Pencapaian auditori kanak-kanak pengguna implan koklea di bawah Program Implan Koklea Kebangsaan

Implan koklea merupakan pilihan intervensi utama untuk mereka yang bermasalah pendengaran sensorineural pada tahap yang teruk dan sangat teruk. Kajian ini bertujuan untuk mengukur pencapaian auditori dalam kalangan kanak-kanak bermasalah pendengaran pralingual yang telah memakai alat implan koklea menggunakan pengukuran terus persepsi terhadap pertuturan (objektif) dan soal selidik ibu bapa (subjektif) serta mengenal pasti faktor demografi yang signifikan menyumbang kepada pencapaian mereka. Seramai 48 orang kanak-kanak daripada Program Implan Koklea di bawah Kementerian Kesihatan Malaysia (KKM) yang berumur pendengaran antara 12 hingga 89 bulan (min = 42.60 ± 19.46 bulan) terlibat dalam kajian ini. Ujian persepi pertuturan dijalankan menggunakan ujian-ujian yang dipilih daripada Evaluation of Auditory Response to Speech (EARS) versi Bahasa Melayu manakala penilaian ibu bapa terhadap pencapaian kanak-kanak dikumpulkan melalui soal selidik Parents’ Evaluation of Aural/Oral Performance of Children (PEACH) versi Bahasa Melayu. Stimulus pertuturan terakam dipersembahkan kepada kanak-kanak dalam medan bebas pada kekuatan bunyi 65 dB SPL dalam bilik terawat bunyi. Keputusan ujian persepsi pertuturan kemudian dikategorikan menggunakan Indeks Kategori Pencapaian Auditori versi Bahasa Melayu (My-CAPI) yang mempunyai 10 kategori bermula daripada ‘0’ hingga ‘9’. Keputusan menunjukkan kebanyakan subjek (N = 20, 41.7%) berada pada kategori ‘2’ dalam tahap My-CAPI (persepsi pertuturan set tertutup yang terhad), manakala tiga orang subjek mencapai kategori maksimum ‘9’ (persepsi pertuturan set terbuka yang tinggi dalam situasi bising). Mod komunikasi adalah satu-satunya faktor demografi yang signifikan berkorelasi dengan My-CAPI dan skor PEACH (p < 0.01). Koefisyen korelasi Pearson menunjukkan perhubungan yang kuat di antara skor PEACH dan My-CAPI (p < 0.01; r = 0.71) mencadangkan soal selidik PEACH boleh memberikan indikasi prestasi auditori jika ujian pertuturan tidak dapat dijalankan. Dapatan kajian menunjukkan majoriti kanak-kanak implan koklea yang diuji belum mencapai prestasi auditori yang memberangsangkan dan penggunaan komunikasi lisan merupakan faktor utama yang dikaitkan dengan pencapaian auditori yang lebih baik

Persepsi pelajar pra-siswazah Universiti Kebangsaan Malaysia (UKM) terhadap golongan pekak dewasa

Anggapan dan stigma masyarakat dimana individu pekak mempunyai banyak kelemahan berbanding individu yang mempunyai pendengaran normal telah mewujudkan sikap negatif seperti diskriminasi dan penganiayaan terhadap golongan pekak ini. Objektif kajian ini adalah untuk mengkaji persepsi mahasiswa prasiswazah Universiti Kebangsaan Malaysia (UKM) terhadap golongan pekak dewasa serta mengenalpasti faktor yang mempengaruhi persepsi mereka. Persepsi antara pelajar berbeza jurusan dan kaum telah dibandingan, dan kesan pengetahuan dan pengalaman dengan golongan pekak ke atas persepsi telah diukur. Kajian rentas ini menggunakan soal selidik yang melibatkan seramai 126 pelajar pra-siswazah UKM Kampus Bangi dan Kuala Lumpur yang direkrut melalui kaedah persampelan mudah. Dapatan kajian menunjukkan persepsi mahasiswa UKM secara keseluruhannya adalah positif. Walau bagaimanapun, terdapat perbezaan persepsi yang signifikan antara pelajar yang berbeza kaum, berbeza jurusan dan yang mempunyai pengetahuan dan pengalaman terhadap golongan pekak dewasa dengan yang tiada (z = 4.513, p < 0.05). Implikasi kajian dan cadangan untuk kajian lanjutan dibincangkan dengan harapan kajian seumpama ini dapat meningkatkan kesedaran masyarakat terhadap golongan pekak supaya budaya ketidaksamarataan ke atas golongan ini dapat ditangani

Is There a Standard Adjuvant Therapy for Resected Pancreatic Cancer?

