The Impact of Amplification on Cognitive Screening Test Scores.

Hearing loss is associated with cognitive decline in older adults. Research has shown that hearing loss negatively affects cognitive screening test measures as patients may mishear verbally administered questions. The purpose of the current study was to investigate the impact of amplification on performance on a commonly used cognitive screening test. Thirty older adults with hearing loss underwent testing with the Mini-Mental State Examination (MMSE) in three conditions: without hearing aids, with hearing aids, and with a personal listening device (PLD). Performance on the MMSE significantly improved with the use of hearing aids or a PLD. Amplification and the use of communication strategies should be considered when administering cognitive screening measures to older adults. Failure to account for hearing status may lead to invalid results and can increase the likelihood of over-referral for further assessment. [Journal of Gerontological Nursing, 48(7), 31-37.].

Effect of Reduced Audibility on Mini-Mental State Examination Scores.

BACKGROUND: The interaction of audition and cognition has been of interest to researchers and clinicians, especially as the prevalence of hearing loss and cognitive decline increases with advancing age. Cognitive screening tests are commonly used to assess cognitive status in individuals reporting changes in memory or function or to monitor cognitive status over time. These assessments are administered verbally, so performance may be adversely affected by hearing loss. Previous research on the impact of reduced audibility on cognitive screening test scores has been limited to older adults with sensorineural hearing loss (SNHL) or young adults with normal hearing and simulated audibility loss. No comparisons have been conducted to determine whether age-related SNHL and its impact on cognitive screening tests is successfully modeled by audibility reduction. PURPOSE: The purpose of this study was to examine the effects of reduced audibility on the Mini-Mental State Examination (MMSE), a common bedside cognitive screening instrument, by comparing performance of cognitively normal older adults with SNHL and young adults with normal hearing. DESIGN: A 1:1 gender-matched case-control design was used for this study. STUDY SAMPLE: Thirty older adults (60-80 years old) with mild to moderately severe SNHL (cases) and 30 young adults (18-35 years old) with normal hearing (controls) served as participants for this study. Participants in both groups were selected for inclusion if their cognitive status was within normal limits on the Montreal Cognitive Assessment. DATA COLLECTION AND ANALYSIS: Case participants were administered a recorded version of the MMSE in background noise at a signal-to-noise ratio of +25-dB SNR. Control participants were administered a digitally filtered version of the MMSE that reflected the loss of audibility (i.e., threshold elevation) of the matched case participant at a signal-to-noise ratio of +25-dB SNR. Performance on the MMSE was scored using standard criteria. RESULTS: Between-group analyses revealed no significant difference in the MMSE score. However, within-group analyses showed that education was a significant effect modifier for the case participants. CONCLUSIONS: Reduced audibility has a negative effect on MMSE score in cognitively intact participants, which contributes to and confirms the findings of earlier studies. The findings suggest that observed reductions in score on the MMSE were primarily due to loss of audibility of the test item. The negative effects of audibility loss may be greater in individuals who have lower levels of educational attainment. Higher levels of educational attainment may offset decreased performance on the MMSE because of reduced audibility. Failure to consider audibility and optimize communication when administering these assessments can lead to invalid results (e.g., false positives or missed information), misdiagnosis, and inappropriate recommendations for medication or intervention.

Examining changes in procedural justice and their influence on problem-solving court outcomes.

The number of problem-solving courts has grown substantially since the mid-1990s. Research consistently indicates that participation in these courts lowers recidivism, which is often attributed to defendants' increased perceptions of procedural justice in these programs. Yet, prior studies are limited in their focus, often examining interactions with the judge in a single court or examining defendant perceptions and outcomes at a single time point. In the present study, we investigate defendant perceptions of procedural justice with judges and case managers across multiple problem-solving courts over time. Findings indicate that procedural justice varies across court actors and over time. Procedural justice is lower among judges than among case managers; however, changes in perceptions of procedural justice with the judge are associated with improved court outcomes. We suggest that defendant perceptions are variable and complex but important in explaining variations in outcomes.

Evaluation of Performance With an Adaptive Digital Remote Microphone System and a Digital Remote Microphone Audio-Streaming Accessory System.

