LED Area Lighting to Reduce Glare for Roof Bolter Operators.

Researchers from the National Institute for Occupational Safety and Health (NIOSH) developed a light-emitting diode (LED) area luminaire called the Saturn and conducted a laboratory study using a Fletcher High Dual-boom Mast Feed (HDDR) roof bolting machine. The Saturn luminaire was designed to (1) enhance floor illumination to enable better detection of trip hazards in the interior spaces of a roof bolter and (2) reduce glare that has typically been an issue of concern on roof bolters. This paper reports on the results of achieving the second objective. The existing roof bolter lighting was the baseline and was compared with three versions of the Saturn luminaire relative to light intensity (100%, 75%, and 50%). Discomfort and disability glare data were obtained from 30 participants that comprised three age groups. Discomfort glare perceptions were obtained using the De Boer rating scale, and disability glare was quantified by using Mars Letter Contrast Sensitivity tests. Discomfort glare was reduced at least 3 levels with all Saturn versions. Also, a predictive model was used to estimate discomfort glare, and the results were similar. Disability glare was the least for the Saturn's 50% intensity, and all Saturn versions had significantly less disability glare than with the baseline lighting. Veiling luminance was calculated and used as another indicator of disability glare. Veiling luminance was 28 to 42 times greater with the baseline lighting as compared with that of the Saturn lighting. Lastly, visibility levels were calculated. The Saturn versions were 4 to 6.5 times better in terms of visibility level.

Performance Comparison of Four Portable FTIR Instruments for Direct-on-Filter Measurement of Respirable Crystalline Silica.

Exposure to dusts containing respirable crystalline silica is a recognized hazard affecting various occupational groups such as miners. Inhalation of respirable crystalline silica can lead to silicosis, which is a potentially fatal lung disease. Currently, miners' exposure to respirable crystalline silica is assessed by collecting filter samples that are sent for laboratory analysis. A more timely field-based silica monitoring method using direct-on-filter (DoF) analysis is being developed by researchers at the National Institute for Occupational Safety and Health (NIOSH) to provide mine operators with the option to evaluate miners' exposure at the mine. This field-based silica monitoring technique involves the use of portable Fourier transform infrared (FTIR) instruments. As a step in the development of this new analytical technique, four commercially available portable FTIR instruments were evaluated for their ability to provide reproducible measurements from filter samples containing respirable crystalline silica. Reported testing indicates that measurements varied within ±4.1% between instruments for filter samples that contained high-purity respirable crystalline silica. Measurements varied within ±3.0% between instruments for filter samples that contained varying mineral composition. Filter samples were repeatedly analyzed by the same instrument over short and extended periods of time, and mean coefficients of variation did not exceed ±1.6 and ±2.4%, respectively. Mixed model analysis revealed that there was no statistically significant (P < 0.05) change in average measurements made over an extended period of time for all instruments. Results suggest that each of the four FTIR instruments evaluated in this study were able to generate precise and reproducible DoF analysis results of respirable dust samples.

Performance Comparison of Real-Time Light Scattering Dust Monitors Across Dust Types and Humidity Levels.

Video techniques for monitoring exposure, such as NIOSH's "Helmet-CAM," employ both real-time dust monitors and mobile video cameras to assess workers' respirable dust exposures. Many real-time personally worn dust monitors utilize light scattering sensing elements, which are subject to measurement biases as a function of dust type (size, composition, shape factor) and environmental conditions such as relative humidity. These biased and inaccurate dust measurements impair the monitor's ability to properly represent actual respirable dust concentrations. In the testing described, instrument mass concentration data was collected using three different types of commonly used commercial off-the-shelf personal dust monitors and compared to a reference standard. This testing was performed in a calm air (Marple) dust chamber in which three units of each make and model (for a total of nine monitors) were used for each test. Equivalency factors (EF, a multiplier to match the Thermo TEOM 1400a reference instrument) ranged between 0.746 and 1.879 across all dusts and environmental conditions tested, and between 0.821 and 1.519 on the ISO test dust.

Testing a revised inlet for the personal dust monitor.

