Helicoverpa spp. Helicoverpa armigera (Hübner) (Lepidoptera: Noctuidae) is a major pest of many legumes and cereal crops. Due to environmental and regulatory concerns, safe alternatives to broad spectrum chemical insecticides are needed for the control of key noctuid pests such as H. armigera. A strain of Beauveria bassiana  was evaluated for its ability to colonize endophytically in chickpea plants, and its effectiveness against second (L2) and fourth (L4) larval instars of H. armigera. B. bassiana was inoculated to chickpea plants through injection and endophytic establishment was confirmed by re-isolating the fungi from leaf samples. A detached leaf assay was used to evaluate pathogenicity. Bacillus thuringiensis was also applied to both larval stages through leaf dip method. In a novel approach, combined treatments of bacteria and endophytic fungi were compared with single-pathogen treatments. Relative to the single treatments, the combined pathogen treatments exhibited an increase in larval mortality, and decrease in pupation, adult emergence and egg eclosion. Specifically, synergistic effects on mortality were observed when larvae were exposed to simultaneous application of B. bassiana (1 × 108 conidia ml–1) with B. thuringiensis (0.75 μg ml−1). Both instars exhibited varying level of growth, development, frass production, diet consumption and fecundity when exposed to the chickpea leaves inoculated with endophytic B. bassiana and dipped with sub-lethal doses of B. thuringiensis. These findings indicate that the integrated application of endophytic colonized B. bassiana and B. thuringiensis can be effectively used against H. armigera.The members of family Noctuidae exist in diverse environments and many species from this group are of agriculture importance, particularly  Cicer arietinum L.) is an important, nutritive and inexpensive crop among the people of the developing world (Helicoverpa armigera (Hübner) (Lepidoptera: Noctuidae) is the most serious  Vuillemin  against different larval stages of lepidopterous insect pests have been recorded  is the production of secondary metabolites  (Lepidoptera: Gracillariidae) management in Indonesia, Malaysia and Philippines   . Endophya system .H. armigera are entomopathogenic bacteria from the genus Bacillus. These bacteria are key antagonists of numerous insect pests of economic importance in various cropping systems  (B. thuringiensis Berliner (Bt) are frequently used against a vast array of insect pests from the orders Coleoptera, Lepidoptera and Diptera etc; these bacteria exhibit a high degree of specificity toward the host and specific stage of the host  . Numerouthe host .B. bassiana and B. thuringiensis resulted in synergistic interactions against some insect species. Later, in another study, synergistic interactions between B. bassiana and B. thuringiensis were confirmed against Colorado potato beetle (Leptinotarsa decemlineata Say), which was consistent under varying environmental regimes  was cut from the center of the leaf with sterilized scissors followed by surface sterilization with 70% ethanol for 2 min followed by 2% sodium hypochlorite for 3 min and then 3 rinses in distilled water. Leaf pieces were dried on sterilized tissue paper and placed on Petri dishes containing 20 ml of Potato Dextrose Agar (PDA)  amended with chloramphenicol (50 μg ml–1), streptomycin sulfate (50 μg ml–1)  and 0.5 g L–1 of dodine (65%). After 14 days on the media plates, leaf pieces that exhibited fungal growth were transferred to glass tubes on Sabouraud Dextrose Agar (SDA)  media slants for storage and future use. The fungus was identified , 14 h Light: 10 h Dark photoperiod. Conidia from each plate were harvested by scraping with a sterilized scalpel, and conidial powder was dried and stored at 4°C until formulation and use. For experimentation, conidial powder was suspended in sterile distilled water containing 0.01% (v/v) Tween-80 . The conidia were dislodged into the suspension with a glass rod. The suspension was filtered through a double layer of sterile cheesecloth (mesh: 36 by 36 threads cm–2) to remove clumps of mycelia. The conidial suspension was poured into a sterile glass tube and vortexed for spore viability determination  for colonization were prepared in 0.01% Tween-80. Fifteen plants were selected for each replication and three replications were used for each treatment. Forty-day old chickpea plants were selected for injection; injections were made to the stem base with 1 ml of respective doses of fungal suspension using a sterile syringe. Control plants were injected with 1 ml of sterile water containing 0.01% Tween-80. The entire experiment was repeated three times.The B. thuringiensis isolate was obtained from the Microbial Control Laboratory collection  and was originally obtained from National Center for Genetic Engineering and Biotechnology (BIOTEC) in Thailand. This strain was then subjected to sporulation by culturing in 50 ml nutrient broth media. Harvesting of cultures was carried out by centrifugation at 6000 rpm for 15 min  and fourth (L4) instar larvae of H. armigera. Fifteen leaves from inoculated (three weeks earlier) and un-inoculated (control) plants were detached and offered to L2 and L4 instar H. armigera larvae. For B. thuringiensis treatments, three concentrations  were prepared. A piece of chickpea leaf (2 × 2 cm2) was immersed in respective doses of B. thuringiensis suspension for 60s and offered to the respective larval stages individually. The larvae were allowed to feed on treated leaves for 48 h and shifted to the artificial diet for rest of the period. In combined treatments B. bassiana inoculated leaves were immersed in respective doses of B. thuringiensis suspension for 60 s and then offered to the larvae. Mortality was recorded after every 48 h up to pupation for both larval instars. The larvae were prodded with a blunt needle and those unable to move in a coordinated manner were considered as dead (Bioassays were conducted to assess the endophytic efficacy of  as dead . From thB. bassiana (1 × 105 conidia ml–1) and B. thuringiensis  on developmental parameters viz. larval duration, larval weight, pre-pupal duration, pre-pupal weight, adult longevity  and adult weight  was recorded on L4 instar larvae of H. armigera. The sub-lethal doses were selected based on preliminary assays. A piece of endophytically colonized B. bassiana and B. thuringiensis were applied alone and in combination against L4 instar larvae and incubated at above mentioned conditions. The larvae were allowed to feed on treated leaves for 48 h and then shifted to the artificial diet for rest of the period. After pupation, the pupae were transferred to separate small plastic jars for adult emergence. The adults were fed on 10% honey solution. Adults were observed on daily basis and mortality was determined until the death of last adult. Each treatment consisted of 45 larvae with three replicates and the experiment was repeated thrice. The environmental conditions were set at 25°C and 65% RH and 14 h Light: 10 h Dark photoperiod inside the incubator.To determine the effect of sub-lethal doses of endophytic H. armigera (L6) were offered sub-lethal doses of endophytic B. bassiana (1 × 105 ml–1) and B. thuringiensis (0.20 μg ml–1). A piece of endophytically colonized chickpea leaf alone and in combination with B. thuringiensis was offered to the larvae. The larvae were allowed to feed on treated leaves for 48 h and then shifted to the artificial diet for rest of the period. Before exposing to the leaves each larva was weighed and transferred to a rearing vial. Every day until the larvae pupated or died, larvae were moved to new vials individually and provided with fresh diet every day. Frass produced during this period was separated from vials using the tip of a fine camel hair brush; the frass was then weighed. Diet left unused in each vial was recovered and dried in a drying oven at 80°C. Prior to the assay, diet in 30 cups was dried to obtain an estimate of the original dry weight. Diet consumption of each larva was determined by subtracting the weight after feeding from before. Moreover, total frass production and weight gain during this period were also determined.A new batch of 6th instar B. thuringiensis and B. bassiana was determined by CTF analysis; CTF = (Oc-Oe)/Oe × 100, where CTF is the co-toxicity factor, Oc is the observed mortality (%) in combined application, and Oe the expected mortality (%), that is the sum of individual mortality (%) encountered in each of the treatments used in the combination  but a non-significant interaction was recorded for instar × treatment   . A syners tested .B. bassiana and B. thuringiensis proved more fatal to both instars compared to single application of each agent. For instance, the highest mortality (77.40%) for L2 instar larvae was observed where simultaneous application of B. bassiana and B. thuringiensis (0.75 μg ml–1) was applied followed by 68.38% when treated with B. bassiana and B. thuringiensis (1.0 μg ml–1) and 49.07% when treated with B. bassiana (1 × 108 conidia ml–1) and B. thuringiensis (0.50 μg ml–1) (B. thuringiensis in integration with endophytic B. bassiana while an antagonistic effect was observed at highest dose of B. thuringiensis and endophytic B. bassiana (There were higher numbers of dead larvae observed when L2 instar exposed to the treatments than L4 instar larvae . The comμg ml–1) . Additivbassiana . A similB. thuringiensis increased  and endophytically colonized chickpea leaves, significant variation was recorded for all factors including incubation of egg period: F7, 71 = 45.4, P ≤ 0.05; larval duration: F7, 71 = 17.3, P ≤ 0.05; pre-pupal duration: F7, 71 = 30.70, P ≤ 0.05; pupal duration: F7, 71 = 21.90, P ≤ 0.05; total immature period: F7, 71 = 63.1, P ≤ 0.05; pre-oviposition period: F7, 71 = 10.8, P ≤ 0.05; oviposition period: F7, 71 = 36.4, P ≤ 0.05; post-oviposition period: F7, 71 = 16.0, P ≤ 0.05; daily fecundity: F7, 71 = 214.0, P ≤ 0.05; total fecundity l: F7, 71 = 1902.0, P ≤ 0.05; adult longevity: . Overall, incubation of eggs, larval, pre-pupal period, pupal duration, total immature period and pre-oviposition period increased as the dose rate of B. thuringiensis application increased, and these parameters tended