Glucose stimulates human beta cell replication in vivo in islets transplanted into NOD-severe combined immunodeficiency (SCID) mice.

AIMS/HYPOTHESIS: We determined whether hyperglycaemia stimulates human beta cell replication in vivo in an islet transplant model METHODS: Human islets were transplanted into streptozotocin-induced diabetic NOD-severe combined immunodeficiency mice. Blood glucose was measured serially during a 2 week graft revascularisation period. Engrafted mice were then catheterised in the femoral artery and vein, and infused intravenously with BrdU for 4 days to label replicating beta cells. Mice with restored normoglycaemia were co-infused with either 0.9% (wt/vol.) saline or 50% (wt/vol.) glucose to generate glycaemic differences among grafts from the same donors. During infusions, blood glucose was measured daily. After infusion, human beta cell replication and apoptosis were measured in graft sections using immunofluorescence for insulin, and BrdU or TUNEL. RESULTS: Human islet grafts corrected diabetes in the majority of cases. Among grafts from the same donor, human beta cell proliferation doubled in those exposed to higher glucose relative to lower glucose. Across the entire cohort of grafts, higher blood glucose was strongly correlated with increased beta cell replication. Beta cell replication rates were unrelated to circulating human insulin levels or donor age, but tended to correlate with donor BMI. Beta cell TUNEL reactivity was not measurably increased in grafts exposed to elevated blood glucose. CONCLUSIONS/INTERPRETATION: Glucose is a mitogenic stimulus for transplanted human beta cells in vivo. Investigating the underlying pathways may point to mechanisms capable of expanding human beta cell mass in vivo.

Effects of gender identity on experiences of healthcare for sexual minority women.

While research examining healthcare experiences of sexual minority individuals is growing, thus far research has been limited on lesbian gender identity and its relationship to physical and mental health. This study explores access to and experiences of healthcare with a sample of 516 butch and femme identified lesbian and bisexual women. In comparison to femme-identified women, it was found that butch women had routine gynecological examinations significantly less frequently, perceived poorer treatment in healthcare settings, were more likely to be out within healthcare settings, placed more importance on securing LGBT-positive healthcare practitioners, and had more difficulty finding LGBT-positive medical doctors. No differences were found for mental health. The results suggest that butch women may be more at risk for physical health concerns than femme women, in particular those illnesses that can be prevented or treated with regular gynecological care (e.g., uterine or cervical cancer). Implications of the study include greater awareness among healthcare professionals of sexual minority gender identity in addition to sexual identity, and more support for butch-identified women to access vital healthcare services.

Field measurements of electromagnetic interference in hearing aids.

This investigation was a preliminary field study to determine the acoustic and perceptual characteristics of hearing aid distortion generated by digital wireless telephones, the usability of the telephones under field conditions, and the extent of bystander interference under field conditions. A two-channel analog-to-digital converter was used to monitor voltages generated by an acoustic (real-ear) and electromagnetic probe. Digital recordings of interference and speech plus interference were made on a laptop computer. Fifty-three hearing aid wearers listened to interference and speech plus interference through personal communication service 1900 and time division multiple access digital wireless telephones and rated them in terms of annoyance experienced and usability of the wireless telephone. Ratings of annoyance were also done for the bystander condition. Approximately 80 percent of the sample rated the telephones as unusable; on the other hand, 70 to 90 percent experienced no annoying interference from telephones being used by another person seated nearby (bystander condition).

The nature of electromagnetic interference.

This report provides a brief tutorial on the underlying physical forces that lead to interference with hearing aids and assistive listening devices, as well as measurement issues and possible solutions to the problem.

Noise reduction in hearing aids: a review.

Background noise is particularly damaging to speech intelligibility for people with hearing loss. The problem of reducing noise in hearing aids is one of great importance--and great difficulty. The problem has been addressed in many different ways over the years. The techniques used range from relatively simple forms of filtering to advanced signal processing methods. This paper provides a brief overview, in nontechnical language, of the issues involved and the various approaches to solving the problem.

Effects of two adhesion boosters on the shear bond strength of new and rebonded orthodontic brackets.

