Non-Quiet Listening for Children with Hearing Loss: An Evaluation of Amplification Needs and Strategies

The goals of this project were to identify and evaluate strategies for non-quiet listening needs of children with hearing loss who wear hearing instruments. Three studies were undertaken: 1) an exploration of the listening environments and situations experienced by children from daycare to high school during the school-day; 2) a comparative evaluation of consonant recognition, sentence recognition in noise, and loudness perception with the Desired Sensation Level version 5 (DSL v5) Quiet and Noise prescriptions and 3) a comparative evaluation of sentence recognition in noise and loudness perception with DSL v 5 Quiet and Noise paired with the hearing instrument features of directional microphone and digital noise reduction (DNR) technology. Results of the first study showed that children experience a wide variety of listening environments and situations, most of which can be classified as “non-quiet”. This finding confirms the need for the development of processing strategies for children listening in non-quiet environments and situations. The second study showed that the DSL v5 Noise prescription does not negatively impact consonant recognition except at low levels, with no significant differences in sentence recognition in noise. Improved comfort for loud sounds was afforded by DSL v5 Noise compared to DSL v5 Quiet. The third study showed that the optimal combination of prescription and hearing instrument features tested was DSL v5 Noise with a directional microphone. The results of these three studies offer a starting point for the development of a protocol for providing a non-quiet listening strategy for children who wear hearing instruments. This result is a significant contribution to the currently discrepant guidelines across countries and pediatric audiology organizations

To submit or not submit: The burden of evaluation on postgraduate medical trainees

Purpose Academic centers utilize web-based surveillance systems to administer their evaluations, but little is known about their impact on the evaluation responsibilities delegated to medical residents. Method Using a mixed-methods approach, a retrospective content analysis was conducted of the evaluation activities experienced by a cohort of 29 residents as they completed their training in general internal medicine from 2009-2012. These data were triangulated with group interviews conducted with current internal medicine residents in 2012-2013. Results The internal medicine program electronically requested that its residents complete 8,614 evaluation reports on clinical faculty, curriculum, and junior trainees (345 requests annually per resident). Residents reported feeling overwhelmed by their ongoing evaluation workload, and admitted that their motivation to submit high-quality appraisals was dissipating. Residents perceived that their program valued certain evaluations more than others, and this was a major factor in their decision regarding whether or not they would eventually submit an appraisal. Feedback submitted on program evaluation related appraisals were viewed as having the least value, and residents were significantly less likely to submit these evaluations. Conclusions Although web-based surveillance systems are efficient in distributing thousands of evaluations, residency programs to engage in ongoing vigilance of the unintended consequences associated with their use

De la compétence à l’empathie : évaluation de l’évolution de la perception qu’ont les étudiants en médecine des chirurgiens dans le cadre d’un programme associant le patient comme enseignant et la réflexion basée sur les arts

Introduction: The purpose of this study was to identify whether the incorporation of a combined Patient as teacher (PAT) and arts-based reflection (ABR) program during a surgical clerkship rotation could influence more humanistic perceptions of surgeons, using an innovative evaluation approach. Methods: A novel, single question evaluation tool was created. Third year medical-students were asked to “list the top 5 attributes of a surgeon, in order of perceived importance” both before and after their surgical clerkship rotations and participation in the PAT/ABR program. Attributes identified by students were coded as either “humanistic” or “non-humanistic,” which were then analyzed using generalized linear regression models under a Bayesian framework. Results: After participation in the PAT/ABR program, the predicted probability of students ranking a humanistic characteristic as the most important attribute of a surgeon had increased by 17%, and the predicted probability of students ranking a humanistic characteristic amongst their top three attributes for a surgeon had increased by 21%. Conclusion: This innovative evaluative method suggested the success of a combined PAT/ABR program in encouraging a humanistic perspective of surgery and this approach could potentially be explored to evaluate other humanistic education initiatives.Résumé Introduction : L’objectif de cette étude était de déterminer si l’introduction d’une nouvelle approche d’évaluation associant la participation de Patients comme enseignants (PCE) à une Réflexion basée sur les arts (RBA) dans un stage d’externat en chirurgie permettait de mieux percevoir les qualités humanistes chez les chirurgiens. Méthodes : Un nouvel outil d’évaluation à question unique a été créé. Des étudiants en troisième année de médecine ont été invités à ‘’énumérer les cinq principaux attributs d’un chirurgien, par ordre d’importance perçue’’, avant et après leur stage d’externat en chirurgie et le programme PCE/RBA. Les attributs identifiés par les étudiants ont été codés comme « humanistes » ou « non humanistes », puis analysés à l’aide de modèles de régression linéaire généralisée dans un cadre bayésien. Résultats : Après leur participation au programme PCE/RBA, la probabilité prédite moyenne que les étudiants classent un trait humaniste comme l’attribut le plus important d’un chirurgien a augmenté de 17 %, et la probabilité prédite que les étudiants classent un trait humaniste parmi les trois premiers attributs d’un chirurgien a augmenté de 21 %. Conclusion : Cette méthode d’évaluation innovante porte à croire que le programme PCE/RBA réussit en effet à favoriser une vision humaniste de la chirurgie. Cette approche peut être explorée pour évaluer d’autres activités de formation axées sur l’humanisme