to be shorter for the combine treatments than the individual treatments ; diet consumption was lower in combined treatments compared with sole applications. Diet consumption was the lowest for the endophytic B. bassiana and B. thuringiensis while the highest consumption was recorded in the control treatment . More frass production was recorded during the initial days of treatments and gradually decreased to zero before pupation. On the other hand, the highest level of frass production was found in non-treated larvae .Diet consumption by 6th instar larvae was significantly influenced by the treatments  has also been studied  Osbeck plants as indicated through systemic colonization of the various citrus plant parts i.e., leaves, stems and roots by BB Fafu-13 strain. Endophytic B. bassiana induced 10% to 15% mortality within 7 days of exposure when adult psyllids that were allowed to feed on the leaves of treated plants, and there was no mycosis detected on any of the dead psyllids  cell line (50 633 ppm)  . Feng etBacillus thuringiensis toxins have also been found to be lethal to a vast array of insect pests belonging to the orders Coleoptera, Diptera, and Lepidoptera  and B. thuringiensis (Bt-k) were sprayed on potatoes to protect against L. decemlineata. Identical findings with dual applications of B. thuringiensis and B. bassiana were also reported in the same host by B. thuringiensis and B. bassiana with synthetic insecticides  and HaCPV, respectively. In the larval development assay, our findings indicated toxic effects of the pathogen as indicated by decreased frass production. These findings corroborate those of Trichoplusia ni were reported with the increase of treatment concentrations . Our laboratory findings of efficacy must be extended to field conditions in future research. Also, this novel approach of combining endophytic fungi with other microbial control applications should be investigated in other pest and cropping systems. This paper is fundamental and meant as proof of concept. As far as practical use, other methods for inoculating the plants with B. bassiana (such as foliar spray or seed dressing etc.) can be used on a larger scale.This study provides evidence from the laboratory that combining All datasets generated for this study are included in the article/supplementary material.WW conceived and designed research. MT and WW conducted experiments. MT, DS-I, and WW analyzed data and wrote the manuscript. WW, DS-I and AA-S edited and finalized the manuscript. All authors read and approved the manuscript.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


Age-related hearing loss (ARHL), also known as presbycusis, is a chronic disorder characterized by impairment of the transduction of acoustic signals. This study analysed the prevalence and demographic characteristics of ARHL in the Korean population.We used the data from the Korea National Health and Nutrition Examination Survey (KNHANES) from 2009 to 2012 and analysed the association between age and hearing impairment. A total of 16,799 adults were selected for the current study. Physical examinations, blood tests, otoscopic examinations, and hearing tests were performed. The demographic variables included age, gender, obesity, economic status, education level, noise exposure history, and underlying diseases.Among 16,799 participants, the prevalence of unilateral hearing loss was 8% , and bilateral hearing loss was 5.9% (989 people). Men were 53.4% more likely to have hearing loss than women. Age and underlying diseases, like hypertension, diabetes, and abdominal obesity, were significantly associated with hearing loss (P < 0.0001). Further, mental health factors, such as cognitive function, depression, and suicidal ideation, were related to hearing loss. The prevalence of hearing loss increased with advancing years, especially in the high frequency of 6 kHz, with a sharply increase in patients aged 65 and over.The analysis of auditory performance in the Korean population confirmed the association of high-frequency hearing loss with advancing age. A threshold of 6 kHz should be included to correctly diagnose hearing impairment in elderly patients. Patients with ARHL should be provided with suitable aural rehabilitation that includes active high-frequency control. Age-related hearing loss (ARHL), also known as presbycusis, is a chronic disorder characterized by impairment of the transduction of acoustic signals. As the auditory organ ages, poor sound discrimination occurs due to increases in the hearing threshold and decreases in central nervous system processing . MultiplARHL especially misses higher-pitched consonant sounds like /s/, /t/ or /f/ and usually shows symmetrical sensory neural hearing loss of high frequencies, which affects understanding in noise. Difficulty hearing in noise is one of the first signs of sensory neural hearing loss . The chiIn the United States, hearing impairment, which is experienced by 13% of the total population, was reported to be age-related . AccordiThis study analysed the prevalence and demographic characteristics of ARHL in the Korean population using data from the Korea National Health and Nutrition Examination Survey (KNHANES) 2009–2012.https://knhanes.cdc.go.kr/knhanes/eng/index.do). The KNHANES annual reports from 1998 to currently 2018 are available in the website, and raw data are also available on request.The KNHANES data, which is a national surveillance system that has been providing the health and nutritional status of Koreans since 1998 was analysed retrospectively. Based on the National Health Promotion Act, the surveys have been conducted by the Korea Centers for Disease Control and Prevention (KCDC) . The surKNHANES data from 2009 to 2012 were used for the current study to estimate the association between age and hearing impairment. A total of 16,799 adults were selected, and those under 19 years old were excluded. Physical examination data, such as body mass index (BMI), and blood, otoscopic, and hearing test  results were collected. The demographic variables included age, gender, obesity, income, education level, noise exposure, and known underlying diseases, such as hypertension, diabetes mellitus, and depressive disorders. Audiometric social hearing loss was defined as average pure tone thresholds of greater than 25 dB in the better-hearing ear at 0.5, 1, 2, and 4 kHz.Statistical analyses were performed using SAS version 9.4 . T-test was used for continuous variables and chi-square test was used for categorical variables. A p-value less than 0.0001 was deemed to indicate statistical significance.The data of KHANES was obtained with the written informed consent from all participants prior to the survey. Based on the National Health Promotion Act, the surveys have been conducted by the Korea Centers for Disease Control and Prevention (KCDC), and anonymised raw data are provided to the researchers under request. This study was carried out in accordance with the Declaration of Helsinki on biomedical research for human subjects and was approved by the Institutional Review Board of Seoul St. Mary’s hospital .Among 16,799 participants, the prevalence of unilateral hearing loss was 8.2% , and bilateral hearing loss was 5.3% (883). Mild hearing impairment (26–40 dB) was present in 51.7% (784) of the participants with unilateral hearing loss. Moderate hearing impairment (41–70 dB) was present in 86.8% (762) of the participants, whereas severe hearing impairment (> 70 dB) was present in 13.2% (121) of the participants with bilateral hearing loss.P < 0.0001).The characteristics of the study participants were shown in The pure tone average in the better ear of the participants of each age showed a curved to linear graph over all frequencies  . As showHearing loss is known to be highly dominant among people older than 70 years , 9; 15% In Korea, the statistical annual report from the Ministry of Health and Welfare in 2000 reported that 7.2% of people over age 65 had a hearing impairment. This report also predicted the prevalence to be 13.2% in 2020. However, our study, which was based on the KNHANES 2009–2012 data, showed that the prevalence of hearing impairment had already surpassed the expectation. As shown in P < 0.0001). Other previous reports also suggested that the duration and severity of diabetes were possible significant predictors of hearing impairment. Bilateral sensory neural hearing loss was a complication associated with type 2 diabetes mellitus [The demographic data of the KNHANES showed several characteristics related to hearing impairment . Diabetemellitus . Systolimellitus . Since hSeveral studies have shown that smoking increased the prevalence of hearing loss –17. UnexThis study has a limitation in that the data did not reflect the latest 5 year survey result. The Database of Korea National Health and Nutrition Examination Survey (KNHANES) has been performed since 1998. However, hearing test was first included as a health examination component since 2008. We excluded the data of the first year, and the data of next three years were analyzed (2009–2012). Currently, the raw data of 2018 was released in May, 2020. In future study, it will be better to include the latest survey result from 2013 to 2018 to analyze a decade survey of Korean hearing test (2009~2018).Hearing impairment negatively impacts the quality of life, especially the social and emotional aspects of communication. However, people, especially those of old ages, often think of it as an inevitable aging phenomenon and do not readily undergo medical examinations. According to the National Center for Health Statistics report in 2010, only 41% of US adults aged 70 years and older reported having had a hearing examination in the past five years . Since tAge-related hearing loss (ARHL) is a major disease that affects the quality of life of elderly people. The analysis of the auditory performance in the Korean population indicated the importance of high-frequency hearing loss in the elderly. People who are with risk for hearing loss should undergo frequent screening for hearing impairment. We also emphasize the necessity of early proper aural rehabilitation that includes hearing aids, with active frequency control for elderly patients with hearing impairment.


