Effects of age at cochlear implantation on vocabulary and grammar: a review of the evidence

Purpose: The increasing prevalence of pediatric cochlear implantation over the past 25 years has left little doubt that resulting improvements in hearing offer significant benefits to language development for many deaf children. Furthermore, given the documented importance of access to language from birth, there has been strong support for providing congenitally deaf children with implants as early as possible. Earliest implantation, in many ways, has become the “gold standard” in pediatric cochlear implantation, on the assumption that it is the key to language development similar to that of hearing children. Empirical evidence to support this assumption, however, appears more equivocal than generally is believed. This article reviews recent research aimed at assessing the impact of age at implantation on vocabulary and grammatical development among young implant users. Method: Articles published between 2003 and 2018 that included age at implantation as a variable of interest and in which it was subjected to statistical analysis were considered. Effect sizes were calculated whenever possible; we conducted a multivariate meta-analysis to compare outcomes in different language domains. Results: Taken together, findings from 49 studies suggest that age at implantation is just one of a host of variables that influence vocabulary and grammatical development, its impact varying with several factors including whether age at implantation is treated as a dichotomous or continuous variable. Results from a meta-analysis showed significant differences across language domains. Conclusion: The pattern of results obtained indicates the importance of considering various child, family, and environmental characteristics in future research aimed at determining how early “early implantation” needs to be and the extent to which age at implantation, duration of implant use, and other factors influence language and languagerelated outcomes. © 2019 American Speech-Language-Hearing Association

Développement des habiletés linguistiques chez les enfants porteurs d'un implant cochléaire

