Ear and Hearing

Background Speech Disrupts Working Memory Span in 5-Year-Old Children Objectives: The present study tested the effects of background speech and nonspeech noise on 5-year-old children's working memory span. Design: Five-year-old typically developing children (range = 58.6 to 67.6 months; n = 94) completed a modified version of the Missing Scan Task, a missing-item working memory task, in quiet and in the presence of two types of background noise: male two-talker speech and speech-shaped noise. The two types of background noise had similar spectral composition and overall intensity characteristics but differed in whether they contained verbal content. In Experiments 1 and 2, children's memory span (i.e., the largest set size of items children successfully recalled) was subjected to analyses of variance designed to look for an effect of listening condition (within-subjects factor: quiet, background noise) and an effect of background noise type (between-subjects factor: two-talker speech, speech-shaped noise). Results: In Experiment 1, children's memory span declined in the presence of two-talker speech but not in the presence of speech-shaped noise. This result was replicated in Experiment 2 after accounting for a potential effect of proactive interference due to repeated administration of the Missing Scan Task. Conclusions: Background speech, but not speech-shaped noise, disrupted working memory span in 5-year-old children. These results support the idea that background speech engages domain-general cognitive processes used during the recall of known objects in a way that speech-shaped noise does not.

Objective Comparison of the Quality and Reliability of Auditory Brainstem Response Features Elicited by Click and Speech Sounds Objectives: Auditory brainstem responses (ABRs) are commonly generated using simple, transient stimuli (e.g., clicks or tone bursts). While resulting waveforms are undeniably valuable clinical tools, they are unlikely to be representative of responses to more complex, behaviorally relevant sounds such as speech. There has been interest in the use of more complex stimuli to elicit the ABR, with considerable work focusing on the use of synthetically generated consonant–vowel (CV) stimuli. Such responses may be sensitive to a range of clinical conditions and to the effects of auditory training. Several ABR features have been documented in response to CV stimuli; however, an important issue is how robust such features are. In the current research, we use time- and frequency-domain objective measures of quality to compare the reliability of Wave V of the click-evoked ABR to that of waves elicited by the CV stimulus /da/. Design: Stimuli were presented to 16 subjects at 70 dB nHL in quiet for 6000 epochs. The presence and quality of response features across subjects were examined using Fsp and a Bootstrap analysis method, which was used to assign p values to ABR features for individual recordings in both time and frequency domains. Results: All consistent peaks identified within the /da/-evoked response had significantly lower amplitude than Wave V of the ABR. The morphology of speech-evoked waveforms varied across subjects. Mean Fsp values for several waves of the speech-evoked ABR were below 3, suggesting low quality. The most robust response to the /da/ stimulus appeared to be an offset response. Only click-evoked Wave V showed 100% wave presence. Responses to the /da/ stimulus showed lower wave detectability. Frequency-domain analysis showed stronger and more consistent activity evoked by clicks than by /da/. Only the click ABR had consistent time–frequency domain features across all subjects. Conclusions: Based on the objective analysis used within this investigation, it appears that the quality of speech-evoked ABR is generally less than that of click-evoked responses, although the quality of responses may be improved by increasing the number of epochs or the stimulation level. This may have implications for the clinical use of speech-evoked ABR.

Working Memory and Extended High-Frequency Hearing in Adults: Diagnostic Predictors of Speech-in-Noise Perception Objective: The purpose of this study was to identify the main factors that differentiate listeners with clinically normal or "near-normal" hearing with regard to their speech-in-noise perception and to develop a regression model to predict speech-in-noise difficulties in this population. We also aimed to assess the potential effectiveness of the formula produced by the regression model as a "diagnostic criterion" for clinical use. Design: Data from a large-scale behavioral study investigating the relationship between noise exposure and auditory processing in 122 adults (30 to 57 years) was re-examined. For each participant, a composite speech-in-noise score (CSS) was calculated based on scores from three speech-in-noise measures, (a) the Speech, Spatial and Qualities of Hearing scale (average of speech items); (b) the Listening in Spatialized Noise Sentences test (high-cue condition); and (c) the National Acoustic Laboratories Dynamic Conversations Test. Two subgroups were created based on the CSS, each comprising 30 participants: those with the lowest scores and those with the highest scores. These two groups were compared for differences in hearing thresholds, temporal perception, noise exposure, attention, and working memory. They differed significantly on age, low-, high-, and extended high-frequency (EHF) hearing level, sensitivity to temporal fine structure and amplitude modulation, linguistic closure skills, attention, and working memory. A multiple linear regression model was fit with these nine variables as predictors to determine their relative effect on the CSS. The two significant predictors, EHF hearing and working memory, from this regression were then used to fit a second smaller regression model. The resulting regression formula was assessed for its usefulness as a "diagnostic criterion" for predicting speech-in-noise difficulties using Monte Carlo cross-validation (root mean square error and area under the receiver operating characteristics curve methods) in the complete data set. Results: EHF hearing thresholds (p = 0.01) and working memory scores (p < 0.001) were significant predictors of the CSS and the regression model accounted for 41% of the total variance [R2 = 0.41, F(9,112) = 7.57, p < 0.001]. The overall accuracy of the diagnostic criterion for predicting the CSS and for identifying "low" CSS performance, using these two factors, was reasonable (area under the receiver operating characteristics curve = 0.76; root mean square error = 0.60). Conclusions: These findings suggest that both peripheral (auditory) and central (cognitive) factors contribute to the speech-in-noise difficulties reported by normal hearing adults in their mid-adult years. The demonstrated utility of the diagnostic criterion proposed here suggests that audiologists should include assessment of EHF hearing and working memory as part of routine clinical practice with this population. The "diagnostic criterion" we developed based on these two factors could form the basis of future clinical tests and rehabilitation tools and be used in evidence-based counseling for normal hearers who present with unexplained communication difficulties in noise.

Time From Hearing Aid Candidacy to Hearing Aid Adoption: A Longitudinal Cohort Study Objectives: Although many individuals with hearing loss could benefit from intervention with hearing aids, many do not seek or delay seeking timely treatment after the onset of hearing loss. There is limited data-based evidence estimating the delay in adoption of hearing aids with anecdotal estimates ranging from 5 to 20 years. The present longitudinal study is the first to assess time from hearing aid candidacy to adoption in a 28-year ongoing prospective cohort of older adults, with the additional goal of determining factors influencing delays in hearing aid adoption, and self-reported successful use of hearing aids. Design: As part of a longitudinal study of age-related hearing loss, a wide range of demographic, biologic, and auditory measures are obtained yearly or every 2 to 3 years from a large sample of adults, along with family, medical, hearing, noise exposure, and hearing aid use histories. From all eligible participants (age ≥18; N = 1530), 857 were identified as hearing aid candidates either at baseline or during their participation, using audiometric criteria. Longitudinal data were used to track transition to hearing aid candidacy and hearing aid adoption. Demographic and hearing-related characteristics were compared between hearing aid adopters and nonadopters. Unadjusted estimated overall time (in years) to hearing aid adoption and estimated delay times were stratified by demographic and hearing-related factors and were determined using a time-to-event analysis (survival analysis). Factors influencing rate of adoption in any given time period were examined along with factors influencing successful hearing aid adoption. Results: Age, number of chronic health conditions, sex, retirement status, and education level did not differ significantly between hearing aid adopters and nonadopters. In contrast, adopters were more likely than nonadopters to be married, of white race, have higher socioeconomic status, have significantly poorer higher frequency (2.0, 3.0, 4.0, 6.0, and 8.0 kHz) pure-tone averages, poorer word recognition in quiet and competing multi-talker babble, and reported more hearing handicap on the Hearing Handicap Inventory for the Elderly/Adults emotional and social subscales. Unadjusted estimation of time from hearing aid candidacy to adoption in the full participant cohort was 8.9 years (SE ± 0.37; interquartile range = 3.2–14.9 years) with statistically significant stratification for race, hearing as measured by low- and high-frequency pure-tone averages, keyword recognition in low-context sentences in babble, and the Hearing Handicap Inventory for the Elderly/Adults social score. In a subgroup analysis of the 213 individuals who adopted hearing aids and were assigned a success classification, 78.4% were successful. No significant predictors of success were found. Conclusions: The average delay in adopting hearing aids after hearing aid candidacy was 8.9 years. Nonwhite race and better speech recognition (in a more difficult task) significantly increased the delay to treatment. Poorer hearing and more self-assessed hearing handicap in social situations significantly decreased the delay to treatment. These results confirm the assumption that adults with hearing loss significantly delay seeking treatment with hearing aids.

Voice Emotion Recognition by Children With Mild-to-Moderate Hearing Loss Objectives: Emotional communication is important in children's social development. Previous studies have shown deficits in voice emotion recognition by children with moderate-to-severe hearing loss or with cochlear implants. Little, however, is known about emotion recognition in children with mild-to-moderate hearing loss. The objective of this study was to compare voice emotion recognition by children with mild-to-moderate hearing loss relative to their peers with normal hearing, under conditions in which the emotional prosody was either more or less exaggerated (child-directed or adult-directed speech, respectively). We hypothesized that the performance of children with mild-to-moderate hearing loss would be comparable to their normally hearing peers when tested with child-directed materials but would show significant deficits in emotion recognition when tested with adult-directed materials, which have reduced prosodic cues. Design: Nineteen school-aged children (8 to 14 years of age) with mild-to-moderate hearing loss and 20 children with normal hearing aged 6 to 17 years participated in the study. A group of 11 young, normally hearing adults was also tested. Stimuli comprised sentences spoken in one of five emotions (angry, happy, sad, neutral, and scared), either in a child-directed or in an adult-directed manner. The task was a single-interval, five-alternative forced-choice paradigm, in which the participants heard each sentence in turn and indicated which of the five emotions was associated with that sentence. Reaction time was also recorded as a measure of cognitive load. Results: Acoustic analyses confirmed the exaggerated prosodic cues in the child-directed materials relative to the adult-directed materials. Results showed significant effects of age, specific emotion (happy, sad, etc.), and test materials (better performance with child-directed materials) in both groups of children, as well as susceptibility to talker variability. Contrary to our hypothesis, no significant differences were observed between the 2 groups of children in either emotion recognition (percent correct or d' values) or in reaction time, with either child- or adult-directed materials. Among children with hearing loss, degree of hearing loss (mild or moderate) did not predict performance. In children with hearing loss, interactions between vocabulary, materials, and age were observed, such that older children with stronger vocabulary showed better performance with child-directed speech. Such interactions were not observed in children with normal hearing. The pattern of results was broadly consistent across the different measures of accuracy, d', and reaction time. Conclusions: Children with mild-to-moderate hearing loss do not have significant deficits in overall voice emotion recognition compared with their normally hearing peers, but mechanisms involved may be different between the 2 groups. The results suggest a stronger role for linguistic ability in emotion recognition by children with normal hearing than by children with hearing loss.

Is There a Safe Level for Recording Vestibular Evoked Myogenic Potential? Evidence From Cochlear and Hearing Function Tests Objective: There is a growing concern among the scientific community about the possible detrimental effects of signal levels used for eliciting vestibular evoked myogenic potentials (VEMPs) on hearing. A few recent studies showed temporary reduction in amplitude of otoacoustic emissions (OAE) after VEMP administration. Nonetheless, these studies used higher stimulus levels (133 and 130 dB peak equivalent sound pressure level [pe SPL]) than the ones often used (120 to 125 dB pe SPL) for clinical recording of VEMP. Therefore, it is not known whether these lower levels also have similar detrimental impact on hearing function. Hence, the present study aimed at investigating the effect of 500 Hz tone burst presented at 125 dB pe SPL on hearing functions. Design: True experimental design, with an experimental and a control group, was used in this study. The study included 60 individuals with normal auditory and vestibular system. Of them, 30 underwent unilateral VEMP recording (group I) while the remaining 30 did not undergo VEMP testing (group II). Selection of participants to the groups was random. Pre- and post-VEMP assessments included pure-tone audiometry (250 to 16,000 Hz), distortion product OAE, and subjective symptoms. To simulate the time taken for VEMP testing in group I, participants in group II underwent these tests twice with a gap of 15 minutes. Results: No participant experienced any subjective symptom after VEMP testing. There was no significant interear and intergroup difference in pure-tone thresholds and distortion product OAE amplitude before and after VEMP recording (p > 0.05). Furthermore, the response rate of cervical VEMP was 100% at stimulus intensity of 125 dB pe SPL. Conclusions: Use of 500 Hz tone burst at 125 dB pe SPL does not cause any temporary or permanent changes in cochlear function and hearing, yet produces 100% response rate of cervical VEMP in normal-hearing young adults. Therefore, 125 dB pe SPL of 500 Hz tone burst is recommended as safe level for obtaining cervical VEMP without significantly losing out on its response rate, at least in normal-hearing young adults.