Derivatives of the vitamin riboflavin, FAD and FMN, are essential cofactors in a multitude of bio-energetic reactions, indispensable for lipid metabolism and also are requisites in mitigating oxidative stress. Given that a balance between all these processes contributes to the maintenance of retinal homeostasis, effective regulation of riboflavin levels in the retina is paramount. However, various genetic and dietary factors have brought to fore pathological conditions that co-occur with a suboptimal level of flavins in the retina. Our focus in this review is to, comprehensively summarize all the possible metabolic and oxidative reactions which have been implicated in various retinal pathologies and to highlight the contribution flavins may have played in these. Recent research has found a sensitive method of measuring flavins in both diseased and healthy retina, presence of a novel flavin binding protein exclusively expressed in the retina, and the presence of flavin specific transporters in both the inner and outer blood-retina barriers. In light of these exciting findings, it is even more imperative to shift our focus on how the retina regulates its flavin homeostasis and what happens when this is disrupted. The water-soluble vitamin, riboflavin  was first isolated in 1879 from milk whey and purified as orange-yellow crystals. Subsequently, since Eijkman’s Nobel Prize-winning work in 1929, vitamins and their biological implications have become a matter of great interest to both biochemists and clinicians alike. As a vitamin, riboflavin is especially essential for human health due to its vast involvement in the bioenergetics, metabolism, growth, and survival of all cells . So, theSLC52A2, a brain-specific riboflavin transporter. Following this discovery, she was immediately administered high-dose riboflavin therapy (10–70 mg/kg) and within 2–4 weeks of the treatment, most of her symptoms subsided  is constituted of a ribitil side chain attached to an isoalloxazine ring, which is a benzene ring attached to a pteridine ring system . The pre+/NADH). Being tricyclic gives flavins the ability to efficiently function as a transformer between electron donors and electron acceptors while the central dihydropyrazine ring of dihydroflavins is highly reactive to molecular oxygen, thus acting as a cofactor for reduction of molecular oxygen to hydrogen peroxide and also for reductive activity of monooxygenation reactions  to GSSG (oxidized form). Glutathione reductase (GR), the enzyme that restores intracellular GSH (reduced form) levels by reducing GSSG (oxidized form) in an NADPH-mediated reaction, utilizes FAD as a cofactor  and the RPE together comprise the retina, which is one of the hotspots of highly reactive species in the whole body. The extremely high metabolic state of this tissue coupled with the high rate of oxygen consumption and the presence of multiple highly reactive phototransduction intermediates makes the retina vulnerable to various oxidative reactions. Thus, it is not surprising that to maintain homeostasis, the retina has developed an efficient system that counts on the ready availability of multiple electron acceptors and free radical scavengers. This is probably one of the reasons why both FAD and FMN are so highly enriched in the NR and the RPE . The whocofactor . Imbalancofactor . GSH depcofactor . Absencecofactor . That ricofactor . If GSH cofactor . This hacofactor , b. The cofactor .2O2 in the mitochondrial matrix and can significantly contribute to oxidative stress , which is an e retina . Surprise retina . This isnditions . Thus, t8 ATP molecules per sec. The most dominant energy consumption is due to the ion fluxes associated with phototransduction and synaptic transmission. During daylight, the energy consumption drops by >75% due to perhaps inhibition of the dark response. The authors also showed that the cones are more energy consuming than rods  in each tissue is determined by the metabolic demands of the tissue . HepaticThe animal flavoproteome known so far can be widely divided into two types: One type is the coenzyme form of flavin derivatives binding to apoproteins either by covalent or noncovalent bonds . ExampleIn a comprehensive review, Lienhart provides a detailed report on the human flavoproteome . The autAmong all the flavoproteins, the mammalian retinal Rtbdn is unique. Rtbdn has the highest sequence homology to RBP of the chicken egg . In mammBlindness is reportedly the disease that can be caused by the most diverse set of gene mutations than any other disease known . MutatioThe absence of Rtbdn also leads to a reduction in NR’s flavin levels, which corresponds with retinal degeneration . Most inPutting all the research into perspective, it seems very important to look at both: (1) the role of flavin homeostasis in retinal physiology as well as (2) the role of flavin homeostasis in retinal pathologies, especially those where metabolic vulnerability and oxidative stress susceptibility is involved. One of the tools available to us to assess the role of flavins in retinal homeostasis is the Rtbdn knockout model . The preTS, MN, and MA-U contributed to writing and editing the manuscript. All authors contributed to the article and approved the submitted version.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


We studied telocytes/CD34+ stromal cells in the normal and pathological peripheral nervous system (PNS), for which we reviewed the literature and contributed our observations under light and electron microscopy in this field. We consider the following aspects: (A) general characteristics of telocytes and the terminology used for these cells  in PNS; (B) the presence, characteristics and arrangement of telocytes in the normal PNS, including (i) nerve epi-perineurium and endoneurium ; (ii) sensory nerve endings ; (iii) ganglia; and (iv) the intestinal autonomic nervous system; (C) the telocytes in the pathologic PNS, encompassing (i) hyperplastic neurogenic processes , highly demonstrative of telocyte characteristics and relations, (ii) PNS tumours, such as neurofibroma, schwannoma, granular cell tumour and nerve sheath myxoma, and interstitial cell of Cajal-related gastrointestinal stromal tumour (GIST), (iii) tumour-invaded nerves and (iv) traumatic, metabolic, degenerative or genetic neuropathies, in which there are fewer studies on telocytes, e.g., neuroinflammation and nerves in undescended testicles (cryptorchidism), Klinefelter syndrome, crush injury, mucopolysaccharidosis II (Hunter’s syndrome) and Charcot–Marie–Tooth disease. Telocytes (TCs), located in the interstitium of many tissues, were described by Popescu and Faussone-Pellegrini in 2010 . TCs areIn the peripheral nervous system, TCs have been termed endoneurial stromal cells, endoneurial fibroblasts, endoneurial fibroblast-like cells, capsular fibroblasts, CD34+ endoneurial cells, dendritic endoneurial cells, endoneurial mesenchymal cells, nerve mesenchymal precursor-like cells and so forth. However, among other procedures, ultrastructural studies have clearly demonstrated that TCs are different from fibroblasts ,2,3. LikIn this section, we considered the presence and characteristics of TCs (TCs/CD34+SCs) in nerves, nerve fibres, free nerve endings, some sensory receptors, with and without specific structures, ganglia and the autonomic nervous system in the digestive tract.In nerves, TCs (TCs/CD34+SCs) are located in the endoneurium  , althougTCs (TCs/CD34+SCs) can be observed in some free nerve endings and in non-encapsulated and encapsulated sensory corpuscles.The spatial relationship of TCs with nerve endings has been described in numerous locations ,59,60,61In Meissner corpuscles, TCs (TCs/CD34+SCs) form a complete or incomplete capsule A. Glut-1In Pacinian corpuscles, TCs (TCs/CD34+SCs) are arranged in a thin layer around the Schwann cells that surrounds the central axon. For García-Piqueras et al., 2017 , this laIn neuromuscular spindles, TCs (TCs/CD34+SCs) are observed in the internal and external capsules . In the TCs have been described in the human trigeminal ganglion in close vicinity to microvessels and nerve fibres around the neural–glial units ,65. We aThe digestive tract  is an ideal anatomic region to understand TC characteristics, arrangement and functions ,70,71,72TCs (TCs/CD34+SCs) participate in most pathological processes of the peripheral nervous system since they are an important part of its sheaths and interrelate with the other cellular components. TC (TCs/CD34+SCs) participation is generally reactive and can be extremely intense. They may therefore become one of the predominant cells in the lesion, as occurs in hyperplastic neurogenic processes and in some tumours of the peripheral nervous system. First of all, we will consider some morphologic variants of the hyperplastic neurogenic lesions, which show their reactive behaviour, as well as their homo and heterocellular relationships . Then, we will examine tumours of the peripheral nervous system, in which TCs/CD34+SCs have an important role, and in tumour-invaded nerves. Finally, we contribute some examples of neuropathies in which TCs/CD34+SCs participate.In this section, we consider two examples of processes with neurogenic hyperplasia: appendiceal neuropathies and neural proliferation in the gallbladder. The first is highly demonstrative of the local hyperplasia of the autonomic nervous system and the second of the changes in nerves, which are increased in number and size (increased nerve area), and neurogenic hyperplasia in the different layers of the gallbladder. In appendiceal nerve lesions, including neurogenic appendicopathy , neurofibromatosis, ganglioneuroma and gangliocytic paraganglioma ,79,80,81Hyperplasia of most components of the autonomic nervous system is observed in these appendiceal neuropathies, including nerve fibres , Schwann cells, neurons and TCs. Vessels, adipocytes, smooth muscle cells and inflammatory/immunitary cells associated with these components. Generally, TCs/CD34+SCs are observed in high numbers and with numerous processes, resulting in a demonstrative morphology. They show a triangular or spindle body with a small somatic cytoplasm, which may be increased, and slender moniliform telopodes. TCs/CD34+SCs form labyrinthine systems—sometimes very intricate—in which they connect with each other or with other tissue components. Thus, TC/CD34+SC telopodes extend and surround independent nerve fibres (around Schwann cells) or small groups of them, isolated neurons between the nerve fibres or forming groups, smooth muscle cells of the muscularis mucosae and lamina propria, adipocytes, varying sized vessels and macrophages or other inflammatory/immune cells. Frequently, telopodes of the same cell are observed extending to different structures . The increased appendiceal nerves also present numerous TCs/CD34+SCs arranged in the epineural layer and within the nerve, delimiting nerve fascicles or nerve fibres.The aforementioned findings are well demonstrated in double-immunostaining   non-pubA–H. TCs/In some cases of uncomplicated symptomatic gallstone disease, nerves can increase in number and size . LikewisAn important population of TCs/CD34+SCs is present in neurofibromas, together with the remaining cellular components of the nerve  and mast cells. In all the variants of neurofibroma, including localized, diffuse and plexiform types, double staining shows that the number of TCs/CD34+SCs can be higher than the number of Schwann cells. In neurofibromas , TCs/CD3In the plexiform type of neurofibroma, the myxoid deposits can be prominent E, and TCFor the CD34+ cells in neurofibromas and in Antoni B zones of neurilemoma, some authors use the term ‘ameboid dendritic CD34+ cells’ . CD34 exTCs/CD34+SCs are observed in Antoni B zones of schwannomas and have been described in this location as endoneurial fibroblasts or CD34-positive fibroblasts ,88,89. TIn the granular cell tumour , which originates from Schwann cells, TCs/CD34+SCs are observed in light and electron microscopy D,F,G, suTCs/CD34+SCs are described as an associated, reactive component in nerve sheath myxoma, considered either a myxoid/hypocellular variant of neurothekeoma  or a disGISTs frequently express C117 (kit protein) F and CD3We have observed a marked reactive response of TCs/CD34+SCs in nerves with perineural invasion by adenocarcinomas (non-published observation). Thus, TCs/CD34+SCs within and around the invaded nerves appear increased in number and size A. The reIn the peripheral nervous system, TCs/CD34+SCs can play a role in processes other than those outlined above, including inflammatory, traumatic, metabolic, immunologic and genetic nerve diseases. In these processes, the relationship between Schwann cells/myelin, axons, macrophages and endoneurial TCs is important, especially the membrane-bound and soluble signalling ,104. BelIn compressed nerves, we observed TCs with lipid droplets around modified nerve fibres C. HoweveWe have reviewed the current state of knowledge about the presence, characteristics and arrangement of TCs/CD34+stromal cells in the normal and pathological peripheral nervous system (PNS), including light and electron microscopic studies in nerves, sensory nerve endings, ganglia and the intestinal autonomic nervous system, as well as in PNS tumoural and non-tumoural diseases. Further studies are required on TCs in other pathological processes of PNS, mainly in inflammatory, immunologic and genetic nerve diseases, in which intercellular communication between TCs, Schwann cells, macrophages, mast cells and lymphocytes can have an important role.


