Validity of hearTest Smartphone-Based Audiometry for Hearing Screening in Workers Exposed to Noise

Abstract Purpose This article investigates the validity of a smartphone-based audiometry for hearing screening to identify hearing loss in workers exposed to noise. Research Design This is a validation study comparing hearing screening with the hearTest to conventional audiometry. The study population included all workers who attended the Brazilian Social Service of Industry to undergo periodic examinations. Sensitivity, specificity, the Youden index, and positive (PPV) and negative predictive values (NPV) for hearing screening obtained by the hearTest were estimated according to three definitions of hearing loss: any threshold greater than 25 dB hearing level (HL), the mean auditory thresholds for 0.5, 1, 2, and 4 kHz greater than 25 dB HL, and the mean thresholds for 3, 4, and 6 kHz greater than 25 dB HL. Note that 95% confidence intervals were calculated for all measurements. Results A total of 232 workers participated in the study. Hearing screening with the hearTest presented good sensitivity (93.8%), specificity (83.9%), and Youden index (77.7%) values, a NPV (97.2%), and a low PPV (69.0%) for the identification of hearing loss defined as any auditory threshold greater than 25 dB HL. For the other definitions of hearing loss, we observed high specificity, PPV and NPV, as well as low sensitivity and Youden index. Conclusion The hearTest is an accurate hearing screening tool to identify hearing loss in workers exposed to noise, including those with noise-induced hearing loss, although it does not replace conventional audiometry.

Reliability of Cobas Amplicor PCR test in detection of Mycobacterium tuberculosis in respiratory and nonorespiratory specimens

Vojnosanitetski pregled ◽

10.2298/vsp0912992l ◽

2009 ◽

Vol 66 (12) ◽

pp. 992-997

Author(s):

Zorica Lepsanovic ◽

Dejana Savic ◽

Branka Tomanovic

Keyword(s):

Mycobacterium Tuberculosis ◽

High Sensitivity ◽

High Specificity ◽

Diagnostic Methods ◽

Nucleic Acid Amplification ◽

Culture Methods ◽

Predictive Values ◽

Polymerase Chain ◽

Low Sensitivity ◽

Background/Aim. Traditional methods for detection of mycobacteria, such as microscopic examination for the presence of acid-fast bacilli and isolation of the organism by culture, have either a low sensitivity and/or specificity, or take weeks before a definite result is available. Molecular methods, especially those based on nucleic acid amplification, are rapid diagnostic methods which combine high sensitivity and high specificity. The aim of this study was to determine the usefulness of the Cobas Amplicor Mycobacterium tuberculosis polymerase chain reaction (CAPCR) assay in detecting the tuberculosis cause in respiratory and nonrespiratory specimens (compared to culture). Methods. Specimens were decontaminated by the N-acetyl-L-cystein- NaOH method. A 500 ?L aliquot of the processed specimen were used for inoculation of L?wenstein-Jensen (L-J) slants, a drop for acid-fast staining, and 100 ?L for PCR. The Cobas Amplicor PCR was performed according to the manufacturer's instructions. Results. A total of 110 respiratory and 355 nonrespiratory specimens were investigated. After resolving discrepancies by reviewing medical history, overall sensitivity, specificity, and positive and negative predictive values for CA-PCR assay compared to culture, were 83%, 100%, 100%, and 96.8%, respectively. In comparison, they were 50%, 99.7%, 87.5%, and 98%, respectively, for the nonrespiratory specimens. The inhibition rate was 2.8% for respiratory, and 7.6% for nonrespiratory specimens. Conclusion. CA-PCR is a reliable assay that enables specialists to start treatment promptly on a positive test result. Lower value for specificity in a group of nonrespiratory specimens is a consequence of an extremely small number of mycobacteria in some of them.

OR07-05 Is Urinary Calcium the Only Predictor of Nephrolithiasis in Patients with Asymptomatic Primary Hyperparathyroidism?

