Arbetet utfördes på Södersjukhusets vuxenakut och utredde avdelningens tympaniska termometrar. Det finns två sorters tympaniska termometrar på vuxenakuten, Genius 2 från Philips och ThermoScan PRO 6000 från Braun. Genius 2 är uppkopplad till patientövervakningssystemet IntelliVue och ThermoScan PRO 6000 är mobil. Arbetet utfördes på förfrågan av Södersjukhuset då personalen på vuxenakuten var missnöjda med Genius 2-termometrarna, detta på grund av att de inte ansågs vara tillförlitliga. Arbetet ämnade att utreda orsaken till Genius 2-termometrarnas höga mätosäkerhet samt vad den generella bilden av termometern var hos personalen.  För att undersöka Genius 2-termometrarna och orsakerna till problematiken på vuxenakuten utfördes fyra olika moment. Utredningens första del började med intervjuer av vuxenakutens sjuksköterskor och undersköterskor. Målet med intervjuerna var att få en bild av problemet från personalens perspektiv för att sedan kunna undersöka problematiken med hjälp av kalibreringar och två termometertest. Del två av undersökningen gick ut på att kalibrera termometrarna för att säkerställa att de termometrar som deltog i termometertesten fungerade på ett korrekt sätt. Den tredje delen gick ut på att utföra två termometertest. Målet med det första termometertestet var att utreda variationen inom och mellan termometrarna Genius 2 och ThermoScanPRO 6000. I detta test var försökspersonerna och användarna densamma och termometrarna varierades. Målet med det andra termometertestet var att undersöka huruvida handhavandet påverkade mätvärdena. I detta test var försökspersonerna, en Genius 2-termometer och en ThermoScan PRO 6000-termometer densamma medan användaren varierades. Den sista delen av undersökningen gick ut på att utreda huruvida kalibreringen av Genius 2-termometrarna var hållbara ur ett tidsperspektiv. Termometrarna som en månad tidigare hade kalibrerats och fått ett godkänt resultat kalibrerades därför igen. Detta för att undersöka vilka termometrar som fortfarande fick ett godkänt resultat.  Resultatet påvisade att Genius 2-termometrarna har mycket större variation både inom och mellan termometrarna jämfört med ThermoScan PRO 6000. Variationen var dock inte så stor att det påverkade patientsäkerheten. Resultatet visade även att handhavandet påverkade mätvärdena och att delar av personalen utförde temperaturmätningar på ett mer komfortabelt sätt för patienten, detta gav också mätvärden som ansågs vara mer korrekta. Från resultatet framkom det att 20 % av termometrarna som tidigare hade klarat kalibreringen fick ett underkänt resultat när kalibreringen kontrollerades en månad senare. Detta innebär att Genius 2-termometern inte uppfyller de krav som finns för att säkerställa att den kan fungera på ett korrekt sätt. Tidigare nämnda resultat medför att personalen på vuxenakuten får arbeta med utrustning som inte lever upp till de förväntningar och krav som finns. Detta medför ineffektivitet, dubbelarbete och en minskad tillförlitlighet för Genius 2-termometern. Alla termometrar som fanns på vuxenakuten deltog inte i testerna och därför finns det behov av att vidare undersöka detta problem. / The investigation was done at Södersjukhuset’s emergency department where two types of tympanic thermometers were investigated. Genius 2 from Philips, which is connected to a patient monitor called IntelliVue and ThermoScan PRO 6000 from Braun, which is mobile. The investigation was done at the request of Södersjukhuset because the staff at the emergency department considered Genius 2 not to be reliable. The intent of the investigation was to determine the cause of Genius 2’s measurement uncertainty and to understand what the general opinion of the thermometer is among the employees.   The investigation began with interviews with nurses and assistant nurses. The goal was to get the general opinion and thereafter investigate the problems using calibrations and thermometer tests. After the interviews, all thermometers that were intended for the tests were calibrated. The calibrations were done to ensure that only working thermometers were included in the tests. The first thermometer test was intended to investigate the variation within and between the Genius 2 and ThermoScan PRO 6000 thermometers. The subjects and the users were constant while the thermometers were varied. The second thermometer test was intended to investigate whether the handling of the thermometers affected the measured values. In this test, the subjects, a Genius 2 thermometer and a ThermoScan PRO 6000 thermometer stayed the same while the user was varied. The last part of the investigation was intended to investigate whether the calibration of the Genius 2 thermometers was consistent after one month.  The results showed that Genius 2 had greater variation within and between the thermometers, compared to ThermoScan PRO 6000. However, the variation was not so great that it affects patient safety. The results also showed that the handling of the thermometers affects the results and that part of the staff were able to execute the temperature measurements in a more comfortable way for the patient. This gave measured values that were considered to be more accurate. The results showed that 20% of the thermometers that had previously undergone calibration failed when the calibration was redone a month later. This means that the Genius 2 thermometer does not meet the existing requirements to ensure that it functions properly. Not all thermometers were included in the investigation which is why our recommendation is to further investigate the problems.