The lack of mothers’ understanding and information can increase their anxiety and lead to unhealthy behaviors, such as pacifier-use, in their children.This study aimed to perform pathway analysis of pacifier use by children whose mothers were hearing impaired or had normal hearing.A cross-sectional study was conducted with 116 Brazilian mothers . Mothers were interviewed about socioeconomic factors and their children’s pacifier use habits. They also completed the deaf or hearing versions of the Brazilian Beck Anxiety Inventory. The pathway analysis was used to determine the effects of different variables in the two groups.P=0.005), bottle-feeding use (P=0.004), and mothers who had maternity leave (P=0.004). The child pacifier use pathway among mothers who were deaf was associated with premature birth (P=0.025) and a short duration of pacifier use (P=0.005). Mothers who were deaf were also more anxious than those who have normal hearing (P=0.002).The child pacifier use pathway among hearing mothers was associated with a long duration of pacifier use (Children of normal hearing mothers used a pacifier for a longer duration than the children of mothers who were deaf. Time of pacifier use was also directly affected by bottle-feeding and maternity leave.These findings provide important information about the cultural path of pacifier use taken by families that had members with and without hearing impairment. There are nearly 360 million people worldwide with hearing impairment and they may experience problems with gaining access to healthcare facilities due to communication barriers . HealthcThe relationship between a mother and child is very important, as the mother is the main caregiver who influences the habits that are established in her children . AnxietyCommunication in response to a child’s crying clearly differs between the mother who is deaf when compared with the reaction of a mother with normal hearing -8. MotheThe presence of one or more people with hearing impairment in a family leads to specific language and communication behaviors. Families with a person who is deaf develop specific forms of nonverbal communication, such as eye contact and touch ,7. Babiest year of life and can persist throughout childhood. These habits occur in both families with hearing impairment or have normal hearing [Non-nutritive suckling habits are common behaviors in the 1 hearing . Pacifie hearing . This ha hearing -12. In c hearing . Up to nThis cross-sectional study included 116 pairs of mothers and their children (2-5 years old) from Belo Horizonte, Brazil. This study consisted of two groups to be compared: Group 1 (G1) that included 29 pairs of mothers with hearing impairment and their children and Group 2 (G2) that included 87 pairs of normal-hearing mothers and their children. Data were collected from December 2017 to October 2018. The study was approved by the Research Ethics Committee of the Federal University of Minas Gerais (protocol 49803115.4.0000.5149). Mothers who agreed to participate signed a term of free and informed consent.Mothers with hearing impairment were recruited from a referral center for individuals with hearing impairment in the city of Belo Horizonte. This center had 250 registered adolescents and adults with hearing impairment, of whom 40% were female. We invited all mothers with hearing impairment and their children to take part in the study. Normal-hearing mothers were recruited from two public day-care centers in Belo Horizonte.In the pilot study, these methods were tested with 10 mothers with hearing impairment and 10 normal-hearing mothers of children enrolled at public schools. The pilot study showed that the methods and questionnaires proposed for the main study did not need to be changed.http://powerandsamplesize.com/). In the pilot study, the prevalence of the pacifier-sucking habit among children of mothers with hearing impairment was 40%, and the prevalence among children of normal-hearing mothers was 80%. We considered a 95% confidence level and 95% power. To achieve these values, the final sample was estimated to be 26 mothers with hearing impairment and 78 normal-hearing mothers . To compensate for possible losses, 10% was added, and the final sample size consisted of 29 mothers with hearing impairment and 87 normal-hearing mothers.Due to the specificity of the sample, an estimation of the sample size needed for the main study was based on pacifier-sucking prevalence among children evaluated in the pilot study. For this purpose, we used online software from the Power Sample website , illiterate normal-hearing mothers, mothers with children with compromised systemic health conditions, physical and/or mental disabilities, or developmental/behavioral disorders .Data were collected by means of mothers’ self-reports obtained using a structured questionnaire. The interviews were performed by trained researchers and administered in an identical manner to mothers with hearing impairment or had normal hearing. The speech therapist specialized in BSL, collected data from deaf mothers (RFN). A deaf mother with higher education, literate in BSL, previously trained the speech therapist (RFN) was asked to adapt the dental terms used in the interview. This mother was not included in the data collection. We contacted normal-hearing mothers through day-care centers. After a telephone call, the mothers and children were visited at their homes. The mothers’ data were collected by answering the self-reporting questionnaires. Similarly, we contacted the mothers with hearing impairment through the referral center. First, we contacted mothers with hearing impairment either by WhatsApp or cellphone messaging. We then visited the mothers with hearing impairment and their children at their homes. Mothers with hearing impairment answered the self-reporting questionnaires. The primary researcher performed data collection with the aid of a research assistant who was a specialist in both speech therapy and BSL.The following variables were collected by means of the questionnaires completed by mothers.The demographic variables were child’s sex  and age of child and mother stated in years.A mother’s level of schooling was assessed by the number of years of schooling. Based on the median value , educational levels were categorized as either <11 years of schooling or ≥11 years of schooling.Household income was categorized in terms of the Brazilian monthly minimum wage (BMMW), which corresponded to US$235.00 for all economically active members of the family at the time of data collection. Based on the median, the family BMMW income was categorized as either ≤2 BMMW or >2 BMMW.As regards the variable of employment, the mother informed whether she worked outside the home or not.The habit of pacifier sucking beyond the age of 2 years reduces the likelihood of spontaneous correction of malocclusion . TherefoThe mother was asked whether the child had received exclusive breastfeeding (yes/no) and if she/he was using a bottle (yes/no).The mother was asked whether she had maternity leave and whether the child was born prematurely (yes/no).All mothers self-reported anxiety symptoms using the Brazilian version of the Beck Anxiety Inventory (BAI) . MothersThe BAI used a self-reported scale that aimed to assess the intensity of anxiety symptoms, differentiating the emotional symptoms from physical symptoms. This tool consisted of 21 items, such as “unable to relax, unsteady, nervous, afraid, heart pounding, fear of losing control, and indigestion,” among others. The response options ranged from 0 (absolutely not) to 3 (severe). The overall score could range from 0 to a had a severe level of anxiety ,17.The data were descriptively analyzed as either the frequency or the mean and SD for categorical and continuous variables, respectively. To verify any associations with pacifier use, we performed a pathway analysis using only the variables observed. The theoretical framework for this was based on a previous study . This tyP-values >0.40 for the final model. We considered the statistical significance when P-values were lower than 0.05. We kept the other associations in the model for goodness-of-fit reasons  and global-fit indices. The SC values can be negative or positive, indicating the relational direction between variables. Values for an acceptable global fit were the root mean square error of approximation value <0.07, the standardized root mean square residual value <0.08, and Comparative Fit Index and Tucker-Lewis Index values >0.95 . We ran  reasons .The referral center for individuals with hearing impairment had 100 women registered, 34 of whom met the eligibility criteria. Five mothers with hearing impairment (14.7%) declined to participate. Of the 129 normal-hearing mothers contacted at the public day-care centers, 42 (32%) refused to receive home visits, and 87 (68%) agreed to participate in the study.SC=0.377, P=0.004), with children of normal-hearing mothers  and with mothers who had maternity leave .SC=−0.378, P < 0.001), and these factors were associated with premature birth . Premature birth was more prevalent among the children of mothers with hearing impairment . Mothers with hearing impairment were also associated with higher anxiety scores . Duration of pacifier use was lower among the children of the mothers with hearing impairment  and a higher level of education . Lower family income, in turn, was associated with mothers with hearing impairment . Older mothers had a higher level of education . Moreover, mothers who did work outside the home had a higher level of education .Maternity leave was associated with higher family income (The children of normal-hearing mothers used pacifiers for a longer period of duration than the children of mothers with hearing impairment. Normal-hearing mothers may have provided pacifiers more frequently to stop the discomfort of hearing their babies cry and for reassurance. A baby’s crying can cause exhaustion and fatigue in parents, which may ultimately lead to marital conflict . Since aMothers with hearing impairment had a higher rate of premature deliveries than normal-hearing mothers. A study conducted in the US found similar results . A natioWe found that mothers with hearing impairment were more anxious than normal-hearing mothers. An American study with 1704 adults with hearing impairment and 3287 normal-hearing adults found that adults with hearing impairment had a higher reported rate of depression or anxiety disorder compared to normal-hearing individuals . People The duration of pacifier use was associated with bottle-feeding and the use of a bottle was associated with the absence of exclusive breastfeeding . A studyLower family income was associated with mothers with hearing impairment, and other studies have confirmed associations between low income and the community of individuals with hearing impairment -32. LimiThis is the first study of a pacifier pathway analysis between mothers with hearing impairment and normal-hearing mothers. It provided important insight into the children’s oral habits and how hearing loss could be related to these factors. The findings of this study led to the reflection that the mother’s understanding of her children’s crying had a strong influence on the duration of use of the pacifier. Although the number of mothers with hearing impairment in the study was small due to the low prevalence of the deaf population , it met We concluded that children of normal-hearing mothers used pacifiers for longer periods of duration than the children of mothers with hearing impairment. The time of pacifier use was also influenced by bottle-feeding and maternity leave. In addition, premature children and high levels of anxiety were observed more frequently among mothers with hearing impairment.These findings provided important information about the cultural pathway of pacifier use taken by families that had members with and without hearing impairment. It was noteworthy that the mother was shown to be an important caregiver regarding the health of her children. The effect of limited communication between health professionals and patients during prenatal care could affect the health of both mothers and their children. Future studies should be encouraged, and public policies should be implemented with a focus on the inclusion of mothers with hearing impairment. This study provided a new perspective on prolonged pacifier use in children of mothers with normal hearing in comparison with mothers with hearing impairment.


