Tuning the mass of chameleon fields in Casimir force experiments

We have calculated the chameleon pressure between two parallel plates in the presence of an intervening medium that affects the mass of the chameleon field. As intuitively expected, the gas in the gap weakens the chameleon interaction mechanism with a screening effect that increases with the plate separation and with the density of the intervening medium. This phenomenon might open up new directions in the search of chameleon particles with future long-range Casimir force experiments.

D-term inflation without cosmic strings

We present a superstring-inspired version of D-term inflation that does not lead to cosmic string formation and appears to satisfy the current cosmic microwave background constraints. It differs from minimal D-term inflation by a second pair of charged superfields that makes the strings nontopological (semilocal). The strings are also Bogomol'nyi-Prasad-Sommerfield strings, so the scenario is expected to survive supergravity corrections. The second pair of charged superfields arises naturally in several brane and conifold scenarios, but its effect on cosmic string formation had not been noticed so far.

The contribution of social noise to tinnitus in young people - a preliminary report

In our study of the Hearing in Young Adults (HIYA) aged 18-25 years, there appeared to be little effect of social noise on hearing thresholds (Smith et al. 1998). There was however, a threefold increase in the reports of tinnitus in those subjects with significant social noise exposure (>/=97 dB NIL). No other abnormality was found of hearing function for those who were exposed to the most social noise. In an attempt to investigate this further we invited a sub-sample of those tested in the earlier phase of the study, to conduct further examinations of their hearing function. The three groups eventually consisted of those in the most social noise group who reported tinnitus (n=15) and those who did not (n=15), plus a group of people who had no social noise exposure but who reported tinnitus (n=8). All the groups were retested for their hearing thresholds, using standard audiometry and also the Audioscan technique to look for notches in the audiogram. Speech tests were carried out using an adaptive FAAF test. Transient-evoked oto-acoustic emissions were measured and also suppressed with a contralateral broad-band noise. Some evidence has been found to suggest that those young people who reported tinnitus are affected by social noise exposure, in terms of pure tone thresholds, speech tests, oto-acoustic emissions and reported hearing problems. Lessons can be drawn from our attempt to follow up this interesting population. First, the population is highly mobile and follow-up is difficult. Second, the presumed noise exposure was often not appropriate because even after a year it was possible for several individuals with insignificant social noise to move into the group with significant social noise exposure. Third, there is a need for a larger multi-centre study to look at the effect of social noise in more detail using a common protocol. The results of our study will be very useful in calculating the numbers needed in such a multi-centre study.

Hippocampal involvement in the expression of kindling-induced fear in rats

Kindling dramatically increases fearful behavior in rats. Because kindling-induced fear increases in magnitude as rats receive more stimulations, kindling provides a superb opportunity to study the nature and neural mechanisms of fear sensitization. Interestingly, these changes in behavior are accompanied by increased binding to inhibitory receptors and decreased binding to excitatory receptors in the CA1 and dentate gyrus regions of the hippocampus. This led us to hypothesize that kindling-induced fear may result from an increased inhibitory tone within hippocampal circuits. To test this hypothesis, we investigated FOS protein immunoreactivity in hippocampal and amygdalar regions of kindled rats that were exposed to an unfamiliar open field. We found that FOS immunoreactivity was significantly decreased in the CA1 region, dentate gyrus, and perirhinal cortex of kindled rats compared to sham-stimulated rats. These results support our hypothesis that kindling-induced fear may be produced by inhibition within hippocampal circuits. They also suggest that neural changes within the hippocampus may be important for the sensitization of fear.

Prevalence of permanent childhood hearing impairment in the United Kingdom and implications for universal neonatal hearing screening: questionnaire based ascertainment study

OBJECTIVE

To estimate the prevalence of confirmed permanent childhood hearing impairment and its profile across age and degree of impairment in the United Kingdom.

DESIGN

Retrospective total ascertainment through sources in the health and education sectors by postal questionnaire.

SETTING

Hospital based otology and audiology departments, community health clinics, education services for hearing impaired children.

PARTICIPANTS

Children born from 1980 to 1995, resident in United Kingdom in 1998, with severe permanent childhood hearing impairment (hearing level in the better ear >40 dB averaged over 0.5, 1, 2, and 4 kHz).

