Profound Losses Research Articles

Modified live infectious bursal disease virus (IBDV) vaccine delays infection of neonatal broiler chickens with variant IBDV compared to turkey herpesvirus (HVT)-IBDV vectored vaccine

Chickens are commonly processed around 35–45days of age in broiler chicken industry hence; diseases that occur at a young age are of paramount economic importance. Early age infection with infectious bursal disease virus (IBDV) results in long-lasting immunosuppression and profound economic losses. To our knowledge, this is the first study comparing the protection efficacy of modified live (MdLV) IBDV and herpesvirus turkey (HVT)-IBDV vaccines against early age variant IBDV (varIBDV) infection in chicks. Experiments were carried out in IBDV maternal antibody (MtAb) positive chicks (n=330), divided into 6 groups (n=50–60/group), namely Group 1 (saline), Group 2 (saline+varIBDV), Group 3 (HVT-IBDV), Group 4 (HVT-IBDV+varIBDV), Group 5 (MdLV) and Group 6 (MdLV+varIBDV). HVT-IBDV vaccination was given via the in ovo route to 18-day-old embryonated eggs. MdLV was administered via the subcutaneous route in day-old broilers. Group 2, Group 4 and Group 6 were orally challenged with varIBDV (SK-09, 3×103 EID50) at day 6 post-hatch. IBDV seroconversion, bursal weight to body weight ratio (BBW) and bursal histopathology were assessed at 19 and 35days of age. Histopathological examination at day 19 revealed that varIBDV-SK09 challenge caused severe bursal atrophy and lower BBW in HVT-IBDV but not in MdLV vaccinated chicks. However by day 35, all challenged groups showed bursal atrophy and seroconversion. Interestingly, RT-qPCR analysis after varIBDV-SK09 challenge demonstrated an early (9days of age) and significantly high viral load (∼5744 folds) in HVT-IBDV vaccinated group vs unvaccinated challenged group (∼2.25 folds). Furthermore, flow cytometry analysis revealed inhibition of cytotoxic CD8+ T-cell response (CD44-downregulation) and decreased splenic lymphocytes counts in chicks after HVT-IBDV vaccination. Overall, our data suggest that MdLV delays varIBDV pathogenesis, whereas, HVT-IBDV vaccine is potentially immunosuppressive, which may increase the risk of early age varIBDV infection in broilers.

Teacher Self-Efficacy, Professional Commitment, and High-Stakes Teacher Evaluation Policy in Louisiana

Currently, a significant number of states are in the process of implementing a high-stakes teacher evaluation (HSTE) system. In many ways, Louisiana’s teacher evaluation system, Compass, is typical of the models that many states have adopted. This article reports the experiences of 37 elementary teachers from five districts across Louisiana after their first 2 years under this system. It is through the multiple lenses of teacher support, autonomy, self-efficacy, and satisfaction that we sought to understand how Compass has shaped teachers’ motivation for improvement as well as their continued commitment to the teaching profession. Analysis of longitudinal interview data reveals a widespread lack of support for change in the form of self-efficacy building experiences—particularly vicarious experiences—for teachers. As a result, many teachers experienced, by the second year, significant negative arousal events and profound losses of satisfaction and commitment to the profession—this despite most being rated as “highly effective.”

Initial classification of pediatric hearing impairment using behavioral measures of early prelingual auditory development

Objective: Determine the sensitivity, specificity, and accuracy of pediatric hearing loss classification using behavioral evidence of early prelingual auditory development (EPLAD). Validate behavioral measures of EPLAD. Design: EPLAD was assessed in a prospective sample of hearing-impaired children using the infant-toddler meaningful auditory integration scale (ITMAIS/MAIS). Hearing losses were classified using tone-burst auditory brainstem response (ABR) and ITMAIS/MAIS scores. This process was repeated in a second retrospective sample. Study sample: The prospective sample was comprised of 139 hearing-impaired children under five years of age. Approximately equal proportions of mild-moderate, severe, and profound losses were included. The second retrospective sample was comprised of case records for 144 hearing-impaired children meeting the same selection criteria. This sample contained more than 80% profound losses. Results: EPLAD trajectories reached different asymptotes after two years of age, depending on the severity of hearing loss, allowing children over this age to be classified. The sensitivity of EPLAD classifications was over 90%; specificity was over 82%; and accuracy was over 88%. Conclusions: Behavioral evidence of EPLAD provides an initial means of classifying pediatric hearing losses which can facilitate initial treatment options prior to diagnostic evaluation with tone-burst ABR.