A person-wearable dust monitor that provides nearly real-time, mass-based readings of respirable dust was developed for use in underground coal mines. This personal dust monitor (PDM) combined dust sampling instrumentation with a cap lamp (and battery) into one belt-wearable unit, with the air inlet mounted on the cap lamp. However, obsolescence of belt-carried cap lamp and batteries in coal mining ensued and led end users to request that the cap lamp and battery be removed from the PDM. Removal of these components necessitated the design of a new air inlet to be worn on the miner's lapel. The revised inlet was tested for dust collection equivalency against the original cap-mounted inlet design. Using calculated inlet respirable fractions and measured dust mass collection, the performance of the two inlets is shown to be similar. The new inlet requires a 1.02 factor for converting dust masses obtained from it to equivalent masses collected from the original inlet.

Evaluating Energy Expenditure Estimated by Wearable Technology During Variable Intensity Activity on Female Collegiate Athletes.

Monitoring an athlete's energy intake and energy expenditure (EE) is an important consideration of nutritional planning for sport conditioning and peak performance. In order to provide appropriate recommendations regarding nutritional requirements and caloric needs, an accurate determination of energy requirements is necessary. By knowing an individual's EE, a coach, athletic performance staff or trainer can effectively determine training loads and volumes necessary for periodization and seasonal planning for a particular sport. The purpose of this study is to examine the accuracy of the BodyMedia Mini armband while measuring EE in female basketball players during various-intensity game-like conditions. This investigation required three testing sessions: an orientation session, and two randomized experimental trials. Trials included a maximal multistage 20-m shuttle run (Trial I) and 30-minute basketball skills session (Trial II). The independent variable for this investigation was EE estimated by the Mini armband. The dependent variable was EE determined by the Cosmed K4b2 indirect calorimetry (IC) method. EE assessed with the Mini and EE measured with the IC method was significantly correlated for both Trial I (r= 0.839) and Trial II (r= 0.833). EE calculated by the Mini was significantly underestimated in both Trial I (9.41 ± 26.1 total kcals) and Trial II (56.71 ± 14.1 total kcals). During Trial I the underestimation of EE increased with a rise in test level and intensity (p<.05). Due to the underestimation of EE by the Mini, the development of exercise specific algorithms to improve the estimation of EE during intermittent exercise in basketball players is warranted.

Physiologic Effects from Using Tight- and Loose-Fitting Powered Air-Purifying Respirators on Inhaled Gases, Peak Pressures, and Inhalation Temperatures During Rest and Exercise.

The goal of this investigation was to evaluate the physiologic stresses of powered air-purifying respirators (PAPRs) used by workers in many industries (e.g., health care, automobile repair, public safety, building trades, etc.) during rest and three levels of energy expenditure. Twelve men and twelve women wore one tight-fitting and three loose-fitting PAPRs at rest (REST) and while walking for four minutes at oxygen consumption (V̇O2) rates of 1.0 l·min-1(LOW), 2.0 l·min-1 (MODERATE), and 3.0 l·min-1 or maximum (HIGH). Minimum inhaled carbon dioxide concentration (FICO2), maximum inhaled oxygen concentration (FIO2), peak inhalation pressure, and end inhalation temperature were measured continuously breath-by-breath. Repeated measures analysis of variance found that neither the main effect of gender, nor any interactions involving gender were significant. The highest minimum FICO2 among PAPRs occurred for MODERATE and HIGH energy expenditures while wearing the loose-fitting PAPR with the largest dead space. The lowest maximum FIO2 was observed during HIGH intensity energy expenditure also for the loose-fitting PAPR with the largest dead space. Among all PAPR models, peak inhalation pressures were negative at V̇O2 > LOW, suggesting that peak inhalation flow was greater than blower flow. Results using the variables reported here suggest that PAPRs used at various levels of energy expenditure may be tolerated among healthy workers. Further research is needed to determine the source of supplemented air when inhalation flow exceeds blower flow.

Aerodynamic profiles of women with muscle tension dysphonia/aphonia.

