Prevalence of hearing impairment and auditory pathology in the Limpopo Province, South Africa

Submitted in fulfilment of requirements for the degree Masters in Audiology In the Department of Speech Pathology and Audiology School of Human and Community Development Faculty of Humanities University of the Witwatersrand Johannesburg February 2015The lack of prevalence data for hearing impairment (HI) in South Africa may negatively impact on the type of audiological services currently available to individuals residing in the rural areas of South Africa. Without relevant prevalence data, the government is unable to plan and budget for appropriate, comprehensive ear and hearing health services. Objective: The aim of this study was therefore to obtain epidemiological data on the prevalence and distribution of auditory pathology and HI in the Elias Motsoaledi Local Municipality of the Limpopo Province. Method: A quantitative, non-experimental, cross-sectional survey design was used for this study. Using a random multi-stage cluster sampling strategy, 357 households were selected in seven wards using the probability proportional to size method. The Ear and Hearing Disorders Survey developed by the World Health Organisation was used to gather information. Participants: All individuals living in the households selected who gave consent and/or assent to participate in the study were included in the study. In total the hearing of 850 individuals from 357 households were tested. The mean age of participants was 27.9 years (range: 1 month to 94.5 years; SD – 22.08). Results: The overall prevalence of disabling HI (> 40 dB) in this rural population is 8.9% (95% CI: 0.08 - 0.12). The age group 65 years and older presented with the highest prevalence of disabling HI at 74.65% (95% CI: 0.62 - 0.83). The prevalence of auditory pathology is 27.53% (95% CI: 0.26 - 0.32) with undetermined causes, impacted cerumen and otitis media occurring most often. Conclusion: The study provided evidence-based data on the prevalence on HI and auditory pathology in the rural context in South Africa. This information will assist all stakeholders in the ear and hearing health care sector to plan for, prioritize, allocate adequate resources and initiate programmes to ameliorate the impact of HI and auditory pathology in the EMLM of the Limpopo Province. Keywords: prevalence; hearing impairment, auditory pathology; Ear and Hearing Disorders Survey, rural, South Afric

Contribution to the study of epidemiological factors associated with sensorineural hearing loss in the population of São Tomé and Príncipe