Black Soundscapes White Stages: The Meaning of Francophone Sound in the Black Atlantic

Black Soundscapes White Stages: The Meaning of Francophone Sound in the Black Atlantic

Rethinking marine infrastructure policy and practice: Insights from three large-scale marina developments in Seattle

The global transformation of the marine nearshore is generating profound losses of ecological and geomorphological functions and ecosystem services, as natural environments are replaced with built. With conservation a diminishing option and restoration often unrealistic, there is a need to rethink development and the potential for marine infrastructure to contribute to net environmental gain. Through analysis of 150 years of change associated with the development of three large-scale marinas in the Seattle area, this research identifies the ways in which evolving policy frameworks and ecological understanding determine the nature, efficiency and environmental outcomes of coastal marine developments. Decisions on infrastructure design, mitigation strategies and policy interpretations directly determined the ecological fate of marine biota inhabiting these structures as well as surrounding ecosystems. In spite of increasing evidence of environmental legislation driving mitigation and innovative engineering, the net ecological trajectories remained negative. There were no tested demonstrations of marine mitigation to confirm which measures would succeed. Where scientific understanding existed, the uptake into planning and legislation was slow. More broadly, this research highlights a need and opportunity to consider marine infrastructure as living laboratories to inform a policy shift from a no-net-loss paradigm to net-environmental-gain. This evolution is timely, with sea level rise requiring new approaches to coastal defenses and with marine energy infrastructure increasingly being located offshore, where there is little knowledge of the ecological changes occurring in both time and space.

Economics of milk yield losses in one dairy farm in Macedonia associated with clinical mastitis

Mastitis remains one of the major disease in dairy herds, causing profound economic losses to the entire milk production chain due to changes in the milk quality and milk yield. A one year cross-sectional longitudinal survey was carried out to evaluate milk yield losses associated with occurrence of clinical mastitis cases in one dairy herd. Cows that had clinical mastitis and clinically healthy cows during lactation were included in the study. The traits analyzed were the average of the monthly test day milk yields, cow parities and days in lactation while first case of clinical mastitis was occurred. For these purpose there were recorded data for monthly test day milk yield of the cows at the 2nd, the 3rd and the 4th monthly test day (TD). TDs were chosen according to the average number of days in lactation to diagnose the first case of clinical mastitis. According these criteria, the 2nd and the 3rd TD were made before the diagnosis of the first lactation case of clinical mastitis, while the 4th TD was made after the diagnosis. Monthly test day milk yields were treated as repeated measurement within an animal in General Linear Model (GLM). Statistical model included fixed effect of cow parity and covariance of days in lactation when the first case of clinical mastitis was occurred. Estimated lactation incidence risk (LIR) for CM in observed population of dairy cows was 21.49%. Regardless parities, the first case of clinical mastitis in dairy herd occurred on the average 108.09±83.182 days in lactation. The LIR tended to significantly increased (p<0.001) with increasing the cow parity, as risk factor for occurrence of clinical mastitis. Before contracting the disease, cows with clinical mastitis yielded more milk than did healthy cows. Mastitis clearly affected the milk yield and the difference between the milk yield of the healthy cows and the cows after clinical mastitis was statistically significant. There was a significant decrease in the milk yield before and after the diagnosis of clinical mastitis case (p<0.001). The estimated daily milk yield losses per cow suffered from case of clinical mastitis, between the 3rd TD and the 4th TD, range from 0.9 kg to 26.0 kg, or average 9.6 kg/day. According this, the monthly milk yield losses per mastitic cow, between the 3rd TD and the 4th TD, were 288 kg. If we take in consideration the price of one kg milk of 0.32 euro, than the total daily economic losses per mastitic cow will be around 3 euro’s and monthly losses per cow will be around 92 euro. Regardless of the time of occurrence during the lactation, mastitis had a long-lasting effect on milk yield; cows with clinical mastitis did not reach their premastitis milk yields during the remainder of the lactation after onset of the disease. The daily milk yield must be taken in consideration for more rapid economic analysis of milk losses associated with occurrence of clinical mastitis in dairy herds.