The purpose of this study was to evaluate the effects of 2 adhesion boosters, Enhance LC (Reliance, Itasca, Ill) and All-Bond 2 (Bisco, Schaumburg, Ill), on the shear bond strength of new and rebonded (previously debonded) brackets. Sixty new and 60 sandblasted rebonded brackets were bonded to 120 extracted human premolars with composite resin and divided equally into 6 groups based on the 2 adhesion boosters used: (1) new brackets/no booster (2) rebonded brackets/no booster (3) new brackets/Enhance (4) rebonded brackets/Enhance (5) new brackets/All-Bond (6) rebonded brackets/All-Bond. Shear bond strength of each sample was tested with an Instron machine (Instron Corp, Canton, Mass). Results show that the new brackets/All-Bond group yielded the highest strength (20.8 +/- 7.5 MPa), followed by the new brackets/Enhance group (18.6 +/- 6.5 MPa), rebond brackets/All-Bond group (17.3 +/- 7.2 MPa), new brackets/no booster group (16.8 +/- 6.3 MPa), rebonded brackets/no booster group (14.2 +/- 7.2 MPa), and rebonded brackets/Enhance group (13.6 +/- 6.7 MPa). No statistically significant difference was found among the 3 groups utilizing new brackets. For groups of rebonded brackets/no booster and rebonded brackets/Enhance, bond strength was significantly lower than groups of 3 new brackets and rebonded brackets/All-Bond. Rebonded brackets/All-Bond group had comparable bond strength to all 3 new brackets groups. It was concluded that in the process of replacing a failed bracket, (1) when new brackets are used, neither All-Bond 2 or Enhance LC improves bond strength significantly, (2) without the use of any adhesion booster, sandblasted rebonded brackets yield significantly less bond strength than new brackets, (3) Enhance LC fails to increase bond strength of sandblasted rebonded brackets, (4) All-Bond 2 significantly increases bond strength of sandblasted rebonded brackets, (5) sandblasted rebonded brackets with All-Bond 2 yield comparable bond strength to new brackets.

An examination of the practicality of the simplex procedure.

OBJECTIVE: The practical importance of the simplex procedure, a subjective technique used to refine the frequency gain characteristic (FGC) of a hearing aid according to listener preference, was determined for individual listeners by measuring hearing aid benefit using both laboratory studies and field studies. DESIGN: A digital research hearing aid with two memories was used as the test hearing aid. The modified simplex procedure was used to select the FGC judged to yield the best speech clarity in the presence of low-level vent noise and again in higher-level cafeteria noise by 10 experienced hearing aid users. The FGCs assessed by the listeners varied systematically from The National Acoustic Laboratories Revised (NAL-R) response in the amount of low-frequency or high-frequency amplification. The benefit obtained with these two simplex-selected settings was compared with that obtained using the NAL-R FGC. Measures of benefit included speech recognition testing in the laboratory and ratings of speech intelligibility in the field. In the first field study, the two simplex settings were compared. In the second field study, the simplex-selected setting for higher level noise and the NAL-R setting were compared. RESULTS: In the laboratory, the majority of listeners selected an increase in the low-frequency channel gain compared with the NAL-R. Desired high-frequency channel gain was correlated with degree of hearing loss and type of background noise. The benefit as measured using nonsense syllables did not differ significantly among the three fittings, but differences in benefit were measurable with the rating procedure. Five of eight participants noticed a significant difference in their speech understanding in the real world for the FGCs selected in different background noises. Two of seven participants reported significantly better speech intelligibility with a simplex-selected FGC compared with the NAL-R FGC in the real world. The remaining subjects reported similar speech understanding capabilities with both hearing aid settings. CONCLUSIONS: The majority of subjects included in this study selected an FGC with real ear insertion gain different than the NAL-R prescription to improve subjective speech understanding in the laboratory. A small number of these listeners rated the selected FGC as providing improved speech intelligibility over the NAL-R FGC in the real world. This finding indicates that the simplex procedure should be used selectively to modify the NAL-R prescription. A screening technique would be useful in selecting those who might benefit from a modified fitting. The simplex procedure may also prove to be useful in selecting listeners who would benefit from multiple memory hearing aids.