ABSTRACT: Otorhinolaryngology, like other medical and non-medical services, can contribute to its humanitarian support. At the end of 2010, the ORL department of CUF Infante Santo Hospital, led by Professor João Paço, was invited to participate in humanitarian missions in one of the Portuguese-speaking countries, former Portuguese colony - Democratic Republic of São Tomé and Príncipe. Without any knowledge of the main ENT pathologies we started this adventure. From research on sub-Saharan African countries, an increase in deafness was expected from chronic otological infections. The mission was organized to have audiological assessment, ENT assessment and surgical interventions. It was in February 2011 that we started the adventure through the hot lands of São Tomé and Príncipe. Deafness was one of the main problems found, but contrary to what we expected, deafness was mainly sensorineural, affecting a high percentage of children, some without language acquisition and with bilateral profound deafness. At the end of the first mission, the results led to the curiosity to understand the reason for the increased prevalence of sensorineural deafness, irreversible and with socio-cultural repercussions important for the development of a country. The absence of clinical records, laboratory exams, imagiologic or audiologic tests led us to a greater clinical challenge of etiological cause of hearing loss in this country. The present doctoral project was born at the end of the first mission. Admission to the doctoral course was accepted in July 2011, and a challenge to research began. The initial research project has undergone several modifications due to there are several diagnostic and economic constrictions. In June 2013, in the scope of the doctoral course, during genetics curricular unit, and due to difficulties in carrying out complementary examinations in the island, born the idea was born to study the association between neurossensorial hearing loss and some of some of the most frequent hemoglobinopathies of the region. These hemoglobinopathiesare known to give some protection for the development of one of the major scourges of the country – Malaria. For that, was carried-out the collection of blood samples on Dried Blood Spot or Guthrie paper from São Tomé and Príncipe for analysis in Portugal. Since São Tomé and Príncipe is an island that has been colonized for many years by Portuguese, we could hypothesize for the existence of an associated genetic factor, and for that reason the evaluation of the main mutations of our people should be investigated. Since São Tomé and Príncipe is an island that has been colonized for many years by Portuguese, we hypothesize the existence of the same genetic factors, and for that reason the evaluation of the main mutations from Portuguese population was investigated. In this country, they had a significant improvement in primary health care, since the implementation of humanitarian aid by the IMVF in cooperation with the Camões Institute. São Tomé and Príncipe have good vaccination coverage, but some vaccines that may have an impact on the appearance of deafness, such as rubella, were not implemented until this project. Rubella is a known etiologic factor for congenital deafness. In São Tomé and Príncipe it is not possible to determine the existence of the disease by laboratory tests, being a pathology often forgotten at diagnosis. For this reason, the research project also contemplated the serological study of rubella in order to confirm the existence of the disease in the community and demonstrate the need to implement adequate measures - vaccination. Knowing that there is not only an etiological factor for deafness, the birth of this project undoubtedly is stimulating for a clinician and a researcher. The curiosity that awakens and the attempt to stop this scourge that interferes so much with the development of a community, leads to the effort which is always rewarded. Analyzing the main effects of the risk factors evaluated, it was found that female gender is in high risk to have HL than male gender; rubella disease could lead to HL if it is during gestational period and represents a double risk to HL. In this sample, self-report of malaria infection augments the risk of HL, around three times more; sickle cell disease (HbSS) have almost two and half folder risk to develop HL and sickle cell trait is protecting to HL; regarding G6PD non-B variant in association with gender, even though it was not found to be statistically significant, male gender almost duplicated the risk to develop HL; the mutations in GJB2 and GJB6 of control group, unilateral and bilateral did not reveal significant difference. There was a wide variability in mutations found, which led to conclude that it is not possible to define a standard and can be justified by the existence of multiple people to colonize the island. Simultaneously with the etiological research project, there is a need to the diagnosis to minimize the effects of deafness. The acquisition of equipment for audiological evaluation (audiogram and auditory evoked potentials) and the acquisition and adaptation of hearing aids to children and young adults with work activity were born with the help of patronage, in order to reduce the effects of social isolation. This project gave rise to another humanitarian project - "Projecto sem Barreiras" of the Fundação Calouste Gulbenkian with the IMVF and Universidade Católica Portuguesa which included the national implementation of the Sign Language of São Tomé and Príncipe (LGSTP) and the Neonatal Auditory Screening of São Tomé and Príncipe (RANSTP), with the acquisition of acoustic oto-emission equipment. Undoubtedly a project that was born with Professor João Paço, cherished by all, with the ambition to contribute to the development of a country - Democratic Republic of São Tomé and Príncipe and scientific knowledge