PURPOSE: One purpose of this study was to evaluate the improvement in speech recognition obtained with use of 2 different remote microphone technologies. Another purpose of this study was to determine whether a battery of audiometric measures could predict benefit from use of these technologies. METHOD: Sentence recognition was evaluated while 17 adults used each of 2 different hearing aids. Performance was evaluated with and without 2 different remote microphone systems. A variety of audiologic measures were administered to determine whether prefitting assessment may predict benefit from remote microphone technology. RESULTS: Use of both remote microphone systems resulted in improvement in speech recognition in quiet and in noise. There were no differences in performance obtained with the 2 different remote microphone technologies in quiet and at low competing noise levels, but use of the digital adaptive remote microphone system provided better speech recognition in the presence of moderate- to high-level noise. The Listening in Spatialized Noise­Sentence Test Prescribed Gain Amplifier (Cameron & Dillon, 2010) measure served as a good predictor of benefit from remote microphone technology. CONCLUSIONS: Each remote microphone system improved sentence recognition in noise, but greater improvement was obtained with the digital adaptive system. The Listening in Spatialized Noise­Sentence Test Prescribed Gain Amplifier may serve as a good indicator of benefit from remote microphone technology.

Evaluation of wideband frequency responses and non-linear frequency compression for children with mild to moderate high-frequency hearing loss.

OBJECTIVE: To evaluate wideband amplification and non-linear frequency compression (NLFC) as a means to improve speech recognition for children with mild/moderate hearing loss. DESIGN: Randomized within-subject design with repeated measures across test conditions. STUDY SAMPLE: Eleven children with mild to moderate hearing loss were evaluated with: (1) Phonak BTE without NLFC, (2) Phonak BTE with NLFC, and (3) Oticon BTE with wideband response extending to 8000 Hz. RESULTS: Use of NLFC provided better detection and recognition of high-frequency stimuli (e.g. /sh/ and /s/). No difference in performance between conditions was observed for speech recognition when measured with the University of Western Ontario (UWO) plurals test and the UWO distinctive features difference test. Finally, there were no differences between conditions on the BKB-SIN test. CONCLUSIONS: Children with mild to moderate hearing loss have good access to high-frequency phonemes presented at fixed levels (e.g. 50 to 60 dBA) with both wideband and NLFC technology. Similarly, sentence recognition in noise was similar with wideband and NLFC. Adaptive test procedures that probe performance at lower input levels showed small but significant improvements in the detection and recognition of the phonemes /s/ and /sh/ with NLFC condition when compared to the NLFC Off and wideband conditions.

Evaluation of the benefits of binaural hearing on the telephone for children with hearing loss.

BACKGROUND: There is a paucity of published studies examining how children with hearing loss understand speech over the telephone. Previous studies on adults with hearing aids have suggested that adults with bilateral hearing aids experience significant difficulty recognizing speech on the telephone when listening with one ear, but the provision of telephone input to both ears substantially improved speech understanding. PURPOSE: The objectives of this study were to measure speech recognition in quiet and in noise for a group of older children with hearing loss over the telephone and to evaluate the effects of binaural hearing (e.g., DuoPhone) on speech recognition over the telephone. RESEARCH DESIGN: A cross-sectional, repeated-measures design was used in this study. STUDY SAMPLE: A total of 14 children, ages 6-14 yr, participated in the study. Participants were obtained using convenience sampling from a nonprofit clinic population. INTERVENTION: Speech recognition in quiet and in noise with binaural versus monaural telephone input was compared in pediatric participants. DATA COLLECTION AND ANALYSIS: Monosyllabic word recognition was assessed in quiet and classroom noise set at 50 dBA in conditions with monaural and binaural (DuoPhone) telephone input. RESULTS: The children's speech recognition in quiet and in noise was significantly better with binaural telephone input relative to monaural telephone input. CONCLUSIONS: To obtain optimal performance on the telephone, the following considerations may apply: (1) use of amplification with binaural streaming capabilities (e.g., DuoPhone), (2) counseling of family and children on how to best use the telephone, (3) provision of telecoil with microphone attenuation for improved signal-to-noise ratio, and (4) use of probe tube measures to verify the appropriateness of the telephone programs.

