Prevalence of Noise-Induced Hearing Loss in Student Musicians

Abstract: This study describes the prevalence and characteristics of noise-induced hearing loss (NIHL) in student musicians (N = 329) aged 18-25 years. Students completed a questionnaire regarding exposures before a hearing assessment. NIHL was defined by the presence of a notch 15 dB in depth at 4000 or 6000 Hz relative to the best preceding threshold. Overall prevalence of NIHL was 45%, with 78% of notches occurring at 6000 Hz. The proportion of the total population with bilateral notching at any frequency was 11.5%, mostly occurring at 6000 Hz. There was a significant increase in the frequency of notching in students who reported more than two hours per day of personal practice. There were no significant associations for instrument group or other noise exposures. The data suggest that susceptibility to NIHL among students of music is not uniform and cannot be ascribed solely to the instrument played and other exposures. Students with bilateral losses tend to have deeper notches and may represent a group that has an inherent predisposition to NIHL. Sumario Este estudio describe la prevalencia y las características de la hipoacusia inducida por ruido (NIHL) en estudiantes de música (N = 329) con edades entre 18 y 25 años. Los estudiantes completaron un cuestionario sobre exposición a ruido antes de la evaluación auditiva. Se definió NIHL como la presencia de una muesca de 15dB en 4000 o 6000Hz con relación al mejor umbral precedente. La prevalencia general de NIHL fue de 44%, con 78% de las muescas en 6,000 Hz. La proporción de la población total con muescas bilaterales en cualquier frecuencia fue de 11.5%, en su mayoría a 6,000 Hz. Hubo un incremento significativo en la frecuencia de la muescas en los estudiantes que reportaban más de dos horas al día de práctica profesional. No hubo una asociación significativa con grupos de instrumentos u otra exposición a ruido. Los datos sugieren que la susceptibilidad a NIHL entre los estudiantes de música no es uniforme y no puede atribuirse solamente al instrumento tocado o a otras exposiciones. Los estudiantes con pérdida bilateral tienden a tener muescas más profundas y pueden representar un grupo que tenga una predisposición inherente a la NIHL. Keywords: Noise-induced hearing loss, Music-related hearing loss, Prevalence of hearing loss, Predisposition Article: Noise-induced hearing loss (NIHL) is the most prevalent sensorineural hearing loss after presbycusis. Prevalence of NIHL increases with continued exposure and advancing age. The prevention of NIHL will require a better understanding of its prevalence in the population and contributing exposure factors. NIHL can be caused by a single traumatic impulse sound but is more typically caused by repeated exposures to high intensity sound. According to NIOSH recommendations for the prevention of NIHL, high intensity sound exposure involves a time-intensity trade-off that begins with an allowable eight-hour exposure at 85 dBA, decreasing the time exposed by half for every three dB increase in intensity. Sound exposure measurements in music students and music teachers document exposure levels over 85 dB

Deploying homeland security technology

The success of each depends on how efficiently they implement new technologies. Although the White House and the Congress have responded swiftly to the events of September 11, 2001, the long-term security of our Nation, and thus the success of the newly created Department of Homeland Security, will depend in a substantial way on the efficiency with which technologies relevant to homeland security are created and, more importantly, deployed. The purpose of this paper is to assess the Administration's revealed understanding of the innovation process, which underlies the creation of new homeland security technology, and attendant factors that relate to the efficiency with which the new technology is deployed. By -revealed understanding‖ we are referring to the written word, namely what is outlined in the Homeland Security Act of 2002 and related documents. Certainly, the Act, and related document s from t he Whit e House, are only init ial templates that frame activities to come. But, as the Brookings Institution's (2002, p. i) early assessment of the Department 's organizat ion, and t he Depart ment 's organization is fundamentally related to its ability to provide incentives for the creation and deployment of homeland security technology, -... while it is possible to revisit or even reverse organizational decisions at a later stage, it is far better to get it right the first time.‖ The Department of Homeland Security will be charged with four primary tasks. The new agency will [1] control our borders and prevent terrorists and explosives from entering our country. It will [2] work with state and local authorities to respond quickly and effectively to emergencies. It will [3] bring together our best scientists to develop technologies that detect biological, chemical, and nuclear weapons, and to discover the drugs and treatments to best protect our citizens. And this new department will [4] review intelligence and law enforcement information from all agencies of government, and produce a single daily picture of threats against our homeland. An emphasis on homeland security technology One of the first policy institutes to offer an opinion on homeland security was the Heritage Foundation (2002). 2 Its report, Defending the American Homeland, recommended four well conceived priorities: protecting the Nation's infrastructures, strengthening civil defense, improving intelligence and law enforcement, and military operations to combat terrorism

Proteomic identification of PKC-mediated expression of 20E-induced protein in Drosophila melanogaster

