Bimodal Group Research Articles

Language and Reading Progress of Young Deaf and Hard-of-Hearing Children.

We examined the language and reading progress of 336 young DHH children in kindergarten, first and second grades. Trained assessors tested children's language, reading, and spoken and fingerspelled phonological awareness in the fall and spring of the school year. Children were divided into groups based on their auditory access and classroom communication: a spoken-only group (n = 101), a sign-only group (n = 131), and a bimodal group (n = 104). Overall, children showed delays in language and reading compared to norms established for hearing children. For language, vocabulary standard scores were higher than for English syntax. Although delayed in language, children made expected gains based on hearing norms from kindergarten to second grade. Reading scores declined from kindergarten to second grade. Spoken-only and bimodal children had similar word reading and reading comprehension abilities and higher scores than sign-only children. Spoken-only children had better spoken phonological awareness and nonword reading skills than the other two groups. The sign-only and bimodal groups made similar and significant gains in ASL syntax and fingerspelling phonological awareness.

Effect of learning modalities on visuomotor performance and mental flexibility in professional students

Background: The style of learning in an individual is the preferable choice of processing and transforming knowledge. The modalities of learning styles are unimodal, bimodal, and multimodal learning style. Trial making test (TMT) is a neurocognitive test which measures the domain of cognition, its speed of processing, its sequencing order, mental flexibility, and visuomotor skills. Aim and Objective: To compare visual-motor skills and mental flexibility in different learning modalities in professional students. Materials and Methods: Institutional ethical clearance and written informed consent was obtained. Cross-sectional observational data were collected. VARK questionnaire was administered to professional students between the age group of 18 and 25 years. 55 unimodal, 56 bimodal, and 36 multimodal students who volunteered for the study performed the TMT consisting of Trial A an index of mental skills and Trial B an index of mental flexibility was measured in time (seconds). TMT composite score (B-A) was used to remove the speed content from the test evaluated, resulting in a more refined index of mental flexibility. Results: Significant differences in visual-motor skills (TRIAL A) and flexibility (TRIAL B) were seen between groups by one-way ANOVA (F [2.144] = 53.8 l, P < 0.001) and (F [2.144] = 69.26 P < 0.001), respectively. Tukey’s post hoc test showed that the visual motor skills was significantly prolonged (P = 0.001) in multimodal students compared to bimodal and unimodal groups and between uni and bimodal groups, while mental flexibility was decreased significantly in multimodals when compared to unimodals. The composite score was statistically significantly different between groups by one-way ANOVA (F [2.144)] = 27.28 P < 0.001) and Tukey’s post hoc test showed that multimodal participants composite score were prolonged compared to unimodal participants (P = 0.001). Conclusion: Visual-motor skills and mental flexibility was significantly prolonged in multimodal compared to unimodal and bimodal learning style.

Epidemiology of Gastrointestinal Malignancies in Nigeria:Port Harcourt Cancer Registry Study

Background: Undocumented observations suggest a rising incidence of gastrointestinal tract cancers (GITc) among urban dwellers in Nigeria. Aim: The aim is to report on the incidence and clinic-pathological characteristics of GITc in Port Harcourt and its environs. Materials and Methods: Clinical, pathological, and demographic information on cancer patients obtained from various hospitals, radiology centers, and pathology laboratories within Port Harcourt and Obio-Akpor local government areas of Rivers state between 2008 and 2017 were reviewed. The information was coded using the International Classification of Diseases for Oncology, 3rd Edition and stored in Canreg 4 software in the Port Harcourt cancer registry. Results: GITc constituted the third-most common systemic cancers consisting of 12.2% (328 cases) with a male-to-female ratio of 1.05:1. The annual age-standardized rate ranged between 1.1–21.6/100,000 for females and 1.8–15.9/100,000 for males, with the highest rate recorded in 2017. The mean age was 51.2 ± 15.8 years with bimodal peak age groups of 50–54 and 55–59 years. The most common sites for GITc were colorectal followed by the liver and stomach consisting of 44.5%, 16.5%, and 15.2% of cases, respectively. Epithelial malignancies, i.e., carcinomas markedly predominated over malignancies of other cell types such as mesenchymal cell malignancies, lymphoreticular cell malignancies, and germ cell malignancies and constituted 92.4% of total GITc. Conclusion: GITc is posing a public health challenge in Port Harcourt and environs. A government-sponsored health plan on cancer control, including awareness campaigns on the adoption of more healthy lifestyles, hepatitis B vaccination, colonoscopy screening with prompt treatment, is advocated.