Journal of the Endocrine Society ◽

10.1210/jendso/bvaa046.1457 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

Author(s):

Federica Saponaro ◽

Filomena Cetani ◽

Laura Mazoni ◽

Matteo Apicella ◽

Marco Scalese ◽

...

Keyword(s):

Positive Predictive Value ◽

Predictive Value ◽

Multivariate Analyses ◽

International Workshop ◽

High Specificity ◽

Risk Profile ◽

Urinary Calcium ◽

Youden Index ◽

Low Sensitivity ◽

Abstract The 4th International Workshop for the management of asymptomatic PHPT included, among the criteria for parathyroidectomy, the presence of hypercalciuria (dUCa> 400 mg/day) and increased biochemical stone risk profile. The aim of the present study was to evaluate the biochemical stone risk profile in 176 consecutive patients (143 females and 33 males) with asymptomatic PHPT. We recorded clinical and biochemical data, including 24 hours urinary measurements of the following parameters: volume and pH, creatinine, calcium, magnesium, sodium, potassium, ammonium, uric acid, oxalate, citrate, phosphate, inorganic sulphate and chloride and kidney ultrasound. In our cohort dUCa> 400mg/day showed a low sensitivity and positive predictive value (PPV) for nephrolithiasis with high specificity (46.2, 32.7, 73.0% respectively), while hypercalciuria by 4 mg/kg/bw (d-UCa>4mg/kg) had a high sensibility, with low PPV and specificity (79.5, 27.7, 40.1%) Daily hypomagnesuria (d-HypoMg), but not any other urinary parameter, was an independent predictor of nephrolithiasis in the univariate (OR 2.97 CI 1.27-7.09 P=0.014) and multivariate analyses adjusting for age, sex, BMI, and eGFR (OR 3.13 CI 1.17-8.42 P=0.02). d-HypoMg was relatively lower in the regression analysis with urinary calcium in patients with nephrolithiasis compared with those without. The mean ratio between (dUCa) and (dUMg) was higher in patients with nephrolithiasis compared with those without (4.6±2.0 vs 3.3±4.1; P<0.001). In the univariate and multivariate analyses the dUCa/dUMg ratio was a significant predictor of nephrolithiasis [OR 4.9 (2.3-10.5); P<0.001; OR 5.3 (2.4-11.6), P<0.001, respectively]. The AUC using the dUCa/dUMg ratio as variables was 0.69 (CI 0.60-0.79; P<0.0001). The best cut-off value, set at the highest Youden index, was equal to 4.0, with a sensitivity of 59.0% and a specificity of 77.4%. In patients with hypercalciuria (>400 mg/24-hour) dUMg was positively correlated with dUCa in those without nephrolithiasis (r=0.50, β=0.2, P=0.002) but not in those with nephrolithiasis (r=0.05, β= 0.014; P=0.8). In patients without hypercalciuria we found that hypomagnesuria remained a predictor of nephrolithiasis using either 400 mg/die (P=0.002, OR 5.12 (1.84-14.24) or 4 mg/kg bw (P=0.014, OR 6.24 (1.45-26.8). Moreover, the OR for nephrolithiasis improved using the combination of d-HypoMg with d-UCa>4mg/kg (OR 8.12, CI 1.92-34.18, P=0.004), but not with dUCa> 400mg/day. The current urinary calcium threshold of >400 mg/24-hour has a low sensitivity in detecting nephrolithiasis; our data suggest that sensitivity, specificity and positive predictive value could be improved including dUMg, dUCa/dUMg ratio and the combination of d-HypoMg with d-UCa>4mg/kg in the stone risk evaluation.

Multi-Slice Computed Tomographic Angiography for Stenosis Detection in Forearm Hemodialysis Arteriovenous Fistulas

The Journal of Vascular Access ◽

10.1177/112972980800900409 ◽

2008 ◽

Vol 9 (4) ◽

pp. 278-284 ◽

Cited By ~ 13

Author(s):

P.P.G.M. Rooijens ◽

G.P Serafino ◽

D. Vroegindeweij ◽

R. Dammers ◽

T.I. Yo ◽

...

