Factors Affecting Speech Discrimination in Children with Cochlear Implants: Evidence from Early-Implanted Infants

Background To learn words and acquire language, children must be able to discriminate and correctly perceive phonemes. Although there has been much research on the general language outcomes of children with cochlear implants (CIs), little is known about the development of speech perception with regard to specific speech processes, such as speech discrimination. Purpose The purpose of this study was to investigate the development of speech discrimination in infants with CIs and identify factors that might correlate with speech discrimination skills. Research Design Using a Hybrid Visual Habituation procedure, we tested infants with CIs on their ability to discriminate the vowel contrast /i/-/u/. We also gathered demographic and audiological information about each infant. Study Sample Children who had received CIs before 2 yr of age served as participants. We tested the children at two post cochlear implantation intervals: 2–4 weeks post CI stimulation (N = 17) and 6–9 mo post CI stimulation (N = 10). Data Collection and Analysis The infants’ mean looking times during the novel versus old trials of the experiment were measured. A linear regression model was used to evaluate the relationship between the normalized looking time difference and the following variables: chronological age, age at CI stimulation, gender, communication mode, and best unaided pure-tone average. Results We found that the best unaided pure-tone average predicted speech discrimination at the early interval. In contrast to some previous speech perception studies that included children implanted before 3 yr of age, age at CI stimulation did not predict speech discrimination performance. Conclusions The results suggest that residual acoustic hearing before implantation might facilitate speech discrimination during the early period post cochlear implantation; with more hearing experience, communication mode might have a greater influence on the ability to discriminate speech. This and other studies on age at cochlear implantation suggest that earlier implantation might not have as large an effect on speech perception as it does on other language skills

Unintended and accidental medical radiation exposures in radiology: guidelines on investigation and prevention

This paper sets out guidelines for managing radiation exposure incidents involving patients in diagnostic and interventional radiology. The work is based on collation of experiences from representatives of international and national organizations for radiologists, medical physicists, radiographers, regulators, and equipment manufacturers, derived from an International Atomic Energy Agency Technical Meeting. More serious overexposures can result in skin doses high enough to produce tissue reactions, in interventional procedures and computed tomography, most notably from perfusion studies. A major factor involved has been deficiencies in training of staff in operation of equipment and optimization techniques. The use of checklists and time outs before procedures commence, and dose alerts when critical levels are reached during procedures can provide safeguards to reduce risks of these effects occurring. However, unintended and accidental overexposures resulting in relatively small additional doses can take place in any diagnostic or interventional X-ray procedure and it is important to learn from errors that occur, as these may lead to increased risks of stochastic effects. Such events may involve the wrong examinations, procedural errors, or equipment faults. Guidance is given on prevention, investigation and dose calculation for radiology exposure incidents within healthcare facilities. Responsibilities should be clearly set out in formal policies, and procedures should be in place to ensure that root causes are identified and deficiencies addressed. When an overexposure of a patient or an unintended exposure of a foetus occurs, the foetal, organ, skin and/or effective dose may be estimated from exposure data. When doses are very low, generic values for the examination may be sufficient, but a full assessment of doses to all exposed organs and tissues may sometimes be required. The use of general terminology to describe risks from stochastic effects is recommended rather than calculation of numerical values, as these are misleading when applied to individuals

Angel-shaped phalango-epiphyseal dysplasia. Case report

Se describe una patología de aparición poco frecuente y esporádica que se caracteriza por deformidad en cuello de cisne en las manos, artrosis de cadera en la adultez, retardo en la edad ósea y malformaciones de las falanges medias, en forma de ángel. El paciente es un niño de 4 años de edad que sufrió un traumatismo de mano, por lo cual se le realizó una radiografía donde se observaron falanges con forma de ángel. A partir de este hallazgo, se obtuvieron otras radiografías y se diagnosticó una displasia epifisaria con falanges en forma de ángel. A raíz de este diagnóstico en el niño y de consultas con el Servicio de Genética, se diagnosticó el mismo síndrome en la madre.We describe a rare and sporadic condition, characterized by swan neck deformity in hands, hip osteoarthritis in adulthood and malformations of the middle phalanges with an angel shape. The patient is a 4 year old boy who suffered hand trauma and on x-ray examination he was diagnosed with angel-shaped phalango-epiphyseal dysplasia. Based on this diagnosis, his mother, who suffered from constant pain in her hips and lower limbs, was diagnosed with this syndrome as well.Fil: Conci, René. Instituto Conci Carpinella; ArgentinaFil: Oller, Alicia. Instituto Conci Carpinella; ArgentinaFil: Moya, Martín Pedro. Hospital Privado Centro Medico de Córdoba. Departamento de Pediatria y Neonatología. Servicio de Neonatologia; Argentina. Universidad Nacional de Córdoba; ArgentinaFil: Echegaray, Adriana. Instituto Conci Carpinella; ArgentinaFil: Frush, Donald. University of Duke; Estados Unido

Further evidence for the involvement of EFL1 in a Shwachman-Diamond-like syndrome and expansion of the phenotypic features.