Clinical presentation and management of severe Ebola virus disease.

Clinicians caring for patients infected with Ebola virus must be familiar not only with screening and infection control measures but also with management of severe disease. By integrating experience from several Ebola epidemics with best practices for managing critical illness, this report focuses on the clinical presentation and management of severely ill infants, children, and adults with Ebola virus disease. Fever, fatigue, vomiting, diarrhea, and anorexia are the most common symptoms of the 2014 West African outbreak. Profound fluid losses from the gastrointestinal tract result in volume depletion, metabolic abnormalities (including hyponatremia, hypokalemia, and hypocalcemia), shock, and organ failure. Overt hemorrhage occurs infrequently. The case fatality rate in West Africa is at least 70%, and individuals with respiratory, neurological, or hemorrhagic symptoms have a higher risk of death. There is no proven antiviral agent to treat Ebola virus disease, although several experimental treatments may be considered. Even in the absence of antiviral therapies, intensive supportive care has the potential to markedly blunt the high case fatality rate reported to date. Optimal treatment requires conscientious correction of fluid and electrolyte losses. Additional management considerations include searching for coinfection or superinfection; treatment of shock (with intravenous fluids and vasoactive agents), acute kidney injury (with renal replacement therapy), and respiratory failure (with invasive mechanical ventilation); provision of nutrition support, pain and anxiety control, and psychosocial support; and the use of strategies to reduce complications of critical illness. Cardiopulmonary resuscitation may be appropriate in certain circumstances, but extracorporeal life support is not advised. Among other ethical issues, patients' medical needs must be carefully weighed against healthcare worker safety and infection control concerns. However, meticulous attention to the use of personal protective equipment and strict adherence to infection control protocols should permit the safe provision of intensive treatment to severely ill patients with Ebola virus disease.

DGR-2 * Longitudinal Evaluation and Treatment of a Latino Patient with Right MCA Hemisphere Stroke following Head Injury

Objective: Although this is an understudied population, low educated patients with moderate to severe traumatic brain injuries suffer profound functional losses due to their limited skill sets (i.e., generally limited to manual labor). When a stroke follows a head injury, the consequences are severe, permanent disability. A review of the literature suggests that the incidence of stroke following head injury is rare. Method: We present the case of a monolingual Spanish-speaking Latino who developed a severe head injury with multiple orthopedic fractures after a 25–30 foot fall, and then experienced a right middle cerebral artery infarct while in the Emergency Room, resulting in right hermiparesis, profound left hemineglect, anosognosia, and behavioral difficulties. Data from neuroimaging studies, two neuropsychological evaluations and follow up treatment over four years are presented. Neuropsychological instruments in Spanish with appropriate norms were used and are compared across time. Visuospatial skills were notable for hemispatial neglect but improvement over time was noted as he implemented compensatory strategies. Other impairments were noted in his attention, executive functions, and processing speed. Verbal skills and memory remained intact. Conclusions: Findings showed consistent lateralized findings across time, with pervasive impairments. He experienced marginal improvements in his hemispatial neglect over four years. While his lack of awareness guarded him against hopelessness, and provided an impetus for his effort in ancillary therapies, it also contributed to his constant conflict with other patients, families and clinicians, attributing his aggression to the motives of others. Cultural issues and their influence on family involvement in patient care are discussed.

In Memoriam

In Memoriam

Psychoanalytic notes on the status of depression in curriculum affected by histories of loss

This paper examines debates about the meaning and value of depression in relationship to efforts to teach about, and learn from, historical loss. It is argued that depression is not solely an individual illness or biological aberration, but a trace and effect of facing the many and profound losses – of culture, language and life – that constitute history. And yet, where there is a tendency to privilege the negative affect of depression as a source of critical insight and remembrance, this paper turns to Andre Green’s (1980) concept of ‘the dead mother’ to examine the inhibiting effects of depression in the context of the inter-generational relationship between parent and child, and arguably, the teacher and student as well. Using a case study from education, I suggest that depression, while indeed a painful trace of loss, can hinder the capacity to represent and so encounter the sadness, vulnerability and lost omnipotence that history leaves in its wake. I conclude with some thoughts on the conditions needed to narrate the meaning and effects of loss that negative affect alone embodies but cannot yet speak.