Evaluation of wideband frequency responses and nonlinear frequency compression for children with cookie-bite audiometric configurations.

BACKGROUND: Previous research has suggested that use of nonlinear frequency compression (NLFC) can improve audibility for high-frequency sounds and speech recognition of children with moderate to profound high-frequency hearing loss. Furthermore, previous studies have generally found no detriment associated with the use of NLFC. However, there have been no published studies examining the effect of NLFC on the performance of children with cookie-bite audiometric configurations. For this configuration of hearing loss, frequency-lowering processing will likely move high-frequency sounds to a lower frequency range at which a greater degree of hearing loss exists. PURPOSE: The purpose of this study was to evaluate and compare the effects of wideband amplification and NLFC on high-frequency audibility and speech recognition of children with cookie-bite audiometric configurations. RESEARCH DESIGN: This study consisted of a within-participant design with repeated measures across test conditions. STUDY SAMPLE: Seven children, ages 6-13 yr, with cookie-bite audiometric configurations and normal hearing or mild hearing loss at 6000 and 8000 Hz, were recruited. INTERVENTION: Participants were fitted with Phonak Nios S H2O III behind-the-ear hearing aids and Oticon Safari 300 behind-the-ear hearing aids. DATA COLLECTION: The participants were evaluated after three 4-to 6-wk intervals: (1) Phonak Nios S H2O III without NLFC, (2) Phonak Nios S H2O III with NLFC, and (3) Oticon Safari 300 with wideband frequency response extending to 8000 Hz. The order in which each technology was used was counterbalanced across participants. High-frequency audibility was evaluated by assessing aided thresholds (dB SPL) for warble tones and the high-frequency phonemes /sh/ and /s/. Speech recognition in quiet was measured with the University of Western Ontario (UWO) Plurals Test, the UWO Distinctive Features Difference (DFD) Test, and the Phoneme Perception Test vowel-consonant-vowel nonsense syllable test. Sentence recognition in noise was evaluated with the Bamford-Kowal-Bench Speech-In-Noise (BKB-SIN) Test. ANALYSIS: Repeated-measures analyses of variance were used to analyze the data collected in this study. The results across the three different conditions were compared. RESULTS: No difference in performance across conditions was observed for detection of high-frequency warble tones and the speech sounds /sh/ and /s/. No significant difference was seen across conditions for speech recognition in quiet when measured with the UWO Plurals Test, the UWO-DFD Test, and the Phoneme Perception Test vowel-consonant-vowel nonsense syllable test. Finally, there were also no differences across conditions on the BKB-SIN Test. CONCLUSIONS: These results suggest that NLFC does not degrade or improve audibility for and recognition of high-frequency speech sounds as well as sentence recognition in noise when compared with wideband amplification for children with cookie-bite audiometric configurations.

Evaluation of speech recognition of cochlear implant recipients using a personal digital adaptive radio frequency system.

BACKGROUND: Previous research supports the use of frequency modulation (FM) systems for improving speech recognition in noise of individuals with cochlear implants (CIs). However, at this time, there is no published research on the potential speech recognition benefit of new digital adaptive wireless radio transmission systems. PURPOSE: The goal of this study was to compare speech recognition in quiet and in noise of CI recipients while using traditional, fixed-gain analog FM systems, adaptive analog FM systems, and adaptive digital wireless radio frequency transmission systems. RESEARCH DESIGN: A three-way repeated-measures design was used to examine performance differences among devices, among speech recognition conditions in quiet and in increasing levels of background noise, and between users of Advanced Bionics and Cochlear CIs. STUDY SAMPLE: Seventeen users of Advanced Bionics Harmony CI sound processors and 20 users of Cochlear Nucleus 5 sound processors were included in the study. DATA COLLECTION AND ANALYSIS: Participants were tested in a total of 32 speech-recognition-in noise-test conditions, which included one no-FM and three device conditions (fixed-gain FM, adaptive FM, and adaptive digital) at the following signal levels: 64 dBA speech (at the location of the participant) in quiet and 64 dBA speech with competing noise at 50, 55, 60, 65, 70, 75, and 80 dBA noise levels. RESULTS: No significant differences were detected between the users of Advanced Bionics and Cochlear CIs. All of the radio frequency system conditions (i.e., fixed-gain FM, adaptive FM, and adaptive digital) outperformed the no-FM conditions in test situations with competing noise. Specifically, in conditions with 70, 75, and 80 dBA of competing noise, the adaptive digital system provided better performance than the fixed-gain and adaptive FM systems. The adaptive FM system did provide better performance than the fixed-gain FM system at 70 and 75 dBA of competing noise. At the lower noise levels of 50, 55, 60, and 65 dBA, no significant differences were detected across the three systems, and no significant differences were found across the quiet conditions. In all conditions, performance became poorer as the competing noise level increased. CONCLUSIONS: In high levels of noise, the adaptive digital system provides superior performance when compared to adaptive analog FM and fixed-gain FM systems.

