Changes caused by genotype and environmental conditions in beta-glucan content of spring barley for dietetically beneficial human nutrition.

Over the 5-year period (2000-2004), a significantly higher beta-glucan content was detected in the waxy varieties Washonubet, Wabet, and Wanubet (6.8-7.6%) and lines formed by crossing these varieties with malting varieties (5.8-7.1%). Conversely, the non-waxy hulled malting-type varieties Kompakt (4.0%) and Krona (4.3%) had significantly lower contents of beta-glucan. The observations also showed that concentrations of beta-glucans in 2000-2004 were significantly affected not only by varieties, but also environmental conditions in the growing periods and interactions of these two factors. Higher precipitation during the flowering time and grain filling period and lower temperatures during the flowering time in 2002 had negative effects on concentration of beta-glucans. Conversely, drier and warmer weather in 2003 enhanced the content of beta-glucans. The results show that it is possible to increase the content of beta-glucan in spring barley grain by implementing selective breeding practices. Compared to the parental malting varieties, the mean content of beta-glucans in F(4)-F(8) generations was increased by 1.8 and 2.0% by recombination in lines Kompakt x Wabet and Wanubet x Krona, respectively. Significant effect of environmental conditions and their interactions with varieties indicated the necessity to assess standard qualities of barley as a food material.

Assessment of tinnitus: measurement of treatment outcomes.

There is a wide range of assessment techniques for tinnitus, but no consensus has developed concerning how best to measure either the presenting features of tinnitus or the effects of tinnitus treatments. Standardization of reliable and valid tinnitus measures would provide many advantages including improving the uniformity of diagnostic and screening criteria between clinics and facilitating comparison of treatment outcomes obtained at different sites. This chapter attempts to clarify issues involved in developing self-report questionnaires for the assessment of tinnitus. While the tinnitus questionnaires that are currently available provide valuable information on which to base diagnostic and screening decisions, they were not originally developed in such a way as to maximize their sensitivity to treatment-related changes in tinnitus. As a result, their construct validity for measuring treatment benefit has not received appropriate attention. In this paper, special emphasis is devoted to the use of effect sizes as an estimate of the ability of questionnaires (and their individual items) to measure changes associated with treatment. We discuss the criteria relevant to evaluating the effectiveness of a questionnaire for diagnostic purposes vs. for treatment-evaluation purposes, and we present a detailed illustration of how the various criteria have been applied in a recent questionnaire development effort.

Effect of cultivar, year grown, and cropping system on the content of tocopherols and tocotrienols in grains of hulled and hulless barley.

In a three-year period (2000-2002) total tocols (tocopherols and tocotrienols), content of vitamin E and its isomers (alpha-, beta+gamma-, delta-tocopherols and tocotrienols) were assessed in grain of 13 barley genotypes. The highest content of tocols (60.3-67.6 mg kg(-1)) and content of vitamin E (Vitamin E equivalent-18.0-20.1 mg kg(-1)) were determined in the waxy varieties Wanubet, Wabet, and Washonubet. Standard varieties, i.e. of a malting type (Krona and Kompakt), had statistically significantly lower content of tocols (49.9 and 53.6 mg kg(-1)) and vitamin E (15.7-16.1 mg kg(-1)) compared to the waxy varieties. The hulless waxy variety Washonubet had statistically significantly higher total content of tocols (67.6 mg kg(-1)) and alpha- tocotrienols isomer (42.1 mg kg(-1)) versus all other genotypes in the set. Chemical treatment and fertilization statistically significantly increased the content of tocols (by 4.7 mg kg(-1)), vitamin E (by 1.9 mg kg(-1)), isomer alpha-tocopherol (by 0.9 mg kg(-1)) and isomer alpha- tocotrienols (by 3.3 mg kg(-1)). The average values of alpha-tocopherols and alpha-tocotrienols in the set were 6.7 mg kg(-1) and 29.7 mg kg(-1), respectively. Some of the reciprocal lines created by us from the malting and waxy varieties are suitable for food use for high contents of all tocopherols and alpha-tocotrienols.

Effect of a barley breakfast cereal on blood glucose and insulin response in normal and diabetic patients.