CONFLICT MANAGEMENT STRATEGIES TO REDUCE CONSEQUENCES ON LIVELIHOODS OF FULANI CATTLE HERDERS AND FARMERS IN KABBA-BUNU, KOGI STATE, NIGERIA

Farmers and Fulanis are in recent times becoming more frequently involved in land resources use conflicts. Alot of lives (human and cattle) as well as crops and properties are lost to this conflict on a regular basis. It isdue to these profound losses that the study aimed at investigating the root causes; determine the consequencesof the conflict on the respondents and ascertain the management strategies in use to curb or reduce the conflict.A total of 486 respondents were randomly selected for the study while a structured questionnaire was used fordata collection. Descriptive statistics and the logit regression were used to analyze the data. The results showsthat majority (76.4%) of the farmers interviewed are middle aged, that is between 40-59 years while majority(76.7%) of the Fulanis are youths between 20 and 39 years. The result further shows that majority (70.0%) offarmers and 47.4% of Fulanis said destruction of crops/animals was the major source of conflict. The results oneffect of conflict on the losses incurred by the farmer’s shows that all the variables had direct relationship withconflict. However, only the loss of crops (2.047) and loss of other properties (1.016) had significant effect onconflict at p < 0.05 and p< 0.01, respectively. The results on the effect of conflict on the losses incurred by theFulanis show that only loss of cattle (1.003) is statistically significant at p < 0.05. It has a direct relationshipwith the Fulanis conflict with the farmers. The result of the conflict resolution methods shows that majority(90.3% and 72.3%) of farmers and Fulanis, respectively, agree that payment of compensation is the best way ofsettling conflict between farmers and Fulanis. The results on the selected conflict management strategiesindicate that majority (49.7%) of farmers and 52.2% of Fulanis hold the view that the use of traditional rulersin conflict resolution is the most preferred. On the basis of these findings, it was recommended among othersthat: Existing laws on grazing routes should be reviewed and strengthened by the National Assembly andvarious State Assemblies. The Nigerian Agricultural Insurance Corporation (NAIC) and other insuranceorganizations should devise insurance policies as strategies of reaching farmers and Fulanis to ensure supportwhenever they suffer losses which will go a long way to mitigate their sufferings and Government should ensurethat adequate compensation is paid to farmers and Fulanis who suffer losses.

P18 “This is so big”

BackgroundThe death of a parent in childhood is one of the most profound losses a child will ever experience. Supporting children whose parents are terminally ill is therefore an emotive...

Outcome assessment alternatives for young children during the first 12 months after pediatric hearing-aid fittings

Objective: Perform longitudinal evaluations of young children during the first 12 months after initial hearing-aid fitting. Document evidence of early prelingual auditory development (EPLAD), identify factors that affect EPLAD, and define performance milestones that can guide best practices. Design: Unblinded, prospective, within-subject, repeated-measures design. Audiological measures and measures of EPLAD were taken at baseline, 3, 6, and 12 months after hearing-aid fitting. Study sample: Subjects were 45 pediatric patients initially fitted with hearing aids between 1 and 5.5 years of age. Four groups were formed for analysis purposes based on severity of hearing loss (moderate-to-severe and profound) and initial fitting age (≤ 30 months and > 30 months). Results: All groups exhibited statistically significant increases in EPLAD within six months of hearing-aid fitting, and those with profound losses exhibited further statistically significant improvement between six and 12 months. Similar EPLAD levels were reached at 12 months regardless of severity of hearing loss. The EPLAD trajectory is similar to that following early cochlear implantation. Conclusions: Measures of EPLAD provide a means of evaluating outcomes following early pediatric hearing-aid intervention, supplementing behavioral audiological measures.

