Receptive language as a predictor of cochlear implant outcome for prelingually deaf adults

Abstract

Objective: This study investigated outcomes and predictive factors, specifically language skills, for a group of prelingually hearing-impaired adults who received a cochlear implant. Design: Speech perception data, demographic information, and other related variables such as communication mode, residual hearing, and receptive language abilities were explored. Pre- and post-implant speech perception scores were compared and multiple regression analysis was used to identify significant predictive relationships. Study sample: The study included 43 adults with a prelingual onset of hearing loss, who proceeded with cochlear implantation at the Royal Victorian Eye and Ear Hospital in Melbourne, Australia. Results: The majority of patients experienced benefit from their cochlear implants, with 88% demonstrating significant improvement in speech perception performance. Volunteers achieved better post-operative speech perception scores if they had a shorter duration of severe-to-profound hearing loss, better language skills, and used an exclusively oral communication mode. Conclusions: Although post-operative speech perception performance is significantly poorer for prelingually hearing-impaired adults compared to postlingually hearing-impaired patients, the study group demonstrated significant benefit from their cochlear implants. The variability in post-operative outcomes can be predicted to some extent from the hearing history and language abilities of the individual patient.     

Left Ventricular Tonic Contraction as a Novel Biomarker of Cardiomyopathy in Duchenne Muscular Dystrophy

Dilated cardiomyopathy (DCM) inevitably afflicts patients with Duchenne muscular dystrophy (DMD) as a consequence of cell death induced by unguarded calcium influx into cardiomyocytes. This mechanism may also inhibit muscle relaxation in early stages of cardiomyopathy. ACE inhibition (ACEi) is known to delay the onset and slow the progression of DCM in DMD. The objective of this study is to use echocardiography to assess for preclinical cardiac changes consistent with intracellular calcium dysregulation before the onset of overt ventricular dysfunction, and to evaluate how prophylactic ACEi may alter these pre-cardiomyopathic changes in the pediatric DMD population. We examined 263 echocardiograms from 70 pediatric patients with DMD. We defined abnormal tonic contraction (TC) as left ventricular internal dimension in diastole (LVIDd) Z-score < ?1.5. In our cohort, we found that TC is detectable as early as 8 years of age, and most commonly affects patients between 11 and 15 years. This effect was independent of LV mass and systolic function. Prophylactic ACEi decreased the incidence of TC (p = 0.007) and preserved cardiac function (p < 0.0001). Left ventricular TC often precedes DCM in DMD, most commonly affecting the 11- to 15-year-old age range. TC is not related to ventricular hypertrophy, but rather may be a clinical correlate of the “calcium hypothesis” of DMD pathophysiology. LV TC is thus a promising biomarker for early detection of cardiomyopathy in DMD. ACEi prophylaxis suppresses LV TC and delays the development of DCM in DMD.     

Accuracy of six antimicrobial susceptibility methods for testing linezolid against staphylococci and enterococci

A challenge panel of enterococci (n = 50) and staphylococci (n = 50), including 17 and 15 isolates that were nonsusceptible to linezolid, respectively, were tested with the Clinical and Laboratory Standards Institute broth microdilution and disk diffusion reference methods. In addition, all 100 isolates were tested in parallel by Etest (AB Biodisk, Solna, Sweden), MicroScan WalkAway (Dade, West Sacramento, CA), BD Phoenix (BD Diagnostic Systems, Sparks, MD), VITEK (bioMérieux, Durham, NC), and VITEK 2 (bioMérieux) by using the manufacturers' protocols. Compared to the results of the broth microdilution method for detecting linezolid-nonsusceptible staphylococci and enterococci, MicroScan results showed the highest category agreement (96.0%). The overall categorical agreement levels for VITEK 2, Etest, Phoenix, disk diffusion, and VITEK were 93.0%, 90.0%, 89.6%, 88.0%, and 85.9%, respectively. The essential agreement levels (results within +/-1 doubling dilution of the MIC determined by the reference method) for MicroScan, Phoenix, VITEK 2, Etest, and VITEK were 99.0%, 95.8%, 92.0%, 92.0%, and 85.9%, respectively. The very major error rates for staphylococci were the highest for VITEK (35.7%), Etest (40.0%), and disk diffusion (53.3%), although the total number of resistant isolates tested was small. The very major error rate for enterococci with VITEK was 20.0%. Three systems (MicroScan, VITEK, and VITEK 2) provided no interpretations of nonsusceptible results for staphylococci. These data, from a challenge panel of isolates, illustrate that the recent emergence of linezolid-nonsusceptible staphylococci and enterococci is providing a challenge for many susceptibility testing systems.     

Physical activity and sedentary time among preschoolers in centre-based childcare: a systematic review

Background

Many preschoolers spend a substantial portion of their day enrolled in centre-based childcare; the amounts of physical activity and sedentary time accumulated in this environment are critical to preschoolers’ ability to meet movement guidelines. The purpose of this systematic review was to provide a comprehensive overview of the objectively assessed physical activity and sedentary time of preschoolers in centre-based childcare (registration no. CRD42016033502).

