Bilateral cochlear implantation or bimodal listening in the paediatric population : retrospective analysis of decisive criteria

Introduction: In children with bilateral severe to profound hearing loss, bilateral hearing can be achieved by either bimodal stimulation (CIHA) or bilateral cochlear implantation (BICI). The aim of this study was to analyse the audiologic test protocol that is currently applied to make decisions regarding the bilateral hearing modality in the paediatric population. Methods: Pre- and postoperative audiologic test results of 21 CIHA, 19 sequential BICI and 12 simultaneous BICI children were examined retrospectively. Results: Deciding between either simultaneous BICI or unilateral implantation was mainly based on the infant's preoperative Auditory Brainstem Response thresholds. Evolution from CIHA to sequential BICI was mainly based on the audiometric test results in the contralateral (hearing aid) ear after unilateral cochlear implantation. Preoperative audiometric thresholds in the hearing aid ear were significantly better in CIHA versus sequential BICI children (p < 0.001 and p = 0.001 in unaided and aided condition, respectively). Decisive values obtained in the hearing aid ear in favour of BICI were: An average hearing threshold measured at 0.5, 1, 2 and 4 kHz of at least 93 dB HL without, and at least 52 dB HL with hearing aid together with a 40% aided speech recognition score and a 70% aided score on the phoneme discrimination subtest of the Auditory Speech Sounds Evaluation test battery. Conclusions: Although pure tone audiometry offers no information about bimodal benefit, it remains the most obvious audiometric evaluation in the decision process on the mode of bilateral stimulation in the paediatric population. A theoretical test protocol for adequate evaluation of bimodal benefit in the paediatric population is proposed

Neuromotor tolerability and behavioural characterisation of cannabidiolic acid, a phytocannabinoid with therapeutic potential for anticipatory nausea

Rationale: Anticipatory nausea (AN) is a poorly controlled side-effect experienced by chemotherapy patients. Currently, pharmacotherapy is restricted to benzodiazepine anxiolytics, which have limited efficacy, significant sedative effects, and induce dependency. The non-psychoactive phytocannabinoid, cannabidiolic acid (CBDA), has shown considerable efficacy in pre-clinical AN models, however determination of its neuromotor tolerability profile is crucial to justify clinical investigation. Provisional evidence for appetite-stimulating properties also requires detailed investigation. Objectives: To assess the tolerability of CBDA in locomotor activity, motor coordination and muscular strength tests, and additionally for ability to modulate feeding behaviours. Methods: Male Lister hooded rats administered CBDA (0.05-5 mg/kg; p.o.) were assessed in habituated open field (for locomotor activity), static beam and grip strength tests. A further study investigated whether these CBDA doses modulated normal feeding behaviour. Finally, evidence of anxiolytic-like effects in the habituated open field prompted testing of 5 mg/kg CBDA for anxiolytic-like activity in unhabituated open field, light/dark box and novelty-supressed feeding (NSF) tests. Results: CBDA had no adverse effects upon performance in any neuromotor tolerability test, however anxiolytic-like behaviour was observed in the habituated open field. Normal feeding behaviours were unaffected by any dose. CBDA (5 mg/kg) abolished the increased feeding latency in the NSF test induced by the 5-HT1AR antagonist, WAY-100,635, indicative of anxiolytic-like effects, but had no effect on anxiety-like behaviour in the novel open field or light/dark box. Conclusions: CBDA is very well tolerated and devoid of the sedative side-effect profile of benzodiazepines, justifying its clinical investigation as a novel AN treatment

The relationship between top management team (TMT) metacognition, entrepreneurial orientation and firm performance in Small and Medium Enterprises (SMEs)

This study integrates entrepreneurial orientation and top management team (TMT) behavioural integration, as a mediator and moderator respectively, to determine the effect of TMT metacognition on firm performance in SMEs. Fifteen hundred SMEs were surveyed and 140 usable returns were used in this study. The result revealed that risk in entrepreneurial orientation is often associated with lower firm performance and innovativeness and proactiveness could be considered the mechanisms through which TMT metacognition contributes most to higher organisational performance. This finding is significant for SMEs, whose resources are limited, and TMT could consider less risky projects, but still maintaining its innovativeness and proactiveness, particularly in the niche market areas. Furthermore, the empirical result supported previous findings that top managers’ abilities and behaviour collectively as a team could be seen as an important factor in their innovative and competitive outcomes in SMEs