Prowashonupana (Prowash) is a shrunken-endosperm, short awn, waxy starch, hulless barley with low starch, high fiber, high protein, and a relatively high concentration of free sugars. The study was designed to compare equivalent breakfast meals (w/w) of Prowash and oatmeal for glycemic response in diabetic and non-diabetic subjects. A commercial liquid meal replacer (LMR) was included as a reference standard. A substantial reduction of the post-prandial glycemic peak following ingestion of Prowash was observed as compared to LMR or oatmeal. In the non-diabetic subjects, the maximal rise in glucose from baseline was 26.3 +/- 3.9 mg/dL after LMR, 41.3 +/- 3.9 mg/dL after oatmeal and 6.4 +/- 2.7 mg/dL after Prowash (p < 0.01). The maximal increase in glucose in the diabetic patients was 69.9 +/- 4.5 mg/dL after LMR, 80.8 +/- 8.8 mg/dL after oatmeal and 28.4 +/- 3.5 mg/dL after Prowash (p < 0.01). The maximal increase in insulin post-LMR was 33.9 +/- 3.6 mIU/ml in the diabetic patients and 54.0 +/- 9.8 mIU/ml in the non-diabetic controls. Oatmeal elicited a maximal insulin increase of 29.9 +/- 4.2 mIU/ml in the control subjects and 21.4 +/- 2.5 mIU/ml in the diabetic patients. In contrast, the maximal insulin increase after Prowash was 8.6 +/- 1.5 mIU/ml in the non-diabetic controls and 6.8 +/- 1.2 mIU/ml in the diabetic patients (p < 0.01).

Development of the Three-Clinic Hearing Aid Selection Profile (HASP).

The Three-Clinic Hearing Aid Selection Profile (HASP) was developed to assess a patient's beliefs about a number of basic considerations felt to be critical to the hearing aid selection (HAS) process. These characteristics are felt to be key to the acceptance of amplification and include motivation, expectations, cost of goods and services, appearance (cosmesis), attitudes about technology, physical function/limitations, communication needs, and lifestyle. The results of the first investigation suggest that we have been successful in developing a 40-item metric with adequate internal consistency reliability that assesses the aforementioned characteristics. Second, results of the administration of this tool to a large group of individuals indicated that (1) age impacted scores on the Technology, Physical Function, and Communicative Needs subscales; (2) gender impacted scores on the Motivation, Expectation, Technology, Communicative Needs, and Appearance subscales; (3) previous hearing aid use affected scores on the Motivation subscale; (4) level of education impacted scores on the Physical Function and Lifestyle subscales; and (5) self-perceived hearing handicap had an effect on Motivation and Communicative Needs subscale scores. Percentile data collected from this subject sample are presented as a benchmark against which to evaluate responses from individual patients. Case studies are presented to illustrate the potential clinical utility of this device.

Cisplatin ototoxicity: the importance of baseline audiometry.

The role and optimal use of audiometry in monitoring for cisplatin ototoxicity are incompletely defined. Audiograms were obtained from 217 patients before treatment with cisplatin-based chemotherapy for cancers of the esophagus, lung, or head and neck. Posttreatment audiometry then was conducted in 53 of these patients. Chemotherapy consisted of two (87%) or three (13%) courses of cisplatin at a dose of 20 mg/m2/day given as a continuous intravenous infusion over 4 days. Simultaneous 5-fluorouracil or paclitaxel also was given, and 38% received concurrent radiation therapy to the head and neck. Air-conduction thresholds for each ear were obtained at 250, 500, 1000, 2000, 4000, 6000, and 8000 Hz. Three three-frequency pure-tone averages (PTA) also were calculated. Framingham gender-specific, age-adjusted norms were used, beginning at age 60 to correct for presbycusis, and the upper limit of normal was calculated as the greater of the Framingham mean plus twice the standard error, or 25 dB. Hearing abnormality was defined as a threshold >10 dB above the norm for any PTA, or >20 dB above the norm for any individual frequency. Hearing loss was defined as an elevation over baseline threshold of >10 dB for any PTA or >20 dB for any individual frequency. Of the 217 patients who underwent baseline testing, 57 (26%) were found to have hearing abnormality in excess of the expected presbycusis. Post-cisplatin audiograms demonstrated hearing loss in 19 of the 53 retested patients (36%) when compared with their own baseline. As determined by tympanometry, none of these subjects had a conductive component to their hearing loss. These observations were independent of the duration of follow-up after treatment and of the total dose of cisplatin administered. The authors conclude that significant preexisting hearing abnormality is common in this patient population and that, even after low-dose cisplatin administration, additional hearing loss occurs frequently. Baseline testing is mandatory if follow-up studies are to be adequately interpreted.

