Evaluation of the PEP mask in cystic fibrosis

Twenty-eight patients suffering from cystic fibrosis, with an age range of 8-21 years entered a randomised cross-over trial to study the efficacy of the Positive Expiratory Pressure (PEP) mask as a method of chest physiotherapy, both on its own and in conjunction with other physiotherapy techniques. Twenty-four of these patients completed the trial consisting of 4 treatment programmes each lasting one month and with no wash-out period between them. Five of these patients went on to a fifth programme of Forced Expiratory Technique (FET) alone. At the end of the trial, no significant difference was found between the programmes as regards growth, Shwachman score, Chrispin-Norman score or pulmonary function tests. Twenty-three patients chose to continue using the PEP mask in conjunction with FET long-term as their chest physiotherapy programme as they felt it was an effective treatment allowing increased independence, with postural drainage being kept to a minimum.     

Word recognition functions for the CID W-22 test in multitalker noise for normally hearing and hearing-impaired subjects

Word recognition functions for Auditec recordings of the CID W-22 stimuli in multitalker noise were obtained using subjects with normal hearing and with mild-to-moderate sensorineural hearing loss. In the first experiment, word recognition functions were generated by varying the signal-to-noise ratio (S/N); whereas in the second experiment, a constant S/N was used and stimulus intensity was varied. The split-half reliability of word recognition scores for the normal-hearing and hearing-impaired groups revealed variability that agreed closely with predictions based on the simple binomial distribution. Therefore, the binomial model appears appropriate for estimating the variability of word recognition scores whether they are obtained in quiet or in a competing background noise. The reliability for threshold (50% point) revealed good stability. The slope of the recognition function was steeper for normal listeners than for the hearing-impaired subjects. Word recognition testing in noise can provide insight into the problems imposed by hearing loss, particularly when evaluating patients with mild hearing loss who exhibit no difficulties with conventional tests. Clinicians should employ a sufficient number of stimuli so that the test is adequately sensitive to differences among listening conditions.     

Reliability of threshold, slope, and PB max for monosyllabic words

The Auditec recordings of the CID W-22 monosyllables were used to generate test and retest intelligibility functions on normally hearing listeners and subjects with mild-to-moderate sensorineural hearing loss. The normally hearing subjects were tested with 50-word lists at SPLs ranging from 15 to 50 dB. Lists of 25 words were used with the hearing-impaired group. The functions were analyzed to assess the reliability of threshold (50% point), slope (20%-80% points), and maximum intelligibility (PB max). The 50% point was obtained at 28 dB SPL for the normally hearing listeners and at a sensation level (SL) of 12 dB respondaic thresholds for the hearing-impaired group. Very stable monosyllabic thresholds were found because 95% of the test-retest values were within 6 dB for both subject groups. Slopes of 4.9% per dB and 2.7% per dB were obtained for the normally hearing and hearing-impaired groups, respectively. Fair reliability was observed; 95% of the test-retest values encompassed a range of +/- 1.9% per dB for the normally hearing subjects and +/- 1.1% per dB for the hearing-impaired group. Although group slopes provide useful information for selecting the range and step size for generating psychometric functions, the value of routinely obtaining slope on an individual basis has not been demonstrated. Even though the same word lists were used for both test and retest measurements, reliability closely agreed with predicted results based on the binomial theorem. In contrast to the large variability for a single list of 25 words, very stable PB max scores were found when two or three scores were averaged on the plateau of the function.     

Latency and amplitude effects of electrode placement on the early auditory evoked response

This study examined the effects of electrode placement on the early auditory evoked response in normally hearing subjects. The electrodes are termed noninverting, inverting, and common. Ten commonly used electrode combinations were evaluated. Both amplitudes and latencies of Waves I, III, and V were measured for each electrode combination. No mean differences in latencies were observed for Waves I, III, or V with any of the 10 electrode combinations. Similarly, no statistically significant Wave I or Wave III amplitude differences were found among the 10 electrode montages. However, larger Wave V amplitudes were found with placement of the noninverting electrode at the vertex (0.53 mu v) as compared to the upper forehead (0.39 mu v). Moreover, Wave V amplitudes were larger for inverting/common electrode placements at the seventh cervical vertebra/forehead, neck/forehead, and neck/neck (approximately 0.50 mu v) than for mastoid/mastoid and mastoid/forehead placements (approximately 0.40 mu v). Thus, three combinations of electrodes gave the largest Wave V amplitudes. These placements for the noninverting, inverting, and common electrodes, respectively, were (a) vertex-seventh-forehead, (b) vertex-neck-forehead, and (c) vertex-neck-neck.     