Bimodal Hearing or Bilateral Cochlear Implants? Ask the Patient Objective: The objectives of this study were to assess the effectiveness of various measures of speech understanding in distinguishing performance differences between adult bimodal and bilateral cochlear implant (CI) recipients and to provide a preliminary evidence-based tool guiding clinical decisions regarding bilateral CI candidacy. Design: This study used a multiple-baseline, cross-sectional design investigating speech recognition performance for 85 experienced adult CI recipients (49 bimodal, 36 bilateral). Speech recognition was assessed in a standard clinical test environment with a single loudspeaker using the minimum speech test battery for adult CI recipients as well as with an R-SPACETM 8-loudspeaker, sound-simulation system. All participants were tested in three listening conditions for each measure including each ear alone as well as in the bilateral/bimodal condition. In addition, we asked each bimodal listener to provide a yes/no answer to the question, "Do you think you need a second CI?" Results: This study yielded three primary findings: (1) there were no significant differences between bimodal and bilateral CI performance or binaural summation on clinical measures of speech recognition, (2) an adaptive speech recognition task in the R-SPACETM system revealed significant differences in performance and binaural summation between bimodal and bilateral CI users, with bilateral CI users achieving significantly better performance and greater summation, and (3) the patient's answer to the question, "Do you think you need a second CI?" held high sensitivity (100% hit rate) for identifying likely bilateral CI candidates and moderately high specificity (77% correct rejection rate) for correctly identifying listeners best suited with a bimodal hearing configuration. Conclusions: Clinics cannot rely on current clinical measures of speech understanding, with a single loudspeaker, to determine bilateral CI candidacy for adult bimodal listeners nor to accurately document bilateral benefit relative to a previous bimodal hearing configuration. Speech recognition in a complex listening environment, such as R-SPACETM, is a sensitive and appropriate measure for determining bilateral CI candidacy and also likely for documenting bilateral benefit relative to a previous bimodal configuration. In the absence of an available R-SPACETM system, asking the patient whether or not s/he thinks s/he needs a second CI is a highly sensitive measure, which may prove clinically useful.

Effects of Early Auditory Deprivation on Working Memory and Reasoning Abilities in Verbal and Visuospatial Domains for Pediatric Cochlear Implant Recipients Objectives: The overall goal of this study was to compare verbal and visuospatial working memory in children with normal hearing (NH) and with cochlear implants (CI). The main questions addressed by this study were (1) Does auditory deprivation result in global or domain-specific deficits in working memory in children with CIs compared with their NH age mates? (2) Does the potential for verbal recoding affect performance on measures of reasoning ability in children with CIs relative to their NH age mates? and (3) Is performance on verbal and visuospatial working memory tasks related to spoken receptive language level achieved by children with CIs? Design: A total of 54 children ranging in age from 5 to 9 years participated; 25 children with CIs and 29 children with NH. Participants were tested on both simple and complex measures of verbal and visuospatial working memory. Vocabulary was assessed with the Peabody Picture Vocabulary Test (PPVT) and reasoning abilities with two subtests of the WISC-IV (Wechsler Intelligence Scale for Children, 4th edition): Picture Concepts (verbally mediated) and Matrix Reasoning (visuospatial task). Groups were compared on all measures using analysis of variance after controlling for age and maternal education. Results: Children with CIs scored significantly lower than children with NH on measures of working memory, after accounting for age and maternal education. Differences between the groups were more apparent for verbal working memory compared with visuospatial working memory. For reasoning and vocabulary, the CI group scored significantly lower than the NH group for PPVT and WISC Picture Concepts but similar to NH age mates on WISC Matrix Reasoning. Conclusions: Results from this study suggest that children with CIs have deficits in working memory related to storing and processing verbal information in working memory. These deficits extend to receptive vocabulary and verbal reasoning and remain even after controlling for the higher maternal education level of the NH group. Their ability to store and process visuospatial information in working memory and complete reasoning tasks that minimize verbal labeling of stimuli more closely approaches performance of NH age mates.

Music Appreciation of Adult Hearing Aid Users and the Impact of Different Levels of Hearing Loss Objectives: The main aim of this study was to collect information on music listening and music appreciation from postlingually deafened adults who use hearing aids (HAs). It also sought to investigate whether there were any differences in music ratings from HA users with different levels of hearing loss (HL; mild, versus moderate to moderately-severe, versus severe or worse. Design: An existing published questionnaire developed for cochlear implant recipients was modified for this study. It had 51 questions divided into seven sections: (1) music listening and music background; (2) sound quality; (3) musical styles; (4) music preferences; (5) music recognition; (6) factors affecting music listening enjoyment; and (7) music training program. The questionnaire was posted out to adult HA users, who were subsequently divided into three groups: (i) HA users with a mild HL (Mild group); (ii) HA users with a moderate to moderately-severe HL (Moderate group); and (iii) HA users with a severe or worse (Severe group) HL. Results: One hundred eleven questionnaires were completed; of these, 51 participants had a mild HL, 42 had a moderate to moderately-severe loss, and 18 a severe or worse loss. Overall, there were some significant differences noted, predominantly between the Mild and Severe groups, with fewer differences between the Mild and Moderate groups. The respondents with the greater levels of HL reported a greater reduction in their music enjoyment as a result of their HL and that HAs made music sound significantly less melodic for them. It was also observed that the Severe group's mean scores for both the pleasant rating as well as the combined rating for the six different musical styles were lower than both the Mild and Moderate groups' ratings for every style, with just one exception (pop/rock pleasantness rating). There were significant differences between the three groups for the styles of music that were reported to sound the best with HA(s), as well as differences between the ratings on more specific timbre rating scales used to rate different elements of each style. In rating the pleasantness and naturalness of different musical instruments or instrumental groups, there was no difference between the groups. There were also significant differences between the Mild and Severe groups in relation to musical preferences for the pitch range of music, with the Severe group significantly preferring male singers and lower pitched instruments. Conclusions: The overall results indicated little difference in music appreciation between those with a mild versus moderate loss. However, poorer appreciation scores were given by those with a severe or worse HL. This would suggest that HAs or HL have a negative impact on music listening, particularly when the HL becomes more significant. There was a large degree of variability in ratings, though, with music listening being satisfactory for some listeners and largely unsatisfactory for others, in all three groups. Music listening preferences also varied significantly, and the reported benefit (or otherwise) provided by the HA for music was also mixed. The overriding variability in listening preferences and ratings leads to the question as to the benefit and effectiveness of generic, manufacturer-derived music programs on HAs. Despite the heterogeneity in the listening habits, preferences, and ratings, it is clear that music appreciation and enjoyment is still challenging for many HA users and that level of HL is one, but not the only factor that impacts on music appreciation.