Psychometric adequacy of the Tinnitus Handicap Inventory (THI) for evaluating treatment outcome.

This study assessed the test-retest reliability/repeatability and 95 percent confidence intervals (CIs) of the Tinnitus Handicap Inventory (THI) and developed categories for classifying self-perceived tinnitus handicap severity. Twenty-nine adults with tinnitus as their primary auditory complaint served as subjects. The THI was administered on two occasions (mean interval 20 days) using a paper-pencil format. Results support the contention that the THI is psychometrically robust. Specifically, the test-retest reliability/repeatability was high. Additionally, the 95 percent CI for the THI was 20-points, indicating that a 20-point or greater change had to occur from test to retest for a change to be considered statistically significant at the 5 percent confidence level. Quartiles calculated from raw scores were used to create a matrix of values representing tinnitus severity. We conclude that the THI is a brief, easily administered, and psychometrically robust measure that evaluates the impact of tinnitus on daily living.

Effect of soaking, germination, and enzyme treatment of whole barley on nutritional value and digestive tract parameters of broiler chickens.

1. An experiment was carried out to determine the effect of soaking at 0 degrees C, soaking at room temperature, germination, or enzyme treatment of whole barley on feeding value and digestive tract parameters of 2- to 4-week old broiler chickens given diets with 700g/kg whole barley. 2. Soaking or germination decreased the soluble and total beta-glucan content (P < 0.05) and, except for soaking at 0 degrees C, the acid extract viscosity of the grain also decreased (P < 0.05). Germination and soaking in the presence of enzymes produced the lowest beta-glucan content and viscosity. 3. Except for soaking in cold water, the soaking, germination and enzyme treatments increased weight gain and decreased food:gain ratio (P < 0.05). Correspondingly, the digestibility of protein, fat, and ash, and the digestible energy content, increased (P < 0.05) after enzyme treatment or germination. 4. Chickens fed on enzyme-treated or germinated barley diets had intestinal contents with a greater proportion of dry matter and lower viscosity than chickens fed on untreated barley (P < 0.05). Consequently, the cages and chickens were cleaner (P < 0.05) and the weight of digestive organs as proportion of live weight was lower. 5. Particle size analysis of excreta revealed that whole barley was efficiently ground by the gizzards of 16-d-old chickens, and very few whole kernels were found.

Self-focused and somatic attention in patients with tinnitus.

Self-focused and somatic attention were examined in a sample of 51 patients with tinnitus using the Self-Focus Sentence Completion Test, Private Self-Consciousness Subscale of the Self-Consciousness Scale, Modified Somatic Perception Questionnaire, and the Somatization Subscale of the Symptoms Checklist-90-Revised. Two subgroups of patients emerged following a cluster analysis of the attentional tasks. One group scored lower on both self-attention and somatic attention measures ("low self-attenders"), whereas a second group was more internally directed and scored higher on the attention measures ("high self-attenders"). Between-group comparisons showed that the high self-attenders were, on average, more depressed, had greater emotional distress due to tinnitus, and had greater perceived tinnitus handicap. In contrast, no differences were observed for pitch and loudness measures using either psychophysical or rating scale techniques. Results of this investigation support the belief that attentional mechanisms play an important role in patients' perception of tinnitus and should be considered when planning management strategies.

Perceived hearing handicap of patients with unilateral or mild hearing loss.

Using the Hearing Handicap Inventory for Adults (HHIA), we assessed self-perceived hearing handicap in a sample of 63 patients having either unilaterally normal hearing or a mild hearing loss (pure tone average < or = 40 dB hearing level). Large intersubject variability in responses to the HHIA confirmed observations that reactions to minimal hearing impairment vary greatly among patients. The individual differences in responses highlight the importance of quantifying the perceived communication and psychosocial handicap, which cannot be determined from the audiogram alone. An item examination of responses to the HHIA revealed a number of emotional and social-situational problems encountered by patients with minimal hearing loss.

Long-term effects of Ménière's disease on hearing and quality of life.

