Impact of technology choice on service provision for universal newborn hearing screening within a busy district hospital.

OBJECTIVE: To investigate the implications of technology choice between automated auditory brainstem response (AABR) and transiently evoked otoacoustic emissions (TEOAE) on service provision for a universal newborn hearing screening (UNHS) program. METHOD: Over a 4-day period, we offered to perform AABR hearing screening on a cohort of 48 well babies in the maternity unit and outpatient department of our busy district hospital. Those parents that consented were asked to sign a consent form and their babies were then screened using the Natus ALGO Model 2e color newborn hearing screener supplied on loan from Neonatal Perspectives Ltd, Manchester, UK. We recorded the patient age at testing, test duration, results obtained (as a pass/refer) and any problems that we experienced with the screening progress, together with parent or user perceived differences between this technology and the current TEOAE screen. A single user carried out all screening. Having collected the AABR data, we then analyzed the implications of the results in relation to service provision in our hospital, utilizing historical data on TEOAE screening. RESULTS: Forty-four mothers, from 48, consented to having their baby screened by AABR and we were able to achieve a result in all 44 babies that we screened. At the standard test criteria of 35 dBnHL, a total 42 babies passed the initial screen in both ears and 2 referred in a single ear only. The test duration was less than 5 minutes for 36 of 44 babies. Applying these results to a model of UNHS generated a per screen cost of 15.98 Pounds for a two-stage OAE/AABR program and 14.25 Pounds for an AABR-only program. Parents found the AABR test acceptable and we found that being able to discuss the screen and hearing with the parents while the screen was taking place both time-efficient and reassuring to parents. In our experience and using our screening model, the OAE/AABR two-stage approach would have generated 509 infants for second-stage screening (AABR stage) before full audiological follow up and the AABR-only approach would have generated 72 infants for second stage. CONCLUSIONS: Testing with the Natus ALGO Model 2e color newborn hearing screener proved to be practical, time-, and cost-efficient. The low initial referral rate would not only save money within our hospital, but serves to keep parental anxiety at a minimum. The high tolerance of ambient noise allowed flexibility in our screening location and timing, improving our ability to screen before discharge. In our setting, the adoption of AABR as our primary screen is more practical and less expensive than TEOAE.

Ear nose and throat diseases in the Bedouin of the South Sinai Desert: a cross-sectional survey and discussion of healthcare needs.

In the summer of 2000, a team of medical and affiliated workers visited the South Sinai Desert to assess the medical problems and needs of the Bedouin population. This paper reports on the ENT diseases of this population, and discusses their healthcare needs.

Environmental monitoring and dose assessment following the December 1991 K-reactor aqueous tritium release.

Between 22 December and 25 December 1991, approximately 570 L of tritiated water was released from the K Reactor at the Savannah River Site. Analyses of river flow rates and measured tritium concentrations showed that approximately 210 TBq of tritium had been released from the reactor and was being transported down the Savannah River. Elevated tritium concentrations in the Savannah River were first detected on 26 December 1991. The maximum measured tritium concentration at Highway 301 (a major sampling point 37 km downstream of the Savannah River Site) was 2.5 Bq mL-1. A hypothetical maximum individual located at Highway 301 would have received a drinking water dose of approximately 0.35 microSv, less than 1% of the Environmental Protection Agency's 40 microSv y-1 drinking water standard. Concentrations at the intake canals to two water treatment facilities, approximately 160 km downstream, began to rise above normal on 28 December. The population dose to users of the downstream domestic water supplies and consumers of Savannah River biota was estimated to be 4.7 x 10(-3) person-Sv.

Can the confidence in long range atmospheric transport models be increased? The pan-european experience of ensemble.

Is atmospheric dispersion forecasting an important asset of the early-phase nuclear emergency response management? Is there a 'perfect atmospheric dispersion model'? Is there a way to make the results of dispersion models more reliable and trustworthy? While seeking to answer these questions the multi-model ensemble dispersion forecast system ENSEMBLE will be presented.