Identifying Otosclerosis with Aural Acoustical Tests of Absorbance, Group Delay, Acoustic Reflex Threshold, and Otoacoustic Emissions

Background: Otosclerosis is a progressive middle-ear disease that affects conductive transmission through the middle ear. Ear-canal acoustic tests may be useful in the diagnosis of conductive disorders. This study addressed the degree to which results from a battery of ear-canal tests, which include wideband reflectance, acoustic stapedius muscle reflex threshold (ASRT), and transient evoked otoacoustic emissions (TEOAEs), were effective in quantifying a risk of otosclerosis and in evaluating middle-ear function in ears after surgical intervention for otosclerosis. Purpose: To evaluate the ability of the test battery to classify ears as normal or otosclerotic, measure the accuracy of reflectance in classifying ears as normal or otosclerotic, and evaluate the similarity of responses in normal ears compared with ears after surgical intervention for otosclerosis. Research Design: A quasi-experimental cross-sectional study incorporating case control was used. Three groups were studied: one diagnosed with otosclerosis before corrective surgery, a group that received corrective surgery for otosclerosis, and a control group. Study Sample: The test groups included 23 ears (13 right and 10 left) with normal hearing from 16 participants (4 male and 12 female), 12 ears (7 right and 5 left) diagnosed with otosclerosis from 9 participants (3 male and 6 female), and 13 ears (4 right and 9 left) after surgical intervention from 10 participants (2 male and 8 female). Data Collection and Analysis: Participants received audiometric evaluations and clinical immittance testing. Experimental tests performed included ASRT tests with wideband reference signal (0.25–8 kHz), reflectance tests (0.25–8 kHz), which were parameterized by absorbance and group delay at ambient pressure and at swept tympanometric pressures, and TEOAE tests using chirp stimuli (1–8 kHz). ASRTs were measured in ipsilateral and contralateral conditions using tonal and broadband noise activators. Experimental ASRT tests were based on the difference in wideband-absorbed sound power before and after presenting the activator. Diagnostic accuracy to classify ears as otosclerotic or normal was quantified by the area under the receiver operating characteristic curve (AUC) for univariate and multivariate reflectance tests. The multivariate predictor used a small number of input reflectance variables, each having a large AUC, in a principal components analysis to create independent variables and followed by a logistic regression procedure to classify the test ears. Results:Relative to the results in normal ears, diagnosed otosclerosis earsmore frequently showed absent TEOAEs and ASRTs, reduced ambient absorbance at 4 kHz, and a different pattern of tympanometric absorbance and group delay (absorbance increased at 2.8 kHz at the positive-pressure tail and decreased at 0.7–1 kHz at the peak pressure, whereas group delay decreased at positive and negative-pressure tails from 0.35–0.7 kHz, and at 2.8–4 kHz at positive-pressure tail). Using a multivariate predictor with three reflectance variables, tympanometric reflectance (AUC 5 0.95) was more accurate than ambient reflectance (AUC 5 0.88) in classifying ears as normal or otosclerotic. Conclusions: Reflectance provides a middle-ear test that is sensitive to classifying ears as otosclerotic or normal, which may be useful in clinical applications

Role of the Cyclooxygenase Pathway in Chemotherapy-Induced Oral Mucositis: A Pilot Study

Goals Oral mucositis can be a significant and dose-limiting complication of high-dose cancer therapy. Mucositis is a particularly severe problem in patients receiving myeloablative chemotherapy prior to bone marrow or hematopoetic stem cell transplant (HSCT). The cyclooxygenase (COX) pathway mediates tissue injury and pain through upregulation of pro-inflammatory prostaglandins, including prostaglandin E2 (PGE2) and prostacyclin (PGI2). The objective of this small (n=3) pilot study was to examine the role of the COX pathway in causing mucosal injury and pain in chemotherapy-induced oral mucositis. Materials and methods We collected blood, saliva, and oral mucosal biopsy specimens from three autologous HSCT patients at the following time-points before and after administration of conditioning chemotherapy: Day −10, +10, +28, and +100, where day 0 is day of transplant. RNA extracted from full-thickness tissue samples was measured by RT-PCR for the following: COX-1, COX-2, microsomal prostaglandin E synthase (mPGES), IL-1β, and TNF-α. Blood and saliva samples were measured by ELISA for PGE2 and PGI2, which are markers of COX activity. Severity of oral mucositis was determined using the Oral Mucositis Index. Severity of pain due to oral mucositis was measured using a Visual Analog Scale. Relationships between the different variables were examined using Spearman rank correlation coefficients. Main results Mean mucositis and pain scores increased significantly after administration of chemotherapy and then gradually declined. The correlation between changes in mucositis and pain scores was strong and statistically significant. The following additional correlations were statistically significant: between tissue COX-1 and pain; between tissue mPGES and pain; between salivary PGE1 and pain; between salivary PGI2 and pain. Other relationships were not statistically significant. Conclusions Our finding of significant associations of pain scores with tissue COX-1 and mPGES, as well as salivary prostaglandins, is suggestive of a role for the cyclooxygenase pathway in mucositis, possibly via upregulation of pro-inflammatory prostaglandins. However, our small sample size may have contributed to the lack of significant associations between COX-2 and other inflammatory mediators with mucosal injury and pain. Thus, additional studies with larger numbers of subjects are warranted to confirm the involvement of the cyclooxygenase pathway in chemotherapy-induced mucositis