Ecdysone receptor (EcR) and its heterodimeric partner, ultraspiracle protein (USP), are nuclear receptors that mediate the action of the insect molting hormone 20-hydroxyecdysone (20E). There is evidence that the activity of both receptors is affected by phosphorylation. Using a proteomic approach, we have shown that protein kinase C (PKC) activity is necessary for mediating 20E-induced expression of 14 specific proteins, including three previously reported 20E responsive proteins, and is also responsible for the intracellular localization of EcR and USP in larval salivary glands of Drosophila melanogaster. The 20E-dependent expression of the proteins was verified using real-time PCR and/or Western blot analysis. For some genes, inhibition of PKC activity reduced 20E-dependent transcriptional activity rapidly, raising the possibility that these are direct gene targets of EcR and USP. The data further indicate that PKC-mediated phosphorylation is also required for genes regulated indirectly by 20E-induced changes in the larval salivary gland

Functional characterization of two Ultraspiracle forms (CtUSP-1 and CtUSP-2) from Chironomus tentans

Two forms, CtUSP-1 and CtUSP-2, of the Chironomus tentans homolog of Ultraspiracle (new nomenclature: Chironomus NR2B4) were described and verified as components of the functional ecdysteroid receptor. The two forms differed from each other in the most N-terminal regions of the A/B domain and were tested for several properties. Both forms showed the ability to heterodimerize with CtEcR and interact with a variety of direct repeat and palindromic EcREs, and both conferred specific ligand binding when heterodimerized with EcR. CtUSP-2 showed a twofold higher ponasterone-binding potential than CtUSP-1. Both USP forms demonstrated the ability to activate ecdysteroid-inducible transcription in HeLa cells and the variations in the A/B domain of these forms were not associated with detectable differences in transcriptional activation. Thus, the two forms function similarly. Among species for which USP forms have been reported, Chironomus is the most closely related one evolutionarily to Drosophila. Despite this proximity, a variety of structural differences were noted in both the A/B and E domains of USP between the two species. The Chironomus USP forms lack many of the amino acid residues associated with the ligand-dependent AF2 transactivation function found in all other RXRs and USPs reported so far

Comparison of Ecdysteroid Production in Drosophila and Manduca: Pharmacology and Cross-Species Neural Reactivity

In both Manduca sexta and Drosophila melanogaster, metamorphic events are driven by ecdysteroids whose production in prothoracic gland (PGs) is stimulated periodically by neural factors. Differences in the life cycle of moths and flies have made it difficult to compare the regulation of ecdysteroid biosynthesis in these two species. As in Manduca, at least two neural factors in the larval Drosophila BVG complex were separable by molecular weight, and they stimulated increased ecdysteroid biosynthesis from the ring gland, a composite organ that includes PG cells. Drosophila neural extracts accelerated ecdysteroid biosynthesis in Manduca PGs and, conversely, partially purified Manduca PTTH preparations elevated ecdysteroid biosynthesis in Drosophila ring glands, suggesting that the two species may share structurally similar prothoracicotropic factors. Drosophila ring glands required the presence of calcium ions to respond to neural extracts, but the phosphodiesterase inhibitor MIX and cAMP analogues exerted little, if any, positive effect on production. Mean ecdysteroid production rates of BVG-ring gland complexes taken from Drosophila larvae during various phases of the wandering period were often submaximal and highly variable, suggesting that they fluctuate widely prior to pupariation. Based on available data in Drosophila and the Manduca model for the control of ecdysteroid biosynthesis, a developmental scheme for neuroendocrine control in Drosophila is proposed

Juvenile hormone bisepoxide biosynthesis in vitro by the ring gland of Drosophila melanogaster: A putative juvenile hormone in the higher Diptera

The in vitro production of juvenile hormone (JH) was investigated by using isolated ring glands from third instar Drosophila melanogaster. A JH-like molecule is secreted that comigrates with a synthetic sample of methyl 6,7;10,11- bisepoxy-3,7,11-trimethyl-(2E)-dodecenoate (JHB3) during TLC, liquid chromatography, and GC analysis. Purified product from farnesoic acid-stimulated ring glands was analyzed by electron impact GC/MS and gave a mass spectrum identical to synthetic JHB3. Additional structure confirmation was obtained following conversion of product from unstimulated biosynthesis to a derivative that comigrated on liquid chromatography with the derivative prepared from synthetic JHB3. Physiological studies revealed that JHB3 is produced solely by the corpus allatum portion of the ring gland in vitro. Isolated ring glands from other cyclorrhaphous dipteran larvae also produce JHB3 almost exclusively in vitro. Corpora allata from mosquito larvae, however, produce only JH HI, indicating that JHB3 production may be restricted to the higher Diptera. Topically applied synthetic JHB3 caused developmental responses in newly formed D. melanogaster white puparia similar to those obtained with JH IH. The data suggest that JHB3 is a fly juvenile hormone

Functional studies on the ligand-binding domain of Ultraspiracle from Drosophila melanogaster