Surgical resection remains the only treatment that offers a potential chance of long-term survival. Unfortunately, about 80% of patients treated with curative intent will develop recurrence. Since 2001, adjuvant therapy with gemcitabine or 5-fluorouracyle was recommended. This approach allows a median overall survival (OS) of around 23 months, and 5-year survival of 22%. In recent years, two phase-3 trials investigating new chemotherapy regimens resulted in considerably improved survival times. The doublet gemcitabine–capecitabine has shown improvement in OS from 25.5 to 28 months (p = 0.032) compared to gemcitabine, in the ESPAC-4 trial. Later, preliminary results of PRODIGE 24 trial presented at the 2018 ASCO meeting showed a superiority of a combination chemotherapy regimen with fluorouracil, leucovorin, irinotecan, and oxaliplatin (mFOLFIRINOX) when compared to gemcitabine alone, both in terms of median disease-free survival (21.6 vs. 12.8 months, p &lt; 0.0001) and OS (54.4 vs. 35 months, p = 0.003). Contrary to chemotherapy, the role of adjuvant radiotherapy is still controversial, even in the case of R1 surgery. A randomized trial exploring the role of chemoradiotherapy in this setting is now ongoing in the US (RTOG-0848). Overall, the management of localized pancreatic adenocarcinoma is evolving. In this review, we summarize the current status and the most up-to-date developments in adjuvant treatment

Comparison of Different Hearing Aid Prescriptions for Children.

OBJECTIVES: To assess whether there are significant differences between speech scores for different hearing aid prescription methods, specifically DSL i/o, DSL V, and NAL-NL1, using age-appropriate closed- and open-set speech tests with young children, designed to avoid floor and ceiling effects. DESIGN: Participants were 44 children with moderate or severe bilateral hearing loss, 8 aged 2 to 3 years, 15 aged 4 to 5 years, and 21 aged 6 to 9 years. Children wore bilateral hearing aids fitted with each prescription method in turn in a balanced double-blind design. The speech tests used with each child (and for some tests the levels) were chosen so as to avoid floor and ceiling effects. For the closed-set tests, the level used was selected for each child based on their hearing loss. The tests used were: (1) The closed-set Consonant Confusion Test of word identification; (2) The closed-set Chear Auditory Perception Test (CAPT) of word identification. This has separate sections assessing discrimination of consonants and vowels and detection of consonants; (3) The open-set Cambridge Auditory Word Lists for testing word identification at levels of 50 and 65 dBA, utilizing 10 consonant-vowel-consonant real words that are likely to be familiar to children aged 3 years or older; (4) The open-set Common Phrases Test to measure the speech reception threshold in quiet; (5) Measurement of the levels required for identification of the Ling 5 sounds, using a recording of the sounds made at the University of Western Ontario. RESULTS: Scores for the Consonant Confusion Test and CAPT consonant discrimination and consonant detection were lower for the NAL-NL1 prescription than for the DSL prescriptions. Scores for the CAPT vowel-in-noise discrimination test were higher for DSL V than for either of the other prescriptions. Scores for the Cambridge Auditory Word Lists did not differ across prescriptions for the level of 65 dBA, but were lower for the NAL-NL1 prescription than for either of the DSL prescriptions for the level of 50 dBA. The speech reception threshold measured using the Common Phrases Test and the levels required for identification of the Ling 5 sounds were higher (worse) for the NAL-NL1 prescription than for the DSL prescriptions. CONCLUSIONS: The higher gains prescribed by the DSL i/o and DSL V prescription methods relative to NAL-NL1 led to significantly better detection and discrimination of low-level speech sounds.We thank Deafness Research UK (now part of Action on Hearing Loss) for funding, Phonak and Oticon for the study hearing aids, PC Werth and Audioscan for the Verifit system, John Deeks for help with calibration, the children and their families, and the audiology host centers

Evaluation of hearing aid performance in school-aged children with moderately severe to profound hearing loss fitted according to the NAL-NL1 and DSL v5 prescriptive procedures