Methods

Eight online databases were searched using terms related to physical activity, sedentary time, preschoolers and centre-based childcare. Published, peer-reviewed primary studies written in English that objectively assessed (via accelerometry) the physical activity and sedentary time of preschoolers (2-5 years) in centre-based childcare were included.

Results

Fifty-five studies (published 2004-2017) from 11 countries, representing 13,956 participants were included. Studies reported light physical activity (n=38) ranging from 2.94 to 29.96 mins/hr, moderate-to-vigorous physical activity (n=46) which ranged from 1.29 to 22.66 mins/hr, and total physical activity (n=42) ranging from 4.23 to 47.17 mins/hr. Sedentary time (n=47) ranged from 12.38 to 55.77 mins/hr.

Conclusion

Physical activity and sedentary time were highly varied and inconsistent between studies; therefore, it is difficult to determine preschoolers’ true amount of physical activity and sedentary time during childcare hours. Despite this variability, preschoolers were noted to participate in high rates of sedentary time in this setting. The lack of homogeneity is an important finding in and of itself as it highlights the lack of consistency in measuring, processing, and reporting paediatric physical activity data.

     

Developing a Motion Comic for HIV/STD Prevention for Young People Ages 15–24, Part 2: Evaluation of a Pilot Intervention

In the United States, young people (ages 15–24 years) are disproportionately affected by human immunodeficiency virus (HIV) and other sexually transmitted diseases (STDs), due at least in part to inadequate or incorrect HIV/STD-related knowledge, attitudes, beliefs, and behavioral intentions (KABI). Comic book narratives are a proven method of HIV/STD prevention communication to strengthen KABI for HIV/STD prevention. Motion comics, a new type of comic media, are an engaging and low-cost means of narrative storytelling. The objective of this study was to quantitatively evaluate the effectiveness of a pilot six-episode HIV/STD-focused motion comic series to improve HIV/STD-related KABI among young people. We assessed change in HIV/STD knowledge, HIV stigma, condom attitudes, HIV/STD testing attitudes, and behavioral intentions among 138 participants in 15 focus groups immediately before and after viewing the motion comic series. We used paired t-tests and indicators of overall improvement to assess differences between surveys. We found a significant decrease in HIV stigma (p < .001) and increases in both HIV knowledge (p = .002) and behavioral intentions to engage in safe sex (p < .001). In summary, this motion comic intervention improved HIV/STD-related KABI of young adult viewers by reducing HIV stigma and increasing behavioral intentions to engage in safer sex. Our results demonstrate the promise of this novel intervention and support its use to deliver health messages to young people.     

The free healthcare initiative in Sierra Leone: Evaluating a health system reform, 2010‐2015

This article presents the findings of a theory‐based evaluation of the Sierra Leone Free Health Care Initiative (FHCI), using mixed methods. Analytical approaches included time‐series analysis of national survey data to examine mortality and morbidity trends, as well as modelling of impact using the Lives Saved Tool and expenditure trend analysis. We find that the FHCI responded to a clear need in Sierra Leone, was well designed to bring about needed changes in the health system to deliver services to the target beneficiaries, and did indeed bring funds and momentum to produce important systemic reforms. However, its ambition was also a risk, and weaknesses in implementation have been evident in a number of core areas, such as drugs supply. We conclude that the FHCI was one important factor contributing to improvements in coverage and equity of coverage of essential services for mothers and children. Modelled cost‐effectiveness is high—in the region of US$ 420 to US$ 444 per life year saved. The findings suggest that even—or perhaps especially—in a weak health system, a reform‐like fee removal, if tackled in a systematic way, can bring about important health system gains that benefit vulnerable groups in particular.     

Self-perceived burden in cancer patients: validation of the Self-perceived Burden Scale

Although caregiver burden has been studied extensively, cancer patients' self-perceived burden on caregivers has been an understudied phenomenon. The purpose of this cross-sectional study was to validate the Self-perceived Burden Scale, a 10-item self-report instrument designed to measure chronically ill patients' experience of burden. Participants were 106 cancer patients (site nonspecific) receiving active cancer treatments at a university cancer center. Factor analysis results indicated that a 9-item version of the scale consisted of a single factor and had good reliability (alpha = .938). Convergent validity was demonstrated with global quality of life (r = -0.546, P < .001), physical well-being (r = -0.547, P < .001), emotional well-being (r = -0.549, P < .001), functional well-being (r = -0.404, P < .001), financial satisfaction (r = -0.284, P = .001), and depression (r = 0.414, P <.001). Tests of divergent validity indicated that the Self-perceived Burden Scale was independent of age, number of people living in the household, disease site, cancer treatment, and sociofamilial well-being. Findings indicate that the Self-perceived Burden Scale may be a useful instrument to assess patients' perceptions of burden on their caregivers. Further studies of the role of patient burden in psychosocial well-being and global quality of life, including validation of the Self-perceived Burden Scale on a larger study sample, are warranted.