PURPOSE: In this study, the authors aimed to (a) determine whether phonatory airflows and estimated subglottal pressures (est-Psub) for women with primary muscle tension dysphonia/aphonia (MTD/A) differ from those for healthy speakers; (b) identify different aerodynamic profile patterns within the MTD/A subject group; and (c) determine whether results suggest new understanding of pathogenesis in MTD/A. METHOD: Retrospective review of aerodynamic data collected from 90 women at the time of primary MTD/A diagnosis. RESULTS: Aerodynamic profiles were significantly different for women with MTD/A as compared with healthy speakers. Five distinct profiles were identified: (a) normal flow, normal est-Psub; (b) high flow, high est-Psub; (c) low flow, normal est-Psub; (d) normal flow, high est-Psub; and (e) high flow, normal est-Psub. CONCLUSIONS: This study is the first to identify distinct subgroups of aerodynamic profiles in women with MTD/A and to quantitatively identify a clinical phenomenon sometimes described in association with it-"breath holding"-that is shown by low airflow with normal est-Psub. Results were consistent with clinical claims that diverse respiratory and laryngeal functions may underlie phonatory patterns associated with MTD/A. One potential mechanism, based in psychobiological theory, is introduced to explain some of the variability in aerodynamic profiles of women with MTD/A.

Problems and accommodation strategies reported by computer users with rheumatoid arthritis or fibromyalgia.

INTRODUCTION: Little is known about the problems experienced by and the accommodation strategies used by computer users with rheumatoid arthritis (RA) or fibromyalgia (FM). This study (1) describes specific problems and accommodation strategies used by people with RA and FM during computer use; and (2) examines if there were significant differences in the problems and accommodation strategies between the different equipment items for each diagnosis. METHODS: Subjects were recruited from the Arthritis Network Disease Registry. Respondents completed a self-report survey, the Computer Problems Survey. Data were analyzed descriptively (percentages; 95% confidence intervals). Differences in the number of problems and accommodation strategies were calculated using nonparametric tests (Friedman's test and Wilcoxon Signed Rank Test). RESULTS: Eighty-four percent of respondents reported at least one problem with at least one equipment item (RA = 81.5%; FM = 88.9%), with most respondents reporting problems with their chair. Respondents most commonly used timing accommodation strategies to cope with mouse and keyboard problems, personal accommodation strategies to cope with chair problems and environmental accommodation strategies to cope with monitor problems. CONCLUSIONS: The number of problems during computer use was substantial in our sample, and our respondents with RA and FM may not implement the most effective strategies to deal with their chair, keyboard, or mouse problems. This study suggests that workers with RA and FM might potentially benefit from education and interventions to assist with the development of accommodation strategies to reduce problems related to computer use.

Outcomes of a multicomponent physical activity program for sedentary, community-dwelling older adults.

This single-group repeated-measures pilot study evaluated the effects of a 10-wk, multicomponent, best-practice exercise program on physical activity, performance of activities of daily living (ADLs), physical performance, and depression in community-dwelling older adults from low-income households (N = 15). Comparison of pretest and posttest scores using a one-tailed paired-samples t test showed improvement (p < .05) for 2 of 3 ADL domains on the Activity Measure-Post Acute Care and for 6 physical-performance measures of the Senior Fitness Test. Repeated-measures ANOVA revealed significant main effects for 3 of 8 physical activity measures using the Yale Physical Activity Scale. Retention rate was 78.9%, and the adherence rate for group sessions was 89.7%. Results suggest that participation in a multicomponent, best-practice physical activity program may positively affect sedentary, community-dwelling older adults' physical activity, ADL performance, and physical performance.

The comparative effectiveness of combined lumbrical muscle splints and stretches on symptoms and function in carpal tunnel syndrome.

OBJECTIVE: To compare the effectiveness of an intensive lumbrical splint/stretch combination with 3 less intensive lumbrical splint/stretch combinations on carpal tunnel symptoms and function. DESIGN: Randomized Clinical Trial. SETTING: Outpatient hand therapy clinics. PARTICIPANTS: Volunteers (N=124) with mild to moderate carpal tunnel syndrome. INTERVENTIONS: A 4-week home regimen of nocturnal splints (lumbrical splints or cock-up splints) combined with stretches (lumbrical intensive or general) performed 6 times daily. MAIN OUTCOME MEASURES: The effect of the intervention on carpal tunnel symptoms and function was examined with the Carpal Tunnel Symptom Severity and Function Questionnaire (CTQ) and Disabilities of the Arm, Shoulder, and Hand (DASH). We also evaluated whether subjects obtained surgery at 24 weeks. RESULTS: There were significant main effects over time for all outcome measures at 4, 12, and 24 weeks. There was a significant interaction effect for the CTQ-Function and DASH at 12 weeks. Post hoc analyses indicated significant differences between the lumbrical splint/general stretch and general splint/lumbrical stretch groups and the other 2 groups. At 24 weeks, a significantly greater percentage of subjects in the general splint/lumbrical stretch group achieved a clinically important improvement on the CTQ-Function. By 24 weeks, only 25.5% of subjects had elected to undergo surgery. CONCLUSIONS: A combination of a cock-up splint with lumbrical intensive stretches was the most effective combination for improvements in functional gains at 24 weeks postbaseline. Our findings support further evaluation of this combination as a method of conservative carpal tunnel syndrome treatment.