Keyword(s):

High Specificity ◽

Computed Tomographic Angiography ◽

Observer Agreement ◽

Predictive Values ◽

Computed Tomographic ◽

Arteriovenous Fistulas ◽

Blinded Manner ◽

Sensitivity Specificity ◽

Tomographic Angiography ◽

Diameter Reduction

Purpose A method of diagnosing the extent and severity of arteriovenous fistula (AVF) stenoses is multi-slice computed tomographic angiography (MS-CTA). The aim of this prospective study was to assess the accuracy of MS-CTA for the detection and grading of stenoses in AVF in comparison to digital subtraction angiography (DSA), which was used as the gold standard of reference. Methods Fifteen hemodialysis (HD) patients with dysfunctioning forearm AVF were included. These AVFs were evaluated by both DSA and MS-CTA and were read in a prospective, blinded manner by two radiologists experienced in vascular imaging. Results ROC analysis revealed areas under the curve of 0.90 ± 0.07 for observer I and 0.87 ± 0.08 for observer II at a stenosis cut-off level of ≥50% diameter reduction. The combined results for MS-CTA showed sensitivity, specificity and positive and negative predictive values of 82%, 98%, 82% and 98% for stenoses ≥50% and 71%, 99%, 77% and 98% for stenoses ≥75%. Inter-observer agreement for the detection of stenoses ≥50% diameter reduction was 0.70 and 1.0, for MS-CTA and DSA, respectively. Conclusion MS-CTA can provide good visualization of forearm HD access AVF and has moderate sensitivity, but high specificity for the detection of flow-limiting stenoses.

Self-Perceived Hearing Loss, Hearing-Help Seeking and Hearing Aid Adoption Among Older Adults in Malaysia

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489418795982 ◽

2018 ◽

Vol 127 (11) ◽

pp. 798-805 ◽

Author(s):

Siti Zamratol Mai Sarah Mukari ◽

Wan Fazlina Wan Hashim

Keyword(s):

Older Adults ◽

Hearing Loss ◽

Help Seeking ◽

Hearing Aid ◽

Pure Tone Audiometry ◽

Cognitive Status ◽

Community Dwelling ◽

Hearing Level ◽

Low Sensitivity ◽

Single Question

Introduction: The aims of this study were to examine the validity of self-perceived hearing loss in detecting hearing loss and factors associated with self-perceived hearing loss and hearing-help seeking and to report hearing aid adoption among a group of community-dwelling older adults in Malaysia. Methods: A total of 301 older adults (⩾60 years of age) participating in a study on aging had their hearing tested using pure-tone audiometry. Self-perceived hearing loss was assessed using a single question. Sociodemographic profile, otologic history, and general cognitive status were also obtained. Results: A single question had low sensitivity in detecting actual hearing loss: 31.3% for 4-frequency average > 25 dBHL and 48.8% for 4-frequency average > 40 dBHL. Besides hearing level, history of otorrhea and tinnitus were factors that were associated with self-perceived hearing loss among older adults with at least mild hearing loss. Hearing-help-seeking behavior was not associated with any of the tested variables. The hearing aid adoption rate was 2.7% and 7.3% among participants with 4-frequency averages > 25 dBHL and > 40 dBHL, respectively. Conclusion: The underestimation of hearing loss in the majority of older adults in this study poses a potential barrier to hearing loss intervention.

