Preregistration of secondary data analysis: A template and tutorial

Preregistration has been lauded as one of the solutions to the so-called ‘crisis of confidence’ in the social sciences and has therefore gained popularity in recent years. However, the current guidelines for preregistration have been developed primarily for studies where new data will be collected. Yet, preregistering secondary data analyses--- where new analyses are proposed for existing data---is just as important, given that researchers’ hypotheses and analyses may be biased by their prior knowledge of the data. The need for proper guidance in this area is especially desirable now that data is increasingly shared publicly. In this tutorial, we present a template specifically designed for the preregistration of secondary data analyses and provide comments and a worked example that may help with using the template effectively. Through this illustration, we show that completing such a template is feasible, helps limit researcher degrees of freedom, and may make researchers more deliberate in their data selection and analysis efforts.

Paraneoplastic Limbic Encephalitis Secondary To Mixed Non-Seminomatous Germ Cell Tumours

Casestudy: Testicular tumors account for 1–2% of all tumors in men, with 95% of these being germ cell tumors. The main risk factor for the development of testicular cancer is cryptorchidism. Paraneoplastic limbic encephalitis is a rare sequela of testicular tumor associated with anti-Ma2 and KLH11 antibodies. The most effective treatment for paraneoplastic limbic encephalitis is treatment of the primary malignancy.

We present a 41-year-old male that presented to the emergency department with two weeks of episodic alteration of consciousness and memory disturbances. Negative neurologic evaluation and imaging led to concern for a paraneoplastic process from a distant malignancy. CT imaging revealed an enlarged, necrotic para-aortic lymph node and subsequent ultrasound demonstrated a right sided testicular mass. Right radical orchiectomy was performed.

Microscopically, the mass consisted of mixed respiratory epithelium, gastrointestinal glands and squamous epithelium with keratinization consistent with a post-pubertal testicular teratoma with associated in-situ germ cell neoplasia.

Resection of the para-aortic mass revealed large anaplastic cells with epithelioid features, nuclear pleomorphism and frequent mitoses. Immunostaining was positive for Pan-Keratin and OCT4, consistent with poorly differentiated embryonal carcinoma. Resection of the primary and metastatic disease, as well as treatment with corticosteroids resulted in resolution of the encephalitis.

This presentation of severe neurological disturbances in the setting of a metastatic mixed nonseminomatous germ cell tumor represents a rare presentation of paraneoplastic limbic encephalitis.

Comment: Well-Being Can Improve Health by Shaping Stress Appraisals

In this brief comment, we bring together two articles that appear in this special section. Jamieson et al. provide an overview of the biopsychosocial model of threat and challenge and suggest that stress-related arousal can be reappraised as a coping resource to facilitate challenge appraisals. Hernandez et al. review evidence for the link between well-being and health. We see a connection between these seemingly unrelated reviews: Well-being may improve health in part by shaping appraisals of stressors’ demands and appraisals of coping resources.

[Fixed angle carbon fiber reinforced polymer composite plate for treatment of distal radius fractures : Pilot study on clinical applications]

BACKGROUND

The clinical implementation of a new carbon-fiber-reinforced polyetheretherketon (PEEK) plate for distal radius fractures might offer advantageous properties over the conventional metallic devices. This includes similar elastic modulus to cortical bone, radiolucency, low artifacts on MRI scans and the lack of metal allergies.

OBJECTIVE

The aim of this study was to evaluate the clinical results at 6-week and 12-month follow-up using either a new fixed angle (monoaxial) PEEK plate system or a fixed angle (polyaxial) titanium plate.

METHODES

We included 26 patients (mean age 59.3) with displaced fractures of the distal radius (all AO types). Radiological and functional outcomes were measured prospectively at a 6-week and 12 month follow-up.

RESULTS

We documented no cases of hardware breakage or significant loss of the surgically achieved fracture reduction with the usage oft the new PEEK device. Operating time was 101.0 min using PEEK versus 109.3 min in titanium plates, recorded times were including preparation, draping, and postoperative processing (ns, p 0.156). At the 6-week follow up the PEEK plate showed a trend for better range of motion and functional results (DASH-score, Mayo-wrist score, VAS) with no statistical significance. Results of 12 month follow up with PEEK showed comparable results with corresponding studies examining titanium plate after this period.

CONCLUSION

First experience with PEEK plate osteosynthesis demonstrate quick clinical implementation with good clinical outcome and the advantage of excellent postoperative radiological assessment. At early follow-up PEEK even showed a trend for improved functional results.