Yes / Past studies have shown evidence of transfer of learning in action video games, less so in other types e.g. strategy games. Further, the transfer of learning from games to inhibitory control has yet to be examined from the perspectives of time constraint and logic contradiction. We examined the effect of strategy games (puzzle, turn-based strategy ‘TBS’, real-time strategy ‘RTS’) on inhibition (response inhibition and distractor inhibition) and cerebral hemispheric activation over four weeks. We predicted that compared to RTS, puzzle and TBS games would (1) improve response and distractor inhibition, and (2) increase cerebral hemispheric activation demonstrating increased inhibitory control. A total of 67 non-habitual video game players (Mage = 21.63 years old, SD = 2.12) played one of three games; puzzle (n = 19), TBS (n = 24) or RTS (n = 24) for four weeks on their smartphones. Participants completed three inhibition tasks, working memory (WM), and had their tympanic membrane temperature (TMT) taken from each ear before and after playing the games. Results showed that only the puzzle game group showed an improved response inhibition while controlling for WM. There were no significant changes in the distractor inhibition tasks. We also found that there was an increase in left TMT while playing RTS, suggesting the presence of increased impulsivity in RTS. Our findings suggest that puzzle games involving logical contradiction could improve response inhibition, showing potential as a tool for inhibition training. / Newton Fund Institutional Links grant ID: 331745333, under Newton-Ungku Omar Fund partnership. The grant is funded by the UK Department for Business, Energy and Industrial Strategy and Malaysian Industry-Government Group for High Technology (MIGHT) and delivered by the British Council / Research Development Fund Publication Prize Award winner, Dec 2021.

L'otite moyenne est une condition fréquente chez le veau et peut parfois être subclinique, rendant difficile son diagnostic à la ferme. L'objectif de cette étude est d’estimer la sensibilité et la spécificité de l'échographie des bulles tympaniques pour le diagnostic d'otite moyenne clinique et subclinique et de déterminer sa répétabilité. Quarante veaux âgés entre 19 et 50 jours ont été sélectionnés dans une ferme de veaux de grain, en fonction des résultats de l'échographie réalisée à la ferme (A). L'échographie a été réalisée une seconde fois par le même échographiste (A') et par un second échographiste (B), et le diagnostic noté pour chaque bulle tympanique comme étant négatif, suspect ou positif. Les images ont été enregistrées pour relecture et le diagnostic noté. Les veaux ont été euthanasiés, soumis en nécropsie et l'histologie a été utilisée comme méthode de référence. À l'histologie, 45 bulles tympaniques étaient atteintes d'otite moyenne et 35 bulles tympaniques étaient saines. Selon l'échographiste et la classification des bulles tympaniques suspectes, la sensibilité de l'échographie variait de 32% à 63% et la spécificité variait de 84% à 100%. La répétabilité était modérée, avec des valeurs de kappa de 0,53 entre A' et B, de 0,48 entre A et A', et de 0,58 et 0,75 pour la relecture de leurs images par A' et B respectivement. / Otitis media is a common disease in calves but can remain subclinical, making diagnosis challenging on the farm. The objective of this study is to estimate the sensitivity and specificity of the ultrasound imaging technique of tympanic bulla for the diagnosis of clinical and subclinical otitis media, and to determine its repeatability. Forty calves 19-50 days of age were selected from a veal calf farm, on the basis of results of ultrasound examination performed on the farm (A). Ultrasound examination was performed a second time by the same ultrasonographer (A') and by another ultrasonographer (B), and diagnosis was recorded for both tympanic bulla as negative, suspicious or positive. Images were recorded for further re-reading. Calves were euthanized and submitted for necropsy, and histopathologic diagnosis was used as gold standard. Based upon histology, 45 bullae were affected with otitis media and 35 bullae were unaffected. Depending on ultrasonographer and on classification of suspicious bullae, sensitivity varies from 32% to 63% and specificity varies from 84% to 100%. Repeatability is moderate, with kappa values of 0.53 for A'-B, 0.48 for A-A', and 0.58 and 0.75 for re-reading of A' and B, respectively.