Genetic Analysis of Dog Congenital Deafness and Herding Behavior

Strong artificial selections of canine morphological and behavioral traits lead to the formation of more than 400 modern dog (Canis familiaris, CFA) breeds within the past 300 years. Most dog breeds are derived from small numbers of founders, and this closed genetic pool within each breed results in the high frequency of occurrence of canine congenital disorders. The majority of these heredopathies share common clinical signs with corresponding human diseases. Therefore, dogs are appropriate spontaneous models for studying human diseases. Congenital deafness can cause both health and welfare problems in dogs, and it is quite prevalent among several dog breeds such as Dalmatian, Australian Cattle Dog, English Setter and Australian Stumpy Tail Cattle Dog (ASCD). However, hearing loss causative or associated genes in these dog breeds are not yet identified. The purpose of the study in Chapter 2 was to identify congenital deafness related genes in ASCD. Three bilateral deaf and one normal hearing ASCDs were whole genome sequenced. The publicly available 722 canine whole genome sequences were also used to investigate potential causative mutations in this study. A case-control genome-wide association study (GWAS) was conducted by setting three deafness affected ASCDs as cases, and one unaffected ASCD and 43 additional herding group dogs were used as controls. The GWAS identified several loci on six chromosomes with potential canine deafness association (CFA3, 8, 17, 23, 28 and 37), and most (7 out of 13) of the significantly associated loci were located within CFA37. The private variants unique to three deaf ASCD were filtered by comparison to 722 canine controls of over 144 modern breeds. Subsequent annotation of these variants was performed, only potentially functional variants were filtered resulting in four remaining missense mutations. A missense mutation in the Kruppel-like factor 7 (KLF7) gene (NC_006619.3: g.15562684G>A; XP_022270984.1: p.Leu173Phe) on CFA37 could be emphasized to be associated considering the variant effect prediction and gene function. KLF7 inner ear expression and a corresponding functional impact in development of inner ear and sensory neurons is known. Further genotyping of the KLF7 variant in 28 affected and 27 normal hearing ASCDs still supported its association with ASCD congenital deafness. Dogs have been selectively bred to intensify the performance abilities in regard to diverse tasks such as herding, hunting or companionship. Finally, modern dog breeds vary diversely in not only morphological but also behavioral traits. GWAS analysis of dog morphological traits using breed standard values have been well studied, and many auspicious genes were identified. However, due to the complexity of dog behavior traits, research progress on this topic is still limited. The study of Chapter 3 was intended to elucidate the candidate genes underlying dog behavior traits including herding, predation, temperament and trainability. The phenotype information of these behavioral traits was obtained from American Kennel Club, which classified dog breeds into seven groups (Herding, Hound, Working, Terrier, Toy, Sporting and Non-sporting) based on the behavior, heritage and historical roles. 268 publicly available dog whole genome sequences of 130 modern breeds were used in this study. Four GWASs were performed to investigate potential candidate genes. Dogs with herding behavior were compared with the other dog categories by GWAS. Candidate neurological genes such as THOC1, ASIC2, MSRB3, LLPH, RFX8 and CHL1 were detected within or nearest to the significant loci of herding GWAS. Regarding dog predation behavior, herding behavior is the modified predatory behavior like repression of killing instinct, while hound dogs were selectively bred to enhance predation behaviors. We then use hound and herding group dogs in GWAS to analyze the dog predation behavior. Three neural genes JAK2, MEIS1 and LRRTM4 that were nearest to the significant loci of predation GWAS were revealed as candidates. In temperament GWAS, candidate neurological gene ACSS3 was significantly associated with dog temperament trait. Dog behaviors were reported to be associated with body mass, so we repeated the four GWASs with incorporating dog breed standard body size as covariates. Similar results except for the significant associations of ASIC2, JAK2 and MEIS1 were observed, while these three candidate genes could contribute to dog behaviors through their effects on dog brain architecture. Linkage disequilibrium (LD) analysis of the herding GWAS significant associated signals were also conducted. Promising neurological processes or cellular components were disclosed in GO analysis of potentially functional private genes of herding dogs. In the study described in Chapter 4, one loss of function mutation in ABHD16B was identified to be associated with bull infertility. However, the exact gene function of ABHD16B remains unknown. Western blot was applied to locate ABHD16B protein expression, uncovering its occurrence in bull testis tissue but not in sperm cells. ABHD16B protein owns a function domain of α/β-hydrolase (ABHD) and several ABHD members are involved in lipid metabolism. It is assumed that ABHD16B could play roles in biosynthesis of sperm membrane lipids. Lipidomes of heterozygous and homozygous wild-type bull sperms were analyzed to explore potential aberrations. Several lipid components including PC, DAG, Cer, SM and PC were found significantly altered which verified our hypothesis. Therefore, the imbalanced lipid homeostasis of sperm membrane could be responsible for the bull infertility problem subjected in this study.2021-10-1