Training a non-native vowel contrast with a distributional learning paradigm results in improved perception and production

Previous distributional learning research suggests that adults can improve perception of a non-native contrast more efficiently when exposed to a bimodal than a unimodal distribution. Studies have also suggested that perceptual learning can transfer to production. The current study tested whether the addition of visual images to reinforce the contrast and active learning with feedback would result in learning in both conditions and would transfer to gains in production. Native English-speaking adults heard stimuli from a bimodal or unimodal /o/-/œ/ continuum. No group differences were found on a discrimination task, possibly suggesting that the supports eliminated previously documented group differences. On an identification task, listeners in the bimodal group showed better performance than the unimodal group on the endpoint stimuli. Production results indicated that both groups showed increased Euclidean distance between the target vowels after training, suggesting that perceptual training improved production skills in both conditions. Contrary to expectations, degree of perception and production learning were not correlated. Together, these results suggest that a bimodal distribution may aid learning, but that adding images to reinforce the contrast and active learning to the training paradigm could mitigate disadvantages found previously for participants exposed to a unimodal distribution.

Changes to perceptual assimilation following training

Adult speakers of American-English have difficulty perceiving front-back rounding contrasts in vowels, such as French /œ/-/o/. These difficulties stem in part from how learners map sounds in a second language onto native-language sound categories. We used a perceptual-assimilation task to test how perceptual training changes listeners’ mapping of nonnative speech sounds. One listener group was trained with a bimodal distribution of stimuli drawn from an /œ/-/o/ acoustic continuum, a second was trained with a unimodal distribution, and a third (control) group completed no training. The training incorporated active learning with feedback and lexical support. In the assimilation task, listeners heard French vowels and were asked to select which of eight English /hVd/ words best matched the French stimulus. Results revealed general perceptual training effects and differences in both trained groups. For /o/, both trained groups differed significantly from untrained controls. However, for /œ/, listeners in the unimodal group did not differ from the untrained controls, but the bimodal group differed from the untrained controls. Thus, exposure to a unimodal distribution can alter perception, but a bimodal distribution may have stronger effects on perception. Bimodal distribution may be better for facilitating assimilation of nonnative sounds to native-like categories.

Benefit of directional microphones for unilateral, bilateral and bimodal cochlear implant users

Objective: To compare the standard T-Mic setting to UltraZoom and StereoZoom in 10 unilateral cochlear implant (CI) users, 10 bimodal device users and 10 bilateral CI users as well as a normal hearing (NH) reference group (n = 10).Method: Speech reception thresholds were measured using the Oldenburg sentence test in noise. Speech was presented from the front at 0°, noise was presented from five loudspeakers spaced at ±60°, ±120°, 180° (setup A) or from four loudspeakers in the front hemisphere at ±30°, ±60° and one at 180° (setup B).Results: There was a significant advantage for UltraZoom and StereoZoom for all groups in both setups. The largest advantage was for StereoZoom in the bilateral group (setup A, 5.2 dB, P < 0.001 and B, 3.4 dB, P < 0.001) There was a significant advantage for StereoZoom over UltraZoom in the bimodal group (setup A, P < 0.01 and B, P < 0.05) and in the bilateral group (P < 0.01, setup B only). The bilateral group performed as well as the normally hearing group in both setups and the bimodal group performed as well in setup A. There was a significant benefit of 1.8 dB for ClearVoice over UltraZoom alone for the unilateral group.Conclusions: UltraZoom and StereoZoom provided a clinically and statistically significant benefit over the T-Mic condition. The largest gain was shown for StereoZoom in the bimodal and bilateral groups. The use of StereoZoom enabled the bilateral group to perform as well as the normally hearing group in both the challenging speaker setups. However, real life environments might provide an even greater challenge than the conditions tested here.