The relationship between physician humility, physician-patient communication, and patient health

OBJECTIVE

Cultural portrayals of physicians suggest an unclear and even contradictory role for humility in the physician-patient relationship. Despite the social importance of humility, however, little empirical research has linked humility in physicians with patient outcomes or the characteristics of the doctor-patient visit. The present study investigated the relationship between physician humility, physician-patient communication, and patients' perceptions of their health during a planned medical visit.

METHODS

Primary care physician-patient interactions (297 patients across 100 physicians) were rated for the physician's humility and the effectiveness of the physician-patient communication. Additionally, patients reported their overall health and physicians and patients reported their satisfaction with the interaction.

RESULTS

Within-physician fluctuations in physician humility and self-reported patient health positively predicted one another, and mean-level differences in physician humility predicted effective physician-patient communication, even when controlling for the patient's and physician's satisfaction with the visit and the physician's frustration with the patient.

CONCLUSIONS

The results suggest that humble, rather than paternalistic or arrogant, physicians are most effective at working with their patients.

PRACTICE IMPLICATIONS

Interventions to improve physician humility may promote better communication between health care providers and patients, and, in turn, better patient outcomes.

An Upward Spiral Between Gratitude and Humility

In two experiments and one diary study, we examined the relationship between self- and other-oriented processes by considering how gratitude can influence humility and vice versa. Humility is characterized by low self-focus, secure sense of self, and increased valuation of others. Gratitude is marked by a sense that one has benefited from the actions of another. In the first experiment, participants who wrote a gratitude letter showed higher state humility than those who performed a neutral activity. In the second experiment, baseline state humility predicted the amount of gratitude felt after writing a gratitude letter compared to a neutral activity. Finally, in a 14-day diary study, humility and gratitude mutually predicted one another, even after controlling for the other’s prior level. Our results suggest that humility and gratitude are mutually reinforcing.

[Prevention and conservative therapy of diverticular disease]

Diverticulosis and diverticular disease are a common problem in daily practice and one third of the patients with diverticulosis develop symptoms. Patients with uncomplicated diverticulitis are very often treated with antibiotics. There is growing evidence that antibiotics are not necessary in uncomplicated cases. One problem is the different classification of diverticulitis and diverticular disease. Therefore, it is not easy to compare different studies. The evidence for therapy with antibiotics, mesalamine, probiotics and fibers are initially discussed and secondly therapeutic recommendations are given for the various stages of diverticular disease.

People Claim Objectivity After Knowingly Using Biased Strategies

People tend not to recognize bias in their judgments. Such “bias blindness” persists, we show, even when people acknowledge that the judgmental strategies preceding their judgments are biased. In Experiment 1, participants took a test, received failure feedback, and then were led to assess the test’s quality via an explicitly biased strategy (focusing on the test’s weaknesses), an explicitly objective strategy, or a strategy of their choice. In Experiments 2 and 3, participants rated paintings using an explicitly biased or explicitly objective strategy. Across the three experiments, participants who used a biased strategy rated it as relatively biased, provided biased judgments, and then claimed to be relatively objective. Participants in Experiment 3 also assessed how biased they expected to be by their strategy, prior to using it. These pre-ratings revealed that not only did participants’ sense of personal objectivity survive using a biased strategy, it grew stronger.

[Endoscopic submucosal dissection]

Endoscopic submucosal dissection (ESD) was developed in Japan but has now also become permanently established in various centers in Europe. ESD is an endoscopic en bloc mucosal resection technique for the treatment of early cancers with a diameter >1 cm and also superficial precancerous lesions, which could only be removed unsatisfactorily in several fragments or with uncertain lateral safety margins using previous loop excision procedures. Using ESD a lesion is excised after circular marking and generous submucosal injection with a safety margin of approximately 5 mm and subsequently resected at the level of the submucosa with a 1-3 mm short diathermic knife. ESD requires high technical skills in interventional endoscopy and is more time-consuming than snare resection techniques. However, numerous studies have shown a clear superiority for ESD with respect to the R0 resection rate and the local recurrence rate. The present article gives a current review of the use of ESD in the upper and lower gastrointestinal tract and demonstrates perspectives of the procedure.