The functional insect ecdysteroid receptor is comprised of the ecdysone receptor (EcR) and Ultraspiracle (USP). The ligand-binding domain (LBD) of USP was fused to the GAL4 DNA-binding domain (GAL4-DBD) and char-acterized by analyzing the effect of site-directed mutations in the LBD. Normal and mutant proteins were tested for ligand and DNA binding, dimerization, and their ability to induce gene expression. The presence of helix 12 proved to be essential for DNA binding and was necessary to confer efficient ecdysteroid binding to the hetero-dimer with the EcR (LBD), but did not influence dimerization. The antagonistic position of helix 12 is indispensible for interaction between the fusion protein and DNA, whereas hormone binding to the EcR (LBD) was only partially reduced if fixation of helix 12 was disturbed. The mutation of amino acids, which presumably bind to a fatty acid evoked a profound negative influence on transactivation ability, although enhanced transactivation potency and ligand binding to the ecdysteroid receptor was impaired to varying degrees by mutation of these residues. Mutations of one fatty acid-binding residue within the ligand-binding pocket, I323, however, evoked enhanced transactivation. The results confirmed that the LBD of Ultraspiracle modifies ecdysteroid receptor function through intermolecular interactions and demonstrated that the ligand-binding pocket of USP modifies the DNA-binding and transactivation abilities of the fusion protein

Providing Patient Education: Impact on Quantity and Quality of Family Health History Collection

Background: Family health history (FHH) is an underutilized tool in primary care to identify and risk-stratify individuals with increased cancer risk. Objective: Evaluate the influence of patient education on quantity and quality of FHH entered into a primary care-based software program, and impact on the program’s cancer risk management recommendations. Design: Two primary care practices within a larger type II hybrid implementation-effectiveness controlled clinical trial. Participants: English speaking non-adopted patients with a well visit appointment December 2012–March 2013. Interventions: One to two weeks prior to their well visit appointment, participants entered their FHH into the program. Participants were then provided educational materials describing key FHH components. They were instructed to use the interval to collect additional FHH information. Patients then returned for their scheduled appointment, and updated their FHH with any new information. Main Measures: Percentage per pedigree of relatives meeting individual quality criteria. Changes made after patient education and changes to recommendations for surveillance, chemoprevention or genetic counseling referral. Key Results: Post patient education, pedigrees exhibited a greater percentage (per pedigree) of: deceased relatives with age at death (84 vs. 81 % p = 0.02), deceased relatives with cause of death (91 vs. 87 % p = 0.02), relatives with a named health condition (45 vs. 42 %p = 0.002), and a greater percentage of relatives with high quality records (91 vs. 89 % p = 0.02). Of 43 participants with pedigree changes that could trigger changes in risk stratified prevention recommendations, 12 participants (28 %) received such changes. Conclusions: Patient education improves FHH collection and subsequent risk stratification utilized in providing actionable evidence-based care recommendations for cancer risk management

Development and Validation of a Primary Care-Based Family Health History and Decision Support Program (MeTree)

Introduction: Family health history is a strong predictor of disease risk. To reduce the morbidity and mortality of many chronic diseases, risk-stratified evidence-based guidelines strongly encourage the collection and synthesis of family health history to guide selection of primary prevention strategies. However, the collection and synthesis of such information is not well integrated into clinical practice. To address barriers to collection and use of family health histories, the Genomedical Connection developed and validated MeTree, a Web-based, patient-facing family health history collection and clinical decision support tool. MeTree is designed for integration into primary care practices as part of the genomic medicine model for primary care.Methods: We describe the guiding principles, operational characteristics, algorithm development, and coding used to develop MeTree. Validation was performed through stakeholder cognitive interviewing, a genetic counseling pilot program, and clinical practice pilot programs in 2 community-based primary care clinics.Results: Stakeholder feedback resulted in changes to MeTree’s interface and changes to the phrasing of clinical decision support documents. The pilot studies resulted in the identification and correction of coding errors and the reformatting of clinical decision support documents. MeTree’s strengths in comparison with other tools are its seamless integration into clinical practice and its provision of action-oriented recommendations guided by providers’ needs.Limitations: The tool was validated in a small cohort.Conclusion: MeTree can be integrated into primary care practices to help providers collect and synthesize family health history information from patients with the goal of improving adherence to risk-stratified evidence-based guidelines

The Genomic Medicine Model: An Integrated Approach to Implementation of Family Health History in Primary Care

As an essential tool for risk stratification, family health history (FHH) is a central component of personalized medicine; yet, despite its widespread acceptance among professional societies and its established place in the medical interview, its widespread adoption is hindered by three major barriers: quality of FHH collection, risk stratification capabilities and interpretation of risk stratification for clinical care. To overcome these barriers and bring FHH to the forefront of the personalized medicine effort, we developed the genomic medicine model (GMM) for primary care. The GMM, founded upon the principles of the Health Belief Model, Adult Learning Theory and the implementation sciences, shifts responsibility for FHH onto the patient, uses information technology (MeTree©) for risk stratification and interpretation, and provides education across multiple levels for each stakeholder, freeing up the clinical encounter for discussion around personalized preventive healthcare plans. The GMM has been implemented and optimized as part of an implementation-effectiveness hybrid pilot study for breast/ovarian cancer, colon cancer and thrombosis, and risk for hereditary cancer syndromes in two primary care clinics in NC, USA. This paper describes the conceptual development of the model and key findings relevant for broader uptake and sustainability in the primary care community