Modified Physiological Hearing Screening: Interim Protocol For Ontario Infants During the COVID-19 Pandemic

This protocol describes interim procedures for a modified physiological hearing screen for Ontario infants who are over 8 weeks corrected age and who were not offered a newborn hearing screen through the Infant Hearing Program (IHP) due to service interruptions as a result of the COVID-19 pandemic. The scope of this document includes details of the modified hearing screen as funded by the Ministry of Children, Community and Social Services (MCCSS) for the Ontario IHP. It will remain in effect as an interim service during the global pandemic and will be recalled at the discretion of the MCCSS

The Effects of Sex on Zebrafish Bone Metabolism

I investigated the effects of diet and sex on zebrafish bone metabolism. Zebrafish were subjected to either a high-calorie or low-calorie diet over a five-week period. After this diet, zebrafish scales were used to measure alkaline phosphatase (ALP) and tartrate-resistant acid phosphatase (TRAP) enzyme activity with a fluorescent substrate. The enzyme activities were markers of the osteoblasts (ALP) and the osteoclasts (TRAP). These data were compared among sex and diet of the zebrafish using a repeated measures ANOVA statistical test. I also measured the number of resorption lacunae per scale (another indicator of osteoclast activity). The results showed higher TRAP activity in the low-calorie diet group (p = 0.03) but no effect of sex (p = 0.55). The low-calorie diet group had a higher number of lacunae per square mm of scale (p = 0.01). I interpret these results as low-calorie treatment increases osteoclast activity in zebrafish

Language Development Services Guidelines Ontario Infant Hearing Program

The IHP Language Development Pathway (LDP) is comprised of the nine steps summarized in the table below (Coutu et al., 2015).While the pathway intends to capture the process for providing language development services, the sequence of steps may not occur exactly as outlined below(e.g.,some steps may be initiated or occur at the same time).The steps may not be sequential and are not intended to describe separate and/or different appointments.The table provides an overview of the service providers who may be supporting a child who is D/HH and their family,during each step in the process. It is not intended to be exhaustive of all professionals who may be working with a child and/or their family

Development and Evaluation of an Audiological Outcome Measure Guideline for Use with Infants, Toddlers, and Preschool Children

The goals of the current work were to: 1) identify caregiver report questionnaires for inclusion in an outcome evaluation guideline for infants, toddlers, and preschool children who wear hearing aids and 2) evaluate the chosen tools to determine their usefulness for the population of interest. A critical review of auditory-related subjective outcome evaluation tools for infants, toddlers, and preschool children is presented (Chapter 2). Good psychometric properties and clinical feasibility were considered important elements for the guideline (Andresen, 2000). Existing norms for the chosen questionnaires were validated with normal hearing children from Canadian English-speaking families (Chapters 3 and 5). Finally, The University of Western Ontario Pediatric Audiological Monitoring Protocol (UWO PedAMP), how it was used to collect clinical data with children who wear hearing aids, and their performance on the questionnaires is provided (Chapter 4). Children with comorbidities and complex factors related to hearing aid use were also investigated. The results of this work revealed two caregiver report questionnaires that were suitable for use within the UWO PedAMP (Chapter 2): the LittlEARS® Auditory Questionnaire (Tsiakpini, et al., 2004) and the Parents’ Evaluation of Aural/Oral Performance of Children (PEACH) Rating Scale (Ching & Hill, 2005). Both questionnaires were considered feasible for clinical use (Moodie, et al., 2011) and are supported by good psychometric properties. Norms for the questionnaires were found to be appropriate for use with normal hearing children (Chapters 3 and 5). Outcomes of children with hearing loss who wear hearing aids were investigated using the UWO PedAMP (Chapter 4). Results indicated typically developing children fitted with hearing aids displayed auditory development and performance similar to their normal hearing peers. Children with comorbidities displayed borderline normal auditory development which progressed as they got older. Children with complex factors related to hearing aid use displayed borderline normal development up to 12 months of age where it began to decline. This work also demonstrated that the UWO PedAMP can be used in a clinical setting to evaluate the outcome of hearing aid fitting to infants, toddlers, and preschool children. This is an important finding since outcome evaluation guidelines for this population are lacking

A Three-Dimensional Functional Assessment of Heart and Vessel Development in the Larva of the Zebrafish (Danio Rerio)