[Diagnostic and interventional endoscopy in gastroenterology : from high-resolution chips and procedures for endoscopic resection to NOTES]

In the past 10 years endoscopic diagnostics has benefited from technologies such as big chips, high-definition television (HDTV) and narrow band imaging (NBI). Video capsule endoscopy and double balloon enteroscopy have facilitated visualization of the entire small bowel. A number of studies on mucosal Barrett's and gastric cancers could prove that endoscopic mucosal resection (EMR) is oncologically equivalent to surgical resection when certain criteria are respected. However, EMR is less invasive and carries a substantially lower complication risk and mortality compared to surgery. Endoscopic submucosal dissection (ESD) facilitates en bloc resection with thorough histopathologic evaluation of the specimen, e.g. for mucosal lesions in the stomach and rectum. Endosonography (EUS) guided transgastric necrosectomy using a flexible gastroscope has set a milestone in the treatment of infected pancreatic necroses and has replaced open surgery in many centers. Natural orifice transluminal endoscopic surgery (NOTES) uses natural body openings as minimally invasive access to the abdomen and mediastinum. Interventional GI endoscopists and minimally invasive surgeons have profited from these innovations in micromechanics and microelectronics.

[Critical analysis of children with suspicion of auditory processing disorders]

BACKGROUND

APDs at infancy has become a common reason of introduction at phoniatric/pedaudiologic departments. The question arises whether this neurocognitive construct can be accounted with the standard clinical diagnostics.

METHODS

The children with suspicion of APD referred to the Department of Phoniatrics/Pedaudiology at the University Hospital Goettingen/Germany were clinically examined.

PATIENTS

Of 107 children 8 % demonstrated abnormal hearing acuity, 7 % learning and intelligence disorders, 7 % developmental dyslexia, 6 % language impairments, and 5 % attention deficit/hyperactivity. So, 59 children remained for evaluating for an APD (mean age: 85.3; SD 16.3 months).

RESULTS

Their auditory performances were normdeviant from 7 % (speech audiometry) to 86 % (auditory sequential short-term memory for non-words). 55 % of the children exhibited a reduced dichotic word discrimination, 59 % a performance below norm level in auditory sequential memory for digits, and 86 % for non-words. Next step, the children of the study group were distributed according to their therapy situations at the time of examination: without; speech therapy; occupational therapy; speech therapy + occupational therapy. No significant group effects were found in the mean performances of the audiometric and psychometric tests, even though the results considerably differed. No auditory dimension made a contribution to separate the groups in a stepwise discriminant analysis.

CONCLUSIONS

There was a notably inherent heterogeneity of the population presenting with auditory processing problems. The overall objective of the APD evaluation must be to assess processing skills apart from complex stimuli like language skills (e. g. parameter of tones, memory of tone pitch).

Stimmfunktion und Lebensqualität

BACKGROUND

Quality of life is a relevant criterion for therapeutical outcome in laryngeal carcinoma patients. The aim of this study was to assess the self-related complaints in quality of life and functional outcome of voice among persons who had undergone laryngeal cancer surgery.

METHODS

The examination took place 67 months (SD 34.8) after the last surgery, on average and finishing of 60 therapy sessions (median). First a measurement with the Goettinger Hoarseness Diagram (GHD) was carried out. Next the subjects answered self-reported standardized questionnaires for life quality in oncological patients on the same day: EORTC-QLQ-C30 and 3 scales of the German Fragebogen zur Lebenszufriedenheit (health-related fulfillment, fulfillment with work/occupation, fulfillment with social environment). For disease-related symptoms of different head and neck domains the EORTC-HandN35 was administered.

SUBJECTS

Forty-four patients (37 males, 7 females) who were treated primarily with minimal invasive laser surgery followed by functional voice rehabilitation (Goettinger Konzept). Mean age: 60.1 (SD 9.7) years.

RESULTS

The acoustic voice quality according to the GHD showed a significant correlation with self-reported "Somatic Functioning" (- 0.32, p = 0.04) and "Social Functioning" (- 0.38, p = 0.01) in the EORTC-QLQ-C30 as well as with the symptom scales "Speech" (0.45, p < 0.0024) resp. "Social Contact" (0.45, p = 0.0021) in the EORTC-HandN35. Also hoarseness and health-related fulfillment (- 0.36, p = 0.02) as well as fulfillment with work/occupation (- 0.33, p = 0.03) correlated significantly. On the other hand, there was no significant association between the GHD and the assessment of global quality of life.