Comfortable loudness levels for speech: effects of signal-to-noise ratios and instructions

The effect of S/N from +20 to -10 db on loudness levels of connected discourse with or without background cafeteria noise was investigated for one set of instructions sampling the most comfortable loudness level (MCLL) and a second set sampling the upper limit of CLL. Normal young adults (N:16) showed no significant differences for either set of instructions in quiet or from 20 to 0 db S/N but mn MCLL was about 5 db lower at -10 db. Elderly hearing-aid wearers (N:10, mn age: 77 yrs) yielded mn differences across S/N of less than 5 db for either set of instructions. No data indicate that the speech CLL accurately predicts optimal hearing-aid gain, while the literature indicates that occasionally the desired maximum intelligibility frequently is not obtained at the MCLL. We question whether MCLL for speech justifies its measurement. A discussion is presented of the Comfort Level Method of adjusting gain in hearing-aid evaluations and a perhaps preferable Threshold Level Method in which the test stimulus is presented at a level corresponding to the predicted threshold and the aid's volume control is adjusted until S just perceives the signal.     

Femoral hypoplasia-unusual facies syndrome in infants of diabetic mothers

Three children with the femoral hypoplasia-unusual facies syndrome are described. Two had the characteristic facial pattern of upslanted palpebral fissures, long philtrum with thin upper lip, micrognathia, and hypoplastic alae nasi. The other, an infant girl who died within 24 hours after birth, had a cleft lip, which distorted some of the other features. She also had a cleft palate, as did one of the two older boys. All three children had ear defects, upper limb involvement, and rib, vertebral, lower extremity, and genitourinary tract abnormalities. The infant girl died of lung hypoplasia associated with dysplastic kidneys and widely patent ductus arteriosus. All three were infants of diabetic mothers, one mother having developed overt diabetes in the first trimester of pregnancy. A literature review of 36 reported cases of FH/UFS revealed 12 individuals who were IDMs, establishing a strong relationship of the syndrome with maternal diabetes. A multifactorial inheritance model fits with the reported patients, with the relationship to diabetes, and with the similarity of FH/UFS to caudal regression, another condition related to maternal diabetes.     

Body image treatment within an inpatient program for anorexia nervosa: the role of mirror exposure in the desensitization process

OBJECTIVE: This pilot study examined the role of mirror confrontation in the desensitization process of a body image treatment within an inpatient program for anorexia nervosa. METHOD: A within-subjects design was used. It compared the impact of two modes of group body image treatment on body dissatisfaction, anxiety, and avoidance behaviors. Both treatments followed a set format of exposure exercises and homework, but the modified treatment also included mirror confrontation as an exposure exercise. RESULTS: Standard treatment did not produce any significant changes. Modified treatment produced a significant and sustained improvement in body dissatisfaction and a significant reduction in body anxiety and avoidance behaviors. DISCUSSION: Mirror confrontation is a more effective form of exposure because of the strong emotional response it elicits. Patients' pronounced emotional response to this exercise allowed easier identification of the affective and behavioral components of body dissatisfaction and more cogent links into a developmental body image timeline.     

Alternatives to unmodified human islets for transplantation

Islet transplantation as a procedure to induce insulin independence is still a long way from benefitting the population of more than 1 million type 1 diabetic patients in the United States. In addition to the problems involved with immune suppression, the most significant obstacle is a scarcity of human organs for transplantation. In 1999, only 5882 donated pancreases were available, of which only 50% could be expected to produce islet yields suitable for clinical purposes. In this article, we review various sources with the potential to provide tissue for transplantation. These sources include islet and nonislet cells derived from both human and nonhuman sources, with an emphasis on human cells.