Tinnitus, biomarkers and quality of life in an older population

Tinnitus is a symptom involving the perception of sound in the ears or head, without a corresponding external acoustic stimulus. It is related to many different conditions and has a major impact on quality of life of the affected person. Currently, its diagnosis and monitoring are based on subjective audiometric and psychometric measures. There are no objective methods for tinnitus identification. In addition, the pathophysiological mechanisms underlying tinnitus remains unknown. The purpose of this thesis was to study the mechanisms underlying tinnitus and their relationship to hearing loss, being that hearing loss is the comorbidity most frequently associated with tinnitus. It also aimed to evaluate the contribution of genetic, audiological and immunological factors to the etiology of tinnitus. For this purpose, systematic reviews (SR) were performed, in order to account the state of art, the perspectives of the patient and their relatives, and previous clinical trials of tinnitus treatments. SRs contributed to the identification of a pool of tinnitus-related complaint domains used by COMIT’ID (Core outcome measures in tinnitus international Delphi) in a 3-round internet-based Delphi survey to identifying core outcome sets (COS), i.e., which complaints related to tinnitus are essential for evaluation in clinical trials. These recommendations are specific to the three main therapeutic modalities: sound, psychological, and pharmacological. In order to contribute to the standardization of tinnitus clinical evaluation and treatment, TINNET, a European network for scientific tinnitus research, was created. Among the different activities carried out in were a systematic review of existing national clinical practice guidelines for the diagnosis and treatment of tinnitus. This review contributed to the development of a multidisciplinary European guideline for tinnitus: diagnosis, evaluation and treatment. This guideline was presented at TINNET final meeting and it is being disseminated widely. Another aim of the present thesis was to review work on somatosensory tinnitus (pathophysiology, diagnosis, treatment and the participation in an international Delphi consensus group on the diagnosis of this subtype of tinnitus), to contribute to a better understanding of this subtype of tinnitus. In order to achieve the objectives of this PhD study, 114 participants aged 55 to 75 years were recruited from the Portuguese population. Participants were divided into four groups according to the presence/absence of tinnitus and hearing loss. The completion of the study protocol gave rise to four original research articles, including a demographic characterization, relevant psychological and quality of life aspects comparing the studied population and the published literature, audiologic markers of tinnitus, and immunological profile of population and biomarkers of presbycusis and tinnitus. The results point to hearing loss as a risk factor for the development of tinnitus and psychological complaints as a risk factor for more severe tinnitus and consequently less quality of life in patients with this symptom. In characterizing audiological markers, the presence of previous noise exposure and the hearing loss increased the probability of developing tinnitus. Also, participants with an abrupt onset of tinnitus and who had a negative effect or rebound on residual inhibition were more likely to develop severe or catastrophic tinnitus. For the population with tinnitus, a reduction in amplitude of auditory evoked potentials wave I and a higher values in the 'Ratio of Waves V/I for both ears' were associated with a greater probability of developing severe or catastrophic tinnitus. The inflammatory profile of the study population showed significant differences in IL10 levels between the group with and without tinnitus. IL1α was significantly higher in patients with tonal tinnitus, while IL2 was higher in participants who reported negative or rebound effect on residual inhibition of tinnitus. A negative correlation was also found between IL10 and tinnitus duration, and between HSP70 and tinnitus intensity. Biomarkers were explored in this thesis. A systematic review was performed to synthesize evidence for the existence and clinical usefulness of biomarkers. GRM7 and NAT2 were evaluated in the thesis population. The results indicate a higher prevalence of the T allele in the GRM7 gene (60.3% T/T and 33.3% A/T). Participants with a T/T genotype appeared to be at a higher risk for ARHL development, and 33% have a lower risk of developing tinnitus compared to participants with A/A and A/T genotype. Regarding the NAT2 phenotype, the slow acetylator (53%) was most common, followed by the intermediate acetylator (35.9%). These results suggest that the AT allele of GRM7 and the slow acetylating phenotype of Nat2 are potential biomarkers of tinnitus severity. The results in this thesis are very interesting and original, showing us the need for future research in larger samples, and employing rigorous methodological design in order to control for confounding variables. On the other hand, translational studies may be the key to clarifying the pathophysiologic dilemmas of tinnitus.O acufeno é um sintoma referente à perceção de um som nos ouvidos ou na cabeça, sem que exista um estímulo acústico externo correspondente. Está presente em diferentes patologias (otológicas ou não) e tem um impacto importante na qualidade de vida da pessoa afetada. Atualmente, o seu diagnóstico e monitorização são baseados em medidas subjetivas audiométricas e psicométricas, sendo que não existem métodos objetivos para a identificação do acufeno. Além disso, os mecanismos fisiopatológicos subjacentes ao acufeno subjectivo permanecem desconhecidos. O objetivo da presente tese é estudar os mecanismos subjacentes ao acufeno subjectivo e a sua relação com a surdez, visto que a surdez é a co-morbilidade mais frequentemente associada ao