MAIN OUTCOME MEASURES

Numbers of cases with date of birth and severity of impairment converted to prevalences for each annual birth cohort (cases/1000 live births) and adjusted for under ascertainment.

RESULTS

26 000 notifications ascertained 17 160 individual children. Prevalence rose from 0.91 (95% confidence interval 0.85 to 0.98) for 3 year olds to 1.65 (1.62 to 1.68) for children aged 9-16 years. Adjustment for under ascertainment increased estimates to 1.07 (1.03 to 1.12) and 2.05 (2.02 to 2.08). Comparison with previous studies showed that prevalence increases with age, rather than declining with year of birth.

CONCLUSIONS

Prevalence of confirmed permanent childhood hearing impairment increases until the age of 9 years to a level higher than previously estimated. Relative to current yields of universal neonatal hearing screening in the United Kingdom, which are close to 1/1000 live births, 50-90% more children are diagnosed with permanent childhood hearing impairment by the age of 9 years. Paediatric audiology services must have the capacity to achieve early identification and confirmation of these additional cases.

Syntaxin 4 heterozygous knockout mice develop muscle insulin resistance

To investigate the physiological function of syntaxin 4 in the regulation of GLUT4 vesicle trafficking, we used homologous recombination to generate syntaxin 4-knockout mice. Homozygotic disruption of the syntaxin 4 gene results in early embryonic lethality, whereas heterozygous knockout mice, Syn4(+/-), had normal viability with no significant impairment in growth, development, or reproduction. However, the Syn4(+/-) mice manifested impaired glucose tolerance with a 50% reduction in whole-body glucose uptake. This defect was attributed to a 50% reduction in skeletal muscle glucose transport determined by 2-deoxyglucose uptake during hyperinsulinemic-euglycemic clamp procedures. In parallel, insulin-stimulated GLUT4 translocation in skeletal muscle was also significantly reduced in these mice. In contrast, Syn4(+/-) mice displayed normal insulin-stimulated glucose uptake and metabolism in adipose tissue and liver. Together, these data demonstrate that syntaxin 4 plays a critical physiological role in insulin-stimulated glucose uptake in skeletal muscle. Furthermore, reduction in syntaxin 4 protein levels in this tissue can account for the impairment in whole-body insulin-stimulated glucose metabolism in this animal model.

Universal neonatal hearing screening: past, present, and future

After a brief review of the history of newborn hearing screening including the Downs behavioral testing procedure, the Crib-o-gram and similar devices, and the use of auropalpebral reflex and otoacoustic emissions, there is a discussion of key issues that need to be resolved before universal hearing screening is introduced. Included are questions regarding the target population(s) of screening programs, well baby versus NICU screening, dealing with false-positives and the effects on parent-child relationships, and finally, the availability of resources for screening and follow-up. The results of a recent study in the United Kingdom that assessed the current state of audiology services and found there is a difference between existing standards and what is actually being done in practice, are presented and considered in terms of current trends in the United States to move ahead with universal screening without a solid database of information regarding the preparedness of clinical centers to deal with the need for services that will result from the initiation of universal programs. Caution is urged.

A novel mutation in the mitochondrial tRNA(Ser(UCN)) gene in a family with non-syndromic sensorineural hearing impairment

We describe a family with non-syndromic sensorineural hearing impairment inherited in a manner consistent with maternal transmission. Affected members were found to have a novel heteroplasmic mtDNA mutation, T7510C, in the tRNA(Ser(UCN)) gene. This mutation was not found in 661 controls, is well conserved between species, and disrupts base pairing in the acceptor stem of the tRNA, making it the probable cause of hearing impairment in this family. Sequencing of the other mitochondrial tRNA genes did not show any other pathogenic mutations. Four other mutations causing hearing impairment have been reported in the tRNA(Ser(UCN)) gene, two having been shown to affect tRNA(Ser(UCN)) levels. With increasing numbers of reports of mtDNA mutations causing hearing impairment, screening for such mutations should be considered in all cases unless mitochondrial inheritance can be excluded for certain.

