Monitoring Cochlear Health With Intracochlear Electrocochleography During Cochlear Implantation: Findings From an International Clinical Investigation.

OBJECTIVES: Electrocochleography (ECochG) is emerging as a tool for monitoring cochlear function during cochlear implant (CI) surgery. ECochG may be recorded directly from electrodes on the implant array intraoperatively. For low-frequency stimulation, its amplitude tends to rise or may plateau as the electrode is inserted. The aim of this study was to explore whether compromise of the ECochG signal, defined as a fall in its amplitude of 30% or more during insertion, whether transient or permanent, is associated with poorer postoperative acoustic hearing, and to examine how preoperative hearing levels may influence the ability to record ECochG. The specific hypotheses tested were threefold: (a) deterioration in the pure-tone average of low-frequency hearing at the first postoperative follow-up interval (follow-up visit 1 [FUV1], 4 to 6 weeks) will be associated with compromise of the cochlear microphonic (CM) amplitude during electrode insertion (primary hypothesis); (b) an association is observed at the second postoperative follow-up interval (FUV2, 3 months) (secondary hypothesis 1); and (c) the CM response will be recorded earlier during electrode array insertion when the preoperative high-frequency hearing is better (secondary hypothesis 2). DESIGN: International, multi-site prospective, observational, between groups design, targeting 41 adult participants in each of two groups, (compromised CM versus preserved CM). Adult CI candidates who were scheduled to receive a Cochlear Nucleus CI with a Slim Straight or a Slim Modiolar electrode array and had a preoperative audiometric low-frequency average thresholds of ≤80 dB HL at 500, 750, and 1000 Hz in the ear to be implanted, were recruited from eight international implant sites. Pure tone audiometry was measured preoperatively and at postoperative visits (FUV1 and follow-up visit 2 [FUV2]). ECochG was measured during and immediately after the implantation of the array. RESULTS: From a total of 78 enrolled individuals (80 ears), 77 participants (79 ears) underwent surgery. Due to protocol deviations, 18 ears (23%) were excluded. Of the 61 ears with ECochG responses, amplitudes were < 1 µV throughout implantation for 18 ears (23%) and deemed "unclear" for classification. EcochG responses >1 µV in 43 ears (55%) were stable throughout implantation for 8 ears and compromised in 35 ears. For the primary endpoint at FUV1, 7/41 ears (17%) with preserved CM had a median hearing loss of 12.6 dB versus 34/41 ears (83%) with compromised CM and a median hearing loss of 26.9 dB ( p < 0.014). In assessing the practicalities of measuring intraoperative ECochG, the presence of a measurable CM (>1 µV) during implantation was dependent on preoperative, low-frequency thresholds, particularly at the stimulus frequency (0.5 kHz). High-frequency, preoperative thresholds were also associated with a measurable CM > 1 µV during surgery. CONCLUSIONS: Our data shows that CM drops occurring during electrode insertion were correlated with significantly poorer hearing preservation postoperatively compared to CMs that remained stable throughout the electrode insertion. The practicality of measuring ECochG in a large cohort is discussed, regarding the suggested optimal preoperative low-frequency hearing levels ( < 80 dB HL) considered necessary to obtain a CM signal >1 µV.

Intraoperative force and electrocochleography measurements in an animal model of cochlear implantation.