"Thesis submitted as a requirement for the degree of Doctor of Philosophy, April 2012""Department of Linguistics, Macquarie University & National Acoustic Laboratories".Includes bibliographical references.1. Introduction -- 2. The National Acoustic Laboratories (NAL) procedure -- 3. The desired sensation level (DSL) procedure -- 4. Comparison of NAL and DSL procedures -- 5. Hearing aid fitting in children -- 6. Study I: the Parents' Evaluation of Aural/oral performance of Children (PEACH) scale in the Malay language : data of normal-hearing children -- 7. Study II: prescribed and achieved gain of hearing aids fitted according to the NAL-NL1 and DSL v5 procedure in children with moderately severe to profound hearing losses -- 8. Study III: evaluation of real-world preferences and performance of hearing aid in children with moderately severe to profound hearing losses fitted according to the NAL-NL1 and DSL v5 procedures -- 9. Summary and conclusions -- References -- Appendices."The National Acoustic Laboratories (NAL) and the Desired Sensation Level (DSL) prescriptive procedures are often cited as the most sustainable, validated procedures and the most common methods used for hearing aid fitting in adults and in children. The overall aim of the present study is to evaluate the relative performance of the two procedures in children. The study focuses on children because they are most likely to rely on hearing aids fitted with techniques based solely on prescriptive approach. Sixteen Malaysian children with moderately severe to profound hearing loss were involved in the study. The children were fitted with the Phonak Naida V SP hearing aids based on the NAL-NL1 and DSL v5 prescriptive procedures. The NAL-NL1 and DSL v5 were the latest versions of the respective prescriptive formulae available at the time when this study was carried out. After hearing aid fitting, an extended period of hearing aid trial was given to each child. The relative performance of the two procedures was assessed using speech tests, paired-comparison judgments of speech intelligibility tests and questionnaires completed by the parents, teachers and the children themselves. The questionnaires used in the study were the Parents' Evaluation of Aural/Oral Performance of Children (PEACH), the Teachers' Evaluation of Aural/Oral Performance of Children (TEACH) and the Self Evaluation of Listening Function (SELF). The questionnaires were adapted into the Malay language. Each child also completed a short diary for them to compare the performance of the two procedures in different listening environments. The results showed a significant difference of performance between the NAL-NL1 and DSL v5 procedures for sentence test in quiet and for the subjective measures using questionnaires completed by the parents, teachers and children. The study concluded that the required hearing aid gain for children with moderately severe to profound hearing loss would seem to approximate the DSL v5 prescription, at least in quiet listening environments. The findings have important clinical implications for country like Malaysia where many children with severe to profound hearing loss still rely on hearing aids as their primary amplification devices". -- Abstract.Mode of access: World Wide Web.1 online resource (xi, 210 pages) illustration

Repercussions d’un tràfic forçat o lliure sobre el consum i pauta d’ingestió del vaquí lleter amb un sistema de munyida robotitzada

Avaluació de l’efecte del tipus de tràfic imposat a les vaques lleteres en sistemes de munyida automàtica sobre la freqüència de munyida, les necessitats d’alimentació, el comportament alimentari i la producció i composició de la lle

Caracterizaci\uf3n Qu\uedmica y F\uedsica de Compost de Lombrices Elaborados a Partir de Residuos Org\ue1nicos Puros y Combinados

The purpose of this experiment was the chemical and physical characterization of some vermicomposts and their most suitable mixture in yield and quality. The experiment design used was complete randomized block with five treatment and five replications: T1 (100% cattle feedlot manure E); T2 (100% kitchen wastes DC); T3 (75% E and 25% DC); T4 (50% E and 50% DC); T5 (25% E and 75% DC). These organic wastes were composted during 90 days and digested by earthworms (Eisenia foetida Savigny, 1826). Vermicompost determinations were sieve yield, loss weight percentage, potentially available nitrogen, available phosphorus, extractable potassium, organic matter and pH. Significant differences were found among mixed wastes compared with the pure materials. Vermicompost produced from 100% cattle feedlot manure had the highest N and P content; highest pH and P levels were found in T2 and T5. Best sieve yield was for T1 and less loss weight was for T3.El objetivo de este trabajo fue caracterizar qu\uedmicamente y f\uedsicamente el compost de lombrices, y determinar la proporci\uf3n de mezcla de substratos m\ue1s conveniente, evaluando su rendimiento y calidad. El dise\uf1o experimental fue de bloques completos al azar con cinco tratamientos y cinco repeticiones, en las siguientes proporciones T1 (100% esti\ue9rcol (E)); T2 (100% desechos de cocina (DC)); T3 (75% E y 25% DC); T4 (50% E y 50% DC); T5 (25% E y 75% DC). Estas mezclas fueron sometidas a 90 d\uedas de composteo y luego a la acci\uf3n de lombrices (Eisenia foetida Savigny, 1826). De los productos obtenidos se determinaron: nitr\uf3geno potencialmente mineralizable; f\uf3sforo disponible, potasio extractable, materia org\ue1nica, pH, rendimiento al tamizado, y la p\ue9rdida de peso de los abonos obtenidos. Se encontraron diferencias significativas entre mezclas con respecto a los materiales puros. El compost de lombriz obtenido con 100% de esti\ue9rcol present\uf3 los valores m\ue1s elevados de N y P; los niveles de potasio y pH m\ue1s altos correspondieron a los de los tratamientos T2 y T5. El mejor rendimiento al tamizado correspondi\uf3 al tratamiento T1, y el que menos merma de volumen present\uf3 fue el T3