acufeno. Pretende-se também avaliar a contribuição dos fatores genéticos, audiológicos e imunológicos na etiologia do acufeno. Para isso, foram realizadas revisões sistemáticas (RS) sobre esta temática de forma a conhecer o estado de arte, primeiramente em relação à forma como os pacientes e os familiares percecionam o acufeno e também sobre os ensaios clínicos existentes acerca da eficácia do tratamento do acufeno. Ambas as RS contribuíram para a identificação de um conjunto de domínios relacionados com o acufeno, usado pelo COMIT’ID (Core outcome measures in tinnitus international Delphi), num método de consensos Delphi, baseado na Internet, com o objetivo de identificar um ‘Core Outcome Set’ (ou seja definir quais as queixas relacionadas com o acufeno que são imprescindíveis para a sua avaliação) recomendado para ensaios clínicos de eficácia terapêutica para o acufeno assim como para o seu diagnóstico. Estas recomendações são específicas para as três modalidades terapêuticas principais: sonora, psicológica e farmacológica uma vez que cada modalidade tem fundamentos específicos e por isso visam avaliar diferentes aspetos do acufeno. Com o objetivo de contribuir para a padronização da avaliação e do tratamento clínico do acufeno, foi constituída a TINNET, uma rede europeia para a investigação científica do acufeno. Considerando o objetivo do presente estudo e a hipótese de integrar esta rede europeia, foram desenvolvidas um conjunto de atividades que em muito contribuíram para o conhecimento sobre o acufenos. Entre as diferentes atividades realizadas com o apoio da TINNET destaca-se a realização de uma revisão sistemática sobre as ‘guidelines’ clínicas existentes para o diagnóstico e tratamento do acufeno. Esta revisão foi uma das bases que conduziu ao desenvolvimento das ‘guidelines’ europeias multidisciplinares para o acufeno: diagnóstico, avaliação e tratamento. Estas ‘guidelines’ foram apresentadas na conferência final do TINNET e estão atualmente em fase de disseminação. Outro foco de interesse da presente tese foi a realização de trabalhos de revisão sobre o acufeno somatosensorial (nomeadamente sobre a fisiopatologia, diagnóstico e tratamento), bem como a participação num grupo de consenso internacional sobre o diagnóstico deste subtipo do acufeno, de forma a contribuir para uma melhor compreensão deste subtipo do acufeno. Também estas atividades contribuíram para o desenvolvimento de competências cientificas essenciais ao desenvolvimento do presente estudo, dado que permitiram uma melhor compreensão deste subtipo do acufeno, demonstrando-se a heterogeneidade e diversidade do acufeno. De forma a alcançar os objetivos deste estudo de doutoramento, recrutaram-se 114 voluntários da população portuguesa com idade dos 55 aos 75 anos. Os indivíduos desta amostra permitiam a realização de diferentes estudos nomeadamente os laboratoriais, tendo a analise dos resultados envolvido a amostra dividida em quatro grupos consoante a presença/ausência do acufeno e de surdez. Dos resultados desta tese fazem parte quatro artigos originais que e incluem uma caracterização demográfica, aspetos relevantes a nível psicológico e de qualidade de vida, marcadores audiológicos do acufeno, perfil imunológico da população e biomarcadores da presbiacusia e do acufeno. Os resultados obtidos sugerem a perda auditiva como fator de risco para o desenvolvimento do acufeno e as queixas a nível psicológico como fator de risco para o acufeno mais grave e consequentemente associado a menor qualidade de vida nos pacientes com este sintoma. A nível da caracterização dos marcadores audiológicos, verificou-se que a presença de antecedentes de exposição ao ruído e a perda auditiva aumentam a probabilidade de desenvolver acufeno. Também, os participantes com um início abrupto do acufeno e que apresentam um efeito negativo ou ‘rebound’ na inibição residual têm maior probabilidade de desenvolver acufeno grave ou catastrófico. Encontrou-se nos Potenciais Evocados Auditivos, uma redução da amplitude na onda I em pacientes com acufeno, bem como valores maiores no ‘Ratio de amplitude das ondas V e I de ambos ouvidos’ estando associados a maiores probabilidades de desenvolver acufeno severo ou catastrófico. O perfil inflamatório da nossa população mostra diferenças significativas entre o grupo com e sem acufeno quando comparados para a IL10. Quanto à relação entre os parâmetros imunológicos e a acufenometria, verificou-se uma correlação entre o aumento da IL1α e acufeno tonal, bem como entre o aumento da IL2 e a inibição residual do acufeno. Foi também encontrada uma correlação negativa para a IL10 e a duração do acufeno e para o HSP70 e a intensidade do acufeno. Estes resultados são muito originais e suscitam a necessidade de estudos futuros que permitam esclarecer os mecanismos subjacentes às correlações encontradas. Em relação aos biomarcadores, foi efetuada uma revisão sistemática com a finalidade de sintetizar evidências para a existência e utilidade clínica dos biomarcadores para o desenvolvimento ou gravidade do acufeno. Foi também realizado um estudo acerca do papel do GRM7 e do NAT2 na nossa amostra. Os resultados apontam para uma maior prevalência do alelo T no gene GRM7 (60,3% T/T e 33,3% A/T). Os participantes com um genótipo T/T parecem ter um maior risco para o desenvolvimento de ARHL e 33% apresentam menor risco para o desenvolvimento do acufeno, em comparação com indivíduos com A/A e genótipo A/T. Em relação ao fenótipo NAT2, o acetilador lento (53%) foi o mais comum seguido pelo intermediário acetilador (35,9%). Os nossos resultados sugerem que o genótipo A/T de GRM7 e o fenótipo acetilador lento de NAT2 como potenciais biomarcadores da severidade do acufeno. Os resultados obtidos são originais e no seu conjunto são muito interessantes, apontando para a necessidade de estudos futuros em larga escala de forma a aprofundar as conclusões aqui obtidas. Por outro lado, os estudos translacionais poderão ser a chave para esclarecer os dilemas da fisiopatologia do acufeno