Epidemiology of permanent childhood hearing impairment in Estonia, 1985-1990

This paper describes a retrospective study of permanent childhood hearing impairment (PCHI) > or = 40 dB HL in the better ear in children born between 1985 and 1990 and resident in Estonia. The prevalence rate of all permanent hearing impairment for the birth cohort 1985-1990 was 172 (95 per cent (CI 151-194) per 100,000 live births and that of congenital impairment was 152 (CI 134-170) per 100,000. For the congenitally-impaired children, 11 per cent had stayed in a neonatal intensive care unit for 48 hours or more, 2 per cent had a craniofacial abnormality, and 31 per cent had a family history of PCHI. As for aetiology, hereditary causes were stated most frequently in 36 per cent of all of the cases of PCHI. The aetiology remained unknown in 34 per cent of cases. Additional disabilities were found in 23 per cent of all cases. Specific syndromes were recognized in 2 per cent of hereditary cases. The mean age at the confirmation of hearing impairment was 46.4 months and at hearing aid fitting 57.0 months. The results were compared with other European studies, particularly the Trent study.

Population-based genetic study of childhood hearing impairment in the Trent Region of the United Kingdom

The objective of the study was to investigate childhood hearing impairment in a population-based sample from a genetic perspective. Participants included 82 families with hearing-impaired children (aged 4-13) previously ascertained in the Trent Health Region. A questionnaire was mailed to all families, followed by a home visit and Connexin-26 35delG mutation screen. The Connexin-26 35delG mutation was identified in seven families (approximately 10 per cent of non-syndromal hearing impairment). Children of these families were significantly more likely than children with other modes of inheritance to have a profound hearing loss with a flat audiogram profile. The families of children with a significant admission to a neonatal intensive care unit were significantly less likely to have had genetic counselling. Eight families visited were found to have features suggestive of a genetic syndrome that had not been previously assigned a specific diagnosis. The study concluded that hearing-impaired children should be investigated systematically according to an agreed-upon protocol, which should include Connexin-26 35delG mutation analysis at least for those with severe-to-profound hearing loss.

Transient-evoked otoacoustic emissions in a representative population sample aged 18 to 25 years

Transient-evoked otoacoustic emissions (TEOAEs) were obtained from 688 ears of a group of 345 young adults aged 18 to 25 years, using the Otodynamics ILO88 in the standard, non-linear mode. Normative data for TEOAEs obtained from 186 otologically normal (ON) ears are presented. In 5 ON ears, there was no recordable response, despite hearing threshold levels better than 20 dB. The main factors affecting the TEOAE level were (1) gender, where females had larger responses on average than males; (2) tympanometric measures, where ears with entirely normal tympanometric measures had larger responses than those with minor tympanometric abnormalities; (3) click stimulus intensity measured in the ear canal, which correlated positively with TEOAE level; and (4) hearing threshold level at 0.5 kHz, which correlated negatively with amplitude. There was also a small effect of social noise exposure in the 2-kHz region of the TEOAE, where the response was lower in those subjects exposed to significant social noise.

The epidemiology of hearing impairment in an Australian adult population

BACKGROUND

This study measured the prevalence of hearing impairment, and major demographic factors that influence the prevalence, in a representative South Australian adult population sample aged > or = 15 years.

METHODS

The study group was recruited from representative population surveys of South Australians. Participants in these surveys who reported a hearing disability were then recruited to an audiological study which measured air and bone conduction thresholds. In addition a sample of those people who reported no hearing disability were recruited to the audiological study.

RESULTS

The data reported in this study are the first in Australia to assess the prevalence of hearing impairment from a representative population survey using audiological methods. The data show that 16.6% of the South Australian population have a hearing impairment in the better ear at > or = 25 dBHTL and 22.2% in the worse ear at the same level. The results obtained in this representative sample compare well with those obtained in the British Study of Hearing, although some differences were observed.

