Incidence of self-reported hearing loss and associated risk factors among the elderly in São Paulo, Brazil: the SABE survey

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Interventions to promote the wearing of hearing protection

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Auditory steady state response in hearing assessment in infants with cytomegalovirus

OBJETIVO:Relatar o caso de um lactente com citomegalovírus congênito e disacusia neurossensorial progressiva, analisado por três métodos de avaliação auditiva.DESCRIÇÃO DO CASO:Na primeira avaliação auditiva, aos quatro meses de idade, o lactente apresentou ausência de Emissões Otoacústicas (EOA) e Potencial Evocado Auditivo de Tronco Encefálico (PEATE) dentro dos padrões de normalidade para a faixa etária, com limiar eletrofisiológico em 30dBnHL, bilateralmente. Com seis meses, apresentou ausência de PEATE bilateral em 100dBnHL. A avaliação comportamental da audição mostrou-se prejudicada devido ao atraso no desenvolvimento neuropsicomotor. Aos oito meses, foi submetido ao exame de Resposta Auditiva de Estado Estável (RAEE) e os limiares encontrados foram 50, 70, ausente em 110 e em 100dB, respectivamente para 500, 1.000, 2.000 e 4.000Hz, à direita, e 70, 90, 90 e ausente em 100dB, respectivamente para 500, 1.000, 2.000 e 4.000Hz, à esquerda.COMENTÁRIOS:Na primeira avaliação, o lactente apresentou alteração auditiva no exame de EOA e PEATE normal, que passou a ser alterado aos seis meses de idade. A intensidade da perda auditiva só pôde ser identificada pelo exame de RAEE, permitindo estabelecer a melhor conduta na adaptação de aparelho de amplificação sonora individual. Ressalta-se a importância do acompanhamento audiológico para crianças com CMV congênito.

Cognition and driving in older persons

In Switzerland, approximately 350,000 people aged 70 years or older own a valid driving license. By law, these drivers are medically assessed every other year, most commonly by their general practitioner, to exclude that a medical condition is interfering with their driving skills. A prerequisite for driving is the integration of high-level cognitive functions with perception and motor function. Ageing, per se, does not necessarily impair driving or increase the crash risk. However, medical conditions, such as cognitive impairment and dementia, become more prevalent with advancing age and may contribute to poor driving and an increased crash risk. The extent to which driving skills are impaired depends on the cause of dementia, disease severity, other co-morbidities and individual compensation strategies. Dementia often remains undiagnosed and therefore general practitioners (GPs) can find themselves in the difficult situation to disclose a suspicion about cognitive impairment and queries about medical fitness to drive, at the same time. In addition, the literature suggests that cognitive screening tests, most commonly used by GPs, have a limited role in judging whether an older person remains fit to drive. Further specialist assessment, for example in a memory clinic or on the road testing (ORT), may be helpful when the diagnosis or its implication for driving remain unclear. Here, we review the literature about cognition and driving, for GPs who advise older drivers who wish to continue driving.

Effect of atazanavir versus other protease inhibitor-containing antiretroviral therapy on endothelial function in HIV-infected persons: randomised controlled trial

OBJECTIVE: Impaired endothelial function was demonstrated in HIV-infected persons on protease inhibitor (PI)-containing antiretroviral therapy, probably due to altered lipid metabolism. Atazanavir is a PI causing less atherogenic lipoprotein changes. This study determined whether endothelial function improves after switching from other PI to atazanavir. DESIGN: Randomised, observer-blind, treatment-controlled trial. SETTING: Three university-based outpatient clinics. PATIENTS: 39 HIV-infected persons with suppressed viral replication on PI-containing regimens and fasting low-density lipoprotein (LDL)-cholesterol greater than 3 mmol/l. INTERVENTION: Patients were randomly assigned to continue the current PI or change to unboosted atazanavir. MAIN OUTCOME MEASURES: Endpoints at week 24 were endothelial function assessed by flow-mediated dilation (FMD) of the brachial artery, lipid profiles and serum inflammation and oxidative stress parameters. RESULTS: Baseline characteristics and mean FMD values of the two treatment groups were comparable (3.9% (SD 1.8) on atazanavir versus 4.0% (SD 1.5) in controls). After 24 weeks' treatment, FMD decreased to 3.3% (SD 1.4) and 3.4% (SD 1.7), respectively (all p = ns). Total cholesterol improved in both groups (p<0.0001 and p = 0.01, respectively) but changes were more pronounced on atazanavir (p = 0.05, changes between groups). High-density lipoprotein and triglyceride levels improved on atazanavir (p = 0.03 and p = 0.003, respectively) but not in controls. Serum inflammatory and oxidative stress parameters did not change; oxidised LDL improved significantly in the atazanavir group. CONCLUSIONS: The switch from another PI to atazanavir in treatment-experienced patients did not result in improvement of endothelial function despite significantly improved serum lipids. Atherogenic lipid profiles and direct effects of antiretroviral drugs on the endothelium may affect vascular function. Trial registration number: NCT00447070.