Nos últimos anos, houve uma tendência na busca por substâncias reguladoras que pudessem otimizar o processo de cicatrização de membranas timpânicas (MTs) perfuradas. Objetivos: Determinar os efeitos da utilização da insulina tópica e da biomembrana de látex natural, de forma isolada e em associação, no processo de cicatrização de perfurações traumáticas de MTs. Materiais e Métodos: MTs de 61 ratos Wistar foram perfuradas nas porções anterior e posterior ao cabo do martelo. Os animais foram divididos em quatro grupos: Controle, Insulina, Látex e Insulina+Látex. No grupo Insulina, as perfurações foram tratadas com uso tópico de insulina regular. No grupo Látex, tratadas com biomembrana de látex natural. No grupo Insulina+Látex, tratadas com associação da insulina e da biomembrana de látex. As MTs foram avaliadas por técnicas histológicas com três, cinco e sete dias após sua perfuração traumática. Foram analisadas as morfometrias das espessuras das camadas epitelial, fibrosa e mucosa; tamanho da perfuração; área de secção transversal da MT; avaliação semiquantitativa e qualitativa da produção de colágeno por microscopia de polarização; e avaliação imuno-histoquímica das células epiteliais, dos miofibroblastos e da vascularização. Resultados: A insulina e a biomembrana de látex anteciparam o fechamento das perfurações traumáticas de MTs (p<0,01); estimularam precocemente o aumento da espessura da camada epitelial externa (p<0,01); promoveram aumento precoce da espessura da camada fibrosa (p<0,01); contribuíram para a maior identificação do anticorpo anti-panqueratina como marcador epitelial (p<0,05); aumentaram a marcação do anticorpo anti-alfa-actina de músculo liso (p<0,05), caracterizando maior proliferação de miofibroblastos. A insulina, isoladamente, provocou maior formação do colágeno tecidual (p<0,05), com fibras colágenas mais espessas e melhor organizadas (p<0,05). Conclusão: A insulina e a biomembrana de látex natural, de forma isolada e em associação, aceleraram o processo de cicatrização de perfurações traumáticas de MTs. / In recent years, there has been a tendency to search for regulatory substances that can optimize the healing process of perforated tympanic membranes (TMs). Objectives: To determine the effects of using topical insulin and natural latex biomembrane, alone or in combination, in the healing process of traumatic perforations of TMs. Methods: TMs of 61 Wistar rats were perforated in two sections, anterior and posterior to the malleus. The rats were divided into 4 groups: Control, Insulin, Latex, and Insulin+Latex. The Insulin group was treated with topical regular insulin. The Latex group was treated with natural latex biomembrane. The Insulin+Latex group was treated with a combination of insulin plus latex biomembrane. The TMs were histologically examined 3, 5, and 7 days post-perforation through morphometric analysis of the thickness of the epithelial, fibrous, and mucosal layers; size of the perforation; cross sectional area of the TM; semiquantitative and qualitative evaluation of the collagen production by polarization microscopy, and immunohistochemical evaluation of epithelial cells, myofibroblasts, and vascularization markers. Results: Insulin and latex biomembrane accelerated the healing process of the perforated TMs (p<0.01); stimulated early thickening of the outer epithelial layer (p<0.01); promoted premature increase in the thickness of the fibrous layer (p<0.01); contributed to a larger identification of anti-pankeratin antibody as epithelial marker (p<0.05); increased labeling of anti-alpha smooth muscle actin antibody (p<0.05), indicating greater proliferation of myofibroblasts. When insulin was used alone, it resulted in greater formation of collagen tissue (p<0.05), with thicker and better-organized collagen fibers (p<0.05). Conclusion: Insulin and natural latex biomembrane, used alone or in combination, accelerated the healing process of traumatic perforations of TMs.