CONCLUSIONS

Overall, there are only a few studies worldwide that have audiologically assessed the impairment of hearing from a representative population sample. The overall prevalence of hearing impairment in Australia is similar to that found in Great Britain, although there are some differences between the estimates of severity of impairment and some sex differences. The corroboration of the two studies reinforces the status of hearing impairment as the most common disability of adulthood. The present study also showed that there are a large number of Australians who may benefit from a more systematic community-based rehabilitation programme including the fitting of hearing aids. Secondly, the study identified the need for health goals and targets for hearing to be based on an epidemiological approach to the problem.

Variations in genetic assessment and recurrence risks quoted for childhood deafness: a survey of clinical geneticists

We report here the results of a questionnaire survey of consultant clinical geneticists in the United Kingdom to which we had an 81% response rate. In this questionnaire we asked about: (1) the nature of services currently offered to families with hearing impaired children, (2) what recurrence risks they quoted in isolated non-syndromic cases, and (3) what they might suggest for improving the range of genetic services available at present. We noted great variation both in these services and in the recurrence risks quoted in isolated cases. Based on the results of the questionnaire, we have proposed a protocol for the investigation of permanent childhood hearing impairment, which we believe to be both comprehensive and practical in an outpatient clinic setting. It is only by improving existing clinical and social understanding and knowledge of childhood hearing impairment that it will become possible to use recent molecular advances to develop comprehensive and consistent services for these families.

Time and cost for recruiting older adults

OBJECTIVES

The purpose of this study was to examine the time requirements and costs of recruiting older adults for participation in a medical center-/university-sponsored, home-based nutrition education study. A two-step recruitment strategy consisting of an introductory letter followed by a telephone call was used.

DESIGN

A random selection of 1300 individuals aged 60 to 74 years was drawn from a patient database of a large, rural, tertiary care hospital to receive introductory letters and recruitment telephone calls. One week after the mailing, potential subjects were contacted by trained interviewers and asked to participate in a home-based nutrition education study.

PARTICIPANTS

Men and women, aged 60 to 74 years, whose names appeared in a rural, tertiary care hospital database.

MEASUREMENTS

Recruitment rate, time required for recruitment by telephone, and cost of the combined mailing and telephone recruitment effort.

RESULTS

Of the 1300 individuals selected, 1077 (83%) people were contacted by phone and 223 (17%) people were unable to be reached. A total of 2895 calling attempts were required to determine the recruitment status of those identified as potential participants. Of those reached by phone, the recruitment rate was 45%. The total cost (mailing, telephone, and database management) per recruited subject was $8.56.

CONCLUSION

This study has helped to establish the costs of recruitment for home-based education interventions using a two-step strategy of an introductory mailing and follow-up telephone interview.

Behavioural and autonomic responses to sound in pre-term and full-term babies

The pattern of motor (body movement) and autonomic (heart rate and respiration) responses to no sound and sound trials were compared in 20 pre-term and 22 full-term neonates. Sound levels were calibrated using neonatal ear-sized couplers to produce, in the neonatal ear, sound levels of 80, 90 and 100 dB SPL. Accelerations in heart rate (> or = beats per minute for pre-terms; > or = 7 beats per minute for full-terms) were found to be the best criterion for establishing a possible response using bandpass noise at 80, 90 or 100 dB SPL. Respiration rate decreased in response to sound stimuli, this being significant for the pre-term group for the 100 dB SPL stimulus when comparing the 5 s period post-stimulus with the stimulus period. The number of movements detected during the sound trials was higher than for the control trials, being statistically significant for the pre-term group. These changes were elicited in response to stimuli presented at levels some 20-40 dB lower than for other studies and for behavioural screening because sounds were calibrated in an appropriately sized coupler. It is concluded that the response to sound is different in the pre-term group compared with the full-term group.

Field sensitivity of targeted neonatal hearing screening by transient-evoked otoacoustic emissions

OBJECTIVE

Population ascertainment of children having bilateral moderate to profound hearing impairment was undertaken to find out how many had passed (false negatives) and how many had failed (true negatives) a neonatal screening test based on transient-evoked otoacoustic emissions (TEOAE).