Aural/Oral Performance of Children with Cochlear Implant under Monaural and Bimodal Listening Conditions: A Parental Evaluation

The study assessed the performance of children with cochlear implant (CI) under monaural and bimodal listening conditions using Parental Evaluation of Aural/Oral Performance of Children (PEACH) questionnaire. A total of 74 children using CI and their parents (either of the biological parent) served as subjects in the present study. The subjects were further divided into two groups based on mode of stimulation used in CI. Group I consisted of children using monaural stimulation in CI i.e. unilateral CI (monaural group). Group II consisted of children using bimodal stimulation in CI i.e. CI in one ear and hearing aid in opposite ear (bimodal group). The results revealed that the subjects of both groups performed significantly poorer under noisy listening conditions compared to quiet listening conditions. The subjects of both the groups performed similar under quiet listening environment. Although, both the groups performed similar under quiet listening condition, the subjects of bimodal group demonstrated significant improvement in aural/oral performance as compared to the subjects of monaural group under noisy listening environment. Thus, it can be inferred that bimodal stimulation in CI provides additional benefits as compared to monaural stimulation in CI especially under noisy listening environments. The findings of the present study complement the existing objective test results which have reported positive outcomes from bimodal stimulation in CI recipients.

Is a Bimodal Force-Time Curve Related to Countermovement Jump Performance?

A countermovement jump (CMJ) represents one of the most frequently used performance tests for monitoring neuromuscular function in athletes. An often-overlooked feature that may provide some useful diagnostic information is the actual shape of the force-time curve. The aim of this study was therefore to consider how the shape of the force-time curve influences jump performance. Thirty-three male rugby union players performed two CMJs on a force plate, with discrete variables and continuous curve analysis used. The subjects were dichotomized based on shape of the force-time curve during the propulsion phase and by jump height. The differences between the unimodal and bimodal groups were unclear for jump height (ES = 0.28, ±0.58) and reactive strength index-modified (ES = −0.30, ±0.59). A substantial difference between high (40.2 ± 2.9 cm) and low (31.2 ± 3.2 cm) jumpers only existed in the late propulsion phase by 79.0% to 97.0% of the normalized force-time curve. A bimodal force-time curve is not representative of an optimal pattern of performance and simply reflects an inefficient stretch-shortening cycle. The inter-individual variability that exists in braking COM displacement renders temporal phase analysis impractical in cross-sectional type studies.

Effects of bimodal intervention on the development of auditory and speech ability in infants with unilateral cochlear implantation

Objective: To explore the effects of bimodal intervention on the development of auditory and speech ability in the infants with unilateral cochlear implantation(CI). Methods: Total 35 bilateral profound sensorineural hearing loss infants with unilateral CI, aged 0.7 to 2.8 years old, were selected. The subjects were divided into two groups: the group with unilateral CI(cochlear implant alone, n= 15), and the bimodal group with CI and contralateral fitting hearing aid(n= 20). Their auditory and speech abilities were estimated at the different time points after switch-on(the 0th, 0.5th, 1st, 3rd, 6th, 12th, 18th, and 24th month, respectively) using Infant Toddler-Meaningful Auditory Integration Scale(IT-MAIS), Meaningful Use of Speech Scale(MUSS), Categories of Auditory Performance(CAP), and Speech Intelligibility Rating(SIR) scores. Results: The IT-MAIS scores of bimodal group after switch-on were higher than unilateral CI group(the 0.5th, 1st, 3rd, 6th, 12th, and 18th month), the statistical significances were identified at the 0.5th, 1st, 3rd, 6th, and 12th month, respectively(P<0.05). The CAP scores of bimodal group before CI operation and after switch-on(the 0.5th, 1st, 3rd, 6th, 12th, 18th and 24th month)were higher than unilateral CI group, the statistical significances were seen at the 3rd, 6th, 12th, 18th and 24th month after switch-on(P<0.05). The MUSS scores of bimodal group after switch-on were higher than unilateral CI group(the 1st, 3rd, 6th, 12th, 18th and 24th month), the statistical significances were found at the 12th, 18th and 24th month, respectively(P<0.05). The SIR scores of bimodal group after switch-on were higher than unilateral CI group(the 3rd, 6th, 12th, 18th and 24th month), and significant differences appeared at the 12th, 18th and 24th month after switch-on(P<0.05). Conclusion: Bimodal intervention could be helpful to the development of auditory and speech ability of infants.

