Immirzi parameter without Immirzi ambiguity : Conformal loop quantization of scalar-tensor gravity

C.W. wishes to thank G. Immirzi and C. Rovelli for early discussions and brief correspondence respectively, and appreciates the EPSRC GG-Top Project and the Cruickshank Trust for financial support. O.V. is grateful to the Aberdeen University College of Physical Sciences for a research studentship.Peer reviewedPublisher PD

Beidseitige Ertaubung durch Labyrinthitis bei M.Crohn

Zusammenfassung: Vestibulocochleäre Störungen bei chronischen Darmentzündungen sind seltene, aber immer wieder beschriebene Komplikationen oder Manifestationen der Grunderkrankung. Ein 26-jähriger Mann erlitt unter immunsuppressiver Therapie aufgrund eines 6Monate zuvor diagnostizierten M.Crohn einen bilateralen Ausfall der Gleichgewichtsorgane sowie eine bilaterale sensorineurale Hörminderung. Es wurde eine ausführliche Diagnostik (Audiogramm, Sprachaudiogramm, kalorische Vestibularisprüfung, Messung vestibulär evozierter myogener Potenziale, Magnetresonanztomographie) durchgeführt. Therapiert wurde mit Azathioprim, Glukokortikoiden systemisch und intratympanal sowie mit monoklonalen Antikörpern. Darunter zeigte sich ein stark fluktuierender, aber progredienter Verlauf der Beschwerden und Befunde bei nur geringfügiger bis keiner Besserung. Erst die beidseitige Versorgung mit einem Cochleaimplantaten (CI) stellte eine befriedigende Lösung dar. Das Fallbeispiel zeigt diagnostische und therapeutische Möglichkeiten und Grenzen einer immunbedingten Erkrankung. Sie verlangt eine enge interdisziplinäre Zusammenarbeit. Bei beidseitiger Ertaubung ist die frühzeitige CI-Versorgung eine geeignete Form der Rehabilitatio

Evaluation of universal newborn hearing screening in Switzerland 2012 and follow-up data for Zurich

BACKGROUND: The European Consensus Statement of Neonatal Hearing recommended universal newborn hearing screening (UNHS) in 1998. UNHS was introduced in Switzerland in 1999 under the auspices of a "Swiss Working Group Hearing Screening in Newborns". The aim of this study was to evaluate the number of newborns being screened and consequently followed-up in Switzerland for the year 2012. METHODS: Postal questionnaires were sent to all registered maternity clinics and birth-centres in Switzerland. To evaluate follow-up of newborns failing the screening process, a retrospective consecutive cohort analysis of newborns failing screening at the University Hospital Zurich between 2005 and 2010 was performed. RESULTS: A total of 102/110 (92.7%) maternity clinics and 1/14 (7.1%) birth-centres routinely performed UNHS. When weighted according to the number of births in the varying locations, 97.9% of all newborn received hearing screening. At the University Hospital of Zurich, 253/12,080 (2.1%) newborns failed the screening test and in 15/253 (6%) a relevant bilateral hearing impairment was found. This makes an overall incidence of congenitally relevant hearing loss of 0.12%. Unfortunately, 33/253 (13%) of newborns with failed screening were lost to follow-up. CONCLUSION: UNHS is well-established in Switzerland and the vast majority of newborns are screened. However, follow-up of failed screens is disappointing. Further measures need to be taken to improve follow up

Subjective Sound Quality Detection (HISQUI) over Time after Vibrant Soundbridge Implantation

Background: To evaluate the long-term audiological outcomes combined with the Hearing Implant Sound Quality Index (HISQUI) after Vibrant Soundbridge (VSB) implantation. Methods: Prospective recall cohort study of patients who received a VSB in a tertiary academic medical center between 1996 and 2017. Air conduction (AC) and bone conduction (BC), sound field thresholds in aided and unaided conditions, and speech discrimination in noise (Oldenburger sentence test) were measured. Postoperative results were compared with preoperative audiograms. Furthermore, the HISQUI was evaluated. Results: Ten patients (eleven implants) were included, the mean follow up period was nine years. The mean AC threshold preoperatively was between 63 and 70 dB, and the BC was between 38 and 49 dB from 500 to 4000 Hz. In the free-field audiogram, the mean threshold was between 61 and 77 dB unaided vs. between 28 and 52 dB in the aided condition. The average signal to noise ratio (SNR) in the Oldenburger sentence test in the unaided condition was 10 dB ± 6.7 dB vs. 2 dB ± 5.4 dB in the aided condition. Three patients reported a good to very good hearing result, four patients a moderate, and three patients a poor hearing result. There was a significant association between the years of implantation and the HISQUI (p = 0.013), as well as a significant decrease by 14 HISQUI points per 10 dB SPL decline (SE 5.2, p = 0.023). There was a significant difference between the change of BC over the years and the HISQUI, as well as the number of years after implantation and the HISQUI. On average, per dB decrease in BC, the HISQUI decreases by 1.4 points, and every year after implantation the HISQUI decreases by 2.7 points. Conclusions: The aided threshold in free field and speech understanding in noise improved significantly with VSB. An increase over time of BC thresholds was observed as well as a decrease in HISQUI score. This decrease in BC thresholds over time may be due to presbycusis. Therefore, monitoring of these patients over time should be considered to discuss alternative hearing rehabilitation measures in a timely manner

Age Dependent Cost-Effectiveness of Cochlear Implantation in Adults: Is There an Age Related Cut-off?