Cognitive and physical performance in patients with asymptomatic carotid artery disease.

The purpose of this study was to determine if patients with asymptomatic carotid artery stenosis and occlusion demonstrate deficits in cognitive and physical performance. The relationship between cognitive measures and performance of instrumental activities of daily living was examined. Seventy-nine patients with asymptomatic carotid artery stenosis of moderate and severe degrees or occlusion were tested. Cognition was assessed via the repeatable battery for the assessment of neuropsychological status (RBANS) and the executive interview (EXIT). Physical performance was assessed via the physical performance test (PPT) and the Lawton instrumental activities of daily living (IADL). Deficits in the RBANS visuospatial/constructional, attention, language and delayed memory domains were found for patients with occlusion. Deficits in all RBANS domains were found for the moderate stenosis subgroup, and deficits in all domains except language were found in the severe subgroup. No deficit was found in executive function in any group. Additionally, deficits were related to sidedness of involvement with visuospatial/constructional deficits related to right sided disease, and deficits in all cognitive domains except language were found in left sided and bilateral disease. Decreased performance on the PPT was identified in all three subgroups with the lowest scores in the moderate stenosis subgroup and the highest scores in the severe stenosis subgroup. The Lawton IADL did not identify any decrease in performance. Deficits in cognitive and physical function were found in this observational study of patients with asymptomatic carotid artery stenosis and occlusion, indicating that asymptomatic patients may not be truly asymptomatic. These areas of function and the potential change in their status need to be considered when patients are being evaluated for interventions to manage their carotid artery disease.

Predicted and actual exercise discomfort in middle school children.

PURPOSE: The purpose of this study was to use a match-mismatch paradigm to examine children's exercise discomfort during an aerobic shuttle run. METHODS: Thirty-four middle school females (n = 18) and males (n = 16) aged 11-14 yr participated. An Exercise Discomfort Index (EDI) was calculated as a rating of perceived exertion for the overall body (Children's OMNI Scale) x a rating of perceived muscle hurt (Children's OMNI Muscle Hurt Scale). Measurements were obtained immediately before (i.e., predicted) and after (i.e., actual) performance of the nationally standardized Progressive Aerobic Cardiovascular Endurance Run (PACER) shuttle test of aerobic fitness. Self-report physical activity and sport participation history were obtained before PACER performance. RESULTS: Two-way ANOVA (gender x assessment time point) showed a significant main effect for assessment time point: predicted EDI (means +/- SD = 25.9 +/- 20.1) was greater than actual EDI (means +/- SD = 19.4 +/- 17.8) for the total group (P = 0.021). However, neither the main effect of gender nor the gender x assessment time point interaction was significant. Idiographic analysis showed that overpredictors of discomfort reported less time (5.25 median h x wk(-1)) and engaged in less recreational activity than underpredictors (11.14 median h x wk(-1)). However, no significant relation (P = 0.508) was observed between PACER laps completed and exercise discomfort. CONCLUSIONS: The sample of middle school children in this study predicted greater exercise discomfort than actually experienced when performing a PACER test. It is possible that a discomfort construct plays an important role in the initiation and maintenance of children's aerobic exercise, providing a basis for physical activity interventions.

Problems experienced by people with arthritis when using a computer.