The use of tactile supplements in lipreading Swedish and English: a single-subject study.

The speech perception skills of GS, a Swedish adult deaf man who has used a "natural" tactile supplement to lipreading for over 45 years, were tested in two languages: Swedish and English. Two different tactile supplements to lipreading were investigated. In the first,"Tactiling," GS detected the vibrations accompanying speech by placing his thumb directly on the speaker's throat. In the second, a simple tactile aid consisting of a throat microphone, amplifier, and a hand-held bone vibrator was used. Both supplements led to improved lipreading of materials ranging in complexity from consonants in [aCa] nonsense syllables to Speech Tracking. Analysis of GS's results indicated that the tactile signal assisted him in identifying vowel duration, consonant voicing, and some manner of articulation categories. GS's tracking rate in Swedish was around 40 words per minute when the materials were presented via lipreading alone. When the lipreading signal was supplemented by tactile cues, his tracking rates were in the range of 60-65 words per minute. Although GS's tracking rates for English materials were around half those achieved in Swedish, his performance showed a similar pattern in that the use of tactile cues led to improvements of around 40% over lipreading alone.

Response time and word recognition using a Modified-Rhyme monitoring task: list equivalency and time-order effects.

OBJECTIVE: The purpose of this study was to assess list equivalency and time-order effects of word recognition scores and response time measures obtained using a digital recording of the Modified Rhyme Test (MRT) with a response time monitoring task (Mackersie, Neuman, & Levitt, 1999). DESIGN: Response times and percent correct measures were obtained from listeners with normal hearing using the MRT materials presented at a signal to noise ratio of +3 dB. Listeners were tested using a word-monitoring task in which six alternatives were presented in series and listeners pushed a button when they heard the target word (as displayed on the computer monitor). Listeners were tested in two sessions. During each session each of the six MRT lists was administered once. Time-order effects were examined both between and within test sessions. RESULTS: All lists were equivalent for both speech recognition accuracy and response time except List 1, which showed slightly higher percent correct scores than the other lists. Varied patterns of systematic change over time were observed in 75% of the listeners for the response time measures and for 33% of the listeners for the percent correct measures. CONCLUSIONS: Lists 2 through 6 of this version of the MRT are equivalent, with List 1 producing slightly higher word recognition scores. Systematic changes over time in response time data for the majority of listeners suggest the need for careful implementation of the test to avoid time-order effects.

A comparison of response time and word recognition measures using a word-monitoring and closed-set identification task.

OBJECTIVES: The primary purpose of this study was to investigate the possibility of improving speech recognition testing sensitivity by incorporating response time measures as a metric. Two different techniques for obtaining response time were compared: a word-monitoring task and a closed-set identification task. DESIGN: Recordings of the Modified Rhyme Test were used to test 12 listeners with normal hearing. Data were collected using a word-monitoring and a closed-set identification task. Response times and percent correct scores were obtained for each task using signal to noise ratios (SNRs) of -3, 0, +3, +6, +9, and +12 dB. RESULTS: Both response time and percent correct measures were sensitive to changes in SNR, but greater sensitivity was found with the percent correct measures. Individual subject data showed that combining response time measures with percent correct scores improved test sensitivity for the monitoring task, but not for the closed-set identification task. CONCLUSIONS: The best test sensitivity was obtained by combining percent correct and response time measures for the monitoring task. Such an approach may hold promise for future clinical applications.

Suggestion audiometry for non-organic hearing loss (pseudohypoacusis) in children.

Pertaining to non-organic hearing loss in children, three goals should be attained: detection of this disease, determination of true hearing levels and information about the possible cause. Recently, objective tests have been used principally for children with non-organic hearing loss; however, these lack the simplicity and convenience of traditional audiometry. A new method, which is referred to as suggestion audiometry, since it is suggested to the patient that hearing will be improved as a result of the test procedure, was developed for the purpose of simultaneously achieving the above-stated three goals. The subjects were 20 patients aged 8-16 years suspected of demonstrating non-organic hearing loss and whose apparent hearing loss had been identified by school hearing examinations. Suggestion pure tone audiometry was useful for the detection of non-organic hearing loss and suggestion speech audiometry was valuable for the determination of true hearing levels. The subjects were classified into four groups according to the test results. We discuss causes of the disease based on the classification of the subjects obtained from this test procedure.