Assessment of Patterns of Lower Limb Injuries at a Medical College Hospital of Central India

Introduction: In the recent era of trauma, about one million people get seriously injured annually. Majority of them suffer from lower limb injuries. Due to lack of trauma registry in India, prediction models are not much effective. The aim of our study was to derive basic pattern for lower limb injuries which can be used to develop better prediction models to reduce morbidities and mortalities. Methods: We conducted an observational study on isolated lower limb injuries without any musculoskeletal disorder at a Medical College Hospital in Akola, Maharashtra between January 2012 to December 2013. The lower limb injuries were classified as per the Limb Salvage Index score (LSI) for further management. Results: A total of 1160 patients were included. Mean age was 44.5 years and 75 percent of them were males. Lower limb injuries showed bi-modal age group with first peak between 30 to 40 years and second at 60 to 70 years. Road traffic accidents were the most common cause of injury followed by fall at home. 1.8 percent patients had Limb Salvage Index ranging between 7 to 12 and underwent amputations. Both lower limbs were almost equally affected with left showing a little higher value than right (49 versus 47 percent, p>0.05). Femur was the most commonly affected bone. Conclusion: This study helped us in identifying certain characteristics that may be useful for planning preventive strategies in an attempt to reduce the numbers of accidents and redirect public investment in health.

Study on bimodal stimulation for aural rehabilitationdevelopmentin infants with a unilateral cochlear implant

Objective:To evaluated the aural rehabilitation development of the bimodal stimulation in deaf infants with a unilateral cochlear implant. Method:The 36 infants, suffering from severe-to-profound bilateral sensorineural hearing loss with residual hearing on at least one side, assigned into two groups randomly:18 wore only the cochlear implant(unilateral A group),while the other 18 used the CI and a contralateral hearing aid at the same time(bimodal group).The aural rehabilitation development was evaluated by sound field test and speech rehabilitation tests(including vowels, consonants, tones, monosyllables, disyllables, tri-syllables and selected hearing) after rehabilitation lasting 3 month(T1),6 month(T2)and 12 month(T3)respectively. Result:At time T1，free-field hearing threshold of 500 Hz of unilateral A group was statistically higher than bimodal group. Free-field hearing thresholds of 500 Hz and 1 000 Hz of unilateral A group were statistically higher than bimodal group attime T2（P<0.05）.At time T1, vowels, consonants, tones ,monosyllables, and disyllables rehabilitation scores of unilateral A group were statistically higher than bimodal group（P<0.05）.At time T2,there were no statistically significant differences between two groups（P>0.05）.However,consonants, tones,disyllables, tri-syllables and selected hearing rehabilitation scores of bimodal group were statistically higher than unilateral group（P<0.05）. Conclusion:The cochlear implant infants with bimodal stimulation have better aural rehabilitation development with the process of aural rehabilitation gradually.Therefore, it is essential to make full use of the advantages of binaural hearing and to choose the appropriate aural rehabilitation mode for every deaf infant.

Impact of thermodilution-derived coronary blood flow patterns after percutaneous coronary intervention on mid-term left ventricular remodeling in patients with ST elevation myocardial infarction.

We recently reported the coronary thermodilution curve can be evaluated by analyzing the thermodilution curve obtained from a pressure sensor/thermistor-tipped guidewire, and presence of a bimodal-shaped thermodilution curve following primary percutaneous coronary intervention (pPCI) in ST-segment elevation myocardial infarction (STEMI) patients was associated with worse outcomes. This study evaluated whether the bimodal-shaped thermodilution curve predicts left ventricular (LV) remodeling after STEMI. The coronary thermodilution curve patterns were evaluated for 75 patients treated by pPCI for their first STEMI using a pressure sensor/thermistor-tipped guidewire, and classified into the three groups according to the thermodilution curve shape: narrow unimodal (n=39), wide unimodal (n=26), and bimodal pattern (n=10). Echocardiography was performed at baseline and 6months after STEMI. LV remodeling was defined as a>20% increase in LV end-diastolic volumes (LVEDV). LVEDV at 6-month follow-up was greater in the bimodal group than in the other groups (p<0.001). The prevalence of LV remodeling was highest in the bimodal group than in the narrow and wide unimodal groups (60, 12, and 15%, respectively; p=0.003). Multivariate analysis revealed a bimodal-shaped thermodilution curve as an independent predictor of the prevalence of LV remodeling. A bimodal-shaped thermodilution curve is associated with LV remodeling after STEMI. This easily assessable coronary thermodilution curve pattern is useful to predict mid-term LV remodeling for STEMI patients at the catheterization laboratory.