CONCLUSION

Postoperative phonatory reductions in patients with laser surgically treated laryngeal carcinoma have only a slight influence on overall quality of life. The same is true for the GHD. Assessment of self-reported quality of life in recommendation of oncologic treatment may not be able to replace the objective findings, but may be useful to detect other problems, e.g. psychosocial.

[Hearing loss in infancy. Who first suspects it? A descriptive analysis?]

BACKGROUND

The aim of this study was to analyze the sensitivity of suspicion preceding the diagnosis of a child's hearing impairment (HI).

METHODS

Parents of children with confirmed HI were questioned in order to evaluate the age and the initiators of the suspicion of congenital or early HI. A total of 185/199 parents provided information on their children aged from 1 to 120 months.

RESULTS

Parents showed more frequent correct suspicion/detection of HI than professionals. In 46% of all cases, the parents were the first to suspect HI (in 20% of all children with conductive losses and 52% of all sensorineural HIs). The first suspicion was raised by pediatricians in 25%, by otorhinolaryngologists and by school entrance examination each with 7%, and by obstetricians in 6% of cases. There was an average delay of 13.2 months from parental suspicion to a valid diagnosis of bilateral sensorineural HI (mean diagnosis age 50.9 months+/-30.3SD). Individual hearing aids were accordingly fitted late (mean aiding age 51.5 months+/-30.7).

CONCLUSIONS

These findings support the use of parental observation as part of the early detection of HI until universal newborn hearing screening can be implemented.

[Not all vocal cord failure following thyroid surgery is recurrent paresis due to damage during operation. Statement of the German Interdisciplinary Study Group on Intraoperative Neuromonitoring of Thyroid Surgery concerning recurring paresis due to intubation]

Since the phoniatrician H. Bauer described the first case of recurrent laryngeal nerve palsy most likely caused by intubation some 45 years ago, several case reports have been published. However, systematic analyses regarding the frequency of recurrent laryngeal nerve palsies due to intubation are scarce, and none of them has used the proper methods to demonstrate clearly that such a mechanism exists. Currently available data justify the assumption that not every recurrent laryngeal nerve palsy following thyroid surgery is due to the operation itself and that the damage caused by intubation, however, may only account for a minority of these cases. The differential diagnosis of postoperative recurrent laryngeal nerve palsy requires the use of specific tools which go beyond simple laryngoscopy and include stroboscopy as well as intra- and extralaryngeal electromyography. A partial palsy of recurrent laryngeal nerve due to intubation would be associated with severe dysphonia or aphonia, not with dyspnea because of the typical intermediate position of the paralyzed vocal folds with a normal electromyographic function of the cricothyroid muscle. The use of these methods to identify the nature of postoperative recurrent laryngeal nerve palsy is recommended in cases of regular intraoperative neuromonitoring but postoperatively impaired function of the vocal cords.

Zuverl�ssigkeit und Konsequenzen des intraoperativen Neuromonitorings in der Schilddr�senchirurgie

Intraoperative neuromonitoring (IONM) has yielded an increasing effect on thyroid surgery. During IONM, the recurrent laryngeal nerve is stimulated electrically and an acoustically transformed electromyographic signal is derived via either a needle electrode placed in the vocalis muscle or an electrode adjusted to the intubation tube. The IONM is used for identifying and predicting the function of the recurrent laryngeal nerve. Especially under difficult anatomic conditions, IONM has proven a valuable tool for identification of recurrent laryngeal nerves. This can lead to decreased occurrence of nerve palsy rates, as shown in numerous studies. The reliability of the IONM signal (defined as the correlation between intraoperative signal interpretation and postoperative vocal cord function) is reflected by a specificity as high as 98.2%, as shown by German multicenter studies. Thus, normal vocal cord function could be demonstrated postoperatively in over 98.2% of patients with intraoperatively unchanged neuromonitoring signals. If the neuromonitoring signal changed during operation, 39% of the patients suffered from transient vocal cord immobility and 12% had permanent loss of vocal cord function.

Software packages for quantitative microarray-based gene expression analysis

Microarray technology enables researchers to investigate the expression of several thousand genes simultaneously. The whole transcriptional response of these genes in normal cells or tissue, in disease condition, as an response to biological, genetical or chemical stimuli or during normal biological processes such as cell cycle or embryonic development can be investigated. This leads to a huge amount of data, from which the relevant information has to be extracted by statistical and computational methods. Several software packages for the analysis of gene expression data are available, both commercially and freely. They differ particularly with regard to the implemented analytical methods, the graphical display and the manageability. In this paper the commercial software packages arraySCOUT, GeneSpring and Spotfire DecisionSite for Functional Genomics are compared and their applicability for analysis of gene expression data is studied. Small artificial and application test datasets are used to compare the computational results of the software packages. As far as possible results are verified with standard statistical software package SAS.