To preserve residual hearing, techniques for monitoring and reducing the effects of trauma during cochlear implant surgery are being developed. This study examines the relationships between intraoperative recordings (electrode insertion force and electrocochleography), trauma, and hearing loss after cochlear implantation. The study also evaluated the efficacy of intravenous steroids for reducing hearing loss after implantation. Thirty-two normal-hearing guinea pigs were randomly implanted with electrode arrays of differing stiffness ('hard' or 'soft'). These arrays used an intracochlear electrode to record electrode insertion force and electrocochleography responses to a multi-frequency acoustic stimulus during implantation. Additionally, sub-cohorts of animals were administered intravenous saline ('control') or dexamethasone ('steroid') prior to surgery. Subsequent hearing loss was assessed using electrocochleography recordings from the round window membrane prior to surgery and 4 weeks after implantation. After 4 weeks, cochleae were harvested and imaged with thin sheet laser imaging microscopy. After 4 weeks, compound action potential (CAP) thresholds did not differ between steroid and control groups. The CAP amplitude at low-mid frequencies decreased after implantation with a hard electrode, an effect which was partly negated by administering steroids. A decrease in the 'intraoperative' CAP amplitude preceded the reporting of insertion resistance by the surgeon by 5.94 s (±4.03 s SEM). Intraoperative CAP declines were also correlated with higher grades of trauma (r = 0.56, p < 0.01) and greater hearing loss (r = 0.56, p < 0.01). This relationship was not repeated with intraoperative cochlear microphonics. A rise in intraoperative force, which preceded the reporting of resistance by 0.71 s (±0.15 s SEM), was correlated with trauma (r = 0.400, p = 0.04) but not hearing loss (r = 0.297, p = 0.27). Preserving intraoperative CAP amplitudes during implantation was predictive of an atraumatic insertion and reduced post-implantation hearing loss. A rise in force usually preceded the reporting of resistance, although by less than 1 s. These results suggest that intraoperative CAPs may offer a more robust feedback mechanism for improving hearing preservation rates than cochlear microphonic and electrode insertion force recordings, especially considering the rapid changes in insertion force and relatively slow human reaction times. Pre-operative steroids were effective in reversing loss of CAP amplitude with hard electrodes and evoked by lower frequency tones, which suggests a possible role in reducing synaptopathy.

Genetic Diversity and Gene Flow of Four South African Venturia inaequalis (Apple Scab) Populations.

Venturia inaequalis isolates were collected during the 2012/13 and 2013/14 seasons from the four principal apple growing regions of South Africa, Elgin (n = 114), Koue Bokkeveld (n = 126), Lower Langkloof (n = 92), and Upper Langkloof (n = 103). Sequence analysis of the ribosomal internal transcribed spacer (ITS) gene regions and genotyping with six (2012/13) and seven (2013/14) microsatellite (SSR) markers was conducted. A subset of 12 isolates from the individual ITS haplotype groups were sequenced for the translation elongation factor-1 alpha (TEF1) and the large subunit of the RNA polymerases II (RPB1) gene regions. Four haplotypes were found for ITS, whereas all isolates were identical for the TEF1 and RPB1 gene regions. The SSR markers revealed considerable variation with an average gene diversity (H) of 0.675. Multivariate analysis (discriminant analysis of principal components [DAPC]) revealed that the two Langkloof populations clustered together with the Koue Bokkeveld population. The population from the warmer winter region, Elgin, clustered separately from the rest of the populations (ΦPT = 0.076 to 0.116; P ≤ 0.05). Estimates of gene flow showed the highest migration rate from the Koue Bokkeveld, toward the Lower Langkloof (M = 151.1), and the least migration to and from the Elgin region (average M = 42.75). Occasionally, identical genotypes (clones) were detected across seasons in the Koue Bokkeveld and Elgin area, which might contribute to overwintering conidia. From this study, it is evident that South Africa most likely has V. inaequalis subpopulations linked to diverse climatic conditions of the coastal Elgin region compared with the mountainous inland regions of the Koue Bokkeveld and the Langkloof.

Mortality reduction associated with HIV/AIDS care and antiretroviral treatment in rural Malawi: evidence from registers, coffin sales and funerals.