DESIGN

Neonatal screening using a purpose-built TEOAE instrument was undertaken in neonates, at eight hospitals in districts distributed around the United Kingdom starting in 1988. Screening was targeted on neonates at risk of hearing impairment. A total of 7500 babies had been tested by the end of 1995. Searching of audiological records in the districts completed at the end of 1995 ascertained 218 children born between January 1988 and December 1993 who had hearing threshold levels in both ears of 50 dB or more, averaged over the speech frequencies 0.5, 1, 2, and 4 kHz. Of those, 47 had completed the neonatal TEOAE screening test. Retrospective examination of their TEOAE records indicated whether they had passed or failed the screening test.

RESULTS

Eleven of the 47 had passed the screening test, although two of those had documented acquired hearing impairment occurring after screening. Disregarding those two cases leaves nine false negatives out of 45, giving a sensitivity estimate of 80% (36 divided by 45). In two of the nine cases, there was documented evidence of progression, one of whom had a family history of progressive hearing loss.

CONCLUSIONS

Targeted neonatal hearing screening programs based on TEOAE can expect to identify hearing impairment in approximately 80% of babies screened. The cause of false negatives is a matter for conjecture. There may be several reasons: the test may give an incorrect result, there may be a later acquired hearing impairment, or there may be a progressive hearing loss of unknown origin. Passing a neonatal screening test is not a valid reason to forego further surveillance, or to disregard parental suspicion of hearing impairment.

Changing performance of the Health Visitor Distraction Test when targeted neonatal screening is introduced into a health district

The change in the performance of the HVDT as targeted neonatal hearing screening has been introduced has been examined for the Nottingham district. The records for all children born in the period 1984-1993 within the district and having a permanent hearing loss of > or = 50 dB in the better ear have been examined. The referral route leading to ascertainment of the hearing loss as well as the result of any screening tests were noted. The data shows an increase in the number referred prior to the HVDT, mainly as a result of neonatal screen failure. At the same time there has been a reduction in the sensitivity of the HVDT from 78% in the first half of the decade to 38% for the second half. There are also some indications of an increase in the coverage and the failure rate over the time. Possible reasons for these changes are discussed.

IgA class switch in I alpha exon-deficient mice. Role of germline transcription in class switch recombination

Studies have implicated defective Ig class switch in the pathogenesis of IgA deficiency. To understand better the molecular events that regulate IgA class switch, a 1.4-kb region of the IgA locus containing the I alpha exon was replaced with a human hypoxanthine phosphoribosyltransferase minigene by gene targeting in murine embryonic stem cells. The I alpha exon-deficient mice derived from these embryonic stem cells had normal IgA levels in serum and secretions and normal numbers of IgA B cells in Peyer's patches and spleen. Further, I alpha exon-deficient B cells efficiently underwent IgA class switch in vitro, despite the absence of I alpha exon-containing germline transcripts. Notably, I alpha exon-deficient B cells did not require TGF-beta for IgA class switch since stimulation with LPS alone led to IgA expression. Nonetheless, whereas I alpha exon-deficient B cells constitutively expressed human hypoxanthine phosphoribosyltransferase transcripts, they did not produce IgA in the absence of LPS stimulation. These results demonstrate that the I alpha exon or transcripts containing the I alpha exon are not required for IgA class switch. Further, the effects of TGF-beta on I alpha locus transcription can be supplanted by expression of a heterologous minigene at that locus, but a second signal is required for the induction of IgA class switch.

The distribution of hearing threshold levels in the general population aged 18-30 years

Hearing threshold levels at audiometric frequencies between 0.25 and 8 kHz were obtained by manual audiometry using 5-dB steps in adults aged 18-30 years, as part of a large random survey of hearing in the UK. After screening to ensure otological normality, including careful analysis of any noise exposure history, the median thresholds of the 241 screened subjects deviated from audiometric zero by an average of 4.3 dB over the frequencies from 0.5 to 4 kHz in the direction of poorer hearing. Even greater deviations were evident at 0.25, 6 and 8 kHz, consistent with the discrepancies between normal hearing threshold and ISO 389 standard reference zero that have been reported previously. Within the age band from 18 to 30 years, age did not influence hearing threshold levels. Socio-economic status defined by occupational group (manual or non-manual) had a significant effect at frequencies up to 2 kHz, with those in non-manual occupations having better hearing than those in manual occupations by an average of 2.4 dB, despite screening for middle-ear disease, noise exposure and other possibly confounding factors. In a screened sample, males had better hearing threshold levels than females, but this difference was sensitive to screening criteria. The unscreened sample had median hearing threshold levels that were at most 2 dB worse than the screened sample across the frequency range.