[Test set for the evaluation of hearing and speech development after cochlear implantation in children]

BACKGROUND

Since autumn 1998 the multicenter interdisciplinary study group "Test Materials for CI Children" has been compiling a uniform examination tool for evaluation of speech and hearing development after cochlear implantation in childhood.

METHODS USED

After studying the relevant literature, suitable materials were checked for practical applicability, modified and provided with criteria for execution and break-off. For data acquisition, observation forms for preparation of a PC-version were developed.

RESULTS

The evaluation set contains forms for master data with supplements relating to postoperative processes. The hearing tests check supra-threshold hearing with loudness scaling for children, speech comprehension in silence (Mainz and Göttingen Test for Speech Comprehension in Childhood) and phonemic differentiation (Oldenburg Rhyme Test for Children), the central auditory processes of detection, discrimination, identification and recognition (modification of the "Frankfurt Functional Hearing Test for Children") and audiovisual speech perception (Open Paragraph Tracking, Kiel Speech Track Program). The materials for speech and language development comprise phonetics-phonology, lexicon and semantics (LOGO Pronunciation Test), syntax and morphology (analysis of spontaneous speech), language comprehension (Reynell Scales), communication and pragmatics (observation forms). The MAIS and MUSS modified questionnaires are integrated.

CONCLUSIONS

The evaluation set serves quality assurance and permits factor analysis as well as controls for regularity through the multicenter comparison of long-term developmental trends after cochlear implantation.

["The main cause of the differences is the crime": An attempt at explaining the excess mortality of illegitimate children in The Hague in the mid-nineteenth century]

During the last quarter of the 19th century, illegitimate children had much higher infant mortality than legitimate children. To investigate which factors played a role in this, we collected information on the household situation and the life course of all illegitimate children, born in the Dutch city of The Hague in the years 1850-1852. Use was made of birth and death certificates and of the population registers of the city. We compared our information with data on a random sample of legitimate children,, born in the same city. After children had reached the age of one month, mortality among illegitimate children became very high, compared to that of our reference group. Proportional hazards analysis showed that this excess mortality was caused by a set of factors, the most important being the age of the mother at birth, regional background, and the socio-economic group to which the notifier of the birth belonged. Aside from those factors, legal status of the child as such had an effect on infant mortality. The unwed mothers most likely to lose their child in its first year of life lived alone with their child and were obliged to resume work to support themselves and their child. The opportunity to breastfeed may have played a key role in this.

Impaired expression of the plastidic ferrochelatase by antisense RNA synthesis leads to a necrotic phenotype of transformed tobacco plants

Protoporphyrin IX is the last common intermediate of tetrapyrrole biosynthesis. The chelation of a Mg2+ ion by magnesium chelatase and of a ferrous ion by ferrochelatase directs protoporphyrin IX towards the formation of chlorophyll and heme, respectively. A full length cDNA clone encoding a ferrochelatase was identified from a Nicotiana tabacum cDNA library. The encoded protein consists of 497 amino acid residues with a molecular weight of 55.4 kDa. In vitro import of the protein into chloroplasts and its location in stroma and thylakoids confirm its close relationship to the previously described Arabidopsis thaliana plastid-located ferrochelatase (FeChII). A 1700-bp tobacco FeCh cDNA sequence was expressed in Nicotiana tabacum cv. Samsun NN under the control of the CaMV 35S promoter in antisense orientation allowing investigation into the consequences of selective reduction of the plastidic ferrochelatase activity for protoporphyrin IX channeling in chloroplasts and for interactions between plastidic and mitochondrial heme synthesis. Leaves of several transformants showed a reduced chlorophyll content and, during development, a light intensity-dependent formation of necrotic leaf lesions. In comparison with wild-type plants the total ferrochelatase activity was decreased in transgenic lines leading to an accumulation of photosensitizing protoporphyrin IX. Ferrochelatase activity was reduced only in plastids but not in mitochondria of transgenic plants. By means of the specifically diminished ferrochelatase activity consequences of the selective inhibition of protoheme formation for the intracellular supply of heme can be investigated in the future.