Early Bimodal Stimulation Benefits Language Acquisition for Children With Cochlear Implants.

Adding a low-frequency acoustic signal to the cochlear implant (CI) signal (i.e., bimodal stimulation) for a period of time early in life improves language acquisition. Children must acquire sensitivity to the phonemic units of language to develop most language-related skills, including expressive vocabulary, working memory, and reading. Acquiring sensitivity to phonemic structure depends largely on having refined spectral (frequency) representations available in the signal, which does not happen with CIs alone. Combining the low-frequency acoustic signal available through hearing aids with the CI signal can enhance signal quality. A period with this bimodal stimulation has been shown to improve language skills in very young children. This study examined whether these benefits persist into childhood. Data were examined for 48 children with CIs implanted under age 3 years, participating in a longitudinal study. All children wore hearing aids before receiving a CI, but upon receiving a first CI, 24 children had at least 1 year of bimodal stimulation (Bimodal group), and 24 children had only electric stimulation subsequent to implantation (CI-only group). Measures of phonemic awareness were obtained at second and fourth grades, along with measures of expressive vocabulary, working memory, and reading. Children in the Bimodal group generally performed better on measures of phonemic awareness, and that advantage was reflected in other language measures. Having even a brief period of time early in life with combined electric-acoustic input provides benefits to language learning into childhood, likely because of the enhancement in spectral representations provided.

Role of bimodal stimulation for auditory-perceptual skills development in children with a unilateral cochlear implant.

SUMMARYThis is a prospective randomised study that evaluated the differences arising from a bimodal stimulation compared to a monaural electrical stimulation in deaf children, particularly in terms of auditory-perceptual skills development. We enrolled 39 children aged 12 to 36 months, suffering from severe-to-profound bilateral sensorineural hearing loss with residual hearing on at least one side. All were unilaterally implanted: 21 wore only the cochlear implant (CI) (unilateral CI group), while the other 18 used the CI and a contralateral hearing aid at the same time (bimodal group). They were assessed with a test battery designed to appraise preverbal and verbal auditory-perceptual skills immediately before and 6 and 12 months after implantation. No statistically significant differences were observed between groups at time 0, while at 6 and 12 months children in the bimodal group had better scores in each test than peers in the unilateral CI group. Therefore, although unilateral deafness/hearing does not undermine hearing acuity in normal listening, the simultaneous use of a CI and a contralateral hearing aid (binaural hearing through a bimodal stimulation) provides an advantage in terms of acquisition of auditory-perceptual skills, allowing children to achieve the basic milestones of auditory perception faster and in greater number than children with only one CI. Thus, "keeping awake" the contralateral auditory pathway, albeit not crucial in determining auditory acuity, guarantees benefits compared with the use of the implant alone. These findings provide initial evidence to establish shared guidelines for better rehabilitation of patients undergoing unilateral cochlear implantation, and add more evidence regarding the correct indications for bilateral cochlear implantation.

Integrated Analysis and Visualization of Group Differences in Structural and Functional Brain Connectivity: Applications in Typical Ageing and Schizophrenia

Structural and functional brain connectivity are increasingly used to identify and analyze group differences in studies of brain disease. This study presents methods to analyze uni- and bi-modal brain connectivity and evaluate their ability to identify differences. Novel visualizations of significantly different connections comparing multiple metrics are presented. On the global level, “bi-modal comparison plots” show the distribution of uni- and bi-modal group differences and the relationship between structure and function. Differences between brain lobes are visualized using “worm plots”. Group differences in connections are examined with an existing visualization, the “connectogram”. These visualizations were evaluated in two proof-of-concept studies: (1) middle-aged versus elderly subjects; and (2) patients with schizophrenia versus controls. Each included two measures derived from diffusion weighted images and two from functional magnetic resonance images. The structural measures were minimum cost path between two anatomical regions according to the “Statistical Analysis of Minimum cost path based Structural Connectivity” method and the average fractional anisotropy along the fiber. The functional measures were Pearson’s correlation and partial correlation of mean regional time series. The relationship between structure and function was similar in both studies. Uni-modal group differences varied greatly between connectivity types. Group differences were identified in both studies globally, within brain lobes and between regions. In the aging study, minimum cost path was highly effective in identifying group differences on all levels; fractional anisotropy and mean correlation showed smaller differences on the brain lobe and regional levels. In the schizophrenia study, minimum cost path and fractional anisotropy showed differences on the global level and within brain lobes; mean correlation showed small differences on the lobe level. Only fractional anisotropy and mean correlation showed regional differences. The presented visualizations were helpful in comparing and evaluating connectivity measures on multiple levels in both studies.