Objective: To analyze the impact of age at implantation on the cost-effectiveness of cochlear implantation (CI). Study Design: Cost-utility analysis in an adapted Markov model. Setting: Adults with profound postlingual hearing loss in a “high income” country. Intervention: Unilateral and sequential CI were compared with hearing aids (HA). Main Outcome Measure: Incremental cost-effectiveness ratio (ICER), calculated as costs per quality adjusted life year (QALY) gained (in CHF/QALY), for individual age and sex combinations in relation to two different willingness to pay thresholds. 1 CHF (Swiss franc) is equivalent to 1.01 USD. Results: When a threshold of 50,000 CHF per QALY is applied, unilateral CI in comparison to HA is cost-effective up to an age of 91 for women and 89 for men. Sequential CI in comparison to HA is cost-effective up to an age of 87 for women and 85 for men. If a more contemporary threshold of 100,000 CHF per QALY is applied, sequential CI in comparison to unilateral CI is cost-effective up to an age of 80 for women and 78 for men. Conclusions: Performing both sequential and unilateral CI is cost-effective up to very advanced ages when compared with hearing aids

Changes of Electrocochleographic Responses During Cochlear Implantation Presented at the Annual Meeting of ADANO 2016 in Berlin

OBJECTIVE: To assess by electrocochleography (ECoG) at which times during cochlear implantation changes of cochlear function occur. METHODS: Tone bursts with a frequency of 500 or 750 Hz were used as acoustic stimuli. The recording electrode was placed on the promontory and left in an unchanged position for all ECoG recordings. RESULTS: Eight subjects were included. After opening the cochlea, an increase of the amplitude of the ECoG signal was detectable in four subjects (mean change 3.9 dB, range from 0.2 to 10.8 dB). No decreases were detectable after opening the cochlea or during the first half of the insertion of the CI electrode array (mean change 0.5 dB, range from -2.2 to 1.6 dB). During the second half of the insertion, the amplitude of the ECoG signal decreased in four subjects (mean change -2.5 dB, range from -0.04 to -4.8 dB). If a decrease occurred during the second half of the insertion, then the decrease continued in the earliest phase after insertion of the CI electrode array (mean change -2.1 dB, range from -0.5 to -5.8 dB). CONCLUSION: Pressure changes inside the cochlea can lead to an increase of ECoG signals after opening the cochlea. If detectable, then a decrease of ECoG signals occurs during the second half of the insertion of the CI electrode array and continues in the earliest phase after completed insertion. These findings suggest that cochlear trauma occurs toward the end of the insertion and that trauma-dependent postoperative mechanisms contribute to postoperative hearing loss

Serum Ascorbic Acid and Thiamine Concentrations in Sepsis: Secondary Analysis of the Swiss Pediatric Sepsis Study.

OBJECTIVES To determine circulating levels of ascorbic acid (VitC) and thiamine (VitB1) in neonates and children with blood culture-proven sepsis. DESIGN Nested single-center study of neonates and children prospectively included in the Swiss Pediatric Sepsis Study. SETTING One tertiary care academic hospital. PATIENTS Sixty-one neonates and children 0-16 years old. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS VitC and VitB1 were quantified in serum of patients (median age, 10.5 mo; interquartile range [IQR], 0.5-62.1 mo) with blood culture-proven sepsis. Median time between sepsis onset and sampling for measurement of vitamins was 3 days (IQR, 2-4 d). Median serum levels of VitC and VitB1 were 32.4 μmol/L (18.9-53.3 μmol/L) and 22.5 nmol/L (12.6-82 nmol/L); 36% of the patients (22/61) had low VitC and 10% (6/61) had VitC deficiency; and 72% (44/61) had low VitB1 and 13% (8/61) had VitB1 deficiency. Children with low VitC were older (p = 0.007) and had higher C-reactive protein (p = 0.004) compared with children with VitC within the normal range. Children with low VitB1 levels were older (p = 0.0009) and were less frequently receiving enteral or parenteral vitamin supplementation (p = 0.0000003) compared with children with normal VitB1 levels. CONCLUSIONS In this cohort of newborns and children with sepsis, low and deficient VitC and VitB1 levels were frequently observed. Age, systemic inflammation, and vitamin supplementation were associated with vitamin levels during sepsis