Human immunodeficiency virus-positive (HIV+) individuals can experience a decrease in antioxidants. Such deficiency can make inner ear cells and synapses more vulnerable to oxidative stress, resulting in auditory alterations, even in the presence of normal thresholds. This study aims to compare the audiological findings of HIV+ patients  to those of healthy individuals.This was a cross-sectional observational study, comprising 42 normal-hearing adults divided into the Control Group (CG), without HIV; Group I (GI), HIV+, without exposure to the highly active anti-retroviral therapy (HAART); Group II (GII), HIV+, with exposure to HAART. All participants underwent conventional audiometry (0.25-8 kHz), high-frequency audiometry (9-20 kHz), transient evoked otoacoustic emissions (TEOAEs), efferent auditory pathway’s inhibitory effect assessment, brainstem auditory evoked potentials (BAEPs), and cognitive potential (P300).In the comparison of the hearing thresholds between the groups, there was a statistically significant difference for most of the frequencies assessed (GII presented hearing thresholds significantly poor when compared with other groups). The presence of TEOAE and the inhibitory effect was also verified in a significantly higher number of individuals in the CG than in the other groups. As for the BAEP, there was a statistically significant difference for the interpeak intervals I-V . For P300, there were no statistically significant differences.Normal-hearing HIV+ individuals (with and without exposure to HAART) presented with poor performance in the audiological procedures, suggesting the presence of auditory alterations even in the presence of normal-hearing thresholds. Acquired immunodeficiency syndrome (AIDS) is caused by the human immunodeficiency virus (HIV), a specific type of retrovirus that affects the immune system, possibly leading to various opportunistic infections and potentially affecting the central nervous system .3.Many HIV-infected individuals present with a preserved level of immune cells, remaining asymptomatic for long periods, not clinically manifesting the disease. According to the Brazilian Ministry of Health , HIV-serCurrently, the most commonly used therapy in infected individuals is the highly active anti-retroviral therapy (HAART), which involves the use of at least three drugs and monitoring the viral plasma concentration .Hearing loss in HIV-positive individuals can be caused by various factors, including direct effects from HIV, increased susceptibility to opportunistic infections in the middle ear and central nervous system, and treatment with potentially ototoxic medications ,5.Reactive oxygen species (ROS) are oxygen mediators with a high reactive capacity for many biological molecules. ROS are produced during various cellular processes and in many organelles .In certain pathological conditions or when several medications are being taken, the exaggerated production of ROS takes place, leading to what is known as oxidative stress. Oxidative stress is caused by the imbalance between ROS production and its removal through strategies and antioxidants available in the organism, including enzymes, proteins, molecules, and vitamins .In individuals with HIV, the depletion of antioxidants essential for the maintenance of the electrolytic balance of the immune system cells can occur, causing a decrease in immune response, and consequently, an increase in HIV replication, possibly aggravating the patient’s condition ,9.A previous study has shown that individuals with HIV have increased levels of biomarkers of oxidative damage to deoxyribonucleic acid (DNA) in the CD4+T cells, as well as decreased DNA glycosylase activity for the repair of oxidative-based lesions in those cells .Studies have shown that oxidative stress contributes to the death of hair cells, which can lead to auditory alterations ,12. ReceHence, it is important that different conditions  that generate oxidative stress be evaluated, for understanding the influence of these factors on the auditory system to advance.This study aims to compare the audiological findings of HIV+ patients  to those of healthy individuals, all of whom had hearing thresholds within normality.This was a cross-sectional observational study, approved by the Ethics Committee for the Analysis of Research Projects  under the number 1026/04. All the participants signed the informed consent form in compliance with the Brazilian National Health Council Resolution 466/12.The sample comprised 42 individuals with normal-hearing (hearing threshold <25 dB HL in the frequencies of 0.25 to 8 kHz) , with an- Group I (GI), comprising 13 HIV-positive individuals (verified through serology) without exposure to anti-retroviral treatment;- Group II (GII), comprising 14 HIV-positive individuals (verified through serology) exposed to anti-retroviral treatment ;- Control Group (CG), comprising 15 individuals without HIV ; audiological, language, or auditory processing complaints; and any history of psychiatric or neurological diseases.The following exclusion criteria were considered for the three above-mentioned groups: pure-tone audiometry with altered hearing thresholds, presence of active opportunistic infections, presence of clinical and/or cognitive impairment preventing or hindering audiological and/or electrophysiological examinations to be performed, and history of otologic surgery and/or otologic diseases unrelated to HIV.GI and GII were referred by the House of AIDS - Zerbini Foundation and by the municipal system health services specialized in sexually transmitted diseases (STD/AIDS) of the São Paulo Municipal Department of Health. The CG comprised a convenience sample.The medical reports of the individuals from GI and GII were analyzed; their otologic history was verified through anamnesis.The audiological assessment included the visual inspection of the external acoustic meatus; acoustic immittance measures (tympanometry and acoustic reflexes) to verify the condition of the middle ear; conventional air-conduction pure-tone threshold audiometry at the frequencies of 0.25 to 8 kHz; and air-conduction high-frequency audiometry at 9 to 20 kHz  in an acoustically treated room, with standard audiometric techniques.Subsequently, for the transient evoked otoacoustic emissions (TEOAEs) to be picked up with and without contralateral noise, the ILO 92 (Otodynamics) system was used. The stimulus was a nonlinear click with an intensity ranging from 78-84 dB SPL peak. For the TEOAE, the responses were considered present when the signal-to-noise ratio was greater than 3 dB SPL in all frequency bands . In the To perform the electrophysiological assessment , the Express Traveler Portable System, from Bio-Logic, was used, along with THD-39 earphones.For the BAEP, the click stimulus with rarefied polarity was used, presented monaurally at 80 dB HL, at a presenting speed of 19.3/s, lasting 0.1 milliseconds, totaling 2,048 stimuli. The absolute latency values of waves I, III, and V, as well as interpeak intervals I-III, III-V, I-V, were analyzed using the normality standard proposed by the Evoked Potential User Manual of Bio-Logic.To pick up the P300, the tone-burst stimulus was used, presented monaurally at 75 dB HL, at a presenting speed of 1.1 stimulus per second, totaling 300 stimuli. The frequent stimulus (80% - 240 stimuli) was presented at 1,000 Hz, and the rare stimulus (20% - 60 stimuli) at 1,500 Hz. The individuals were instructed to remain alert and pay attention to the rare stimuli, which appeared randomly among a series of frequent stimuli , mentally counting whenever they appeared (thus performing the cognitive activity). In the trace resulting from the subtraction of the rare stimulus from the frequent stimulus, the latency of the P300 component was analyzed. As normality criteria, the values proposed by McPherson  were conp-value<0.05 was considered significant.Descriptive analyses and hypotheses tests were conducted. The one-factor Analysis of variance (ANOVA), Tukey’s, and chi-square tests were used. Initially, the left and right ears of each group were compared for each procedure. As no significant differences were found, the right and left ears were grouped together and then compared between the groups. A Regarding the hearing thresholds, statistically significant differences were verified between the groups for all frequencies assessed in the conventional and high-frequency audiometry, except for 9 kHz. In general, it was noted that individuals in the CG presented better hearing thresholds compared with those in GI and GII, and in turn, the GI’s hearing thresholds were better than those of GII  and 2.Concerning the P300 and BAEP latencies, the three groups presented similar values . The onlOxidative stress occurs when ROSs reach high levels, which cannot be neutralized by the defense mechanisms, thus damaging and altering the functions of biological molecules, potentially harming the cells. These alterations can be observed in the presence of pathological conditions, as in the case of AIDS, and when various medications are being taken, as, for instance, anti-retrovirals ,26. In tThe frequent manifestation of auditory abnormalities, from the middle ear to the central auditory nervous system, in individuals with HIV/AIDS has already been known for some time . NeverthThus, this study sought to verify the occurrence of auditory alterations in normal-hearing HIV-positive individuals  comparing them with normal-hearing individuals without the virus.The findings in this study highlighted that the study groups GI and GII presented hearing thresholds significantly higher in relation to the CG, although still within normality standards in pure-tone threshold audiometry. Similarly, high-frequency audiometry showed higher hearing thresholds than the other two groups. These results suggest that there are mechanisms of HIV and of the ototoxic medications  -34 that Recent studies in noise-exposed animals suggest that, in addition to the vulnerability of cochlear hair cells because of oxidative stress, there may concomitantly be a process that would damage the synapsis between the hair cells and auditory nerve fibers. This alteration in the synapses could cause an alteration in the processing of acoustic information, even in the presence of hearing thresholds within normality, contributing to the presence of abnormalities, such as speech-in-noise difficulties and/or tinnitus -13,36.In the case of seropositive individuals participating in this study, the hearing thresholds of the conventional audiometry were within normality, while the absence of TEOAE was verified in approximately 50% of the individuals in GI and GII, which points to the existence of subclinical cochlear damage. Previous studies conducted in normal-hearing noise-exposed adults showed the absence of otoacoustic emissions for both types of evoked otoacoustic emissions ,38. ThusRegarding the efferent auditory pathway’s inhibitory effect, it was believed that the role of the olivocochlear efferent system was to protect the hair cells from noise exposure. However, after the vulnerability of the synapses between the hair cells and auditory nerve was discovered, some studies highlighted the efferent system’s protective role against synaptopathy. Two studies on guinea pigs exposed to noise  and age Concerning our findings, only half of the individuals belonging to GI and GII could be assessed for the inhibitory effect since this can only be measured in individuals who had TEOAE present. Of these, more than 70% of the individuals in GII and 100% of those in GI had no inhibitory effect. As the number of individuals with absent responses differed by only two between the two groups among seven individuals, it was challenging to make assumptions about the possible differences between GI and GII. However, the percentage of the presence of the inhibitory effect in CG differed significantly in relation to GI and GII.Accordingly, analyzing the absence of the efferent auditory pathway’s inhibitory effect in more than 70% of the individuals in GI and GII, it can be suggested that these individuals present auditory alterations not restricted only to the cochlea. This is in agreement with the study by Carvallo et al. , which eFor the results concerning BAEP, this study agrees with previous findings suggesting that HIV-seropositive individuals have a higher percentage of alterations, indicating an impairment of the central auditory pathway, regardless of exposure to the anti-retroviral treatment ,47. HoweA previous study detected high levels of oxidative stress markers in the central