Redundant Information Is Sometimes More Beneficial Than Spatial Information to Understand Speech in Noise Objectives: To establish a framework to unambiguously define and relate the different spatial effects in speech understanding: head shadow, redundancy, squelch, spatial release from masking (SRM), and so on. Next, to investigate the contribution of interaural time and level differences to these spatial effects in speech understanding and how this is influenced by the type of masking noise. Design: In our framework, SRM is uniquely characterized as a linear combination of head shadow, binaural redundancy, and binaural squelch. The latter two terms are combined into one binaural term, which we define as binaural contrast: a benefit of interaural differences. In this way, SRM is a simple sum of a monaural and a binaural term. We used the framework to quantify these spatial effects in 10 listeners with normal hearing. The participants performed speech intelligibility tasks in different spatial setups. We used head-related transfer functions to manipulate the presence of interaural time and level differences. We used three spectrally matched masker types: stationary speech-weighted noise, a competing talker, and speech-weighted noise that was modulated with the broadband temporal envelope of the competing talker. Results: We found that (1) binaural contrast was increased by interaural time differences, but reduced by interaural level differences, irrespective of masker type, and (2) large redundancy (the benefit of having identical information in two ears) could reduce binaural contrast and thus also reduce SRM. Conclusions: Our framework yielded new insights in binaural processing in speech intelligibility. First, interaural level differences disturb speech intelligibility in realistic listening conditions. Therefore, to optimize speech intelligibility in hearing aids, it is more beneficial to improve monaural signal-to-noise ratios rather than to preserve interaural level differences. Second, although redundancy is mostly ignored when considering spatial hearing, it might explain reduced SRM in some cases. Use of Commercial Virtual Reality Technology to Assess Verticality Perception in Static and Dynamic Visual Backgrounds Objectives: The Subjective Visual Vertical (SVV) test and the closely related Rod and Disk Test (RDT) are measures of perceived verticality measured in static and dynamic visual backgrounds. However, the equipment used for these tests is variable across clinics and is often too expensive or too primitive to be appropriate for widespread use. Commercial virtual reality technology, which is now widely available, may provide a more suitable alternative for collecting these measures in clinical populations. This study was designed to investigate verticality perception in symptomatic patients using a modified RDT paradigm administered through a head-mounted display (HMD). Design: A group of adult patients referred by a physician for vestibular testing based on the presence of dizziness symptoms and a group of healthy adults without dizziness symptoms were included. We investigated degree of visual dependence in both groups by measuring SVV as a function of kinematic changes to the visual background. Results: When a dynamic background was introduced into the HMD to simulate the RDT, significantly greater shifts in SVV were found for the patient population than for the control population. In patients referred for vestibular testing, the SVV measured with the HMD was significantly correlated with traditional measures of SVV collected in a rotary chair when accounting for head tilt. Conclusions: This study provides initial proof of concept evidence that reliable SVV measures in static and dynamic visual backgrounds can be obtained using a low-cost commercial HMD system. This initial evidence also suggests that this tool can distinguish individuals with dizziness symptomatology based on SVV performance in dynamic visual backgrounds. Acknowledgment: The work was supported by Defense Health Affairs in support of the Army Hearing Program. The views expressed in this article are those of the author and do not reflect the official policy of the Department of Army/Navy/Air Force, Department of Defense, or U.S. Government. The identification of specific products or scientific instrumentation does not constitute endorsement or implied endorsement on the part of the author, DoD, or any component agency. The views expressed in this presentation are those of the author and do not reflect the official policy of the Department of Army/Navy/Air Force, Department of Defense, or U.S. Government. The authors have no conflicts of interest to disclose. Received March 27, 2018; accepted March 2, 2019. Address for correspondence: Ashley Zaleski-King, Walter Reed National Military Medical Center (WRNMMC), 8901 Rockville Pike, Bethesda, MD 20889, USA. E-mail: ashley.c.king8.civ@mail.mil Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved. Predicting Speech-in-Noise Deficits from the Audiogram Objectives: In occupations that involve hearing critical tasks, individuals need to undergo periodic hearing screenings to ensure that they have not developed hearing losses that could impair their ability to safely and effectively perform their jobs. Most periodic hearing screenings are limited to pure-tone audiograms, but in many cases, the ability to understand speech in noisy environments may be more important to functional job performance than the ability to detect quiet sounds. The ability to use audiometric threshold data to identify individuals with poor speech-in-noise performance is of particular interest to the U.S. military, which has an ongoing responsibility to ensure that its service members (SMs) have the hearing abilities they require to accomplish their mission. This work investigates the development of optimal strategies for identifying individuals with poor speech-in-noise performance from the audiogram. Design: Data from 5487 individuals were used to evaluate a range of classifiers, based exclusively on the pure-tone audiogram, for identifying individuals who have deficits in understanding speech in noise. The classifiers evaluated were based on generalized linear models (GLMs), the speech intelligibility index (SII), binary threshold criteria, and current standards used by the U.S. military. The classifiers were evaluated in a detection theoretic framework where the sensitivity and specificity of the classifiers were quantified. In addition to the performance of these classifiers for identifying individuals with deficits understanding speech in noise, data from 500,733 U.S. Army SMs were used to understand how the classifiers would affect the number of SMs being referred for additional testing. Results: A classifier based on binary threshold criteria that was identified through an iterative search procedure outperformed a classifier based on the SII and ones based on GLMs with large numbers of fitted parameters. This suggests that the saturating nature of the SII is important, but that the weights of frequency channels are not optimal for identifying individuals with deficits understanding speech in noise. It is possible that a highly complicated model with many free parameters could outperform the classifiers considered here, but there was only a modest difference between the performance of a classifier based on a GLM with 26 fitted parameters and one based on a simple all-frequency pure-tone average. This suggests that the details of the audiogram are a relatively insensitive predictor of performance in speech-in-noise tasks. Conclusions: The best classifier identified in this study, which was a binary threshold classifier derived from an iterative search process, does appear to reliably outperform the current thresholds criteria used by the U.S. military to identify individuals with abnormally poor speech-in-noise performance, both in terms of fewer false alarms and a greater hit rate. Substantial improvements in the ability to detect SMs with impaired speech-in-noise performance can likely only be obtained by adding some form of speech-in-noise testing to the hearing monitoring program. While the improvements were modest, the overall benefit of adopting the proposed classifier is likely substantial given the number of SMs enrolled in U.S. military hearing conservation and readiness programs. ACKNOWLEDGMENTS: The authors thank Dr. Gary Kidd for sharing his TDT data and Dr. Ken Grant for sharing his SPRINT data. The authors also thank Kari Buchanan and the Hearing Center of Excellence for sharing the DOEHRS-HC data. All authors contributed equally to this work. All authors were involved in the data analysis and discussed the results and implications and commented on the manuscript at all stages. The views expressed in this article are those of the author and do not reflect the official policy of the Department of Army/Navy/Air Force, Department of Defense, or U.S. Government. The authors have no conflicts of interest to disclose. Received December 3, 2017; accepted March 14, 2019. Address for correspondence: Daniel E. Shub, National Military Audiology and Speech Center, Walter Reed National Military Medical Center, 4954 North Palmer Road, Bethesda, MD 20889, USA. E-mail: daniel.e.shub.civ@mail.mil Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved. Children With Normal Hearing Are Efficient Users of Fundamental Frequency and Vocal Tract Length Cues for Voice Discrimination Background: The ability to discriminate between talkers assists listeners in understanding speech in a multitalker environment. This ability has been shown to be influenced by sensory processing of vocal acoustic cues, such as fundamental frequency (F0) and formant frequencies that reflect the listener's vocal tract length (VTL), and by cognitive processes, such as attention and memory. It is, therefore, suggested that children who exhibit immature sensory and/or cognitive processing will demonstrate poor voice discrimination (VD) compared with young adults. Moreover, greater difficulties in VD may be associated with spectral degradation as in children with cochlear implants. Objectives: The aim of this study was as follows: (1) to assess the use of F0 cues, VTL cues, and the combination of both cues for VD in normal-hearing (NH) school-age children and to compare their performance with that of NH adults; (2) to assess the influence of spectral degradation by means of vocoded speech on the use of F0 and VTL cues for VD in NH children; and (3) to assess the contribution of attention, working memory, and nonverbal reasoning to performance. Design: Forty-one children, 8 to 11 years of age, were tested with nonvocoded stimuli. Twenty-one of them were also tested with eight-channel, noise-vocoded stimuli. Twenty-one young adults (18 to 35 years) were tested for comparison. A three-interval, three-alternative forced-choice paradigm with an adaptive tracking procedure was used to estimate the difference limens (DLs) for VD when F0, VTL, and F0 + VTL were manipulated separately. Auditory memory, visual attention, and nonverbal reasoning were assessed for all participants. Results: (a) Children' F0 and VTL discrimination abilities were comparable to those of adults, suggesting that most school-age children utilize both cues effectively for VD. (b) Children's VD was associated with trail making test scores that assessed visual attention abilities and speed of processing, possibly reflecting their need to recruit cognitive resources for the task. (c) Best DLs were achieved for the combined (F0 + VTL) manipulation for both children and adults, suggesting that children at this age are already capable of integrating spectral and temporal cues. (d) Both children and adults found the VTL manipulations more beneficial for VD compared with the F0 manipulations, suggesting that formant frequencies are more reliable for identifying a specific speaker than F0. (e) Poorer DLs were achieved with the vocoded stimuli, though the children maintained similar thresholds and pattern of performance among manipulations as the adults. Conclusions: The present study is the first to assess the contribution of F0, VTL, and the combined F0 + VTL to the discrimination of speakers in school-age children. The findings support the notion that many NH school-age children have effective spectral and temporal coding mechanisms that allow sufficient VD, even in the presence of spectrally degraded information. These results may challenge the notion that immature sensory processing underlies poor listening abilities in children, further implying that other processing mechanisms contribute to their difficulties to understand speech in a multitalker environment. These outcomes may also provide insight into VD processes of children under listening conditions that are similar to cochlear implant users. ACKNOWLEDGMENTS: The authors wish to acknowledge the contribution of the following undergraduate students from the Department of Communication Disorders at Tel Aviv University for assisting in data collection: Feigi Raiter, Feigi Grinvald, Shani Rabia, Adi Amsalem, Miri Rotem, Lea pantiat, Daniel Lex Rabinovitch, and Orpaz Shariki. The authors wish to thank Steyer grant (School of Health Professions, Tel-Aviv University) for their financial support. The authors specially thank all the adults and children who participated in the present study. All authors contributed to this work to a significant extent. All authors have read the article and agreed to submit it for publication after discussing the results and implications and commented on the article at all stages. All authors are, therefore, responsible for the reported research and have approved the final article as submitted. The authors have no conflicts of interest to declare. Received September 30, 2018; accepted March 17, 2019. Address for correspondence: Yael Zaltz, Department of Communication Disorders, The Stanley Steyer School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. E-mail: yaelzaltz@gmail.com Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved. Switching Streams Across Ears to Evaluate Informational Masking of Speech-on-Speech Objectives: This study aimed to evaluate the informational component of speech-on-speech masking. Speech perception in the presence of a competing talker involves not only informational masking (IM) but also a number of masking processes involving interaction of masker and target energy in the auditory periphery. Such peripherally generated masking can be eliminated by presenting the target and masker in opposite ears (dichotically). However, this also reduces IM by providing listeners with lateralization cues that support spatial release from masking (SRM). In tonal sequences, IM can be isolated by rapidly switching the lateralization of dichotic target and masker streams across the ears, presumably producing ambiguous spatial percepts that interfere with SRM. However, it is not clear whether this technique works with speech materials. Design: Speech reception thresholds (SRTs) were measured in 17 young normal-hearing adults for sentences produced by a female talker in the presence of a competing male talker under three different conditions: diotic (target and masker in both ears), dichotic, and dichotic but switching the target and masker streams across the ears. Because switching rate and signal coherence were expected to influence the amount of IM observed, these two factors varied across conditions. When switches occurred, they were either at word boundaries or periodically (every 116 msec) and either with or without a brief gap (84 msec) at every switch point. In addition, SRTs were measured in a quiet condition to rule out audibility as a limiting factor. Results: SRTs were poorer for the four switching dichotic conditions than for the nonswitching dichotic condition, but better than for the diotic condition. Periodic switches without gaps resulted in the worst SRTs compared to the other switch conditions, thus maximizing IM. Conclusions: These findings suggest that periodically switching the target and masker streams across the ears (without gaps) was the most efficient in disrupting SRM. Thus, this approach can be used in experiments that seek a relatively pure measure of IM, and could be readily extended to translational research. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and text of this article on the journal's Web site (www.ear-hearing.com). ACKNOWLEDGMENTS: The authors thank Rachel Ellinger and Andrea Cunningham for their help with data collection. This work was supported by NIH R01 DC 60014 grant awarded to P. S., and an iCARE ITN (FP7-607139) European fellowship to A. C. The authors have no conflict of interest to disclose. Received June 4, 2018; accepted March 17, 2019. Address for correspondence: Axelle Calcus, Ecole Normale Supérieure, 29 rue d'Ulm, 75005 Paris, France. E-mail: axelle.calcus@ens.fr Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved. Genetic Inheritance of Late-Onset, Down-Sloping Hearing Loss and Its Implications for Auditory Rehabilitation Objectives: Late-onset, down-sloping sensorineural hearing loss has many genetic and nongenetic etiologies, but the proportion of this commonly encountered type of hearing loss attributable to genetic causes is not well known. In this study, the authors performed genetic analysis using next-generation sequencing techniques in patients showing late-onset, down-sloping sensorineural hearing loss with preserved low-frequency hearing, and investigated the clinical implications of the variants identified. Design: From a cohort of patients with hearing loss at a tertiary referral hospital, 18 unrelated probands with down-sloping sensorineural hearing loss of late onset were included in this study. Down-sloping hearing loss was defined as a mean low-frequency threshold at 250 Hz and 500 Hz less than or equal to 40 dB HL and a mean high-frequency threshold at 1, 2, and 4 kHz greater than 40 dB HL. The authors performed whole-exome sequencing and segregation analysis to identify the genetic causes and evaluated the outcomes of auditory rehabilitation in the patients. Results: There were nine simplex and nine multiplex families included, in which the causative variants were found in six of 18 probands, demonstrating a detection rate of 33.3%. Various types of variants, including five novel and three known variants, were detected in the MYH14, MYH9, USH2A, COL11A2, and TMPRSS3 genes. The outcome of cochlear and middle ear implants in patients identified with pathogenic variants was satisfactory. There was no statistically significant difference between pathogenic variant-positive and pathogenic variant-negative groups in terms of onset age, family history of hearing loss, pure-tone threshold, or speech discrimination scores. Conclusions: The proportion of patients with late-onset, down-sloping hearing loss identified with potentially causative variants was unexpectedly high. Identification of the causative variants will offer insights on hearing loss progression and prognosis regarding various modes of auditory rehabilitation, as well as possible concomitant syndromic features. ACKNOWLEDGMENTS: This study was provided with bioresources from the National Biobank of Korea, Centers for Disease Control and Prevention, Republic of Korea (4845-301, 4851-302 and -307). This research was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT & Future Planning (2015R1A1A1A05001472 to S.M.H., 2017M3A9E8029714 to J.J.S., 2014M3A9D5A01073865 to C.J.Y., 2018R1A5A2025079 to H.Y.G.) M.H.S., J.J., H.Y.G., and J.Y.C. designed the study conception. J.J, J.H.R., H.J.C., and J.S.L. performed the experiment. M.H.S., J.J., H.J.L., and B.N. analyzed and interpreted the data. M.H.S., J.J., H.J.L., B.N., H.Y.G., and J.H.R. wrote the article. The authors have no conflicts of interest to disclose. Received July 25, 2018; accepted March 2, 2019. Address for correspondence: Jae Young Choi, Department of Otorhino laryngology, Yonsei University College of Medicine, 50–1 Yonsei-ro, Seodaemun-gu, Seoul 120–752, Republic of Korea. E-mail: jychoi@yuhs.ac Address for correspondence: Heon Yung Gee, Department of Pharmacology and Brain Korea 21 Project for Medical Sciences, Yonsei University College of Medicine, 50–1 Yonsei-ro, Seodaemun-gu, Seoul 120–752, Republic of Korea. E-mail: hygee@yuhs.ac Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved. Improving Clinical Outcomes in Cochlear Implantation Using Glucocorticoid Therapy: A Review Cochlear implant surgery is a successful procedure for auditory rehabilitation of patients with severe to profound hearing loss. However, cochlear implantation may lead to damage to the inner ear, which decreases residual hearing and alters vestibular function. It is now of increasing interest to preserve residual hearing during this surgery because this is related to better speech, music perception, and hearing in complex listening environments. Thus, different efforts have been tried to reduce cochlear implantation-related injury, including periprocedural glucocorticoids because of their anti-inflammatory properties. Different routes of administration have been tried to deliver glucocorticoids. However, several drawbacks still remain, including their systemic side effects, unknown pharmacokinetic profiles, and complex delivery methods. In the present review, we discuss the role of periprocedural glucocorticoid therapy to decrease cochlear implantation-related injury, thus preserving inner ear function after surgery. Moreover, we highlight the pharmacokinetic evidence and clinical outcomes which would sustain further interventions. ACKNOWLEDGMENTS: The authors have no conflicts of interest to disclose. Received October 8, 2018; accepted March 14, 2019. Address for correspondence: Cecilia Engmér Berglin, Department of Otorhinolaryngology, B53, Karolinska University Hospital, 141 86 Stockholm, Sweden. E-mail: cecilia.engmer-berglin@sll.se Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved. The Effect of Hearing-Protection Devices on Auditory Situational Awareness and Listening Effort Objectives: Hearing-protection devices (HPDs) are made available, and often are required, for industrial use as well as military training exercises and operational duties. However, these devices often are disliked, and consequently not worn, in part because they compromise situational awareness through reduced sound detection and localization performance as well as degraded speech intelligibility. In this study, we carried out a series of tests, involving normal-hearing subjects and multiple background-noise conditions, designed to evaluate the performance of four HPDs in terms of their modifications of auditory-detection thresholds, sound-localization accuracy, and speech intelligibility. In addition, we assessed their impact on listening effort to understand how the additional effort required to perceive and process auditory signals while wearing an HPD reduces available cognitive resources for other tasks. Design: Thirteen normal-hearing subjects participated in a protocol, which included auditory tasks designed to measure detection and localization performance, speech intelligibility, and cognitive load. Each participant repeated the battery of tests with unoccluded ears and four hearing protectors, two active (electronic) and two passive. The tasks were performed both in quiet and in background noise. Results: Our findings indicate that, in variable degrees, all of the tested HPDs induce performance degradation on most of the conducted tasks as compared to the open ear. Of particular note in this study is the finding of increased cognitive load or listening effort, as measured by visual reaction time, for some hearing protectors during a dual-task, which added working-memory demands to the speech-intelligibility task. Conclusions: These results indicate that situational awareness can vary greatly across the spectrum of HPDs, and that listening effort is another aspect of performance that should be considered in future studies. The increased listening effort induced by hearing protectors may lead to earlier cognitive fatigue in noisy environments. Further study is required to characterize how auditory performance is limited by the combination of hearing impairment and the use of HPDs, and how the effects of such limitations can be linked to safe and effective use of hearing protection to maximize job performance. ACKNOWLEDGMENTS: This work is sponsored by the US Army Natick Soldier Research, Development, and Engineering Center under Air Force Contract FA8721-05-C-0002 and/or FA8702-15-D-0001. Any opinions, findings, conclusions or recommendations expressed in this material are those of the author(s) and do not necessarily reflect the views of the Department of the Army. Distribution Statement A: Approved for public release. Distribution is unlimited. C.J.S. designed and performed experiments, analyzed data, provided statistical analysis and wrote the article; P.T.C provided data analysis and wrote the article; A.P.D, J.P.P., T.P., and J.B. collected and analyzed data; T.F.Q. and M.M. provided contributions to conception of the work and critical editing; P.P.C provided editing and final approval of the version to be published. The authors have no conflicts of interest to disclose. Received June 4, 2018; accepted February 21, 2019. Address for correspondence: Bioengineering Systems and Technologies Group, MIT Lincoln Laboratory, 244 Wood St. Lexington, MA 02421, USA. E-mail: christopher.smalt@ll.mit.edu Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved. Neural Indices of Vowel Discrimination in Monolingual and Bilingual Infants and Children Objectives: To examine maturation of neural discriminative responses to an English vowel contrast from infancy to 4 years of age and to determine how biological factors (age and sex) and an experiential factor (amount of Spanish versus English input) modulate neural discrimination of speech. Design: Event-related potential (ERP) mismatch responses (MMRs) were used as indices of discrimination of the American English vowels [ε] versus [I] in infants and children between 3 months and 47 months of age. A total of 168 longitudinal and cross-sectional data sets were collected from 98 children (Bilingual Spanish–English: 47 male and 31 female sessions; Monolingual English: 48 male and 42 female sessions). Language exposure and other language measures were collected. ERP responses were examined in an early time window (160 to 360 msec, early MMR [eMMR]) and late time window (400 to 600 msec, late MMR). Results: The eMMR became more negative with increasing age. Language experience and sex also influenced the amplitude of the eMMR. Specifically, bilingual children, especially bilingual females, showed more negative eMMR compared with monolingual children and with males. However, the subset of bilingual children with more exposure to English than Spanish compared with those with more exposure to Spanish than English (as reported by caretakers) showed similar amplitude of the eMMR to their monolingual peers. Age was the only factor that influenced the amplitude of the late MMR. More negative late MMR was observed in older children with no difference found between bilingual and monolingual groups. Conclusions: Consistent with previous studies, our findings revealed that biological factors (age and sex) and language experience modulated the amplitude of the eMMR in young children. The early negative MMR is likely to be the mismatch negativity found in older children and adults. In contrast, the late MMR amplitude was influenced only by age and may be equivalent to the Nc in infants and to the late negativity observed in some auditory passive oddball designs. ACKNOWLEDGMENTS: The authors thank A. Barias and M. Wroblewski for helping with data collection, B. Tagliaferri for technical support, and W. Strange and R. G. Schwartz for advice on the design. This research was supported by NIH HD46193 to V. L. Shafer. V. L. S. oversaw the project, designed the experiments, and was involved in writing the article; Y. H. Y. helped with data collection, performed data analyses, and wrote wrote the initial draft in conjunction with V. L. S., and led the manuscript revision process;. C. T. helped with data collection and interpreting the language measures; H.H. and L. C. performed the early stages of the Mixed-Effect Modeling analysis in conjunction with Y. H. Y.; N. V. helped design the language background questionnaire and collect the data; J. G. helped collect the data; K. G. and H. D. helped design and pilot the electrophysiological paradigm and helped collect the data. All authors were involved in revising the article. The authors have no conflicts of interest to disclose. Received May 10, 2018; accepted January 24, 2019. Address for correspondence: Yan H. Yu, Department of Communication Sciences and Disorders, St. John's University, 8000 Utopia Parkway, Queens, NY 11437, USA. E-mail: yuy1@stjohns.edu and Valerie L. Shafer, Ph.D. Program in Speech-Language-Hearing Sciences, The Graduate Center, City University of New York, 365 Fifth Avenue, New York, NY 10016, USA. E-mail: vshafer@gc.cuny.edu Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved. Impact of Lexical Parameters and Audibility on the Recognition of the Freiburg Monosyllabic Speech Test Objective: Correct word recognition is generally determined by audibility, but lexical parameters also play a role. The focus of this study was to examine both the impact of audibility and lexical parameters on speech recognition of test words of the clinical German Freiburg monosyllabic speech test, and subsequently on the perceptual imbalance of test lists observed in the literature. Design: For 160 participants with normal hearing that were divided into three groups with different simulated hearing thresholds, monaural speech recognition for the Freiburg monosyllabic speech test was obtained via headphones in quiet at different presentation levels. A software manipulated the original speech material to simulate two different hearing thresholds. All monosyllables were classified according to their frequency of occurrence in contemporary language and the number of lexical neighbors using the Cross-Linguistic Easy-Access Resource for Phonological and Orthographic Neighborhood Density database. Generalized linear mixed-effects regression models were used to evaluate the influences of audibility in terms of the Speech Intelligibility Index and lexical properties of the monosyllables in terms of word frequency (WF) and neighborhood density (ND) on the observed speech recognition per word and per test list, respectively. Results: Audibility and interactions of audibility with WF and ND correctly predicted identification of the individual monosyllables. Test list recognition was predicted by test list choice, audibility, and ND, as well as by interactions of WF and test list, audibility and ND, ND and test list, and audibility per test list. Conclusions: Observed differences in speech recognition of the Freiburg monosyllabic speech test, which are well reported in the literature, depend not only on audibility but also on WF, neighborhood density, and test list choice and their interactions. The authors conclude that future creations of speech test material should take these lexical parameters into account. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and text of this article on the journal's Web site (www.ear-hearing.com). ACKNOWLEDGMENTS: The authors thank Sascha Bilert, Tina Gebauer, Lena Haverkamp, Britta Jensen, and Kristin Sprenger for their support performing the measurements and categorizing the monosyllables per database. The authors also thank Daniel Berg for technical support and Thomas Brand for support on the SII predictions. English language support was provided by www.stels-ol.de. This work was supported by the Ph.D. program Jade2Pro of Jade University of Applied Sciences, Oldenburg, Germany. The authors have no conflicts of interest to disclose. Received October 14, 2017; accepted March 8, 2019. Address for correspondence: Alexandra Winkler, Institute of Hearing Technology and Audiology, Jade University of Applied Sciences, Ofener Straße 16/19, D-26121 Oldenburg, Germany. E-mail: alexandra.winkler@jade-hs.de Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved. Age-Related Changes in Temporal Resolution Revisited: Electrophysiological and Behavioral Findings From Cochlear Implant Users Objectives: The mechanisms underlying age-related changes in speech perception are still unclear, most likely multifactorial and often can be difficult to parse out from the effects of hearing loss. Age-related changes in temporal resolution (i.e., the ability to track rapid changes in sounds) have long been associated with speech perception declines exhibited by many older individuals. The goals of this study were as follows: (1) to assess age-related changes in temporal resolution in cochlear implant (CI) users, and (2) to examine the impact of changes in temporal resolution and cognition on the perception of speech in noise. In this population, it is possible to bypass the cochlea and stimulate the auditory nerve directly in a noninvasive way. Additionally, CI technology allows for manipulation of the temporal properties of a signal without changing its spectrum. Design: Twenty postlingually deafened Nucleus CI users took part in this study. They were divided into groups of younger (18 to 40 years) and older (68 to 82 years) participants. A cross-sectional study design was used. The speech processor was bypassed and a mid-array electrode was used for stimulation. We compared peripheral and central physiologic measures of temporal resolution with perceptual measures obtained using similar stimuli. Peripherally, temporal resolution was assessed with measures of the rate of recovery of the electrically evoked compound action potential (ECAP), evoked using a single pulse and a pulse train as maskers. The acoustic change complex (ACC) to gaps in pulse trains was used to assess temporal resolution more centrally. Psychophysical gap detection thresholds were also obtained. Cognitive assessment included two tests of processing speed (Symbol Search and Coding) and one test of working memory (Digit Span Test). Speech perception was tested in the presence of background noise (QuickSIN test). A correlational design was used to explore the relationship between temporal resolution, cognition, and speech perception. Results: The only metric that showed significant age effects in temporal processing was the ECAP recovery function recorded using pulse train maskers. Younger participants were found to have faster rates of neural recovery following presentation of pulse trains than older participants. Age was not found to have a significant effect on speech perception. When results from both groups were combined, digit span was the only measure significantly correlated with speech perception performance. Conclusions: In this sample of CI users, few effects of advancing age on temporal resolution were evident. While this finding would be consistent with a general lack of aging effects on temporal resolution, it is also possible that aging effects are influenced by processing peripheral to the auditory nerve, which is bypassed by the CI. However, it is known that cross-fiber neural synchrony is improved with electrical (as opposed to acoustic) stimulation. This change in neural synchrony may, in turn, make temporal cues more robust/perceptible to all CI users. Future studies involving larger sample sizes should be conducted to confirm these findings. Results of this study also add to the growing body of literature that suggests that working memory is important for the perception of degraded speech. ACKNOWLEDGMENTS: We thank Paul Abbas for helpful suggestions on study design and data analysis, and Jacob Oleson for assistance with statistical analyses. We also acknowledge Wenjun Wang for help in developing the perception testing software. This study was funded by a Student Investigator Research Grant from the American Academy of Audiology (B. S. M.) and by an NIH P50 DC000242 grant. The authors have no conflicts of interest to disclose. Received June 21, 2017; accepted February 21, 2019. Address for correspondence: Bruna S. S. Mussoi, AuD, PhD, Kent State University, Speech Pathology and Audiology, A140 Center for Performing Arts, 1325 Theatre Drive, Kent, OH 44242, USA. E-mail: bmussoi@kent.edu Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved. Ep. 2019-2.2: BONUS Interview with Samantha Kesteloot at the AAA 2019 Conference In this bonus episode recorded at the 2019 American Academy of Audiology (AAA) Conference in Columbus, OH, D'Anne Rudden and Samantha Kesteloot take a deep dive into Samantha's early struggles as a child then a teenager with hearing loss and how she overcame those struggles in her pursuit of a career in audiology. Read the transcript here.  Ep. 2019-2: Audiology Professional with Hearing Loss with Samantha Kesteloot An audiology professional with hearing loss? It's inspiring what audiologists and AuD students with first-hand experience with hearing loss could contribute to patient care. Listen to this podcast with D'Anne Rudden and guest, Samantha Kesteloot, an outstanding third-year AuD student with hearing loss, as they explore Samantha's the trials and triumphs in becoming an audiologist while managing her own hearing loss. Read the transcript here Ep. 2019-1: Storytelling with Dawn Heiman, AuD Storytelling offers a unique way of engaging with patients in their hearing care. Explore effective strategies to get started with storytelling using social media with these experts, D'Anne Rudden, AuD and Dawn Heiman, AuD. Read the podcast transcript here.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