Cette thèse examine le développement du langage des enfants sourds qui ont reçu un implant cochléaire (IC) en bas âge. Une première étude rapporte une revue systématique qui avait pour but d’évaluer les connaissances actuelles concernant le développement du vocabulaire et de la grammaire chez les enfants qui ont reçu un IC avant l’âge de trois ans. Vingt-huit études ont été sélectionnées; une analyse descriptive de même qu’une méta-analyse ont été effectuées séparément pour chaque aspect du langage évalué (vocabulaire et grammaire, aspect réceptif et expressif). Au résultat, en dépit de la variabilité observée dans les études, il appert que l’implant cochléaire influence positivement le développement langagier; toutefois, seule une minorité de participants aux études a atteint des niveaux de langage comparables à ceux d’enfants entendants de même âge chronologique. La majorité des enfants continuent de présenter divers degrés de retard de langage, tant au plan réceptif qu’expressif, et ce, après jusqu’à cinq années de port de l’appareil. Les résultats suggèrent aussi, malgré la variabilité observée dans les études, que les bénéfices langagiers sont influencés par le fait de recevoir l’implant à deux ans plutôt qu’à trois ans. À partir des tendances retrouvées dans la littérature, les habiletés de vocabulaire et de grammaire chez 27 enfants qui ont reçu l’implant cochléaire en bas âge (entre 8 et 28 mois) ont été comparées avec celles d’un groupe d’enfants entendants, en utilisant des outils d’évaluation standardisés. Alors que les résultats de groupe montrent que les enfants qui reçoivent un IC autour de l’âge de deux ans atteignent des niveaux de langage dans les limites de la normale, les résultats individuels d’un sous-groupe formé de enfants les plus âgés font état de quatre profils de développement, soit des niveaux de langage dans les limites de la normale pour l’ensemble des composantes, un retard généralisé à l’ensemble des composantes, des habiletés lexicales dans la norme assorti d’un retard morphosyntaxique et enfin un profil atypique montrant des disparités importantes à travers les composantes du langage. Dans trois des quatre profils, la compréhension des phrases était particulièrement faible. Ces résultats suggèrent que le fait de recevoir un implant cochléaire entre l’âge d’un et deux ans ne garantit pas l’atteinte de niveaux de langage dans les limites de la normale malgré une expérience de port de l’appareil d’une durée appréciable. Une étape antérieure du développement linguistique a été examinée de plus près dans la troisième étude. La taille et la composition du vocabulaire expressif de onze enfants ayant reçu un IC à un âge moyen de 15 mois ont été comparées à celles de l’échantillon d’enfants entendants ayant servi à établir les normes en français québécois pour le questionnaire Mots et énoncés des Inventaires MacArthur-Bates du développement de la communication (IMBDC). Les scores d’âge équivalent selon la taille totale du vocabulaire des enfants avec IC étaient supérieurs à l’âge auditif (correspondant à la durée de port de l’appareil) mais inférieurs à l’âge chronologique. La représentation grammaticale en fonction de la taille du vocabulaire des enfants avec IC suit la tendance observée dans la norme. Ces résultats suggèrent que le profil lexical des enfants avec implant est très similaire à celui des enfants entendants lorsque le nombre total de mots acquis est le même. Les résultats de cette thèse suggèrent que l’implant peut, de manière générale, avoir un effet « normalisant » sur le langage ; toutefois, il semble que l’amélioration de l’accès auditif ne suffise pas pour rattraper à coup sûr le niveau de langage des pairs entendants dans l’ensemble des composantes du langage. Alors que les habiletés lexicales se rapprochent du profil typique, les habiletés de compréhension morphosyntaxique sont fortement atteintes chez une majorité d’enfants, suggérant un profil apparenté à un trouble de langage.This dissertation examines language development in children who received a cochlear implant (CI) at a young age. A systematic review studied the main outcomes reported in the literature concerning vocabulary and grammar development of profoundly deaf children who received a CI before the age of 3 years. A total of 28 studies met inclusion criteria. Studies varied widely in participant characteristics, assessment tools, study designs, and overall methodological quality. A descriptive synthesis and a meta-analysis were completed separately for each language domain (receptive and expressive vocabulary and grammar). Results showed a positive impact of cochlear implantation on language development, but only a minority of children achieved language levels on par with their hearing age-mates. The majority of the children involved in the primary studies continued to exhibit varying levels of delay in receptive and expressive vocabulary and grammar after up to 5 years of cochlear implant use. Results showed that the minority of children who achieved language levels on par with hearing children were likely to have received their implant by the age of two, thus suggesting that age at implantation influences language achievement. A second study examined receptive and expressive vocabulary and grammar achievement of 27 French-speaking children who received a CI between the age of 8 and 28 months. Standardized measures were administered and the language levels attained by children with CIs were compared with those of the normative sample of same-age hearing peers for each measure. As a group, children exhibited language levels within normal limits on all standardized language measures. Examination of individual patterns in a subgroup of children revealed 4 different language profiles: a) normal language levels in all domains, b) general language delay, c) vocabulary within the norm with morphosyntactic delay, and d) an atypical profile (discrepancies across language domains). In three of these profiles, comprehension of sentences was impaired. Findings suggest that receiving a cochlear implant between the age of 1 and 2 years does not ensure that language abilities will be within normal limits after up to 6 years of experience with the implant. An earlier stage of formal language was examined in the third study. Vocabulary size and grammatical composition in 11 children who received their CI at a mean age of 15 months were compared to that of the Quebec French normative sample for the Words and Sentences questionnaire of the MacArthur-Bates Communicative Development Inventories (MBCDI). Results showed that age equivalent scores according to total vocabulary size were superior to hearing age (equivalent to the duration of device use) but inferior to chronological age. Distribution of grammatical categories according to vocabulary size followed the same pattern as in the normative sample. These results suggest that the lexical profile of children with implants was very similar to that of normally-hearing children who had the same number of words. Taken together, results of this dissertation suggest that the cochlear implant can have a “normalizing” effect on language. However, they also suggest that improved access to auditory input does not seem sufficient to allow children to attain language levels within normal limits in all components. Whereas early lexical abilities were comparable to typical development, receptive morphosyntactic abilities remain severely impaired in a majority of children

Fusion partielle et microstructures associées dans l'auréole de contact du complexe igné de Duluth, Minnesota

La mise en place du Complexe igné de Duluth a provoqué un métamorphisme thermal, l'assimilation et la fusion partielle des roches l'entourant y compris la Formation de Virginia. Celle-ci est principalement constituée de métapélites et est la principale roche encaissante dans la partie nord-ouest du Complexe igné de Duluth. L'étude porte sur des échantillons provenant de différentes parties de cette formation. Afin d'établir les aspects minéralogiques et microstructuraux, une étude pétrographique et géochimique a été effectuée. La pression au moment de l'intrusion était d'environ 2-2.5 kbar et la température était plus élevée que 650°C étant donné la présence de fondu. En fait, la température a dû atteindre au moins 750°C (nécessaire pour la production de pyroxene), voire même 800°C étant donné l'absence de biotite résiduelle dans quelques diatexites. La fusion partielle a permis le développement de microstructures particulières. Plusieurs évidences de fluage et de ségrégation (séparation liquide - matériel solide) sont observées sur le terrain et dans les lames minces. Malgré cela, seul quelques échantillons montrent une perte de liquide minime (5-10%) à l'échelle de l'échantillon. Néanmoins, l'analyse géochimique de petits secteurs de quelques lames minces révèle un taux de fusion de plus de 26%. L'échelle de ségrégation n'était pourtant que de l'ordre du millimètre au centimètre. La faiblesse des contraintes de déformation et la durée du métamorphisme sont en cause. En effet, le refroidissement dans un contexte de métamorphisme de contact est rapide et la déformation faible. Tout congèle rapidement et empêche la ségrégation de se poursuivre