The narrative processes coding system: research applications and implications for psychotherapy practice.

The Narrative Processes model is focused on the strategies and processes by which a client and therapist transform the events of everyday life into a meaningful story that both organizes and represents the client's sense of self and others in the world. Some investigators have elected to use clients' within session descriptions of relationship events or micronarratives as their unit of narrative analysis. In contrast, we are centrally interested in the development of the macronarrative framework in which the singular events described in a therapy relationship-micronarratives-come to be articulated, experienced, and linked together in such a way that the client's sense of his or her life story-in essence, the sense of self-may be transformed at the conclusion of the therapeutic relationship. The following paper details the Narrative Processes theory of therapy and the coding system that has been developed to identify and evaluate empirically key components of the model. Findings emerging from the analyses of successful psychotherapy dyads are described and the implications for future research and practice are discussed.

Consonant enhancement effects on speech recognition of hearing-impaired children.

Differences in gain (enhancement, in dB) required to optimize the consonant/vowel intensity ratio in nonsense syllables were determined for stops and fricatives, both voiced and voiceless, in 12 children with congenital moderate to severe sensorineural hearing loss. The test stimuli were vowel/consonant nonsense syllables with various levels of enhancement ranging from 0 dB (for the unprocessed stimulus) to 24 dB of gain, in steps of 3 or 6 dB. Results showed that significant improvements in consonant recognition can be obtained with individualized adjustment of consonant amplitude for children as young as 5 years of age.

Selective visual masking in speechreading.

Using digital video technology, selective aspects of a face can be masked by identifying the pixels that represent it and then, by adjusting the gray levels, effectively eliminate that facial aspect. In groups of young adults with normal vision and hearing, consonant-viseme recognition was measured for closed sets of vowel-consonant-vowel disyllables. In the first experiment viseme recognition was measured while the tongue and teeth were masked and while the entire mouth was masked. The results showed that masking of the tongue and teeth had little effect on viseme recognition, and when the entire mouth was masked, participants continued to identify consonant visemes with 70% or greater accuracy in the /a/ and /(ball)/ vowel contexts. In the second experiment, viseme recognition was measured when the upper part of the face and the mouth were masked and when the lower part of the face and the mouth were masked. The results showed that when the mouth and the upper part of the face were masked, performance was poor, but information was available to identify the consonant-viseme /f/. When the mouth and the lower part of the face were masked, viseme recognition was quite poor, but information was available to discriminate the consonant-viseme /p/ from other consonant visemes.

The effect of compression ratio and release time on the categorical rating of sound quality.

Two experiments were carried out to determine how manipulating the compression ratio and release time of a single-band wide dynamic range hearing aid affects sound quality. In experiment I, compression ratio was varied over the range from linear to 10:1 (low compression threshold, attack time = 5 ms, release time = 200 ms). In experiment II, compression ratios of 1.5, 2, and 3:1 were combined with release times of 60, 200, and 1000 ms (attack time = 5 ms). Twenty listeners with sensorineural hearing loss rated the clarity, pleasantness, background noise, loudness, and the overall impression of speech-in-noise (Ventilation, Apartment, Cafeteria) processed through a compression hearing aid. Results revealed that increasing compression ratio caused decreases in ratings on all scales. Increasing release time caused ratings of pleasantness to increase, and ratings of background noise and loudness to decrease. At the 3:1 compression ratio, increasing the release time caused increases in ratings of clarity, pleasantness, and overall impression, and a decrease in background noise. Significant correlations were found between scales. Regression analysis revealed that the contributions of the scales of clarity, pleasantness, background noise, and loudness to the prediction of overall impression differed as a function of the competing noise condition.

Consonant-vowel intensity ratios for maximizing consonant recognition by hearing-impaired listeners.