nervous system of HIV-infected humans , which cConcerning the P300 latency values in this study, these were similarities between groups, suggesting that individuals with HIV positive, with and without exposure to anti-retroviral treatment, did not present cognitive difficulties, behaving similar to the CG. This fact can be explained by the phase of AIDS the patients were in, as none of them were in the advanced stage of the disease when cognitive decline could occur. A previous study conducted by Fein et al.  emphasizOxidative stress has been shown to be an important factor in the pathogenesis of many diseases, including neurodegenerative diseases and AIDS. The increase in oxidative damage linked to mitochondrial DNA dysfunction contributes to aging, affecting different cell signaling systems and neuronal connectivity, potentially leading to the death of hair cells and neurons, as both are vulnerable to oxidative stress ,2,27.A literature review conducted by Jong et al.  highlighHence, the findings in this study suggest that the alterations observed throughout the auditory pathway  can be related to oxidative stress caused by HIV itself and the anti-retroviral medications (in the case of GII). Therefore, the need for new studies to be developed on the subject is emphasized, as well as the use of complementary examinations, in assessing individuals with HIV, for the early detection of possible auditory alterations.Normal-hearing HIV-positive individuals, with and without exposure to anti-retroviral treatment, presented with poor performance in the behavioral, electroacoustic, and electrophysiologic audiological procedures, when compared with the CG, indicating the presence of auditory alterations even with hearing thresholds within normality. These findings suggest that oxidative stress can be an influencing factor in these alterations.This study was carried out at the Speech Therapy and Audiology Research Laboratory in the Auditory Evoked Potentials of the Speech Therapy Course, in the Department of Physiotherapy, Speech Therapy and Audiology, and Occupational Therapy, Medical School, University of São Paulo.Matas CG and Samelli AG designed, provided interpretative analysis, analyzed data, wrote, and critically revised the paper. Padilha FY and Angrisani RM provided interpretative analysis, wrote, and critically revised the paper.


Neither hearing loss severity nor hearing aid experience influenced sentence comprehension at the behavioral level. In contrast, hearing loss severity was associated with increased activity in left superior frontal areas and the left anterior insula, but only when processing specific complex sentences (i.e. object-before-subject) compared to simple sentences. Longer hearing aid experience in a sub-set of participants (n = 19) was associated with recruitment of several areas outside of the core speech processing network in the right hemisphere, including the cerebellum, the precentral gyrus, and the cingulate cortex, but only when processing complex sentences. Overall, these results indicate that brain activation for language processing is affected by hearing loss as well as subsequent hearing aid use. Crucially, they show that these effects become apparent through investigation of complex but not simple sentences.Age-related hearing loss typically affects the hearing of high frequencies in older adults. Such hearing loss influences the processing of spoken language, including higher-level processing such as that of complex sentences. Hearing aids may alleviate some of the speech processing disadvantages associated with hearing loss. However, little is known about the relation between hearing loss, hearing aid use, and their effects on higher-level language processes. This neuroimaging (fMRI) study examined these factors by measuring the comprehension and neural processing of simple and complex spoken sentences in hard-of-hearing older adults ( The consequences of this are largely unknown but highly relevant, as many countries face an aging population and untreated hearing loss is associated with cognitive decline5 and incident dementia6.Age-related hearing loss typically affects an older adult's ability to hear high frequencies. This type of hearing loss is often left untreated, with large numbers of hard-of-hearing older adults not using a hearing aid in their daily life. For example, only an estimated 14% of hard-of-hearing people over the age of 50 in the US use a hearing aid7), respond slower to comprehension questions about complex sentences8, and show increased sentence processing times9 compared to normal-hearing peers.Hearing loss also affects the processing of spoken language. While this may sound like a logical consequence of degraded auditory input, the effects seem to go beyond the auditory level, also affecting higher-level linguistic processing. For example, adults with mild-to-moderate hearing loss have problems with the comprehension of complex sentences .The neural processing of speech typically relies on a network that includes the middle and superior temporal gyrus and the inferior frontal gyrus20. Moreover, hearing aids may alleviate some of the speech processing disadvantages associated with hearing loss. Specifically, hearing aid users compared to non-users show shorter processing times under similar hearing conditions21, which seem to level out when non-users are fitted with hearing aids for 6 months22. Similarly, improvements in speech identification have been found following hearing aid fitting24.Age-related hearing loss can be treated quite effectively through the fitting of hearing aids. Recent research has shown that 3 months after being fitted with a hearing aid, hard-of-hearing subjects report improved speech understanding and decreased listening effort in everyday life25 using EEG source reconstruction found increased activity in auditory, frontal, and pre-frontal areas for hard-of-hearing subjects without hearing aids compared to a control group when processing visual symbols. In addition, more severe hearing loss correlated with increased right auditory activation. The same hard-of-hearing subjects showed a reversal of these effects following the use of bilateral hearing aids for 6 months. In addition, subjects' speech perception in noise improved as a result of using hearing aids. In contrast, Dawes et al.26 found no neural effects of hearing aid fitting on the processing of simple tones using EEG measures. Hwang et al.27 provided subjects with one hearing aid in order to compare effects on the aided versus the unaided ear. Using fMRI measures, they found decreased activity—compared to a baseline measure before hearing aid fitting—in the superior temporal gyrus following the presentation of speech sounds to the unaided ear as well as the aided ear. Finally, Habicht et al.28 used fMRI measures and found decreased activity in superior and middle frontal regions outside of the speech processing network in hearing aid users compared to hard-of-hearing unaided listeners when processing speech in noise. In addition, they found increased activity in the lingual gyri and the left precuneus with longer hearing aid use when processing complex sentences. Since decreased activity in frontal regions has been found when hearing aid use was used as a grouping factor28, but increased activity in other regions has been found to correlate with length of hearing aid use28, both the location and the direction of the influence of hearing aid use on neural processing remain unclear. In addition, many of these studies had small sample sizes  and in Habicht et al.28 the significance thresholds were not corrected for multiple comparisons. As the authors28 acknowledge the accompanying higher risk of false positives and the need for follow-up studies, it is clear that more research on hearing aid use in relation to sentence processing is needed. Thus, even though there are some indications of behavioral as well as neural effects of hearing aid use, the relationship between hearing loss, the use of hearing aids, and their effects on higher-level language processes in relation to neural changes is not well understood yet. In addition, the influence of the duration of hearing aid use on linguistic processing has as of yet not been examined in a structured manner.Regarding the neurophysiological effects of hearing aid use, findings are less clear. A recent study30. The first change involved putting the object before the subject. This leads to increased processing cost32. The second change involved changing the position of the adverb, from the third position  to the first. Finally, these two word order changes were combined to create, presumably, the most complex structure shown in (2). An overview of all sentence structures is shown in Table In this study, we investigate the correlation between hearing loss severity and hearing aid use on the one hand and the comprehension and neural processing of simple and complex sentences on the other. We used an experimental paradigm in which participants were presented with auditory recordings of simple and complex sentences. Specifically, we manipulated word order to create sentences of different complexities in German. Simple sentences were as in 1), where the subject of the sentence precedes the object and the adjunct is in third position. Complex sentences were derived from that by two word order changes. These two changes are assumed to involve different types of syntactic processing, where t32]. Thus, effects of these hearing-related measures may be found during the processing of complex sentences but not during the processing of simple sentences (as in28). Individual measures of hearing loss and the duration of hearing aid use (hearing aid experience) were obtained from each participant, so that their associations with sentence processing could be investigated. In addition, a non-verbal secondary task  was included to increase the load on participants and therefore to potentially elicit stronger effects of hearing loss and hearing aid experience. Dual-task situations are common in everyday life. Crucially, the secondary task (a fixation cross change detection task) was domain-unspecific  and therefore increased load in a different domain than the increase caused by complex sentences. Specifically, the task was aimed at increasing demands of visual attention and executive control without taxing working memory or interfering with auditory processing. This way, it can be examined whether sources of processing load in different modalities [domain-specific (sentence complexity) vs. domain-general (secondary task)] are affected by hearing loss and hearing aid experience in different ways.Furthermore, by using different sentence structures, we could reduce the predictability of the upcoming sentence. The sentences therefore require continuous linguistic processing for correct interpretation. Also, some effects of hearing loss or hearing aid use might only emerge when a task is sufficiently difficult, such as the processing of complex sentences . No behavioral effects were found in the current study, although we do not interpret this as evidence of an absence of effects of hearing aid experience on sentence processing, especially as effects were found at a neural level. In our view, these results merely signal that evaluating processing at a neural level is a more sensitive measure than comprehension at a behavioral level; the latter might be indistinguishable in different individuals even though compensatory cortical neuroplasticity is involved. Neural measures, in contrast, can pick up changes in processing that are not necessarily reflected in performance.Lastly, we expected improved comprehension of complex sentences following previous findings of improvements in speech identification following hearing aid fitting [e.g.,In the current study, we investigated the influence of hearing loss and hearing aid experience on sentence processing. To this end, we ran an fMRI study in which participants processed simple and complex auditory sentences. In comprehension, we found no influence of hearing loss severity or hearing aid experience on sentence comprehension. In neural processing, however, hearing loss severity was associated with increased activity in left superior frontal and left anterior insular areas, but only when processing complex object-before-subject sentences. Longer hearing aid experience was associated with the recruitment of several areas outside of the core speech processing network, including the cerebellum, right precentral gyrus, and right cingulate cortex when processing the most complex sentences used in the experiment. We interpret these findings as illustrating that the brain adapts to the use of hearing aids and that this influences language processing, indicating that it is important to investigate the adaptive capacity of the brain with regard to the effect of hearing aid use and language processing.Supplementary Information