The prevalence and predictive value of dipstick urine protein in HIV-positive persons in Europe.

INTRODUCTION Proteinuria (PTU) is an important marker for the development and progression of renal disease, cardiovascular disease and death, but there is limited information about the prevalence and factors associated with confirmed PTU in predominantly white European HIV+ persons, especially in those with an estimated glomerular filtration rate (eGFR) of 60 mL/min/1.73 m(2). PATIENTS AND METHODS Baseline was defined as the first of two consecutive dipstick urine protein (DPU) measurements during prospective follow-up >1/6/2011 (when systematic data collection began). PTU was defined as two consecutive DUP >1+ (>30 mg/dL) >3 months apart; persons with eGFR <60 at either DPU measurement were excluded. Logistic regression investigated factors associated with PTU. RESULTS A total of 1,640 persons were included, participants were mainly white (n=1,517, 92.5%), male (n=1296, 79.0%) and men having sex with men (n=809; 49.3%). Median age at baseline was 45 (IQR 37-52 years), and CD4 was 570 (IQR 406-760/mm(3)). The median baseline date was 2/12 (IQR 11/11-6/12), and median eGFR was 99 (IQR 88-109 mL/min/1.73 m(2)). Sixty-nine persons had PTU (4.2%, 95% CI 3.2-4.7%). Persons with diabetes had increased odds of PTU, as were those with a prior non-AIDS (1) or AIDS event and those with prior exposure to indinavir. Among females, those with a normal eGFR (>90) and those with prior abacavir use had lower odds of PTU (Figure 1). CONCLUSIONS One in 25 persons with eGFR>60 had confirmed proteinuria at baseline. Factors associated with PTU were similar to those associated with CKD. The lack of association with antiretrovirals, particularly tenofovir, may be due to the cross-sectional design of this study, and additional follow-up is required to address progression to PTU in those without PTU at baseline. It may also suggest other markers are needed to capture the deteriorating renal function associated with antiretrovirals may be needed at higher eGFRs. Our findings suggest PTU is an early marker for impaired renal function.

Cochlear implant candidates with psychogenic hearing loss.

Abstract Conclusions: Specific requests for cochlear implantations by persons with psychogenic hearing loss are a relatively new phenomenon. A number of features seems to be over-represented in this group of patients. The existence of these requests stresses the importance of auditory brainstem response (ABR) measurements before cochlear implantation. Objective: To describe the phenomenon of patients with psychogenic hearing losses specifically requesting cochlear implantation, and to gain first insights into the characteristics of this group. Methods: Analysis of all cases seen between 2004 and 2013 at the University Hospital of Bern, Switzerland. Results: Four cochlear implant candidates with psychogenic hearing loss were identified. All were female, aged 23-51 years. Hearing thresholds ranged from 86 dB to 112 dB HL (pure-tone average 500-4000 Hz). ABRs and otoacoustic emissions (OAEs) showed bilaterally normal hearing in two subjects, and hearing thresholds between 30 and 50 dB in the other two subjects. Three subjects suffered from depression and one from a pathologic fear of cancer. Three had a history of five or more previous surgeries. Three were smokers and three reported other close family members with hearing losses. All four were hearing aid users at the time of presentation.