Habiletés morphosyntaxiques des enfants sourds porteurs d’implants cochléaires: une revue systématique = Morphosyntactic skills in deaf children with cochlear implants: a systematic review

Thanks to an increasingly early implantation, the majority of children with cochlear implants (CCI) now succeed in reaching the standard with regards to overall language skills. However, some difficulties persist in morphology. This study therefore attempts to better understand morphosyntactic skills, the means to evaluate these skills and the tasks that provide a detailed description of same. In terms of methodology, a systematic review of the scientific literature published between 2000 and 2013 helped us identify 215 publications of which 18 studies analysed included children who received their implant before the age of 36 months. The results confirm the inferior performance in morphology by CCI’s, especially in the complex stages of grammatical development. Their typical errors, often omissions and substitutions, involve the less salient and more exacting morphemes with regards to perceptual, semantic, and grammatical processing, that is agreement markers for gender and number of determinants and clitic pronouns, as well as verbal flexions. Our study demonstrates that global tests, specialized tests, and questionnaires only provide a partial image of the difficulties in morphosyntax, such that the analysis of the spontaneous language still remains the best tool for the clinician to identify CCI’s real abilities and challenges. Future research should therefore attempt to develop standardised and more sensitive evaluation tools that are better adapted to the realities of CCI’s, leading to a more targeted and efficient intervention. © 2014 Canadian Association of Speech-Language Pathologists and Audiologists. All rights reserved

Targeting "Lifestyle" Conditions: What Justifications for Treatment?

Patients suffering from "lifestyle" conditions are most often viewed as responsible for their illness, and so not considered to be a priority for healthcare resources. Instead, their treatment is financed on instrumental grounds: it is better to treat the condition now than to incur higher costs later of not doing so. An alternative register of justification at work in public healthcare policies is not motivated by instrumental considerations. Instead, it seeks to articulate an ethical case for prioritizing lifestyle conditions. Within this framework, we draw on the notion of vital need within the tradition of humanistic philosophy to argue that solidarity justifies the treatment of such conditions, exemplified here by obesity. We use the theoretical framework of economics of convention to present these two registers of justification at work in public healthcare policies. The importance of humanistic criticism prevents instrumental logic from being completely dominant

La résilience chez les adultes ayant une surdité acquise : une étude exploratoire = Resilience in adults with acquired deafness: an exploratory study

Hearing loss is an invisible condition that affects communication and social interaction. For many individuals, sudden or gradual loss of their hearing, either partial or total, constitutes a dramatic event that demands specific adjustments. Although a few studies have explored personal variables associated with the adaptation process in the presence of a hearing loss, to our knowledge, no study has explored resilience in adults with acquired deafness. Our main purpose was to gain a better understanding of resilience in the context of a postlingual hearing loss. We measured resilience in 35 adults with acquired deafness using the Connor-Davidson Resilience Scale (CD-RISC). Participants, aged 20 to 84 years, filled out the CD-RISC and a sociodemographic questionnaire electronically via a secure website. We gathered information on the degree of hearing loss, hearing device use, education, and living arrangements. We then examined potential predictors of resilience score, using a regression model. Degree of hearing loss and living arrangements were both associated with resilience. Our results suggest that resilience is an evolutionary process influenced by external factors. On a clinical level, our results reinforce the importance of personal and environmental factors in adults with acquired deafness and the importance of taking resilience capacities into account. © 2017, Canadian Association of Speech-Language Pathologists and Audiologists. All rights reserved

Increased soil temperature and atmospheric N deposition have no effect on the N status and growth of a mature balsam fir forest

Nitrogen (N) is a major growth-limiting factor in boreal forest ecosystems. Increases of temperature and atmospheric N deposition are expected to affect forest growth directly and indirectly by increasing N availability due to higher rates of N mineralization. In order to understand the potential impacts of these changes, a mature balsam fir stand in Québec, Canada, was subjected during three consecutive growing seasons (2009-2011) to (i) experimentally increased soil temperature (4 C) and earlier snowmelt (2-3 weeks) as well as (ii) increased inorganic N concentration in artificial precipitation (3 × current N concentrations using 15NH4-15NO3). Soil inorganic N was measured using buried ion-exchange membranes (PRS™ probes) and standard soil extractions. Dendrometers were used to monitor the variations in diameter growth and needles were analyzed annually for N to assess the nutritional response of trees. Results from the second (2010) and third (2011) year of treatment are reported. After three years of treatment, there was no significant increase in soil nitrate (NO3) or ammonium (NH4) availability either in the organic or in the mineral soil as measured with standard soil extractions. Similar results were obtained with ion-exchange membranes, except for NH4 in the forest floor, which increased by an average of 54% over the two years. No effect of treatments were observed on needle N or diameter growth, but an 8-day earlier peak in diameter growth was measured in heated plots in 2010. We attributed the limited effects of our treatments to the acute soil competition for available N at the site. As a result, the projected modifications of the forest N cycle and concomitant increased forest growth due to an earlier snowmelt, increased soil temperature and N deposition should be considered with caution in similar cold N-poor ecosystems