Oral Health Sciences

President's message K Sadashiva Shetty International Journal of Oral Health Sciences 2019 9(1):1-1

Secretary's message IM Ali International Journal of Oral Health Sciences 2019 9(1):2-2

Oral health and overall health K Ravindra International Journal of Oral Health Sciences 2019 9(1):3-3

Editorial C Shubha International Journal of Oral Health Sciences 2019 9(1):4-4

Estimation of salivary flow in oral submucous fibrosis patients using vibrotactile stimulation Apurva Prashant Deshpande, Kajal V Gokak, Sagar Jalihal, Anjana Bagewadi International Journal of Oral Health Sciences 2019 9(1):5-8 Introduction: Xerostomia is encountered commonly in dentistry and also features in oral submucous fibrosis (OSMF), due to fibrosis and hyalinization in and around salivary glands. Vibrotactile stimulation of salivary glands is a new reliable noninvasive method for stimulation of saliva. Purpose: The aim of this research is to determine the efficacy of vibrotactile stimulation in increasing salivary secretions. Materials and Methods: Study was conducted on 20 individuals with OSMF and equal control group. Resting saliva was measured by asking the participants to accumulate saliva in the mouth for 3 min and then collect it in a container by spitting method. Later, masseter muscles were stimulated by extraoral vibrations of 90 Hz frequency through the apparatus for 3 min and stimulated saliva was collected immediately in a container. The volume of the stimulated and resting saliva was then compared. Results: The study comprised of majority male subjects with average age of 35 years. On vibrotactile stimuli, there was a rise in stimulated saliva in both the groups with a statistically significant P value. Conclusion: Although there is saliva blockage due to the fibrosis in minor salivary glands (MSGs) and ducts of major salivary glands in OSMF, this study showed increased salivary flow upon vibratory stimuli. Increase in salivation is assumed to be from tonic vibration reflex (TVR) of muscles and conduction of vibrations by the bone till the major salivary glands and MSG. The reported apparatus can be used to stimulate salivary flow by patients itself without any need of assistance.