OBJECTIVE: To evaluate long-term hearing results and quality of life in patients with Ménière's disease. STUDY DESIGN: Detailed audiometric evaluation and disease-specific as well as global health quality evaluation of patients with Ménière's disease. SETTING: Ambulatory evaluation was conducted in a large multispecialty clinic. PATIENTS: Ménière's disease in only one ear, were at least 1 year posttreatment, were < 65 years of age, had no neurologic or psychologic disorders, and lived within driving distance of the ambulatory clinic. MAIN OUTCOME MEASURES: Audiometry, the Hearing Handicap Inventory, Dizziness Handicap Inventory, Tinnitus Handicap Inventory, and SF-36 Health Survey. RESULTS: No statistically significant differences in long-term hearing results were detected from natural history in medically or surgically treated patients with Ménière's disease. A significant disease-specific symptom handicap was detected. The global health handicap was greater for emotional disability than for physical disability. CONCLUSIONS: Medical and surgical treatment does not significantly influence hearing results in Ménière's disease. Patients with Ménière's disease have a greater emotional disability than a physical disability.

Comparison of performance and intestinal characteristics of broiler chickens fed on diets containing whole, rolled or ground barley.

1. In two experiments, no consistent differences in weight gain or food intake appeared between broiler chickens given diets based on whole or rolled barley, but food: gain ratio and gizzard weight as a percentage of live weight were reduced (P < 0.05) when barley was rolled. Grit addition did not affect performance or intestinal characteristics. 2. In a third experiment, whole barley diets gave significantly higher weight gain than ground barley diets; this was attributable to the significantly higher food consumption. Gizzard weight as a percentage of live weight increased (P < 0.05) when whole barley was fed, while food: gain ratio was not significantly (P > 0.05) affected by the form of barley. 3. The number of particles in the intestinal contents with sizes larger than 2.4 mm was not significantly (P < 0.05) different between broiler chickens fed on whole barley and those fed ground barley, but the number of particles with sizes between 2.4 and 0.7 mm was lower P < 0.05) when diets with whole barley were fed. 4. Enzyme addition increased (P < 0.05) weight gain and the DM of intestinal contents, and decreased (P < 0.05) intestinal viscosity, food: gain ratio and pancreas weight as a percentage of live weight regardless of form of the barley.

Electrophysiological indices of selective auditory attention in subjects with and without tinnitus.

The present investigation was conducted in an attempt to determine whether selective auditory attention abilities differed between normal subjects and subjects with bothersome tinnitus. Subjects were 37 adults with tinnitus and high-frequency hearing loss (not affecting thresholds at 500 and 1000 Hz) and 15 subjects who were audiometrically and otologically normal. Results suggested that an electrophysiological index of early selective auditory attention (i.e., the negative difference wave, Nd) was of greater magnitude in tinnitus patients. Also, the cortical NI component occurred significantly later in the presence of selective attention in tinnitus subjects only. Results of this investigation may support the view that early selective auditory attention in subjects with bothersome tinnitus differs from that of normal subjects.

Development of the Tinnitus Handicap Inventory.

OBJECTIVE: To develop a self-report tinnitus handicap measure that is brief, easy to administer and interpret, broad in scope, and psychometrically robust. DESIGN: A standardization study of a self-report tinnitus handicap measure was conducted to determine its internal consistency reliability and convergent and construct validity. SETTING: Audiology clinics in tertiary care centers in two sites. PARTICIPANTS: In the first investigation, 84 patients reporting tinnitus as their primary complaint or secondary to hearing loss completed the 45-item alpha version of the Tinnitus Handicap Inventory (THI). In the second investigation, 66 subjects also reporting tinnitus completed the 25-item beta version. OUTCOME MEASURES: Convergent validity was assessed using another measure of perceived tinnitus handicap (Tinnitus Handicap Questionnaire). Construct validity was assessed using the Beck Depression Inventory, Modified Somatic Perception Questionnaire, symptom rating scales (annoyance, sleep disruption, depression, and concentration), and perceived tinnitus pitch and loudness judgments. RESULTS: From the alpha version of the THI, we derived a 25-item beta version with the items grouped into functional, emotional, and catastrophic subscales. The total scale yielded excellent internal consistency reliability (Cronbach's alpha = .93). No significant age or gender effects were seen. Weak correlations were observed between the THI and the Beck Depression Inventory, Modified Somatic Perception Questionnaire, and pitch and loudness judgments. Significant correlations were found between the THI and the symptom rating scales. CONCLUSION: The THI is a self-report measure that can be used in a busy clinical practice to quantify the impact of tinnitus on daily living.