Recent prevalence estimates indicate that in 2015 almost half a billion people—about 6.8% of the world’s population—had disabling hearing loss and that prevalence numbers will further increase. The World Health Organization (WHO) currently estimates that at least 34 million children under the age of 15 have disabling hearing loss. Based on a 2012 WHO report, approximately 7.5 million of these children were under the age of 5 years. This review article focuses on the importance of high-quality newborn and infant hearing screening (NIHS) programs as one strategy to ameliorate disabling hearing loss as a global health problem. Two WHO resolutions regarding the prevention of deafness and hearing loss have been adopted urging member states to implement screening programs for early identification of ear diseases and hearing loss in babies and young children. The effectiveness of these programs depends on factors such as governmental mandates and guidance; presence of a national committee with involvement of professionals, industries, and stakeholders; central oversight of hearing screening; clear definition of target parameters; presence of tracking systems with bi-directional data transfer from screening devices to screening centers; accessibility of pediatric audiological services and rehabilitation programs; using telemedicine where connectivity is available; and the opportunity for case discussions in professional excellence circles with boards of experts. There is a lack of such programs in middle- and low-income countries, but even in high-income countries there is potential for improvement. Facing the still growing burden of disabling hearing loss around the world, there is a need to invest in national, high-quality NIHS programs. Hearing loss has become the fourth leading cause of disability globally ,2. DisabThe number of people in the world who suffer from a disabling hearing loss has increased from 42 million in 1985 to 360 million in 2010 , mainly In a recent Lancet publication, Wilson and co-authors  noted thThis alarming situation has developed despite increased knowledge about the substantial health care burden caused by poorly treated or untreated hearing loss. Unfortunately, permanent hearing loss is generally underestimated by the public health administrators and politicians and is not a high priority in most countries ,8,9. ThiFor children, prevention has been identified as the most effective strategy to reduce disabling hearing loss in countries with low economic prosperity , whereasCommon risk factors for hearing loss, most of which are relevant to newborns and young children, are ear infections , rubella, measles, mumps, meningitis, congenital cytomegalovirus, ototoxic agents, and exposure to occupational or recreational noise. Some of these factors have become less common during recent years in some regions of the world , while others are increasing . Eighty percent of people with disabling hearing loss live in low- or middle-income countries , where cThe WHO has made a sustained effort for many years to prevent, identify, and treat disabling hearing loss. In 1995 the World Health Assembly passed a resolution that urged member states to prepare national plans for the prevention and control of major causes of avoidable hearing loss, and for early detection of hearing loss in babies, toddlers, and children, as well as in the elderly, within the framework of primary health care . HoweverSince the 1995 resolution, WHO has made several efforts to promote a common understanding about the concepts, mechanisms, and strategies for providing appropriate hearing health care and to develop and establish instruments for planning, implementation, and monitoring hearing health care programs in individual countries , summariAccording to recent WHO estimates, more than 60% of hearing loss in children could be prevented—75% in middle- and lower-middle-income countries, 49% in high-income regions  Figure . The difEffective strategies for preventing hearing loss include reducing the incidence of infections such as rubella, meningitis, cytomegalovirus, mumps, measles, and otitis through immunization, hygienic measures, timely medical and surgical treatment, mother and child health programs, and reductions in the use of ototoxic agents . For exaSequelae of untreated or late-treated infant hearing loss are deficits of language, cognitive, social, emotional, and academic development, with negative consequences for the families of the children, their community, and their society . There iA universal newborn hearing screening program should involve at least 95% of the newborns in a region.Newborn hearing screening procedures should target the detection of at least all infants with bilateral hearing loss of ≥35 dB in the better hearing ear.The proportion of babies who fail the newborn hearing screen and are referred for formal audiological testing should not exceed 4%.The false negative rate for babies who passed the screening despite a substantial hearing loss should approach zero.At least 95% of the babies failing the screening should be followed up with audiological diagnostics and, in cases of confirmed hearing loss, receive appropriate treatment.The follow-up and access to diagnosis and treatment should be well organized, so that parents whose babies have failed the hearing screening can be referred directly to medical and audiological service centers that are qualified to provide accurate diagnostics and appropriate treatment for infants.The audiometric diagnostics should be completed before 3 months of age and treatment for those with hearing loss should be initiated before 6 months of age.NIHS programs should include a data collection system to ensure that the program meets the criteria specified above and is capable of tracking babies who have failed or missed the screening.Procedures and tools for training and supervision of the people carrying out hearing screening should be implemented to ensure that screening is properly done.Both of the WHO resolutions about hearing loss have addressed this issue by urging WHO member states to develop, implement, and monitor screening programs for early identification of ear diseases and hearing loss in infants and young children ,22. UnivOverarching principles of NIHS programs have also been published by the WHO in 2010 . AutomatAffordable, portable, easy-to-use hearing screening technology is available. There are also emerging technologies that make it possible to use wireless bi-directional data transfer for both screening and diagnostics after a failed hearing screen, with telehealth supervision from an expert screening centre ,41,42. SThe prevalence of neonatal permanent hearing loss is reported globally to be about 0.5 to 5.0 per 1000 infants, and in some low- and middle-income countries even higher . Nearly Genetic factors account for at least 40% to 60% of permanent childhood hearing loss and occur more frequently in cases of parental consanguinity ,47,49,50Family history of permanent childhood sensorineural hearing lossIn-utero infection of mothers Syndromes which may be associated with hearing loss , or stigmata and findings associated with such syndromes (such as white forelock for Waardenburg syndrome)Craniofacial malformations, including those that involve the pinna and/or ear canal, such as ear tags, ear pits, and temporal bone anomaliesDiseases or conditions that require extended neonatal intensive carePersistent pulmonary hypertension associated with mechanical ventilation, and conditions requiring the use of extracorporeal membrane oxygenationElevated levels of hyperbilirubinemiaExposure to ototoxic medications Postnatal infections associated with hearing loss such as bacterial meningitisFor neonates who have one or more risk factors for neonatal hearing loss, the prevalence is much higher—from 1% to 3% . Risk faTo improve the situation of people with permanent hearing loss, countries should have a strategic plan that takes into consideration the demographic profile, requirements, and resources of the country. A manual on planning and monitoring of national strategies for ear and hearing care as published by the WHO  outlinesThe national committee should address, and possibly create task forces to deal with issues such as technology, training, infrastructure, equipment, finance, and advocacy. It should also guide, organize, supervise, and monitor the NIHS program. As part of this effort, relevant tools, standard operating procedures, and information materials should be developed. The standard operating procedures should include how, where, and when babies with a positive screening test should be referred . ProceduIf a comprehensive newborn hearing screening program is not yet operational, a situation analysis of needs and resources, as well as a strengths, weaknesses, opportunities, and threats (SWOT) analysis, should be performed, optimally by using the Ear and Hearing Care Situation Analysis Tool of the WHO . This toIf not already done, all countries should establish national committees for ear and hearing health, including a newborn hearing screening program. A part of this program should include the prevention of neonatal hearing loss as mentioned above and described in the WHO publication on childhood hearing loss . For situations where primary prevention of permanent infant hearing loss is not possible, NIHS programs can be an effective secondary prevention strategy that ensures detection and treatment of childhood hearing loss as early as possible. Early intervention using a family-centered, multidisciplinary approach that includes audiological, medical, therapeutic, rehabilitative, and pedagogical components and focuses on the importance of the family for child health can often prevent hearing loss from becoming disabling in its nature.The 2017 WHO resolution calls for the preparation of a World Report on Ear and Hearing based on the best available scientific evidence. The resolution also urges member states “…to collect high-quality population-based data on ear diseases and hearing loss in order to develop evidence-based strategies and policies” . Hence, Disabling hearing loss is a global problem that is far from being solved, despite increased awareness among professionals and expert groups. This “invisible disease” is still underrepresented in the public and political awareness. As rising prevalence and growing burden related to hearing loss (as measured by YLDs), together with economic and sociodemographic indicators for different countries and regions suggest, a focus on prevention and treatment of childhood hearing loss would be very effective in reducing the burden of hearing loss in countries with lower levels of economic prosperity and sociodemographic indices .Wilson and his colleagues  proposedhttp://www.who.int/deafness/wolrd-hearing-forum/en/). This forum may also be helpful in the implementation of national early hearing detection and intervention programs by supporting advocacy and resource allocation.As an important step towards such an alliance, WHO has recently established the World Hearing Forum, a global advocacy network of stakeholders including representatives of governments, nongovernmental organizations, disabled people’s organizations, development agencies, academic institutions, and professional societies promoting ear and hearing care worldwide and aiming to foster the implementation of resolution WHA 70.13 .The growing prevalence of disabling hearing loss and the associated increase in the global burden of hearing loss call for action that includes the implementation and improvement of NIHS programs. Such programs should be part of national programs for ear and hearing care. Regular and standardized data collection is necessary to better understand what is being accomplished and how to improve program effectiveness. Newborn hearing screening and follow-up treatment has been shown to be an excellent investment of resources. Nevertheless, adequate funding and resource allocation for these programs is needed, in particular for screening centers which provide tracking of babies and program monitoring. The foundation of a global alliance on hearing as proposed by the WHO could support the implementation, standardization, and supervision of national screening programs. We agree with the concluding sentences of Wilson et al. : “The bu