Workplace Turbulence and Workforce Preparedness

The year 1973 marked a divide in the postwar economy.1 During the 25 years between 1948 and 1973, private sector productivity increased at an annual rate of 2.9%. Productivity improvement after 1973 fell way below this long-term trend, leveling off at about 0.6% a year until 1981 and rising to only 1.6% a year between 1981 and 1987. A similar pattern is reflected in the real wages of the workforce.2The conventional interpretation of this difference in the U.S. economy before and after 1973 is that it reflects the combined influence of the OPEC oil shock and the influx into the labor market of inexperienced workers born in the postwar baby boom, possibly reinforced by growth in regulatory costs.3 However, when the productivity data are analyzed in a growth accounting framework, these economic factors can only account for about two thirds of the productivity decline.4 What then explains the balance of the shortfall in productivity? Many analysts have pointed to the intangible effects on managers of increased economic uncertainty since 1973—growing business cautiousness, increased emphasis on short-term financial objectives, and inadequate entrepreneurial incentives.5 But economic change and uncertainty can also affect productivity through their impact on jobs and workers

Fostering Equity and Diversity in the Nova Scotia Legal Profession

The Province of Nova Scotia has, for many years, attempted, through a variety of means, to address issues of diversity and affirmative action. However, despite the lessons of history there are still those who question the need for programs and policies that promote, encourage and enforce equality. Even though significant advances have been made on many fronts Nova Scotia continues to struggle with issues of inequality. As with many problems faced by society acknowledging the existence of the problem is the first step towards developing solutions

Development and preliminary evaluation of a telephone-based coping skills training intervention for survivors of acute lung injury and their informal caregivers

Survivors of acute lung injury (ALI) and their informal caregivers have difficulty coping with the physical and emotional challenges of recovery from critical illness. We aimed to develop and pilot test a telephone-based coping skills training intervention for this population

The optical spectroscopy of extraterrestrial molecules

The ongoing quest to identify molecules in the interstellar medium by their electronic spectra in the visible region is reviewed. Identification of molecular absorption is described in the context of the elucidation of the carriers of the unidentified diffuse interstellar bands while molecular emission is discussed with reference to the unidentified Red Rectangle bands. The experimental techniques employed in undertaking studies on the optical spectroscopy of extraterrestrial molecules are described and critiqued in the context of their application.Comment: 21 pages, 9 figures, Invited review Australian Journal of Chemistry, accepted for publicatio

Demonstration of quantum volume 64 on a superconducting quantum computing system

We improve the quality of quantum circuits on superconducting quantum computing systems, as measured by the quantum volume, with a combination of dynamical decoupling, compiler optimizations, shorter two-qubit gates, and excited state promoted readout. This result shows that the path to larger quantum volume systems requires the simultaneous increase of coherence, control gate fidelities, measurement fidelities, and smarter software which takes into account hardware details, thereby demonstrating the need to continue to co-design the software and hardware stack for the foreseeable future.Comment: Fixed typo in author list. Added references [38], [49] and [52

Baby Business: a randomised controlled trial of a universal parenting program that aims to prevent early infant sleep and cry problems and associated parental depression

<p>Abstract</p> <p>Background</p> <p>Infant crying and sleep problems (e.g. frequent night waking, difficulties settling to sleep) each affect up to 30% of infants and often co-exist. They are costly to manage and associated with adverse outcomes including postnatal depression symptoms, early weaning from breast milk, and later child behaviour problems. Preventing such problems could improve these adverse outcomes and reduce costs to families and the health care system. Anticipatory guidance-i.e. providing parents with information about normal infant sleep and cry patterns, ways to encourage self-settling in infants, and ways to develop feeding and settling routines <it>before </it>the onset of problems-could prevent such problems. This paper outlines the protocol for our study which aims to test an anticipatory guidance approach.</p> <p>Methods/Design</p> <p>750 families from four Local Government Areas in Melbourne, Australia have been randomised to receive the <it>Baby Business </it>program (intervention group) or usual care (control group) offered by health services. The <it>Baby Business </it>program provides parents with information about infant sleep and crying via a DVD and booklet (mailed soon after birth), telephone consultation (at infant age 6-8 weeks) and parent group session (at infant age 12 weeks). All English speaking parents of healthy newborn infants born at > 32 weeks gestation and referred by their maternal and child health nurse at their first post partum home visit (day 7-10 postpartum), are eligible. The primary outcome is parent report of infant night time sleep as a problem at four months of age and secondary outcomes include parent report of infant daytime sleep or crying as a problem, mean duration of infant sleep and crying/24 hours, parental depression symptoms, parent sleep quality and quantity and health service use. Data will be collected at two weeks (baseline), four months and six months of age. An economic evaluation using a cost-consequences approach will, from a societal perspective, compare costs and health outcomes between the intervention and control groups.</p> <p>Discussion</p> <p>To our knowledge this is the first randomised controlled trial of a program which aims to prevent both infant sleeping and crying problems and associated postnatal depression symptoms. If effective, it could offer an important public health prevention approach to these common, distressing problems.</p> <p>Trial registration number</p> <p>ISRCTN: <a href="http://www.controlled-trials.com/ISRCTN63834603">ISRCTN63834603</a></p