Value and Diagnostic Efficacy of Fetal Morphology Assessment Using Ultrasound in A Poor-Resource Setting

Diagnostics ◽

10.3390/diagnostics9030109 ◽

2019 ◽

Vol 9 (3) ◽

pp. 109 ◽

Author(s):

Ukweh ◽

Ugbem ◽

Okeke ◽

Ekpo

Keyword(s):

Predictive Value ◽

Performance Metrics ◽

Area Under The Curve ◽

Youden Index ◽

Likelihood Ratios ◽

Diagnostic Efficacy ◽

Predictive Values ◽

Resource Setting ◽

Post Test ◽

Background: Ultrasound is operator-dependent, and its value and efficacy in fetal morphology assessment in a low-resource setting is poorly understood. We assessed the value and efficacy of fetal morphology ultrasound assessment in a Nigerian setting. Materials and Methods: We surveyed fetal morphology ultrasound performed across five facilities and followed-up each fetus to ascertain the outcome. Fetuses were surveyed in the second trimester (18th–22nd weeks) using the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) guideline. Clinical and surgical reports were used as references to assess the diagnostic efficacy of ultrasound in livebirths, and autopsy reports to confirm anomalies in terminated pregnancies, spontaneous abortions, intrauterine fetal deaths, and still births. We calculated sensitivity, specificity, positive and negative predictive values, Area under the curve (AUC), Youden index, likelihood ratios, and post-test probabilities. Results: In total, 6520 fetuses of women aged 15–46 years (mean = 31.7 years) were surveyed. The overall sensitivity, specificity, and AUC were 77.1 (95% CI: 68–84.6), 99.5 (95% CI: 99.3–99.7), and 88.3 (95% CI: 83.7–92.2), respectively. Other performance metrics were: positive predictive value, 72.4 (95% CI: 64.7–79.0), negative predictive value, 99.6 (95% CI: 99.5–99.7), and Youden index (77.1%). Abnormality prevalence was 1.67% (95% CI: 1.37–2.01), and the positive and negative likelihood ratios were 254 (95% CI: 107.7–221.4) and 0.23 (95% CI: 0.16–0.33), respectively. The post-test probability for positive test was 72% (95% CI: 65–79). Conclusion: Fetal morphology assessment is valuable in a poor economics setting, however, the variation in the diagnostic efficacy across facilities and the limitations associated with the detection of circulatory system anomalies need to be addressed.

Comparative study of colour Doppler vs. FNNAC findings in WHO grade II thyroid enlargement in adult females

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20192724 ◽

2019 ◽

Vol 5 (4) ◽

pp. 1025

Author(s):

Sudhakar Rao M. S. ◽

Navneeth T. P. ◽

John C. J.

Keyword(s):

Pulsatility Index ◽

Low Cost ◽

Resistive Index ◽

Colour Doppler ◽

Who Grade ◽

Predictive Values ◽

Non Invasive ◽

Adult Females ◽

The Mean ◽

Background: Thyroid gland disorders form one of the most common endocrinal and surgical problems encountered in clinical practice. FNNAC is widely accepted as the primary and better method than FNAC for investigation but has its disadvantages. Colour Doppler is a non-invasive, low cost, easily available and repeatable investigation with least patient discomfort and can be valuable in detection of benign and malignant thyroid enlargements.Methods: Forty cases of adult females with WHO grade 2 thyroid enlargement attending the department of otorhinolaryngology selected on simple random basis were included in this study. Following written consent, Colour Doppler scanning and FNNAC test were done on the thyroid swelling and the results were analysed. Results: The mean age of patients was 32.44 years. The mean age of malignancy was 44.66 years and showed statistically significant association. The Resistive and Pulsatility index and combination of both were found to have statistically significant results in detecting malignant and benign lesions The sensitivity, specificity, positive and negative predictive values of RI and PI were 83.33%, 94.12%, 71.43%, 96.97% and 50%, 94.12%, 60% and 91.43% respectively. On combining both the indices, the sensitivity was 91.67% and the positive predictive value was 97.06%.Conclusions: Colour Doppler can differentiate between benign and malignant thyroid enlargements using Resistive index (of>0.75) and Pulsatility Index (of>1.5) and can be a complementary diagnostic tool in the thyroid enlargement lesions, considering its accuracy, cost-effectiveness, easy availability and non-invasive repeatable nature.

