and pioglitazone are registered for use in monotherapy, and in combination with sulfonylureas and metformin. Pioglitazone is also licensed for use in combination with insulin. There is level II evidence that in patients with inadequate glycaemic control both drugs reduce the level of HbA(1c) and fasting plasma glucose (FPG) when used as monotherapy and in combination with sulfonylurea or metformin or insulin; and both drugs increase levels of HDL and LDL and lower free fatty acid levels, but only pioglitazone significantly lowers triglyceride levels. Both drugs lower fasting insulin and C-peptide levels. In monotherapy, they may be slightly less potent at reducing the level of HbA(1c) than sulfonylureas or metformin. The maximal effect of these agents may not be seen for 6-14 weeks after commencement. Both drugs are well tolerated but liver function must be checked at baseline every second month for the first year, and periodically thereafter. The drugs are currently contraindicated in patients with moderate to severe liver dysfunction and alanine aminotransferase levels more than 2.5 times normal, New York Heart Association III-IV cardiac status, pregnancy, lactation and in children. The main side effects include weight gain, oedema, and mild dilutional anaemia.

Intraindividual allometric development of aerobic power in 8- to 16-year-old boys

Purpose: The aims of this study are two-fold: first, to analyze intraindividual allometric development of aerobic power of 73 boys followed at annual intervals from 8 to 16 yr, and second, to relate scaled aerobic power with level of habitual physical activity and biological maturity status. Methods: Peak (V) over dot O-2 (treadmill), height, and body mass were measured. Biological maturity was based on age at peak height velocity (PHV) and level of physical activity was based on five assessments between 11 and 15 yr and at 17 yr. Interindividual and intraindividual allometric coefficients were calculated. Multilevel modeling was applied to verify if maturity status and activity explain a significant proportion of peak (V) over dot O-2 after controlling for other explanatory characteristics. Results: At most age levels, interindividual allometry coefficients for body mass exceed k = 0.750. Intraindividual coefficients of peak (V) over dot O-2 by body mass vary widely and range from k' = 0,555 to k' = 1,178. Late maturing boys have smaller k' coefficients than early maturing boys. Conclusion: Peak (V) over dot O-2 is largely explained by body mass, but activity level and its interaction with maturity status contribute independently to peak (V) over dot O-2 even after adjusting for body mass.

A normative study of distortion product otoacoustic emissions in six-year-old school children

Evoked otoacoustic emissions have demonstrated potential for application in the community-based hearing screening of paediatric populations. Distortion-product otoacoustic emissions (DPOAEs), as opposed to transient evoked otoacoustic emissions (TEOAEs), have not been extensively researched in this regard. The current study aimed to describe the range of DPOAE values obtained in a large cohort (1576 ears) of 6-year-old children in school settings and to examine possible ear asymmetry, gender and history of ear infection effects on the data. Results indicated a variety of significant effects, particularly in the high frequencies, for DPOAE signal-to-noise ratio. The measurement parameter, DPOAE amplitude (DP-amp), was found to display potentially less clinical applicability due to large standard deviation values. Use of descriptive normative data, as derived in the present investigation, may contribute toward future improvements in the hearing screening of 6-year-old schoolchildren