Naturalistic paradigms for neuroimaging and bedside measures of conscious awareness

Complex, naturalistic stimuli can test for covert awareness in behaviourally non-responsive patients. For patients with poor visual function, this thesis aimed to identify an auditory-only stimulus that could evaluate executive function. Also, it assessed if Galvanic Skin Response could be a suitable bedside testing method. Healthy individuals listened to 4 auditory stimuli in the fMRI scanner. During Galvanic Skin Response recording, an independent group of controls listened to an audio narrative and watched a movie. Behaviourally non-responsive patients were also tested during movie viewing. Using fMRI, an audio narrative was identified that produced widespread brain synchronization between healthy participants, critically in the frontoparietal network. Healthy controls showed highly similar GSR to a suspenseful movie. A locked-in syndrome patient had a similar GSR to controls during movie viewing. The audio narrative can be used for future patient testing, and GSR can be used to test for consciousness at the bedside

Modular Construction of Complete Coalgebraic Logics

We present a modular approach to defining logics for a wide variety of state-based systems. The systems are modelled by coalgebras, and we use modal logics to specify their observable properties. We show that the syntax, semantics and proof systems associated to such logics can all be derived in a modular fashion. Moreover, we show that the logics thus obtained inherit soundness, completeness and expressiveness properties from their building blocks. We apply these techniques to derive sound, complete and expressive logics for a wide variety of probabilistic systems, for which no complete axiomatisation has been obtained so far

Evolution of Neural Networks for Helicopter Control: Why Modularity Matters

The problem of the automatic development of controllers for vehicles for which the exact characteristics are not known is considered in the context of miniature helicopter flocking. A methodology is proposed in which neural network based controllers are evolved in a simulation using a dynamic model qualitatively similar to the physical helicopter. Several network architectures and evolutionary sequences are investigated, and two approaches are found that can evolve very competitive controllers. The division of the neural network into modules and of the task into incremental steps seems to be a precondition for success, and we analyse why this might be so

Study Protocol for Investigating Physician Communication Behaviours that Link Physician Implicit Racial Bias and Patient Outcomes in Black Patients with Type 2 Diabetes Using an Exploratory Sequential Mixed Methods Design

Introduction Patient-physician racial discordance is associated with Black patient reports of dissatisfaction and mistrust, which in turn are associated with poor adherence to treatment recommendations and underutilisation of healthcare. Research further has shown that patient dissatisfaction and mistrust are magnified particularly when physicians hold high levels of implicit racial bias. This suggests that physician implicit racial bias manifests in their communication behaviours during medical interactions. The overall goal of this research is to identify physician communication behaviours that link physician implicit racial bias and Black patient immediate (patient-reported satisfaction and trust) and long-term outcomes (eg, medication adherence, self-management and healthcare utilisation) as well as clinical indicators of diabetes control (eg, blood pressure, HbA1c and history of diabetes complication). Methods and analysis Using an exploratory sequential mixed methods research design, we will collect data from approximately 30 family medicine physicians and 300 Black patients with type 2 diabetes mellitus. The data sources will include one physician survey, three patient surveys, medical interaction videos, video elicitation interviews and medical chart reviews. Physician implicit racial bias will be assessed with the physician survey, and patient outcomes will be assessed with the patient surveys and medical chart reviews. In video elicitation interviews, a subset of patients (approximately 20–40) will watch their own interactions while being monitored physiologically to identify evocative physician behaviours. Information from the interview will determine which physician communication behaviours will be coded from medical interactions videos. Coding will be done independently by two trained coders. A series of statistical analyses (zero-order correlations, partial correlations, regressions) will be conducted to identify physician behaviours that are associated significantly with both physician implicit racial bias and patient outcomes