OBJECTIVE: To describe the prevalence of computer use problems experienced by a sample of people with arthritis, and to determine differences in the magnitude of these problems among people with rheumatoid arthritis (RA), osteoarthritis (OA), and fibromyalgia (FM). METHODS: Subjects were recruited from the Arthritis Network Disease Registry and asked to complete a survey, the Computer Problems Survey, which was developed for this study. Descriptive statistics were calculated for the total sample and the 3 diagnostic subgroups. Ordinal regressions were used to determine differences between the diagnostic subgroups with respect to each equipment item while controlling for confounding demographic variables. RESULTS: A total of 359 respondents completed a survey. Of the 315 respondents who reported using a computer, 84% reported a problem with computer use attributed to their underlying disorder, and approximately 77% reported some discomfort related to computer use. Equipment items most likely to account for problems and discomfort were the chair, keyboard, mouse, and monitor. Of the 3 subgroups, significantly more respondents with FM reported more severe discomfort, more problems, and greater limitations related to computer use than those with RA or OA for all 4 equipment items. CONCLUSION: Computer use is significantly affected by arthritis. This could limit the ability of a person with arthritis to participate in work and home activities. Further study is warranted to delineate disease-related limitations and develop interventions to reduce them.

Clinical predictors of aspiration on radionuclide salivagrams in children.

OBJECTIVE: To determine patient characteristics and clinical factors that are predictive of positive radionuclide salivagram results. DESIGN: Retrospective chart review (spanning 32 months). SETTING: Tertiary care children's hospital. PATIENTS: The study included 129 consecutive pediatric patients with suspected chronic aspiration. INTERVENTION: All subjects underwent radionuclide salivagrams to evaluate for aspiration. MAIN OUTCOME MEASURES: The association of 16 patient characteristics and clinical factors (eg, age, sex, diagnoses, study indications, medications, and previous surgical procedures) with salivagram results. Each factor was examined individually (chi(2) or Fisher exact test). For those factors that were significantly associated with positive salivagram results, the risk was estimated with the odds ratio (OR). A multivariable logistic regression model was constructed to determine how well significantly associated factors together predicted positive salivagram results. RESULTS: The mean (SD) patient age was 4.5 (5.4) years. There were 84 boys (65%) and 45 girls (35%). Aspiration was identified in 27 of 129 salivagrams (21%). On univariate analysis, positive salivagram results were significantly associated with chronic respiratory infections and/or pneumonia (OR, 2.6), prescription of antireflux medications (OR, 2.7), developmental delay (OR, 2.8), and reactive airway disease exacerbations (OR, 3.3) (P<.05). None of the other clinical factors were significantly associated with salivagram results. On multivariate analysis, salivagram results were significantly associated with the 4 above-mentioned factors (P = .009). However, these 4 predictive factors were not independent of each other owing to the statistically significant associations among them. CONCLUSIONS: We identified 4 clinical factors that are predictive of aspiration on salivagram. A high level of suspicion for aspiration should be maintained in children with these potential risk factors.

Comparison of Pediatric Voice Outcome Survey, Reflux Symptom Index, Reflux Finding Score, and esophageal biopsy results.

OBJECTIVE: To examine correlations between the Pediatric Voice Outcome Survey (PVOS) score, the Reflux Symptom Index (RSI) score, the Reflux Finding Score (RFS), and esophageal biopsy findings in children undergoing upper aerodigestive tract endoscopy. DESIGN: Retrospective review of pediatric voice quality-of-life and laryngopharyngeal reflux surveys. Blinded assessment of endoscopic laryngeal images. SETTING: Tertiary care children's hospital. PATIENTS: The study included 36 children with the primary problem of dysphonia (n = 28) or cough (n = 8) who underwent endoscopy. INTERVENTIONS: The PVOS and the RSI were administered to the patient's parents before surgery. The patients underwent laryngotracheobronchoscopy and esophageal biopsy. Four raters independently assigned an RFS to the laryngeal photographs. MAIN OUTCOME MEASURES: The assessment included (1) PVOS scores, RSI scores, and RFSs; (2) internal consistency of PVOS and RSI scores; (3) RFS intrarater and interrater reliability; and (4) correlations between PVOS score, RSI score, RFS, and esophageal biopsy findings. RESULTS: The mean (SD) age of the patients was 7.5 (2.6) years; the mean (SD) PVOS score, 71.9 (21.4); and the mean (SD) RSI score, 16.2 (9.1). The PVOS and the RSI scores demonstrated good internal consistency (Cronbach alpha = 0.79 and 0.78, respectively). The RFS exhibited good intrarater reliability (r = 0.66-0.98) and moderate interrater reliability (r = 0.32-0.70). The PVOS and RSI instruments displayed significant correlation (r = -0.30; P = .04). There were no other significant correlations between RFSs, esophageal biopsy results, PVOS scores, or RSI scores (P > .05). CONCLUSIONS: The RSI may be a useful parent-proxy instrument in addition to the PVOS for pediatric voice patients. The RFS is reliable in children, but its validity could not be demonstrated in this patient population.