Effect of smoking reduction and cessation on cardiovascular risk factors

This open study examined the effect of smoking reduction and smoking cessation on established cardiovascular risk factors. Fifty-eight healthy adult smokers (smoking >or=15 cigarettes/day for at least 3 years) were provided with nicotine nasal spray (to be used ad libitum) and asked to stop smoking. The primary goal during the first 8 weeks, however, was to reduce their daily smoking by at least 50%. Subjects were then followed for another 8 weeks; at this point, 33 participants had successfully stopped smoking. Cardiovascular risk factors including fibrinogen, hemoglobin, hematocrit, triglycerides, and cholesterol were measured at baseline and at 9 and 17 weeks. After 8 weeks of smoking reduction, the mean number of cigarettes smoked per day had decreased from 21.5 +/- 0.6 (baseline) to 10.8 +/- 0.6 (p < 0.001). This was accompanied by significant improvements in fibrinogen (from 2.9 +/- 0.1 g/l at baseline to 2.6 +/- 0.1 g/l, p = 0.011), white blood cells (from 7.0 +/- 0.4 to 6.2 +/- 0.3 x 10(9)/l, p = 0.005) and the high-density/low-density lipoprotein (HDL/LDL) ratio (0.33 +/- 0.03 to 0.37 +/- 0.03, p < 0.005). Following 8 weeks of abstinence from smoking, the mean white blood cell count was further reduced (to 6.1 +/- 0.3 x 10(9)/l, p = 0.026 vs. baseline) and there were also significant improvements in HDL (from 1.16 +/- 0.06 mmol/l at baseline to 1.32 +/- 0.06, p < 0.001) and LDL (from 3.78 +/- 0.16 mmol/l at baseline to 3.52 +/- 0.17, p = 0.015). In conclusion, 8 weeks of smoking reduction resulted in clinically significant improvements in established cardiovascular risk factors. These improvements were even greater after an additional period of abstinence from smoking.

Stable insertion of the early light-induced proteins into etioplast membranes requires chlorophyll a

Etiolated plant seedlings exposed to light respond by transient accumulation of the nucleus-encoded, plastid-located early light-inducible proteins (Elips). These proteins are distant relatives of the light-harvesting chlorophyll a/b-binding gene family and bind pigments with unusual characteristics. To investigate whether accumulation of Elips in plastid membranes is post-translationally regulated by pigments, reconstitution studies were performed, where in vitro transcribed and translated low molecular mass Elip precursors of barley were combined with lysed barley etioplasts complemented with various compositions of isolated pigments. We showed that the membrane insertion of Elips, as proven by protease protection assays and washes with a chaotropic salt or alkali, depended strictly on chlorophyll a but not on chlorophyll b or xanthophyll zeaxanthin. The amount of inserted Elips increased almost linearly with the chlorophyll a concentration, and the insertion efficiency was not significantly influenced by a light intensity between 1 and 1,000 micromol x m(-2) x s(-1). In contrast, in vitro import of Elip precursors into greening plastids was enhanced by high intensity light. Thus, we conclude that although chlorophylls bound to Elips seem to not be involved in light harvesting, they are crucial for a stable insertion of these proteins into the plastid membrane.

[Unilateral hearing loss in childhood. An empirical analysis comparing bilateral hearing loss]

BACKGROUND

Unilateral cochlear hearing loss is considered as a risk factor for auditory, verbal-communicative, behavioral and academic development. An early diagnosis is therefore necessary.

METHOD/PATIENTS

182 consecutive patients with an age up to 10 years were diagnosed with permanent hearing loss in the mild to profound range in a defined 5-years-period (1.10.1994-30.9.1999) in the Pedaudiologic Outpatient Clinic of the University Göttingen. Fifty children (27.5%) had a unilateral hearing loss (30 sensorineural, 20 conductive caused by aural atresia with or without microtia), 132 a bilateral one. This paper presents the data of the consecutive series of the 30 sensorineural unilaterally hearing-impaired children (> 25 dB).

RESULTS

A slight male predominance was present (53.3%). The left ear was affected in 43.3%, the right ear in 56.7%. In the majority of the cases the hearing loss was severe and profound. The hearing-impairments were diagnosed by the median age of 69.5 months and all aided by the median age of 70 months. The etiology remained unknown in 60 per cent of the cases. Hearing aid acceptance at the first follow-up (on average after 6 months) was found to be 79 per cent.