Epidemiology of bacterial meningitis

This 10 year retrospective study of all causes of bacterial meningitis for children resident in Nottingham District Health Authority area reports an annual incidence rate per 100,000 children aged 0-16 years of 16.0 (95% confidence interval 14.0 to 18.1). There was a steady increase in incidence from 9.6/100,000 in 1980 to 24.3/100,000 in 1989. This was mainly due to an increase in the incidence of meningococcal infections in the age group 1 month to 5 years. Incidence rates varied with age being: 37.2/100,000 (25.9 to 53.5) for 0-28 days of age, 115.5/100,000 (93.9 to 141.9) for 1-11 months of age, 28.5/100,000 (23.1 to 35.3) for 12-59 months of age, and 2.8/100,000 (1.9 to 4.1) for 5-16 years of age. Overall annual mortality incidence per 100,000 was 1.8 (1.2 to 2.8). For the different age groups this was: 10.1 (4.8 to 21.1) for 0-28 days, 11.5 (6.0 to 22.2) for 1-11 months, 1.0 (0.3 to 3.1) for 12-59 months, and 0.4 (0.1 to 1.2) for 5-16 years of age. There were interactions between the type of meningitis and the year of the infection on the mortality rate. Mortality decreased in those with infections caused by bacteria other than Neisseria meningitidis and Haemophilus influenzae.

A null c-myc mutation causes lethality before 10.5 days of gestation in homozygotes and reduced fertility in heterozygous female mice

To directly assess c-myc function in cellular proliferation, differentiation, and embryogenesis, we have used homologous recombination in embryonic stem cells to generate both heterozygous and homozygous c-myc mutant ES cell lines. The mutation is a null allele at the protein level. Mouse chimeras from seven heterozygous cell lines transmitted the mutant allele to their offspring. The analysis of embryos from two clones has shown that the mutation is lethal in homozygotes between 9.5 and 10.5 days of gestation. The embryos are generally smaller and retarded in development compared with their littermates. Pathologic abnormalities include the heart, pericardium, neural tube, and delay or failure in turning of the embryo. Heterozygous females have reduced fertility owing to embryonic resorption before 9.5 days of gestation in 14% of implanted embryos. c-Myc protein is necessary for embryonic survival beyond 10.5 days of gestation; however, it appears to be dispensable for cell division both in ES cell lines and in the embryo before that time.

Investigation of coelectroporation as a method for introducing small mutations into embryonic stem cells

We have investigated coelectroporation as a method for introducing minor genetic changes into specific genes in embryonic stem cells. A selectable marker (neo) and a targeting replacement vector designed to insert a 4-bp insertion into exon 3 of the mouse hypoxanthine-guanine phosphoribosyltransferase (HPRT) gene were coelectroporated into embryonic stem cells and selected in G418 and 6-thioguanine (6-TG). HPRT-negative clones were obtained at a frequency of approximately 1 per 520 G418r clones. Southern analysis and the polymerase chain reaction were used to demonstrate that 3 of 36 of the 6-TG-resistant clones had the desired 4-bp insertion without any other disruption of the HPRT locus. Initial studies indicated that the other 33 6-TG-resistant clones probably resulted from the targeted integration of a concatemer containing both the targeting construct and the selectable neo gene.

The effects of hearing loss and age of intervention on some language metrics in young hearing-impaired children

This study examined the oral language production abilities of a group of young children with bilateral sensorineural hearing impairments (greater than 25 dB HL). The effects of age of intervention-as indexed by age of detection, referral, first appointment and hearing-aid fitting-and of the severity of their hearing impairments on spoken language and communication were the foci of the study. Children were aged between 27 and 80 months with hearing threshold levels ranging from 32 to 98 dB in the better ear. All were audio- and video-taped in their own homes, in an unstructured play setting with the mother. Measures of expressive language ability were extracted including mean length of utterance, vocabulary size, words per min., total utterance attempts per min., proportion of non-verbal utterances and the proportion of questions asked by the child. No significant correlations were found between the children's hearing impairments and their scores on the language measures once age at interview had been statistically controlled. However, significant correlations were found between the language measures and the ages at which the children received intervention for their hearing impairments, in particular for vocabulary and those language measures denoting the rate and quality of the child's interaction during the episode recorded. This finding is consistent with some of the arguments to be found in the small body of data addressing the question of early intervention.