Inclusion/integration of children with hearing impairment in pre-primary education in Tanzania

The study investigated the inclusion/integration of children with hearing impairment in pre-primary education in Tanzania. The worldwide inclusion of young children with disabilities into regular pre-primary schools/streams in Tanzania is a subject worthy of investigation. The government of Tanzania has pledged to provide education for children with disabilities in pre-primary education in an inclusive setting. Inclusive education is considered as a means to eliminate exclusion in society and build an inclusive society. However, it is observed that, despite the advocacy of inclusion, exclusion in education still exists; more importantly in early childhood education programs. Early childhood experience shapes the whole life of the individual and is a foundation for the later stage of child development. Early childhood education can thus be perceived of as a springboard for primary education and other subsequent levels of education. Most children with disabilities face great challenges including failure and drop out in primary education. Therefore, there is a need to ensure a solid background education in pre-primary education, specifically in an inclusive setting, the most preferable educational setting providing education to all children worldwide and in the respective country. The study was guided by four research questions; the first question focused on the policy concerning children with disabilities in pre-primary schools. Second, the methods and ways used to identify, assess and place children with hearing impairment in schools in Tanzania were considered. The third consideration focused on the kind of activities and support provided during the teaching and learning process in the pre-primary learning environment and the fourth governed the challenges facing integration/inclusion of children with hearing impairment in Tanzanian education. The study was conducted in two regions: Dar es Salaam and Shinyanga. Two schools in Dar es Salaam and two schools in Shinyanga were purposively selected for data collection. The study employed a document review, semi-structured interviews and direct observation methods in the collection of data. Various documents were reviewed to generate the required information on policy, regulations, guidelines and key information about the children. Teaching, learning activities and play were observed. Teachers were interviewed concerning their personal details including qualifications, professional background and experience, specific information about each child observed during classroom observation and their views and opinions concerning inclusion of children with hearing impairment- more specifically, hard of hearing and deaf (HH/D) children- in pre-primary education. Results revealed that in general the government of Tanzania has put some effort into providing an education service for children with disabilities. Education was realized as a basic human right for every child regardless of the status of the child. However, much needs to be done to ensure that this right is fully realized. Also, there was no guideline at national level for identifying and assessing children with disabilities, e.g. screening procedures. HH/D children and likewise other children with severe disabilities were educated in segregated settings such as special schools and special units/classes in integrated settings. Teaching and learning activities were based largely on the observations generated by the interaction of teacher and child. Environmental and personal factors and child personality influenced the interaction during the classroom learning process and out-door play activities. Environmental factors included the nature of classroom and school environment, classroom structure, size and space. Personal factors observed focused on gender, age of teachers, academic and professional qualifications, teaching experience, training in special education needs (SEN) and motivation to teach pre-primary children with HH/D. Moreover, the study observed a shortage of support provision to teachers, schools, children and their parents. In addition, several challenges exist concerning policy, the school management, HH/D teachers, parents of HH/D and the HH/D children. The whole HH/D ecological system was subjected to various difficulties affecting the child at the center. Generally, the study found that the ecology of the HH/D was affected by many factors; thus, it was recommended that the provision of pre-primary education for the HH/D should consider all systems surrounding the individual child