Extraction of ozone and chlorophyll-A distribution from AVIRIS data

The potential of airborne imaging spectrometry for assessing and monitoring natural resources is studied. Therefore, an AVIRIS scene of the NASA's MacEurope 1991 campaign - acquired in Central Switzerland - is used. The test site consists of an urban area, the Lake Zug with its surrounding fields, the Rigi mountain in the center of the test site, and the Lake of Four Cantons. The region is covered by the AVIRIS flight #910705, run 6 and 7 of the NASA ER-2 aircraft resulting in an average nominal pixel size of about 18 m. Simultaneous to the ER-2 overflight spectroradiometric measurements have been taken in various locations. Preselected reference targets were measured in the field with a GER Mark V spectroradiometer, and radiance measurements were taken to the lake using a Li-Cor LI 1800UW specroradiometer below and above the water surface. A comprehensive meteorological data set was obtained by joining the POLLUMET experiment which carried out measurements to investigate the summer smog in Switzerland on the same day. The quality assessment for the actual data set can be found in detail in Meyer et al. A parametric approach calculating the location of the airplane was used to simulate the observation geometry. This parametric preprocessing procedure, which takes care of effects of flight line and attitude variations as well as the pixel-by-pixel topographic corrections is described in Meyer

CRIM-negative infantile Pompe disease: 42-month treatment outcome

Pompe disease is a rare lysosomal glycogen storage disorder characterized by deficiency of acid α-glucosidase enzyme (GAA) and caused by mutations in the GAA gene. Infantile-type Pompe disease is a multiorgan disorder presenting with cardiomyopathy, hypotonia, and muscular weakness, which is usually fatal. Enzyme replacement therapy (ERT) with recombinant human GAA (rhGAA) has recently been shown to be effective and subsequently yielded promising results in cross-reactive immunologic material (CRIM)-positive patients. CRIM-negative patients showed a limited response to ERT and died or were ventilator dependant. Over a period of 44months, we monitored cognitive and motor development, behavior, auditory function, and brain imaging of a CRIM-negative infantile Pompe disease patient on rhGAA and monoclonal anti-immunoglobulin E (anti-IgE) antibody (omalizumab) treatment due to severe allergic reaction. Cardiorespiratory and skeletal muscle response was significant, with almost normal motor development. Cognitive development—in particular, speech and language—deviated increasingly from normal age-appropriate development and was markedly delayed at 44months, unexplained by moderate sensorineural hearing impairment. Brain magnetic resonance imaging (MRI) at 18, 30, and 44months of age revealed symmetrical signal alteration of the deep white matter. Titer values of IgG antibodies to rhGAA always remained <1:800. The potential role of omalizumab in immune modulation remains to be elucidated; however, this is the first report presenting a ventilator-free survival of a CRIM-negative patient beyond the age of 36months. The central nervous system (CNS) findings are hypothesized to be part of a yet not fully described CNS phenotype in treated patients with longer surviva

Hearing Loss in Cancer Patients with Skull Base Tumors Undergoing Pencil Beam Scanning Proton Therapy: A Retrospective Cohort Study.

To assess the incidence and severity of changes in hearing threshold in patients undergoing high-dose pencil-beam-scanning proton therapy (PBS-PT). This retrospective cohort study included fifty-one patients (median 50 years (range, 13-68)) treated with PBS-PT for skull base tumors. No chemotherapy was delivered. Pure tone averages (PTAs)were determined before (baseline) and after PBS-PT as the average hearing thresholds at frequencies of 0.5, 1, 2, and 4 kHz. Hearing changes were calculated as PTA differences between pre-and post-PBS-PT. A linear mixed-effects model was used to assess the relationship between the PTA at the follow-up and the baseline, the cochlea radiation dose intensity, the increased age, and the years after PBS-PT. Included patients were treated for chordoma (n = 24), chondrosarcoma (n = 9), head and neck tumors (n = 9), or meningioma (n = 3), with a mean tumor dose of 71.1 Gy (RBE) (range, 52.0-77.8), and a mean dose of 37 Gy (RBE) (range, 0.0-72.7) was delivered to the cochleas. The median time to the first follow-up was 11 months (IQR, 5.5-33.7). The PTA increased from a median of 15 dB (IQR 10.0-25) at the baseline to 23.8 (IQR 11.3-46.3) at the first follow-up. In the linear mixed-effect model, the baseline PTA (estimate 0.80, 95%CI 0.64 to 0.96, p ≤ 0.001), patient's age (0.30, 0.03 to 0.57, p = 0.029), follow-up time (2.07, 0.92 to 3.23, p ≤ 0.001), and mean cochlear dose in Gy (RBE) (0.34, 0.21 to 0.46, p ≤ 0.001) were all significantly associated with an increase in PTA at follow-up. The applied cochlear dose and baseline PTA, age, and time after treatment were significantly associated with hearing loss after proton therapy