AP17 and AP19, the mammalian small chains of the clathrin-associated protein complexes show homology to Yap17p, their putative homolog in yeast

AP17 and AP19 are the smallest polypeptide chain components of AP-2 and AP-1, the clathrin-associated protein complexes found in coated structures of the plasma membrane and Golgi apparatus of mammalian cells. cDNA clones representing the entire coding sequence of AP17 and AP19 were isolated from rat and mouse brain cDNA libraries, respectively. Determination of their nucleotide sequence predicts proteins of 142 and 158 amino acids with Mr 17,018 and 18,733. A sequence comparison of rat brain AP17 with mouse brain AP19 demonstrates that the small chains are highly related. A computer search for other related proteins has uncovered in yeast a previously unknown gene whose DNA sequence encodes a protein homologous to the small chain of AP complexes. The yeast sequence predicts Yap17p, a protein with 147 amino acids and a Mr of 17,373 that is slightly more related to the mammalian AP17 chain than to its AP19 counterpart.

Epidemiological profile of hearing impairments: the scale and nature of the problem with special reference to the elderly

The nature and scale of services for hearing-impaired people should be formed in the light of the demographic profile of the hearing-impaired. This paper furnishes data for three elements of that profile: the number of hearing-impaired people in England and Wales, the increase in the number of hearing-impaired that might be expected given the growth of the elderly population in England and Wales, and the major factors that influence use of hearing services at present. The combination of reliable prevalence data (1) with demographic information (2) gives good estimates of the numbers of hearing-impaired people and their age distribution. Thus an estimate of 7.4 million people with average hearing thresholds at mid frequencies of 25+ dBHL can be made for an adult population of 38.7 million (aged 18+ years). Eighty percent of these hearing-impaired people are aged over 60 years. Given no change in prevalence rates over the next 20 years, the demographic structure of England and Wales will increase the number of hearing-impaired by approximately 20%. The detailed form of service for the elderly will need to take into account factors shown to put groups at a disadvantage. In particular, the large shortfall in services for the very elderly (over 80 years) and those in manual occupations needs to be addressed.

Longitudinal study of hearing

Our knowledge of the progression and aetiology of hearing impairments is mainly inferred from cross-sectional studies of populations or individual case studies of relatively rare conditions. Longitudinal studies of carefully stratified samples enable scientific analysis of these two aspects of the ageing auditory system and also provide much needed incidence data on the basis of which to plan comprehensive hearing services. This preliminary paper using data from two studies over relatively short periods (between 2-4.5 years in Great Britain (GB) and up to 8 years in Denmark (DK] confirms (a) that deterioration of hearing impairment appears to be continuous and gradual for the majority (up to 97% on a 2-year assessment) with a median of about 5-6 dB/decade, and (b) that for mid-frequency average hearing levels applied to the samples of average age 55 (range 40-65) the incidence of hearing impairment is predicted accurately by interpolation of the relevant prevalence figures, and runs at about 1.8% per annum for 25+ dBHL bilateral hearing impairments. However, the actual rate of deterioration does seem to be influenced by age, those over 55 showing a high rate of up to 9 dB/decade against 3 dB/decade for those under 55. This implies that study over a much longer time is required to find a more exact form for the relationship between age and the rate of deterioration of hearing impairments.

Early detection of hearing impairment: what role is there for behavioural methods in the neonatal period?