The use of technology has been suggested as a means of allowing continued autonomous living for older adults, while reducing the burden on caregivers and aiding decision-making relating to healthcare. However, more clarity is needed relating to the Activities of Daily Living (ADL) recognised, and the types of technology included within current monitoring approaches. This review aims to identify these differences and highlight the current gaps in these systems. A scoping review was conducted in accordance with PRISMA-ScR, drawing on PubMed, Scopus, and Google Scholar. Articles and commercially available systems were selected if they focused on ADL recognition of older adults within their home environment. Thirty-nine ADL recognition systems were identified, nine of which were commercially available. One system incorporated environmental and wearable technology, two used only wearable technology, and 34 used only environmental technologies. Overall, 14 ADL were identified but there was variation in the specific ADL recognised by each system. Although the use of technology to monitor ADL of older adults is becoming more prevalent, there is a large variation in the ADL recognised, how ADL are defined, and the types of technology used within monitoring systems. Key stakeholders, such as older adults and healthcare workers, should be consulted in future work to ensure that future developments are functional and useable. Population ageing affects many countries globally and is associated with substantial social, financial, and health challenges . In the To overcome these issues, current trends in geriatric care are increasingly allowing or assisting older people to live independently in their own homes ,4. This Activities of Daily Living (ADL) are the “fundamental activities needed for an individual to function independently in everyday life” . TypicalThe scales used to measure ADL function vary in terms of the type of ADL measured, the specific activity, and the level of detail assessed . This maTo overcome these issues, it has been suggested that objective measures performed within a home environment may be the most appropriate method of assessing functional ability ,17,19,20Typically, objective ADL measurements are collected from wearable sensors, such as accelerometers; environmental sensors, such as motion detectors; or other technology, such as cameras . Data frUbiquitous monitoring systems are capable of continuous monitoring, something that traditionally would only be achieved by having a caregiver constantly present, which is both impractical and may lead to changes in an individuals’ performance . The con(1)Which ADL are recognised by technology?(2)What types of technology are currently used to recognise ADL in free-living older adults?(3)How are ADL recognised by technology (inferred/direct measurement)?This scoping review aims to investigate the current technology that is capable of recognizing the activities of daily living of older adults in a free-living environment. It includes technological monitoring systems that have been implemented in the homes of older adults, including commercially available systems and those that have been used in research only. This review will also explore how technological monitoring systems can aid healthcare by comparing their capabilities with existing ADL measures, highlighting how the two approaches can be used together. Specifically, it aims to answer the following questions:As the area of objectively monitoring ADL function is developing rapidly, with many new advances being disseminated through conference papers and commercial systems being released without being published in academic papers, a scoping review was deemed the most appropriate approach, as it allows for the inclusion of “grey literature” . There iThe aim of this review was to identify the technology capable of monitoring ADL function of independently living older adults without cognitive impairment. A scoping review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines . The seaReference  summarisThe search terms used  were basThis review had three main objectives: (1) identify the ADL that are recognised; (2) identify the types of technology currently used; and (3) identify whether the ADL are recognised from direct measures or inferred from sensor data. The search process identified 14 ADL, 20 types of technology, and 39 systems, separated into three categories .Currently available systems recognise a mixture of BADL, IADL, and SADL . Most ofThe details of each identified system, including the sensors used, ADL recognised, and outcome measures, are provided in n = 36): systems using only environmentally based technology, such as motion sensors and video cameras [Environmental only : systems using only body-worn technology, such as accelerometers [Wearable only : systems using a combination of body-worn and environmentally based technology [Environmental + wearable  [n = 10) [n = 10) ,56,57,58[n = 10) ,64,66,69[n = 10)  and only[n = 10) ,68.Two systems were categorized as wearable only , one utiInterestingly, the systems with the most sensor types ,68 did nThe identified systems use either direct measurement, indirect inference, or a combination of both methods to recognise ADL . DirectlOf the 14 ADL, nine were recognised indirectly, meaning that they were inferred from sensor data such as room movement or water consumption . Only twThis scoping review aimed to identify the types of technology currently used to recognise the activities of daily living of older adults within a free-living environment. The use of technology has been suggested as a means of allowing continued autonomous living while providing support and monitoring functional ability, allowing early interventions where needed . Three kOverall, the systems identified through this review recognised 14 different ADL, ranging from BADL, such as feeding and grooming; IADL, such as medicine and household; and SADL, associated with social interaction .It should be noted that the systems identified are designed to monitor whether an ADL action has been completed, rather than testing the individual’s ability to complete an ADL action. However, there is an overlap between the two approaches, which if capitalized on effectively could make healthcare more targeted and therefore more efficient. For example, seven of the recognised ADL  are also present in the common assessment scale of the Barthel Index . HoweverAlthough the ability to recognise several sub-activities is undeniably helpful in identifying where functional decline may be occurring, there needs to be a consensus on which sub-activities are genuinely helpful to monitor compared to the ones being recognised purely because the technology is capable. For example, inferring “feeding” from kitchen activity and object interaction, compared to identifying specific movements, such as spreading butter and using cutlery . It has Some of the ADL recognised are not associated with common assessments of independent living ability, such as the Barthel ADL index or Lawton and Brody iADL scale, namely, “sleep” and “social interaction”. Both sleep and social interaction may have a large impact on functional ability of other ADL; however, this interaction is currently not well understood or included within objective, technology-based measures. There is a growing appreciation of the need for a biopsychosocial approach to healthcare , which pThe general nature of the “feeding” and “grooming” ADL can explain why they are recognised by most of the systems identified, whereas the more specific ADL of “stair usage” and “medicine” are recognised much less frequently . “Stair Since 2014, ADL recognition systems have become more complex in terms of the range of sensor types included; however, this has not correlated to a wider range of recognised ADL. Many of the developments in recent years have related to identifying ADL that are difficult to recognise due to privacy issues; for example, introducing humidity and sound sensors to detect bathing activity. Over time, there has been a tendency away from sensors requiring greater user interaction, such as RFID tags or wearable sensors, which may reflect the desire of older adults to have sensors that they are not necessarily aware of. The reasons for the lack of interest in these sensor types should be investigated further, as they may present a reasonable solution to current issues within monitoring systems, such as the ability to distinguish separate people in a cohabitation setting.Most current systems favour motion sensors , as theyEnvironmental-only systems were the most common in the current survey, as they can improve the accuracy of activity recognition ,57 withoAnother issue with the current monitoring systems is the ability to distinguish the ADL function of different people within the same space, and therefore many are not suitable for multi-occupancy housing . To overSeveral of the systems recognised the ADL indirectly based on a sequence of interactions with the environment , which sThere were some limitations within this review. Firstly, it aimed to identify the types of technology currently used within recognition systems, and therefore did not include the specific number of sensors used within each system. Future work should identify the most effective set-ups within systems, in terms of the number of sensors included, and where they are placed within the living environment. The scope of this review was also limited in that only ubiquitous systems consisting of wearable and/or environmental systems were included. This means that other technological advances, such as systems including artificial intelligence, or the role of social robots, were not considered despite their potential in supporting ageing-in-place. Although social robotics and AI share the same sensor technology as those reviewed in this article, they provide a crucial, separate contribution in terms of data analysis (AI) and novel forms of interfacing (robotics), whereby the user is prompted to perform certain behaviours. These aspects of monitoring technology were beyond the scope of this review; however, they should be the focus of future work.Future work should establish a clear consensus as to the key ADL required from an older adult and healthcare worker perspective, the most appropriate sensor types to utilise, and the most suitable method of ADL recognition to use in order to enhance the effectiveness of current ADL monitoring systems . This maThis scoping review aimed to identify the systems currently used to recognise the ADL of community-dwelling older adults. This included discerning the ADL recognised, the types of technology used, and the method employed for ADL recognition.Fourteen ADL were recognised, ranging from basic ADL, including feeding and grooming, to more complex iADL, such as medicine management and social ADL, including time spent away from home and the presence of visitors. However, there was some disagreement surrounding the specific activities that were included within the ADL of “feeding”, “grooming”, and “social interaction”. There is a need to come to a consensus on the most important ADL, and the level of specificity relating to ADL recognition required from these systems.In terms of the types of technology used, environmental-only systems were the most common, with wearable sensors rarely used. Door and motion sensors are the most common technology types, used on their own or in combination with other sensors such as power consumption, light, or temperature. Systems ranged in complexity, from utilising one to seven types of technology, although this did not appear to correlate with an increase in the number of different ADL recognised. Therefore, more work is needed to understand the most efficient combinations of technology types in terms of both functionality and user acceptability.Most ADL were inferred from room activity rather than direct measurement, implying that systems are limited in terms of their ability to detect detail relating to ADL performance. Currently, the systems can identify when changes in ADL performance occur but are unable to determine why. This restricts their usefulness as a tool for aiding healthcare decisions, as there is still a need for further tests or subjective measures to determine the exact cause of a decline in function. Through enabling a more detailed tracking of ADL function, we will be able to better understand the disablement process and therefore develop more efficient interventions.