Hearing Screening of High-Risk Newborns with Brainstem Auditory Evoked Potentials: A Follow-up Study

PEDIATRICS ◽

10.1542/peds.73.1.22 ◽

1984 ◽

Vol 73 (1) ◽

pp. 22-26 ◽

Author(s):

Dorothy A. Shannon ◽

Jacob K. Felix ◽

Allan Krumholz ◽

Phillip J. Goldstein ◽

Kenneth C. Harris

Keyword(s):

Hearing Loss ◽

High Risk ◽

Predictive Value ◽

Screening Test ◽

Normal Hearing ◽

Hearing Screening ◽

Auditory Evoked Potential ◽

Hearing Level ◽

Lost To Follow Up

Numerous techniques have been used in attempts to find a reliable and efficient screening method for determining auditory function in the newborn. The brainstem auditory evoked potential (BAEP) is the latest method advocated for that purpose. The BAEP was evaluated as a hearing screening test in 168 high-risk newborns between 35 and 45 weeks of conceptual age. Follow-up data were obtained after 1 year (mean 17.3 months) on 134 of the infants (80%). Normal hearing was defined as a reproducible response in both ears to a 25 dB normal hearing level (nHL) click stimulus; 21 infants (12.5%) failed the initial screening test. Follow-up on 19/21 infants revealed 18 infants with normal hearing and one infant with an 80 dB nHL bilateral hearing loss substantiated. One infant with an abnormal screening test died before retesting, and the other infant was lost to follow-up but had only a unilaterally abnormal BAEP. None of the infants with a normal BAEP screening study had evidence of hearing loss on retesting. Sensitivity of the BAEP was 100%, specificity was 86%, predictive value of a positive test was 5.26%, and the predictive value of a negative test was 100%. The incidence of significant hearing loss in our population was between 0.75% (1/134 infants) confirmed, and 2.24% (3/134 infants) including infants who failed screening but were lost to follow-up. The BAEP is a sensitive procedure for the early identification of hearing-impaired newborns. However, the yield of significant hearing abnormalities was less than predicted in other studies using BAEP for newborn hearing screening.

Clinical Performance of the Spot Vision Photo Screener before and after Induction of Cycloplegia in Children

Journal of Ophthalmology ◽

10.1155/2019/5329121 ◽

2019 ◽

Vol 2019 ◽

pp. 1-7 ◽

Author(s):

Konuralp Yakar

Keyword(s):

Positive Predictive Value ◽

Negative Predictive Value ◽

Predictive Value ◽

Clinical Performance ◽

High Specificity ◽

Screening Criteria ◽

Predictive Values ◽

Before And After ◽

Sensitivity Specificity ◽

Vision Screener

Aim. To compare the clinical performance of the Spot Vision Screener used to detect amblyopia risk factors (ARFs) in children before and after induction of cycloplegia; the children were referred because they met the screening criteria of the American Association for Pediatric Ophthalmology and Strabismus (AAPOS). Methods. The Spot Vision Screener and a standard autorefractometer were used to examine 200 eyes of 100 children aged 3–10 years, before and after cycloplegia induction, in terms of ARFs. Sensitivity, specificity, and positive and negative predictive values for the detection of significant refractive errors were measured using the AAPOS referral criteria. It was explored that Spot Screener data were affected by cycloplegia. The extent of agreement between cycloplegic/noncycloplegic photoscreening data and cycloplegic autorefraction measurements was assessed using Wilcoxon and Spearman correlation analyses. Results. The Spot’s sensitivity was improved from 60.9% to 85.3% and specificity from 94.9% to 87.4% with cycloplegia compared to cycloplegic standard autorefractometer results. The positive predictive value of Spot was 75.7%, and the negative predictive value was 90.4% without cycloplegia. With cycloplegia, the positive predictive value of Spot was 63.6% and the negative predictive value was 95.8%. Conclusions. The Spot Screener afforded moderate sensitivity and high specificity prior to cycloplegia. The sensitivity and negative predictive value improved after induction of cycloplegia. Examiners should be aware of the effects of cycloplegia on their findings.