BACKGROUND: To report on the trend in all-cause mortality in a rural district of Malawi that has successfully scaled-up HIV/AIDS care including antiretroviral treatment (ART) to its population, through corroborative evidence from a) registered deaths at traditional authorities (TAs), b) coffin sales and c) church funerals. METHODS AND FINDINGS: Retrospective study in 5 of 12 TAs (covering approximately 50% of the population) during the period 2000-2007. A total of 210 villages, 24 coffin workshops and 23 churches were included. There were a total of 18,473 registered deaths at TAs, 15781 coffins sold, and 2762 church funerals. Between 2000 and 2007, there was a highly significant linear downward trend in death rates, sale of coffins and church funerals (X(2) for linear trend: 338.4 P<0.0001, 989 P<0.0001 and 197, P<0.0001 respectively). Using data from TAs as the most reliable source of data on deaths, overall death rate reduction was 37% (95% CI:33-40) for the period. The mean annual incremental death rate reduction was 0.52/1000/year. Death rates decreased over time as the percentage of people living with HIV/AIDS enrolled into care and ART increased. Extrapolating these data to the entire district population, an estimated 10,156 (95% CI: 9786-10259) deaths would have been averted during the 8-year period. CONCLUSIONS: Registered deaths at traditional authorities, the sale of coffins and church funerals showed a significant downward trend over a 8-year period which we believe was associated with the scaling up HIV/AIDS care and ART.

Metabolic Profile of HIV-Infected Women in Mangaung; Free State

Objective: To determine the biochemical nutritional status of HIV-infected women in Mangaung. Design: Cross-sectional. Setting: The community of Mangaung; Free State; South Africa. Subjects: A representative group of 500 black women (25-44 years) was selected randomly to participate. Outcome measures: Biochemical analyses were performed for total lymphocytes; serum protein; serum albumin; plasma fibrinogen; serum insulin; serum glucose; serum triglycerides and serum cholesterol using standard methodology. Values were compared to standard references; and between HIV-infected and HIV-uninfected women. Results: After screening for eligibility; 488 women qualified. Sixty-one per cent of the younger women (25-34 years) and 38of the older women (35-44 years) were HIV-infected. HIV-infected women had significantly lower median blood values for total lymphocytes (p = 0.0001 and p = 0.02 for younger and older group respectively) and serum albumin (p = 0.0001 for both age groups); but significantly higher median concentrations of serum protein (p = 0.0001 for both age groups) than uninfected women. Plasma fibrinogen and serum insulin concentrations were significantly lower in HIV-infected younger women than in their uninfected counterparts (p = 0.002 for both parameters). Older HIV-infected women had significantly lower total serum cholesterol values (p = 0.01) than older HIV-uninfected women. Serum glucose and serum triglycerides did not differ significantly between HIV-infected and HIV-uninfected women. Conclusions: The results indicate a possible impact of HIV infection on serum protein and serum albumin; which may adversely affect biochemical nutritional status and the course of HIV progression. Future research into the causes and possible treatment of metabolic changes in women in this community should be prioritised

An analysis of dietary micronutrient intakes in two age groups of black South African women.

OBJECTIVE: To assess micronutrient intake of black women living in Mangaung, South Africa. SUBJECTS AND METHOD: A sample of 500 pre-menopausal black South African women (496 qualified to participate) from two age groups (25-34 and 35-44 years) were selected randomly in Mangaung, the black residential area of Bloemfontein. A validated Quantitative Food Frequency Questionnaire (QFFQ) was used to determine dietary intake of participants. Data were categorized into the two age groups. Median micronutrient intakes were compared to the Recommended Dietary Allowance (RDA) and Adequate Intake (AI). The prevalence of women with intakes < or = 67% of the RDA was calculated. RESULTS: Median calcium and vitamin D intakes were lower than the AI. Of all women, 46.2% to 62.2% consumed < or = 67% of the RDA for total iron, selenium, folate and vitamin C, and more than 94% consumed < or = 67% of the RDA for selenium. At least 25% of all women consumed < or = 67% of the RDA for vitamin A and E. The vitamin B6 intake of older women was inadequate and a fairly large percentage of the total sample consumed < or = 67% of the RDA. CONCLUSION: Generally, micronutrient intakes were adequate in this population. Attention should be given to those micronutrients where median intakes were < or = 67% of the RDA and those that were not at or above the respective AI in these groups of women.