No description available.

Otitis media (OM), one of the commonest of childhood diseases, causes much suffering. OM exists in a variety of forms, two of which are acute otitis media (AOM) and otitis media with effusion (OME). The clinical courses of these conditions differ, AOM usually presenting with earache, fever and/or aural discharge, and the OME usually with hearing impairment. The tympanic membrane (TM) mirrors the events in the middle ear cavity, and pars flaccida (PF) is the initial site of inflammatory changes in the TM. PF is rich in mast cells (MCs), which by releasing various mediators, may trigger TM inflammation. The aims of the present studies were to investigate early inflammatory changes in the TM in rat models of OM; after mast cell degranulation, in response to AOM, and OME, after myringotomy in AOM and in normal ears. Furthermore, we developed a new rat AOM model, that excludes surgical trauma and resembles the natural route of infection in man. AOM and OME elicited the first inflammatory response in PF of the TM. The response to OME was discrete, but a slight increase in macrophages was found. During the first 48 hours of AOM, the inflammatory response was intense, following a bimodal pattern. This reaction is similar to that found after MC degranulation. In AOM, macrophages were the predominant cell in PF, while in pars tensa (PT), polymorphonuclear cells (mainly neutrophils) predominated. When myringotomy was performed in AOM ears, the healing time was shorter than that of myringotomy in normal ears. The highly inflamed lamina propria seemed to promote healing. During early AOM, as well as following myringotomy, fibrin extravasates into PF and PT. This fibrin deposition may be involved in regulating the inflammatory response. Repeated nasal challenge with the otitis media pathogen Streptococcus pneumoniae provoked AOM and concomitant TM stimulation reduced the number of AOM cases. This new rat AOM model has the advantage of avoiding trauma in the middle ear cavity, while eliciting an intense inflammatory response in the middle ear cavity (MEC).

Myringotomy plays an important role in otological therapy. The procedure requires an efficient anesthesia, which can be obtained without general anesthesia. However, the use of local anesthetics on the tympanic membrane (TM) has been abandoned in many places, as general anesthesia has been readily available. In the present study the effects of some commonly used topical anesthetics on the TM structure and inner ear were tested in an animal model (rat and guinea pig).Four different anesthetic compounds—Xylocaine®, Bonain's liquid, phenol and Emla®—were applied to the TMs of the animals, which were sacrificed 10 minutes to 5 months after application. Morphological effects regarding time after treatment and number of applications were elucidated. At sacrifice the tissue was fixed and the TMs analysed by light microscopy (LM) and transmission electron microscopy (TEM). In nine animals phenol, Xylocaine® Spray or Emla® was applied to the round window niche and ABR recordings were made at 24 h to 6 months after exposure. After the final ABR evaluation the animals were sacrificed and the cochleae prepared for LM and scanning electron microscopy (SEM).On the TM phenol and Bonain's liquid caused instant destruction of the keratinizing stratified squamous epithelium followed by long-lasting hyperplasia of this epithelium and the underlying connective tissue. A pronounced hyperplasia of these two layers was also noted for the Xylocaine® Spray group, but without immediate destruction of the keratinizing epithelium. The extent of structural changes differed in relation to the extent of spreading of the agent. Emla® showed little, if any, sign of epithelial reaction and had no effect on the connective tissue. Regarding the inner ear Emla®, Xylocaine® Spray and phenol induced significantly impaired ABR thresholds mainly affecting the higher frequencies. However, the impaired ABR thresholds were reversible and at the end of the experiment there was no significant impairment compared to the control data. All agents, except Xylocaine®, damaged the hair cells in the basal part of the cochlea as shown by cytocochleogram and SEM analysis.Instant destruction of the epidermis seems to be necessary for an instant anesthetic effect. All agents caused profound connective tissue reactions. The manner of application, depending on the physical properties of the agent, determined the extent of the structural changes. The changes of the connective tissue were concentrated to the submucosal layer, which seems to be the area for reconstruction of the damaged TM. All agents caused functional inner ear changes. With the exception of Xylocaine® they also caused morphological alterations of the cochlea. The functional changes were partly reversible. Topical anesthetics applied to the TM should be used with caution and when used in an appropriate manner they can be considered safe, especially in an inflamed middle ear, with a thickened round window membrane, which should prevent the agents from reaching the inner ear structures. / digitalisering@umu