Effect of ozonated water on dentin bond strength Attiguppe R Prabhakar, Ravi S Kumar, Divya Prahlad International Journal of Oral Health Sciences 2019 9(1):9-14 Objective: Residual bacteria under restorations can survive and proliferate even in the presence of a good seal. This can be prevented using adjunctive treatment with antibacterial agents during dentin bonding. However, its use can interfere with the bonding process. The current research was designed to study the influence of pretreatment with 2% chlorhexidine (CHX) gluconate (Consepsis), and ozonated water on shear bond strength, and microleakage of resin-modified glass ionomer cement (RMGIC) to primary tooth dentin. Materials and Methods: Thirty-six noncarious primary molars were selected, and the study was conducted in two parts as follows: evaluation of (1) Shear bond strength and (2) Microleakage. The teeth were randomly divided into three groups as follows: group I – Distilled water (control), Group II – 2% CHX gluconate, and Group III – ozonated water. The shear bond test was done using a Universal Testing Machine (Instron, USA). The results were analyzed using one-way ANOVA for multiple group comparisons and post hoc Tukey's for group-wise comparison. Microleakage was evaluated using stereo microscope. The results were statistically analyzed using the Chi-square test for group-wise comparison. Results: Bond strength was comparable across the three groups with distilled water showing the highest bond strength values followed by ozone group and 2% CHX group. CHX group showed significantly greater microleakage when compared with that of the ozone group. Interpretation and Conclusion: Ozonated water did not affect the shear bond strength or the sealing ability of RMGIC to primary tooth dentin, and hence is a viable option for cavity disinfection.

Relationship of salivary levels of sialic acid in obese patients with chronic periodontitis: A biochemical study Vivek Kumar, Amrita , Gargee Rawat, Mahendra Pratap, Gaurav Kumar, Anshul Verma International Journal of Oral Health Sciences 2019 9(1):15-19 Background: Sialic acid (SA) participates in multiple physiological functions, such as cell-to-cell interactions, cell migration, and proliferation. The levels of SA may provide intimation about the severity and state of underlying disease processes. Hence, the aim of the present study was to assess the salivary levels of SA in obese patients with and without chronic periodontitis (CP) and nonobese healthy patients. Materials and Methods: A total of 45 patients were divided into three groups: Group 1: nonobese healthy, Group 2: obese without CP, and Group 3: obese with CP. Whole saliva samples were collected, and SA levels were evaluated using the thiobarbituric acid method of Skoza and Mohos. The results were analyzed using SPSS and Mann–Whitney analysis. Results: The highest SA levels from the saliva were detected in Group 3 while the lowest in Group 1. A significant difference in SA levels in the saliva was found when Groups 1 and 2 were compared with Group 3 (P < 0.0001). Conclusion: The level of SA was higher in the saliva of CP patients. SA may be used as an inflammatory marker for the detection of periodontal disease.

Evaluation of biological effects of X-radiography and computed tomography scan on oral microflora Ali Abdul Hussein S Al-Janabi, Mohammid Hamid H AI-Baghdadi International Journal of Oral Health Sciences 2019 9(1):20-24 Introduction: X-ray is the most valuable tool for diagnosis of various diseases. Its radiation energy has a serious effect on living cells. The effects of X-radiography and computed tomography (CT) scans on the viability of oral microflora in the human were investigated. Methods: A total of 432 patients in two groups exposed to X-radiation were included in a cohort study. Group I (215) was exposed to X-radiography and Group II (217) to CT scan. Swab samples from the oral cavity were collected. Viability of normal oral flora in those patients was measured by microbial counting before and after exposure. Results: Radiation of X-ray techniques, especially for CT scan, showed an effect on most of bacterial multiplication by increasing their count after exposure. Meanwhile, fungal isolates and one of the bacteria (Staphylococcus aureus) were decreased in number after exposure. Some isolates were not affected by radiation from X-radiography. Conclusion: Radiation of routinely diagnostic X-ray found to play an important role in disturbance of microbial counting balance among oral flora through increasing the density of most kinds of them. Limitation of X-ray exposure is a safety precaution that should be taken to prevent adverse effects on normal flora of the human body.

Toothbrush bristles, a harbor of microbes and the risk of infection Philip Asumang, Samuel Eguasi Inkabi, Shirley Inkabi International Journal of Oral Health Sciences 2019 9(1):25-27 Microbes survive in a wide variety of environments, including toothbrush bristles regardless where they are kept once they are unsterilized. Toothbrush bristles serve unintentionally a great source of favorable condition for the growth and survival of microorganisms. Conducting a literature review of previous studies, we explored the microbial contamination of toothbrush bristles occurrence, and the risks this poses for disease infections in susceptible individuals in this review article.

Oral field cancerization: Tracking the invisible Harsha Mallegowda, Ruthushree Theresa, Vikram S Amberkar International Journal of Oral Health Sciences 2019 9(1):28-35 Cancer is one of the most common diseases affecting humans worldwide, despite latest advances made in molecular and cell biology, how cancer cells progress through carcinogenesis and acquire their metastatic ability is still questionable. Oral cavity is one of the commonest site for potentially malignant disorders. These pre-malignant pathologies may progress to dysplastic lesions then to invasive carcinomas.The presence of one or more mucosal areas consisting of epithelial cells that have cancer-associated genetic or epigenetic alterations.The prognosis of squamous cell carcinoma patients is adversely influenced by development of a new tumor. This review highlights the pathophysiological changes during field cancerization

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

Pediatric Nephrology

From the Editorial Board Arvind Bagga Asian Journal of Pediatric Nephrology 2019 2(1):1-1

Nutritional challenges across the spectrum of chronic kidney disease Kristen Sgambat, Kaushalendra Amatya, Asha Moudgil Asian Journal of Pediatric Nephrology 2019 2(1):2-15 Maintenance of optimal nutrition plays a key role in the management of children with chronic kidney disease (CKD) across different stages of CKD, during dialysis and following transplantation. Malnutrition, both under- and over-nutrition, is widely prevalent and negatively impacts short- and long-term outcomes. It leads to growth retardation, increased risk of hospitalization and infections, poor cognition, and decreased quality of life. Understanding of the pathogenesis of malnutrition is crucial for its proper management. This review discusses the definition, prevalence, pathogenesis, and management of malnutrition in different stages of CKD.

Next-generation sequencing-based genetic diagnosis of steroid-resistant nephrotic syndrome: Benefits and challenges Varsha Chottusing Pardeshi, Ambily Narikot, Anil Vasudevan Asian Journal of Pediatric Nephrology 2019 2(1):16-24 Steroid-resistant nephrotic syndrome (SRNS) is the second-most common cause of chronic kidney disease in children and in those requiring kidney transplantation. The disease shows significant heterogeneity in its age at onset and clinical course. The discovery of mutations in NPHS1, the gene encoding nephrin that is a key component of the podocyte slit diaphragm, in a subset of children with congenital NS, led to identification of a distinct subgroup of patients of SRNS that has an underlying genetic etiology. Subsequently, mutations in over 53 podocyte genes have been implicated in monogenic forms of SRNS with no clear genotype-phenotype correlations. The large number of genes implicated in SRNS, phenotypic variability, and lack of information about frequency of mutations in these genes, makes the use of genetic testing in the management of children with SRNS challenging in terms of decisions on who to test, which genes to screen, and how to use the information obtained from testing in the clinical setting. Given the genetic heterogeneity and phenotypic variability, Sanger sequencing is not a feasible approach for routine testing. Next-generation sequencing (NGS) technology is emerging as the preferred method to screen multiple genes in genetically heterogeneous diseases like SRNS. Such high-throughput sequencing method permits rapid and cost-effective simultaneous screening of large number of individuals and genes. However, the high throughput combined with significant phenotypic and genetic variability of monogenic SRNS poses unique challenges for clinicians in the interpretation of genetic result. This review provides an overview of utility of genetic testing with focus on NGS-based genetic testing and the challenges in the interpretation of genetic results in clinical settings.

Renal angina index in the prediction of acute kidney injury in critically ill children Suma Sundararaju, Aditi Sinha, Pankaj Hari, Rakesh Lodha, Arvind Bagga Asian Journal of Pediatric Nephrology 2019 2(1):25-30 Background: Renal Angina Index (RAI) was recently proposed as a tool to identify patients at high risk for severe acute kidney injury (AKI) by integrating baseline, contextual, and clinical evidence of renal injury and to optimize biomarker utility in intensive care units. Methods: In this unicentric prospective observational study, we estimated RAI at admission in 285 critically ill patients, aged 1 month to 18 years, and evaluated the utility of renal angina (RAI ≥8) in identifying patients with severe or any AKI on day 3 and day 7. The relationship between RAI and need for renal replacement therapy (RRT) and duration of mechanical ventilation and hospital stay was also examined. Results: Renal angina was present in 49.4% of 285 patients. Severe AKI, observed in 29 (10.2%) patients on day 3 and 13.2% of 144 patients followed to day 7, had an incidence of 1.1 (0.8–1.6) episodes per 100 person-days. Thirty-six (12.6%) patients required RRT. RAI satisfactorily identified patients at risk of severe AKI on days 3 (area under the curve [AUC]: 0.82; 95% confidence interval [CI]: 0.73–0.90) and 7 (AUC: 0.73; 95% CI: 0.62–0.84), was more useful than Pediatric Index of Mortality in such discrimination, and correlated with duration of mechanical ventilation and hospital stay. However, RAI thresholds ≥12 or ≥20 had higher specificity, Youden index, and positive predictive value than that of RAI ≥8 in discriminating severe AKI on day 3 or 7 and distinguished between patients with and without need for RRT. Conclusions: RAI usefully predicts the development of subsequent severe AKI on days 3 and 7, and is associated with duration of mechanical ventilation and hospital stay. A higher RAI threshold (≥12 or ≥20) is more discriminatory than RAI ≥8.

Outcomes of pediatric renal transplantation at a single center Mital Parikh, Umapati Hedge, Abhijit Konnur, Sishir Gang, Mohan Rajapurkar, Hardik Patel, Neel Patel Asian Journal of Pediatric Nephrology 2019 2(1):31-35 Introduction: Renal transplantation is the preferred treatment option for children with end-stage renal disease (ESRD). There is scant information on comparative outcomes of pediatric renal transplantation in centers in developing regions. Materials and Methods: We retrospectively reviewed outcomes of renal transplantation in pediatric recipients of renal transplantation at a single center between 2001 and 2018. Information of underlying etiology of ESRD, pretransplant renal replacement therapy (RRT) modality, donor type, immunosuppression regimen, surgical complications, rates of rejection, compliance to immunosuppression, graft survival, and overall patient survival is presented. Results: Of 100 patients (77 boys) who received transplantation at the mean age of 15.7 ± 2.3 (5–18) years, chief underlying etiology of ESRD was chronic glomerulonephritis (n = 19), chronic tubulointerstitial nephritis (n = 31), and Alport syndrome (n = 1). Modality of RRT was predominantly hemodialysis (n = 90) or peritoneal dialysis (n = 6). Allograft survival was 98%, 85%, 80%, and 73% at 1, 3, 5, and 10 years, respectively. No deaths were observed. Conclusions: Pediatric renal transplantation at a single center in India was associated with satisfactory short-term patient and allograft outcomes. Rates of allograft survival at 10-year follow-up were lower as compared to other unicentric reports from the region.

Pediatric acute poststreptococcal glomerulonephritis: A single-center experience Sherif Mohamed El-Desoky, Lujain K I. Al-Sulimani, Manar T O. Alkhatieb, Khalid A Alhasan, Amr S Albanna, Jameela A Kari Asian Journal of Pediatric Nephrology 2019 2(1):36-40 We evaluated the frequency, severity, and outcome of children with acute poststreptococcal glomerulonephritis (PSGN) by retrospectively reviewing case records of all children diagnosed with PSGN between 2007 and 2015. The diagnosis of PSGN was based on the evidence of recent streptococcal infection, including positive streptococcal culture from the skin or throat, high or rising antistreptolysin O titer (>333 IU/ml), or high anti-deoxyribonuclease B level (>200 IU/ml). In addition, low serum complement 3 level and/or kidney biopsy results were considered. Children with evidence of chronic kidney disease (CKD) were excluded from the study. Sixty-six children (50 boys) with age 8.4 ± 3.4 years were included in the study. Ninety percent of the children had proteinuria and 79% had impaired glomerular filtration rate at presentation. One child had rapidly progressive glomerulonephritis. At 1-year follow-up, 10% of the children had renal impairment, 25% had hypertension, and 40% had proteinuria. As a considerable percentage of patients with PSGN in this series had CKD at 1-year follow-up, careful prolonged follow-up of such patients is advisable.