Distributional Learning of Lexical Tones: A Comparison of Attended vs. Unattended Listening.

This study examines whether non-tone language listeners can acquire lexical tone categories distributionally and whether attention in the training phase modulates the effect of distributional learning. Native Australian English listeners were trained on a Thai lexical tone minimal pair and their performance was assessed using a discrimination task before and after training. During Training, participants either heard a Unimodal distribution that would induce a single central category, which should hinder their discrimination of that minimal pair, or a Bimodal distribution that would induce two separate categories that should facilitate their discrimination. The participants either heard the distribution passively (Experiments 1A and 1B) or performed a cover task during training designed to encourage auditory attention to the entire distribution (Experiment 2). In passive listening (Experiments 1A and 1B), results indicated no effect of distributional learning: the Bimodal group did not outperform the Unimodal group in discriminating the Thai tone minimal pairs. Moreover, both Unimodal and Bimodal groups improved above chance on most test aspects from Pretest to Posttest. However, when participants’ auditory attention was encouraged using the cover task (Experiment 2), distributional learning was found: the Bimodal group outperformed the Unimodal group on a novel test syllable minimal pair at Posttest relative to at Pretest. Furthermore, the Bimodal group showed above-chance improvement from Pretest to Posttest on three test aspects, while the Unimodal group only showed above-chance improvement on one test aspect. These results suggest that non-tone language listeners are able to learn lexical tones distributionally but only when auditory attention is encouraged in the acquisition phase. This implies that distributional learning of lexical tones is more readily induced when participants attend carefully during training, presumably because they are better able to compute the relevant statistics of the distribution.

Impact of a moving noise masker on speech perception in cochlear implant users.

ObjectivesPrevious studies investigating speech perception in noise have typically been conducted with static masker positions. The aim of this study was to investigate the effect of spatial separation of source and masker (spatial release from masking, SRM) in a moving masker setup and to evaluate the impact of adaptive beamforming in comparison with fixed directional microphones in cochlear implant (CI) users.DesignSpeech reception thresholds (SRT) were measured in S0N0 and in a moving masker setup (S0Nmove) in 12 normal hearing participants and 14 CI users (7 subjects bilateral, 7 bimodal with a hearing aid in the contralateral ear). Speech processor settings were a moderately directional microphone, a fixed beamformer, or an adaptive beamformer. The moving noise source was generated by means of wave field synthesis and was smoothly moved in a shape of a half-circle from one ear to the contralateral ear. Noise was presented in either of two conditions: continuous or modulated.ResultsSRTs in the S0Nmove setup were significantly improved compared to the S0N0 setup for both the normal hearing control group and the bilateral group in continuous noise, and for the control group in modulated noise. There was no effect of subject group. A significant effect of directional sensitivity was found in the S0Nmove setup. In the bilateral group, the adaptive beamformer achieved lower SRTs than the fixed beamformer setting. Adaptive beamforming improved SRT in both CI user groups substantially by about 3 dB (bimodal group) and 8 dB (bilateral group) depending on masker type.ConclusionsCI users showed SRM that was comparable to normal hearing subjects. In listening situations of everyday life with spatial separation of source and masker, directional microphones significantly improved speech perception with individual improvements of up to 15 dB SNR. Users of bilateral speech processors with both directional microphones obtained the highest benefit.