CONCLUSIONS

The data suggest the relevance and necessity of a pedaudiometric prevention. They demonstrate the urgent necessity of a molecular genetic cause investigation. Recessive sensorineural hearing loss with onset in infancy may exist with no antecedent family history.

[Acceptance of wearing hearing aids by children: a longitudinal analysis]

There exist no systematic longitudinal studies concerning the acceptance of hearing aids in Germany. This study examines the acceptance of a hearing aid (defined by its daily/weekly use) in the management of children with persistent sensorineural hearing loss over a period of years. 35 children with monaural or binaural hearing loss were treated with a hearing aid. All children had at least a 25-dB averaged mid-frequency pure-tone hearing loss (500, 1000, 2000, 4000 Hz). The data consist of standardized parent ratings at 4 points in time over a period of nearly 30 months. Unilateral-impaired children wore their hearing aids less often than bilateral-impaired children. This effect was not significant at the beginning (P = 0.85) but increased over time. By the end the difference was significant (P = 0.004). Mild to moderate monaural hearing-impaired children accepted their hearing aids, whereas children with severe to profound hearing loss refused to wear them. Bilateral hearing-impaired children demonstrated, a priori, a better wearing acceptance that even improved with time. There was never a significant difference between boys and girls in their average wearing time. A significant correlation of age and wearing acceptance was also not observed at any time. Hearing aids are an effective treatment with high acceptance and compliance, especially by children with bilateral sensorineural hearing loss. The quality of acceptance of monaural hearing-impaired children needs to be studied further.

[Higher touch and kinesthetic functions in children with former speech/language development disorders: a neuropsychological study]

Two groups of children took part in this study to test the hypothesis that children diagnosed in infancy as specific speech/language-impaired have deficits in tactile-kinesthetic functions: A formerly clinical group of 25 German-speaking pupils with a mean age of 8;7 years (SD 7.1 months) who have previously been identified as specific speech/language-impaired (on average at 4;11 years, SD 10.6 months) and a control group of 25 normal pupils in elementary school without a former or actual speech/language disorder (mean age: 9;2 years, SD 8.3 months). The control group was matched with the formerly clinical group for gender and age. Performance scores of both groups on a nonverbal intelligence test (the Raven's Matrices), on a tactile-kinesthetic subtest (Berliner-Luria-Neuropsychologisches Verfahren f¿r Kinder), and on a developmental language test (Heidelberger Sprachentwick- lungstest) were compared. There was a significant difference (p < 0.05) in the mean tactile-kinesthetic performance of both groups (3.1 vs. 4.0) who present a nearly identical nonverbal intelligence. Thirty-two percent of the formerly clinical group demonstrated a performance below the norm. Analysis of the laterality did not reveal significant differences in performance between left and right hand, neither in right-handers nor in left-handers of both groups. Nevertheless right-handers demonstrated on average a better somatosensory performance with their left hand. Mean language and tactile-kinesthetic performance correlate significantly in the formerly clinical group (r = 0.45, p < 0.05), but not in the control group (r = 0.08). The formerly clinical group was inferior in performance to the normal subjects especially in complex functions as in the tactile discrimination of sharp/blunt and in topognosia.

Acoustic voice analysis by means of the hoarseness diagram

The hoarseness diagram (Michaelis, Fröhlich, & Strube, 1998a) has been proposed as a new approach to describe different acoustic properties of voices. To test its performance in the analysis of pathologically disturbed and normal voices five requirements are suggested that should be met by any acoustic voice-analysis protocol to be used in voice research and clinical practice. The hoarseness diagram is then tested with regard to these requirements. Individual voices are found to show a satisfactory localization in the diagram. Aspects of stationarity are discussed in the context of four case studies. The different cases illustrate that changes in the acoustic analysis results are observed if the voice-generation conditions change, whereas results are stationary if phonation conditions do not change. Different pathological voice groups defined on grounds of the specific phonation mechanism are found to map to specific regions of the hoarseness diagram, with differences between group locations being significant. All results can be interpreted without exceptions if the two hoarseness diagram coordinates are taken to reflect the vibrational irregularity of the voice-generation mechanisms on the one side and the degree of closure of the vibrating structures on the other side. The hoarseness diagram and its underlying algorithms are thus shown to constitute a useful approach to acoustic voice analysis in research and clinical practice. The tests themselves demonstrate several application possibilities, including the quantitative monitoring of individual voices.