Reappraisal of the monothermal warm caloric screening test.

The usefulness of a monothermal warm caloric screening test (MWST) for predicting alternate binaural bithermal test abnormalities has been reexamined. Previously, researchers have reported false-negative rates for the MWST ranging from 0% to over 35%. Alternate binaural bithermal test data from 504 consecutive patients were evaluated with MWST failure criteria of 24.5% and 29%, with and without the addition of failure criteria from subtests of the electronystagmography examination. Sensitivity of the MWST alone was high, and improved with additional failure criteria. The specificity levels were correspondingly high. Results support the use of the MWST with adjunctive failure criteria when patients have otherwise normal electronystagmography findings.

Headache disability inventory (HDI): short-term test-retest reliability and spouse perceptions.

We have reported previously that the 25-item Headache Disability Inventory has good internal consistency reliability, robust long-term (2 month) test-retest stability, and good construct validity. We conducted further investigations to evaluate the short-term (1 week) test-retest reliability and spouse perceptions of patients' self-perceived headache disability. The short-term test-retest reliability of the Headache Disability Inventory was excellent. Additionally, the spouse and patients' perceptions of the patient's headache disability generally were congruent, although we observed instances where the differences were marked.

Retest stability of the tinnitus handicap questionnaire.

The test-retest stability of the Tinnitus Handicap Questionnaire was assessed for a sample of 32 tinnitus patients. The questionnaire is a self-report measure that quantifies the physical, emotional, and social consequences of tinnitus (factor 1), the interfering effects of tinnitus on the hearing ability of the patient (factor 2), and the patients' view of tinnitus (factor 3). Retest stability estimates were obtained in order to determine the applicability of using the questionnaire as an outcome measure following tinnitus management. High test-retest correlations emerged for factors 1 and 2, whereas factor 3 yielded inadequate retest reliability. Therefore, it is recommended that only factors 1 and 2 be used for documenting changes in self-perceived tinnitus handicap following medical, surgical, or rehabilitative intervention.

When paroxysmal positioning vertigo isn't benign.

The electronystagmographic auditory brainstem response and magnetic resonance imaging findings for a 33-year-old male with a 3.5 cm left vestibular schwannoma are presented. Of particular interest was the presence of an unusual positioning nystagmus following the Dix-Hallpike maneuver in the right head-hanging position. The patient demonstrated a nystagmus that was immediate in onset and not fatigueable upon repeated positioning. During positioning, the patient experienced a vertical bobbing sensation and dysphoria, but not rotational vertigo. Most importantly, the nystagmus had a predominant downbeating vertical component. the case illustrates the diagnostic significance of downbeating nystagmus elicited by the Dix-Hallpike maneuver.

Hearing loss in Paget's disease of bone: the relationship between pure-tone thresholds and mineral density of the cochlear capsule.

We have developed a unique method of quantitative computed tomography (QCT) that enables measurement of the density of the cochlear capsule in vivo. We performed pure-tone audiometry and QCT on 67 ears from 35 subjects with radiographically confirmed Paget's disease of the skull and on 40 ears from twenty volunteer subjects. The Pearson product-moment correlation coefficients (age- and sex-adjusted) in the group affected by Paget's disease were -0.63 for left ears and -0.73 for right ears for high-frequency air conduction pure-tone thresholds (mean of 1, 2, and 4 kHz) versus cochlear capsule density. Correlation coefficients (age- and sex-adjusted) between cochlear capsule density and air-bone gap (mean at 0.5 and 1 kHz) for the affected group were -0.67 for left ears and -0.63 for right ears. All correlations between hearing thresholds and cochlear capsule density in pagetic subjects were significant at p < 0.001. The regressions were consistent throughout the ranges of hearing level. There were no significant correlations between cochlear capsule mean density and hearing level in the volunteer subjects. These findings demonstrate the feasibility of precise and accurate density measurements in the temporal bone in vivo and support the use of the mean cochlear capsule density as a marker of disease effect. Alteration of cochlear capsule bone density may be related to the mechanisms of hearing loss in Paget's disease of bone.