The effect of social stress on milking efficiency in dairy ewes differed in milk flow kinetic

The aim of this study was to evaluate the effect of social stress on milking parameters in dairy ewes raised in Slovakia. Twenty-seven cross breed ewes of Tsigai and Improved Valachian breeds with Lacaune were included into the experiment. Ewes were selected from the flock on the basis of their milk flow type during the two pre-experimental milkings. According to milk flow types, they were divided into three groups representing three patterns of milk flows – bimodal group (GB; 11 animals), non-bimodal group (NG; 8 animals) and plateau group (PLG; 8 animals). Before milking, the following treatment to each ewe was applied: social isolation (free movement in parlour alone) in dairy parlour for at least 4min, and afterwards, the ewe was fixed into a milking stall and disturbed by unknown person standing in front of the head who was gently touching it during whole milking (milking under stress). Parameters of milkability and milk flow type were measured using electronic collection jar. For statistical evaluation, data from last pre-experimental (control) and milking under stress were compared. The significant decline of total and machine milk yield was observed during milking under stress as compared to control milking in all three groups. The machine stripping yield and milking time were reduced in BG and peak flow rate in NG. During milking under stress, the clear increase of non-bimodal milk flow types was recoded compared to control milking in BG and PLG. In conclusion, milk flow kinetic can serve an important parameter for evaluation of physiological response of ewes to milking and for further improvement of milking conditions and increasing the milk performance of ewes.

Abstract 19059: Thermodilution-derived Coronary Blood Flow Pattern Immediately After Coronary Intervention as a Predictor of Long-term Clinical Outcomes in Patients With ST-segment Elevation Myocardial Infarction

Background: We reported that coronary blood flow (CBF) can be evaluated by analyzing thermodilution curve that is measured with a single pressure sensor/thermistor-tipped guidewire in the cardiac catheterization laboratory during percutaneous coronary intervention (PCI). Bimodal shape of thermodilution curve was associated with microvascular damage and predictors of left ventricular functional recovery after ST-segment elevation myocardial infarction (STEMI). However it is unknown whether the bimodal shape of thermodilution curve predicts mortality and re-hospitalization for heart failure in long term period for patients experiencing STEMI. Methods: Between September 2009 and August 2012, 97 consecutive patients with a first STEMI were prospectively enrolled in this study. Using a pressure sensor/thermistor-tipped guidewire, CBF pattern was assessed from the thermodilution-curves after successful PCI at maximum hyperemia. CBF pattern was classified into 3 groups according to the shape of thermodilution curve: a narrow unimodal (a rapid fall and rise of temperature-time curves) (n=47), a wide unimodal (a gradual fall and rise of temperature-time curves) (n=33), or bimodal (two populations with valley deeper than 20% of peak temperature drop) (n=17). Major adverse cardiac events (MACE) were defined as cardiac death and/or heart failure re-hospitalization within this study period. Results: Median follow-up period was 2.4 years. Although patients in the narrow-unimodal group and the wide unimodal group had a significantly lower incidence of MACE, patients in bimodal group had a higher risk of MACE during this study period (71, 15, 21%, p&lt;0.001). Multivariate analysis revealed that bimodal shape of the thermodilution-curve was the only independent predictor of MACE after STEMI (hazard ratio, 8.38; 95% confidence interval, 2.13-33.00; P=0.0023). Conclusions: A bimodal shape of the thermodilution curve is associated with the poor long-term clinical outcomes. This easily assessable coronary flow pattern is useful in clinical risk stratification for STEMI patients in the cardiac catheterization laboratory immediately after PCI.

Quality of life in bimodal hearing users (unilateral cochlear implants and contralateral hearing aids).

The main objective was to evaluate the bimodal self-rated benefits on auditory performance under real conditions and the quality of life in two groups of cochlear-implanted adults, with or without a contralateral hearing aid. The secondary objective was to investigate correlations between the use of a hearing aid and residual hearing on the non-implanted ear. This retrospective study was realized between 2000 and 2010 in two referral centers. A population of 183 postlingually deaf adults, implanted with a cochlear experience superior to 6 months, was selected. The Speech, Spatial, and other Qualities of Hearing Scale were administered to evaluate the auditory performances, and the Nijmegen Cochlear Implant Questionnaire to evaluate the quality of life. The population was divided into two groups: a group with unilateral cochlear implants (Cochlear Implant-alone, n = 54), and a bimodal group with a cochlear implant and a contralateral hearing aid (n = 62). Both groups were similar in terms of auditory deprivation duration, duration of cochlear implant use, and pure-tone average on the implanted ear. There was a significant difference in terms of pure-tone average on low and low-to-mid frequencies on the non-implanted ear. The scores on both questionnaires showed an improvement in the basic sound perception and quality of social activities for the bimodal group. The results suggest that the bimodal stimulation (cochlear implant and contralateral hearing aid) improved auditory perception in quiet and the quality of life domain of social activities.