A survey of the use of behavioural methods for neonatal hearing screening in 1985 (1) concluded that the future for automated methods was quite promising. Since then several studies have assessed the two main automated behavioural tests: the Auditory Response Cradle (ARC) and the Crib-o-Gram (COG). As a screen targeted at neonatal intensive care unit (NICU) babies and other high risk groups (at present the most cost-effective form of neonatal hearing screening), the ARC is shown to have low sensitivity, even for severe hearing impairments, and the COG has an unacceptably low specificity. Any future for behavioural testing during this period must therefore rely on new implementations flowing out of a fundamental understanding of (a) the way in which neonates respond to sound and (b) the ways in which a behavioural test might complement screening with Auditory Brainstem Responses (ABR) or Evoked Oto-acoustic Emissions (EOAE). A clearer understanding of the relative benefits of detecting different degrees of hearing impairment at birth in both the NICU population and the unrestricted population is urgently needed. To determine what role should be played by specific screening programmes such benefits need to be balanced against the total costs of screening assessment and rehabilitation, in which false positives (low specificity) play a large part.

Hearing disability in people aged 50-65: effectiveness and acceptability of rehabilitative intervention

OBJECTIVE

To determine the best means of detecting hearing disability in subjects aged 50-65 and whether rehabilitative intervention is acceptable in this age group.

DESIGN

Questionnaire survey of patients on general practice age-sex registers. Two types of questionnaire were used, one being based on the closed set approach of the Institute of Hearing Research questionnaire, which had been used in a pilot study, and the other being a simplified version of this questionnaire developed by the Welsh Hearing Institute and based on open set questions. Questionnaires were sent up to three times, and any patients who had not responded two months after the last posting were personally contacted.

SETTING

Two general practices in Glyncorrwg and Blaengwynfi in the Afan valley, West Glamorgan.

PATIENTS

271 Patients in Glyncorrwg (136 men, 135 women) and 333 patients in Blaengwynfi (173 men, 160 women) aged 50-65.

INTERVENTIONS

All patients indicating hearing disability in answering the questionnaires were invited to attend for a evaluative session in their village. After audiometric testing advice and arrangements for fitting a hearing aid were offered as appropriate.

MAIN OUTCOME MEASURES

Response rates and prevalence of hearing disability before intervention and of possession of hearing aids before and after intervention.

RESULTS

After three postings and personal contact the response rate was 98% (266/271) in Glyncorrwg, where the complex questionnaire was used, and 97% (322/333) in Blaengwynfi. The prevalence of hearing disability was respectively 53% (141/266) and 46% (148/322) and the prevalence of owning a hearing aid 7% (19/266) and 8% (24/322). After intervention the possession of hearing aids rose to 24% (64/266) in Glyncorrwg and 22% (71/322) in Blaengwynfi; six months later the aids were being used regularly. A direct comparison of the two questionnaires in 69 subjects from Blaengwynfi showed no significant differences in the amount of disability detected by each one. The first posting of questionnaires detected 65% (189/289) of the hearing disability in the two villages or 78% (72/92) of those prepared to accept hearing aids for the first time; 96% (88/92) of those who accepted hearing aids were detected by two postings.

CONCLUSIONS

Simple questionnaires are effective in detecting hearing disabilities in people aged 50-65, and intervention was acceptable in many of those who reported having difficulties in hearing. The response rates from successive postings suggest that two postings are sufficient in terms of the return in detecting those who will accept intervention.

The prevalence of hearing impairment and reported hearing disability among adults in Great Britain

Estimates for the prevalence of self-reported hearing disability and measured hearing impairment as a function of age in the adult population of Great Britain (GB) are reported from two 2-stage surveys. The main study was conducted in Cardiff, Glasgow, Nottingham and Southampton, with rigorous audiological assessment at the second stage. A supplementary study used a sample representative of GB with simplified domiciliary audiological assessments. In the main study, neither stage showed any gross bias arising from the particular cities chosen; the estimates from the first stage are free of bias arising from non-response. The estimates from the second stage are relatively free of bias arising from non-attendance. For the present purposes, defining a 'significant' level of hearing impairment as at least 25 dBHL averaged over the frequencies 0.5, 1, 2, 4 kHz, 16% of the adult population (17-80 years) have a bilateral, and about one in four a unilateral or bilateral, hearing impairment. About 10% of the adult population (aged 17+) report bilateral hearing difficulty in a quiet environment.