There has been considerable recent interest in the development of the circulation in the zebrafish. Optical techniques typically used to visualize changes in heart size allow measurement of stroke volume during early vertebrate development, but this approach is complicated in zebrafish larvae because of the heart\u27s irregular shape and its significant change in morphology during the first 6 d of development. By use of a three-dimensional integration of the early zebrafish heart and vessels, we have greatly reduced measurement error of stroke volume and cardiac output and have determined the cross-sectional growth of major vessels in the developing zebrafish larvae. A dramatic 500%-600% increase in cardiac output (from 10 to 50-60 nL min(-1)) occurs on days 5 and 6 postfertilization in Danio rerio. Cross-sectional area of key vessels (dorsal artery, caudal artery, dorsal vein) as well as between-individual variation significantly decreased over the first 6 d of development. Associated with the decrease in cross-sectional area is a significant increase in red blood cell velocity on days 5 and 6 postfertilization. Together, the three-dimensional data of the cardiac and vascular systems have shown that the most profound physiological and developmental changes occur in days 5 and 6, which corresponds with the appearance of the adult form of the heart and the transition from diffusive to convective O-2 supply to internal tissues

Evaluation of hearing aid manufacturers\u27 software-derived fittings to DSL v5.0 pediatric targets

Background Hearing aid prescriptive methods are a commonly recommended component of evidence-based preferred practice guidelines and are often implemented in the hearing aid programming software. Previous studies evaluating hearing aid manufacturers\u27 software-derived fittings to prescriptions have shown significant deviations from targets. However, few such studies examined the accuracy of softwarederived fittings for the Desired Sensation Level (DSL) v5.0 prescription. Purpose The purpose of this study was to evaluate the accuracy of software-derived fittings to the DSL v5.0 prescription, across a range of hearing aid brands, audiograms, and test levels. Research Design This study is a prospective chart review with simulated cases. Data Collection and Analysis A set of software-derived fittings were created for a sixmonth- old test case, across audiograms ranging from mild to profound. The aided output from each fitting was verified in the test box at 55-, 65-, 75-, and 90-dB SPL, and compared with DSL v5.0 child targets. The deviations from target across frequencies 250-6000 Hz were calculated, together with the root-mean-square error (RMSE) from target. The aided Speech Intelligibility Index (SII) values generated for the speech passages at 55- and 65-dB SPL were compared with published norms. Study Sample Thirteen behind-the-ear style hearing aids from eight manufacturers were tested. Results The amount ofdeviation per frequencywas dependent on the test level and degree of hearing loss. Most software-derived fittings for mild-to-moderately severe hearing losses fell within_ 5 dB of the target formost frequencies. RMSE results revealed more than 84% of those hearing aid fittings for the mild-to-moderate hearing losseswere within 5 dB at all test levels. Fittings for severe to profound hearing losses had the greatest deviation from target and RMSE. Aided SII values for the mild-to-moderate audiograms fell within the normative range forDSL pediatric fittings, although they fellwithin the lower portion of the distribution. For more severe losses, SII values for some hearing aids fell below the normative range. Conclusions In this study, use of the software-derived manufacturers\u27 fittings based on the DSL v5.0 pediatric targets set most hearing aids within a clinically acceptable range around the prescribed target, particularly for mild-to-moderate hearing losses. However, it is likely that clinician adjustment based on verification of hearing aid output would be required to optimize the fit to target, maximize aided SII, and ensure appropriate audibility across all degrees of hearing loss

Cadherin2 (N-cadherin) plays an essential role in zebrafish cardiovascular development

BACKGROUND: Cadherins are cell surface adhesion molecules that play important roles in development of vertebrate tissues and organs. We studied cadherin2 expression in developing zebrafish heart using in situ hybridization and immunocytochemical methods, and we found that cadherin2 was strongly expressed by the myocardium of the embryonic zebrafish. To gain insight into cadherin2 role in the formation and function of the heart, we analyzed cardiac differentiation and performance in a cadherin2 mutant, glass onion (glo). RESULTS: We found that the cadherin2 mutant had enlarged pericardial cavity, disorganized atrium and ventricle, and reduced expression of a ventricular specific marker vmhc. Individual myocardiocytes in the glo mutant embryos became round shaped and loosely aggregated. In vivo measurements of cardiac performance revealed that the mutant heart had significantly reduced heart rate, stroke volume and cardiac output compared to control embryos. Formation of the embryonic vascular system in the glo mutants was also affected. CONCLUSION: Our results suggest that cadherin2 plays an essential role in zebrafish cardiovascular development. Although the exact mechanisms remain unknown as to the formation of the enlarged pericardium and reduced peripheral blood flow, it is clear that myocardiocyte differentiation and physiological cardiovascular performance is impaired when cadherin2 function is disrupted