Effect of Cognitive Impairment on Driving-Relevant Cognition in Older Persons

Intact cognitive abilities are fundamental for driving. Driving-relevant cognition may be affected in older drivers due to aging or cognitive impairment. The aim of this study was to investigate the effects of cognitive impairment on driving-relevant cognition in older persons. Performance in selective and divided attention, eye-hand-coordination, executive functions and the ability to regulate distance and speed of 18 older persons with CI-Group (cognitive impairment group) was compared to performance of older control group (18 age and gender-matched cognitively normal subjects) and young control group (18 gender-matched young subjects). The CI-Group showed poorer performance than the other two control groups in all cognitive tasks (significance level (p) < 0.001, effect size (partial η2) = 0.63). Differences between cognitively impaired and cognitively normal subjects were still significant after controlling for age (effect sizes from 0.14 to 0.28). Dual tasking affected performance of cognitively impaired subjects more than performance of the other two groups (p = 0.016, partial η2 = 0.14). Results show that cognitive impairment has age-independent detrimental effects on selective and divided attention, eye-hand-coordination, executive functions and the ability to regulate distance and speed. Largest effect sizes are found for reaction times in attention tasks.

A common mechanism of defective channel trafficking underlying DFNA2 hearing loss result in different cell surface expression levels of KCNQ4 mutants

KCNQ4 mutations underlie DFNA2, a subtype of autosomal dominant hearing loss. We had previously identified the pore-region p.G296S mutation that impaired channel activity in two manners: it greatly reduced surface expression and abolished channel function. Moreover, G296S mutant exerted a strong dominant-negative effect on potassium currents by reducing the channel expression at the cell surface representing the first study to identify a trafficking-dependent dominant mechanism for the loss of KCNQ4 channel function in DFNA2. Here, we have investigated the pathogenic mechanism associated with all the described KCNQ4 mutations (F182L, W242X, E260K, D262V, L274H, W276S, L281S, G285C, G285S and G321S) that are located in different domains of the channel protein. F182L mutant showed a wild type-like cell-surface distribution in transiently transfected NIH3T3 fibroblasts and the recorded currents in Xenopus oocytes resembled those of the wild-type. The remaining KCNQ4 mutants abolished potassium currents, but displayed distinct levels of defective cell-surface expression in NIH3T3 as quantified by flow citometry. Co-localization studies revealed these mutants were retained in the ER, unless W242X, which showed a clear co-localization with Golgi apparatus. Interestingly, this mutation results in a truncated KCNQ4 protein at the S5 transmembrane domain, before the pore region, that escapes the protein quality control in the ER but does not reach the cell surface at normal levels. Currently we are investigating the trafficking behaviour and electrophysiological properties of several KCNQ4 truncated proteins artificially generated in order to identify specific motifs involved in channel retention/exportation. Altogether, our results indicate that a defect in KCNQ4 trafficking is the common mechanism underlying DFNA2