Effects of input processing and type of personal frequency modulation system on speech-recognition performance of adults with cochlear implants.

OBJECTIVES: The objective of this study was to compare speech recognition in quiet and in noise for cochlear implant recipients using two different types of personal frequency modulation (FM) systems (directly coupled [direct auditory input] versus induction neckloop) with each of two sound processors (Cochlear Nucleus Freedom versus Cochlear Nucleus 5). Two different experiments were conducted within this study. In both these experiments, mixing of the FM signal within the Freedom processor was implemented via the same scheme used clinically for the Freedom sound processor. In Experiment 1, the aforementioned comparisons were conducted with the Nucleus 5 programmed so that the microphone and FM signals were mixed and then the mixed signals were subjected to autosensitivity control (ASC). In Experiment 2, comparisons between the two FM systems and processors were conducted again with the Nucleus 5 programmed to provide a more complex multistage implementation of ASC during the preprocessing stage. DESIGN: This study was a within-subject, repeated-measures design. Subjects were recruited from the patient population at the Hearts for Hearing Foundation in Oklahoma City, OK. Fifteen subjects participated in Experiment 1, and 16 subjects participated in Experiment 2. Subjects were adults who had used either unilateral or bilateral cochlear implants for at least 1 year. RESULTS: In this experiment, no differences were found in speech recognition in quiet obtained with the two different FM systems or the various sound-processor conditions. With each sound processor, speech recognition in noise was better with the directly coupled direct auditory input system relative to the neckloop system. The multistage ASC processing of the Nucleus 5 sound processor provided better performance than the single-stage approach for the Nucleus 5 and the Nucleus Freedom sound processor. CONCLUSIONS: Speech recognition in noise is substantially affected by the type of sound processor, FM system, and implementation of ASC used by a Cochlear implant recipient.

Simulation of the energy distribution of relativistic electron precipitation caused by quasi-linear interactions with EMIC waves.

[1]Previous studies on electromagnetic ion cyclotron (EMIC) waves as a possible cause of relativistic electron precipitation (REP) mainly focus on the time evolution of the trapped electron flux. However, directly measured by balloons and many satellites is the precipitating flux as well as its dependence on both time and energy. Therefore, to better understand whether pitch angle scattering by EMIC waves is an important radiation belt electron loss mechanism and whether quasi-linear theory is a sufficient theoretical treatment, we simulate the quasi-linear wave-particle interactions for a range of parameters and generate energy spectra, laying the foundation for modeling specific events that can be compared with balloon and spacecraft observations. We show that the REP energy spectrum has a peaked structure, with a lower cutoff at the minimum resonant energy. The peak moves with time toward higher energies and the spectrum flattens. The precipitating flux, on the other hand, first rapidly increases and then gradually decreases. We also show that increasing wave frequency can lead to the occurrence of a second peak. In both single- and double-peak cases, increasing wave frequency, cold plasma density or decreasing background magnetic field strength lowers the energies of the peak(s) and causes the precipitation to increase at low energies and decrease at high energies at the start of the precipitation.

Long-term effects of non-linear frequency compression for children with moderate hearing loss.