Base de données sur les études de cas en innovation sociale produites dans le cadre des activités du CRISES. Présentation générale et manuel de codification

Ce cahier vise à présenter les travaux qui ont été réalisés afin de conceptualiser et d’implanter la Base de données sur l’innovation sociale (BDIS) mise en place par le Centre de recherche sur les innovations sociales (CRISES). Le document détaille le contexte de production de la BDIS, l’approche de l’innovation sociale (IS) adoptée et la littérature consultée en appui au modèle conceptuel, la méthode employée pour la sélection et la définition des entités, attributs et catégories, l’utilité du modèle conceptuel pour l’étude de l’IS et la présentation du modèle

Impact of the COVID-19 pandemic on older adults: rapid review

Background: The COVID-19 pandemic has drastically changed the lives of countless members of the general population. Older adults are known to experience loneliness, age discrimination, and excessive worry. It is therefore reasonable to anticipate that they would experience greater negative outcomes related to the COVID-19 pandemic given their increased isolation and risk for complications than younger adults. Objective: This study aims to synthesize the existing research on the impact of the COVID-19 pandemic, and associated isolation and protective measures, on older adults. The secondary objective is to investigate the impact of the COVID-19 pandemic, and associated isolation and protective measures, on older adults with Alzheimer disease and related dementias. Methods: A rapid review of the published literature was conducted on October 6, 2020, through a search of 6 online databases to synthesize results from published original studies regarding the impact of the COVID-19 pandemic on older adults. The Human Development Model conceptual framework–Disability Creation Process was used to describe and understand interactions between personal factors, environmental factors, and life habits. Methods and results are reported following the Preferred Reporting Items for Systematic Reviews and Meta-analyses Statement. Results: A total of 135 records were included from the initial search strategy of 13,452 individual studies. Of these, 113 (83.7%) studies were determined to be of level 4 according to the levels of evidence classification by the Centre for Evidence-Based Medicine. The presence of psychological symptoms, exacerbation of ageism, and physical deterioration of aged populations were reported in the included studies. Decreased social life and fewer in-person social interactions reported during the COVID-19 pandemic were occasionally associated with reduced quality of life and increased depression. Difficulties accessing services, sleep disturbances, and a reduction of physical activity were also noted. Conclusions: Our results highlight the need for adequate isolation and protective measures. Older adults represent a heterogeneous group, which could explain the contradictory results found in the literature. Individual, organizational, and institutional strategies should be established to ensure that older adults are able to maintain social contacts, preserve family ties, and maintain the ability to give or receive help during the current pandemic. Future studies should focus on specific consequences and needs of more at-risk older adults to ensure their inclusion, both in public health recommendations and considerations made by policy makers

Multiple novel prostate cancer susceptibility signals identified by fine-mapping of known risk loci among Europeans

Genome-wide association studies (GWAS) have identified numerous common prostate cancer (PrCa) susceptibility loci. We have fine-mapped 64 GWAS regions known at the conclusion of the iCOGS study using large-scale genotyping and imputation in 25 723 PrCa cases and 26 274 controls of European ancestry. We detected evidence for multiple independent signals at 16 regions, 12 of which contained additional newly identified significant associations. A single signal comprising a spectrum of correlated variation was observed at 39 regions; 35 of which are now described by a novel more significantly associated lead SNP, while the originally reported variant remained as the lead SNP only in 4 regions. We also confirmed two association signals in Europeans that had been previously reported only in East-Asian GWAS. Based on statistical evidence and linkage disequilibrium (LD) structure, we have curated and narrowed down the list of the most likely candidate causal variants for each region. Functional annotation using data from ENCODE filtered for PrCa cell lines and eQTL analysis demonstrated significant enrichment for overlap with bio-features within this set. By incorporating the novel risk variants identified here alongside the refined data for existing association signals, we estimate that these loci now explain ∼38.9% of the familial relative risk of PrCa, an 8.9% improvement over the previously reported GWAS tag SNPs. This suggests that a significant fraction of the heritability of PrCa may have been hidden during the discovery phase of GWAS, in particular due to the presence of multiple independent signals within the same regio