Plasma Infusion versus plasma exchange as first line therapy in atypical hemolytic uremic syndrome: A single centre experience Shankar Prasad Yadav, Arpana Iyengar, Anil Vasudevan Asian Journal of Pediatric Nephrology 2019 2(1):41-45 Plasma exchange (PEX) remains the standard therapy for the management of atypical hemolytic-uremic syndrome (aHUS) in regions where eculizumab is not available. Where even PEX is not feasible or afforded, patients are managed with plasma infusion (PI). This single-center, retrospective study compares the efficacy of PI with PEX and examined for predictors of renal recovery in pediatric patients with aHUS admitted at a single center in a developing country from January 2005 to June 2017. Endpoints for comparison were time to hematological remission, duration of hospitalization, rates of complete and partial renal recovery, time to progression to chronic kidney disease Stage 5, and occurrence of relapses. Of 53 children presenting at 6.3 ± 3.9 years of age, 24 and 22 patients were managed with PI and PEX, respectively. The latter group of patients was sicker at presentation and included 13 children with antibodies to complement factor H. All patients achieved hematological remission, including four patients refractory to PI who were switched to PEX. Patients managed on PI were discharged from hospital earlier than those on PEX and were more often with complete renal recovery (55% vs. 27%). At 1.5 (0.5–72) months of follow-up, similar proportions of 31 patients managed with PI and PEX showed complete and partial renal recovery and had comparable rates of relapse and disease progression. Presentation with acute kidney injury Stage 3 and edema were independent predictors of incomplete renal recovery at discharge. Both PEX and PI are associated with satisfactory short-term outcomes in patients with aHUS lacking access to eculizumab, and PEX might be preferred over PI in patients with severe disease and those with anticomplement factor H antibodies.

Ulbright-Hodes syndrome Majid Malaki Asian Journal of Pediatric Nephrology 2019 2(1):46-47 Phocomelia is a well known dysmorphism associated with antenatal use of thalidomide. Phocomelia may also be a part of many syndromes that overlap with each other. This case report presents a case of Ulbright-Hodes syndrome in a 7-yr-old boy with phocomelia, hypoplastic kidneys and short stature.

Atypical hemolytic uremic syndrome with critical illness neuropathy Neethu Rajeev, Georgie Mathew, Aditi Sinha, Pankaj Hari, Arvind Bagga Asian Journal of Pediatric Nephrology 2019 2(1):48-49

Fractures, abnormal skull shape, and metabolic acidosis in a young child Sherif Mohamed El-Desoky, Jameela A Kari Asian Journal of Pediatric Nephrology 2019 2(1):50-53

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

Dermatology

Antifungal drug susceptibility testing of dermatophytes: Laboratory findings to clinical implications Sunil Dogra, Dipika Shaw, Shivaprakash M Rudramurthy Indian Dermatology Online Journal 2019 10(3):225-233

What is new in narrow-band ultraviolet-B therapy for vitiligo? Urmi Khanna, Sujay Khandpur Indian Dermatology Online Journal 2019 10(3):234-243 Vitiligo is an acquired disorder of skin pigmentation that produces significant psychological impact especially in those with skin of color. Narrow-band ultraviolet B (NB-UVB) therapy, which was first used in vitiligo in 1997 by Westerhof and Nieuweboer-Krobotova, has emerged as one of the safest and most effective therapy for this dermatosis. The light source used for NB-UVB phototherapy is the TL-01 lamp, and the most common model of the NB-UVB phototherapy device is the upright in-office booth or chamber which has 24–48 such lamps. In recent years, there have been several advances in the understanding of the mechanism of action of NB-UVB and the use of combination treatments, many of which increase the efficacy of NB-UVB. In 2017, the Vitiligo Working Group made vital recommendations on the dosage, frequency, and safety of NB-UVB in vitiligo. Furthermore, home phototherapy devices are gaining popularity as they lead to an improved patient compliance. There is still need for large multicenter randomized controlled trials to assess benefits of home phototherapy in vitiligo and studies investigating additional benefits of phototherapy following surgical therapy.

Newer treatment modalities in epidermolysis bullosa Leena Bruckner-Tuderman Indian Dermatology Online Journal 2019 10(3):244-250 The term epidermolysis bullosa (EB) refers to a group of hereditary skin blistering diseases. The group is clinically and genetically heterogeneous, but all EB forms are associated with mechanically induced skin blistering and fragility. The causative gene mutations of most EB types are known. The current international consensus classification contains four main types: EB simplex (EBS), junctional EB (JEB), dystrophic EB (DEB), and Kindler syndrome (KS). The classification is based on the morphological level of blister formation. In EBS, the split is intra-epidermal, in JEB along the basement membrane and in DEB below the basement membrane. In Kindler syndrome, the dermal-epidermal junction is disorganized, and blisters can occur on all three levels. Each major EB type has further subtypes which may differ in terms of their genetic, biological or clinical characteristics. Traditionally, EB treatments have been symptomatic, but increasing understanding of disease etio-pathogenesis is facilitating development of novel evidence-based therapy approaches. First gene- and cell-based therapies are being tested at preclinical level and in clinical trials. New knowledge on secondary disease mechanisms has led to development and clinical testing of urgently needed symptom-relief therapies using small molecules and biologicals.

Clinical profile of cutaneous adverse effects of epidermal growth factor receptor inhibitors: A prospective observational study of 76 cases Neerja Saraswat, Aradhana Sood, Dharmesh Kumar, Rajesh Verma, Kumar Sushil Indian Dermatology Online Journal 2019 10(3):251-255 Background: Epidermal growth factor receptor (EGFR) inhibitors are an extensively utilized class of chemotherapeutic agents which form an integral component of treatment in solid organ malignancies such as non-small-cell lung carcinoma, pancreatic carcinoma, colorectal carcinoma, and head and neck carcinoma. It has two subclasses: epidermal growth factor inhibitors (erlotinib) and monoclonal antibody (cetuximab). A wide array of cutaneous adverse effects has been attributed to this class of drugs, such as papulopustular eruptions, paronychia, xerosis, and changes in hair and nails. Materials and Methods: A total of 76 cases of various malignancies on EGFR inhibitors who developed cutaneous side effects while on therapy and reported or referred to us by oncologists from January 2017 to January 2018 were included in the study. All the patients who were on other associated medications or radiotherapy were excluded. Result: In all, 45 (59.2%) were males and 31 (40.7%) were females. Non-small-cell lung carcinoma was the most common carcinoma in 32 (42.1%) patients, and cetuximab was the most common drug in 29 (38.1%) cases. Papulopustular eruptions were seen in 61 (80.2%) patients, xerosis in 31 (40.7%), mucositis in 6 (7.8%), hair growth problems in 4 (5.6%), and paronychia and pyogenic granuloma in 2 (2.6%) patients each. Conclusion: Although most of the skin toxicities associated with EGFR inhibitors can be managed conservatively, a critical analysis of the cases that are significantly affected due to these side effects is required in cohesion with the treating oncologist to improve the therapeutic compliance of the drug.

Mycetoma: A common yet unrecognized health burden in central India Gitesh U Sawatkar, Vaishali H Wankhade, Bhagyashree B Supekar, Rajesh Pratap Pratap, Dharitri M Bhat, Supriya S Tankhiwale Indian Dermatology Online Journal 2019 10(3):256-261 Context: Mycetoma is a chronic suppurative infective disorder of skin, subcutaneous tissue, fascia, and bones caused by the traumatic inoculation of either fungal (eumycotic) or bacterial (actinomycotic) organisms present in the soil. Triad of tumefaction, discharging sinuses, and grains characterizes the disease. Aims: This study was undertaken to study the clinical spectrum and treatment response of mycetoma in central India. Settings and Design: It was a retrospective study of clinical and/or biopsy-proven and treated cases of mycetoma from November 2015 to October 2016. Subjects and Methods: Medical records of diagnosed and treated mycetoma patients were enrolled retrospectively during November 2015 and October 2016. Case records of patients were evaluated with respect to demographic, clinical, microbiological details, bone involvement, and treatment. Type of therapies and outcome, wherever available, were also assessed. Statistical Analysis: Statistical analysis was done using proportion, mean, and percentages. Results: Eleven cases (male = 8) were seen during the study period (seven actinomycetoma and four eumycetoma). Foot and lower extremity was the most common site (9/11), whereas upper extremity and forehead were involved in one case each. On culture, the organisms isolated were Phialophora and Fusarium. Modified Welsch regimen was started in six of seven patients with actinomycetoma, whereas one was started on sulfamethoxazole–trimethoprim and a combination of amoxicillin and clavulanic acid therapy. All four cases of eumycetoma were treated with itraconazole. On follow-up, six cases of actinomycetoma cases showed significant improvement. Two cases of eumycetoma showed mild to moderate improvement and one case required surgical intervention. One case each of actinomycetoma and eumycetoma were lost to follow-up. Conclusion: Mycetoma has been recognized as a neglected tropical disease by the World Health Organization, recently. There are very few case reports from the central part of India. Prominent case detection in our study emphasizes the need of larger studies to know the extent of disease in this part of India.

The menace of superficial dermatophytosis on the quality of life of patients attending referral hospital in Eastern India: A cross-sectional observational study Nibedita Patro, Maitreyee Panda, Ajaya K Jena Indian Dermatology Online Journal 2019 10(3):262-266 Background: Superficial dermatophytic infections have come up with multiple challenges and comorbidities recently regarding its chronic and recurrent course. Aims: The present study aims at measuring the impact of the disease on the quality of life (QoL) of the patients. Methods: A cross-sectional observational study was conducted over 6 months. The patients attending the dermatology outpatient department were recruited after screening and were made to fill up the Dermatology Life Quality Index (DLQI) and 5D-pruritus scale questionnaires. The P value was calculated and data were compared using the Pearson's correlation coefficient. Results: A total of 294 patients were studied. The effect on QoL was estimated to be moderate [males, ≤10% body surface area (BSA) involvement, ≤6 months duration, low and medium socio-economic status (SES)] to very large (females, >10% BSA involvement, >6 months duration, high SES, and medium and high educational status) according to the DLQI scoring and correlated strongly with the disability scoring in 5D-pruritus scale (r = 0.802, P < 0.0001). Limitations: Small sample size of the study may not reflect the impact on general population, urging the need for multicenter studies. Conclusions: Although considered previously as a simple fungal infection, the present state of superficial dermatophytosis has emerged as a social, psychological, and economic burden on the society.

Transepidermal water loss in psoriasis: A case-control study Vrushali N Nikam, Rochelle C Monteiro, Sukumar Dandakeri, Ramesh M Bhat Indian Dermatology Online Journal 2019 10(3):267-271 Context: Psoriasis is a common papulosquamous disorder characterized by increased epidermal turnover resulting in excessive skin shedding and a compromised barrier function of the skin. Transepidermal water loss (TEWL) is an effective and non-invasive way to measure the barrier function in this condition. Aims: To measure the physiological changes in the skin barrier function in psoriasis by measuring the extent of TEWL. To study the differences in TEWL in pathologically involved and uninvolved skin in psoriasis. To compare the TEWL in skin lesions in psoriatic patients and site matched controls. Subjects and Methods: To determine the barrier quality of the stratum corneum, we performed TEWL measurements using the closed chamber evaporation method (VapoMeter Delfin Technologies, Kuopio, Finland). The ambient temperature ranged between 21°C and 24°C, with a mean relative humidity range of 39%–50%. In total, four sites were measured for all the 50 cases, two involved plaques on the body were selected for the study of lesional psoriatic skin, and the standard sites of ankle and elbow were measured irrespective of being involved or uninvolved with psoriatic skin. TEWL measurements in controls were site matched. Statistical testing was done using SPSS ver. 17. The interval scale data were tested for normality using Shapiro-Wilk test, and between groups testing was done using Mann-Whitney test. Results: The TEWL was higher among the cases in all the four measured areas compared to the controls, thus showing overall impaired skin barrier function in psoriatic skin. In addition, among the cases, the involved sites show higher TEWL in comparison to the uninvolved skin. This is highly suggestive that plaques of psoriasis have reduced water holding capacity. Conclusions: Psoriasis is a dermatosis with overall compromise of the skin barrier function exhibiting exponential TEWL in lesional skin, with increased TEWL over non-lesional skin as well. Thus, it may be concluded that TEWL is an effective, non-invasive and objective method in assessment of skin barrier function.