A patient-specific in silico model of inflammation and healing tested in acute vocal fold injury.

The development of personalized medicine is a primary objective of the medical community and increasingly also of funding and registration agencies. Modeling is generally perceived as a key enabling tool to target this goal. Agent-Based Models (ABMs) have previously been used to simulate inflammation at various scales up to the whole-organism level. We extended this approach to the case of a novel, patient-specific ABM that we generated for vocal fold inflammation, with the ultimate goal of identifying individually optimized treatments. ABM simulations reproduced trajectories of inflammatory mediators in laryngeal secretions of individuals subjected to experimental phonotrauma up to 4 hrs post-injury, and predicted the levels of inflammatory mediators 24 hrs post-injury. Subject-specific simulations also predicted different outcomes from behavioral treatment regimens to which subjects had not been exposed. We propose that this translational application of computational modeling could be used to design patient-specific therapies for the larynx, and will serve as a paradigm for future extension to other clinical domains.

Efficacy of sinonasal simulator in teaching endoscopic nasal skills.

OBJECTIVES/HYPOTHESIS: To develop a nasal model (NM) which accurately simulates human texture and anatomy and to study the effect of training with NM on performance of video rigid nasal endoscopy and video flexible laryngoscopy. At the conclusion of this presentation, the participants should be able to demonstrate that training with nasal endoscopic simulation enhances efficiency and may improve comfort to the patient. STUDY DESIGN: A randomized blinded control trial. METHODS: Twenty medical students without prior endoscopic experience, stratified by prior video game experience, were randomized to training or no training on NM. All participants viewed a 15-minute video instruction on endoscopy. Students randomized to training then practiced on the NM for 15 minutes. All students were tested within 90 minutes of the initial instruction with a timed identification of structures on NM followed by a timed flexible laryngoscopy on a human volunteer who ranked comfort/discomfort on a visual analogue scale. RESULTS: The students in the training group had a significantly shorter procedure time on NM using rigid nasal endoscopy compared with untrained students (61 seconds vs. 104 seconds, P = .025). The trained students showed a trend, which did not reach statistical significance, toward faster flexible laryngoscopy on the model (23 seconds vs. 32 seconds, P = .085). The trained students had average lower discomfort scores (0.89 vs. 1.33) compared with untrained students, but this did not reach statistical significance. CONCLUSIONS: Our NM accurately simulates human texture and anatomy and provides an opportunity for endoscopic training without concern of bloodborne pathogens and expense of cadavers. Further development of the NM is warranted to expand the training utility.

High-frequency sensorineural hearing loss after stapedectomy.

OBJECTIVE: To describe the pattern and duration of high frequency sensorineural hearing loss after stapedectomy. STUDY DESIGN: Retrospective case series. SETTING: Tertiary referral center. PATIENTS: All patients who underwent stapedectomy by the senior author during the period between January 1, 1998, and October 1, 2005, with preoperative, 4- to 6-week postoperative, and at least 9-month postoperative audiograms were included. Fifty-three patients met the inclusion criteria, with surgeries performed on 61 ears. INTERVENTION(S): Stapedectomy was performed using a CO2 laser. MAIN OUTCOME MEASURE(S): Mean preoperative and postoperative pure-tone bone thresholds, mean preoperative and postoperative pure-tone air thresholds, and hearing outcomes for 4,000 Hz bone conduction (BC) and 8,000 Hz air conduction (AC) based on the patient's age and interval after the operative procedure. RESULTS: : Mean BC thresholds at 4,000 Hz BC worsened by 6 dB at 4 to 6 weeks and improved by 3 dB by 9 months. There was an 8-dB average loss at 8,000 Hz AC at 4 to 6 weeks with a gain of 4 dB by 9 months. Patients older than 40 years were 4 times more likely to experience early loss at 4,000 Hz BC when preoperative thresholds were held constant. The late outcome for hearing loss was dependent more on the preoperative threshold than was the age of the patient. At 8,000 Hz AC, the preoperative hearing threshold was a predictor of early and late hearing loss at 8,000 Hz. CONCLUSION: High-frequency sensorineural hearing loss is initially seen after stapes surgery, and improvement does occur over time. When preoperative hearing threshold is held constant, patients older than 40 years are more likely to experience short-term hearing loss at high frequencies than patients younger than 40 years. Age was not a predictor of postoperative high-frequency hearing loss in the long term.