OBJECTIVE: To evaluate non-linear frequency compression (NLFC) as a means to improve speech recognition for children with moderate to moderately-severe hearing loss following a six-month acclimatization period. DESIGN: Within subject design with repeated measures across test conditions. STUDY SAMPLE: Fifteen children, ages 5 to 13 years, with moderate to moderately-severe high-frequency sensorineural hearing loss were fitted with Phonak Nios, micro-sized, BTE hearing aids and evaluated after two six-week intervals with and without NLFC and again after a six-month period of consecutive NLFC use. RESULTS: Using repeated measures analyses, the six-month results were compared to data that was collected following six-week trials with and without NLFC hearing aids (Wolfe et al, in press). Improvements seen with NLFC in the initial study (Wolfe et al, in press) were maintained or significantly increased in the present study. When compared to the six-week data, aided non-sense syllable speech recognition thresholds in quiet and speech recognition in noise were significantly better at the six-month interval. CONCLUSIONS: These results suggest that NLFC improves audibility for and recognition of high-frequency speech sounds for children with moderate to moderately-severe hearing loss. In many cases, improvements found with NLFC increased with a longer period of acclimatization to the technology.

The effect of front-end processing on cochlear implant performance of children.

OBJECTIVE: Previous research shows that children using cochlear implants experience significant difficulty with speech perception in noisy listening situations. There are several types of input signal processing available for the cochlear implant sound processor; however, there is a paucity of research to support this technology for children. The primary objective of this study was to examine the potential benefits of 2 types of input signal processing, adaptive dynamic range optimization (ADRO) as compared with autosensitivity (ASC) plus ADRO for children using Cochlear Corporation implants. RESEARCH DESIGN: Cross-sectional repeated-measures design. SETTING: Outpatient nonprofit foundation providing audiology services and auditory-verbal therapy. PATIENTS: Eleven children, aged 4 years 4 months to 12 years, with unilateral or bilateral Cochlear Limited implants. All children used their cochlear implant(s) for at least 1 year, had no additional disabilities, were enrolled in preschool or elementary school, and had age-appropriate receptive and expressive language. INTERVENTION: All children used Cochlear Limited cochlear implants with either the Nucleus Freedom or Nucleus 5 cochlear implant sound processor. Performance was assessed while these children used ADRO-only input processing and ASC+ADRO input processing. MAIN OUTCOME MEASURES: Speech perception of PBK-50 monosyllabic words in quiet and BKB-SIN sentences in noise was measured for each child. In the noise conditions, children were using the ADRO-only or ASC+ADRO input signal processing strategies. The data in quiet were analyzed with descriptive statistics, and the conditions in noise were compared using a 1-way repeated-measures analysis of variance. RESULTS: All children demonstrated word recognition in quiet at or above 90% correct. In noise, sentence-perception performance in the ASC+ADRO condition was significantly better than that in the ADRO-alone condition. CONCLUSION: The results of the study suggest substantial benefit from combining 2 types of input signal processing, ASC and ADRO, for children with unilateral and bilateral cochlear implants. Specifically, signal processing to adjust the sensitivity of the sound processor microphone automatically has substantial positive effects on speech-perception thresholds in noise.

Do physiotherapy staff record treatment time accurately? An observational study.

OBJECTIVE: To assess the reliability of duration of treatment time measured by physiotherapy staff in early-stage stroke patients. DESIGN: Comparison of physiotherapy staff's recording of treatment sessions and video recording. SETTING: Rehabilitation stroke unit in a general hospital. SUBJECTS: Thirty-nine stroke patients without trunk control or who were unable to stand with an erect trunk without the support of two therapists recruited to a randomized trial evaluating the Oswestry Standing Frame. Twenty-six physiotherapy staff who were involved in patient treatment. MAIN MEASURES: Contemporaneous recording by physiotherapy staff of treatment time (in minutes) compared with video recording. STATISTICAL ANALYSIS: Intraclass correlation with 95% confidence interval and the Bland and Altman method for assessing agreement by calculating the mean difference (standard deviation; 95% confidence interval), reliability coefficient and 95% limits of agreement for the differences between the measurements. RESULTS: The mean duration (standard deviation, SD) of treatment time recorded by physiotherapy staff was 32 (11) minutes compared with 25 (9) minutes as evidenced in the video recording. The mean difference (SD) was -6 (9) minutes (95% confidence interval (CI) -9 to -3). The reliability coefficient was 18 minutes and the 95% limits of agreement were -24 to 12 minutes. Intraclass correlation coefficient for agreement between the two methods was 0.50 (95% CI 0.12 to 0.73). CONCLUSIONS: Physiotherapy staff's recording of duration of treatment time was not reliable and was systematically greater than the video recording.