Association of acanthosis Nigricans and insulin resistance in indian children and youth – A HOMA2-IR based cross-sectional study TM Nithun, P. S. S Ranugha, Jayadev B Betkerur, Veeranna Shastry Indian Dermatology Online Journal 2019 10(3):272-278 Introduction: The American Diabetes Association includes acanthosis nigricans (AN) as an indicator of diabetes mellitus risk in overweight youth entering puberty. Some argue that AN is not an independent predictor of insulin resistance (IR), when body mass index (BMI) is controlled for. There is a paucity of studies on the association of AN and IR among children and young adults from India. Homeostatic model assessment-IR (HOMA2-IR), a computerized updated model, which is supposed to be superior to HOMA1-IR, has rarely been used for quantification of IR. Methods: Sixty cases (irrespective of BMI), aged 2–24 years with AN, and 30 age- and sex-matched normal weight controls were included. A thorough clinical examination and grading of AN was done. BMI, fasting glucose levels, and fasting insulin levels were measured for all. HOMA-IR calculator V.2.2.3 was used to calculate IR. Those with HOMA 2-IR >1.8 were considered insulin-resistant. Lifestyle modifications were advised for patients with IR. Results: The mean HOMA2-IR value in cases and controls was 2.422 and 1.322, respectively, which was statistically significant. Overweight and obese cases had 2.5 and 11.25 times higher risk of having IR, respectively, by logistic regression. The association of AN with IR was found to be statistically significant in normal weight cases when compared with controls (P = 0.045). Grade 4 of neck severity (P = 0.007), Grade 3 of neck texture (P = 0.001), and Grade 4 of axillary severity (P = 0.001) of AN were found to be significantly associated with IR. Limitations: The relatively small sample size may not reflect the accuracy of AN as a marker of IR. Conclusion: Acanthosis nigricans is associated with IR in both normal and obese. We propose that all children, adolescents, and youth with AN be screened for IR irrespective of BMI. Early identification and prompt lifestyle interventions may prevent or delay the onset of diabetes later.

Prescription and usage pattern of topical corticosteroids among out-patient attendees with dermatophyte infections and its analysis: A cross-sectional, survey-based study Raju G Chaudhary, Santoshdev P Rathod, Ashish Jagati, Kalgi Baxi, Akshay Ambasana, Disha Patel Indian Dermatology Online Journal 2019 10(3):279-283 Background: There is scarce scientific data on topical corticosteroids (TCS) prescription by non-dermatologists including registered medical practitioners, ayurvedic, homeopathic practitioners, and over-the-counter (OTC) use of TCS-containing creams. Objective: The main objective of this study is to analyze the prescription and usage pattern of topical steroids among out-patient attendees with dermatophyte infection. To study health-seeking behavior of patients with dermatophyte infections. Material and Methods: An open, cross-sectional, duration-based study of 3 months. Inclusion criteria: Patients with dermatophytosis having a history of topical steroid application; either prescribed or purchased OTC and used themselves. Exclusion criteria: Patients who were not willing to give informed consent. Patient's data like socio-demographic profile, duration, frequency, site of application, contents of the topical cream used, prescriber information, and patients' desire to continue the use of topical steroids were recorded. Results: Total of 18.40% (n = 503) patients were already using cream-containing TCS at the time of presentation to the tertiary dermatology care center. The study shows that almost half of the patients (48.90%) were using unprescribed TCS. Registered medical practitioners were the most common source of TCS creams prescription (59.92%) in the prescribed group, while 26.07% patients were prescribed TCS by dermatologists. Clobetasol propionate (47.91%), was most common steroid agent used. Conclusion: Patients are able to get “prescription-only” drugs as OTC products. Such OTC use of TCS puts patients at risk of steroid modified dermatophytosis and topical steroid damaged skin. Even dermatologists may be culprit in creating menace of steroid abuse.

Association of skin tag with metabolic syndrome and its components: A case–control study from Eastern India Tapaswini Tripathy, Bhabani S.T.P Singh, Bikash R Kar Indian Dermatology Online Journal 2019 10(3):284-287 Background: Skin tags are benign polyps, usually found in the natural folds of the skin. Some studies have found an association of skin tags with obesity, diabetes, hypertension, and atherogenic lipid profile. Metabolic syndrome refers to co-occurrence of these cardiovascular risk factors such as insulin resistance, obesity, dyslipidemia, and hypertension. Aims and Objectives: To find out any possible association of skin tags with metabolic syndrome and its components. Materials and Methods: A case–control study was conducted including 140 participants. Seventy patients with skin tags were considered cases, and 70 age- and sex-matched patients without skin tags were considered as controls. Various anthropometric and biochemical parameters were compared and analyzed between the two groups. Results: Univariate analysis revealed significantly higher waist circumference, high triglyceride, and low high-density lipoproteins (HDLs) in cases compared to controls. The prevalence of diabetes, hypertension, and metabolic syndrome was significantly higher in patients with skin tags, and risk of developing metabolic syndrome was 11.13 times higher in cases compared to controls (P < 0.05). Multivariate logistic regression analysis revealed high waist circumference and low serum HDL had significant association with skin tags. Conclusion: Risk of development of metabolic syndrome is significantly higher in patients with skin tags. Among the various components of metabolic syndrome, only high waist circumference and low serum HDLs are significantly associated with skin tags.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

Oral Surgery, Oral Medicine, Oral Pathology ,Oral Radiology

Comparison of in situ cone beam CT scan data with ex vivo optical scan data in the measurement of root surface area Publication date: Available online 16 May 2019 Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology Author(s): Pengcheng Jia, Gang Yang, Wenjie Hu, Kwok-Hung Chung, Yijiao Zhao, Muqing Liu, Curtis S.K. Chen Abstract Objective To compare root surface area (RSA) measurements of single-root teeth in a sheep mandible based on cone beam computed tomography (CBCT) to measurements made with an optical scanner. Study Design Eight anterior teeth of a sheep cadaver mandible were scanned in situ using CBCT with 3 different exposure parameters, followed by treatment with smoothing software. The teeth were then extracted and scanned individually with an optical scanner. Three-dimensional (3-D) digital models of the teeth were reconstructed based on CBCT and optical scanner data. RSA data were calculated and an equivalence test was used to statistically compare the measurements with significance of difference established at α=0.05. Results The means of the differences between RSA measurements from CBCT and optical scanning ranged from 0.33% to 3.01%. There were no statistically significant differences between the two methods. The smoothing parameters for good fitness of the linear regression were determined to be 0.8 for the smooth factor, 8 for iterations, and 0 for compensate shrinkage. Conclusions The proposed CBCT technique to measure RSA is feasible. RSA data obtained from CBCT in situ are as accurate as optical scanner measurements ex vivo.

Risk factors for hypoesthesia following repair of facial fractures Publication date: Available online 16 May 2019 Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology Author(s): Jae Min Song, Sang Hun Shin, Jae Yeol Lee Abstract Objective The aim of this study was to investigate the incidence of hypoesthesia in patients with facial bone fractures, and to identify the relationships between post-traumatic hypoesthesia and risk factors, including general and fracture-related characteristics. Study Design A total of 437 patients who underwent surgery for facial bone fractures were included. Clinical neurosensory testing was performed at different time points (post-trauma and 1 week, 1 month, and 6 months after surgery). The results of these assessments were compared between characteristics and fracture sites. Results The hypoesthesia incidences were highest in the mandible (19.1%), maxilla (18.3%), and orbit (8.5%). Sensation was recovered by 97.3% of all patients by 6 months after surgery. Risk factors for hypoesthesia were direct nerve injury (p = .002), distance (≤ 10 mm) between the fracture and nerve foramen (p = .002), the amount of bony displacement (p = .035), and age (p = .004). There were significant differences among the fracture sites. Conclusions Post-traumatic hypoesthesia increased temporarily after surgery but most patients recovered by 6 months postoperatively. Recovery from postoperative hypoesthesia was related to the fracture site and pattern. Cases in which the patient did not recover involved direct nerve injury.

Oral health-related quality of life in women with temporomandibular joint disc anterior displacement, before and after disc repositioning and anchoring surgery, assessed with The Oral Health Impact Profile (OHIP-14) Publication date: Available online 16 May 2019 Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology Author(s): Roberto Ferreira Zanin, Guilherme Ommizolo, Alexandre Weber, Cláiton Heitz, Eduardo Martinelli Santayana de Lima ABSTRACT Objectives to assess and compare oral health-related quality of life (OHRQOL) in women with temporomandibular join (TMJ) disc displacement without reduction, before disc repositioning and anchoring surgery, in short-term follow-up, different age groups, and using the Oral Health Impact Profile (OHIP-14). Study Design fifty women between 17 and 60-years-old were divided into four age groups: 17-27, 28-38, 39-49, and 50-60 years. All the patients were asked to answer the OHIP-14 form before surgery and during their short-term follow-up. Seven domains of OHRQoL were rated in a five-point Likert scale from 0 (never) to 4 (very often). Domains' scores and total OHIP-14 wer compared between times with Student's t test in whole sample and age groups. Results The whole sample and groups 17-27, 28-38, 39-49 years showed a decrease statistically significant in all scores (p < 0.01). The group 50-60 years showed a decrease in score significant only in functional limitation (p = 0.05) Conclusion TMJ disc anterior displacement had a negative impact on women's OHRQOL due to physical pain, physical disability, and psychological discomfort. TMJ disc repositioning and anchoring surgery improved overall OHRQOL in patients between 17 and 49-years-old; however, in patients between 50 and 60-years-old only improved physical pain.

Asymptomatic intrabony radiolucency of the anterior mandible Publication date: Available online 16 May 2019 Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology Author(s): Ho-Hyun Sun, Sheng-Chuan Lin, Chan M. Park, Jeffrey A. Elo

In Memoriam: Ray Melrose Publication date: Available online 9 May 2019 Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology Author(s):

Relationship of Gray Values in Cone Beam Computed Tomography and Bone Mineral Density Obtained by Dual Energy X-ray Absorptiometry Publication date: Available online 7 May 2019 Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology Author(s): Abbas Shokri, Mahsa Ghanbari, Fatemeh Hafez Maleki, Leila Ramezani, Payam Amini, Leili Tapak Abstract Objectives To assess the correlation between bone mineral density (BMD) determined by cone-beam computed tomography (CBCT) gray values and BMD determined by dual energy X-ray absorptiometry (DEXA). Study Design Women over 50 years of age who required CBCT scans for implant treatment were selected. BMD was determined by calculating the mean gray value of CBCT cross-sectional images of anterior, premolar, retromolar, and tuberosity areas of the mandible and maxilla. Patients were then subjected to DEXA of the femoral neck and lumbar spine. Independent t-tests, ANOVA, Pearson's correlation tests, and receiver operating characteristic (ROC) evaluation were used for data analysis. Results Of 61 asymptomatic patients with a mean age of 64 years, 47.5% and 55.7% had abnormal BMD based on the T-score of the femoral neck and lumbar spine, respectively. Significant correlations were noted between T-scores of both the femoral neck and lumbar spine with gray values of the maxillary incisor and tuberosity areas. Conclusion A strong correlation exists between CBCT gray values at different sites in the maxilla and the results of DEXA. A gray value <298 at the maxillary tuberosity can differentiate between osteoporotic and normal individuals with 66 - 67% accuracy and suggests the need for DEXA analysis.

TMJ MORPHOLOGY DOES NOT INFLUENCE THE PRESENCE OF ARTHRALGIA IN PATIENTS WITH DISC DISPLACEMENT WITH REDUCTION: AN MRI-BASED STUDY Publication date: Available online 4 May 2019 Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology Author(s): Rodrigo Lorenzi Poluha, Carolina Ortigosa Cunha, Leonardo Rigoldi Bonjardim, Paulo César Rodrigues Conti Abstract Objective To compare temporomandibular joint (TMJ) morphology, by magnetic resonance imaging (MRI), between patients with disc displacement with reduction (DDWR) with and without arthralgia and a control group, and to identify which factors are associated with the concomitant presence of arthralgia in DDWR patients. Methods In this investigation, 36 TMJ MRIs were divided into three groups. Group 1 (n=12): patients with DDWR and arthralgia; group 2 (n=12): patients with DDWR without arthralgia; and group 3 (n=12): control group. Disc and mandibular condyle morphology, articular eminence morphology and inclination; size of the mandibular fossa; joint space size; joint effusion; bone marrow of the mandibular condyle; and the relative signal intensity of retrodiscal tissue were evaluated. Results Fisher's exact test and one-way ANOVA revealed no significant differences (p>0.05) between groups for any variable. Logistic regression analysis showed that no anatomical variables were related to the concomitant presence of arthralgia in DDWR patients (p>0.05). Conclusion As evaluated on MRI scans, no significant differences in anatomical characteristics of the TMJ were detected between DDWR patients with and without concomitant arthralgia and with the control group. There were no factors associated with the concomitant presence of arthralgia in DDWR patients.

Contrast-enhanced computed tomography image assessment of cervical lymph node metastasis in patients with oral cancer by using a deep learning system of artificial intelligence Publication date: May 2019 Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 127, Issue 5 Author(s): Yoshiko Ariji, Motoki Fukuda, Yoshitaka Kise, Michihito Nozawa, Yudai Yanashita, Hiroshi Fujita, Akitoshi Katsumata, Eiichiro Ariji Objective Although the deep learning system has been applied to interpretation of medical images, its application to the diagnosis of cervical lymph nodes in patients with oral cancer has not yet been reported. The purpose of this study was to evaluate the performance of deep learning image classification for diagnosis of lymph node metastasis. Study Design The imaging data used for evaluation consisted of computed tomography (CT) images of 127 histologically proven positive cervical lymph nodes and 314 histologically proven negative lymph nodes from 45 patients with oral squamous cell carcinoma. The performance of a deep learning image classification system for the diagnosis of lymph node metastasis on CT images was compared with the diagnostic interpretations of 2 experienced radiologists by using the Mann-Whitney U test and χ2 analysis. Results The performance of the deep learning image classification system resulted in accuracy of 78.2%, sensitivity of 75.4%, specificity of 81.0%, positive predictive value of 79.9%, negative predictive value of 77.1%, and area under the receiver operating characteristic curve of 0.80. These values were not significantly different from those found by the radiologists. Conclusions The deep learning system yielded diagnostic results similar to those of the radiologists, which suggests that this system may be valuable for diagnostic support.