L'otite moyenne est une condition fréquente chez le veau et peut parfois être subclinique, rendant difficile son diagnostic à la ferme. L'objectif de cette étude est d’estimer la sensibilité et la spécificité de l'échographie des bulles tympaniques pour le diagnostic d'otite moyenne clinique et subclinique et de déterminer sa répétabilité. Quarante veaux âgés entre 19 et 50 jours ont été sélectionnés dans une ferme de veaux de grain, en fonction des résultats de l'échographie réalisée à la ferme (A). L'échographie a été réalisée une seconde fois par le même échographiste (A') et par un second échographiste (B), et le diagnostic noté pour chaque bulle tympanique comme étant négatif, suspect ou positif. Les images ont été enregistrées pour relecture et le diagnostic noté. Les veaux ont été euthanasiés, soumis en nécropsie et l'histologie a été utilisée comme méthode de référence. À l'histologie, 45 bulles tympaniques étaient atteintes d'otite moyenne et 35 bulles tympaniques étaient saines. Selon l'échographiste et la classification des bulles tympaniques suspectes, la sensibilité de l'échographie variait de 32% à 63% et la spécificité variait de 84% à 100%. La répétabilité était modérée, avec des valeurs de kappa de 0,53 entre A' et B, de 0,48 entre A et A', et de 0,58 et 0,75 pour la relecture de leurs images par A' et B respectivement. / Otitis media is a common disease in calves but can remain subclinical, making diagnosis challenging on the farm. The objective of this study is to estimate the sensitivity and specificity of the ultrasound imaging technique of tympanic bulla for the diagnosis of clinical and subclinical otitis media, and to determine its repeatability. Forty calves 19-50 days of age were selected from a veal calf farm, on the basis of results of ultrasound examination performed on the farm (A). Ultrasound examination was performed a second time by the same ultrasonographer (A') and by another ultrasonographer (B), and diagnosis was recorded for both tympanic bulla as negative, suspicious or positive. Images were recorded for further re-reading. Calves were euthanized and submitted for necropsy, and histopathologic diagnosis was used as gold standard. Based upon histology, 45 bullae were affected with otitis media and 35 bullae were unaffected. Depending on ultrasonographer and on classification of suspicious bullae, sensitivity varies from 32% to 63% and specificity varies from 84% to 100%. Repeatability is moderate, with kappa values of 0.53 for A'-B, 0.48 for A-A', and 0.58 and 0.75 for re-reading of A' and B, respectively.

In order to get a better insight into the function of the human middle ear it is necessary to simulate its dynamic behaviour by means of the finite-element method. Three-dimensional measurements of the surfaces of the tympanic membrane and of the auditory ossicles malleus, incus and stapes are carried out and geometrical models are created. On the basis of these data, finite-element models are constructed and the dynamic behaviour of the combinations tympanic membrane with malleus in its elastic suspensions and stapes with annular ligament is simulated. Natural frequencies and mode shapes are computed by modal analysis. These investigations showed that the ossicles can be treated as rigid bodies only in a restricted frequency range from 0 to 3.5 kHz. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

This paper presents a method of parameter identification for a finite-element model of the human middle ear. The parameter values are estimated using a characterization of the difference in natural frequencies and mode shapes of the tympanic membrane between the model and the specimens. Experimental results were obtained from temporal bone specimens under sound excitation (300–3,000 Hz). The first 3 modes of the tympanic membrane could be observed with a laser scanning vibrometer and were used to estimate the stiffness parameters for the orthotropic finite-element model of the eardrum. A further point of discussion is the parameter sensitivity and its implication for the identification process. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.