Tropical and Subtropical Maize in Asia: Production Systems, Constraints, and Research Priorities

This book examines future technological and policy prospects for the sustainable intensification of rainfed upland maize production in Asia, and derives R&D priorities for specific maize production environments and markets. Village-level and farmer-group surveys were conducted to characterize upland maize production environments and systems in China, India, Indonesia, Nepal, the Philippines, Thailand, and Vietnam. Survey findings, particularly farmer-identified constraints to maize production, complemented with other relevant data, were used in country-level, R&D priority-setting workshops. High on the list of farmer constraints was drought, estimated to affect three production environments that are home to about 48 million rural poor and produce an estimated 16 million tons of maize, and others such as downy mildew, stem borers, soil erosion/landslides, waterlogging, poor agricultural extension/ technology transfer services, and poor access to low-interest credit and markets. Farmers felt that socioeconomic and policy-related constraints impact maize productivity more than technical constraints do. It is important to recognize that technology is not the only key to increasing productivity and bettering the conditions of marginal maize farmers in Asia. There is a growing trend towards commercializing and intensifying maize production that is different from the staple food self-sufficiency paradigm that has been the cornerstone of agricultural policy in most developing countries. Appropriate government policies could help alleviate the adverse consequences of commercialization and promote sustainable intensification of maize production, especially in marginal environments inhabited by resource-poor subsistence farmersMaize, Agricultural development, Farming systems, Production policies, Environmental factors, Cropping systems, Research projects, Project management, Asia, Crop Production/Industries, E10,

Morphological and morphometric changes in the faces of female-to-male transsexual (FTM) people

Facial changes associated with the administration of exogenous testosterone and bilateral oophorectomy in female-to-male (FtM) transsexual people (trans men; trans males) has not been previously documented. This study aimed to describe the qualitative and quantitative transformation from a female to a male facial appearance and to identify predictable patterns of change. Twenty-five trans men were studied using morphological and morphometrical analysis of pre-transition 2-D images and post-transition 3-D scan models. The mean subject age was 39 years and all subjects had been taking testosterone for at least 3 years, with a mean duration of therapy of 8.6 years. While 32% of subjects were classified by a majority of observers as male appearing in pre-transition photographs, this rose to 95.5% in post-transition images. Eighty-six percent of subjects demonstrated an increase in male classification after transition. Morphometrically, 44% of subjects became wider in the face overall and 100% of subjects measured demonstrated a narrower nose after transition. Testosterone virilizes adult female faces and will cause widening of the face. The most consistent facial change was the production of a narrower nasal width at the alae, which may be a result of fat re-deposition not related to ageing effects or body mass index (BMI)