Effects of E-cigarette Vapor on Zebrafish Cell Regeneration and Wound Healing

In regards to wound healing, smoking traditional tobacco cigarettes is known to have negative effects on wound healing (Akoz, 2002). An increased risk of skin necrosis has been observed in patients who smoke throughout the surgical process (Akoz, 2002). It is known that nicotine, whether introduced through inhalation or intravenously, leads to peripheral skin vasoconstriction (Akoz, 2002). The full physiological effects of e-cigarettes are not known and research is being done to improve our understanding on the effects that these products may have on our bodies. This research is intended for that purpose. Zebrafish have recently been used as a model organism for studying the effects of cutaneous wound healing (Richardson, 2013). They have an adaptive immune system as adults which gives them an advantage for research over other vertebrates for immune system and healing studies (Novoa, 2011). This research is aimed at answering the scientific question of how the chemicals in e-cigarettes may affect wound healing and regeneration of the caudal fin of adult zebrafish after prolonged use

Cardiovascular system in larval zebrafish responds to developmental hypoxia in a family specific manner

BACKGROUND: Genetic and environmental variation are both known to influence development. Evolution of a developmental response that is optimized to the environment (adaptive plasticity) requires the existence of genetic variation for that developmental response. In complex traits composed of integrated sets of subsidiary traits, the adaptive process may be slowed by the existence of multiple possible integrated responses. This study tests for family (sibship) specific differences in plastic response to hypoxia in an integrated set of cardiovascular traits in zebrafish. RESULTS: Cardiac output, which is the integrated product of several subsidiary traits, varied highly significantly between families, and families differed significantly in the degree and direction of response to developmental oxygen level. The cardiac output response to oxygen environment was entirely family specific with no significant overall trend due to oxygen level. Constituent physiological variables that contribute to cardiac output all showed significant family specific response to hypoxia. Traits that were not directly related to cardiac output, such as arterial and venous diameter, and red blood cell velocities did not respond to hypoxia in a family specific manner. CONCLUSION: Zebrafish families vary in their plastic response to hypoxia. Genetic variation in plastic response to hypoxia may therefore provide the basic ingredient for adaptation to a variable environment. Considerable variation in the degree of familial response to hypoxia exists between different cardiovascular traits that may contribute to cardiac output. It is possible that the integration of several subsidiary traits into cardiac output allows the maintenance of genetic variance in cardiac response

What do Speech-Language Pathologists want to know when assessing vocal development in children who are deaf/Hard-of-Hearing?

Abstract Purpose: Delays in vocal development are an early predictor of ongoing language difficulty for children who are deaf/hard-of-hearing (CDHH). Despite the importance of monitoring early vocal development in clinical practice, there are few suitable tools. This study aimed to identify the clinical decisions that speech-language pathologists (SLPs) most want to make when assessing vocal development and their current barriers to doing so. Method: 58 SLPs who provide services to CDHH younger than 22 months completed a survey. The first section measured potential barriers to vocal development assessment. The second section asked SLPs to rate the importance of 15 clinical decisions they could make about vocal development. Results: SLPs believed assessing vocal development was important for other stakeholders, and reported they had the necessary skills and knowledge to assess vocal development. Barriers primarily related to a lack of commercially available tests. SLPs rated all 15 clinical decisions as somewhat or very important. Their top 5 decisions included a variety of assessment purposes that tests are not typically designed to support, including measuring change, differential diagnosis, and goal setting. Conclusions: SLPs wish to make a number of clinical decisions when assessing vocal development in CDHH but lack access to appropriate tools to do so. Future work is needed to develop tools that are statistically equipped to fulfill these purposes. Understanding SLPs’ assessment purposes will allow future tests to better map onto the clinical decisions that SLPs need to make to support CDHH and their families and facilitate implementation into clinical practice