Micronutrient Intake of HIV-Infected Women in Mangaung; Free State

Background. Poor nutritional status in HIV/AIDS patients can affect immune function profoundly; leading to faster disease progression and earlier death.Objective. To determine the micronutrient intake of HIV-infected women in Mangaung.Design and setting. A cross-sectional study was undertaken in Mangaung; Bloemfontein; Free State.Subjects and methods. A representative group of 500 pre-menopausal women (25 - 44 years) was randomlyselected to participate in the study. Micronutrient intake was determined using a Quantitative Food FrequencyQuestionnaire (QFFQ). Median micronutrient intakes were compared with the Recommended Dietary Allowance(RDA) or Adequate Intake (AI) values. The prevalence of women with intakes 67of the RDA or AI was calculated. Median micronutrient intakes were compared between HIV-infected and uninfected women using non-parametric 95confidence intervals (CIs) and the Mann-Whitney test.Results. Sixty-one per cent of women in the younger age group (25 - 34 years) and 38of older women (35 - 44 years) were HIV-infected. Between 46.6and 70.7of all women consumed 67of the RDA or AI for calcium;total iron; selenium; folate and vitamin C. At least 25of HIV-infected women did not meet either the RDA or the AI for vitamins A; D and E. Younger HIV-infected women had significantly higher intakes of calcium (p = 0.046);phosphorus (p = 0.04); potassium (p = 0.04); vitamin B12 (p = 0.01); vitamin D (p = 0.03) and vitamin E (p = 0.04)than their HIV-uninfected counterparts. Older HIV-infected women had significantly lower intakes of haem iron (p = 0.03); non-haem iron (p = 0.04) and selenium (p = 0.04) than their HIV-uninfected counterparts.Conclusions. Insufficient micronutrient intakes are common in both HIV-infected and uninfected women. A well-balanced diet and micronutrient supplementation seem warranted to ensure optimal health and survival; particularly in HIV-infected women

Differences regarding job satisfaction and job involvement of psychologists with different dominant career anchors.

In order to contribute to higher levels of job satisfaction, job involvement and productivity, a match or fit should be established between the dominant career anchor associated with a specific occupation and that of the employee. A career anchor is an individual's set of self-perceived talents, abilities, motives, needs and values that form the nucleus of one's occupational self-concept. Psychologists have always been part of the service orientated careers and therefore one would expect that it is likely that their dominant career anchor would be service orientation. If this is the case, psychologists with service as their dominant career anchor are supposed to have greater job satisfaction and job involvement compared to those with different career anchors. However, according to literature, this assumption is not necessarily correct. The primary goals of the current study were to determine whether in fact service is the dominant career anchor of psychologists in the Free State and whether there are significant differences regarding job satisfaction and job involvement between psychologists with and without service as their dominant career anchor. A third goal was to determine whether psychologists with different dominant career anchors differ significantly from one another regarding job satisfaction and job involvement. Questionnaires measuring career orientations, job satisfaction and job involvement were sent to 165 of the 171 registered psychologists in the Free State region. Only 75 psychologists (45,5%) responded which exceeded the traditional return rate of 20 to 30%. Due to the small sample of respondents, a nonparametric statistical test, namely the Mann Whitney U test was conducted to determine possible differences. An analysis of the data showed that 21 respondents had entrepreneurship as their dominant career orientation while 12 fell in the technical/functional, 12 in the challenging, 9 in the service and 8 in the autonomy categories of dominant career anchors. No significant differences regarding job satisfaction between psychologists with and without service as dominant career orientation could be determined. Both groups experienced a fairly high degree of job satisfaction and a higher level of intrinsic job satisfaction occurred compared to extrinsic job satisfaction. A significant difference between the two groups in terms of job involvement occurred. Psychologists with service as dominant career orientation showed a higher level of job involvement, although the degree of job involvement for both groups was fairly low. No significant differences regarding job satisfaction and job involvement among psychologists with different career orientations could be found.