Fixed drug eruption on the tongue associated with piroxicam: report of two cases and literature review Publication date: May 2019 Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 127, Issue 5 Author(s): Eleni-Marina Kalogirou, Konstantinos I. Tosios Objective The aim of this study was to describe 2 patients with piroxicam-associated fixed drug eruption on the tongue and to review the literature. Study Design Two females presented with recurrent ulcers after taking piroxicam for dysmenorrhea and pelvic pain. The English language literature was reviewed for cases of piroxicam-induced fixed drug eruptions, with a report on the site of occurrence. Results The ulcers reappeared in the identical lingual site after piroxicam intake; 3 times in patient #1 and 2 times in patient #2. Extraoral lesions were not observed. Following discontinuation of piroxicam, no relapse was reported. The literature review found 25 patients with piroxicam-associated fixed drug eruption. The oral mucosa/lips were affected in 8 patients who also had cutaneous/genital lesions. Solitary tongue involvement was not reported in any of them. Cross-sensitivity among different drugs of the same class is not unusual. Conclusions Fixed drug reactions to piroxicam are rare, although nonsteroidal antiinflammatory drugs are among the most common causes of fixed drug eruptions. Of these rare fixed drug reactions to piroxicam, cutaneous lesions are reported much more often compared with oral mucosal lesions. Discontinuation of the causative drug is essential to promote healing and to avoid recurrences. Patients with history of piroxicam-induced fixed drug eruption should also avoid other oxicams because of potential cross-sensitivity.

Effect of "surgery first" orthognathic approach on temporomandibular symptoms and function: a comparison with "orthodontic first" approach Publication date: May 2019 Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 127, Issue 5 Author(s): Kensuke Yamauchi, Tetsu Takahashi, Yoshihiro Yamaguchi, Hikari Suzuki, Shinnosuke Nogami, Junji Sugawara Objective The aim of this study was to comparatively evaluate the effects of the surgery-first approach (SFA) and the orthodontics-first approach (OFA) on temporomandibular joint (TMJ) function and maximum mouth opening. Study Design This retrospective study investigated the outcomes of patients with diagnosed skeletal class III dentofacial deformities. Twenty-four patients were enrolled in the OFA group, and 23 patients were enrolled in the SFA group. All patients were examined in the same manner 4 times: before surgery and at 1, 3, 6, and 12 months after surgery. Range of mouth opening (ROM) was measured between the maxillary and mandibular central incisors. Symptoms were evaluated subjectively by using a questionnaire with items pertaining to pain on mandibular movements, TMJ sounds, and pain in masticatory muscles region. Results No severe complications or relapse occurred in either group during the 12-month follow-up period. Postoperative changes in ROM showed similar tendencies, but there was no significant difference in ROM during the follow-up period between the OFA and SFA groups (P < .05). The percentage reduction was nearly 45% at 1 month postoperatively and 20% at 3 months postoperatively compared with the preoperative situation. After 6 months postoperatively, the ROM was almost the same as before surgery. The number of patients with such sounds increased with time until 12-month postoperative examinations in the OFA group but increased slightly during this period in the SFA group. During the first 3 months postoperatively, less than 10% of patients in both groups had newly detected pain of TMJ and/or muscles. At 6 and 12 months postoperatively, only 1 patient in the SFA group had pain. Conclusions No significant differences in TMJ symptoms or function were observed during a 12-month follow-up period between patients with skeletal class III malocclusion treated with the SFA and those treated with the OFA.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

Minerva is devoted to the study of ideas, traditions, cultures, and institutions in science, higher education, and research. It is equally focused on historical as well as present practices and on local as well as global issues. Moreover, the journal does not represent one single school of thought, but rather welcomes diversity within the rules of rational discourse.

Esha Shah, Who is the Scientist-Subject? Affective History of the Gene

Stress-Testing Europe: Normalizing the Post-Fukushima Crisis Abstract The Fukushima accident was a crisis in Japan, and a crisis elsewhere. In Europe, the aftermath of Fukushima was a period of intense questioning, about how to ensure the safety of nuclear reactors, and how, at the same time, ensure the ability of the European Union to act as a consistent political actor in the face of potentially catastrophic risks. Using empirical material related to the post-Fukushima stress tests and the subsequent discussions about the European regulatory framework for nuclear safety, this paper shows that stress tests have provided a peculiar form of European intervention, restabilizing regulatory boundaries while extending the European gaze. It describes the overall operation thereby performed as the "normalization of the crisis" whereby the exceptional situation enters the realm of the normal functioning of the public administrations, and where the actions undertaken take the form of the legal norm.

Variation in Valuation: How Research Groups Accumulate Credibility in Four Epistemic Cultures Abstract This paper aims to explore disciplinary variation in valuation practices by comparing the way research groups accumulate credibility across four epistemic cultures. Our analysis is based on case studies of four high-performing research groups representing very different epistemic cultures in humanities, social sciences, geosciences and mathematics. In each case we interviewed about ten researchers, analyzed relevant documents and observed a couple of meetings. In all four cases we found a cyclical process of accumulating credibility. At the same time, we found significant differences in the manifestation of the six main resources that are part of the cycle, the mechanisms of conversion between these resources, the overall structure and the average speed of the credibility cycle. The different ways in which the groups use data and produce arguments affect the whole cycle of accumulating credibility. In some cultures, journal publications are the main source of recognition, but in others one can earn significant amounts of recognition for conference contributions or service to the academic community. Moreover, the collaboration practices in the respective fields strongly influence the connection between arguments and publications. In cultures where teams of researchers collaboratively produce arguments, it is more strongly embedded in the process of writing publications. We conclude that the credibility cycle can only be used as an analytical tool to explain the behavior of researchers or research groups when taking differences across epistemic cultures into account.

The Ethos of Science in Contemporary Poland Abstract Modern science is moving away from Michael Polanyi's vision of 'the Republic of Science' and gradually becoming subordinate to political and economic social institutions. This process is accompanied by changes in the normative structure of science. Poland provides an interesting case for empirical study of the scientific ethos mostly because in a relatively short time it experienced a significant reform of the science system, especially in terms of evaluating and financing scientific work. In this paper we examine whether different sets of values and norms are embedded into the normative structure of science in contemporary Poland. The results of a representative survey conducted among 801 researchers were examined with the use of confirmatory factor analysis and fuzzy clustering. The statistical analysis revealed a great complexity in the normative structure of science that goes beyond the expectations formulated on the basis of the theories reviewed. We identified three distinctive groups of researchers, guided by different sets of values and norms in their professional conduct (academic science, post-academic science and the industrial science) and a cluster of researchers with an unidentified system of principles. We argue that the complexity of the normative structure of science should be taken into account in the decision-making regarding any future reforms of the science system.

What are Clinician Scientists Expected to do? The Undefined Space for Professionalizable Work in Translational Biomedicine Abstract Clinician scientists have gained institutional support in the era of translational research, as the key solution to closing the 'translational gap' between biomedical research and medical practice. However, clinician scientists remain an 'endangered species' in search of a secure niche, while new grants and training programs attempt to counteract their measurable decline in numbers over the past decades. Our study asks how an occupational space for clinician scientists is currently situated between the politics of translation, professional dynamics, and the specialization of academic disciplines. We interviewed clinician scientists, their adjacent professions—clinicians and biomedical researchers—, and contrast their views with expectations from the discourse on clinician scientists in the biomedical and policy literature. We identify professionalizable work and tasks that relate to, first, being able to speak the two languages of both clinic and research, second, translating patients' needs and clinical experience for further research, and third, counteracting the trends towards specialization by providing an inclusive point of view. We find that clinician scientists are overburdened with fulfilling a hybrid role of simultaneously being clinicians and scientists. Based on these findings, we suggest a path for the future professional development of clinician scientists towards the role of a translator.

The Perception of Scientific Authorship Across Domains Abstract We extend previous research by systematically investigating whether perceptions of scientific authorship vary between domains. Employing regulations for authorship of scientific journals as well as the Scientists Survey 2016 conducted by the German Centre for Higher Education Research and Science Studies (DZHW), we provide a comprehensive picture of perceptions of scientific authorship across domains from the perspective of the supply side (journals) as well as the demand side (researchers). We find considerable differences in the perception of authorship across disciplines on both sides. Hence, not only domain-specific "formal norms," but also domain-specific statements about ideals can be observed with regard to scientific authorship. The results have important implications: in order to avoid that researchers in disciplines with much narrower definitions of authorship are disadvantaged when compared to their colleagues from disciplines that rely on broader authorship definitions, domain-specific perceptions of authorship should be taken into account when allocating funding and jobs.

Symbolic Violence in Academic Life: A Study on How Junior Scholars are Educated in the Art of Getting Funded Abstract It is widely recognized that universities all around Europe have taken on a more market-oriented approach that has changed the core of academic work life. This has led to a precarious situation for many junior scholars, who have to seek research funding to cover their own wages in an increasingly fierce competition over scarce resources. Thus, at present, research funding is a Gordian knot that must be cut by each individual researcher. As a response to this situation, some Swedish universities provide guidance to junior scholars on how to navigate in an increasingly entrepreneurial academia through open lectures by senior and successful professors. In this paper, I study these lectures as socialization processes and the role of symbolic violence in the justification of a competitive academic work ethos as well as a pragmatic acceptance of the prevailing funding conditions. The aim is to explore the role of a subtle form of power wielding that is not immediately understood or recognized as power, but that nonetheless reproduces a market-like behavior and legitimizes a career system marked by uncertainty, shortcomings and contradictions.

Enhancing Socio-technical Governance: Targeting Inequality in Innovation Through Inclusivity Mainstreaming Abstract Socio-technical governance has been of long-standing interest to science and technology studies and science policy studies. Recent calls for midstream modulation direct attention to a more complicated model of innovation, and a new place for social scientists to intervene in research, design and development. This paper develops and expands this earlier work to demonstrate how a suite of concepts from science and technology studies and innovation studies can be used as a heuristic tool to conduct real-time evaluation and reflection during the process of innovation – upstream, midstream, and downstream. The result of this new protocol is inclusivity mainstreaming: determining if and how marginalized peoples and perspectives are being maximally incorporated into the model of innovation, while highlighting common problems of inequality that need to be addressed.

The Rationalization of Korean Universities Abstract The expansion of the higher education system and the rationalization of universities in South Korea, while broadly following the global patterns, reflect the characteristics of the national political system. We show the rapid growth of universities and document core organizational changes among universities: the elaboration of faculty performance evaluation rules, the expansion and differentiation of central administrations, and the emergence of engagement in vision statements. These changes, constructing universities as organizational actors, parallel the changes in higher education systems elsewhere. However, the uniqueness of the Korean experience lies with the role of the state as a catalyst guiding the overall direction and the structure and strategy of universities. We discuss the implications of our research for the rationalization of universities in a highly centralized system.

Re-disciplining Academic Careers? Interdisciplinary Practice and Career Development in a Swedish Environmental Sciences Research Center Abstract Interdisciplinarity is often framed as crucial for addressing the complex problems of contemporary society and for achieving new levels of innovation. But while science policy and institutions have provided a variety of incentives for stimulating interdisciplinary work throughout Europe, there is also growing evidence that some aspects of the academic system do not necessarily reward interdisciplinary work. In this study, we explore how mid-career researchers in an environmental science research center in Sweden relate to and handle the distinct forms of uncertainty that arise from conflicting institutional and policy impulses. Our material suggests that interdisciplinary academics are often confronted with and at times themselves operate with a surprisingly dichotomous, value-laden view of their research practice. Disciplinarity is primarily associated with the ideals of scientific rigor, while interdisciplinarity becomes conflated with application-oriented work and a lack of 'theory.' We also draw attention to the underlying practical dynamics that reproduce this tension and entangle it with the very process of academic socialization. Specifically, we analyze the ambivalent consequences of the various work-arounds that researchers rely on to carve out opportunities for ongoing interdisciplinary research within heterogeneous funding landscapes. These tactics turn out to be undermined by the overriding normative power of formal career incentives at universities, which continue to emphasize the ideals of the individual high-performing academic who publishes in disciplinary journals and attracts the most selective grants. Under such circumstances, the work-arounds themselves become an insidious mechanism that allows researchers to stay in academia but systematically marginalizes their voices and epistemic ambitions in the process.

ianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com