Antioxidant protection from HIV-1 gp120-induced neuroglial toxicity

BACKGROUND: The pathogenesis of HIV-1 glycoprotein 120 (gp120) associated neuroglial toxicity remains unresolved, but oxidative injury has been widely implicated as a contributing factor. In previous studies, exposure of primary human central nervous system tissue cultures to gp120 led to a simplification of neuronal dendritic elements as well as astrocytic hypertrophy and hyperplasia; neuropathological features of HIV-1-associated dementia. Gp120 and proinflammatory cytokines upregulate inducible nitric oxide synthase (iNOS), an important source of nitric oxide (NO) and nitrosative stress. Because ascorbate scavenges reactive nitrogen and oxygen species, we studied the effect of ascorbate supplementation on iNOS expression as well as the neuronal and glial structural changes associated with gp120 exposure. METHODS: Human CNS cultures were derived from 16–18 week gestation post-mortem fetal brain. Cultures were incubated with 400 μM ascorbate-2-O-phosphate (Asc-p) or vehicle for 18 hours then exposed to 1 nM gp120 for 24 hours. The expression of iNOS and neuronal (MAP2) and astrocytic (GFAP) structural proteins was examined by immunohistochemistry and immunofluorescence using confocal scanning laser microscopy (CSLM). RESULTS: Following gp120 exposure iNOS was markedly upregulated from undetectable levels at baseline. Double label CSLM studies revealed astrocytes to be the prime source of iNOS with rare neurons expressing iNOS. This upregulation was attenuated by the preincubation with Asc-p, which raised the intracellular concentration of ascorbate. Astrocytic hypertrophy and neuronal injury caused by gp120 were also prevented by preincubation with ascorbate. CONCLUSIONS: Ascorbate supplementation prevents the deleterious upregulation of iNOS and associated neuronal and astrocytic protein expression and structural changes caused by gp120 in human brain cell cultures

Protocol for the Provision of Amplification

This Protocol addresses the provision of amplification (hereafter: \u27Amplification\u27) to infants and pre-school children who are receiving services from the Ontario Infant Hearing Program (IHP). Providing amplification includes the process of prescribing a hearing aid based on appropriate assessment information, verification that the specified acoustical performance targets have been achieved, fitting the device on the child, and evaluation of device effectiveness in daily life

Protocol for the Provision of Amplification v 2023.01

This Protocol addresses the provision of amplification (hereafter: \u27Amplification\u27) to infants and children who are receiving services from the Ontario Infant Hearing Program (IHP). For the purposes of this protocol, providing amplification includes the processes of prescribing a hearing aid (air or bone conduction) and/or other hearing assistance technologies based on appropriate assessment information, verification that the specified acoustical performance targets have been achieved, fitting the device on the child, and ongoing evaluation of device effectiveness in daily life. Amplification within the IHP does not include the provision of cochlear implants

Effects of modality and filtering on emotional responses in adults with normal hearing

The purpose of this project was two-fold. First, it was to evaluate the contribution of low- and high-frequency information to emotional responses to non-speech sounds in adults with normal hearing. The second purpose was to evaluate the effect of stimulus modality on emotional responses, with particular focus on the effect of disrupted affective processing in the auditory domai

To submit or not submit: The burden of evaluation on postgraduate medical trainees

Abstract Purpose Academic centers utilize web-based surveillance systems to administer their evaluations, but little is known about their impact on the evaluation responsibilities delegated to medical residents. Method Using a mixed-methods approach, a retrospective content analysis was conducted of the evaluation activities experienced by a cohort of 29 residents as they completed their training in general internal medicine from 2009-2012. These data were triangulated with group interviews conducted with current internal medicine residents in 2012-2013. Results The internal medicine program electronically requested that its residents complete 8,614 evaluation reports on clinical faculty, curriculum, and junior trainees (345 requests annually per resident). Residents reported feeling overwhelmed by their ongoing evaluation workload, and admitted that their motivation to submit high-quality appraisals was dissipating. Residents perceived that their program valued certain evaluations more than others, and this was a major factor in their decision regarding whether or not they would eventually submit an appraisal. Feedback submitted on program evaluation-related appraisals were viewed as having the least value, and residents were significantly less likely to submit these evaluations. Conclusions Zibrowski E, Crukley J, Malett J, Myers K MedEdPublish https://doi.org/10. 15694/mep.2016.000058 Page | 2 Although web-based surveillance systems are efficient in distributing thousands of evaluations, residency programs to engage in ongoing vigilance of the unintended consequences associated with their use