The effect of adjusting the consonant-vowel (C-V) intensity ratio on consonant recognition in 18 subjects with sensorineural hearing impairment was investigated. C-V intensity ratios in a set of 48 vowel-consonant nonsense syllables were adjusted in steps of 3-6 dB depending on the subject's dynamic range of hearing. An increase in consonant intensity is referred to here as consonant enhancement (CE). The value of CE producing the highest consonant recognition score (CRmax) is defined as CEmax. Both CEmax and CRmax were determined for each subject for each of the 48 nonsense syllables. Consonant type was found to have a highly significant effect on CRmax, the gain in consonant recognition, and CEmax. The effect of vowel environment was also significant, but of much smaller magnitude. Audiogram configuration was found to have a small effect and was only significant for CRmax. The results of the study also showed that individualized adjustment of the C-V intensity ratio for each subject and consonant-vowel combination can produce substantial improvements in consonant recognition. These data can be used to estimate upper bounds of performance that, in principle, can be obtained by appropriate adjustment of the C-V intensity ratio.

Enamel preparation for orthodontic bonding: a comparison between the use of a sandblaster and current techniques.

Four methods of enamel preparation before orthodontic bonding that are currently in use or proposed for use were investigated. The study consisted of two parts. Part one evaluated the roughness of the prepared enamel surfaces by using optical profilometry and scanning electron microscopy (SEM). Part two compared the debonding force for the prepared enamel surfaces by using a mechanical testing machine. The teeth were divided into four groups as follows: In group A, the surfaces were only sandblasted. In group B, the surfaces were sandblasted and acid etched. In group C, the surfaces were buffed with an 1172 fluted bur and acid etched. In group D, the surfaces were pumiced and acid etched. There was no statistical difference in surface roughness among the four groups at p < 0.05, nor was there any statistical difference in bond strength among the three groups that were acid etched. However, there was a significant difference in bond strength between these groups and the group that received only sandblasting (no acid etching). Thus, in this preliminary study, sandblasting does not appear to damage the enamel surface and can therefore be used as a substitute for polishing with pumice. It should be followed by acid etching to produce enamel surfaces with comparable bond strengths.

Effect of release time in compression hearing aids: paired-comparison judgments of quality.

Paired-comparison judgments of quality were obtained from 20 hearing-impaired listeners for speech processed through simulated compression hearing aids varying in release time (60, 200, 1000 ms) at three different compression ratios (1.5, 2, 3:1) and for three different background noises (ventilation, apartment, cafeteria). Analysis revealed that the main effect of release time did not have a significant effect on perceived quality. The interaction between release time and noise type was found to be significant. While no significant difference in preference for release times was evident for the ventilation noise, the longer release times (200 and 1000 ms) were preferred for the higher level noises (apartment noise, cafeteria noise). Post hoc testing revealed that the mean preference scores for the 200- and 1000-ms release time were significantly greater than that of the 60-ms release time with the competing cafeteria noise (p < 0.05). Analysis of individual subject data revealed statistically significant preferences that differed from the group mean, suggesting that individualized fitting of this parameter of a compression hearing aid might be warranted.

Processing of speech signals for physical and sensory disabilities.

Assistive technology involving voice communication is used primarily by people who are deaf, hard of hearing, or who have speech and/or language disabilities. It is also used to a lesser extent by people with visual or motor disabilities. A very wide range of devices has been developed for people with hearing loss. These devices can be categorized not only by the modality of stimulation [i.e., auditory, visual, tactile, or direct electrical stimulation of the auditory nerve (auditory-neural)] but also in terms of the degree of speech processing that is used. At least four such categories can be distinguished: assistive devices (a) that are not designed specifically for speech, (b) that take the average characteristics of speech into account, (c) that process articulatory or phonetic characteristics of speech, and (d) that embody some degree of automatic speech recognition. Assistive devices for people with speech and/or language disabilities typically involve some form of speech synthesis or symbol generation for severe forms of language disability. Speech synthesis is also used in text-to-speech systems for sightless persons. Other applications of assistive technology involving voice communication include voice control of wheelchairs and other devices for people with mobility disabilities.