A Balancing Act

DOI: 10.1200/JCO.2011.41.5695 My day began and ended at the bedside of a woman who was suffering. For nearly a year, cells had been proliferating inside her body, growing imperceptibly at first but crescendoing to a loud, agonizing climax. Now, to describe her as “an uncomfortableappearing female” in the written medical record would have been a gross understatement. And there was not just one woman; rather, there were two women, in different rooms, in different hospitals, each approaching the end of her pain. The two women had undergone physical transformations in parallel, their abdomens swelling synchronously as I had observed them both during the preceding months. The first woman was my patient, in the last throes of being ravaged by an aggressive angiosarcoma, a tumor that had replaced her liver and flooded her belly with ascites until her skin was drum tight. The second woman was my wife, giving birth to our second child after a difficult pregnancy. These two women had shared my longstanding worry about their outcomes, but as I stood beside each of them in turn, moving from the intensive care unit in the morning to the obstetric ward in the evening, I witnessed their paths diverge to the diametric opposites of death and life. The timing was eerily simultaneous. While my son’s first moments were spent having a nuchal cord disentangled, elsewhere the noose of end-stage cancer tightened mercilessly around a young mother. He entered the world at almost the exact instant when she made her premature exit. I had seen my patient’s death approaching from a distance. From our initial encounter, I was sure that her tumor, having already metastasized at presentation, was going to kill her. With the inevitability of Chekhov’s gun, it was only a matter of time before the final disaster, and my sense of foreboding progressed along with her advancing disease. But I could not have predicted that her tragic end would intersect precisely with a blissful beginning, posing the ultimate challenge to my notion of work-life balance. Throughout fellowship, I had struggled to maintain a great divide between my occupation and my family. Then that awful, wonderful day, with its tumult of feelings and obligations, proved to me that the barrier was permeable. The horrors encountered in my job were not so easily contained, and they could coincide with my most precious joys. The addition of a healthy child to our family would in no way compensate for the wrenching loss levied against another. This was not an equation to be solved like emotional algebra, yet I had to acknowledge a deep conflict. I was ecstatic yet grieving, apparently in danger of betraying two commitments. In mourning, was I guilty of not properly celebrating the birth? Or was I rejoicing despite my patient’s death? Never before had I experienced such extreme feelings at the same time, and the dissonance was unsettling. Perhaps my immaturity as an oncologist in training was partly to blame for the confusion. I have since been told by more experienced physicians that I do not actually mourn when a patient under my care succumbs to their disease; removed from the true despair reserved for a loved one, I should feel only an attenuated sadness, and to claim otherwise would be maudlin. To a certain extent, this distinction seems semantic, but I can acknowledge the difference. Admittedly, I do not experience a patient’s demise with the same devastation that accompanied, for instance, the death of my father, a sorrow that can still feel acute decades later. A series of equally profound losses would surely cripple me as a caregiver, given the distressing frequency with which my patients are terminally ill. That said, I fear becoming insensate more than I fear the pain of repeated bereavement. If I do not feel somber at the time of each patient’s death, then I will have become unresponsive to the mortal struggles that drew me to this precarious specialty in the first place. Even in my inexperience, I can already foresee a career spent reconciling resilience with compassion, donning emotional armor while hoping to retain some modicum of vulnerability. As my patient’s death threatened to loom over the joy of my son’s arrival, I was reminded that the human toll of the terrible diseases we treat can haunt us. In his magnificent chronicle of cancer, The Emperor of All Maladies, Siddhartha Mukherjee includes an account of his own daughter’s birth, which he rhapsodizes as “perhaps the singularly transformative event” of his life. Mukherjee describes JOURNAL OF CLINICAL ONCOLOGY A R T O F O N C O L O G Y VOLUME 30 NUMBER 15 MAY 2