Need for informed consent for dentists who use mercury amalgam restorative material as well as technical considerations in removal of dental amalgam restorations.

Amalgam restorative material generally contains 50% mercury (Hg) in a complex mixture of copper, tin, silver, and zinc. It has been well documented that this mixture continually emits mercury vapor, which is dramatically increased by chewing, eating, brushing, and drinking hot liquids. Mercury has been demonstrated to have damaging effects on the kidney, central nervous system, and cardiovascular system, and has been implicated in gingival tattoos. While mercury amalgams may result in detrimental exposure to the patient, they can also be a danger in dental practices. In Europe, the federal governments of Norway, Finland, Denmark, and Sweden have enacted legislation requiring that dental patients receive informed consent information about the dental restorative material that will be used. In the United States, a few state governments have enacted informed consent legislation for dental patients receiving dental restorations. These state legislations were enacted by Maine, California, Connecticut, and Vermont. It is a sad tragedy that mercury is causing such health damage to many people. The American Dental Association has said for the past 150 years that the mercury in amalgam is safe and does not leak; however, no clinical studies were ever done and the Food and Drug Administration approved amalgam under a grandfather clause. Subsequent studies have shown this claim of safety not to be true. Over ten years ago, the Federation of American Societies for Experimental Biology Journal published a comprehensive article calling mercury restorative material a major source of mercury exposure to the U.S. population. The authors of this paper recommend that federal and state legislation be passed throughout our country to ensure that consent forms are given to patients receiving silver-mercury amalgam restorative material.

Conformational stability and disassembly of Norwalk virus-like particles. Effect of pH and temperature.

Greater than 99% of the Norwalk virus (NV) capsid consists of 180 copies of a single 58-kDa protein. Recombinantly expressed monomers self-assemble into virus-like particles (VLPs) with a well defined icosahedral structure. NV-VLPs are an appropriate vaccine antigen since the antigenic determinants of the parent virion are preserved. They also constitute very simple models to study the mechanisms of assembly and disassembly of viral capsids. This work examines the inherent stability of NV-VLPs over a range of pH and temperature values and provides detailed insight into structural perturbations that accompany disassembly. The NV-VLP structure was monitored using a variety of biophysical techniques including intrinsic and extrinsic fluorescence, high resolution second-derivative UV absorption spectroscopy, circular dichroism (CD), dynamic light scattering, differential scanning calorimetry, and direct observation employing transmission electron microscopy. The data demonstrate that NV-VLPs are highly stable over a pH range of 3-7 and up to 55 degrees C. At pH 8, however, reversible capsid dissociation was correlated with increased solvent exposure of tyrosine residues and subtle changes in secondary structure. Above 60 degrees C NV-VLPs undergo distinct phase transitions arising from secondary-, tertiary-, and quaternary-level protein structural perturbations. By combining the spectroscopic data employing a multidimensional eigenvector phase space approach, an empirical phase diagram for NV-VLP was constructed. This strategy of visualization provides a comprehensive description of the physical stability of NV-VLP over a broad range of pH and temperature. Complementary, differential scanning calorimetric analyses suggest that the two domains of VP1 unfold independently in a pH-dependent manner.

Texas passes first law for safe patient handling in America: landmark legislation protects health-care workers and patients from injury related to manual patient lifting.