Recent evidence has implicated EFL1 in a phenotype overlapping Shwachman-Diamond syndrome (SDS), with the functional interplay between EFL1 and the previously known causative gene SBDS accounting for the similarity in clinical features. Relatively little is known about the phenotypes associated with pathogenic variants in the EFL1 gene, but the initial indication was that phenotypes may be more severe, when compared with SDS. We report a pediatric patient who presented with a metaphyseal dysplasia and was found to have biallelic variants in EFL1 on reanalysis of trio whole-exome sequencing data. The variant had not been initially reported because of the research laboratory's focus on de novo variants. Subsequent phenotyping revealed variability in her manifestations. Although her metaphyseal abnormalities were more severe than in the original reported cohort with EFL1 variants, the bone marrow abnormalities were generally mild, and there was equivocal evidence for pancreatic insufficiency. Despite the limited number of reported patients, variants in EFL1 appear to cause a broader spectrum of symptoms that overlap with those seen in SDS. Our report adds to the evidence of EFL1 being associated with an SDS-like phenotype and provides information adding to our understanding of the phenotypic variability of this disorder. Our report also highlights the value of exome data reanalysis when a diagnosis is not initially apparent

Faculty Perspectives: The Diffusion of Competency-Based Education

This roundtable is a dialogue of faculty perspectives concerning competencybased education. Adult educators facilitating in graduate programs may want to pay close attention to the transformation across the nation related to degree completion as many of our learners will be at the forefront of addressing these issues and implementing change

Logistical Bodies of Fulfillment

existence occurs in a spatial assembly of multiple scalar experiences that is intensified and brought to perception by the exponential advancement of a virtual extension. the physical realm that human cognition experiences acts as a bound container influenced by natural law and trusted forces. the virtual realm exists as a medium through which linkages are made that suppose unseen law, forces, and connections. the human existence experiences an interface between the multiplicities of the physical and the virtual. as technologies advance exponentially the recognition of a multiple temporality is intensified by digital networks and spatial extensions. the trusting of physical bounds is skewed at possible specific moments and seeks to create a new nature of spatial assemblage. this spatial assembly occurs across multiple strata of scales and ranges. a new spatial extension questions the influence of experiences towards the factors of existence including politics, economy, and culture. does the recognition of an extended spatial assembly across scales through a virtual realm anticipate a future trajectory for the discipline of architectural practice? logistical bodies of fulfillment speculates on the provocations of a new spatial extension intensified by a virtual existence. this speculation seeks provocations on the notions of bodily engagement and fulfillment through the logistical sequences of assemblage across multiple strata of scales

Are Accelerated Learning Formats the Answer to Meeting the Demand for Increased Adult Programs?

Accelerated learning formats allow adult learners to balance their personal and professional responsibilities with their role as a learner. The roundtable discussion will provide an opportunity to discuss the positive and negative implications of these learning formats and the quality of education that is being delivered

East meets West: Meditation in distance learning environments

This study investigates the infusion of eastern philosophy, specifically meditation into distance learning environments. How does adding meditative practice alter the learning setting for adult learners in distance learning environments? Literature on learning, yoga, meditation, compressed video, online learning, and neuroscience will be reviewed and addressed to look at the values of practice

Exploring Ways to Investigate Instructors’ Roles in Facilitating Transformative Learning Processes for International Students

The purpose of this roundtable session is to identify, and develop ideas and methods to research ways in which face-to-face and online instructors of international students can most effectively facilitate positive transformation. The transitions and challenges that international students often experience will be discussed as well as varying perspectives about how these adult learners can be optimally supported. The benefits and limitations of previous research methods used to investigate international students’ transformation will be explored

Prevention of Work-Related Shoulder and Neck Injuries: A Systematic Review

Background Musculoskeletal disorders accounted for 33% of all workplace injuries and illnesses in 2011; sprains, strains and tears accounted for 38% of injuries. Typically, injuries resulted from repetitive motion and required a median of 23 days away from work. Currently, there are no practice guidelines for the prevention of work-related shoulder and neck injuries. Due to the social and economic costs of workplace musculoskeletal injuries, there is an urgent need to identify the most effective preventative interventions. Purpose To evaluate the current evidence for workplace interventions for the prevention of work-related shoulder and neck injuries. Method A systematic search of the following databases was performed using a comprehensive set of categorized search terms: CINAHL, EMBASE, MEDLINE, and PsychINFO. The search was limited to English articles published after the year 2000, yielding 17 systematic reviews and 21 randomized controlled trials. A team of 3 researchers evaluated each systematic review and 2 researchers independently reviewed each randomized controlled trial using the PEDro scale. Results 13 randomized controlled trials received a score of at least 6/9 on the PEDro scale and were included in this review. 11 articles investigating prevention of neck pain and injury yielded mixed evidence for ergonomic intervention, strength training, and all-around exercise. 2 separate studies showed positive evidence for microbreaks and for an integrated health program. 8 studies investigating prevention of shoulder pain and injury showed strong evidence for strength training and all-around exercise and mixed evidence for ergonomic intervention. 1 study showed positive effects of microbreaks. Conclusion Overall, there is a lack of quality evidence for the prevention of work-related shoulder and neck injuries. Current evidence shows a strong effect of strength training and exercise for preventing shoulder injuries. Ergonomic interventions, including forearm support, workplace modifications, and microbreaks have demonstrated mixed results. Strength training and all-around exercise should be utilized for the prevention of work-related shoulder injuries; however, more quality research needs to be performed to identify more effective interventions in this area