Use of the physical performance test to assess preclinical disability in subjects with asymptomatic carotid artery disease.

BACKGROUND AND PURPOSE: The purpose of this study was to determine whether subjects with asymptomatic carotid artery stenosis and occlusion demonstrate deficits in physical performance compared with a comparison group. These deficits may indicate that a person is demonstrating preclinical disability. SUBJECTS: Seventy-one subjects with no known disease and 39 subjects with asymptomatic carotid artery stenosis of moderate and severe degrees or with occlusion were included. METHODS: Physical performance was assessed with the 9-item and 7-item versions of the Physical Performance Test (PPT). Individual tasks also were timed for the subjects with disease. RESULTS: There were significant differences between the comparison group and the subjects with carotid artery stenosis on the 9-item PPT (P<.00) and on the 7-item PPT (P<.03). Subjects with asymptomatic carotid artery stenosis and occlusion demonstrated less than optimal performance on the PPT (9-item PPT, mean=27 of 36; 7-item PPT, mean=21 of 28). Subjects with moderate stenosis were the slowest in performing the task of simulated eating. DISCUSSION AND CONCLUSION: Subjects with asymptomatic carotid artery stenosis and occlusion exhibited changes in function, as indicated by their performance on the PPT relative to that of a comparison group. This finding may be indicative of preclinical disability, indicating that these people are symptomatic. This indication may affect the medical and surgical options that can be considered for their care.

Comparison of Multi-Test II skin prick testing to intradermal dilutional testing.

OBJECTIVES/HYPOTHESIS: Intradermal dilutional testing (IDT) has been considered more sensitive than prick testing for detecting low-level allergies. Multi-Test II is one of the most sensitive and reproducible prick testing methods available. This study compares Multi-Test II prick testing with IDT. DESIGN: Retrospective chart review and data analysis on patients who had allergy testing with both Multi-Test II and IDT. SETTING: Outpatient allergy clinic in the otolaryngology department of an academic tertiary care medical center. POPULATION: Forty adult patients had complete allergy testing with both Multi-Test II and IDT for a standard panel of twelve antigens between January 2002 and April 2002. INTERVENTION: Analysis and comparison of test results on Multi-Test II and IDT for each antigen separately and across all antigen tests together. RESULTS: Forty patients had complete testing for all antigens during the time period for the study. Six of these patients did not react to the positive control on Multi-Test II and were eliminated from the main analysis. Of the 34 patients included in the main analysis, all were positive for at least one antigen on IDT; one half (17/34) were negative for all antigens on Multi-Test II. A significantly greater number of patients were positive on IDT than Multi-Test II for all antigens except dog (P < 0.05). There was a statistically significant correlation between IDT endpoint and Multi-Test II score for several antigens (P < 0.05). Of 408 total antigen tests performed, 339 (83.1%) were negative on Multi-Test II. Of these 339 negative Multi-Test II tests, 148 (43.7%) were negative on IDT and 191 (56.3%) were positive on IDT; 174/339 (51.3%) had an IDT endpoint of 2 or 3 and 17/339 (5.0%) had an IDT endpoint > or = 4. A significantly greater number of antigen tests were positive on IDT than on Multi-Test II (P < 0.001). The overall Spearman correlation coefficient between IDT endpoint and Multi-Test II score was 0.370 (P < 0.001). CONCLUSION: Patients were more likely to have a positive test on IDT than on Multi-Test II. IDT therefore may be a more sensitive testing technique for inhalant allergies than Multi-Test II prick testing. In addition, Multi-Test II score may not be a good predictor of IDT endpoint. Although a statistically significant correlation is demonstrated between Multi-Test II score and IDT endpoint, the correlation coefficient is low enough that clinical application may not always be safe or appropriate. The clinical significance of positive IDT results in the presence of negative Multi-Test II results is not known.