On June 17,2005, Texas Governor Rick Perry (R) signed into law Senate Bill 1525, making Texas the first state in the nation to require hospitals and nursing homes to implement safe patient handling and movement programs. Governor Perry is to be commended for this heroic first stand for safe patient handling in America. The landmark legislation will take effect January 1, 2006, requiring the establishment of policy to identify, assess, and develop methods of controlling the risk of injury to patients and nurses associated with lifting, transferring, repositioning, and movement of patients; evaluation of alternative methods from manual lifting to reduce the risk of injury from patient lifting, including equipment and patient care environment; restricting, to the extent feasible with existing equipment, manual handling of all or most of a patient's weight to emergency, life-threatening, or exceptional circumstances; and provision for refusal to perform patient handling tasks believed to involve unacceptable risks of injury to a patient or nurse. Manually lifting patients has been called deplorable, inefficient, dangerous to nurses, and painful and brutal to patients; manual lifting can cause needless suffering and injury to patients, with dangers including pain, bruising, skin tears, abrasions, tube dislodgement, dislocations, fractures, and being dropped by nursing staff during attempts to manually lift. Use of safe, secure, mechanical lift equipment and gentle friction-reducing devices for patient maneuvering tasks could eliminate such needless brutality. Research has proven that manual patient lifting is extremely hazardous to health-care workers, creating substantial risk of low-back injury, whether with one or two patient handlers. Studies on the use of mechanical patient lift equipment, by either nursing staff or lift teams, have proven repeatedly that most nursing staff back injury is preventable, leading to substantial savings to employers on medical and compensation costs. Because the health-care industry has relied on people to do the work of machines, nursing work remains the most dangerous occupation for disabling back injury. Back injury from patient lifting may be the single largest contributor to the nursing shortage, with perhaps 12% of nurses leaving or being terminated because of back injury. The US health-care industry has not kept pace with other industries, which provide mechanical lift equipment for lifting loads equivalent to the weight of patients, or with other countries, such as Australia and England, which are more advanced in their use of modern technology for patient lifting and with no-lifting practices in compliance with government regulations and nursing policies banning manual lifting. With Texas being the first state to succeed in passing legislation for safe patient handling, other states are working toward legislative protection against injury with manual patient lifting. California re-introduced safe patient handling legislation on February 17, 2005, with CA SB 363, Hospitals: Lift Teams, following the September 22, 2004, veto of CA AB 2532 by Governor Arnold Schwarzenegger, who said he believes existing statutory protection and workplace safety standards are sufficient to protect health care workers from injury. Massachusetts HB 2662, Relating to Safe Patient Handling in Certain Health Facilities, was introduced December 1, 2004. Ohio HB 67, signed March 21, 2005 by Governor Bob Taft (R), creates a program for interest-free loans to nursing homes for implementation of a no-manual-lift program. New York companion bills AB 7641 and SB 4029 were introduced in April, 2005, calling for creation of a 2-year study to establish safe patient handling programs and collect data on nursing staff and patient injury with manual patient handling versus lift equipment, to determine best practices for improving health and safety of health-care workers and patients during patient handling. Washington State is planning re-introduction of safe patient handling legislation, after WA HB 1672, Relating to reducing injuries among patients and health care workers, was stalled in committee in February, 2005. Language from these state initiatives may be used as models to assist other states with drafting safe patient handling legislation. Rapid enactment of a federal mandate for Safe Patient Handling No Manual Lift is essential and anticipated.

Selection of protective epitopes for Brucella melitensis by DNA vaccination.

The Brucella melitensis 16M genome was examined for proteins in excess of 100 amino acids and for immunogenicity-associated genes. One subset of 32 annotated genes or open reading frames was identified, and each of these were cloned into the eukaryotic vector pcDNA3.1. Purified recombinant plasmids were used to intramuscularly (i.m.) immunize BALB/c mice. After challenge with B. melitensis 16M strain, two protective antigens were found: the periplasmic protein, bp26, and the chaperone protein, trigger factor (TF). Protective efficacy was confirmed with DNA vaccines for these two B. melitensis proteins and, when combined, protection against wild-type challenge was significantly enhanced. Both proteins were found to be immunogenic since elevated serum immunoglobulin G (IgG) antibodies without a specific IgG subclass bias were induced subsequent to i.m. DNA immunization. Antigen-restimulation assays revealed that bp26 and TF stimulated gamma interferon and only bp26 induced interleukin-4 (IL-4), IL-5, and IL-6 cytokines as measured by cytokine enzyme-linked immunospot assay. These collective results suggest that both bp26 and TF are excellent candidates for use in future vaccination studies against brucellosis.