Cardiac findings in children admitted to a hospital general ward in South Africa: a comparison of HIV-infected and uninfected children.

The aim of this prospective observational study was to determine the presence of cardiac abnormalities in HIV infected versus uninfected children who were admitted to a general paediatric ward during a two-month period. HIV status was determined by antibody and p24 antigen testing. Clinical information, echocardiography and electrocardiography (ECG) were performed for all children. There were 90 HIV-infected and 118 uninfected children. The median age was 9.6 and 11.8 months for infected and uninfected children, respectively. Baseline left ventricular dysfunction, defined as a shortening fraction < or = 25%, was found in 13 (17%) of the HIV-infected children compared to 5 (8%) uninfected children (p < 0.05). Left ventricular end-diastolic enlargement above the 98th percentile for age was found in 24% of the infected and 20% of uninfected children. Pericardial effusions, although common, were sub-clinical and not different in the groups. ECG findings and resting heart rates were also similar. Left ventricular dysfunction was the most significant cardiac abnormality present in hospitalised HIV-infected children. Other abnormalities, although common, were mostly asymptomatic and found with the same frequency in uninfected children. Further studies are indicated.

Mast cells and vasculature in atopic dermatitis--potential stimulus of neoangiogenesis.

BACKGROUND: Atopic dermatitis skin lesions are characterized by inflammatory changes and epithelial hyperplasia requiring angiogenesis. As mast cells may participate in this process via bidirectional secretion of tissue-damaging enzymes and pro-angiogenic factors, the present study aimed to assess the occurrence and possible function of mast cells in the papillary dermis and in epidermal layers of atopic dermatitis lesions. METHODS: Semi-thin and serial sections in combination with immunohistochemistry, histochemistry and proliferating cell nuclear antigen (PCNA)-activity assays were used and related to epidermal thickness and targeted gene expression studies. RESULTS: Mast cells were located in the papillary dermis and migrated through the basal lamina into the epidermis of atopic dermatitis lesions. An increased PCNA-activity in cells of superficial epidermal layers indicated an activation of keratinocytes and stimulation of endothelial growth. Only approximately 30% of the papillary mast cells stained with the tryptase were toluidin-blue-positive, and approximately 80% were chymase positive. A high number of mast cells expressed c-kit. Most papillary and epidermal mast cells were localized close to endothelial cells. Vascular expression of endoglin (CD105) demonstrated neoangiogenic processes. Mast cells stimulation led to the expression of proangiogenic factors. Also, gene expression of tissue-damaging factors such as matrix metalloproteinases was increased. CONCLUSIONS: These data suggest that in atopic dermatitis, mast cells are abundantly localized close to and within the epidermis where they may stimulate neoangiogenesis. Via the new vessels, inflammatory cells, together with complement components and antibodies, can be transported to the epidermis to aid in the defense against environmental antigens and to maintain chronic inflammation.

Evaluation of clinical teaching and professional development in a problem- and community-based nursing module.

In South Africa the main focus is on primary health care. This affects the education and training of nurses, and training schools must respond by developing appropriate teaching modules. A school of nursing developed, implemented and revised a problem- and community-based learning module over a period of three years (1996-1998). This student-centered module focuses on students' needs, active participation, collaboration, accountability, self-assessment, self-study, life-long learning and appropriate skills. In the formal clinical teaching environment PBL was the main approach. However, this approach was also supported by a variety of strategies, for example group discussions and scenarios. The knowledge, attitudes and professional development skills acquired in the PBL approach were then applied informally in the community setting (CBE). The purpose of the study was to evaluate a first year clinical teaching module as part of an extensive programme. A quantitative research method, a descriptive design, and a variety of data collection techniques were used. Conclusions were that clinical teaching was effective within the problem- (PBL) and community-based (CBE) approaches; 78% of respondents were positive about the clinical learning environment; 61% stated that expectations were met; 81% preferred group activities, and 67% indicated that they had developed professional skills. Facilitators agreed that clinical teaching met the requirements of PBL & CBE. The pass rate also improved.