Step Up and Whistle

Step Up and Whistle Andrew Lam (bio) How my uncle ended up almost exactly where he was three decades ago, repeating the same gestures that turned his life upside down, would be too bizarre to imagine, let alone make up. But since “The Staircase Incident” was written up in the local papers and he was called “mentally disturbed” on the evening news, it demands explanation. First, given his profound losses, Uncle Bay is far from being “disturbed” and is one of the most caring human beings I know. Since he is a devout Buddhist and a vegetarian who volunteers weekends to teach kids math and Vietnamese at the Vinh-Nghiem Buddhist temple in San Jose, the idea that he assaulted someone is absolutely absurd. The security guard fell off the stairs. The guard was not pushed. We have witnesses who can testify on Uncle Bay’s behalf. Second, my wife, our daughter, and I were with him when the whole thing happened. As a matter of fact, we were witnesses and participants—especially my daughter, who, if you come down to it, was his accomplice, if not the instigator of the whole thing. It was Kim-Ninh who skipped up and down those stairs and cussed like a sailor, which caused Uncle Bay to immediately give chase. She was the main reason he’d come up to visit every six months or so, to see his “precious,” as he would often say. And going back a little bit, it was Dianne’s idea to visit the museum. She thought it would be good to show Kim-Ninh what Vietnamese went through during the war. And, without a second thought, I said, “OK, honey, why not?” Uncle Bay didn’t know what to expect, but why should he? He was visiting us from San Jose, California. He visits because it’s us he loves, not the Midwest weather. Third—and this is very, very important—Uncle Bay has Tourette’s Syndrome. I informed the police that he had TS when they arrested him, and, for that matter, so does my daughter, Kim-Ninh. That’s something the newspaper didn’t bother to mention, and neither did the anchor-woman on Channel Five. If his case goes to trial, and I sincerely hope it doesn’t, people need to be informed about TS. It’d help make a whole lot of sense of why he and my daughter were seemingly acting out of the norm. [End Page 136] Here’s a definition of TS from a medical journal: an inherited neurological disorder with onset in childhood, characterized by the presence of multiple physical (motor) tics and at least one vocal (phonic) tic; these tics characteristically wax and wane. Tourette’s was once considered a rare and bizarre syndrome, most often associated with the exclamation of obscene words or socially inappropriate and derogatory remarks (coprolalia). Tourette’s is defined as part of a spectrum of tic disorders, which includes transient and chronic tics. Of my mother’s many siblings, he was loved the most by her. He lived with us and helped us out in America until my little brother went to college. Since our father was long dead—killed near the end of the war, in the DMZ—Uncle Bay helped my mother raise us in America. She, who regularly yelled and screamed at her two boys, would automatically soften her tone when addressing her Bay. Yet even among folks with TS, Uncle Bay’s symptoms are considered a rarity. He indeed has a phonic tic, and it’s quite a talent. He doesn’t cuss, and there’s none of those repetitive movements like hand gestures or frequent jerks of the head to one side. Nor does he utter weird phrases or derogatory remarks. No, he whistles. His lips, when pursed, become a bona fide musical instrument. With a few bars of his clear, pitch-perfect notes, you can easily “name that tune.” But here’s the thing: he whistles all the time and especially when it’s inappropriate, and it’s almost always something jarring and ironic. A series of loud wolf whistles, say, when someone’s kissing a baby...

The AMA Method of Estimation of Hearing Disability: A Validation Study

To test the assumptions of the 1979 American Medical Association (AMA) method for estimation of hearing disability. One thousand and one patients attending five regional audiology centers competed conventional audiometric testing and the Communication Profile for the Hearing Impaired. A Communication Performance (CP) score calculated from scales of the Communication Profile for the Hearing Impaired served as the gold standard for self-assessed hearing disability. Pure-tone thresholds and word recognition scores (WRSs), and combinations thereof, were compared with the CP scores using correlation and multiple regression analysis. Several different better-ear pure-tone averages (PTAs) correlated reasonably well with self-assessed CP; none were significantly better than the 0.5, 1, 2, and 3 kHz PTA used in the current AMA method. Better-ear to worse-ear weights ranging from 3:1 to 9:1 performed similarly, but none were better than the AMA better-ear weight of 5:1. The AMA method assumes no disability below 25 dB HL and linear growth of disability above this "low fence"; this study showed a similar relationship between PTA and self-assessed hearing disability. There were too few subjects with severe and profound speech-frequency losses to permit validation of the AMA "high fence" of 92 dB HL. Combining pure-tone thresholds and WRSs improved prediction of hearing disability only very slightly. This study supports the continued use of the 1979 AMA method. Incorporation of WRSs, as typically measured clinically, into methods of estimating hearing disability is not supported because of negligible improvement in accuracy and inability to control exaggeration for speech tests in medical-legal settings.

Jewish Aging: Model Programs in Social Service, Adult Learning, Intergenerational Exchange, and Research

Religious beliefs and practices perform basic human functions as evidenced by the historical depth and contemporary breadth of their existence. These beliefs and practices are particularly important in late life as older adults cope with profound challenges and losses. This article focuses on Jewish aging as this denomination has strong support in scripture as well as demonstrable achievement in the community. It summarizes selected Jewish model programs, with important program characteristics highlighted. The model programs are offered to older adults, most—but not all—of whom are Jewish, in the areas of Social Service, Adult Learning, Intergenerational Exchange, and Research.

