A comparison of cochlear implant processing strategies in children using Speech Pattern Audiometry

Abstract

The aim of this study was to use Speech Pattern Audiometry (SPA) to compare phoneme perception performance between SPEAK and ACE processing strategies with children using the Nucleus 24 cochlear implant. Listeners were evaluated in terms of ability to identify two synthetic word pairs, one signalling a voicing contrast and the other signalling a place of articulation contrast. For both word pairs, ACE was associated with more ‘normal’ phoneme boundaries than SPEAK. There was also a nonsignificant trend for better identification ability with ACE compared to SPEAK. The study suggests that there may be a place for SPA as part of the clinical battery of tests used for evaluation of cochlear implant speech processing strategies in children. Copyright © 2005 John Wiley & Sons, Ltd.     

Molecular biology of epidermal growth factor receptor inhibition for cancer therapy

Understanding the role of the epidermal growth factor receptor (EGFR) in cellular signalling processes underlying malignancy has enabled the development of rationally designed EGFR-targeted therapeutics. Strategies have been devised to interfere with the EGFR signalling at three different levels: at the extracellular level, competing with ligand binding; at the intracellular level, inhibiting the activation of the tyrosine kinase; or at the mRNA level, modulating the expression of the EGFR protein. Each of these strategies has proven to have an antitumour effect mediated by events such as inhibition of cell proliferation, induction of apoptosis, decrease of cellular invasion and migration; and/or inhibition of angiogenesis. Furthermore, the combination of these strategies with traditional chemotherapy or radiotherapy has generally resulted in enhanced antitumour effects. Likewise, the benefit of interfering simultaneously with different signalling pathways has been documented to improve tumour growth inhibition. These preclinical results have encouraged clinical studies that led to the FDA approval of three drugs. However, finding the perfect strategy for each individual patient appears to be a limiting factor, demanding further research to be able to generate relevant molecular expression profiles on a case-to-case basis. Taken together, a successful EGFR inhibition will require a better understanding of signalling pathways in combination with the development of rationally designed effective molecules.     

A delicate web: Household changes in health behaviour enabled by microcredit in Burkina Faso

Abstract

Providing microcredit to women in developing countries has long been highlighted as a simple and effective strategy for poverty reduction and health improvement. However, little is known about how microcredit enables changes in health behaviour. This knowledge is critical to further strengthen microcredit initiatives. This qualitative study, conducted in Burkina Faso, shows how microcredit can not only facilitate savings and investment strategies, but also lead to changes in household decision-making, enabling women to initiate health prevention, seek health treatment and manage health emergencies. Some changes led to increased household burdens for women that impeded health gains, such as administrative loan delays by the microcredit institution and reduced household contributions by the husband. Furthermore, the study highlighted the fragile nature of health gains, which may be eroded due to economic shocks on a household, such as crop failure, drought or illness.     

Evaluation of Border Entry Screening for Infectious Diseases in Humans

In response to the severe acute respiratory syndrome (SARS) pandemic of 2003 and the influenza pandemic of 2009, many countries instituted border measures as a means of stopping or slowing the spread of disease. The measures, usually consisting of a combination of border entry/exit screening, quarantine, isolation, and communications, were resource intensive, and modeling and observational studies indicate that border screening is not effective at detecting infectious persons. Moreover, border screening has high opportunity costs, financially and in terms of the use of scarce public health staff resources during a time of high need. We discuss the border-screening experiences with SARS and influenza and propose an approach to decision-making for future pandemics. We conclude that outbreak-associated communications for travelers at border entry points, together with effective communication with clinicians and more effective disease control measures in the community, may be a more effective approach to the international control of communicable diseases.     

老年人工髋关节置换围术期应激性溃疡的预防性护理

目的：探讨我院老年人工髋关节置换围术期应激性溃疡预防性护理的临床疗效。方法选取2010年4月～2013年4月在我院骨科住院髋部骨折且接受手术的老年患者106例，随机分为对照组和观察组，每组53例。对照组采用常规护理，观察组采用预防性护理。比较两组患者应激性溃疡发生率，术后1d、5d、10d、14d消化性溃疡症状分级量化积分。结果观察组应激性溃疡发生率明显低于对照组（P＜0．01）；观察组术后1d、5d、10d、14 d消化性溃疡症状评分明显优于对照组，差异有显著意义（ P＜0．01）。结论中西医结合预防性护理干预对预防老年人工髋关节置换围术期应激性溃疡效果显著，促进了疾病的康复，提高了患者的生活质量。     

Evidence-Based Strategies for the Treatment of Peritoneal Malignancies during Health Care Resource Restriction: The COVID-19 Pandemic

Background: The COVID-19 pandemic has put enormous pressure on hospital resources, and has affected all aspects of patient care. As operative volumes decrease, cancer surgeries must be triaged and prioritized with careful thought and attention to ensure maximal benefit for the maximum number of patients. Peritoneal malignancies present a unique challenge, as surgical management can be resource intensive, but patients have limited non-surgical treatment options. This review summarizes current data on outcomes and resource utilization to help inform decision-making and case prioritization in times of constrained health care resources. Methods: A rapid literature review was performed, examining surgical and non-surgical outcomes data for peritoneal malignancies. Narrative data synthesis was cross-referenced with relevant societal guidelines. Peritoneal malignancy surgeons and medical oncologists reviewed recommendations to establish a national perspective on case triage and mitigating treatment strategies. Results and Conclusions: Triage of peritoneal malignancies during this time of restricted health care resource is nuanced and requires multidisciplinary discussion with consideration of individual patient factors. Prioritization should be given to patients where delay may compromise resectability of disease, and where alternative treatment options are lacking. Mitigating strategies such as systemic chemotherapy and/or surgical deferral may be utilized with close surveillance for disease stability or progression, which may affect surgical urgency. Unique hospital capacity, and ability to manage the complex post-operative course for these patients must also be considered to ensure patient and system needs are aligned.     

Attentional Difficulties and the Effectiveness of a Visual Representation Strategy for Counseling Drug-Addicted Clients

Three hundred thirty-one opioid-addicted clients in methadone treatment were randomly assigned to counselors who used either mappingenhanced or standard counseling. Those counseled with mapping had lower percentages of during-treatment urine specimens that were positive for either cocaine or opiates, and they were rated by their counselors as having higher rapport, motivation, and self-confidence. Clients were further classified into those exhibiting either good or poor attention during an intake interview. The results suggest that clients with poor attention are more likely to have positive urines, but that this tendency appears to be reduced under mapping-enhanced counseling.     

A Model of First‐responder Coping: An Approach/Avoidance Bifurcation

The work of first responders is fraught with numerous stressors, ranging from potentially traumatic critical incidents to institutional strains. The severity and pervasiveness of these difficulties prompt a necessary consideration of the coping methods employed by first responders. The present study developed an empirical model of first‐responder coping strategies, based upon a nationally representative survey sample of 6240 first responders. Participants were drawn from Swedish first responders in the following occupations: coast guard, customs control, military, emergency medical services, fire department and police services. In the final model, exposure to stress related to well‐being through several indirect paths that in sum accounted for the original direct relationship between these constructs. These several indirect paths were classified theoretically as either approach or avoidance coping behaviours or subsequent health outcomes. In general, approach coping behaviours were related to better well‐being; and avoidance was related to a decrease in the outcome. The size of the present sample, as well as the diverse nature of the included first responders, suggests that the resulting model may offer a unique insight into potentially adaptive pathways for first‐responder coping. Copyright © 2016 John Wiley & Sons, Ltd.