Explaining national road fatalities.

The purpose of this paper is to report on a model that can be used to explain the differences in road fatalities of individual countries. National infrastructure, transportation and socio-economic variables from international databases were considered as possible variables. The model was developed by means of stepwise regression analyses. It was found that the passenger car ownership is a better predictor of fatalities per 100000 passenger cars than vehicle ownership as a predictor of fatalities per 100000 vehicles. Many individual infrastructure and socio-economic variables have a significant effect on the fatality rate. The final model includes passenger car ownership, the Human Development Index (HDI), and the percentage of other vehicles as explanatory variables.

Nutritional status of preschool children in informal settlement areas near Bloemfontein, South Africa.

OBJECTIVE: To determine the nutritional status and household resources of preschool children. DESIGN: A cross-sectional survey. SETTING: : Two informal settlement areas, Joe Slovo (JS) and JB Mafora (JBM) in Mangaung, near Bloemfontein, South Africa. SUBJECTS: Preschool children (<72 months) of a randomly selected sample of households in JS (experimental) (n = 162) and JBM (control) (n = 186) were included. Standard methods were used to obtain household and care-giver particulars, weight and height measurements, blood and stool samples, and 24-hour dietary recalls. RESULTS: Breast-feeding and dietary intake in the two areas were nearly similar; breast-feeding was continued for 12 months and longer. Although the children's total protein intake was sufficient, their energy intake was low. A low median intake of micronutrients prevailed, including iron, zinc, calcium, niacin, riboflavin, thiamine and vitamins C, B6, A and D. The prevalence of being underweight (JS = 19.8%; JBM = 18.8%), stunted (JS = 29%; JBM = 21. 5%) and wasted (JS = 6.5%; JBM = 3.7%) were fairly similar in both areas, as well as the prevalence of marginal vitamin A deficiency, anaemia, iron deficiency and parasite infestations. No significant associations could be found between household and nutritional status indicators, probably due to the small number of well-nourished children and the generally poor household situation of the participants. CONCLUSIONS: The generally poor nutritional status and environmental conditions emphasize the urgency of intervention for these children.

Prediction of nurses' job satisfaction level.

Indications are that job satisfaction of nurses in South Africa is at a low level. The need to determine factors related to this situation prompted a study in which an attempt was made to determine whether self-concept (measured by Vrey's self-concept Scale) and career orientation scores (determined by means of the Career Orientation Inventory (COI) developed by Schein) could predict the level of job satisfaction of nurses (measured by means of the Minnesota Job Satisfaction Questionnaire (MSQ)). The instruments were applied to 86 professional nurses employed in an academic (teaching) hospital. The sample was divided into a high satisfaction group (N = 46) and a low satisfaction (N = 40) group. Hotelling's T2, MANOVA, Stepwise Multiple Regression and discriminant analyses were used to analyze the data. Results indicated that the two groups differed on several self-concept scales and on one career orientation scale. Eighteen per cent of the variance in job satisfaction could be explained by means of career orientation and self-concept scores. Sixty seven per cent of the respondents were placed in the correct group (in terms of their job satisfaction level) using self-concept and career orientation scores.

Trisomy 5 in Ph+ chronic myeloid leukemia in association with megakaryocytosis.

A patient with a megakaryocytosis associated with a Philadelphia chromosome-positive chronic myeloid leukemia (CML) was found to have a trisomy of chromosome five. To our knowledge, this is the first case of trisomy 5 associated with a Ph + CML, particularly one with a megakaryocytosis. The trisomy 5 may be associated with the resistance to cytostatic drugs found in this patient.

Serological reactions to Leptospira species in buffalo (Syncerus caffer) from the Kruger National Park.

Four hundred and six serum samples from buffalo (Syncerus caffer) were tested for leptospirosis, using the microscopic agglutination test. Seven buffaloes (1.7%) reacted positive and 27 (6.6%) inconclusive. Reactions against L. tarassovi and L. hardjo were the most prevalent.