A Descriptive Analysis of Language and Speech Skills in 4- to 5-Yr-Old Children With Hearing Loss

Early intervention through hearing aids (HAs) and cochlear implants (CIs) aims to reduce the negative effects of childhood hearing loss and to promote optimal communication development over time. The primary goal of this study was to examine the communication outcomes of children with CIs and children with HAs at age 4 to 5 yrs and to consider their spoken language skills relative to a group of typically developing hearing peers. In this multicenter observational study, communication results were obtained for a total of 88 children at age 4 to 5 yrs. Participants were recruited from three clinical programs in two cities in the province of Ontario, Canada. This study was undertaken shortly after the introduction of a new provincial population screening initiative and included both children who were screened and not screened for hearing loss. The study sample comprised 51 children with sensorineural hearing loss and 37 children with normal hearing. Of the 51 children with hearing loss, 26 used CIs and 25 used HAs. The degree of hearing loss ranged from mild to profound. All children were enrolled in rehabilitation programs focused on oral language development. Children's language skills were assessed with an extensive battery of child- and parent-administered speech and language measures. Assessment of language skills showed no significant differences between the children with severe to profound hearing loss using CIs and children with varying degrees of hearing loss using HAs. However, children with HAs showed better articulation skills. Overall, both groups of children obtained scores on communication measures that were lower than their hearing peers. The number of children with hearing loss who obtained spoken speech-language scores within 1 SD of normative populations ranged from 65 to 86% depending on the test measure. Children with average hearing loss of 70 dB HL or better generally obtained scores on all measures in line with those of age-matched norms while scores were quite variable for children with severe and profound hearing loss. Factors influencing performance in children with hearing loss included degree of hearing loss (pure-tone average) and parent education. Age at diagnosis of hearing loss was not a significant predictor of speech-language outcomes in this study. Results indicated that overall, children with all degrees of hearing loss who were fit with hearing technology and who received auditory-based rehabilitation services during the preschool years demonstrated the potential to develop spoken language communication skills. As a group, children with CIs and children with HAs did not differ significantly on language abilities although there were differences in articulation skills. Their performance at age 4 to 5 yrs was delayed compared with a group of hearing peers. The findings reinforce the need for research to identify factors that are likely to lead to age-appropriate communication skills for preschool-age children with hearing loss.

The effect of composition on the formation of light-emitting Si nanostructures in SiO x layers on irradiation with swift heavy ions

The SiOx layers different in composition (0 < x < 2) are irradiated with Xe ions with the energy 167 MeV and the dose 1014 cm−2 to stimulate the formation of light-emitting Si nanostructures. The irradiation gives rise to a photoluminescence band with the parameters dependent on x. As the Si content is increased, the photoluminescence is first enhanced, with the peak remaining arranged near the wavelength λ ≈ 600 nm, and then the peak shifts to λ ≈ 800 nm. It is concluded that the emission sources are quantum-confined nanoprecipitates formed by disproportionation of SiOx in ion tracks due to profound ionization losses. Changes in the photoluminescence spectrum with increasing x are attributed firstly to the increase in the probability of formation of nanoprecipitates and then to the increase in their dimensions; the latter effect is accompanied with a shift of the emission band to longer wavelengths. The subsequent quenching of photoluminescence is interpreted as a result of the removal of quantum confinement in nanoprecipitates and their coagulation.

Frail older adults and patterns of exercise engagement: understanding exercise behaviours as a means of maintaining continuity of self

In this article, we draw on data from in‐depth interviews with five men and five women, aged 71–87, who had between four and 17 chronic conditions, to explore patterns of engagement in exercise amongst frail older adults. Having experienced marked declines in their health statuses over the previous two‐year period, our participants scored low on tests of functional abilities and reported profound physical changes and concomitant social losses. Despite their grave health statuses, seven were engaged in formal exercise programmes. We use Atchley’s continuity theory of ageing to discuss the three patterns of participation in exercise across the life course that emerged in our analysis, namely, lifelong participation, lifelong non‐engagement and later‐life adoption. In all three patterns, participants’ decisions to engage or not engage in exercise reflected efforts to maintain continuities of self and valued social or physical activities. We argue that rather than simply focusing on barriers and facilitators, we need to situate older adults’ decisions regarding exercise in the context of continuities of self.