Sickle cell crisis as evaluated from measurements of hydroxybutyrate dehydrogenase and myoglobin in plasma.

Clinical Chemistry ◽

10.1093/clinchem/27.2.314 ◽

1981 ◽

Vol 27 (2) ◽

pp. 314-316 ◽

Cited By ~ 9

Author(s):

E F Roth ◽

P A Bardfeld ◽

S J Goldsmith ◽

E Radel ◽

J C Williams

Keyword(s):

Steady State ◽

Sickle Cell Disease ◽

Sickle Cell ◽

High Specificity ◽

Mean Value ◽

Cell Disease ◽

Sickle Cell Crisis ◽

The Mean ◽

Low Sensitivity ◽

Sickle Cell Crises

Abstract Data on plasma hydroxybutyrate dehydrogenase activity (I) and myoglobin concentration were used to evaluate painful sickle cell crises. I was increased during non-crisis steady state in patients with sickle cell disease as compared to normal values (232, SD 79.7 vs 85, SD 33 Sigma units/mL). During crisis, the mean value for I increased further to 379 (SD 139) Sigma units/mL. For 12 patients evaluated both during steady state and crisis, there was a mean increase in plasma I of 131% (SD 76%). Repeated determinations of I in sickle cell disease patients during several months while they were in steady state showed that baseline I varied by no more than 20% from the mean. Plasma myoglobin in patients with sickle cell disease was not above normal, but during crisis 21 of 39 patients tested had increased plasma myoglobin concentrations. Our data suggest that I may be a useful indicator of sickle cell crisis when the patient's own baseline value is available for comparison. Plasma myoglobin measurements give evidence of muscle damage during crisis with high specificity but low sensitivity.

Bolus Residue Scale: An Easy-to-Use and Reliable Videofluoroscopic Analysis Tool to Score Bolus Residue in Patients with Dysphagia

International Journal of Otolaryngology ◽

10.1155/2015/780197 ◽

2015 ◽

Vol 2015 ◽

pp. 1-7 ◽

Cited By ~ 11

Author(s):

Nathalie Rommel ◽

Charlotte Borgers ◽

Dirk Van Beckevoort ◽

Ann Goeleven ◽

Eddy Dejaeger ◽

...

Keyword(s):

Rating Scale ◽

Intraclass Correlation ◽

Correlation Coefficients ◽

Posterior Pharyngeal Wall ◽

High Specificity ◽

Analysis Tool ◽

Pharyngeal Wall ◽

Specificity And Sensitivity ◽

Low Sensitivity ◽

Background. We aimed to validate an easy-to-use videofluoroscopic analysis tool, the bolus residue scale (BRS), for detection and classification of pharyngeal retention in the valleculae, piriform sinuses, and/or the posterior pharyngeal wall.Methods. 50 randomly selected videofluoroscopic images of 10 mL swallows (recorded in 18 dysphagia patients and 8 controls) were analyzed by 4 experts and 6 nonexpert observers. A score from 1 to 6 was assigned according to the number of structures affected by residue. Inter- and intrarater reliabilities were assessed by calculation of intraclass correlation coefficients (ICCs) for expert and nonexpert observers. Sensitivity, specificity, and interrater agreement were analyzed for different BRS levels.Results. Intrarater reproducibility was almost perfect for experts (mean ICC 0.972) and ranged from substantial to almost perfect for nonexperts (mean ICC 0.835). Interjudge agreement of the experts ranged from substantial to almost perfect (mean ICC 0.780), but interrater reliability of nonexperts ranged from substantial to good (mean 0.719). BRS shows for experts a high specificity and sensitivity and for nonexperts a low sensitivity and high specificity.Conclusions. The BRS is a simple, easy-to-carry-out, and accessible rating scale to locate pharyngeal retention on videofluoroscopic images with a good specificity and reproducibility for observers of different expertise levels.