Sonar bat for visually impaired people

Visually impaired people have many difficulties when traveling because it is impossible for them to detect obstacles that stand in their way. Bats instead of using the sight to detect these obstacles use a method based on ultrasounds, as their sense of hearing is much more developed than that of sight. The aim of the project is to design and build a device based on the method used by the bats to detect obstacles and transmit this information to people with vision problems to improve their skills. The method involves sending ultrasonic waves and analyzing the echoes produced when these waves collide with an obstacle. The sent signals are pulses and the information needed is the time elapsed from we send a pulse to receive the echo produced. The speed of sound is fixed within the same environment, so measuring the time it takes the wave to make the return trip, we can easily know the distance where the object is located. To build the device we have to design the necessary circuits, fabricate printed circuit boards and mount the components. We also have to design a program that would work within the digital part, which will be responsible for performing distance calculations and generate the signals with the information for the user. The circuits are the emitter and the receiver. The transmitter circuit is responsible for generating the signals that we will use. We use an ultrasonic transmitter which operates at 40 kHz so the sent pulses have to be modulated with this frequency. For this we generate a 40 kHz wave with an astable multivibrator formed by NAND gates and a train of pulses with a timer. The signal is the product of these two signals. The circuit of the receiver is a signal conditioner which transforms the signals received by the ultrasonic receiver in square pulses. The received signals have a 40 kHz carrier, low voltage and very different shapes. In the signal conditioner we will amplify the voltage to appropriate levels, eliminate the component of 40 kHz and make the shape of the pulses square to use them digitally. To simplify the design and manufacturing process in the digital part of the device we will use the Arduino platform. The pulses sent and received echoes enter through input pins with suitable voltage levels. In the Arduino, our program will poll these two signals storing the time when a pulse occurs. These time values are analyzed and used to generate an audible signal with the user information. This information is stored in the frequency of the signal, so that the generated signal frequency varies depending on the distance at which the objects are. RESUMEN Las personas con discapacidad visual tienen muchas dificultades a la hora de desplazarse ya que les es imposible poder detectar los obstáculos que se interpongan en su camino. Los murciélagos en vez de usar la vista para detectar estos obstáculos utilizan un método basado en ultrasonidos, ya que su sentido del oído está mucho más desarrollado que el de la vista. El objetivo del proyecto es diseñar y construir un dispositivo basado en el método usado por los murciélagos para detectar obstáculos y que pueda ser usado por las personas con problemas en la vista para mejorar sus capacidades. El método utilizado consiste en enviar ondas de ultrasonidos y analizar el eco producido cuando estas ondas chocan con algún obstáculo. Las señales enviadas tendrán forma de pulsos y la información necesaria es el tiempo transcurrido entre que enviamos un pulso y recibimos el eco producido. La velocidad del sonido es fija dentro de un mismo entorno, por lo que midiendo el tiempo que tarda la onda en hacer el viaje de ida y vuelta podemos fácilmente conocer la distancia a la que se encuentra el objeto. Para construir el dispositivo tendremos que diseñar los circuitos necesarios, fabricar las placas de circuito impreso y montar los componentes. También deberemos diseñar el programa que funcionara dentro de la parte digital, que será el encargado de realizar los cálculos de la distancia y de generar las señales con la información para el usuario. Los circuitos diseñados corresponden uno al emisor y otro al receptor. El circuito emisor es el encargado de generar las señales que vamos a emitir. Vamos a usar un emisor de ultrasonidos que funciona a 40 kHz por lo que los pulsos que enviemos van a tener que estar modulados con esta frecuencia. Para ello generamos una onda de 40 kHz mediante un multivibrador aestable formado por puertas NAND y un tren de pulsos con un timer. La señal enviada es el producto de estas dos señales. El circuito de la parte del receptor es un acondicionador de señal que transforma las señales recibidas por el receptor de ultrasonidos en pulsos cuadrados. Las señales recibidas tienen una portadora de 40 kHz para poder usarlas con el receptor de ultrasonidos, bajo voltaje y formas muy diversas. En el acondicionador de señal amplificaremos el voltaje a niveles adecuados además de eliminar la componente de 40 kHz y conseguir pulsos cuadrados que podamos usar de forma digital. Para simplificar el proceso de diseño y fabricación en la parte digital del dispositivo usaremos la plataforma Arduino. Las señales correspondientes el envío de los pulsos y a la recepción de los ecos entraran por pines de entrada después de haber adaptado los niveles de voltaje. En el Arduino, nuestro programa sondeara estas dos señales almacenando el tiempo en el que se produce un pulso. Estos valores de tiempo se analizan y se usan para generar una señal audible con la información para el usuario. Esta información ira almacenada en la frecuencia de la señal, por lo que la señal generada variará su frecuencia en función de la distancia a la que se encuentren los objetos.

Providing shelter for the homeless on underutilized federal properties pursuant to the McKinney Homeless Assistance Act [microform] : hearing before a subcommittee of the Committee on Government Operations, House of Representatives, One Hundredth Congress, second session, October 13, 1988.

CIS Microfiche Accession Numbers: CIS 89 H401-22

Oversight hearing on access to health insurance [microform] : hearing before the Subcommittee on Labor-Management Relations of the Committee on Education and Labor, House of Representatives, One Hundredth Congress, second session, hearing held in Washington, DC, June 9, 1988.

"Serial no. 100-94."

Homelessness during winter 1988-89 [microform] : prospects for change : hearing before the Ad Hoc Task Force on the Homeless and Housing of the Committee on the Budget, House of Representatives, One Hundredth Congress, second session, December 20, 1988.

CIS Microfiche Accession Numbers: CIS 89 H261-4

Permissible uses of jointly administered union trust funds. Hearing, Eighty-ninth Congress, first session. August 5, 1965.

"H.R. 7720, a bill to amend section 302(c) of the Labor management relations act, 1947, to permit the participation of retired employees of employers, employees of certain labor organizations, and employees of certain trust funds, as well as certain self-employed persons to participate as beneficiaries of welfare and pension trust funds."

Training of civil aircraft mechanics : hearing before a subcommittee of the Committee on Interstate and Foreign Commerce, House of Representatives, Seventy-seventh Congress, first session on H.R. 5695 a bill to amend the Civilian Pilot Training Act of 1939 so as to provide for the training of civilian aviation mechanics, December 8, 1941.

Mode of access: Internet.